Stories from the Road: Rwanda

Frederick A. Godley, MD, Humanitarian Efforts Committee member

Frederick A. Godley, MD

In Rwanda, the land of 1,000 hills, the new University of Global Health Equity (UGHE) and the expanded Butaro Teaching Hospital (BTH) sit like pearls amid lush, green hills within view of Volcanoes National Park and its renowned mountain gorillas. There is a new and exciting opportunity to support the expansion of otolaryngology care and training in Rwanda in partnership with BTH and the UGHE. 

BTH is a Ministry of Health-owned hospital founded in 2011 and supported by Partners in Health (PIH), an international nonprofit that has successfully developed healthcare systems to serve the world’s poorest communities. It is the main teaching hospital for the medical students from the UGHE School of Medicine and is also one of two cancer centers for patients in Rwanda.

A view of lush Volcanoes National Park in northwestern Rwanda.

The University of Global Health Equity, Butaro Campus, Rwanda.BTH is located 10 minutes from the UGHE campus and serves Burera District, which encompasses a geographic area of 645 km² and a population of 380,000 people. BTH recently built a new inpatient unit, including inpatient oncology, pediatrics, and intensive care facilities. Additional improvements include a CT scanner, an outpatient ENT clinic space, and more operating theaters. The goal is to provide expanded services to the population of Burera District and beyond.

Location, Need, and Sustainable Solutions

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There are only 27 otolaryngologists in Rwanda, serving a population of 13.2 million people. Currently the only otolaryngologist in the Northern and Western Provinces (where BTH is located) works at Gisenyi Hospital in the far west of Rwanda. Patients referred for evaluation and management of ENT conditions must travel three to four hours to access an otolaryngologist in a referral hospital in Kigali in central Rwanda. This difficulty in accessing specialized care means that many patients present with diseases that are advanced and more complicated to treat. Starting in 2024, otolaryngologists from Kigali will rotate through the new BTH ENT clinic at intervals.

BTH is also a teaching hospital for UGHE medical students. In late January 2024, a week of ENT lectures was held, followed by nine weeks of clinical rotations in small groups. With the new ENT clinic established, the first four to six months of 2024 will reveal the burden of ENT disease that has likely gone undiagnosed given the lack of ENT expertise in the region.

Dr. Godley visits the new ENT clinic at Butaro Teaching Hospital in Rwanda.Backed by the passionate dedication of Rwandan ENTs, this newly expanded ENT service at BTH has created opportunities for otolaryngologists from abroad who are interested in partnering to enhance clinical care and education. For the past two years, practicing otolaryngologists have supported UGHE ENT medical student clinical rotations. Additionally, visiting clinicians have enhanced surgical subspecialty skills by operating alongside Rwandan ENTs. As the ENT services at BTH expand, additional, exciting opportunities may arise, such as expansion of surgical capacity and resident education. We expect students from other medical schools across the country and beyond may be allowed to serve their clerkship at BTH. Furthermore, these partnerships will be of benefit for very remote local communities in particular, as well as the communities of the Northern and the Western Provinces, by increasing their access to ENT surgical and non- surgical care.

BTH is not yet equipped to provide advanced surgeries. But as soon as the critical care services are established and anesthesiology services expanded, ENT services will likely continue to expand. The team leading the establishment of the new ENT services at BTH plan to collect information about the volume of patients, nature of health issues, and capability of the hospital over the next six months. 

A Model for Surrounding Countries

Dr. Godley visits the University of Global Health Equity Simulation Lab in Butaro, Rwanda.My dermatologist wife and I visited the UGHE campus and new Butaro outpatient clinic facility in the fall of 2023. We were inspired by the potential for this hospital to become a unique medical center in a rural setting. Since our visit, Gratien Tuyishimire MD, MMED, and his colleagues have secured funding for equipping the new ENT clinic. And the hospital has hired its first full-time anesthesiologist. We also attended the UGHE campus, which boasts state-of-the-art facilities, including a simulation lab.

Patients and their families at the new Butaro outpatient clinic in Butaro, Rwanda.Finally, we toured the surrounding villages where there were small medical clinics attended by visiting healthcare workers as well as a local community health worker. The country’s level of organization and dedication to improving the health of its population has been a model for surrounding countries. The impressive progress over the past 30 years demonstrates the potential for improving the care of head and neck conditions around the country in coming years.