Annette Uwamuhaye, 19, a resident of Nzige sector, Rwamagana District was born with a cleft lip and palate, a malformation where the upper lip has an opening that extends into the base of the nostril and another opening on the roof of the mouth.

As a result, her speech and hearing were impaired and this attracted stigma from school mates and even the general community.

Most times, she barely smiled fearing that her deformity would be exposed more. In short, her self-esteem was low.

But in February 2013, she was lucky to be one of the 130 people who received free cleft lip and palate surgery at University Central Hospital of Kigali (CHUK) courtesy of Operation Smile, a non-profit volunteer medical organisation based in South Africa.

"I now feel more beautiful and my attitude towards life has improved ever since,” Uwamuhaye says.

Operation Smile also trained 256 local medical professionals on treatment and surgery for the deformity, and of those 10 were trainers of trainers.

Foreign medical teams

The medical volunteering organisation is just one of the many that have been in the country in recent years; either on invitation by particular hospitals, the Ministry of Health or non-governmental organisations.

The teams have not only offered specialised care that is lacking in various fields, but also provided training to local staff, thereby improving the quality of human resources.

For instance, last month, during  a 10 day exercise at  the University Teaching Hospital of Kigali (CHUK), over 144  people benefited  from various types  surgeries; ranging from urology, ophthalmology, orthopedic, plastic, dental, maxillofacial and  gynecology courtesy of a-16 member team from India under the auspices of the Rotary Medical Mission.

The same team, but this  time with Nigerians on board, offered free plastic surgery to  358 genocide survivors for minor and major scars during a ten-day exercise at the same very hospital in October last year. They have been here for a third consecutive year.

In June this year, about  500 patients  benefited from various types of care in areas like oncology, gynecology, cardiac and  orthopedic issues, during a  week-long exercise at  Hopital LaCroix Du Sud, Kigali (commonly known as Kwa-Nyirinkwaya) organised by a volunteering four-member team of  specialists from NarayanaHrudyalaya Health City, a hospital chain  based in India.

"We believe that health transcends borders, offering our services across territories  does not only give us a chance to save lives, but also learn best practices from other countries,” said Dr Saikat Kanjilal, a cardiologist with  the team.

During the same month, 8 patients got free open heart surgery at King Faisal Hospital carried out by a Saudi-based international team of medics.

The 18 member group under the name, Physicians Across Continents, was here on the invitation by Open Windows, a locally based charity.

That month also saw about 30 people access free urologic surgery at King Faisal and Rwanda Military hospitals manned by a team of 7 medics from a nonprofit organisation known as IVUmed based in Utah, U.S.A.

Urologic surgery is a specialty that deals with ailments affecting the urinary tract (kidneys, ureters, bladder and urethra) and the male reproductive organs (penis, testes, scrotum, prostate, etc.). And some of these diseases include; hypospadias, undescended testes, Epispadias, bladder prolapsed, hematuria, prostatitis.

According to Dr Africa Gasana , a urological surgeon attached to King Faisal and Rwanda Military Hospitals, only three hospitals can offer that kind of care in the country. So the services offered by the group were highly welcome.

He mentioned that patients were saved a lot financially, for instance, care for urologic ailments like bladder exstrophy in private hospitals does not go below $1000.

"We have capacity to handle most of the Urologic ailments, however volunteers like these ones help us clear the backlog of patients,” Gasana remarked.

In March this year, a group of 44 American specialists from Boston, under Team Heart, performed 16 open-heart surgeries 

The team that was on their seventh visit has conducted 102 surgeries since 2008, with a success rate of 98 per cent.   

"These specialists do not only donate their vacation time, but also pay their own air fare just to come and volunteer in this service,” Patton-Bolman, the group’s programme co-ordinator said.

According to Bolman, Team Heart has no plans of ending their operations in the country "until a specialised cardiac hospital is established.”

The group fundraises about $250,000 (about Rwf170 million) on average annually and more than $300,000 (about Rwf202 million) worth of equipment around the USA to support the project in Rwanda. 

Currently, Rwanda is the only country on the continent where Team Heart operates.

Similarly, at the end of last month, a team of 116 health experts from 23 universities in the U.S, arrived to offer training to local medics in a year-long exercise.

The team, comprising specialists, nurses, and health managers offered training in areas like; internal medicine, surgery, obstetrics and gynaecology, paediatrics, pathology, anaesthesiology, emergency medicine, nursing, midwifery, public health, global health delivery, and health management, and targets  4,000 members of the health sector.

The project is an implementation of the Human Resources for Health Program (HRHP), an innovative seven-year partnership between the Government of Rwanda, United States Government, and Global Fund to Fight Aids, Tuberculosis and Clinton Foundation which started in 2012.

According to Prof. Phillip Cotton, the Principal of the College of Medicine and Health Sciences at University of Rwanda, the visitors will not only train, under and post graduate students at the institution, but also staff in various district and referral hospitals country wide.

"Though about 4,000 health sector players are influenced by this training every year generally, the biggest focus is on medical specialists and nurses, and that at least 500 and 5000 respectively, are expected to benefit country wide by 2019,” said Prof. Cotton.

The HRHP programme is a unique programme between Rwanda and the U.S, which will see the number of visiting medics decline over time as newly trained Rwandan faculty members assume teaching and mentorship roles.

"We are here not only to share  knowledge and experience in the medical field, but also to learn something from out counterparts,” said Dr Francis Fezeu, a neurosurgeon with  the University of Virginia, US, but currently working with CHUK.

About 160 medical specialists were trained under the same programme in the last two years, according to Parfait Uwaliraye, the Director General of Planning and Health Information Systems at the Ministry of Health.

Jean d’Amour Manirafasha, the Rulindo District Health Officer, welcomed the move.

"I am glad that this training of medics will be on job-based, saving time and money that would have been spent travelling to acquire the same skills in a foreign country,” he noted.

Implication of gaps

However the influx of foreign medical volunteers is also an indication of a sector that is lacking in terms of specialised human resources, equipment and infrastructure.

For instance the country has one major university that trains medical students admitting only 100 students per year, has only 5 referral hospitals, that do not handle certain complicated cases like open heart surgery and advanced cases of cancer.

So the only option is to rely on visiting experts or the patients are referred to countries like Kenya or India, where for instance, the cost of open heart surgery ranges from  $10,000 to $30,000.

Currently there are only three urologists, three oncologists and five fully trained cardiologists country wide.

"We discovered that for a nation of 11 million people, there is no cardiac surgery hospital. Yet back in the US for every less than a million people there is one,” Patton-Bolman , the Team Heart programme co-ordinator said.    

She also cited lack of equipment in highly specialised fields.

"During our first year of operation, we had to bring every equipment, ranging from the heart lung machine to all other surgery implements.”

Bolman noted that because of in adequate local specialists, sometimes it’s even difficult to follow up patients who have been worked on by visiting experts.

"Since most of us immediately depart after the exercise, it’s difficult to follow-up all the patients we have worked on,” she said.

As of August 2012, Rwanda had 633 general practitioners, 7,286 nurses and 45,000 community health workers.

Dr Vincent Rusanganwa, the in charge of medical education and research at the health ministry said there is still shortage of medical workers country-wide. For example, there is only one doctor for every 15,000 people.

According to Rusanganwa, there is need to recruit more medical personnel at least to achieve a ratio of one doctor for every 10,000 people.