Rwanda is stepping up its preparedness to respond to epidemics, including wastewater sampling in airlines and at border sanitation facilities, in line with protecting the health of its population, according to the Minister of Health, Dr Sabin Nsanzimana.

He made the observation, on February 19, during a session between the Senate’s Committee on Social Affairs and Human Rights, officials at the Ministry of Health, and the Rwanda Biomedical Centre (RBC). The session was looking at Rwanda’s efforts to prevent and deal with epidemics.

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Epidemic surveillance

In line with the early detection of epidemics, Nsanzimana said there is an integrated epidemic response system which helps deal with outbreaks by sharing alerts and analysing them, including taking samples to confirm whether reported symptoms amount to an epidemic. This system is used by medical personnel as well as community health workers across the country.

He indicated that providing alerts is important in disease surveillance or detection.

Testing wastewater from airlines, cross-border sanitation facilities

A new method known as the wastewater sampling technique is changing the way people detect epidemics which enter or come out of a given country by testing samples of wastewater collected from hand-washing facilities and toilets used by aircraft passengers, and those crossing land borders.

He said that RBC has been using the technique in the country for a year, a water sample with waste, post passenger use in an airline, is collected at the airport to determine the illness affecting individuals on that aircraft.

Though you cannot immediately identify the affected person in question with this technique, it reveals that there might be a given epidemic or virus.

Enhancing laboratory capacity

Nsanzimana said that laboratory capacity is very important since laboratory results help to identify the disease in question through testing collected samples, and are based on finding an appropriate treatment.

By the time Covid-19 broke out [in March 2020], Nsanzimana said, Rwanda had only one laboratory at a five-star level, capable of conducting molecular testing using Polymerase Chain Reaction (PCR). This facility was situated at the National Reference Laboratory in Kigali.

"And this where I think we had not built firm capacity in the last years – in line with laboratory – where you can take a sample in Bweyeye [a sector in Rusizi District], and it is sent to Gihundwe [district hospital in Rusizi] or Mibilizi [district hospital], tested and within 24 hours, you know what happened: which virus, bacterium, what caused a given issue among the population in that area, or anywhere else in the country,” he said.

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"Now, we have five-star rated laboratories at least in each province. Those laboratories helped us a lot during the Covid-19 period, and they can also be used in case of other epidemics. They can carry out Polymerase Chain Reaction (PCR) tests such as for comprehensive virus analysis, citing HIV and Covid-19.”

Medical oxygen production and ventilators

Nsanzimana said that medical oxygen is critical as it is needed for the treatment of patients in ICU (Intensive Care Unit) and emergency cases, who need respiratory assistance.

When the Covid-19 outbreak occurred, the country had medical oxygen production capacity that was concerning the diseases that already existed by then, but the pandemic made the country significantly increase such capacity.

"Now, we increased by three times the capacity to produce medical oxygen that we had before [Covid-19]. That is enough in the country such that we do not have medical oxygen issues in hospitals,” he said, indicating that medical oxygen-making plants are available at the provincial level.

According to information from the Ministry of Health, medical oxygen production capacity in public health facilities was 182Nm3/h (normal cubic metres per hour as a unit of oxygen measurement) before Covid-19, and it rose to 642Nm3/h after Covid-19.

The effective use of medical oxygen is closely connected to the availability of ventilators.

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Data from the Ministry of Health shows that before Covid-19, there were 39 full-option ventilators, and no transport (portable) ventilators in public health facilities.

Currently, there are 122 full-option ventilators and 100 transport ventilators.

Also, he said the country was putting more effort into upskilling medical personnel in emergency care.

Isolation facilities

Having isolation centres in different parts of the country contributes to dealing with an epidemic, indicating that the country has isolations at the provincial level, where unusual disease cases can be handled, Nsanzimana indicated.

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Also, Nsanzimana said that there is a centre of excellence for management of highly infectious diseases whose construction is underway and it is expected to be completed by the end of the year.

It is expected that the centre will be equipped with technology that ensures that people who suffer from highly infectious diseases are treated at the same time, ensuring that health workers attending to them are protected from contracting such diseases.