It was a chilly Friday afternoon when we went to King Faisal Hospital for an interview with Dr Vincent Ndayiragije, a specialist in internal medicine and geriatrics.

Despite his busy schedule attending to numerous patients daily, especially given the intricacies of his specialty that demand extended patient care, he eventually welcomed us into his office as per our appointment.

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Dressed in a white lab coat and wearing a stethoscope around his neck, he calmly gestured for us to take a seat across from his table.

After introductions, we delved into his specialty: geriatrics, a medical field focused on delivering top-notch, patient-centred care for elderly individuals.

We were curious about his interest in a profession uncommon among doctors in Rwanda, how it operates, the challenges he faces, and more.

Ndayiragije mentioned that geriatrics involves caring for frail patients with multiple medical conditions, requiring a comprehensive evaluation and a systematic care plan.

"Our care doesn’t stop at the hospital, it’s more than internal medicine, we ensure that our patients stay in a safe environment, and are on safe medications that do not complicate their ongoing medical disease.

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"We try to minimise the side effects of these medications, and maintain their quality of life. If they can walk, eat, cater for themselves, and manage their bills, farms, businesses, and their daily tasks, we ensure that we don’t impair their functioning or health status.”

Ndayiragije explained that the health of elderly individuals should be maintained. Any medical procedure should aim to benefit them without causing a decline in their quality of life.

This, he said, requires dedication because it is demanding. The care of elderly people extends to knowing their families and much more.

Beyond care

Senior citizens require comprehensive care; when doctors prescribe medication, they should ensure that the patients will adhere to the treatment.

"Geriatrics is a more detailed care of an older person who has multiple medical conditions, among other issues. For young people, a formal consultation takes about 30 minutes, but for patients of about 75 years, a formal consultation goes for more than one hour because of the approach,” Ndayiragije said.

Every detail about them, such as how they spend their day and their fears, matters. Some patients see doctors as their own children, and therefore, expect them to listen to their thoughts and provide their perspective on various matters, he added.

Ndayiragije defines a great geriatrician as one who listens attentively, remains dedicated, coordinated, and respectful, ensuring the patient’s dignity is upheld, and said geriatricians attend to all medical conditions.

He further explained that in developed countries like France, elderly people have home-based care like Hopital a domicile, a platform where the hospital reaches out to the family to treat and follow up on the patients; Hopital du jour, which is a hospital-based full-day ambulatory care; and acute care for the elderly, available for patients 75 years and older who are acutely ill, have several medical problems at one time and are at risk of losing the ability to function.

Other types of care include re-education and rehabilitation, post-acute illness geriatric care, serving as a transition between home and hospital, and accommodation establishment for dependent elderly people.

Ndayiragije said some elderly people undergo palliative care—specialised medical care for people living with illnesses such as cancer, blood and bone marrow disorders requiring stem cell transplant, heart disease, cystic fibrosis, dementia, end-stage liver disease, kidney failure, and lung disease, to name a few.

Another option is providing care for patients in a well-equipped facility where they receive entertainment, meals, medical check-ups, and additional services.

Some patients come from home and stay at the hospital during the day to benefit from medical care, physiotherapy, entertainment, memory or brain exercises, and meals, and then return home later.

The geriatrics expert noted that some patients seek medical assistance and return home—this is organised according to one’s age. Successful ageing consultations start from the age of 55 to 74, whereas geriatric consultations start from the age of 75 and above.

Doctors do preventative consultations to prepare one for ageing which can be referred to as successful ageing consultations. Geriatricians assess if an individual has a medical disability, or hearing impairments, among other medical conditions, and discuss accordingly.

When it comes to geriatric assessment, doctors help patients find solutions to their medical issues and improve their quality of life based on their current health status, emphasised Ndayiragije.

"We organise their care, offer them advice if they require to see other medical experts, or need to renovate their houses if they don’t suit their condition anymore or, have activities that are not suitable for their age.

"At times, we involve the government and social organisations that are in charge of advocacy to seek legal support for their different welfare as applicable,” he stated.

Additionally, elderly people have inpatient care which comprises acute attention of older patients—it requires trained staff and ensures that they are protected as they are fragile, for example, exposure to infections like pneumonia can result in death. Children are not allowed in geriatric acute care units because they often have viral infections.

In medical rehabilitation, elderly patients have their own treating physicians who oversee their prescriptions. They consult a geriatrician as needed.

Diet

Losing weight at an older age may lead to reduced immunity, resulting in more severe diseases, such as depression-related illnesses, and increased mortality, said Ndayiragije.

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For elderly individuals, he suggests consuming protein from animal and dairy sources, vitamins from fruits and vegetables, and caloric intake tailored to their age and weight requirements daily.

For older adults, he recommends getting protein from animal and dairy products, vitamins from fruits and vegetables, and adjusting calorie intake to meet their age and weight needs every day.

"Successful ageing requires physical activity like walking for more than 30 minutes a day. I don’t advise going to the gym. Old people who remain sedentary lose their muscles, which triggers protein loss. They then become immunosuppressed, thus higher chances of developing more complicated illnesses.”

He encourages older individuals to adhere to a well-rounded diet tailored to their requirements, emphasising the importance of understanding the reasons behind their food choices.

Status of geriatrics in Rwanda

The care of an elderly person is more challenging, they can’t be treated by one doctor, they require a specialised hospital and Rwanda has these hospitals and services.

"Our health system is well organised. The challenge is the shortage of medical personnel. There is a need to facilitate transfers from the primary healthcare level. Some of the hospitals possess trained healthcare providers who can care for old people,” Ndayiragije said.

He pointed out that additional efforts are required to train specialists, general practitioners, nurses, and community healthcare workers. It is also important to raise awareness in the community so that elderly individuals are not viewed solely as old, but rather as ‘valued patients’ across all levels.

Ndayiragije said the future of geriatrics looks promising as it continues to evolve, emphasising the importance of raising awareness in communities to educate people on geriatrics and how to properly care for the elderly.

"Treat them as you would wish to be treated when you get older. These are people who have contributed to the development of the community, excelled in their work and efforts for the betterment of the nation.”

Fulfilling job

Ndayiragije chose a fellowship in geriatrics to care for vulnerable individuals. During his internal medicine specialisation, he aimed to make a difference and found fulfilment in geriatrics. He aspired to guide others in coordinating the care of elderly patients.

"If you want to treat more people, opt for internal medicine, and if you desire to make a difference, go for geriatrics,” he counselled.

He has been a medical doctor for nearly 10 years, having pursued his studies in general medicine at the University of Rwanda.

After completing this course, he worked as a general practitioner at Muhima Hospital, and University Teaching Hospital of Kigali (CHUK) in the intensive care unit as a medical officer in 2016. He also worked at the University Teaching Hospital of Butare (CHUB), Rwanda Military Hospital, and King Faisal Hospital along with his specialisation in internal medicine.

From 2021 to 2022, Ndayiragije was appointed as an internist (Internal Medicine Physician) at Kibungo Referral Hospital, Ngoma District by the Ministry of Health.

He pursued the Fellowship of Geriatrics at Sorbonne Université in Paris, France for both theoretical and practical training, graduating in October 2023. In November 2023, he became a specialist in internal medicine and geriatrics at King Faisal Hospital.