Severien Muneza, 52, was the first Rwandan to graduate as a neurosurgeon; a physician who specialises in the diagnosis and surgical treatment of disorders of the central and peripheral nervous system, including congenital anomalies, trauma, tumours, vascular disorders, infections of the brain or spine, stroke, or degenerative diseases of the spine. He has been working at University Teaching Hospital of Kigali (CHUK) since graduation in 2005. He talked to Bertrand Byishimo about the hurdles of pursuing this career and the pathway to living his dream.

When did you decide to become a neurosurgeon?

Being a doctor has always been my dream. When I would go to doctors, I admired their work. At the age of four, I used to make needles with grass and pretend I am injecting people.

That drove me to focus on education, I attended the former Mugina Commune (current Kamonyi District) Primary School, and high school at Byimana School of sciences in Ruhango District.

So, after graduation, Chinese Medical University was looking for students with good grades who could move to their campus in China. I was among the best and was selected.

That is where I did medical studies and got specialised in neurosurgery because the service was at a low level in Rwanda, it was highly needed and I felt like that would be a suitable contribution to my country.

Were neurosurgery services available in Rwanda before your graduation?

Yes, I came in 2005, but before me, Rwanda had a tri-partite agreement with foreign neurosurgeons from Cuba and South Africa from 2001. But they were time-based, so permanent doctors started in 2005 when I came. After three years, Emmanuel Nkusi, another Rwandan neurosurgeon stepped in but we were still few. In 2007, we had only 12 Rwandan specialised doctors in all medical fields. So after realising that there is a scarcity of specialised doctors in the field of neurosurgery, among others, we developed a local training of neurosurgery and we are now six neurosurgeons nationally. But the training is ongoing and we are producing more neurosurgeons as time goes on.

How do you feel before conducting brain surgery?

When you are about to treat someone, you put yourself in their shoes. In that case, you get the possible protection to avoid any mistake that can be made. So, you should imagine that the patient is your mother, brother or daughter, then you will treat them with your heart and soul. Of course fear is there, but you get used to it as you gain more experience. In addition, you start with supervisors, so fear is allayed that way.

Tell us the worst case you have ever encountered?

We have plenty of cases, where the patient’s pathology (affected part) is not accessible. In most cases, those who have had internal bleeding get the disease and it requires carrying out an endo-vascular surgery (sending a tube called a prope to the brain to treat the tumour); that is very dangerous and can’t be carried out here in Rwanda, so we transfer them abroad, unfortunately, some of them cannot afford this. In other instances, we meet patients with incurable diseases like brain cancer which can be hereditary or attack randomly. It is very disappointing to see a teen or youth with the disease because it kills them in less than a year.

What motivates you?

People come here suffering, with diseases or on the verge of death due to an accident, so seeing them smile after recovery is the best motivation any doctor can have. It is joy! Starting something and seeing it accomplished well. It is an achievement to change someone’s life for the better.

Do you come across cases where severe complications are possible after treatment?

Normally, when conducting surgery, the internal parts of the body are subjected to the external environment which contains germs, so these germs do enter the brain and cause complications in the part that was being cured. This causes a brain infection which takes long to treat or can cause death, or even result in long-term disability. This happens, as we meet a lot of patients, I conduct surgery for 300 patients on average per year and one surgery takes about two hours, so such can occur if you are not careful.

What is your take on healthcare in Rwanda? 

We are lucky to have favourable health policies and community health workers who do a good job at the grassroots level. There are African countries that experience a lesser amount of patients yet their neurosurgeons are fewer than us, because most of them go to traditional doctors. However, that is not the case in Rwanda because the population is sensitised by community health workers. But those traditional doctors cause severe complications. The cults of "Guca ibyinyo” or "Guca ibirimi” have dangerous side effects and complications as they give way for germs to enter the brain.

Moreover, the people also have to embrace early treatment, healthy hygienic habits and avoid smoking as they greatly affect the brain.