The zeal to see children healthy, and put a smile on their parents’ faces after successful surgeries is what enthuses Axelle Aimee Nduwimana to wake up every single day to execute her duty as a paediatric surgeon.

Nduwimana was the first person in her family to pursue a medical course. She was intrigued to opt for this career at the age of eight through a French Tv series ‘Sous le soleil’ where one of the characters who was a doctor, Laure, was diligent in her work.

"Though the TV series wasn’t medical, Laure’s character of performing her role in the best manner inspired me to be just like her,” Nduwimana says. It is at this point that she yearned to be a doctor, to save lives, and to incite joy in her patients.

Nduwimana who hails from Burundi went to the University of Rwanda- the School of Medicine- where she graduated in 2016. She later worked as a general practitioner at King Faisal Hospital for two years and a half, before joining a surgical residency in May, 2019.

She is now working at The University Teaching Hospital of Kigali (CHUK) since 2022, where she is eligible to perform surgeries.

Her aspiration was to study neurology (a branch of medicine that deals with disorders of the nervous system, which include the brain, blood vessels, muscles and nerves) but in her second year of study, rotated in pediatric surgery, she never looked back.

"After high school, my mother was very supportive when I told her I wanted to do medicine. I had secured a scholarship to go to Morocco to study another course. Having told my mother about the change of plan to instead enrol for a medical course at the University of Rwanda, she was very understanding,” Nduwimana said.

Nduwimana recalls her first time in the operation room in a single case when reality kicked in. Although she didn’t panic physically, her heart was racing.

Given the fact that there is a supervisor to help out, it offered her confidence. Her first solo surgery was a success. She operated on a six-week-old child with a Hypertrophic Pyloric Stenosis defect.

This is a blockage of the passage out of the stomach due to thickening (hypertrophy) of the muscle at the junction between the stomach and the intestines.

The condition occurs most often in babies under six months old. In this ailment, the muscles block food from entering the small intestine. It occurs more often in males.

"With the help of my supervisor, we performed a pyloromyotomy procedure, where we opened the muscle that is between the stomach and the small intestines which allowed whatever the baby ate, to pass to the bowels.

The procedure that is normally completed in about fifteen to twenty minutes was done in thirty minutes. Since she had observed her supervisors do it before, Nduwimana was certain of what to do.

"I was very excited after successfully completing my first surgery, and with all the practice I have acquired, I must say that I can perform this surgery very well with my eyes closed,” she said.

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Nduwimana finds specializing in kids’ conditions an amazing experience because they are "exhilarating”, for instance, one morning she is operating them, and the next day they are up on their feet, strong and playing.

Witnessing the joy of a child or a parent after a successful operation leaves her satisfied. For example, Nduwimana recalls operating a rare condition of two-day-old conjoined girl twins on August 13, 2022 with a team of two supervisors. The disorder is known as Omphalopagus, where twins are conjoined, sharing parts of the gastrointestinal system and abdominal wall.

"One of the babies was critically ill and because they were sharing the same blood supply. We sought fast measures to save at least one of them, so we rushed them to the theatre for the separation. Unfortunately, one baby died immediately after the surgery due to congenital anomalies but the other survived. This filled the mother with joy as she didn’t know that such a surgery could be done in Rwanda. A year later, the baby is healthy, and the mother is happy,” Nduwimana stresses.

This isn’t the only complicated surgery that Nduwimana has performed. Though she has lost count of the operations done individually, she is certain that over fifty of them have been successful.

What are the challenges in the field?

Nduwimana stresses that pediatric surgery in Rwanda is still new, highlighting that there are still few intensive care units for older kids.

"At CHUK, we only have a few beds in the pediatric ICU and two Mechanical ventilators in ICU. It’s a big challenge because most children are transferred here when they are critically ill and require mechanical ventilation postoperatively,” she noted.

This, she notes, delays surgery but can be curbed if the hospital acquires an open intensive care unit for post-operation recovery.

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The surgeon carries on that although CHUK has a children’s operating room, most of the emergency surgeries are shared in operations rooms with other departments thus delaying the operation process, a thing that is tricky.

Nduwimana further notes that pediatric surgeons are overworked since they’re few, an issue she believes should be solved from the roots.

It is for this reason that she urges the Ministry of Health to get involved in availing more training facilities and offer sponsorship opportunities to encourage students to take on courses in this career.

"We also need to advocate medical students and general practitioners in hospitals to join this field because they’re mostly not interested in surgery.”

What keeps her going?

For her, medicine is a long course but very satisfactory. It is not routine as it exposes doctors to different cases with unique reactions.

At the end of the day, Nduwimana goes home smiling because she has saved a life, and made a mother smile and regain hope.

What excites me more than seeing a child cured and go back to school and live normal lives? This is a fulfilling career, she notes.

"Even with the cases that don’t go well, I know I did my best.”

Way forward

After completion of her course in pediatric surgery in December, Nduwimana anticipates training in cleft lip and palate surgery, and also partake in a fellowship in Neonatal surgery.

This is performed on babies shortly after they are born. It is meant to treat conditions that cannot be diagnosed and addressed while still in the womb.

She also encourages medical students, especially women, to join surgery because "it’s a very rewarding specialty” as the outcomes are immediate and the country still needs many more surgeons.

"Many people think women can’t do surgery because of social constraints like motherhood and family. In the past, these were not thought compatible with medicine, but with many of our elders getting engaged and being very successful in surgery, it should be a call to the younger women that we too can do it,” she says.