Medics on how to consolidate gains made in health sector

Training health workers is a costly venture. Unfortunately, the demands on the health sector have more than doubled as more people seek quality health care. The world continues to grapple with emerging health needs, with the African continent suffering the most in terms of brain drain, insufficient manpower, and limited facilities among others. It is a fact that Rwanda has made big strides in uplifting healthcare services through initiatives like the management of community-based insurance, improving the fight against malaria, improving the state of neurosurgery through promoting 3D technology and advancements in maternal health, among others. However, health experts believe other shortcomings could be addressed through provision of sufficient medical training. Training of specialists in noncommunicable diseases, as well as boosting local manufacturersDr Jean Claude Nyirinkwaya, the chairman of the Rwanda Healthcare Federation, explains that Rwanda has succeeded in fighting common diseases such as malaria and flu, but more efforts are needed to curb other non-communicable diseases. “Diseases, like cancer and diabetes are among those that currently require more attention and this is where we have to put more training efforts,” Nyirinkwaya says. In addition to provision of such training, Nyirinkwaya suggests that the huge number of health facilities need constant supply of products which could be manufactured locally. “If you look around, our hospitals use simple solutions in drips, but the drip itself is imported as well as the solution. Well, we may not be able to manufacture other sophisticated instruments but we can train people to manufacture such simple things,” he adds. Statistics show that, there are at least 70 private pharmacies involved in wholesale, 249 retail pharmacies, 206 private health facilities, which include two hospitals, 65 clinics and 19 polyclinics that require constant supply of materials and manpower. Dr Nyirinkwaya, who is also the proprietor of Croix du Sud Hospital in Remera, points out that most times training institutions put more focus on doctors and neglect equipping other personnel such as nurses, yet the health sector needs both in big numbers to be more effective. According to The Human Resource for the Health Programme Rwanda, there are 8 nursing schools, one dental school and one school of public health. The College of Medicine and Health Sciences located at the University of Rwanda in Butare. The School of Nursing & Midwifery (SoNM) and the School of Dentistry (SoD) at the former Kigali Health Institute in Kigali. The School of Public Health is also located in Kigali in addition to other 5 government schools of nursing and midwifery: Nyagatare, Kibungo, Byumba, Rwamagana and Kabgayi. On the other hand, students can seek internships in any of the four referral hospitals in the country namely; University Teaching Hospital Kigali (CHUK), University Hospital of Butare (CHUB), King Faisal Hospital (KFH) and Kanombe Military Hospital.Address needs for the handicapped Most times, people have complained that people with disabilities are not always catered for because of limited therapists. Dr Jeanne Kagwiza, the dean of School of Health Science at UR’s College of Medicine and Health Sciences, earlier told the Healthy Times that occupational therapists are now needed in Rwanda to relieve physiotherapists of the huge work. “Originally, physiotherapists had to attend to both those with disabilities to provide rehabilitation and at the same time serve those who get accidents. It was a lot of work,” she says. Kagwiza adds that with insufficient occupational therapists, there is incomplete rehabilitation, which delays the integration of victims back into society. “If you are to put someone back into society, they should completely be healed to fully take care of themselves on a daily basis,” she adds. A medical worker explains how radiology works. These are some of the skills medical students have to obtain to be able to deliver more effectively. (Solomon Asaba) Need for trained anaesthesiologists If demand for manpower in these hospitals were combined with that at the district level in at least 430 health centres, then more medical training for professionals would be needed. Dr Pauline Ruhato Banguti, the director of the Anaesthesia programme at the University of Rwanda, notes that more training of anaesthesiologists to increase safety during surgery is needed. “We have over 50 hospitals and at least 120 operating rooms which need surgeons and physicians. Although the physicians are many, some are inexperienced and young,” says Banguti. Banguti created a network to link surgeons and anaesthesiologists to improve service delivery. “This is a set of safety protocols to improve health and links different professionals all over the country. There is exchange of advice on consultation and that way, the burden of surgical disease is reduced,” he explains.Eradicate brain drain Dr Achille Manirakiza, a medical resident at the University Teaching Hospital, believes that movement of health workers from the country is greatly affecting service delivery. “Medical workers move because they need to experience fresh scientific challenges in specialties that are not available on the continent. When a medic leaves, it is possible to remain there because they have access to enough materials for practice instead of starting from scratch if they consider returning,” Manirakiza explains. Manirakiza, who is currently pursuing a masters degree in clinical oncology (the study and treatment of tumours) in Tanzania, explains that sometimes, health professionals are not motivated enough and that is why they have to look for better opportunities. “Everyone seeks for greener pastures, especially medical professionals from Africa who go to Europe. Provided salaries are good on the continent, medics don’t have to move,” he adds.Sustain maternal and child health breakthrough Although the health sector has seen improvement in maternal and child health for the past decade, there is more need to sustain the achievements through training of health personnel. According to the World Health Organisation, Rwanda ranks among 11 countries in the world that are vigorously fighting maternal mortality. In 2000, about 1,500 Rwandan mothers out of 100,000 were dying while giving birth or after giving birth, but maternal mortality decreased at an average of 6.1 per cent per year over the past quarter-century and the number of children who die before their fifth birthday fell as well. In line with the UN Millennium Development Goals, the figure was slashed down to 340, a 76 per cent decline, which saw Rwanda ranking 34 in recording fewer deaths and government efforts need to be geared towards sustaining these achievements. This, therefore, implies that the momentum should be scaled up to ensure that the successes registered in the health sector are sustained. ***************************************** Your say... Brave Igiraneza Brave Igiraneza, general medicine student at University of Rwanda College of Medicine: In general practice, I will be able to handle all cases in different departments. The medical department should try to get us trainers from other advanced countries so that we can gain more experience that can prepare us to compete outside Rwanda. Gonzalue Niyigaba Gonzalue Niyigaba, a dentist at CHUK: The training I got during my student days has helped me a lot. I think during practicals, the students should be exposed to serious cases than the normal ones. This is because when they are used to serious cases, they can do anything in medicine as it gives them enough hands-on experience. Bandora Yves Iraguha Bandora Yves Iraguha, fourth year student of medicine: I think we learn more through practical training than theory. During our training, one can be posted anywhere in the country, and those in charge of the health sector should make sure that even in the health centres at the grassroots level we are able to get everything that’s is needed for our training. Vanessa Uwimana Vanessa Uwimana, student of medicine at UR’s College of Medicine: What we get from the training is enough because we learn by observing, following instructions and also asking questions while we are still with the patient. This pure practical work is vital. However, students who go to clinics or hospitals that lack experienced doctors miss out on this exposure. Jean Pierre Nkuzimana Jean Pierre Nkuzimana, fifth year student of internal medicine: The knowledge we get here allows us to get access to the real materials used and exposure to patients. For instance, in the theatre room, we observe as we also assist the doctors to bring the materials needed for the operation. It would be better if student doctors spent all their learning sessions doing practicals. Compiled by Lydia Atieno