Wednesday, May 30, 2018

Redefining Global Health as Development and Sustainability

Mark J. Harris, MD MPH 
BWH Anesthesia, PGY3
May 25, 2018

Redefining Global Health as Development and Sustainability

Hello from Kigali, Rwanda! I am here with Dr. Stewart Chritton (BWH) as part of the CASIEF/ASAGHO (Canadian Anesthesiologists’ Society International Education Fund and American Society of Anesthesiologists Global Humanitarian Outreach) Rwandan Teaching Program, which invites faculty and trainees in anesthesia to come to Rwanda and help further the education of the anesthesia residents here.

The Rwandan Teaching Program, which began in January 2006, has worked to “build capacity for anesthesia training in Rwanda so that, over time, there will be enough local staff anesthesiologists to run the program without the need for international support.” (Link: Over time and with the help of dedicated in-country and visiting staff, the anesthesia residency has grown and prospered, now numbering 30 trainees spanning 3 post-graduate levels. For a further treatment of the history of anesthesia in Rwanda, check out the following article published by BWH attending Ramon Martin and colleagues in 2017 (PMID: 28160992; Link:

In general, there are two contrasting models in the realm of “global health.” One model refers to the conduct of medicine in low-resource settings, usually by teams of physicians and nurses who travel to an area for a defined period of time in order to provide clinical care. These medical or surgical missions are often organized around needs-based assessments and the idea that with the right combination of people, equipment, and resources, a team can address this need. Cleft palates can be fixed; congenital heart conditions can be repaired. However, at the end of the mission, these teams typically pack up their equipment and people and return to their respective homes.

Another model of global health is based upon a philosophy of development of extant in-country resources and long-term sustainability. Instead of asking about “need” and framing the issue in terms of “lack,” “deficiency,” and “low-resource settings,” this model forces us to take a different viewpoint. This model forces us to ask, “What resources exist in this country already? What skills, ideas, and training do the in-country clinicians already bring to the table? How can I contribute to improving or furthering their skills and training?” These questions identify and highlight the capability of the practitioners already working in this context, and it emphasizes the ongoing and iterative process of learning and improvement. This model also allows for a bi-directional flow of knowledge.

Our program is built upon the latter model. While here, our focus is educational, not purely clinical. Mondays are academic days, where we cover basic and advanced topics relevant to anesthesia, facilitate classroom discussions, and lead simulation and hands-on skills sessions. The rest of the week, we follow and observe residents in the operating rooms of CHUK, King Faisal Hospital, and Kanombe Military Hospital, and do intraoperative teaching.

The faculty and residents in Kigali have been extremely hospitable and welcoming. They work hard, and they are eager to learn. We share the same goal: to provide the highest quality and safest anesthesia possible. I hope my time here can help nudge us further in that direction.

Attending Dr. Sam, resident doctors Brigitte and Jean Pierre, and me posing for a photo at King Faisal Hospital, Kigali, Rwanda.