Global Health Community Entry in Kigali, Rwanda

Nana Sefa

PGY 3

Emergency Medicine Critical Care Fellow

Global Health Community Entry in Kigali, Rwanda

I arrived in Kigali, Rwanda for a two-week elective rotation in the Intensive Care Units of the University Teaching Hospital (CHUK) and the King Faisal Hospital on October 26, 2018. This was my first visit to Rwanda. One of the objectives of this visit was to establish relationships for future global health collaboratives with staff at this institution and other Rwandan Healthcare facilities.

So how did I ensure a mutually beneficial trip with very limited time and no previous relationships to build on? I started off by meeting everyone I had email exchanges with prior to my visit. These were my initial champions. They helped introduce me to influential clinical staff who run the day-to-day activities in the ICU. Additionally, I tapped into the institutional goodwill and credibility of my mentor and the Brigham and Women’s Hospital. My mentor has been working with the ICU at CHUK for over 5 years and is well liked. This ensured that anyone she introduced me to welcomed me with open arms. Additionally, the Brigham and Women’s Hospital Emergency Medicine faculty were involved at the start of the country’s first emergency medicine residency about 5 years ago. Thus, I was able to tap into some of the goodwill that Brigham has at CHUK.

That said, reliance on the goodwill of people and institutions is helpful only to establishing an initial encounter. I subsequently had to roll up my sleeves and build on these links to establish my own relationships. I started off by asking lots of questions. The clinical practice and protocols used in the institution were relatively different from what I had used, which provided an avenue to learn more about why they did things the way they did. In asking my questions, I had to be tactful so that even for practices that were not evidence based, I did not come off as passing judgement or looking down on the care that was being provided. I also had to understand that some of their practices were influenced by unavailability of resources. This meant that even when I suggested changes, I had to first ensure that the resource I was suggesting was available.

My experience in Kigali also meant interacting with a completely different culture than I had ever been exposed to. But I dove right in. In doing so, I had to acknowledge that there were cultural differences and to let my hosts know that although I was not familiar with their culture, I respected the fact that their culture was important to them. I also had to ask questions specifically about what was culturally appropriate to do or to ask.

Additionally, for each frontline clinical staff I interacted with, I had to find out what was important to them and how I could be of help to them. This inquiry started during the email exchanges before my arrival. For instance, the residents in the ICU were eager to learn and sent me topics they wanted to discuss before my arrival. This provided an initial mutually beneficial relationship that ensured a fruitful interaction even on the first day. What is interesting about asking what was important to an individual is that each person had his or her unique evolving interests that were very different from what the institution or unit head had communicated. For instance, although not mentioned before my arrival, one resident’s main goal during my visit was to learn to do ultrasound-guided subclavian central lines. For this individual, my visit would not have been successful without teaching him this skill. Continually asking what would be important and meaningful to counterparts is thus crucial to a successful global health collaborative.

Although my two-week visit was short by all the means of evaluating a successful global health interaction, I deemed it successful because of the relationships I was able to build. I am sure I will be able to build on these relationships to ensure more productive interactions in the future.