Capacity Building in Rwanda

Jessica Crothers, MD

Fellow, Medical Microbiology, Brigham and Women’s Hospital

PGY 7

May 8, 2019

Reviewing cases at the multiheaded microscope at CHUK in Kigali, Rwanda

The plane doors open and I step down the portable staircase onto the tarmac.  The warm, humid air surrounds me. It feels vaguely familiar, like a strange homecoming. I have never been to Rwanda, but after 11 years of medical school, residency, and fellowship, I have once again donned my red backpack and reentered the world. More than a decade ago, I wore this same backpack across Asia, South America and Europe. I had wanted to step away from the comforts, contacts, and safeties of home and see if the world would catch me; it did. As many fellow travelers can attest to, the world has a strange way of offering you just what you need if you are open to receiving it. It’s not always what you think you want, or the easiest road, but the universe, and the people in it, tend to provide to those with the faith to leap. I had leapt and was rewarded. New friends, new ways of seeing, new experiences, beautiful places, scary places, stories to tell. But, I had wanted to “help”, to participate, to add to the experience of humanity, and I quickly realized that desire was not enough. I needed something – a skill, knowledge, resources - in order to be useful. And so I ultimately returned home and began the long, arduous path of medical training. Now, 11 years later I return.

Histology slides processed at CHUK laboratory 

Armed with new knowledge, experience and an ever-increasing folder of power point presentations, I come to Rwanda to help train their next generation of pathologists. I come with my mentor, who began coming to Rwanda a decade ago (about the same time I left the road, he began to forge the one that I now join). At that time, the country was home to only two pathologists, both foreign-born. Many diagnoses went un-made, specimens un-grossed, slides un-reviewed. The push was for “tele-medicine” and international consultation, but the decision and motivation existed to increase local capacity and a local pathology residency training program was born. Now, 17 Rwandese pathologists practice in Rwanda! The residency program has more than a dozen trainees. They eagerly bring us interesting cases, hoping to confirm difficult diagnoses and proudly sharing exciting ones. They show us new developments: a new cryostat, grossing facility, histology capabilities. The day has come: Rwandese are providing high quality medical care for Rwandese.

New grossing bench at CHUK!

Rwandan has suffered more than most and its story is complicated, but the present reality is inspiring. Ravaged by a holocaust only 25 years ago, the country has made incredible progress in rebuilding and rebonding. The residents we teach are children of this holocaust, having lived through it as toddlers and small children. Each has their own story, but all are survivors. At first it seems abstract, but as I get to know each them, it becomes real, personal, and strangely inspiring. After so many years of slow, careful, difficult building, we are all in a place to finally create the future we believe in.