Diversity and Disparity: Understanding Healthcare in Rwanda

Alex Robertson ’20 began thinking about a career as a physician in middle school. A summer program in cardiothoracic medicine at Stanford University during the summer of 2018 helped seal the deal.

“The program at Stanford was very hands-on,” says Alex. “We spent part of our time in a non-operating OR working on pig’s hearts doing real procedures with real tools, including coronary artery bypass grafts (CABG) and aortic root transplants using actual porcine valves.”

With support from a Meg Page’74 Fellowship, Alex continued his experiential exploration of public health and medicine last summer during a month-long journey through Rwanda, where he witnessed the diversity and disparity of health services available in a nation still recovering from the horrific 1994 genocide. There, Alex worked in a home for disabled children and young adults operating in a small village with very limited resources. He also spent time at a new, modern, progressive medical facility that has become a center for medical education and cancer care in East Africa, with top clinicians from across the globe leading the way.

It Takes a Village

Alex and seven other high school students began their work in Rwanda in the southeastern village of Nyamata, where they lived in a guest house attached to the local district hospital. Each morning, they walked 45 minutes across the village to a home for children with profound physical disabilities.

“None of us were expecting the severity of it and none of us had worked with disabled children before,” Alex explains. “But we became comfortable very quickly, and were happy to support Cecile and the children.”

Cecile Munyana was a nurse at Nyamata Hospital in 2005 when a disabled child arrived for medical treatment. “As a health worker, I realized that the baby needed more support on top of medicine,” Cecile told Rwanda’s The News Times earlier this year. 

She quickly came to realize that there were many other children, babies, and even young adults with disabilities in her community, many of whom had been abandoned by their parents. Cecile began taking them in and providing both medical care and loving support. 

“There are currently 20 kids in Cecile’s care,” Alex says. “They range in age from four to 29. The oldest suffers from a rather severe form of cerebral palsy; he was found abandoned in a river during the genocide.”

Cecile has two full-time employees to help her care for the children. She also relies on volunteers like Alex, and the support of the Nyamata village. 

“It is a very tight community,” says Alex. “That Cecile has the heart to devote her life to these children is profound and heartwarming. But she also runs a small low-cost clinic in her home. While we were there, I was able to shadow her in the clinic, where patients are often treated for malaria. The neighbors she cares for support her, in turn. I was involved with a manual labor project there, and people from the neighborhood came out and volunteered to help us dig a 20-meter hole for Cecile. Seeing that sense of caring and community had a very deep effect on me.”

Alex also arranged to spend his free time in Nyamata shadowing the head of the district hospital. 

“Dr. William showed me around, talked to me about the limited work they do at this facility—the hospital has only two surgeons and 30 doctors. They do not offer trauma care, and have no emergency room,” Alex explains. “But he also talked to me about the overall healthcare system in Rwanda. They have such a strong healthcare system, such a strong ministry of health, and very strong hospitals across the country.”

Rising Above

In the aftermath of the 1994 genocide, Rwanda became the world’s poorest country, with the world’s highest child mortality and lowest life expectancy rates. Almost immediately, the government prioritized the development of healthcare systems within the country. As a result, life expectancy in Rwanda has doubled since 1995. Partners in Health, a Boston-based non-profit which has helped build and grow healthcare systems in ten nations across the globe, notes that “Rwanda has become a model for how resource-poor countries can build health systems from almost nothing.” They point to the Butaro District Hospital as a shining example.

“After we left Nyamata we traveled to Rwanda’s northern district of Burera, where the Butaro Hospital is. We traveled up a winding dirt road for about an hour and a half, through mountains and seeing really almost nothing along the way,” recalls Alex. “Then quite suddenly a modern, new hospital with a very large campus came into view. It offers an incredible range of medical services—they have an ER, a pharmacy, oncology, internal medicine, pediatrics, surgery—everything.”

Opened in 2011, the mountain-top facility brought modern medical care to an area that previously had none. A year later, The Butaro Cancer Center of Excellence opened at the complex. More than 1,700 cancer patients from across Rwanda travel to Butaro each year. Close by, Partners in Health operates the University of Global Health Equity (UGHE), which awards master of science degrees in global health delivery, and where students are taught by Harvard Medical School faculty. Alex and his peers spent time in each of the facilities, shadowing physicians and meeting with students.

“Before I went on this trip I wasn’t really thinking about going outside the United States to work in medicine. Now, I want to go back; I want to use some of the inside knowledge I have gained to work in Rwanda. With luck, I will return to Nyamata to take Dr. William up on his offer, and see Cecile and the children again.”

Alex’s travel was funded in part by a Meg Page ’74 fellowship. To honor her commitment to compassionate health care, Meg Page ’74 Fellowships are awarded annually to students who wish to explore an experience or course of study devoted to the provision of better health care in areas such as public health, family planning, medical research, mental health, and non-Western practices of healing.