Transcript CASIEF's support to Rwandan Anesthesiology Residency: Achievements, Challenges and Perspectives

Canadian Anesthesiologists’ Society
International Education Foundation(CASIEF)
in Rwanda
Support to the Anesthesiology Residency :
Achievements,Challenges & Perspectives
Theogene TWAGIRUMUGABE, MD
Anesthesiology Programme Director
Department of Anesthesiology & ICU
National University of Rwanda
RWANDA :
In the centre of Africa
Background
Socio-economic:
* Total population: 8,2 millions
* Per Capita GNP: 250US $
* Infant and Maternal Mortality
* Infant mortality: 86/1000 (DHS,2005)
* Under 5 Mortality: 152/1000 (DHS, 2005)
* Maternal mortality: 750/ 100,000 (DHS, 2005)
* Doctors: 1/50,000 inhabitants
* Nurses: 1/3,900 inhabitants
Background
Lack of personnel, very crucial in rural areas
• A large proportion of MDs practise in urban centres
where only 15%population live:
3 referral hospitals ↔ 40 district hospitals
• 17% of Nurses in rural areas
• Anesthesia = among depressed areas of
specialisation in developing world / Rwanda
Rationale of Postgraduate
programme in Rwanda
• Growing demand of specialist care in the world
• European universities do no longer accept
candidates for the clinical training
• Anti-brain-drain mechanism?
• Community-based educational system
orientation
►Introduction of Postgraduate programme of
Medicine/ National University of Rwanda (NUR)
Postgraduate at NUR
• Launched in 1997 at NUR :
Obstetrics/Gynecology, Internal Medicine,
Pediatrics, General Surgery
• Anesthesia joined in 2002: part of residency in
France, Tunisia and/or Belgium
• The whole training in Rwanda began in 2006
with CASIEF’s support (MoU 2005)
nt of
niversity
th
November 2005
Signing of Memorandum of Understanding
CASIEF
The CASIEF support
• Start: January 2006
• Goal : To assist NUR and Rwanda to develop and run its
own sustainable residency training program in
anesthesiology ( previous experience in Nepal, 1980s)
• Training programme duration: 4 years
• Degree: Master’s in Anesthesiology from NUR
• Send Lecturers: volunteers
• CASIEF to pay flight & visa expenditures
(Members’ donation)
• Lodging/Transport: Ministry of Health & NUR
• Teaching mission duration: at least 1
month/volunteer
ACHIEVEMENTS
Year
Volunteers
CASIEF
Volunteers
USA/Australia
Residents
CANADA
2006
3
3
1
2007
5
3
3
2
4
1
3
+Pain Nurse
2008
7
+Pain Nurse
2009
8
(+2 RT, 1 Pain
Nurse)
ACHIEVEMENTS
Volunteers’ mission
• Formal Teaching (seminars): one halfday/week
• Clinical Training in OR in the 3 training
hospitals
• Mentoring of dissertations & final
assessments of the first graduants
• Curriculum review
ACHIEVEMENTS
Residents
(2009): 9
• PG-Y4: 2
• PG-Y3: 2
• PG-Y1: 5
ACHIEVEMENTS
August 2008: Visit of CASIEF chair
Review of the programme to build a self-sustaining
programme:
• Coordination of teaching/symbiosis:
- Programme Director (PD)
- Assistant PD
- Chief Resident
• Other Important issues:
- Training staff in educational and assessment techniques
-Fellowships in the main & important specialisations
- Rwandan Residents Overseas Rotation to improve skills and
knowledge
CHALLENGES
Volunteers:
• Working conditions: old equipment, shortages of drugs
and other supplies
• Living conditions
• Some clinical sub-specialities absent
• May be asked to teach a block/module different from
their area of expertise
• Not really involved in the assessment
( 1 month?)
• Continuity of the programme?
• Creation of symbiosis
CHALLENGES
Local staff/Residents:
• Very young staff
• Number of staff: 10 anesthesiologists in
the country
• Not enough time to fully devote to
education
• Symbiosis volunteers-local staff
• Lack of attraction of Medical students to
the program
Local staff with Dr Carli F.
PERSPECTIVES
• Residents Elective in Canada(6 mo at least):
- settled objectives
- before their final assessment
- Educational license?
• Young Staff:
- Fellowships tailored to the urgent needs/key
areas: Obstetrics,Emergency,Paediatrics,Intensive
Care ,…
- APD: training in Educationnal techniques
Summary
•
•
Crucial need of anesthesiologists in Rwanda→Patient
Safety: WHO 2008« Safe Surgery Saves Lifes »
Training supported by CASIEF: fruitful
( volontary service)
BUT:
• A self-sustaining programme needs:
1. Training of trainers: Fellowship
2. Residents to rotate abroad ►future trainers; for skills&
knowledge in safe anesthesia, enthusiasm, attraction
Support from Canadian
Institutions is welcomed
THANKS