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Specialists Without Borders Rwanda Seminar in Surgery - September 2010

Specialists without Borders continued its medical education initiatives into Africa with a seminar in surgery over three days in Kigali, Rwanda. This was followed by teaching at the medical school in Butare. Thirteen Australasian surgeons participated as lecturers as well as, for the first time, five medical students, who were partly sponsored by Allergan, and two surgical Registrars. As this was a new experience for the medical students it is worthwhile, I think, to quote from one of the student’s experience, which bears reporting.


I am not exaggerating when I say the experience I gained from this trip has helped shape me as a person and as a future doctor. Specialists Without Borders student

“Although we only stayed there for a week, the eye-opening experience I gained there is invaluable. This was my first time to be in Africa, it amazed me how much Rwanda has developed since the 94 genocide, which was only 16 years ago. The cities were clean and people were very friendly. I visited a local African family, who showed us around their house and farm. They have very little materially compared to us, yet they are happy and work hard to provide for their children.

The Rwandan people are also very gentle – for example, in the local markets they do not push us to buy things despite the fact a lot of them struggle to make a living, unlike the scenes we commonly encounter in markets in other developing countries. As I am involved in the Surgical Students' Society of Melbourne, I am currently in touch with the head of Rwandan Students' Society, whom I have met there, to look at possible ways of us helping them financially to develop AIDS and hepatitis C prevention programs for the local Rwandan community. Our next step is also to set up a students exchange program for electives.

As personally I have learned enormous amount of clinical experience by tagging along the Rwandan doctors just for a day or so, I believe it would be extremely beneficial for more Australian medical students to see what it is like in Africa and for Rwandan medical students most of whom have never been abroad to see the Western system.


I am not exaggerating when I say the experience I gained from this trip has helped shape me as a person and as a future doctor. The surgeons from SWB have inspired me to pursue surgery as a future career and I would love to get involved with SWB in the long term.”


Seminar


The seminar in surgery was requested by the Rwandan Surgical Society, to which SWB has now become an official affiliate, and the National University of Rwanda/medical school as a way to continue the postgraduate medical education and to build on the successful seminar conducted in 2009 on medical and surgical emergencies
.

SWB had had very positive feedback from evaluation questionnaires from the 2009 meeting but was also looking to improve on the type of teaching delivered. The National Executive therefore decided to move to Structured Clinical Instruction Modules (SCIMS) to build on didactic sessions which would be delivered in the morning.

There was also a request to feature breast surgery in conjunction with a breast cancer awareness day in Rwanda. SWB was also asked to assist with the promotion of a research day, to which the Executive provided the incentives of a laptop, textbook and money awards for best case presentations.


Professor Jegan Krishnan leading an Orthopaedics Structured Clinical Instrution Module

130 Rwandan doctors registered for the seminar run over three days. The seminar was conducted in a large conference facility at the Serena Kigali hotel. Each of the consultants who presented on topics was requested to create a SCIM which would be developed in conjunction with the Executive and which would reinforce material presented in morning lecture sessions. Each of these SCIM sessions was to be over 40 minutes, with six sessions per afternoon on a rotational basis. It is hoped that these modules will then be part of an evolving curriculum for SWB teaching In developing countries. To this end SWB appointed an educational adviser, Don Bramwell from Flinders University in South Australia to provide guidance and assist in the development of both the SCIMS and feedback questionnaires.


Each of the afternoon sessions had six small groups, each with an interpreter in case there were difficulties understanding the English/Australian accents of the consultants, French being the primary language in Rwanda.The medical students were involved as part of the organisation of small groups and contributed significantly to the smooth running of the programme.


Outcomes


The seminar was featured on national television in Rwanda, which further enhanced the standing of SWB, and also not unnaturally elicited further political support from the Rwandan Ministry of Health.


“Initially there were concerns from the Rwandan doctors as to how SCIMS would work in a seminars such as this. However after day one, there was a unanimous approval from the local doctors for this method of teaching.”

Consultants had provided in advance a summary of their lectures which was translated into French and presented to all the doctors attending. While the understanding of English is very good, having a translation in French was considered to have been a thoughtful and helpful gesture.


Each of the consultants/lecturers had also provided PowerPoint copies of their lectures in advance which had all been copied to 150 USB flashcards which were then distributed to all the Rwandan doctors who attended as their permanent electronic copy of the seminar. This was another innovation that was considered successful


Informally the seminar was considered to be a great success. Initially there were concerns from the Rwandan doctors as to how SCIMS would work in a seminars such as this. However after day one, there was a unanimous approval from the local doctors for this method of teaching. Interestingly,the SWB consultants/lecturers also found the small SCIM groups challengingly interactive and therefore more rewarding than just the delivery of lecture material. While the independent analysis has not yet been reviewed, informal feedback has indicated that this type of teaching would be preferred in any future seminars.


An ambulance at Butare University Hospital, Rwanda

SWB is therefore looking at evolving the SCIM as a preferred teaching module in developing countries. In Africa this is to be undertaken with the school of medicine/national University of Rwanda.The Executive of SWB feel that the SCIM module can be refined further to incorporate different levels of teaching at undergraduate/postgraduate and specialists levels. This would enhance the attractiveness and allow more specific targeting of levels of postgraduate medical/surgical education. Clearly part of this development would require a curriculum for each of the subspecialty areas along with an incorporated evaluation programme such as the OSCE which is part of the ongoing commitment of Specialists without Borders.


Medical Students


As part of SWB’s commitment to exposing future doctors to different cultures and clinical problems, five medical students - two from Monash University, two from Melbourne University and one from Flinders University in South Australia - as well as a Surgical Registrar from Perth, were selected to accompany the surgeons. They were encouraged to be fully involved with the seminar and were introduced to Rwandan medicine through the public hospital system in Kigali and then again to the students at the medical school in Butare.


The students took full advantage of the opportunity and contributed significantly to the success of the seminar but also developed through an exposure to a different medical system and appreciation of not only the advantages that they had in Australasia but the difficulties their fellow students encountered in a developing country. As an Executive we were delighted both with their involvement and learning. 


Future Developments


A follow-up a seminar has been requested in Rwanda in 2011. Requests have also been initiated from Cambodia/Honduras and Burma. With the growth of SWB it is felt that with a growing consultant database three or four postgraduate surgical seminars per year would be possible


Royal Australasian College of Surgeons ASC meeting– Adelaide, May 2011


We will be running a seminar in conjunction with the College of Surgeons meeting, International forum day, in May of 2011, this will look to address the issues of coordinating medical education globally and what can be done from an Australasian perspective. This seminar run over two and a half hours would also look at the most effective ways of utilising aid in developing countries and would look to have speakers not only from some developing countries but also from the business/corporate world.


Teaching Database


Register with Specialists without Borders and become part of our growing international database of specialist teachers that we can use in future teaching seminars.