Supporting Global Surgical Collaboration in Rwanda
By Dr. Wesley Chou
I had the recent privilege to attend a reconstructive urologic workshop in Kigali, Rwanda through IVUmed this past October. The staff I worked with were Dr. Frank Burks with Comprehensive Urology in Michigan, Dr. Sarah Christianson with Intermountain Health in Utah, and Dr. Tarah Woodle, a GURS fellow at University of Utah. This was my first international medical experience, and it was an incredibly educational whirlwind.
Through various flights, our team linked up in Amsterdam before flying into Kigali on Saturday. On Sunday, we met the Rwandan team, led by Dr. Jean Marie Vianney Nyonkuru and Dr. Emmanuel Muhawenimana, for preoperative clinic at the University Teaching Hospital of Kigali (CHUK per its French initials). Together we saw 38 patients. Many had been discussed at a recent conference call, and aside from a few patients who needed more workup, everyone else was indicated for procedures. There were far more patients than available OR time and hospital beds, so we had to prioritize based on their wait time and living situations.
From Monday to Friday, we performed 20 cases. Most were urethroplasties for strictures that were either traumatic or infectious in etiology. It was valuable to have so many repetitions in a short amount of time, and I saw non-transecting approaches, excision and primary anastomoses, and numerous variations of buccal grafting. Of note were the repairs of pelvic fracture urethral disruptions, which I had not seen before.
These were tough cases, appropriately so, given that the Rwandan team triaged cases with which they desired assistance. Despite the complexity of these cases though, the equipment that we brought (sharp scissors, retractors, fine PDS sutures) was not numerous. I am applying into urologic oncology fellowships, and though I anticipate performing many robotic procedures in the future, the ability to make do with relatively scant supplies in this setting was refreshing.
Additionally, I particularly enjoyed interacting with the Rwandan urology residents. We picked each other’s brains regarding common consults (e.g. retention and hematuria were ever present, but acute stones seemed much less common in Rwanda) and how these were managed at our respective institutions. Dr. Woodle and I also joined the Rwandan team for morning rounds on our postoperative patients, with the attendings asking familiar questions regarding expected positioning injuries and other postoperative complications.
Dr. Burks, who had gone to Rwanda the most times on the American team, described how the Rwandan team had gained a substantial amount of proficiency in not only performing the actual reconstructive procedures, but in working up and choosing procedures for patients. It was a helpful reminder of the purpose of these workshops. Although I certainly jumped at the opportunity to be primary assist in certain cases or to lead a junior resident through graft harvest or closures, I took more of an observership role or scrub where necessary when one of the reconstructive attendings directly precepted members of the Rwandan team.
I deeply appreciate the support from the Western Section of the AUA to participate in this workshop. I cannot overstate the generosity of the Rwandan team as well and the work they put into working up the patients and ensuring there were enough hospital beds to accommodate this spike in admissions. I hope to return to Rwanda in the future. Dr. Niyonkuru said that Rwanda will have their first surgical robot in two years. If the stars align, perhaps I could help support the transition into those cases.