Canadian Anesthesiologists

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Canadian Anesthesiologists Society
International Education Foundation(CASIEF) in
RwandaSupport to the Anesthesiology Residency
Achievements,Challenges Perspectives

• Theogene TWAGIRUMUGABE, MD
• Anesthesiology Programme Director
• Department of Anesthesiology ICU
• National University of Rwanda

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RWANDA In the centre of Africa

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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

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Background

• Lack of personnel, very crucial in rural areas
• A large proportion of MDs practise in urban
  centres where only 15population live
• 3 referral hospitals ? 40 district hospitals
• 17 of Nurses in rural areas
• Anesthesia among depressed areas of
  specialisation in developing world / Rwanda

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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)

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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
  CASIEFs support (MoU 2005)

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November 2005 Signing of Memorandum of
Understanding
CASIEF
Government of Rwanda National University of
Rwanda Kigali Health Institute
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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 Masters 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

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ACHIEVEMENTS
Year Volunteers CASIEF Volunteers USA/Australia Residents CANADA
2006 3 3 1
2007 5 Pain Nurse 3 3
2008 7 Pain Nurse 2 4
2009 8 (2 RT, 1 Pain Nurse) 1 3
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ACHIEVEMENTS

• Volunteers mission
• Formal Teaching (seminars) one half-day/week
• Clinical Training in OR in the 3 training
  hospitals
• Mentoring of dissertations final assessments of
  the first graduants
• Curriculum review

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(No Transcript)
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ACHIEVEMENTS

• Residents (2009) 9
• PG-Y4 2
• PG-Y3 2
• PG-Y1 5

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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

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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

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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

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Local staff with Dr Carli F.
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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

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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
• Training of trainers Fellowship
• Residents to rotate abroad ?future trainers for
  skills knowledge in safe anesthesia, enthusiasm,
  attraction

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Support from Canadian Institutions is welcomed
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THANKS