1. 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

2. RWANDA : In the centre of Africa

3. 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

4. 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

5. 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)

6. 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)

7. November 2005 Signing of Memorandum of Understanding CASIEFGovernment of Rwanda National University of Rwanda Kigali Health Institute

8. 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

9. ACHIEVEMENTS YearVolunteers CASIEF Volunteers USA/Australia Residents CANADA 2006331 20075 +Pain Nurse 33 20087 +Pain Nurse 24 20098 (+2 RT, 1 Pain Nurse) 13

10. 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

12. ACHIEVEMENTS Residents (2009): 9 PG-Y4: 2 PG-Y3: 2 PG-Y1: 5

13. 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

14. 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

15. 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

16. Local staff with Dr Carli F.

17. 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

18. 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

19. Support from Canadian Institutions is welcomed

20. THANKS