Building bridges to better care

Robin Petroze, MD, MPH, spearheads our Global Surgery and Health Equity program. For more information about the program, click here.

Even after 10 years and more trips than she can count, when UF Health pediatric surgeon Robin Petroze, M.D., M.P.H., moves about in Rwanda, she’s still called “Mzungu.’’

Translated as “foreigner’’ or “outsider,’’ the word reminds Petroze of the importance of building strong collaborations with the small medical community serving this country of 12 million in East Africa. As with any type of mission trip or international academic venture, she said, the important thing is to avoid a savior complex and to develop sustainable local relationships.

Dr. Robin Petroze, right, collaborates as a mentor and examiner for surgical trainees through the College of Surgeons of East, Central and Southern Africa. She is pictured here with senior Ethiopian pediatric surgeon Dr Milliard Derbew.

Robin Petroze Milliard Derbew

“Given the history within Rwanda, you have to remember that you are a guest and have the option of leaving,” said Petroze. “It’s also really important to understand your role and the historical/political context in which you are working. Going in unprepared is one of the most dangerous things you can do.”

Petroze’s passion for Rwanda began when she was a general surgery resident at the University of Virginia and spent two years as a research fellow in the country studying the burden of surgical disease and contributing to surgical education.
Now an assistant professor in the UF College of Medicine’s department of surgery, she travels to Rwanda to deliver care in their 520-bed hospital as well as mentor, train and teach medical students and residents.

There is only one pediatric surgeon in the country, so for nearly two years, Petroze has provided some clinical respite for him and filled in as a faculty member at the University of Rwanda on the pediatric surgical service. Together, they are developing outcomes research and quality improvement projects for neonatal surgical conditions.

Before her first trip to Rwanda in 2009, Petroze researched the nation’s history. Much of what she learned dealt with the 1994 genocide against the Tutsi ethnic minority, where close to 1 million people were killed during a 100-day period.

Since then, Rwanda has developed a reputation as one of the safest places in the world, according to websites offering advice for travelers. The ongoing COVID-19 pandemic, however, has led to a travel advisory from the U.S. Department of State about traveling to the country.

Petroze said she has been able to do her work in Rwanda without fear for her safety. “I feel more comfortable there walking on the streets than I do here in the United States,” she said.

The genocide wiped out the health infrastructure in the country. In the early 2000s, Rwanda had the worst health indicators in the world with the highest maternity mortality and the worst child survival rates. Since then, the country has made dramatic strides in health care development with a substantive focus on health equity.

“Seeing both the need, as well as a government and a population that is really engaged in making changes, are part of why I chose Rwanda,” said Petroze.

Dr. Robin Petroze, left, works with surgical fellows in Kenya.

Robin petroze in kenya

Much of Petroze’s international work is done in academic collaboration with surgical training programs around the world. She is involved in the College of Surgeons of East, Central and Southern Africa, or COSECSA, which is the regional college for higher certifications of surgeons in regards to education, research and publications and is similar to the American College of Surgeons in the U.S. COSECSA has worked to standardize training certifications in different regions in order to improve access to surgical care in multiple nations.

While Rwanda is considered relatively safe for travelers, regional conflicts, particularly in the neighboring Democratic Republic of Congo, and significant health concerns such as Ebola are present. Over her time in Rwanda, Petroze has noticed times when there have been larger refugee populations from conflicts in bordering nations.

“I’ve had to trust the local government and my direct colleagues to tell us what is happening in the country,” said Petroze. “Trusting others has allowed myself to be more vulnerable, which can be both scary and liberating.”

Petroze’s passion for global health and providing care in distant countries is rewarding, she said, but it can also be emotionally challenging.

“There are times when you do the right thing, but the patients don’t survive because you don’t have the same resources you have here in the U.S.,” she said. “Some conditions we treat as pediatric surgeons have a 95% survival rate here and a 5% survival rate there.

“Sometimes, going back and forth can be frustrating and heart-wrenching,’’ Petroze said. “Because you know there are kids in parts of the world who have access to great health care and kids in other parts who don’t.”