Report from the field: Global surgery elective in Rwanda

A collage of photos of Rwanda's outdoors.

The UF Department of Surgery’s Global Surgery Program offers international resident rotations as approved by the ACGME and the RRC. Residents can count cases for approved rotations. Read about surgical resident Andrea Riner’s rotation with our partners in Kigali, Rwanda.

Q: Where did the majority of your OR time take place?

A: At Centre Hospitalier Universitaire De Kigali, or CHUK, there were two general surgery teams — emergency surgery and elective general surgery. I spent the month working with consultant surgeons, a title equivalent to attending surgeon, on the elective general surgery team. The majority of each day was spent operating, but I also had the opportunity to make rounds in the morning, see consults in the emergency department or the medical wards, and had the fortune of working with medical students, interns and residents.

Q. What are some moments that really stood out to you during your rotation?

A: The pathologies that I saw were quite different from those that I commonly encounter in the United States. For example, I did not operate on anyone with acute cholecystitis, appendicitis, or diverticulitis. However, I took care of quite a few patients who had peritonitis due to other diseases, like typhoid or tuberculosis, as well as peptic ulcer disease. So their common pathologies were different than what we see here. In addition, many of the patients I took care of presented with advanced stage cancer. I operated on a large splenic cyst, and on a patient who’d fallen and was impaled by two rebars. We stabilized the patient initially, but they were not operated on until the next day. Nonetheless, he had a great recovery. From a cultural perspective, Rwandans are incredibly welcoming. I’ve never been to another place in the world where people have been so friendly and warm. They have a very beautiful culture.

Q: Do you feel like any experiences over there have informed how you approach medicine here?

A: When I reflect on how we provide care in comparison, I think that sometimes we may, for example, order tests out of reflex or because it’s what we’re used to doing, and sometimes we don’t think twice about the necessity of those tests. In places with more limited resources, that isn’t necessarily standard practice. And while we also have limited resources here, it has made me re-assess the tests and labs that I order, homing in on when that is necessary. A diagnostic test like a CT scan, though available in Rwanda, isn’t as easily accessible. A patient getting a CT scan is a process of thoughtful deliberation, rather than something ordered routinely for diagnostic purposes. It makes me pause to think about cost-effectiveness and use of our health care resources.

Q. What is something you’d like to do more of after your rotation?

A: I’m pursuing a career in surgical oncology, so I paid particular attention to the delivery of cancer care. I realized that things like endoscopy and chemotherapy, although available, are not easily accessible, which confirmed my interest in working with clinicians in low and middle-income countries to enhance preexisting cancer care and make it more comprehensive. Multi-modal treatment is the standard of care for many cancers, and I would love to see equity in cancer care around the globe. My ultimate goal is to be part of cancer center development in low- and-middle-income countries, which could eventually provide sites for cancer trials in those areas as well. As a clinician with a background in public health, I believe it’s simply the right thing to do.

Q: What did you take away from your peers, other trainees, while in Rwanda?

A: I was incredibly impressed with the junior residents and interns. Their educational system is structured differently from ours — They complete an intern year and then they serve as a general practitioner for two years, before coming back to complete their surgical residency. So they have an in-depth knowledge about how to take care of patients medically because of the extra experience that they receive. I also respected and admired the sense of community and closeness between trainees from various surgical specialties as they shared a common call room and congregated there whenever they were not in the operating room or wards. There is just so much to learn, and I look forward to going back, hopefully sooner than later.

A collage of different photos of a hospital in Rwanda, and areas surrounding it.