This story is part of our ongoing “UW Goes Global” series, in which Department of Emergency Medicine faculty, residents, and fellows share stories and insights from their time engaged in emergency medicine in low resource settings, both within the United States and abroad.
For my clinical elective in global health, I spent two weeks in Rwanda working alongside residents and faculty at the African Health Sciences University (AHSU) and University Teaching Hospital of Kigali (CHUK).
In a small rural hospital in Kibuye, I learned a lot about local disease pathology including typhoid fever, complicated malaria and disseminated tuberculosis. I also saw later stage sequelae of congenital heart disease, as many children are born at home with limited access to routine prenatal and newborn outpatient care. With only upper body X-ray, one cardiac monitor and one handheld ultrasound, I learned a lot about the treatment and stabilization of patients in resource-limited setting, triaging patients for transfer to higher level of care and starting empiric treatment for truly undifferentiated shock.
In comparison, CHUK in Kigali serves as an urban safety net receiving facility. It’s faced with significant boarding including critically ill ICU patients. Working with senior residents there, I was inspired by their ability to lead the emergency department team, respond to multiple cardiac arrests, manage the care of multiple ventilated ICU boarders, and see new patients despite having a limited number of monitors, procedural equipment and no digital medical records.
At a large referral center in Kigali, I continued to see a variety of surgical and medical cases along with the social challenges that providers faced. For example, a mother needed admission for a cholecystectomy but was still breastfeeding and was unable to afford childcare. The residents worked with the departments of pediatrics and surgery to get both the mother and child admitted, preventing delays in care. Having had patients leave against medical advice due to caregiving responsibilities, it was great to see the multi-departmental collaboration in addressing a challenging social situation.
During my time in Rwanda, I learned so much about local disease pathology, skills to adapt to different healthcare systems and creativity in practicing in limited resources settings. In turn, I was able to provide ultrasound teaching and didactic and simulation sessions on topics less frequently seen in Rwanda such as opioid overdose.
The residents and staff that I worked with were incredibly welcoming and we were able to share in a truly collaborative educational and clinical work environment. I hope to bring the knowledge I learned to the smaller, urban community hospital I will be working at next year and to return to Rwanda and continue my working relationship with AHSU and CHUK in the years to come.
Samuel Wing, MD, MS completed his bachelor’s of science degree in neuroscience at the University of Michigan, and his master’s degree in medial sciences and doctor of medicine degree at Boston University School of Medicine.