Expanding Rheumatology practice in Rwanda
The African country of Rwanda, population 12 million, does not have a single practising rheumatologist at present, despite rheumatic disease being prevalent across the population. Carol Hitchon, MD, FRCPC, and Rosie Scuccimarri, MD, FRCPC, are working to establish Rheumatology capacity in Rwanda with the help from an International Development, Aid and Collaboration grant.
“Rheumatology has not been a priority in Rwanda, mostly due to competing economic and health care priorities,” says Dr. Hitchon, a Winnipeg-based rheumatologist. “There is an urgent need to establish capacity there.”
Combatting disability in younger populations
Inflammatory and autoimmune rheumatic conditions are major contributors to physical disability worldwide, but get little attention in many developing countries. Moreover, these diseases often affect people during their prime working and child-raising years, which has a substantial impact on individuals, families and society.
“The burden of rheumatic disease can be significantly reduced with optimal treatment, but disease management is often complex,” says Dr. Hitchon. Her project will pursue two main goals to improve treatment of rheumatic disease in Rwanda.
The first priority is to send a Rwandan Internal Medicine resident for two years of Rheumatology subspecialty training at the University of KwaZulu-Natal in Durban, South Africa. IDAC funding will cover tuition and some living expenses. The candidate will return to Rwanda with advanced knowledge they can use to treat complex cases and train other physicians in Rheumatology.
The second goal is to provide virtual training in Rheumatology practice for Internal Medicine residents in Rwanda. A 16-week course will cover a broad range of Rheumatology topics, and volunteer faculty will deliver live lectures and tutorials. All the work will be undertaken with strong support from the Centre Hospitalier Universitaire de Kigali in Rwanda. Faculty will include African rheumatologists to ensure that culturally appropriate topics are covered.
“We’re pursuing a train-the-trainer approach, where Rwandan internists develop capacity and bring it to others in the country,” says Dr. Hitchon.
Dr. Hitchon says an evaluation process following virtual programs has helped her group improve the training with every cohort. “We always ask the trainees and faculty what worked and what didn’t. We learned from our first cohort and adapted things for the second. We’ll continue with this evaluation approach in the future.”
A program built on a strong foundation
Dr. Hitchon has ample experience bringing Rheumatology training to eastern Africa. She and her colleagues helped internists from Ethiopia – a country of nearly 115 million people with previously no practising rheumatologists – complete Rheumatology specialty training in South Africa. “As of 2021, these rheumatologists are providing care in Ethiopia and educating medical trainees,” says Dr. Hitchon. She and her colleagues continue to mentor Ethiopia’s new rheumatologists as they establish their clinical and academic careers.