Healthcare in Rwanda

Such a weighted topic. I know studying and working in America has made me biased as to a very high standard of care, however it's still difficult to see some of the common practices here. I understand that for the majority of practices, there is legitimate and logical reason, but part of me still wants to claim that there needs to be another way.

The largest difference between care of patients in Rwanda as compared to America is the treatment of privacy. In the States, HIPAA rules all. You cannot speak show or transport patient records, speak of another patient, or let slip in any way any possible patient identifier. Individuality and privacy are as fundamental as breathing in the American healthcare system. In Rwanda though, patient confidentiality is non-existant. Blood is taken by going efficiently down the row of waiting patients, ARVs are passed out and advised upon to two or more patients at the same time, and the idea of private records is laughable. In other words, everyone knows why everyone else is at the health center. It is a reflection of the difference in cultures I understand, but after 5 years of having HIPPA drilled into me upon fear of failing or losing my license, it is a shock to see the openness people have.

Another startling difference is the lack of safe and proper procedure. Though there is still a lot of emphasis placed on the safety of the patients, using sterile needles, cleaning the skin, and aspirating before injecting, there is an apparent lack of regard for nurses' safety. Gloves are not routinely worn and when they are donned, the same pair is used for everyone. Also, recapping is a common practice. Thank you Luther and Caregivers for instilling in me such high educational standards; it still makes my heart skip a beat whenever someone goes to recap their needle. Like I stated before, I do understand the reasons for these practices. Lack of supplies and funding makes it impossible to use a new set of gloves for every person that passes through the center. I know this is not an appropriate way to provide care, but I also know that unless a suitable alternative is presented, it doesn't do any good to try and enforce the standards I am used to in America.

Rwanda, while still woefully behind in technical skills and available resources, has an interesting health care system overall. Kigali has the largest and most advanced hospital, King Faisal, which hosts some of the only medically advance equipment in Rwanda such as ventilators, CT scans, and MRI machines. I might be mistaken but I believe they also have a mental health hospital as well. Rwanda is split into 5 provinces (North, East, South, West, and Kigali), which is then divided into 31 districts, and all but two of these have hospitals, however these are in the process of being constructed. From there you get down to the secteur level are the health centers which offer services such as Maternity, Prevention Mother to Child Transmission (PMTCT), ARV distribution, VCT, as well as a lab, pharmacy, and 3 day "hospitalization" wing. This is where I work. Secteurs are broken down into cells, and then further into umudugudus, which would be the equivalent of a large neighborhood. In each umudugudu there are a minimum of 2 health workers, the majority having at least 3; one for men, one for women, and one for pregnant women and small children. These health workers have the power to give out basic medicine, refer people to health centers, and do basic diagnostic work, such as detecting Malaria. I find the expansion of the healthcare system to be extremely encouraging and can see the ambition to provide the population with care. Amazingly as well, Rwanda's major health insurance provider Mutuelle covers nearly 80% of people. With all these steps however, Rwandans still have low rates of treatment owing mainly to inability to access health systems due to atrocious roads as well as lack of resources in the health centers and hospitals. There is so much promise in this country, but unfortunately ideas first have to be adapted to Rwanda's many obstacles.