A Partner’s in Health site, Rwanda has seen a dramatic shift in the past several years with the resolution of the war and genocide that paralyzed the nation for decades. The country of nearly 10 million has an infant mortality rate of 97/1000 and a life expectancy of 52. There is a renewed dedication by the Ministry of Health to health care delivery improvement. The Global Pediatrics Program is joining with several large efforts to address infrastructure and quality improvement.
Reaching underserved populations worldwide is a top priority for humanitarian reasons and is critical to meeting the 4th Millennium Development Goal to reduce by two thirds the under-five mortality rate by 2015. Members of the Neonatal Intensive Care Unit staff at Boston Children's Hospital have worked with Partners in Health and the Rwandan Ministry of Health to improve neonatal health in Rwanda.
A team of clinicians lead by CHB neonatologist Anne Hansen and clinical nurse specialist Michelle Labrecque has collaborated to develop and implement a neonatal protocol, medical record template, and series of teaching materials based on United States Level II Special Care Nurseries for use in hospitals in rural Rwanda. From June to August 2010, they worked on-site at three district hospitals (Rwinkwavu, Butaro, and Kirehe) in collaboration with local doctors and nurses, to adapt the material to local conditions.
The new protocols have since been accepted as the National Standard for Neonatal Care in Rwanda by the Rwandan Ministry of Health.
Surgery in Rwanda
One of the components of the research agenda for global surgery focuses on establishing and developing the foundational literature on the economics of surgical care in low- and middle-income countries. We have undertaken economic modeling estimates to demonstrate the clinical and economic impact of surgical interventions in sub-Saharan Africa, Ecuador, and Rwanda in order to provide irrefutable evidence that the provision of surgical care is both cost-effective and that it represents a beneficial return on investment for LMICs.
Improving Mental Healthcare for Children
Since 2009 Dr. Raviola has provided support to the mental health team at Inshuti Mu Buzima (Partners In Health) in Rwanda. The IMB mental health team provides technical assistance to MOH district hospital mental health teams comprised of psychologists and psychiatric nurses. Mental health program development at IMB has included the development of mental health services at the new Butaro Hospital with a greater focus on quality improvement in mental health care, articulation of a continuum of care integrating health center and community levels, and collaboration with the Harvard School of Public Health Family Strengthening Intervention (FSI). Led by Dr. Theresa Betancourt of HSPH and Professor Bill Beardslee of CHB, FSI is a community-based effort to support children and families based on Professor Beardslee’s groundbreaking work to strengthen families in which a parent suffers from depression.
An Oncology team, including Leslie Lehmann and Sara Stulac, has been working with the Ministry of Health and PIH to develop a national strategy for cancer care. Initiatives have included a recent 2 day conference to formalize recommendations regarding prioritization of diseases to be treated, protocol development and discussion of issues such as drug procurement and availability of radiation equipment for diagnostic and therapeutic purposes. This was followed by the 1st National Cancer Training conference where physicians around the country were given a week-long training in the fundamentals of cancer care. This included didactic lectures, case studies and training in procedures such as breast biopsy.
Currently, care is provided for pediatric patients with a specific group of oncologic diagnoses. Cases are managed jointly by a Global Pediatric Fellow and Rwandan physician and nurse specialist with oversight provided by DFCI/CHB oncologist. Cases are discussed on weekly conference calls and outcomes are tracked.