In Rwanda, there also is funding from the Doris Duke Charitable Foundation, which is earmarked to support Rwandan researchers and clinicians, to expand the centralized services, and to evaluate and study the implementation of the programs to get a sense of what works.
What have been some of your greatest challenges?
I think the biggest challenge is establishing the first generation of people who are skilled and can train others, but that is really gratifying. We believe in making an early investment in leadership. In some ways the biggest challenge is nurturing, mentoring, and sustaining leadership early. This is critical to success, and we have been very fortunate to have leaders who are enormously committed to patients and have learned the discipline extraordinarily well. In the end, it is all about the people.
Another challenge has been finding supply chains that work. If people don’t have the tools to do what they need to do, they are going to be demoralized. Similarly, if patients don’t have services available, or if they can’t get services for financial reasons, that will be demoralizing. That’s why it is important to link these services to community health insurance to make health care affordable and accessible to the population.
What surprised you most about the potential for improving health care in Rwanda?
It still surprises all of us how compelling the patients are. These are young patients with often very treatable conditions for which there are great interventions. And the commitment of the Rwandan government has been a real inspiration to all of us.
For information and online discussions with clinicians about endemic noncommunicable diseases and global health, visit GDHonline.
-Interviewed by Heidi Splete
Think globally. Practice locally.
U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, send an e-mail to imnews@elsevier.com.