Rwanda Trip: Our final days in Rwanda and Next Steps

DAYS 4 AND 5

On our fourth and fifth days in Rwanda, teams of three of us held all-day sessions at each of the four hospitals to orient the hospital staff leaders to the World Health Organization guidelines for implementing a Hand Hygiene program.  We also provided 1,000 wristbands to each hospital for them to begin a Patient Identification program.  Attendance was excellent at each hospital; 15-25 staff members from each attended, and were instructed as to how they can establish a training program for the entire hospital staff on Hand Hygiene. Essentially, we were “training the trainers.” We received very positive feedback from the staff members of each hospital, and presented everyone in attendance with a Mercy4ubuzima logo T-shirt as well as a bottle of hand sanitizer.  We also gave each hospital laminated posters on proper hand hygiene procedures from WHO to display around the hospitals.  We explained that proper patient identification requires two identifiers on each wristband: name and date of birth.  In addition to the wristbands, we supplied Sharpie permanent ink pens for staff members to use to write information on the wristbands. Below are some photos from those hospital sessions. During Day 5, Regional President of Mercy Oklahoma Di Smalley and her son, Troy, also had an opportunity to tour each of the four hospitals we have been working with. 

DAY 5 Dinner

On the evening of day 5 we held a dinner for all of the hospital leaders and government officials who had participated in our trip.  The attendance of dignitaries and helpful leaders was heartwarming.  Dr. Mike O’Neil, the Chancellor of the University of Rwanda, presided, and Minister of Health Dr. Agnes Binagwaho, U.S. Ambassador to Rwanda Donald W. Koran, one of Kigali’s two Vice Mayors, several additional representatives from the Mayor’s office and several representatives of the U.S. Agency for International Development were all present.  The attendance of these and other dignitaries and helpful leaders was heartwarming. There were excellent presentations by Di Smalley, John Nkuranga and Minister of Health Dr. Agnes Binagwaho.  A highlight of the evening was the announcement that Mercy had facilitated a grant from the USAID for $15,000 each to two of the four hospitals in Kigali, which will permit them to buy supplies to implement the Hand Hygiene program for one year. We can’t overstate how proud we are of this accomplishment, nor how grateful we are to USAID and all of those who helped to facilitate this pivotal financial aid.

DAY 6

Two of the four hospitals began their Hand Hygiene training program by having their first training session.  Members of our team were present as observers only.  We were exhilarated by the quality of the training programs put on by both of the hospitals.

Several members of the team met with the U.S. Ambassador Donald W. Koran, Peter Malnak, mission director for USAID and members of the USAID staff at the U.S. Embassy. We were told that our work in Rwanda had been noticed and that our approach was well-received.  We had very fruitful discussions about future activities in Rwanda, particularly the implementation of telemedicine, which would involve using electronic communication to allow hospitals in cities—and Mercy, in particular—to collaborate with those in more remote areas in order to provide better care to patients at rural or small hospitals. We also discussed the exciting possibility of a partnership between USAID and Mercy in the future. 

On Monday, July 28,  Di Smalley, Mike O’Neill and John Nkuranga met with President Paul Kagame and several representatives of the Rwandan government.  Again, the response to Mercy’s activities in Rwanda was very positive.  President Kagame was particularly interested in the development of telemedicine capabilities between Mercy and Rwanda.  He strongly supported building the infrastructure necessary to utilize Tele-Medicine in Rwanda. 

We feel that this trip represented a significant stride forward in the partnership between Mercy and Rwanda, our sister cities, and the improvement of healthcare practices in Rwanda. We have come back to many new projects, possibilities and goals, and—though there is a great deal of work to be done—we are thrilled with the progress that has and will be made.  We are all so grateful for the interest and support that we have received, and look forward to updating you on the next exciting steps in our mission!

 

Dr. Don Rahhal trains a member of one of the hospital's staff on proper hand hygiene.

Dr. Don Rahhal trains a member of one of the hospital’s staff on proper hand hygiene.

Di Smalley writes example patient information on wristbands during a demonstration on proper patient identification.

Di Smalley writes example patient information on wristbands during a demonstration on proper patient identification.

Members of our Mercy group with staff members of the hospitals during the training session.

Members of our Mercy group with staff members of the hospitals during the training session.

Hospital staff members receive their Mercy4Ubuzima t-shirts and hand sanitizer at the training session.

Hospital staff members receive their Mercy4Ubuzima t-shirts and hand sanitizer at the training session.

Day 3

Tuesday, our third day in Rwanda was a critical one for our mission.  We met with the top two leaders from each of the hospitals we intend to work with in order to present our plan to help them improve their Hand Hygiene and Patient Identification practices.  We also presented a proposal for the leaders of the four hospitals to form a Collaborative Leadership Group (CLG), which will encourage the leaders to work closely together and to share and learn from one another’s experiences.  We gave presentations on our progress in Rwanda in 2013 and 2014, then each hospital presented summaries of the progress they had each made in response to our recommendations last year to help them achieve Joint Commission International Certification. We presented a short course on Leadership.  We began the Hand Hygiene and Patient Identification initiatives.
What was the response of the leaders?  Nothing short of fantastic.  They were engaged, enthusiastic, committed.  The day could not have gone better.
Here are some photos from that day:
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Dispatch from Day 2 in Rwanda—Monday, July 21

On Monday, our second day here in Rwanda, the entire Steering Committee for Mercy4ubuzima—comprised of Cindy Carmichael, Cathy Dirickson, Reagan Hightower, John Nkuranga, Donald Rahhal and Laurie Weathers—revisited the four hospitals that we reviewed in 2013.
 We were received warmly at each hospital.  All were interested in working with us to implement our first pair of initiatives: Hand Hygiene and Patient Identification.  The relationships that John Nkuranga has maintained in Rwanda have provided a great foundation of trust between our steering committee and those we are working with here.  Without this spirit of collaboration, our mission would not function and be fruitful in the way that it has been so far.
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We were interested and pleased to see some of the creative practices that these hospitals are using in lieu of more expensive supplies and methods. As pictured below, one of the hospitals has fashioned “wheel chairs” by attaching wheels and foot rests to plastic lawn chairs.  At another (bottom right photo), a mother of twins uses the “Kangaroo Care” technique.  When providing “Kangaroo Care,” a mother maintains skin-to-skin contact with her infants for extended periods of time.  This practice has many benefits, and most importantly provides security, encourages breast-feeding, and helps to regulate the body temperatures of premature babies.  In areas where incubators are not available, this method has been shown to be an effective alternative. In fact, most Neonatal Intensive Care Units (NICUs) in the United States use Kangaroo Care instead of or in addition to traditional and more technologically advanced methods of neonatal care.
      (For more on Kangaroo Care, check out the World Health Organization, KangarooMotherCare.com, or the information on the        Cleveland Clinic’s site.)
One of the hospitals we visited had come up with a clever substitute for wheel chairs.          
Tuesday will be a very important day.  We have invited 2 leaders from each hospital, the Vice Mayor, a physician from the Mayor’s office and a representative of the Minister of Health to a full-day meeting at our hotel in order to discuss the progress they’ve made in implementing the recommendations we made last year, and to seek their “buy-in” of our project.  We are eager to hear what has been accomplished in the last year, as this will determine how the rest of the week goes.
Check back with our blog soon for a report of the progress that’s been made an update on what our potential next steps might be!

First report from the Steering Committee for Mercy4ubuzima

A group of 6 of us traveled to Kigali. We will be joined by Di Smalley and Mike O’Neil later in the week.

Sunday we attended church as guests of the Vice Mayor Hope Tumukunde at the Christian Life Assembly Church. The church has a large congregation; we attended the second service at which there were about 1500 members present. We could see immediately why the attendance was so large. The powerful service was conducted in English, and the music was truly wonderful and inspirational. They had a visiting choir from an Anglican church with which they have a very good relationship. The Anglican choir sang Hallelujah in both English and kinyarwanda. The pastor’s message was one of the best any of us have ever heard. His delivery was filled humorous and moving, and this message eloquently demonstrated the scripture that the sermon was based upon.

After church we met as a group to finalize plans for Monday, which will be primarily devoted to re-connecting with the four hospitals we surveyed last year by visiting each of them. We are very excited to revisit these hospitals and to continue our mission here.

Below are photos of our group at at the Hotel Serena in Kigali, our group outside the church, and of choir performing at the church.

Check back with our blog soon for updates on our activities and progress in Kigali!

 

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Reflections: Jamie Campbell, RN

Reflections: Jamie Campbell, RN

“It was my second day at Muhima Hospital and I was sitting with April, the HRH nurse midwife, doing a chart review. April was helping me because most of the chart was written in French and needed to be translated. As we were talking she looked me in the eye and said, “I know sometimes our workers seem unmotivated, but please understand they come to work hungry. Sometimes they have not had a meal for a day or two and they are hypoglycemic.” This forever changed my heart and in that moment I realized just how lucky we are to have what we have. I know there have been times when I have been working and I have been hungry. But this was not because of lack of food, I was simply too busy to stop. We need to remember to pray for our Brothers and Sisters in Africa and do all we can to help this amazing culture of people.” — Jamie Campbell, RN, Mercy 4 Ubuzima team nurse

Rwanda Military Hospital

(L to R) Dr. Jeff Reames, Jessica Williams, Trisha Ponds, RN, and Bill Peterson visited Rwanda Military Hospital in Kigali.

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Rwanda Military Hospital is a 350-bed hospital that provides the general public and military personnel with general surgery, internal medicine, pediatrics, gynecology, emergency medicine, medical imaging (they’re completing a building ready to house a 64-slice CT scanner), orthopedics, intensive care radiology and Prepex. The Prepex Center is probably the most unique aspect of this hospital. The Prepex Center focuses on circumcision of male youth and some adults to improve the reproductive health of men in Rwanda. Leaders at Rwanda Military Hospital want to be the best quality tertiary care provision in the country, providing quality health for the general public, security personnel and high government officials in the country and beyond. Rwanda Military Hospital also works with HRH, who has a nurse mentor from the U.S. focused on development of the hospital’s intensive care unit. The team reported the hospital has made huge strides in its intensive care facilities, equipment and practices. The hospital has many areas under construction and the team sees opportunities to offer input during construction that will provide the best possible facility for quality care.

Here are some photos we took during our time at Rwanda Military Hospital. We hope you enjoy!

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