Rwanda

Rwanda, known as the land of 1,000 hills, is a landlocked country in Africa’s Great Lakes region. It is the most densely populated country in Africa, with a population of approximately 11 million people in an area of 26,338 square km. Advances in economic growth and health areas, such as family planning, in recent years has been rapid, but there are many obstacles remaining to make motherhood safer for Rwandan women.

USAID-supported fistula services in Rwanda began in October 2006. Fistula Care Rwanda is currently working with four public hospitals:

Central University Teaching Hospital (CHUK), Kigali
Kanombe Military Hospital (KMH), Kicukiro
Kibogora Hospital, Southwest Province
Ruhengeri Hospital, Ruhengeri, North Province

Some assistance in equipment and supplies has also been provided to three additional public facilities:

Gahini Hospital, Muhanga district
Kabgayi Hospital, Muhanga district
Nyamata Hospital, Bugesera district

Program Results

As of March 2013 (since October 2006):

A total of 1,212 fistula repair surgeries supported.
127 nurses were trained in pre- and postoperative fistula care.
Twenty-five surgeons have received training in fistula repair with USAID funding.
Theater space at Ruhengeri has been renovated, and Ruhengeri, CHUK and KMH have been provided operating theater equipment and supplies.

News and Resources

Program Update: New Lights in Rwanda and Uganda

Program Update: Rwandan Doctors Trained aboard the Africa Mercy

Program Update: Fistula Care Promotes Family Planning Integration to Prevent Fistula in Rwanda

Program Update: Fistula Care Begins Support to a Third Site in Rwanda

Supported Sites

Central University Teaching Hospital (CHUK) of Kigali was founded in 1918. In the beginning it was only a dispensary but, over time, it became first a hospital and then university teaching hospital. Today, the CHUK is a national center of medical training and a referral hospital managed by the Ministry of Health. Forty-two of its 418 beds are for maternity services where the specialists treat a wide variety of gynecological problems. The CHUK’s maternity services program includes the repair of at least two fistulas per week. CHUK’s mission is to assure the provision of quality health services, to serve as a center of training and research and to provide technical assistance to district hospitals.

Kanombe Military Hospital (KMH) is a military hospital that also serves civilians in the district of Kicukiro. It is a 360-bed facility with 49 beds for obstetrics/gynecology and 3 beds reserved for fistula patients. There are three delivery rooms and one operating theater available for cesarean deliveries and other gynecological procedures. The facility is currently being upgraded by the MOH to serve as the district hospital and will be renamed the Rwanda Military Hospital. The upgraded facility will include a ward of 15 beds and an operating theater exclusively to serve fistula clients. One day each week is currently reserved for fistula repair surgery and fistula repair and training is also offered during periodic outreach workshops in collaboration with visiting surgeons.

Kibogora Hospital is a rural hospital of 269 beds, located in southwest Rwanda on the shores of Lake Kivu. It serves a population of approximately 250,000 people. Kibogora is also a referral center for 12 neighboring health centers. The hospital provides surgical, general medical, pediatric, maternity and neonatal services, with an extremely busy outpatient department. Fistula Care has trained a surgeon and his team to provide fistula services at this site. In addition, the project has collaborated with UNFPA to provide fistula repair during an outreach workshop.

Ruhengeri Hospital is located in the North Province near Lake Bulera and the national volcano park renowned for its population of gorillas. Fistula patients come to Ruhengeri from all corners of Rwanda, and some arrive from the Democratic Republic of Congo’s eastern provinces. Ruhengeri dates back to the opening of a dispensary in 1964. Today, it has 409 beds, including a 100-bed maternity ward, and serves a population of more than 350,000. Surgical repair and training in repair for fistula is primarily available at Ruhengeri during fistula workshops led by visiting surgeons. Routine services are available for simple repairs. The facility recently renovated a pre-post op ward for fistula patients with support from Fistula Care.

Gahnini, Kabgayi and Nyamata hospitals have been designated by the MOH to serve as fistula treatment and prevention sites. Under the MOH’s plan, these sites provide fistula services primarily through outreach services from local surgeons. Fistula Care will provide equipment and supplies for these facilities to support the fistula services at these sites.

Program Activities

Strengthening services

Fistula Care partners with the Ministry of Health, GIZ, and UNFPA to increase access and sustainability of quality fistula repair services. Periodic fistula treatment and repair training workshops have been supported at CHUK, Kanombe, Kibogora, and Ruhengeri providing fistula repair to reduce the backlog of cases and training a cohort of surgeons and their surgical teams to provide this service. Fistula Care supports routine fistula repair services at CHUK and Kanombe, and is building capacity at Ruhengeri Hospital to offer routine repair services. Fistula Care has provided advanced training to surgeons to hone their skills in treatment and training. In addition, the project is supporting the renovation of a fistula ward at Ruhengeri and CHUK and has provided operating theater equipment and other materials and supplies to support fistula treatment at CHUK, Kanombe, and Ruhengeri.

Improving fistula prevention

Fistula Care is building capacity in emergency obstetric care, especially targeting partograph use, early catheterization and cesearean, fistula counseling and family planning at all supported sites to improve prevention interventions. In addition, normal and cesarean delivery kits are being provided to all supported sites. The project is collaborating with the MOH and other partners to integrate family panning with fistula and other maternal health services to improve prevention of fistula.

Improving the quality of services

Staff at CHUK, Kanombe, and Ruhengeri Hospitals monitor the outcomes of fistula surgeries and report on their progress quarterly. The project trains staff at these sites to improve the use of data to make decisions about the quality of services. Staff have also been trained in facilitative supervision and other quality improvement approaches at CHUK and Kanombe to ensure the quality of care for fistula clients.

Encouraging a supportive policy environment

Fistula Care provides technical and logistical support to the National Safe Motherhood Technical Working Group and the fistula sub-committee. This provides a forum for groups working on fistula in Rwanda to coordinate their efforts and develop or adapt guidelines, tools, job aids, curriculae and strategies for fistula programming. The sub-committee has been critical in raising the awareness of local leaders, health care providers and the community about fistula. In this capacity, it is helping to develop a national strategy document to tackle the problem of fistula in Rwanda.