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 more than 8 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 seven public hospitals:

Ruhengeri Hospital, Ruhengeri, North Province
Central University Teaching Hospital, Kigali
Kanombe Hospital, Kicukiro
Kibogora Hospital,
Kabgayi Hospital, Muhanga district
Nyamata Hospital
Gahini Hospital, Muhanga district

Program Results

As of September 2011 (since October 2006):

A total of 1014 fistula repair surgeries supported.
Thirty-six nurses were trained in pre- and post-operative fistula care.
Theater space at Ruhengeri has been renovated, and Ruhengeri, CHUK and KMH have been provided operating theater equipment and supplies.
Nineteen surgeons have received training in fistula repair with USAID funding, and the project is now focusing on the continuing training of five surgeons from CHUK, Ruhengeri, Kibogora, and Kanombe Hospitals.

Supported Sites

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 for fistula is currently available at Ruhengeri only during fistula workshops held by visiting surgeons.

The Central University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali, or CHUK) dates back to 1918. It was at first a dispensary, but with time it grew into first an ordinary hospital and then a teaching hospital. Today, CHUK is a national teaching and referral hospital run by the Ministry of Health. Forty-two of the hospital’s 418 beds are in its maternity, where specialists treat a wide range of gynecologic problems. CHUK organizes its schedule to repair at least two fistulas each week. CHUK’s mission is to ensure the provision of quality health care services, to serve as a teaching and a clinical research center, and to provide technical support to district hospitals.

Kanombe Military Hospital (KMH) is a military hospital that also serves as a designated district hospital 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. Kanombe Hospital has renovated an adjoining space to serve as an additional operating theater for OB/GYN and fistula patients. One day each week is currently reserved for fistula repair surgery.

Kabgayi Hospital is a faith-based hospital that serves as the designated district hospital in Muhanga district located in the southern part of Rwanda. It is a 416-bed facility with 92 beds for obstetrics/gynecology and no beds reserved for fistula patients. There are four delivery rooms and two operating theaters available for ceasarean deliveries. This site will be supported primarily for prevention interventions.

Gahini Hospital is a faith-based hospital that serves as the designated district hospital in Muhanga district, located in the eastern part of Rwanda. It is a 152-bed facility with 33 beds for obstetrics/gynecology. No beds are reserved for fistula patients. There is one delivery room with three beds and two operating theaters available for cesarean deliveries. Gahini is being supported primarily as a prevention site.

Program Activities

Strengthening services

Fistula Care Rwanda has partnered with the Ministry of Health, GTZ, and UNFPA to increase access to quality fistula repair surgery. Periodic fistula treatment and repair training workshops have been supported at Ruhengeri and CHUK and have helped many women waiting for services. Fistula Care is supporting routine fistula repair services at KMH and CHUK, and is building capacity at Ruhengeri Hospital to offer repair services as well. Fistula Care has provided advanced training to surgeons to hone their skills in treatment and training.

Improving fistula prevention

Fistula Care will partner with the USAID-supported bilateral projects to increase awareness in the community about fistula, safe motherhood, and family planning. The project is also building capacity in EmOC, especially targeting partograph use, early catheterizaiton and cesearean, fistula counseling and family planning at all supported sites to improve prevention interventions. The project is collaborating with the MOH and other partners to integrate fistula and other maternal health services with family planning to improve prevention of fistula.

Analyzing and reporting data

Staff at CHUK, KMH, and Ruhengeri Hospital monitor the outcomes of fistula surgeries and report on their progress quarterly. The project is working with these sites to improve the use of data to make decisions to improve the quality of services.

Encouraging a supportive policy environment

Fistula Care Rwanda 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.In this capacity, it is helping to develop a national strategy document to tackle the problem of fistula in Rwanda