COUNTRY REPORT
Imaging in the Land of 1000 Hills: Rwanda Radiology
Country Report
David A. Rosman1*, Jean Jacques Nshizirungu2, Emmanuel Rudakemwa2, Crispin Moshi3, Jean de Dieu
Tuyisenge3, Etienne Uwimana2, Louise Kalisa3
1
Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
Department of Radiology, King Faisal Hospital, Kigali, Rwanda
3
Department of Radiology, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
2
*Corresponding author. Current address: Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114; darosman@gmail.com
OPEN ACCESS
Introduction
© 2015 Rosman, Nshizirungu,
Rudakemwa, Moshi, Tuyisenge,
Uwimana, et al. This open access
article is distributed under a Creative
Commons Attribution 4.0 License
(https://creativecommons.org/
licenses/by/4.0/)
RWANDA is an equatorial country in central Africa
DOI: 10.7191/jgr.2015.1004
Received: 1/12/2015
Accepted: 3/9/2015
Published: 3/30/2015
Citation: Rosman DA, Nshizirungu
JJ, Uwimana E, Rudakemwa E,
Kalisa L, Moshi C, et al. Imaging
in the land of 1000 hills: Rwanda
radiology country report. J Glob
Radiol. 2015;1(1): Article 6.
Keywords: Rwanda, global radiology, diagnostic skills, diagnostic
equipment, radiology market, global
public health
Word count: 4,924
1/7 | 10.7191/jgr.2015.1004
(Figure 1), and part of the East African Community
of Burundi, Kenya, Uganda and Tanzania. It is a
small country, just over 10,000 square miles. Its
population of nearly 12,000,000 makes it the most
densely populated state in continental Africa.
Rwanda’s capital, Kigali, is a mile-high city. Its
elevation makes the climate much cooler and more
comfortable than a typical equatorial climate.
The average annual temperature is 20.5 degrees
Celsius with a narrow range – April, the coldest
month has an average temperature of 20 degrees,
whereas August, the warmest month has an average
temperature of 21.5 degrees. Economically, Rwanda
functions as a subsistence agricultural country but
has been actively striving to emerge as a middleincome country. Its primary exports are coffee and
tea.
In 1994, the majority Hutu population carried
out mass genocide of the ethnic Tutsi minority In
a coordinated slaughter committed by neighbors
against each other, and with low-technology
weapons like machetes, nearly 1,000,000 people were
killed in 100 days (1). The country was devastated.
Immediately post-genocide, Rwanda was one of the
poorest countries in the world with nearly 70% of
the population living below the poverty line (2).
Until 1997, Rwanda had the lowest life expectancy
of any country in the world (3). The physician work
force was depleted due to the direct and indirect
consequences of the Rwandan Genocide. Since this
time there has been a steady economic recovery (4),
along with remarkable medical recovery. Average
life expectancy nationwide, only 27 years in the
early 1990s, has now reached 63 years (3).
Since the 2012 publication (5) highlighting its
advances, radiology in Rwanda has benefitted from
the capital infusion that has helped to propel the
overall growth in the economic and health sectors.
As of 2012, there are five national referral hospitals,
41 district hospitals, one military hospital and 451
health centers (6). The health centers are staffed
primarily by nurses, while the district hospitals
are staffed by general practitioners (graduates of
March 2015
medical school without a post-graduate education).
Of the 625 total physicians in the country in 2011,
150 had completed residency (3).
The radiology environment
Radiologists in Rwanda
There are 11 practicing radiologists in Rwanda
(Table 1), and one additional retired radiologist.
There are six Rwandan nationals and five ‘expatriot’ radiologists.
Of the Rwandan nationals, all practice in Kigali.
One works principally at the university-based
public hospital, University Central Hospital of
Kigali (CHUK). Four of the Rwandan radiologists
split time between a partially private hospital
(King Faisal Hospital) and the Rwandan Military
Hospital (RMH), and one is in private practice in
Kigali. None of these radiologists were trained in
Rwanda. Some were trained in Europe (Belgium
and France), and others were trained elsewhere in
Africa (Kenya, Tanzania, and South Africa).
Of the five ex-patriot radiologists, one is
Tanzanian and was trained in Tanzania, one is
American, two are Ugandan, and one is Indian.
The Tanzanian and American radiologists are
funded by the Human Resources for Health Grant,
and both work at CHUK. One of the Ugandan
radiologists works in the south at the University
Teaching Hospital of Butare (CHUB). The other
Ugandan radiologist, along with the Indian
radiologist, works in private hospitals in Kigali.
Only one radiologist in the country has a fulltime academic appointment, with some having
honorary appointments. The medical community
looks to African journals for publication, although
there are a few researchers, particularly the Minister
of Health, who have collaborated internationally
and published in top medical journals.
Technologists in Rwanda
There are 118 technologists or “radiographers”
in Rwanda. All have their primary training from
the University of Rwanda College of Medicine
and Health Sciences, and received an Advanced
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Rosman, Nshizirungu, Rudakemwa, et al. (2015)
Kafunzo
Merama
RWANDA
UGANDA
Lake
Mutanda
Lake
Bunyonyi
Cyanika
Kidaho
Ruhengeri
Goma
CONGO
NORTHERN
PROVINCE
Ngororero
Lac
Kivu
Mabanza
Masango
mba
Rutare
Kigali
Runda
Butamwa
Kamembe
Gisakura
Gikongoro
Bukavu
Rwumba
Cyangugu
Kitabi
Cyimbogo
Karengera
Nyakabuye Bugumya NYUNGWE
NAT'L PARK
Ruramba
Bugarama
The boundaries and names shown and the designations used
on this map do not imply official endorsement or acceptance by
the United Nations.
Map No. 3717 Rev. 10
June 2008
Rusatira
Karama
Runyombyi
Lac
Kivumba
Kayonza
Lac
Nasho
Kigarama
Bugesera
Rilima
Kibungo
Lac
Rweru
ge
Lake
Bisongou
Rusumo
Bare
Ka
Lac
Lac Mpanga
Cyambwe
Rukira
Sake
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Lac
Cyohoha
Sud
TANZANIA
Rwamagana
Bicumbi
Gashora
UNITED
REPUBLIC OF
Kirehe
ra
Butare
Gisagara
Busoro
Munini
Lake
Mujunju
Lac
Ihema
Nemba
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Karaba
Rukara
Lac
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Ruhango
yaru
Rwesero
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BURUNDI
0
an
Ile
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EASTERN
PROVINCE
Lac
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AKAGERA
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NATIONAL Mikindi
PARK
TOWN OF
KIGALI
SOUTHERN
PROVINCE
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ong
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WESTERN
PROVINCE
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GISHWATI
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Lac Hago
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Lac
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DEMOCRATIC
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BIRUNGA
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RWANDA
Rwemhasha
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Ka
National capital
Prefecture capital
Town, village
Airport, airstrip
International boundary
Provincial boundary
Road
Track
Kagitumba
Ak
0
UNITED NATIONS
10
20
10
30
20
40
50 km
30 mi
Department of Field Support
Cartographic Section
Figure 1. Rwanda Map No. 3717 Rev. 10.
United Nations, Department of Field Support, Cartographic Section. June 2008. Retrieved from http://www.un.org/Depts/Cartographic/map/profile/rwanda.pdf.
Diploma in Medical Imaging Sciences. Any technologist who desires
further training must obtain it out of the country. Reportedly, five
technologists have Bachelor’s degrees from varying universities, as
does one sonographer. Sonography, however, is largely performed
by physicians.
circumstances.
b) Traditional diagnostic MRI is performed.
c) Interventional procedures, including MRI arthrography, have
not yet been utilized.
Angiography
a) To date, there is no conventional angiography being performed.
Diagnostic and interventional skills
X-ray
a) No x-ray limitations
Computed tomography
a) Essentially, anything that can be done with CT is done in
Rwanda, including cardiac imaging, angiography, etc. At this
time, no CT colonography is performed.
Fluoroscopy
a) Basic fluoroscopy examinations, including VCUG,
cholangiography, HSG, barium swallow and follow through,
fistulography, IVP and pediatric enema, are performed.
b) In the public hospital there are not sufficient materials to perform
adult enemas. Imaging rectal tubes, contrast bags and tubing are
not stocked. Barium and air reductions procedures are not yet
performed.
Ultrasound
a) In the imaging community, FAST, abdominal and pelvic
ultrasound and venous vascular ultrasound are performed
regularly.
b) There is no advanced arterial vascular ultrasound (e.g. for renal
artery stenosis).
c) FAST scans have been taught by outside organizations to internal
medicine, pediatric, surgical and emergency residents with some
success.
Power supply
MRI
a) MRI is only available in the private sector. As the Rwandan
government owns a portion of the private King Faisal Hospital,
access with public insurance can be attained in certain
According to Rwanda’s chief energy supplier, the Energy Water
and Sanitation Authority (EWSA), energy consumption in Rwanda
is 85% from biomass, 11% from petroleum products, and only 4%
from electricity (7). After major investment, there has been a tripling
of the access rate to electricity in Rwanda from 5% in 2005 to 18%
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March 2015
Other intervention
a) Minimal interventional procedures – predominately ultrasound
guided – are performed on an ad-hoc basis. There is currently
insufficient staff time, as well as investment in interventional
materials, to provide a significant interventional service.
Journal of Global Radiology
JGR
Rosman, Nshizirungu,
Nshizirungu, Rudakemwa,
Rosman,
Uwimana,, et
et al.
al.(2015)
(2015)
in 2014 (7). The goal is for 70% access by 2017. This is compared to
Africa’s average of 40% access (7).
The cost of electricity is high and most is sourced by hydropower,
leaving Rwanda’s energy sector vulnerable to drought. The
government has also utilized diesel generators, which, despite their
high cost, have helped to expand the supply. The result is a cost
of between US $0.14-0.25 per kWh (depending on time of day and
tax-exempt status) (8), as compared to a regional cost of around US
$0.10-0.12 per kWh (9). The government has had to subsidize the
costs in order to maintain current growth rates (7).
Inconsistency in the power supply is also a source of frustration.
A 2008 report indicated that Rwanda experienced 80 days per year
without power (10), and data in 2011 suggested four days per month
without power (11). Many hospitals also utilize power generators
and uninterruptible power supply (UPS), which can back up in case
of power failure, although this is typically for controlled shutdown
time rather than prolonged continued use.
Radiology equipment in Rwanda
The majority of high-end equipment in Rwanda is found in Kigali.
Equipment service contracts depend on the suppliers, as well as the
original negotiation. A large majority of the equipment in Rwanda
is manufactured by Siemens (Siemens Healthcare Global, Germany;
Table 2, Table 3).
There are two MRIs in Rwanda, both located in Kigali. One is
a 1.5T Philips, installed in 2010 at King Faisal Hospital. This is
accessible to those with private insurance and who privately pay for
services. Under certain conditions, a patient with public insurance
(Mutuelle de Santé) can access this magnet. A second MRI, a 1.5T
Siemens, has just been installed in 2014 at Mediheal, a Nairobi-based
private hospital newly opened in Kigali.
Computed tomography
There are five total CT scanners in Rwanda, three of which are
located in Kigali. The busiest by far is the 64-Slice Siemens Somatom
Definition, installed at CHUK in July 2011. The other publicly
available scanner, a 16-Slice GE Multiplanar scanner, is located in
Butare, and was installed in 2013. The first CT installed in Rwanda
was the 6-Slice Siemens Somatom, installed at King Faisal Hospital
in 2005. A new 64-Slice scanner, identical to the one at CHUK, has
been installed at the private Mediheal clinic in 2014. No current
replacement plan is in place for any of these scanners, and the
scanners can go down for prolonged periods of time. At the time
of this writing, the scanner in Butare is non-functional. .KFH is
planning to buy a 128-Slice scanner, and Kanombe also is planning
to buy a 64-Slice scanner, both by next year.
Fluoroscopy
Table 1. Radiologists in Rwanda, 2014
Country of Origin
MRI
Countries of Training
There are six fluoroscopes in the country, with four located in
Kigali, one in Kibungo in the east, and one in Butare in the south.
Five are Siemens Duo Diagnostics installed in 2012 at CHUK, and
two others are located at Rwanda Military Hospital and King Faisal
Hospital. Additionally, a Philips Duo Diagnostic was installed at
Rwanda Military Hospital in 2013. At the time of this writing in
2014, one fluoroscope is being installed in Butare, and another in
Kibungo.
Number
Rwanda
Belgium, France, South
Africa, Kenya, Tanzania
6
Uganda
Uganda, Germany
2
Tanzania
Tanzania
1
India
India
1
United States
United States
1
X-ray
MRI
2
0
0
There are approximately 60 total X-ray machines in various
hospitals in Rwanda. Most of the major referral hospitals have
more than one. Of the district hospitals, 33 use an analogue system,
eight utilize a digital system and two utilize both. Twenty-five
are manufactured by Siemens, ten by General Electric (General
Electric, USA), 12 by Philips (Philips, USA) and 12 by various other
companies. It is difficult to obtain a date of installation or working
condition of these machines. A recent survey demonstrated that
there were various challenges in keeping the X-ray equipment
functional.
CT
2
2
1
Service
Nuclear
0
0
0
Ultrasound
Unknown
See Table 3
X-Ray
Unknown
See Table 3
Table 2. Radiology equipment in Rwanda, 2014
Equipment
Private
Public
Other
PACS
King Faisal hospital has had a picture archiving and
communication system (PACS) installed since 2011. The PACS is
web-based and accessible both locally and remotely. It is not fully
backed up, and thus a recent crash resulted in the loss of patient data.
Wisely, the same PACS was chosen for the 2014 PACS installation,
allowing for potential intercompatibility during PACS expansions in
the future. Ultrasound images are not currently being uploaded to
PACS at CHUK, but further investment will eventually resolve this
issue. More nodes can be added to allow centralized interpretation
of images on a national level, as the number of radiologists grows
sufficiently to meet demand.
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March 2015
There is a local Siemens tech representative who can troubleshoot
software and some basic hardware issues. Response time is usually
same day, although given a single representative’s workload,
responses may arrive the following day. Local repairs and system
fixes are often accomplished by the next working day. Any repairs
involving parts replacement can take longer. On more than one
occasion during the past year, the CT scanner at CHUK has been
nonfunctional for over one month. This issue is not unique to
CHUK. One problem lies in moving materials from Europe to
Rwanda. Customs in Rwanda exacerbates the challenge, as materials
need to pass through receiving and clearing processes before moving
on to the hospital. It is rare that an issue resulting from a part that is
not local to the country can be solved in under three weeks.
The MRI is also locally serviced. This young machine has been
reliable to this point, with little unplanned downtime. A recent need
for coolant replacement resulted in ten days of downtime.
Occasionally, the equipment functions but certain supplies are
lacking. For example, the hospital may be without contrast medium
or film for a month at a time. Although both King Faisal and CHUK
function now with PACS, the lack of film is a significant patient-care
issue for many reasons, such as their referring physician likely has
no way to read an image on a CD.
Journal of Global Radiology
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Rosman, Nshizirungu, Rudakemwa, et al. (2015)
since 2003. According to the World Bank, per capita GDP was US
$131.56 in 1994, US $186.64 in 2002, and at last report in 2013, it had
reached US $632.76 (12).
Another measure of the economy for the purpose of potential
investment is income distribution. The GINI index is a measure of
income distribution and how it varies from perfect equality (13). A
GINI index of 0 represents perfectly equal distribution, whereas 1
represents perfectly unequal distribution (one person would have all
of the money) (13). In the late 2000s, all GINI coefficients in the
OECD countries ranged from 0.24 to 0.49 (13).
The highest GINI coefficients are seen in Africa, with the world’s
highest in South Africa, estimated to be between 0.63 and 0.7 (14).
In 1985, Rwanda’s GINI was 0.289, and in 2011 it was 0.508 (15).
Ten percent of the population holds 43.2% of the total income share
(16). The lack of income equality, as well as overall low GDP (despite
impressive growth), translates into a relatively small population who
can electively purchase high-cost services.
There are high-end restaurants, cafés, hotels and private hospitals
in Rwanda. Such amenities are likely accessible to less than one
percent of the population. Within this rubric, a new private fertility
hospital has opened with a 64-Slice scanner and 1.5T magnet. Two
foreign radiologists are performing interpretations. It is unclear the
number of examinations being performed, and what segment of the
population is able to access these services.
Job opportunities
Radiologists
There is a clear need for more radiologists in the country, as
demonstrated by the government’s decision to allocate precious
limited resources to creating a radiology residency. Although a
full description is a topic for another paper, this residency is being
created under the rubric of the Human Resources for Health (HRH)
program (3). A single American radiologist has been working onsite
with the local radiologists to write a curriculum, have it accepted
through the relevant channels, and then recruit a first class for a
four-year residency program. The program intends to utilize both
local resources and supplemental e-learning in order to achieve
education in all subspecialties of imaging.
At least one of the private hospitals is currently hiring for part-time
work. Although the Ministry of Health is not currently advertising
radiology job openings, one would likely find an interested partner
in the government health sector, should they offer quality services.
Technologists
The supply of technologists currently exceeds the demand for their
employment. Most are employed through the Ministry of Health or
in the public sector, with a small percentage employed by private
institutions. One would anticipate that as the Minister of Health
continues to prioritize growth of the imaging sector, employment
opportunities for technologists would also continue to grow.
Radiology market and service capacity
In a country of 12 million people, there are four clinical CT
scanners in use – two in the private sector and two in the government
sector. This compares with 34.3 scanners per million population in
the USA in 2007, or 13.9 per million population in Canada in 2011
(17). There are, in fact, fewer X-ray machines per million population
in Rwanda than there are CTs or MRIs in Canada or the USA.
The government-funded portion of the health sector is more
Economics and imaging
Readiness for radiology entrepreneurship
To understand the local medical economy, it is important to
first understand the Rwandan economy in general. There has been
massive growth of the economy since 1994, and more specifically
Hospital
Bushenge
Beds
143
X-Ray Units
1
Ultrasound Units
2
Butaro
167
1
1
Byumba
180
1
2
CHUB
N/A
N/A
N/A
CHUK
500
4
2
Gahini
200
1
1
Gakoma
83
2 (both mobile)
1
Gihundwe
205
2(1 given to Mibirizi)
1
Gisenyi
346
2
2
Gitwe
200
1(0 functioning)
1(0 functioning)
Kabaya
130
1(0 functioning)
1
Kabgayi
400
1
3
Kabutare
235
1
1
Kacyiru
N/A
N/A
N/A
Kaduha
N/A
N/A
N/A
Kibagabaga
230
1
3(1 functioning)
Kibilizi
N/A
N/A
N/A
Kibogora
245
2
2
Kibungo
242
2
3
Kibuye
218
2
2
Kigeme
178
1
2 and 2 portable
Kinihira
300
1
2
Kirehe
154
1
3
Kirinda
N/A
N/A
N/A
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Table 3, Part 1. Rwanda hospital
summary, 2014
March 2015
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Rosman, Nshizirungu, Rudakemwa, et al. (2015)
Hospital
Beds
X-Ray Units
Ultrasound Units
Kiziguro
82
1
Masaka
100
2
2
Mibirizi
N/A
N/A
N/A
Mugonero
121
2(1 functioning)
2(1 is functioning)
Muhima
153
1
5(2 are functioning)
2
Muhororo
112
1
2
Munini
65
1
2
Murunda
127
1
2
Ndera
N/A
N/A
N/A
Nemba
173
2(1 is mobile)
3
Ngarama
110
2(1 functioning)
3
Nyagatare
200
1
3
Nyamata
N/A
N/A
N/A
Nyanza
182
4(2 functioning)
3
Remera Rukoma
N/A
N/A
N/ A
RMH
250
3
3
Ruhango
128
1
2
Ruhengeri
385
2
3
Ruli
178
1
3
Rutongo
106
1
1
Rwamagana
236
1
3(1 is functioning)
Rwinkwavu
130
1
3
Shyira
N/A
N/A
N/A
developed, as the vast majority of the population earns an income
that primarily grants them access only to the public system. In
2011/2012, enrollment in public insurance (Mutuelle de Santé) was
90.7% (18). In 2012/2013 it was 80.7%, and in 2013/2014 it was 73%
(18). It is likely that a substantial portion of the population not
covered by Mutuelle de Santé still accesses the public health care
system, with far less than 10% having sufficient income or insurance
to access the private sector.
However, recent legislation and regulation are encouraging
private sector growth in order to expand the economy, as evidenced
by the increasing appearance of new private hospitals and clinics.
MTN, costs 43,000 RWF or approximately $62 US. No larger
packages are readily available. One can purchase a WiMax solution,
with unlimited downloading at 2 Mbit/s speeds, at a cost of $120 per
month.
Although maximum Internet speeds are up to 7.88Mbit/s, these
are rarely available to most people. For example, at CHUK, the
largest hospital in Rwanda, the maximum download speed is
quoted as 3Mbit/s. Because the entire hospital depends upon one
connection, individuals usually cannot achieve download or upload
speeds that even approach this number.
Disease profile and differentiating demographic and cultural
factors
Radiology volunteerism
Ideally, Rwanda would be entirely self-sufficient, and to that end
the country is investing heavily in creating residencies, including
one in radiology. That said, the government is realistic and knows it
will be quite some time before it has the workforce to properly serve
the population. For this reason there is a legitimate and enthusiastic
interest in medical volunteerism.
It is critical to note, however, that Rwanda is not interested in
volunteerism that is not aligned with the national goals outlined
in President Kagame’s vision for the future of Rwanda, Vision 2020
(19). Over the next several years, contact with any of the authors or
with the Human Resources for Health leadership would serve as a
first step for entre into volunteering in the system.
Internet access
Rwanda was ranked first in Africa for download speeds and
62nd globally with speeds of 7.88Mbit/s in February 2013 (20).
The Rwandan Internet functions on an updated 3G system, now
including 3.5G and 3.75G. An upgrade to 4G is currently well
underway (21).
Internet access exists in a few major cities but is primarily limited
to Kigali. Most who can afford access do so via mobile devices and
USB-based modems. A 20 GB data plan with the largest provider,
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Table 3, Part 2. Rwanda hospital
summary, 2014
March 2015
Rwanda was forever changed by the Genocide of 1994 and
the events that followed. With the genocide, the combination of
murder and exodus demolished human resources. The country
was essentially depleted of physicians and of higher education. The
watershed for the national turnaround was Kagame’s Presidency, and
Vision 2020 specifically. The plan aims to transform Rwanda into
a middle-income, knowledge-based economy. So far, the country
is on track to meet its ambitious goals, as the desire for systemic
change seems to pervade the actions and decisions of governmental
authorities. In the general population, too, there is palpable pride in
the continued movement towards national improvement.
In recent years, Rwanda has seen a remarkable, unprecedented
reported increase in life expectancy and decrease in prevalence
of disease. The prevalence of HIV is approximately 3%, but the
mortality from HIV has reportedly decreased 78.4% in the last
decade (22). Farmer et al. (22) reported a decrease in mortality from
tuberculosis and malaria by 77.1% and 87.3%, respectively, and a
maternal mortality ratio decrease of 59.5%. Despite these incredible
figures, there remains a substantial amount of tropical disease such
as tuberculosis, neurocysticercosis and amebiasis, particularly in
referral hospitals.
Rwanda is undergoing a transformation of health delivery with
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Rosman, Nshizirungu, Rudakemwa, et al. (2015)
the Human Resources for Health (HRH) program, which was
created in 2012 to establish and improve in-country residency
training programs in many specialties (23). The program aims to
move physicians from the rank of general practitioner to specialist.
For the time, though there remains a paucity of sufficiently trained
physicians.
As noted, the health centers are staffed primarily by nurses, and
the district hospitals by general practitioners. Patients present first
to health centers, and the sickest are referred to district hospitals.
The most critical of these are then referred to one of the five referral
centers. For this reason, cases presented at the referral centers have
often reached advanced stages, allowing a view of disease not often
afforded in wealthier settings.
Culture and tourism overview
Cultural attractions, languages spoken
Rwanda is a beautiful country to visit. It is one of only three
countries in the world where one can ‘trek’ mountain gorillas, or
visit them in their natural habitat accompanied by a guide - a must
for any animal lover. Additionally, Nyungwe National Park offers
affordable “mini-safaris” on which one can see elephants, giraffes,
zebra, hippopotamus and many more animals (more information:
www.rwandatourism.com).
To speak of Rwandan culture and tourism without mentioning
the Tutsi Genocide would be a mistake. The country gathers every
year on April 7th to memorialize those killed in the genocide (24).
There is a “never again” understanding of the Genocide and a visit to
Rwanda without a visit to the memorials would be incomplete (more
information: www.kwibuka.rw).
To the uninitiated North American or European, the thought
of a visit to Africa may conjure the image of mud huts and all dirt
roads. Although such things exist in much of Rwanda, Kigali, the
capital has modern hotels, predominately paved roads, a reasonably
reliable power and water supply and most amenities that a traveler
(or resident) could need. To those familiar with the development
of East Africa this will be unsurprising, but others will be happy to
find restaurants of all types – Japanese, Indian, Korean, Chinese,
Italian – and most are run by an expatriate of the same nationality
as the cuisine.
The official languages of Rwanda are English, French, and
Kinyarwanda. In 2008, schools changed the language of education
to English (25). Most of your patients will speak Kinyarwanda
exclusively. Most of the educated populace speaks French, and many
speak at least some English. Because the language of education has
changed, the younger population is, on average more proficient in
English. In Kigali, a traveler can get by speaking nothing but English.
Nonetheless, a simple “Murakoze cyane” (Thank you so much) or a
“Mwaramutse, amakuru?” (Good morning, how are you?) can go a
long way towards breaking the ice in new conversation.
Travel access, currency, local accommodations
Methods of entering the country vary depending on your country
of origin. Americans and many others with a passport valid for at
least six months are allowed entry without a visa application (more
information: http://www.rwandahc.org/consular-and-visa-services/
visa-information-and-applications/).
There are many flights in and out of Rwanda. Coming from Europe
or the USA, the typical options are KLM through Amsterdam,
Brussels Airlines through Brussels, Turkish Airlines via Istanbul,
and Qatar airways via Doha. Although not every airline flies every
day, with flexibility in carrier, there are daily flights to Europe. It
is also, of course possible to travel from within Africa, particularly
from Nairobi, Johannesburg, Addis Ababa and Dar es Salaam.
Local accommodation is bountiful and ranges from the five-star
Serena hotel, priced around $500 per night, to guesthouses for under
$30 per night. There are also executive-style apartments for those
looking at longer stays and wishing to self-cater.
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Local security and safety situation
Security is given high priority nationwide. Most major shops,
hotels and restaurants have guards and metal detectors for entry.
Most wealthy Rwandan homes, whether occupied by Rwandans or
expatriates, are gated and have guards who operate the gates and
control entry to the house.
At the time of this writing, there is sufficient stability for a
resident or tourist to feel quite safe in Kigali, day or night. Normal
precautions against walking alone late at night should be taken, but
this is no different from any typical city throughout the world.
At the time of this writing, the political situation in Rwanda is
also relatively stable, and certainly in comparison to neighboring
countries. There are border skirmishes with the Democratic
Republic of Congo and some standing travel warnings from multiple
embassies against traveling to certain border regions, but on day-today basis, none of this impacts the daily life of someone not living
on the border. One should always check with their embassy prior
to travel.
Travel within Rwandan borders is exclusively by automotive
transport. Kigali has an extensive bus system, but it can be somewhat
confusing for the uninitiated. For an ex-patriot or visitor with the
means to purchase a car or hire a driver, travel within Kigali and
throughout the country can be relatively simple given a few simple
rules. The roads outside of Kigali are mostly unlit, making driving
after dark a dangerous enterprise. The US embassy forbids its
employees from driving outside of Kigali after 6pm. Many locals use
motorcycles for short transport within Kigali. This radiologist, who
has seen far too much motorcycle (“moto”) trauma would strongly
urge the reader never to utilize this option, no matter how tempting
because of the low cost. The US embassy also forbids their use. There
was an attempt in 2006 to ban the use of motos, but the outcry from
their drivers and passengers caused the ban to be overturned after
only one week.
Health advisories
At the time of this writing, there is a risk of contracting yellow
fever in Rwanda, and proof of yellow fever vaccination is required
for all entrants in the country except infants. There is also a malaria
risk. Some argue that the altitude of Kigali serves as protection from
malaria, but this author has seen far too much of the disease among
locals and expatriates alike to accept that myth. Malaria prophylaxis
is needed while travelling in Rwanda. It is the norm to sleep under
mosquito nets. Although Rwandan pharmacies may at times be well
stocked, the supply of a given medication is inconsistent. It is advised
that a traveler bring all of his or her own medications, including his
or her own malaria prophylaxis, and sufficient medication to treat
traveler’s diarrhea, etc. A medical worker should consider bringing
his or her own HIV post-exposure prophylaxis. For up-to-date
information, please consult the CDC recommendations.
Tap water is not safe to drink in Rwanda. One should consume
only bottled water and clean all fruits and vegetables according to
appropriate standards. The typical recommendation is to only eat
cooked or peeled foods. One must weigh one’s own level of risk
tolerance. Most expats eat salads at restaurants, and though all
regret it from time to time, a given restaurant is often consistent.
Asking colleagues for recommendations is a good first step.
When to visit
Rwanda has “dry” and “rainy” seasons. The rain comes primarily
from March to May, and then from September through November.
I believe the typical expat would think a priori that the dry season
is the more appealing. During the rainy season though, the country
is beautifully lush and the rain typically only lasts about an hour
of the afternoon. If forced to choose, I would likely come just as a
rainy season ends, when the land is still lush, and before the long dry
occurs. If one were to combine a trip to Rwanda with a safari in an
adjacent country, the timing could be based on animal migrations.
Overall, Rwanda is a beautiful country to visit any time of year. ☐
Journal of Global Radiology
JGR
Rosman, Nshizirungu, Rudakemwa, et al. (2015)
Acknowledgments
The authors would like to express our appreciation to the Ministry
of Health of Rwanda as well as the leadership of the Human
Resources for Health Grant; to Drs. Barbara Weissman and Steven
Seltzer and the Department of Radiology at Brigham and Women’s
Hospital for their unwavering support of Radiology in the Human
Resources for Health Grant; Drs. James Brink, Giles Boland and
Debra Gervais and the Department of Radiology at Massachusetts
General Hospital for their enthusiastic support of Dr. Rosman’s
participation in the Grant. Dr. Rosman would like to express his
personal appreciation of the Rwandan authors on the paper who
made his involvement in patient care and the radiology community
in Rwanda both possible and a joy.
Conflict of interest
DR participates in the Human Resources for Health Grant,
funding for which flows through the Rwandan Ministry of Health,
which is in part responsible for hiring decisions for the grant.
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Journal of Global Radiology