Immediate and Long-Term Outcomes and Patients Treated during Rwanda Endoscopy Week
By: Kamila Zakowicz, MED'28
Spending six weeks in Rwanda last summer proved to be an incredibly eye-opening experience. I conducted Quality Improvement (QI) research related to the Rwandan Endoscopy Week (REW) – an annual collaborative between gastroenterology faculty from across the globe to Rwanda, who provide high-level care to patients in Rwanda, while teaching Rwandan physicians endoscopic skills via lectures and hands-on training. My project sought to understand the immediate and long-term outcomes of patients treated during REW.
The first two weeks were spent with 5th-year students rotating in internal medicine at the University Teaching Hospital of Kigali (CHUK), a tertiary academic hospital. These students welcomed me, embraced me, and whispered answers to me when I was asked questions right along with them during rounds - I hadn’t even taken my renal course yet.
I planned out the logistics of my REW QI follow-up project along with a resident, Josiane. We ran into many obstacles that I highlighted in my QI report - from variable REW survey completion rates to navigating new electronic medical record (EMR) systems to finding an interpreter to call patients in Kinyarwandan. Eventually, we both realized I would need to travel in person to sites where REW was conducted to gather data on patients’ status after REW, from the University Teaching Hospital of Butare to Gisenyi on Lake Kivu. For the last 2 weeks of my visit, I did just that. Traveling overland by bus across Rwanda. I met many kind people who helped me find places to stay, internet to review patient charts, and even staff who could interpret. I am grateful for all the support, adventures, and kindness I found along the way.
In the end, I visited four of the nine sites with Josiane and completed 249/258 chart reviews for patients who needed follow-up. Of those patients, 83 were called if they had an uncertain or incomplete follow-up status. Although the primary goal of the project to quantify follow-up rates from each REW site and discern if and why patients could not complete their follow-up, may not be fully realized due to the limitations of time and data collection, this project has turned into so much more. I helped a resident in Rwanda learn to use REDCap (Research Electronic Data Capture) to collect data, and I encouraged him to pursue a REDCap license for CHUK, which is now in progress. I attended a wedding, learned traditional Rwandan dances, hiked a volcano, and trekked with mountain gorillas. Beyond learning from this pilot venture and improving data collection for future REW projects, I met so many incredible people who care deeply about their families, patients, and the future of healthcare in Rwanda.
I have learned about the obstacles patients face in obtaining care, including travel, communication barriers, and financial hardship. I have so many stories to share with friends, family, and colleagues about what I learned in such a short time. I plan to stay on the REW team as we pursue QI and future projects - and hopefully attend an endoscopy week in the future. Thank you to the Center for Global Health Equity for believing in me. I will cherish this summer for all the wisdom, adventure, and clarity it has given me about my future career as a physician interested in global health.
Kamila Zakowicz, MED'28
QI and Evaluation of GI Care Follow-up after Rwanda Endoscopy Week: A Pilot Analysis of 4/9 Sites