Titilayo Mabogunje, MED'26, clinical elective experience with the University Teaching Hospital of Kigali in Rwanda
A Month at CHUK: Rethinking What Feels Routine
by Titilayo I. Mabogunje, MED'26
I didn’t expect to be startled by an avocado. But during my first week at the Centre Hospitalier Universitaire de Kigali (CHUK), a loud bang on the metal roof made me stiffen instinctively. “It’s just an avocado,” my colleagues laughed. Earlier that day, they had been equally surprised by something I carried around without thinking: a hospital badge listing emergency codes—Code black for bomb threats, code amber for infant abductions, and so on. “People come with bombs to the hospital?” a Rwandan medical student asked. Their confusion forced me to confront something uncomfortable—how routine these situations had become in my experiences. That moment set the tone for my month in Rwanda: a steady unraveling of assumptions I didn’t realize I had.
Bridging the Resource Gap
As a medical student rotating through pediatrics and gastroenterology, I quickly learned that practicing medicine in a resource-limited setting demands a different kind of intentionality. In the U.S., it’s easy to order tests reflexively—sometimes to confirm a diagnosis, sometimes to protect against uncertainty. At CHUK, that reflex is checked by reality: patients often must pay out of pocket before labs or imaging are performed, and delays in payment often delay care. I still remember a physician pushing back when I proposed we get a chest X-ray: “What will it add?” he nudged. It was a simple question, but one that exposed a deeper truth—investigations should serve the patient, not the provider’s comfort. And yet, I couldn’t ignore the tension: in a different setting, with different resources, I might have ordered the imaging test.
Transnational Care
Beyond the clinical decisions, I was struck by the human dynamics of care. In the pediatric high-dependency unit, mothers stayed at their children’s bedsides around the clock—sleeping beside them, feeding them, holding vigil. Many had other responsibilities waiting at home, yet they remained. Over time, I watched them form a quiet community: sharing food, comforting each other’s children, stepping in during
difficult moments. In a space with limited privacy and tightly packed beds, they created a deeply supportive community for one another. It made me wonder about the trade-offs in more resourced systems, where private rooms offer comfort but can also isolate families from one another during some of their hardest moments.
Clinically, the differences extended to the very patterns of disease and how they’re
managed. Frequently diagnosed conditions in the U.S., like pediatric inflammatory
bowel disease, were rare here, while others—like H. pylori infections—were so common
that treatment was often initiated based on clinical patterns rather than confirmatory testing.
Procedures like colonoscopies weren’t used for routine screening but reserved for patients with clear symptoms, reflecting the realities of limited specialists and equipment. These weren’t just differences in practice—they were reflections of broader systems, where resource availability shapes not only what is possible, but what becomes standard.
Feelings
My time in Rwanda challenged me in ways I expected—navigating language barriers, adapting to new workflows—but also in ways I didn’t. It pushed me to reflect on what I take for granted, from access to diagnostics to the culture of medical training itself. I don’t yet know exactly where my career will take me, but I know this experience will stay with me. It reshaped how I think about responsibility in medicine—not just to provide care, but to question how and why we provide it the way we do. I’m so grateful for the kindness and patience of the medical students (shout out to Robert and Gloria!), attendings, nurses, residents, and the patients I had the privilege of interacting with during this experience! Murakoze cyane!