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A Culture Change

The Human Resources for Health (HRH) Program faculty from Dartmouth are now six weeks into their work here in Rwanda. Spread across a handful of teaching hospitals, the physicians have been partnered with local faculty “twins,” and after some initial work developing resident rotations built on care team model and revising resident curriculum, they are now busy mentoring and teaching residents as well as medical students.

Their Rwandan colleagues have been very welcoming, but it has quickly become apparent to the American faculty members that the prevailing service-oriented culture, where residents are primarily seen as simply additional staff on the wards who can help provide much-needed patient care, needs to change to a deliberate educational culture, where physician faculty consider the teaching and training of their medical residents as a priority on a par with patient care.

Such active teaching takes more time, however, and the Rwandan faculty are already stretched in many different directions. And that, of course, is the whole point of the HRH program: to increase the number of faculty, which in turn enables the medical education system in Rwanda to train more physicians. With the start of the HRH program, the ministry of health has doubled the number of residents in the pipeline. Those residents will be a welcome addition to the Rwandan health care system when they graduate in a few years, but it's imperative that some of them be hired as medical school faculty so that they may help teach future residents-in-training and thus begin to address Rwanda’s acute shortage of physicians.

The other big challenge for the visiting faculty has been to strike a balance between working as faculty extenders (faculty mentors and trainers of trainers) and acting as faculty replacements (filling the obvious gaps in the system caused by a shortage of local faculty).

There is so much work to be done – patient care needs are extensive and constant, and faculty members must cover out patient department duties, administrative duties, as well as their own educational duties – and it is  so tempting to simply step in and “do what so clearly needs to be done.”

That, however, is emphatically not the goal of the HRH program, and the US physician faculty need to remind themselves that if they fall for the temptation to just step in and take over, then little will have changed by the end of the seven year program. While patient needs might be met though the efforts of compassionate visiting doctors, the Rwandan medical system will not have increased its capacity to meet its own needs and become less reliant on continued outside assistance.

And that, above all else, is the goal with this ambitious long-term program.