{"id":3642,"date":"2014-08-22T13:54:18","date_gmt":"2014-08-22T17:54:18","guid":{"rendered":"http:\/\/geiselmed.dartmouth.edu\/news\/?p=3642"},"modified":"2014-09-09T09:48:48","modified_gmt":"2014-09-09T13:48:48","slug":"finding-inspiration-in-rwanda","status":"publish","type":"post","link":"https:\/\/geiselmed.dartmouth.edu\/news\/2014\/finding-inspiration-in-rwanda\/","title":{"rendered":"Finding Inspiration in Rwanda"},"content":{"rendered":"

When Steve Bensen<\/a> (\u201990) talks about the two months he spent in Rwanda<\/a> earlier this year, you can hear the optimism in his voice. Exhilarated by his first foray into global health, he wants to help others have a similar experience.<\/p>\n

Bensen, an associate professor of medicine at Dartmouth's Geisel School of Medicine and physician at Dartmouth-Hitchcock Medical Center, who specializes in gastroenterology and hematology, is the first gastroenterologist to participate in the Human Resources for Health<\/a> (HRH) program. A seven-year partnership between the Rwandan Ministry of Health, the Clinton Foundation, and several U.S. medical schools, including Geisel, HRH is committed to rebuilding the medical education and health-care systems in Rwanda.<\/p>\n

\u201cI tried for a number of years to do something like this and investigated different avenues,\u201d Bensen says. \u201cBut it\u2019s difficult for a gastroenterologist because we are dependent on technology when offering our skills.\u201d<\/p>\n

\"Bensen
Bensen (center) with two physicians he worked with in Rwanda.<\/figcaption><\/figure>\n

Although there is significant gastrointestinal (GI) disease in Rwanda, physicians lack both the equipment and training to provide specialized care. Armed with hundreds of donated endoscopic devices\u2014biopsy forceps, snares, balloon dilators, PEG kits, and esophageal band ligators\u2014Bensen\u2019s goals were to teach physicians, residents, and interns to perform simple GI procedures and to show hospital managers the importance of providing these devices. \u201cThere\u2019s an amazing amount of good to be done with fairly simple instruments,\u201d he says.<\/p>\n

Benson divided his time between two hospitals, Centre Hospitalier Universitaire de Butare (CHUB), where he partnered with Tim Walker, an Australian gastroenterologist, and Centre Hospitalier Universitaire de Kigali (CHUK), where he partnered with Rwandan physician Vincent Dusabejambo, an internist.<\/p>\n

Rounds were like going back in time in terms of the advanced state of pathological findings. \u201cDiseases that you read about in textbooks and that you may see once-in-a-lifetime are common there,\u201d he says.<\/p>\n

One such case came when Bensen saw a 29-year-old male patient whose spine had been destroyed by vertebral tuberculosis, also know as Pott\u2019s Disease, and was unable to walk. \u201cThe residents got into a heated discussion about the duration of treatment and then asked me what I did in my big American hospital,\u201d Bensen recalls. \u201cThey were a bit disillusioned when I had to admit that we haven\u2019t seen a case of Pott\u2019s Disease in the past 30 years.\u201d<\/p>\n

By the time patients reach one of Rwanda\u2019s four academic referral hospitals, they are in the late stage of severe disease. With the availability of universal health insurance their first line of defense when sick is to visit a community health center. Those who are very sick, Bensen explains, are sent to a district hospital staffed by recent medical school graduates. From there, the sickest patients are sent to one of the four teaching hospitals, two of which are CHUB and CHUK.<\/p>\n

Rwandan hospitals bear little resemblance to modern American hospitals. Their large buildings with open wards are filled with rows of patient beds. There are one or two nurses for each ward of 48 patients. Patients are required to bring a caregiver with them, usually a family member or a friend. The caregiver is responsible for buying medicine, administering the medicine, doing laundry, and cooking meals.<\/p>\n

\u201cIn some ways, the medical system here is far behind our system; in others we can learn a lot from them,\u201d Bensen says. \u201cPatients are never alone, there are always so many people around, whether outside on the lawn overlooking the beautiful mountains or sitting at their bedside, patients are with their loved ones.\u201d<\/p>\n

The wealth of warmth and caring found in the hospitals is a stark contrast to the dearth of resources. There were times, Bensen says, when the hospital labs didn\u2019t have a reagent needed to run basic tests, or film to print CT scans. \u201cResourceful residents and interns would use their smartphones to snap photos of scans to show to me,\u201d he says.<\/p>\n

\"Bensen<\/a>
A patient ward at one of the hospitals where Bensen worked.<\/figcaption><\/figure>\n

Bensen\u2019s hands-on teaching sessions and lectures drew crowds of medical students and residents. To augment those sessions, he introduced interns and residents to \u201cGI Bleeding Jeopardy\u201d\u2014none of them had heard of Jeopardy, nor were they familiar with television game shows, but they liked the new format and interactive learning style, Bensen says. Everyone was pushed beyond their comfort zone.<\/p>\n

\u201cContributing to the education of Rwandan medical students, medical house staff, and physicians has been an incredible experience,\u201dBensen says. \u201cThere is a dedication to patient care and an enthusiasm for learning that is uplifting in spite of limited medical resources.\u201d<\/p>\n

The residents were so excited about the prospect of further specialty training within Rwanda that Dusabejambo asked Bensen to develop a proposal for a gastroenterology fellowship for submission to the Minister of Health. \u201cWe put forth a good proposal and I\u2019m confident that it will be approved,\u201d Bensen says.<\/p>\n

It is hard for Benson to believe how much was accomplished in just two months, but he trusts in the ability of those he has trained. \u201cThere has been significant headway in advancing therapeutic endoscopy to a core group of experienced and dedicated doctors,\u201d he says. \u201cWe have successfully performed multiple dilations with life-changing results, and we performed more than 20 esophageal band ligation procedures. And we placed two PEG feeding tubes in patients. Yet so much more remains to be done.\u201d<\/p>\n

Committed to giving Dartmouth trainees an opportunity to have a similar experience to his, Bensen intends\u00a0 \u201cto be as influential as I can to make exchanges possible\u2014sending our trainees to Rwanda and bringing Rwandan trainees here.\u201d He\u2019s been invited by Walker to return for three months next spring, and Bensen will be taking three trainees and a GI fellow with him.<\/p>\n

\u201cI wish I\u2019d been able to do something like this sooner,\u201d he says. \u201cThis experience has been inspiring and it makes you reflect on why you went into medicine\u2014you come away from it feeling like you\u2019ve really done some good.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Steve Bensen, an associate professor of medicine, had long wanted to get involved in global health work. He recently got his chance when he spent two months helping to train physicians and residents at two hospitals in Rwanda.<\/p>\n","protected":false},"author":12,"featured_media":3644,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[14,1],"tags":[17,23,185,366],"class_list":["post-3642","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-improving-lives","category-news","tag-alumni-2","tag-global-health","tag-rwanda","tag-steve-bensen","author-12"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-content\/uploads\/sites\/2\/2014\/08\/bensen-featured1.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4r3h1-WK","_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/3642","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/comments?post=3642"}],"version-history":[{"count":8,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/3642\/revisions"}],"predecessor-version":[{"id":3663,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/3642\/revisions\/3663"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media\/3644"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media?parent=3642"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/categories?post=3642"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/tags?post=3642"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}