How is Rwanda like Lakin, Kansas? Both want to improve health care
August 04, 2015
By Joe Stumpe
Two decades after his country was ravaged by genocide, Dr. Prince Jean Bosco Kanani is proud of the progress Rwanda has made in health care. Deaths from AIDs, tuberculosis, and malaria have dropped dramatically, as have maternal and child mortality rates.
"I don't think another country has managed to do that in a short time like this," he said. Kanani believes Rwanda's success has been due to President Paul Kagame. "He's a visionary leader."
Publications from The Atlantic to The New York Times agree, using words like "historic" and "miracle" to describe the transformation. But the sub-Saharan African nation is still looking for ways to improve, which is why Kanani traveled to Kansas in July to learn about family medicine and look for opportunities to improve Rwanda's health care delivery system.
"What's family medicine?"
Kanani visited Kansas as the guest of Benjamin Anderson, chief executive officer at Kearny County Hospital in Lakin. The two met last year while pursuing their Masters of Health Care Delivery Science from Dartmouth College in New Hampshire. That program draws doctors, health administrators, insurance providers, and public health professionals from around the world for 18 months of study.
When Anderson told Kanani about the importance of family medicine in Kansas, Kanani asked, "What's family medicine?"
Rwanda only has about 800 physicians for its 12 million people. Anderson told Kanani how the KU School of Medicine-Wichita trains physicians to provide a spectrum of care for families stretching from the cradle to the grave.
A two-way learning experience
"We're training doctors as well as anywhere in the nation," said Anderson, whose hospital staff includes two Wichita grads, Drs. Arlo Reimer and Drew Miller. "He said 'That sounds like it would work in our rural areas.' I said 'Why don't you come out and see it?'"
Kanani has spent more than a decade in the public health sector, specializing in HIV treatment, and is currently director of Rwanda Catholic Health Services, a network of 117 facilities. Rwanda is about one-quarter the size of Kansas, with a dense but largely rural population. To westerners, the country may be best known for the genocide that killed an estimated 800,000 people in 1994.
Kanai and Anderson's friendship hasn't been a one-sided learning experience.
Anderson is intrigued by the low cost of Rwanda's health care system. According to Kanani, the country annually spends about $55 per person on health care. Rwanda trained 45,000 community health workers that provide in-home care and psycho-social support for HIV patients as well as basic primary care.
"It's so different than what's happening in the United States," Anderson said. "We are too focused on in-patient and high-cost care."
Future cross-cultural collaboration
Before heading to Lakin, Kanani toured KU School of Medicine-Wichita and its family medicine residency program. Five of Lakin's current physicians came through the residency program.
Rwanda's shortage of physicians and nurses "is still a big issue," he said, and it is seeing an increase in cancer, diabetes, and other non-communicable diseases. Currently, community health workers do much of the traditional work of nurses, nurses do some of the work of doctors, and doctors who may or may not be specialists are required to function as such in some cases.
Kanani would love to see a partnership develop between the Wichita campus and Rwanda's Ministry of Health, whether it takes the form of Rwandans coming here to train, international rotations in Rwanda for KU residents, elements of KU's curriculum being used in Rwanda, or some other form.
Kearny County Hospital serves a 12-county area in a part of western Kansas known for its oil and gas production, irrigated farming, cattle, and meat processing plants. The hospital delivers over 200 babies a year, and has expanded to six physicians and six mid-level providers. Anderson has used an innovative offer of paid leave to serve as medical missionaries abroad to lure physicians to Lakin.
Anderson, pushing infant twins David and Naomi in front in a double stroller ("My wife needs a break," he said), showed Kanani the campus' hospital rooms, family medicine clinic and its large facility for independent, assisted, and nursing home care.
At one point on his tour, Kanani found himself being greeted in an African dialect by Lacey Mollel, who works in clinic registration, and whose parents were missionaries in Tanzania. Kanani speaks half a dozen languages fluently.
Kearny County Hospital personnel seemed intrigued by Rwanda's lack of family physicians, repeatedly asking Kanani, "How do you do it?" Anderson expects to visit Rwanda as Kanani's guest next year to get part of that answer.
Gorillas, horses ... common goals
"We made a commitment to each other," Anderson said. "If I would go see the gorillas in Rwanda - he would ride a horse in Kansas and see the work we're doing here."
In fact, Kanani rode a horse during a recreational outing to the Gardiner Angus Ranch in Ashland. "I want to go beyond the health facilities and learn more about their culture," he said.
Despite the obvious differences between Rwanda and Kansas and their respective health care systems, Kanani said there's one big similarity.
"We share the same values," he said. "What you are doing is patient-centered, and improving life. It's about people."KU School of Medicine-Wichita