Gastroenterologists join forces during Rwanda Endoscopy Week.
In October 2018, I had the opportunity to participate in Rwanda Endoscopy Week, a program established by an international coalition of gastroenterologists eager to advance endoscopy in Rwanda. Participating in Endoscopy Week was certainly among the highlights of my years as a practicing gastroenterologist. I have been in practice for 35 years—a practice that I have enjoyed and that has provided for my family. I have always felt that medicine is nothing if not a calling to serve, and the chance to help an underserved community was irresistible.
A Team of Experts
I had participated in other overseas medical missions, mostly in South America, but because these trips focused on surgery, I rarely had the opportunity to share my expertise as a gastroenterologist. When I read an article about Rwanda Endoscopy Week, I quickly sent an email to Steven Bensen, MD, a founding member of the program, and joined in. I found a team of kindred spirits who were anxious to help make a difference in a place that had suffered unspeakable hardships.
Our team consisted of attending gastroenterologists, fellows, endoscopy techs, anesthesiologists and biomedical engineers. We participated in rounds, taught endoscopic techniques and immersed ourselves in Rwandan culture and history.
We conducted procedures at four different sites, performing 448 procedures, including 66 colonoscopies, 379 EGDs (esophagogastroduodenoscopies) and 3 ERCPs (endoscopic retrograde cholangiopancreatographies), one of which included stenting of a malignant stricture.
Fulfilling a Need
There is a desperate need for endoscopic services in Rwanda, as the burden of GI disease is considerable. One young woman who had large esophageal varices, which bled due to non-cirrhotic hypertension due to schistosomiasis, had a parasitic infection of the liver.
We were able to place bands around the varices to prevent further bleeding. We also saw an 18-year-old boy who had a gastric cancer, which, of course, was very rare for someone of that age. There appears to be a large presence of H. pylori, which can be easily treated with the appropriate medications early on to prevent this kind of complication.
In this, the second year of the program, we had more doctors and nurses participating—both from the U.S. and Rwandan medical teams—but the lack of infrastructure was a challenge. Even though we had certain instruments, if anything broke, there were no facilities, no biotech industry to repair it. This is a frequent problem with older equipment.
Certainly, we could have treated more people, but the lack of working equipment was the limiting factor.
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