Rwanda medical mission trip ‘a jewel in our curriculum’

Faculty and medical students from the University of South Alabama College of Medicine cared for patients at Kibogora Hospital in Rwanda as part of a medical mission trip with the Christian Medical Ministry of South Alabama.

Practicing medicine in remote areas of the world presents challenges for even the most seasoned clinicians. For medical students, the experience allows them to apply the knowledge and skills they’ve learned in a completely unfamiliar setting, creating numerous teaching moments they will carry with them for the rest of their lives.

Representing the University of South Alabama College of Medicine and USA Health, a group of 25 clinical faculty members, fourth-year medical students, advanced care providers and support personnel recently served on a month-long medical mission trip in Rwanda. Since 2012, the Christian Medical Ministry of South Alabama (CMMSA) has led the annual trip to Kibogora Hospital, a rural referral hospital in Rwanda.

Andrew Bright, D.O., assistant professor of surgery at the USA College of Medicine, has participated in the Rwanda mission as a medical student, resident, fellow and twice as an attending physician. Each trip is unique in terms of the pathology encountered, group dynamics, and intended specialties and goals of the students, he said.

“I have noticed that senior medical students, displaced from their normal environment, tend to have that same amazement that they had when they saw their first patients,” Bright said. “I get to witness a new beginning of sorts when they see 30 to 40 patients in the same ward, which is a large room. There is barely enough room to walk bed to bed as the whole room is full.”

Fourth-year student Kelsea Wright, who is pursuing an anesthesiology residency, assisted in anesthetic procedures for surgery. “At USA, we are encouraged to be very hands on and to take responsibility for our patients, even as students, which helped prepare me for the increased autonomy I was given during this trip,” she said. “During my anesthesiology rotation at USA, I performed multiple intubations and spinal blocks, so when the opportunity came for me to perform those procedures at Kibogora Hospital, I felt confident in my abilities, with some guidance from the CRNAs.”

As a fourth-year student going into emergency medicine, Travis Goodloe III worked in the procedure room performing laceration repairs, abscess drainages, minor excisions, burn and wound care, and dressing changes. He also coordinated the delivery of medical supplies the group donated to the hospital, which is often burdened by a shortage of supplies and qualified staff.

“There is an endless flow of patients that funnel into Kibogora Hospital, thus having USA physicians, residents, and medical students present for a month really allows for a stress reliever on the existing medical system,” Goodloe said. “The local staff that we interacted with during our trip made it very clear how grateful they are for this. It truly keeps the hospital afloat in a lot of ways.”

Bright, who also serves as a trauma, critical care and burn surgeon with USA Health, said the hospital’s lack of tools and technologies he is accustomed to using in the United States forced him to become a more resourceful surgeon. The staff at Kibogora, which includes only one general surgeon, are experts at maximizing the reach of materials and minimizing waste, he said.

“We operated successfully on a 94-year-old man with large chronic burn-related wounds of the legs. I had to set up the whole case from start to finish, not just ‘my part,’” Bright said. “There were no blood transfusions available, and blood loss was expected as he had significant tissue destruction. We had to find enough ACE dressings in the hospital to facilitate mechanical hemostasis, and mix our own epinephrine bath for hemostasis. We had to mix our own antibiotic solution, made with bleach.”

In addition to addressing the patients’ medical needs, the hospital staff and volunteers tended to the patients’ spiritual needs.

“The hospital has a few chaplains and a prayer team that visit the wards each Sunday afternoon to sing songs with the patients,” Wright said. “We joined them for two Sundays, and it was so moving to see the patients and their families filled with joy as they sang, danced and clapped.”

Goodloe was also touched by the Rwandan people’s culture and focus on spirituality, he said.

“They are often more vocal and intentional about their faith than many of us are here in the U.S.,” Goodloe said. “Their freedom of worship even within the hospital during spiritual rounds on Sunday afternoons was powerful and eye opening to many of us. I do believe that these spiritual rounds consisting of praying, singing and dancing, and worship provided just as much healing as any medical care that we were able to provide.”

A particularly moving experience for Goodloe was a home visit. The patient lived high in the mountains, in a small mud home with dirt floors and no electricity. Goodloe, classmate Will Martin, and the palliative care nurse from the hospital provided care for the patient, who was a quadriplegic and no longer able to provide for his family of eight children. As they talked with him about how to care for his wounds at home, the patient described how he trusted in God’s plan for him and his family.

“This experience demonstrated the value of a robust and healthy faith, even in light of unhealthy and unfortunate physical conditions,” Goodloe said. “For all of these reasons, this experience was the most impactful of the trip for me, far more so than any specific medical care, procedure or surgery that we were able to provide over the course of our month in Rwanda.”

In the summer of 2017, after completing their first year of medical school, Wright and Goodloe spent two weeks in Senegal, West Africa, as part of a medical mission trip with CMMSA. Their experiences in Senegal largely influenced their decisions to take part in the Rwanda trip.

Rwanda was the first medical mission trip for Dorothy Dickinson, GME program coordinator for surgery. She assisted with spiritual rounds and met with the chaplain to help structure the hospital’s weekly Bible studies.

“When a person can commit their time to a mission trip to see the needs and opportunities around the world involving other people of different cultures, it gets into your heart,” Dickinson reflected. “This changes everything including how you spend your time, energy and resources.”

Goodloe called the Rwanda trip “a true jewel in our curriculum.”

“The opportunity for learning and the opportunity for development of young physicians on so many levels during this trip is totally invaluable. It is worth its weight in gold,” Goodloe said. “I have no doubt that I will begin residency in a few months much better prepared clinically, emotionally, spiritually and personally than had I not immersed myself in this Rwanda experience for the past month.”

Visit www.cmmsa.org to learn more about the Christian Medical Ministry of South Alabama.