Globally, five billion people do not have access to safe, affordable, and timely surgical care. The burden of this falls disproportionally on people in low-and middle-income countries where nine out of 10 people cannot access basic surgical care.

Operation Smile and the UBS Optimus Foundation have partnered on a project to help combat this issue by improving access to safe surgery in three communities in Nicaragua, Madagascar and Vietnam.

The project seeks to improve the surgical infrastructure of hospitals and to spread awareness about surgically-treatable conditions to the people of these regions.

Dr Faustin Ntirengonya, plastic surgeon from Rwanda
Dr. Faustin Ntirenganya, the head of the surgery department at the University of Rwanda. Photo: Margherita Mirabella.

Don’t fish for us, teach us how to fish — I like that approach. I used to be involved in cleft surgeries and programmes with people coming from abroad. The old way of doing business was to come, operate and go. Then I heard Operation Smile was looking at something more sustainable, which meant coming to train residents.

Dr. Faustin Ntirenganya, Head of Surgery department at the University of Rwanda
Cleft Surgeon Steve Naum from the USA
Dr. Steve Naum, Operation Smile volunteer surgeon educator. Photo: Margherita Mirabella.

A volunteer surgeon with Operation Smile since 1998, Dr. Steve Naum of Grand Rapids, Mich. has been a central figure in the development of the rotations since his first visit to Rwanda in 2010. Naum volunteered at Rwinkwavu District Hospital, where he recognised the opportunity for Operation Smile to support surgical training there.

The effort started with small teams of volunteers in anaesthesia and nursing both at Rwinkwavu District Hospital and Butaro Hospital in Rwanda’s northern region before focusing on surgical training last year.

Ntirenganya and Naum share the same outlook regarding the importance of conducting the surgical training rotations.

It is easy for us to come to a place, do a number of cases, feel good about it and leave; but we don’t leave anything necessarily behind if we have not exchanged information or built some sort of knowledge or skill base for local surgeons to continue. Ultimately, there is so much work and such a surgical burden in Africa that there is no way any volunteer service is going to get to all of it. The only way we are going to make a difference is to train people to continue doing that work.

Steve Naum, Cleft surgeon and Operation Smile volunteer

In addition to building surgical capacity for the future, Operation Smile volunteer plastic surgeon Dr. Bruce Ferris, who has been visiting Rwanda regularly since 2011, pointed to the benefit training rotations have on the safe surgical care patients receive.

“When I first started investigating doing rotations, it became very obvious to me that there were patients who needed surgical care that just weren’t getting it — languishing in hospitals for a very long time when they could have been cared for,” said Ferris, who practices in Wichita, Kan. “It made sense that if we could develop the rotations, many of these patients would be taken care of and not have to be hospitalised for the long term.”

The surgical residents involved in the 2015 rotation are a passionate crew, and among them is Dr. Christophe Mpirimbanyi, who was introduced to Operation Smile while working as a general practitioner and serving as an observer on a medical mission. Immediately, he was enthralled and inspired to become a plastic surgeon. Now in his third year of residency, his passion for positive surgical outcomes was almost palpable when he spoke of why this is more of a calling than a career.

Cleft Surgeon Steve Naumv teaching to local surgery residents during the surgical rotation in Rwanda
Dr. Christophe Mpirimbanyi and Dr. Jean Paul Shumbusho review notes with Dr. Steve Naum. Photo: Margherita Mirabella.

When you treat children with cleft lip and other craniofacial defects you don’t only treat them, but you also treat the community and even the family. There are children that have been abandoned or stigmatised, but when you treat them, you give them hope.

Dr. Christophe Mpirimbanyi, plastic surgery resident
Head Neck Surgeon Francis Hart teaching to local surgery residents during the surgical rotation in Rwanda
Photo: Margherita Mirabella.

The success surgical training led to the inclusion of anaesthesiologists at the March 2016 mission at Rwinkwavu District Hospital.

The training of anaesthetists in Rwanda is led by Dr. Paulin Banguti, who completed much of his medical training in the Democratic Republic of Congo before returning to Rwanda in 2004 with a desire to make an impact on the nation’s healthcare system. With only 15 active nurse anaesthetists and anaesthetists in the entire country, the workload is immense.

“If we can train 60 active anaesthetists by 2024, we’ll see if we can get to 100 or 120 anaesthetists by 2030 — then we will be closer to the goal,” Banguti said.

The path to success looks to be long and challenging, but ultimately the goal remains the same: a time when Rwanda produces enough doctors to meet their nation’s surgical needs. The residents’ enthusiasm following the 2015 training rotation embodies this hope for a healthier future.

In October, we sent three of our third-year residents. They came back saying, ‘Why did we wait so long before starting something like this?’ They really benefited from this experience and the tremendous surgeons.

Dr. Faustin Ntirenganya, Head of Surgery department at the University of Rwanda

Help training the next generation of life-savers.