Reversing the Brain Drain: Expanding Medical Opportunities in Rwanda

By Josh Ruxin

July 27, 2011 3:12 pm

John Streit Gitwe Hospital, a regional hospital in Southern Rwanda and one of the many projects spearheaded by Gerard Urayeneza, a Rwandan who is committed to expanding medical capacity in his native country.

For decades, young doctors and nurses have been fleeing poor countries for the bright lights and fat paychecks of wealthier nations, abandoning the parts of the world with the highest burden of disease and most desperate need for medical help. Sixty percent of medical doctors who trained in Ghana in the 1980s have since left the country, and there are more Ethiopian doctors in Washington DC than in all of Ethiopia. Sub-Saharan Africa today houses more than a tenth of the world’s population, and shoulders a quarter of the global burden of disease, but it has just three percent of the world’s health care workers.

That said, some young Africans have broken the mold.

Cousins Gerard Urayeneza and Vianney Ruhumuliza were born and raised in a small, isolated town in Southern Rwanda. Both grew up with lofty dreams of practicing medicine. With a little luck and a lot of opportunity, they were able to access medical training in Rwanda. Vianney even finished his schooling abroad in Michigan. Gerard and Vianney did something even more unusual, though: they bucked the international brain-drain trend that is dangerously affecting medicine in the developing world, and committed themselves to building local medical capacity in their native country.

Rwanda, where I live, has just one medical school for a growing population of nearly 11 million. Aspiring students face stiff competition for the limited number of spots available in the school –just 42 students will graduate this year – so many have no choice but to desert the dream of becoming a doctor or nurse altogether. The result is that medical capacity in Rwanda is severely limited, and many rural districts (with about 300,000 people per district) have fewer than a dozen full time medical doctors. Without a robust medical educational system that promises high pay for public health doctors, it’s hard to imagine how Rwanda will overcome its current situation.

Well aware of how grave the challenges are, my ears perked up a few years ago when Dr. John Streit, a retired obstetrician-gynecologist from Saratoga Springs, New York, told me that he was working with Gerard and Vianney to start a new Rwandan medical school. John met Gerard at a conference in Rwanda and was compelled by his story: After Gerard received his medical training, he worked as a skilled nurse practitioner and ultimately transformed a rural, two-room clinic near his hometown into a fully functioning health center – no small feat with his limited resources. Today, it is a three-story regional facility called Gitwe Hospital. It serves 285,000 Rwandans, has 200 beds, and employs nine doctors and 50 nurses.

Gerard Urayeneza, pictured, along with his cousin, Vianney Ruhumuliza, have worked to open a regional hospital, a private college, and now, a medical school–all in their native Rwanda– to create a larger medical infrastructure throughout their country.

Next, Gerard started Rwanda’s first private college, which has four majors (including pre-medicine) and a widely respected reputation; another impressive accomplishment for anyone, especially a man from a rural village in Rwanda. There is still one huge problem, though: when students graduate from this college, they face extraordinary challenges if they want to become doctors. The one medical school in the country housed at the National University of Rwanda simply does not have enough capacity to train them all.

Recognizing this challenge, Gerard connected with his cousin Vianney to lay the groundwork for building and staffing a second medical school. A partnership with the Rwandan Government and the NGO Medical Missions for Children (www.mmfc.org) jumpstarted plans to make Kigali Medical University (KMU) a reality. Gerard and Vianney designed an English curriculum and invited John Streit to serve as President.

Dr. John Streit, a retired obstetrician-gynecologist from Saratoga Springs, New York, is working with two Rwandans to build and run a medical school in Gitwe, Rwanda, called Kigali Medical University.

What’s more, recognizing the promise of the initiative, The Rwandan Development Bank added funds to the KMU Foundation (www.kmuf.org) by granting a one-million-dollar loan to help construct the complex and provide more space for hospital-teaching purposes. Construction on the first of three academic buildings is nearing completion.

Not all the graduates from KMU will choose to stay in Rwanda, though with guidance from Gerard, Vianney, and John, most probably will. But building educational institutions in this developing country has more benefits than meets the eye. Rwanda doesn’t have much in natural resources. But it does have a great reserve of human capital: Citizens ready, willing and able to serve their country. Rwanda must develop that resource, and there is perhaps no better way to start than through education.

KMU will accept its first class of medical students this year and the school will continue to expand. Though perfect targets for the brain-drain phenomenon, talented Rwandans now have the chance to train, practice and serve at home, healing Rwanda in more ways than one.

Josh Ruxin is the founder and director of Rwanda Works and a Columbia University expert on public health. He is also the director of the Access Project and Access’s Neglected Tropical Disease Control Program. Dr. Ruxin has extensive experience operating at the intersection of public health, business and international development. He lives in Kigali, Rwanda, with his wife and two daughters