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My Impressions: 2018 School Health Checkup Program in Rwanda

Publication date:2019-01-16
 
By Takashi Yorifuji, MD, PhD
(Associate Professor, Okayama University)

Introduction:

From 14th - 24th September 2018, I had the honor of visiting the Republic of Rwanda to take part in a program pertaining to pediatric health, which overlaps with my own research field. And although it wasn’t my first time to be part of it, my impressions for this year’s program were quite different from previous years’.

This year’s topic covered war-induced post traumatic disorders along with our visit to the Genocide Museum. Because of this, I became more aware of what this country had gone through. It is fully understandable that some of the stories cannot be easily shared, but if one were to understand Rwanda, one must learn the history of it.

Every year, I have been mesmerized by the wonderful landscapes of Rwanda as they somewhat resemble a Japanese farming village. Yet, it concerns me greatly that the increasing number of traffic could harm the environment in the course of time.
 

Itinerary:

The team of visiting experts

1) 16-17 September:
Upon arrival in Kigali, we visited Mbilizi Hospital in the southwest to observe the perinatal data entry procedure. With the hospital staff, we tried to come up with an efficient data-collection method.

2) 18-19 September:
After moving back to Kigali, we provided a medical consultation service in Miyove ECD Center in the northern suburb. On the 18th, five of our doctors saw 121 people. On the following day, we provided a similar service in Umuco Mwiza, a local school in Kigali City, examining 235.

3) 20-21 September:
After seeing 594 patients in Kibagabaga Primary School, we paid a courtesy visit to the Embassy of Japan in Rwanda and the Rwandan Ministry of State. For the latter, our team was privileged to meet Minister Dr. Ndimubanzi.
 

Findings:

The health checkup was held in the same locations as previous years, namely, Miyove, Kibagabaga, and Umuco Mwiza. As last year, the results revealed a significant regional gap in which, even within the same city, the disparity between Kibagabaga and Umuco Mwiza was tremendous.

As far as children’s health conditions and growth status were concerned, Umuco Mwiza marked better results than others. However, the further we moved away from the city center, the scores got worse and problems such as poor sanitation, malnutrition and infectious diseases started to emerge.
 

Examples:

A six-year-old girl in Miyove, who was 92cm-tall and weighed 14.5kg, seemed to be suffering from chronic malnutrition as her stomach was bloated and had tachycardia (140bpm). It was also reported that there was a child who vomited roundworms after coughing.

Children at Miyove ECD

A health checkup at Miyove


In Kibagabaga, there was another boy with obvious malnutrition (nine-year-old, 125cm-tall and weighed 21.7 kg) who also had undescended testicles. According to his mother, he is only able to eat one meal a day. The underprivileged family is unable to have health insurance and is not able to receive any type of medical care.

Another girl had dactylosymphysis on her left hand. Since two of the finger bones were present, it was possible to separate the fingers by surgical operations. However, her mother did not wish the surgery to be conducted due to financial difficulties. Dr. Calliope took over the case and listened to the crying mother’s claim, but it was unlikely that the girl would get it treated.

In Kibagabaga

A boy after the checkup holding
an origami crane


Some of the ailments which caught my eyes were, 1) cavity, earwax, untreated wounds and eye-related diseases (conjunctivitis and pains) that stem from poor sanitary conditions, 2) low height/ weight and peeling skin that could be the signs of malnutrition, 3) diseases that occur as a result of unhygienic conditions combined with malnutrition (respiratory and digestive infections), 4) otitis and head skin mycosis, as well as 5) parasitic infections including malaria and roundworms.

It is also worth mentioning that bodily deformations were yet to be highlighted which included undescended testicles, dactylosymphysis and neurological developmental disorders. As for the overall status of ailments and regional disparities, they remained similar to previous years.

In the last two years, the project has accumulated sufficient data to be used to analyze, a) what ailments can be detected through the medical checkup, and b) how much medical intervention can be made. Seeing this project as a pilot program, the data is expected to serve as a basic reference upon implementing this initiative on the national level.

While it is difficult to ascertain the effectiveness of the program, it was tangible that the program has somewhat encouraged the children and parents to take care of their health conditions more than before. It was possible to presume that their behavioral change was partially due to the voluntary health advice given by school staff. As a matter of fact, I did witness the children and parents receiving dental advice and health-related guidance after the checkup. I also sensed that more parents were present at the checkup this year which could also be the sign of change.  

Based on the ailment detection, possible medical interventions and secondary elements mentioned in the above, the further development of this health-check program needs to be assessed. At the meeting with the said minister, we were asked if the program could be launched on the national level. The minister suggested that by working with the Education Ministry, it should be implemented in the way in which many people can benefit. As is the case, this matter needs to be discussed with relevant government institutions and organizations.

Children lining up for the checkup

Children and parents in line

 

A woman after giving birth (Mbilizi)

On one hand, academic research was one area where all of the concerned parties could actively exchange thoughts. The perinatal data entry procedure at Mbilizi Hospital has been going fairly well and it should certainly bear fruit in the days to come. If the data can reveal the causes of low birth weight or premature birth, it is expected to lead to the betterment of prenatal and postnatal health of mothers, not to mention the infant health. It is for this reason that the area deserves further study.

Unfortunately, we could not obtain much information regarding the introduction of “mother and child health handbook” (MCH handbook). However, this has to be continuously addressed on the regular basis. One regret this time was that we were not able to actively conduct the exchange of medical expertise at medical facilities as the only occasion we had was at Mbilizi Hospital.

On a positive note, by letting Dr. Urayama (pediatrician) involved in the project this year, we have so far managed to dispatch a pediatrician, a neonatologist and a pediatric surgeon from Okayama Medical Center to Rwanda. This gives us hope for further interactions between Rwandan and Japanese medical facilities.
 

Conclusion:

Now, more than a month has passed since returning to Japan. Whenever I see a beautiful scenery that reminds me of Rwanda, I find myself at a loss as to where I am now, seeing the landscape that unfolds before my eyes. Contrary to the imaginary view, however, the circumstances around Rwandan children are still dire. It is hard to get the image off my mind of those children with malaria-induced encephalopathy, HIV-induced pneumonia and malnutrition (especially the boy who could only eat one meal a day). I feel powerless and frustrated for not being able to help them while knowing that they are unable to receive appropriate medical care for the lack of health insurance.

But I do have hope. Rwandan medical students who served as our interpreters had just begun their clinical training and they were eager to discuss what kind of doctor they wish to become or how they want to pursue their medical career. Seeing this moved me: I was convinced that the next generation of aspiring doctors are definitely coming along.

I am fully being aware of the fact that the children’s health conditions will not improve easily without resolving the deep-seated problems of unhygienic environment, malnutrition, infectious diseases and poverty. Still, I am hoping to make the utmost effort in realizing a better tomorrow for the children in the near future.

Last but not least, I would like to express my gratitude to Ms. Marie Louise Towari of NPO “Think About Education in Rwanda” as well as everyone at Umuco Mwiza, Kibagabaga Primary School and Miyobe ECD Center for their untiring support.

I would also like to thank His Excellency Takayuki Miyashita and Dr. Watanabe at the Embassy of Japan in the Republic of Rwanda, Ms. Tae Namba and Ms. Chiaki Hashimoto of AMDA International, and Ms. Saori Irie of Okayama University for their kind assistance.

 
    •  Primary Health Care & Promotion of Health Awareness (Promotion of Health)
    •  Rwanda
    •  2018

 
 
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