Butaro Hospital brings tech savvy modern healthcare to Burera
For many years Marie Chantal Mukandayisenga, 18, has suffered from chronic respiratory complications and ulcers. Every time the diseases flare up she has to go to the hospital, but the nearest one to her home in the mountains is approximately 80km away, of which 50km is extremely rough. Getting transport to the hospital is difficult. She either has to walk close to 50km in order to get a bus or sit for six to eight hours as she waits for the bus to arrive.
Today, Mukandayisenga, a resident of Butaro, Burera district in northern Rwanda, is in total relief.
On 23 January 2011, President Paul Kagame inaugurated the US$5.8 million modern Butaro Hospital in Burera built in partnership with the government of Rwanda, Partners in Health, and the Clinton Health Access Initiative (CHAI). The people of Burera also contributed.
The tech savvy hospital, equipped with outstanding modern facilities and high speed internet connectivity, is a five minute walk from the center of town, and has come at a time when Burera was desperately in need of such a facility. When President Kagame visited Burera district in 2003, residents told him there was nothing they wanted more than a hospital.
He promised he would deliver, and immediately began sourcing for funding and partners. In 2008, former US President Bill Clinton offered financial support and launched the construction of the hospital.
At the time, Burera had the least developed public health infrastructure in Rwanda. It was one of the last two districts in the country without a hospital; one physician served a population of over 320,000 and electricity, water and sanitation services were scarce. Health indicators in Burera were among the poorest in the nation. Family planning was below 30 percent, malnutrition was alarming, malaria was at its peak, and so many other diseases had found a safe haven.
“It’s an area that has traditionally had almost no access to health care,” says Dr. Mathew Craven, the Deputy District Manager for Partners in Health, adding that a temporary hospital was built in 2008 that has been helping serve the area for the last two years, though it wasn’t offering the services that were required.
“This is the first permanent hospital this area has ever had,” Dr. Craven says.
The 152-bed facility, with a state of the art emergency room, two operating theatres, an intensive care unit and a full maternity and neonatal intensive care unit (NICU), is the first facility of its kind in rural Rwanda.
Like King Faisal and University Teaching Hospital of Kigali (CHUK), Butaro has a clinical, radiology, pharmacy, laboratory, dentistry, physiotherapy and HIV and Counceling department, an accident and emergency unit and operation theatre support services.
“We have created a model district hospital that has the potential to serve as an example for rural health facilities throughout sub-Saharan Africa,” Dr. Craven observes.
Equipment was purchased using funds from the Ministry of Health and contains a range of brand new, high quality hardware, including two digital X-ray systems, sonosite portable ultrasound machines, specialty surgery instrument kits, orthopedic traction beds, advanced anesthesia machines, an oxygen generating plant that pipes oxygen to the bedside, and incubators. There are also phototherapy lights and warming tables for advanced neonatal care. A high capacity, diesel-powered medical waste incinerator, morgue refrigeration system, and autopsy table and kits are also available.
Sixteen doctors, 86 nurses and three midwives will staff the hospital.
“The health of the nation’s citizens is paramount to its present well-being and future prosperity,” said President Kagame while unveiling the new hospital. “This is why we have placed such a high premium at strengthening our health sector and why the government of Rwanda has committed increasing expenditure in the sector, especially in primary health services and quality of care.”
Paul Farmer, Co-Founder of Partners in Health, who had joined President Kagame at the ceremony says, “When I’m going through the hospital, any hospital, my eye catches all the tiny details that aren’t perfect—a drop of paint here or there, a missing reagent, a damaged door—but this hospital is so much better than any other because of all the feedback loops, the punch lists, the commitment, the enthusiasm, the partnerships, the camaraderie, the commitment to patients, the history, the friendships, and, most of because of the love of our patients.”
To provide adequate and modern health services, Rwanda intends to establish similar hospitals like the one in Butaro across the country. President Kagame was quoted in The New Times, a local daily, saying “we realized that we alone cannot achieve it [and] that is why we are so pleased to have partners who understand our priorities and put their effort and resources.”
The Global Fund, Partners in Health, and the Clinton Health Access Initiative are some of the partners helping Rwanda improve its health care system.
Before the government invited partners to set up the Butaro hospital, the heath center in the area “was pretty much non-functional,” says Dr. Craven. “There was only one doctor in the district, very few services offered, and some still went to Ruhengeri, but we were able to help most people in the district at the temporary hospital.”
Mukeshimana says the hospital is a miracle and a blessing. “We are so excited, because this hospital has come at a time when we extremely needed it,” she says.
According to the hospital’s medical director, Dr. Tharcis Mpunga, now that the hospital is complete “the health center will only be offering ordinary medical services.”
The new hospital will not only provide medication, it will also feed patients. While many people in the rural area have abundant food, some families do not.
“The hospital will provide food for in-patients and some out-patients as well,” Dr. Craven says, adding that there is food support for out-patients who are poor or malnourished.
“If a patient has a disease like HIV, TB or malnutrition and they are from a poor family and need extra food, we will be giving them a food support package, for those who need it,” he says.
It is assumed that patients from around the province and elsewhere will flock to the hospital looking for good medical services, which will create an influx of patients to the hospital.
“The number of patients we have now is fewer than the number of beds we have, so we do have the capacity to take more,” Dr. Craven says.
In fact, because the hospital is so close to Uganda, about 5km from the boarder, some patients are expected to also use the facility.
“Patients come from Uganda across the border, because we are so close,” says Dr. Craven.
“Assume a Ugandan is sick, has no money and no health insurance,” Dr. Mpunga says. “We treat them, and we charge zero.”
But he is quick to point out that “it is a political issue and we are going to discuss it with the administration [government].”
It is estimated that 2.6 million dollars will be required to run the Butaro hospital.
At the national level, figures published by the Ministry of Health indicate that by 2010, 91.036 percent of the population will have access to universal health insurance referred to in Rwanda as Mutuelle de Sante.
According to Joseph Zaraduhaye, the vice mayor in charge of finance and development in Burera district, subscription to Mutuelle de Sante hit 94 percent last year, and out of the remaining 6 percent, 97 percent have already registered for insurance.
Rwanda’s health indicators, in general, have been progressing in past years. There is currently one doctor for every 18,000 people, and one nurse for every 1,690. A national survey completed in 2008 indicates that 62.8 percent of nurses serve in rural areas and 38.2 percent in urban areas.
Infant mortality in Rwanda over the last two years was 62 per 1,000, and the mortality rate for children five years and under was 103 per 1,000, but the Ministry of Health estimates a tremendous drop in the figures. Maternal mortality in 2009 was estimated at 383 per 100,000 with 62 percent of mothers giving birth through assisted deliveries.
In 2002, for example, only 11 health centers in the country offered free testing for pregnant women to prevent the transmission of HIV from mother to child. As of June 2010, there are currently 390 sites that now offer this service.
Preventative measures have also seen the risk of HIV positive pregnant woman passing the disease to her baby reduced to 4.1 percent from over 25 percent.
written by Major Adam Kifaliso, February 09, 2011
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