Closing The Gap: Q&A with Dr. Paulin Banguti, Rwandan Anaesthesiologist

We envision a future where Operation Smile delivers enough long-term medical training, patient education, and capacity-building resources that there will no longer be a need for our work. This is why we have been investing heavily in local medical systems, building capacity for communities around the world.

Aneasthesia is as vital to a surgical procedure as any instrument wielded by the surgeon. As part of Operation Smile’s Global Standards of Care, it’s a medical standard that enables the delivery of the safest surgery and is essential for successful medical outcomes. While this may seem like an obvious standard — if not the most important standard — it reflects a dramatic shortcoming that the Rwandan health care system faces.

For example, the densely-populated country Rwanda, home to 11.9 million people, is served by only 15 nurse anesthetists and anaesthesiologists. Though we’re so proud that nearly 85% of our medical volunteers are health care professionals from the low- and middle-income countries we serve, we have ambitious goals to continue building capacity.

Meet Dr. Paulin Banguti, director of the post-graduate anaesthesia program at the University of Rwanda, who is working toward filling this massive void. During the March 2016 Operation Smile surgical training rotation at Rwinkwavu District Hospital, Banguti led a group of anaesthesia residents to observe and learn from volunteer anaesthesiologists from around the world.

Banguti’s goal is bold; to train 60 active anaesthesiologists by 2024 before doubling that total by 2030.

Q: What inspired you to shift your focus toward training anaesthesiologists?

A: “After completing my medical training in the Democratic Republic of the Congo, I returned home to Rwanda in 2004 and worked as a general practitioner specialising in maternity. Rwanda launched its first anaesthesiology specialisation program in 2005 and it really started from the ground-up. There were not enough mentors to teach us, so we were taught by nurse-anesthetists, who are skilled technicians, but not doctors. There were some ups and downs in the training, which inspired me to offer the best training of residents and anaesthesia practices for the safety of my country.”

Q: How does Operation Smile’s commitment to education align with your vision?

A: “I’m really passionate about education, because I think it’s where we can fill the gap. The training of anaesthesiologists shouldn’t just be one-on-one instruction — you need to have many different partners and teachers involved in different programs where people can take pieces from each and make their own solution.

“What’s great is that Operation Smile isn’t bringing us the curriculum or the program to adopt. When my residents join this program, they continue to follow our curriculum while learning which aspects to adjust. Operation Smile is partnering with us to achieve the goals we have set and that is why we think it’s sustainable — because with or without them, we have a goal to achieve. That’s the benefit of working with Operation Smile, they don’t come in and say, ‘Destroy whatever it is you have, we have a new machine.’ They’re just continuing what we started and strengthening it.”

Q: What are the challenges you face in retaining Rwandan anesthetists?

A: “You are touching on one of our biggest problems; it’s brain drainage. Since there are only 15 nurse anesthetists and anaesthesiologists for 11.9 million people, some become exhausted and think, “I’d rather leave this country to go work less,” at the same or even a lesser salary. If you increase the inflow of anesthetists, it will create a balance of those sharing the workload. With that improvement in the quality of their lives, they can feel like it’s better to stay in Rwanda. We need to grow the number of anesthetists so that everyone can work closer to 45 hours per week and have time for social and family lives.

“What’s great is that many Rwandans now believe in their country. It’s what makes us believe we can have many anesthetists. The strength of our country are young people who believe they can create a new story of a new Rwanda. We even have a song which talks about making it a paradise both in Africa and the whole word. I think that is the ideology that is inspiring many people to do the same as the leaders are doing.”

Q: Do you feel like this style of training has long-term potential?

A: “Yes. The University is trying to extend training beyond Rwanda’s three teaching hospitals and into the district hospitals where residents there would have the opportunity to learn. If we can perform missions in many different hospitals, the residents will benefit and we can build toward sustainability. I see the impact in three different ways; clinical, academic and administrative. In addition to the technical, clinical training, the residents also learn the academic side of training, meaning they can discuss techniques, become teachers and share the knowledge. Administratively, they learn how to work with pharmacists and logisticians to prepare, conduct and evaluate a mission. We hope to take what we have learned from Operation Smile and one day repeat what they have done for us.”

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