Learning through partnership in Rwanda

Catherine Arkell, an obstetrics & gynecology resident at UBC, spent four weeks completing an elective in Rwanda.

"In November 2023, I had the privilege of spending four weeks in Butare, Rwanda, as an Obstetrics and Gynecology resident on elective. The University of Rwanda and the

University of British Columbia have developed a rich partnership over the past several years, with Internal Medicine and Pediatrics learners from both countries engaging in educational exchange and experiences. Building on this foundation, the Obstetrics and Gynecology department at UBC worked with the relevant stakeholders to establish a pilot elective. I was extremely fortunate to have been selected as one of two residents to

participate in this exciting opportunity.

Though this was not my first international elective, I was particularly excited about this

opportunity, as it was evident that significant thought and effort had been put into

developing this program from a social justice and equity lens, where partnership and

mutual benefit were at the forefront. These principles were evident throughout the

process, from the in-depth pre-departure training, to the presence of UBC staff on the

ground who provided support to us as residents and maintained constant

communication with local staff about how best to partner. I observed how this ongoing

communication fostered an iterative experience, where day-to-day adjustments were

made to how we spent our time as residents and staff, to maximize potential benefit and

decrease the burden on the local system. For example, it became evident that, due to

human resource shortages, there was limited local capacity to provide formal teaching

to learners, particularly the more junior learners (medical students and interns). UBC

residents were able to set up formal teaching opportunities and these were very well

received. By our second week, Jill (the other UBC resident) and I were providing formal

lectures more than twice weekly, in addition to daily clinical bedside teaching and

supervising and supporting medical students with their required academic

presentations. A particular highlight for me was being able to share some of my

knowledge and experience with research. The Rwandan Obstetrics and Gynecology

residents are required to complete a substantial research project during their residency.

Due to local resource constraints, they are not able to be provided with much support

for this. Having had formal training in statistics and epidemiology, as well as research

methodology - both quantitative and qualitative - through my masters degree, I was

delighted to help meet this need. I gave a presentation on research methodology, after

which the residents were able to workshop some of their research questions. I received

a lot of positive feedback from the residents on the session, and subsequently spent

many hours one-on-one with two of the residents and two medical students helping to

support them further in developing their research projects. I have remained in contact

with several of the learners and was asked to give a talk on research to the Medical

Students’ Association of Rwanda. By request, I presented at grand rounds with a

Rwanda resident on an approach to critical appraisal of evidence, using research from

UBC on opportunistic salpingectomy to apply the approach. Because of the open lines

of communication between both the staff physicians and the trainees from both

institutions, we were able to shift our efforts to areas where we could provide the most

benefit, such as teaching and research capacity building.

It goes without saying that this was not a unidirectional exchange of knowledge and

experience. I learned an immense amount from my Rwanda colleagues. Practicing

medicine in resource-constrained settings, be they abroad or within Canada, requires

incredible ingenuity and practicality. In addition to the learning that resulted from being

exposed to more complex medical presentations than we typically encounter in

Canadian urban settings, the most impactful learning during my elective in Rwanda

came from the informal exchanges I had with my Rwandan co-residents. Through

candid discussions about how cases are managed in our respective practice

environments, the profound impact of inequity on outcomes was starkly evident. I am

deeply grateful to my co-residents for their openness and candor during these

discussions. These exchanges became the foundation for what are now cherished

friendships with some of the residents.

While I am hopeful that our time in Rwanda was, on balance, more beneficial than

detrimental, I am acutely aware of the time and effort that went into supporting us in an

already resource-constrained environment. Due to language barriers and lack of

familiarity with the system, every clinical encounter required a translator and our

seemingly endless questions were patiently answered by our local colleagues.

This was a pilot Obstetrics and Gynecology elective. I am hopeful that the excellent

groundwork performed by administrators and staff in cultivating these partnerships will

lead to an ongoing reciprocal relationship that will continue to benefit the host

institutions, their members, and the communities they serve. For my part, I am

extremely grateful to have had this opportunity, both for the educational benefit it provided and the personal enrichment derived from building new connections and friendships in a unique setting."