Browsing by Author "Riviello, Robert"

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Building trauma and EMS systems capacity in Rwanda: lessons and recommendations
(Ubiquity Press Ltd , Unit 3.22, East London Works, 65-75 Whitechapel Road, London, England, E1 1du, 2021) Jayaraman, Sudha; Ntirenganya, Faustin; Nkeshimana, Menelas; Rosenberg, Ashley; Dushime, Theophile; Kabagema, Ignace; Uwitonze, Jean Marie; Uwitonize, Eric; Nyinawankusi, Jeanne d'Arc; Riviello, Robert; Bagahirwa, Irene; Williams, Kenneth L; Krebs, Elizabeth; Maine, Rebecca; Banguti, Paulin; Rulisa, Stephen; Kyamanywa, Patrick; Byiringiro, Jean Claude
Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations. Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/ research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for empowerment of staff, improving clinical service delivery, and investing in systems and infrastructure. Funding was sought and incorporated into the Sector Wide Approaches to Planning process at the Ministry of Health of Rwanda. Findings: A shared mental model was created through a fully funded immersion program for Rwandese leaders from emergency medicine, nursing, prehospital care, and injury policy. Prehospital care delivery was standardized within Kigali through a train-thetrainers program with four new context-appropriate short courses in trauma, medical, obstetric/neonatal, and pediatric emergencies and expanded across the country to reach >600 staff at district and provincial hospitals. Forty-two protocols and checklists were implemented to standardize prehospital care across specialties. The WHO Trauma Registry was instituted across four major referral centers in the country capturing over 5,000 injured patients. Long-term research capacity development included Masters’ Degree support for 11 staff. Conclusions and Recommendations: This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in EMS, and investing in systems and infrastructure. This can be a useful model for trauma and EMS system capacity development in other LMICs.
Collaboration in Surgical Capacity Development: A Report of the Inaugural Meeting of the Strengthening Rwanda Surgery Initiative
(SPRINGER , ONE NEW YORK PLAZA, SUITE 4600 , NEW YORK, United States, NY, 10004, 2013) Petroze, T Robin; Mody, Gita N; Ntaganda, Edmond; Calland, J Forrest; Riviello, Robert; Rwamasirabo, Emile; Ntakiyiruta, Georges; Kyamanywa, Patrick; Kayibanda, Emmanuel
Background Increasing access to surgical care is among the prioritized healthcare initiatives in Rwanda and other low income countries, where only 3.5 % of surgical procedures worldwide are being performed. Partnerships among surgeons at academic medical centers, non-governmental organizations, and representatives of industry for building sustainable local surgical capacity in developing settings should be explored. Methods With the goal of improving collaboration and coordination among the many stakeholders in Rwandan surgery, the Rwanda Surgical Society (RSS) convened a participatory workshop of these groups in Kigali in March 2011. The meeting consisted of presentations from Rwandan surgical leaders and focused brainstorming sessions on collaborative methods for surgical capacity building. Results The outcome of the meeting was a set of recommendations to the Rwandan Ministry of Health (MOH) and the formation of an ad hoc team, the Strengthening Rwanda Surgery (SRS) Advising Group. The inaugural meeting of the advising group served to establish common goals, a framework for ongoing communication and collaboration, and commitment to a fully Rwandan agenda for surgical and anesthesia capacity development. The SRS Advising Group continues to meet and collaborate on training initiatives and has been integrated into the MOH plan to scale up human resources across disciplines. Conclusions The SRS Initiative serves as an example of the concept of early communication and international collaboration in global surgical and anesthesia capacity building partnerships.
Enhancing Formal Educational and In-service Training Programs in Rural Rwanda: A Partnership Among the Public Sector, a Nongovernmental Organization, and Academia
(Lippincott Williams & Wilkins , Two Commerce Sq, 2001 Market St, Philadelphia, Usa, Pa, 19103, 2014) Cancedda, Corrado; Farmer, E. Paul; Kyamanywa, Patrick; Riviello, Robert; Rhatigan, Joseph; Wagner, Claire M; Ngabo, Fidele; Manzi, Anatole; Drobac, Peter C; Mpunga, Tharcisse; Nutt, Cameron T; Kakoma, Jean Baptiste; Mukherjee, Joia; Cortas, Chadi; Condo, Jeanine; Ntaganda, Fabien; Bukhman, Gene; Binagwaho, Agnes
Global disparities in the distribution, specialization, diversity, and competency of the health workforce are striking. Countries with fewer health professionals have poorer health outcomes compared with countries that have more. Despite major gains in health indicators, Rwanda still suffers from a severe shortage of health professionals.This article describes a partnership launched in 2005 by Rwanda's Ministry of Health with the U.S. nongovernmental organization Partners In Health and with Harvard Medical School and Brigham and Women's Hospital. The partnership has expanded to include the Faculty of Medicine and the School of Public Health at the National University of Rwanda and other Harvard-affiliated academic medical centers. The partnership prioritizes local ownership and-with the ultimate goals of strengthening health service delivery and achieving health equity for poor and underserved populations-it has helped establish new or strengthen existing formal educational programs (conferring advanced degrees) and in-service training programs (fostering continuing professional development) targeting the local health workforce. Harvard Medical School and Brigham and Women's Hospital have also benefited from the partnership, expanding the opportunities for training and research in global health available to their faculty and trainees.The partnership has enabled Rwandan health professionals at partnership-supported district hospitals to acquire new competencies and deliver better health services to rural and underserved populations by leveraging resources, expertise, and growing interest in global health within the participating U.S. academic institutions. Best practices implemented during the partnership's first nine years can inform similar formal educational and in-service training programs in other low-income countries.
Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda
(Kerman Univ Medical Sciences , Jahad Blvd, Kerman, Iran, 7619813159, 2018) Cancedda, Corrado; Cotton, Phil; Shema, Joseph; Rulisa, Stephen; Riviello, Robert; Adams, Lisa V; Farmer, Paul E; Kagwiza, Jeanne N; Kyamanywa, Patrick; Mukamana, Donatilla; Mumena, Chrispinus; Tumusiime, David K; Mukashyaka, Lydie; Ndenga, Esperance; Twagirumugabe, Theogene; Mukara, Kaitesi B; Dusabejambo, Vincent; Walker, Timothy D; Nkusi, Emmy; Bazzett-Matabele, Lisa; Butera, Alex; Rugwizangoga, Belson; Kabayiza, Jean Claude; Kanyandekwe, Simon; Kalisa, Louise; Ntirenganya, Faustin; Dixson, Jeffrey; Rogo, Tanya; McCall, Natalie; Corden, Mark; Wong, Rex; Mukeshimana, Madeleine; Gatarayiha, Agnes; Ntagungira, Egide Kayonga; Yaman, Attila; Musabeyezu, Juliet; Sliney, Anne; Nuthulaganti, Tej; Kernan, Meredith; Okwi, Peter; Rhatigan, Joseph; Barrow, Jane; Wilson, Kim; Levine, Adam C; Reece, Rebecca; Koster, Michael; Moresky, Rachel T; O’flaherty, Jennifer E; Palumbo, Paul E; Ginwalla, Rashna; Binanay, Cynthia A; Thielman, Nathan; Relf, Michael; Wright, Rodney; Hill, Mary; Chyun, Deborah; Klar, Robin T; McCreary, Linda L; Hughes, Tonda L; Moen, Marik; Meeks, Valli; Barrows, Beth; Durieux, Marcel E; McClain, Craig D; Bunts, Amy; Calland, Forrest J; Hedt-Gauthier, Bethany; Milner, Danny; Raviola, Giusappe; Smith, Stacy E; Tuteja, Meenu; Magriples, Urania; Rastegar, Asghar; Arnold, Linda; Magaziner, Ira; Binagwaho, Agnes
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
Vital Statistics: Estimating Injury Mortality in Kigali, Rwanda
(Springer, One New York Plaza, Suite 4600 , New York, United States, Ny, 10004, 2016) Kim, Woon Cho; Byiringiro, Jean Claude; Ntakiyiruta, Georges; Kyamanywa, Patrick; Irakiza, Jean Jacques; Mvukiyehe, Jean Paul; Mutabazi, Zeta; Vizir, Jean Paul; Ingabire, Jean de la Croix Allen; Nshuti, Steven; Riviello, Robert; Rogers, Selwyn O; Jayaraman, Sudha P
Background Globally, injury deaths largely occur in low- and middle-income countries. No estimates of injuryassociated mortality exist in Rwanda. This study aimed to describe the patterns of injury-related deaths in Kigali, Rwanda using existing data sources. Methods We created a database of all deaths reported by the main institutions providing emergency care in Kigali—four major hospitals, two divisions of the Rwanda National Police, and the National Emergency Medical Service—during 12 months (Jan–Dec 2012) and analyzed it for demographics, diagnoses, mechanism and type of injury, causes of death, and all-cause and cause-specific mortality rates. Results There were 2682 deaths, 57 % in men, 67 % in adults[18 year, and 16 % in children\5 year. All-cause mortality rate was 236/100,000; 35 % (927) were due to probable surgical causes. Injury-related deaths occurred in 22 % (593/2682). The most common injury mechanism was road traffic crash (cause-specific mortality rate of 20/100,000). Nearly half of all injury deaths occurred in the prehospital setting (47 %, n = 276) and 49 % of injury deaths at the university hospital occurred within 24 h of arrival. Being injured increased the odds of dying in the prehospital setting by 2.7 times (p\0.0001). Conclusions Injuries account for 22 % of deaths in Kigali with road traffic crashes being the most common cause. Injury deaths occurred largely in the prehospital setting and within the first 24 h of hospital arrival suggesting the need for investment in emergency infrastructure. Accurate documentation of the cause of death would help policymakers make data-driven resource allocation decisions.