Browsing by Author "Rulisa, Stephen"

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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.
Emergency Obstetrics Knowledge and Practical Skills Retention Among Medical Students in Rwanda Following a Short Training Course
(WILEY , 111 RIVER ST, HOBOKEN, USA, NJ, 07030-5774, 2013) Homaifar, Nazaneen; Mwesigye, David; Tchwenko, Samuel; Worjoloh, Ayaba; Joharifard, Shahrzad; Kyamanywa, Patrick; Wilkinson, Jeff; Rulisa, Stephen; Thielman, Nathan M
Objective:To describe rates of improved knowledge following a structured 2-day emergency obstetrics trainingcourse.Methods:Quantitative assessments to evaluate emergency obstetrics knowledge and practical skillswere administered before, immediately after, and 3–9 months following the training course for 65final-yearmedical students at the National University of Rwanda. A survey was administered during thefinal assessment.Results:In total, 52 (80.0%) students demonstrated knowledge improvement after training. Fifty-seven (87.7%)students improved or maintained their scores from the post-training written test to thefinal assessment,and 32 (49.2%) retained practical skills. Twenty-one (32.3%) of the class demonstrated competency in bothwritten and practical skills. According to multivariable logistic regression analysis, female gender was associatedwith overall competency (P=0.01), and use of the internet for academic purposes more than 3–5 timesper week tended toward competency (P=0.11).Conclusion:A 2-day emergency obstetrics training courseincreased knowledge among medical students. Because educational policies are tailored to address highrates of maternal mortality in resource-poor settings, workshops dedicated to emergency obstetrics shouldbe promoted.
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.
Knowledge, Attitudes, and Practices in Safe Motherhood Care Among Obstetric Providers in Bugesera, Rwanda
(Wiley, 2012) Puri, Ruchi; Rulisa, Stephen; Joharifard, Shahrzad; Wilkinson, Jeffrey; Kyamanywa, Patrick; Thielman, Nathan
Objective To determine the knowledge, attitudes, and practices of obstetric care providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of safe motherhood services. Methods A quantitative descriptive survey in Kinyarwanda targeting all OCPs in the district was implemented in November 2010 to determine demographic characteristics, safe motherhood knowledge, obstetric practices, and attitudes toward additional training. Results The study captured 87% of OCPs, of whom 137 of 168 (82%) were A2 level nurses. Most expressed a need to improve their knowledge (60.6%) and skills confidence (72.2%) in safe motherhood. The mean percentage of correct answers of 50 questions assessing overall knowledge was 46.4%; sections on normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest. Fundal pressure during vaginal delivery was practiced by 60.8%, and only 15.9% of providers practiced active management of the third stage of labor for all deliveries. Providers supported additional training, and 89.3% expressed willingness to participate in a 2-day workshop even if it were their day off. Conclusion The study has identified a need to improve safe motherhood knowledge and practices of OCPs in the Bugesera District of Rwanda. OCPs support additional training as an intervention to reduce maternal mortality.