Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study

Abstract

Background: Rwanda is a landlocked East-African country that was the site of the 1994 genocide, during which much of its health infrastructure was destroyed. It remains one of the poorest and least developed countries in the world. In the last two decades, there have been significant efforts to rebuild its healthcare system. No study has since examined Rwanda’s emergency medicine (EM) infrastructure. Study objective: To perform an initial descriptive study of EM infrastructure in post-conflict Rwanda. Methods: We employed two methods. The first was 160 h of direct observation at six healthcare sites in the capital city of Kigali leading to a descriptive understanding of Rwanda’s EM infrastructure. The second method utilized face-to-face narrative interviews based on a 5-item open-ended questionnaire with a convenience sample of 54 healthcare workers. Results: A relatively basic EM infrastructure was found to exist. Emergency care is available to all, though timely access and demand for payment are barriers to care. Emergency care is delivered at all levels, from local community health centres to district hospitals to national referral centres. The majority of physicians working in the Emergency Departments (EDs) are general practitioners, and only one hospital provides specialised training at the BLS level to EM practitioners. Prehospital care is almost entirely missing. The three most commonly cited problems facing EM infrastructure in Rwanda were lack of resources (94% of respondents), need for specialised EM training (89%), and absence of prehospital care (74%). All except one worker surveyed (98%) were satisfied with the progress Rwanda has made to improve EM in the last 10 years. Conclusion: Despite ongoing challenges, the infrastructure for the delivery of emergency care is much improved since 1994, and Rwanda’s continuing progress can serve as a model for EM development in other developing and/or post-conflict countries in Africa.

Keywords

• Emergency medicine infrastructure
• Rwanda
• Post-conflict
• Prehospital
• Education
• Survey