For many patients in Rwanda, needing surgery does not only mean a medical diagnosis—it often means waiting.

If the case is not an emergency, that wait can stretch to 12 months, according to Rwanda Surgeon Association.

ALSO READ: Over 42 patients get plastic surgery at CHUK in one week

"Rwanda has 180 surgeons. This is about eight times below what is needed,” said Prof. Faustin Ntirenganya, Chair of the Department of Surgery at the University of Rwanda’s College of Medicine and Health Sciences, and Director of the Global Surgery Research Hub.

He said the impact is directly felt by patients.

"If you need surgery today and it is not an emergency, you are probably going to wait between six and 12 months,” he said.

"Some patients think surgeons are busy doing something else—not at all. There are simply very few surgeons.”

ALSO READ: Doctors at CHUK perform Rwanda’s first surgery on epilepsy patient

Across Africa, the challenge is even broader, with the continent recording the lowest surgeon-to-population ratio globally—about 0.5 surgeons per 100,000 people.

But experts say even where surgeons are available, operating theatres and equipment are still insufficient. Rwanda has about 0.9 operating theatres per 100,000 people, far below the recommended five to six.

"The worst thing is to train surgeons who cannot operate because there are no theatres, equipment, or supplies,” Ntirenganya said.

Rwanda is currently investing in training more specialists. About 226 surgical trainees are enrolled in different programmes that take between four and six years.

An initiative known as The Making of a Surgeon is also working to train 30 reconstructive surgeons by 2030, aimed at easing pressure on existing specialists.

Despite the gaps, retention remains relatively strong.

"About 90 percent of surgeons trained in Rwanda stay in the country, which is a very good rate,” Ntirenganya noted.

He added training needs to keep pace with population growth.

In the meantime, short-term interventions are helping to reduce the backlog.

At the University Teaching Hospital of Kigali (CHUK), a recent week-long plastic surgery outreach brought together local doctors and visiting specialists.

During the exercise, 78 patients were assessed and 42 underwent successful operations. Supported by supported by Operation Smile, a non-profit organization, the teams performed 10 to 12 surgical cases per day, compared to the usual 3 to 4 cases handled on regular working days.

For young doctors, such programmes are also a key learning opportunity.

"We learn by doing—through supervised practice and hands-on experience,” said Vicky Mukamitali, a surgical resident.

"But that also means we need to meet with enough patients, equipment, and theatre time to build confidence.”

She believes the pipeline into surgery needs to start earlier than medical school.

"Many only fully understand surgery when they are already in medical school, yet the decision should start much earlier,” she said.

Mukamitali also noted that training specialists locally improves retention.

"When specialists are trained within the country, they understand the system and the needs of patients better,” she said. "And surgery is rewarding—you see immediate results in patients’ lives."

The experts also said technology would shape the future of surgical care in Rwanda.

"Surgery is very dependent on technology. We must keep up with innovations like minimally invasive and robotic surgery,” Ntirenganya said.

While progress is visible, experts agree that Rwanda still needs stronger investment in both infrastructure and human resources to close the gap.

Ntirenganya believes approaches should be shared from the classrooms, curriculums, to policy making.

"Surgery should not be seen as a surgeon’s issue. It is a shared responsibility because everyone is a potential patient,” he said.

He noted that curriculums need to be updated every five years to match the technologies, skills and the awareness of equipment usage among professionals.