PHOTOS: How one hospital in rural Rwanda is becoming an eye care hub

As early as 5:30am, patients begin to stream into the corridors of Rwanda Charity Eye Hospital, located in Bishenyi, Runda sector, Kamonyi district, in the Southern Province – waiting for the opportunity to see a doctor. It is quite busy here. Nurses and assistants pace up and down, preparing patients with surgery appointments, while others conduct a series of tests and examinations as suggested by the optometrists. ALSO READ: Rwandans tipped on eye health While the hospital starts operations at 7 am, gates open at 5:30 am to allow patients book for treatment slots. The hospital receives a huge number of patients on a daily basis – from newborn babies, children, adults and elderly people, including many from outside Rwanda – you find people from different walks of life. We arrived at the hospital at the opening hour but the parking lot was already full by 8 am. We had to look for improvised parking by the roadside. We were shocked to hear that people start to flock in as early as 4:30 am to secure appointments. Just a few years ago, Bishenyi and Runda, located about 12km from the City of Kigali, on the road to the Southern Province, were rural areas with a few shops by the roadside, market and households thriving on farming. From 2018, when the Rwanda Charity Eye Hospital opened and today, Bishenyi has tremendously transformed from a rural trading centre to a busy commercial hub, with many commercial activities emerging around the hospital. From restaurants, to shops and accommodation facilities, tarmac roads and street lights, Runda sprung to life – thanks to the vision brought by the hospital. “We open as early as 4:30 am because we already have people who woke up early to come to the hospital, looking for a quick breakfast,” says Janvier Niyomugabo, a worker in one of the restaurants near the hospital. Inside the hospital’s cafeteria, patients with eye conditions, who have travelled from near and far, sip on hot beverages to beat the morning cold, emanating from the lush green hills of Runda – Kamonyi. The traffic at this medical facility is not by mistake or coincidence. The hospital has cut a name as one of the best eye care centres, not just in Rwanda but also in the region. Patients with eye and vision problems travel from different countries including Democratic Republic of Congo (DRC), Burundi, Uganda and Tanzania, among others, to seek treatment here. On the Tuesday we visited, we found Evariste Kagambage, 64, a resident of Musenyi sector, Bugesera district, who had undergone surgery on the second eye, after the operation on the first delivered results. “I came very early because I heard there is always a big number of patients. When I got here, they received me warmly and worked on me,” “Previously I wasn’t able to see anything. Now I can see everything clearly. My left eye was completely blind. I really appreciate the services here,” says Kagambage, who for a year had been grappling with vision challenges. It was the same case with Esperance Muteteri, a resident of Nyamugari cell, in Eastern Province, who started developing sight problems. It turned out she was developing cataracts in both eyes. “In three months, I was going blind. I developed big cataracts and my eyes were quickly clouding. I went to Kiziguro Health Centre and they told me my condition had already gone out of hand,” Muteteri, 68, says. For elderly people like Kagambage and Muteteri, the hospital has become a sight saver, restoring hope when the future was getting blurry. They are satisfied that they can still see for a foreseeable future. How the hospital came about... At the hospital, we were met by Dr Piet Noë, an ophthalmologist and ophthalmic surgeon, who hails from Belgium but has been living in Rwanda for the past 15 years, five of which he has spent running the hospital. Noë is a simple, soft spoken and down to earth man, who remains focused on delivering the change he envisaged when he set out to start the hospital in 2018, which is touching people’s lives. He is a hands-on person. He does not just run the facility, he also religiously attends to patients, conducting surgeries on all the days of the week except Tuesdays and Thursdays when he does consultations. “For the last five years, I’ve been working at Rwanda Charity Eye Hospital and I am permanently living in Rwanda. I very much enjoy working and living in Rwanda,” Noë says, pointing out chose to concentrate on eye diseases to help address an existing gap in access to eye care services. “We do a lot of different surgeries and treatments. The main thing is cataract surgery, but we also do retinal surgery, cornea, glaucoma, and screen surgeries. We have a lot of patients with trauma,” he adds. Apart from those conditions, Noë says they also deal with children with retinoblastoma – a type of cancer which normally attacks tissues of the retina especially in children, which he says they can treat and heal using surgery on laser therapy. For Noë, the work they do is not just saving eyesight but also lives. While ophthalmology is not one of the biggest medical specialties, for Noë it is more impactful, which is why he chose to study it when he took on medicine. He says they started this new hospital five years ago in order to help Rwandans and also people from abroad, and in all categories, poor or rich. “It is a “charity hospital” because it pays particular attention to the less privileged of the society, mainly because eye treatments tend to be a little costly, especially for the ordinary citizens,” Noë explains. Beyond serving everybody, Noë says the mission was to provide good and top-quality ophthalmology services over profit, which is how the hospital has turned itself into a centre of excellence. “We try to give quality eye care to everybody and we nearly give all treatments in the field of ophthalmology,” Noë says, adding that they also integrate the latest models of technology in what they do. However, during school holidays, the majority are children, which goes to show how diverse and serious a challenge eye conditions, are. “Our population of patients reflects the population of Rwanda. Rwanda has a very young population. So, most of our patients are young,” “But some eye diseases are more common and frequent in older people, so for some eye diseases, we see more elderly people,” Noë observes. Modern vs tradition... The passionate ophthalmologist says the biggest challenge they face today is that the majority of people first try to treat conditions using traditional medicine yet this is one of the delicate medical fields where traditional methods of treatment are not efficient at all. “People put leaves and all types of things in the eyes, which afterwards get very bad infections. Some people lose their eyesight. Sometimes we need to do very complicated treatments like corneal grafts to save the eye,” “This could be prevented if people do not use traditional medicine for the eyes. Perhaps for other diseases, traditional medicine can help but for ophthalmology, the eyes, the traditional medicine is very dangerous,” Noë points out. The other challenge Noë identifies that contributes to increasing eye problems relates to people who work in places where they can be exposed to things that can damage their eyes but do not wear protective gear. These include people who work in construction sites, mines, factories and more, where metals or sharp objects injure or perforate eyes, something he says can be avoided by people wearing protective glasses at work. “We see so many accidents, so many infections, which could be prevented,” he says, adding that those preventable ones contribute to already existing ones resulting from traffic accidents. Demystifying the cost of treatment... Noë says many people do not go to seek medical care because they think eye care is costly, something he says is not true. “Some people don't want to come to an ophthalmologist because they think it's costly but it's not true. I think we give very cheap and good treatment for everybody who comes here,” “We work with Mutuelle de Santé, which already pays 90 per cent of the costs, so it's only 10 per cent of the cost for the patients. I think it is very affordable, even if you compare with other African countries,” “You can never find a country where you get, for example, a phaco, which is a cataract surgery done in the way you do it in Europe for Rwf8, 000. It's very cheap and also, the medicines are not expensive,” he says, adding that Mutuelle de Sante is the gamechanger. But that also comes with its own challenges. The hospital receives a lot of patients from all over the country and they have to be attended to. Noë says their biggest challenge is lack of staff, specifically professional ophthalmologists who are still few in Rwanda. However, he is hopeful that in four years’ time Rwanda will have enough eye doctors, now that the University of Rwanda is going to train new eye doctors under the new ophthalmology programme. Currently, the hospital works with the university to offer internships but he hopes more eye doctors can come on board to help fill the gap. Though the hospital closes outpatient services at 6pm, they remain open to emergency cases, often resulting from accidents. They also offer all ophthalmology services, including medicine and glasses. For orbital surgeries, the hospital has 25 private rooms, and 70 ordinary wards for admitted patients. “We have patients coming from Burundi, from Eastern Democratic Republic of Congo, especially from Goma and Bukavu. We also have patients coming from Congo Brazzaville, from Uganda, Tanzania and also from [South] Sudan,” Noë reveals. With RwandAir flying to different countries in the region and the continent, it has become easy for patients to travel from afar to come to seek treatment in Bishenyi. Why Runda? Noë says they chose to build the hospital on Runda Hill in Kamonyi because they were looking for bigger space, which they couldn’t find in Kigali, or if they did, it would be more costly to set up the facility. Today, they are looking to expand and they have enough space to do so. The fact that it isn’t far, just 12km from Kigali, it accessible for all people but most especially those in rural parts of the country who can’t afford private hospitals in Kigali. He is thankful to President Paul Kagame for promising to build a tarmac road connecting the hospital to the main road and it was delivered. “We received a very nice road from the main road, which is one and a half kilometres long, thanks to His Excellency the President. Five years ago, the President promised us the road,” “After six months, the road was here. We are very grateful for this because it helps us to be a lot more accessible. Now we are really accessible because it's a big tarmac road, with even lights on it,” Noë says. Their speciality over other hospitals is that they do a lot of surgeries and they offer all types of eye treatment, which makes them sort of unique from other eye hospitals. Also, the fact that they are accessed by patients using Mutuelle de Sante makes Rwanda Charity Eye Hospital unique, according to Noë. A wake-up call... According to Rwanda Biomedical Centre (RBC) eye diseases are classified among the top five diseases for which people come for treatment at hospitals in recent years. The most common eye diseases are short, long sightedness and cataracts, with the latter being the most dominant. A World Health Organisation (WHO) report published in 2023 showed that there are at least 1 billion people with eye diseases, the main conditions causing distance vision impairment or blindness being cataract (94 million), refractive error (88.4 million), age-related macular degeneration (8 million), glaucoma (7.7 million) and diabetic retinopathy (3.9 million). A Rapid Assessment of Avoidable Blindness conducted in Rwanda showed that 1 per cent of people aged 50 years and more are blind, often due to avoidable causes, accounting for about 84 per cent. The prevalence of severe visual impairment (SVI) and mild visual impairment was found to be worrisome. Donatha Mujawamariya, an ophthalmology nurse at Rwanda Charity Eye Hospital, says it is high time people paid attention to their eyes, starting by taking good care of them and seeing the doctor early to avoid going blind. Mujawamariya advises parents to monitor their children’s screen time and also ensure that often children play from outside, in natural light to improve their vision, because most eye problems can be avoided at a young age. She warns against people using over-the-counter eye drops which are used to cure dryness, redness, allergies and itching, sold in pharmacies without a doctor’s prescription, pointing out that they pose a serious danger to eye health. Mujawamariya advises people with health conditions such as diabetes, high blood pressure and others, to regularly check with their eye doctors, at least every six months, to avoid going blind early in life.

News

PHOTOS: How one hospital in rural Rwanda is becoming an eye care hub