So much happened in Rwanda’s health sector in 2019 — setbacks and remarkable milestones. The year began with the outbreak of Ebola in eastern Democratic Republic of Congo and Rwanda took several measures to combat it, and the efforts paid off. In its first issue of the New Year, Healthy Times looks at major moments and events that defined the previous year in the Rwandan health sector across different disciplines. RWANDA’S HIV PREVALENCE TARGET New data released in September this month demonstrated Rwanda’s remarkable progress towards achieving HIV epidemic control — particularly in attaining high levels of linkage to treatment and viral load suppression among people living with HIV. Results from the Rwanda Population-based HIV Impact Assessment (RPHIA) show that 76 per cent of all HIV-positive adults, including almost 80 per cent of HIV-positive women, have achieved viral load suppression, a widely used measure of effective HIV treatment in a population. This surpasses the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 73 per cent by 2020. “Rwanda has made tremendous progress by reaching or exceeding the UNAIDS 90–90–90 targets particularly among women and, nationally, by attaining 84–98–90 among adults,” reads a related press release. The survey was a joint effort by the Government of Rwanda, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University. HIGH SURGERY OPERATIONS 2019 also saw Rwanda commencing inner body surgical operations without using the normal cutting materials, but technological rays. This is called ‘Minimally Invasive Surgery’. Here, doctors only make a small wall on the patients’ body and use it to operate the rest of the inner body parts. It takes a very short time. This method is used to operate the stomach, caesarian section and testicles operation. Also, in 2019, two babies defied the odds to become the first in the country to survive being born so premature. The babies, born to Peace Umutoni and Felix Ntaganira, residents of Kinyinya, Gasabo District, were born at 24 weeks (roughly five months). Born with very low weight, the premature delivery was caused by a condition of high blood pressure that their mother developed during pregnancy. NEW DOCTORS Corneille Karekezi and Edward Musoni were Rwanda’s first female neurosurgeon and cardiologist respectively in 2019. On May 24, Dr Maurice Musoni became Rwanda’s first cardiothoracic surgeon, a specialist in surgical procedures of the heart and other chest organs. He graduated at the University of Witwatersrand in South Africa after pursuing his first medical degree at the University of Rwanda. We also had Rwanda’s first female neurosurgeon, Dr Claire Karekezi, who in 2009 after her graduation, worked as a general practitioner for almost a year and a half before enrolling for her specialisation in neurosurgery in Morocco in 2011, where she stayed until 2016. “It is six years (University of Rwanda) plus five years (in Morocco),” she told Healthy Times last year. Karekezi also added extra training for almost two years in the United States and Canada in pursuit of her goals. RWANDA’S FIGHT AGAINST EBOLA The previous year recorded the Ebola pandemic especially in the eastern Democratic Republic of Congo. It was one of the most pressing continental and global challenges in the last five years. Current figures show that in neighbouring D.R Congo, at least 3,287 cases of the epidemic struck as of May 2018. Rwanda, as a neighbouring country, had to take certain measures to protect its citizens and prevent it from spreading. The country has been proactive and efficient in Ebola preparedness at all levels since the outbreak was declared in DRC. A health worker uses a thermometer to test temperature for signs of the Ebola virus. The country has trained medical personnel at various levels to deal with possible outbreak. / Net photo According to the Ministry of Health, Rwanda has established a number of measures to avoid the epidemic making its way to the country. Among these, a detailed National Preparedness Plan was put in place and is training health workers in early detection and response, educating communities about Ebola, vaccinating health workers in high-risk areas, equipping health facilities, and conducting simulation exercises to maintain a high level of readiness. The country has trained 23, 657 people, including medical personnel at various levels, police officers, and Red Cross volunteers in preparation to deal with possible outbreak. Screening for Ebola symptoms at points of entry has been ongoing since the beginning of the outbreak in the Democratic Republic of the Congo, and has been reinforced since the confirmation of a case in the DRC’s city of Goma. Many people cross the border from Goma to Rwanda’s Gisenyi every day. People crossing the border have their temperatures checked, they also wash their hands, and listen to Ebola awareness messages. An Ebola Treatment Centre has been set up in Rwanda and 23 isolation units are being prepared in hospitals in 15 priority districts. Ebola response simulation exercises have been conducted in Kanombe Military Hospital, Gihundwe District Hospital, Kamembe International Airport, and Rugerero Ebola Treatment Centre to test Rwanda’s preparedness in response to a case, which will include Emergency Operations Centre activation, active surveillance, case management and laboratory testing. About 3000 health workers in high-risk areas have been vaccinated as a preventative measure, including more than 1100 in Gisenyi. ZIPLINE In what looked like a confirmation of government’s confidence in services delivered by Zipline, a US-based technology company that operates the world’s only drone delivery system for urgent medicines in Rwanda, the company has been given a green light to deliver not only blood to Rwandan hospitals but also other essential medicines. According to the Health Minister, Dr Diane Gashumba, the government had extended Zipline’s deal with a renewable three-year contract. Thanks to the contract, plans are underway to include basic pharmaceuticals on the list of urgent medicines that Zipline can deliver by drones. Zipline launched operations in Muhanga District, Southern Rwanda, about three years ago as the world’s first commercial regular drone delivery service, on agreement that it will be paid by the Ministry of Health on per delivery arrangement. In 2019, Zipline increased its geographical reach in the country and served public hospitals and health centres after drones are now delivering blood to 26 hospitals, mostly in the Eastern and Southern parts of the country. Going forward, Zipline is due to establish a drone assembling and maintenance plant in the country and it also opened a second drone port, which is located in Kayonza District, Eastern Province. ICASA The year also marked Rwanda hosting the 20th International Conference on AIDS and Sexually Transmitted Diseases in Africa) (ICASA) 2019. It went on for six days and saw hundreds of sessions on different topics either on HIV, infectious diseases or human rights, to treatment. Health experts advise to get tested and know your HIV status. / File photo In 2017, the biannual gathering was held in Cote d’Ivoire. 2019’s conference in Kigali was themed “AIDS-Free Africa: Innovation, Community and Leadership”. It brought together 10,000 people from 150 countries including Presidents Paul Kagame and Filipe Nyusi of Mozambique, five African first ladies including Jeanette Kagame, heads of international organisations and civil society organisations. SUICIDE CASES ON THE RISE As of September, Rwanda recorded 121 suicides. CP John Bosco Kabera, Rwanda National Police Spokesperson, in an interview with a local media house, said that among 205 people who tried to commit suicide, 121 died. In the City of Kigali, 11 attempted, in Eastern Province 55, 64 in Western Province, 34 and 31 in South and North respectively. TEEN PREGNANCIES The Government of Rwanda made the fight against teenage pregnancies a top priority. This commitment is evidenced by a policy framework that creates an environment aiming to fight the vice. Campaigns such as ‘Baho Neza Integrated Health Campaign’ were put in place and one of its major purposes is to fight teenage pregnancies. However, the problem of teen pregnancy persists. According to recent media reports, 19,832 underage girls were impregnated last year. Nyagatare District had 1,465 cases; Gatsibo 1,452 cases, Gasabo 1,064 and Kirehe had 1,055 cases. This year alone, 200 cases have been reported in Muhanga District. The National Institute for Statistics of Rwanda (NISR) shows that a total of 17, 337 cases of teenage pregnancies were reported in 2017. Further measures include the proposal to lower age of contraceptive access though it is yet to be considered. SANITARY PADS TAXES WAIVES In August 2013, the East African Legislative Assembly (EALA) passed a resolution urging partner states to waive taxes on sanitary pads in order to increase their accessibility for girls and women. A woman buys sanitary pads in a supermarket in Kigali. The country announced it was scrapping VAT on sanitary pads to make them more affordable. / File photo In 2019, Rwanda announced it was scrapping Value Added Tax (VAT) on sanitary pads to make them more affordable. Menstrual Hygiene Management (MHM) activists and beneficiaries applauded the move as it indicates that more effort will be put in the matter.