Over the past decade, Rwanda's healthcare system has undergone a remarkable transformation, particularly in facial reconstructive surgery. Ten years ago, complex procedures like nasal reconstruction were unimaginable for many Rwandans. Today, the country has made significant strides in restoring not only the physical appearance of those who have lost facial features but also their sense of identity and dignity. Marie Claire Nzitabakuze, a 48-year-old woman Rubavu District, experienced a life-altering event when she lost her nose after a violent altercation with her husband that led to the loss of her nose. “It was a terrible day, we had been fighting for a long time, but that day was different, Nzitabakuze said. He bit her and that's when her nose fell off. She was taken to the local health centre and transferred to Gisenyi hospital, but they too couldn't help much, she explains. She recalls wearing a mask to hide her injury and fearing that insects might cause infections to the exposed wound. “I couldn’t breathe properly, I couldn’t eat, and I had major issues with even basic movements. I couldn’t put anything on my head, couldn’t bend my neck—everything was just unbearable, she said. I was essentially sitting there, waiting for help, and even the food that I was being fed made me sick. A woman born without a nose Angelique Mukeshimana, 35, a mother of three from Gasabo District, was born without a nose due to a birth defect called cleft palate (ibibari in Kinyarwanda). For the largest part of her life, she has faced daily struggles due to the congenital condition. For 31 years, I had a hole in my face. The biggest challenge was how people treated me. They would laugh at me because I didn’t look like everyone else. Even when I went to school, students would mock me, and I felt so ashamed, and I didn't want attend classes, she narrates. However, Mukeshimana's life changed after undergoing surgery three years ago. One day, she heard about foreign doctors who were in Rwanda to treat people with cleft palate. They didn't help her, but her childhood hope to get treated was rekindled. Rwanda’s evolving healthcare system The University Teaching Hospital of Kigali (CHUK) began offering plastic and reconstructive surgery in 2015. The service was previously unavailable in Rwanda. Before 2015, people in need of this type of treatment had to seek care abroad, as Dr Isaiah Ncogoza, the head of the Ear, Nose, and Throat (ENT) department at CHUK, explains. “Before we had plastic surgery in Rwanda, patients who needed such surgeries had to either go abroad, if they had the means, or they had to remain with the defect. I can give you an example of a patient who came in after suffering an injury where a dog bit off his nose. The patient had to live with the defect for a long time, and even his family was afraid to approach him,” he said. Dr Ncogoza said a turning point in the country’s surgery capabilities was reached when CHUK got a facial plastic surgeon, Dr David Shaye. He emphasizes that the ability to perform surgeries on facial tumors has been a huge leap forward for Rwanda in the past five years. “We used to just excise tumors without reconstructing, but we started doing plastic surgery a few years ago, and we have been able to perform facial cancer cases where after excision we reconstruct the patient's features,” he said. Dr Shaye specializes in facial reconstruction and has been working with patients affected by car accidents, cancer, and congenital deformities. With 20 years of experience, he has spent the past 11 years dividing his time between Rwanda and the United States. He detailed the process of nasal reconstruction explaining that it’s a complex three-dimensional task, as the nose requires an inside, a structure, and an outside where for the inside they use tissues and three rib cartilages that are extracted and for the outside which is for the external covering of the nose they use a technique called the forehead flap. “The reason we use the rib is because it's very strong, and it's also very bendable. You can bend the rib for the curve here, and you can also find a straight part of the rib for this, and this cartilage is extracted, typically from one or two ribs, which patients can live without, and you can cut them up and build a structure,” he explains. Dr Shaye noted that, like woodworking, small pieces of rib cartilage can be joined together to form a strong and flexible framework for the nose, adding that the forehead flap is reliable and involves using the center part of the forehead skin, which has properties that closely match the skin of the nose. “The centre part of the forehead skin matches the nasal skin very well, much better than skin anywhere else on the body,” he added. A life-changing transformation Nzitabakuze recalls the fear she felt before her surgery. “The day of the surgery, I woke up at around 5 pm and realized something new was done to me. I still had the bandage, and I took medications for some days. When the bandage was off, I looked at myself in the mirror, and I realized I had become Marie Claire again,” she said. After the surgery, Mukeshimana was overjoyed to see her new nose, and happy the fact that the surgery was covered by Mutuelle de Santé, the community-based health insurance. When I looked in the mirror, I realized I was finally like everyone else. I can now breathe, sleep, and live without fear. I thank President Kagame for improving healthcare in Rwanda so people like me can be treated. And I thank the doctor who cared for us,” she said.
