Thirty years ago, specialised procedures such as neurosurgery and kidney transplants were rare in Rwanda. With only six surgeons nationwide, many patients had no choice but to seek treatment abroad. Today, however, the landscape has dramatically changed, with more than 150 surgeons performing complex procedures in operating theatres across the country. ALSO READ: Inside push to localise specialist healthcare In an exclusive interview, Prof. Martin Nyundo, the Head of Clinical Services at the University Teaching Hospital of Kigali (CHUK), explained the country’s three-decade journey in building surgical care, from a handful of surgeons after the 1994 Genocide against the Tutsi to a system defined by modern technology and specialised training. The excerpts: How has surgical care in Rwanda transformed over the past three decades? Surgery in Rwanda has come a long way. Over the past three decades, it has undergone an incredible transformation. Immediately after the genocide, Rwanda had only about six surgeons. Today, we have around 170 surgeons and 20 surgical residents—doctors in training to become specialists. ALSO READ: Rwanda trains 400 African medics in minimally invasive surgery We moved progressively from open surgical techniques to minimally invasive surgery, endoscopic procedures, microsurgery, and image-guided surgery. These advances brought our surgical care in line with global standards. The quality of care improved considerably. Modern surgery requires more than skilled hands. How has Rwanda built the infrastructure to match these advanced techniques? Infrastructure develops alongside techniques. For example, microsurgery requires microscopes. Minimally invasive surgery requires lab towers - equipment used to guide laparoscopic procedures, and imaging machines like MRI and CT or scanners for detailed diagnosis and surgical planning, are essential for precision. A big milestone has been IRCAD Africa, a training center that uses simulation with animal models. Surgeons can practice minimally invasive procedures on pigs and dry labs before operating on humans. This training is crucial because modern surgery demands precision, and practicing on models helps ensure better patient outcomes. With advanced skills and equipment now in place, how has Rwanda reduced the need for patients to seek complex surgeries abroad? For many years, patients were transferred abroad for complex conditions we could not manage. Today, with new skills and equipment, we can treat most of them here. When I started, surgery was largely general. Everyone worked in the same unit with little distinction. Now, Rwanda has about 12 surgical subspecialties, and more are developing. Neurosurgeons can now operate on large brain tumours using microscopes or endoscopic techniques, cases that were previously sent overseas. Renal transplants are done at King Faisal Hospital. Cardiac surgery, including catheter-based interventions, is now available locally. Orthopaedic surgeons perform arthroplasty or joint replacement surgery including hip and knee replacements, which was not possible 10 years ago. Gastrointestinal surgeons can resect colon or stomach tumours using minimally invasive techniques. Ten years ago, patients with these conditions were either referred abroad or, if transfer wasn’t possible, risked death. Today, they receive care here. These advanced surgeries sound expensive. How are patients able to access them, and how much does insurance help? Community-based health insurance (Mutuelle de Santé) covers procedures at CHUK, Rwanda Military Referral and Teaching Hospital, the University Teaching Hospital of Butare, and Level 2 hospitals. Advanced procedures at King Faisal, like kidney transplants or open-heart surgery, are also covered. Patients pay only 10 percent. For perspective, a hip replacement in India costs around $7,000. In Rwanda, the same procedure costs about $3,000 at King Faisal and less than $2,000 in teaching hospitals. With Mutuelle de Santé, patients pay only about $50 for a procedure that would otherwise cost thousands abroad. This reduces expenses for both the government and individuals. How are modern surgical procedures changing patients’ lives compared to traditional surgery? Modern surgery provides precision, which reduces the risk of complications. Minimally invasive surgery leads to less blood loss, fewer infections, shorter hospital stays, and faster recovery. I recently conducted a study on patients with gallbladder stones. Using minimally invasive surgery, 50 patients were admitted in the morning, operated on the same day, and discharged the next day. All 50 patients had no complications or readmissions. In contrast, open surgery for the same condition requires at least three days in the hospital, with higher infection risk. Shorter hospital also reduce social and economic impacts. Patients recover faster and return to work sooner, while those who develop infections can be off work for weeks. What investments has the government made in surgical equipment, and how does this support the work of surgeons? The government has invested heavily in surgical infrastructure. We have microscopes for neurosurgery and ENT, lab towers for laparoscopic and endoscopic surgery, cardiac surgery machines, and kidney transplant equipment. Imaging equipment like MRI and CT scanners is critical. These machines are costly. Neurosurgical microscopes cost about $300,000. Laparoscopic towers are around $150,000. MRIs can cost over Rwf1.5 billion. At CHUK, we have five laparoscopic towers, three endoscopic towers, and two microscopes, one for neurosurgery and one for ENT. These investments allow surgeons to operate safely and efficiently. What challenges do hospitals still face in providing modern surgery to patients? Despite progress, there are still some challenges. For instance, equipment is expensive, hospital space and beds are limited, and staffing is not yet sufficient. At CHUK, for instance, we are moving some services to Masaka to address space issues. The Ministry of Health’s 4×4 programme, which aims to quadruple the number of health professionals in four years, is helping address staffing shortages. Expanding subspecialty training will ensure more surgeons are available across the country. What does the future of surgery in Rwanda look like? We are moving toward robotic and minimally invasive surgery, which provides greater precision and better outcomes. Expanding subspecialties is also a priority, allowing surgeons to focus on areas like endoscopy, vascular surgery, and epilepsy surgery. IRCAD Africa continues to be central to training, with ongoing investment in equipment, training, and subspecialties, Rwanda’s surgical care will continue to improve and reach global standards. Any message for young doctors considering surgery? Surgery is challenging and demanding, but it is very rewarding. We need young doctors to join this field, especially in subspecialties. Trauma and other complex surgical conditions are common in Rwanda, and we need skilled surgeons to meet this demand.
