On a hot sunny morning, we set off to meet one of the most famous names in Rwanda’s health sector – so renowned that his hospitals are generally known by his surname, rather than their real names. When we arrived atat around 9 am, his staff were reluctant to tell us whether he was available or not. “Did you talk to him? Is he expecting you?” they queried. Dr. Jean-Chrysostome Nyirinkwaya is a man of the people. The people around him try to limit access to him, especially since he ‘retired’ in 2021 and is no longer actively involved in the day-to-day management of the hospital located in Remera, Gasabo District. The 69-year-old gynecologist still practices at his hospital but attends to only a few cases. He still comes in early to oversee deliveries and also follows up on ongoing expansion works at the facility. We preferred doing the interview in Bugesera District, in Eastern Province, where he spends most of his post-retirement time, following up on the work of Nyirinkwaya Foundation, a charitable and research organization he established to keep the legacy of his father going. The tall and healthy-looking medic, though seemingly exhausted from the morning cesarean operations, told us to find him at a spot where he parks his car near the hospital extension. He showed up clad in a grey t-shirt, blue jeans, and sneakers; cutting an image of someone enjoying his retirement. Back in the day, the people around him feared for his life because he used to put in very many hours of work and less sleep. One can tell the amiable doctor is now enjoying the fruits of his hard work, while at the same time still doing what he does best—impacting people’s lives. After about two hours on the road, we arrived in Kamabuye sector, Bugesera District, where Nyirinkwaya, runs a research centre. He is into several projects including trying out herbal research for medicinal and therapy purposes. He also carries out a number of socio-economic activities to benefit surrounding vulnerable communities, including the deaf and mute, who come to the centre to be taught sign language by a professional teacher. They are also trained in modern farming practices. In the same locality, he also has a macadamia farm with about 23, 000 trees where rural folks from the neighborhood work to support their households. Nyirinkwaya has been growing macadamia in the area for the past 15 years. In 2022, he expanded operations by integrating research and agriculture as well as charitable causes. After giving us a tour of different activities at the centre, we sat down with him for a chat about life in general, practicing medicine, and why he chose to do what he is doing in retirement. He spoke with fond memories of his childhood. He grew up in Burundi where he was born in 1954, just like many Rwandans born in exile. At the age of five, his family moved to Belgium. In 1965, his father, a doctor, returned to Burundi to practice. Nyirinkwaya Jr continued his studies in Burundi, where he, following in his father’s footsteps, joined the University of Bujumbura to study medicine. In 1978, Nyirinkwaya moved to Dakar, Senegal, to further his studies in obstetric gynecology – the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and the postpartum period) and gynecology (covering the health of the female reproductive system. On graduation, he stayed in the West African country to practice until 1988, when he returned to Burundi. “By the time I returned to Burundi in 1988, I was married, with one child. My firstborn was born in 1988. When I returned to Burundi, I started working with a public hospital; Prince Regent Charles Hospital,” Nyirinkwaya recalls. In 1990, he joined his father to work in his clinic, and it was around that time that the Rwanda Patriotic Front (RPF-Inkotanyi) launched a liberation struggle. In July 1994, shortly after the country was liberated, Nyirinkwaya and his family returned to Rwanda. Upon arrival, he was appointed the head of medical services in the City of Kigali, where he served for two years before opening his first polyclinic in Nyamirambo, a suburb of Kigali, in 1996. From a little boy who was scared of planes on his first encounter, Nyirinkwaya went on to establish himself as one of the leading players in Rwanda’s health sector. In 2009, he opened La Croix du Sud Hospital, in Remera. To this day, he continues to expand it. Even in retirement, from the look of things, he has already planned a transition that will see his hospital continue to be sustainable even when he is not around. Medicine runs in the blood Growing up in exile, Nyirinkwaya had many dreams, like any other child split between wanting to become a mechanical or electrical engineer or even a soldier. It was exposure to his father’s medical books that played a major role in influencing him to follow in his father’s footsteps. “When you are young, you go through phases of decision-making. One time I wanted to be in the military because of the prestige of the uniform. But given the kind of life; knowing that you are a refugee in another country, it wasn’t possible.” It was never his desire to be a medical doctor but the more he read his father’s books, the more interesting the subject became. “I was very interested in reading novels and it was not my desire to be a doctor,” he said. His dream was to do something that required him to be outdoors or move but not an office job. But as they say, it seems that for Nyirinkwaya, medicine runs in the blood. As they say, your life's calling is what makes you feel that life is meaningful. It helps you live a purposeful life. And, to date, Nyirinkwaya has never regretted the decision. “I was very pleased with what I was doing because I was passionate. When you are passionate, you can do many things, you can do more than anyone else can do.” “So, as long as things are going well, the passion will continue but be careful. When the passion is no longer there anymore, it is the beginning of the end,” he warned. People wouldn’t see it but I would be devastated He kept going simply because he loved what he was doing, and never got tired of doing his job. Even as he ‘retires’, Nyirinkwaya remains actively involved in dealing with patients because sometimes patients will specifically ask for him. The downside of his work is to lose a patient, or baby, something that always affects him, deeply. “Every time I had a problem with a patient, maybe a baby or mother dies, I would be devastated. People wouldn’t see it but I would be devastated,” he said, pointing out that it would make him question his responsibility as a doctor “This is very important because it helps you to do better next time,” he said, emphasizing that dealing with delivery or the lives of women and babies is not an easy job. It takes preparation. “You must be ready for any eventuality,” he said, adding that the solution is to try and minimize the risk by having the right equipment and tools as well as skilled support staff, including doctors and nurses, to make sure that no life is lost while giving life. It is something he has strived to achieve in his hospital, arguably one of the leading private hospitals in Rwanda. He has been recognized for his contribution to the development of the health sector. Nyirinkwaya is open to the longstanding criticism of service delivery in health facilities. He believes that is the only way people can improve and build professionalism. That is why even in retirement, he is still carrying on with practice, playing his part by availing his skills and know-how, while at the same time encouraging his staff to put in their very best. There are certain things he cannot delegate, especially when it comes to patients who specifically request his service. His presence and hands-on approach play a key role because, in a way, it motivates the personnel to stay focused. A difficult sector Perhaps one of the reasons he cannot afford to stay away even in retirement is because he understands the dynamics of the health sector. He describes it as a difficult sector where heavy investment is required, not just in the facilities but also in medical equipment, which is currently costly on the international market due to inflation and other factors. For big facilities, incomes are very tight given the expenditure and the reinvestment required. In some cases, some hospitals have had to lay off staff or send them to retirement, while others are grappling with loan repayments. All these challenges, and more, keep him going. Total retirement is not guaranteed yet at this point. Keeping his father’s legacy alive One thing is for sure; Nyirinkwaya has been able to set aside time to do something worth doing in retirement – setting up the foundation and research center in Bugesera where he dedicates time to doing things that impact the society positively. Nyirinkwaya comes to the countryside to rewind and breathe fresh air. But most importantly, he comes to do work that will keep his father’s legacy going, now that he has fulfilled the call to follow in his footsteps. Nyirinkwaya heard many testimonies of the good deeds of his father, who was a doctor in Burundi, especially how he impacted lives, and he also thought he could do the same. His two-pronged initiative has a medical and agricultural aspect, where he is investing in research in herbal remedies, especially for preventive purposes when it comes to non-communicable diseases. The foundation also engages in activities to create awareness of sexual and reproductive health services, given the challenge of teenage pregnancies in rural Kamabuye sector and the country at large The father of four was hurt to see a young girl coming to ask for abortion services. In the media, it was mentioned how different districts in the country faced the challenge of teenage pregnancies. “I asked myself, why are very many young girls getting pregnant when we have family planning methods?” he posed. He intends to go to schools to talk to young boys and girls about the dangers of teenage pregnancy, as well as ways of accessing sexual and reproductive health services. He is focusing on fighting unwanted pregnancies through family planning means because, for him, prevention is better than cure. Young people are sexually active, he acknowledges, and teaching them how to prevent unwanted pregnancies intentionally can be more effective. Battling NCDs As part of his retirement plan, Nyirinkwaya also thought of doing something that would contribute to the fight against Non-Communicable Diseases (NCDs), especially cancer, which is becoming a heavy burden to the continent. “There is a big problem here in Rwanda, Africa, and the world - cancer. There is cervical cancer, breast cancer, gastro-colorectal cancer and there is prostate cancer. These cancers are killing many people today. “What can we do? Through the foundation we want to see how we can promote prevention through awareness,” he said, pointing out that prevention entails doing the right tests and scans for early detection. “We have to do something.” The foundation, which started in 2022 is investing in research in medicinal plants and pesticides, as well as natural remedies. He practices what is known as permaculture, the growth of agricultural ecosystems in a self-sufficient and sustainable way. The practice draws inspiration from nature to develop synergetic farming systems based on crop diversity, resilience, natural productivity, and sustainability. Marc d'Haenen, the Executive Secretary at Nyirinkwaya Foundation, said they are trying out lots of things so that by 2024, they have a fully-fledged research and agriculture centre where people can go to learn. Beyond macadamia, they plan to introduce new crops and add value through intercropping, while at the same time growing and testing medicinal, aromatic, and hermetic plants. Initially, they wanted the research and training centre to focus on those but people asked why they are not focusing on edible crops, which is why they added a section to the farm dedicated to the research of traditional Rwandan crops. “Visitors who came here kept asking us why there is nothing to eat here. So, we decided to start a new type of garden with everything that you can find on the Rwandan diet,” said Haenen, who is a herbal medicine specialist. Medicinal plants grown at the farm include amaranth, which helps people to increase hemoglobin, currently consumed by the surrounding communities, as well as artemisia, from which the antimalarial drug is manufactured. The idea is to give local communities seeds to start commercial farming of the plants, a plan which will transform the lives of many. Nyirinkwaya was born in Bubanza, Cibitoke Province, Burundi, in a family of seven siblings. He believes that beyond his work in the health sector, what he is doing now will also contribute to nation-building in one way or another, and that is a gift to his country.
