A glance into the life of Rwanda’s only neck surgeon

AFTER COMPLETING his medical course at Mbarara University of Science and Technology (MUST) in Uganda, Rajab Mugabo returned to his motherland to fulfill his other dream –to work at the King Faisal Hospital in Kigali. He was employed as a general medical practitioner amidst the challenges of the time, but Mugabo could never have asked for more. “While still in medical school, we used to come and work at the Military Hospital in Kanombe, but would occasionally come to work here at King Faisal,” he recalls. Whenever he went to King Faisal Hospital, he would be struck by the neatness and general sense of order that abound at the facility. So, together with three fellow trainee doctors at the time, they vowed to come back and find employment at the hospital after medical school. In October 2001, after completing his internship at the Mbarara Teaching Hospital, Mugabo found a job King Faisal. “King Faisal was quite better than all the other public hospitals I had been to. There was a lot of work, and we were just four general practitioners in the entire hospital [handling] emergency and inpatient cases. What saved the situation is that we worked as a team and as friends, since we had been to school together. If you had a problem, you were covered by a colleague. “As a general practitioner”, he recalls, “I knew very little about Ear Nose and Throat (ENT), both the medical and surgical bits of it.” Detour Mugabo’s initial excitement at working for his dream employer was soon put to test. At the time he and his colleagues joined, the hospital was in dire straits. It was in dire straits in the sense that it suffered an acute shortage of specialist medical personnel and equipment. “Our investigative capacity and that of treating patients was very low—which made the work even more difficult. At the time, King Faisal had no ENT specialist, no plastic surgeon, no neuro-surgeon, no urologist …. The only ENT surgeon in Kigali at the time was based at the Kigali University Teaching Hospital, so King Faisal was forced to employ foreign specialists from Uganda, Kenya and India, which was very costly.” With these new expatriate hands, the situation improved, especially with regards to handling complicated cases, but just a small bit, as Mugabo notes: “The expatriates that were brought to help the situation had no equipment to work with. On many occasions, they would go and hire equipment all the way from Nairobi, deal with cases and then fly the equipment back, which was very costly.” Eventually, things started looking up again around 2004, with the acquisition of more equipment like the CT Scan. “Real change started coming when our own local doctors started returning from studies abroad to practice at home.” One in a million Today, Dr Rajab Mugabo is one among only eight ENT specialists currently operating in the country, two of who are non-Rwandan. However, he is the only head and neck surgeon in the country. At the King Faisal Hospital where he works, his job title is Consultant ENT/head and neck surgeon. He describes head and neck surgeons as an “endangered species”, and explains why: “There is only one head and neck surgeon in Rwanda, one in Uganda, and one in Kenya. There is no head and neck surgeon in Tanzania, DR Congo and South Sudan. All head and neck surgeons in sub Saharan Africa were trained in South Africa. Actually, even South Africa itself has got no more than five.” Basically, he spends the better part of his working day dealing with ear, nose and throat complaints at King Faisal Hospital, and the rest of it performing head and neck operations at the Kigali University Teaching Hospital (CHUK). He states that “head and neck surgery is the fourth component of ENT”, about which he says: “the three (ear, nose and throat) communicate. The nose communicates with the ears and the throat, so diseases that affect one also have an effect on the others. Common ear ailments he handles on a day to day basis include accumulation of wax, ear pain, hearing problems, and dizziness. He says that ear complications are more prevalent among children below ten years, and the elderly (sixty five and over). For the nose, he deals with complaints like common cold, allergies of the nose, nasal breakage and congestion, bleeding and loss of smell, while the throat comes with such complications as; pain, difficulty in swallowing, and ulcers. Mugabo believes that his work is in a different league from other professional callings: “You become a confidante of the people. People put all their trust in you, and tell you all their problems, and as a doctor, you have to work hard not to let them down.” “Medicine is a calling, not a job, because it’s all about people’s lives. In this profession, we don’t measure success in terms of money made, but how many people you have helped live another day. A doctor may be rich, but still, you can’t treat this job as a business.”