Rwanda has an Electronic Medical Records (EMR) system that is used across the country – which is more than we can say for the US. Rwanda’s EMR was developed through a collaboration between the Ministry of Health (MoH) and Partners in Health/Inshuti Mu Buzima (PIH/IMB) and was designed initially to diagnose and treat those diseases with the biggest impact on communities such as HIV/AIDS and TB. Over time, the system has grown and now incorporates information on a variety of medical conditions. Adding data fields and patient encounter windows for tracking hepatitis throughout Rwanda takes teamwork between EMR specialists, clinicians and the health program managers who review EMR data. Imagine adding one data window to a medical record for one hospital in the US and you can picture the scope of incorporating new data into a country wide EMR system.
Part of the challenge in developing a surveillance system for hepatitis in Rwanda is understanding the interactions between Rwanda’s EMR system, the lab systems at the district hospitals and data capture from community events organized to screen for hepatitis B or C. What data is captured in a screening system, what data is captured in the EMR and what data just stays on paper in a patient’s chart? Getting a diverse team to align on these questions takes time and this is what I’m currently working on.
Did I mention that Rwanda’s EMR system is OpenMRS – https://wiki.openmrs.org/? If EMR systems interest you, you should check it out since it is an open source EMR product used in a number of countries. Open source EMR takes away the commercial vendor aspect of EMR, and possibly some of the difficulty of sharing data between different EMR systems. From the US perspective, a single, open source EMR system sounds pretty interesting.
School Health Program
Even though I’ve been focusing on hepatitis, I’ve had an opportunity to look across the myriad programs offered by PIH/IMB to strengthen health care in Rwanda. One of the programs I hope to be able to support is the School Health Program (SHP). The SHP is designed to help teachers and students recognize common health issues (malaria, malnutrition, STDs) and help to manage those health issues. A pilot of the SHP in 15 schools in Rwanda’s Eastern province has shown that teachers can effectively diagnose and begin malaria treatment, thereby helping children stay in school and helping parents understand their child’s health status. The program hopes to expand during the 2019-2020 school year.
Rwanda’s moniker is “Land of a thousand hills”. In the north of the country, some of those hills are volcanoes. It is on these volcanoes that the famous mountain gorillas live. You can get a permit and a guide to hike any of the volcanoes and a group of ex-pats at PIH suggested we hike Bisoke. Bisoke was the agreed destination because you could hike the mountain in a day and it was described as a “mild” hike. I obviously associated myself with the wrong hiking group, since “mild” involved 6-7 hours of very vertical, rocky and wet ascending and descending. The descending part meant that I spent a fair amount of time sliding on my ass, which did provide entertainment for the rest of my group. While challenging, the hike was a lot of fun and the misty hills, crater lake and descriptions from the guides were all worth the embarrassment of my descent.