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Doug Fish, PharmD, reflects on teaching in east central Africa

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Author Staff | Publish Date February 10, 2009

Health care in Rwanda today is much like health care was in America 40 or 50 years ago. “In some ways it’s like taking a step back in time,” says Doug Fish, PharmD, chair of the Department of Clinical Pharmacy, of his recent teaching experience in the east central part of Africa.

As part of the University of Colorado’s Global Health Initiative, Fish spent two weeks conducting morning rounds, lectures and discussing cases with medical students and doctors at the country’s two teaching hospitals.

“It opened my eyes. The practice of medicine is both simpler and more complicated than in the United States,” says Fish.

Rwanda’s history is important to understanding its current situation. Pre-1994, Rwanda was a relatively stable country with a progressive health care system based upon the European model. Then, civil war broke out, wiping out the entire medical infrastructure and 800,000 people in 100 days.  “Doctors, students, professors – all gone,” says Fish. Essentially the country had to start over again.

Rwanda and its health care system are in the throes of rebuilding itself. Because of the lack of resources, medical practitioners rely on good clinical exams and are not as data driven.  In fact, there is one CT scanner in the entire country – serving nearly 11 million people. By comparison, there is one CT scanner for every 58,000 people in America. “What you might use here, they don’t have access to, so you have to rethink how you practice.”

“They are using drugs in first-line therapies that we haven’t used in decades,” says Fish. The reason – they’re cheap and accessible. Working primarily off of the World Health Organization’s list of essential medications, the government negotiates the best prices on the drugs they want, purchasing mostly from India and China. If the government can’t negotiate a deal, it will do without.

Without access to newer medications or advanced technology to make diagnoses and therapeutic decisions, Fish had to think differently. The entire experience kept him on his toes. “It’s not good or bad. It’s just how it is,” says Fish.

Today, 87 percent of the population has access to health care, but with only two doctors and two paramedics per 100,000 people, there is a long way to go. And experts like Doug Fish are helping Rwanda recover and rebuild much-needed knowledge and infrastructure.

“The goal of the professional exchange is to help Rwanda advance one step further and try to make improvements in how medicines are utilized and how people are treated. It’s not to bring Rwanda to the level where the U.S. is today.”

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