Journey Through Residency in Rwanda: An Emergency Physician’s Story

By Destry Jensen, MPH, on behalf of the SAEM Global Emergency Medicine Academy

Emergency medicine training is relatively new in many African countries, but the specialty has rapidly developed across several regions, allowing those interested in medicine to pursue specified training in the field. This was so for Dr. Kamunga Badibanga Laurent Gamy, who started his medical career as a primary care physician in the Democratic Republic of Congo, and then chose to specialize in emergency care.

Dr. Kamunga has always held a passion to pursue medicine, explaining, “I think it was something I was called for — my destiny or something I was meant to do.”

In his secondary education, Dr. Kamunga felt the most comfortable in biology and chemistry courses, which first piqued his interest in medicine. He completed medical school, then worked as a general practitioner in the Congo. After a few years, he moved to Rwanda to continue his practice. While working as a general practicioner in Rwanda, the country’s first emergency medicine training program was started. Dr. Kamunga was interested in emergency medicine, as general practitioners often worked with emergency conditions in the Congo due to limitations in emergency medicine as a standalone specialty within the country. While watching the development of the program, he saw specialized emergency training as an advantageous step in his career and a way to improve his skills.

The emergency residency in Rwanda is a four-year training program for those who have graduated from medical school, consisting of weekly academic lectures, written exams, simulation learning, rotations to various emergency departments and the intensive care unit (ICU), and research requirements. Rigorous research requisites include a quality improvement project during the second year of the program and a publishable quality thesis project during the last year of residency. Graduation is awarded to those who pass an extensive written exam, an Objective Structured Clinical Exam, case simulation examination, as well as a thesis defense that includes both a written portion and an oral presentation.

Concerning the most challenging aspect of residency: “You do everything under pressure, which can be beneficial because you are forced to learn self-control, responsibility, decisionmaking, and how to best respond to circumstances quickly.”

— Dr. Kamunga

Dr. Kamunga then described the contrast between his experience in general medicine and emergency training, explaining that during residency he had higher expectations from faculty and seniors while having to master both academic knowledge and applied skills. He further explained that because emergency medicine is a new field in Rwanda, there is consistent pressure within the department to define what the specialty entails to other departments within the hospital.

Despite such challenges, Dr. Kamunga gained valuable skills and knowledge during his years of training. He explained that as a resident, he learned to be flexible, compliant, reliable, and responsible. As he ruminated over his time in residency, Doctor Kamunga thought of a quote written on a wall in the emergency department of the University Teaching Hospital of Kigali. The words “think quickly, perform well, and save a life” are printed across the old tan paint of the trauma room where critical patients are kept. He explained every time he received a critical patient, he told himself that if he thought quickly and performed well, he could save a life. He would often go home thinking that despite the stress and pressure of the emergency environment, he was able to save lives. Dr. Kamunga shared, “every day that I went home and was able to say to myself ‘I saved a life’ was a good day.”

The emergency medicine training residency in Kigali, Rwanda also incorporates international colleagues and frequent global collaboration. Dr. Kamunga explained that during the establishment of the residency, several faculty came to Kigali from overseas to lead trainings. This is not an uncommon phenomenon when instituting a new medical specialty, especially in Eastern Africa, where novel medical practices often seek to establish a sustainable ‘train the trainer module’ where graduates can teach future trainees. While the emergency residency was developed in Kigali, Doctor Kamunga observed as a general practitioner. He saw residents being trained and graduating to attending emergency doctors. He was encouraged by the faculty to join the program and is grateful for the decision to do so. He expressed gratitude for such encouragement and detailed that he has continued on Page 35

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While emergency medicine practices and training differ in various regions globally, the COVID-19 pandemic has a strenuous impact on all emergency care providers across every corner of the world. Countless records detail the mass global morbidity and mortality caused by the disease, often hitting hardest in emergency care settings. Doctor Kamunga strongly felt such hardships, despite organized and strict lockdown regulations by the Rwandan government. While impacting patient volume and case severity within the emergency department, the pandemic also had numerous ripple effects. One such effect was that Laurent was the only person in his cohort, as he began residency during the onset of the pandemic; however, he felt very supported by faculty and senior residents. With such encouragement Laurent completed his first year of residency; however, during his second year the pandemic was still strongly impacting global health systems. Despite this, the emergency residency continued in Rwanda which caused stress for students and faculty. He explained that several physicians, including himself, saw a lot of suffering and death. This time caused Laurent to question himself, often asking “what am I doing?” Such hesitation and timorousness were undoubtedly pervasive for countless health care providers across the world during the spikes of the pandemic. Despite this