Rwandan Minister of Health Urges International Partnerships During Visit to Georgetown

Posted in GUMC Stories

NOVEMBER 1, 2015 - The Honorable Agnes Binagwaho, MD, PhD, Minister of Health for Rwanda and distinguished pediatrician, spoke to the Georgetown University community on October 21 and emphasized the need for strong knowledge-sharing partnerships between American universities and developing countries. Her visit preceded a ceremony at the Institute for Health Metrics and Evaluation of Washington University, where she was given the David and Barbara Roux Price Award for her innovation in the application of data-based disease burden research in her country.

Throughout her presentation, Binagwaho showed the tremendous progress in Rwanda’s public health over the past 20 years, as well as areas still in need of improvement. Since the country endured a devastating genocide in 1994, Binagwaho and her colleagues in the Rwandan government have made remarkable strides toward achieving the United Nations Millennium Development Goals (MDGs). Four of the eight goals focus on health, calling for reduction of child mortality, improvement in maternal health, reversal of growth for HIV/AIDS and other diseases, and eradication of childhood hunger.

Achieving these milestones requires effective medical professionals trained by a high-class education system. Rwanda has had a sharp increase in the number of students enrolled in elementary school through high school, but professional training at the highest level is particularly important in increasing access to health care and improving the quality of health providers – two of Binagwaho’s top priorities.

“Our goal is to promote lifelong learning aligned with sustainable development goals,” she said. We need to increase [tertiary education] because the people enrolled there are the people who will teach our children.”

The graduates of these higher education programs will enter a multi-tiered, community-centered health care structure that is distinct from the hospital-based model of the U.S.Structured as a multi-tiered pyramid, the system in Rwanda provides services at the community, sector, district and province level.

“If someone gets sick at eight o’clock at night, they are not going to go to the hospital. They go to their community health worker,” said Binagwaho. “We’ve decreased the distance between services and need.”

SOCIAL CAPITAL AND PLACES FOR PARTNERSHIP

Binagwaho stressed her desire to maintain an “integrated, people-centered, sustainable health  care system.” According to her, this requires not only bringing health care to people, but involving them in its rebuilding.

“Money is not the problem – thinking is the problem,” she said. “Organization is the problem. We have to make people own what we do.”

It also requires acknowledging the importance and power of interpersonal connections. Community-based systems only work if community members trust one another.

“When we came back to the country in 1996, we were afraid,” she said. “The trust was ruined. That is an important lesson for the United States – the danger of divisions … We cannot let go of social capital.”

As Binagwaho illustrated, there are plenty of areas where other countries can learn from Rwanda. Over the past decade, it has dramatically decreased its childhood and maternal mortality rates and reversed the spread of infectious diseases. Quite strikingly, it not only retains more patients in HIV care than the United States, but it has achieved these gains while spending far less money on health care per person.

She also noted that the opportunity for learning goes both ways – Rwanda can benefit from collaborating with the U.S., specifically American universities.

“Where we can partner is research. Evidence is key,” she said. “When I present a policy to the ministry, I have to be able to back up what I say.”

Universities such as Georgetown aren’t just research institutions, however – they can also help developing nations by assisting with educational initiatives. Even as infectious diseases decline in Rwanda, the rise of other illnesses presents new challenges.

“Cancer is a nightmare,” Binagwaho said. “We don’t have the infrastructure. Many of our oncologists are still in school and won’t be trained for another two years.”

A GEORGETOWN CONNECTION

Fortunately, pre-existing relationships between Rwanda and Georgetown may help fulfill some of these research and education needs.

Anton Wellstein, MD, PhD, professor of oncology and pharmacology, is working with Rev. Jean-Baptiste Mazarati, a former PhD student from his laboratory, to spearhead a collaboration between Rwanda’s Ministry of Health and Georgetown Lombardi Comprehensive Cancer Center. After Mazarati completed his doctoral studies in Georgetown Lombardi’s Tumor Biology program in 2012, he was appointed Deputy Director of the National Reference Laboratory (NRL) at the Rwanda Biomedical Center. Now Mazarati wants to partner with Georgetown to bring the knowledge he received during his training in Wellstein’s laboratory to the scientists at the NRL.

“During his time at Lombardi, Mazarati learned a variety of molecular diagnostic techniques that he used to study how bone marrow cells can aid cancer growth and metastasis spread,” says Wellstein. “Our hope is to send some of our staff from Georgetown to his lab so they can teach those researchers these very techniques.”

If all goes according to plan, the collaboration will eventually expand beyond diagnostics training into other areas.

“I’m excited to pursue what I believe will be a mutually enriching partnership for both institutions,” Wellstein says. “These kinds of connections are important because they allow both sides to contribute their expertise and learn from one another.”

Binagwaho has personally worked with Georgetown by serving as a commissioner on the Lancett-O’Neill Institute Georgetown University Commission on Global Health and the Law, which seeks to identify ways in which law can be used to improve public health and safety. Commission co-chair John Monahan, senior advisor for global health to Georgetown University president John DeGioia, says Binagwaho was able to offer “practical and creative” insight by describing how she tried using the legal system to hold a company accountable for distributing 3 million substandard mosquito nets that led to an increase in malaria deaths.

Binagwaho’s vision is for these and future collaborations to benefit the Rwandan people as a whole. As she showed a slide outlining changes in health outcomes over the last several years, she highlighted a notable trend.

“The biggest gains are in the poorest people. That’s how I know I’ve done my job.”

Meghan Lasswell
GUMC Communications