Photo courtesy of Dr. Robin Petroze
Dr. Robin Petroze completed the first comprehensive
assessment of Rwanda's surgical system during her
By Arthur Allen
Not long after arriving in Rwanda for her Fogarty research fellowship, Dr. Robin Petroze got ready to email a survey of surgical capacity to each of the country's hospitals. Not a good idea, her Rwandan colleagues said - she'd never get good data that way. So, Petroze decided to use old-fashioned rubber-tire epidemiology. She rented a car and got a friend, a Congolese salsa dancer, to drive her to each of the 44 hospitals.
Luckily, Rwanda is a small country and her driver had a lead foot. Starting at 5 a.m. and usually returning the same day, she covered the entire country in a month. At a cost of less than $5,000, she completed the first comprehensive assessment ever of a nation's surgical system. "It was an adventure and amazingly educational, and it helped me integrate into the surgical staff, because my colleagues were more respectful after seeing me taking the time to see their country and its system," she said.
Fogarty's Global Health Program for Fellows and Scholars provides one-year, mentored clinical research experiences overseas for postdoctoral Fellows and pre-doctoral Scholars. Petroze joined a growing number of participants with interests outside the traditional infectious disease realm.
Rwanda's surgical community found Petroze's study - coauthored with three Rwandan colleagues including her local mentor, Dr. Georges Ntakirayuta - to be enormously helpful. So did surgeon Dr. Atul Gawande, who wrote in the British Journal of Surgery that the survey marked "a major leap forward" in efforts to strengthen surgery in underserved countries.
Poorer countries have barely a fraction of the surgical services of more developed lands. The study found just 124 operating rooms, 45 full-time surgeons and 12 anesthetists in Rwanda, a nation of 10 million. That's about one-fortieth the number of surgeons recommended by research studies. The study provides a baseline that indicates how Rwanda's surgical care needs to expand.
After spending 2010-2011 in Rwanda on the Fogarty fellowship, Petroze decided to remain another year, supported by the University of Virginia, where she is now completing her residency. This allowed her to continue helping build a surgical research infrastructure, with the development of a trauma registry that tracks all patients entering emergency rooms at the country's two university teaching hospitals. In 2011, she helped organize a meeting to harmonize the country's surgical agenda with regional and international partners.
A native of northern Kentucky, Petroze had always been interested in global health. During her medical studies she volunteered with a mission organization performing surgeries in the Dominican Republic and a project providing health care to remote Tanzanian communities. Her research agenda in Rwanda, Petroze said, evolved from a list of priorities developed by the Rwandan Health Ministry and surgeons from the National University of Rwanda.
"The biggest benefit of the Fellowship is building relationships," she said, and learning to navigate among the various government, civil and international groups in a landscape where research faces severe challenges - cultural and language barriers, poverty and simple road access.
The experience deepened Petroze's belief that building local capacity is key to improving health outcomes. "If you treat someone for HIV for 20 years and they are in a car accident and no one is available to repair their broken leg, are you really servicing the community's needs?" she asked.
"Before doing this fellowship I knew I wanted to do international health, but now I know that it is my focus," said Petroze. "The field of global surgery really is just developing, and I definitely want to have this international, collaborative educational focus as I move on."