Category Archives: Roper in Africa

The NUR Med School and the CDC

Today I had a very helpful meeting with Dr. Patrick Kyamanywa, the dean of the Faculty of Medicine of the National University of Rwanda. The med school is in Butare, where I will be in a few days, but he and I met in Kigali.

Patrick is a surgeon, with an active medical practice, who is now the acting dean of the med school. We shared insights about the opportunities and challenges of managing a school of medicine at a public university. He is very much a leader in the health sector of Rwanda, and works closely with the Minister of Health and others.

From him, as from others I have met, I gained important insights about Rwanda ? its past, present and future. He is a very impressive person in every respect.

Lunch with CDC Rwanda team

Lunch with CDC Rwanda team


Later I went to the US Embassy, where I met with the CDC team based there. About 30 CDC employees are assigned to Rwanda, and I got the chance to have lunch with a number of them, especially the Country Director for CDC-Rwanda, Dr. Pratima Raghunathan. She is a former EIS officer, who has been with CDC for more than ten years in a number of different assignments. She has been in Rwanda for two years.

CDC's global health mission has grown and developed very substantially since the time I was director (1990-93). In those days we had a global focus, and world-wide reach and impact, but it is now so much greater. With PEPFAR (The President's Emergency Fund for AIDS/HIV Relief) and other US government programs, CDC now has many more people and much more resources on the ground around the world, including here in Rwanda.

Ambassador Stuart Symington

Ambassador Stuart Symington

I was also able to see the US Ambassador, Stuart Symington, and to visit briefly with him. I am very proud of what CDC and the US Government more generally are doing in Rwanda.

Public Health and Health Care in Rwanda

Neonatal unit in CHUK

Neonatal unit in CHUK

Today I had the privilege of meeting with several health leaders here in Kigali.

I was introduced to them via my friend, Nathan Thielman, MD, who is a faculty member at Duke Med School. Nathan is an internist who does work in infectious diseases, HIV/AIDS, and global health.

I visited with two Ob/Gyn physicians with whom he is collaborating here in a project to lower Rwanda's maternal mortality rate. It is currently about 350 maternal deaths per 100,000 live births.

I met Dr. Stephen Rusila, who is head of research at the Central Teaching Hospital of Kigali. It goes by its French acronym, CHUK.

The med school in Rwanda is in Butare, where it is a part of the National University of Rwanda. In North Carolina terms, Butare is the smallish university town ? the Chapel Hill, and Kigali is the large, capital city ? the Raleigh, or even Charlotte. All med students get their basic science teaching in Butare, but a sizeable number get clinical training at the Central Teaching Hospital in Kigali, much like we send students for clinical rotations to AHEC sites across North Carolina.

I also met Dr. Janvier Rwamwejo, who is on the staff of King Faisal Hospital ? it is widely said to be the finest hospital in the country.

We talked about their project ? and the efforts to train mid-wives and other health workers to recognize problem pregnancies and to manage them or refer them.

The infant mortality rate in Rwanda is estimated to be 65 per 1000 live births this year. That is in the middle of the range of the various African countries' rates. By contrast, the US rate this year is between 6 and 7 deaths, before one year of age, per 1000 live births.

P1010969 Tomorrow I am meeting with the dean of the Faculty of Medicine of the National University of Rwanda, and the next day with the Minister of Health. This is proving to be a very enlightening and very pleasant visit.

I added some local beauty to my hotel room today ? I bought some flowers from the shop in the hotel lobby ? the arrangement is not nearly as attractive as those my wife does ? but it still brightens up the room!

I am now also posting photos to my Flickr page. You can see them here.

More at Shyira Hospital

Shyira Hospital


I spent two days at the remote and idyllic Shyira Hospital.

In many respects they lack much of what we take for granted in the US ? for example, they only have electricity for two hours each evening, when the generator is running.

But in other respects, they have so much that we lack ? peacefulness and even solitude. We went to bed shortly after the lights went out at 8:30pm, and got up before 6:00am, fully rested. The hospital starts its day at 7:00am.

Caleb King translating for me

Caleb King translating for me

Today, after morning report, I gave a talk, at the Kings' invitation. Caleb translated ? into French, which the staff understand. They also speak some English and everyone is fluent in Kinyarwanda, the national language.
I used a talk I gave a couple of years ago at Duke ? on spirituality and health. I think it all went fine.

Both yesterday and today we spent time rounding on the wards ? peds, adult medicine and obstetrics.

Will with a kindergarten class

Will with a kindergarten class

Today Will put together home-made Play-Doh, and taught the kindergartners how to make things. He is having a great time at Shyira.

This evening I left him there and returned to Kigali, where I'll spend the next couple of days.

Senate Finance Committee Chair unveils his plan

Last week, President Obama spoke to a joint session of Congress about health reform, and polling afterwards has shown an upturn in support for him and for his recommendations for overhauling health care in America.

Today, Senator Max Baucus, the chair of the Senate Finance Committee, unveiled his long-awaited proposal. I continue to believe the SFC will be the main focus of congressional action on this very important issue. Click here to download a pdf version of the proposal.

The Baucus plan is still being analyzed by all the pundits and policy wonks I plan to write soon about its details. But based on the summary I've read, I like it. I believe it is a serious effort to deal with the big issues we face in an honest fashion.

Our concerns about the cost of care, the lack of access due to uninsurance and the quality and safety of health care in America are very real and they deserve to be faced and dealt with in a comprehensive fashion. The American people know that a lot is up for grabs, and they want this done right.

On September 17th, I will be part of a press conference at the National Press Club in Washington, DC. Several of us will be speaking on behalf of a much larger group of people who have worked on these issues for a long time researchers, clinicians and other leaders. This group from across the ideological spectrum is urging the Congress and the President to work together to make the most of this opportunity to put right some basic problems in our health care system.

Here is a link to the letter and a partial list of those of us who have signed it: http://www.healthreformusa.com/petition/index.php

Also, the leaders of the four medical schools and academic medical centers in North Carolina have come together to put forward our recommendations on health reform. Drs. Victor Dzau from Duke, Paul Cunningham from ECU, John McConnell from Wake Forest and I wrote a letter, which we sent last week to Senator Kay Hagan and Senator Richard Burr.

We believe that the academic medical perspective on health reform is important to the national effort but it is especially important in North Carolina, given our major role in research, teaching the future health workforce, and caring for so many of our most vulnerable citizens. We will be working together to articulate these issues and concerns over the coming weeks.

This major national debate is now at full stage but it will go on for a while yet. In football terms, I'd say we are mid-way through the third quarter now.

Stay tuned much more to come.

Edward M. Kennedy a Personal Reflection

Today the news is filled with stories about the passing of Senator Edward Kennedy of Massachusetts from an incurable brain tumor. kennedy

During his almost fifty years in the Congress, Senator Kennedy has been a dominant leader in so many areas of our national life health and health care, education, civil rights, and on and on.

Twenty years ago, in the summer of 1989, as a mid-level member of President George H. W. Bush's White House staff, I was tapped to be the Administration's negotiator with the Congress for what came to be known as the Americans with Disabilities Act.

My chief counterpart in those negotiations was a person on Senator Kennedy's staff and across that summer I had many, many long meetings up on Capitol Hill. Some of those sessions included our bosses and there I was privileged to meet and get to know Senator Kennedy a bit.

I grew to admire him a great deal for his earnest commitment and tireless energy and focus. He was, and we were, ultimately successful, and the ADA is now the law of the land.

Of all the activities I have been involved with, across a number of government jobs, I am proudest of my work on the ADA.

Today I recall proudly and fondly my time twenty years ago and how I intersected briefly and in a small way with Senator Edward Kennedy.

He will be greatly missed.

Influenza H1N1 and other interesting sights


We had a very full day yesterday.

We spent the morning at the South Building of the University of Trujillo, meeting with the Rector (like our Chancellor) and others. He was about to receive an official delegation from the University of Guantanamo, in Cuba, and he invited us to join him for the meeting. The two heads of universities signed an official memorandum of cooperation, and we had lots of picture taking. There was a fair amount of light-hearted talk some of which I understood about President Obama and President Castro needing to do the same thing.

Then we went to one of the main teaching hospitals which was founded in the 1500s!

At noon about 200 faculty, students and administrators gathered and I presented my talk on influenza. With lots of help from Dr. David Weber at UNC, I talked about the overall scientific and epidemiologic context of swine flu, and then dwelt on what we are doing to prepare for the upcoming flu season scenario planning, stockpiling drugs and personal protective equipment, etc.

Given that Peru is in the Southern Hemisphere, they are already in the winter flu season. They are having some cases, but a large amount of concern that it will be much worse. Many people described what they think is happening as panic.

The large audience stayed long and I got lots of questions. Doug Morgan did a very impressive job of translating my presentation and then the Q&A period. It all flowed quite well.

I believe they are generally on the right track with their flu activities. I saw lots of posters and other communications designed to educate professionals and the lay public on what is happening in Peru with influenza.

In the afternoon we went to a nearby archeological site, called Chan Chan. It is a huge area perhaps 20 acres that was an adobe city in pre-Inca times. The walls of the city and the intricate buildings and other structures were really interesting.

Then we went to a place on the beach and watched surfers. The Pacific Ocean there has really big waves and great surfing.

A Visit with Dr. Bingu wa Mutharika

This week I had the privilege of visiting with Dr. Bingu wa Mutharika, the President of the Republic of Malawi. Irving Hoffman, who directs the UNC Project in Malawi, and I traveled to New York, and met with the President there. He was in New York City for the United Nations General Assembly.

At our meeting we described UNC’s long-standing and far-reaching activities in his country, including patient care, teaching and research efforts. I told him about my trip to Malawi in May and June of this year, and I gave him a copy of my blog entries that describe the visit.

He welcomed us warmly and told us of his desire to expand and deepen our partnership work.

I invited him to come to UNC and to North Carolina, so that we can show him our Carolina hospitality.

Global health surely involves governments and institutions, but fundamentally it is about people — people working together to improve the human condition.