March 6-20, 2011 Thyroid, Cleft and Dental Missions to Gitwe, Rwanda

May 19, 2011

In March, MMFC traveled to Gitwe for the fifth time.  Dr. Jag Dhingra and his team performed  25 thyroidectomies. Under the auspices of the MMFC Dental Program, Dr. Alaleh Zadmehr performed dozens of dental procedures, several under general anesthesia and donated dental equipment allowing for the expansion of the services offered at the Gitwe Dental Clinic.  Dr. Dennis Snyder and his surgical team operated on 37 patients with cleft lip and palate deformities.

MMFC Executive Director Liz Desmarais was invited to meet with the Minister of Health in the capital city of Kigali to present the wonderful work being done at Gitwe Hospital, and to voice support for Dr. John Streit’s efforts to build Kigali Medical University and expand Gitwe Hospital into a teaching hospital. MMFC was the first international cleft organization to go to Rwanda five years ago to provide free reconstructive surgery. Appearing before the Minister of Health to recount MMFC’s history of surgery at Gitwe Hospital was a proud and humbling moment for MMFC.

MMFC would like to thank the following individuals and foundations whose financial support made this mission possible and provided much needed equipment for the operating room and dental clinic:  Dr. Jag Dhingra and Dr. Meera Mahalingam , the Hellman Family Foundation, the Smile Train, Inc. and Anonymous.

Dr. Alfred Mugenshuro and Dr. Faye Evans in Gitwe, Rwanda

One of MMFC’s volunteer team members is Dr. Faye Evans, a pediatric anesthesiologist at Emory University and Children’s Healthcare of Atlanta.  She is also an Assistant Professor at Emory School of Medicine.  Among her many humanitarian alliances,  Dr. Evans serves as an advisor to MMFC regarding its Global Education and Training Program. Dr. Evans can be reached at fmazo@emory.edu.

Dr. Evans and MMFC are both committed to fostering collaboration between visiting physicians on short-term surgical missions and local physicians and physicians in training especially in the areas of anesthesia and surgery.  In fact, during the fall 2010, Dr. Evans spent two weeks traveling in Rwanda under the auspices of The Harvard Humanitarian Initiative (HHI).  As a representative of HHI, Dr. Evans and her colleagues assessed the current surgical and anesthesia capacity, and measured the needs of the health system in Rwanda .  HHI is conducting this ongoing survey in 10 countries in east and West Africa.  The purpose of this effort is to inform the international community, including donors and humanitarian agencies, on the growing surgical services crisis and the need for physical infrastructure, education and training for surgical and anesthesia providers, adequate equipment and medications. The results of Dr. Evans’s work under the auspices of the Harvard Humanitarian Institute (HHI) will be published this fall in the World Journal of Surgery.

In March of this year, Dr. Evans traveled with MMFC to Gitwe, Rwanda to perform surgeries removing large goiters and correcting cleft lips.  Prior to the mission, Dr. Evans contacted the Rwandan Anesthesiology Residency director Dr. Theo Twagirumugabe to coordinate an opportunity to work with the Rwandan Anesthesiology Residency Program.  This four year program leads to a Master’s degree in Anesthesia and was established in Rwanda in 2006.  It is a collaboration between the National University of Rwanda and the Canadian Anesthesiologists’ Society and the American Society of Anesthesiologists Overseas Teaching Programme.    Each year 5 new residents are accepted into the program.  Dr. Evans and MMFC were fortunate to have Dr. Alfred Mugenshuro , a third year anesthesiology resident from the Rwandan program spend the first week working with the MMFC team.  It was an incredible experience for everyone involved.   After the trip, Dr. Mugenshuro wrote to Dr. Evans, “I have really appreciated to be with the team even if the time was too short. I have learnt some technical skills, but apart from that, I have also experienced your team work, empathy, situational awareness, etc.  Even if the next year I will be busy in preparing my final exam, let me be informed when you return to Gitwe, because I will be glad to work with you again.” MMFC and the Rwandan Anesthesia and Surgical residents will continue to work together on all future missions to Gitwe.

Dr. Andrew Patterson and Dr. Ana Crawford teaching Dr. Alfred Mugenshuro to use the glidescope.

The US Ambassador to Rwanda, W. Stuart Symington visited Gitwe Hospital during this mission to thank MMFC for its tremendous work in both caring for patients and providing needed education and training to Rwandan medical residents and other medical professionals.  It was a rewarding and exciting visit.Ambassador Symington  met with Olivier Urayeneza, MD, a native of Gitwe who is the son of Gerard Urayeneza, the individual who built Gitwe Hospital.  Dr. Urayeneza has been in the United States attending medical school and is now in his residency at Bassett Heathcare in Cooperstown, NY, US. He traveled back to Gitwe with MMFC during the March mission as a surgical resident. He will move back to Gitwe as a surgeon when he completes his training in the United States. He intends to use his knowledge and skill to help his homeland.

US Ambassador Symington and Dr. Olivier Urayeneza

Finally, we had the pleasure of having Amber Webb of Smile Train, one of the Rwanda mission sponsors,  visit Gitwe Hospital during cleft week. Ms. Webb delighted in meeting and spending time with so many of the children who received surgeries because of the financial support Smile Train provides.

Amber Webb, Smile Train Program Administrator is welcomed by the children of Gitwe

There were so many children and patients whose stories humbled all of us. Ms. Webb was particularly moved by Alice’s story and she recounts it for us here.

MMFC performed cleft lip surgery on Alice, age 12, in 2010 and her 4 month old son, Joshua, in 2011

“Last March, Alice Mukanyongera, walked eight hours with her mother to Gitwe Hospital from her village of Ruhango in order to have her cleft lip repaired.

A year later the two made the long journey again, this time with Alice’s four month-old son, also born with a cleft lip.

The two, strenuous journeys to the hospital were the least of the small family’s hardships though.

Now her mother’s only child, Alice at one time had been the proud older sister to three siblings, all of whom passed away. Her father, who, upon seeing her cleft lip, gave Alice the surname Mukanyongera, meaning “What God gives to you, you receive it; you do not change it,” is now in prison for genocide crimes.

Before her cleft repair last year, Alice had no friends, was called ugly, and was often referred to as inhuman. So when a young, male family friend showed interest in Alice one day before her cleft repair, she enjoyed the attention. As the day progressed he bought her beer and asked her to come to his home so he could tell her a secret. Alice went. It was then when Alice was raped and became pregnant with Joshua.

Although many people in the village has begun to gossip about Alice’s pregnancy, she refused to admit to her mother that she was with child. Finally, after becoming fed up with the rumors of her neighbors, Alice’s mother confronted her daughter. Overwhelmed, Alice was unable to speak so her mother cornered her in order to lift her shirt, revealing a 5-month pregnant stomach.

After discovering the pregnancy and the identity of the child’s father, Alice’s mother decided to confront the mother of her grandchild’s father, who also was her best friend. The father denied he was responsible for the pregnancy and said there could be many other potential fathers. His mother agreed, ending the friendship between the two families.

Four months later Joshua was born. Despite the circumstances surrounding Joshua’s conception and his cleft lip, mother and grandmother were happy to welcome the newest member to their family. Even months after his birth, Joshua’s grandmother’s eyes widen and her speech becomes loud and rapid when talking about him. Her lips, previously held in a sullen position immediately turn to a smile. When Joshua’s mother holds him she never takes her eyes away from her baby.

Now, a year after her repair Alice not only has many new friends, but also a family. She is happy that her son also soon have the same opportunities she is just now beginning to experience.”

And finally, a dedication and farewell … to our dear friend and devoted colleague, Greg Feldman, MD.  MMFC’s  mission to Gitwe, Rwanda in 2011 is dedicated to Greg who understood the Power of One  in  helping to heal.  A part of his spirit will always sleep in the land of a thousand hills.


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