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Yale Team Creates Rheumatology Curriculum in Rwanda

May 02, 2023
by Shin Mei Chan

When Joshua Bilsborrow, MD, MHS, assistant professor of clinical medicine (rheumatology, allergy & immunology) traveled to Rwanda in 2016 as a Yale/Stanford Johnson & Johnson Global Health Scholar, he recalls learning about a dire shortage of rheumatologists in the country.

“In the entirety of Rwanda, there was only one rheumatologist who practiced in the private hospital and was close to retirement,” he remembers.

Prior to that visit, clinical experiences as a medical student in Nicaragua and Guatemala sparked his interest in global health. As he completed his residency in internal medicine and fellowship in rheumatology at Yale New Haven Hospital, he began working on a global health education project with Richard Bucala, MD, PhD, Waldemar Von Zedtwitz Professor of Medicine (rheumatology) and professor of pathology, Yale School of Medicine, and of epidemiology (microbial diseases), Yale School of Public Health. Dr. Bucala had previously founded a program to enhance rheumatology training in Zambia, which had a similar shortage of trained rheumatologists as Rwanda.

In 2019, Bilsborrow and Bucala were awarded a grant from the International League of Associations for Rheumatology (ILAR) to create a rheumatology educational and workshop series for Rwandan internal medicine residents with the goal of increasing rheumatology knowledge among internists and to stimulate interest in pursuing rheumatology training. Historically, epidemiological studies have inadequately described the extent of the rheumatologic diseases that pervade Rwanda and as a whole, these diseases have been overlooked within the country. However, it is now becoming clear that many rheumatologic ailments that pervade high-income countries are also prevalent in low-and-middle-income countries like Rwanda, but that there are too few physicians to recognize these ailments and too few resources to effectively treat rheumatic diseases in particular.

In the wake of COVID-19, the in-person lecture series was converted into a longitudinal, virtual lecture series. The series, both organized and taught primarily by Bilsborrow, provides a core rheumatology curriculum to internal medicine residents in Rwanda so they may gain knowledge of the pathophysiology and clinical management of various ailments including osteoarthritis, infectious arthritis, osteoporosis, lupus, vasculitides, and rheumatoid arthritis. Additionally, skills-based workshops and small-group, problem-based-learning sessions are provided. Using program funding, the team has also purchased shoulder and knee models to be used for skills-based practice.

As the lecture series concludes, Bilsborrow hopes to gain as much feedback as possible to assess the impact and improve the program. He has also been learning a lot in the process, including adapting the lectures to best reflect current medical practices in Rwanda, such as the most effective treatments based on the availability of specific medications. Bilsborrow’s goal is to continually refine these lectures with improvements as a mobile rheumatology curriculum that can be reused and implemented in other countries lacking rheumatologists.

With optimism, Bilsborrow states, “We hope to continue to increase capacity and knowledge among generalists given the number of patients per doctor in Rwanda. Ideally, in the long-term, we can also potentially facilitate the training and education of rheumatologists at Yale who would then return to practice in Rwanda and other countries with limited resources for rheumatic disease patients.”

The Section of Rheumatology, Allergy & Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.

Submitted by Julie Parry on May 02, 2023