report of shyira hospital hernia training course, … · inguinal hernia repair 15 umblical hernia...
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RELIGIOUS-BASED ORGANIZATION Headquarter office: Kigali Sector, Nyarugenge District, Kigali City.
Telephone 0788300639
Email: [email protected], [email protected]
Website: rwandalegacyofhope.com
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https://www.youtube.com/watch?v=XZk1o_T-ubc&app=desktop http://www.kigalitoday.com/ubuzima/ubuvuzi/article/abaganga-babaga-umutwe-bazahajwe-n-akazi-kubera-ubuke-bwabo https://www.youtube.com/watch?v=FEZ9FAbHflY&app=desktop http://mobile.igihe.com/amakuru/u-rwanda/article/kicukiro-abagiraneza-bagobotse-abaturage-barenga-400-batagira-ubwiherero
TABLE OF CONTENTS
SECTION CONTENT PAGE
INTRODUCTION .................................................................................................. 2
ACHIEVEMENTS ................................................................................................. 2
2018 MISSION...................................................................................................... 4
SHYIRA HERNIA TRAINING ............................................................................... 5
FEEDBACK FROM LECTURES .......................................................................... 5
IMPROVEMENT IN OVERALL KNOWLEDGE .................................................... 6
IMPROVEMENT IN KNOWLEDGE OF ASPECTS OF HERNIA SURGERY .......... 6
% IMPROVEMENT IN KNOWLEDGE .................................................................. 7
ASSESSMENT OF COMPETENCE .......................................................................... 7
CASES PERFORMED .............................................................................................. 8
SUCCESSES ............................................................................................................ 8
CHALLENGES .......................................................................................................... 9
RECOMMENDATION FOR SHYIRA HOSPITAL ................................................. 9
ENT INTRODUCTION AND CASES PERFORMED .......................................... 10
ENT RECOMMENDATION ................................................................................ 11
NEUROSURGERY INTRODUCTION AND CASES PERFORMED .................... 12
NEUROSURGERY RECOMMENDATIONS ....................................................... 13
ACKNOWLEDGEMENT AND GRATITUDE ....................................................... 14
ANNEXES ........................................................................................................... 15
COMBINED REPORT
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1. INTRODUCTION
1.1 This is a combined report on RWANDA LEGACY OF HOPE / OPERATION HERNIA Mission
to Rwanda from March 16-25, 2018. This report will summarise the activities of the 3
specialties in the Team: Hernia Training, ENT and Neurosurgery.
1.2 Detailed Specialty Report
The detailed Specialty reports will be attached to this combined report as Annexes A, B, and
C.
1.3 The RWANDA LEGACY OF HOPE and OP HERNIA Partnership has served the people of
RWANDA in the health sector for 6 years. We are thankful and honoured to be given the
privilege to serve the people of RWANDA. We would like to express our sincere gratitude to
President Kagame for the welcome we have always received in the country. We would also
like to thank Hon Diane Gashumba for her personal support and for the for the unparalleled
support that we receive from the Ministry of Health. In the Acknowledgement section I will
list all the individuals who have helped us achieve the successes we have recorded.
2. Achievements Over Past 6 Years
The health sector of RLOH has celebrated the following successes since our first visit in
2012.
2.1. Hospitals Visited: We have worked in the following 8 Hospitals: NYAMATA, Remera-
Rukoma, GAHINI, Kibogora, Kigeme, Rwamagana, CHUK and now, SHYIRA Hospital on 48
occasions
2.2. Patient Numbers: We have offered essential, surgery to over 800 patients.
2.3. Volunteers: There have been over 100 volunteer episodes. Volunteers have come from
mainly the UK and GERMANY but also from Austria. Each of the volunteers have funded
their flights to RWANDA. In the early years they also paid for accommodation and
subsistence. Since 2016 the Min of Health has magnanimously sorted out the logistics of our
stay in Kigali. We are extremely grateful. We have always been catered for in the districts
hospitals.
2.4. Surgical Specialties: Our early missions concentrated on Hernia Surgery. We have now
expanded our remit to meet the needs of the Rwandan people. Our later missions have
therefore included Plastic Surgery, Orthopaedics and ENT Surgery. This year has been
ground breaking. For the first time we have a Neurosurgical team. All these specialist teams
have worked at CHUK.
2.5. Provision of Hospital Equipment: RLOH has provided Rwandan Hospitals with
equipment worth over £200.000 (RWF 230 million). The equipment ranges from routine
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Surgical instruments to theatre tables and air conditioners fitted in theatre. In 2016,
one theatre in Rwamagana was equipped as a training centre.
2.6. Training of Junior doctors: Training is now a major plank of RLOH mission. It builds
capacity for delivery of surgical services. We have trained local doctors in every district
hospital we have worked in. In 2016 we had our first specifically organised Hernia Course.
This comprised a series of lectures to provide a theoretical basis followed by intensive one
to one training in theatre. In 2017, we were invited by CHUCK to train their first-year
surgical residents in Hernia Surgery. 13 surgical residents were successfully trained.
We have followed that up with a similar course at SHYIRA Hospital on this mission. It is
hoped that we will return in 2019 to CHUK to train the next batch of surgical residents.
3. 2018 MISSIONS
Two missions have been scheduled for this year- March 2018 and September 2018. The
former has involved ENT, NEUROSURGICAL and GENERAL SURGICAL TEAMS. The September
mission will involve Plastic Surgery and Orthopaedic teams.
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4. MARCH 2018 MISSION The just concluded March 2018 mission comprised 3 teams. CHUK welcomed one ENT
Consultant and a Neurosurgical team which included 1 Consultant Neurosurgeon, a
consultant Anaesthetist and a Neurosurgical senior Theatre nurse. The third team was a
hernia team that went to SHYIRA HOSPITAL. It is our first mission to northern RWANDA. The
team comprised 2 consultant Surgeons, a consultant Anaesthetist and a theatre nurse.
5. The Teams
Table 1
NAME DESIGNATION TEAM
1 Mr Chris Oppong Cons Surgeon HERNIA
2 Mr David Sedgewick Cons Surgeon HERNIA
3 Dr Peter Stoddart Cons Anaesthetist HERNIA
4 Leah Thorpe Nurse HERNIA
5 Mr Samiul Muquit Cons Neurosurgeon NEUROSURGERY
6 Dr Lorenzo Dimpel Cons Anaesthetist NEUROSURGERY
7 Della Ball Nurse NEUROSURGERY
8 Miss Kate Heathcote Cons ENT Surgeon ENT
9 Dr Ella Bennett Medical Student Self-Funded
Accommodation
6. Hospital Equipment
Every year RLOH / OP HERNIA donates equipment to the various hospitals we visit. I would
like to acknowledge the support we have had from the Ministry of Health with customs
clearance. This year’s equipment is worth £8919.71 (RWF 10, 211, 476.54). This comprised 6
sets of Hernia surgical Instruments, Neurosurgical Instruments, Anaesthetic drugs and
Anaesthetic equipment. I have attached the full list as Annex D
7. Accommodation, Food and Transport
The team had excellent accommodation. The team was very well looked after. The food was
of top quality and transportation was good. We would like to record our deepest gratitude
to The Government of Rwanda and to the Ministry of Health for the extremely generous
hospitality
7. SUMMARY OF SPECIALTY REPORTS
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3.6 3.8 4 4.2 4.4 4.6 4.8
1
2
3
4
5
6
7
8
9
10
7.1 SHYIRA HERNIA COURSE AT SHYIRA HOSPITAL I would like to commend the Director General of Shyira Hospital, Dr Theoneste
Rubanzabigwi, for organising a successful training course for both the Trainees and the
Trainers.
6 doctors were selected for training. 2 withdrew. 4 doctors were enlisted for the training
programme which consisted of the ff:-
1. Lectures on relevant aspects of Hernia Surgery ( 1 Day)
2. Intensive 5-day hands on practical training in theatre.
The published OPERATION HERNIA TRAINING FORMAT was used for the hands-on theatre
training. This has been used at CHUK in 2017 and has been used on two COSECSA Training
courses. At the end of the course the competency of the 4 trainees were assessed by the
Trainers using the Competency Assessment tools used by the Royal Colleges in the UK
8.0 Feedback from lectures
Feedback from the lectures was very good as shown in Fig 1.
Scores ranged from 76% to 91%
Fig 1
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10
5
0 ANATOMY OF
GORIN IMPORTANCE
KNOWLEDGE OF NERVES ABOUT MESH PAEDIATRIC
HERNIAS
Column1 POST
PRE
PRE POST
TISSUE HERNIA
REPAIR LOCAL ANAESTHETIC
INFILTRATION
9. RESULTS: ASSESSMENT OF KNOWLEDGE OF HERNIA SURGERY
An assessment of the knowledge of the trainees on the various aspects of hernia surgery was
carried out before and after the lectures. Overall scores improved from 4 to 8 Assessment of
knowledge of specific hernia surgery topics also produced similar significant improvement.
Fig 2
Overall Assessment of knowledge of hernia repair
Fig 3: Knowledge of Individual Aspects of hernia Surgery Pre and Post Course
This shows the detail of the responses
10
8
6
4
2
0
PRE POST
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Fig 4
Percentage Improvement in Knowledge of Hernia Surgery
10. ASSESSMENT OF SURGICAL COMPETENCE OF TRAINEES BY TRAINERS
At the end of the 5 days of training, the competence of the trainees was assessed. The
assessment tools developed and employed by the UK Royal Surgical Colleges were adopted
for this training programme. The 4 trainees were assessed as follows: -
Table 2: Trainers Assessment of Surgical Competence
LEVEL COMPETENCE Small
hernias Large
Hernias
Level 1 Unable to Perform procedure 0 0
Level 2 Able to Perform Aspects of the procedure 0 1
Level 3 Able to Perform Procedure with Supervision 1 2
Level 4 Able to Perform with minimal supervision / Occasional
Help
2 1
Level 5 Able to perform independently 1 0
10.1. COMMENT ON TRAINEES’ COMPETENCE
1. At the end of the programme, all trainees were able to perform mesh hernias repair of
small hernias with various degrees of supervision. One trainee was judged able to perform
hernia repair without supervision. This is a major achievement because the majority had no
personal experience of Hernia Surgery
1000
500
0
73 100 181 372 482 550
ANATOMY IMPORTANCE
OF NERVES SHOULDICE
KNOWLEDGE
% INCREASE REPAIR
OF MESH PAEDIATRIC
REPAIR HERNIAS LOCAL
ANAESTHETIC
INFILTRATION
% IN
CR
EA
SE
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11. OPERATIONS PERFORMED AT SHYIRA HOSPITAL
Total Number of Cases: 32
Total Number of Children: 15 (47%)
Table 4 Operations Performed
OPERATION NO OF CASES
INGUINAL HERNIA REPAIR 15
UMBLICAL HERNIA REPAIR 2
HYDROCOELE OPERATION 13
MISCELLANEOUS OPERATIONS 2
TOTAL 32
12 AWARD OF TRAINING CERTIFICATE OF PARTICIPATION
Certificates were awarded to the Trainees at a closing ceremony.
13. SUCCESSES
1. Training in Hernia Surgery: 4 doctors in district hospitals have been trained by
experienced Consultant surgeon Trainees to a high standard of competency. The majority
had no personal experience of hernia surgery as already documented. When they are well
established will reduce the number of referrals of groin hernias to CHUK
2. Training in Basic Surgical Skills: Knot tying
3. Service to Patients: 32 patients including 15 children have has surgical operations for which
they would have been referred to CHUK for surgery
4. Good Feedback: Very good feedback from Trainees regarding Hernia Lectures and Theatre
Training.
5. Improvement in Theatre Safety: The UK theatre nurse, Leah Thorne, introduced theatre
staff, to
5.1. Time and Theatre management
5.2. Theatre safety measures, which were adopted by theatre staff: -
WHO Safety Protocol
Instrument Counting.
Handling of Sharps
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14. CHALLENGES
1. Breakdown of Autoclave.
The theatre autoclave broke down during the training week. This undoubtedly hampered the
training of doctors. The industry of the theatre lead nurse enabled us to use a mini autoclave
for the rest of the week
2. Availability of Nurses
There are inadequate numbers of nurses on the wards, particularly, at night. This affects the
safety of patient in the postoperative period. This was worsened when ward nurses were
drafted to support theatre staff for the Training Programme.
15. RECOMMENDATIONS FROM HERNIA TEAM AT SHYIRA HOSPITAL
1. Further Training
Further training will improve competence levels. It is therefore proposed that a subsequent
course be organised for the trainees. Operation Hernia has provided pre-sterilised affordable
polypropylene mesh for further training. This will help upgrade their competence to level 5
competence.
2. To Increase Nursing Staff Numbers
3. Theatre Facilities: Air Pump should be introduced into Theatre. This will reduce the
constant use of Oxygen system which is expensive and potentially harmful to patients
undergoing general anaesthetic
4. Regular Maintenance of Autoclave. This will avoid the unfortunate breakdown which did
adversely affect the training.
5. Maintain the New Theatre standards: Theatre staff should maintain the new safety
measures they have learnt.
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16. ENT SURGERY AT CHUK 16.1 Introduction
This is the second ENT RLOH Mission to CHUK. The mission was undertaken by Dr Kate
Heathcote, UK ENT Consultant Surgeon. We did not have on the mission dedicated ENT
Anaesthetist and Theatre nurse.
The full report is attached as Annex B. The reports will be provided to the local ENT team,
the head of Surgery and the CHUK Medical Director.
Dr Heathcote assessed the patients before their operations and has made some very
important observations which will help improve the CHUK ENT service.
A lot of very complex cases were performed. Several cases lasted several hours and the
team always left theatres very late. Apart from the complexity of the cases, there were
several other important factors which led to prolongation of theatre time.
16.2 Theatre Cases
No of cases: 10: Most Cases were complex Major
The magnitude of the work done in these ENT cases should not be assessed by the sheer
NUMBER of cases done. What should be considered is the complexity of cases and the
experience and skill of the surgeon. Dr Kaitesi’s departure has impacted the ENT
department significantly.
DIAGNOSIS OPERATION COMMENT
1.Laryngeal Tumour Laryngectomy, bilateral neck
dissection and right
hemithryoidectomy
Required re-staging preop
2.CSOM with Cholesteatoma Left Radical Mastoidectomy Erosion of Cholesteatoma
3.Tracheal Tumour Direct laryngoscopy and
endoscopic debulking of
tracheal tumour
1.Lack of appropriate
instruments
4.Tracheal Stenosis Endoscopic balloon dilation of
tracheal stenosis
5.CSOM with
Cholesteatoma
Right Radical Mastoidectomy Extensive disease. Erosion of
Facial Nerve. Previous Meningitis
due to disease
6.Requiring Tympanosplasty Tympanoplasty converted to
Radical Mastoidectomy 1. Undiagnosed Cholesteatoma
2. No pre-op CT
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7. Aspergilloma of the
Sphenoid sinus
Endoscopic Sinus Surgery for
Aspergilloma No Microdebrider available
8.Tracheal Stenosis Balloon Dilation 1.Appropriate Laser instrument
unavailable at CHUK
9.Laryngomalacia causing
difficulty in breathing
Aryepiglottopexy. Premature born
10. CSOM with
Cholesteatoma
Right Radical Mastoidectomy 1. Erosion of bone.
2. Facial Nerve exposed and
inflamed.
16.3 Crucial Observations and Recommendations from ENT 1. There is a lack of experience in the senior ENT staff at CHUK, this has been exacerbated by
the recent departure of their most experienced surgeon. The abilities of the senior doctors
naturally dictates the effectiveness of the department as a training centre for junior doctors
and medical students. As the University Hospital in the capital city, the capabilities of the
senior doctors is fundamental. Investment in their training should be of the highest
consideration.
2. There is a shortage of quality instruments, microscopes, lasers, and microdebriders required
for high quality, advanced ENT surgery.
3. The operating table is inadequate for long procedures
4. The intensive care unit is not experienced in the care of major head and neck cases.
5. Post operative care is sub-optimal. The supply of free tracheostomy tubes is minimal. The
patients have to buy their own intraoperative and post-operative medication and topical
drops/ointments. There is no service for speech rehabilitation with valves or servox devices
after laryngectomy.
6. The aim of a radical mastoidectomy is to get rid of the cholesteatoma disease that causes
destruction of local structures with a risk of facial palsy, hearing loss, vertigo, meningitis,
septicaemia and intracranial abscesses. Once the disease is cleared the resultant cavity
needs regular cleaning. I am not confident that this will occur.
7. There was a shortage of qualified anaesthetists.
8. There is no culture of using scrub nurses to assist surgeons. This would make the surgery
faster.
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17. NEUROSURGERY AT CHUK
17.1 Introduction
We are very proud to record that this is the first Neurosurgery RLOH Mission to CHUK. The
mission was undertaken by Mr Sam Muquit, Consultant Neurosurgeon, Dr Lorenzo Dimpel,
Consultant Anaesthetist and Della Ball Senior Neurosurgery Theatre Sister.
The full report is attached as Annex C The reports will be provided to the local
Neurosurgical team, the head of Surgery and the CHUK Medical Director.
17.2 The Local Team and Their Huge Workload
The RLOH team worked with 2 CHUK Neurosurgeons, Dr Muneza and the recently appointed Dr
Hitimana. “The two neurosurgeons are highly skilled and provide the full spectrum of neurosurgical
procedures in adults as well as children”. They however have an impossible work load because they
serve the whole of Rwanda. They are therefore limited to operating on mostly emergency cases. This
has led to a mounting waiting list. Some patients have developed complications from their brain
pathology whilst waiting on this long waiting list. The RLOH Mission was therefore an invaluable
opportunity to help desperate patients with Brain pathology.
17.3 Intensive Care
Overall, the intensive care department provided an excellent level of post-operative care.
17.4 CASES
Like the ENT cases, numbers of cases were not great. This is because the Neurosurgical
cases, like ENT cases, were very complex. Given the complex nature of the cases each
operation took between 8 and 10 hours.
17.5 Total Number of Cases: 5
One case performed per day because of the duration of Operation
DIAGNOSIS OPERATION COMMENT
1.Large tuberculum sellae
meningioma causing
compression of optic chiasm
Right pterional craniotomy for
resection of tuberculum sellae
meningioma
Patient presented with Acute
Loss of Vision
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2.Large cerebellopontine
tumour was causing
compression of the left
cerebellar hemisphere and
brainstem.
Left retrosigmoid craniectomy
for resection of tumour
Extension to compress the left
cerebellar hemisphere and
brainstem. Pt unable to stand
unaided or walk.
3.Large right vestibular
schwannoma
Right retrosigmoid
craniectomy for debulking of
vestibular schwannoma
Cerebellar and brainstem
compression.
4. Pituitary adenoma Left pterional craniotomy for
resection of giant pituitary
adenoma
Acromegaly
Recurrent Large Pituitary
Tumour
Redo left pterional craniotomy
for debulking of tumour
Extension into the suprasellar
cistern, with compression of the
optic chiasm and left optic nerve.
17.6 Crucial Observations and Recommendations from NEUROSURGICAL TEAM
1. Improvement In Pre-Visit Communication
Before the mission communication between myself and Dr Muneza was easy and clear. An
improvement for future mission may be to exchange scan images, allowing for more precise
planning of surgical time. A challenge to this is that patients carry ‘hard copies’ of their scans, which
are not available on a computer PACS system.
2. Improvement of Theatre Access
Easier daily access to theatre for the neurosurgical team in CHUK would help management of
emergency cases. This may result in fewer elective case cancellations.
3. Early surgery To Avoid Severe Complications
Early surgical treatment of neurosurgical conditions, before development of severe neurological
deficit will result in a better post-operative prognosis.
4. Better Anaesthetic Support.
Anaesthetic support for complex neurosurgical cases with consultant anaesthetist support would
reduce risks of complications during surgery.
5. Essential Neurosurgical Instruments
Availability of a second Mayfield head rest and microinstruments would make surgery safer and
more efficient. A second operating microscope would allow efficient concurrent running of two
neurosurgical theatres.
6. Improve Theatre Doors
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Finally, a very simple recommendation: Installation of operating room doors which can be closed
may reduce the risk of post-operative infections.
18. ACKNOWLEDGEMENT AND GRATITUDE
1. Dr Diane Gashumba , Minister of Health for officially inviting the RLOH team and seconding
Dr Colonel Zuberi Muvunyi, Director General of Clinical and Public Health Services and
Nathalie Umutoni, Director of Health Policies and Regulation. Min of Health. to assist, support
and advice the RLOH team.
2. Dr Théoneste Rubanzabigwi for organising a very successful Training Workshop.
3 The Government of Rwanda arranged Medical and Nursing Registration for the RLOH
Medical Team.
4 The Government of Rwanda waived all Custom and Clearance costs for medical equipment
imported by RLOH
5 The Government of Rwanda provided high quality accommodation for RLOH team during
their stay in Kigali. Shyira provided very good accommodation for the Shyira team
6. Other Acknowledgement
1 Dr Colonel Zuberi Muvunyi Director General of Clinical and Public Health Services
2 Dr Nathalie Umutoni, Director of Health Policies and Regulation. Min of
Health. Rwanda
3 Dr Theobald Hategekimana, Medical Director, The Univ Teaching Hospital, Kigali.
Rwanda (CHUK)
4 Dr Martin Nyundo Deputy Director, CHUK
5 Dr Faustin Ntirenganya Head of Surgery, CHUK
6 Dr Isaie Ncogosa Head of ENT, CHUK
7 Dr Muneza Severien Head of Neurosurgery ,CHUK
8 Dr Hitimana Cons Neurosurgeon
9 Dr Théoneste Rubanzabigwi Medical Director, SHYIRA Hospital
10 All Anaesthetists CHUK and SHYIRA HOSPITALS
11 All Theatre Staff CHUK and SHYIRA HOSPITALS
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13 All Admin and Lab Staff CHUK and SHYIRA HOSPITALS
14 All Drivers CHUK and SHYIRA HOSPITALS
15 All Kitchen Staff CHUK and SHYIRA HOSPITALS
18. ANNEXES
The documents in the Annexes are provided separately.
ANNEX A
Full Hernia Training Report From SHYIRA
ANNEX B
Full Report ENT Report from CHUK
ANNEX C
Full Neurology Report From CHUK
ANNEX D
Hospital Equipment for Shyira, and CHUK
ANNEX E Report for Mituelle
ANNEX F Report for Sport
ANNEX G
Report for toilet roofs
ANNEX H
Report for Opening free Computer & Internet homework Club for school children
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Report for Health Insurance (Mituelle)
Report for Rwanda Legacy of Hope Sport
Rwanda legacy of hope donated Heath insurance of 190 people in March 2018 120 people from Nyarugenge
District and 70 from Gahanga sector Kicukiro District
BACKGROUND CHARACTERISTICS OF STREET CHILDREN IN RWANDA ACCORDING NATIONAL COMMISSION FOR
CHILDREN (NCC)
Socio- demographic profile of street children This chapter provides a socio-demographic profile of street
children interviewed during the study on the situation of street children in Rwanda carried out in 11 districts.
Rwanda Legacy of Hope has started sport activities to help this children and young people our strategy for
sport is that “ all young people and children participate in sport can improve the quality of life of individuals
and communities, promote social inclusion, improve health, counter anti-social behaviour, and raise individual
self-esteem and confidence?
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Report for toilet roofs
REPORT FOR OPENING FREE COMPUTER & INTERNET HOMEWORK CLUB FOR
PRIMARY AND SECONDARY SCHOOL KARAMA AND MOUNT KIGALI GROUP SCOLAIRE AT GAKONI SECTOR
Rwanda Legacy of Hope have donated 50 toilet roofs to the people form Gahanga sector Kicukiro District to replace toilets like this
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ject
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Do
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Hernia repair/ 50 patients MARCH2018 100,000,000FRW 100,000,000FRW
Screening of patients Hernia repair surgery using mesh techniques 0
A breakthrough was introduction of Hernia Repair under 0
Local Anesthetic infiltration. All hernias had hitherto been 0
performed under spinal anesthetic. 0
0
0
ENT 15 pantients March 2018 at CHUK 75,000,000FRW 75,000,000FRW
Screening of patients for plastic surgery procedures 0
Surgical intervention and post-operative care 0
Training to medical staff in surgical procedures ( Neurosurgery) 0
Donated surgical/ medical equipment and pharmaceuticals 0
0
Training of medical doctors in hernia repair surgery 40,000,000FRW 40,000,000FRW
10 doctors we will receive training in Mesh
or alternative Low tension Repair March2018 at Shyira hospital
Medical equipment donated MARCH 33,756,000FRW 33,756000FRW
Medical equipment donation to Shyira and CHUK hospital
(Mutuelle de santé 2018 MARCH
220 people will receive community based health insurance 660,000FRW 660,000FRW
NEUROSURGERY AT CHUK MARCH 30 PATIENTS 180,000,000FRW 180,000,000FRW
NEUROSURGERY SEPTEMBER AT CHUK 30 PATIENTS 180,000,000FRW 180,000,000FRW
Rwanda Legacy of Hope Sport- Football Club
This football club will contribute to the reduction of 15,000,000FRW 150,000,000FRW
vandalism and drug-related crimes in many young people.
Report for toilet roofs 300,000FRW 300,000FRW
Free computer & internet homework club 24,000,000FRW 24,000,000FRW
Opening free computer & internet homework club
for Primary and secondary school Karama and
TOTAL BUDGET FOR ACTION PLAN 2018-2019 648,716,000FRW 648,716,000FRW
Mount Kigali Group Scolaire at Gakoni sector
36
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2018-2019 ACTION PLAN FOR RWANDA-LEGACY OF HOPE RELIGIOUS-BASED ORGANIZATION
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21 | P a g e
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Hernia repair/ 32 patients MARCH2018 64,000,000FRW 64,000,000FRW
Screening of patients Hernia repair surgery using mesh techniques 0
A breakthrough was introduction of Hernia Repair under 0
Local Anesthetic infiltration. All hernias had hitherto been 0
performed under spinal anesthetic. 0
0
0
ENT 10pantients March 2018 at CHUK 50,000,000FRW 50,000,000FRW
Screening of patients for plastic surgery procedures 0
Surgical intervention and post-operative care 0
Training to medical staff in surgical procedures ( Neurosurgery) 0
Donated surgical/ medical equipment and pharmaceuticals 0
0
Training of medical doctors in hernia repair surgery 24,000,000FRW 24,000,000FRW
6 doctors we will receive training in Mesh
or alternative Low tension Repair March2018 at Shyira hospital
Medical equipment donated 23,125,564FRW 23,125,564FRW
Medical equipment donation to Shyira and CHUK hospital
(Mutuelle de santé 2018
190people will receive community based health insurance 570,000FRW 570,000FRW
NEUROSURGERY AT CHUK MARCH 2018 12PATIENTS 72,000,000FRW 72,000,000FRW
Rwanda Legacy of Hope Sport- Football Club
This football club will contribute to the reduction of 15,000,000FRW 150,000,000FRW
vandalism and drug-related crimes in many young people.
Report for toilet roofs 300,000FRW 300,000FRW
Free computer & internet homework club 24,000,000FRW 24,000,000FRW
Opening free computer & internet homework club
for Primary and secondary school Karama and
TOTAL MARCH MISSION 2018 208,995,564FRW 208,995,564FRW
Mount Kigali Group Scolaire at Gakoni sector
36
Mo
nth
ACHIEVEMENT FOR 2018 REPORT FOR RWANDA-LEGACY OF HOPE RELIGIOUS-BASED ORGANIZATION
Rw
an
da
-Le
ga
cy o
f H
op
e -
Um
ura
ge
w'I
by
irin
gir
oR
wa
nd
a-L
eg
acy
of
Ho
pe
- U
mu
rag
e w
'Ib
yir
ing
iro
He
alt
h
He
alt
h
Op
erat
ion
Her
nia
UK
& G
erm
any;
All
Nat
ion
s M
inis
trie
s U
K;
P
last
ic
Su
rger
y U
K;E
NT
UK
,Ort
ho
ped
ics
UK
R
wn
da-
leg
acy
of
Ho
pe
Kar
on
gi &
Kay
on
za D
istr
icts
. K
irin
da
& G
ahin
i,Kig
eme,
Rw
amag
ana
and
CH
KH
osp
ital
s
Kar
on
gi &
Kay
on
za,N
yaru
gen
ge
Dis
tric
ts.
Kir
ind
a &
Gah
ini,K
igem
e,R
wam
agan
a an
d C
HK
Ho
spita
ls
Op
erat
ion
Her
nia
UK
& G
erm
any;
All
Nat
ion
s M
inis
trie
s U
K;
Pla
stic
Su
rger
y U
K;E
NT
Ort
ho
ped
ics
UK
R
wn
da-
leg
acy
of H
op
e
36
Mo
nth
22 | P a g e
Pro
ject
nam
e
Fild
of i
nte
rven
tion
/ Do
mai
n
Du
ratio
n
Pla
nn
ed A
ctiv
ities
Pla
nn
ed B
ud
get
Pla
nn
ed b
ud
get
201
9
Are
a o
f in
terv
enti
on
Pro
vin
ce,D
istr
ict,
Sec
tor
Do
nn
ors
Hernia repair/ 120 patients MARCH 2019 240,000,000FRW 240,000,000FRW
Screening of patients Hernia repair surgery us ing mesh techniques 0
A breakthrough was introduction of Hernia Repair under 0
Local Anesthetic infi l tration. Al l hernias had hi therto been 0
performed under spina l anesthetic. 0
0
0
ENT 30 pantients March 2018 at CHUK 150,000,000FRW 150,000,000FRW
Screening of patients for plastic surgery procedures 0
Surgical intervention and post-operative care 0
Training to medical staff in surgical procedures ( Neurosurgery) 0
Donated surgical/ medical equipment and pharmaceuticals 0
0
Training of medical doctors in hernia repair surgery 40,000,000FRW 40,000,000FRW
10 doctors we will receive training in Mesh
or alternative Low tension Repair March2019 in 5 hospistal
Plastic Surgery 30 Pantients 150,000,000FRW 150,000,000FRW
Orthopeadics Surgery 30 Pantients 150,000,000FRW 150,000,000FRW
Medical equipment donated 33,756,000FRW 33,756000FRW
Medical equipment donation to Shyira and CHUK hospital
(Mutuelle de santé 2018
100 people will receive community based health insurance 300,000FRW 300,000FRW
NEUROSURGERY AT CHUK MARCH 2018 20 PATIENTS 120,000,000FRW 120,000,000FRW
International training Plastic Surgery, Orthopaedics
and 2 nurses from CHUK UK and Singapore
Dr Faustin Ntirenganya invited to attend a recognized 7,000,000FRW 7,000,000FRW
international microsurgical practical course at Singapore and UK
A senior CHUK orthopaedic surgeon and 2 nurses will be invited 6,000,000FRW 6,000,000FRW
to visit UK trauma centres to gain training, experience
Maintance for computer & internet homework club 100,000FRW 100,000FRW
TOTAL BUDGET ACTION PLAN 2019-2020 913,400,000FRW 913,400,000FRW
Kar
on
gi &
Kay
on
za,N
yaru
gen
ge
Dis
tric
ts.
K
irin
da
& G
ahin
i,Kig
eme,
Rw
amag
ana
and
CH
K
Ho
spit
als
Op
erat
ion
Her
nia
UK
& G
erm
any;
All
Nat
ion
s
Min
istr
ies
UK
;
P
last
ic S
urg
ery
UK
;EN
T
Ort
ho
ped
ics
UK
R
wn
da-
leg
acy
of H
op
e
36 M
on
th36
Mo
nth
2019-2020 ACTION PLAN FOR RWANDA-LEGACY OF HOPE RELIGIOUS-BASED ORGANIZATION
Rw
and
a-L
egac
y o
f H
op
e -
Um
ura
ge
w'Ib
yiri
ng
iro
Rw
and
a-L
egac
y o
f H
op
e -
Um
ura
ge
w'Ib
yiri
ng
iro
Hea
lth
Hea
lth
Op
erat
ion
Her
nia
UK
& G
erm
any;
All
Nat
ion
s M
inis
trie
s U
K;
P
last
ic
Su
rger
y U
K;E
NT
UK
,Ort
ho
ped
ics
UK
R
wn
da-
leg
acy
of
Ho
pe
Kar
on
gi &
Kay
on
za D
istr
icts
. K
irin
da
& G
ahin
i,Kig
eme,
Rw
amag
ana
and
CH
KH
osp
ital
s