With more than 12 million people and fewer than 40 registered dentists serving them, Rwanda needs more practicing clinicians. But things are about to get better, as the University of Rwanda recently graduated its first class of 10 bachelor of dental surgery degree students.
“It is an incredible blessing to be part of this historic moment in Rwanda. It is some of the most challenging, enjoyable, and rewarding work I’ve ever done,” said Donna Hackley, DMD, MA, instructor in oral health policy and epidemiology at the Harvard School of Dental Medicine (HSDM), which is one of the program’s partners.
The program began seven and a half years ago with an initiative started by Partners in Health (PIH), the Clinton Health Access Initiative (CHAI), and the Rwandan ministries of health and education. The resulting Rwanda Human Resources for Health (HRH) Program was designed to advance medical education and improve healthcare delivery systems in the country.
“Given the connection of oral health to overall health, the rise of noncommunicable diseases, and the potential for preventive care to mitigate disease, it was critical that dentistry be included in the program,” said Jane Barrow, MS, HSDM associate dean for global and community health.
Barrow urged HRH representatives to include a dental school in their plans. A training process began with HSDM representatives, the Rwandan ministries, the dental therapy program at the Kigali Health Institute, CHAI, PIH, and the University of Maryland with the goal of launching Rwanda’s first dental school and dental surgery program.
Brittany Seymour, DDS, HSDM assistant professor of oral health policy and epidemiology, accompanied Barrow on the initial HRH team visit to help make the case for a dental surgery program to the Rwanda ministers of health and education.
“We were thrilled to see dentistry included in this groundbreaking project,” said Seymour.
“Being the first of anything is difficult, and we faced unique challenges starting the program from scratch, but this signified a transformative moment in global health: a movement toward contextually relevant approaches and ownership, long-term sustainability, and capacity-building for oral health education and delivery systems within the Rwandan national health system,” Seymour said.
A team of HSDM faculty and alumni served on site in Rwanda as faculty mentors and teachers, working with local colleagues to build the educational infrastructure from the ground up.
“We were very fortunate to have a dedicated team of Rwandan, HSDM, and University of Maryland faculty who brought a wide range of experience and expertise to the project and who were able to contribute in all aspects, from curriculum design and mentoring to research and community outreach,” Barrow said.
“I wanted to be in the first wave of volunteers in order to better appreciate the culture of the people we were to serve,” said Brian Swann, DDS, assistant professor of oral health policy and epidemiology, who was one of the early volunteers serving six months in Rwanda.
“Cultural sensitivity is vital. Together, both teams had to learn how to best communicate in a way that was accurate. I also wanted people to know that we were in this program to stay and that we believed they had capacity to sustain their program,” said Swann.
In the fall of 2013, the new school welcomed its inaugural class into the five-year dental surgery degree program. The students spent the first two years of training with their medical school classmates at the University of Rwanda’s School of Medicine in Huye before beginning dental training in the capital city of Kigali. They also adopted the nickname “The Pioneerz.”
“Some of the students had never experienced a dental visit and did not know any dentists,” said Hackley. “This was not only a new school and program, but totally new territory for them, so they truly are pioneers. They were faithful and resilient throughout the program. I’m incredibly proud of all they have achieved.”
“The passion for education and desire to gain knowledge among the Rwandese students is unmatched. As a faculty member, I involved myself with the students beyond the classroom to accommodate their thirst for knowledge,” said Mohammed Razzaque, MBBS, PhD, visiting professor of oral health policy and epidemiology.
“As a teacher, there is nothing more joyful than being surrounded by the knowledge-seeking eager students, and Rwandese students gave me enormous joy,” said Razzaque.
To better understand the nation’s oral health needs, the partners planned and conducted Rwanda’s first oral health survey. It found a substantial burden of oral diseases and conditions, including unmet dental caries and periodontal treatment needs, underscoring the need for greater access to dental care and for the new school. Its results will inform workforce and delivery system planning, allow for oral health monitoring, and build research capacity.
“In rural areas, we need more care. People outside of town suffer a lot because of lack of care,” said Julienne Murererehe, assistant lecturer at the University of Rwanda. “Graduation is a very big achievement not only for the students and faculty, but for the whole country. It’s important for the development of oral health services in Rwanda.”
HRH funding will provide ongoing support for the program for the next six years. HSDM faculty will continue to assist with curriculum delivery and provide technical and strategic support as the school shifts to its new campus.
“It was hard work,” said University of Rwanda School of Dentistry dean Chrispinus Mumena, DDS. “We have done our best and worked together with team spirit to reach farther than any one of us could reach alone. I am very proud of our graduating students. I am also very pleased with the collaborations between our faculty and the HRH Rwanda program.
“I am very excited and happy for today’s graduation. It is the day I have waited for, for a long time,” said graduate Joseph Nshimiyimana. “We are going to do our best to achieve more for our country.”