The stakes for safe surgery are high. Each year, 260,000 mothers die from complications during childbirth, with improperly performed C-sections being a major contributor. The National Institute of Statistics of Rwanda (NISR) recorded 203 maternal deaths per 100,000 births in 2024. Globally, the risk of serious complications is nearly three times higher with cesarean delivery compared to natural birth, often due to postpartum hemorrhage and anesthesia complications. 

With these global statistics, there are stories of progress and development. In Rwanda, Butaro, the University of Global Health Equity (UGHE), is training the next generation of global health leaders, equipping them not only with knowledge and skills, but also with compassion and humility; traits that can’t be fully taught in textbooks, but thrive in real-world practice. 

In some medical schools around the world, students may graduate without ever leading a surgery. But at UGHE, this experience is different by design. The curriculum emphasizes early, and ongoing clinical exposure, paired with close guidance from experienced faculty. This hands-on approach ensures students develop the skills and confidence needed to provide frontline care immediately after graduation.   

Dr. Marlene Muhongerwa, who has completed her medical studies at UGHE, now pursuing her Master of Global Health Delivery Program, is a testament to this model. During her internship, she successfully led a cesarean section procedure, commonly known as a c-section. “My first feeling was gratitude, to my mentors for trusting me, and to my patient for allowing me to be part of such a significant moment in her life,” Dr. Marlene reflects.   

Of course, there were nerves, a natural response when stepping into uncharted territory. But Dr. Marlene reminded herself that she was prepared, well-trained, and above all, supported. “Once in the operating room, my focus was entirely on ensuring the patient’s safety and completing each step of the procedure adequately,” she shares. 

In the procedure, a skilled, women-led team supports Dr. Marlene, including dedicated nursing staff, the anesthesia team, and her fellow assistants. Also, her mentor, a UGHE faculty member, Dr. Birhanu Abera, is closely monitoring and explains that this unique model is intentionally designed.  

“Part of this success stems from a deliberate structural advantage. We have small class sizes, so when they’re divided among hospitals, there might be only five per site. In a maternity ward like Butaro Level II Teaching Hospital, which sees about 208 deliveries a month, with 80 of them being cesarean sections, that translates into significant exposure.” Dr. Birhanu Abera emphasises.  

UGHE students receive practical, hands-on training as an integral part of their education. Most practice sessions are held in the simulation centre, a facility equipped with labs, mannequins, and machines designed to replicate human anatomy. Among these mannequins is Mutoni. In their medical studies, students practice safe childbirth techniques on Mutoni, learning how to help mothers deliver their babies, while preventing complications for both the mother and newborn. 

“Mentorship has been at the heart of my growth, both in medical school and during my internship. My professors have not only taught me surgical techniques, but also demonstrated how to approach each patient and procedure with patience, compassion, and skill.” Dr. Marlene reflects.  

Surgery has long been seen as a male-dominated field, even though more women have graduated from medical schools in recent years. This seems to be true in both developed and developing countries. Recent data from certain research shows that women account for less than 25% of professionals across 10 surgical specialties. Another research has shown female physicians are less likely to perform cesarean delivery and often don’t prefer it. This goes with the fact that women in surgery also often face discrimination, sexual harassment, and false assumptions about their abilities. 

“Being part of a female-dominated surgical team was inspiring. In a field traditionally led by men, it showed that women not only belong in surgery, but can thrive as leaders, decision-makers, and experts.” Dr. Marlene says.  

Several weeks have passed since the procedure, and the patient is recovering well while caring for her newborn. She has been advised to carefully monitor her incision site and watch for any signs of infection, a critical concern that poses significant health risks, especially in low-resource settings with limited access to medical facilities or trained professionals. The patient has also received guidance on breastfeeding effectively while recovering from surgery, ensuring both her well-being and her baby’s health. 

Moments like this also speak to UGHE’s commitment to gender equity in medicine, especially in surgical spaces where women remain underrepresented. Of all admitted students, 70.75 are women. Watching a young woman leading her peers through a successful cesarean delivery is a signal of the change UGHE is helping shape.