We live in a new normal. One of masks and gloves, and silence on the streets. Even with its comparatively small numbers of infected patients, Rwanda has enforced robust prevention measures against COVID-19, and it did so early. Bars and restaurants lie closed and quiet, its borders closed, and places of worship empty. The overriding message to all? Stay home.

And who could advocate for this message more strongly than someone on the inside of one of Rwanda’s frontline health facilities? Nicole Jabo currently works in the epidemiology unit of Rwanda Biomedical Center’s (RBC) tracking and testing facility in partnership with the Ministry of Health, an operation that was initiated before the first identified case in Rwanda, and since grown in scale. The facility was set up both to track, test and isolate new cases – using investigation and data – as well as to inform the wider public about ways to protect themselves and others around them from the destructive spread of the virus. 

Before becoming an RBC Program Associate, Nicole was part of UGHE’s first cohort of full-time MGHD students in 2019, and now continues her commitment to the UGHE family as a part-time Research Assistant in the Center for One Health. 

We set up a video call and Nicole picks up after a small pause. She is on a short morning break at the facility and wears a clinical mask. Behind her is a large, buzzing room with groups sitting around tables. There is the constant ring of phones and voices answering them but, notably, a sense of calm and order. 

We hear a lot about the importance of testing on the news. How does the process of tracking and testing work in Rwanda’s facilities? 

Rwanda has 75 confirmed cases of COVID-19 as of today (March 31st). We have field investigators working around the clock to gather information about all activities and close gatherings the patients were involved in before testing positive. We then have multiple teams following up on these unique contacts of each case – which is where my role comes in. I head up one of the 16 teams responsible for following up on the contacts on a number of cases; for each case, this contact list could range between 12 to 50 people. For people living in close proximity in the community, this usually reaches 60. 

We identify and differentiate contacts through color categories – red, orange and yellow. Close contacts are highlighted as red rings; these are immediate family and friends, and generally more likely to have received exposure to transmission.  

When we call people we introduce who we are and ask them how they’re feeling, whether they’re experiencing symptoms, where they were on that day that they came into contact with the patient, and who they were with – which, in turn, helps us find leads for further suspected cases. It’s also key to provide reassurance – about the situation in general as well as how we are supporting and caring for the patient, who to them is often a friend or family member.

And how receptive are people when you call them? 

Overall, we’ve found that most people we speak to are very receptive to the daily call and the information we give them. They feel comfortable knowing that a health professional is checking in on them. 

One of the commendable things you see when you go out into the street is the level of discipline that people have in self-isolating – there is hardly anyone around. The people you do see around are generally only making essential travel, and are disciplined in washing their hands before entering facilities.

Is it just medical professionals involved in Rwanda’s COVID-19? 

It’s true to say many of my colleagues here are intern doctors, but we also have police representatives working alongside us, as well as immigration officers who support us in obtaining information from flight passengers such as details about seat numbers and contact information. Everyone is working together – it’s a smooth operation. 

A lot of the tracking is done by the data science team who are working on an interesting project that includes projections on how many people will be suspected of infection in the future. We also have a Communications department who disseminate information around prevention as well as reassurance. They design engaging ways of talking to the public such as radio skits and adverts on TV that speak about protection and prevention. 

Recently, the number working in the facility has also included mental health personnel, who can help address some of the feelings of anxiety or depression that patients or non-patients can experience by being in isolation. 

And finally the rapid response team. They evacuate people from their homes who have reported any symptoms. These people are brought to a facility (managed by the isolation and quarantine team) where they will stay in quarantine. They are tested both when they arrive, and again when they leave after the 14 days is up.

How did you get into what you are doing now? 

After I graduated from the University of Global Health Equity in 2019, there was an event in Kigali called Meet The President. I was lucky enough to be one of the speakers talking about my experience in research – mostly trying to inspire young people to work hard and do meaningful research for their communities. It was a lot of exposure. A few days later, I was recruited to join the Rwanda Biomedical Center under the leadership of Dr. Sabin Nsanzimana, RBC’s Director General and UGHE Adjunct Faculty, to organize the largest conference on AIDS in Africa ICASA (International Conference on AIDS and STIs in Africa), and now on COVID-19 response.

This is a time of huge uncertainty and also a time of great strain on our health systems. What is the current environment like where you’re working? 

It’s evolved over time. Everyone here feels really grateful for being a part of the team. We all feel that we are contributing to protecting our country which is vital to remember. It was tough in the first week because there were so many variables and the process itself requires very careful preparation. Right now, as we are speaking, the feeling is one of calmness and control; we have now got used to the flow of things, the reporting system (of new suspected cases) is very smooth, and we are working to improve the tracking systems to ensure we are getting everyone. 

How do the learnings from UGHE’s MGHD program support what you are doing for COVID-19 currently? 

UGHE’s MGHD program equipped me with the leadership skills to step into a managerial role. While some health education programs see these skills as an “add-on,” a big part of the program at UGHE focuses on training students how to be bold leaders, and giving them the tools to drive impactful change in health systems. MGHD is a comprehensive program; it covers everything from problem-solving and critical thinking skills, to health policy and experiential learning; crucially, it makes me feel comfortable doing what I am doing now. I now find myself coordinating and facilitating a lot of seemingly small details that make a big impact on our daily progress.

I think, most importantly, the program covers the principles of global health. It made me understand even before the pandemic that diseases aren’t confined by borders, they cross back and forth between countries. This knowledge puts me in a more comfortable position to adjust to this current global situation and to commit myself to the team making efforts to contain it.

What would you say is the biggest takeaway from your experiences working on the frontline of Rwanda’s response? 

My biggest learning from this is the importance of effective teamwork. This work requires a lot of collaboration and the varied nature of the wider team means that we have a lot of different dynamics. I am learning a lot from the people around me and inspired by their continued commitment to produce good results. 

Leadership too is critical. This process would not work without the organizational capacity of our coordinators and managers who designate roles and responsibilities to us all, and who work to adapt the process to the constantly evolving status of the disease. Above all, I’m learning a lot about my country’s health system in a time of crisis, and I love being an active participant in some of the solutions now and for the future. 

If you are currently in Rwanda and experiencing COVID-19 symptoms, you can call the emergency 24/7 hotline on 114 to speak to a trained medical officer like Nicole and get your symptoms checked.