Having worked in public and private hospitals in Rwanda and in refugee settings in South Sudan, Dr. Fernand Rwamwejo, UGHE’s MGHD’21 student,  clearly saw what inequities mean in health care because to some of the patients access to it was a luxury instead of a right. This moved him to pursue an MGHD program at UGHE where he received hands-on experience that will help him to address social determinants of health and other structural forces that dictate who gets access to basic needs and how it will be implemented, particularly by focusing on tackling infectious diseases affecting low-income families. UGHE equipped him with the ability to work, advocate, and execute interventions aimed at breaking disparities. He plans to use that to contribute to strengthening the healthcare system of Rwanda while aiming at health equity for all Rwandans. We caught up with Fernand to reflect on his passion for global health and his future plans.  

Q1. Where did your passion for global health first start? 

I wouldn’t say there was a quick snap, like if I suddenly discovered a passion, but rather a gradual process. I’ve worked in various settings in Rwanda, such as public and private hospitals, and also in South Sudan, where I worked in refugee settings, and I saw some patterns of inequity, disparities in access to care, and who gets access to certain interventions and health care. In the past, I actually heard some individuals say that they were going to sell their possessions to pay for health care, treatments for family, and so on.  All of these events fueled my passion for global health, and I began searching for ways to solve them. As a physician, I could only see one patient at a time, and so on, but I wanted to work in a profession where I could do more.  Ultimately I came across this MGHD, a program providing hands-on experience in addressing and dealing with such inequities. It has been a rewarding trip and full of lessons so far.

Q2. What does an equitable world look like to you? How do you intend to carry these equity values with you in your next chapter to serve the underserved?

To me, equitable society is one in which individuals have access to fundamental necessities that enable them to live a good life. For example, it might be access to clean water, access to education, access to quality and affordable health care, and so on. As a global health leader, I plan to address social determinants of health and other forms of structural violence, including things that prevent people from reaching their full potential. Eventually, I’d want to join the fight for health to be considered a human right, which is currently not the case. 

Q3. You are deeply committed to tackling infectious illnesses that afflict low-income nations. How has MGHD assisted you in addressing such inequities?

The MGHD program exposed me to a comprehensive approach that treats not just infectious diseases but also all facets of the illness. Typically, most of our training as clinicians focuses on the disease itself: how to diagnose it, treat it, and what kind of advice to give to patients. However, through this program, I saw how this holistic approach considers the social determinants of health and other structural forces that dictate who gets access to basic needs and how it will be implemented.

There is also what is known as the poverty cycle, which often leads to infectious diseases because families living in poor or low-income families do not have access to food, safe water, health, or education, which leads to hunger, poor sanitation, and a lack of education. This increases the risks of infectious diseases, particularly malnutrition. UGHE equipped us with the ability to work, advocate, and execute interventions aimed at breaking this pattern and, eventually, offering people a better quality of life.

Q4. How do you plan to apply your MGHD learnings to further strengthen Rwanda’s resilient health system?

Rwanda has a robust health system. Much has been done to restore it after the genocide against Tutsi in 1994, which had catastrophic effects on health infrastructure, human capital for health, and financial resources available for health. A lot has been accomplished with this rebuilding. We have received heartfelt praise for our health system, which is an example of universal health coverage for the population not only in Africa but also globally. I want to apply my knowledge and skills gained through this MGHD program to continue this journey of strengthening our health system.

This might be accomplished by integrating more system thinking, which is a holistic approach to addressing the problems still existing in the health system and not only looking at the health system in parts but at it as a whole. So, in other words, making sure that all the building blocks of the health system interact, those building blocks being the government, human resources for health, health financing, service delivery, and so on. Making sure that financing is not seen as financing for health, how does financing influence the government, how does financing influence service delivery, and so on. Make certain that it is strengthened, and make certain that all stakeholders involved in health care are engaged in the health care journey. The end goal will, of course, be to have more patient-centered care where patients’ needs are taken into account while continuing to ensure equity for all in Rwanda.