Imaging in the Land of 1000 Hills: Rwanda Radiology Country Report

Rwanda is an equatorial country in central Africa (Figure 1), and part of the East African Community of Burundi, Kenya, Uganda and Tanzania. It is a small country, just over 10,000 square miles. Its population of nearly 12,000,000 makes it the most densely populated state in continental Africa. Rwanda’s capital, Kigali, is a mile-high city. Its elevation makes the climate much cooler and more comfortable than a typical equatorial climate. The average annual temperature is 20.5 degrees Celsius with a narrow range – April, the coldest month has an average temperature of 20 degrees, whereas August, the warmest month has an average temperature of 21.5 degrees. Economically, Rwanda functions as a subsistence agricultural country but has been actively striving to emerge as a middle-income country. Its primary exports are coffee and tea. In 1994, the majority Hutu population carried out mass genocide of the ethnic Tutsi minority In a coordinated slaughter committed by neighbors against each other, and with low-technology weapons like machetes, nearly 1,000,000 people were killed in 100 days (1). The country was devastated. Immediately post-genocide, Rwanda was one of the poorest countries in the world with nearly 70% of the population living below the poverty line (2). Until 1997, Rwanda had the lowest life expectancy of any country in the world (3). The physician work force was depleted due to the direct and indirect consequences of the Rwandan Genocide. Since this time there has been a steady economic recovery (4), along with remarkable medical recovery. Average life expectancy nationwide, only 27 years in the early 1990s, has now reached 63 years (3). Since the 2012 publication (5) highlighting its advances, radiology in Rwanda has benefitted from the capital infusion that has helped to propel the overall growth in the economic and health sectors. As of 2012, there are five national referral hospitals, 41 district hospitals, one military hospital and 451 health centers (6). The health centers are staffed primarily by nurses, while the district hospitals are staffed by general practitioners (graduates of medical school without a post-graduate education). Of the 625 total physicians in the country in 2011, 150 had completed residency (3).