LETTER TO THE EDITOR Year : 2022  |  Volume : 35  |  Issue : 2  |  Page : 75-76

Community-based education in rural Rwanda

Lotta Velin1, Jacquelyn Corley2, Alyssa Corley3, Eden Gatesi4, Olivier Mbarushimana Nshuti4, Genereuse Irakoze Iradukunda4, Zahirah Z McNatt5, Akiiki Bitalabeho4, Denys Ndangurura4, Abebe Bekele4
1 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
3 Beth Israel Deaconess Medical Center, Boston, MA, USA
4 School of Medicine, University of Global Health Equity, Kigali, Rwanda
5 School of Medicine, University of Global Health Equity, Kigali, Rwanda; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA

Date of Submission05-Apr-2021Date of Decision21-Mar-2022Date of Acceptance05-Dec-2022Date of Web Publication12-Jan-2023

Correspondence Address:
Dr. Abebe Bekele
School of Medicine, University of Global Health Equity, Kigali
Rwanda

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/efh.efh_163_21

How to cite this article:
Velin L, Corley J, Corley A, Gatesi E, Nshuti OM, Iradukunda GI, McNatt ZZ, Bitalabeho A, Ndangurura D, Bekele A. Community-based education in rural Rwanda. Educ Health 2022;35:75-6
How to cite this URL:
Velin L, Corley J, Corley A, Gatesi E, Nshuti OM, Iradukunda GI, McNatt ZZ, Bitalabeho A, Ndangurura D, Bekele A. Community-based education in rural Rwanda. Educ Health [serial online] 2022 [cited 2023 Jan 13];35:75-6. Available from: https://educationforhealth.net//text.asp?2022/35/2/75/367614

Dear Editor,

Community-based education (CBE) fosters health personnel to be responsive to the populations they will serve, through training in close relation to these communities. We present a CBE model initiated at the University of Global Health Equity (UGHE) in Butaro, Rwanda. To our knowledge, this is the first initiative on the continent to integrate CBE throughout the entire medical program.

Butaro is in the rural Burera district, which has a population of approximately 336,000 people. UGHE was inaugurated in 2015 and received the first cohort of medical students in 2019. Embedded in the curriculum is the CBE model which involves student interactions with the surrounding community and theoretical classes.

We distributed a survey with 21 questions in May 2020 to the students who had finished the first semester in the program. All students provided informed consent before partaking. Descriptive statistics were used to analyze demographics and summarize Likert scale responses. Free-text answers were analyzed thematically; variables were coded, and similar codes were grouped. This project was approved by the UGHE Institutional Review Board.

Nineteen students responded (63.3% response rate), of which most were female (n = 12). Most believed that their training was enhanced by the small class size, rural environment, and participation in community service, which are three pillars of the CBE program. Social determinants of health, social justice, and gender equity issues were seen as important components of their education. All students agreed that CBE was worthwhile, and most reported improved communication and interpersonal skills, personal growth, and confidence that they will be better doctors [Figure 1].

Fifty free-text responses were received regarding CBE improvement. Six themes were identified: (1) “provide more time” (n = 12), (2) “ensure benefits for the community” (n = 11), (3) “make CBE more practical” (n = 8), (4) “go to other rural areas” (n = 5), (5) “avoid a split between students and community” (n = 3), and (6) “allow for feedback” (n = 3).

The importance of the rural setting was emphasized, and more than half of the students stated that they were more likely to work in a rural area after having had CBE. This aligns with previous literature indicating that early exposure to rural or impoverished communities helps foster a patient-centered and societal perspective and promotes values of service and accountability.[1] CBE exposure also impacts students' future practice locations, particularly through increased willingness to practice in rural settings.[2],[3] This may be of great importance in Rwanda, where most people live in rural, medically underserved areas. The benefits of CBE align with the UGHE vision, which embodies the sense of service that is integral to the school's mission.[4]

Although the CBE program was highly appreciated, respondents provided recommendations for further improvement. Particularly, students wished to work with the government to implement projects. A similar program in South Africa implemented CBE projects and reported short-term benefits such as improved service delivery, reduction in hospital referrals, and increased in-home visits, and long-term benefits such as student familiarity with the health system and students becoming “agents of change” in the communities where they worked.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Howe, A. Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education. Med. Educ. 35, 666–672 (2001).  
    2.Critchley, J., DeWitt, D. E., Khan, M. A. & Liaw, S. A required rural health module increases students' interest in rural health careers. Rural Remote Health 7, 688 (2007).  
    3.Amalba, A., van Mook, W. N. K. A., Mogre, V. & Scherpbier, A. J. J. A. The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices. BMC Med. Educ. 16, 130–130 (2016).  
    4.The University of Global Health Equity. University of Global Health Equity.  
    5.Diab, P. & Flack, P. Benefits of community-based education to the community in South African health science facilities. Afr. J. Prim. Health Care Fam. Med. 5, 474 (2013).  
    
  [Figure 1]