Anesthesia is as vital to a surgical procedure as any instrument wielded by the surgeon.

As part of Operation Smile's Global Standards of Care, it’s a medical standard that enables the delivery of the safest surgery and is essential for successful medical outcomes. While this may seem like an obvious standard — if not the most important standard — it reflects a dramatic shortcoming that the Rwandan health care system faces.

This densely-populated country of 11.9 million people is served by only 15 nurse anesthetists and anesthesiologists.

However, Dr. Paulin Banguti, director of the post-graduate anesthesia program at the University of Rwanda, is working toward filling this massive void. During the March 2016 Operation Smile surgical training rotation at Rwinkwavu District Hospital, Banguti led a group of anesthesia residents to observe and learn from volunteer anesthesiologists from around the world.

“I have appreciated the teamwork spirit. The way the surgeons are communicating, they are very humble,” said Rwandan Dr. Josua Nzarora, a fourth-year anesthesia resident. “With Operation Smile, everyone respects each other, there is teamwork and things go smoothly and fast.”

Paulin’s goal is ambitious; to train 60 active anesthesiologists by 2024 before doubling that total by 2030. We caught up with Paulin for more insight into the state of Rwandan anesthesiology and this groundbreaking educational program.

Q: What inspired you to shift your focus toward training anesthesiologists?

A: “After completing my medical training in the Democratic Republic of the Congo, I returned home to Rwanda in 2004 and worked as a general practitioner specializing in maternity. Rwanda launched its first anesthesiology specialization program in 2005 and it really started from the ground-up. There were not enough mentors to teach us, so we were taught by nurse-anesthetists, who are skilled technicians, but not doctors. There were some ups and downs in the training, which inspired me to offer the best training of residents and anesthesia practices for the safety of my country.”

Q: How does Operation Smile’s commitment to education align with your vision?

A: “I’m really passionate about education, because I think it’s where we can fill the gap. The training of anesthesiologists shouldn’t just be one-on-one instruction — you need to have many different partners and teachers involved in different programs where people can take pieces from each and make their own solution.

“What’s great is that Operation Smile isn’t bringing us the curriculum or the program to adopt. When my residents join this program, they continue to follow our curriculum while learning which aspects to adjust. Operation Smile is partnering with us to achieve the goals we have set and that is why we think it’s sustainable — because with or without them, we have a goal to achieve. That’s the benefit of working with Operation Smile, they don’t come in and say, ‘Destroy whatever it is you have, we have a new machine.’ They’re just continuing what we started and strengthening it.”

Q: What are the challenges you face in retaining Rwandan anesthetists?

A: “You are touching on one of our biggest problems; it’s brain drainage. Since there are only 15 nurse anesthetists and anesthesiologists for 11.9 million people, some become exhausted and think, “I’d rather leave this country to go work less,” at the same or even a lesser salary. If you increase the inflow of anesthetists, it will create a balance of those sharing the workload. With that improvement in the quality of their lives, they can feel like it’s better to stay in Rwanda. We need to grow the number of anesthetists so that everyone can work closer to 45 hours per week and have time for social and family lives.

“What’s great is that many Rwandans now believe in their country. It’s what makes us believe we can have many anesthetists. The strength of our country are young people who believe they can create a new story of a new Rwanda. We even have a song which talks about making it a paradise both in Africa and the whole word. I think that is the ideology that is inspiring many people to do the same as the leaders are doing.”

Q: Do you feel like this style of training has long-term potential?

A: “Yes. The University is trying to extend training beyond Rwanda’s three teaching hospitals and into the district hospitals where residents there would have the opportunity to learn. If we can perform missions in many different hospitals, the residents will benefit and we can build toward sustainability. I see the impact in three different ways; clinical, academic and administrative. In addition to the technical, clinical training, the residents also learn the academic side of training, meaning they can discuss techniques, become teachers and share the knowledge. Administratively, they learn how to work with pharmacists and logisticians to prepare, conduct and evaluate a mission. We hope to take what we have learned from Operation Smile and one day repeat what they have done for us.”