Spring 2023 (Volume 33, Number 1)
Rheumatology for All in East Africa
By Carol A. Hitchon, MD, FRCPC, MSc; and
Rosie Scuccimarri, MD, FRCPC
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| Drs. Birhanu Demelash Desyibelew & Becky Abera Adugna |
Dr. Hanna Lishan |
Access to rheumatology care varies globally but is
particularly limited in resource-poor countries
such as those in East Africa. In these regions, there
are few or no rheumatologists to provide rheumatology
specialty care. Rheumatology education to medical
trainees is often limited, with only limited rheumatology
infrastructure and issues with access to diagnostic testing
and medications.
In 2016, following a visit to the rheumatology clinic
of Tikur Anbessa Hospital in Addis Ababa, Ethiopia,
our group established “Rheumatology for All” (RFA)
(rheumatologyforall.org), an American-based registered
charity whose mission is to increase access to rheumatology
care in under-resourced regions. We have adopted a
“train-the-trainer” approach in order to create self-sustaining
rheumatology units. This has been done by 1) funding
the education of local physicians to become rheumatologists;
and 2) providing educational programs to the
local residents until this can be provided by the returning
rheumatologist. All programs are conducted with the full
support and collaboration of local medical faculties.
Fellowship support: Our initiatives started in Ethiopia,
a country of nearly 115 million people previously without a
practicing rheumatologist. RFA funded a two-year rheumatology
fellowship for two internists who completed this training
at the University of Kwazulu-Natal, in Durban, South
Africa, in 2021. Drs. Birhanu Demelash Desyibelew and
Becky Abera Adugna are now affiliated with Addis Ababa
University and have established busy rheumatology practices
seeing more than 150 patients weekly, are contributing
to rheumatology clinical education for medical trainees in
Addis Ababa and are supervising several trainee research
projects. Their success was recently highlighted by their Internal
Medicine Department, when the rheumatology unit
was recognized for its excellence in clinical services and resident
education. This is outstanding considering that there
were no rheumatology services at Tikur Anbessa Hospital
before 2021. RFA, through charitable donations, is now
also able to fund a pediatric rheumatology fellowship for
Dr. Hanna Lishan who will start training in Cape Town,
South Africa, in 2023.
Dr. Hanna Lishan will join
Drs. Desyibelew and Adugna in providing rheumatology
clinical care and advocating for rheumatology resources for
Ethiopians of all ages.
Rwanda, one of the most densely populated countries
with a population greater than 13 million, had no practicing
rheumatologist. Rheumatology education and rheumatology
clinical care were provided by internists and
non-rheumatology specialists. With the full support of
the Department of Medicine in Kigali, we have recently
obtained funding from the Royal College of Physicians
and Surgeons (RCPSC) through the International Development
Aid and Collaboration program, to provide rheumatology
subspecialty training for Dr. Jean Paul Basbose,
who will be starting his adult rheumatology fellowship
in 2023. Our group will continue to support and provide
mentorship to these new rheumatologists as they advance
their clinical and academic careers.
In addition to funding fellowship training, we have
developed a rheumatology curriculum that can be provided
in person or virtually to trainees in resource-limited
regions. In 2018, visiting professors from Canada and the
U.S. provided an intensive rheumatology program to senior
internal medicine residents in Addis Ababa. The visiting
rheumatologists provided lectures and clinical skills
training. The participating residents also gave presentations,
thereby developing their skills to teach their junior
colleagues. A virtual adaptation of the visiting professor
program (due to COVID-19) was continued until the return
of Drs. Desyibelew and Adugna.
In 2021, at the request of the University of Kigali Medical
School in Rwanda, we developed an expanded
16-week virtual rheumatology program for second-year
internal medicine residents. The lectures and interactive
tutorials were provided virtually, in English, by an
international faculty with representation from Africa,
the U.K., the U.S. and Canada, thereby ensuring culturally
and regionally relevant content. Lectures and tutorials
were supplemented with clinical skills videos. The
course was repeated in 2022 and 2023. Resident feedback was positive, although most participants requested
in-person teaching, especially for clinical skills. Thus, in
2023, to supplement the virtual teaching, Drs. Hitchon,
Scuccimarri, Colmegna, and Meltzer have planned an in-person
visit to provide clinical skills teaching and tutorials
for both internal medicine and pediatric resident trainees.
The combined approach of supporting funding for
fellowship training and providing rheumatology educational
programs to medical and pediatric residents
in under-resourced regions aims to develop sustainable
rheumatology capacity for clinical care and education,
and thereby improve outcomes for individuals with rheumatic
diseases in these regions. This work could not be
possible without the generous support of our donors, the
project-specific funding from organizations such as the
RCPSC, and the commitment of our volunteers, all of
which are important to help achieve the mission of RFA.
Carol A. Hitchon, MD, FRCPC, MSc
Associate Professor of Medicine, University of Manitoba
Winnipeg, Manitoba
Rosie Scuccimarri, MD, FRCPC
Associate Professor, Department of Pediatrics,
McGill University
Pediatric Rheumatologist,
Montreal Children's Hospital
Montreal, Quebec
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