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Conversation with a Paediatric Surgical Scholar

Dr. Axelle Aimee Nduwimana, a paediatric surgery fellow training at King Faisal Hospital Rwanda, is among 34 students currently being sponsored through the Smile Train and KidsOR surgical scholarship programmes. Once graduated, Dr. Axelle is set to become the third paediatric surgeon (and the first female) in her country of Burundi.

We recently sat down with her to discuss life as a paediatric surgical trainee.

Why paediatric surgery?

Surgery has been my dream since I was a teenager. Why paediatric? Children are the future of tomorrow. Dealing with their health, saving their lives, seeing their parents happy. It all makes it worthy.

In 2024, on completion of your studies you’ll become the first female paediatric surgeon in Burundi, what do you envision this will be like?

It is a bit scary to think about it, as per now there is no paediatric surgeon in the country. Paediatric surgery will be a new specialty in the next few years. There will be much work to be done for us beginners: Work setting: having a trained team to manage surgical children, neonatal and paediatric equipment (Operating Room, surgical sets…) is not to be taken for granted.

What are the main challenges you face as a fellow in paediatric surgery?

My clinical responsibilities overstep my academic duties; sometimes I do not have time to study. Bed management of paediatric surgical cases is troublesome; therefore, we have to postpone or delay elective cases. Given the volume of emergency surgical cases, and post- operation care needed for critically ill children, we would handle more cases if we had another paediatric Operating Room and paediatric ICU beds.

What, in your opinion, is the reason for low numbers of paediatric surgeons in Africa as a whole? How can we change the situation?

Paediatric surgery is a new subspecialty across the continent, hence the low number of surgeons. Can we change the situation? Nothing is impossible if everyone puts their heart into it. Training more surgeons and retaining them in the continent will limit brain drain outside the region.

Could you give an example of a case or cases that you have been involved in recent past that were significant to you?

A rare case of separation of conjoined twins- joined to the abdomen “omphalopagus” with associated gastroschisis. The mother was a prisoner; she didn’t know until delivery that she had conjoined twins.

Referred from a district hospital, an emergent surgery was scheduled after investigations for both babies. It was established that the child on the right side had complex congenital heart anomalies and could also harm the other twin's blood circulation. Further, this twin had 80 percent ischemic bowels (which happens when there is not enough blood flow to a child's intestines) at arrival. The twins were also sharing the liver. The mother was then counselled: if nothing is done urgently, she may lose both twins; but there was a chance that one of the children may survive. An operation was then done the following day (August 13th/22), to try to save the life of the child. The operation was a success, the child was discharged a month later with good progress: breastfeeding well, gaining weight (birth weight:1.7kg, weight on discharge: 2.5kg).

The mother could not believe that such surgery could be performed in Rwanda and in a well timely manner. 

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