Growing Hope: Building a teaching hospital in Africa

To help ensure their success, the team prepared for 5 years before starting work in Burundi.

In the face of harsh realities in sub-Saharan Africa, John Cropsey, MD, and a cadre of colleagues are partnering with Hope Africa University to grow a teaching hospital.

Kibuye Hope Hospital (KHH) is 6,000 feet high in the mountains of Burundi and a 2.5-hour drive from the main campus of Hope Africa University in the capital city of Bujumbura. Originally established in the 1930s as a mission of the Free Methodist Church, KHH is now the main training hospital for the university medical program and serves as a regional medical center in one of the poorest and hungriest countries on earth.

“We went from a rural district hospital with just a trickle of patients in 2013 to a major national referral center for tens of thousands of patients every year,” Cropsey said in his presentation of the 2018 David Paton, MD, Lecture in Academic Global Ophthalmology at Wills Eye Hospital. Cropsey was co-chief resident at Wills Eye Hospital in 2009.

The “we” that Cropsey refers to is “the McCropders,” a team of six physicians and their families who committed to Hope Africa University’s vision of “making the medical program a self-sustaining source of high-quality medical professionals.” These American expatriates relocated to Africa in 2013 and include a general surgeon, family practitioner, obstetrician/gynecologist, medical/pediatric physician, ophthalmologist (Cropsey) and emergency medicine physician. The staff also includes six Burundian general medical doctors.

To help ensure their success, the American team prepared for 5 years before starting work in Burundi.

“In 2007, we committed to do this together as a team. We went to Tenwek in Kenya for 2 years to try to hone our team vision and be mentored for 2 years to learn how to be doctors in Africa,” Cropsey said. “We wanted to go to a place where people wouldn’t normally go. Long story short, that’s how we ended up in Burundi, one of the more remote countries in Africa.”

The team then committed to being long-term medical missionaries and returned to the U.S., where they joined Serge Global and spent a year raising funds. Because they were going to be teaching at a French-speaking university, the group moved to France for a year and learned or improved their French language skills.

Student body

From 2013 through 2016, about 1,000 students were trained at Kibuye, Cropsey said.

“We have 40 students at any given time rotating as medical students at Kibuye for 4 months at a time,” Cropsey said, with students spending a total of a year “with us up in the hills” during their 3 clinical years.

Besides medical students, nursing students and other paramedical students augment the student body so that about 100 students at any one time are in training at KHH, according to Cropsey.

“Our first term there was about laying the foundation of the medical curriculum, especially the clinical side,” Cropsey said. Now, the first internships in the country and a general surgery residency are being planned.

“Burundi has one of the lowest surgeon-to-population ratios in the world, about 10 to 13 general surgeons for the entire country. Only two [of those surgeons] are outside the capital, including ours,” he said.

Eye care service

Regarding students, “I would say one per 40 show serious interest and passion in pursuing ophthalmology as a career. Many more would if they thought they could obtain a residency spot,” Cropsey told Ocular Surgery News.

“We try to focus on technology that makes sense for our students,” he said.

In the NICU, for example, incubators and hospital beds have been designed using local materials — lightbulbs, a thermostat and mosquito netting — so mothers and infants can stay together.

“These are things we can make in Burundi,” Cropsey said. “A lot of times you go into the hospitals and they’ve been given equipment and it’s just sitting in a corner because it’s broken down or nobody knows how to use it. We want to focus on sustainable technologies.”

Along the same lines of using low-cost, low-tech, sensible technology in eye care, Cropsey said manual small-incision cataract surgery is the main technique taught at the university.

“MSICS is our go-to primary technique day in and day out. This is what is primarily taught to all our trainees,” he told OSN.

Sustainability

“Before we could start taking care of patients, we had to do a ton of infrastructure development,” Cropsey said. “People need jobs in Burundi, and so by keeping things low-tech and using manpower, at our peak, we had over 300 people on our construction crew alone. That doesn’t include the 200 other people employed by the hospital. So that’s about 500 people who have a job because of this development. That’s a big deal.”

Projects in the works are based on a 20-year engineering plan, so “when we build a building it makes sense for the future,” he said.

“We’re putting in almost a million dollars of infrastructure a year into Kibuye,” Cropsey said. “That being said, for sustainability reasons, we don’t underwrite the operating costs of the hospital. We want that to be generated by revenue of the hospital, so that what we build is then sustainable with revenue from the hospital.”

Ophthalmology is an important element of that revenue stream.

“The ophthalmology and surgery services are the main revenue generators of the hospital,” Cropsey told OSN. “All the other services are hemorrhaging money as they care for extremely sick, poor patients at a loss most days, given the government mandate to care for all pregnant women and children free of charge (the government reimburses but below the cost of the care provided and often behind schedule).”

Cropsey said he believes KHH serves as a model for medical education of the future.

“Our model is really trying to train on location in context, so people have a higher chance of being able to be productive in their own environment,” he said. – by Patricia Nale, ELS

Disclosure: No products or companies that would require financial disclosure are mentioned in this article.

In the face of harsh realities in sub-Saharan Africa, John Cropsey, MD, and a cadre of colleagues are partnering with Hope Africa University to grow a teaching hospital.

Kibuye Hope Hospital (KHH) is 6,000 feet high in the mountains of Burundi and a 2.5-hour drive from the main campus of Hope Africa University in the capital city of Bujumbura. Originally established in the 1930s as a mission of the Free Methodist Church, KHH is now the main training hospital for the university medical program and serves as a regional medical center in one of the poorest and hungriest countries on earth.

“We went from a rural district hospital with just a trickle of patients in 2013 to a major national referral center for tens of thousands of patients every year,” Cropsey said in his presentation of the 2018 David Paton, MD, Lecture in Academic Global Ophthalmology at Wills Eye Hospital. Cropsey was co-chief resident at Wills Eye Hospital in 2009.

The “we” that Cropsey refers to is “the McCropders,” a team of six physicians and their families who committed to Hope Africa University’s vision of “making the medical program a self-sustaining source of high-quality medical professionals.” These American expatriates relocated to Africa in 2013 and include a general surgeon, family practitioner, obstetrician/gynecologist, medical/pediatric physician, ophthalmologist (Cropsey) and emergency medicine physician. The staff also includes six Burundian general medical doctors.

To help ensure their success, the American team prepared for 5 years before starting work in Burundi.

“In 2007, we committed to do this together as a team. We went to Tenwek in Kenya for 2 years to try to hone our team vision and be mentored for 2 years to learn how to be doctors in Africa,” Cropsey said. “We wanted to go to a place where people wouldn’t normally go. Long story short, that’s how we ended up in Burundi, one of the more remote countries in Africa.”

The team then committed to being long-term medical missionaries and returned to the U.S., where they joined Serge Global and spent a year raising funds. Because they were going to be teaching at a French-speaking university, the group moved to France for a year and learned or improved their French language skills.

Student body

From 2013 through 2016, about 1,000 students were trained at Kibuye, Cropsey said.

“We have 40 students at any given time rotating as medical students at Kibuye for 4 months at a time,” Cropsey said, with students spending a total of a year “with us up in the hills” during their 3 clinical years.

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Besides medical students, nursing students and other paramedical students augment the student body so that about 100 students at any one time are in training at KHH, according to Cropsey.

“Our first term there was about laying the foundation of the medical curriculum, especially the clinical side,” Cropsey said. Now, the first internships in the country and a general surgery residency are being planned.

“Burundi has one of the lowest surgeon-to-population ratios in the world, about 10 to 13 general surgeons for the entire country. Only two [of those surgeons] are outside the capital, including ours,” he said.

Eye care service

Regarding students, “I would say one per 40 show serious interest and passion in pursuing ophthalmology as a career. Many more would if they thought they could obtain a residency spot,” Cropsey told Ocular Surgery News.

“We try to focus on technology that makes sense for our students,” he said.

In the NICU, for example, incubators and hospital beds have been designed using local materials — lightbulbs, a thermostat and mosquito netting — so mothers and infants can stay together.

“These are things we can make in Burundi,” Cropsey said. “A lot of times you go into the hospitals and they’ve been given equipment and it’s just sitting in a corner because it’s broken down or nobody knows how to use it. We want to focus on sustainable technologies.”

Along the same lines of using low-cost, low-tech, sensible technology in eye care, Cropsey said manual small-incision cataract surgery is the main technique taught at the university.

“MSICS is our go-to primary technique day in and day out. This is what is primarily taught to all our trainees,” he told OSN.

Sustainability

“Before we could start taking care of patients, we had to do a ton of infrastructure development,” Cropsey said. “People need jobs in Burundi, and so by keeping things low-tech and using manpower, at our peak, we had over 300 people on our construction crew alone. That doesn’t include the 200 other people employed by the hospital. So that’s about 500 people who have a job because of this development. That’s a big deal.”

Projects in the works are based on a 20-year engineering plan, so “when we build a building it makes sense for the future,” he said.

“We’re putting in almost a million dollars of infrastructure a year into Kibuye,” Cropsey said. “That being said, for sustainability reasons, we don’t underwrite the operating costs of the hospital. We want that to be generated by revenue of the hospital, so that what we build is then sustainable with revenue from the hospital.”

PAGE BREAK

Ophthalmology is an important element of that revenue stream.

“The ophthalmology and surgery services are the main revenue generators of the hospital,” Cropsey told OSN. “All the other services are hemorrhaging money as they care for extremely sick, poor patients at a loss most days, given the government mandate to care for all pregnant women and children free of charge (the government reimburses but below the cost of the care provided and often behind schedule).”

Cropsey said he believes KHH serves as a model for medical education of the future.

“Our model is really trying to train on location in context, so people have a higher chance of being able to be productive in their own environment,” he said. – by Patricia Nale, ELS

Disclosure: No products or companies that would require financial disclosure are mentioned in this article.