Practicing Neurosurgery in Sub-Saharan Africa
Author: Claire Karekezi, MD
My name is Claire Karekezi; I am a neurosurgeon currently working in Rwanda—the only woman neurosurgeon in Rwanda. I developed my passion for Neurosurgery early in chool; It was very difficult at that time for anyone coming from Sub-Saharan Africa (SSA) to get into neurosurgery. When I finished my training I said there is no better way of giving back than working in my own country, treating Rwandese and working with others to improve care. Neurosurgery for me means simply being able to treat the most in need wherever and whenever, despite challenges.
I received my MD degree from the University of Rwanda College of Medicine and Health sciences (2009) and completed my Residency in Neurosurgery from the Mohamed V University of Rabat/WFNS Rabat Training Center for African Neurosurgeons (2016). I was further involved in fellowship programs in the US and Canada, received the 2016 AANS International Visiting Surgeon Fellowship in Neurosurgery/ NeuroOncology at the Brigham and Women Hospital in 2016, and later completed a Clinical Fellowship in NeuroOncology and Skull Base Surgery at Toronto Western Hospital, University of Toronto in Canada (2017/2018).
I was privileged to train under world-renowned experts at great institutions, was exposed to well-organized clinical Neurosurgery, and gained extensive experience in the full spectrum of brain tumor treatment. Most former teachers became great mentors and still look after me. Everything I learned with their supervision helps me today in my daily practice: knowledge, great clinical judgment, proper diagnosis and optimal management of patients, but also providing care with dedication and good work ethic.
Like other countries in the East-central Africa region and SSA in general, Rwanda suffers from a great shortage of neurosurgeons, with only six neurosurgeons serving 12 million people. When I came back to my country in 2018 after completing my fellowship, I earned a position at the Rwanda Military Hospital in the capital Kigali, where I am the only Neurosurgeon. Transitioning from well- established neurosurgical units with mentors/supervisors and dedicated teams to a situation where you have to initiate everything from scratch has been one of the most challenging missions I have ever been given.
My beginnings were challenging, from being able to do simple cases to more complex ones, and organizing a team and allocating appropriate surgical instrumentation. I spent first months of my practice setting up a functional neurosurgical unit and interestingly found myself in an unexpected leadership position. The lessons I learned about neurosurgical education and healthcare systems organization during my overseas fellowship have helped me in setting up the new unit. Most cases I see include trauma, CNS infections, congenital anomalies and brain tumors. I have seen more than 2500 patients and operated on 80 patients in the last ten months.
Even though my story of being Rwanda’s first and only female Neurosurgeon broke the internet, I feel like there is still much to learn and accomplish as a young, (African) woman neurosurgeon. Each step all along my journey has been tough but achievable, from choosing a career/training in Neurosurgery to carrying residency and fellowship programs abroad to starting career as a young attending neurosurgeon. I learned a lot all along the way. There are no small roads; I had moments of discouragement but dedication and perseverance keep me going. I am thankful to all my former mentors who invested their time in me, recognized and shaped me into a good neurosurgeon, and who are still following up on me, guiding each step through my career development.