Over the past few weeks, Rwanda has battled its first known outbreak of the dangerous hemorrhagic fever caused by the Marburg virus. From the outset, many public health experts have noted that Rwanda’s healthcare system is better equipped and prepared than those of other countries in the region that have experienced similar outbreaks. If current trends continue, there is potential for Rwanda to limit the outbreak in terms of both the number of cases and its duration, which could result in one of the lowest fatality rates ever recorded for a virus of this nature.
Achieving this public health success, if realized, would not be as surprising as it may sound; it has been years in the making on both local and global levels. Experiences from the COVID-19 pandemic, along with enhanced preparedness protocols for Ebola and Mpox outbreaks, have strengthened Rwanda's contact tracing system and its infrastructure for procuring and distributing personal protective equipment (PPE). During this same period, the Rwandan government has made significant efforts to build a skilled healthcare workforce. In addition to fostering a well-informed public that diligently follows healthcare recommendations, the government has established clear channels for rapid and effective global collaboration during outbreaks, working with organizations such as the WHO, CDC Africa, and other governments.
This potential outcome is underscored by poignant, heroic stories of healthcare providers who have demonstrated immense sacrifice and unwavering altruism. It is essential to recognize that every case of Marburg virus disease (MVD) is harrowing, and each fatality is heartbreaking, regardless of one’s background or role in society. This outbreak, however, has particularly affected healthcare personnel, both in terms of cases and fatalities. Despite its strong foundations, the Rwandan healthcare system remains in its early stages relative to the ambitious goals the country aims to achieve. The loss of even one highly skilled healthcare provider is tragic and poses a significant setback for this developing institution.
For instance, initial cases of the Marburg virus were identified in the Intensive Care Unit (ICU) at King Faisal Hospital (KFH), Rwanda’s top-ranked medical facility. This hospital attracts the most skilled healthcare professionals in the country, and its ICU serves as a center where the best doctors and nurses converge to provide expert care to critically ill patients. Unsurprisingly, the ICU team at KFH has been particularly impacted in terms of exposures, cases, and fatalities. Close exposure to the virus may result in quarantine and absence from work, overextending the remaining healthcare staff and increasing their risk of exposure.
It’s important to note that the Marburg virus outbreak has affected not just King Faisal Hospital (KFH), but also other major medical centers, including the University Teaching Hospital of Kigali (UTHK or CHUK). Among those lost to the virus was a young emergency medicine resident from CHUK, Dr. Francois Ntawuruhunga, with whom both of us had the opportunity to work. He is survived by his wife and their infant son. He is remembered by his peers as a man of few words but great wisdom, known for his humility and hard work. Even amid the chaos in the emergency room, where patient acuity and volume could be overwhelming, he always remained calm and composed. Deeply dedicated to his patients, he was actively treating individuals in the ICU at KFH when the outbreak began. He and the other healthcare workers who lost their lives will always be remembered for their tenacity during the long and demanding years of medical training, as well as for their expertise in the field of medicine. Above all, they will be honored for their unwavering commitment to their patients, even when facing the unpredictable challenges that only those devoted to medicine can truly understand.
Other healthcare providers, while fortunate to survive, have recounted their harrowing experiences dealing with the deadly illness as patients. They were acutely aware of the odds they faced, describing their ordeal as both terrifying and life-altering. These experiences have reshaped their perspectives on medicine, resilience, and the fragility of life. Those who have thus far been spared continue to show up every day to treat patients presenting with symptoms often similar to those of the same hemorrhagic fever caused by the Marburg virus. The emotional and physical toll on these professionals cannot be overstated. Their road to recovery will be long and will require perseverance, resolve, tremendous dedication, and much-needed community support, both locally and globally.
The current trajectory of the MVD outbreak in Rwanda offers hope and emphasizes the importance of healthcare system readiness and global collaboration. It also underscores the need to understand the nature of these outbreaks more deeply. However, it is crucial to remember the profound impact of epidemics on individual healthcare personnel and the healthcare system as a whole. Ultimately, if anything defines the remarkable story of Rwanda, it is resilience. The Rwandan healthcare system has the potential and tools to recover and build on the expertise gained through this outbreak, striving for greater heights.
Seraphina Negash, MPH, is a graduate of the Brown School of Public Health and the University of Rhode Island. She is the 2024-2025 Rwanda Research and Development Fellow and currently lives in Kigali, Rwanda. Seraphina works closely with residents in the Emergency Medicine and Critical Care department at CHUK to build their research capacity and intends to pursue a doctoral degree in medicine after this fellowship.
Robert Gakwaya, MD, is a senior fellow in pediatric emergency medicine at Brown University/Hasbro Children’s Hospital. Throughout his medical training, Dr. Gakwaya has traveled to Rwanda multiple times to teach and learn from healthcare providers, particularly at CHUK, in both the emergency medicine and pediatrics departments. He grew up in Rwanda before relocating to the USA for his education and is a graduate of UMass Chan Medical School.
Both writers are affiliated with the Brown Emergency Medicine Department, Division of Global Emergency Medicine (GEM), at the Warren Alpert School of Medicine, Brown University. The GEM has been actively involved with the emergency medicine residency at CHUK since its inception, fostering collaboration and knowledge exchange between the two programs. Numerous residents and attending physicians from the Brown Emergency Medicine Department have worked alongside their Rwandan counterparts, including those affected by the Marburg virus outbreak. The lessons learned from this outbreak will inform the partnership between Brown University and CHUK and create opportunities for effective future support. This experience has the potential to enhance collaboration and provide vital assistance moving forward.