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Rwanda is training health workers for an interconnected world

Growing scientific evidence shows that environmental transformations such as climate change and pollution are linked to people’s health. The number of extreme events is increasing, often driven by human activities, and they often pose an immediate threat as well as having long-term effects on health. This is a future for which healthcare professionals need to be prepared.
The outbreak of the new coronavirus, COVID-19, is only the most recent example of the links between the environment, animals and activities and people’s health. The virus is suspected to have originated from a bat and was transmitted through an animal market in Wuhan, China. The 2002-2003 acute respiratory syndrome pandemic was another global epidemic attributed to human interaction with wildlife.

The interdependence between man, animals and the environment is becoming more pronounced. It is time to tackle health problems in a broad and interdisciplinary way. The attitudes and practices of healthcare professionals will have to change.

There is already a conceptual framework for this. It just needs to be adopted more broadly and urgently, supported by politics and education.

The One Health approach recognizes the links between man and his biophysical, social and economic environment. He sees these connections reflected in the health of the population. One Health differs from other approaches to health in that it considers the integrative effort of multiple disciplines that work locally, nationally and globally to achieve optimal health for animals, the environment and humans.

Many international institutions, such as the World Health Organization and Centers for Disease Control and Prevention, have adopted One Health in principle. And it is partly integrated into academic planning, including medical and veterinary schools.

The One Health approach emphasizes the development of students who analyze, interpret and create plans for both the present world and the future. It takes disciplinary strengths and their best practices and forces them to work together.
Challenge existing obstacles and offer a platform to consider innovative solutions. One Health embraces complexity and looks at the whole picture to identify changes that will impact health. Also look for places where intervention creates change.

One Health in Rwanda

Rwanda is a country, among others in East Africa such as Kenya and Uganda, which is incorporating One Health into its way of doing things. The country adopted the One Health approach in 2011. This was driven by emerging and re-emerging infectious diseases and their potential impact on socio-economic growth.

One Health in Rwanda offers a formal, institutionalized, multisectoral and coordinated approach to detect and respond to outbreaks and other health threats. Rwanda has the second highest population density in sub-Saharan Africa and is bordered by countries where outbreaks of diseases such as Ebola and Marburg have occurred. This puts him at risk of health problems in the human-animal-environment interface. It also has a strong network of community health workers, rapid response teams and academic partnerships that support the One Health approach.

Professional education is part of the plan. At the University of Global Health Equity, located in rural Rwanda, graduate students in medicine and global health are introduced to One Health through field learning. Visits to the site include a local pig farm, wetlands surrounding the campus, community farms and a model village where displaced people have been moved. These visits allow students to see the links between animals, the environment and human health.

For example, at the pig farm, students observe the direct interactions between farmers, pigs and the environment in which the farm is located. They learn the protective measures used to prevent the transmission of zoonotic diseases from pigs to humans and vice versa. I am able to ask the company’s vet questions about how they interact with healthcare professionals regarding emerging diseases.

By the end of the program, students will have acquired a range of different skills and the managerial and communicative training necessary to respond to complex health challenges. For example, a doctor who participated in the site visits would ask patients further questions to determine the patient’s medical history, for example if they interact with animals. This more holistic approach to health can provide the key to determining the cause of the patient’s condition.

The results of these efforts in Kenya suggest that training the next generation of professionals to use the One Health goal will help solve complex health challenges such as global disease outbreaks.

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