Adapting Transfusion Camp in Rwanda

Yulia Lin, Jacob Pendergrast and Teresa Skelton

“How about a global arm of Transfusion Camp?” This was the question Dr. Teresa Skelton asked of us in February 2020. Terri is a pediatric anesthesiologist with international experience educating colleagues and trainees in developing countries through the Vital Anesthesia Simulation Training program. She had heard of Transfusion Camp, a transfusion medicine education program for postgraduate trainees that has expanded across medical universities nationally and internationally since 2012.¹ She also recognized the World Health Organization’s action framework to advance universal access to safe and effective blood products. Essential parts of providing this care are access to education on how to prescribe blood transfusion and partnerships to address local challenges, especially in resource-limited settings where there is high clinical load and limited resources for teaching.

The opportunity to collaborate came when Terri was planning a 3-month term in Kigali, Rwanda. Rwanda has many transfusion similarities to Canada. Their blood supply is made up of nearly 100% voluntary and non-remunerated donors; they process blood into components including red blood cells, plasma, platelets and cryoprecipitate; and they have the ability to deliver blood quickly to hospitals across the country using Zipline Rwanda, a fleet of autonomous fixed-wing, battery powered drones. Partnering with Canadian Blood Services and the Rwandan Biomedical Centre – Blood Transfusion Division, the Canadian Transfusion Camp faculty worked closely with the Rwandan faculty to pilot an adapted version of Day 1 of Transfusion Camp for postgraduate trainees in Rwanda. The focus was on foundational knowledge (indications for blood transfusion) using the same format as Transfusion Camp Canada: didactic sessions consolidated by team-based learning seminars to apply the concepts. Faculty modified and pre-recorded didactic sessions for asynchronous viewing and then brought the trainees together for an afternoon retreat to run the seminars.² Thirty-one trainees from anesthesia, surgery, obstetrics, emergency and critical care, pediatrics and internal medicine from the University of Rwanda attended. We were able to demonstrate an improvement on a pre- and post-test from 41% to 68%. Eighty-five percent responded that the course content was applicable to daily practice.³ Although the camp was very well-received, we knew that the model was not a sustainable solution. We needed to train more faculty to be able to teach Transfusion Camp.

With an educational grant from the International Society of Blood Transfusion, Transfusion Camp Rwanda – Train the Trainer, a two day event was held in May 2023. The aim was to deliver context-appropriate, up-to-date transfusion education, teach participants how to independently deliver a team-based learning curriculum and identify strategies to promote change in transfusion practice in Rwanda. Jacob, Terri and I had the privilege of travelling together to Rwanda to help implement this program. There were 51 attendees from all 5 Rwandan provinces: 39 physicians of diverse specialties and 12 laboratory staff. Rwandan faculty delivered half of the lectures and led all of the seminars. There was an incredible exchange of information between clinicians and laboratory staff about national transfusion guidelines, available blood products, and strategies to improve transfusion practice locally.⁴ In May 2024, another Transfusion Camp for Rwandan Staff, now 2.5 days including a massive hemorrhage simulation, was held with an audience expanded to include nurses and midwives as well as physicians and laboratory staff; 116 participants in total. This session was supported by Research for Development, a non-governmental organization with an interest in structural reform in healthcare, and was attended by representatives from Uganda and Kenya who were interested in further regional expansion. Most recently, in July 2024, our colleague Dr. Aimable Kanyamuhunga led a Transfusion Camp initiative for the graduating medical class of the University of Kigali, attended by 96 medical students just prior to their dispersion as interns across Rwanda’s hospitals. Over the course of the initiative, over 300 Rwandan clinicians and laboratory staff have participated! It is amazing to see how Transfusion Camp has grown. From a local educational initiative, it has expanded across Canada, to sites in the United Kingdom and now to Rwanda where it has taken on a life of its own. The ultimate reward has been seeing others teach and lead in transfusion education. Little did we know how one simple question could inspire such wonderful collaborative experiences and advance the state of transfusion education globally.

References:

Lin Y, Tilokee E, Charge S, Alam A, Cserti-Gazdewich C, Lau W, Lee C, Lieberman L, Nixon P, Owens W, Pavenski K, Pendergrast J, Saidenberg E, Shehata N, Skeate R, Yi QL, Conrad D, Dudebout J, Hsia CC, Murphy M, Prokopchuk-Gauk O, Shah A, Solh Z, Trudeau J, Zeller MP, Callum J. Transfusion Camp: a prospective evaluation of a transfusion education program for multispecialty postgraduate trainees. Transfusion 2019;59: 2141-9.
Skelton T, Nizeyimana F, Pendergrast J, Hagumimana J, Masaisa F, Kanyamuhunga A, Gashaija C, Callum J, Pavenski K, Khandelwal A, Lieberman L, Charge S, Kapitany C, Morgan M, Meirovich H, Lin Y. Transfusion medicine education delivery in Rwanda: Adapting Transfusion Camp to a resource-limited setting. Transfusion 2023;63: 2159-69.
Hagumimana J, Skelton T, Pendergrast J, Nizeyimana F, Masaisa F, Kanyamuhunga A, Gashaija C, Charge S, Kapitany C, Morgan M, Meirovich H, Lin Y. Transfusion Camp Rwanda: A prospective feasibility study evaluating the delivery of Transfusion Camp to a multidisciplinary group of postgraduate medical trainees in Rwanda. Transfusion 2023;63: 2170-8.
Nizeyimana F, Pendergrast J, Ntegerejuwampayee A, Lin Y, Kanyamuhunga A, Gashaija C, Masaisa F, Uzamukunda C, Mutuyimana G, Ndicunguye F, Gaseminari A, Mulindwa B, Muyombo T, Charge S, Skelton T. Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education. Vox Sang 2024;119: 563-71.