Global Health
on Equal Terms

Rwanda, a nation of 14 million in the heart of East Africa, saw its healthcare system decimated by genocide in 1994. Over just 100 days, 800,000 Rwandans—primarily Tutsi, along with moderate Hutu—were killed, with well over a million lives lost over the course of the broader conflict. Among the dead were countless physicians, nurses, and other healthcare professionals. The country’s medical infrastructure lay in ruins. Resources were depleted. Cholera ran rampant. Hospital wards stood empty. Buildings had been destroyed. Everything had to be rebuilt from the ground up.

“We had lost knowledge,” says Agnes Binagwaho, MD, PhD, former Minister of Health of Rwanda and adjunct professor of pediatrics at the Geisel School of Medicine at Dartmouth. “We were not in the condition to provide continuous quality care, and the little we were providing was absolutely out of standard.”

Three decades later, in 2024, then-Geisel medical student Cheema’s six-week clinical rotation at CHUK provided her a window into the rebirth of the Rwandan healthcare system. Her visit was possible thanks to Geisel’s Center for Global Health Equity (CGHE), through which the school’s faculty train physicians in low-income countries both in their home country and in the U.S., helping develop curricula, mentor students and residents, and expand access to advanced medical education. Geisel students, including Cheema, participate in CGHE’s Rwanda program through global health electives at hospitals like CHUK, where they gain practical experience and contribute to patient care while learning from local healthcare practices.

CGHE’s work extends well beyond Rwanda. From Haiti and Peru to Kosovo and Tanzania, Geisel has built partnerships around the globe, all following the same model: letting local experts lead.  

“Our job is to support—and get out of the way,” says Lisa V. Adams, MD, MED ’90, associate dean for global health and director of CGHE. “Equity demands we check our privilege at the border. Without this awareness, we risk replicating the very inequities we seek to mitigate.”  

Healing Old Wounds

Adams is acutely aware of the dangers of repeating history. After spending six months helping launch the Rwandan-led Human Resources for Health (HRH) program in 2012—designed to rebuild Rwanda’s medical workforce and establish specialty training—Adams directed Geisel’s efforts in curriculum development and long-term faculty placements. Her goal was to ensure HRH was a true partnership rather than a paternalistic extension of Western aid. Originally built in 1918 under Belgian colonial rule, CHUK prioritized European interests over those of Rwandans. Colonial healthcare policies not only deepened existing inequities but also inflamed ethnic divisions— tensions that would later erupt in the 1994 genocide.  

“Colonialist attitudes permeate every aspect of global health, from the metrics we use to the way we describe interventions,” Adams says. “We need to radically shift our language and attitudes so that neither power nor pity determine our ability to collaborate.  

“Rebuilding Rwanda’s health system therefore required more than monetary aid or physical infrastructure—it demanded that Rwandans lead, foreign partners empower, and both sides learn continuously from one another. “Equity in partnership is the means to achieve equity in health,” she says. “So we ask our partners what matters most to them, rather than seeking input on plans we’ve already designed.”  

Today, through CGHE, Geisel faculty provide hands-on clinical training in specialties like gastroenterology, oncology, and emergency medicine—fields that previously had little or no local expertise. In partnership with CHUK and the University of Rwanda, CGHE also helps design medical curricula and establish residency and fellowship programs to train future generations of Rwandan physicians, ensuring that medical knowledge and expertise remains in the nation’s borders.  

Geisel faculty like Steve Bensen, MD, MED ’90, regularly travel to Rwanda to help specialists become independent leaders in their fields. “When Geisel joined HRH, Rwanda had no trained gastroenterologists,” says Bensen, who is a professor of medicine at Geisel and gastroenterologist at Dartmouth Hitchcock Medical Center (DHMC). “Today, the country has several who have trained abroad as well as the first four graduates of the newly established Rwanda GI fellowship.” Additionally, Geisel faculty and Rwandan colleagues co-founded the Rwanda Society of Endoscopy in 2016 and launched Rwanda Endoscopy Week in 2017.  

The Power of Reciprocity

Beyond sending students and faculty abroad, Geisel’s program also brings Rwandan medical professionals to DHMC in Lebanon, New Hampshire, for training. Since 2015, CGHE has sponsored over 30 Rwandan medical professionals for specialized training at DHMC. Each year, multiple Rwandan residents complete rotations in the U.S. before returning home to apply their knowledge in Rwanda. By embedding long-term training and bilateral exchange into its global health strategy, Geisel aims to avoid the pitfalls of “one-off” medical missions.  

Geisel students visiting Rwanda also study the influence of their presence. During their four-week rotation in CHUK’s pediatric emergency room, Caley Dickinson, MD, MED ’24, and Sirey Zhang, MD, MED ’24, also conducted research on how visiting medical students impact Rwandan training and education. “It forced us to reflect on how global health must be about partnership, not paternalism,” Dickinson says.  

Their preliminary findings revealed “a broad imbalance of people coming to learn about Rwandan medicine but not a lot of Rwandans who come to high-income countries,” Zhang notes. Between 2019 and 2024, for example, CHUK hosted over 4,000 medical students from more than 70 countries, whereas only a few hundred Rwandans had the opportunity to train in high-income countries.  

This discrepancy is all too common in international partnerships, Bensen says. “At some institutions, they fund just a few international students to come to the U.S. compared to the number they send abroad. At Dartmouth, our ratio is better than one to one—we bring more Rwandans than [students] we send.”  

A Reverberating Impact

This approach leaves a lasting impression overseas. In 2024, Amer Al-Nimr, MD, director of the Global Child Health Program, arranged for Rwandan physician Gaspard Habimana to complete a 24-week pediatric gastroenterology training at DHMC. In all of Rwanda—a nation where almost half the population is children— there were no pediatric gastroenterologists. When Habimana returned home in early 2025, he became the first.