COMBINED REPORT 2019-2020

HEADQUATER OFFICE: NYARUGENGE DISTRICT Tel +250 788 300 639, +250788 828 828 Email: contactus@rwandalegacyofhope.com,

Email: rwandalegacyofhope1@gmail.com Website: https://www.rwandalegacyofhope.com/

UK Office: Catherine Street Plymouth PL1 2AD Tel 01752 651817 Office

The Minister of Health Hon. Dr Gashumba paid a visit to the team at Gorilla hotel Nyarutarama and gave a moral boosting speech expressing appreciation for the work done by the RLOH Mission over the 6 years.

Give a child a chance sport

The Minister of Health Hon. Dr Gashumba paid a visit to the team at Gorilla hotel Nyarutarama and gave a moral boosting speech expressing appreciation for the work done by the RLOH Mission over the 7 years.

TRAINING

RLOH computer training for the young people and women’s

LEADERSHIP TRAINING: Rwanda Legacy of Hope has organised Leadership training for 6 days in Rwanda. 110 leaders from various denominational churches attended the training being led by Reverend Neil Collins at Living Well Church, Plymouth and Reverend Osee Ntavuka, Founder and Legal Representative of Rwanda Legacy of Hope on the last day of the training, everyone in attendance will receive a certificate of qualification and all leaders are very excited and are looking forward to the teaching

COMBINED REPORT

1. INTRODUCTION

1.1This is a combined report on RWANDA LEGACY OF HOPE / OPERATION HERNIA/SURGEONS FOR AFRICA Mission to Rwanda from March 14-01 April 2019. This report will summarise the activities of the 3 specialties in the Team: Hernia Training, ENT and Neurosurgery. I will employ the template used for the 2018 report.

1.2 Detailed Specialty Report

The detailed Specialty reports will be attached to this combined report as Annexes A, B, and C.

1.3 The RWANDA LEGACY OF HOPE and OP HERNIA Partnership has served the people of RWANDA in the health sector, successfully, for 7 years. I would like to register the vital partnership with the Ministry of Health and Dr Diane Gashumba, Minister of Health and the Government of Rwanda. This humanitarian venture would not have enjoyed so much success without the generous support received.

2. Achievements over Past 7 Years The health sector of RLOH has celebrated the following successes since our first visit in 2012. 2.1. Hospitals Visited: We have worked in the following 8 Hospitals: NYAMATA, Remera-Rukoma, GAHINI, Kibogora, Kigeme, Rwamagana, CHUK , SHYIRA Hospital and this year, CHUB and Ruhango Hospitals on 53 occasions. 2.2. Patient Numbers: We have offered essential, surgery to over 800 patients.

2.3. Volunteers: We are indebted to our Volunteers who are passionate about giving of their best to the people of Rwanda. There have been over 100 volunteer episodes. Volunteers have come from mainly the UK and GERMANY but also from Austria. Each of the volunteers have funded their flights to RWANDA. In the early years they also paid for accommodation and subsistence. Since 2016 the Min of Health has magnanimously sorted out the logistics of our stay in Kigali. We are extremely grateful. We have always been catered for in the district’s hospitals.

2.4. Surgical Specialties: Our early missions concentrated on Hernia Surgery. We have now expanded our remit to meet the needs of the Rwandan people. Our later missions have therefore included Plastic Surgery, Orthopaedics and ENT Surgery and Neurosurgery.

2.5. Provision of Hospital Equipment: RLOH has provided Rwandan Hospitals with equipment worth over £230.000 (RWF 274 million). The equipment ranges from routine surgical instruments to theatre tables and air conditioners fitted in theatre. In 2016, one theatre in Rwamagana was equipped as a training centre.

1 | P a g e

2.6. Training of Surgical Residents: There has been a shift of emphasis in General Surgery to Training. RLOH Missions have always trained junior doctors. We are now concentrating on training of Surgical Residents. This report will include a report on the 2019 Residents Training. Training builds capacity for improved delivery of surgical services.

2.7 FIRST Train The Trainers ( TTT) Course: As part of the drive to build capacity and hence improve access to surgical services, RLOH / Operation Hernia mission organised a TTT course for 2 Consultant Surgeons. The training took place at CHUB. The 2 Consultants will supervise the further training of the Residents who have participated in the Hernia Course. They will also join the Faculty of Trainers for the 2020 course and beyond. The aim is to increase the pool of local trainers who will eventually take the running of this vital course.

2.8 Visit by Dr Diane Gashumba, Minister of Heath: Dr Gashumba paid a visit to the Team at their Kigali accommodation and gave a moral boosting speech expressing appreciation for the work done by the RLOH Mission over the years.

2.9 COMMUNITY WORK UMUGANDA: At the invitation of Dr Gashumba, the team made a 3hour trip to the Burera Bugwe District to join the village at their Community Work (Umuganda) This was inspirational and a highlight of the mission

3. MARCH 2019 MISSION

The 2019 Mission comprised the following :- 1. Train The Trainer Course at CHUB 2. Residents Hernia Course at CHUB and Rwamagana Hospital 3. Adult Hernia Service at Remera Rukoma and Ruhango Hospitals 4. Paediatric Hernia Service at Shyira and Remera Rukoma Hospitals

4.The Teams The Team comprised a UK and Germany contingents of Consultant Surgeons, Consultant Anaesthetists, Theatre Nurses and Technicians, totalling 33 Volunteers. The full list of names is provided in Annex A

5. Hospital Equipment

An important facet of improving access to surgical care in Rwanda is the provision of important Theatre Equipment. This year RLOH / OP HERNIA /SURGEONS FOR AFRICA have donated equipment worth Euro 80,000 ( RWF 81 million) This comprised sets of Hernia surgical Instruments, Diathermy machine, Neurosurgical Instruments, Anaesthetic drugs and Anaesthetic equipment. A full list is provided in Annex B

2 | P a g e

Hospital Equipment donation

6. Accommodation, Food and Transport We have enjoyed the traditional warm hospitality of the Rwandan people. The team had excellent accommodation in Kigali. The Remera Rukoma Hospital team, unfortunately, had to be relocated because of health and safety issues with their accommodation. We are grateful to The Government of Rwanda and to the Ministry of Health for this hospitality.

7. SUMMARY OF SPECIALTY REPORTS

7.1 TRAIN THE TRAINER HERNIA COURSE AT CHUB

3 Consultant Surgeons registered for the Train the Trainer Hernia Course. One consultant withdrew due to unforeseeable circumstances. 2 Surgeons, Dr Dr Robert Munyaneza ( CHUB) and Dr Herbert Butana ( Rwamagana Hospital) were trained to join the Faculty of Hernia course Trainers. We are grateful to Dr Munyaneza for organising both the TTT and Residents Courses. Training involved the following aspects:-

1.Interactive Lectures on relevant aspects of Hernia Surgery 2.Practical training in theatre.

The TTT course theatre session was cancelled due to logistics issues in theatre.

8. RESIDENTS HERNIA COURSE AT CHUB AND RWAMAGANA HOSPITALS A full report on the Training has been produced and will be made available as Annex C. I will summarise the course in this report.

7 Year 2 Surgical Residents were selected by Dr Faustin Ntirenganya from all the Kigali teaching Hospitals. For the course. The course consisted of a day and a half of Lectures followed by 5 days of intensive one to one hands on training in theatre. After the Lectures, they were split in 2 groups of 4 and 3 Residents to be trained at CHUB and Rwamagana. They were all trained to a satisfactory level of competence.

Summary of Results of Training.

Table 1: Results of Pre-course survey of surgical skill

OPERATION NO OF TRAINEES CASES RANGE WITH

EXPERIENCE

NON-MESH REPAIR IF INGUINAL HERNIA 2 out of 7 5

MESH REPAIR OF INGUINAL HERNIA 0 0

3 | P a g e

ASSISTED AT HERNIA REPAIR 7 out of 7 Median 33 7-75 BEEN ASSISTED AT HERNIA REPAIR 7 out of 7 3 0-10 CAESAREAN SECTION 6 out of 7 Median 50 0-500

Feedback from lectures Fig 1 Lectures Feedback This shows good to excellent feedback of 76%

Evidence Tissue Repair Excellent

Local Anaesthesia very good

Video SHOULDICE good

average Complications

poor Epidemiology

0% 20% 40% 60% 80% 100%

Fig 2

Assessment of Overall Knowledge of Hernia Repair

overall knowledge

10

0

before after

Fig 3

Assessment of Overall Knowledge of Hernia Repair

4 | P a g e

knowledge of anatomy

10

0

before after

12.1 Assessment of Trainees by Trainers At the end of the 5 days of training, the competence of the trainees was assessed. The assessment tools developed and employed by the UK Royal Surgical Colleges were adopted for this training programme.

At the end of the programme, all trainees were able to perform mesh hernias repair of small hernias with various degrees of supervision. Three trainee were judged able to perform hernia repair without supervision. This is an incredible achievement considering the fact that the majority of Residents had little personal experience of hernia surgery. The 7 trainees were assessed as follows: -

Table 4: Trainers Assessment of Surgical Competence

LEVEL COMPETENCE Small Large hernias Hernias

Level 1 Unable to Perform procedure 0 0

Level 2

Able to Perform Aspects of the procedure 0 0

Level 3

Able to Perform Procedure with Supervision 1 1

Level 4

Able to Perform with minimal supervision / 3 6 Occasional Help

Level 5

Able to perform independently 3 0

9. GENERAL HERNIA SURGERY SERVICE AT REMERA RUKOMA, SHYIRA AND RUHANGO HOSPITALS

5 | P a g e

RLOH Mission visited Ruhango hospital for the first time. The team had not been to Remera Rukoma for a few years. Shyira Hospital was dedicated as a Paediatric Unit. The Surgical team that visited were Paediatric specialists. The Remera Rukoma team comprised an Adult and Paediatric Teams. An adult hernia team went to Ruhango hospital.

9.1 Clinical Outcome ( Table 5) The table outlines the total clinical activity undertaken by the general surgical team. A total of 156 Operations were performed.

Mesh Shouldice Herniotomy Other Hydrocoele Others TOTAL

Repair Repair Hernias

RWAMAGANA 14 14 3 9 8 48 RUHANGO 10 1 0 3 10 1 25 SHYIRA 6 0 7 4 4 1 22 CHUB 18 1 2 2 0 1 24 REMERA 10 0 2 3 1 9 25 RUKOMA

TOTAL 58 16 14 21 23 12 144 ENT 6 NEURO 6

156

10. SUCCESSES

1. Very successful Residents Hernia Course 2. First Train The Trainer Course 3. Very good hospitality at all the Hospitals. ( Remera Rukoma had an issue)

4. Remera Rukoma deserves commendation for a very effective recruitment

programme. They recruited well over 40 Patients, the second best after Rwamagana Hospital.

5. The first visit of Dr Diane Gashumba spoke volumes to the team of volunteers. 6. Community Work.

6 | P a g e

10. GENERAL SURGERY CHALLENGES

1. Ruhango Hospital: Patient Recruitment at Ruhango was abysmal. The mission to the hospital looked doomed to failure. The hospital had not prepared for the team. An SOS message was sent by the team on the first day of the Mission. Patients were diverted from Remera Rukoma to Ruhango. This affected the productivity of the Team at Remera Rukoma. I have attached a report from the Ruhango Team as Annex C

2. Water supply at Ruhango hospital failed for 2 days.

3. The plumbing system at the Remera Rukoma accommodation was blocked. This posed health risks to the team who had to be relocated.

4. Patient recruitment at CHUB was apparently satisfactory. Unfortunately many of

the patients did not turn up. This threatened the effectiveness of the training at CHUB. In the end we had the required minimum for satisfactory training.

5. All Operations were performed with minimal complications and No Fatalities. 11. RECOMMENDATIONS

1. Ruhango Hospital: should be reviewed before another visit by RLOH team.

2. CHUB: Factors affecting attendance of recruited patients at CHUB have been reviewed and recommendations made. This will hopefully improve patient numbers in 2020

3. Remera Rukoma Hospital: The plumbing at Remera Rukoma accommodation should

be repaired. It would not be advisable to accommodate another team at the hospital for health and safety reasons, until this is resolved.

7 | P a g e

12. ENT SURGERY AT CHUB

REPORT OF ENT MISSION TO CHUB MARCH 2019

RWANDA LEGACY OF HOPE / OPERATION HERNIA MISSION

Surgeon: Dr Montio Morgan

Anaesthesiologist: Dr Ian Geraghty

Background.

OH and RLOH have a long history of collaboration with CHUK and other health institutions in Rwanda. Two years ago, we had the first ENT/Anaesthesiology team mission at CHUK. This was a very positive mission and was followed up by another successful mission to CHUK last year.

This year, we were directed to the ENT department at CHUB. Prior to arrival at CHUB, contact was made with Dr Alice Mugwaneza (Head of ENT Department) and following discussions on email and WhatsApp, it was decided that this mission would concentrate on Ear Surgery. This was because my clinical skills lie in Otology and Rhinology and as there is no available equipment for Nasal surgery at Butare, the only other option was to do Ear surgery.

Before arriving Butare, the understanding was that there was an operating microscope in theatre, a microscope in Outpatients department, and that the patients would be screened and prepared for

th surgery to begin on Monday the 25 March. Unfortunately the head of the ENT department had sustained an ankle sprain, which meant that she had been off work for a while before we arrived.

The ENT department at Butare is staffed by 2 full time specialists (Dr Alice and Dr Francoise) and one part time specialist (Dr Jean Marie). The latter was on annual leave during our visit and we did not meet him. There are also 2 Medical officers who see outpatients and do on call on a rota basis. Furthermore, there are some ENT nurses who are the backbone of the department, and are rota’d to cover outpatients, ENT ward, Theatre, Audiology, triage and reception, and on call duties.

There was no ENT resident at Butare during our week long mission.

Daily routine

Day 1 was spent screening patients who had been asked to attend for consideration of surgery by the mission team. On this first day, a patient was listed for theatre in the afternoon. Subsequently, we were able to do one tympanoplasty surgery a day for the five days (see below)

8 | P a g e

Preop patients were seen before surgery by the Non-Physician Anaesthetists.

A total of 28 patients were seen in clinic – Majority of these required audiology and counselling for their chronic suppurative otitis media. Most of the patients with ear discharge had tubotympanic disease and we did not see any cholesteatoma cases.

The following 6 patients underwent surgery by myself, or by Dr Alice and Dr Francoise supervised by me.

Logbook of Theatre Cases

Date Patient ASA Procedure Anaesthesia

demo Class

25.3.19 Male, 25 1 Left tympanoplasty GA

26.3.19 Male, 24 1 Right GA

tympanoplasty

26.3.19 Male, 19 1 Examination under Sedation

microscope of both

ears

27.3.19 Female, 19 1 Right Type 3 GA

tympanoplasty

28.3.19 Male, 19 1 Left tympanoplasty GA

29.3.19 Female, 24 1 Left tympanoplasty GA

Compliments due

CHUB is kept very clean and tidy and it is worth commending the staff who kept the hospital in a pristine condition as if by second nature.

CHUB has a very comprehensive integrated patient flow document incorporating medical, surgical, anaesthetic and perioperative information.

Despite not having formal Audiology training, some of the nursing staff were able to obtain relatively accurate Pure Tone Audiograms with the available equipment which requires a lot of attention.

Very good ENT surgical instruments.

Generous hospitality – a lovely hot and nutritious lunch in theatre- and warm welcome by the local team.

9 | P a g e

Challenges encountered

WHO checklist – Although there was some understanding of the necessity for this to be carried out, there was not the tendency for all theatre staff to stop and pay attention to the process.

Communication- This is cardinal for the good running of any department and especially one with a high turnover as the ENT department at Butare. Mobile phone use was integral to the system, however planning meetings would help to prevent some of the issues encountered,

Surgical instruments – Otology instruments are fine and dainty and should be protected within the sterile box. However, the instruments were left lying loose in the box with other heavier instruments and were at risk of destruction.

Operating microscope- This was satisfactory but needed to be lubricated.

Suggestions

I believe that the ENT department at CHUB has a great deal of potential and with some focus, would go from a great to a fantastic department!

- Audiology training and education support for the nursing staff - Scrub nurse training and education for the nursing staff - Review of clinical management structure; mentoring links with head of department.

- Institution of a more rigorous and structured system of communication within the team

i.e. staff meetings, case presentations, discussion of complex presentations.

- Continuation of links between myself and the ENT specialists to provide support and encourage development.

I was privileged to be able to spend a week with this team, and I would be grateful for another chance to return next year.

Montio Morgan FRCSEd (Oto) FRCS (ORL)

Consultant ENT surgeon

BTUH Basildon

Essex SS16 5NL

10 | P a g e

ANAESTHETIC REPORT

OPERATION HERNIA ENT TEAM VISIT TO CHU BUTARE

25-29 MARCH 2019

As described in Miss Morgan’s report, clinical activity was much less than expected and only 5 operative cases were performed under general anaesthesia, which was disappointing. Organisational changes should mean that future visits are busier and utilise the team’s time and skills better.

CHUB has 6 operating theatres, all impeccably clean with running water and a reliable power supply. The anaesthesia equipment was adequate but poorly maintained and calibrated. This meant that low flow anaesthesia was not possible. Not only does this have an adverse environmental impact in terms of ‘greenhouse gases’, it also has a considerable cost implications for the hospital in terms of carrier gas and volatile agent consumption. Considerable savings could be achieved if the anaesthetic machines were properly calibrated. Halothane was available in all theatres and isoflurane in some. Most basic anaesthetic drugs were available, although there was no propofol or thiopental at the time of our visit. Pulse oximetry and capnography were available in all theatres although there was a supply issue with ECG electrodes. Airway equipment and adjuncts were good and there was a videolaryngoscope available.

I had the pleasure of meeting several specialist and resident anaesthesiologists and anaesthetic officers and had the opportunity to work with them in theatre.

On returning to Kigali, I was fortunate to meet the President and officers of the Rwandan Society of Anaesthesiologists. They were unaware of our mission but, given adequate notice of future missions, would be prepared to assign residents on the MMed training programme to our consultants for training.

Dr Ian Geraghty

Consultant Anaesthesiologist

UK

11 | P a g e

17. NEUROSURGERY AT CHUK

Introduction This is the second Neurosurgical visit to CHUK. A further visit is planned for later in 2019. Neurosurgical Operations are very complex and tend to take the best part of the day. The team performed 6 Skull Base Complex Surgical Procedures. One patient was operated on per day. The clinical outcome was good. There were no major complications of fatalities. A full Neurosurgical Report will follow.

19. SIGNED

CHRIS OPPONG MEDICAL DIRECTOR RWANDA LEGACY OF HOPE CHAIRMAN

OPERATION HERNIA

12 | P a g

Kwibuka25: Rwandans in Plymouth Commemorate Genocide against Tutsis http://www.topafricanews.com/2019/05/21/plymouth-rwandans-and-friends-of-rwanda-honor-victims-of-the-genocide-against-tutsi/?fbclid=IwAR01uRswliBrV-7vLpsBvaPIlB_OhYb6fHPngZpGu27rBALjeYVqMjxvVrQ

The Lord Mayor Councillor Richard Ball attend the Event

Reverend Osee NTAVUKA

Honourable Luke Pollard MP First Secretary of Rwanda High Commissioner IHIRWE Francoise KANEZA

Pro

ject

nam

e

Fild

of i

nte

rven

tion

/ Do

mai

n

Du

ratio

n

Pla

nn

ed A

ctiv

ities

Pla

nn

ed B

ud

get

Pla

nn

ed b

ud

get

201

9

Are

a o

f in

terv

enti

on

Pro

vin

ce,D

istr

ict,

Sec

tor

Do

nn

ors

Hernia repair/ 120 patients MARCH 2019

240,000,000FRW 240,000,000FRW

Screening of patients Hernia repair surgery using mesh techniques

A breakthrough was introduction of Hernia Repair under

Local Anesthetic infi ltration. All hernias had hitherto been

performed under spinal anesthetic.

ENT 30 pantients March 2019 at CHUK 150,000,000FRW 150,000,000FRW

Screening of patients for plastic surgery procedures

Surgical intervention and post-operative care

Training to medical staff in surgical procedures ( Neurosurgery)

Donated surgical/ medical equipment and pharmaceuticals

Training of medical doctors in hernia repair surgery 40,000,000FRW 40,000,000FRW

10 doctors we will receive training in Mesh

or alternative Low tension Repair March2019 in 7 hospistal

Medical equipment donated 33,756,000FRW 33,756000FRW

Medical equipment donation to Shyira and CHUK hospital

(Mutuelle de santé 2018

100 people will receive community based health insurance 300,000FRW 300,000FRW

NEUROSURGERY AT CHUK MARCH 2019/ 20 PATIENTS 120,000,000FRW 120,000,000FRW

Give a Child a Chance as umufatanyabikorwa with Nyarugenge district this children was given by Nyarugenge

to look after them

TOTAL BUDGET ACTION PLAN 2019-2020 583756000 FRW 583,756,000 FRW

2019-2020 ACTION PLAN FOR RWANDA-LEGACY OF HOPE RELIGIOUS-BASED ORGANIZATIONR

wan

da-

Leg

acy

of

Ho

pe

- U

mu

rag

e w

'Ibyi

rin

gir

oR

wan

da-

Leg

acy

of

Ho

pe

- U

mu

rag

e w

'Ibyi

rin

gir

o

Hea

lth

H

ealt

h

Op

erat

ion

Her

nia

UK

& G

erm

any;

All

Nat

ion

s M

inis

trie

s U

K;

K

Rw

nd

a-le

gac

y o

f H

op

e

RW

AM

AG

AN

A,C

HU

K,C

HU

B,R

EM

ER

A

RU

KO

MA

,SH

YIR

A,R

UH

AN

GO

RW

AM

AG

AN

A,C

HU

K,C

HU

B,R

EM

ER

A

RU

KO

MA

,SH

YIR

A,R

UH

AN

GO

O

per

atio

n H

ern

ia U

K &

Ger

man

y; A

ll N

atio

ns

Min

istr

ies

UK

;

EN

T

UK

Rw

nd

a-le

gac

y o

f H

op

e

36 M

on

th36

Mo

nth

Pro

ject

nam

e

Fild

of i

nte

rven

tion

/ Do

mai

n

Du

ratio

n

Pla

nn

ed A

ctiv

ities

Pla

nn

ed B

ud

get

Pla

nn

ed b

ud

get

201

9

Are

a o

f in

terv

enti

on

Pro

vin

ce,D

istr

ict,

Sec

tor

Do

nn

ors

HERNIA OPERATION 144 PATIENTS /2millions Frw/each pantient 288,000,000Frw 288,000,000FRW

Screening of patients Hernia repair surgery using mesh techniques value of volunteer time 2019 in cash

A breakthrough was introduction of Hernia Repair under

Local Anesthetic infi ltration. All hernias had hitherto been

performed under spinal anesthetic.

ENT 6 pantients March 2019 at CHUB /5millions Frw/each pantient 30,000,000Frw 30,000,000FRW

Screening of patients for plastic surgery procedures value of volunteer time 2019 in cash

Surgical intervention and post-operative care

Training to medical staff in surgical procedures ( Neurosurgery)

Donated surgical/ medical equipment and pharmaceuticals

Training of local doctors in hernia repair surgery 400,000Frw/each 32,000,000FRW 32,000,000FRW

8 doctors we will receive training in Mesh value of volunteer time 2019 in cash

or alternative Low tension Repair March2019 in 7 hospistal

Medical equipment donated 81,000,000FRW 81,000,000FRW

Medical equipment donation to 7hospitals New equipment donation

(Mutuelle de santé 2019

100 people will receive community based health insurance 300,000FRW 300,000FRW

cash

N EUROSURGERY AT CHUK MARCH 2019/ 6PATIENTS 5millions Frw/each 30,000,000FRW 30,000,000FRW

Give a Child a Chance as umufatanyabikorwa with value of volunteer time 2019 in cash

Nyarugenge district this children was given by Nyarugenge Cash 350,000frw 350,000frw

to look after them

TOTAL BUDGET ACTION PLAN 2019-2020 461,650,000FRW 461,650,000FRW

ACHIEVEMENT FOR 2019-2020 RWANDA-LEGACY OF HOPE RELIGIOUS-BASED ORGANIZATIONR

wan

da-

Leg

acy

of

Ho

pe

- U

mu

rag

e w

'Ibyi

rin

gir

oR

wan

da-

Leg

acy

of

Ho

pe

- U

mu

rag

e w

'Ibyi

rin

gir

o

Hea

lth

H

ealt

h

Op

erat

ion

Her

nia

UK

& G

erm

any;

All

Nat

ion

s M

inis

trie

s U

K;

K

Rw

nd

a-le

gac

y o

f H

op

e

RW

AM

AG

AN

A,C

HU

K,C

HU

B,R

EM

ER

A

RU

KO

MA

,SH

YIR

A,R

UH

AN

GO

RW

AM

AG

AN

A,C

HU

K,C

HU

B,R

EM

ER

A

RU

KO

MA

,SH

YIR

A,R

UH

AN

GO

O

per

atio

n H

ern

ia U

K &

Ger

man

y; A

ll N

atio

ns

Min

istr

ies

UK

;

EN

T

UK

Rw

nd

a-le

gac

y o

f H

op

e

36 M

on

th36

Mo

nth

NB THE NEXT MISSION IS PLANNED FROM 12 SEPTEMBER TO 26 OCTOBER 2019 specialist surgeons BREAST CANCER,TUMOR CANCER, ENT and BSc Physiotherapist. Reference:https://www.facebook.com/search/top/?q=rwanda%20legacy%20of%20hope&epa=SEARCH_BOX https://www.kigalitoday.com/ubuzima/ubuvuzi/article/remera-rukoma-abarwaye-indwara-zirimo-

izifata-imyanya-myibarukiro-bari-kuvurwa-ku-

buntu?fbclid=IwAR3xsntEp4Tf0HJ49qArrTNdbkKLgwNdFED9nEmj66LXgQYcekMhbccph1o

https://www.facebook.com/100010473660387/videos/803256553366793/?id=100010473660387

https://www.kigalitoday.com/ubuzima/ubuvuzi/article/inzobere-40-mu-kubaga-zije-kumara-

icyumweru-zivura-ibibyimba-byo-mu-bwonko-ku-

buntu?fbclid=IwAR28izIQiJKbloF3Hfeepc1PVBl17xBB6L-XGZyn-zgxpbhEVJ5igJcrlgU

https://mobile.igihe.com/ubuzima/article/abarwaye-indwara-zirimo-ibibyimba-byo-mu-mutwe-

bagera-kuri-250-bagiye-kubagwa?fbclid=IwAR31ahbZToZv_s-

YVoqRgVM0gpZ9u09uFQiaRBwUygIjCoqEqRzteqtI5RE#.XJec5rto7SA.whatsapp

Reverend Osee Ntavuka BA/M.T.S Founder & Legal-Representative Rwanda-Legacy of Hope (Umurage W'Ibyiringiro) Email:contactus@rwandalegacyofhope.com, rwandalegacyofhope1@gmail.com Website:www.rwandalegacyofhope.com

26 June 2019