PAEA President Howard Straker was among several U.S. PAs who travelled to Kigali, Rwanda, in early March, to share information and build relationships with African and Asian colleagues at the second international conference of the Global Association of Clinical Officers and Physician Associates (GACOPA). Along with colleagues from the NCCPA and former PAEA President Lisa Mustone Alexander, who has been involved in the profession in Rwanda for many years, Straker attended meetings with officials from the Rwandan Ministry of Health and the University of Rwanda and spoke to attendees about the trajectory of PA education in the United States.
During his well-attended presentation, Straker also touched on current issues such as the use of technology in teaching, student debt, and the ongoing investigation of potential new professional titles. The title change was an issue that resonated with the predominately African audience, made up largely of “clinical officers (COs),” “physician associates,” and others with similar, PA-like titles and scopes of practice but differing names and specific roles in the health systems of the mostly East African nations represented.
“They were curious about demographic trends, our recent explosive growth, and how we have advocated to grow our profession over the years,” said Straker. “Seeing similarities in how the profession evolved in the U.S. validates that they are on the right track. We struggled in the beginning too. I talked about how data are important to our organization to support the growth of the profession and PA education.”
The conference was designed to bring increased visibility to the growing CO profession in Rwanda and highlight its potential to increase access to care in the country, said Nathan Rutatina, a registered clinical officer and president of the Rwanda Medical Clinical Officers’ Organization (RMCOO), one of the conference organizers. Clinical officers have been graduating in Rwanda since 2013 but have yet to be fully recognized by the country’s ministry of health. One of the goals of RMCOO, explained Rutatina, is to strengthen its “evidence-based advocacy” to gather data to show the efficacy of COs to convince the ministry to further support the profession. The country already has universal health coverage and one of the best developed health care systems in Africa, but COs could “make a more significant contribution if they were able to practice in Health Centers and District Hospitals,” added Rutatina. He hopes that U.S. PAs, as well as experts at the University of Rwanda, may be able to help with funding and expertise in gathering and mobilizing evidence to support advocacy efforts.
PAs in East Africa
The PA profession has been taking root in Rwanda for some years, according to Alexander. She has been involved in the development of the PA profession in that country since she was part of a delegation from George Washington University (GW) that consulted on the development of medical education curriculum as Rwanda was rebuilding in the wake of the genocide that devastated the country in 1994. “We could see it would take a long time to ramp up the workforce,” said Alexander. “It was obvious that ‘This country needs PAs.’” Alexander was able to secure Fulbright funding to return several times to Rwanda and help develop curriculum for a clinical officer program, using the terminology that was in place in neighboring Uganda and Kenya for a clinician that is similar to the American PA. In 2017, the various interested parties — policy makers, licensing bodies, academics — held a “Stakeholder Summit” to try to move the profession forward, said Alexander. “We are seeing the slow uptick of the profession here,” she added.
Rutatina said that the East African PAs ultimately want to develop not only a common name, but a common curriculum and reciprocal licensing system, beginning in East Africa but perhaps also moving beyond.
“Dr. Straker and our American colleagues have been very supportive from the beginning,” noted Rutatina. “We have problems that cannot be solved solely by ourselves — only in partnership with other people including NCCPA and PAEA.”
Straker sees further opportunities for collaboration moving forward. “There is potential for learning in both directions,” he said. “We talked about faculty exchanges across countries. We can learn from each other and see what we can take back. PAEA represents the largest training of PAs in the world so they are looking at us as a potential role model.”
“We live in a global world now,” added Alexander. “Our students are passionate about health and economic disparities. Visiting Africa helps them to recognize what it looks like to have fewer resources.” She noted that one of the GW students, who was a former Peace Corps volunteer, did a presentation on title change, which generated great interest among the local Rwandan CO students. “This is a global discussion,” she said.