For years, Rwandan patients with severe knee injuries, complex fractures, or chronic joint pain learned to pack their bags long before they knew their surgical dates--heading to India, South Africa, and sometimes Europe, wherever a referral letter and personal savings could take them.
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It was not uncommon to spot patients on crutches in airports, recuperating from surgeries that their homeland still could not provide. In 2012, Dr. Emmanuel Bukara met one such family by chance. He was abroad when he struck up a conversation with a Rwandan couple. The husband was on crutches. They explained that he had undergone a knee arthroscopy--a procedure that takes barely 30 minutes--in India, because at the time, such surgery was not available in Rwanda.
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"That moment stayed with me," Bukara recalls. "I remember thinking: why should our people have to leave the country for care that we can build here? It was not just about convenience; it was about dignity and access to quality care. Every Rwandan deserves treatment close to home."
More than a decade later, that question has taken shape as a concrete answer: Kigali Specialized Orthopaedic Hospital (KSOH), the country's first fully dedicated orthopaedic hospital, specializing in sports injuries, traumatology, joint reconstruction, spine care, and advanced musculoskeletal treatment.
On our tour of the new hospital next to Christian Life Assembly (CLA) in Kigali's Nyarutarama neighbourhood, we witnessed a facility transforming healthcare access and offering new hope to the community it serves. The expansion is visible, with new additions that include a fully equipped pharmacy, a restaurant, and ample parking area.
We were welcomed by Dr. Bukara, one of the country's leading orthopaedic specialists and the hospital's Managing Director. He introduced us to a key member of the medical team, Dr. Gerald Kirenga, a consultant anaesthesiologist and interventional pain physician. The subsequent interview and a guided tour of the facility offered insight into the hospital's development and the range of services it provides.
For Dr. Bukara, the project is not a vanity venture. It is the culmination of more than two decades spent watching Rwanda's health system evolve, and noticing where it still fractures under pressure.
A surgeon shaped by systems
Dr. Bukara's journey into orthopaedics began far from the modern operating theatres where he now operates from. He first trained as a medical doctor at Mbarara University of Science and Technology in western Uganda, before completing his Master's degree in Orthopaedic Surgery following residency training in South Africa. He returned to Rwanda in the early 2000s, working first as a general practitioner. Orthopaedics, at the time, was a small and overstretched specialty.
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"There were very few orthopaedic surgeons in the country then," Dr. Bukara says. "You could almost count them on one hand. I saw how many patients were forced to travel abroad for procedures that could be done here if the infrastructure and systems were in place."
"Mentorship from Professor Alex Butera pushed me to specialize further, and that led me to the University of the Witwatersrand in South Africa, where I undertook advanced training in orthopaedics, followed by a super-specialty in sports orthopaedics and arthroplasty, particularly in knee surgery."
Sports medicine, he explains, is not just about athletes.
"Sports medicine is often misunderstood as something only for elite athletes, but in reality, it is about movement, function, and quality of life. Knee, hip, shoulder and ankle injuries, and joint degeneration affect farmers, police officers, soldiers, and factory workers just as much as footballers."
Sports orthopaedics, he explained, simply sits at the intersection of injury and function, and that is why it matters in a country like ours.
Soccer star Abdul Rwatubyaye's successful surgery 'changed perceptions'
By the early 2010s, Dr. Bukara had become a key figure in Rwanda's orthopaedic landscape, working at major referral facilities including King Faisal Hospital. Before 2013, many patients requiring reconstructive surgery, particularly arthroscopic ligament reconstructions or complex joint procedures, were routinely referred abroad.
Then Dr. Bukara and colleagues started performing advanced sports orthopaedic procedures locally. Gradually, cases that once required travel to India or South Africa were managed in Kigali. One symbolic turning point was in 2014 when Abdul Rwatubyaye, a national team footballer suffered a career threatening injury. The surgery was performed locally, successfully.
"That case changed perceptions," Dr. Bukara says. "Not just among patients, but among professionals. It showed that we could achieve high standards here, without leaving the country."
Since then, sports injuries among footballers, military personnel, police officers, and civilians have increasingly been treated in the country. Referrals abroad have become rare, reserved only for exceptional cases.
Rwanda's major hospitals have long provided orthopaedic care, but orthopaedics in most facilities remains a department within general surgery, competing for theatre time, equipment, and attention.
"You have spine cases, trauma, joint replacements, and oncology-related bone disease, all under one small unit, and they all compete for attention," Dr. Bukara explains.
"This limits depth and the ability to offer specialized care. Patients can wait weeks for surgery, and even when they receive it, follow-up and rehabilitation are not coordinated. That gap is what inspired Kigali Specialized Orthopaedic Hospital."
At the new facility, orthopaedics is the sole focus. The hospital unites sports orthopaedics, joint replacement, spine surgery, foot and ankle surgery, hand surgery, orthopaedic oncology, bone infection treatment, rehabilitation, and interventional pain management--all under one roof.
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"Patients come knowing exactly what they are being treated for, and clinicians work in teams that speak the same language. From admission to post-operative care, everything is structured around orthopaedics, not as an add-on," Dr. Bukara says.
Although the new facility has been operating for just over two months, its ambitions extend far beyond its current patient load. The hospital runs 24/7, with both general practitioners and specialists on-site, and is equipped to perform emergency surgeries at any time.
"It's very easy now for hospitals to transfer patients here," Dr. Bukara notes. "They know the capacity exists. Staffing is sub-specialized: spine surgeons manage spine cases; foot and ankle specialists handle their own cases, and sports injuries are treated by surgeons trained specifically in that area. The result is not just better surgery, but better decision-making and care."
That philosophy is reflected in Dr. Kirenga, who has practiced medicine for nearly 20 years. He addresses a frequently overlooked need: managing chronic pain--whether post-surgical, cancer-related, or stemming from phantom limbs.
"Pain management is not just giving painkillers. Chronic pain is a disease in itself, and it requires targeted, multidisciplinary approaches," Dr. Kirenga explains.
"At KSOH, we use image-guided techniques like ultrasound and fluoroscopy to deliver precise treatment directly to the pain source. This avoids damage to surrounding tissues and offers meaningful relief. It only works when surgeons, physicians, physiotherapists, and pain specialists collaborate closely. Here, that collaboration is built into the system."
'Goal is to ensure dignity and quality, regardless of income'
For Rebecca Nanyondo, a Ugandan patient, the difference was immediate. She had lived with a painful wrist condition since childhood. Hospitals in Kampala offered no lasting solution. She arrived in Kigali only days before her procedure.
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"The care was immediate. The tests, the X-rays -- everything was done on time. The procedure was successful, but what stayed with me most was not just the outcome," she says. "I was treated like a human being. I did not expect that level of attention and respect."
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For Dr. Bukara, stories like Nanyondo's are the point. Orthopaedics is expensive. Implants, consumables, and specialized equipment are largely imported. Costs are high - not just in Rwanda, but across Africa.
"This is an implant-driven specialty, and there's no way around that," Bukara says. "Yet insurance coverage has expanded significantly, and many procedures at KSOH are covered. Accessibility is non-negotiable.
"This hospital is not for elite patients; it's for anyone who needs specialized care. Our goal is to ensure dignity and quality, regardless of income."
Training the next generation
One of Dr. Bukara's ambitions is capacity-building. The orthopaedic training programme at University of Rwanda (UR) has produced more than 50 orthopaedic surgeons, many now working in provincial hospitals.
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"KSOH complements this progress by offering fellowship-style exposure and sub-specialty experience in Arthroscopic Surgeries. We've trained our own doctors and also from Uganda, Nigeria ...under AO Alliance Scholarships right here in Rwanda, something that would have been unthinkable 20 years ago," he says.
A regional future, built locally
This is not an easy project, Dr. Bukara admitted, stressing that it is necessary. Recruiting and retaining highly specialized staff remains difficult, equipment procurement is complex, and balancing sustainability with affordability is a constant tension.
"We are building a system that will serve patients for decades, and that requires patience, precision, and investment."
Dr. Bukara believes Rwanda can become a regional hub for specialized orthopaedic care, not by competing with global centers, but by eliminating unnecessary outbound referrals.
"If we can treat patients from the region here, with quality and dignity, that changes everything."
For Dr. Bukara, the operating room was never the endgame. It was preparation for a broader vision: a Rwanda where orthopaedic care is accessible, specialized, and locally anchored.
