Wearing a white shirt and glasses, Remy Pacifique Ntirenganya smiled into a computer screen while calling a colleague in Boston over Skype. He moved around a room of colorful wall hangings, trying to get a better signal in a staff house outside Rwinkwavu Hospital, a public facility Partners In Health supports in Rwanda.
The call was squeezed between his evening jog and a visit to a warehouse to check medical supplies. Ntirenganya had begun his day there, checking the temperature of refrigerated medicines before moving on to draft materials for an upcoming workshop. All on a public holiday.
Working outside normal hours is typical of him. Ntirenganya manages PIH’s pharmacy program at Inshuti Mu Buzima, as PIH is known locally, which covers 15 pharmacies at clinics and other hospitals across the country.
The 31-year-old and his team developed the program over four years, also creating a system for monitoring and replenishing medical supplies across PIH’s three sites in Rwanda. Ntirenganya also published the first internationally recognized paper on medicine prescription patterns in PIH-supported hospitals, and mentored young pharmacists to follow in his footsteps—all while studying for a master’s degree in public health from the University of Rwanda.
“He’s just an extraordinary person to work with,” says Emmanuel Kamanzi, a PIH officer in Rwanda.
Ntirenganya grew up in a poor, rural area in eastern Rwanda, not far from Rwinkwavu Hospital. His widowed mother made sure he and his younger brother put their education first. The family sometimes had to skip meals to pay for school fees, but they were rewarded—the boys’ report cards were full of A’s.
“No one expected it,” laughed Ntirenganya.
By the time he took his national exams at 15, he was the top student in his home province of Kibungo, and he ranked sixth in the country for his age group.
Ntirenganya’s prize was a government-sponsored trip to Lausanne, Switzerland, where the International Olympic Committee invited young students from post-conflict countries to visit, meet students from Europe, and broaden their horizons.
“I had never even been to Kigali, [Rwanda’s] capital city,” he recalls. Ntirenganya passed through Geneva. He saw the Alps. These were things he read about in books, he said, but never imagined he’d see.
Ntirenganya continued to excel. In 2012, he won a fellowship with Global Health Corps, which places young professionals with global health nonprofits, and joined PIH as a supply chain analyst, keeping track of and ordering medical goods for PIH teams across Rwanda. He proved invaluable during a period in which PIH expanded its medical services to oncology and non-communicable diseases, which need predictable supply chains of medications. A year later, when PIH decided to create a larger pharmacy program, Ntirenganya became the manager.
It was a challenging project. Until then, individual clinical teams had ordered their own medical supplies, but Ntirenganya’s team took on the task of equipping the entire organization. This meant selecting every product—from freezers to IV bags. They projected quantities, assessed their supply chain, and managed the intricacies of a new budget. In doing so, they became integral to the functioning of PIH. Like spokes on a wheel, every clinical team at PIH relied on the pharmacy hub for its medications and equipment supplies, with Ntirenganya at the center.
Ntirenganya assists in a training session held in Rwinkwavu, Rwanda, in February 2015. Photo by Cecille Joan Avila / Partners In Health
From there, Ntirenganya’s team broadened its work even further: They teamed up with Rwanda’s Ministry of Health to revamp the dispensaries. Together the teams produced workshops, trainings, and presentations. Endless inventory lists were compiled, assessed, and then redrafted. Gradually they created robust pharmacy programs, which in turn enabled the clinics and hospitals to stock a reliable supply of medications.
With an accurate record of medical supplies, the teams learned that some drugs were in higher demand than expected, including those for noncommunicable diseases such as diabetes, hypertension, and asthma. A PIH grant enabled these drugs to be stocked throughout the three PIH-supported districts, which serve a population of 900,000.
But Ntirenganya’s greatest challenge was yet to come. In September 2014, PIH as an international organization was in the throes of the Ebola crisis in West Africa. Teams were strapped, and medical supplies were taking longer to reach Rwanda. The pressure was on him and his team to fill the gap.
Laura Gould, a PIH supply chain analyst in Boston who talked with him often, said Ntirenganya didn’t hesitate to get his hands dirty. He hauled boxes. He called vendors. He stayed at a PIH warehouse on weekends to make sure medicines kept cold in the event of power outages.
“It’s hard to say what he didn’t do,” she says.
When away from his supply closets and inventory lists, Ntirenganya is now among a small group of Rwandans venturing into academic research. He published his first paper in 2015, in the International Journal of Pharmacy. Working closely with colleagues at Rwanda’s Ministry of Health and Harvard Medical School, he dug through hospital medical records to discern clinicians’ prescribing habits.
They found that the volume and types of drugs given to patients were within the World Health Organization’s guidelines—a reassuring finding for PIH, which supports the hospitals. And it’s a model study that could be applied to more hospitals across Rwanda to help the government estimate cost and supply.
“Pacifique epitomizes the new generation of passionate and dedicated global health leaders that the world and Africa needs to tackle existing and emerging global health challenges,” says Dr. Alex G. Coutinho, executive director of PIH in Rwanda. “He is showing that pharmacy and supply chain are as important as laboratory diagnostics or clinical care in responding to health inequity or disease threats.”
On to Liberia
Ntirenganya’s workload isn’t getting any lighter. Last September he joined PIH’s team in Liberia, where his work supports a small hospital and a health center in the southernmost county. Liberia ranks 177th out of 188 countries in the U. N.’s 2015 Human Development Index. Thirty-five percent of the population lives in extreme poverty. Maternal mortality, which indicates the state of a country’s health system, is horrific. For every 90 or so children born alive, a woman dies from pregnancy-related complications.
The acting director of Liberia’s National Drug Service welcomed him. “He told me, ‘To be successful here, you need to perform miracles,’” laughs Ntirenganya.
He’s not worried. “Slowly, slowly, you can see change,” he says.
The hardest part about moving was leaving friends and family in Rwanda, especially a boy named Shema. Shema used to hang around the pharmacy warehouse and became friends with Ntirenganya, who saw something of himself in the 6-year-old. After talking to Shema’s parents, who are separated and struggling financially, Ntirenganya bought him shoes, clothes, and books. Then he enrolled Shema in school. Then he invited Shema to live in his home with his mother.
“There were so many people supporting me,” he says. He wants to do the same for Shema.