As a child growing up in Rwanda during the 1980s and ‘90s, Claire Karekezi dreamed of becoming a doctor. But what she calls her “guiding star” has taken her far beyond that initial goal to join the ranks of what is perhaps medicine’s most demanding specialty.

In early July, the 35-year-old will return home as the first and only female neurosurgeon in Rwanda, says Toronto Western Hospital, where she has spent the last year honing her skills in neuro-oncology and skull base surgery, specializing in the removal of brain tumours.

Providing that service to brain cancer patients in a country with only one hospital-based MRI and few CT scanners will be a daunting task, but it’s one Karekezi is determined to overcome, just as she has all the challenges and sacrifices needed to fulfil her childhood dream.

It was a childhood scarred by the 1994 genocide that killed an estimated 800,000 people in the African nation, a bloodbath that retired Canadian general Romeo Dallaire and his inadequately manned contingent of UN peacekeepers were powerless to prevent.

“In 1994, I was 10 years old ... so I experienced the genocide as a growing kid,” said Karekezi, who was living with her parents and two older siblings in Kigali, the capital. “Everyone had to get out, people were being killed on the roads.”

She lost cousins and aunts in the massacre — a 100-day period she is loathe to speak about in any detail.

“I always tell people that that’s what sort of made us who we are today as Rwandese people, because we grew up knowing that we cannot count on anyone but ourselves.

“So this kind of spirit kept me going, to do whatever it takes to get where I want to go,” she says. “I keep pushing because the genocide happened, the whole world was watching and no one did anything. But we came through that, we are a strong nation, and we have very brave people who have managed to do impressive things now.”

Karekezi can surely count herself among their number.

After finishing high school in 2001, she was awarded a full government scholarship as an outstanding student to study medicine at the University of Rwanda in Butare, the city where she was born.

In 2007, with a couple of years left until she graduated as a doctor, Karekezi applied and was accepted as an exchange student to study at the University of Linkoping in Sweden through the International Federation of Medical Students.

“That time, my purpose was to go to Europe,” she admits, smiling coyly. It was her first time away from home.

But it was July, and the only department in operation through the traditional summer-holiday period was neurosurgery, an area of medicine she’d never considered.

“I knew nothing about neurosurgery, I had no training in brain anatomy,” Karekezi concedes, adding that she had planned to study radiology.

But that guiding star must have had other notions.

Serendipitously, she found herself taken under the wing of department head Dr. Jan Hillman, who led Karekezi to the operating room and had her scrub in to observe surgery on a patient with a brain tumour.

“That was the first time I saw the brain,” she says. “I was amazed. I was like ‘This is the brain?’”

Hillman became her first mentor, explaining and demonstrating to Karekezi the intricacies of the brain and encouraging his protege to embrace the complex specialty and eventually practise it in Rwanda, where at the time there was not a single neurosurgeon.

“He saw this light in me,” she says of the Swedish doctor, calling him her “father in neurosurgery.”

Back at home, she continued reading texts about neurosurgery on her own while finishing her medical degree. A month before graduation in 2009, she was accepted for a short neurosurgery program at Oxford University in the U.K.

Determined to follow her new dream, she doggedly kept emailing the head of the Rabat Reference Center for Training Young African Neurosurgeons in Morocco, seeking a spot in the program that had been set up under the auspices of the World Federation of Neurosurgical Societies.

She was finally accepted after securing government funding and moved to Morocco in 2011, spending the next five years immersed in learning the specialty. In her final year, she was named chief resident.

“At the end, I was a neurosurgeon,” says Karekezi, who is fluent in French, English, Rwandan and Swahili, with some knowledge of Arabic from her time in Morocco.

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But that guiding star wasn’t done with her yet.

In 2013, she had been given a Women in Neurosurgery award sponsored by Dr. Mark Bernstein, a neurosurgeon at Toronto Western Hospital, who holds the Greg Wilkins-Barrick Chair in International Surgery.

Though they hadn’t met in person, Karekezi contacted Bernstein about applying for one of four annual fellowships at Toronto Western in neuro-oncology, also sponsored under the Wilkins-Barrick chair.

Having heard about her through the Women in Neurosurgery award and from an African colleague who knew her, Bernstein decided “she would be a very worthy candidate” for the program.

“It just seemed she had what it takes, she seemed to be sharp and very dedicated and committed,” he said. “She had been through a lot to get where she is, and that struck me as well.”

So last July, Karekezi arrived in Toronto, ready to tackle the final stretch of what has been a 12-year journey.

That odyssey has been one of sacrifice: years away from her family, moving from country to country, and putting relationships, marriage and motherhood on hold.

Still, she is philosophical about what she has missed out on. “I need to carry the dream to the end — and then I can think about settling.”

When she returns to Rwanda in July, Karekezi will take home not only her skills in neurosurgery, but also a mental blueprint learned in Toronto of how to more efficiently deliver services to patients, by smoothing the paths between surgeons, oncologists, radiation therapists and other care providers.

Her next dream is to collaborate with her colleagues — there are four male neurosurgeons now practising in the country of 12 million people and a fifth is just finishing his training — to work towards developing such a multidisciplinary neuro-oncology centre.

“I really respect what she’s done,” said Bernstein. “She’s looking to get to the moon and she’s going to get there.”

So what is it that continues to drive Karekezi?

“It’s passion, it’s dedication,” she says, simply. “It’s not about money — I’m living my dream and I love what I do.

“This is something I can do. This is something I can bring back to Rwanda.”