2016; Volume 17, No 3, March

IAHPC Traveling Scholar’s Report

Rwanda – a surgeon’s dream turns to palliative care

Dr. Christian Ntizimira is a Palliative Care Expert and Educator in the Advocacy and Research Department of the Rwanda Palliative Care and Hospice Organisation, Kigali, Rwanda. Here, he tells us about his work in Rwanda and explains how an IAHPC Traveling Scholarship has contributed to his knowledge and practice.

I live in Rwanda, a small, landlocked country in Central East Africa with an estimated population of 11 million and a dark history. The country has been deeply affected by the 1994 genocide of Tutsi, which took the lives of more than one million people in 100 days and made another two million refugees. Rwanda was the first country in Africa to develop and implement a stand-alone national palliative care policy; it also has a national palliative care strategic plan and practice standards.

Launched by the Ministry of Health in April 2011, these groundbreaking policies commit the country to providing all Rwandans suffering from life-limiting illnesses with high quality and affordable palliative care services to meet their physical, psychological, social and spiritual needs by 2020. The program is slowly being integrated into the public health system because of huge demand, especially among HIV/AIDS and cancer patients.

In my childhood, and throughout my medical training, I dreamt of being the best surgeon one could be. That was until the day I met a young man of 24, dying of liver cancer and suffering from unimaginable pain. When I first learnt about palliative care, I knew this was the way to fulfill my ‘calling’. Worse than the pain he was enduring was the fact that I, a trained medical doctor, could not relieve his suffering because of regulatory and cultural barriers in Rwanda that prevent access to morphine, an essential pain medication. During the tragedy of the genocide a part of our humanity was lost, but I feel sure that the concept of palliative care will contribute to bringing this back.

The first multidisciplinary palliative care team trained in Rwanda

This is why, through the Rwanda Palliative Care and Hospice Organisation (RPCHO), a non-profit, non-governmental organization located in Kigali city, we are working to improve the quality of life of patients with life-limiting illness. One of the most successful activities is the mobile clinic for home-based care where a nurse and a physician visit patients at home every day to give pain relief and symptom control. Through this activity, patients, families and health providers have found a platform to engage the community and bring back a sense of humanity.

As an African, my perception of palliative care fits with our rooted philosophy that we call ‘Ubuntu’, defined simply as “I am what I am because of you.” And there is an African expression of Ubuntu: “Your pain is my pain, my wealth is your wealth, your salvation is my salvation.” My ignorance to provide an appropriate management of care and treatment to patients with life-limiting illness is also their ignorance and my education in palliative care is now their education.

A global understanding to tackle palliative care

In November 2015, I received a travel scholarship from the IAHPC to attend the 22nd Canadian Conference on Global Health held in Montreal, Canada. This was really helpful as it enabled me to meet different local and international experts in global health to share experiences and contacts for future collaboration in order to close the divide between high-income countries and low- and middle-income countries in palliative care. I gave a presentation about the experiences of Rwanda in using community health workers as a future human resource in global health, especially in palliative care. My attendance at the conference gave me a better understanding about the need for collaboration between North-South and South-South, especially the need for ‘a global understanding’ to tackle palliative care. I also learnt about different strategies to engage and involve the community; for example, by using non-medical staff or volunteers it is possible to raise the quality of service to a much higher level, and to achieve better value in palliative care.

I hope to be able to help Rwanda to implement pain relief and palliative care at all levels of its healthcare system, including in the home, that is sustainable, that strengthens the overall healthcare system, and that yields great results in terms of preventing and relieving suffering of all kinds, physical, psychological, social, and spiritual.

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