At about 2pm on the 9th April, 1994 we loaded up our Peugeot 504 with clothes for a week or two, a few personal belongings, a picnic, our three children and their homework and school uniforms, and drove with two other car loads of expatriates who were also fleeing to Tanzania. It was the last day I had worked in Cahini Hospital, Rwanda. That morning, I had repaired the Achilles tendons of a man who had been hamstrung by the local militia, but had been brought to the hospital by the police and then tried to sew up and replace the intestines of another who had been speared or knifed in the abdomen. (The former survived and is well, the latter died later that morning.) It was after the police had left that the militia attacked the Hospital, seeking out and destroying their "enemies" who had taken refuge there. Early during the attack, some youths banged on the operating theatre door demanding keys. It was my refusal to co-operate that elicited my own death threat. Sometimes listening to the cries of the victims, sometimes even hearing the thud of the machete hitting its target, we waited for the attackers to break in and kill those of us who were working or hiding in the theatre, but they left us alone. By lunchtime, we had received the British Consul's instructions and the local Bourgmestre's advice to leave at once. Numb with the horror of the morning's events, with the fear for our own and our children's lives and with the shame that there was nothing we could do, we drove south towards Tanzania, and the next day, crossed the Rusumo Falls to safety.
I was first hooked by Rwanda when I came to Gahini in 1974 for my elective period. In 1978, Trisha Williams, a physiotherapist from St. Thomas' began a three year contract with Tear Fund to help Liz Hardinge start a physio-aid training programme at Gahini. I had known Trisha for a number of years, but it was as she slipped off to Central Africa, that I realised that I loved her, and wanted to marry her. (I was on my way back from the Nazareth Hospital as she flew to Kigali.) Two-thirds of the way through that contract, a short-term doctor was required at Gahini. I was accepted both by the Hospital and by Trisha. She came to LTK for the wedding, and I was able to work at Gahini with her for 15 months. On our return to UK, I did a GP traineeship in South Worcestershire, but in 1982, as I was looking for a GP partnership, we were informed of the need for a new Director at Gahini, and we felt that the call was clear and irresistible.
And so from May '83 until April '94, my medical practice was gloriously general. The Church-owned District General Hospital was rebuilt and expanded while I was there from 96 to 130 beds. Most of the time, there were 2 doctors, myself and a Rwandan colleague. Occasionally we were three when we managed to recruit young British short-termers, but for a couple of periods of 6-9 months, we were down to one.
Our most common illnesses were malaria, respiratory infections and diarrhoea, but there were plenty of tropical and non-tropical rarities to keep us on our toes. Out-patients was a delight, if it was not too heavy or if there were no obstetric nor other urgent interruptions. As in all general practice, there was such variety, but the diversity was so much greater here - verrucas to vesico-vaginal fistulae, colds to club feet. The other difference was that we seldom referred elsewhere, the facilities and expertise may have been better, but in general, the care was not, and patients did not like, nor could they afford to go to the capital. We did one or two cold lists of surgery each week, mainly hernias, other lumps and bumps, vagotomies and corrective surgery for handicap, since the physiotherapy department at Gahini had a nation-wide service and often needed surgical help, As for most of our repertoire, following instructions f rom the book, we had a go at cleft lips and other plastic procedures. No-one else was doing them in Eastern Rwanda, and the results were often very satisfying.
At the medical end of the spectrum, we also had to deal with palliation for horrific tumours and other terminal illnesses with minimal resources. When we first came to Gahini in 1983, AIDS had only just been described; by the time we left, the seropositivity rate at our ante-natal clinic was just over 11 %, and our beds were increasingly occupied by patients with AIDS-related illnesses.
Obstetric emergencies gave us the most adrenaline-pumping excitement, but since we never did more than 100 Caesarean Sections each year, of which only a few presented as uterine rupture, we were seldom overwhelmed.
Treating expatriate and missionary colleagues also gave us very anxious moments. We had a couple of diabetic crises, a myocardial infarction, two serious prolapsed inter vertebral discs, and worst of all, a Road Traffic Accident which necessitated a transfer to Nairobi and took over two harrowing days to achieve. The patient had a stove-in chest and was becoming increasingly hypoxic. Minutes after we delivered her to the Intensive Care Unit, she had a cardiac arrest, but was resuscitated, ventilated and eventually made a complete recovery.
In the earlier years, we built on my predecessor's foundation and developed a community health programme in our locality, which I was later able to leave to a team comprising an expatriate nurse/midwife, a social worker and a vaccinator. Driving out to sectors bordering on the Akagera National Park to discuss health issues with the local population was such a pleasure. Later we tried to introduce a simple insurance scheme to try and encourage the poorer sections of the community to use our services. It failed, but it was an interesting experiment. Had the war not intervened, we might have had another go. Financing medical services which are accessible to the very poor in developing countries is a major challenge.
One day I hope to find an article written by a Rwandan cleric about the difficulties of working with expatriate doctors but they would probably be too polite to be critical. There were certainly times of discord and conflicts of interest between some of my ecclesiastical superiors and me. The hiring of a crooked contractor to rebuild the hospital, and the struggle to remove a senior clergyman's daughter from the position of pharmacist and cashier particularly spring to mind. Towards the end of my time in Rwanda, a new Bishop was appointed who was a man of integrity and spiritual stature; it was such a privilege to work with him, both there and later in Tanzania.
But the most stressful were the times of war and civil disturbance. In October 1990, the Rwandan Patriotic Front first attacked Rwanda from the Northeast. As Trisha, my two year old son and I were returning from Kigali on the third day of the war with supplies, we thought we had found ourselves in the middle of a battle when a hail of bullets whistled over the bonnet of our car. We could not reach Gahini, but were able to return to Kigali, where, two nights later, we seemed to be in the middle of another battle; the machine gun nest at the top of the garden was extremely busy, and we were expecting a mortar shell to land on the house, or a grenade to be thrown through the window at any moment.
At times like those, I do not function very well; I did not get immune to the tension, rather I became allergic to it. I could never chose to work in dangerous situations, but we did experience God's grace when there was no escape. Also we have had the privilege of knowing what it is like for millions who have no choice but to live constantly under the threat of violence.
I am sure have been describing the experience of many medical mission partners over the last decade and a half, and there are many today who are still attempting to provide high-quality, low-cost care to the poor in Church-owned hospitals. But I am wondering if this species of doctor is dying out?, at least in Rwanda and Burundi, countries served by my Society, Mid-Africa Ministry. It would not surprise me if there were not many doctors willing to drop out of UK earning for several years, and I can understand the reticence to take themselves and their families into areas of doubtful security. I have also heard it said that it is no longer appropriate for Western-trained doctors to work in small Church hospitals; rather, well-trained Christian specialists should go to university centres where the sharing of their medical skills and testimony with their colleagues and students would be more strategically concentrated.
However, many Church leaders genuinely see a role for Christian expatriate doctors in their hospitals as a means of providing health care and even justice, to the poor. Not only do they provide a channel for resources to flow from North to South, but they can also redress the inequity of distribution of health services in the country by treating both privileged and peasant with the same quality of care and Christian love. In Rwanda and Burundi, there are not many committed national Christian doctors, and even fewer who feel called to work anywhere but in the major urban centres.
All I can say is that after 15 years in East Africa, 2 of which were spent working in a refugee camp, I am profoundly grateful that I stopped looking for a GP partnership in 1982, and came here. Life has been rich, and now we have the challenge and stimulation of a mid-life career change.
We do bring back some sadnesses, though. After the war, when I returned to Gahini to visit in March 1995, there was no sign that Dr. Robert had ever existed - my office was completely empty, all records dating back to the foundation of the hospital, were gone. The house we had lived in for 11 years showed no sign of Wilson habitation, except the silhouettes of two of our children pinned to the mud-brick wall of our veranda. All other possessions - books, diaries, slides, mementoes of immense sentimental value - were gone. Most painful though is the way it all ended, in an outburst of hatred, destruction and bloodshed. Fear, suspicion, the desire for vengeance and greed linger on as Rwandans wait for justice for the guilty, and for the innocent.
The hospital is now in the hands of the government which has appointed its own Director. There are now no ward nor staff prayers, no chaplaincy, and when I asked the authorities if I could work as a volunteer at Gahini for the last few months of my time in Africa, my offer was declined. We wonder if the Church in Rwanda will ever be able to take back the hospital. It would have been satisfying, and, I suppose, 'successful" if I had been able to hand over the hospital direction to a Rwandan Christian doctor, but a British Mission Partner would have sufficed. Has my sub-species, of which Joe Church was the first and I the most recent member now spluttered to an untimely extinction? Perhaps the question is purely sentimental?
What is certain is that God still loves the bereaved, the suffering and the oppressed in Rwanda and Burundi, and He is looking for hearts and hands to show it.
I was first hooked by Rwanda when I came to Gahini in 1974 for my elective period. In 1978, Trisha Williams, a physiotherapist from St. Thomas' began a three year contract with Tear Fund to help Liz Hardinge start a physio-aid training programme at Gahini. I had known Trisha for a number of years, but it was as she slipped off to Central Africa, that I realised that I loved her, and wanted to marry her. (I was on my way back from the Nazareth Hospital as she flew to Kigali.) Two-thirds of the way through that contract, a short-term doctor was required at Gahini. I was accepted both by the Hospital and by Trisha. She came to LTK for the wedding, and I was able to work at Gahini with her for 15 months. On our return to UK, I did a GP traineeship in South Worcestershire, but in 1982, as I was looking for a GP partnership, we were informed of the need for a new Director at Gahini, and we felt that the call was clear and irresistible.
And so from May '83 until April '94, my medical practice was gloriously general. The Church-owned District General Hospital was rebuilt and expanded while I was there from 96 to 130 beds. Most of the time, there were 2 doctors, myself and a Rwandan colleague. Occasionally we were three when we managed to recruit young British short-termers, but for a couple of periods of 6-9 months, we were down to one.
Our most common illnesses were malaria, respiratory infections and diarrhoea, but there were plenty of tropical and non-tropical rarities to keep us on our toes. Out-patients was a delight, if it was not too heavy or if there were no obstetric nor other urgent interruptions. As in all general practice, there was such variety, but the diversity was so much greater here - verrucas to vesico-vaginal fistulae, colds to club feet. The other difference was that we seldom referred elsewhere, the facilities and expertise may have been better, but in general, the care was not, and patients did not like, nor could they afford to go to the capital. We did one or two cold lists of surgery each week, mainly hernias, other lumps and bumps, vagotomies and corrective surgery for handicap, since the physiotherapy department at Gahini had a nation-wide service and often needed surgical help, As for most of our repertoire, following instructions f rom the book, we had a go at cleft lips and other plastic procedures. No-one else was doing them in Eastern Rwanda, and the results were often very satisfying.
At the medical end of the spectrum, we also had to deal with palliation for horrific tumours and other terminal illnesses with minimal resources. When we first came to Gahini in 1983, AIDS had only just been described; by the time we left, the seropositivity rate at our ante-natal clinic was just over 11 %, and our beds were increasingly occupied by patients with AIDS-related illnesses.
Obstetric emergencies gave us the most adrenaline-pumping excitement, but since we never did more than 100 Caesarean Sections each year, of which only a few presented as uterine rupture, we were seldom overwhelmed.
Treating expatriate and missionary colleagues also gave us very anxious moments. We had a couple of diabetic crises, a myocardial infarction, two serious prolapsed inter vertebral discs, and worst of all, a Road Traffic Accident which necessitated a transfer to Nairobi and took over two harrowing days to achieve. The patient had a stove-in chest and was becoming increasingly hypoxic. Minutes after we delivered her to the Intensive Care Unit, she had a cardiac arrest, but was resuscitated, ventilated and eventually made a complete recovery.
In the earlier years, we built on my predecessor's foundation and developed a community health programme in our locality, which I was later able to leave to a team comprising an expatriate nurse/midwife, a social worker and a vaccinator. Driving out to sectors bordering on the Akagera National Park to discuss health issues with the local population was such a pleasure. Later we tried to introduce a simple insurance scheme to try and encourage the poorer sections of the community to use our services. It failed, but it was an interesting experiment. Had the war not intervened, we might have had another go. Financing medical services which are accessible to the very poor in developing countries is a major challenge.
One day I hope to find an article written by a Rwandan cleric about the difficulties of working with expatriate doctors but they would probably be too polite to be critical. There were certainly times of discord and conflicts of interest between some of my ecclesiastical superiors and me. The hiring of a crooked contractor to rebuild the hospital, and the struggle to remove a senior clergyman's daughter from the position of pharmacist and cashier particularly spring to mind. Towards the end of my time in Rwanda, a new Bishop was appointed who was a man of integrity and spiritual stature; it was such a privilege to work with him, both there and later in Tanzania.
But the most stressful were the times of war and civil disturbance. In October 1990, the Rwandan Patriotic Front first attacked Rwanda from the Northeast. As Trisha, my two year old son and I were returning from Kigali on the third day of the war with supplies, we thought we had found ourselves in the middle of a battle when a hail of bullets whistled over the bonnet of our car. We could not reach Gahini, but were able to return to Kigali, where, two nights later, we seemed to be in the middle of another battle; the machine gun nest at the top of the garden was extremely busy, and we were expecting a mortar shell to land on the house, or a grenade to be thrown through the window at any moment.
At times like those, I do not function very well; I did not get immune to the tension, rather I became allergic to it. I could never chose to work in dangerous situations, but we did experience God's grace when there was no escape. Also we have had the privilege of knowing what it is like for millions who have no choice but to live constantly under the threat of violence.
I am sure have been describing the experience of many medical mission partners over the last decade and a half, and there are many today who are still attempting to provide high-quality, low-cost care to the poor in Church-owned hospitals. But I am wondering if this species of doctor is dying out?, at least in Rwanda and Burundi, countries served by my Society, Mid-Africa Ministry. It would not surprise me if there were not many doctors willing to drop out of UK earning for several years, and I can understand the reticence to take themselves and their families into areas of doubtful security. I have also heard it said that it is no longer appropriate for Western-trained doctors to work in small Church hospitals; rather, well-trained Christian specialists should go to university centres where the sharing of their medical skills and testimony with their colleagues and students would be more strategically concentrated.
However, many Church leaders genuinely see a role for Christian expatriate doctors in their hospitals as a means of providing health care and even justice, to the poor. Not only do they provide a channel for resources to flow from North to South, but they can also redress the inequity of distribution of health services in the country by treating both privileged and peasant with the same quality of care and Christian love. In Rwanda and Burundi, there are not many committed national Christian doctors, and even fewer who feel called to work anywhere but in the major urban centres.
All I can say is that after 15 years in East Africa, 2 of which were spent working in a refugee camp, I am profoundly grateful that I stopped looking for a GP partnership in 1982, and came here. Life has been rich, and now we have the challenge and stimulation of a mid-life career change.
We do bring back some sadnesses, though. After the war, when I returned to Gahini to visit in March 1995, there was no sign that Dr. Robert had ever existed - my office was completely empty, all records dating back to the foundation of the hospital, were gone. The house we had lived in for 11 years showed no sign of Wilson habitation, except the silhouettes of two of our children pinned to the mud-brick wall of our veranda. All other possessions - books, diaries, slides, mementoes of immense sentimental value - were gone. Most painful though is the way it all ended, in an outburst of hatred, destruction and bloodshed. Fear, suspicion, the desire for vengeance and greed linger on as Rwandans wait for justice for the guilty, and for the innocent.
The hospital is now in the hands of the government which has appointed its own Director. There are now no ward nor staff prayers, no chaplaincy, and when I asked the authorities if I could work as a volunteer at Gahini for the last few months of my time in Africa, my offer was declined. We wonder if the Church in Rwanda will ever be able to take back the hospital. It would have been satisfying, and, I suppose, 'successful" if I had been able to hand over the hospital direction to a Rwandan Christian doctor, but a British Mission Partner would have sufficed. Has my sub-species, of which Joe Church was the first and I the most recent member now spluttered to an untimely extinction? Perhaps the question is purely sentimental?
What is certain is that God still loves the bereaved, the suffering and the oppressed in Rwanda and Burundi, and He is looking for hearts and hands to show it.
