Most doctors are trained to fight death. Few are taught how to stand beside it. In Rwanda, Dr. Christian Ntizimira, a palliative care physician and advocate, is challenging that mindset — proving that compassion, not just cure, can transform healthcare. ALSO READ: Understanding palliative care; why a mindset change is needed to address gaps As the world observed World Hospice and Palliative Care Day, on October 11, healthcare systems and communities were reminded of the importance of dignity, compassion, and support for people facing life-limiting illnesses. In Rwanda, this observation resonates deeply, reflecting a quiet revolution in palliative care championed by Dr. Ntizimira, a Fulbright and Harvard Medical School alumnus whose work blends medicine, culture, and humanity – something the world badly needs. ALSO READ: How best can Rwanda improve palliative care services? A few years ago, in a quiet hospital ward in Kigali, Dr. Ntizimira met a young man whose life was tragically drawing to a close. At only 24, he was battling advanced liver cancer. While the physical pain was intense, what struck Dr. Ntizimira most was the profound suffering that went beyond the physical – emotional, psychological, and spiritual. The patient’s mother knelt beside him, pleading for a way to ease his suffering, even if it meant helping him sleep and never wake. ALSO READ: Expert speaks out on the need for palliative care in chronic diseases “I was terrified to prescribe morphine,” recalls Dr. Ntizimira, the Executive Director of the African Center for Research on End-of-Life Care (ACREOL), a non-governmental organization dedicated to improving health outcomes through evidence-based policy influence, education, and innovation. Dr. Ntizimira is also a faculty member at the Palliative Care Centre for Excellence in Research and Education (PalC), an initiative based in Singapore that focuses on improving the quality of palliative care through research, education, and clinical excellence. ALSO READ: Terminally ill elderly Genocide survivors get palliative care room “I had worked in surgery and understood physical pain, but this was different. His suffering was mixed with fear, despair, and cultural dimensions I hadn’t been trained to handle. I felt helpless, and it shook me to the core. That moment made me question why I became a physician if my only role was to witness suffering without being able to alleviate it.” This encounter became a turning point in Dr. Ntizimira’s career. His early dream of becoming a surgeon — a path through which he hoped to help rebuild Rwanda’s health system — transformed into a passion for palliative care. This shift led him to explore the intersections of medicine, culture, and humanity — eventually developing what he calls the “Safari Concept,” a culturally rooted framework for understanding suffering and delivering care in Rwanda. According to him, the Safari Concept, is an African framework for end-of-life care. ‘Meeting patients at their most fragile moments teaches you more about humanity’ After medical school, Dr. Ntizimira dreamed of being a surgeon because he thought that was “the best way I could contribute” to rebuilding Rwanda’s health system. “I wanted to help, but I also wanted to understand the social and cultural context of illness,” the doctor says. His life changed dramatically after the encounter with the young patient. “I realised that our training left us unprepared to address suffering beyond the physical,” he says. “Even when morphine was available, I was too afraid to prescribe it. I thought twice, as a physician, that day: not because of competence, but because I couldn’t meet the patient’s real needs. That is when I discovered palliative care, and it shifted everything.” Dr. Ntizimira later attended Rwanda’s first formal palliative care training and it is here that he started to shape his journey in the unknown at the time. “It was meant to teach me about patient suffering, but it made me confront my own ignorance. I realised that what we need is not just clinical expertise but also cultural understanding, empathy, and the ability to accompany patients and families in their suffering. Palliative care is about connecting with the person, the family, and the broader community,” he says. He also reflects on his personal life: “I am married and have three boys. But even as a father, I have learned that the most important lessons in life and medicine often come from those in vulnerable situations. Meeting patients at their most fragile moments teaches you more about humanity than any textbook ever could.” The hidden barriers: Mindset over medicine Dr. Ntizimira reckons that Rwanda has made historic strides in palliative care. In 2011, it became the first African country to implement a standalone national policy and implementation plan for palliative care, ensuring morphine availability and training healthcare workers across the country. Today, University of Rwanda (UR) integrates palliative care into its medical curriculum, producing a new generation of culturally competent healthcare professionals. Yet Dr. Ntizimira stresses that the greatest barrier is not infrastructure, funding, or medication. It is mindset. “Many people still associate palliative care with giving up. But it is about life: making every remaining day meaningful, managing pain, and supporting patients and their families emotionally and spiritually.” Health systems often prioritise curing disease over alleviating suffering, he observes, creating situations where pain relief and emotional support are secondary. A hospital may have morphine, but physicians may hesitate to prescribe it due to fear, stigma, or lack of training. Overcoming this requires a paradigm shift that places human dignity at the centre of care. Education is critical, he emphasises: “We need to train new generations of healthcare workers, and communities to understand that palliative care is not about surrender. It is about accompaniment, compassion, and shared responsibility. We must teach that alleviating suffering is as noble a mission just as curing disease.” Safari Concept: Redefining care through culture Dr. Ntizimira’s “Safari Concept” frames illness and dying as a journey shared by the patient, family, and community. Drawing on ethnographic research, he observed that in Rwandan culture, illness is never an individual experience. It is communal. Families participate in decision-making, provide emotional support, and help navigate suffering. “In Western medicine, autonomy is often cantered solely on the patient. In our context, autonomy must be balanced with community responsibility. Decisions are made together, and that shared ownership strengthens care outcomes,” he explains. He distinguishes between treating the disease and treating the person, two aspects he says go hand-in-hand. “You can treat the disease without treating the person, but if you treat the person, you are more likely to achieve meaningful outcomes. Understanding the social environment, family dynamics, and cultural values is as important as any clinical intervention.” Spirituality, Dr. Ntizimira says, is another critical dimension. “Every patient is spiritual, even if they are not religious,” he explains. “Recognising and addressing spiritual needs is essential for comprehensive care. It shapes how families cope and how patients perceive dignity and comfort. This awareness is a core part of our approach in Rwanda.” Care that begins with connection Rwanda’s culture of communal support provides a strong foundation for compassionate care, if it can be well-harnessed. “Compassion is part of African culture,” he says. “At weddings, funerals, and other social gatherings, people naturally show up for one another without expectation or reward. We can harness that to support patients in vulnerability,” he says. “New programmes now equip community health workers to identify patients in need, support families in caregiving, and mobilise local volunteers,” says Dr. Ntirizimira. “Care is no longer limited to hospitals, patients are being reconnected with their communities, ensuring no one spends their final days in isolation. Compassionate communities are becoming the true frontline of palliative care.” He recalls his experiences in the United States which showed that it can even be easier to provide palliative care in African countries, compared to the countries where the discipline is well advanced. “During a fellowship in Boston, I saw patients in palliative care units surrounded by photographs of distant family members. Many patients were alone, yet displayed the images of loved ones to maintain connection.” In Rwanda, he says, we do not need photographs because families and communities are present. “The power of human presence cannot be replaced by objects. Care is relational, social, and cultural, not merely medical,” he says. Breaking the luxury myth One persistent misconception, Dr. Ntizimira notes, is that palliative care is a luxury or an elective service for the wealthy. “In Rwanda, palliative care is integrated into the national health system. Morphine is available at all district hospitals, and community-based health insurance covers most costs, making access nearly universal,” he says, emphasising the importance of according it to patients who are in dire need. “Anyone who needs palliative care, whether in a remote village or an urban hospital, should have it. When palliative care is only for the rich, the system fails its most vulnerable. In Rwanda, it is a right, not a privilege.” He contrasts Rwanda’s approach with other countries: “In some places, access is determined by wealth. Here, we ensure that even the poorest and most remote communities receive care. We are not recreating the wheel; we are using the culture, the health system, and lessons from successful programmes like HIV and tuberculosis care to expand palliative care nationwide.” Policy, research, and 3D approach Dr. Ntizimira stresses the need for evidence-based policy and continuous research. “We need data on paediatric care, gender disparities, access gaps, and community engagement. Research ensures policies reflect local realities rather than imported frameworks.” His 3D approach emphasises democratisation, destigmatisation, and deconstruction. Care must be simple and accessible, myths about palliative care must be addressed, and local models should replace imported frameworks. “The way a patient dies reflects how society lives. By treating the person and integrating family and community, we honour humanity. That is the essence of palliative care,” Ntizimira observes. Vision for Africa Dr. Ntizimira envisions African health systems where palliative care is standard in universal health coverage. “Rwanda’s model can inspire the continent,” he adds. “By blending scientific rigor with cultural intelligence, we can create inclusive, compassionate systems. Africa has something powerful to teach the world about empathy, community, and dignity.” He recalls the young patient who inspired him: “Medicine is ultimately about accompaniment. The safari is about walking together, understanding suffering, and restoring humanity. That is the future of palliative care in Africa and the world.” His work also emphasises the importance of reconciling patients with their disease and families with the reality of illness. “Patients sometimes deny their condition; families are shocked by what seems sudden,” Dr. Ntizimira says. “Part of our work is guiding both to acceptance, to ensure decisions are informed, compassionate, and culturally appropriate. Medicine is more than treatment; it is navigation through suffering with humanity at its core.” Dr. Ntizimira’s journey, from surgery to palliative care, reflects a deep understanding that healing extends beyond the body. By integrating culture, community, and compassion, Rwanda is redefining how a society cares for its most vulnerable. The Safari Concept is not just a framework; it is a call to see patients as people, to walk with them, and to honour life even in its final chapters. Through this lens, palliative care becomes a shared journey, a communal act of empathy, and a model that Africa can proudly show to the world. On World Hospice and Palliative Care Day 2025, Rwanda’s story stands as proof of what is possible when humanity and policy walk together. But as Ntizimira emphasises, it is a work in progress.
