“This is not a personal achievement; this is an award for the patients and families in Rwanda who are facing serious illness. They deserve to be treated with dignity. Dr Christian Ntizimira told The Sunday Times after he was awarded for his approach and advocacy to the integration of Palliative Care in health systems at the annual Global Health Catalyst Summit at Harvard Medical School in Boston, Massachusetts in the United States.
The Rwandan palliative care expert and educator was also acknowledged for his active role in the Lancet Commission on Global Access to Palliative Care and Pain Control.
Yet, even though Dr Ntizimira has been praised for his active role in the field of palliative care, this is something he had never dreamed of.
“My dream was to be the best surgeon. I never thought I would ever do palliative care in my life because I was impressed by surgery when I was doing my internship at CHUK,” he reveals.
His turning point
After he graduated from medical school, Ntizimira was deployed to Kibagabaga district hospital for two years, by the Ministry of Health, where he planned to start a residence programme surgery after two years.
It was then that his dream changed, when he was sent by the clinical director for ward round in internal medicine department as a general practitioner.
“It was during the rounds that I met a 24 year old patient who had diagnosed with liver cancer and I could tell that he was in excruciating pain. It was the first time that I had met someone in such pain. I was really shocked and concerned that I asked the nurses why he was in such pain,” he narrates.
Moved by the young man’s condition, he decided to prescribe pentilin tablets, a strong pain killer, but was afraid because he was not trained to use the OPDs at that time. The pain killers, did not last long.
“What shocked me most was that the mother pleaded with me to give his son anesthesia, so that he could sleep and not wake up which wasn’t allowed, ethically.”
“I was touched by the young man’s story, and as I went home, I kept imagining how I could complete seven years of medical school and still be unable relieve pain of a patient. He died the next day,” he narrates of the ordeal.
This was the turning point of his medical career and he immediately underwent two weeks of training in palliative care.
“It was during the training that I realised that there is something missing in our medical training but also in the way we manage our patients. It was after the training that I realised that it was a calling that I needed to do even if I dreamed of being a surgeon.”
“The boy was about to complete his undergraduate studies, and he was the hope of his family, but here he was about to die like a dog, because he lacked appropriate management. As a physician, this is just unacceptable and I immediately decided to undertake palliative care,” he recalls.
Changing the state of palliative care
In 2010, Ntizimira was appointed the acting medical director of Kibagabaga, and confirmed in 2012. While there, he completely changed the management of patients especially the vulnerable patients.
“I also changed the protocol of using Morphine, a narcotic pain reliever. It was used for those who have severe pain and introduced the spirit of palliative care in the hospital. It was not a great achievement on my side but on the side of patients and their families.”
He later became one of the founding members of the Rwanda Palliative Care & Hospice Organization, a non-profit organisation based in Kigali that advocates for access to pain control and palliative care in primary care, mostly home based care.
“I think we made a great step because, since 2011, many things have changed. Morphine is now available in syrup but at that time it was injectable, yet you cannot treat pain with pain,” he said.
Some 1,500 health care providers in district and teaching hospitals, and health centers have since been trained in palliative care. Last month, the Ministry of Health launched the best home care practitioners to help patients at the community level.
“I’m happy that palliative care is the vocabulary now and people are beginning to understand the whole concept. In the beginning, people did not understand why I was doing this and were asking why I cared for people who were already condemned,” he says.
A tribute to patients
“My best award is the satisfaction of the patient and their family. For me, it is more than a trophy or award because if I was to work for any award, I do not think that I would still be in palliative care.”
“The Rwandan social context is such that when you are well you belong to yourself and when you are sick you belong to your family. That’s why when one is ill, it is the family that is mostly involved.
His perception about palliative care is associated with the African philosophy ‘people through other people.’
“You see here we focus on the dignity and humanity. Because a patient has been diagnosed with an incurable disease, it does not mean that they lose their dignity. ”