Australian Medical Support Force UNAMIR II 

RWANDA, how quickly this country became the focus of world media attention. Genocide, on a scale unheard of since WW2, was presented to us nightly in our living rooms. It was estimated that between 500,000 and 1 million civilians were killed during this civil war.

Like so many Australians, I was distressed by what I saw, little knowing that I would soon, along with a 300 plus contingent, be on my way to Rwanda as part of the Australian Medical Support Force UNAMIR II (United Nations Assisted Mission In Rwanda). Our task being to establish a hospital facility to provide health care to the 5,500 United Nations troops who were part of UNAMIR II.

To those of us in military service, an overseas deployment is seen as a pinnacle of service life. It was truly a ‘trip of a lifetime’ to those of us given the opportunity to go to Rwanda.

Around the 22 August 1994 the majority of Nursing Officers arrived in Kigali. The Kigali Airport was dark, very quiet, rather eerie and the heavens opened as we arrived, so by the time we were transported from the US Galaxy to the terminal, we were not only anxious, apprehensive and tired, we were wet as well! For the first couple of hours the war damaged terminal was our home. The lighting was subdued and there was obvious structural damage from RPG’s and mortars to walls and ceilings. Only one or two toilets ‘sort of worked’ and the toilet paper was purple which seemed a little out of place amongst the destruction.

At 0600 hrs, after sleeping with one eye open, we were ready to move to the barrack blocks. Our trip from the airport to our home for the next six months was a surprise, as we saw gum trees which reminded us all of home. The weather was hot, and the smell of death and the overwhelming stench of sewerage filled the air around us.  

This was the first time since Vietnam War the Australian Government had deployed a medical mission of this size, and throughout our time in country we provided medical support to large numbers of people including UN troops, local Rwandans, the ex-patriot Non-Government Organization (NGO) personnel, UNAMIR employees, VIP Rwandans as defined by the Medical Director of the Central Hospital  Kigali (CHK) and even the odd Rwandan Patriotic Army (RPA) soldier. This medical support was provided in a variety of different health care settings.

The Role of the Medical Company AUSMED

Medical Company was made up of 93 individuals from 29 different medical units from the three services (Army, Navy and Airforce). X-Ray being the only department which deployed with a composite staff. So this presented a challenge when selecting appropriate individuals to fill the establishment positions to achieve the most effective combination of staff. This would have been a smoother process had a formed unit or at least elements of  formed units had been sent.

The area of CHK where medical company was located had previously been the private obstetric wing. An advance party, which had arrived two weeks prior to the main body, was faced with the difficult task of cleaning this wing. Here they faced caked on blood and faeces and had to manually remove waste from the toilet bowls. Evidence of significant carnage was to be seen here also, patients having fled leaving intravenous lines just hanging, splatters of blood on the walls from those fleeing for their lives. The smell, alone, stifling. On arrival the main body continued to clean and very quickly formed the now termed Military Wing of CHK. We had the only ICU in the country and until the NGO side of CHK had their X-Ray Department up and running, Australian Medical Support Force (ASMSF) was the only X-Ray department in Rwanda.

Within a few days of arrival we had our first patients in both the medical/surgical ward and ICU. The ICU patient was a young RPA soldier who had a below knee amputation, following a grenade explosion. We basically ‘hit the ground running’. Staff were exposed to a wide variety of trauma not seen in our peace time military system back in Australia. The lead up to this deployment had been very short for a number of our staff, and some were ill-prepared for the type of patients and the experiences they were to encounter. Many faced a very steep learning curve and performed exceptionally well.

Communication posed a real problem, as the majority of Australians are mono-lingual very few of us spoke Kinyarwandanise, French or Swahili. Inexperienced interpreters provided the necessary link here, their inexperience lay in the area of medical terminology and in particular western health care. In most instances, prior to the war, the interpreters had been university students or professionals with no medical knowledge, hence gaining clinical details from patients was incredibly time consuming.

We had to be creative with the limited resources available and could take nothing for granted. Improvisation always challenges creativity and we were not left wanting in this area.

By the sixth week in the country we began to see improvements and had treated many nationalities. An average week in hospital saw above and below knee amputations, grenade injuries, split skin grafts, delayed primary closure, debridement, motor vehicle accidents, gun shot wounds, ventilated patients and a wide range of infectious diseases. Tuberculosis and malaria were prevalent as was HIV and Aids related conditions.