Treatment Section Group (TSG)

Within one week of arriving, in Rwanda, a treatment Section Group was deployed to SW Butare. The staff were accommodated in the Medical School of the University of Butare and here they provided a resuscitation capability with limited patient holding capacity. Daily they would also visit local clinics and eventually went to the Kebeho Refugee Camp, which was the largest in the country, holding 140,000 people. By November 1994 the refugee numbers had fallen to 70,000 as Rwandans returned to their homes or fleeing back to Burundi. However, in April 1995, Kebeho Camp was once again the focus of world media attention when RPA Soldiers massacred more than 4,000 refugees.

The refugee camps afforded many opportunities for nursing officers and, to a limited extent, medical assistants to act as autonomous practitioners. This occurred as medical officers were not always available and staff were treating up to 400 refugees per day. The most common conditions treated were worms, malaria, flu, dehydration, malnutrition, meningitis and dysentery. Large numbers of patients were children and many refugees required dressings on previously untreated and infected war injuries.

Non-Government Organization (NGO)

It became evident, very quickly, that the civilian side of CHK required assistance to elevate their standard of patient care. Daily, as our capabilities allowed, teams would go to the NGO areas of the operating rooms, post-surgical wards and obstetrics. The humanitarian side of Operation Tamar was the secondary role for ASMSF personnel.

In November 1994, a contract was struck between ASMSF nurses, SP and Emergency to render assistance to the NGO wards of CHK. We developed a philosophy of care which basically stated ‘An endeavor to share our knowledge with the Rwandan nurses, while improving the standard of care”. This was to be done regardless of the working environment.

The specific areas of need identified were - to initiate a daily ward routine where the Rwandan nurses were involved in ward rounds with ASMSF surgeons, this was necessary to prevent patients we’d cared for being neglected when returned to the NGO section of the hospital. Remembering cultural differences we aimed to improve hygiene, which was difficult given the lack of running water and the reluctance to change old habits. We educated the local staff on patient lifting, post-operative care and daily revision was given on oral and IV medications. Raising the patient care standard and working within the African culture was both frustrating and amusing, providing us with a constant challenge.

Aero Medical Evacuation (AME)

AME wasn’t plentiful and, when activated, was by daylight only. Initially we shared the AME responsibilities with the Canadians. A Spanish plane called a CASA was located in Nairobi and helicopters were used for AME in Rwanda. We also used the Mobile Intensive Care Rescue Facility (MIRF).

The MIRF is an Australian design and is a self contained transportation medical system with its own power supply, ventilator, monitoring equipment, infusion pump, suction unit and defibrillator. It can be fitted into planes and ambulances and it was found to have its greatest use in strategic AME. Its real value was that a critically ill patient, once placed on the MIRF wasn’t disturbed until reaching the necessary health care facility for on going care.

Conclusion

Throughout our time in Rwanda we saw the many highs and lows of health care in a Third World country. We were touched by the gentleness of the people who had lost so much, and we became angry when we saw their own people continue to harm and kill each other. We were amazed at the stoicism displayed by both children and adults who had suffered significant injuries, and we endeavored to understand a culture so different to our own.

It was a privilege to have been given the opportunity to work in Rwanda. Hopefully, we have left some legacy for improvement within their health care system. In essence, we were positive in our approach and persevered to assist the local staff to become empowered to bring about effective change.

I do know personally that we did a great deal for so many who had lost so much and still have along way to go.