Christian Ntizimira

His name is Christian Ntizimira, and he is a Rwandan palliative and end-of-life physician seeking to change how Rwandan patients and families experience death and dying. “Palliative care is about giving voice to the voiceless.” Dr. Ntizimira, the founder of the African Center for Research on End-of-Life Care (ACREOL), firmly believes that “taking care of patients or family facing life-limiting illnesses is not about medical decisions only.” He is currently spreading the idea among his colleagues that social, psychological, cultural and spiritual factors are as important as physiological ones during caregiving. For Dr. Ntizimira, the concept of palliative care, in the context of the Genocide against the Tutsis, can contribute to a sense of humanity lost during those devastating 100 days.

“My dream when I was young was to be the best surgeon.” Christian grew up as a refugee in the Democratic Republic of Congo, formerly Zaire, and when his family moved back to Rwanda after the Genocide against the Tutsis in 1994, he decided to help rebuild his country. So, he visited a hospital in Gisenyi. There he saw many wounded and thought the best way to help was to become a surgeon.

After finishing medical school, while working in a surgery department, he met a patient dying of liver cancer. “It was the first time in my career as general practitioner preparing to become a surgeon that I saw someone in really that much pain; I can’t even describe it.” The patient’s mother came to Dr. Ntizimira and knelt before him, asking him to do something for his son. “I felt that I failed twice,” says Ntizimira.

First, he failed as a doctor. Medical education does not encourage prescribing morphine to the patient. “For physicians, pain is not a priority.” Then, he failed as a Rwandan. “In our culture, when an elder kneels before a young person, it means you failed.”

He went home that night and, after questioning himself, he shifted his dream from surgery to palliative care passionate. When describing palliative care, Ntizimira says, “It’s not only about withdrawing or withholding medication. It’s about dignity. It’s about compassion, empathy, and bonding.”

What he realized from meeting that desperate mother is that medical care lacks a sense of humanity. “I said, no more suffering of this kind, especially in a country like Rwanda.” He then narrowed his efforts to two questions: “How do African patients die?” and “How would African patients wish to die?” 

When asked how he led palliative care in Rwanda, Ntizimira responds: “I don’t have followers. Actually, I’m following the patients. Patients are the leaders.”

However, Ntizimira is actively inviting palliative care specialists to learn from how things are changing in Rwanda. He has observed that the intersection between patient autonomy and community responsibility, the decision-making involved, which is crucial in Rwanda, is foreign to Western colleagues. He refers to Ubuntu, which is sometimes translated as “I am because we are” or “humanity towards others.” He means that palliative care should center around the family, or community and not just the individual.

Moreover, Western techniques and philosophies seem hard to grasp to Rwandan families which have as many as 40 or 50 members. That’s why Ntizimira is “writing a book on families’ communication in end-of-life care in Rwanda.” So, he has used local illustration from 12 animal architypes as metaphors to decode the language of suffering in family members meetings.

Once, Ntizimira tended to a woman dying of ovarian cancer in very dire conditions. He wrote down a heart-felt text expressing his frustration with the patient’s situation. The text ends courageously:  “I’m not ashamed because we are not beholden to the guilt, fear, death or stigma, but to a life of dignity and Ubuntu. I’m not ashamed because I cannot do everything but must do something. So, this is my future.”