Are SA Medical Officer Missionaries routinely Shuffled across Territories? Part One

THE SALVATION ARMY - HOWARD HOSPITAL - ZIMBABWE
Opened 1923

Forty years ago, Zimbabwe (then Rhodesia), was considered to have had a model health care program and educational system.  The World Health Organization’s reports consistently showed that it was one of the leading countries in Africa, the only major exception being the Republic of South Africa.  However, since the 1990s, participation in the Congo war, rampant 1,000% inflation and a lack of foreign investment has left the country economically ravaged.  In 2008, Zimbabwe’s health care system was in a state of collapse, unable to provide basic health services or protect its people from ongoing HIV epidemics and sporadic outbreaks of infectious diseases, and calls for urgent intervention from humanitarian organizations around the world were growing by the day.

In this environment, Captain Dr. Paul Thistle had been serving at The Salvation Army’s Howard Hospital, Chiweshe, Mazowe district of Mashonaland since 1995; and as Chief Medical Officer since 1999.

Thistle is from Scarborough Ontario, and received his medical degrees from the University of Toronto.  Besides being a specialist in gynecology and obstetrics, he was honoured by the Royal College of Physicians and Surgeons of Canada as the first recipient of the Teasdale-Corti Humanitarian award; the Paul Harris Rotary Fellow award; and a Doctor of Laws degree by the University of Windsor. His clinical and research interests at the Howard, included prevention of mother to child transmission of HIV, AIDS prevention and treatment, cervical cancer screening and long-term methods of family planning.  Many of his colleagues have referred to him as “the best bush surgeon in the world”.

During his tenure patients came from the 100,000 peasant farmers, commercial farm and mine workers in the immediate area.  Others were referred from hospitals in a larger area encompassing a population of over 270,000.  Minor procedures were done on the spot by doctors, and often, by trained paramedics and nurses.  More difficult surgical cases were done on Tuesdays and Thursdays, and if there was an excess of cases, on other days as well.  The hospital welcomed 300 patients a day via the large adult outpatient and separate maternal child health clinics.  The majority were seen and treated by nurses who then referred some one hundred a day to the remaining doctors.  The nurse’s training school offered education for medical assistants of primary care. Likewise, there was a school for midwifery soon to be headed by Paul’s wife Pedrinah, providing both upgrading and complete training.

In the department of obstetrics, also known as Family Child Health (FCH), there were 2500 deliveries each year.  Within the hospital premises an ante-natal shelter offered accommodation to expectant mothers to prevent problems arising from delays in transportation.  A home care program was established for chronic and palliative care, including patients with AIDS related diseases, under the supervision of chaplains and nurses.  A supplemental feeding program was provided for children with malnutrition.  Child sponsorship was available for orphans whose parents died from AIDS and who could otherwise not afford to go to school.   A comprehensive HIV counseling and treatment center was launched in conjunction with an expanded effort to diagnose and manage tuberculosis.  An education team provided outreach to the schools, churches and community centres, with the message of AIDS prevention using the means of song, art and puppetry.  Much of this innovative ministry came to an abrupt halt in August 2012, when the Thistles were dismissed, and given twenty four hours to leave the Hospital grounds and forty eight hours to leave the country, by the then Territorial Commander Commissioner Vinece Chigariro, who has since been transferred to the East Kenya territory.

In late summer 2012, the FSAOF was asked to intervene in the seemingly unfair dismissal and repatriation of Captain Dr. Paul Thistle. The alert reached us too late for our fellowship’s involvement. We were however, made to realize that the dismissal was unethical (against Zimbabwe government standards of medical ethics) and subsequently the cause of much suffering and even deaths of patients.

This tragic story surfaced again last week when we were made more fully aware of the troubling circumstances that led to the dismissal of Dr. Paul Thistle. He is presently in Canada where he returns and undergoes regular training. He’ll soon return to Zimbabwe with his family to begin his 18th year as a surgeon, however, not in the SA’s 90 year old Howard Hospital, but at a neighboring mission hospital where he is presently a volunteer.

Dr. Thistle shared earlier this week with FSAOF: “Pedrinah and I remain deeply disappointed, that in official correspondence from IHQ, and in official Salvation Army press releases, no one ever wondered if people might be suffering. When you abruptly reduce the physician staff from 3 to 2 including removal of the only surgeon, it doesn’t take a rocket scientist or any health care experience to deduce that people will suffer.  Surgeries booked weeks and month in advance were cancelled.  When you receive phone calls from relatives stating that their mother or sister has died for lack of medical care at Howard, it is devastating.  The people, poor and disempowered, have had a basic human right withdrawn over a ‘routine transfer’ without stated reason. There has been no hint of an apology from the Salvation Army and very little has changed on the ground since August 2012 in regards to the delivery of health care services.” 

According to the latest reports from the Zimbabwean government the lack of trained medical staff continues to be a problem. 

In 2010, the World Health Organization reported that there were fewer than two doctors for every ten thousand people and that approximately 80% of the positions available for midwives remained unfilled. 

Doctors, pharmacists, laboratory technicians and nurses continue to leave the country to find better working conditions and salaries in South Africa, Canada, and the United Kingdom.  Basic health care services are uneven and some medical facilities suffer from a shortage of drugs.

Paul’s predecessor as the CMO, Major Dr. James Watt, former CMO of the Hospital, now retired in Canada, said the same day: “This is what I would prefer the FSAOF blog to focus on… that you would place the humanitarian crisis at Howard back into the public forum… it should be discussed urgently, i.e. before the High Council. Whether the Thistles are part of the solution to the restoration of Howard Hospital … that is a different question.


Nearly a year has passed since he (Dr. Paul Thistle) was removed from Howard Hospital; no suitable replacement has been found, and the hospital is in financial difficulty.  Furthermore, patients continue to die at Howard (over 10% mortality), among those referred to Harare, the capital two hours distant, for care (no money, no treatment), and at home, seeing the uselessness of coming to hospital. 

Many of these are Salvationists.  Many of them are known to me by name. My chief concern has always been the welfare of the people of Chiweshe. From my perspective, the health and well-being of the patient in the community is paramount."

Less than half the population has proper sanitation with the result that there are outbreaks of cholera from time to time.

UNAID reports that about one million people over the age of fifteen are infected with HIV/AIDS and that life-expectancy had dropped to forty nine years in 2009. The United Nations Children’s Agency believes that one in three children suffer from chronic malnutrition..  At one time the United Nations World Food Program was feeding half of the population, and the 2011 Famine Early Warning Systems Network warns that millions may again require food assistance.

In the light of the ethical concerns and responsibilities associated with the above information, the FSAOF seeks answers as to whether TSA IHQ, Zimbabwean THQ and Canada and Bermuda THQ officials sought to address the legitimate concerns of the HH donors and stakeholders, or simply made empty assurances in an effort to distract and dismiss them? 

For example, in making its decision to order Captain Dr. Thistle out of the country within a forty-eight hour time ultimatum;

• Was attention given to the ethical breaches, those forced on or committed against Dr. Thistle and his wife, and the SA?

• Were potential ramifications given even superficial consideration?

• Did they consider how this might affect the availability of quality health care in general or focus instead on international flight departure times out of Harare?

• Did they realize the negative impact that the removal of one of three Howard Hospital doctors and the only surgeon would have on the region? 

• Was the decision made before being able to provide an immediate replacement even though assurances had been given by the SA? 

• How great was the time lapse before a Chief Medical Officer was in place, and what are the qualifications-certifications of the person so employed? 

• Was The Salvation Army correct in its statement that its medical missionaries are routinely shuffled?

• What is the average duration of a SA medical officer’s overseas appointment? 

We would like answers from those responsible for making the decision.

End Part One  (This is part One in a series - Part Two will follow on or about July 11, 2013)

Dr. Sven Ljungholm Liverpool, UK - Former Officer
Dr. John Sullivan Oshawa, Ontario - Former Officer