'HOWARD HOSPITAL ON THE VERGE ' Part One

In a country devastated by the AIDS crisis, The Salvation Army Howard Hospital in Zimbabwe is a shining example of community based cooperation and resilience. Under the leadership of Canadian trained physician Dr. Paul Thistle, this small Zimbabwean hospital has achieved an international reputation while fulfilling its mission to meet human needs in a compassionate manner to all those seeking medical care. The Howard Hospital is situated in the Chiweshe communal land of Zimbabwe and serves a catchment area of 270,000 people. The hospital is now on the verge of collapse since Thistle was abruptly dismissed by The Salvation Army leadership last August.

Before his dismissal, Thistle started his day at the hospital at 7:15 a.m., supervising rounds with the staff, then starting a busy operating room schedule, then attendance at the outpatient clinic, followed by on-site ward rounds. He would leave for dinner at approximately 7 p.m., spending a short time with his family and then get to work on the computer dealing with his administrative duties.

Most evenings and nights were interrupted by a return to the hospital for emergency surgeries or critical events on the wards. This pace would go on six days a week and then included further administrative work and attendance for emergencies on Sundays. His rare furloughs in Canada involved non-stop fundraising and development of partnerships to help maintain the programs at the Howard. He had kept up this exhausting pace for over 17 years. Fortunately he is a man blessed with incredible energy, good humour and a positive attitude. This enabled him to continue his duties despite the enormous challenges of trying to give first class medical care in a rural developing world setting with an ongoing HIV crisis and severe economic challenges.

Despite these challenges, it is important to emphasize how successful the Howard Hospital has been at providing first class medical care. This is partially due to Thistle's enormous talent as a clinician and surgeon. Thistle was trained as a physician and then as an Obstetrician/Gynaecologist at the University of Toronto. Canadian surgical volunteers have worked side by side with him at the Howard, and all are in awe of the technical prowess, efficiency and professionalism with which he gives outstanding care despite severe challenges.

Thistle is able to do this due not only to having been blessed with "great hands" and a gift as a surgeon, but also due to his paying attention to all of the details necessary to work safely and successfully in this environment. Morning staff rounds always included Thistle quietly checking the batteries of the flashlights to make sure that when the inevitable power outages occur he would be assured that the flashlights will be working to allow the operation to be safely completed.

Like everything he does, he took on this responsibility because it is crucial for patient care. No task was "beneath him." He gave everything he has to the care of his patients and they saw this. He treated all patients with respect and deep heartfelt compassion. His co-workers were also treated to a generosity of spirit, gentleness and respect. It is for these reasons that he is deeply loved by the local community.

The Howard's success is also due to the numerous community-based programs for men, women and children living with HIV/AIDS and other chronic diseases. The Howard Hospital's HIV/TB treatment centre, Tariro (Hope) Clinic is a place of counselling, treatment and care for 2,500 adults and children living with HIV. In a country where health care institutions have a fee for service model, the Howard has never turned a patient away for financial reasons. The hospital's Mobile HIV Treatment Program was designed for patients who cannot afford to travel to the hospital to access services. Its Home Based Care program enlists volunteers, nurses and chaplains to care for the 5,000 residents living with AIDS and other chronic diseases.

Under Thistle's leadership, the Howard was the first facility in Zimbabwe and one of the first in Southern Africa, to offer a prevention of mother to child transmission of HIV program. Many other medical firsts for Zimbabwe have also started at the Howard due to Thistle's initiative. The Howard was the first site to offer the new WHO mandated breastfeeding approach, and in fact started the program two years before the guidelines were published.

The first program to detect drug resistant TB in Zimbabwe was recently started at the Howard. In fact, under Thistle, the Howard was a National and International leader in medical innovation. We are aware of at least 17 different peer reviewed publications or presentations at International medical meetings all based on Thistle's work. This would be remarkable in any situation, but to do this from a rural mission hospital is unprecedented.

END PART ONE

Dr. Michael Silverman, MD, FRCP, FACP. Global Scholar, PAS Center for

International Health, Mount Sinai Hospital

Sarah Zelcer, Director of International Programs, Ve'ahavta: The Canadian Jewish Humanitarian and Relief Committee.

July 7, 2013

The most recent news is that the Army has ordered their Zimbabwe schools for orphans not to accept donations from Friends of Howard Hospital, a long time Canadian support group that has donated thousands of dollars. The FOHH is one of the donor groups requesting greater transparency.