The FSAOF has been encouraged to feature a
series of articles focusing on the morality and ethics exhibited by a
multi-national organizations that operates in a totalitarian, autocratic and
militaristic fashion - (disenfranchising members). The series begins tomorrow.
We include up-to-date poll results directly following this article.
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Zimbabwe's Best Surgeon, Ordered Back to Canada
Posted: 10/19/2012
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.
Thistle
worked not only to assure excellent medical care at the Howard Hospital, but
also to assure that there was an improvement in medical standards throughout
the country. He trained medical students from the University of Zimbabwe, with
students getting rural experience at the Howard. He was very involved with the
College of Physicians in Harare, which ensures that all physicians working in
the country are properly certified, and receive ongoing education and training.
The commitment to teaching is a family process within the Thistle household,
with his wife Pedrinah also being a talented and highly respected nursing
educator and midwife.
It was not
just the medical care of the community that Thistle and his wife attended to.
The general community welfare was critical to both of them. Paul and Pedrinah
were deeply involved in the care of local orphans. Quietly and without fanfare,
Dr and Mrs Thistle assured that local boys and girls receive the care and love
that they need. This involved individual attention to help keep the children in
school and getting them the funding to make that possible. It also involved
supporting local orphanages with fund raising. Even with his busy schedule,
Thistle found time every Sunday evening to play ball hockey with the local
children. He made sure that they have equipment, and made sure their needs are
being met. These games were deeply loved by the children with 20-30 coming
every week to play.
An
international outcry sounded when Thistle and his wife were relieved of their
duties without warning or cause. The Thistles, Salvation Army Officers, were
ordered by The Salvation Army leadership to abandon their home and work, and
return to Canada. The tragedy is that it is innocent Zimbabweans who are being
punished in a most inhumane way.
Thistle's
abrupt dismissal from the Howard Hospital has led to a rapid decrease in
medical services and has dealt devastating blow to the community. Thistle is
the only surgeon in the region, and in his absence most elective and emergency
surgery has ceased. The very existence of the hospital and the survival of its
many community based programs are now under threat. The Salvation Army has not
proposed a transition plan. Their leadership did not consult with the community
before making a decision that affects their lives and their deaths.
After over
17 years of Thistle at the helm of the hospital, no plans were considered to
involve him in the handing over of the clinical reigns to an incoming physician
or surgeon. No incoming physician or surgeon has yet even been identified by
The Salvation Army leadership and no start date has been indicated. The once
thriving hospital is operating at 10 per cent capacity. The thousands of
patients receiving Anti-Retroviral Therapy for HIV are now at risk of
defaulting on their treatment. Fifteen hundred orphans and vulnerable children
were left without financial support to pay for school fees this September and
thus have not been able to attend their classes. The residents of Chiweshe have
forcefully stated their support of Thistle, and have demanded that he be
reinstated.
Thistle has
been a loyal member of The Salvation Army and has not spoken out against it in
public. We are aware of allegations of corruption and misuse of donor funds and
donated goods by The Salvation Army in Zimbabwe. We believe that Thistle's
attempts to maintain the integrity of accounts has raised the ire of The
Salvation Army Church in Harare and is likely the reason for their insisting on
his prompt removal.
We have had
the privilege to work closely with Thistle for many years. We know him to be
honest, reliable, and motivated by compassion. We, like hundreds of others, have
been inspired to do whatever we could to help the Howard after witnessing the
incredible commitment, professionalism, and devotion with which Thistle has
cared for both his patients and the entire local Zimbabwean community.
This is a
humanitarian crisis unfolding before our eyes. A group of concerned doctors and
other professionals have formed the Interfaith Friends of Howard Hospital
(IFHH). We have all worked as volunteers beside Thistle in Zimbabwe and have
facilitated millions of dollars' worth of medical equipment, medicine and
funds, including grants from international aid agencies, Canadian registered
charities, and faith-based groups. Future donations to the hospital are now in
jeopardy, as donors are no longer confident that there is adequate management
or supervision on the ground to ensure that donor dollars are utilized for
their intended purpose.
Our efforts
to work to address this crisis with The Salvation Army leadership at its
Canadian and International headquarters have been fruitless. The Salvation Army
leadership continues to ignore the crisis precipitated by their removal of this
exceptionally qualified surgeon from his practice.
The
Salvation Army leadership has offered no explanation to the people of Chiweshe
or supporters of the Howard Hospital as to why it has suddenly pulled the
brakes on the exceptional model of sustainable health care. It has a moral
obligation to permit the Thistles to return to their positions at the Howard
Hospital. The Salvation Army leadership must take responsibility for the
devastation they have caused, and restore hope and healthcare to those it
professes to serve. This is a particularly great shame as The Salvation Army
does inspiring and important work around the world. It is critical that this
situation is rectified promptly in order to regain the trust that volunteers
and donors have placed in this venerable institution.
Some might
ask whether it would not it be better for Thistle to return to Canada? After
all, clearly he could do dramatically better financially working as a physician
in Canada where the opportunities for him are limitless. He could work in a
Canadian facility where resources are plentiful and most of the inconveniences
would be taken care of by a strong support network and infrastructure providing
a steady source of medical supplies and equipment.
Where the
work days would be much shorter and he would have surgical colleagues to cover
for him so that he could get a reasonable amount of time off. But Thistle does
not want this. He wants to stay at the Howard. The only reason is because he
worries about the 270,000 people in the surrounding area and how they will
access affordable medical care if he leaves. Thistle once said, "I went
into medical school in order to work where I can best serve, not just where I
can make money." He and Pedrinah are resolute that they can't leave and
abandon the community that they have grown to love and become a deep part of.
As a
physician, Thistle has sworn an oath not to abandon his patients unless he can directly
transfer care to another physician who has the necessary skills and is able to
accept immediate responsibility. As a soldier in The Salvation Army he is being
ordered to break this solemn oath. No reason for this order has been provided
by The Salvation Army other than that this has been "determined by
leadership." To ask for dedicated staff to break ethical principles
without any specific reason being given except that it has "been
determined" is an unacceptable practice for a humanitarian and religious
organization.
There are
very few true heroes. The term is used all too often for and by people who
perform everyday good deeds that seem to suggest a strong moral sense but no
great personal sacrifice. Very rarely do true heroes emerge. Paul and Pedrinah
Thistle are heroes. They have chosen to do something that involves enormous
long term personal sacrifice for the benefit of their community. We need to do
everything we can to support the few real heroes that God blesses us with.
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
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