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