A Rwandan Experience

Rwanda, a small country in central Africa between Zaire and Tanzania, is the size of Vermont. Before the war there was a population of 8,500,000 making it the most densely populated country in Africa.

A century ago the original inhabitants of Rwanda were the Twa pygmies who were gradually displaced by the Hutu tribes people and the Tutsis. The Tutsis gained dominance over the Hutus and established a feudal land system with the Tutsis as lords and the Hutus as peasants. In 1890 the Germans took over the country in their expansion of German East Africa. Following World War I Rwanda was mandated by the League of Nations to Belgium, The Belgians cooperated with the Tutsi dominance by including them in their bureaucracy and promoting a Tutsi monopoly of an educational system operated by Catholic missionaries. With a population makeup of 89% Hutus and 10% Tutsis and with the Tutsis firmly in control of the political system and the economy, there was great unrest.1

In 1959 a clash between the two tribes resulted in 100,000 Tutsi deaths. Forced to introduce political reforms when independence was granted in 1962, the Belgians brought a Hutu majority into power, Having lost their privileged status, the Tutsis launched a guerrilla movement followed by intermittent killings by both sides. In 1990 a Tutsi military organization, the Rwandan Patriotic Front known as the RPF and based in Uganda, launched a campaign into Rwanda. This was repulsed with the help of French and Belgian troops, but the Rwandan army went on a rampage against the Tutsis with a tremendous loss of Tutsi lives, and many again fled to Uganda as refugees where the RPF reorganized. By this time there was some Hutus support for the RPF by Hutus opposed to the corrupt government in power.

With this historical background and tribal hatred at a fever-pitch by the recurring killings, Rwanda was ripe for a catastrophe. On April 6 a plane carrying the president of Rwanda crashed under mysterious circumstances. The Hutu government blamed the Tutsis, which triggered the Rwandan disaster. The Hutu militia and civilians went on a maniacal Tutsi killing spree. As a million Tutsi refugees poured into Tanzania and countless others into the hills of northern Rwanda, the RPF launched a campaign to gain control of the country and stop the killings. The RPF rapidly defeated the government forces, and when Kigali, the capital ofRwanda, and other key cities fell, there was another mass exodus of refugees. This time a million Hutus and militia, many of whom feared reprisals for the Tutsi killings, crushed into Goma, Zaire and the French-protected area of southwestern Rwanda. A cholera epidemic in the Goma area resulted in 60,000 deaths, and the pathos of the magnitude of the dying and the hellish conditions of the living received wide media coverage. The world, calloused by a steady diet of atrocities, was shocked by the horror of Rwanda. A million people were dead from the killings and from diseases. Over two million refugees were in neighboring countries, and another two million were displaced in their own country.

As international aid organizations mobilized to relieve the desperate plight of the Rwandans, two sister organizations, World Medical Mission and Samaritan’s Purse International Relief, directed by Franklin Graham and headquartered in Boone, North Carolina, sent an assessment team to Rwanda to determine how to minister to the needs of those fleeing the carnage. These Christian organizations are dedicated to emergency relief aid to victims of war, famine, disease and natural disasters worldwide. A refugee camp was found at Rutare in the mountains 18 miles north of Kigali in an area controlled by the RPF. Three thousand refugees were arriving each day and eventually the camp total reached102,000. The RPF estimated that the camp had 4,700 orphans, several hundred of whom had no extended family members to care for them and many were forced to scrounge for survival and sleep on the ground. The camp was in desperate need of medical care, food, water and sanitation. Malaria, pneumonia, intestinal parasites, diarrhea and machete and gunshot wounds were prevalent with no medicines and no doctors available. After negotiations with the RPF, Samaritan’s Purse agreed to provide medical services including a surgical unit and care for the orphans. Other international aid organizations involved in providing food, water, and non-food items were CARE, WorldVision, OXFAM, UNICEF and theInternational Red Cross. The RPF agreed to provide security and guards as needed.

Having worked for World MedicalMission in several African countries before, I volunteered to go to the Rutare refugee camp as a surgeon with Samaritan’s Purse. Traveling to Rwanda by way of Uganda, we picked up an RPF guard at the border who escorted us to Rutare through frequent RPF roadblocks where we were identified as guests of the RPF. Rutare was located at an elevation of 6,500 feet in beautiful mountainous country. The refugee camp was an amazing tent city of 100,000 people covering the hills. Samaritan’s Purse was assigned several old buildings to convert into a hospital and orphanage. Living arrangements were sleeping bags and tens and a supply of candles. Two empty rooms without water or electricity were designated as operating rooms. I brought three duffel bags of instruments, surgical supplies, anesthetics, medicines, and a head lamp, which was the only light in the operating room. OXFAM set up a water tank at roof level which was supplied daily by water tankers from Uganda, and a small generator was used as a source of electricity for the head lamp.

Surgery became a routine of starting the generator before each operation, giving the anesthesia, having no blood available for transfusions, and sterilizing the instruments in a pressure cooker with a kerosene burner at the end of the day. We began each operation with prayer at the operating table, and I was reminded continually of the inscription on a plaque above the entrance to the operating room at a hospital in Swaziland, “He is yours, Lord. Heal him or take him home.”

The first few weeks the surgical load was primarily machete and gunshot wounds from the fighting in Kigali 18 miles away. As the RPF rapidly won the war, I began to do more civilian surgery, which is largely obstetrics and gynecology in Africa. For a period of several weeks Samaritan’s Purse was the only surgical service between Kigali and Uganda, and serious surgical problems were being transported to Rutare from as far away as the Uganda border.

A tragic consequence of the war was an estimated 50,000 orphans. Samaritan’s Purse established an orphanage for over 400 orphans, many of whom had advanced malnutrition, and deaths were common. Some of the older orphans told stories of seeing their families brutally hacked to death by machete-wielding Hutus, which emphasized the emotional trauma and psychological scarring to which these children had been exposed. A four-year-old boy who had been completely withdrawn and never talked ran up to a two-year-old girl one day and began to talk and laugh as he hugged her. He had found a sister, his only remaining family.

The refugee population included very few old people. When asked where the old people were, the response was that they were unable to run fast enough to escape.

Problems unrelated to the war surfaced among the refugees, one of which was AIDS. Also called “the slim disease,” AIDS in Africa often presents as a fulminating diarrhea and rapid weight loss leading to death. A large tent, “the diarrhea tent,” was set up, and working here was the most unpleasant of tasks for the nurses on the project. It is estimated that in some areas of Rwanda as many as 40% of the adults have AIDS or are harboring the AIDS virus.

As the RPF won the war, the refugees left Rutare to return to what was left of their homes as rapidly as they had arrived. In a period of ten days 70,000 refugees left and roads were lined with the mass migration of people. As the population shifted, Samaritan’s Purse moved part of its staff to the capital, Kigali, to begin rehabilitating a 600-bed hospital with the help of multinational aid organizations. The last surgery I did in Kigali was a tragic case of a 21-year-old pregnant woman who stepped on a land mine with the loss of both her legs in the explosion. We operated with an Italian assistant, a French nurse and a Belgian anesthetist.

Since there were no commercial flights serving Kigali when I was due to leave, I hitched a ride on a UN cargo plane in Nairobi, Kenya. Leaving Rwanda, I looked down on a country totally destroyed, a country with no economy, no political stability, no family social structure, and no end in sight. I was overwhelmed with a sense that there was no hope for Rwanda, and then the words of Jeremiah came to mind, “There is nothing too hard for God to do.” Rwanda needs massive international aid, but what the country needs most is a spiritual revival that overcomes the tribal hatred between the Tutsis and the Hutus. The prescription for Rwanda’s ills is the love of Christ in the hearts of men. “Love keeps no record of wrongs. Love does not delight in evil. It always protects, always trusts, always hopes, always perseveres. Love never fails.”


1 Crowther, Jeff, et aI, Africa, (Hawthorn, Australia: Lonely Planet Pub!.). pp. 850–851.

Dr. Paauw, a member of Walnut Creek CRC, is a retired general surgeon who makes at least two volunteer medical assistance trips per year to various areas of the world.