Reflections on ANZAC Day; Rwanda Peacekeepers.

We had just arrived at the war-torn Kigali Central Hospital, to join the Australian Medical Support Force, being the second Australian Medical Specialist rotation. Walking down the corridor I was introduced to a young boy with a serious problem. ”We have been keeping him for your arrival, Sir,” the young medical Officer said. He had a very pulsatile swelling in his neck, a result of a piece of shrapnel piercing his carotid artery and creating a “ false aneurysm”. Eventually, it would rupture and he would bleed to death.

Arriving at the hospital had been quite an experience from the day a gentle female voice over the phone asked me if I would be prepared to go with the Army Medical contingent to Rwanda. It seems to me they always had a female soldier ring and ask if I would be able to go on deployments. “Sir” they always started with and you knew what would follow. It seemed to me there was no point in being in the Reserve if you weren’t able to serve and they were always in need of experienced surgeons, a feeling shared by all my colleagues in the team.

The decision was straightforward after discussing it with my family, but as my wife said there was a dash of danger! Little did she know the extent…in 1994 war erupted in the central African nation of Rwanda and a genocide ensued on a scale not seen since WWII, with over a million men, women and children shot or hacked to death, no one was spared.

So it was with some relief that the first person I would operate on would have a vascular problem. Familiar territory, anatomically speaking, but no angiogram or ultrasound just the clinical appearance.

Confidence is important in undertaking surgery and it comes from your training but also an appreciation of the people you are working with and the environment. Peter Tralaggan was a specialist anesthetist doing heart Surgery at RPA in Sydney and had been careful to acquire a number of pediatric devices knowing the army at that stage would not have such supplies. The theatre staff we knew from exercises in Australia where we had deployed a mobile operating theatre, so it was the ‘shot up’ Kigali operating theatre we were to work together this time, in this strange and hostile environment.

A very sophisticated operating table had been installed by the French some time ago, we had similar tables at Concord Hospital, but the hydraulics of this table no longer worked limiting its flexibility. In the usual Aussie ‘can do’ approach minor adjustments made it possible to use it.

So we got going, the nurses comforting the young boy in these very unfamiliar circumstances as he went to sleep. Child size intubation tubes that Peter had brought secured the airway and we were underway. In fact, a fairly straightforward dissection and control of bleeding followed. The artery wall was repaired and the wound closed in a normal way.

Next was a test of the postoperative care and facilities but all went well and our patient made a quick recovery given his youth.

This was a very gentle start and over the ensuing weeks all manner of injury, mine and bullet wounds, abdominal trauma from motor vehicle accidents and sundry other surgical cases flowed through this makeshift facility. The quiet professional expertise of our nurses, medical officers, and support staff helped things go smoothly, often late into the night and after extremely busy runs of trauma of the type we had seldom or never seen before.

Not since the Vietnam War had Australia sent a medical contingent with full operating capability and medical support overseas, as happened following a United Nations request for our support in Rwanda.

In today’s wars, children and families are often caught up or are “collateral damage” and incur horrific injuries though not actually combatants. However, in Rwanda, there had also been a deliberate attempt at genocide, sparing no one with a Tutsi background.

When asked to go with the contingent to Rwanda little did I expect to draw on the varied skills I had acquired in my training in dealing with the injuries that came to us.

I was of the old school where we rotated through the various surgical specialties so for a year I had been exposed to neurosurgery at St. Vincents which proved handy. This baby had stopped feeding after falling and fracturing his skull. The depressed bone was pushing on his brain and with the help of our team I was able to elevate the fracture and he returned to a normal thriving baby. In my mind, I thanked those surgeons who had taught me the basic skills of head injuries.

Mine injuries were our ’bread and butter’ and it is still difficult to put out of your mind the horrific images, but at the time we just got on with the work of cleaning up the wounds, amputating what was not salvageable and with the dedication of the nursing staff, supporting the patients and their families.

A young mother walking down a pathway after heavy rain set off a mine that had shifted resulting in major limb injuries. Multiple operations were necessary to save her left leg having lost the right. Amazingly she was still able to smile.

We had not experienced such resilience and often talked among our medical staff about their desire to live under such circumstances. In fact, talking about what we had experienced was a very important way of coping with the situation.

We were taken to see and appreciate a grim reminder of the Genocide at Ntarama, a village 35 kilometers from Kigali, where the local residents had taken shelter in the little church. Hand grenades had been lobbed into the church killing many instantly and those who tried to escape were hacked to death with machetes.

It was the most sobering sight you could imagine, a deep silence hung over the site and as we moved about we could see the bodies cut in half with the mud rising, as it were, to consume them.

I stepped into the church only to have the step collapse…it was the chest of a fallen victim that was now covered in mud, a memory that will last forever!

Up the pathway was the Sunday school house where the same fate was dealt out to the children.

Continuing back at the Hospital, all manner of injuries including burns to children had to be cared for. A burns clinic was also run in the Non-Government Organisation (NGO) section of the hospital which we attended. It was run by a very brave nurse who told us how she had paid to have her parents shot to death rather than being chopped to death by machete. She had then escaped with her children covered in the back of a bus.

It was difficult at times to carry out the surgery necessary to save lives…not the surgery itself but knowledge of the long-term issues the patients would face and in this war-torn environment what support would there be. The long-term consequences had yet to sink in.

As this breakdown shows, the Australian Defence Force support in Rwanda dealt with a significant number of serious cases. The medical wards also were extremely busy with John Flynn our physician doubling up in running the intensive care ward.

I have often said the very presence of our medical support force enabled the United Nations soldiers to enforce the peace knowing there was good medical backup. This probably saved many more lives by putting the dampers on the aggression than we did in the hospital.

In writing this blog I thought a first-hand account of the positive contribution made by the Australian forces might be of interest. Teamwork and a clear understanding of our capabilities and limitations are key factors of course but also in the hospital setting a special kind of humanity is everpresent, that comes with the nature of the people involved.

There are many more stories of bravery and courage carried out by our military in this endeavor and maybe I will relate these another day.

Photo of the handover of specialists, December 1994, the red cross and the gun and a “Dash of Danger”

Bibliography

Lusby R J et al. The Australian Medical Support Force in Rwanda. Med J Aust. 163: pp646-651. 1995

Gavin Fry Rwanda The Australian Contingent 1994-1995 The Australian Army