Dr. Christian Ntizimira
​​​​​​​​​​Dr. Christian Ntizimira, Executive Director of the African Center for Research and End of Life Care, completed a technical fellowship at UHN's Princess Margaret Cancer Centre in 2024. He is working to reduce stigmas and promote wider acceptance of palliative care in Rwanda by advocating for a culturally-sensitive approach. (Photo: Courtesy Christian Ntizimira)

By Shauna Mazenes

Witnessing the aftermath of the genocide against the Tutsi in Rwanda in 1994 is what motivated Dr. Christian Ntizimira to get into medical school and follow his dreams to become a surgeon.

Years later, the challenge of treating the pain and suffering of a 24-year-old end-stage liver cancer patient saw him shift his career towards a new calling — palliative care.

"The problem was not pain," says Dr. Ntizimira, who at that time was completing his surgical apprenticeship at a district hospital in Rwanda. "The problem was pain mixed with suffering. I've never experienced that in my time at the hospital, because I was so focused on treating physical ailments.

"I needed to learn how to touch the dignity of the patient because my medical training did not teach me how to be a human. It taught me how to be a physician."

Tuesday, Feb. 4 is World Cancer Day. Dr. Ntizimira's approach to palliative care reflects this year's theme — "United by Unique" — a calling to champion people-centred cancer care all across the globe.

Dr. Ntizimira's holistic approach to patient-centred care was further developed at UHN's Princess Margaret Cancer Centre, where he completed his technical fellowship through the Union for International Cancer Control (UICC) in 2024.

"The Princess Margaret Global Cancer Program has partnered with UICC to bring experts like Dr. Ntizimira to Toronto for short-term, focused, exchange opportunities," says Dr. Danielle Rodin, Director of the Global Cancer Program. "This partnership directly aligns with our goals to foster global collaborations, train the next generation of cancer leaders and advance bi-directional knowledge translation.

"These exchanges are incredibly enriching for our staff at the Princess Margaret and provide opportunities to learn about new approaches and perspectives that better serve our diverse patient population."

'It's the role of the community to support th​at need'

During his fellowship, Dr. Ntizimira worked with both the Global Cancer and Palliative Care Programs. They not only expanded his knowledge of palliative care techniques, but reinforced the importance of taking a holistic approach to patient care by integrating global perspectives.

One of his biggest observations during his time studying palliative care in the West were differences in family dynamics. He was surprised to see many patients had pictures of family in their rooms instead of members of their family actually there with them.

"In Rwanda, we don't have pictures, we have people," he says. "And, those people are there 24/7.

"When vulnerability presents itself in someone's life, it's the role of the community to support that need. Despite its pre-colonial origins, the roots of that philosophy still remain in Rwandan families and social culture.

"That's why we need to develop our own model of palliative care in Africa — one that accounts for the role of the family — to bring back humanity for those who are suffering."

Recognizing those cultural differences, Dr. Ntizimira used what he learned to develop an "adopt and adapt" approach to palliative care in Rwanda, which laid the foundation for his book: The Safari Concept.

In the book, Dr. Ntizimira personifies his experiences with the behaviours of Rwandan patients and their families as animals. Each animal represents a different type of suffering, in which he provides techniques to communicate with families and find solutions.

He says the animal metaphors are a good way to engage African doctors who are not trained in palliative care or interested in palliative oncology.

'Recognize the power in treating the human being'

"They resonate with the animals and the different types of suffering experienced within the community," Dr. Ntizimira says.

While palliative care has come to be advanced in the West, he says it's still highly stigmatized in Africa, with many barriers to break and inequities to address. His time working with Dr. Gary Rodin and the Palliative Care and Psychosocial Oncology team at the Princess Margaret solidified his motivation to keep going.

Dr. Ntizimira is now working towards supporting a psycho-oncology program in the first radiotherapy cancer centre in Rwanda.

"Dr. (Gary) Rodin's ability to create a global impact through his work at the local level was truly inspiring," he says. "His story resonated deeply with me, as I am following a similar path as a pioneering physician in palliative care in Rwanda."

Dr. Ntizimira hopes to shift the perception of palliative care in Africa away from an end-of-life practice towards an opportunity to bring back Ubuntu. That is an African concept that emphasizes humanity towards others — especially so, after the trauma brought about by the genocide against the Tutsi.

But to do that, he says the concept of palliative care first needs to be decolonized in Africa.

"We've never had the chance to develop our own model of care," he says, highlighting most concepts came from France, Germany, the United States and other Western countries during the colonial period — back when it was viewed as a hopeless practice for dying patients.

"Once we're able to achieve that — once we're able to recognize the power in treating the human being — I believe it will be the most beautiful medical practice one may experience," he says.

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