Index

Background

The Second Australian Services Contingent (ASC 2) was deployed to Rwanda in February 1995. ASC 2 consisted of a total of over 300 personnel drawn from the three services and many different units across the ADF. Although mostly Army there were also 5 RAN personnel and 21 RAAF. The RAAF element included medical officers, nursing officers, medical assistants and an interpreter. Our primary role was to provide aeromedical evacuation (AME) support to UNAMIR as well as general medical support at the hospital.

The unit formed in Townsville in January 1995 and after three weeks of hell.... sorry, pre-deployment training, deployed to Rwanda on 20 Feb 1995, taking over the facilities already established by the first contingent in Kigali. Although primarily a medical mission, our contingent also consisted of other elements in support of the medical mission. Elements included

Where we lived

The facilities we adopted in Kigali consisted of "The Compound" which was where we lived, ate, slept, and partied, and the UN Hospital which was established in a wing of the Centeral Hopital Kigali (CHK) (right). Both areas were secured by the Rifle Company and surrounded by barbed wire. In moving between the two facilities, a mere five minute walk, we were required to pass the RPA barracks and therefore it was necessary to carry a loaded Steyr rifle and, in the case of females, have at least two male escorts at all times.                                  

Med Coy Services

The UN Hospital operated by Med Coy consisted of all of the services expected of a Level 3 hospital in Australia and in some cases exceeded this level. It included a 25 bed ward, an ICU staffed by both permanent and ICU- trained reserve nursing officers, operating theatres, x-ray, pathology, dental, and physiotherapy departments. The contingent medical personnel were augmented by specialist reserve doctors on 6 week rotations and these included a general surgeon, orthopaedic surgeon, anaesthetist, tropical medicine specialist and ICU specialist. Due to the effects of the genocide (most health professionals were killed) we operated the best medical facility in the country. However some patients exceeded our capabilities and for those UN patients who required even more specialised treatment or consultation, we provided an AME service to Nairobi.

Patients

We treated many UN soldiers, mostly from African nations but despite our mission statement, the majority of our work was with the local population either from the CHK casualty (right) or wards where some of our own nursing staff were working. We also provided medical support to the local orphanage (left) run by Mother Theresa's order and these victims of the genocide were without doubt our favourite patients.                                   

Clinical Cases

By treating such large numbers of the local population, we were able to increase our clinical knowledge and saw many illnesses we would not see in Australia. These included:

We became experts at dealing with the type of injuries we would see if we really did go to war and from this point of view it was excellent experience we could not have gained on an exercise in Australia.

Resource Management

The mission was also a great lesson in resource management as the amount of support we could provide depended not on the cost of medical supplies as it might back home, but simply on their availability. The UN supply system in Africa was a bureaucratic nightmare, with some drugs taking four or five months to arrive after ordering. Often this called for some tough decisions and "playing God". For instance this little orphan who I had to decide not to treat aggressively due to a shortage of oxygen supplies. She died a few hours later.

Success Story

We also had some great success stories like Uwamariya an eight year old girl who presented with a grossly infected leg. The infection subsequently spread throughout her body despite antibiotics and she ended up in ICU with everyone expecting her demise. After many weeks she began to improve and although an amputation looked probable, the leg was saved by stripping and grafting her dead tibia, and then skin was grafted over the large defect in her leg. By the time she left us she was charging around on crutches but when she returned for a visit these had been discarded.                   Uwamariya (right) and Buregeya

AME

AME was supposed to be one of the major roles for the RAAF personnel however our services in this area were limited somewhat. We nevertheless gained considerable experience although being somewhat hampered by some "organisational problems" at UNAMIR HQ. We performed a total of 21 AMEs in the 6 months we were there. Most of our AMEs were tactical or forward AMEs in country using Canadian Bell 212 helicopters under contract to the UN. 

Reflections

Overall, Rwanda was a incredible experience for ADF health services personnel. We were fully tested in an operational environment and gained invaluable experience in dealing with the types of scenarios we may see in war. There were of course many personal and professional frustrations, and working in the Army was, shall we say, an interesting experience, however learning to deal with these problems was great experience and preparation for the "real thing" for all concerned. I suppose the biggest source of discontent early in the tour was wishing we could do more to help these people, however learning to do the best we could with the resources available, and to be satisfied with the results obtained, was in itself a valuable lesson. For me, this six month tour was undoubtedly the highlight of my career as a military medical officer and, to answer the question I am most often asked, yes I would do it again.

For more on ASC 2, see Kibeho

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