A New Approach to End-of-Life Care
Most doctors are trained to fight death. Few are taught how to stand beside it. In Rwanda, Dr. Christian Ntizimira, a palliative care physician and advocate, is challenging that mindset — proving that compassion, not just cure, can transform healthcare. As the world observed World Hospice and Palliative Care Day, on October 11, healthcare systems and communities were reminded of the importance of dignity, compassion, and support for people facing life-limiting illnesses. In Rwanda, this observation resonates deeply, reflecting a quiet revolution in palliative care championed by Dr. Ntizimira.
A Life-Changing Encounter
A few years ago, in a quiet hospital ward in Kigali, Dr. Ntizimira met a young man whose life was tragically drawing to a close. At only 24, he was battling advanced liver cancer. While the physical pain was intense, what struck Dr. Ntizimira most was the profound suffering that went beyond the physical – emotional, psychological, and spiritual. The patient’s mother knelt beside him, pleading for a way to ease his suffering, even if it meant helping him sleep and never wake.
“I was terrified to prescribe morphine,” recalls Dr. Ntizimira, the Executive Director of the African Center for Research on End-of-Life Care (ACREOL), a non-governmental organization dedicated to improving health outcomes through evidence-based policy influence, education, and innovation. Dr. Ntizimira is also a faculty member at the Palliative Care Centre for Excellence in Research and Education (PalC), an initiative based in Singapore that focuses on improving the quality of palliative care through research, education, and clinical excellence.
The Turning Point
“I had worked in surgery and understood physical pain, but this was different. His suffering was mixed with fear, despair, and cultural dimensions I hadn’t been trained to handle. I felt helpless, and it shook me to the core. That moment made me question why I became a physician if my only role was to witness suffering without being able to alleviate it.”
This encounter became a turning point in Dr. Ntizimira’s career. His early dream of becoming a surgeon — a path through which he hoped to help rebuild Rwanda’s health system — transformed into a passion for palliative care. This shift led him to explore the intersections of medicine, culture, and humanity — eventually developing what he calls the “Safari Concept,” a culturally rooted framework for understanding suffering and delivering care in Rwanda.
Understanding Suffering Through Culture
According to him, the Safari Concept, is an African framework for end-of-life care. “Meeting patients at their most fragile moments teaches you more about humanity.” After medical school, Dr. Ntizimira dreamed of being a surgeon because he thought that was “the best way I could contribute” to rebuilding Rwanda’s health system. “I wanted to help, but I also wanted to understand the social and cultural context of illness,” the doctor says.
His life changed dramatically after the encounter with the young patient. “I realised that our training left us unprepared to address suffering beyond the physical,” he says. “Even when morphine was available, I was too afraid to prescribe it. I thought twice, as a physician, that day: not because of competence, but because I couldn’t meet the patient’s real needs. That is when I discovered palliative care, and it shifted everything.”
Overcoming Mindset Barriers
Dr. Ntizimira reckons that Rwanda has made historic strides in palliative care. In 2011, it became the first African country to implement a standalone national policy and implementation plan for palliative care, ensuring morphine availability and training healthcare workers across the country. Today, University of Rwanda (UR) integrates palliative care into its medical curriculum, producing a new generation of culturally competent healthcare professionals.
Yet Dr. Ntizimira stresses that the greatest barrier is not infrastructure, funding, or medication. It is mindset. “Many people still associate palliative care with giving up. But it is about life: making every remaining day meaningful, managing pain, and supporting patients and their families emotionally and spiritually.”
Redefining Care Through Culture
Dr. Ntizimira’s “Safari Concept” frames illness and dying as a journey shared by the patient, family, and community. Drawing on ethnographic research, he observed that in Rwandan culture, illness is never an individual experience. It is communal. Families participate in decision-making, provide emotional support, and help navigate suffering.
“In Western medicine, autonomy is often cantered solely on the patient. In our context, autonomy must be balanced with community responsibility. Decisions are made together, and that shared ownership strengthens care outcomes,” he explains. He distinguishes between treating the disease and treating the person, two aspects he says go hand-in-hand.
The Power of Human Connection
“Compassion is part of African culture,” he says. “At weddings, funerals, and other social gatherings, people naturally show up for one another without expectation or reward. We can harness that to support patients in vulnerability.” New programmes now equip community health workers to identify patients in need, support families in caregiving, and mobilise local volunteers.
He recalls his experiences in the United States which showed that it can even be easier to provide palliative care in African countries, compared to the countries where the discipline is well advanced. “During a fellowship in Boston, I saw patients in palliative care units surrounded by photographs of distant family members. Many patients were alone, yet displayed the images of loved ones to maintain connection.”
Breaking the Luxury Myth
One persistent misconception, Dr. Ntizimira notes, is that palliative care is a luxury or an elective service for the wealthy. “In Rwanda, palliative care is integrated into the national health system. Morphine is available at all district hospitals, and community-based health insurance covers most costs, making access nearly universal.”
Policy, Research, and a 3D Approach
Dr. Ntizimira stresses the need for evidence-based policy and continuous research. “We need data on paediatric care, gender disparities, access gaps, and community engagement. Research ensures policies reflect local realities rather than imported frameworks.” His 3D approach emphasises democratisation, destigmatisation, and deconstruction. Care must be simple and accessible, myths about palliative care must be addressed, and local models should replace imported frameworks.
Vision for Africa
Dr. Ntizimira envisions African health systems where palliative care is standard in universal health coverage. “Rwanda’s model can inspire the continent,” he adds. “By blending scientific rigor with cultural intelligence, we can create inclusive, compassionate systems. Africa has something powerful to teach the world about empathy, community, and dignity.”
A Call to Action
His work also emphasizes the importance of reconciling patients with their disease and families with the reality of illness. “Patients sometimes deny their condition; families are shocked by what seems sudden,” Dr. Ntizimira says. “Part of our work is guiding both to acceptance, to ensure decisions are informed, compassionate, and culturally appropriate.”
Through this lens, palliative care becomes a shared journey, a communal act of empathy, and a model that Africa can proudly show to the world. On World Hospice and Palliative Care Day 2025, Rwanda’s story stands as proof of what is possible when humanity and policy walk together. But as Ntizimira emphasises, it is a work in progress.
