The Safari Concept

Dr Christian Ntizimira - Executive Director, ACREOL, Kigali, Rwanda

Could you tell us about “The Safari Concept”?

Safari means a journey, it’s nothing with animals. So I did my safari from Kigali to Dakar and I didn’t see any animals, so it’s nothing with animals, it’s just a journey. The concept is based by using language familiar with most African proverbs and citations which can reflect the psychosocial distress from the families. It was really important to understand that our language is totally difference with some of the realities from English or French vocabularies. So the concept is based to understand the psychosocial distress from the family members but using African languages and metaphors.

Why is it so important in Africa?

It’s really important because the perception of care is totally different. Physical pain can be the same – if you have pain here in Africa, you have pain in the US, in Europe, it is the same. Pain is the same. Maybe the assessment could be different. But psychological emotion and spiritual distress could be totally different so this is why we need to contextualise. Part of that, one of the social contexts say that when we are well you belong to yourself but when you are sick you belong to your family. So you have the patient autonomy and the community responsibility as well. So it’s really important to understand that the patient autonomy does not include the community responsibility as the community responsibility does not include the patient’s autonomy. So we need to work on both sides for decision making.

So try to contextualise but when I mean contextualise I mean to adopt then to adapt. You need first to adopt the local perception of care then you adapt it to the current challenges and that is really important in our culture. Modern medicine needs… how can I say it? There is a way that modern medicine and traditional approaches need to work together instead of saying, ‘This has to exclude… this is not really good.’ It’s not good and bad, it’s just about sharing and learning, which is really important.

What message would you give to your colleagues about palliative care?

I have two messages. One, as you mentioned, about the Safari concept. The Safari concept versus the book, it’s a book talking about all animals representing this psychosocial distress. Then to understand that palliative care doesn’t mean end of life care. End of life care is part of palliative care but palliative care is not part of end of life care.

So my second message, it’s about a poem I wrote when I was really tired to see how palliative care has been neglected in oncology because of misunderstanding. So I wrote… I’m going to read some few paragraphs, if you allow me. That will be my last message for the world about palliative care.

“So I feel naked when I see the suffering of family members and the caregivers, helpless and hopeless to support the patient as they would wish. I feel naked when I visit patients and family members in social, psychological and spiritual pain. I feel naked when the dignity and the value of the patient are viewed through the lens of the disease, not the humanity. I feel naked when I see that access to treatment depends on your place in the world. I feel naked when inequity and inequality, social injustice and the culture of me prevail over the connection between people and culture. I feel naked when people are happy to publish data from developing countries but are less eager to support their countries. I feel naked when colleagues from developed countries claim what we are doing is not palliative care. They focus only on comparison, not to the reality of our compassionate efforts to patients and families in our limited resources. I feel naked when I read the expression of gratitude, satisfaction, hope and life in the eyes of my patient and their families just because we are there. But I am not ashamed because we are not belonging to hate, guilt, fear, death or stigma but to life, hope, dignity and ubuntu. I am not ashamed at all.”