Could a physician be capable of promoting genocide?
I’m sorry to write yet another piece associating Rwanda uni-dimensionally with the events of 1994. But after a month in the hospital here, I realize that avoidance of the topic is equivalent to writing a biography on an amputee, and pretending the absent appendage has no effect on daily life. The equivalent of discussing Israeli history without mention of Palestine; Libyan politics without Gaddafi; Brad without Angelina.
In 1994, almost 20% of the population was eliminated in the span of 100 days (~10,000 murdered every day, ~400 per hour, ~7 per minute). There is no one who was unaffected.
50% of the hospital staff I worked with over the past month had family members who were killed. The other 50% had a family member in jail.
Sometimes there’s a misconception that the genocide was orchestrated by the “poor and undereducated.” However, mass killings were organized by government officials, and, in part, by individuals like us — educated in Western Universities. At the International Criminal Tribunal, Rwandan Prime Minister Kambanda told the court “…one cabinet minister said she was personally in favor of getting rid of all Tutsi; without the Tutsi, she told ministers, all of Rwanda’s problems would be over.”
Two weeks ago, I treated a genocidaire who was a doctor.
I wanted to believe that he was imprisoned for “white-collar” level involvement, but whether his hand was holding a machete, or a pen that facilitated mass-murder is irrelevant.
What led someone in a ‘healing’ profession to be complicit in mass murder? Could practicing as a physician have helped desensitize him to the point of promoting suffering? When does reductionism equal dehumanization?
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In the ED, it is simply efficient to give handover by reducing individuals to a chief complaint or disposition: “I’ve got a chest pain awaiting repeats in room 1, an appy pending surgical consult in 3, 4 is being discharged…”
At times, working Emerg on a Friday night gives me flashbacks to my years waitressing: “table 1 needs a coke, 2 a side of guacamole, 3 — the bill…. stat…“
Accurate diagnosis does require a degree of reductionism. The isolationist approach of simplifying complex, multi-organ systems down to the biochemical level of CBC, electrolytes, glucose, Cr, Ur, LFTs, trop/CK, is undeniably helpful.
It’s hard to remember the first time as a physician-trainee when you understood that inflicting pain was sometimes the first step towards healing: the abscess won’t resolve unless lanced; the limb won’t function properly unless the bone is set; the diagnosis of acute abdomen requires repetitive intruding pokes in the most painful spot.
Notwithstanding the utility of the reductionist approach, I fear how desensitization towards suffering may culture us towards dehumanization. Tempt us to see patients as individual problems to be solved, rather than see their individuality.
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I would like to think that I am more “upstanding” than the genocidaire physician, but I can’t help but wonder: if I were born into his shoes(or lack thereof), to his mother (or lack thereof), under his particular political/cultural/financial/social/personal situation — would I have behaved better?
I’m not sure what we can do to protect our heart & minds from becoming emotionally cold: but it is certainly not an automatic product of education, exposure, and experience.
In an effort not to forget some of the individuals I treated in Rwanda and help me to ‘anti-dehumanize’, I share a few photos from my experience at the hospital and a video clip from the genocide memorial in Kigali.
“Si tu me connaissais, et si tu te connaissais vraiment, tu ne m’aurais pas tué.” | “If you knew me, and if you really knew yourself, you would not have killed me.”
– Felicien Ntagewna