A FSAOF SPECIAL REPORT, AUGUST 2013
THE STORY OF HOWARD HOSPITAL, DR. PAUL THISTLE, AND THE SALVATION ARMY
Howard Hospital, Zimbabwe
FSAOF SPECIAL REPORT, AUGUST 2013
International HQ, London
ABOUT THIS REPORT As a member of the Former Salvation Army Officers Fellowship (FSAOF), I first learned of the situation with Dr. Thistle and Howard Hospital from a post that was shared on the FSAOF website blog. My heart was broken for the Thistles, for the people of Chiweshe and for the Salvation Army. As a 5th generation Salvationist whose great-grandparents became involved with the Army in the late 1800â€™s, I just found it hard to believe that this was happening with the Army I was born into, raised in and have loved all of my life. So, I decided to try to find out more about what happened. My research took many hours and led me to many sources of information. The more I researched, the more heartbroken I grew, and, yes, the more disappointed I grew with those in my beloved Army who perpetuated this tragedy and with those who have allowed it to go unchecked and uncorrected. That is why I wrote this report and am sharing it with the FSAOF. The information presented in this report has been derived from many sources, most of them publically available on the Internet. But the report would not be complete without the contributions of many individuals who have provided first-hand knowledge of events, eye-witness accounts and general background to provide proper context to the report. To those FSAOF members, Salvation Army officers, soldiers and supporters and those who worked at Howard Hospital who have contributed to this report, I want to express my deep appreciation and gratitude. A special thank you goes to those who have reviewed and edited preliminary versions of this report, providing gracious correction and guidance. You know who you are. I am indebted to you. The FSAOF website is located at http://www.fsaof.org/. The FSAOF blog is located at http://www.fsaof.blogspot.com/ . Emails to the editor of the FSAOF blog regarding this report should be sent to UKFSAOF@aol.co.uk . Emails to me regarding this report should be sent to COOPER.FSAOF@hotmail.com.
Jolinda Cooper Author August 15, 2013
FSAOF SPECIAL REPORT, AUGUST 2013
PROLOGUE It has been said that there are two sides to every story. In most cases, there are more than two sides. For the past several weeks, we have been covering the tragic events of the last year at The Salvation Army Howard Hospital. The information presented was drawn from a number of sources; the Zimbabwean press, the Canadian press, broadcasted podcast and YouTube video interviews, online blogs authored by supporters of Dr. Paul Thistle and Howard Hospital listing first-hand accounts of patients, visitors and volunteers at Howard Hospital, email exchanges from those with first-hand knowledge, and from press releases issued by The Salvation Army International HQ and Canada HQ. We freely note that we have not had any direct input from either Dr. Thistle or any one in Salvation Army leadership. It is understandable that Dr. Thistle would refrain from speaking out directly. Zimbabwe is a country that faces many difficulties and challenges, and for Dr. Thistle to speak out directly could likely have serious, if not dangerous, repercussions from certain people within Zimbabwe. However, Dr. Thistle does not speak out mainly because he sees no reason to defend himself, nor does he speak out because he does not want to give the impression that he is speaking badly of anyone. We also recognize that there are certain aspects of this issue that The Salvation Army must withhold comment on in order to maintain good relationships with the government of Zimbabwe, in order to be able to continue the work of the Army and to maintain a positive environment for the tens of thousands of its soldiers in Zimbabwe. Additionally, we recognize that there are personnel issues that remain to be settled between Dr. Thistle and The Salvation Army. However, The Salvation Army has shown a disturbing lack of transparency, accountability and truthfulness about this issue. We find these actions to be wholly unacceptable, as there are several points that should have been addressed that would not have compromised the relationship between The Salvation Army and the government of Zimbabwe. Not only has The Salvation Army been haughtily silent, they have also issued the equivalent of gag orders to officers involved in and aware of this issue. The dishonesty displayed by The Salvation Army is unacceptable, period. There is never a reason for dishonesty. It is no secret that there are difficulties working in countries where there is widespread corruption. The Salvation Army should never deny that problems have arisen, nor should they deny that solutions take time. Such denials lead to a lack of trust. Our intentions have been and will continue to be those of holding The Salvation Army accountable for their actions, or lack thereof, and a call for a change in the leadership methods so that such tragedies never occur again.
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SO, WHAT DO WE ACTUALLY KNOW? Let’s begin with some background information about the places and people. HOWARD HOSPITAL The Salvation Army Howard Hospital is located in the rural Chiweshe communal lands, approximately 80km (50 miles) north of Harare, the capital city of Zimbabwe. It serves a population of over 270,000 residents of all ages and health conditions. Howard Mission was established in 1923, and from its inception provided some types of medical care. The Howard Hospital roots started in 1918, when Major Bradley was providing medicines and medical care in the bush. The facility grew into a hospital slowly as the need for a regional health care provider became apparent. The early Howard facility of a clinic with four wards was built in 1928, and the core of the present facility was constructed in 1958. The Howard's full-fledged expansion into a semi-modern hospital in the 1960s was started by Captain (Dr.) Jock Cook, who arrived at the Howard in 1967. Captain Cook added X-ray capabilities, an operating suite, and TB and isolation wards. Although surgeries were performed prior to Cook’s arrival, Cook began to do quite complex surgeries. When Captain Cook left, he was replaced by Dr. Pedersen in 1969. When Dr. Pedersen became ill in 1970, he was replaced by Major (Dr.) James Watt (Retired). With a 144-bed capacity, Howard Hospital provided a vast number of services to the community; inpatient and out-patient, newborn to elderly, primary care and advanced surgical procedures. In addition to the on-site health care practice, a mobile clinic supported an area ranging up to 100km from the Howard, providing immunization programs, pediatric & obstetric care, and family planning. On-site at Howard Hospital, other associated programs were running with a nurses’ training school and a school for training midwifes. The epidemic of AIDS in Africa was being addressed with a comprehensive treatment and counseling center, including antiretroviral therapy. The children left orphaned when their parents died from AIDS could receive a sponsorship at The Salvation Army’s Chinyaradzo Children's Home. Chinyaradzo is an orphanage in Highfields, a suburb of Harare. After the fight for Independence, Zimbabwe struggled with staggering inflation. Inflation has been under control since the introduction of the US dollar and the South Africa Rand as currency. However, the overwhelming increases in the cost of health care often puts needed medical care out of the financial reach of many Zimbabweans. To provide a comparison, farmers in the areas surrounding Howard Hospital live on an average of $1 per day. A recent account was shared about the X-ray machine which had broken down at Howard Hospital. A young man came in with pneumonia and was sent to Harare to obtain an X-ray. This cost the patient US$250, which represents over 4 months of salary. Minor operations performed in Harare costs US$3,000, and that does not include the cost of tests or hospital admission fees. FSAOF SPECIAL REPORT, AUGUST 2013
In contrast, the fees charged by Howard Hospital under Dr. Thistleâ€™s administration were small when compared to what private doctors and hospitals charge. Howard Hospital charged $2 for a consultation, between $1 and $5 for medication and between $5 and $100 for surgery. Children and seniors receive free health care. The hospital has a serve first, pay later policy. It asks families to pay for surgeries in installments after the fact. Most families do their best to repay the debt, but nonpayment is not a barrier to future treatment. Before Dr. Thistle was transferred from Howard Hospital, the hospital was seeing an average of 300 people a day and reached 75,000 people through its in-patient and out-patient departments a year. About 2,700 babies were born at the hospital each year and thousands of patients relied on it for life-saving HIV treatment in a country with staggering infection rates. The reputation of Howard Hospital was well known and well respected. In fact, on many occasions, the private and government-run hospitals referred their patients to Howard Hospital. DR. PAUL THISTLE A Canadian, Dr. Paul Thistle graduated from the University of Toronto with a degree Medicine in 1989, and completed further training as an obstetrician and gynecologist. He acquired extra training in general surgery, oncology surgery, urology surgery and complex wound management. He has spent time in Indonesia, Pakistan, and in the mid-1980s, in Afghan refugee camps, working with the Salvation Army. In 1995, Dr. Thistle came to Howard Hospital, where he served under Major (Dr.) Watt, who passed the title of Chief Medical Officer to Thistle in 1999. During his first years in Zimbabwe, Dr. Thistle met his wife Pedrinah, a Zimbabwean-born nurse and midwife, who served as an educator at the hospital. They married in 1998. They have two sons, James, born in 2001, and Alexander, born in 2004. In 2005, The Salvation Army invited the Thistles to become Salvation Army officers. They attended the Booth University College and the officer training facility. They were commissioned in 2007, with the ranks of Captain. On June 11, 2008, the Chancellor of the University of Windsor conferred on Dr. Paul Thistle the Degree of Doctor of Laws, honoris causa. The Salvation Army issued marching orders to the Thistles the beginning of August, 2012, ordering them back to Canada. The community which depends on the Howard Hospital protested and the Territorial Commander, Commissioner Venice Chigariro, responded by giving the Thistles a 24hour notice to leave the Howard Hospital and a 48-hour notice to leave the country of Zimbabwe. The Thistles were stripped of their officership in November 2012 for refusing to leave Zimbabwe. Dr. Paul Thistle began working in his new position in Karanda Hospital in January, 2013.
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DONORS AND SUPPORTERS Interfaith Friends of Howard Hospital (IFFH) – A group of concerned doctors and other professionals formed this group, worked as volunteers on-site at Howard Hospital, and facilitated millions of dollars' worth of medical equipment, medicine and funds, including grants from international aid agencies, Canadian registered charities, and faith-based groups. Dr. Michael Silverman and Sarah Zelcer met with Salvation Army leadership and wrote articles published in the press and conducted interviews broadcast on the Internet about the situation at Howard Hospital. (Dr. Michael Silverman, MD, FRCP, FACP. Global Scholar, PAS Center for International Health, Mount Sinai Hospital; Sarah Zelcer, Director of International Programs, Ve'ahavta: The Canadian Jewish Humanitarian and Relief Committee) Doug MacLellan – A friend of the Thistles and professional photographer. MacLellan previously photographed Howard Hospital in 2001, 2006, 2008 and 2010. These photographs raised thousands of dollars for Howard Hospital and inspired many doctors to volunteer. Additionally, The Salvation Army has published his photos in their magazines and books in four countries. Brian Nichols – Psychotherapist/Specialist in Grief and Trauma Counseling. He worked with a fundraising group who contributed over $210,000 for Howard Hospital, and who visited and worked at Howard Hospital a number of times. Dr. Norman Fenton – A frequent donor and volunteer at Howard Hospital. A member/volunteer with the SHUMBA Medical Society. SALVATION ARMY LEADERSHIP INVOLVEMENT Commissioner Venice Chigariro – Territorial Commander of Zimbabwe, Harare, Zimbabwe. Commissioner Chigariro is a native-born Zimbabwean. She received transfer orders on October 6, 2012 to become the Territorial Commander in the Kenya East Territory, effective 1/1/2013. Previously she had held positions as Finance Officer for Zimbabwe, and Hospital Administrator of Howard Hospital. Commissioner Amos Makina – International Secretary for the Africa Zone, Salvation Army International HQ, London, England. Commissioner Makina is a native-born Zimbabwean. He and his wife retired effective 1/1/2013. This retirement date was set prior to the events at Howard Hospital. Makina previously served as Territorial Command of Zimbabwe. Major Dean Pallant - Under-secretary for Program Resources, International Health Services Co-coordinator, Salvation Army International HQ, London, England Major Pallant is a native-born Zimbabwean. As a youth, he knew of and was known by Major (Dr.) James Watt of Howard Hospital. Major Pallant had also previously served as a hospital administrator in Zambia for The Salvation Army Major Pallant issued press statements on behalf of The Salvation Army International HQ, and conducted meetings with at least two representatives from major Canadian donor organizations. His wife, Eirwen, also a Major in The Salvation Army and a medical doctor, served as international health services co-coordinator. She completed a clinical assessment of Howard Hospital on September 20, 2012.
FSAOF SPECIAL REPORT, AUGUST 2013
Commissioner Brian Peddle – Territorial Commander of Canada & Bermuda Territory, Toronto, Canada. Commissioner Peddle is a Canadian. He has issued press statements expressing concern for the welfare of the Thistles, the conditions at Howard Hospital following the departure of the Thistles, and the return of the Thistles to Canada. Peddle also facilitated a face-to-face meeting between General Linda Bond and concerned Canadian donors. Commissioner Barry Swanson – Chief of Staff, Salvation Army International HQ, London, England Commissioner Swanson is an American and was the Chief of Staff at the time of Dr. Thistle’s ordered removal and expulsion. He received transfer orders on October 6, 2012 to become the Territorial Commander in the United States Eastern Territory, effective 1/1/2013. Commissioner Kenneth Hodder – International Secretary for Personnel & Legal and Constitutional Adviser to the General, Salvation Army International HQ, London, England Commissioner Hodder is an American and served as the Secretary for Personnel and Legal Advisor to the General at the time of the removal of Dr. Thistle. He received transfer orders on October 6, 2012 to become the Territorial Commander in the Kenya West Territory, effective 1/1/2013. Commissioner Andre Cox – Chief of Staff, Salvation Army International HQ, London, England Commissioner Cox is also a native-born Zimbabwean. He was promoted to the position of Chief of Staff on 1/1/2013, replacing the outgoing Commissioner Swanson. Due to the immediate retirement of General Linda Bond, Commissioner Cox had been serving as the Acting General of The Salvation Army. He called for the convening of the High Council in July 2013 to elect a new General of The Salvation Army. On August 3, 2013, Commissioner Cox was elected as the 20th General of the Salvation Army. General Linda Bond – International Leader of The Salvation Army, Salvation Army International HQ, London, England General Bond is a Canadian. She issued the letter ordering the removal Dr. Thistle. She also met with Canadians supporters of Dr. Thistle who wanted to discuss their concerns over the issue. She shocked The Salvation Army world when she decided to end her time as General short of her full appointment and retire on June 13, 2013, effective immediately. This action left The Salvation Army without a top leader, pending the election of a new General by the High Council. It should be noted that Commissioners Chigariro, Peddle, Cox, Hodder and Swanson were all members of the High Council of 2013, and as such, had a vote in the selection of the next General of the Salvation Army. Commissioners Cox, Swanson and Hodder were nominated for the office of the General, which ultimately went to Commissioner Andre Cox.
FSAOF SPECIAL REPORT, AUGUST 2013
ZIMBABWEAN GOVERNMENT AND POLITICS The Howard Hospital is not exempt from having to deal with local and national mindsets, policies & procedures, or political intrigue. It is often a delicate dance of carrying out the work and mission of Howard Hospital while not stepping on some toes. Zimbabwe has known more than its share of political and social upheaval. It is still recovering from the effects of its inflation crisis that culminated in 2008 with the loss of its currency shortly after the introduction of a $100 trillion note. Following independence from an oppressive white government, African leaders objected to anything appearing like white control. This perception and defiant attitude was very evident at Territorial Headquarters (THQ) Zimbabwe, where even auditors from Salvation Army International Headquarters (IHQ), London were seen as neo-colonial. Some suggest that to prevent any continued neo-colonization of the SA in Zimbabwe and neighboring African countries, the thenInternational Secretary for Africa (Makina) and the then-Zimbabwean Territorial Commander (Chigariro), both Africans (Zimbabweans) and very good friends, felt that they had to exhibit solidarity and balk at any supervision or direction as it pertained to the Howard Hospital. Not only does mission work face the neo-colonial prejudice, but there is a recently enacted law in Zimbabwe called the “Indigenisation and Empowerment Act”. According to the Indigenisation Act, any foreign-owned businesses with a net asset value of US$500,000 and above should all be in the hands of the locals in the next five years. Zanu PF (Zimbabwe African National Union – Patriotic Front), which is driving the program, said the program is meant to empower the locals and redress colonial imbalances. This act is viewed as aiming at transferring mineral wealth to indigenous Zimbabweans, but could affect all sectors of society. It is unclear at this time how the Indigenisation Act will affect the work of Howard Hospital or any other mission-based operation. While facilities are owned and equipped by their supporting sponsor organizations and donors, the funding for day-to-day operations of these missions come from outside of Zimbabwe, and are directly earmarked for use at the missions for salaries, medicines, equipment and other necessities. The monetary value of these donations would certainly cross the threshold of US$500,000, but the items of transient value should not be considered assets. Staff salaries, medical consumables such as drugs and one-use supplies (latex gloves, suture silk, bandages, etc), and operating expense for utilities and repairs would not normally be considered as assets in a mission-based hospital facility. The interpretation of categorization of the monies used on these items is unclear. JOICE MUJURU, VICE-PRESIDENT OF ZIMBABWE There can be no significant discussion about the issue with Howard Hospital and Dr. Paul Thistle without including Acting President (VP) Joice Mujuru. At the time of this writing, Mujuru was waging a political campaign for the Presidency in the upcoming elections. An Internet search of Joice Mujuru reveals a great deal about her. FSAOF SPECIAL REPORT, AUGUST 2013
A member of the ZANU-PF party, and the country’s first female Vice President, Mujuru is no stranger to The Salvation Army or the Howard Hospital. Majuru attended the Howard Secondary School, leaving the school mid-term to join the guerrilla movement/insurgents. In the capital city of Harare in August 2005, VP Mujuru, along with the acting mayor of Harare and the town clerk of Harare, all of whom are Salvationists, welcomed General and Mrs. John Larsson to the first ever All Africa Congress. In November 2009, General and Mrs. Shaw Clifton led the Zimbabwean Congress in Harare. According to the news article produced and distributed by The Salvation Army: “The General paid a pastoral visit to the acting President of Zimbabwe, the Honourable Vice President Joice Mujuru, a Salvationist, at her Munhumutapa office. The acting President commended the role being played by The Salvation Army in Zimbabwe in the field of education, health and community development. She said that the coming of the General had cemented the relationship between the peoples of Zimbabwe and The Salvation Army”. “The acting President of Zimbabwe hosted a private farewell dinner for the international leaders at her family home. The dinner was attended by Salvation Army cabinet members and Government officials who are products of Salvation Army schools and Salvationists.” A review of various press reports found Mujuru listed as a “senior Captain” in The Salvation Army. She is often photographed wearing her Salvation Army uniform to various social and political events. In a Zimbabwean news paper, dated July 19, 2013, the following staff writer article was printed: SOME churches in Zimbabwe have postponed their annual gatherings, which usually take place between July and August, fearing the events would be hijacked by politicians as the country marches towards crucial polls set for July 31. Sources in the Salvation Army said the church’s annual meeting that had been pencilled for July in Gweru was called off to avoid politicians turning the events into political rallies. “We were to have our annual meeting in Gweru but judging by the political temperatures which are rising, the leadership decided to postpone them until after the elections,” said a Salvation Army member. “In the past we have seen politicians taking over our meetings and turning them into rallies.” The sources also said Vice-President Joice Mujuru, who is a senior captain in the Salvation Army, would most likely have attended the meeting with her party supporters. As part of its campaign strategy, Zanu PF is approaching churches to woo voters in an attempt to reverse the loss President Robert Mugabe and Zanu PF suffered in 2008 to Prime Minister Morgan Tsvangirai and the MDC-T. Further press reports have alleged that Mujuru herself had a hand in the ousting of Dr. Paul Thistle from Howard Hospital:
FSAOF SPECIAL REPORT, AUGUST 2013
Earlier this month, Chiweshe residents told SW Radio Africa that armed police had been called in to evict the doctor, apparently on orders from Vice President Joice Mujuru. Mujuru is a senior Salvation Army official and it is understood that her clampdown on Howard Hospital is part of the worsening infighting in ZANU PF over the future leadership of the party. Chiweshe is said to be a stronghold of Mujuru’s rival Emmerson Mnangagwa and her attempts to control the respected hospital are allegedly linked to her attempts to control the area.
TIMELINE OF EVENTS We have outlined the details of events with the information that we know from the various sources listed at the beginning of this article. We have provided exact dates as we know them, and where the exact date is not known, we have provided a context to the date based on the information provided about the event. 1990’s – Approximately US$42,000 disappeared from the reserve account (an account that tracks money for projects in process; not yet completed) of Howard Hospital. This occurred when THQ Harare changed banks. THQ Harare held all Salvation Army monies, including those for Howard Hospital. A bottom-line review was done, and while there was no over-all loss in total monies held by The Salvation Army, the missing funds were dismissed as an error in accounting entries. During that time period, Commissioner Chigariro was, for part of that time, the Hospital Administrator at Howard Hospital, and, at the end, the Finance Officer at THQ Harare. As of this writing, the missing $42,000 has yet to be accounted for. 1995 – Dr. Thistle accepted a position at Howard Hospital. 1998 – Dr. Thistle married Pedrinah. 1999 – Dr. Thistle becomes CMO (Chief Medical Officer) of the Howard Hospital. 2000 – Commissioner Makina, then Territorial Commander of Zimbabwe, began plans to build a new Howard Hospital facility. Commissioner Makina rejected any input from the Howard Hospital administration (Dr. Thistle was in Canada on furlough at the time). After intervention by Salvation Army leadership above him, Makina was persuaded to share the plans, which had already been created, for the new facility. Major Phillip Mountain was assigned by IHQ to supervise construction and oversee the books. July 2005 – Conjoined twins, Tinashe and Tinotenda, delivered in 2004 by Dr. Thistle at Howard Hospital, were separated during an operation at The Hospital for Sick Children in Toronto, Canada. Dr. Thistle coordinated the effort to have the children flown from Zimbabwe and treated in Canada. The children returned to Zimbabwe after the operation and recovery, and are doing well. 2005 – The Salvation Army invited the Thistles to become Salvation Army officers. 2006 – The monies donated toward the building of the new Howard Hospital (exceeding US$1mil) ran out and construction was halted. Major Mountain was refused access to the construction site by Commissioner Makina. It is unclear who was responsible for the project from 2000 until now. The new facility became dilapidated from non-use and neglect, and the Zimbabwean authorities declare it unfit for use. 2007 – Paul and Pedrinah Thistle were commissioned as Salvation Army officers with the rank of Captain and returned to Howard Hospital, Zimbabwe. 2008 – Dr. Thistle received the Teasdale-Corti Humanitarian Award from the Royal College of Physicians and Surgeons of Canada. FSAOF SPECIAL REPORT, AUGUST 2013
2008 - During the 2008 elections, Dr. Thistle and The Howard Hospital defied Zanu (PF) militias and treated badly injured suspected MDC members. July 2009 - Dr. Paul Thistle received Rotary’s Paul Harris Fellow Award. 2007-June, 2012 – The Thistles expanded the work at Howard Hospital, adding AIDS and tuberculosis programs, visiting medical professionals programs and an antiretroviral program for expectant mothers, which reduced the risk of mother-to-child transmission of HIV infection. Dr. Thistle also tirelessly acted as a fundraiser for Howard Hospital, bringing in donations of monies, medicines, supplies and equipment worth hundreds of thousands of US dollars. Early 2012 – The Salvation Army Howard Hospital won a CIDA grant from Canada worth US$250,000 for HIV treatment at the hospital. The leadership of The Salvation Army in Zimbabwe declined the grant on the grounds that they would not agree to the conditions associated with the grant. The grant monies were returned to the Canada after Zimbabwean Salvation Army officials insisted the money flow through their office and refused to verify how it would be spent June 2012 – The Thistles were in Canada on furlough and continued to do as they had always done; meeting with donors and supporters, and raising awareness of the needs of the people of Zimbabwe cared for by Howard Hospital. August 2012 – The Thistles returned to Zimbabwe. August 4, 2012 – Dr. Thistle met with Commissioner Chigariro. He was given official notice of his transfer. This order, dated July 25, 2012, instructed the Thistles to leave Howard Hospital and return to Canada. No reason was given for the transfer and, contrary to standard Salvation Army practices, no indication was given of the next assignment. August 6, 2012 – Dr. Thistle told his supporters via email that the Salvation Army had ordered him to leave his post as chief medical officer effective September 1st. August 12, 2012 – Brian Nichols emailed Zimbabwe THQ. His fund raising group sent $20,000 back to Howard Hospital with Dr. Thistle when he returned to Zimbabwe from his Canadian furlough. Nichols explained in his email that the money sent with Dr. Thistle could not be spent if Thistle was being told to leave Howard Hospital and if they (the group of volunteer medical professionals Nichols belonged to) were no longer to be welcomed there. Nichols explained that the Canadian government does not allow charitable donations to go to projects out of Canada if the donors are not directly involved in the project. All of Nichols’ attempts to communicate directly with the hospital and with The Salvation Army in Zimbabwe and Canada have been ignored. August 15, 2012 – Major (Dr.) Watt wrote to General Linda Bond, warning this action will result in deaths of patients at Howard Hospital. General Bond took no action. August 18, 2012 – Local Chiwesheans protested at the Howard Hospital, upset about the decision to remove Dr. Thistle. This was no ordinary protest. The protesters numbered in the several thousands, carrying placards and posters and marched outside the Howard Hospital grounds. A vehicle sent by Zimbabwe Salvation Army THQ (apparently to remove Dr. Thistle) was overturned. Police were called in, tear gas was used and then the officers moved into the hospital to arrest community members and hospital staff, including several nurses, on suspicion of inciting violence. These nurses, apparently named by someone within the hospital, were beaten at their nursing stations before being arrested. A Canadian volunteer team of 11 doctors, pharmacists, dentists and others — in Zimbabwe with Short Term International Medical Missions Abroad – had arrived at Howard Hospital, about 80 kilometers northeast of Harare, just days earlier and had planned to help out at the facility, which serves about 270,000 people in the surrounding region, until August 29th.
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Thistle sent an email to his supporters explaining that issue had to do with the organization’s funds. “The root of the problem has been financial, and control of funds,” he wrote. “Within the current Salvation Army system the funds do not arrive, or arrive very late. People are suffering today.” August 19, 2012 – Dr Thistle was called to Harare to meet with Commissioner Chigariro, who then issued a 24-hour notice for the Thistles to leave Howard Hospital and a 48-hour notice for the Thistles to leave the country of Zimbabwe. The Salvation Army IHQ provided 4 one-way airline tickets to be used by the Thistles to leave Zimbabwe. Note: This author has found no indication that the order to leave the country was given by the Zimbabwean government. It appears to be an order issued by Chigariro herself. There was no opposition to Thistle from the government of Zimbabwe per se, including the opposition parties, or even from Mugabe himself, who, all other faults aside, has honestly been interested and concerned in rural health care. August 20, 2012 – One of the Canadian volunteers filmed a video which was shared on YouTube. During the interview, one could see the frantic activity surrounding Dr. Thistle as people help the family pack their belongings so they can leave the hospital grounds as ordered by Chigariro. The video ends with Thistle’s choked statement: “I love the people of Zimbabwe…” and then overcome with emotion, Thistle waved off the camera and says “no further comment”. August 20-21, 2012 – The Thistles left Howard Hospital – destination and whereabouts unannounced. Additionally, the STIMMA volunteers who had come to work at Howard Hospital were asked to leave the hospital “for their safety” and they returned to Harare. August 21, 2012 – Commissioner Chigariro told the Associated Press that Thistle had challenged church leaders and that he was being reassigned “for the good of the church”. The AP noted that this statement called into question Thistle’s loyalty to the church and its leaders. August 23, 2012 – The Salvation Army Canada THQ issued a press statement indicating that the Army “remains committed to Howard Hospital in Zimbabwe”. This same press release indicated “A new Acting Hospital Administrator has been assigned and is in place to guide the facility through this transition”. Late August 2012 - The first death reported due to the dismissal of Dr. Thistle. According to Chiweshe residents, who were, understandably, very upset, a woman of about 40 was brought by her children at the appointed time to check on her colostomy (Dr. Thistle had saved her life with a partial bowel resection), only to find the good doctor had been removed at 24-hours notice. Angry, her children appealed to the Provincial Governor who helpfully provided transport to Bindura Hospital. The doctors there, not specialists and not knowing her history, did what they thought was right, opening her up and reconnecting the bowel as best they could. After discharge, on the way home in a car, the wound broke open, her intestines spilled out and she died of shock, a respected woman and well-loved mother. Late August 2012 – Salvation Army officials in Toronto said international leaders would be sending a team to review and analyze the situation in Zimbabwe. Late August/Early September 2012 – Chiweshe residents gave reports of the arrest and torture of some of their community. Because of this, they had taken no further action or protest. September 5, 2012 – Sources said that the Thistle family was reported to be resident inside the Canadian embassy in Harare. This was also reported in the Zimbabwean press. “Dr Thistle is at the Canadian embassy that’s where he and his family have been living since they left Chiweshe last month,” highly placed Salvation Army church members told Radio VOP. Early/Mid September 2012 – Dr. Michael Silverman and 4 other members of IFHH meet with leaders of The Salvation Army in Toronto. The Canadian leadership said that it wasn’t up to them (Canadian Salvation Army) but it was up to The Salvation Army IHQ. FSAOF SPECIAL REPORT, AUGUST 2013
Early/Mid-September 2012 – Dr. Silverman flew to London to meet with Majors Dean and Eirwen Pallant. There were 2 meetings of 2.5 hours duration each. There was discussion about a possible grievance that would be the cause of removing Dr. Thistle from Howard Hospital but no direct answer was given to Silverman (in Silverman’s opinion) by the Pallants. However, one issue brought up was that Dr. Thistle didn’t communicate well with The Salvation Army. Silverman felt that this “explanation” didn’t make sense, due to the fact that Howard Hospital doesn’t have reliable telephone or internet service. Additionally, Thistle’s primary responsibilities at Howard Hospital were as a physician and a surgeon, and not that of a hospital administrator. Silverman indicated that 95% of Thistle’s time was spent in his primary duties, and the administrative work that Thistle was doing was being done after hours because there was no one else to do it. He pointed out to the Pallants that they could bring in an administrator to handle the business and communications needs of Howard Hospital instead of depending on Thistle to do it. Silverman also indicated to the Pallants that they should let Thistle continue working at the hospital until such time as a replacement is brought in. He points out that there was no emergency back in Canada requiring Thistle’s presence. The parties came to a three-part agreement as to what was to happen:
Dr. Thistle would get a furlough to stay in Zimbabwe until after the Salvation Army-supplied investigating team came and conducted a review. The team was to investigate the concerns that there were missing monies and materials There would be a review to see if Thistle could be reinstated during this investigation. Thistle was supposed to be able to remain there until the completion of the trials of the nurses who were arrested during the protests in August. A decision as to the reinstatement of Thistle in Zimbabwe at Howard Hospital would not be decided until after the review. This reinstatement would allow Thistle return as a physician and surgeon with the idea that a hospital administrator would be brought in to handle those duties and free up Thistle to do his medical work.
The Pallants agreed to these items in the agreement. Silverman stated that the Pallants asked him to please not discuss the contents of the meeting, because they were finding it difficult and the media was pressuring The Salvation Army to act and they wanted to do their internal investigations. Silverman agreed to this request and didn’t say anything to any media sources, despite being asked. The Pallants also stated they would speak with The Salvation Army Canada THQ. Shortly after this, Thistle began receiving communications from Canada THQ stating that the decision to remove him was final, that they agreed with IHQ that the decision was absolutely final and to not have any misunderstandings about the finality of the decision. He was given a date to leave Zimbabwe of October 5th. All of these messages occurred before the promised investigations were carried out. Silverman was upset that the Salvation Army request of him to stay quiet and not speak to the media to forestall any prejudging the decision of the review and allowing them to finish their deliberations was misleading. He felt that The Salvation Army clearly finished their deliberations and were not going to wait for the review because they told Thistle everything was final and they emphasized that in several follow-up emails.
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September 20, 2013 – Major Eirwen Pallant completed a clinical assessment of Howard Hospital and stated the hospital continued to be functional and served the people and more than 200 babies were born last month and maternal and child health services were operating normally, that more than 4,000 outpatients had been treated in the past four weeks, there had been 1,756 inpatient beds nights and there had been more than 100 operations in the theatre. September 26, 2012 – Dr. Michael Silverman, as Chief Coordinator of IFHH, gave an interview to Alex Bell of SW Radio Africa. In this interview, Dr. Silverman made the following assertions (paraphrased): Dr Thistle chooses to work at Howard Hospital because he cares and because of his Christian beliefs Thistle would be better off financially if he left the Salvation Army and went back to Canada but he didn’t leave because he cares about the people of Zimbabwe Thistle had no outside income and lived modestly, like the people of Zimbabwe The hospital is in crisis, running at 10%, maybe 20% at best, capacity. Before Thistle left, the hospital was often operating over-capacity People aren’t coming to Howard Hospital because Thistle isn’t there The Salvation Army told Dr. Silverman that someone was coming in December to replace Thistle The Salvation Army never told Silverman why Thistle was removed in such an “emergency” manner and long before they had anyone to replace Thistle The Salvation Army emphasized that the person to replace Thistle will not perform surgery; that they were going to a “primary care” model of health care, despite the fact that surgeries have been done at Howard for years. Dr. Silverman stressed that primary care only would not help those who are found to have issues that require surgery (such as a woman who finds out via a routine pap test that she has cancer). The cessation of the surgical care was not discussed with the surrounding community People came from throughout Zimbabwe (and even from other countries, such as South Africa and Botswana) to Howard Hospital because the medical services were affordable. People were not, however, turned away if they couldn’t pay The fees collected by Howard Hospital were used to subsidize the hospital. None of the money charged for services went to Thistle personally – all monies went into the hospital coffers Generally, there are no surgeons in rural areas except for Dr. Thistle Between the fees charged for surgeries and the outside donation funds, these monies were paying the salaries of the staff. Now that Thistle was gone, there is no money coming in from donors or surgeries, the staff salaries have been cut in half and the hospital will soon start having to lay off staff. The hospital economics are no longer viable without Thistle Dr. Silverman called Howard Hospital a beacon. He compared how the Howard operated compared to other hospitals he had volunteered at in other parts of Africa and South America – he praised how well it ran despite the small amount of resources and the difficult situation of Zimbabwe. He stated that the Howard did an “amazing job” and the quality of care given at Howard “was extremely high”. This opinion was shared by many other doctor and surgeon volunteers The Salvation Army told Dr. Silverman that the plan was to stop all surgical work at Howard Hospital – permanently Silverman outlined the contents of 2 meetings in London with Salvation Army officials Thistle may have been a whistleblower over missing monies FSAOF SPECIAL REPORT, AUGUST 2013
Silverman detailed the events of the meetings with the Pallants at Salvation Army IHQ in London (see previous event listing of early September). He stated that because of the actions of the Salvation Army, there was no longer any need for him to stay silent about the situation Silverman felt the public needs to know what is going on because it has significant public health implications The community surrounding Howard Hospital needed to know and have a say about what was happening with their health care Alex Bell addressed the $250,000 grant that was returned. Silverman outlined the details around the obtaining of the grant, the Salvation Army’s stance on how the grant money would be handled and accounted for, and how the grant money was returned to the granting agency The Salvation Army refused to have transparent accounting and refused to dedicate all the funds to an HIV program
October 5, 2012 – The date that the furlough granted to the Thistles by The Salvation Army ended. Canada THQ had ordered the Thistles to return by this date. This was the second attempt by the Army to get the Thistles to leave. Thistle refused to leave Zimbabwe, despite several attempts to force him onto a plane. Although he left the hospital grounds within 24 hours of his dismissal, he remained with family in Harare. He told his mother that he would not leave Zimbabwe until he knew the fate of his nurses and the Army provided answers to the other vital questions: where was the money raised in Canada and where did the Army intend to place him? Until he had solid answers about his own future and the fate of his nurses, he stood resolute in his beliefs, determined to help and support the people of the land he grew to love. October 8, 2012 – Eight nurses and 12 other Chiweshe residents that were arrested during protests against Dr. Thistle’s dismissal in August have been accused of inciting violence. The group was back in court, where four Salvation Army officials testified against them. A source who was in court Monday told SW Radio Africa that the testimonies from the four officials provided conflicting information about events at the protest. He said testimonies were given by Majors Makiwa, Nyahuma and Ncube, and Colonel Moyo. The case meanwhile had been remanded once again, until October 19th. October 26, 2012 – The Salvation Army IHQ issued a press release regarding the situation at Howard Hospital dismissing all claims about fiscal mismanagement and loss of donated materials. According to the press release: 1) there was no sign that donated funds had been diverted from their original purpose, and 2) donated goods, falsely reported to have gone missing, were all accounted for. This press release was followed up by a transcript of the press conference question and answer period. Major Pallant stated that The Salvation Army was in the process of the appointment of a new Chief Medical Officer at Howard Hospital. At the moment Dr. Aaron Museka, Zimbabwean doctor, was acting as the Chief Medical Officer. November 2-4, 2012 – General Linda Bond arrived in Toronto to participate in the “All-Ontario Salvationist’s Rally” on November 2nd. On November 3rd, she received an honorary doctor of divinity degree from Tyndale University College in Toronto. The Interfaith Friends of Howard Hospital (IFHH) learned of Bond’s appearance and advertised on the Internet that they were going to hold a demonstration outside of the rally to expose what The Salvation Army had done in Zimbabwe / Howard Hospital. The Salvation Army Canada HQ learned of the planned demonstration by IFHH and asked IFHH to cancel it. In exchange, Canada HQ offered FSAOF SPECIAL REPORT, AUGUST 2013
IFHH a chance to meet one-on-one for a 30-minute meeting with General Bond after the Friday rally and the Saturday award ceremony activities were concluded. Dr. Silverman felt they should not appear to be unreasonable and agreed to the meeting. The meeting was not held in a private location but was instead held in the public chapel at the Toronto Pearson International Airport. Because it was a public venue, it was not closed off to the public and therefore there were people in the chapel who had no relationship with either The Salvation Army or the IFHH. IFHH sent 4 representatives to meet with the uniformed Salvationists – General Linda Bond, Commissioner Brian Peddle and other unidentified officers. Ray Richardson, representing the Rotarians, reported that they were lectured by Bond. Larry Gillman and Sarah Zelcer said the meeting was appalling, lasting less than 20 minutes before the General’s “handler” whisked her off. The IFHH representatives reported that General Linda Bond actually raised her voice at them in a public place as onlookers observed in the airport chapel. IFHH reports that Bond would not listen to them and quoted her as saying that nothing they could say “would change IHQ’s decision to remove Paul Thistle from the Howard Hospital”. November 8, 2012 – The Salvation Army Canada issued a press release providing an update on Howard Hospital. In it they stated: Over recent months, The Salvation Army has been maligned and falsely accused of wrongdoing. Allegations have been made concerning the administration of donated funds and goods at Howard Hospital. In response, The Salvation Army’s International Headquarters sent a fact-finding team to Zimbabwe to examine the processing and use of donations to the hospital. The team reported that: • There was no sign that goods or funds donated directly to The Salvation Army in Canada for use by the Howard Hospital were diverted from their original purpose. • The hospital continues to operate with qualified medical personnel serving thousands of people each month. • Media reports that the hospital is functioning at 10% are false. Patients continue to be treated at Howard and more difficult cases are being referred to other facilities. They also stated further on in the release: Reports have circulated in the media that the Thistles were moved because they brought accusations of corruption against The Salvation Army in Zimbabwe. These reports are simply not true and at no time were such concerns shared with Salvation Army leadership by either of them. The decisions related to Captains Dr. Paul and Pedrinah Thistle are final. The Salvation Army, like most denominations, does not discuss personnel moves in a public forum. The Salvation Army Canada remains committed to the work of Howard Hospital. Over the past few weeks and months, the organization: • paid for a shipment of medical supplies worth $300,000; • paid overdue bills totaling $30,000 to keep the electricity on; • paid $15,000 for much-needed pharmaceutical supplies.
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They also addressed the question of a Chief Medical Officer: The Salvation Army’s International Headquarters is in the process of appointing a new Chief Medical Officer at Howard. November 11, 2012 – Photographer Doug MacLellan arrived in Harare, Zimbabwe November 16, 2012 – Doug MacLellan was refused permission to take photographs at Howard Hospital November 22, 2012 – The Salvation Army stripped the Thistles of their officership and terminated their employment. The official reason given to the Thistles was stated as “Persistent refusal to carry out lawful orders and instructions”. Late November/Early December 2012 – Major Gillian Brown, Director of World Missions for The Salvation Army Canada and Bermuda HQ sent an email with an update after her visit to Howard Hospital. In this email, Brown asserted that communications and relationships were being rebuilt with the Chiweshe local leaders of the tribes in the areas around the Howard, which represent a large number of the patients treated at Howard. Further assertions stated that Howard Hospital had not been “financially sustainable over many years” and that there may be changes in the next 6 months; a project was in place to stabilize the hospital and provide an opportunity for plans to be put in place for a “long-term institutional support project”. She stated that this was not unusual and that many other Salvation Army schools, homes and medical facilities were supported in this manner. Brown reported the donation of a new ambulance to Howard Hospital on November 19th from the Canadian Rotary Club. She stated that is was one of “many signs” that underline the continuing support of Howard Hospital by donors and the international Salvation Army. (Author’s note: this ambulance donation project was initiated and carried through by Dr. Thistle). She stated that funds processed through The Salvation Army bank accounts had been accounted for, although she didn’t identify which Salvation Army bank account the accounting comes from. She stated that other funds had been “harder to track”, which was a veiled implication that monies and donations not processed through the various HQs involved had been mismanaged. Addressing the report of building materials stolen, she states that these materials have been fully accounted for with receipts and photographs. However, no one who has asked has seen the receipts or the photographs of said located materials. There was a statement about cement that has been paid for but not delivered, as the cement would only be delivered at time of construction. There was no mention of when said paid-for cement will ever be used. The email concluded with statements of IHQ’s commitment that Howard Hospital would continue to offer a ministry that was expert and compassionate. She stated support from a majority of the staff and much of the community for the future of the hospital, and that the local corps, which was involved in the protests of Thistle’s dismissal, was once again thriving. December 6, 2012 – A Zimbabwean newspaper article described the donation of anesthetic and surgical equipment by Commissioner Chigariro to another Salvation Army hospital in Zimbabwe: Salvation Army-run Tshelanyemba Hospital in Matobo District, Western Zimbabwe, received an anaesthetic machine and surgical led light. The equipment is expected to reduce the number of referrals to overburdened Bulawayo hospitals. The anaesthetic machine is used in all operations while the surgical led light is essential to provide different light colours during operations. FSAOF SPECIAL REPORT, AUGUST 2013
The machines valued at USD49,000 were donated by outgoing Salvation Army Territorial Commander, Commissioner, Vinece Chigariro, at a farewell ceremony held in Bulawayo recently. Presenting the state-of-the-art equipment, Chigariro said it was part of the church’s vision to provide affordable and quality healthcare to all. “I am happy to be presenting these two machines to Tshelanyemba Hospital. And I am sure they will go a long way in saving lives of many in this part of the country. I would like to thank the church’s women’s ministries which raised money for these machines.” In an acceptance speech, an official at the hospital, Major Edward Jeremiah, thanked Chigariro for the equipment. “We thank the Commisioner for the timely donation because our machines were outdated and we could not perform major operations at our institution. This will ease pressure on Mpilo Central Hospital, United Bulawayo Hospitals and [Catholic-run] Mater Dei where we used to refer patients.” January 1, 2013 – The Howard Hospital website was shut down. A message directed people to contact The Salvation Army directly. Mid-December/Early January 2013 – The Thistles were in Canada for the holidays and would remain until they could work out their next steps. They remained committed to return to Zimbabwe. January 31, 2013 – A Zimbabwean news source printed an article that Dr. Paul Thistle had joined the surgical team at Karanda Hospital, a few hours’ drive from the troubled Howard Hospital. The article also described how the international funds provided by donors were going to Karanda Hospital, now that Thistle was serving there. February 3, 2013 – Dr. Norman Fenton met with the Secretary of Salvation Army THQ Harare, LtCol Varughese and Major Angeline Kapere in Harare in order to collect medical equipment (worth approximately $7000) originally transported by SHUMBA to Howard Hospital. None of the equipment provided to Howard Hospital for SHUMBA use was found. The medical equipment presented to Dr. Fenton as the supplied equipment was of significant vintage and poor quality and complexity - not the original SHUMBA set. February 11, 2013 – Dr. Fenton arrives at Howard Hospital and met with Major Gillian Brown from Toronto (THQ), Major Dean Pallant (IHQ), Major Angeline Kapere (Harare HQ), Sister in charge of theatre, as well as the new hospital administrator, assistant administrator and hospital matron. Dr. Fenton reported that Major Pallant asked him to not wander around the hospital premises “as there had been a lot of mistruths spread about the hospital situation, and with the overall sensitive nature of my visit, it was better that way.” Dr. Fenton’s driver did not have the same restriction about wandering around the hospital. The driver reported that there were about two and five patients in the male and female wards respectively, and few patients in the children's ward. Additionally, Dr. Fenton noted that more noticeable was the lack of booths and people hanging around on the road around the front entrance of the hospital (the so-called market) and the courtyard of the hospital. Normally, this was a busy location but since Dr. Thistle’s dismissal, people no longer come to Howard Hospital. February 24, 2013 – Zimbabwean press published an article entitled “RelZim reporter witnesses Howard Hospital’s demise”. The article outlined how the hospital now runs out of medicine, and that after Christmas no painkillers were available. It also quoted Chiweshean villagers as saying they now travel to the Karanda Mission Hospital (where Dr. Thistle is now serving), a distance of almost 200km. A staff member, under the protection of anonymity, said that things have changed drastically. She is quoted as saying: “The inflow of patients, the general working conditions and the morale has changed. Patients are now very few. We used to have floor-beds but we are now admitting a maximum of 12 patients and not many of them are staying for many days. This is also affecting the incentives that we used to get when Dr Thistle was still here. The doctors that are still here do not FSAOF SPECIAL REPORT, AUGUST 2013
perform major operations. Even the working conditions are deteriorating. We don’t know where we will end up being. It’s unfair for us and it is also unfair for the patients,” A patient who had recently been in Howard Hospital indicated that the level of cleanliness of the hospital has drastically declined also. July 17, 2013 – Information was received that equipment and cash left by St. Matthew’s-Donwood United Church, Peterborough, Ontario remain missing, though photos of the equipment were said to have been made (however, no photos have been forthcoming). The donation is said to be US$10,000 cash, and $18,000 in materials, which were receipted but not followed up as it did not go through IHQ and was therefore "harder to track". However, properly followed accounting principles would have had those donations entered as receivables in the books. July 19, 2013 – An article in the Zimbabwe Independent prints the following: Sources in the Salvation Army said the church’s annual meeting that had been pencilled for July in Gweru was called off to avoid politicians turning the events into political rallies. “We were to have our annual meeting in Gweru but judging by the political temperatures which are rising, the leadership decided to postpone them until after the elections,” said a Salvation Army member. “In the past we have seen politicians taking over our meetings and turning them into rallies.” The sources also said Vice-President Joice Mujuru, who is a senior captain in the Salvation Army, would most likely have attended the meeting with her party supporters. July 29, 2013 – Reports from the Howard Hospital indicated that the new CMO for Howard Hospital promised by The Salvation Army in press releases dated October 26 and November 8 of 2012 and in a meeting with Dr. Michael Silverman at the beginning of September 2012 had not yet arrived at Howard. As the official letter of transfer given to Thistle was dated July 25, 2012, this means that it has been more than 1 year that has elapsed since The Salvation Army has known about the need to replace the out-going Thistle with a new CMO. The bed count for patients remains quite small, with 5 patients on the male ward, 6 on the female ward and about the same in the children’s ward – this in a hospital with 144 beds which during Thistle’s time were quite often all full, necessitating accommodations to be made using beds on the floors of the wards. Medicines are still in short supply but the X-ray equipment is once again working.
THE HEART OF THE MATTER Dr. Paul and Pedrinah Thistle have moved on. That statement, even in its simplicity, speaks volumes. It speaks of the loss to the Chiweshean people of a dedicated physician and surgeon, and midwife and educator. They no longer have access to the level of medical expertise and care that had been available to them for almost 20 years. Their medical care will cost them more; in terms of money by having to seek care from private doctors and surgeons in Harare, and in terms of time and effort by having to travel to Karanda Hospital to be treated by Dr. Thistle. The losses grow when you add what the Thistles lost; a warm and loving community, and friendships made with young and old alike. They lost, at least temporarily, the fields they felt called of God to care for. And for a period, they lost equilibrium as a result of having to make drastic changes in a short period of time. Institutions are not exempt from loss. Howard Hospital lost its driving force. The facility and staff serves a diminished patient base, donations are drying up, and the vibrant thrum of the ebb and flow of life is now faint. But the statement also speaks of hope and a bright future. FSAOF SPECIAL REPORT, AUGUST 2013
God has provided the Thistles a new field to care for. They can remain in their beloved Zimbabwe. The Karanda Mission Hospital in the Zambezi River valley gained a doctor and midwife who know the language and the ways of the Zimbabwean people, and who stepped up and started serving immediately. The nursing program now has a midwife educator added to their staff. The skills and abilities of a physician who is called by his colleagues “one of the best bush surgeons in the world” is once again available to the sick and suffering. THE FUTURE OF HOWARD HOSPITAL
No one wants Howard Hospital to fail. However, at the moment its future looks very bleak and it is on shaky ground. Consider this:
The hospital has no surgeon. It is down one doctor, and it is reported that the doctors who do remain are busy with private practices. It is down one midwife and instructor. The current hospital administrator is new, and the third one in five months Donations from Canadian supports have dried up Volunteer medical professional no longer come to work on short-term missions The first choice for Chief Medical Officer turned down the position The second choice Chief Medical Officer is tied up in immigration issues and has not yet arrived – more than a year since Thistle was given notice to leave Howard Hospital 144 beds available and less than 20% of them are occupied by patients Medicines are in short supply and often not even available The hospital facility is falling into neglect – reports of simple janitorial tasks going undone are received
Howard Hospital isn’t out of business yet. There are a few faint glimmers of hope. Commissioner Makina was replaced as International Secretary for Africa by Commissioner Joash Malabi, and Commissioner Chigariro was replaced as Territorial Commander of Zimbabwe by Colonel Henry Nyagah. And the Salvation Army world announced the results of the High Council, charged with selecting a new General, naming General Andre Cox on August 3, 2013. Perhaps these new appointees with the guidance and support of the new General will be able to make a difference and bring Howard Hospital back to life. FSAOF SPECIAL REPORT, AUGUST 2013
FINANCIAL ISSUES AND FAILURES The track record for the financial issues involving Howard Hospital is disturbing. Over the last 20 years, there are a number of recorded instances where monetary and material gifts from foreign donors were delayed, misappropriated, misspent, or simply vanished. Reserve account monies in the name of Howard Hospital totaling approximately US$42,000 went missing in the 1990â€™s when Harare THQ changed banks. THQ held all Army accounts, including that of Howard Hospital. A review of the bottom line of all monies held by Harare THQ reflected no loss or shortages of monies; however, the balance sheet for Howard Hospital was mysteriously short a full $42,000. This was waved off as a mistake in bookkeeping and presumably entered as a â€˜correctionâ€™. A new facility was planned to replace the old Howard facility, with construction to begin in 2000. The project was doomed to fail from the beginning. The Territorial Commander at the time, Commissioner Amos Makina, spear-headed the project. The architect engaged had no professional experience in the complex field of designing a hospital, and was incapable of designing one in the African bush and this was noted when Makina was finally persuaded to share the plans with Major (Dr.) Jim Watt the Chief Medical Officer. Not only was the design inadequate for the intended purpose, it was also under-funded at US$1million. A more realistic figure was 3.5 times that when inflation and other on spot payments were included in the total. The plans were re-worked to fill the requirements of a bush hospital and approval was given to begin the project. IHQ provided an officer to oversee the project and the accounting; Commissioner Makina stonewalled him and kept him from doing either. At the conclusion of building, the project ended up costing US$2million, twice the original estimate. Sadly however, in the end, the new facility was deemed unfit for its intended use, by the Zimbabwe government. Having never been used, it sits there near the old facility, dilapidated and falling apart. A colossal waste of money. Donations had a habit of being delayed or disappearing altogether. Consequently, on an ever increasing and demanding schedule Dr. Paul Thistle had to rely on direct donations to keep the hospital operational, with donations often hand-delivered by volunteers or handed directly to him at fundraising events he conducted in Canada during his furlough periods. The direct donations were deposited directly into the Howard Hospital operating account, bypassing the administrative fees assessed by the different Salvation Army HQs as a donation passed through the official donation chain. The Salvation Army has a long-standing policy of assessing a 10% administrative fee for monies passed through its books in transit to other Salvation Army entities. Therefore, Army policy dictated that a donation submitted at a divisional HQ level would have to be assessed at a 10% fee prior to forwarding the remaining monies to territorial HQ. Then THQ could assess a 10% fee before passing it to IHQ; IHQ could assess a further 10% fee before passing it to the receiving territory, which would assess yet another 10% fee before depositing the remaining balance into the operating account of the destination entity. FSAOF SPECIAL REPORT, AUGUST 2013
In the case of Howard Hospital, Canadian DHQs often waived their assessment fee, as did Canada THQ. It is unknown if IHQ assessed a fee on transferred funds, although we have no reason to believe that they waived it. However, the assessment fee of 10%, and sometimes more, was levied on incoming donations into Harare THQ. There are first-hand accounts of Commissioner Chigariro requiring a 30% assessment fee against designated funds coming into Harare specifically earmarked for mission-based projects in Zimbabwe. Dr. Thistle’s actions in obtaining direct donations, which bypassed the assessment channels, could not be tolerated by Commissioner Chigariro, and she therefore terminated the volunteer medical professionals program, instituted by Thistle, and set about to engage a more pliable doctor as her man in charge of Howard. Without his knowledge, various charges were brought up against Dr. Paul Thistle at IHQ until his reputation suffered causing a shadow of doubt on his credibility among IHQ and THQ officers. All this is in sharp contrast with the views of the Zimbabwe people at all levels, and fellow doctors and renowned surgeons who think very highly of him and celebrate his achievements. So when Chigariro asked for Dr. Thistle to be removed, the General consented (acquiesced to the demands of Chigariro and Makina) and tasked Commissioner Makina, International Secretary for Africa, and Chigariro to carry out the order, which they did in a vindictive manner that was negligent in not providing (even a year later) a replacement for his skills, nor assuring a continuity of the antiretroviral programs in place for those suffering with AIDS. THE CHARGES LEVIED AGAINST CAPTAIN (DR.) THISTLE
Not following strict Salvation Army protocols regarding donation remittance (there is no suggestion that moneys were not properly submitted to the SA) o Those accusing Thistle were also guilty of sidestepping protocol-SA regulation
Not following CRA (Canada Revenue Agency) protocols regarding donations as it pertained to monies donated by IFHH and other Canadian donor groups o Canadian officials were aware of the circumstances and did not register any complaints
Disobeying orders from THQ and IHQ. o This charge is not disputed. Dr. Thistle resisted attempts by Harare THQ to turn Howard into a for-profit private hospital, thereby maintaining affordable fees for the poor. He has also spoken out for the welfare of his staff, guaranteeing sustainable salaries and preventing Harare THQ from demanding arbitrary payments from hospital employees. When he was dismissed, lower level employees’ salaries were cut by over 50%, salaries were late in coming, and employees were required to contribute to THQ meetings at Victoria Falls.
Thistle was stubborn, arrogant and unable to get along with people o This certainly wasn’t the opinion of those who he served and of those with whom he served, nor of those who gave their money, or time and talents to travel halfway around the world to volunteer at Howard Hospital. Unfortunately, most of those at THQ and IHQ had not met or worked with Thistle, and the critique leveled against Thistle was based solely on the opinion of those wishing to get rid of him.
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Not communicating with IHQ o
All correspondence with IHQ would go to Commissioner Makina’s desk first, making this accusation suspect.
Being "too big for his boots" and "going too far" o True, but not out of pride. Humbly, he presented the world with the needs of the poor, and put Howard on a good financial standing.
Using outdated drugs and so endangering the lives of his patients o A research study conducted by the US Food and Drug administrator on behalf of the US military has shown that there is no danger, and most drugs are still at ‘labeled potency’ even years past their expiry date. Harvard University reported that medical authorities state expired drugs are safe to administer, even those that expired years ago. It is true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. There are a few rare exceptions, such as tetracycline, nitroglycerin, insulin, and liquid antibiotics, but these drugs do not represent the drugs used by Howard Hospital. Dr. Thistle has said he would rather give an outdated but still potent drug than no drugs. One of the containers of drugs bound for Howard was labeled "near expiry date" (it had been delayed) and did not reach the hospital, having been "disposed of".
Performing complex procedures which the Army could not afford to cover in case of a malpractice suit o This was said to Dr. Silverman, who became very angry and replied that the Army would not have to be concerned with malpractice, as Paul was held in the highest regard by his peers both in Canada and Zimbabwe
Turning the hospital from its original "Primary Care" model to a surgical specialist unit o This accusation is false on both counts. From the start, Howard Hospital tried to provide total care, including dental, surgical, orthopedic, obstetric, and eye surgery, utilizing the skills of visiting doctors. The first doctor at Howard, Jock Cook, prided himself in being able to provide total care, including complex surgery. Thistle has been at the forefront of preventive medicine, especially in HIV and TB, with the collaboration of the highly respected Dr. Silverman and universities in Canada. This has mostly come to a halt since he left, including a mobile educational team with puppeteers that covered schools and beer halls.
Attracting patients from all over Africa instead of concentrating on his own community o This is true, and to be commended. These were high-paying patients, the income from which was used in providing care for the poor in the local communities.
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Thistle is white, and the hospital “should have black African leadership”.
That his pattern of leadership was neo-colonial. o This is hardly true, as staff were free to run their own programs and make suggestions on how to improve hospital health provision services. All black African staff. Now they are all under tight Harare THQ control with no input requested from the Howard Hospital staff.
THE SALVATION ARMY'S LOFTY STATEMENTS DO NOT MATCH THE ON GROUND REALITY August 23, 2012: Press Release: "The Salvation Army remains Committed to Howard Hospital": Commissioner Brian Peddle, Territorial Commander, Canada & Bermuda: "We consider the health of its patients and the well-being of the staff at Howard Hospital to be of paramount importance." If the health of the patients had been of "paramount" importance, reasons to move Dr. Thistle would have been "secondary" and would have been delayed and coordinated with the onsite arrival replacement surgeon, and is not yet resolved a year later. And was any logical thought or consideration given to how Dr. Thistle, given just 24 hours to vacate the hospital and another 24 hours to leave the country? Seventeen years of accumulated files, research, medical records to sort through- patients needing their medical charts updated and shared with those taking over Thistle’s typical 18-hour daily rounds. And what about all the patients scheduled for surgery at the hands of this exceptionally skilled physician? And children in a boarding school… The expulsion was rushed and negligent of any patient safety or concern with reprehensible consequences: many patients died. In Canada (Dr. Thistle’s home country), such a situation would have led to charges of criminal negligence leading to death. Many staff members spoke out against Thistle’s dismissal, fully aware that retaliation, including bodily harm might follow. As far as Commissioner Peddle’s assurance for the well-being of the staff, at the time of the above statement, eight nurses from the hospital had been beaten, arrested, tortured and denied food. It was reported that the Hospital Administrator gave the police names of nurses who opposed Dr. Thistle's move. No Salvationists (HQ) visited these nurses in prison except Dr. Thistle, who refused orders from IHQ to abandon them. It’s logical to assume that THQ Toronto was simply echoing the hollow assurances being sent out from IHQ. Officers from Zimbabwe THQ witnessed against them at their trial. However, their witness statements were “contradictory" and "unreliable" according to the judge, who set seven free for "lack of evidence". When asked about the nurses' plight by Stephen Lewis of the Stephen Lewis Foundation, Lewis reported that the General replied, "They were inciting violence." The nurses’ presence must not have been of sufficient threat, as all but one returned to work at Howard Hospital. Martin Zindoga, was still charged and convicted but his case is under appeal. He has been dismissed from the hospital. 26 October, 2012: "Statement Regarding the Salvation Army's Howard Hospital, Zimbabwe": "The Salvation Army is able to report that: FSAOF SPECIAL REPORT, AUGUST 2013
there is no sign that donated funds have been diverted from their original purpose donated goods, falsely reported to have gone missing, are all accounted for "
Donors in Peterborough, Ontario have requested some $10,000 donated to the hospital and receipted, for construction of a duplex residence, be returned, as the residence has not been built. They have received no answers to these requests. The money remains missing to this date, obviously diverted from its original purpose. Donated goods, including building materials for the above structure and medical instruments owned by SHUMBA Medical were not ‘falsely reported to be missing’; they are indeed missing and unaccounted for, and remain so. It has been reported by the SA Zimbabwe that some of the building materials are at the hospital (door and window frames) and that photographs have been taken and are available, but no photos have ever been provided. When asked about bricks, sand, lumber (roof beams) and roofing sheets, the Salvation Army Zimbabwe would not respond. They did acknowledge that that the cement, a highly valued black market commodity, which had already been purchased, had not yet been delivered. November 7, 2012: Online press release, reported in Peterborough Examiner, November 13: "The hospital continues to operate with qualified medical personnel serving thousands of people each month and reports the hospital is functioning at 10% are false, the church said. Spokesman Andrew Burditt said the hospital served 7,623 patients in September, down from 9,571 in June, meaning it was running at about 80% capacity, he said. Patients continue to be treated at Howard and more difficult cases are being referred to other facilities, Burditt added." Maternity services at the hospital are popular and highly valued, thanks to an excellent midwife and staff, however, the quality has lessened since Thistle’s departure. Doctors do perform Caesarian sections, though maternal mortality is up. In contrast, the main hospital wards, usually operating at 100% capacity, and often over capacity, were at a disturbingly low 10% of capacity at the time Burditt’s statement was written, and remain between 10% and 20% of capacity to the date of this report, August 5, 2013. Even if one were to include the Maternity wing, no one visiting the hospital in recent weeks has ever witnessed it 80% full. The near-empty main wards contradict official statements to such a degree that visiting donors are not allowed to enter them. Two recently entered secretly under the cover of darkness, another had his driver perform a count, a newspaper reporter managed to get in, and nearby residents keep count, all agreeing on the low numbers. Patients who are referred to Harare hospitals, Zimbabwe’s capital, are treated only if they are able to pay the high costs demanded there. Most are unable to do so, and have been left unattended and untreated. Many have died. 11 July 2013: John Murray, IHQ: "IHQ Official Response to all Enquiries re: Howard Hospital": "However, for the record, the Salvation Army is pleased to advise that three doctors are in place at the hospital and staff morale is improving as confidence increases. The Salvation Army International Headquarters recently appointed Dr. Per-Gote Lindgren, a Swedish surgeon, and his wife Birgitta to Howard Hospital."
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As of the date of the writing of this report, almost one month later, this third doctor is still not in place at the hospital, confirmed by telephone. Dr. Lindgren, a Salvationist and son of SA officers, is a retired surgeon; however, he will not be registered in Zimbabwe to practice medicine. His appointment is not as a surgeon, as implied above, but as Hospital Administrator. These are only a part of the allegations. Only an independent audit conducted by a credible outside agency, with no restrictions placed on it as to the reporting of the outcome, is needed to restore confidence in the face of the false SA press releases. In seeking credible verifiable information in researching our investigative report E-mails have been sent to the Army’s International Headquarters requesting clarification on Dr. Thistle’s removal. No direct responses have been received. All requests are automatically re-directed to the Army’s Canadian Territorial Headquarters. Comments posted by visitors to the SA Canadian website confirm unwavering support for Dr. Thistle and condemnation for the Army’s reprehensible handling of this matter. All active and retired officers in the Canada & Bermuda territory have been told not to comment online or off-line about the Howard Hospital debacle. Secrecy and gag orders are how many militaristic organizations function: keep those on the front lines ignorant of the decisions being made by those in the war room. Official reports continue to give glowing reports of the restoration of the hospital, while visitors are not allowed to visit the wards and see first what the true conditions are. The count of patients in the wards remains at less than 20% of the 144-bed capacity. The two Zimbabwean doctors at HH reportedly keep busy with private practice patients in addition to the employment at the hospital. Medicines and supplies have run out or are in short supply. And yet the Salvation Army continues to provide an exaggerated picture of hope and wellbeing, the opposite of the reality that we know to be is the Howard Hospital. Many are suffering. Many are dying. On August 4, 2013, we received a newsletter from the Thistle family. Below is a portion of the newsletter: We have often been asked on furlough for an update on the situation at Howard Hospital. In response we have had little news to report. Unfortunately, the first-hand reports from the hospital staff, family members, and Chiweshe patients who are seeking medical care at Karanda continue to contrast sharply with the official Salvation Army communications. We request your prayers for:
Peace in Zimbabwe after the elections. The people of Chiweshe. For reconciliation at Howard. Nurse Milton Zindoga who is out on bail over the Howard Hospital protest. His High Court appeal starts next week. Accessible and affordable health care for the people of Zimbabwe. Karanda has a vital role to play here. Education assistance for our orphans and vulnerable children in Chiweshe and Mount Darwin. The Thistle family. For our health, and our safety on the roads as the boys go back and forth to school. James (Grade 7) and Alexander (Grade 3) will be starting their new year of school in August.
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A CLARION CALL TO THE SALVATION ARMY LEADERSHIP On August 3, 2013, Commissioner Andre Cox was named as the 20th General of The Salvation Army, having been elected by the High Council. We are issuing a clarion call to General Cox, and to all Salvation Army leadership. We are going to hold you accountable. We challenge you to incorporate the following into the leadership model of the Salvation Army, for yourself and for those who are leaders under your direction: Transparency – no longer will we accept the past method of secrecy of the inner workings of the Army. This includes, but is not limited to, the Salvation Army Act of 1980, the Constitution of The Salvation Army, processes followed for officer promotion, and details about trustee and cabinet relationships and processes. Honesty – information coming from the Army must not be anything less than factual and honest. No more issuing statements and releases that employs lies, exaggerations and halftruths. No more issues statements that have been crafted to present information in an obfuscatory manner. Given the sophisticated communication options available today whereby stories of interest and concern are researched and the truth extracted with a few clicks of a mouse, it is devastating to the reputation of the Army and, even worse, to the face of Christianity when falsehoods are uncovered. Integrity – we are, to the unsaved, the embodiment of Christ here on earth. We must act like it and give no ground for criticizing to those who have seen the dishonesty, the corruption and the injustices perpetrated by the Army or those in the employ of the Army in the recent past. Consistency – a set of fair and consistent standards must be established, published and applied to all, alterable only by governmental or legal exceptions in effect for in the specific location of the issue requiring attention. Respect – an Army-wide mandate that soldiers, adherents, employees, volunteers and advisory board members be treated with respect and dignity. Checks and Balances – the creation and fostering of committees of officers, soldiers and advisory board members in territories around the world who are empowered, free of the potential of repercussion or retribution, to advise and admonish Army leadership at divisional, territorial, national and international levels on issues, good and bad, facing the Army. Board of Redress – the creation and maintenance of a Board of Redress at divisional and territorial levels, consisting of officers, soldiers and trusted non-Army advisors to provide a fair and balanced forum in which conflicts can be resolved appropriately. Financial Accountability – no longer is the internal accounting and auditing practices of the Salvation Army sufficient. Bring in external auditing to address Army financial accountability. It is not enough to do the right thing; we must be seen to do the right thing. Leadership Development – return to the Biblical “shepherd” model of leadership. Commissioner Chigariro, who had her best officer terminated and her nurses arrested was not a good leader because she was not a good shepherd – not interested in the welfare of her “sheep”.
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With regards to the tragedy at Howard Hospital, General Cox, you and all senior leadership are urged to do the right thing, even at this late hour. The issue at Howard Hospital is a watershed moment in Army history. It is unparalleled in the scope of corruption, deceit, and human suffering and death. Soldiers and officers alike are horrified that the leadership of the Salvation Army has allowed this to happen. They are questioning whether the Army has lost its way and many have lost faith in the Army. They are removing their uniforms, decreasing their tithes, and some are even looking for new places of worship. And the reputation of the Army has been brought into question by those outside the Army who have previously supported and championed the work of the Army. Those outside have started to channel their support, financially and materially, to other institutions where there is no question or concern of the integrity, honesty or compassion. Dr. Paul and Pedrinah Thistle are owed an apology. They have had their character and ministry maligned, their lives disrupted, and have been caused untold heartache, frustration and despair. Only they can say if they would accept any reinstatement and/or position working with the Salvation Army in the future. The people of Chiweshe are owed an apology, although the dead cannot accept any apologies. They have had a year of lack of affordable medical services, a year of loss of life-saving antiretroviral therapies, a year of losing family and friends who may have been saved had Dr. Thistle and the visiting volunteer medical professional been available when needed. Those who had depended on the therapies and medicines to help them with their on-going health problems with HIV and TB have lost ground in the slow-down or amelioration of their diseases; ground which may never be recovered, and in fact, may have accelerated their disease because it had gone unchecked by medical therapies. A leadership review is needed of those whose actions caused this tragedy and who allowed it to occur. We call on the leadership of the Salvation Army to make this situation right. Restore Howard Hospital to the functionality it had, conducting not only primary health care but also surgeries. Appoint a qualified surgeon. Rebuild and resume the visiting medical professionals program. Reestablish and resume the HIV and TB programs. Establish the necessary checks and balances to provide a sound framework from which a revived Howard Hospital can recover, grow and thrive. A revived and thriving Howard Hospital can then, once again, be a place of health and healing in the name and love of Christ for the people of Chiweshe and Zimbabwe.
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