"You matter because you are you, and you matter to the end of your life.
We will do all we can not only to help you die peacefully,
but also to help you live until you die!"
Dame Cicely Saunders
take a moment to listen to the important message from the founder of the modern hospice movement
~2022 Sunset at the future site of Amahoro Hospice~
It may not have looked like much at the moment we first laid eyes on the dilapidated old building, but the Kibogora Level 2 Teaching Hospital and the Free Methodist Church of Rwanda recognized and generously donated this unique and centrally located site to HWB to fulfill our shared aspiration to build the 'Amahoro Hospice House,' and in partnership with their palliative care department, create a center of excellence for palliative care practice and learning in Rwanda.
To begin this essay, let us say clearly: Hospice Without Borders is ever grateful to the leadership of the Honorable Minister of Health, our colleagues at the Rwanda Biomedical Center (RBC), and of course the leadership team at the Kibogora Level 2 Teaching Hospital, and Bishop Samuel of the Free Methodist Church of Rwanda, for this rare and precious opportunity to be of service to the good people of Rwanda!
We look forward to you joining us!
The old house in 2023
Once completed Amahoro Hospice House will sit secluded atop this lovely and centrally located overlook in the Western Province of Rwanda, incorporated into the Kibogora Level 2 Teaching Hospital which lies just below.
The patients and families who arrive here for hospice care, will enjoy an expansive south facing view of hills from which many will have come. To the southeast they will see Nyungwe National Forest, and to the southwest, Lake Kivu.
The hospice is being built just across the street from the Mission Station Guesthouse where HWB volunteers typically stay when serving with us in Kibogora. It's also just across from Free Methodist Church of Rwanda, where from which guests of the hospice will hear choir practice most evenings, and singing on Sundays. (For those interested, the church is seen during the videos we've posted above and below).
Conveniently, it also turns out Amahoro Hospice will be situated just a few steps down the street from the local college, Kibogora Polytechnic, which boasts an excellent nursing school: one where we often teach the principles of palliative care and hospice to the young students!
Finally, and particularly important to us, Amahoro Hospice is located across the street from one of the many smaller genocide memorials in Rwanda, which is auspicious in our view because it represents a very unique opportunity to remain mindful of one's responsibility in this life to practice the path of
UBUMUNTU ~ the realization of our interconnectedness and shared humanity
These are the original profiles drawn by Mike Ward, who first walked and surveyed the site in 2018
It is Mike's original design that is now becoming Amahoro Hospice House!
We can never repay his generosity, skill, vast knowledge, and commitment to bringing this project to fruition!
A short video update we did from Kibogora in October 2024, just after the old building was removed ~ progress!
This is the site after May 2025 Umuganda (the once monthly community service in Rwanda).
People from Kibogora came out to insure the site was ready to go!
For our guests, Amahoro Hospice House will be a safe and peaceful refuge to receive end of life care. For staff and volunteers, it will be we hope a
meaningful place to serve and deepen one's practice.
As you read this, with your generosity and support, together we are transforming this site of former genocide into a global palliative care center of excellence, a place of peace, and a 'balm for all wounds' as Etty Hillesum encouraged us to be in the world ~ regardless of our circumstances.
June 14, The Construction Sign Going Up!
Curious as to how we arrived to this point?
14 June 2025 ~ Inside the worksite just prior to the formal excavation!
16 June 2025 ~ The one day we hired a machine to do the excavating!
26 June ~ Mike Ward and Jean Paul Nsengiymva seen here discussing the layout for Amahoro Hospice House!
Mike Ward along with protege Fabrice Kwizera (founder of Fabera Construction, Ltd), shown here together on site making sure the final levels are just right!
A happy crew hard at work digging out the retaining wall! Men & Women working side by side
~ Equal Pay for Equal Work ~ That's the law of the land in Rwanda!
27 June ~ Amahoro Hospice staked out with very little room to spare!
12 July ~ Similar to above, West to East, but look at the change in just 2 weeks!
12 July ~ Preparing to lay a deep foundation for peace, looking East to West!
17 July ~ Strong footers being set in stone here at the South East corner of Amahoro Hospice!
19 July ~ The retaining wall is intended as a vehicle for community building...
Notice to the right what will be a quiet and shaded spot to find a place of rest and create community.
22 July ~ Teammates carefully preparing to bind the 'ring beam'
This next step will insure Amahoro Hospice is prepared to evenly bear its burdens
with strength and resilience for generations to come!
23 July ~ Nshuti ~ Friends Clearing the Path.
23 July ~ The interior layout now clearly coming into view as we're at ground level!
26 July ~ transitioning from footers to floors ~ nice looking concrete.
28 July ~ Going Vertical Now!
31 July ~ Ring Beam Complete and All Columns Up!
31 July ~ Getting ready to pour the floors ~ Compacting the Ground in the future East Wing of Amahoro Hospice!
31 July ~ Here we can appreciate how the ramp will connect to the veranda!
1 August ~ Brick Walls Now Going Up!
1 August ~ The team wrapping up for the day, takes a moment for a photograph!
These folks from Fabera Ltd, are all local people from Kibogora!
Building a foundation for Peace at Amahoro Hospice
Turi kumwe ~ We are together!
The importance of community engagement cannot be overstated if we are to consider our work in palliative care a Peacebuilding practice.
In the above photograph, we see the builders of Amahoro hospice after a long days work. The team is comprised of local people from Kibogora, men and women, the young and elderly alike...Everyone comes from Kibogora proper or the surrounding hills you see in the many photographs throughout this essay. Everyone is working together in common purpose to create this safe sacred refuge that will care for the community's most vulnerable at the very end of life. The building team knows that
the primary mission of the hospice will be to care for the dying.
In order for our effort to foster a sense of common purpose, we need to engage the community as owners of the project. In the future, members of this very same team may continue to work or volunteer in new capacities at Amahoro Hospice. Additionally they themselves or their family members may one day be served here. During this early stage of building, we aim to engender community ownership and responsibility for the success of the hospice.
Community Growth ~ Sacred Reciprocity!
Sacred Reciprocity implies the integration of empathic concern and sense of shared responsibility for the well being and happiness of one another, coupled with a proper appreciation for the sanctity of each and every one of us: Again it was Dr. Saunders who reminded the dying: "You matter because you are you." If properly tended, sacred reciprocity creates a momentum towards sustainable and peaceful community growth. Amahoro Hospice represents our commitment to supporting the sanctity of living and dying alike, and working together in solidarity with the community in furtherance of that sustainable and sacred peace we are seeking to build.
The hospice in construct, can be thought of as 'neutral ground' for people who may have very different points of view, and may at times come into disagreement and conflict. The reality of being in those intense moments of change and loss and impending death, to ourselves or loved ones we expected to be stressful. We refer to that stress as 'anticipatory grief,' a time where we are processing the reality of the loss to come. The journey through this period if often rich, full of closure and manifestations of love and gratitude, and a period with great potential for healing and growth and legacy creation. Yet it can also a period prone to conflict. It is a time where unresolved feelings and issues that may not yet have been addressed, may now come boiling up from deep currents swirling below the surface.
~Conflict is normal in human relationships,
and conflict is a motor of change~
John Paul Lederach
At Amahoro Hospice our practice is to be supportive of nurturing sacred reciprocity: we want to intentionally create a safe spacious and neutral ground that supports all people on their journey, in finding meaningful expression for those thoughts and feelings they are experiencing in response to the inexorable change and loss that culminates at or near the moment of death, but also continues for those who live on. We are intentionally cultivating a culture that 'welcomes everything and pushes away nothing.' In this way we hope to foster a culture of acceptance, where what social worker Jenny Hunt describes in her '9 cell bereavement table' as an opportunity for concordance to exist between what we feel and what we express
over time on our bereavement journey as it unfolds over our life.
"How people die lives on in the memory of those who live on."
Dr. Cicely Saunders
We premise there exists a linkage from the immediate care of a particular individual at the hospice, to the care of the entire community, and that intentionally strengthening this linkage over time, will lead to improved inter-group relations, trust, and cooperation in domains not necessarily limited to providing care for the dying. For example in domain of community building projects and
conflict transformation when required.
In the coming years we aim to measure whether our efforts here at Amahoro Hospice lead to greater community cohesion, trust, and the fundamental
value we place in one another as we venture forth.
'Twahuriye mu'nzira ~ We met along the path'
When we meet one another along that path, these moments can become intersections of commonality, hubs of opportunity, and above all serendipitous
nodal points of transformative idealism. Here on the path we want to greet one another with curiosity and spaciousness and trust in sacred reciprocity, as we assert with courage and humility, I come in peace.
To walk the path of peace means walking with our eyes open, cultivating peripheral vision, meaning a willingness and capacity to expand our point of view, all whilst maintaining our moral bearing, and thus proceeding with courage, imagination and a desire to co-create unity in the midst of complexity, adversity, and change.
~Buhoro buhoro ni rwo rugendo~Slowly together we take the journey~
Albert Bandura asserted in his theory of social cognition: people learn by observing others, and that this learning includes learning to empathize with others and the development of 'self-efficacy,' which we may define as confidence in meeting with success during important and challenging moments during our individual and collective journeys: amidst situations we encounter where our
values and moral standards are challenged.
Learning and integrating self-efficacy occurs by observing the empathic practice of others, and by directly experiencing empathic concern from others. The idea here is that we can build and strengthen empathic capacity via systematically modeling empathic concern for others, with others, and also for ourselves. This is the heart of Ubumuntu ~ empathic concern for all ~ happiness of all.
Conversely, when empathic concern is not modeled and instead anti-social attributes such as fear, mistrust, racism, and hatred (amongst others) are taught and modeled, individuals within the community are at risk of disengaging and disconnecting from their moral standards. This outcome is particularly dangerous because when we disengage from our moral standards, we may then go on to participate in harmful and even violent behavior, which as Vincenc Fisas wrote, "[violence] is the behavior of someone incapable of imagining other solutions to problems at hand." In some instances individuals may succumb to provocations to embrace dehumanization and a 'logic of atrocity,' which represents a pathologic disintegration of empathy.
The logic of atrocity is a predicate for structural violence and in the
worst case scenario, genocide.
"People can be taught to be bad,
but they can also be taught to be good"
Honorable Paul Kagame
President of Rwanda
The good news is that when people are taught and modeled consistent principled altruism and empathic concern, (as we plan to model and teach in every room at every moment in Amahoro Hospice House), research shows such individuals will internalize principled moral standards and exhibit high degrees of 'self-efficacy,' exhibiting a capacity to resist calls to disconnect from and abandon those moral standards and that efficacy. Such people are more likely to embrace a 'peace-oriented mindset', and a 'logic of reciprocity.' As such they are more likely to engage in prosocial behavior, practice 'ethical transformation,' and participate in community-based structural Peacebuilding efforts.
When we practice Ubumuntu and cultivate the 'peace-oriented mindset', an orientation that promotes cooperation and shared understanding amongst people, we find an expectation of sacred reciprocity and peace as the normative: one where it becomes inconceivable to allow our fellow human beings to fall outside the
web of mutual care and concern, even as we understand that
web to include our 'so-called enemies'.
~Ubumuntu is a 'ring beam' at Amahoro Hospice~
Take a moment to scroll back up and revisit the photos of the ring beam construction. Recall that the ring beam serves a couple functions. It is that layer of reinforced concrete that binds the foundations to the anticipated loads and stressors on the roof and joists and walls above, and it also is a linkage system, that connects each and every room, thus distributing the loads and more securely anchoring us to our foundation. One can appreciate how Ubumuntu may also be construed as a ring beam: one that links us in solidarity and community as we strive to maintain our moral standards and equanimity in times of conflict and distress, simultaneously binding us to our internalized foundation of peace.
~Gira neza wigendere~Do good and continue your journey~
As Bernie Glassman encouraged in his writing on bearing witness, we recognize that within us exists the complexity of both unity and diversity. In this context we choose to embrace our complex diversity as well our inherent unity, and commit to the creative act, meeting moments of joy, sorrow, misunderstanding and yes conflict, which is inevitable, with kindness, compassion and love. This is the path to
transcending violence and building peace. And as our sister
Etty Hillesum encouraged...
~We must strive to be a balm for all wounds~
Every action I undertake at Amahoro Hospice is intended to foster Ubumuntu and a 'Peace Orientation.' This orientation is aimed at improving my capacity to listen respectfully and engage from the body, heart, and mind, and in so doing practice consistent and principled altruism ~ compassionate action! As we work together in constructive and collaborative dialogue to address the natural ebb and flow of human relationship, we celebrate differences as well as similarities, we bear witness to our joys and sorrows, and we seek to create meaning, shared understanding, and find common ground upon where we are all
welcomed and embraced with love and acceptance!
As we meet upon the path let us together confidently assert...
~N'Amahoro ~ It's Peace ~
Gratitude to Dame Cicely Saunders, Roshi Bernie Glassman, John Paul Lederach PhD, Frank Osteseski, Courtney Martin MA, Karen Armstrong M.Litt. Etty Hillesum, Jenny Hunt MSW, Jean Vanier, and Albert Bandura PhD
1 August ~ The Sun Setting Over Amahoro Hospice
~May tomorrow be another day where together once again, we practice the path of peace~
Dukomeza ~ Let's Continue!
4 August ~ The north face of the hospice~
There will be a path and some benches and a sitting wall
A place to sit and share stories in community.
4 August ~ The southwest ramp to Amahoro House
The Methodist church roof and roof-top cross can be seen just above the worksite!
Think of the choir permeating the hospice filling it with the very spirit of this community.
8 Aug ~ Reaching the "Lintel Beam" that joins the walls to the Roof!
You can just see a slice of Lake Kivu visible to the South West, between and amidst the trees!
15 August ~ The Lintel beam is essentially complete. We're getting ready to install the interior floors then roof.
19 August ~ Soon building the roof!
19 August ~ Properly grading the bank.
This will be covered with green grass and flowering shrubs and cooling shade trees.
19 August ~ Rose Flannigan, HWB Board Member and Quilter Extraordinaire!
Seen here packing 14 hand made community quilts ~ one for each bed and
one for the entry to Amahoro Hospice House.
23 August ~ North West bedroom preparing to pour the floor.
Out to the stone wall and hillside above. Soon to be covered in green!
23 August ~ South East Shared Bedroom.
23 August ~ 1st layer of concrete through Unity Commons to the South Porch!
23 August ~ West to East as if down the driveway!
We're envisioning places where we might plant a few local vegetables!
26 August ~ Roofing Trusses Being Put Together!
26 Aug ~ A temporary fence being placed along the east side of the hospice, while the flowering hedge to be planted adjacent, grows to 1.8m ~ afterwhich this fence will be removed.
28 Aug ~ Some Plaster work is beginning
28 Aug ~ Some finishing work on the north wall underway
28 Aug ~ The south retaining wall with ramps on both sides to the central porch.
We hope to plant a kitchen garden on the slopes below this wall with leeks and onion and dodo, all to
provide nutritional support with familiar foods, to the guests and families at Amahoro Hospice Kibogora.
1 September ~ Calling in the machinery once more to expedite move ground in preparation for the parking,
the driveway, and the NW garden area of the hospice.
1 September ~ The team seen here beginning to prepare the parking and drive at the west side of
Amahoro Hospice house.
2 September ~ The beginnings of our roof!
Dr. Cicely Saunders famous words, now placed upon the
Amahoro Hospice Quilt, written in both Kinyarwanda and English
That's the update as of 3 September 2025. We are continuously adding content to this photographic journal meant to memorialize the development of Amahoro Hospice House. Please read on below to learn more about our partnerships with Kibogora L2 Teaching Hospital, and how HWB came to be working here!
Why Kibogora
HWB volunteer Margo Hill conducting a home visit with a very poor woman up in the hills. This patient's situation of extreme poverty and suffering would make her an obvious person to invite to Amahoro Hospice House!
Hospice Without Borders has been working with Kibogora Hospital Palliative Care Department since 2015 and we have a strong relationship with our partners. Our primary focus has been consistency of oral morphine accessibility, the development of home based palliative care services, the expansion of bereavement care to both adults and children, clinical education for health care professionals, and creating international palliative care volunteer opportunity.
Kibogora epitomizes one's picture of old Rwanda with beautiful and rugged mountainous country.
It is also however a region that is quite challenging for patients and families with progressive terminal illness with limited material means, where the survival of a family often depends on everyone to meet the daily needs! Incurable illness can disrupt the tenuous stability in an instant. As it can with all of us of course.
The above photo with our volunteer and board member Margo is typical of the circumstance patients often find themselves. Our hospice will serve as a safe and peaceful refuge to people who find themselves in similar challenging circumstances.
Building the Hospice
The original interior layout of the hospice drawn by Mike Ward when we first asked him to survey the site of the small tract of land donated to us for this hospice!
As you can appreciate, the building will have 8 bedrooms and accommodate up to 14 guests with room for family members if available.
There will be a kitchen and common gathering room we call "UNITY COMMONS," as well as a lovely porch overlooking the surrounding hills to the south.
The final architectural design was completed by Khemet Ltd, a Rwandan architectural firm, but was overseen by Mike every step of the way!
The hospice is being now built as you see above by Fabrice Kwizera, the owner of Fabera Construction Ltd., and the protege of Mike! This makes it an especially sweet and touching collaboration!
If you are interested in reviewing the detailed action plan and budget for the hospice, please contact Dr. David Slack by sending a message at Take Action!
And please remember, while we do have the funding to build the hospice, that doesn't mean we don't need your support for outfitting the building and supporting the development of training and care practices. Also, it would be nice to have a small ongoing budget if possible to support the needs of the staff, patients, and their loved ones.
Sustaining the Vision
Lake Kivu from the Kibogora Mission Station
The Amahoro Hospice at Kibogora is to be an integrated clinical service at the hospital. This portends favorably being connected to the hospital because this means the Ministry of Health will be responsible for staffing the hospice. This means we do not have to raise funding year after year to pay staff which then becomes a sustainability challenge. Our task is to build the hospice, provide input to policy, procedure, hospice care plan development including nursing care, and to support the concept development of interdisciplinary team care.
We will also work with the staff at the hospice and provide volunteers and supply donations as able.
Kibogora already has an excellent nationally recognized palliative care service and in 2023
the Ministry of Health designated Kibogora Hospital as one of 6 new teaching hospitals in the country, meaning young nurses and physicians and social workers and pastoral care providers will now have a world class training opportunity at Amahoro Hospice.
Finally, Kibogora is a place where international volunteers come to serve in Rwanda and there is ample lodging like the view from the mission station above.
Amahoro Hospice will be a great place to work and a greatear place to serve and cultivate Ubumuntu and Compassionate Action!
When I feel challenged and find myself asking, 'what can I possibly offer to meet the vast ocean of suffering', I take heart and remember the words of Dr. Margaret Mead, PhD. who famously wrote as follows...
"Never doubt that a small group of thoughtful committed individuals can change the world. In fact, it's the only thing that ever has.”
If you have a message for our hospice team!
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