Renee Bach wasn't a doctor, but she still treated many patients in Uganda, lawsuit says

LONDON -- Renee Bach was still a teenager when she left her small hometown in rural Virginia and moved halfway across the world to Uganda, after spending just 10 months there on a mission trip.

She set up a Christian nonprofit, Serving His Children, in southeast Uganda in 2009, first providing free meals to families in need, then offering free inpatient and outpatient treatment for malnourished children as well as community engagement programs aimed at breaking the cycle of malnutrition. The organization's website is peppered with Bible verses, appeals for donations and images of Ugandan children, many with the telltale signs of severe malnutrition: sunken eyes, protruding ribs and bloated bellies.

"At the time, I didn't even know that malnutrition was a huge problem in Uganda," Bach, 30, told ABC News in a recent telephone interview. "That wasn't something I had been exposed to. It definitely wasn't the plan initially."

Serving His Children, which works with local doctors and nurses, claims to have successfully treated thousands of malnourished children in the region's rural, impoverished communities over the past several years. Success stories and transformation photos of young patients are featured on the organization's website and social media pages.

But a lawsuit filled with sweeping accusations that was filed in Uganda earlier this year tells a different story, claiming that Bach, who has no formal medical training, diagnosed and treated children while running an unlicensed medical facility there, leading to the deaths of "hundreds of children."

The court documents, obtained by ABC News, detail a litany of complaints against Bach and Serving His Children, with statements from two mothers whose children died as well as affidavits from former employees and volunteers. Among the allegations against Bach are performing medical procedures such as blood transfusions and inserting intravenous catheters, disregarding sanitary protocols and attempting to diagnose patients who showed symptoms frequently related to serious illnesses like HIV and AIDS.

One former volunteer stated in her affidavit that Bach allegedly "frequently wore a stethoscope around her neck" and "was aware" she was known in the community as the "white doctor." The person claimed that Bach based her treatment on her "gut feelings," relied heavily on the book "Where There Is No Doctor" and "did not follow orders of any local medical professional."

Bach's attorney, David Gibbs, has vehemently denied the "nonsensical" allegations and maintained that his client is "innocent." Gibbs, who is president of the National Center for Life and Liberty, a Florida-based Christian legal advocacy group, said his client's organization provides "quality care meeting national guidelines and under the supervision of the Uganda Ministry of Health."

"This hurts Renee, obviously, and what she's done with Serving His Children," the attorney told ABC News in a recent telephone interview. "But the ultimate victims in this are the malnourished children in Uganda that aren't able to receive services when these types of lies and misinformation are put forward, and it is very disruptive and it's very unfortunate."

In a statement released late last month, Gibbs said Bach "worked alongside Ugandan medical professionals" where she "learned skills to help provide assistance as necessary." He also maintained that she "never represented herself as a doctor or nurse, but she made nutritional care provided by qualified medical professionals more accessible for families in rural areas."

And Ugandan health officials investigated Bach and Serving His Children earlier this year, finding no evidence that large numbers of children died or that Bach was treating children.

'I feel his life was snatched from my arms'

Bach and Serving His Children are being sued in civil court in Uganda by two mothers who claim their children died because of the care they received from Serving His Children. Their lawsuit was filed in the High Court of Uganda on Jan. 21 by the Women's Probono Initiative, a Kampala-based advocacy group that provides free legal services to women and girls in Uganda.

The Women's Probono Initiative said it is seeking accountability and the enforcement of human rights, as well as monetary damages for the two mothers who lost their children.

"It is unacceptable, narcissistic behavior, for any one, black or white, rich or poor, missionary or angel to pass off as a 'medical practitioner' when they are not," Beatrice Kayaga, a lawyer with the Women's Probono Initiative, said in a statement. "By doing so, they mislead unsuspecting vulnerable members of the public."

The first mother named in the lawsuit, Zubeda Gimbo, said in an affidavit that at some point after her 3-year-old son, Twalali, had been diagnosed as malnourished at a health center, an unnamed woman she says she later learned worked for Serving His Children came to her village in Namutumba district in July 2013 and, along with Tawali's grandmother, brought him to the organization's facility in Jinja district for treatment. Three days later, Gimbo said she received a telephone call that her son had died at the facility. The woman who had taken Gimbo's son returned his body and gave the family 50,000 Ugandan shillings (about $13.50), then left the village before the burial without providing any explanation as to what happened, according to the complaint.

In court documents filed on March 11 in response to the lawsuit, Bach said she wasn't even in the country when Gimbo's child was at Serving His Children's facility, but that he was cared for by a doctor and nurses. Copies of Bach's passport and the organization's patient records, which were included in the court documents, show that Bach was out of the country at the time of his care.

Alonyo Constance Milech, a midwife who has been working as the head nurse at Serving His Children since 2010, said in an affidavit that Twalali suffered from "acute malnutrition associated with severe malaria" and was "given the best care possible."

The second mother named in the lawsuit, Annet Kakai, said in an affidavit that she was in her village in Buikwe district in July 2018 when she was introduced to a woman named Fatuma who she says she later learned worked for Serving His Children. Kakai said Fatuma convinced her to take her 1-year-old son, Elijah, to their facility "to feed him so he can grow fat." Kakai said they first went to a medical center where Elijah was diagnosed with tuberculosis. Then they went to the Serving His Children facility in Jinja district where "a white lady," whom Kakai said she later learned was Bach, took her baby and "went into a room with him" for an hour, then returned him to her and said to come back the next day, according to the complaint.

When Kakai returned with Elijah, she said the Serving His Children staff drove them to the government-run Kigandalo Health Center IV in neighboring Mayuge district, where health workers checked her son's weight and gave him milk. Kakai said they were discharged from the health center after two days, without any further instructions or medication for her child. Kakai said the Serving His Children staff drove them back to Jinja district and gave her 2,000 Ugandan shillings (less than $1) to find her way back home, according to the complaint.

In the following days, Kakai said, Elijah became "so weak" that she had to take him to a local hospital where he was given medication but was vomiting, according to the complaint. He died three days later. Kakai said in her affidavit that she "strongly" believes that Bach and the Serving His Children employees of Serving His Children "did something to my child that led to his death."

"I feel his life was snatched from my arms by the actions of Ms. Renee Bach," Kakai said in a statement released by the Women's Probono Initiative. "I hope the court can give me justice."

In an affidavit in response to the Kakai's claims, Bach said no one named Fatuma has ever worked for Serving His Children. Bach said the facility in Jinja district was shuttered at that time and the organization was providing inpatient treatment only at the Kigandalo Health Center IV in Mayuge district. Bach said the child could not have received treatment because there are no records of Kakai's son ever being admitted to facilities either in Jinja or Mayuge, and that Elijah was referred to a hospital where he could be treated for tuberculosis, according to the court documents.

'We did the very best with what we were handed'

Former coworkers said that they witnessed Bach appearing to portray herself as a medical professional, according to the civil lawsuit.

Semei Jolley Kyebanakola said in an affidavit that he worked as an agriculturalist for Serving His Children from 2009 to 2017, during which time he was "aware" that Bach "encouraged mothers to escape" from a children's hospital in Jinja and bring their babies to her facility for treatment instead. Kyebanakola said he assumed Bach was a health worker because she wore a "clinical coat" and "often" had a stethoscope around her neck. He also said he observed her treating children "on a daily basis," according to his affidavit.

In an affidavit filed in response to Kyebanakola's claims, Bach said she never encouraged mothers and their children to escape from hospitals. Bach also said that, as a gardener and later an agriculturist, Kyebanakola had limited contact with children and mothers at the center, and he was "fully aware" she was not a medical worker because she always introduced herself as the organization's program director, according to the court documents.

"I have never represented myself or passed off as a medical professional," Bach stated in her affidavit, "and I have never put on a clinical coat."

Charles Olweny said in an affidavit that he worked as a gatekeeper and then field program manager for Serving His Children from 2009 to 2017. Olweny said he and other staff members raised concerns during a meeting with the organization's interim director in May 2017 over Bach's lack of medical qualifications and the allegedly "high death rates" at the facility, after learning from "colleagues from the missionary community" that she was not a trained health worker, according to the court documents.

"She would take blood, offer diagnoses, administer drugs through IVs put on by herself and write prescriptions," Olweny stated in his affidavit.

"I saw several children dying at the facilities," Olweny added. "On average, I would drive at least seven to 10 dead bodies of children back to their villages each week."

Bach told ABC News that Olweny's statements are "completely false" and that he was unhappy with Serving His Children after being laid off due to downsizing in the wake of the Jinja facility's closure.

Bach provided data that showed 119 deaths out of the 3,596 total patients treated by Serving His Children from 2010 through 2018, which is a case fatality rate of 3.3%. According to a 2007 study published by the U.S. Department of Health and Human Services' National Institutes of Health, case fatality rates in hospitals treating severe acute malnutrition is 20 to 30% in most developing nations.

"It's hard to talk about that because it's not just a number," Bach told ABC News. "We mourned the loss of every one of those children."

In an affidavit filed in response to Olweny's claims, Bach said that any deaths that occurred at Serving His Children were "normal as a result of severe acute malnutrition at advanced stages or underlying medical conditions complicated by malnutrition." Speaking to ABC News, Bach said there were times when her staff received children who were very ill and needed to be transferred to a hospital for treatment but died on the way there.

"We did the very best with what we were handed," she said, "and sometimes what we were handed was a really rough situation."

In her affidavit, Bach also said that no allegations against herself nor Serving His Children were brought up during the meeting with the interim director in May 2017, while she was out of the country for several months.

Jacqueline Grace Kramlich, an American registered nurse who serves as the executive director at a home healthcare agency, said in an affidavit filed with the civil lawsuit that she started volunteering for Serving His Children in Jinja in August 2011 but quit after four months "due to my inability to remain in such an unethical environment."

Kramlich, who is now working in Washington state, said she observed Bach attempt to diagnose and treat pediatric patients who apparently showed symptoms frequently associated with serious ailments, including severe acute malnutrition, tuberculosis, HIV and AIDS, malaria and heart failure. Kramlich said she saw Bach carry out various procedures without any oversight from a medical doctor, including inserting intravenous catheters, taking blood, administering injections, performing blood transfusions, treating wounds, the prescribing and dosing of various medications, taking vital signs, conducting health assessments, assisting in the labor and delivery of a newborn, and preparing a dead body for burial, according to the court documents.

Kramlich said Bach "frequently administered rehabilitation feeds that were dangerously high in caloric content for fragile children" as well as "large amounts of intravenous fluids to children in fragile states, and many of these children died." Kramlich said, to her knowledge, no death certificates were ever obtained or issued nor were any autopsies performed, according to the court documents.

Kramlich said she rarely saw Bach follow universal precautions and guidelines, such as wearing gloves or washing hands, as she moved from patient to patient, according to the court documents.

"When I asked what she based her treatments on, she stated she relied heavily on the book, 'Where There is No Doctor,' as well as her 'gut feelings,'" Kramlich stated in her affidavit, adding that Bach also said at times she "felt God would tell her what to do for the child."

Kramlich said Bach "gave orders to her nursing staff who were employed there at the time" and "would override their judgement [sic] and decisions on a regular basis," according to the court documents. When Kramlich asked why she didn't always seek outside medical help, Bach allegedly told her she "didn't believe Ugandan doctors knew what they were talking about," and according to Kramlich's affidavit, Bach "felt she had more knowledge because she had access to online resources."

In "one of the more disturbing" interactions, Kramlich said Bach asked whether giving a bottle of intravenous iron instead of a blood transfusion would help a child with severe anemia. "I really just want to try it to see what happens," Bach allegedly said.

Bach told ABC News that she and Kramlich "didn't part under the best terms." And in an affidavit filed in response to her claims, Bach, who never went to college, said that Kramlich "repeatedly made it known that she did not like working with me, someone who was younger than herself and who was without her level of academic training although she understood this would be the situation."

Bach also said in her affidavit that although she "discussed symptoms and associated risks" with Serving His Children's medical staff, she "did not attempt to diagnose or treat such illnesses as alleged." Bach noted that Serving His Children had three full-time registered nurses on staff who were responsible for patient care while Kramlich was a volunteer there.

Speaking to ABC News, Bach said "death summary reports" were provided to the families who were then expected to file the documents with local authorities. Bach also said that Kramlich has had no personal knowledge of Serving His Children's operations since she stopped volunteering in late 2011.

"Once Jackie left, she never returned to observe activities to see how things were being run," Bach told ABC News.

The controversial facility

According to court documents filed in response to the lawsuit, Bach said Serving His Children initially did not provide any medical services, starting a malnutrition rehabilitation program first in 2011 and then becoming a licensed health facility in Jinja district on March 4, 2014. A copy of the certificate was included in the court documents, with an expiration date of Dec. 31, 2014. The organization said it would refer more serious cases to the local hospital, according to the court documents.

Serving His Children's facility in Jinja district was shut down in March 2015 after the district health officer made an "unannounced inspection" in response to complaints about Bach and her organization. After two hours of searching through the organization's records, inspecting medicines and interviewing staff, the district health officer identified three areas that required improvement: having an overdue license registration but within a standard three-month grace period, not having a separate room for children with tuberculosis and not referring children to a higher level of care if necessary, according to the court documents.

Bach said Serving His Children was in the process of renewing the license at the time of the inspection. Later that month, the Resident District Commissioner of Jinja wrote a letter of recommendation for Serving His Children to renew its license. Bach said in an affidavit that "multiple government officials" told Serving His Children that it could reopen the facility and resume care of malnourished children, but the organization's board in the United States made the decision to remain closed for a time because Bach and her staff were facing "threats from members of the community." Still, Serving His Children continued an outreach program in food supplements and nutrition.

In June 2017, Serving His Children in partnership with Uganda's Ministry of Health opened an inpatient treatment center in Mayuge district and began outpatient treatment services for malnourished children. A community engagement program was established that October, according to the court documents. To date, these programs have continued to run based out of the Kigandalo Health Center IV under a Ugandan team of nine nurses (six full-time and three contract), two clinical officers, one medical officer, a nutritionist, a social worker and a pastor, according to the court documents.

A spokesperson for Uganda's Ministry of Health told ABC News that the Uganda Medical and Dental Practitioners Council, a quasi-government professional organization mandated by the health ministry, launched an investigation into Serving His Children earlier this year in light of the civil lawsuit. Investigators were "unable to support allegations that children died in large numbers" due to the services provided by Bach's organization. They also did not find evidence that Bach was treating any children herself, according to the health ministry spokesperson.

When asked whether there will be another investigation, the spokesperson told ABC News they will "wait [for] the court matters to conclude."

'The mindset of a white savior'

The allegations have ignited claims that Bach was playing the role of a "white savior" by moving to Uganda with no formal medical training and starting an organization that ultimately began caring for sick children.

According to an affidavit from Kayaga, one of the lawyers at the Women's Probono Initiative, which filed the civil lawsuit, a white savior complex is "the belief that any white person irrespective of their academic status or training and social economic standing can offer aid to poor black minorities."

A group called No White Saviors has spoken out against Bach in numerous social media posts. The group has said on its Twitter and Instagram pages that its members are in talks with Virginia-based lawyers to explore options for bringing legal action against Bach and Serving His Children in the United States. ABC News has reached out to the group for comment.

Bach told ABC News she understands why people may be quick to label her a "white savior," and even admitted she first came to Uganda with that mentality.

"I definitely went to Uganda with, you know, the mindset of a white savior," Bach said. "I think it's impossible to say that any person coming from a developed country, such as America, going to a place that would be considered underdeveloped, such as Uganda, wouldn't have a bit of a white savior complex. You know, your desire is to help."

"I don't think that's a bad mindset. I think it's how you live that out," she added. "And it was a quick turnaround for me to realize that I'm not needed here. You know, all of our programs are completely Ugandan-run and operating."

Court battle continues

An initial court date set in March was postponed, and the case is now expected to be heard in January. Bach has not been criminally prosecuted for the allegations.

Meanwhile, Bach has stepped down from her role as Serving His Children's program director and has temporarily returned to the United States, where she is working in a volunteer capacity to raise funds for the organization's team in Uganda.

Bach said she believes the lawsuit grew out of a personal "vendetta" waged by people in the community who dislike her as well as disgruntled former employees.

She admitted that she was "involved in some medical activities" and would offer an extra set of hands in emergencies, but always under the oversight of a doctor or nurse who was present.

"They're taking a little grain of something that they saw or experienced and blowing it into this huge story," she told ABC News.

Bach said she questions the motive behind the lawsuit and whether the accusers have the best interest of the Ugandan people at heart.

"We've seen a lot of hurt and a lot of negative things come from this situation. Our Ugandan staff that are working hard and doing what they do best and are dedicated are being threatened, you know, in their workplace and in their home because of this," she told ABC News. "They're putting these people at risk and putting children's lives at risk."

ABC News' Moses Bwayo contributed to this report from Kampala, Uganda.