Working with Dr. Schweitzer

Chapter 3. Everyday Life in Lambaréné

By Louise Jilek-Aall, M.D.
I belong unfortunately to the number of those medical men who have not the robust temperament which is desirable in that calling, and so are consumed with increasing anxiety about the condition of their severe cases.

(Albert Schweitzer, My Life and Thought p. 118)

- Author's translation

When the first excitement over a new job begins to wane and the enthusiasm simmers down, there comes a time of disenchantment, or even depression. Then the impulse to quit the job becomes hard to resist. A good employer will watch out for such a crisis and find means to help his new employee overcome this difficult stage of adjustment. If there is a healthy atmosphere among the staff, the co-workers will help the newcomer to attain a realistic attitude towards his job situation. Whether the employee is going to stay or not will finally depend on the interpersonal relationships he has been able to establish during those crucial first weeks on the new job.

As I was myself struggling with fatigue and doubts whether I should stay or quit, I tried to understand what it was about Albert Schweitzer and Lambaréné that made so many men and women stay and work there for years. The external factors were indeed not conducive to enjoying one's work. Even the most basic facilities of modern living were lacking, and the air was saturated with humidity during the rainy season, making it nearly unbearably hot.

We would use the relatively cool morning hours to visit seriously ill patients at the bedside, but as the sun rose higher, nurses and doctors had to seek refuge in the sun-protected consultation building. We would spend the hottest hours of the day there because we simply could not move around. Each physician sat at his assigned table. The patients were brought to his table by relatives and orderlies, who also helped them back to their beds after examination and treatment. Lightheaded and nauseated from the heat and with sweat running down our bodies, every movement became torment to us. It needed all the willpower one could muster to get up from the table end walk the few steps necessary during a consultation.

To most of the European staff, French was a second language and since the local interpreters, who spoke several African languages, had only a limited knowledge of French, communication was cumbersome and time consuming.

People had to wait for hours. They stood in lines which started at the tables, crossed each other in the room, and continued down the stairs into the sun-baked passage between the hospital buildings. Patients too ill to be exposed to the sun were carried inside, and the consultation room was soon crowded. The hot, stifling air was filled with coughing, crying, moaning, laughing, and chatting. There was a constant coming and going.

In the midst of all this turmoil, at the largest table, sat the old man, Schweitzer. During my time, he did not give direct treatment to patients anymore, but he came to the consultation room every morning. His table was placed in a strategic position, from which he could see the physicians and nurses at work. While writing letters or working on the evening lecture he prepared for us every day, he kept a watchful eye on us all. If he spotted a difficult situation or noticed a worried expression on a face, he would come over to the table, look at the patient, discuss the problem, and offer his suggestions--or just say some friendly words of encouragement. Such was the power of his personality that even the briefest encounter would lift the spirits, filling staff, patients, and relatives with renewed confidence.

One would strive to keep Dr. Schweitzer's interest to have him stay at one's table as long as possible. Watchful eyes from the other tables would peer over and resentment would arise if one savored his attention for an unduly long period. There were certain persons among us who had the tacit privilege of taking up more of Dr. Schweitzer's time than others. Newcomers and those of us not belonging to the permanent staff were expected to be modest in the use of such privileges.

Special visitors were sometimes taken along by Dr. Schweitzer and invited to sit at his table or to follow him around in the consultation room. The visitor would have to be a very understanding person to gain our sympathy. Our dislike was especially aroused if we sensed that the visitor was only out for sensation, or if he disturbed us by insensitive questioning that betrayed untimely curiosity rather than genuine interest or empathy.

In that regard, we were much more critical than Dr. Schweitzer himself. I do not think he ever bothered to read the criticism that flowed so freely from the pens of some visitors who peeped only briefly into Lambaréné. He felt obliged to give his best in every situation; what the individual visitor did with it was not his concern. This was what endeared him so much to those of us who stayed long enough to look behind his personal shyness. We came to love him for this and for his noble mind and intellectual generosity.

During my time in Lambaréné, there were only three permanent physicians, Dr. Friedman, Dr. Takahashi, and Dr. Müller, who then was replaced by Dr. Munz who later turned out to become the man Dr. Schweitzer chose as his successor. Dr. Takahashi spent most of his time in the leper village. I therefore had to assist at any major surgery. The operating room was built on poles, high above the ground. The only cooling was afforded by an occasional breeze coming through the mosquito screens on the sides of the room which faced the river. The ordeal of standing for hours in the humid, hot air, face mask, hair cover, heavy gowns, rubber gloves and all, was nearly more than I was able to endure.

We tried to get the surgery done in the early morning hours, but unforseen complications or emergencies often forced us to continue far into the day.

Incarcerated hernias, bowel resection, and the removal of large amounts of tissue in elephantiasis, were some of the time-consuming operations we had to perform every week. The duty nurse had to constantly wipe our faces to prevent the sweat from dripping into the operating field. Sometimes when one of us was close to collapse, she would quickly get us a cold drink. We had to twist our heads backwards without letting go of the surgical instruments to sip the vitalizing drink from a cup she held to our lips from behind.

One of the drawn-out operations which so often presented an emergency situation was that of a twisted bowel or an incarcerated hernia. For some not clearly understood reasons, this condition is more frequent in Africans than in other people. Due to a weakness of the abdominal wall, young African men may easily have parts of the small bowel herniate when lifting a heavy burden. Most of the time the bulging parts can be pushed back into the abdomen, but sometimes the herniated bowel part gets twisted, gangrene sets in quickly, and the unfortunate man will die an agonizing death if he cannot quickly get to a hospital.

The damaged tissue must be surgically removed, the bowl reunited, and the hernia opening closed.

But the surgical procedure I dreaded the most was one which Dr. Müller had perfected; namely the removal of the overgrown tissue on the leg of a patient suffering from elephantiasis. This illness is caused by the Filaria parasite, a thin worm which might nestle itself in the lymphatic vessels of the lower extremities, brought there by the bite of a fly. The lymphatic flow may get obstructed with the result that the tissue under the skin begins to grow until the whole leg becomes grotesquely thick and heavy, hence the name.

In order to remove the superfluous tissue, the surgeon must first lift off the skin over the afflicted area, then cut out the fibrous material, painstakingly ligate all the blood vessels, and finally rejoin the skin over the large wound area. The operation may last for hours but with good postoperative care, the success is astonishing and the relieved patient may finally return home with a leg of practically normal size.

My task was mainly to hold up the heavy leg, a dreadful ordeal in the oppressing heat. I would grind my teeth and hold on, sometimes having to use all my willpower not to collapse.

After those long and agonizing hours in the operating room, I often felt utterly drained and close to giving up; I could not see myself facing this ordeal over and over again. But because none of the others complained about the physical discomfort they suffered, I did not want to bring it up either. It was simply not acceptable to talk about such things as the climatic conditions. When guests and other newcomers inevitably remarked about the terribly hot weather, they were met with cool indifference by Albert Schweitzer and with little sympathy from the others. Further elaboration on that theme was strongly discouraged until finally the newcomer would give up his futile protests. Like the rest of us, he would resign himself to accepting that it was and would always be very, very hot. Once that stage was reached, there was less mental agony connected with the physical discomfort, a fact that made it easier to adjust to the tropical climate; unlike air-conditioned rooms which constantly remind one of the temperature differences.

The work in the old operating theater in Lambaréné was not without its heroic and humorous moments, however, and that put some glamor into the drudgery. Once we operated on a young woman with a ruptured extra-uterine pregnancy. As we opened the abdomen, blood gushed forth and we knew the patient urgently needed a blood transfusion. But there was no blood available, as none of the woman's family was present. There were pints of her own blood in the sterile container of her abdominal cavity, though. Why not give it back to her? Quickly we got hold of a strainer and, with the help of some anticoagulants, we had a makeshift “auto-transfusion” going, scooping up the blood from her abdomen and infusing it through her arm vein. The surgeon was then able to complete the operation and the woman recovered without any complications.

Another time it happened that a lizard, overpowered by ether vapors, dropped from the ceiling right into the open abdomen. Without a word, the surgeon took the forceps, fished out the lifeless animal, and threw it over his shoulder. He sprinkled antibiotic powder into the abdomen and continued the operation as if nothing unusual had happened. The patient never showed any ill effects from that unexpected intruder.

Except for our contact with the visitors, we were quite isolated in Lambaréné. No television or radio connected us with the outside world. Venturing down to Lambaréné village after work was no exciting experience; the sleepy little place provided no western entertainment. Therefore we had to rely upon our own ingenuity for recreation.

We all had our times of fatigue and depression and would watch each other, looking out for signs of an impending crisis. If a nurse became tearful more often than usual, or if a colleague began to withdraw from our evening socialization, we would surround that person with sympathy, make him ventilate his feelings, and find something with which to cheer him up. Next time, when one of us felt down, he would do the same.

Because women were in great excess of men, the women learned to moderate their competition for male attention. When it became clear that a romance was developing, the group discreetly allowed the couple some privacy, though emotional expression was quite inhibited. Maybe this was due to the presence of the old man Schweitzer, whose self-discipline was legendary; or maybe it was the realization that true friendship within a group depends upon emotional restraint and a fine balance of giving and taking.

We genuinely enjoyed each other's company and none of the permanent members of staff felt left out or unwelcome. We used to invite each other over in the evening and compete in providing good entertainment: a gourmet meal; music played on the old record player, a poem read aloud, or just an interesting theme for discussion; everything was received with gratitude and in good spirit.

On occasion, we stayed on in the dining room where some of us practiced chamber music while others were reading or sitting together listening and talking. Great was our excitement when we had a piece of music ready for presentation. Then we would invite Dr. Schweitzer to come over. As nervous as if we were in a concert hall, we waited for him and his entourage to be seated. If our performance went well and we saw the warm glimmer of appreciation in his eyes, a feeling of accomplishment and pride filled us all. Albert Schweitzer would stay on for a while and play on the piano, or just mingle amiably with us; he would soon have everybody laughing over his witty remarks.

Once I got the idea of molding chess figures of wax from red and white candles. Eric, our Danish carpenter, made a chess board, beautifully inlaid with black and yellow wood, and for a while Lambaréné was in uproar; chess wars raged from one end of our quarters to the other. Before we realized what was happening, we had fiercely competitive male against female chess matches.
Once, when I called Dr. Müller checkmate, the outburst of triumph by the nurses finally annoyed him so much that we had to stop playing. The zest for the game got somehow lost after that incident.

Whether there were any broken hearts when it became obvious that Eric was courting the hot-tempered housekeeper Katharina, I did not find out. It seemed to me that everybody was happy because Eric, who was a shy, rather withdrawn and hardworking young man, had found himself such a lively companion and we smiled when we heard her teasing laughter through the thin walls of Eric's room. When Katharina got ill and was ordered by Dr. Schweitzer to return to Europe, Eric soon followed her. She recovered quickly and they married in her hometown in Southern Germany. As far as I know, they both returned to continue their work with Dr. Schweitzer sometime after I had left Lambaréné.

Sometimes nurse Anne-Lise spent the better part of the evening at the hospital looking after sick children. I loved to accompany her on her rounds. We carried kerosene lamps, since there was no electricity at Lambaréné except for that produced by a small generator for the operating room and for some hospital apparatus. Dr. Schweitzer did not want to have the beauty of the tropical night disturbed by the noise of big generators.

The Africans would light small fires in front of their tiny hospital compartments. There they cooked their evening meals, the families and often also their sick members sitting or lying around the fire talking and eating. The hospital provided cooking bananas, maniok, and other fruits and vegetables to supplement the people's own provisions and there was enough food for everybody. Dogs, goats, and chickens belonging to the people went in and out of the rooms.

Smoke burned in our eyes as Anne-Lise and I stepped cautiously over pots and pans and sleeping children in the narrow spaces between the houses. The smell of food and the peaceful noises of people eating and preparing for the night gave us a relaxed feeling as we searched for our little patients in the crowd. People were lying everywhere; it did not seem to matter to them whether they slept in, under, or above the beds, or simply on boards which they covered with grass mats. It was dark inside the compartments.

I admired this nurse, who could distinguish the patients from among the sleeping children in the dim light of the kerosene lamp. She joked with the people and gave her instructions for the night. People responded with friendliness and gratitude. We felt glad with them when a little child showed improvement and shared their concern when its condition had worsened.

Together Anne-Lise and I walked up the hill to our own sleeping quarters after doing the rounds. As we listened to the many noises of the tropical night and watched the brilliant stars shining through the gently swaying branches of the palm trees, there was peace in our minds and a fine feeling of friendship between us.

When the first few weeks had passed, I began to wake up every morning refreshed and full of joy, curious about what the day would bring and looking forward to the hours after work with my new friends. I knew now that it was the fondness for Dr. Schweitzer and the spirit of friendship among the staff which helped us overcome all hardships and which induced many of us to stay on for a long time.

I seemed to get along well with everybody in Lambaréné, with one exception: the big, fat turkey which walked around the yard. For some reason he had singled me out as his Enemy Number One. As the only way of getting to the outhouse was by crossing the yard and walking down the narrow path toward the river, I could not avoid the daily confrontation with this ugly bird. No sooner had he seen me than he came running, his wings dragging and his head red and swollen in anger. He would puff himself up, letting out warning noises that sounded like little explosions. Stretching forward his beak, he tried to get at me from behind as I hastened across the yard to reach the narrow path before he had a chance to corner me.

The others laughed at my trouble, but I was really afraid and suffered much discomfort trying to hold off my visits to the outhouse until dark when the turkey was not around. One day as I was again fending off his angry attacks, Albert Schweitzer happened to pass by.

“Why does this turkey always bother me?” I cried out in exasperation.

“I guess he enjoys pinching your legs, young lady,” he joked, with a chuckle.

An old African, noticing my plight, picked up a stick and began to chase the turkey away.

“Que fais-tu!” shouted Dr. Schweitzer with thundering voice. The man threw himself to the ground and face down prostrated himself at the feet of the old doctor. “Eh bien, get up,” said Albert Schweitzer and continued on his way.

The whole scene had lasted only a few seconds and nobody else seemed to have noticed it. But I felt just as shaken as the poor man. Later, when I described this event to one of the nurses, she told me that many of the older Africans believed Albert Schweitzer to be a supernatural being whose anger they feared like the wrath of an ancestral spirit.

People of the tropical forest feel great respect and admiration for the aged. They reason that you must be exceptionally intelligent and have a strong spirit to be able to survive into old age. The older a person gets, the more he is revered until, after death, he becomes something like a deity. To the people of the Ogowe River, with their short lifespan, Albert Schweitzer appeared immortal. He was there when they were born, they heard about his deeds when their parents were young, and he was still strong while they grew old and weak. The power of his personality overwhelmed and frightened them. It is precisely these ambivalent feelings which also characterize the attitude toward a powerful healer in their own culture. The jungle people's faith in the old doctor's healing power was limitless. It colored everything in Lambaréné and influenced every African who lived and worked there.

Copyright © 1990 Louise Jilek-Aall
Reprinted with permission

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