When I made my tour of the new hospital that first evening, there resounded from every fire and every mosquito net the greeting: “It's a good hut, Doctor, a very good hut!” So now for the first time since I began to work in Africa my patients were housed as human beings should be!
(Albert Schweitzer, My Life and Thought p. 245)
Long before I came to Lambaréné I had heard criticism of Albert Schweitzer. Journalists and visitors, especially from affluent countries, blamed him for running an overcrowded, old-fashioned, and unhygienic hospital. When I first arrived, I discovered those statements about the hospital did indeed appear to be true, but it did not take me long before I understood why the Africans nevertheless crowded into Albert Schweitzer's compound instead of going to the half-empty government hospital near Lambaréné village.
Like most of the so-called “modern” hospitals that I saw in Africa, the government hospital had solid, whitewashed brick walls, hard cement floors, and large wards with two rows of beds, twenty or more to the room. The rural Africans were frightened of an atmosphere seemingly desolate and too cool for comfort. Accustomed as these people were to dark, small huts with the familiar physical closeness of their people, they felt dejected and lonely in bright and spacious hospital wards.
How often had I observed the pitiful, lonely African patient tightly wrapped in his hospital blanket, with head covered in order to feel protected. If disturbed, the patient would peep out with frightened eyes from under the covering, throwing fearful glances at staff, hospital equipment, and at the patients in the surrounding beds.
Few foreign nurses and physicians, I think, can know the anxiety such a person experiences, lying defenseless and close to others whose sick-making spirits may jump over to him, or who might come from an enemy tribe likely to harm him during the night. Unable to understand the language of those around him, the patient is often terrified when nurses take blood or urine for examination, with no explanation as to where it goes and what is done with it. In the African's world, body materials are commonly used for magic and sorcery against the owner. While lying helpless in the hospital, alone and far away from his village, the patient worries about his family at home. Loneliness, worries, and fears are impeding the healing process. Anxiety and depression often render the patient sleepless at night; fears of poisoning make him dread the hospital food.
Albert Schweitzer, as well as those of us who had lived for years in tropical Africa, knew that after a prolonged absence from home, a man might return to find his hut in ruins. Taking advantage of his absence and a defenseless family, old enemies or marauders from neighboring tribes might rob the place, drive away the livestock, and abduct his women and children. To avoid such tragedies and to make the sick person feel at ease while recovering in the hospital, Dr. Schweitzer allowed the patient to bring his entire family along--grandparents, wives, children, goats, dogs, chickens and all.
Dr. Schweitzer's hospital did not have large hospital wards. Each patient and his family was allowed a compound; a large room where everybody could live and sleep with what little privacy they needed and with cooking facilities outside in front of the quarter as well as space for their animals and for whatever food or other supplies they had brought along.
Aware that anxiety can kill, Albert Schweitzer did not allow non-emergency treatment to start before the patient and his kin were comfortably installed. Everybody, including the next-door neighbors, must feel at ease, even if it were to take much time and a lot of shifting around of people. Only while under intensive treatment and for a few days before and after surgery did a patient stay in a separate ward where modern hygiene prevailed. As soon as was medically feasible, he was returned to the family compound. There, trusted relatives cooked their food and attended to the person's needs under the supervision of hospital staff.
In exchange for their quarters, the healthy family members were expected to render services to the hospital. Some helped in the upkeep of the buildings, others worked in the garden, which provided fruits and vegetables for the hospital population; some attended to the children, while others did the hospital laundry. With this arrangement, patients and families felt they were part of the hospital community, as their lives continued in much the same way as in their own village. The shock of being sick and hospitalized was thus greatly reduced. To be surrounded by his own, caring family gave the patient peace of mind and the courage needed to endure pain. Even death in the hospital lost some of its frightening aspects because the family was there to perform the required rituals.
In the operating and the recovery rooms, Dr. Schweitzer's hospital was equipped as modernly as it was possible in such a remote place. Here the staff had to keep up with modern standards of hygiene. Patients were thoroughly prepared and sterilization procedures of all instruments followed the rules of any modern hospital. During the postoperative recovery phase, the patients were kept in a separate building where they were attended to by nurses with all the most sophisticated and modern medicines the time could offer. But as soon as the patient was out of danger he would be returned to the care of his family in their private compound. Schweitzer's hospital thus provided the feeling of security that is so important for keeping up the patient's resilience and will to live.
Observing the astonishing recovery rate of Albert Schweitzer's patients and the remarkable resistance of African villagers to wound infections, I was convinced that more Africans fall victim to stress and anxiety in modern “sanitary” hospitals than to whatever unhygienic conditions there were in Albert Schweitzer's cozy establishment.
Although families of the patient often arrived with their canoes loaded with goats, chickens, and other provisions, there was always a need for more staple food than the people and the hospital gardens could provide. Dr. Schweitzer, therefore, bought large quantities of cooking bananas, rice, and other crops from villages around Lambaréné. For that purpose, he had had roads built to connect the scattered villages with the hospital. Siegfried, a German-American volunteer who drove a hospital truck, made a round trip through the villages once a week with a few local people to buy whatever supplies were available. They also took it upon themselves to maintain the roads, which were quickly damaged during the rainy season.
It was considered a holiday when Siegfried took along a staff member on one of those trips. We helped each other out with the work at the hospital so that whoever needed a break could have the opportunity. Because of the very busy time at the children's clinic, I was only once able to accompany Siegfried on one of his shopping trips.
We started out early in the morning. While the truck crept along the dirt road, carefully avoiding the biggest potholes, I leaned back and enjoyed the freshness of the early hours. As usual, there had been a heavy downpour during the night. Now, as the sun came up and glittered in myriads of raindrops on leaves and grasses, a smell of decaying underbrush mixed with fragrant whiffs of tropical flowers came through the open windows of the truck.
People were already waiting for us along the roadside with bundles of bananas and sacks of rice. It was a pleasure to just sit back and relax, to observe and listen to the hustle and bustle around. The vendors joked with Siegfried and drove a bargain, more for the fun of it than because they expected a high price. They knew the food was their contribution for the upkeep of “their” hospital, and eventually everyone settled for what was reasonable.
There was probably no family along the road that hadn't had at least one of its members helped at the hospital at one time or other. People also knew that a physician or a nurse coming along in the truck would see to the sick in the villages. To my delight, some women recognized me as “la doctoresse,” who had treated their children. Mothers came up to the truck to shake my hand, show me their children, or give me some small present of fruits or eggs. One woman ran back into the village and reappeared with a live chicken. The boys took care of the struggling bird for me.
It was past noon when the truck was filled with cargo and we were on our way back to the hospital. I was dozing in the midday sun when Siegfried brought the truck to an abrupt halt. An old man was blocking the road. He approached and anxiously asked Siegfried if a doctor had come along, as his wife was very ill. Siegfried knew of some business he could do in the meantime, so I followed the old man to his hut.
Coming from the bright sunshine outside, it took me a while before I could distinguish the figure of a woman in the dark room. She was lying on a mat beside a smoldering fire, but she sat up and smiled when I knelt beside her. Apart from a large abdomen, she was quite emaciated; her skin lay in folds around her limbs. I judged her to be well past middle age. The husband, who spoke some French, explained to me that a lump inside her stomach had grown steadily for several months, causing her great discomfort and pain. I examined her carefully. To my surprise, I found her to be pregnant!
I looked at her wrinkled face and dried-out breasts. Could I be mistaken? I went over her more thoroughly and was sure I could feel a child's head under the thin abdominal wall. Placing my stethoscope on her abdomen, I clearly heard the rapid fetal heartbeats. There was no doubt. I told the couple the exciting news. The husband laughed and shook his head.
“Why you make a joke?” he asked, “we are prepared for bad news.”
I repeated there was no illness but that the child was nearly at term and would soon be born. The old man shook his head again. Turning to his wife, he said something in their language that was unfamiliar to me. She laughed and covered her face with her hands.
“Do you not see that my wife is an old woman?” the husband asked indignantly. “She, who has given birth to eleven children already, would she not know if she was with child? This is indeed a bad joke, it would be better if you told us the truth, or simple admitted you do not know what is wrong.”
He raised his voice so that the neighbors, peeping in curiously, could hear his words. It was an odd situation. The couple was by now visibly upset. As elders, the idea embarrassed them in front of their people. They were afraid they would become the laughing stock of the whole village. But nature, not I, had made the joke.
The woman was probably not as old as she looked. At any rate, she would have to give birth. I could see the pregnancy had sapped her strength and she might not survive the ordeal of childbirth in her present weakened state. I quietly agreed that her condition was indeed serious; he'd better take her to the hospital and let Dr. Schweitzer decide what to do.
They readily consented and the husband agreed to bring her in. Dr. Schweitzer was at first amused when I told him about the old couple's dilemma, but when he spoke it was with concern.
“What will the future hold for this child? To the Africans,” he explained, “it is an unnatural event to bear a child at this mother's advanced age. Witchcraft will be suspected by the neighbors. Even the parents will be afraid of the child and probably let it succumb before long. Perhaps we can persuade the parents to leave the child in the nursery.”
There were always some abandoned children and orphans at the hospital being looked after by kindhearted African women and nurses. Another baby would pose no problems.
The couple arrived in Lambaréné a few days later in their canoe. The expecting mother was by now so feeble she had to be carried into the consultation room. It was indeed a pitiful sight, the weary old woman and her sad-looking husband, prepared to hear that she was going to die from a terrible disease.
They were not pleased to see me and turned away. Dr. Schweitzer talked to the husband about bygone days while he examined the woman. When he saw that the couple felt more at ease, he turned to the pregnant woman. Through an interpreter, he asked about her children, how many she had borne, whether they were still alive, and what they were doing. He continued to examine her carefully as he talked gently to her. Then he sent away the interpreter and other onlookers.
When we were alone, he told the husband in French: “My friend, there is no doubt, your wife is going to have a child.” As the old man bowed his head in dismay, Dr. Schweitzer continued, “I know it sounds impossible to you and you would rather not have another child at your age, but to us, this will be a special baby. We would like to make it a child of the hospital. Leave the child with us--if it is a boy, I shall give it my name; if a girl, we shall name it after la doctoresse. You need not tell anyone. Just stay at the hospital and look after your wife until she is well. When the child is born, we will keep it in our nursery. Should you wish to return at a later date to see your child, you will know which one is yours by its name. Our hospital children can be adopted by anyone who wants them. If you decide that you want your child back, you can adopt it just as easily as any other family can.”
The old man, unable to find words, pressed the venerable doctor's hand. The couple left with the nurse, who would be the only other person to know their secret. She took them to living quarters separate from the patient population.
We used the short time before delivery to build up the nutrition of the expectant mother. Then one night I was awakened by the breathless husband, who had run up the hill to our quarters. Fortunately the child was born without much labor. It just easily followed the path of eleven previous babies. The mother hardly knew that birth had started before the baby was already born ... and by working swiftly the nurse and I were able to prevent too much bleeding. Blood-loss was something this feeble mother could hardly have survived. When the mother woke up from an exhausted sleep, I could tell her that Louise, the newborn baby girl, was resting peacefully in the nursery. The old mother barely smiled. Her husband was visibly shaken. They had not really believed us until the baby was actually lying there between the mother's legs.
It was quite touching to observe how well the old man cared for his wife while she was recovering. It took weeks before she was well again but there was no drop of milk in her breasts. Had she remained in their village, both she and the baby would surely have perished. The couple lingered on in the hospital much longer than we thought necessary. But we never saw them visit the nursery or display any interest in their child. Suddenly, one day they were gone. They had slipped away in their canoe and returned to their village without a word.
Baby Louise became a much-loved hospital child. Whether her parents ever came back for their daughter I do not know, for as long as I was there she lived and thrived in the nursery.
Copyright © 1990 Louise Jilek-Aall
Reprinted with permission
[Previous Chapter] [Contents] [Next Chapter]
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.