Constantian 1
THE GOLDWYN DIARY OF NOVEMBER AND DECEMBER 1960, AT THE ALBERT SCHWEITZER HOSPITAL, LAMBARENE, GABON
Robert M. Goldwyn, MD
Clinical Professor of Surgery, Harvard Medical School
Edited and Forword by
Mark B. Constantian, MD
Active Staff, Department of Surgery, Saint Joseph Hospital, Nashua, NH,
and the Division of Plastic Surgery, University of Wisconsin Medical Center,
Madison, WI
DR. SCHWEITZER’S BACKGROUND
Dr. Albert Schweitzer was born on January 14, 1875 in Kaysersberg, a town near Strasbourg in Alsace, then German, now French. The older son (he had also three sisters) of a Lutheran pastor and studied at the University of Strasbourg, where he took his doctorates in philosophy and theology. In 1910 he wrote an unusual book that gained him fame: The Quest of the Historical Jesus. In addition to these achievements he was a brilliant organist and had a doctorate in music also from Strasbourg.
Despite his many activities and accolades he was struggling to make his life worthwhile by his own standards. “It struck me as incomprehensible that I should be allowed to lead such a happy life.” In 1904 he read the bulletin of the Paris Missionary Society: “I quietly began my work. My search was over.” He was 39.
The following year Dr. Schweitzer announced his intention to become a mission doctor in Africa. The Dean of the University, in fact, thought his decision so bizarre that he suggested that Schweitzer seek a psychiatrist. Nobody and nothing could deter him then and never would.
DR. SCHWEITZER’S LIFE IN AFRICA
In 1913 Dr. Schweitzer officially received his Medical Degree. With his wife, Hélène Bresslau they sailed from Bordeaux to Lambaréné. Mrs. Schweitzer had received training as a nurse and was to be an invaluable helper.
He went not to convert but to serve medically all who needed him. With the help of the natives, he built his hospital, even to supervising the felling of trees. Dr. Schweitzer equipped this rudimentary hospital and maintained it at first with earnings from his concerts and writings. A unit for those afflicted with leprosy and their families was added later with the money ($33,000) that he received from the Nobel Peace Prize in 1952.
During World War I, he was interned in Gabon as an enemy alien because he was German. He was later transferred to France as a prisoner of war. While in Africa and able to continue his hospital work only sporadically, he constructed a simulated organ with foot pedals so he could practice his beloved Bach.
After WWI ended, he wrote Kulturphilosophie (1923) “Philosophy of Civilization”, in which he expressed his belief in “reverence for life,” an ethical principle that he had conceived in 1913 while on a boat on the Ogowe River. Schweitzer believed “reverence for life” was essential for the survival of civilization. In 1924 he returned to Africa to rebuild the hospital.
GOLDWYN AND SCHWEITZER AFTER LAMBARÉNÉ
After I had left Lambaréné, I corresponded with Dr. Schweitzer but was concerned I was burdening him because he would feel an obligation to answer me. Nevertheless, I could not resist maintaining my connection with him. He was extremely gracious and prompt in replying. Dr. Schweitzer had the amazing ability of making those who visited and especially those who worked with him in Lambaréné feel a special affinity to him.
Dr. Schweitzer died at 90 and was buried next to his wife at the hospital. He had spent 52 years in Gabon.
This diary I can honestly say I never thought would become public. The years have passed; I am now 77. I realize that not many of those who served in a medical capacity at his hospital are still alive and not everyone will share his or her experiences.
I want to make clear that I was with Dr. Schweitzer only two months. I would not want anyone to think that I played a strategic role at the hospital. I did not but I helped as best I could.
Although I have traveled throughout the world and have been a surgeon in many out-of-the-way places, I have not returned to Lambaréné. The reason, I confess, is that I wanted it to remain in my mind as it was. For Dr. Schweitzer and those who served there, his hospital was a way of life. It was a world of its own and, though small, it came into being because of the arching ideals and unflagging dedication of a remarkable man. His example should inspire us to enlarge our personal horizons, not just to recognize the less fortunate but to act without delay on their behalf. For each of us there is an Ogowe waiting to be crossed.
THE GOLDWYN DIARY: THE FIRST MONTH
Day 1 at Lambaréné – November 2, 1960
I was taken to lunch and, as the most recent arrival, placed opposite Dr. Schweitzer, with whom I conversed in French. His voice surprised me by being slightly high pitched. At dinner we sat around an enormous table and the lighting was by kerosene lamps. The food was abundant and tasty: fried bananas, tuna fish salad, cheese soufflé, stewed mangoes, and cold (boiled) water. Dr. Schweitzer (as I later learned would be his custom) then read the Bible in German and gave a two hour lecture on the rise of Luther. I had taken enough German in college to understand most but not all of what he said. He then played a hymn (sometimes he played two hymns) on the piano that was against the wall of the dining room to the left as one entered. Dr. Schweitzer quickly stood up, announced: “To work (in German)” took his hat off the hook, and left to return to his room, as did we to our own quarters.
There is a Leper Colony with about 170 patients, and if one includes families, the total is about 400 people. The average stay is about 3.5 years. Sulfones have been introduced within the past few years and are now being used routinely. The larger hospital has about 350 other patients as well as their families. Routine upon admission: CBC, urinalysis, and there is a native who reads urine and stool for ova and parasites. Almost 100% have amebiasis as well as ascariais and 80% have filariasis. Because of these parasites and other ailments, an average of one to two weeks is required to prepare the patient who might also need a transfusion. Many come here with uterine fibroids, one of the most common problems, and supracervical hysterectomy is a frequent procedure. Herniorrhaphies, unilateral or bilateral, occupy most of the schedule. Patients do not seemingly mind (but probably did) pelvic and rectal examinations which are done without chaperones. Total operations were about 500 for the year 1959-1960 and can be as high as 50 a month.
Clinic days are Monday, Wednesday and Friday. Operations are scheduled on Tuesday, Thursday and Saturday mornings. Dr. Schweitzer sits in the Pharmacie (called formally La Grande Pharmacie) at his desk. Patient beds are close together and each bed can accommodate 2 or 3 of the same family. There is no separation of males and females, and families are never divided. The sick person with his family entourage surrounds him. Beds are high enough to allow storage of cooking utensils. There is no common kitchen. Each family prepares its own food because of fear of poisoning. Promiscuity is high with fights. At eight PM the bell sounds for bedtime and peace.
The Ogowe River has no crocodiles but electric eels and hippopotami. A “casque” (sun helmet) is worn at the request (demand) of Dr. Schweitzer to prevent injury from a falling coconut. We wear white (for me a white shirt ad yellow chinos) and one can see the mosquitoes or tsetse flies better against that color.
The natives in this area are Fang (a bantu speaking people of North Gabon, Equatorial Guinea and Southern Cameroon). They are said to have been warlike, now jovial but quick tempered. They originally came to Gabon through Port Gentil, which had a large slave trade.
Snake bites are rare although vipers are common. Wild boars are said to be common also and occasionally a goat is a victim of a boar. However, only one boar has been seen by one nurse during her stay here of 5 years.
Dr. Schweitzer is not liked by all the natives, who consider him too autocratic, but he and the hospital are respected. Because of him, it has a large reputation with troupes of patients coming here from the jungles.
Dr. Schweitzer’s ether device (for anesthesia) sometime ago resulted in two patients being lost since there was no monitoring (of vital signs) involved. No pure oxygen exists.
Day 2 at Lambaréné - November 3, 1960
In the operating room equipment is adequate but anesthesia spotty. Local anesthesia is used whenever possible. For general anesthesia open drop ether or a bellows with an endotracheal tube is employed. For very short cases intravenous muscle relaxant is given and ethyl chloride administered.
In general the nurses are attractive, strong, German, Swiss or Dutch and seem to have no fear. They are good diagnosticians and are good with the natives’ family. There are formal rounds to see patients, especially those who have had a recent operation. Rest hour is from 12 to 2 with breakfast at 7:30 AM and lunch at 12:20 PM and dinner at 7:00 PM, bells sound the events.
The dinner table is massive, solid, covered with a white table cloth. It usually seats 25 to 28 people although it can accommodate more. Dr. Schweitzer is always at the center facing the dining room entrance. A nurse and 2 cooks who have been with him for decades prepare food for the white staff, visitors of color and guests. Thursdays we had spaghetti and meatballs, plain bread, no butter, dessert of apple sauce from local orchards. On Saturdays a special meal with bread and butter, cheese, salami, coco (We ate well). Dr. Schweitzer occasionally has special portions. Mlles Mathilde and Ali help serve him. Mlle Ali handles a tremendous amount of his correspondence. She has had only one vacation in 10 days.
Occasionally Dr. Schweitzer drums his fingers on the table and practices on his organ in the morning and at night. He can work in the Pharmacie (outpatient department, dispensary, operating room) through all noises, interruptions and without adequate lighting – always writing letters.
More pets of Dr. Schweitzer include many goats, two chimps, and the pelican called Parsifal, named after the Opera by Richard Wagner, whose works Schweitzer admired. He knew Wagner’s second wife, Cosima, who has helped him raise money for the hospital.
We could use more x-ray equipment and do more chest x-rays and flat films of the abdomen. We could have better care if we had more nurses (the nurses in Lambaréné were extremely hard working, totally dedicated, unbelievably efficient and resourceful).
Day 3 at Lambaréné – November 4, 1960
It is amazing that Dr. Schweitzer built all this from practically scratch – that he can still write books on philosophy, plays the organ superbly and maintains his great knowledge of their construction, and is a master of the compositions of Bach. He works continuously and did so when he used to operate. He treats disease in very practical ways and carriers on an immense correspondence.
I note that the native women’s posture is amazingly good perhaps from always carrying things on their head.
Dr. Schweitzer is informed about a lady who had a cataract operation and the diagnosis of pneumonia was missed. Dr. Schweitzer said “All our life we doctors learn. In old patients, always examine more carefully, always try to avoid surgery.”
It is reassuring to see Dr. Schweitzer walk around the hospital, sometimes in deep thought, with his hands clasped behind his back but nevertheless managing to observe almost everything and stopping to pay attention to his pets or to give an order whenever he thinks it is necessary. This hospital is his domain and will always be his as long as he is here. Continually we have visitors and journalists, bags of mail, reporters and new books arrive all the time with dedication to Dr. Schweitzer. I look at the stamps to see from what country they were sent.
When patients have a cough we obtain a chest film and since it may be pneumonia, penicillin is given, which serves also to treat gonorrhea if it happens to be present. For tuberculosis, we use streptomycin which has been employed here for many years. We do not see evidence of vestibular damage, such as dizziness.
When a patient is hospitalized, usually the whole family comes: sister, wife (or wives) daughters serve as nurses; brothers, husbands and sons work around the hospital and this is the way the patient earns his keep.
Treatment for worms is always paid for even if it is a token amount – something that would correspond to ten or twenty cents or maybe even eighty cents; otherwise every native would come for treatment even if they do not have the disease because they like the idea of going to the hospital and of receiving pills. The wards, about 26 of them, are called Cases and may bear in addition the name of a nurse or philanthropist – always a friend – can accommodate 30 with families. Besides the bed there are bananas, grass mats, stools to squat upon – a piece of wood, bidet, water basin, roots for eating, occasionally even chickens. The proximity of the patient to his family and their emotional support and even physical help in the care is something we can in so called developed countries learn from. Dr. Schweitzer asked me at the end of an operation: “You like this learning experience?” I replied in the affirmative enthusiastically and thanked him for the opportunity.
With so many visitors, to protect oneself and get the work done, doctors have to maintain some routine. Visitors themselves display their own weaknesses. Many do not know tropical diseases and occasionally the other doctors here generalize this weakness into the visitor’s sphere of knowledge where he is proficient. I am glad to have few distractions – no paper (except for this diary), TV, or radio. I am here to observe, to do and I am able to think clearly. At home, previous associations except for Roberta (wife) and parents seem alarmingly distant.