Judith N. Wagner, MD
Max Planck Institute for Psychiatry, Munich, Germany

The Albert Schweitzer Hospital

Welcome to the jungle

In a sultry day in equatorial Africa. The oppressive heat stifles all but the most necessary conversation between the few individuals perched on a wooden plank of the canoe floating along the vast lazy stream. On the banks of the Ogooué, lush vegetation drifts past. The monkeys’ howls mingle with the chirp of colorful birds and the buzzing of mosquitos. The searing sun burns down from a steel blue sky, but the slow build-up of towering clouds augurs another torrential tropical rainfall. The canoe leaves the central current, drifting off towards a small landing stage protruding into the river.  The new arrivals become aware of an aggregation of yellow single-story buildings dotting the emerald green of the virgin forest. It is a place teeming with life, human and animal. The chime of church bells penetrates the humid air, a welcome for the visitors clambering out of their dugout.

The initial impression for a first-time visitor arriving at the Albert Schweitzer Hospital in Lambaréné, Gabon during the lifetime of its founder must have been that of entering an African village rather than a medical precinct.1 Various barracks were strewn about the bank of the Ogooué, Gabon’s largest river, the buildings set on poles to prevent rainwater from seeping in. The facilities included an operating room, a house for post-surgical patients, staff quarters, a kitchen, and a dining-hall.2 For ventilation, openings were left under the roofs on the transverse sides of the huts. Only the patients’ lodgings had electricity – staff members would rest, eat, and study by the light of a kerosene lamp. Patients were accompanied by at least one or two family members who tended the invalid – preparing meals, washing clothes, and assisting with personal hygiene. Patients, staff and visitors shared the area with a number of feral and domesticated animals – a tribute to Schweitzer’s ethos of “reverence for life”, which prohibited even the killing of vermin and mosquitos.

The history of the Albert Schweitzer Hospital (ASH)
The first foundations of the ASH were laid in Andende, a district of Gabon’s provincial capital of Lambaréné, located on the right bank of the Ogooué opposite the current site of the ASH. The Alsatian Schweitzer (born January 1875) had already excelled as a theologian, philosopher, and organist when he took up medical studies in 1905. From the very beginning, he was captivated by the idea of becoming a medical missionary in Africa and established ties with the Paris Missionary Society.3 When he launched his African adventure in 1913, the Society provided the premises for the first ASH (ASH I) – albeit not much more than a makeshift consulting room in a chicken pen where a former cook translated the patients’ native tongues into French. The outbreak of World War I further hampered Schweitzer’s efforts: house arrest was imposed upon him and his wife Helene, and his medical activities were severely impeded. Finally, in 1917, the couple was interned and deported to France. In 1918 they moved back to Alsace. Run out of funds, Schweitzer worked as an assistant physician in a Strasbourg hospital, all the while scheming to return to Africa.

In 1924 he was finally ready to once more shoulder the arduous journey to Lambaréné. On arriving to  the site of ASH I he was confronted with its ruins, the tropical climate having taken a heavy toll on the bamboo structures. Supported by a medical student, Noël Gillespie, Schweitzer reconstructed the hospital (ASH II) and resumed patient care.

The new facilities, however, proved insufficient when only one year later outbreaks of dysentery unsettled Gabon. Schweitzer was dismayed that he could not separate infectious patients from the non-infectious ones to prevent contagion on his premises – the area did not allow for expansion of the hospital. Furthermore, he rejected his dependence on the good will of the missionaries and their Parisian headquarters. Determined to alter these conditions, Schweitzer went about erecting ASH III, creating a place of refuge for the destitute and ailing that would remain in place up to the present day.

ASH III was built according to Schweitzer’s drafts on the left bank of the Ogooué, where sufficient land was available to realize his ideas. The construction was completed in 1927. The final object to be moved there from Andende was Schweitzer’s piano. This instrument had beforehand served for the passengers’ amusement on the ocean liner Schweitzer had frequented on his transatlantic travels. On one occasion, it was presented to him by the captain and transferred to Lambaréné, where Schweitzer played it for the edification of his staff. He was professional enough a musician to please their ears even after half of the keys had succumbed to the rigors of the elements.

To accommodate the growing numbers of patients and their companions, the hospital kept being expanded over the years. Schweitzer laid out a garden to provide fresh fruit and vegetables for staff and patients. Water was collected in a deep cistern and boiled before use in the hospital.

Schweitzer directed special attention towards the care of those afflicted by leprosy. Somewhat apart from the hospital, a leprosarium had existed from its very beginning. After World War II, foreign donations and the money awarded with the Nobel Peace Prize which Schweitzer gained in 1952 allowed him to replace the lepers’ village’s basic bamboo huts with cabins of corrugated metal. He called the hamlet “village lumiére” – village of light, and it remains in place to the present day. Schweitzer was also one of the first physicians to use dapsone for treating leprosy.

On September 4, 1965, Albert Schweitzer – aged 90 – died in Lambaréné. He was buried in the hospital’s cemetery next to his wife Helen. His death, political upheavals leading to Gabon’s independence in 1960, decreasing foreign donations, and rising complaints about the hospital’s antiquated infrastructure led to a crisis.

Controversies and transformations
Yet during his lifetime, Schweitzer had been confronted with critique: by some he was deemed autocratic and paternalistic towards the staff, not accepting the local African people as equals but rather regarding them as “my brother, but my younger brother.”3 There were complaints about hygiene and sanitation as humans and animals co-exited on the premises, and patients’ family members spread over the compound, washing clothes and preparing meals with toddlers stumbling about. Also, modernization had not yet found its way into the hospital. Several buildings lacked electricity and running water, the barracks were rotting away, and some patients languished in windowless rooms.

Despite of these shortcomings, the rush of patients demanding treatment at the hospital remained unabated. To meet their needs, major transformations were unavoidable. In 1974 the patronage of the hospital was transferred to an international foundation working according to Gabonese law. The foundation was jointly financed by the revenues generated at the hospital, payments by the Gabonese government and donations.4 With monetary funds being secured, a modern hospital was built at the site of ASH III, where it was ceremonially inaugurated in 1981. But there remained accusations of colonialism as staff – and particularly the leadership ranks – were principally composed of Europeans. Tensions between white and black hospital board members culminated in 2011, when controversies about the institution’s director led to a strike by the staff.5 Leading the ASH into the future would require turning it into a truly Gabonese hospital – a transformation successfully accomplished. Nowadays, most of the doctors and nurses are recruited from the local population. In 2012 the institution came under African leadership for the first time in its history – Gabon-born Antoine Nziengui was unanimously approved by staff and the board of directors as the hospital’s director.

The hospital today
Today, the ASH is a modern hospital with about 270 employees, two operating rooms, a dental clinic, and inpatient wards for pediatric, adult medicine, surgical, and obstetrical patients.6 The leprosarium still exists while only fifteen  patients continue to live there. In 2013, a total of 6246 in-patients and 22300 out-patients have been treated at the ASH, mostly in internal medicine and pediatrics.7 The hospital engages in public health, training regional health workers, and launching community outreach programs to provide village-based health care with a focus on infectious diseases such as tuberculosis, HIV, and malaria. Its good reputation – mortality rates of children with severe malaria are among the lowest on the African continent – prompts patients from as far as Gabon’s capital Libreville at 230 kilometers from Lambaréné to seek treatment at the ASH.8 The hospital has also gained a reputation as a scientific institution: in 1981 a research department focusing on infectious diseases was established.9 It  participates in clinical studies of the RTS, S malaria vaccine and has been recognized by the U.S. National Institute of Health as one of the five leading facilities in Africa engaged in investigating malaria.

In contemporary discussions Albert Schweitzer remains a controversial figure, saint for some, post-colonial autocrat for others. Yet undoubtedly, he has left a legacy in Gabon. In his obituary, the New York Times summed up: "A jungle saint he may not have been; a jungle pioneer he surely was.”10

References

  1. “Interview with Ary van Wijnen: my idol – Albert Schweitzer” (in German), German Lepra and Tuberculosis Aid (DAHW), accessed January 6, 2015, http://www.dahw.de/aktuelles/news/albert-schweitzer-interview-mit-dem-zeitzeugen-dr-van-wijnen?gclid=COiT2KaS-sICFcjLtAodNB8AEA.
  2. Association Internationale Schweitzer Lambaréné (AISL), accessed January 6, 2015, http://www.schweitzer.org/2012/de/lambarene/geschichte-des-spitals/97-3-spital-lambarene-1927-1981.
  3. Wikipedia: “Albert Schweitzer”, accessed January10, 2015, http://de.wikipedia.org/wiki/Albert Schweitzer.
  4. Fondation Internationale de l’hôpital Albert Schweitzer, accessed January 15, 2015, http://www.schweitzerlambarene.org/de/stiftung/geschichte.html.
  5. “Can a Gabonese director cure the Albert Schweitzer hospital?” BBC News Africa, accessed January 15, 2015, http://www.bbc.com/news/world-africa-18120920.
  6. “Legacy”, Schweitzer Symposium, accessed January 21, 2015, http://www.schweitzersymposium.com/en/albert-schweitzer#hospital.
  7. Deutsches Albert Schweitzer Zentrum, accessed January 21, 2015, http://www.albert-schweitzer-zentrum.de/lambarene/aktuelle-berichte/.
  8. “Albert Schweitzer: Life for Africa” (in German), Deutsche Welle, accessed January 21, 2015, http://www.dw.de/albert-schweitzer-leben-f%C3%BCr-afrika/a-16613717.
  9. Ramharter, M., Adegnika, A.A., Agnandji, S.T., Matsiegui, P.B., Grobusch, M.P., Winkler, S., Graninger, W., Krishna, S., Yazdanbakhsh, M., Mordmüller, B., Lell, B., Missinou, M.A., Mavoungou, E., Issifou, S., Kremsner, P.G. „History and perspectives of medical research at the Albert Schweitzer Hospital in Lambaréné, Gabon.” Wien Klin Wochenschr. 119 (2007):8-12.
  10. “Albert Schweitzer, 90, dies at his hospital“, New York Times on the Web, accessed January 20, 2015, http://www.nytimes.com/learning/general/onthisday/bday/0114.html.

 


 Judith Wagner, MD, graduated from Freiburg University in 2004 after studying in Freiburg (GER), London, Mendoza (ARG) and Boston. In 2014 she worked in the Department of Neurology, Klinikum Grosshadern, University of Munich, Germany. Currently, she is completing a psychiatry rotation with the Max Planck Institute for Psychiatry in Munich. Supported by a DFG (German Research Community) grant, she spent one year (2012) at the Favaloro Foundation in Buenos Aires, Argentina, investigating the spatial orientation in patients with Pisa syndrome.