ECU Field Journal: Africa

Marie's Blog

(most recent posts at the top)

November 9, 2008

What better weekend to return home than during Homecoming and to a Pirate victory? Go Pirates! It feels so good to be back in Greenville, seeing family and friends after being away for so long. I am both happy and sad that my journey in Lambaréné has come to an end. In my first post I stated, “With so many questions, I am eager to learn, to explore, and to serve the Gabonese people. I know that I will bring Gabon back to North Carolina with me, sharing not only the knowledge and experience in their community and health care, but sharing Dr. Schweitzer’s “Reverence for Life” and what passion it brings to others.” Little did I know how much of Gabon I would bring back and what effect it would continue to have on me. read more...

Hello. Goodbye.
October 27, 2008

Lambaréné welcomed another Pirate this weekend. My dear husband Mike traveled halfway around the world to bring his wife home. When he first arrived at the airport, I waited anxiously on the other side of the terminal gate for him. Words cannot express my excitement. I had a special pagne made just for his arrival, and couldn’t wait for him to see me in my Gabonese attire. Well, little did I know what was in store. read more...

“Grow into your ideals ... "
October 25, 2008

Dr. Schweitzer once said, “Grow into your ideals, so that life can never rob you of them.” I have lived and worked in Lambaréné for three months now, away from my family and friends, away from a life so very different from here, and I have asked myself, many times over, what I will take away from this experience? The hardships I have seen here, not only in healthcare but in the daily lives of the people, are far more severe than I had ever imagined. I have much to reflect on—both good experiences and bad. There have been patients and circumstances so difficult at times that it was almost incomprehensible. Keeping this blog has been especially cathartic for me. In writing about specific patients, I have found a way to process the sadness and despair that I fear might otherwise have enveloped me. read more...

Here comes the PMI team!
October 17, 2008

Beep! Beep! As we enter each village, the Schweitzer truck signals its arrival, prompting every mother and child to head to the Dispensaire, the designated clinic area. In each village, the Gabonese government has built either a cement building or open courtyard where inhabitants may seek medical care from the resident nurse, or in our case, with the PMI team. The Protection Maternelle-Infantile program reaches out to provide childhood vaccinations, nutrition and obstetrical screenings, and acute care medical evaluations for anyone in the surrounding villages. Each village is visited once every six weeks according to a rotating schedule. I have mentioned this program with affection in previous posts as I thoroughly enjoy my time in these villages. I learn the most about life and culture in Gabon here through the PMI program, and it helps me to better connect with my patients back at the hospital by seeing where they live and work. My experience would not be what it has been without this program and the dedicated souls who have run it since its inception 10 years ago. The PMI team consists of Dr. Diallo, and nurses Sophie (whom everyone affectionately calls Mama Sophie), Marie Benoit, and Hortense. They are absolutely phenomenal both as individuals and in the work they do helping so many new mothers and children. read more...

Retraite de deuil
October 12, 2008

The Gabonese way of celebrating life and thereafter…

As medical students, we are taught about death and dying. It is a topic we now better understand and can discuss with much more ease thanks to the work of Dr. Elisabeth Kubler-Ross. In the 1960s, she identified five stages of grief and bereavement, and students are taught to look for these stages in patients and their families coping with death.

Before coming to Gabon, I had not had much experience with death. In my short time here, I have been confronted by it to the point where it seems relentless. With each patient’s passing here at Schweitzer, I have witnessed expressions of grief and sadness, which at first startled me. It is only now I am beginning to realize this seemingly very different expression of bereavement follows similar stages to what we see as coping skills back home. Dr. Kubler-Ross’s five stages, denial and isolation, anger, bargaining, depression, and acceptance are universal and knowing such stages has enabled me to explore and confront all that encompasses death. read more...

Young women dance in a traditional Gabonese ceremony
celebrating life.


The edge of a razor...
October 8, 2008

In The Illiad Homer wrote, "Life and death are balanced on the edge of a razor." How true. It is now 5:19 a.m. and I have been lying awake since 3:00 a.m. I woke up thinking about my patient who died at the hospital today. How could this have happened? What were the events in her life that led to that moment? What could we have done differently? I decide the answers to this tragedy have to be somewhere—that there must be a medical explanation somewhere in my books. I know that finding it won’t bring her back, but it may save a future patient like her. In order to drown out my thoughts of her young life lost, her pain, and the role I played at the end of her life, I open my computer to listen to music. As I open iTunes I feel shame for the frivolous technology at my fingertips when we lack even the most basic necessities at the hospital. We don’t even have thermometers right now. I try to rationalize the chaos of emotions I feel. She is the first patient that has passed before my eyes. I will never forget her face. I will never forget how helpless I felt. I grieve for the loss of her life and for our inability to help. She died of severe disseminated intravascular coagulopathy. She was 18. read more...

Looking back...
October 3, 2008

So I can't show you how, exactly, health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable. —Paul Farmer

Looking back at my original application for this fellowship, it’s amazing to see how many of the questions I posed now have answers. Sadly, those answers concern me. In my application to become a Schweitzer fellow, I wrote:

Having grown up in a small town on the water, I imagine that I share many similarities with the Gabonese people living along the Oogué River. I know the hardships in such a rural landscape, especially when resources are limited. I am interested to see how they live, what they must endure, and what diseases confront them. By living in their community and serving in their health care system, I would have the opportunity to learn and connect with them. I would like to learn what health care means to the people there. What is the physician-patient relationship like and how does it compare to our own? I would like to learn the challenges that confront them and how each challenge is approached. I understand that there are major challenges in terms of medications or lack thereof. How does the physician approach the medical management and care of the patient in this setting?

Living in eastern North Carolina, I have learned much about rural medicine and the disparities therein. How does this compare to Gabon? I understand people come from hundreds of miles away to be seen in Lambaréné. What systems are in place to meet the challenges of the patient and physician? With so many questions, I am eager to learn, to explore and to serve the Gabonese people. I know that I will take Gabon back to North Carolina with me, sharing not only the knowledge and experience in their community and health care, but also teaching “Reverence for Life” and what passion it brings to others.

My recent experiences have provided me with answers to many of these questions, but they have also raised new ones. When my time here is through, how will I continue to work in the U.S. knowing firsthand the suffering that exists here? While I claimed to “know the hardships in such a rural landscape, especially when resources are limited,” I now realize how naive I was. read more...

Doctor, d’abord tout, la santé!
September 28, 2008

I often hear, “Oui Docteur, d’abord tout, la santé!” which translates “Yes Doctor, my health comes first!” This seems to be an ingrained response for patients here. If you ask them if they could cut back on smoking, drinking, eating, or whatever the case may be, this is invariably the answer. In using this reflexive response, I know patients are telling me what I would like to hear, and it does not frustrate me the slightest. Rather, I catch myself grinning at their response. I know they mean well and are trying to acknowledge my request. Life is so much different here that such behaviors may be the least of their worries. read more ...

Weekend in La Lopé
September 21, 2008

After a little over seven weeks living and working in and around Lambaréné, it was time to leave the hospital compound, and get to know life outside of Schweitzer territory. Since there has only been one travel guide ever written for this country (now many years outdated), the decision of where to start our adventure was difficult. Gabon, unlike much of Africa, is not a tourist destination. It is more expensive, and more secluded than many of its counterparts on the continent. So for a weekend adventure our choices were limited. We could either catch the riverboat to Port Gentil, or hop the train to Lopé National Reserve, where we could see that which makes Gabon so unique—the place where savannah meets tropical forest, and where so many species of birds, primates, and the rest of Eden’s inhabitants live in harmony. If you know me, the answer was quite obvious. Off we went to Lopé! read more ...

Close Encounters of the Gabon Kind...
September 14, 2008

My latest adventure occurred not in the village or around the hospital, but right in my very own room. Last night, I decided to prepare my medical bag for the upcoming week. As I was emptying my bag, I felt something warm brush up against my hand. I looked down and saw an ill-defined shape inside my bag. It was brown with a hint of yellow. I didn’t think anything of it because just the other day, I had found an old banana in my bag that I had forgotten to eat while working in the village. I bent down to get a closer look and saw "LEGS!!!" My brain kicked in “medical-student mode,” and I immediately scanned a differential diagnosis of all the things it could be. After a few seconds, I had it … B-A-T!!! read more ...

Spiritual Healing
September 7, 2008

Remember when I first met Cheetah? That day, I was supposed to witness a spiritual healing ceremony at the home of a woman who works at the hospital. Well, it was not meant to be that day, but luckily we got a rain check for this past weekend. When we arrived at Marie Benoit’s house, she was dressed monochromatically in white, as was her husband, the Spiritual Healer. We had no expectations for what was to come, but at the same time became very anxious. What if something happened? What if we have to decline participation, or the like? Would we offend anyone? read more ...

On My Own...
September 5, 2008

Looking back over my last entries, I have made much progress and overcome many challenges. As Dr. Schweitzer would say, I have confronted my “boulders,” in such challenges.

“Those who do good should not expect people to clear the stones from their path on this account. They must expect the contrary: that others will roll great boulders down upon them. Such obstacles can be overcome only by the kind of strength gained in the very struggle. Those who merely resent obstacles will waste whatever force they have.”
—Albert Schweitzer
read more ...

Meet Cheetah
September 1, 2008

It has been a little more than one month since I left home in the United States. Sometimes I look at my calendar and wonder where the month went. Other times I can’t believe I’ve been away from my family for so long. I have been looking forward to September just so I can say to my husband and daughter, “I will see you next month” when I speak with them. Their e-mails and phone calls (thank you Skype!) have provided me with such strength over here. I simply could not have done this without their support. They encouraged me to do this because they knew it has always been my dream. I am so grateful to them. So guys, if you are reading this, I’ll see you next month!!!!! read more ...

The dynamics of the physician-patient relationship…what “school of thought” do I attend?
August 23, 2008

What kind of relationship should exist between a physician and patient? Should the physician lead and the patient follow? Or should it be egalitarian of sorts, where each plays an equal role in the relationship?
read more ...

And so the festivities to honor Gabon’s 48th birthday begin!
August 19, 2008

Gabon gained independence from French Equatorial Africa on August 17, 1960, and each year the country joins together to celebrate. Independence Day here is as festive a day as any July 4th celebration in the United States, with plenty of good food and good company. But the day was most memorable to us ex-pats for its parade. Why? Because we were in it! The Schweitzer Hospital is always well represented in the parade by its employees, volunteers, and of course, us students. We all received T-shirts in red, yellow, or green, and we walked together grouped in colors to symbolize the Gabonese flag. As we passed the mayor of Lamberéné, the women in my group gestured with what I thought were instructions to wave. I followed, and joined the simultaneous rise of arms, and began to wave, only to quickly realize that they weren’t waving but SALUTING him, as in “Hail Caesar!” And then there I was…waving like a beauty queen. My arm and hand came to a screeching halt and assumed the tense position of my counterparts. I just had to giggle, hoping no one actually caught my little misunderstanding! Lesson learned.

Disparity has taken on a whole new meaning for me here in Gabon….
August 16, 2008

Yes, you are indeed seeing a heart—a heart that took my breath away as I held the radiograph to the light. This heart belongs to a 22-year-old Gabonese woman with no documented past medical history. She becomes short of breath at the slightest activity, and is always tired and swollen with fluid. When I ask her if she has been sick before, or seen by a cardiologist, she only knows that she has been like this since childhood. She recalled episodes of palpitations and difficulty breathing if she played too hard.
read more ...

Beginning to understand my new world
August 15, 2008

I have grown more comfortable in my daily routine here at the hospital, as I have finished my second of 13 weeks in Lambaréné. I am beginning to better understand the Gabonese dialect of French, and I am able to ask the necessary questions to allow me to better compare and contrast medicine here with medicine in the United States.
read more ...

First week at the hospital.
August 4, 2008

I have finally begun my first week at the hospital. Monday was certainly overwhelming as it is the busiest day at the hospital. Adding to the stress is the fact that everyone here speaks French. I speak French, but medical French is different, and I had a blank stare by the end of the day. I was able to familiarize myself with the layout of the hospital grounds, our daily schedules, and the location of our most coveted building on the grounds—the malaria research lab, where we access the internet!
read more ...

Lambaréné, glad to meet you.
August 2, 2008

Hopital d’Albert Schweitzer is like one large family compound. The people here are very nice and polite all the time. Everyone says “Bonjour,” “Bonne apres-midi,” and “Bonne soir” without fail. There are people from all over the world here: France, Germany, Spain, Switzerland, Ukraine, Cote d’Ivoire—the list goes on. read more ...

Gabon, glad to meet you.
August 1, 2008

The adventure continues! We arrived in Libreville, Gabon’s capital, and were immediately bombarded by Gabonese taxi drivers at the airport entrance. With our bags in hand, Katie and I pushed through the crowd hoping to find someone from the Albert Schweitzer Hospital waiting for us. We had our doubts, as our plane was more than two hours late. The driver from the hospital was indeed there, but unfortunately, I had already dismissed him as being another taxi driver. We finally found him, and he led us through the crowd and down a dark alley. Katie and I struggled to keep up—me especially with my 50-pound travel backpack and carry-on bags. I was so relieved to see the Schweitzer truck there, like the North Star in the dark night! read more ...

July 30, 2008

Wednesday we spent in the airport trying to find some way to get to Africa. We were told that they would not be able to get us there until August 7. How could we be stuck in Paris? We were not happy about the thought of falling prey to such an expensive city (no self-control here!) Both of us had been to Paris several times and it was never like this...what happened to the almighty dollar? We exchanged $100 and received 60 euros. A bottle of water costs five dollars!

Well, to make a long story short, after many expensive phone calls and emails to airline representatives (we literally walked down the streets of Paris with Katie's iPod Touch trying to find a free WIFI signal), we left for Africa on Friday after five days in Paris. We will soon be in Africa. I’m so excited!

The Journey Begins
July 29, 2008

Well, I arrived in Paris on Monday, July 28, and found my fellow Albert Schweitzer Fellow, Katie Ratzan, on Tuesday morning at the airport. We anxiously waited at our gate ALL DAY only to finally learn that our flight was cancelled. Apparently there was a labor strike involving the air traffic controllers in Western Africa, so needless to say, we were not leaving for Libreville anytime soon. Our airline shuttled all the passengers to a very dim and questionable hotel. Katie and I thought that we might actually have to break out our insecticide in Paris!

The next day, we returned to the airport to find the airplanes still on the ground. Now hundreds of passengers were waiting, and the confusion and impatience were rising exponentially. The airline announced that since the disruption was a strike, it was NOT their fault, meaning they would not help us with accommodations. Normally this would have been a terrible turn of events, but we were actually happy to it hear after seeing where they had already sent us to sleep! We booked our reservations online from the airport and everything is okay.

Albert Schweitzer Fellow
July 25, 2008

After finishing the proverbial drinking-out-of-a-fire-hydrant, third year of medical school, I am about to embark on a long-awaited journey to work at the Albert Schweitzer Hospital or Hopital d’Albert Schweitzer in Lambaréné, Gabon, where I will live and work for the next three months. Where is Gabon, you ask? It is considered a part of central Africa, and is bordered by Congo, Cameroon, and the Atlantic Ocean. Why this hospital? The Albert Schweitzer Hospital is the product of the vision and dedication of Dr. Albert Schweitzer. Long story short, Dr. Schweitzer was a renaissance man of sorts, who answered a call for help. He literally became a physician for the sole purpose of helping the people of Africa. After falling in love with the region of Lambaréné and people therein, he literally built a hospital out of a chicken coop and began practicing medicine. Even after more than 90 years, including periods of political unrest and war, his hospital lives on and cares for the people of Gabon. read more ...