ECU Field Journal: Africa

Marie's Blog from Lambaréné, Gabon<-- back

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.

After witnessing the burdens people here face in their daily lives, I must confront the fact that I did not know true hardship before coming to Gabon. One’s perspective defines what is a hardship. One’s experiences define disparity. The problems of daily living in Gabon, while severe, are nothing compared to the difficulty of access to medical care. Yes, you can see a specialist of your choosing in the capital, Libreville, but most cannot afford it. Knowing what is available worldwide, that is hard to accept. If it were not for the Hopital d’Albert Schweitzer, this population would truly suffer. This hospital is as much a place of healing as it is a place of community here in Lambaréné. Every morning you see men, women and children hauling impressive amounts of wood and fish back to their homes. You see them bringing supplies to their loved ones at the hospital. You see women scrubbing their clothes at the community water fountains against bare cement. You smell the smoldering remains of the fire pits where they cook their meals. Many of the illnesses that confront the Gabonese people are a product of their environment and activities of daily living. I see countless elderly working en brousse, carrying such heavy loads for miles and miles. Women of 60, 70 years of age work this way, with their bodies bent by the burden. They do not complain. It is life to them. “It is Africa,” they tell you. When you talk to the Gabonese, asking about life and health, you do not hear them complain about daily living, you hear their pleas for the sick.

As I stated in my application, I wanted to learn what systems were in place to help the people of Lambaréné and its surrounding villages, because I believe learning about other communities helps us better understand our own. There are many systems in place here in Lambaréné, but limited resources often render them useless. Fortunately, the people here are very communal and eager to help in any way possible. This communal spirit is reflected in the health care system here. Although I have written solely about the Schweitzer Hospital, it is not the only one in Lambaréné. There is a public hospital just down the road. Both hospitals are lacking in many, often vital, resources, but they work together to fill a gap when the other cannot. For example, we have not been able to perform blood chemistries recently at the Schweitzer Hospital because our machine is broken. The public hospital is helping us with these tests. Conversely, the Schweitzer Hospital’s Protection Maternelle et Infantile program goes out to the surrounding villages each week and administers immunizations to young children, and prenatal care to pregnant women, something the public hospital can’t do.

My journals have told of the difference between life here and life back home which can be so different and yet so amazingly similar—usually when you least expect it. Health care is a universal need. We are human and vulnerable to not only the environment, but to our own bodies as well. If we do not have access to health care or the means to pay for it, what are we to do? This very issue links the population of Lambaréné to that of the United States. Just as you question a patient in the United States why they waited so long to seek treatment of their illness, the same question is asked here. When a patient comes to see us in crisis, or drowning from their pulmonary edema, it is because of the same reason patients in the United States pour into emergency rooms at death’s door—the lack of affordable or accessible healthcare.

Medications are just as much an issue here as they are at home. We have been out of glucose intravenous fluids, any form of antihistamine, anti-inflammatory, and most anti-hypertensive medications for almost two months. Many of these are available for sale in town, but my patients tell me it is too expensive to buy them there. I find myself writing prescriptions with three different types of NSAIDs (anti-inflamatory/antipyretics) listed with their respective dosages and directions, as we never know what is available in town, or what the patient can afford. I have learned to understand my patient’s financial state and living conditions before I order any tests or prescribe any medications. If I order a test that is not absolutely essential to their diagnosis and treatment, I may keep them from eating that night. It is a hard lesson to learn, but I know I must be content in knowing that I am doing what is best medically as well as learning what I can do with the resources available.

I am now at the point where I can appreciate many accomplishments, both my own and those of the other Schweitzer Fellows. I understand that the role of a Fellow is to serve in any way that is needed, no matter the task. In the beginning, I spent so much time worrying about whether I was learning what I was supposed to, or understanding as much as I should. I now realize that it is not about knowing the intricacies of each and every disease, it is about serving the hospital and patients who seek our assistance. Just as Dr. Schweitzer saw so clearly, “It is not a race, nor competition for perfection, in helping those in need.” Understanding what is essential to alleviating a patient’s pain or slowing the progression of his or her illness is what is important. Documenting every sign and symptom won’t help the patient feel better. It is our challenge as physicians, in the name of service, to remain sensitive to our purpose and our goals so that we may follow our true compass and help those who entrust us with their care.