Sleep has never come easily for doctors at Albert Schweitzer's hospital. Animal talk fills the stagnant night air of the African jungle. The drumbeats of far-off rituals drift down the twisting Ogooue River.
Then, shortly before dawn, the new patients begin to arrive, as they have every day for 75 years. Families lugging bed sheets and dishes come in dugout canoes, gliding beneath the river mist. Bush taxis deliver others by dusty road.
The waiting room filled quickly the other day: thin chests racked with tuberculosis; stomachs bloated with parasites. The chief surgeon himself had a 103-degree fever from malaria, but he was working anyway.
In the pediatrics ward, Dr. Tamara Kolakowska shooed away three ragged-eared dogs as she made her rounds. An infant boy, almost killed by a witch doctor's brew, was beginning to recover in one of the open-air rooms.
See Trouble Ahead
The legend of the white medical missionary lives on here at Schweitzer's isolated hospital deep in Africa. But the current hospital director and doctors see trouble ahead.
As in Schweitzer's time, many of the people in this equatorial region are poor, living on fish from the river and what they can kill in the forest or pull from the trees. But Gabon, unlike most of the rest of the continent, has the means to pay for its own health care.
Thanks to the oil it produces, this tiny country has the highest average income per person of any black-ruled African country. There seems little doubt that if Schweitzer were scouting Africa for a site for his bush hospital today, he would not choose Gabon.
As a result, donors have become less willing to support the hospital. The Gabonese government in the past several years has contributed about one-third of the hospital's $2.5-million annual budget.
Need to Attract Donors
Unless the Schweitzer Hospital Foundation opens a new hospital in a poorer African country, the foundation and the hospital here "will eventually be condemned to death," says Philippe Michel, the director and secretary general of the foundation.
"We still get money from Dr. Schweitzer's old friends, so we will be fine for a few years," Michel says. "But people in the United States and Europe have so many opportunities to give money today. We must have something to offer them. We need to open a hospital in a country where we are needed."
Schweitzer already had earned a reputation as a theologian, musician and world authority on the composer J.S. Bach when he decided to go to medical school and help people in what he came to call in his books "the primeval forest."
He founded the hospital in 1913 and except for frequent fund-raising trips abroad, he lived here for more than half a century, until his death in 1965 at age 90. By then, the sight of the old doctor, with his thick white hair and long, wavy mustache, had long since become world-famous, along with his hospital. In 1952, he had been awarded the Nobel Peace Prize.
The doctor selected this site, in what was then the colony of French Equatorial Africa, after sailing up the Ogooue River from its mouth, 100 miles away on the Atlantic Ocean. At the time the only foreigners who had ever seen the place were some French loggers and a few other missionaries.
His was a simple clinic. Some doctors in Schweitzer's later years criticized him for ignoring modern technology. When he died in 1965, for instance, there still was no plumbing and the only electricity was provided by a small generator in the operating room.
Upon returning home, foreign visitors often described the doctor as compassionate but autocratic and prone to angry outbursts at hospital workers. A Schweitzer friend and admirer, author Norman Cousins, has written: "At Lambarene, I learned that a man does not have to be an angel to be a saint."
The original hospital was built of wood amid the coconut palms and mango trees on a gentle slope above the river bank. Supplies would arrive by canoe, either from freighters in the ocean or Lambarene, the small town that sits on an island in the river across from the hospital.
These days the old hospital buildings, a ramshackle collection under rusting tin roofs, house about 1,000 Gabonese hospital workers and their families. The old consultation room has cobwebs in the corners. A few old jars of medicine are arranged in the old pharmacy, as they were originally, by the body parts they were intended for rather than drug name--drugs for the ear under oreille , those for the eye under oeil and so on.
Up the hill from the old clinic, a new hospital with 300 beds and three operating rooms was built in 1981. The staff of the modern, single-story concrete building includes about 120 Gabonese, many of them nurses, and 23 foreigners, including the five full-time physicians, a French doctor and two husband-and-wife teams of doctors from Poland.
"Schweitzer never thought the hospital would be extended like this, but he'd be happy that we continued his work," says Maria Lagendijk, a Dutch nurse who came here to work for the doctor in 1938. Now 80, she still lives in a room on the hospital grounds overlooking the river.
Kin Stay With Patients
Although there is a new hospital, family members are still encouraged to stay with the patient, as they have done since Schweitzer's time. They sleep under or beside the patient's bed and build small fires near each room's outside door to prepare meals.
The hospital is treating more patients than it ever did. Last year, the doctors and nurses here dealt with 30,000 cases, ranging from malaria to tuberculosis to hypertension, and performed 2,500 surgical procedures.
Although Gabon has public hospitals around the country, patients often come here from other areas because of the Schweitzer hospital's reputation.
The villages up and down the Ogooue River remain remarkably isolated from the rest of the country, and doctors have to be aware of special cultural practices, such as a prohibition against autopsies.
Witch doctors still hold sway over many of the people. In Schweitzer's time, the tribal doctors would hang around the outskirts of the clinic, drumming up business among the discontented relatives of hospitalized patients. Even today, patients often try the witch doctor before seeing a modern doctor.
Took Son to Witch Doctor
Mno Belagie took her son, Andre, who had a liver infection, to the local witch doctor last month because "people told me his disease could only be treated by the witch doctor," she said. But the witch doctor's medicine turned out to be toxic and Andre ended up in the hospital here, very near death. After a few days with no improvement, the boy's father wanted to take the boy to a second witch doctor.
"It's up to you," Dr. Kolakowska told the family. "Your child might die here. But outside of here he has no chance."
The parents chose to stay, and now Andre is showing signs of improvement.
While doctors here complain that patients get sicker while waiting for tribal healing, they acknowledge that the traditional doctors have some success with people suffering from mental illnesses.
"If you come to Africa as a doctor, you have to accept the witch doctors," said Dr. Slawomir Kolakowski, 40, the chief of surgery.
Most of the hospital's cases involve diseases common in the tropics or Third World countries. Hundreds of cases of malaria and internal parasites were treated here last year.
Advanced Cases of TB
The hospital internist, Dr. Halina Petrykowska, admits at least one patient with advanced tuberculosis to the hospital every week. Many of them are young adults who already have developed large holes in their lungs, putting them beyond complete recovery. She believes that alcoholism, a problem in Gabon, may be contributing to the rise in TB.
The idealism that has brought doctors and nurses here since 1913 has not waned. Many talk of early memories of Schweitzer's works.
"It was an adventure in my life to come here," says Petrykowska. "I had read about Dr. Schweitzer when I was young and I thought many times that it would be great to work here."
During his four years as chief surgeon, Kolakowski says he has lost count of the number of times that he has come down with malaria.
"Sure, the life is difficult here for doctors," Kolakowski says. "But this is Africa and it's hard for everyone."
The doctors receive about $2,500 a month, considerably less than they could earn in Western Europe or the United States, although the salary is about equal to what a doctor earns in Poland.
Doctors Leave in 2 Years
Few stay more than two years, however, preferring to return home and catch up on new medical procedures and research that they miss during their time in Africa. All four of the Polish doctors are due to return home this year.
The hospital has been in trouble several times. When Schweitzer died, some of his financial supporters thought it should be closed. But a hospital foundation was eventually set up in Switzerland and the work here continued.
Then, three years ago, shortly after the new building opened, the hospital was again in danger of closing. It had a $1-million operating deficit and a fat payroll, and some supporters were beginning to lose confidence in the entire project.
So the foundation hired Michel, who cut the staff size nearly in half, erased the deficit, raised extra money in Europe and persuaded the government of Gabon to begin contributing to the hospital's budget. He has been trying to set up a foundation in the United States for several years, but the Internal Revenue Service has not yet granted it tax-free status.
The director ran into some trouble when he raised prices for a consultation and full treatment at the hospital, for those who could pay, from about $5 to $10. Room charges are extra, about $7 a day.
Compares Fee to Beer Price
Government officials, who are among the paying customers here, told Michel that the hospital was getting too expensive. He silenced them by pointing out that the new charge equaled the price of 12 bottles of beer. The Gabonese consume, on average, nearly 200 bottles of beer a year per person.
Schweitzer himself was a believer in asking patients to pay. Now about 15% of the annual budget comes from paying patients.
The high cost of living in Gabon, caused mostly by the oil boom and inflated government salaries, has been one of the hospital's enduring problems.
"We could run three hospitals elsewhere in Africa for what it costs to keep this hospital going," Michel said.
Some potential donors may prefer to give their money to help people in poorer countries, where fewer dollars do more good. But some of Schweitzer's old supporters see no reason to move to other lands. The hospital in Lambarene was Schweitzer's only hospital, they note.
"I have to think of Dr. Schweitzer's friends, who give their money only for this hospital in Lambarene, and I have to respect their wishes," Michel said. "But we should have other options as well."
To protect Schweitzer's memory, Michel raised money to rebuild the doctor's two-room house here, which had been eaten away by termites and ants, and turn it into a museum. Opened last year, the museum contains many of Schweitzer's possessions, including his pith helmet, piano, reading glasses, the oil lamp by which he wrote thousands of letters.
Schweitzer was notorious for working on his correspondence late into the steamy night. The nurses, worried about his health, would stop by to remind him of the hour. Their words are still used in parts of Europe to remind children it is time for bed: "It's midnight, Dr. Schweitzer."