FIRST IMPRESSIONS AND EXPERIENCES
LAMBARENE, _July_, 1913.
Strict orders had been widely published that only the most serious
cases were to be brought to the doctor for the first three weeks, so
that he might have time to settle in, but, naturally, not much
attention was paid to them. Sick people turned up at every hour of the
day, but practical work was very difficult, as, first of all, I had to
rely on any interpreter who might be picked up on the road, and,
secondly, I had no drugs, instruments, or bandages except what I had
brought in my trunk.
A year before my arrival a black teacher in the mission school at
Samkita, N'Zeng by name, had offered his services as interpreter and
doctor's assistant, and I had sent word to him to come to Lambarene
immediately on my arrival, but he did not come because in his native
village, sixty miles away, he had to carry through a legal dispute over
a will. At last I had to send a canoe with a message that he must come
at once, and he promised to do so, but week after week went by and
still he did not arrive. Then Mr. Ellenberger said to me with a smile:
"Doctor, your education has begun. You are finding out for the first
time what every day will prove to you more conclusively, how impossible
it is to rely upon the blacks."
{30}
During the night of April 26th we heard the whistle of the steamer and
soon learnt that our cases had been unloaded at the Catholic mission
station, which is on the river bank, the captain having refused to
venture on the, to him, unknown water of our branch stream.
Fortunately, however, Mr. Champel and Mr. Pelot, the industrial
missionaries from N'Gômô, had come to Lambarene, with ten of their
native labourers, to help us. I was extremely anxious about the
conveyance of my piano with pedal attachment, built for the tropics,
which the Bach Society of Paris had given me, in recognition of many
years' service as their organist, so that I might keep myself in
practice even in Africa. It seemed to me impossible that such a piano,
in its heavy zinc-lined case, could be carried in a hollowed-out tree
trunk, and yet there are no other boats here! One store, however,
possessed a canoe, hewn out of a gigantic tree, which could carry up to
three tons weight, and this they lent me. It would have carried five
pianos!
[Sidenote: Settling in]
Soon, by dint of hard work, we got our seventy cases across, and to get
them up the hill from the river bank every sound set of limbs in the
station came to help, the school children working as zealously as any
one. It was amusing to see how a case suddenly got a crowd of black
legs underneath it and two rows of woolly heads apparently growing out
of its sides, and how, amid shouting and shrieking, it thus crept up
the hill! In three days everything had been carried up, and the N'Gômô
helpers were able to go home. We hardly knew how to thank them enough,
for without their help we could not possibly have managed the job.
Unpacking was a trial, for it was difficult to dispose {31} of the
various articles. I had been promised a corrugated-iron building as a
hospital, but it was impossible to get its framework erected, as there
were no labourers to be had. For several months the timber trade had
been very good, and the traders paid the labourers wages with which the
Mission could not compete. In order, however, that I might have ready
at hand, at any rate, the most necessary drugs, Mr. Kast, the
industrial missionary, fixed some shelves in my sitting-room, the wood
for which he had himself cut and planed. One must be in Africa to
understand what a boon some shelves on the wall are!
That I had no place in which to examine and treat the sick worried me
much. Into my own room I could not take them for fear of infection.
One arranges at once in Africa (so the missionaries impressed on me
from the beginning) that the blacks shall be in the white people's
quarters as little as possible. This is a necessary part of one's care
for oneself. So I treated and bandaged the sick in the open air before
the house, and when the usual evening storm came on, everything had to
be hastily carried into the verandah. Treating patients in the sun
was, moreover, very fatiguing.
* * * * *
Under the pressure of this discomfort I decided to promote to the rank
of hospital the building which my predecessor in the house, Mr. Morel,
the missionary, had used as a fowlhouse. I got some shelves fixed on
the walls, installed an old camp-bed, and covered the worst of the dirt
with whitewash, feeling myself more than fortunate. It was, indeed,
horribly close in the {32} little windowless room, and the bad state of
the roof made it necessary to wear my sun-helmet all day, but when the
storm came on I did not have to move everything under cover. I felt
proud the first time I heard the rain rattling on the roof, and it
seemed incredible that I could go quietly on with my bandaging.
At the same time I discovered an interpreter and assistant. Amongst my
patients there turned up a very intelligent-looking native, who spoke
French remarkably well, and said he was a cook by trade but had had to
give up that kind of work as it disagreed with his health. I asked him
to come to us temporarily, as we could not find a cook, and at the same
time to help me as interpreter and surgical assistant. His name was
Joseph, and he proved extremely handy. It was hardly surprising that,
as he had acquired his knowledge of anatomy in the kitchen, he should,
as a matter of habit, use kitchen terms in the surgery: "This man's
right leg of mutton (gigot) hurts him." "This woman has a pain in her
upper left cutlet, and in her loin!" At the end of May N'Zeng arrived,
the man whom I had written to engage beforehand, but as he did not seem
to be very reliable, I kept Joseph on. Joseph is a Galoa, N'Zeng a
Pahouin.
[Sidenote: Practice in a fowlhouse]
Work was now fairly well started. My wife had charge of the
instruments and made the necessary preparations for the surgical
operations, at which she served as assistant, and she also looked after
the bandages and the washing of the linen. Consultations begin about
8.30, the patients waiting in the shade of my house in front of the
fowlhouse, which is my surgery, and every morning one of the assistants
reads out--
{33}
THE DOCTOR'S STANDING ORDERS.
1. Spitting near the doctor's house is strictly forbidden.
2. Those who are waiting must not talk to each other loudly.
3. Patients and their friends must bring with them food enough for one
day, as they cannot all be treated early in the day.
4. Any one who spends the night on the station without the doctor's
permission will be sent away without any medicine. (It happened not
infrequently that patients from a distance crowded into the schoolboys'
dormitory, turned them out, and took their places.)
5. All bottles and tin boxes in which medicines are given must be
returned.
6. In the middle of the month, when the steamer has gone up the river,
none but urgent cases can be seen till the steamer has gone down again,
as the doctor is then writing to Europe to get more of his valuable
medicines. (The steamer brings the mail from Europe about the middle
of the month, and on its return takes our letters down to the coast.)
These six commandments are read out every day very carefully in the
dialects of both the Galoas and the Pahouins, so that no long
discussion can arise afterwards. Those present accompany each sentence
with a nod, which indicates that they understand, and at the finish
comes a request that the doctor's words shall be made known in all the
villages, both on the river and on the lakes.
At 12.30 the assistant announces: "The doctor is going to have his
lunch." More nods to show that they understand, and the patients
scatter to eat their own bananas in the shade. At 2 p.m. we return,
but at {34} 6 p.m. there are often some who have not yet been seen, and
they have to be put off till the next day. To treat them by lamplight
cannot be thought of because of the mosquitoes and the risk of fever
infection.
Each patient is given, on leaving, a round piece of cardboard on a
string of fibre, on which is the number under which his name, his
complaint, and the medicines given him are recorded in my register, so
that if he comes back I have only to turn to the page to learn all
about the case, and be spared a time-wasting second diagnosis. The
register records also all the bottles, boxes, bandages, etc., which
were given; only with this means of control is it possible to demand
the return of these things, which in about half the cases we do get
back. How valuable bottles and boxes are away from the civilised world
only he can rightly estimate who has had to get medicines ready in the
primeval forest for patients to take home with them!
The atmosphere is so damp here that medicines, which in Europe can be
wrapped in paper or distributed in cardboard boxes, can only be kept in
good condition in a corked bottle or in a tin box which closes
perfectly. I had not taken sufficient account of this, and I found
myself in such difficulty about it that I had to fall out with patients
who said they had forgotten or lost a tin box. My friends in Europe
were entreated by every post to collect from their acquaintances
bottles big and little, glass tubes with corks, and tin boxes of all
sorts and sizes. How I look forward to the day when I shall have a
sufficient supply of such things!
The round cardboard ticket with the number on it most of the patients
wear round their neck, together with {35} the metal one which shows
that they have paid their five franc poll tax for the current year. It
is seldom lost or forgotten, and many of them, especially among the
Pahouins, regard it as a kind of fetish.
My name among the natives in Galoa is "Oganga," _i.e._, fetishman.
They have no other name for a doctor, as those of their own tribesmen
who practise the healing art are all fetishmen. My patients take it to
be only logical that the man who can heal disease should also have the
power of producing it, and that even at a distance. To me it is
striking that I should have the reputation of being such a good
creature and yet, at the same time, such a dangerous one! That the
diseases have some natural cause never occurs to my patients: they
attribute them to evil spirits, to malicious human magic, or to "the
worm," which is their imaginary embodiment of pain of every sort. When
they are asked to describe their symptoms, they talk about the worm,
telling how he was first in their legs, then got into their head, and
from there made his way to their heart; how he then visited their
lungs, and finally settled in their stomach. All medicines have to be
directed to expelling him. If I quiet a colic with tincture of opium,
the patient comes next day beaming with joy and tells me the worm has
been driven out of his body but is now settled in his head and is
devouring his brain: will I please give him something to banish the
worm from his head too?
A great deal of time is lost trying to make them understand how the
medicines are to be taken. Over and over again the interpreter tells
them, and they repeat it after him; it is written, also, on the bottle
or box, so that they can hear the directions again from {36} any one in
their village who can read, but in the end I am never sure that they do
not empty the bottle at one go, and eat the ointment, and rub the
powders into their skin. I get, on the average, from thirty to forty
people a day to treat, and the chief complaints are skin diseases of
various sorts, malaria, the sleeping sickness, leprosy, elephantiasis,
heart complaints, suppurating injuries to the bones (osteomyelitis),
and tropical dysentery. To stop the discharge from the sores the
natives cover the place with powder made from the bark of a certain
tree. This hardens gradually into a paste which hinders the escape of
the pus and, of course, makes the case much worse.
From the list of the complaints which come oftenest to be treated the
itch (scabies) must not be omitted. It causes the blacks very great
distress, and I have had patients who had not slept for weeks because
they had been so tortured by the itching; many had scratched their
whole body till the blood came, so that there were festering sores to
treat as well as scabies. The treatment is very simple. The patient
first washes in the river, and is then rubbed all over, however tall he
is, with an ointment compounded of flower of sulphur (_sulphur
depuratum_), crude palm oil, remains of oil from sardine tins, and soft
soap. In a tin which once contained sterilised milk he receives a
quantity of this ointment with which to give himself at home two more
rubbings. The success of this is wonderful, the itching ceasing to
worry on the second day, and this ointment has in a very few weeks made
me famous far and wide. The natives have great confidence in the white
man's medicine, a result which is partly, at any rate, due to the
self-sacrificing spirit and the wise understanding {37} with which they
have been treated for a generation here on the Ogowe. In this
connection I may specially mention Mrs. Lantz, of Talagouga, a native
of Alsace, who died in 1906, and Mr. Robert, of N'Gômô, a Swiss, who is
now lying seriously ill in Europe.
My work is rendered much harder by the fact that I can keep so few
medicines in the fowlhouse. For almost every patient I have to cross
the court to my dispensary, there to weigh out or to prepare the
medicine needed, which is very fatiguing and wastes much time. When
will the iron building for the hospital be seriously taken in hand?
Will it be ready before the autumn rainy season begins? What shall I
do if it is not ready? In the hot season I shall not be able to work
in the fowlhouse.
I am worried, too, by the fact that I have hardly any medicines left,
for my _clientèle_ is much more numerous than I had expected. By the
June mail I sent off an extensive order, but the things will not be
here for three or four months, and my quinine, anti-pyrin, bromide of
potassium, salol, and dermatol are almost exhausted.
Yet what do all these disagreeables count for compared with the joy of
being here, working and helping? However limited one's means are, how
much one can do with them! Just to see the joy of those who are
plagued with sores, when these have been cleanly bandaged up and they
no longer have to drag their poor, bleeding feet through the mud, makes
it worth while to work here. How I should like all my helpers to be
able to see on Mondays and Thursdays--the days set apart for the
bandaging of sores--the freshly bandaged patients walking or being
carried down the {38} hill, or that they could have watched the
eloquent gestures with which an old woman with heart complaint
described how, thanks to digitalis, she could once more breathe and
sleep, because the medicine had made "the worm" crawl right away down
to her feet!
As I look back over the work of two months and a half, I can only say
that a doctor is needed, terribly needed, here; that for a huge
distance round the natives avail themselves of his help, and that with
comparatively small means he can accomplish a quite disproportionate
amount of good. The need is terrible. "Here, among us, everybody is
ill," said a young man to me a few days ago. "Our country devours its
own children," was the remark of an old chief.
{39}