Cap Esterias

Now that my excitement over the lumbar puncture has died down a bit, I can write with a clear head about this weekend. It was definitely time to get out of Lambarene. I have been in country for a month with only small weekend day trips and outings with the PMI as my means of escape. The other Americans also needed to move a bit and shake things up. Initially we planned to go to Nyonie, which is a beach resort just south of Libreville. It is run by an expatriate French woman who has set up nice bungalows near the water with day-long safaris organized every day. Did I mention that alcohol is included in the price of the weekend? And there is the possibility of seeing elephants on the beach? All in all it sounded like a sweet set-up. Except we ran into two artists at the hospital who convinced us that the Nyonie experience was too expensive to be worth it. They also connected us with a ride to Libreville and recommendations for other beach resorts to try.

Armed with knowledge and a resolve to have a relaxing weekend we gamely decided to try their suggestions. We arrived in Libreville at 4pm on Friday afternoon, with enough time to enjoy an awesome exhibit about the history of Gabon called “Ma Terre, Ma Future.” It was organized by the Ministry of Tourism for the 50th anniversary of Gabon and was the best thing I have seen put out by this country so far. In giant air-conditioned tents there were six exhibits about the country: geological and archeological history (apparently multi-cellular life began in Gabon!), the different ecosystems, the traditional foods and arts, French colonial presence, independence and the government, and the future plans. Local college students who are studying the different subjects acted as guides. This was in many ways the best part of the exhibit: these people were so enthusiastic and proud of their country. It was very cool to add that interaction to the exhibit. We loved it.

The next morning we woke up with dual goals in mind: find local tissue/panne (fabric) at the big market near our hotel and find a clandestine taxi (unofficial/unlicensed) to take us to Cap Esterias. Done and done. The market was huge and crazy but we managed to get some cool tissue even in the midst of all that turmoil. I'm going to have a dress and pants made by a tailor here. When in Afrique, il faut faire comme les Afriquaines.

We also had pretty great luck getting out to the cape, which turned out to be a gem of a town. Libreville is a big crowded bustling dirty African city and this town just 25km away was completely calm and cute. No one hassled us like they do in the cities. We took long walks, hung out on the beach, drank local beers, ate some good seafood, and swam in the ocean. Then at night, the owner of our hotel's niece invited us to the one local bar in town to drink and dance. So fun. Dancing here is a lot like home, girls on one side, boys on the other, circles of dance-offs, lots of giggling and high fives. I love it-- it's so fun. (As a sidenote for my friends who know how I love a good non-judgemental dance party, I now have to call it a SDSJ, or soiree de dance sans jugement).

The next morning, the nephew of the hotel owner took us on a long walk on the beach and explained about local trees and plants and showed us the site of the first local Catholic mission. Amusingly enough the mission is now a training site for the French military and when we showed up there were about 30 shirtless men in tiny running shorts milling about. The scene was very homoerotic lost boys style. The coastline running north from the cape was so beautiful. I loathe that my internet is not fast enough to load photos because I would love to show it to everyone. When I get back to the states, I will add pictures to the blog which to make it complete and illustrative. For now imagine an unspoilt greenish gray paradise. That was my backdrop this weekend.

Champagne Tap!!!!

Bonjour mes amis!! I miss everyone terribly but I just had the sweetest doctor in training moment-- a champagne tap (for non-medical people this is when you get spinal fluid from the back without introducing blood into the sample) on a screaming, writhing meningitic 5 year old in perhaps less than sterile conditions. It feels good, oh yes it feels good.

I will write about this at another time, but we American ladies also had a great weekend at the beach outside Libreville. So nice to get away to a tiny beach town, not unlike the Oregon coast, unwind, drink some GinTonic (deja pre-mixed!), and get away from the hospital. Love it. Off to celebrate my success, more about the weekend soon.

An unfortunate conclusion

Tomorrow me and my two American roommates are heading out on a baby safari to Nyonie, on the Atlantic coast. It is savannah land and we hope to see elephants. Since we have to up early to pack and head out, I will make tonight's blog quick. Plus, I am still digesting what happened so maybe I will write more once I have thought about it more. Basically the tetanus kid died abruptly and peacefully yesterday evening. He had a cardiac arrest and could not be revived. His mother and father were wailing and the whole pediatric ward emptied to pay their respects to the family and to the body. The mother walked through the whole hospital compound singing/wailing a mourning song. It was incredibly sad and yet weirdly calm inside of me. Some of the other deaths have roiled me, I have felt sweaty, or the urge to vomit, or cry. But this time I felt oddly and perhaps incongruently calm and quiet. Maybe I was kidding myself thinking that he might make it through. Perhaps I had to believe it so that when I would see him and his parents in the morning, I could credibly convey those hopes to them. I asked one of the staff doctors here whether he has seen a child pull through tetanus. One of approximately ten in 2 years he said. Those are bad odds. Online it says that mortality ranges from 25-60% and that is for places with ICU support. Our small hospital in equitorial Africa does not offer anywhere near that level of monitoring, support, or intervention. I could not help but hope for him though.

Tetanus Update

Today was a great day at the hospital, I felt really good in terms of my patient care and my ability to manage multiple cases. It also seems like the number of patients with gastro enteritis are going down leaving room for more interesting cases. There were a lot of new, exciting cases today. I saw a kid with a severe neurologic delay from birth. He was sixteen months old, couldn't sit up, couldn't hold his head still, can't talk, can't really interact with other people. On exam his muscle toner was very flaccid, but his reflexes were all hyper reactive. I spent a while with the mom trying to find a physical therapist and a child development specialist in Libreville, the capitol city. It was interesting to think about all the ancillary services that are available in the US (to varying degrees depending on where you live and how much money you have) that cannot be found here. Or they are extremely difficult to discover. Tomorrow I plan to call the pediatric hospital in Libreville to see if they have any leads.

I managed to convince a mother who was very reluctant to pay for surgery for her child with two broken arms (! fall from a mango tree!) to stay in the hospital overnight so that we could operate first thing in the morning. And, joy of joys, the tetanus child is still alive. We will see how he makes it over the next few days but I am cautiously hoping that he makes it out. We gave immunoglobulin, have valium on board to relax the muscles and calm spasms, are giving metronidazole as the recommended antibiotic, are lining up his tetanus vaccine to give him passive immunity, and are looking for esmolol. I have learned a lot in this case and will anxiously await improvement in his clinical course.

Bad day

Today ranks among my sheistier days here in Lambarene. There were some really sick kids in the hospital today and some terrible outcomes. The first thing that happened was a kid who arrived with tetanus. Straight out tetanic spasms, sardonic smile, lockjaw, arched back, and lack of proper vaccination (only one of three DPT vaccines). It was awful to see. The kid seems super sweet too. He kept telling his mom not to cry, that she shouldn't worry about him. But then when we gave him medicine and he went into deeper spams he started whimpering “je vais mourir, je vais mourir” which means I am going to die. Too freakin depressing. We looked up the dosage for tetanus immunoglobulin and then went to see if the pharmacy had some. They did. So I mixed up a big syringe full of immunoglobulin and adminstered it. Yes, that's right. Today I adminstered tetanus immunoglobulin. Never in my life did I think I would do such a thing. He is hanging in there for now, but we will see how it plays out. I am not too optimistic.

The other maddeningly depressing event today was the arrival of two day old twins in septic shock. We couldn't figure out a source or a causative bacteria so we put them on amp and gent, which is the standard when you don't know the source of infection. Then we waited. Within a few hours one of the twins went into arrest. By the time the mom alerted us, the baby was cool and very dead looking. We did CPR for 10 minutes while the mom and grandma cried beside us. It was so sad to hold a tiny dead baby in my hands and try to pump its heart and lungs back to life with no effect.

The Agony and the Ectasy

This morning two striking events occurred in close proximity to each other that illustrate the polar opposite of pediatrics both in the US and in Gabon. In the first case there was a young girl of five who arrived during the night with a peanut lodged in her windpipe. It was a big peanut that she had choked on and it was blocking most of the air in and out of her lungs. At some point overnight she went into cardiopulmonary shock and had to be resuscitated. This morning she was holding up alright on 5L of oxygen until we were about to start rounds. She went into arrest again and this time none of our efforts worked to revive her. It was crazy sad. Her mom, aunt, and GM all started wailing the child's name and other laments. The whole hospital kind of stopped to watch and listen, Just a very very sad scene all the way around for a child to pass away from such bad luck.

Not five minutes later I had one of my greatest successes yet. It drives me crazy when parents seem not to look after their children's health be it back home in Chicago or here in Lambarene. So when a parent really does take a close interest it makes me incredibly happy and thrilled. I had looked up an electrophoresis result for a recently discharged patient and it had come back positive, meaning that the girl had sickle cell disease. I called the mom's cell and she promised to bring the daughter the next morning (ie this morning). Not only did she show up on time, but she had lots of questions about the diagnosis and treatment of sickle cell. I wrote down a bunch of information for her and arranged our first follow-up appointment in a month to monitor hemoglobin and thick smear status. Satisfaction in the midst of an otherwise dismal morning.

Room for Improvement

(written Thursday August 19th) It's pretty amazing to think that I have been working at Schweitzer for almost three weeks now. Time flies when you are treating gastroenteritis and malaria, eating pseudo-European meals, and fighting off mosquitos after 6pm. Sidenote: even with 95% DEET on I am a freaking mosquito magnet. It's a good thing that there are few malaria carriers around the hospital and that mefloquin is such an effective prophylactic medication because otherwise I would certainly have had malaria 10 times already.

Tomorrow marks my ¼ of the time here and thus I would like to take a moment of reflection and respite. I have come a long way in my tropical medicine and medical French ways. I can take on and entire afternoon's worth of patients on my own. I am learning the names and dosages of European medications. Ca arrive. But I am also at the point where I can think about making improvements in my treatment of patients as well as how the pediatrie handles things. Thus I would like to send a special thought/question out to my medically minded family and friends: if you imagine yourself practicing medicine in a developing country, what kinds of things would you focus on for improvement? Specific knowledge base? Management of certain diseases? Approach/education of patients and their families? Community health mini-initiative? Any thoughts or ideas would be much appreciated. I definitely want to continually improve as a practioner while I am here so I will make a plan of attack based on people's input and my own reflection. Please email or leave comments. Thank you in advance and a toute a l'heure mes amis!

Gabonese independence

Yesterday marked 50 years of Gabonese independence from French rule. There was much drinking and carousing in the streets. Lots of yellow, green, and blue (the national colors of the Gabonese). Dancing. Parades. Fireworks. Surprisingly little political fanfare or discussion. I wonder what people really think of the French or of being a former colony. Whenever I ask people, I feel as though I don't get a straight answer. And I probably do not. For me the best part was that two of the French girls here had organized a soiree of Gabonese foods and one of the nurses at the pediatrie, who lives nearby, taught us how to cook some basic local dishes. It was fun to mash bananas the traditional way and to have everyone laugh at our inept whiteness. Plus some of the things are delightfully yummy like fonlon leaves, which are a creamier spinach.

Lambarene 10K

I have never regretted forgetting my camera more than I did yesterday morning. Today is the celebration of 50 years of independence for Gabon. There already has been drinking and carousing and there will be much more celebrating today. As part of the festivities, the mayor's office organized a 10K (approximately 10K, no one knows the real distance) road race yesterday morning. My roommate found out about it and invited me to come along with her. Oh the scene of it all! We took a taxi out to a police checkpoint outside Lambarene where we found about 40 people milling about with their tiny and brightly colored running ensembles. And oh the footwear! Most people were running in plastic sandals called jellies or barefoot. I could not believe it! As we lined up for the start I wished so badly that I had not left my camera back at the house. It was too incredible of a scene with all the young lithe men in jellies and tiny Gabon emblazoned singlets. There were three women besides me and my roommate to run as well. The first was a young woman who competes in track in Libreville the capital city. She was tiny and fast and beat us all handily. The second was a high school aged girl who ran in, yes, jellies, and had incredible blisters at the end of the race, but still beat me. Elise edged her out for second though. The final woman was about 50 years old and a total ham. I loved her esprit. As we wound through the different neighborhoods of Lambarene people all came out to the road to cheer for us and yell “bon courage”. I laughed with a lot of the people because I get really red when I run, which was a hilarious sight to them. Little kids ran with me, teenage boys ran with me, and at the end this super fast guy doubled back to run with me and coach me to the finish. It was very cool and felt a little like running a marathon in the US except it was tropical weather, there were no water stations, and government officials waited at the finish line here to clap for us. There was a trophy presentation ceremony at the end, and I got the “esprit de competition” trophy, which cracked me up. I think the race officials felt bad because Elise had won a 2nd place trophy and I won nothing. It also reminds me of how I always won spirit awards in high school athletics. At least if I'm not the best, than I have a good time with the competition! Once again, the internet is too slow to load pics, but Elise and I took a bunch of photos with our winnings after the race when we got back home. I'll post when I can. What a hilarious time though. Later today we'll head into town to watch the parade and celebration of Independence. A toute a l'heure mes amis!

Community Health at Schweitzer

This Thursday I went out with the community health nurses to do a PMI visit there. It was pretty fascinating. Allow me to explain. PMI stands for Protection Maternale et Infantile. It is the community health arm of the hospital and has been run for almost 30 years by a nurse named Maman Sophie who is famous throughout the region for her efforts. The nurses have a clinic here on the hospital campus where they do immunizations and weigh children. Vaccination is free up until 1 year of age, provided by the Gabonese government. They actually just got the Penta vaccines here (DPT, Hepatitis B, and HiB make it up, I think). In any case, it's a great early childhood vaccine. They also still use BCG vaccine against TB. The Schweitzer PMI have achieved great vaccination coverage for this region, averaging around 85% of kids vaccinated. For Africa that is an impressive number.

As I was saying they vaccinate kids here at the hospital, but also on community visits every Wednesday and Thursday. They have 16 towns around Lambarene that they visit on a rotating basis. When they arrive, they weigh all the babies. This was quite the scene Thursday as there were about 50 moms and babies waiting for us. They all rushed forward to get a little harness for their kid, then they strip them nude, load them in the harness, and hang the kids up on hanging scales. For some reason all the babies hate this and so there was a crazy ruckus with all these naked kids screaming and hanging on scales.

Once they get weighed, the nurses go through the kids' health booklets to see what vaccines they need. Then they give them out. Another wild round of tears. While the three nurses were doing all the vaccines, Maman Sophie and I did “consulations” together. Basically this means doing a little clinic visit together. We are in the midst of an intense gastroenteritis (vomiting, diarrhea) epidemic, so that was the majority of cases. There was also an impressive case of a little one with months of scabies burrows that the mom had not taken care of. Those things can really get situated in your skin if you let them. After Maman Sophie and I saw the moms, I would take them over to this ancient chest of drawers that contained all the medicines and would try to get out all of the medicines that they needed. At the end, Maman Sophie gave a talk about safe sex, family planning, dehydration, and education. It was community public health at its best. I really enjoyed getting out a bit and seeing how things work outside of the hospital. Its neat to see how this system of vaccination and triage works in Gabon and to note its success.

The local nourishment

A number of people have asked about this and so I figured it was time to discuss both the traditional foods of Gabon as well as the foods that I eat here. Obviously, the two do not overlap perfectly.

Gabon is an equitorial country and as such it is relatively warm here all year long. Also there are a uniform number of hours of sunlight every day. This makes for a strange and poor growing season. Two things grow naturally here. Bananas of a great sort and variety and manioc, which is a tuber similar to a potato. Bananas are eaten raw, but more often cooked like french fries, deep-fried in oil. Delicious and treacherous to the waistline. Manioc can be eaten both as the root itself, in which case you boil it, or you can eat the leaves, which look like spinach, sauteed. On its own manioc smells and tastes like vegetal sweaty gym socks. The leaves are very tasty though. I thought of them as a richer version of sauteed spinach. As far as other things that are grown here—and there aren't many things, Gabon imports almost all of its nourishment—there are mangoes, grapefruits, passion fruits, peanuts, and taro. Basically tropical fruits. Some places are also trying to get cocoa and coffee plantations underway.

As far as what I eat, this is deeply influenced by living at a hospital encampment controlled by a French administration. In short, I eat a nouveau Franco-gabonese style cuisine at the refectectoire, or cafeteria on campus. We have coffee and baguette for breakfast every morning. Always. That is the only thing I have eaten for breakfast here. I may die a carbohydrate induced death. For lunch and dinner, it is always a salad, a main dish, a side vegetable dish, and a desert. The salad is often shredded cabbage, cut tomatoes, or some lettuce. Then we have a meat entree, or grilled fish (which I prefer for obvious vegetarian reasons). The grilled fish is delicious and caught locally (in the Ogooue River). Some people eat the whole thing, head and all, but I have not worked up to that point yet. The side vegetable is usually aubergine, corn, or leek, usually swimming in a sea of delicious palm oil. Desert can either be fruit, or occasionally a small piece of cake or pie. In sum, we eat well. Like when I lived in India, I may very well gain weight in Gabon. At the supermarket, they also have a tremendous array of little cakes and biscuits as well as two fine local beers, Castel and Regab. In sum, Gabon is not my ideal gustatory zone but I am holding up pretty well all things considered.

Adjustements

I am quickly adjusting to life in Gabon and at Hopital Schweitzer especially. I still feel a little tired and stomach achy, but it is going down. To me, this indicates that my immune system is adapting to all of the new antigens that are assaulting it. I have also been washing my hands like a crazy person which I think has avoided any giant gastro-intestinal problems thus far. Interestingly I had a lot of problems sleeping the first few nights because all the noises kept me up. Now I sleep like an old log at night and during my afternoon siesta. The sounds of animals, people, wind, water, insects no longer bother me. Speaking of insects, on Monday we had a migratory ant invasion. Apparently, a huge column of ants arrived at 7pm and invaded the house. According to my roommate (I was out at dinner) they covered the drapes and the floor. She fought valiantly against them with water and bug spray, and was able to get rid of them. By the time I got home they were much less numerous. Still you could sweep up giant piles of dead ants and the kitchen sink was full of drowned ants.

In terms of hospital work, there is a French medical student working with me in pediatrie and we are seeing patients all by ourselves all day long. We do the newborn visits in the morning, help with rounding, see patients in the late morning and develop the treatment plans together. We even admit our patients and follow them in the hospital now. Most of the cases we see are gastroenteritis and malaria, but even with the trickier things we are starting to head out on our own. It's a nice pace of work. Sometimes I worry that we are going to screw something up for a patient, but I remember that you can get antibiotics at the pharmacy here without seeing a doctor and that a lot of people use traditional healers still, so we cannot be doing more harm than those two avenues of health care. I do need to organize what I have learned and my work into more of a guide though. That way I will become more efficient and be able to help out even more. For example, today we saw 11 patients in total. I think within a few weeks I should be able to see even more.

My first real patient

Not Crocodiles, Waterfalls

One instructive part about living in a semi-jungle is that plans change frequently and that you have to be flexible and go with the flow (toaist if you will). My roommate and I had hoped to go out crocodile viewing with a friend of a friend who studies crocodile biodiversity. He was going to take us this weekend, hunt some crocodiles in a nearby lake, catch them, tie their mouths shut and then take samples and pictures. But he ended up leaving at the earliest possible morning light, without us and our eager virgin crocodile eyes. So we had to retool our plans. I ended up going to a goodbye party for a Gabonese/German student who had been here the past months. This was a great success and interesting for its good mix of people from different parts of the world and different parts of the hospital and research center. Then on Sunday my partner in pediatrie who is a super French med student and I headed out to see the chutes de Fugamou, or les chutes de l'Imperatrice, named by a French explorer after Napoleon's wife, the empress Eugenie. It was a good day trip, both for the experience of traveling in Gabon itself, always by taxi and in a big group of people, and for seeing all these small villages along the side of the road. People here are accustomed to white people and unlike in India, no body begs. In fact, the only reason people approach you in general is to try and pick you up. Polygamy is relatively common here and a wedding ring is not even a mild deterrent. Anyway, Eve and I, the French girl, made it to the chutes in fine form. We even navigated the jungle-dense terrain on our own on the way home. A good weekend all in all. Just sans crocodiles unfortunately. A toute a l'heure mes amis.

Drama in Gabon

One thing that has been interesting in my first week is how communal the hospital experience is for patients. (Sorry that I did not write for two days family, I just felt fluish and under the weather and slept a lot, apparently this is a common reaction to arriving in Gabon. It's a full on immune system attack so it takes a bit of time to adjust.) Patients are kept three to a room and everybody knows exactly what is going on with all the different babies in the room, they help each other out, they answer each other's questions from the doctor. There is little concern about health care privacy. Even clinic visits are done two to a room. There was a particularly dramatic example of this communal health care on Thursday when a 14 year old girl who had arrived 3 days earlier from a small village with a premature baby that she had just given birth to that was all floppy and weak asked to leave the hospital. She told us that her father had called from the village and wanted them to come home. The main pediatrician refused saying that the baby is too weak, which he is. He barely breast feeds and only takes 2ccs of breast milk every few hours through a naso-gastric tube. The girl insists. Then the nurse gets the father's phone number and calls. He has not asked for any such thing as the girl returning to her village. Clearly she wanted to get out and this was her ruse. Interestingly, the nurse (and nurses do a lot of public health type stuff her with what they say to patients) announces to everyone in the room what the girl wanted to do. All the moms start in on her about how she has to care for her baby, does she want a dead baby, what will she do when she shows up at the village with a dead baby. The other nurses start nagging her about staying. It was as if the small pseudo-village in the pediatrie waiting room rose up to issue collective advice and pressure. I had never seen anything like it in the US. And what did the young mom do? Of course, after all that, she stayed.

La Palu, or Malaria

Before I came to Lambarene I had never seen a case of malaria. My first day here I saw 15. It is incredible the time and resources at the hospital that are dedicated to malaria, just a huge percentage of what we do. Then when you imagine how much time and energy it takes for the families to come to the hospital, scrape together money to pay, time off work, worry for everyone involved. It is just an enormous amount of stuff in this country decimated by malaria. Even though we try to give out mosquito nets and tell people to have little ones sleep under them, it still dominates the health care scene here (Unicef article on the current state of the fight against malaria). Briefly, malaria is a parasitical infection caused by one of four main parasites (here is Gabon, mostly falciparum). It enters the blood by the bite of a certain kind of mosquito. Then the parasite multiplies within red blood cells until they are so many that their mass causes the cell to lyse and they all rush into the blood stream causing a fever spike. Each parasite has a specific reproduction cycle length, giving a specific every 48hr, 72hr, or 96hr fever. Malaria also gives headaches, vomiting, loss of appetite, and (possibly) severe anemia. It can also cause neural malaria, which is the worst and deadliest manifestation possible. If I get back to the US and there is a malaria case, I am going to manage it like no body's business. As a sidenote to my medical school compatriots- I had somehow remembered that sickle cell disease is protective against malaria. It is not. Sickle cell trait is (and even then they can still have mild cases). Sickle cell disease gives a terrible malaria with worse anemia than otherwise. A toute a l'heure mes amis.

La Pediatrie

As I now have two days of working at the hospital under my belt, I think I can talk a bit more authoritatively about the daily schedule. It is both similar to medical school rotations in the United States and crazily different. First thing we do is gather to hear about the patient's overnight from the nurse who was on call. There is no doctor who takes call normally. The nurses just have everyone's cell phone numbers and they call if something really serious is going on. The report also consists of kids who had fevers, and the rest is "rien a signaler" (nothing to report). Next we round on all the patients, the first day there were 44, this morning there were 40. Patients are 3, to a room, or if they sick/premie babies there are 4 incubators, 2 to a room. We chat with each patient, look at their hemogram if they have one, and then move on. There are no daily notes, certainly no daily labs, and a very difficult to learn formulary list of medications. Rounding takes a couple of hours. Then we go do newborn baby checks, which I loved in Chicago and continue to do so here. Next we start "consultations" which are basically clinic appointments. These run until 1/2pm, we have lunch, come back and finish up with consults who need lab results returned to them and anyone else who may have straggled in. But at any point if there are emergencies or things to talk about then we do those things as well when the moment calls for it.

So far that about makes up my day. I work with an ever changing team of French/German/Gabonese/Togoan/Guinean doctors which also makes things interesting and spicy. I took some pictures today and will post them soon. A toute a l'heure mes amis.

Baby CPR

First day today-- totally exhilirating--I loved the hospital experience. I'll write tons more later, I'm just super tired. Let's just say my first act of the day was to perform infant CPR on a 1-day old baby born premature at 7mos. And it lived! Now that is a crazy way to get started with you big hands holding the delicate chest of a 1,2 kg baby and pressing you two thumbs against its tiny thorax. A toute a l'heure mes amis!

Albert Schweitzer, back story

After writing yesterday about the basics of Gabon, I thought today it might behoove me to write a bit about Albert Schweitzer, the man who started the hospital at Lambarene, where I begin my work tomorrow. Once I start work, I can start explaining the hospital and my patients.

So, notre grand Docteur Schweitzer was German-French, having been born in 1875 in Alsace. He initially was a theologian and distinguished himself by writing a famous treatise on the historical Jesus. Along with his theological doctorate, he was also well-known for his masterful organ recitals and seminal work on Bach. In 1905 he read about the Paris Theological Mission's call for a doctor to come to their mission site in Lambarene, Gabon. Although he had no medical training and disagreed with much of their theology, he embarked upon a 7 year process of obtaining a medical doctorate so that he could serve as their doctor and "make his life argument." Schweitzer also argued that rather than preaching to Africans about Christianity, dedicating his life to service in Africa would allow him to show compassion and humanity directly.

After he obtained his medical degree, he and his wife moved to Lambarene, started building the hospital, and saw patients initially in a converted chicken coop. He worked at the hospital most of the time until his death in 1965. He also spent time abroad, giving speeches and organ recitals to raise money for the hospital. In 1952 he received the Nobel Prize for Peace for his work. Discussion and criticism of Schweitzer linger, and probably always will, as to whether he bore paternalistic attitudes towards local Gabonese staff and patients. Regardless of what you think about that question, and how you judge Schweitzer's attitudes, you cannot dispute that he followed through on commitment to moving to Gabon and serving as a doctor here. That shows incredible strong will, faith, and dedication. Coupled with his diverse intellectual achievements and engagements, I find Schweitzer personally relevant and inspirational in my life.