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.

Gabon, the back story

A few of you may be wondering, as I did when researching the Lambarene fellowship, where is Gabon? And what is the story there? I'll give you a few lines of background so that the rest of my time here will make more sense to you. Thus, as a point of departure, my current location: Gabon is an equitorial country on the West coast of Africa, bordering the Atlantic, often referred to as the Last Eden as over 85% of the countryside is still covered with rainforest. The town of Lambarene is located 200km inland on the Ogooue River, Gabon's largest and longest river. Schweitzer chose this location because the river afforded him the ability to float all of the construction and building supplies to the site. Amusingly enough, Lambarene is south of the equator while Libreville, the capital city, is north of the equator so when we drove in from the capital, I passed from "summer" to "winter" in a few short hours. The notion of seasons doesn't quite work out near the equator, apparently here there is a hot wet season and a hot dry season. We are in the hot dry combination right now, which the locals call the "bon temps". It is surprisingly nice. Cloudy, but high 70s to mid 80s both days that I have been here.

Ok, we've gone through geography and climate, now a tiny bit on history and culture. The area that comprises Gabon has been inhabited for thousands of years, unsurprisingly, since it is Africa. The pygmy tribes were the most numerous for much of that time, only to be pushed out by the Bantu, who remained the dominant tribe until the French arrived. The French officially entered Gabon in 1885, though Europeans such as the Portuguese and Dutch had been there in various capacities since the 1500s. In 1910 Gabon became one of four "French Equitorial Colonies" and remained a territory until 1960. On August 17, 1960 (50 year anniversary this year- it's going to be a big celebration!) Gabon gained independence from France. The first president of Gabon, elected in 1961, was Léon M’ba, with Omar Bongo Ondimba as his vice president. Omar Bongo became president in 1967 and remained so until his death in 2009. His son, Ali, succeeded him with a landslide victory in the polls. Gabon is often touted as one of the richest Africa nations, with a per capita income of $5000 annually, but I think the figure is skewed by the petrol companies operating off shore here. Fundamentally, the country remains an impoverished tropical nation, straddling modernity (cell phones and satellite TV) and poverty (living in huts without electricity or running water and turning to a traditional voodoo sorcery belief system in times of need). It will be interesting to start my time here on Monday and start interacting with locals on more than a bonjour basis. A toute a l'heure mes amis.

PS I wanted to post pictures today of the landscape, but that would have required a functional converter to charge my rechargable batteries. I know where to buy a good converter and I will do so soon so that I can start showing, as well as telling you about the land.