Once everything was moved from the beach, Albert looked around, feeling discouraged. Crates were piled on the veranda and in every room of the house, but there was nowhere to unpack them, nowhere to stow their contents. He thought of the hospital at Strasbourg with its neatly arranged rows of medicines and powders on the pharmacy shelves, the freshly sterilized sets of surgical instruments laid out precisely on clean white towels in the operating room. That all seemed a million miles away from the jungle of Gabon. Albert glumly asked himself if it was possible to reach even half that degree of cleanliness and order out here.
Chapter 11
Outpost of the Kingdom of God
The next morning Albert talked to Jacob Kast, the mission’s handyman, about building shelves along the walls of their living room. Jacob took some measurements and made a sketch in a notebook. “I think I can build something like this using the wood from the packing crates,” he said.
Albert looked at the sketch and said, “This design will do perfectly.”
Albert and Hélène unpacked one box at a time. Then Jacob pried the nails out of each box, sawed the sides in half, and turned the wood into shelves. When each set of shelves was complete, Albert and Hélène arranged their medical supplies on them while Jacob constructed the next set. It took a day and a half to unpack all the crates and organize their contents on the new shelves lining the living room.
Albert was pleased with the result. Things might not be as well organized as at the hospital in Strasbourg, but the shelves did the job. Now it was time to get the old henhouse ready for patients. Jacob used scraps of wood and attached them to the henhouse walls to make more shelves, and René gave Albert a camp bed to use as an examination table. There was no room for anything else.
Each morning people gathered outside the new clinic to see Albert. Sometimes he was relieved when he had to leave the clinic to walk up to his house to get drugs for a patient. So many of the men, women, and children he was treating suffered from the most painful medical conditions he could imagine. Getting drugs for them gave him a moment to compose himself. Soon after Albert arrived at Lambaréné, an old African man told him, “Among us everyone is ill. Our country devours her own children.” Surrounded by so much suffering, Albert found himself agreeing with the old man’s assessment. Nothing, he decided, could have adequately prepared a European doctor for the medical conditions here.
Still, Albert thrived on challenges. He wrote a letter to his sister outlining the medical situations he saw and ended it with, “Evenings I go to bed dead-tired, but in my heart I am profoundly happy that I am serving at the outpost of the kingdom of God!”
Albert was also grateful for Hélène and the fact that she’d trained as a nurse. She took responsibility for washing and rewinding bandages, sterilizing medical instruments, and keeping patient records in order.
Albert decided not to do surgeries until the new hospital was built. It seemed safer to wait until he had a fully enclosed and sterile operating room. But that changed one morning when a man who was doubled over in pain was led into the clinic. Albert examined him and determined the man was suffering from a strangulated hernia, a condition in which an internal organ pushes through an opening in the muscle tissue that should have held it in place. By now Albert had noted that hernias were more prevalent around Lambaréné than in Alsace. Once he had the new operating room, he expected to do a lot of hernia surgeries. But a strangulated hernia needed immediate attention, or this man would die. Even if it had to be done in a henhouse, Albert knew he must perform emergency surgery.
Albert sent Hélène to ask Noël if he had any better ideas. Soon a plan was made. Noël gave the boys the afternoon off school and then wiped down the desks and other surfaces in the empty classroom with disinfectant. Meanwhile Hélène collected the needed towels, sheets, and bandages and prepared the anesthetic. Albert set about sterilizing the surgical instruments and arranged them in the schoolroom for the operation.
That afternoon Albert and Hélène worked as a surgical team for the first time. Albert wielded the scalpel while Hélène administered the anesthetic and monitored the patient’s vital signs. Much to Albert’s relief, the surgery went well, with no complications.
Once word was out that Albert could operate on hernias, he knew that many more people would find their way to his doorstep. But because of the labor shortage, there was still no new hospital in sight. René assured Albert that since the rainy season was now ending, the men would return to their villages, and some might be willing to build the hospital. It was frustrating for Albert to wait, but he had no other option.
Not long after the emergency hernia surgery, a young man from the Galoa tribe came to receive a checkup. His name was Joseph Azoawani. As Joseph sat on the edge of the camp bed, he entered into lively conversation in French with Albert. Joseph’s French was excellent, and he explained to Albert that he’d worked for a white man who taught him to speak fluently. He also said he could speak nine regional dialects, including Pahouin and his Galoa mother tongue. Suddenly Albert realized he had the perfect interpreter sitting right in front of him. Albert offered him a job, and Joseph accepted on the spot. It didn’t take long for Albert to appreciate what a gift Joseph was. It was such a relief to be able to communicate thoroughly with the patients through a skilled interpreter.
Joseph did have one quirk Albert found amusing. Joseph had learned anatomy from cooking meat for his previous employer, and he continued referring to human body parts that way. “This patient has a sore left cutlet,” he would tell Albert, or “an infection in his lower right brisket.” Albert tried correcting Joseph, but Joseph was stubborn, and in the end Albert accepted Joseph’s unique contributions to medical conversations.
Although he’d never been taught to read or write, Joseph was unusually observant. Within a week he had learned to identify the various bottles of pills and medicines by the shapes of the words printed on their labels. Albert watched many times to make sure that Joseph selected the correct medicines, and he never saw Joseph make a single mistake. Before long he trusted him implicitly.
Now that he had a language assistant, Albert was able to bring order to the unruly patients and their families who showed up each morning. He asked himself what the most important things were that he wanted to tell them. As they came to mind, he wrote them down. “1) Spitting near the doctor’s house is strictly forbidden.” Spitting was a big problem, especially since diseases were transmitted through contact with bodily fluids. Each time Albert saw or heard someone spit, he could feel his blood pressure rise. He knew he would probably never stop the locals from spitting altogether, but at least he could ban it near his house and the clinic where so many sick people sat or stood close together.
Albert continued writing. “2) Those who are waiting must not yell.” Again, this was something that grated on his nerves. Sometimes it was so noisy outside the clinic it was impossible to call the next patient.
“3) Patients and their friends must each bring enough food for one day.” Food was a problem. Sometimes patients had to wait all day to be seen, and as they waited, they got hungry. Albert didn’t want patients and their family members arriving at the clinic and expecting the mission to take care of all their needs, including food, for as long as they stayed. He firmly believed that patients should help in their own care as best they could. That included bringing enough food with them to eat for a day.
“4) Anyone who spends a night on mission property without the doctor’s permission will be sent away without any medicine.” Albert knew this sounded harsh, but the patients and their families sometimes invaded the school dormitories, demanding that students vacate their beds so the adults could sleep in them. Not only was it disruptive to the school, but it also ran the risk of infecting schoolchildren with many illnesses.
“5) All bottles and tin cans in which medicines are given must be returned.” Albert doubted he would get 100 percent compliance, since anything made of glass or tin was precious in the humid jungle. He suspected people sometimes visited the clinic just so they could receive a pill bottle or tin. They prized them as fetishes, hanging them around their necks to ward off evil spirits.
“6) In the middle of the month, when the steamer has gone upriver, only urgent cases can be brought to the doctor. When the steamer comes from the coast, all others may come, as the steamer will be bringing more medicines for the doctor to give out.”
Albert asked Joseph to memorize the six rules and announce them each morning in French, Pahouin, Galoa, and the other dialects he spoke, to those gathered outside the clinic.
Slowly Joseph started taking over some of Hélène’s workload. Albert observed that most of his patients and their families were deathly afraid of touching blood or pus. Joseph, however, was not, and he cheerfully washed bandages and held bloated limbs steady while Albert lanced boils or cleaned out abscesses.
The local Africans blamed many kinds of sickness on “the worm.” To them the worm entered their bodies through the feet, and if they were lucky, it exited through the top of the head. Albert basically agreed with their view. Worms and parasites entering their bodies were the root cause of most deadly tropical diseases. In order to diagnose a patient’s health problem, Albert often spent hours hunched over a microscope, examining blood samples for various parasites.
By mid-June 1913, Albert felt he had a clearer picture of what medicines he needed for the next few months. He wrote to friends and supporters in Strasbourg to explain the situation:
I am now in a position to judge which medications are the most important. They are quinine; sodium sulfur; chaulmoogra oil, which is effective when blended with olive oil (to treat leprosy); sulfur (for scabies); potassium iodide (for a number of skin diseases); all cardiotonics (since the number of people suffering from heart disease and pneumonia is shockingly high); anything required for the preparation of soothing and desiccant ointments; bromine (epilepsy) and arsenicals. . . .
As long as the medical barracks are incomplete, working here is an arduous task. I spend my days in an old chicken coop without windows. . . . The people are very grateful for what we do for them. The misery is enormous.
In follow-up letters Albert appealed to his friends to send old clothing to a small band of church women at St. Nicholas Church in Strasbourg. The women would cut the items of clothing into strips for bandages and send them to Lambaréné. Most of all, Albert begged people to save glass bottles and tins for use in the clinic.
Albert and Hélène celebrated their first wedding anniversary on June 18, 1913. They went for a walk on the sandbar, which the low dry-season river level had exposed. They had to tread carefully, as this was the time of year that crocodiles became restless and were more likely to attack.
In late July, laborers were hired to start laying the foundation for the first hospital building. The structure would consist of four rooms—two large rooms for consulting and surgeries, and two smaller rooms to serve as a dispensary and a sterilizing room. Once the workers had poured the foundation and the cement floors, they began erecting framework. The work went slowly. To Albert it seemed that every time he turned his back the laborers stopped working to smoke cigarettes and argue about things going on in their villages. Yet they still expected to be paid for a full day’s work. Albert grew so frustrated he talked to Joseph about it.
“Don’t be so anxious, Oganga. After all, it is your own fault,” Joseph told him. “The men have come to work for you. When you’re not there, they do not work. Why would they? If you want them to work, you must stay and work beside them.”
