Читать книгу On the Edge of the Primeval Forest - Albert Schweitzer - Страница 7

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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."

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!

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 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 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.

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—

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 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 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 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 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.