LAMBARENE, Gabon — Sleep has never come easily for doctors at Albert Schweitzer's hospital. Animal talk fills the stagnant night air of the African jungle. The drumbeats of far-off rituals drift down the twisting Ogooue River.
Then, shortly before dawn, the new patients begin to arrive, as they have every day for 75 years. Families lugging bed sheets and dishes come in dugout canoes, gliding beneath the river mist. Bush taxis deliver others by dusty road.
The waiting room filled quickly the other day: thin chests racked with tuberculosis; stomachs bloated with parasites. The chief surgeon himself had a 103-degree fever from malaria, but he was working anyway.
In the pediatrics ward, Dr. Tamara Kolakowska shooed away three ragged-eared dogs as she made her rounds. An infant boy, almost killed by a witch doctor's brew, was beginning to recover in one of the open-air rooms.
See Trouble Ahead
The legend of the white medical missionary lives on here at Schweitzer's isolated hospital deep in Africa. But the current hospital director and doctors see trouble ahead.
As in Schweitzer's time, many of the people in this equatorial region are poor, living on fish from the river and what they can kill in the forest or pull from the trees. But Gabon, unlike most of the rest of the continent, has the means to pay for its own health care.
Thanks to the oil it produces, this tiny country has the highest average income per person of any black-ruled African country. There seems little doubt that if Schweitzer were scouting Africa for a site for his bush hospital today, he would not choose Gabon.
As a result, donors have become less willing to support the hospital. The Gabonese government in the past several years has contributed about one-third of the hospital's $2.5-million annual budget.
Need to Attract Donors
Unless the Schweitzer Hospital Foundation opens a new hospital in a poorer African country, the foundation and the hospital here "will eventually be condemned to death," says Philippe Michel, the director and secretary general of the foundation.
"We still get money from Dr. Schweitzer's old friends, so we will be fine for a few years," Michel says. "But people in the United States and Europe have so many opportunities to give money today. We must have something to offer them. We need to open a hospital in a country where we are needed."
Schweitzer already had earned a reputation as a theologian, musician and world authority on the composer J.S. Bach when he decided to go to medical school and help people in what he came to call in his books "the primeval forest."
He founded the hospital in 1913 and except for frequent fund-raising trips abroad, he lived here for more than half a century, until his death in 1965 at age 90. By then, the sight of the old doctor, with his thick white hair and long, wavy mustache, had long since become world-famous, along with his hospital. In 1952, he had been awarded the Nobel Peace Prize.
The doctor selected this site, in what was then the colony of French Equatorial Africa, after sailing up the Ogooue River from its mouth, 100 miles away on the Atlantic Ocean. At the time the only foreigners who had ever seen the place were some French loggers and a few other missionaries.
His was a simple clinic. Some doctors in Schweitzer's later years criticized him for ignoring modern technology. When he died in 1965, for instance, there still was no plumbing and the only electricity was provided by a small generator in the operating room.
Upon returning home, foreign visitors often described the doctor as compassionate but autocratic and prone to angry outbursts at hospital workers. A Schweitzer friend and admirer, author Norman Cousins, has written: "At Lambarene, I learned that a man does not have to be an angel to be a saint."
The original hospital was built of wood amid the coconut palms and mango trees on a gentle slope above the river bank. Supplies would arrive by canoe, either from freighters in the ocean or Lambarene, the small town that sits on an island in the river across from the hospital.
These days the old hospital buildings, a ramshackle collection under rusting tin roofs, house about 1,000 Gabonese hospital workers and their families. The old consultation room has cobwebs in the corners. A few old jars of medicine are arranged in the old pharmacy, as they were originally, by the body parts they were intended for rather than drug name--drugs for the ear under oreille , those for the eye under oeil and so on.
Up the hill from the old clinic, a new hospital with 300 beds and three operating rooms was built in 1981. The staff of the modern, single-story concrete building includes about 120 Gabonese, many of them nurses, and 23 foreigners, including the five full-time physicians, a French doctor and two husband-and-wife teams of doctors from Poland.