Working with Dr. Schweitzer

Chapter 12. Poorest of the Poor

By Louise Jilek-Aall, M.D.
His (the mental patient's) continual fear is that he may be compelled to leave the hospital where he has been so well cared for, knowing well as he does, what sort of fate awaits him in his village.

(Albert Schweitzer, More from the Primeval Forest p. 167)

Visitors who for some reason or other were disappointed in their trip to Lambaréné, easily found something to criticize about Dr. Schweitzer. Among the issues repeatedly raised was that no Africans were eating at Dr. Schweitzer's table. Since the only Africans present in the dining room were servants, it was easy to accuse him of a bias. We who worked at his hospital and experienced the relaxed, friendly relationship between the European staff and the African aides knew that Dr. Schweitzer was not the person to cultivate prejudice.

What many visitors probably did not know was that Gabon at that time had very few indigenous people with higher education, and that those would be found in the capital or in Paris, but certainly not in the old doctor's jungle hospital on the Ogowe River.

The Africans who worked in Lambaréné usually had their families there and went to the village after work. Not only did they prefer to spend their free time at home, but they also preferred to eat their customary African foods and not the European-style meals. And African tourists, as such, were practically non-existent. Once, an African diplomat from Katanga (now Shaba, Zaire) visited Dr. Schweitzer. He received the place of honor at the dinner table and was in no way treated differently from other important guests who came to Lambaréné.

Dr. Schweitzer took a personal interest in those who worked for him. As with his European staff, he never begrudged the African employees who left on short notice. He greeted them as friends upon their return and rehired them if possible. The employees thus had considerable personal freedom.

Certainly, Dr. Schweitzer had an idiosyncratic way of handling his African staff. This was the result of many years of interaction and was based upon mutual understanding of a unique kind. But the Africans liked the warm, personal touch of Dr. Schweitzer and they readily accepted the difficulties that inevitably developed in a work situation with the kind of person the doctor was.

African workers felt secure in Lambaréné. As long as they worked at the clinic, they and their families were protected from sickness and famine, the two greatest threats that those living in the jungle have to face.

Among the Africans who served at the dinner table was Leo, a man who had been with Dr. Schweitzer for more than twenty years. A rather shy person who seldom spoke, Leo organized the work in the dining room with ease. He allowed no one else to serve Albert Schweitzer and his guests. He served with elegance, and with pride in his work.

Whenever I hear criticism of Dr. Schweitzer's handling of his African employees, I remember Leo, who was so visibly proud of making Dr. Schweitzer and staff happy with his service. There was a uniquely friendly relationship between those who served and those who were served in Schweitzer's Lambaréné. Leo's tall figure and stern face were so much a part of the dining room that his absence was always noted. He had the habit of visiting his home village without letting anybody know in advance. Everybody felt relieved and happy when he returned, something that he knew very well.

Once, however, luck turned against Leo; not by anything Dr. Schweitzer did, but rather because of Leo's own personality and the African environment in which he lived.

Returning home from one of his trips, Leo found a strange man visiting with his wife, Leah. Overwhelmed by jealousy, he chased the man away and, in a sudden rage, beat up his wife. He did not come to his senses until Leah fell to the floor, unconscious. Then, filled with shame, Leo brought her to the hospital. Leah was in acute pain and to our regret we could not prevent her from having a miscarriage a few hours later. Word travels fast in the jungle and many of Leah's relatives soon arrived at the hospital.

Leo was the one most deeply upset by the event. Ashamed, he stood at Leah's bedside. With lowered head, he held her hand, while the relatives heaped scorn upon him. I could not understand what Leah's agitated kinspeople were saying, but it seemed to me that she tried to defend her husband.

One man was especially indignant; in an agitated voice, he talked to Leo, not giving him a chance to answer. The commotion was disturbing Leah, who was still quite weak, so I ordered everyone except Leo to leave. He remained with Leah as long as she was in the hospital, and slept on the floor beside her bed.

After a few days, Leah was well and home again; but Leo was not his old self anymore. He went around with a depressed, haunted look on his face and spoke even less than before. Appearing taller and thinner than ever, he became increasingly irritable and short-tempered in the dining room.

I had made friends with Leah during her short hospital stay and sometimes visited with her after work. One evening when I mentioned the changes we had noticed in her husband, she burst out: “I am so worried about him, I am afraid he is going to die.” She sobbed.

“Why should he die?” I asked. “You are the injured one.”

“Do you remember the angry man at the hospital?” she asked. “That was my oldest brother. According to the custom of our people my brother would have been intimately involved in the raising of our child.”

On the fateful day of the beating, she explained, her brother had had the impertinence of demanding a large sum of money from her husband in order to compensate him for the eventual bridal price in case the unborn child should have turned out to be a girl. Leo had refused to pay.

“Then my brother cursed him and vowed vengeance. I know Leo feels bad about what happened anyhow, and now he is afraid of what my brother might do. But it is not only that....”

Leah hesitated and looked around anxiously. When she felt sure nobody else could hear us, she continued in a low voice.

“Leo and I became Christians many years ago. We are not supposed to believe in the ancient ways anymore. But now, because of what has happened and because of my brother's curse, Leo is no longer sure his Christian faith can protect him. It is as if all the old beliefs are coming back in this time of crisis.

“I know Leo tries to fight it. For hours he kneels on the floor at night when he cannot find sleep; in tears, he prays to Jesus for help and forgiveness. But then he covers his ears with his hands to protect himself from voices which I cannot hear. He fears my brother's witchcraft and also the thought that ancestral spirits might be angry and seek revenge. I know he has secretly visited a sorcerer to ask for advice and for protective medicine. He also paddled up the river to see the missionary and to pray at the little chapel there. But nothing seems to help.”

Leah started to cry again. “I wish I knew how to help my husband,” she said. I comforted her as best I could, encouraged her to be patient, and suggested that she persuade her brother to reconcile with Leo.

A few evenings later, I had to return for something in the dining room. Leo was alone, cleaning up the table. His behavior appeared peculiar and I stopped to watch him closely. Preoccupied with what seemed to be a kind of ritual, he did not even notice my presence. Holding a big knife like a spear in his hand, he went from plate to plate and meticulously cut all the food leftovers into small pieces.

“What are you doing?” I asked in surprise, immediately regretting my question, for Leo recoiled as if caught redhanded at an evil deed. He grinned sardonically.

“I'll get you,” he said in a low voice, “Oh yes, I'll get you all. You little devils cannot hide in the food. I'll kill you all. No one is going to escape.”

He looked fierce. My heart began to pound. Without taking my eyes off him, I backed out of the door. I stood in the dark. What should I do? Something was awfully wrong with Leo.

“Come to me any time you have a problem,” Dr. Schweitzer used to tell us. Here was indeed a problem!

I ran to get my kerosene lamp and hurried across the yard to Dr. Schweitzer's house. He looked up from his books in surprise, but a glance at my face convinced him of the urgency of my visit. He quickly put down his pen and listened attentively as I related the scene I had just witnessed. Dr. Schweitzer called nurse Ali and told her to have Leo come right away. While we waited, I told him everything I knew of what had happened to Leo and his wife.

Soon Leo appeared at the door. He looked haggard and anxious. He fell to his knees and covered his face with his hands.

“Leo, my friend, what has happened to you?” Dr. Schweitzer asked gently.

Leo was crying. “I am finished,” he sobbed. “They are without mercy; they will get me.”

He raised his face towards Dr. Schweitzer, his eyes closed, tears streaming down his hollow cheeks. “If I could only find some rest,” he continued in a trembling voice. “I sleep in a different place every night so they won't find me. I pray to Jesus, for I have sinned, but the spirits will not go away. I know, they want my life for the new life I destroyed.”

It was quite shocking to see this usually composed and self-confident man disheveled and shaken with such fear.

“If I could only get some sleep,” Leo repeated with despair in his voice. “I am so tired.”

He opened his eyes and looked at us. “Please help me!” he whispered. His lips twisted in pain. “I can fight no more.”

For a moment Dr. Schweitzer was at a loss for what to say. We looked at each other. Had this once so-strong man, now burdened with guilt and tormented by sleeplessness, lost control of his mind?

“If we find a place for Leo to stay at night where he could feel secure,” I thought, “then he might get some sleep and regain enough strength to deal with his problems.”

I knew that, to the Africans, we Europeans were considered to be outside the sphere of their witchcraft and magical powers. A storehouse that Eric had built, came to mind. It was not far from Leo's home. Maybe he would feel safe in there? I mentioned it to Dr. Schweitzer while Leo waited, still on his knees.

“Maybe you are right,” Dr. Schweitzer said after he had thought it over for a while. “Could you and Leah get it ready while Leo and I talk? I may be able to relieve some of the feelings that burden his mind.”

While Leo opened his troubled heart to the old doctor, I went to Leah, who was anxiously waiting for her husband. Leo stayed with Dr. Schweitzer for a long time and when he finally returned, he appeared much calmer. We accompanied him to the storehouse, which still smelled of freshly cut wood and where we had arranged some furniture and made up a bed for him. With a sigh of relief, Leo went in and locked the door.

He lay down and soon we could hear from his regular breathing that he had fallen fast asleep.

But the peace did not last. When he heard that his brother-in-law had refused reconciliation, Leo fell into a brooding mood. He was very much afraid of his wife's brother and voiced a suspicion that his food was poisoned. He hardly ate at all. It did not help that Leah tasted the food first.

“You are not the one who is cursed,” he would say and turn away.

Leo became suspicious and withdrawn. Leah told me that he was mumbling to himself, arguing with invisible spirits, that he insisted he could see spirits sneaking around at night, looking for him everywhere. But he was clever, he told her, for they never thought to peer into the European-built storehouse.

Because of his harassed look and repeated displays of ill-temper in the dining room, Dr. Schweitzer suggested Leo should take time from his job until he felt better. Leo gave Dr. Schweitzer a hurt look and continued to work the rest of the day in silence; he wore a somber expression on his face.

Screams in the night! I was jolted out of bed and lit the kerosene lamp with trembling hands, hastily put on some clothes, and darted out into the dark. People were running from all directions, converging on the storehouse. Inside a voice filled with horror and torment cried for help. The door was locked. We could hear screams and noises like fighting inside. We called Leo's name and pleaded with him to unlock the door.

There was a sudden silence. This seemed to us even more frightening than the turmoil before. We threw ourselves against the door until the lock finally broke and we tumbled into the room, kerosene lamps held high. Smashed furniture and torn bedding was scattered on the floor. Crouched in the corner behind the overturned bed, a pair of terror-stricken eyes glowed in the flickering lamplight. Leo, pressed against the wall, stretched out his arm and pointed a long finger at the opposite side of the room.

“The Devil! the Devil! I saw him. I hit him. I got him,” he croaked.

Indeed, a kerosene lamp was lying there, smashed against the wall. In the sudden dark, fear must have overpowered Leo so he finally cried out for help. But even our presence did not reassure him. He suddenly jumped from behind the bed, throwing his arms around as if fighting for his life. The men had to overpower him. They threw him to the ground and bound his arms and legs with the torn sheets, thus preventing him from doing harm to himself or the others.

In the meantime, Leah and some of her relatives had arrived. She knelt beside her husband and called his name, pleading for him to speak to her. But Leo was beyond reach. Eyes rolling, and frothing at the mouth, he spoke incoherently. His glance was so fierce that even Leah backed away. We stood around for a while until somebody suggested we take him to the psychiatric unit of the hospital. Leo was placed on a blanket and carried off. With many kerosene lamps lighting the way, I led our procession a long way around the hospital so that Leo's yelling would not disturb the other patients. The compound for the mentally ill had been built at a certain distance from the rest of the hospital exactly for that reason.

Psychiatry is usually the last branch of medicine to be developed in tropical Africa. As far as I know, there was no psychiatric facility in the whole of Gabon except for this unit at Schweitzer's hospital. It had a capacity of 20 beds.

The fate of the mentally ill in such a country was often deplorable. Psychotics who manifested aggressive behavior either vegetated in dungeons, languished in prison cells, or had to endure bondage and other restraint in the villages. Nothing perpetuates fears of witchcraft and malevolent spirits as much as a raving maniac, and the amount of beating and harsh treatment he has to suffer depends upon the intensity of fear he arouses in the villagers.

Even when no longer dangerous, such a person might never find a place in his society again. If he has recurrent violent attacks or lasting personality changes, he will remain an outsider. His fears of being poisoned or ostracized further damage the relationship between the mentally ill and the other villagers, until there will be another outburst of violence, sometimes in self-defense, at other times in response to delusions. In panic, the disturbed person might run blindly into the jungle and, as the villagers are often too afraid to rescue him, he succumbs to starvation or to wild animals. If he tries to find refuge in another village, he is met with suspicion and hostility, and will soon be chased away, or killed outright. Should he be lucky enough to reach a medical facility, chances are he will be turned over to the police for custody.

In spite of the uproar caused in the hospital each time an insane person was brought to Lambaréné, Dr. Schweitzer never had the heart to turn away the “poorest of the poor,” as he once termed the mentally ill. He had never had a psychiatrist working at Lambaréné but his hospital could at least provide some form of treatment for the mentally ill, affording them protection and medical care--which Dr. Schweitzer performed himself until he let Dr. Friedman take over this difficult task. Many a psychiatric patient had recovered enough under the care of the hospital staff to return to his village. Some would come back looking for help again when they felt a relapse threatened their lives or that of other villagers. Those who did not dare to return home or were chronically disabled either stayed on in the hospital, helping out with the other psychiatric patients, or found a new home in the more tolerant African community of Lambaréné.

After a frightening experience in the old hospital when a violent patient broke out of confinement and harassed the other patients, Dr. Schweitzer had built a separate compound for the mentally ill in his new hospital. It consisted of three buildings constructed around an inner yard.

In two of these buildings were maximum-security rooms. The third building housed patients who were only moderately disturbed.

Dr. Schweitzer had personally supervised the construction of this structure, making sure the rooms in it were built solid enough to withstand the onslaught of even the most violent psychotic patient. These rooms had no windows and no furniture; the patients slept on mats spread on the floor. Facing the yard was a heavy wooden grill above and around the door. Fresh air and light came into the room through it and the patient could keep in contact with the outside world. The nursing staff was also able to watch the patient without having to open the barred and securely bolted entrance; if necessary, food could be handed in through a narrow slot in the door.

It was to one of these rooms that we carried Leo. Two men untied the ropes and hastily retreated, locking the door of the cell as they stepped outside. Fortunately, Leo had calmed down. He probably felt protected from the spirits in his new environment and even allowed an orderly to give him tranquilizing medication, which, finally, made him fall asleep. Relieved, we all returned to our quarters--except for Leah, who sat on the ground outside, crying silently and praying for her husband's sanity.

For days Leo was completely unreachable, ranting and raving in his cell. No amount of medicine could pacify him and it was such a battle to subdue him for an injection that we gave it up, since it did not seem to help. He was constantly fighting imaginary enemies, and at times we were afraid he would succeed in tearing apart the walls. His shrill voice and bloodcurdling yells could be heard all over the place and created a tense atmosphere among the patients. Fear crept through the hospital at night. Children clung to their parents and people whispered to each other with anxious faces. Afraid to talk aloud, they threw shy glances in the direction of the compound where Leo was fighting his noisy baffle.

A maniac may appear intimidating to anybody, but because of the African folk belief that the evil spirits might jump from one person to another, people were terribly frightened. Usually they were reluctant to talk about their beliefs regarding the causes of insanity, but the events of Leo's illness, and the fact that I showed interest and concern for the sick man, made them open up. They began to talk, especially when we met in the yard or on the way to visit Leo.

Some people thought Leo might have been poisoned and worried that in-laws might try to sneak in harmful substances; others assumed ancestral spirits were taking revenge for the unborn child whose death he had caused; some believed that Leo was bewitched and that an evil spirit possessed him. They told me that such a spirit had the shape of a bird and would lodge in a person's chest. If one placed the hands flat on the chest, one could feel the bird flutter, beating its wings against the ribs, they said. A medicine man could remove the spirit by making a hole in the chest cage and letting it fly out; or he might prepare a potion which would kill the bird-spirit and thereby cure the madness.

A few people told me in a whisper that it could be the Christian Devil who had taken hold of Leo for what he had done; others speculated that perhaps “African spirits” wanted him to forsake Christianity and again live the “African way of life.” For hours people would watch from a safe distance how the madman tore up the floor and furiously shook the wooden lattice, spitting at anyone who dared to come close.

Leo did not seem to recognize anybody. He stuffed his ears with his own excrement and smeared it all over his body and on the walls. He looked at us with piercing eyes and when we handed in food through the slot in the door, he stiffened with fear, grabbed the food, and threw it at us, yelling, “Poison! Poison! You want to kill me!”

For several days he did not eat or drink at all and wasted away until he looked like a living skeleton. At that point, we decided to force-feed him in order to save his life. By now he was too weak to offer much resistance, but it was still an ordeal to push the feeding-tube down the throat of the terrified patient, so we took turns in performing this unpleasant task. Fortunately, he had a gap between his front teeth and could not bite off the tube when clenching his teeth. Once the tube was in the stomach, Leo appeared to derive a peculiar pleasure from the feeding. With a placid expression on his face, his eyes fixed at the feeding bottle, he sucked at the tube like a baby.

Afterwards he would fall asleep for a while--until a new wave of excitement tore him from his slumber.

Gradually there was a change in Leo's condition. He became increasingly withdrawn, his excited states lasting for shorter periods, until he would sit for hours in the darkest corner of his room, staring into space and hardly moving at all. When we dragged him out of the corner at feeding time, he would remain fixed in whatever position he was placed. We had to sit him up and open his mouth. He would stay immobile, his mouth gaping open, and would not flinch at all while we passed down the feeding tube. We talked to him, but he did not seem to hear.

After the feedings, he just remained in the position he was left, with an indescribable expression of suffering on his face. He did not stir even when his wife called his name. People stood around speechless, astounded by so much suffering; even men had tears in their eyes. Neighbors came forth, reassuring him that nobody held any grievance against him; even his brother-in-law begged to be forgiven the insult he had caused. All to no avail. We thought Leo was going to die.

Every day Dr. Schweitzer inquired about Leo's condition. When we told him that Leo was probably not going to make it, he went to see the sick man for himself.

As Dr. Schweitzer slowly walked across the yard to the compound where Leo was confined, many people accompanied him, eagerly clearing aside little children and goats, for if the old doctor himself was going to see the sick man, he would surely recover. The confidence and veneration that shone on their formerly so-anxious faces was quite moving. Dr. Schweitzer seemed oblivious to the stir his presence created; he appeared deep in thought. For a while the old doctor looked at the patient in silence. Then he stepped close to the grid.

“Leo,” he said in a low but stern voice, “it's enough! You have shown us your sorrow and you went to the limits of what a human can endure. Your friends and relatives are suffering with you. Nobody wants to harm you; we all wish you to be with us. Come back to us now--or you will die. If you die, there will be more suffering and grief. To atone for what you did to your wife, you have to live! Show her that you are a man of courage as well as a man of heart.”

There was deep silence. Everybody drew closer; one could sense the goodwill that went out towards the sick man. Did Dr. Schweitzer's words reach him? Leo's eyes did not blink; he remained like a statue, immobile, with an aura of mystery about him.

“We count upon you, Leo. We want you to stay with us!” repeated Dr. Schweitzer. He turned away and slowly walked back to the hospital.

The spell was broken. People hastened forward; they stretched out their arms through the grid, trying to touch the rigid body inside while they called Leo with friendly, persuasive voices.

Leo did recover! At first it was just that he lay down to sleep. Then he opened his eyes and looked when his name was called. He began to respond to the sympathy of the people and even smiled at his wife. Slowly he began to eat and drink. But for days he remained helpless like a baby. He let us feed and groom him like an infant and could not decide anything for himself. He would observe us with wide-open eyes and imitate our movements; laugh when we laughed and talk when we talked, repeating every word we said.

The next step in his recovery came when he began to speak on his own. At first he spoke only in the form of questions. “Should I eat now? Should I lie down? Is it all right to sleep now? May I use the spoon?”

Only when constantly reassured that he was doing the right thing did he dare to eat, drink, or move around.

Then he slowly began to turn his attention towards Leah, who had faithfully stayed near him all this time. He started to talk with her. Finally came the day when we could open the cell door without fear and let Leo out. Unsteady on his feet, he hesitated before he stepped out into the sunlit yard. He looked around in silence, but the glance of his eyes was normal and his expression peaceful. He took the arm of his wife and slowly they walked off, back to their own little hut, away from the place where both had suffered so much.

It was a great day for all of us when Leo appeared in the dining room to take up his duties again. Although still thin and weak, he went about doing his work as before, maybe a bit more gentle in his manner. It did not take long before he regained his full self-confidence. Soon he showed the same joy in his work as he had before. What agreement he had made with his wife's family we never got to know. When later asked about his illness, he would give us an embarrassed smile and answer that he could not remember anything of it at all.

Copyright © 1990 Louise Jilek-Aall
Reprinted with permission

[Previous Chapter]     [Contents]     [Next Chapter]

to top

Internet Mental Health ( copyright © 1995-2011 by Phillip W. Long, M.D.