Call Mama Doctor

Chapter 21. Back in Europe

By Louise Jilek-Aall, M.D.

Nearly a year had passed since that day when I stepped over the kifafa-toad at the mountain mission in East Africa. I had not yet found a way to vanquish the beast, but neither had I given up fighting it. After a short holiday with my family in Norway, I went to Switzerland where I thought I would have the best chance to find support for my African plans. Professor Manfred Bleuler, chief of the university psychiatric hospital in Zurich, had for years shown great interest in my work in Africa and had supported it financially. As soon as he knew I was back in Europe, he offered me a position at the Burgholzli hospital.

Once I was established in my new job, Professor Bleuler encouraged me to work on my doctoral thesis under his supervision. I was to write about the medical, psychological, and social aspects of kifafa. He also used his influence to give me the opportunity of presenting the case of the African epileptics at scientific congresses and at meetings of charitable organizations. My presentations met with much interest and the humanitarian aspect of my work was fully recognized, but nobody offered financial support for the clinic at Mahenge. To my dismay I discovered that epilepsy held low priority in the health care planning of governments and international agencies. Epilepsy falls between the specialties of neurology and psychiatry. It is a stepchild of medicine and therefore institutions for epileptics usually suffer from a lack of funds.

Through the endeavors of Professor Bleuler, however, I received an invitation to present my kifafa treatment project to the World Health Organization in Geneva. Full of excitement I sat in the train on the way to Geneva, planning what I would say in front of the international experts. When I ascended the broad steps of the Palais des Nations it felt like a dream come true. I soon found myself seated at a large green table in a dark conference room. A dim light shone from a desk lamp standing beside the only other person present in the room. This was an elderly gentleman who, at that time, was in charge of Mental Health at the W.H.O. He seemed to hide behind a pair of dark glasses as he faced me across the table, and when he asked in a cold dry voice what I had to tell him, my confidence failed. Intimidated beyond recovery, I tried desperately to gather my thoughts. I had the feeling that I was addressing the green table, the empty chairs, the little lamp and the pair of dark glasses. While I was describing the plight of the kifafa sufferers and how a relatively small amount of money and outside help could create a self-sufficient center for epileptics with workshops, housing units and rehabilitation facilities both for the patients and for their families, the old man in the obscurity of the lampshade listened without moving or asking any questions. When I had finished, there was a long silence while I anxiously awaited his reply.

“Are you a specialist in neurology or psychiatry?” he asked. “No, but I . . .” “Well then, young lady,” he interrupted me, and his voice sounded annoyed, “neither Professor Bleuler's recommendations nor your beautiful eyes will help you in this matter. Since there appears to be some virtue in your proposals, I suggest you come back to us when you are a specialist and have made a name for yourself. We may then consider lending you the umbrella of W.H.O.” He called his secretary, dictated a few sentences to that effect and filed the note away in a thin folder upon which my name was written. “We are not discussingme!” I wanted to say. “What about all the epileptics in the meantime?” The hard face with the dark eyeglasses made further discussion impossible. Frustrated and humiliated, I ran down the steps I had climbed with so much hope. On my return trip to Zurich the disappointment changed to anger. I was going to show him. Even if it was to take many years, I would come back; and I would never let anybody put me down like that again.

When I told Professor Bleuler about my ill-fated expedition to W.H.O. he tried to cheer me up, discussing what else could be done. He suggested that I take part of my training at the Swiss Institute for Epileptics in Zurich, headed by his friend Dr. Landolt, an international authority on epilepsy. He said he would contact pharmaceutical companies to have them donate medication and funds for the epileptics in Mahenge. He spoke with such warmth and enthusiasm that I regained my self-confidence and exclaimed, “I am going to build the Treatment Center for kifafa even if I do not get any help from W.H.O.!” “That would mean spending many years in Africa,” Professor Bleuler said after a thoughtful silence. “I wonder whether you are fully aware of the consequences for your own life if you embark upon such a project? You might jeopardize your professional career here in Europe, and if you excuse me for becoming personal, you would probably risk your chance of ever getting married, if this is of any concern to you.” He added gently, “Remember you are not getting any younger, and believe me, there are few men who would be prepared to follow you to Africa for such a task. ” I looked at him anxiously. Consequences I had not thought of before now appeared very threatening to me. “What shall I do then? Of course I would want to marry and have a family, but I cannot just forget the epileptics I pledged to help. Physicians in tropical Africa say it is not possible to treat epileptics in remote areas. I have shown that it can be done. If I give up now, many epileptics in the African bush who otherwise would have a chance to start a new life will have to go on untreated and miserable.” “True”, Professor Bleuler said with a smile, “no doubt this task is important, but you must understand that it is by no means a matter of course that one puts one's life last for the sake of others. That is a matter of personal principle. I only want you to think it over carefully and not drift into a situation which you have not really planned and which might have serious consequences for your whole life.”

I had to think about these words for a long time. Had my life in Africa not been that way? Drifting from one situation to the next, I had seldom taken time to reflect on my actions. Even coming to Zurich and starting training in psychiatry had been more an outgrowth of my work in Africa than part of my original intention.

Life as a resident psychiatrist at the Zurich University Clinic was not an easy one at a time when most of the modern medications were not yet available and there were indeed moments when I had doubts about continuing in this branch of medicine. At the Burgholzli the staff physicians still lived in the hospital just as Professor Bleuler and his father before him had done. Professor Bleuler's home was right there in the main building, and most of the residents in psychiatry had their rooms next to his suite. We were expected to make ward rounds before and after the regular work hours, and the physician on call had to go through the whole hospital in the late evening before retiring for the night. Being used to the open spaces and the bright sunshine of Africa, the old hospital with its long corridors, dark rooms and locked doors appeared very oppressive to me. Here too the drama of life and death was acted out, but with a difference. When I wandered through the dark corridors at night, hearing shrieks and moans, as the orderly with the bundle of heavy keys unlocked one door after the other, I tried to ease the tension I felt by thinking of my friends in Africa. How this place would have frightened them! They would have thought that the whole hospital was full of menacing spirits and that many of the agitated patients would turn into wild animals at any moment.

The psychiatric orderlies accompanying me on the rounds reminded me of the faithful “dressers” I had worked with in Africa. Having worked in the jungle of mental suffering for years, these orderlies knew how to handle the patients entrusted to them. Friendly and calm, they stayed at my side, protecting me from agitated patients and tactfully suggesting to me, the beginner, how best to manage each individual case. Thanks to them I soon felt more comfortable. But among my colleagues I remained an outsider. I was not able to find my way back into the life of a modern European city. Even at social events I felt out of place.

Thinking of Professor Bleuler's words, I began to look closer at the men I met. I seemed to bore them with my never-ending preoccupation with Africa. Africa was like an obsession, like a fever in my blood. How could these European city dwellers understand the magic spell Africa casts upon those who have lived there? We obviously did not speak the same language, and I felt exceedingly lonely. Had it not been for Professor Bleuler, my fatherly friend, and the many letters I received from Africa, I might have lost myself in depressive brooding. Every Friday I saw before my inner eye the patients gather at the Mahenge Clinic to receive their medicine. Whenever the Clinic ran out of funds I sent part of my salary to the nurse. Her letters told me how well patients were doing and contained thankful notes from them which made up for any hardship I felt. One of the patients wrote:

Dear Doctor, I am very pleased to write you in order to inform you that my health and condition as regard to my ailments you know are very well progressing. I must try to identify to you my movements because of these tablets with the very precious treatments which must make me remain always thankful to you for carefully managing to care for my disease. I have disposed of this not very bright invention of a letter hereby presented obediently to you thus God may heed to what remains best for thanking you doctor. You being away from Tanganyika is a straight sorrow especially to those depending thoroughly on you, like the poor lad as I am. Kindly present my best wishes to your parents, sisters and brothers and all your countrymen and women. Yours cordially. Amani.

Those charming letters from African schoolboys I used to get, reached me now even in Europe.

Dear doctor of mine, I am sure you won't remember me, if you only read this letter, but I will remind you that on the day before you left Mahenge for Europe, there were two young men who came to your office for a farewell. The young men asked for your address which you kindly handed to them. They also asked you to find girl friends for them in your country, whose request you kindly accepted. I'm one of those young men.

Well charming lady, it's now about a year since you left us. In due time I had a strong desire to write to you but I could unfortunately not find your address. Even though I did not lose your imaginary photograph which is still existing in my mind. I don't think that I'll have a minute of forgetting you one day till the end of my life. This afternoon I found your address in one of my books. Now imagine how lucky I have been. Unexpressable!

To state the fact, the friendship I introduced on that day wasn't for anybody in your country as I mentioned, but for yourself. I like you to be a pen pal of mine. I am a school boy who loves you. It's true that I've never come across a generous lady like you. You talk freely, you smile freely, you have initiative in your work. When you smile you look very pretty and I like you remaining that way all the time, and when you don't it makes no difference. I also like seeing you that way. Hullow, I appreciate that you are different from the other ladies, really exceptional. Should you prefer me remaining with only the imaginary photograph of yours I love you anyhow remembering how you look at me, sit, stand and walk.

My present address is as at the top of page one with the same name as at the bottom of page two.

When are you coming back again to Africa please? Yours in love, Francis.

Another schoolboy asked for my picture in a more sophisticated way. He wrote:

Nowadays we are learning about culture, and we are trying to analyse Bantu culture. It is suggested as an hypothesis that the Bantu is not satisfied with abstract information or communication.

He is more interested in concrete information given by a human being physically present than otherwise. Whether this hypothesis is in accordance with reality or not you might discover it when you come to Africa. But in fact this is the case with me. I would rather meet and talk with a person than write a letter to that person if meeting is possible and cheap. If meeting is not possible I cherish to read a letter from a person while being in possession of that person's picture. In short I am asking for one of your photos.

At Mahenge last year we met for a very short time to leave each other. I hope one day we will meet for a long time to live and work together, where and when I hope, I shall give you many thanks for what you have done for me. Please, Yours Mawanja.

In the meantime the work on my thesis was progressing with difficulty. I often wondered how the people of Mahenge would react to my discussion of their kifafa-sufferers, and this doubt slowed down my writing until, one day, I hit upon the idea of writing to the Catholic bishop of Mahenge, himself a member of the Wapogoro tribe, asking for his advice. He sent me the following answer:

Dear Doctor Louise, Thank you very much for your letter. Owing to lack of time I have been very late in answering you. Today I am going to answer with this letter.

I am very impressed by your eagerness to help our poor epileptics. It is a pity that so far you have not found any encouraging responses to your appeal for financial help.

After getting your first letter I went to the different chiefs to get a clearer picture about how many epileptics there are in my diocese. One chief reported that there are about 150 more untreated epileptics in the Mahenge area. The other chiefs have not given their report as yet. It is very difficult to get exact numbers, because since the epileptics are shunned by other people, nobody likes to say that he or she is one. Even their near relatives help them to hide it until they can no more do so. Therefore only those who have epilepsy in a very advanced stage, and have repeated fits, are known by many people. It is my desire to help you as much as I can do. But it is a pity that my time is so much limited.

I am glad to hear that you are going to write a book about the Wapogoro and their kifafa's. I think you can write about the poverty of Wapogoro, their beliefs about kifafa, and their attitude towards those who have kifafa. Nobody will be offended if it is done in a manner which does not show that you intend to despise them for these weaknesses. Therefore you must be very careful in your description to avoid anything which may make Wapogoro think that you want to despise them. You may state the fact about their poverty, their beliefs about kifafa, and their attitude towards those who have kifafa. But then it would be good to point out that the cause of all these lies in the lack of facilities of improving their standard of living, and in lack of education about the causes of illness. Such a book will be all right, and every reasonable Mpogoro will be delighted to read it.

I think you must not hide the name of the place and of the tribe about which you are going to write, as there is no need to do so. Moreover, by hiding the name of the place and of the tribe about which you are going to write, you will, I think, sacrifice a very important element of the book, and needlessly. Therefore, I would advise you to describe everything clearly, courageously, but tactfully.

Wishing you good success, I pray God to bless your endeavour. Yours sincerely, Elias Mahenge, Bishop of Mahenge.

This answer encouraged me so much that I was able to complete the thesis in the next few weeks and then I left the Burgholzli hospital to start working at the Swiss Institute for Epileptics. On the first day, when Dr. Landolt took me around to show me the Institute and to introduce me to the epileptic patients, I felt deeply moved. Here was the model of what I had been hoping to create for my African patients. The epileptics lived in houses surrounded by fields and gardens. They worked together in workshops and on the farm and took care of the animals. They shared happiness and sorrow and assisted each other when one of them took a seizure. The Institute had a modern EEG laboratory where the patient's progress could be monitored closely and where Dr. Landolt and his co-workers conducted research into new treatment methods. Dr. Landolt was a shy and friendly man, loved by staff and patients alike. He became greatly interested in what I told him about kifafa.

There is no spirit-toad of epilepsy in modern Western society, he told me, but there is prejudice against the epileptics, reaching far back in time. The ancient Latin term for epilepsy, morbus sacer, a disease sacred as well as demoniac, reveals a deeply engrained ambivalent attitude toward those afflicted. In discussion with Dr. Landolt I found, to my surprise, that much of the magic belief surrounding epilepsy in Africa had also been part of European tradition until modern times. During the Middle Ages epilepsy had counted as one of the eight contagious diseases. Saliva of the convulsing epileptic had been thought of as especially dangerous. That epileptic attacks were influenced by the phases of the moon was firmly believed, just as it still is among the Wapogoro today; nor has the suspicion that epilepsy might be sent by God as a punishment for sins quite disappeared among European peoples.

A few months after I had begun to work with the epileptics I was called to see the professor of pharmacology at the University of Zurich for whom I had brought medicinal herbs from Africa. With him was a representative of the pharmaceutical laboratories where the herbs had been analyzed. My heart began to beat faster when he broke the news that the bark I had received from the medicine man in Mahenge indeed possessed anti-epileptic properties. A decoction of the bark had been administered to test rats and had diminished the induced convulsions. Unfortunately the amount of material had been too small for further experiments. The researcher was now interested in obtaining a larger quantity. As much as a thousand pounds would be needed for conclusive analysis, he said. The question now was, would I be willing to undertake an expedition to gather the material if all expenses were paid by a pharmaceutical company?

For a while I was speechless. It was as if suddenly all the patients in Africa came alive inside my head, rushing forward, laughing, crying, calling and demanding. To my own surprise, my first feeling was apprehension rather than joy. Going to Africa right now? It would not be adventure any more--I knew that life too well. It was easy to dream about Africa in my comfortable apartment in Zurich--but to face all those problems again? What about my training which would have to be interrupted, and my well-paying job? I dropped my head in shame. Alas, there was the truth, the personal principle Professor Bleuler had talked about. I seemed to care more for myself than for the patients in Mahenge. Was it not the kifafa-toad I heard laughing in the distance? Finally I asked for time to think it over.

The following days I went around in a daze. Sometimes I felt happy and confident. What a triumph for my friend, the medicine man! He had told me that kifafa sufferers only needed to drink his decoction regularly for about a month to achieve relief from attacks for years. No modern medicine could match that. At other times I felt anxious and full of doubts. How could I get hold of a thousand pounds of the bark? Would the medicine man be willing to collect such an amount for me? What would the other tribesmen say? Would they not take offence at such a commercial undertaking? After all, the knowledge of medicinal herbs belonged to the sacred lore of the whole tribe. In any case it would take a long time to collect the material and while I was there in Mahenge many new epileptics would come for treatment and swell the number of patients attending the clinic. What should I do with them? How would I support them all? I recoiled from the many problems I knew I would have to face anew. And what about the loneliness? Had I not wept bitter tears in my bed there in Mahenge? Had I not stayed in my room at night so that the moon would not shine upon a lonely person?

One summer evening at the end of a workday I sat at my desk gazing forlorn out the window over the sunlit Lake of Zurich. “It is such a beautiful evening. I am driving out of town to the old castle of Rapperswil to take some pictures. Would you care to come along?” The friendly voice pulled me out of my painful loneliness. I turned around. An Austrian colleague who also worked at the Institute had come back to the office to pick up some books. We had never met outside the hospital, but I loathed the awful struggle that was going on in my mind and I accepted his invitation. We drove alongside the lake, but I was absentminded and could not catch on to the conversation. We stopped in Rapperswil at the bridge which traverses the lake at a narrow point. From here one has a marvelous view of the old castle. People were taking their evening stroll on the bridge. My colleague brought out his tripod and camera and we too set out across the bridge. In the middle of the bridge there was a space with flowers and benches. An amorous young couple was sitting on one, and my new friend, deciding that here was the best view of the castle, without the slightest embarrassment placed his tripod right in front of them. The young man looked up with a frown and said something in Italian. My colleague responded with a joke also in Italian. They all had to laugh and the couple did not mind being photographed with the castle in the background. Watching from a distance I enjoyed the scene. The picturesque castle glowing in the setting sun was mirrored in the calm waters. And as I stood at the railing, smiling to myself, a new awareness came over me. Never had the colors of the sky appeared so warm, the songs of the birds sounded so gay and the sight of gold-rimmed clouds filled me with such content. In my heart I recognized that it all happened because I was not alone.

On the way back there was a good feeling between us and little by little I began to talk about what burdened me. I spoke of Africa and the difficult decision I would have to make. My colleague listened with interest and sympathy as he drove me back to Zurich. But when he had dropped me off and I was again alone in my apartment, I felt less inclined than ever to leave for Africa.

My indecision exhausted me and threw me into a depressed mood. When the day came for my answer, I knew I had to accept the proposal, but I did not feel happy about it. Just as I was leaving the Institute for the meeting with the pharmaceutical representative, my photographer-colleague caught up with me and quite simply asked whether it would be of any help if he came along to Africa? “I have some years of experience in neurology and psychiatry,” he said “and since I have worked at the Institute here for over a year now I could easily arrange to be away for a few months.” I looked at him in blank astonishment for I had never thought of such a possibility. It took me a long time to rearrange my thoughts. Slowly a feeling of great relief spread through me. I would not have to go back to Africa alone. Here was somebody willing to share responsibility with me, an experienced colleague whom I would be able to consult when facing difficult patients, someone to turn to when I was in trouble. I felt I could trust his judgement and count upon his friendship. “You really want to come with me to Africa?”--my voice was trembling with disbelief. “And I don't even know your first name!”

Copyright © 1979 Louise Jilek-Aall
Reprinted with permission

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