A Reverence for Life

With its long commitment to global and community health, it’s natural that HMS would be a wellspring of Albert Schweitzer Fellows. Schweitzer is often remembered as a Nobel Prize laureate who, late in life, dedicated himself to abolishing nuclear weapons. Decades earlier, however, he was renowned worldwide as a physician who delivered medical care in areas of Africa that were bereft of such care. In 1913, with his wife, Hélène, he established his eponymous hospital in Lambaréné, Gabon.

The hospital’s supporters have kept it functioning since Schweitzer’s death in 1965. The Fellowship has been integral to the facility’s survival.

The Lambaréné Schweitzer Fellowship Program, established in 1979, annually sends four senior medical students to the Albert Schweitzer Hospital for three-month rotations in pediatrics and internal medicine. It wasn’t until 1987 that a fellow was named from a U.S. medical school other than HMS.

As fellows, HMS students experience firsthand diseases they’ve only read about—malaria, schistosomiasis, and intestinal parasites—but also treat more familiar conditions such as gastroenteritis, otitis media, and anemia. In addition, they learn to work effectively within the limitations of medicine in a rural area in a developing nation.

Action Figure

Before he left for Lambaréné, Samuel Stanley, Jr., ’80 told a reporter that he was looking forward to the opportunity to get actively involved in patient care rather than “being the fourth person to listen to someone’s heart.”

Little did he know how active that involvement would be: Stanley found himself in charge of the children’s hospital during his first two weeks in Gabon, filling in for the chief pediatrician who had returned home to Switzerland.

“It was an extraordinary amount of responsibility for a third-year medical student,” says Stanley, now president of Stony Brook University in New York and a professor of medicine in its medical school, “but it made me learn so much medicine rapidly.”

He remembers one incident. A child arrived with a swollen knee joint. Stanley performed several taps to obtain fluids for testing but drew only blood. He observed that the patient’s brother, who had accompanied the boy and their mother, had a bloody wad of cotton stuffed in his mouth where he’d lost a tooth. A light flipped on in Stanley’s brain.

“I hadn’t really thought about hemophilia because of its low incidence in Africa,” he says. “I realized I had to start relying on my observational and physical exam skills, especially because we didn’t have access to a lot of the standard laboratory tests.”

During his time in Gabon, Stanley developed an interest in infectious diseases, fueled in part by the high incidence of malaria he saw among children at the Schweitzer Hospital.

“I realized that although we had the tools to treat malaria and make the children better, that wasn’t enough,” he says. “More research was needed to create a malaria vaccine or to find other ways of eradicating the malaria parasite. I realized you could help an individual patient as a physician, but if you really wanted to get into the disease problem, you had to engage in research.” To that end, Stanley is currently part of a collaborative effort that has established a global health institute in Madagascar that will provide clinical assistance to the people of that island nation while also conducting health-related research worldwide.

A Nexus for Change

The entire three months that Ashaunta Anderson ’06 was in Gabon, she and her colleagues at the Schweitzer Hospital were assured that vaccines were “on the way.” Yet none appeared. Although Anderson had experience in clinical medicine and research—she’d spent the previous year at the National Institutes of Health—until the fellowship she hadn’t fully grasped how systems operate in delivering health care.

“I came to understand that health and health care delivery are much more than what we see happening in the clinic or the hospitals, or at the bench,” says Anderson, who divides her time between the University of California–Riverside School of Medicine, where she’s an assistant professor of pediatrics; the RAND Corporation, where she’s a health policy researcher; and the clinic. “I started to have a broader perspective that included public health, policy, and government systems. I became interested in the role those entities played, and how I might engage that broader perspective to try to help more people.”

Anderson kept a blog during her time in Gabon, documenting routine clinic days. After having seen CPR poorly executed on multiple occasions, she gave presentations on proper CPR technique, as well as on how to identify and treat hyperbilirubinemia, to physicians and the women serving as nurses.

While the fellowship reinforced a sense of service in Anderson, it also taught her that she enjoys working with other mission-oriented people, helping underserved populations, and taking positions that might be considered risky. Those characteristics are now reflected in her work at UC Riverside, a young medical school in a high-needs area that also has a shortage of physicians. She’s still interested in health disparities and the social determinants of health, and, because education is one of the most consistent predictors of length and quality of life, she’s also zeroed in on school readiness as a way to affect health outcomes.

“I’ve gone a little further upstream with both school readiness and health outcomes to look at racial socialization,” she says, “which is the process by which children learn the meaning of race in society. My goal is to develop a program or an intervention that would help parents and community members properly teach racial socialization to children so they can have good outcomes in both school and health.”

That First Step

According to Louise King ’92, an HMS instructor in medicine at Brigham and Women’s Hospital, her time as a Schweitzer Fellow served as a “stepping-off point” for her life. She followed her three months in Lambaréné with three more in what was then Zaire, working alongside her uncle, a surgeon at The Good Shepherd Hospital in Tshikaji, before returning to Boston for six months of research, ultimately taking what would amount to a year’s leave from medical school.

“It gave me the confidence to look for opportunities,” she says, “and I realized the huge needs that are there.” Although King says that during her fellowship she learned firsthand about tropical diseases including Buruli ulcer, tuberculosis, and monkeypox, her time in Gabon also allowed her to consider the broader picture of health care.

“It made a big impression on me how different the medicine was there,” says King, “but it provided an important lesson on practicing medicine in a different culture.”
In addition to working at the hospital, King traveled off-site with the hospital’s nurses on vaccination campaigns, sometimes traveling by boat to reach patients. “It was a wonderful way to be exposed to community health delivery in the third world,” she says.

Today King lives in Rwanda with her husband, Caleb King ’88, and their children, seeing patients at Ruhengeri Hospital while also participating in teaching internal medicine to the hospital’s family medicine residents. Through the Division of Global Health Equity at Brigham and Women’s, King is working with the Rwanda Human Resources for Health program, an HMS-Rwanda partnership supported by a consortium of medical-related institutions, including Brigham and Women’s and Boston Children’s Hospital.

King’s clinical work at the Ruhengeri Hospital excites her because it’s providing her with an opportunity to manage a wide variety of diseases. Although she acknowledges there are some challenges to having sufficient knowledge to diagnose cardiac problems, examine peripheral blood smears, and treat rheumatoid arthritis, King also knows she is never more than a keystroke away from colleagues and specialists around the world.

A Life Altered

In the spring of 1982, Lachlan Forrow ’83 and his close friend and HMS classmate Bob Ely left the United States to go “to Africa to help poor people in need.” But a few weeks after their arrival, Ely drowned in a swimming accident, a tragedy that Forrow witnessed. Unsure of what he should do, Forrow contacted HMS advisors as well as friends and family; they all told him to pack up and come home.

So he stayed.

“I realized that if I went running home as soon as things got hard for me,” says Forrow, “I would have proved to myself that going to Africa had never truly been about helping other people.”

Forrow spent his remaining months in Lambaréné caring for patients and reflecting on “the concrete realities of human suffering.” He also found himself thinking about Schweitzer and the suffering he and Hélène had witnessed, and experienced, themselves.

“Schweitzer wrote about what he called ‘the Fellowship of those who bear the Mark of Pain,’ ” says Forrow. “The fact that sooner or later every one of us, and everyone we care about, experiences suffering is a very deep bond that connects us to each other. If we recognize that bond, maybe we can understand that this solidarity is a powerfully motivating moral basis for trying to help each other.”

Forrow, who is an associate professor of medicine at HMS, director of the Ethics Programs and of Palliative Care Programs at Beth Israel Deaconess Medical Center, and president emeritus of the Albert Schweitzer Fellowship, has shepherded the fellowship’s expansion to include the U.S. Schweitzer Fellowship programs. These programs, he says, expose “young health professionals to the suffering of people who have inadequate health care in ways that help them experience the fulfillment that comes from making a difference.”

Translational Medicine

While in Lambaréné, Clara Jones ’81 and her colleagues frequently had to choose a point in the long line of waiting patients. After that point, they would need to turn patients away, knowing that they probably had traveled far, on foot or by boat, to reach the medical center. Knowing, too, that many had been waiting all day. Jones recalls that some of the patients were there for treatment of chronic problems she had studied at HMS, such as hypertension, diabetes, and asthma. Others, however, would be diagnosed with advanced cases of cervical cancer or lymphoma, diseases that might have been prevented or treated earlier with proper screening. For Jones, witnessing what happens when people have limited access to health care has translated into a medical career focused on people in underserved urban areas.

Although Jones, like most of the Schweitzer Fellows, spoke some French before heading to Gabon, she used an interpreter while communicating with patients there, especially those who spoke only African languages. She knew it wasn’t a perfect solution. Jones would ask how long a patient’s problem had been active, for example, and after a lengthy, animated response, the interpreter would say: “Two years.”

“You knew you were missing something!” says Jones. “All of that information, and you don’t get it because you don’t understand the language.” Because medical records were sparse—just notes on oversized index cards—good communication with each patient was essential, especially for chronic concerns.

Achieving good patient-doctor communication has remained a concern for Jones in the years since her fellowship. As an assistant professor of public health and community medicine at the Tufts University School of Medicine and a former internist at the Dimock Center in Roxbury, Massachusetts, she’s met with many Spanish-speaking patients. Although she’s made a point of becoming semifluent in the language, when she conducts psychosocial interviews or wants to be sure a patient understands care details, she relies on an interpreter. Even so, she listens carefully. “There’ve been times I’ve said, ‘Tell her to take this medication twice a day,’ and the translator instead says twice a week. It highlights how important good communication is.”

Sarah Zobel is a health, education, and housing writer based in Vermont.

Images: David Baron/Public Radio International (top); Michael McGregor (Stanley); Sean Russell (Anderson); John Soares (Forrow)