Can a Gabonese director cure the Albert Schweitzer hospital?
A famous charitable institution in Africa, the Albert Schweitzer Hospital in Gabon, is nearing its hundredth birthday. But after a century spent healing the sick, the hospital has spent the past year healing itself amid bitter race rows.
Albert Schweitzer was, in his day, one of the most admired men on Earth.
A German-born philosopher and theologian, Schweitzer decided in 1904, aged 29, to study medicine and move to Africa as a doctor.
His goal was to alleviate suffering. He said he wanted to atone for the sins white Europeans had committed against black Africans.
From 1913 until his death in 1965, Schweitzer ran a hospital in what was then a part of French Equatorial Africa and is now Gabon.
Schweitzer's life inspired a generation of humanitarians, and his work earned him the 1952 Nobel Peace Prize. But today, the Albert Schweitzer Hospital is struggling to achieve the goals of its founder while adapting to a new century and a different Africa.
Downside of charity
The Albert Schweitzer Hospital, which sits above the Ogooue River in the town of Lambarene, treats almost 30,000 patients each year.
"Back there you have maternity, you have pediatrics," said Dr Hans-Peter Muller, pointing to low-slung buildings connected by covered walkways. "Far back it's the internal medicine department."
Dr Muller is a Swiss surgeon who first volunteered here in 1996. He now serves on the hospital's governing board.
Dr Muller has helped raise millions of dollars for the hospital. "It has truly been a combined international effort," he says. He comes to Lambarene several times a year. Yet he now finds himself questioning what his work for the hospital has accomplished.
"It's this dependency," he says, lamenting that when local people see him, they think: "A white man is coming, let's ask him to do something for me."
Dr Muller blames himself. "We have come in and made the people here a bit like this."
Many charities face this dilemma. How do you ensure that good deeds don't breed dependency? How do you help people to help themselves? How and when do you hand control to local people?
A history in black and white
For most of its history, the Albert Schweitzer Hospital was paid for by white people and staffed by white people.
"The hospital functioned with a lot of Europeans," says long-time Gabonese nurse Mipimbou Sophie, better known simply as "Mama Sophie."
"The doctors we had were European," she says. So were the nurses and the office staff. But in recent years, that has been changing.
Dr Muller explains: "It has always been the goal to make out of this colonial hospital, or post-colonial hospital, a real Gabonese hospital," he says.
Today, almost all the nurses and doctors and office workers are black African. Much of the hospital's funding comes from the Gabonese government. The board is majority Gabonese.
And yet, white people have generally remained in charge.
Taking that last step - sharing control of the hospital - requires trust on both sides of the colour divide. And, recently, that has been in short supply.
A year of turmoil
Things came to a head last year.
For some time, black staff had complained about the most recent white director of the hospital, a retired French military officer, Marc Libessart. They said he was arrogant, abusive, and racist.
"He hired a technical director whom he asked to oppress the workers - the black workers - saying they don't work properly if you don't oppress them," said the hospital's chief accountant, Pierre Claver Bouka.
Mr Libessart adamantly denies having said that. He contends that some members of staff were stealing money, and when he tried to clamp down on this, the workers rose up against him.
Indeed, a year ago, the staff staged an illegal strike. They blockaded the hospital, chanted, and carried a coffin with Mr Libessart's name on it.
Mr Libessart and two other French managers quit the hospital - and the country.
The events left the hospital without a permanent director and left everyone scarred.
"Someone had a vision that the great doctor, Albert Schweitzer, was looking across the river and turned his back on the hospital," said Mama Sophie.
"It means he was very angry about how things were going here. Everything that happens, the dead see."
A new direction
Meanwhile, there was tension between the Gabonese and the Europeans on the hospital board.
The one American on the board - Lachlan Forrow, a doctor at Harvard Medical School - was troubled by the antagonism.
The European board members were frustrated with their Gabonese colleagues, who in turn felt that the Europeans did not respect their efforts.
"It was a vicious circle," says Dr Forrow.
He saw an opportunity to change that pattern of behaviour.
Gabon had elected a new president who vowed to tackle the corruption and inefficiency that had long plagued the country.
Meanwhile, Dr Forrow became president of the Schweitzer hospital board, and vowed to reach out to the new government and to his Gabonese colleagues in a new spirit of solidarity, not charity.
But it wasn't so easy putting that philosophy into practice, he says.
Gabon's President Ali Bongo - son of the previous leader - had promised new funding for the hospital, but the money took months to materialise.
The president wants the hospital to train Gabonese medical students and work more closely with the public health system. Dr Forrow supports those goals, but says that coordinating efforts with the government has been frustrating.
"There have been a number of times when it really has seemed like this is hopeless," he says. He has asked himself: "Am I crazy? Can this possibly work? Is the country ready?"
But Dr Forrow says the hard work is starting to pay off in a new relationship between local people and outsiders. There has been a major recent development.
Hospital's new face
Several months ago, I asked hospital workers whom they would like to see as a replacement for the French hospital director who had been driven out by the staff. Would they like a Gabonese director?
"No," said Mama Sophie. "A white man should be the director. Three-quarters of the staff want the hospital director to be white."
Many of the Gabonese did not think anyone from their country would have the right skills.
Dr Muller said Gabonese members of the board told him: "We are not mature yet [to run the hospital]."
But Dr Forrow wants to challenge that thinking and recruited an experienced Gabonese hospital administrator - Antoine Nziengui - to serve as interim director.
After several months, Mr Nziengui won over the staff and board, which recently voted unanimously to make him permanent in his job.
"The Gabonese staff, when I was at the hospital this past time, told me how wonderful Antoine was," Dr Forrow says after returning to the United States from the most recent board meeting.
"One of them said: 'He has saved the hospital.'"
That may be an overstatement.
The Albert Schweitzer Hospital still faces huge obstacles: A million-dollar budget deficit, antiquated facilities, a rising burden of HIV and tuberculosis.
But for the first time since the hospital was founded nearly 100 years ago, an African is in charge.
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