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"For each of us, your lifespan, and the quality of your life, may be pre-set purely by the disparities you are forced to suffer," Gurley says. "When you are dying (slowly or quickly), and are unable to get help, nothing else matters."

Since 1979, ASF’s Lambaréné Schweitzer Fellows Program has selected senior U.S. medical students to serve clinical rotations as junior physicians at the iconic Schweitzer Hospital in Lambaréné, Gabon, Africa—the region’s primary source of health care since Dr. Albert Schweitzer founded it in 1913.

Jan Gurley, MD is one of those Fellows. In 1986, she spent three months at the Schweitzer Hospital – and the trajectory her life has taken post-Lambaréné is both impressive and inspiring. She is an internal medicine physician seeing patients in a San Francisco homeless clinic, and she also writes for several outlets, including the San Francisco Chronicle’s SFGate. (Her trademark blend of humor, social commentary, science, practicality, and heart is also on full display on her blog and Twitter feed.) She was a recent Annenberg Center California Endowment Health Journalism fellow, and is also currently a staff writer for Annenberg’s Reporting on Health site. She recently received Saffron Strands’ first ever Voice of the Homeless media award for her coverage of homeless issues.

In today’s Five Questions for a Fellow interview, we talk with this physician, journalist, and advocate about the value (and challenges) of taking a primary care path, the extreme health disparities impacting homeless patients, the fulfillment that can be found by undertaking meaningful work—and roosters. (Yes, roosters.)

Why did you decide to apply to become a Lambaréné Schweitzer Fellow?

The Schweitzer Fellowship was an exciting opportunity to combine a chance to see the world with a chance to do tremendous good. It was a unique opportunity to put into use the budding clinical skills that we had learned at medical school. What’s more, with the potential for working as a Schweitzer Fellow looming, the motivation to learn more and work harder and think more globally became of paramount importance during my rotations.

What was a typical day like for you at the Schweitzer Hospital in Lambaréné, and was it what you expected?

The “day” began in the night when that blasted rooster let rip from the branches of a mango tree right outside my screen-walled room.

There are air-raid sirens that seem downright timid in comparison to that shrieking bird. Every night, somewhere between 3 and 4 a.m., he would let me know that the day had gloriously begun. In the dark.

“My” rooster was definitely a part of Lambaréné I could never have expected, and, like all things that inspire shock, awe and good war stories, he became a quirk I came to love. After a communal breakfast, we rounded in either the pediatrics ward or the adult ward. There were two medical students, and French and Russian doctors, and many fabulous nurses from Gabon. I was mothered and sistered, and mentored by these nurses, who shared their homes, their clinical skills and their affection with me.

Being on call, alone, as a medical student whose French was slippery when roused from deep sleep, was an adrenaline-depth-charge of an experience. People are so polite, and diseases so virulent, that you knew if someone awoke you in the middle of the night, it was going to be bad.

There was almost nothing that was what I expected. And that was, without a doubt, one of the best parts of the program.

How did your experience as a Lambaréné Schweitzer Fellow impact your ensuing professional choices and trajectory?

As a Harvard Medical School student in the late 1980’s, primary care was not considered a desired career course. Even becoming an internist was generally seen as merely a stepping stone to a subspecialty. For me, however, I found in Lambaréné a deep desire to hold onto the magical experience of what happens alone in an exam room between a patient their primary doctor. I went to UCSF in straight internal medicine, but when it was time to choose a subspecialty, I found that I could not give up any of the other disciplines. To become a cardiologist meant never managing my patient’s fever. And to become an ID doctor meant never being responsible for my patient’s on-going wellness over time.

Lambaréné also taught me the addictive power of spending one’s days doing something worthwhile. That powerful draw has profoundly affected my choices. I work in a clinic for the homeless for the San Francisco Department of Public Health. I chose to go to Haiti twice on medical relief missions. I write about topics that I care about, whether they are popular or not with the mainstream press. I am well aware of how blessed I am to be able to do these things. And I mean blessed in so many other ways than purely monetarily. As we move into mid-life, we so often hear the laments of friends and acquaintances who are struggling with whether their jobs (and, therefore, so much of life) is devoted to something meaningless or not. For me, spending each day in meaningful work is a powerful gift. No matter how annoying or stressful or frustrating or time-consuming my day has been, at the end I do not have to struggle with whether or not a day of my life has been wasted.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

Health disparities are now so extreme that America is looking more and more what others might call “Third World.” I refer to my homeless patients as living in the “Fourth World” — to suffer Third World conditions while living side-by-side with first world affluence. It is its own unique form of suffering. For each of us, your lifespan, and the quality of your life, may be pre-set purely by the disparities you are forced to suffer. Our society’s common good seems to have become an afterthought, and the health impacts of that, for all of us, are of paramount importance. When you are dying (slowly or quickly), and are unable to get help, nothing else matters.

What does being a Schweitzer Fellow for Life mean to you?

The Schweitzer Fellowship changed the course and quality of my life.

That experience has been a touchstone around which so many other of my life’s experiences are vectored. Lambaréné, and all the work of the Schweitzer Fellows’ programs, teach us the commonality of our humanity, and allow us to envision a world that is different from the one we are shown each day—both for ourselves and others.

Jan Gurley, MD is a Lambaréné Schweitzer Fellow for Life. Click here to read more about the Lambaréné Schweitzer Fellows Program and the Fellows for Life alumni program. To make a gift to support the Lambaréné Schweitzer Fellows Program, click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows and Fellows for Life across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.