acute health care, Africa, Africans, cancer, Centennial, CHU, Flavien Nziengui-Nzoundou, Gabon, Gabonese, HAS, health and well-being, humanity, infrastructure, international collaboration, Lachlan Forrow, Malaria, Maternal health, Minister of Health, Partnerships, patients, public health problems, Schweitzer Fellows, Schweitzer Hospital, TB, tuberculosis
Last Thursday, The Albert Schweitzer Fellowship (ASF) President Lachlan Forrow, MD met with Flavien Nziengui-Nzoundou (the Minister of Health for Gabon, Africa) to discuss current and future collaboration—and lay groundwork for the 2013 Centennial celebration of Albert Schweitzer’s founding of his iconic hospital in Lambaréné, Gabon, Africa.
In addition to supporting 250 Schweitzer Fellows annually at 13 program sites across the U.S., ASF has sent over 100 senior U.S. medical students to serve clinical rotations at the Schweitzer Hospital in Lambaréné since 1979. Forrow himself was one of those Lambaréné Schweitzer Fellows—and now, in addition to serving as ASF’s president, he is the president of the Schweitzer Hospital. In that role, Forrow is forging collaborations with Gabon’s new government and other partners in order to advance the health and well-being of the country’s citizens, and serve as a replicable model elsewhere in Africa.
Read on for our interview with Nziengui-Nzoundou – who met Albert Schweitzer in 1963 when his father was a patient in Lambaréné.
ASF: What is the most pressing health-related issue facing Gabon today?
Nziengui-Nzoundou: In our country, there are two particular health problems: malaria and AIDS. We are a tropical country near the equator – very humid. The population is concentrated in the big cities without any real urban organization, and there’s a real problem of sanitation. There are a lot of places with stagnant water, which is the perfect breeding ground for mosquitoes. We have a public-private partnership with the Global Fund to address the high incidence of malaria.
Additionally, we allocate 3 billion CFA [$6 million dollars] of our national public budget to engage Gabon in the fight against malaria. We particularly prioritize pregnant women and children under five—which is one of the main objectives of the Millennium Development Goals. We’ve had some successes, but there’s much, much more to do.
The second major pathology is the HIV/AIDS epidemic. Gabon has approximately 5.2% seroprevalence, which is enormous for a population of only 1.5 million people. Four months ago, Gabon President Ali Bongo Ondimba tripled the national budget against HIV/AIDS, implemented free testing and the distribution of free medications, and started construction throughout the entire country for ambulatory treatment centers. We also have a public-private partnership with the Global Fund with a budget of 10 billion CFA [$20 million dollars]. AIDS is something you have to tackle at multiple levels—education, prevention, and treatment.
And of course we can’t forget tuberculosis, and also other diseases like leprosy. We have programs that are in the process of tackling these problems.
ASF: I know Lachlan has been working to gather support for a new tuberculosis [TB] initiative based out of the Schweitzer Hospital as the first major project of the planned Centre Hospitalier Universitaire Albert Schweitzer a Lambaréné—but has not yet been able to procure a stream of medications and a vehicle to check on follow-up. Where does progress on that stand, and what other efforts to address TB has the Ministry of Health undertaken?
Nziengui-Nzoundou: This CHU in Lambaréné will attack the problem of tuberculosis as a top priority, but we have had difficulty securing the distribution of tuberculosis medications. The Global Fund is the secondary partner in this, and there is a United Nations Program that we are also working with. So when money arrives, it first goes to the local UN program, which orders the TB medications. There are often interruptions in the flow of medications, so we have revised the procedures. So now, it’s the country itself that orders the medications. The goal is to ensure that there will never again be an interruption.
ASF: Is there a recent public health success that you and your team at the Ministry of Health are particularly proud of?
Nziengui-Nzoundou: Something we’re really proud of is the creation of a master plan for public health by the president that offers medical care at the curative level. Since we have 70 percent of the entire population living in large cities that have problems with primary care—especially Libreville, the capital—we are in the process of creating three CHUs in Libreville. One is in North Libreville, one is in Central Libreville (linked to a center focusing on maternal health), and one is in South Libreville.
The North Libreville CHU will open on December 15, and the cancer center affiliated with it will open in April. The Central Libreville CHU will also have two modules. The first, a technical block with operating rooms and emergency medicine, will open on December 15. Construction will start on the second module – which will offer the enhanced maternal health services – in January, and it will take a year and a half to build. This is in addition to eight regional hospital centers that have already been constructed in recent years—and then of course we have CHU Albert Schweitzer.
The vision of the president is to figure out how to ensure that every citizen of the country is provided with health care of high quality—and that when we have finished developing all of these aspects of the system, we will become a medical resource for all of Africa, not just for our own country. We are building the infrastructure, and we intend to complete that as soon as possible, and then we will be using that infrastructure to put operationally into place systems of education and of prevention.
ASF: For the past 30 years, ASF has sent senior U.S. medical students to the Schweitzer Hospital to help provide care (and more recently, public health students as well). What message do you hope these students will bring back to the U.S. after their time in Gabon?
Nziengui-Nzoundou: We are a young country, and we need partnerships to work on improving health professional training. I hope that the American students who have come to Gabon – like Lachlan – can think together about the vision they have based on their experience of our country, and become partners with us in making actual results happen. But of course, a real partnership works in both directions.
We really hope that we can also involve young doctors in training, researchers, and others from Gabon in coming to the United States and understanding research and training there, that they can then bring back to our country.
We hope that over time, we will have Gabonese and American partners in medicine, research, and public health who can work together to make sure that our ambitious health, science, and other goals in Gabon are accomplished. The centennial celebrations in April 2013 provide a perfect focal point for this. We hope that many of the Americans who worked in Lambaréné as students will come back for those celebrations—as well as engage in serious discussions with Gabonese about how they can work together as partners to achieve important health goals.
ASF: As you’ve mentioned, 2013 marks the centennial of Albert Schweitzer’s founding of the Schweitzer Hospital. What does Albert Schweitzer’s legacy mean to the people of Gabon?
Nziengui-Nzoundou: Let me speak very personally. When I was very young, I had the chance to shake the hand of Dr. Schweitzer. My father worked in Lambaréné. In 1963, he fell from a palm tree. He was brought to the Albert Schweitzer Hospital, and I was with him because I was very young.
When Dr. Schweitzer came and made rounds to see the patients, he was so close, at a human level with the patients—and also with all of their family members, because at the Schweitzer hospital, it’s not just the patient. The patient is there with the family. So he reached out to touch with his hands, to connect at a deep and personal human level, not only my father, but also me. I will never forget this direct experience of his humanity.
So for us in Gabon, from my own direct experience, Dr. Schweitzer came to be with people who suffered and to help them. He gave his life to the service of my people, the Gabonese—so the people of Gabon are waiting with great excitement for the centennial in 2013.