New York – The perennial debate in the U.S. over health care costs vs. quality of care, and the increasing commercialism of many of my medical colleagues remind me of a meeting I had during one of my medical missions in Africa.
I was visiting Río Muni, the continental half of Equatorial Guinea, with some medical colleagues. We were assessing the health situation in the country and had arrived at Niefang, a small, sparsely populated, neglected town in the interior.
In the town hospital I met a young Spanish physician. Calm and self-assured, he radiated warmth.
He was treating a difficult case, an older man whose body was covered by large, irregularly shaped, infected ulcers. The infections, with the heat and lack of hygiene, reeked. Dr. Ramón Vila described the health status of the other patients in the ward, and then he led us on a tour of the rest of the hospital.
He took us to the delivery room. Ill at ease, he told us that they had to share it with the first-aid room, which increased the possibilities for the spread of infections. The hospital’s scarce financial resources, he explained, made this unavoidable.
We continued our visit. Everywhere we went I received the same impression: crowded facilities, poverty, lack of essential items, run-down services. Dr. Vila did not seem to be affected by these difficulties. I, however, felt discouraged.
Soon afterwards he took us to his house, located near the hospital. The house was small but well kept. Most of the time, it lacked running water and electricity. I asked Dr. Vila about his background. He had graduated from university in Barcelona, he said, where he married a fellow student. Since they were both interested in working in developing countries, they went to Nicaragua.
“We chose Nicaragua following a curious circumstance,” he said. “I was studying a rather unusual case, one of only 211 recorded in the medical literature. Suddenly, I was struck by the irrationality of my study. What was its purpose, I thought, when all over the world millions of human beings are hungry and live in total misery?
“So we decided to go to Nicaragua, where I learned to look at death in a new way. I found the Nicaraguans to be a truly remarkable and stoic people, with a profound sense of friendship and love. When one of them was killed during the war, they quietly buried the dead and continued their struggle for life.”
After a while in Nicaragua, Dr. Vila and his wife decided to go to Africa and, through a Spanish government organization, they went to the rural hospital where we met. They soon developed a special relationship with the people in the area. When we were visiting the hospital, we watched his wife, Mercedes, teaching a nutrition class to a group of community health workers.
We had some cold drinks — a rare treat in the oppressive heat and humidity — and continued our chat. We discussed the case of the patient with the ulcers. We agreed on the usefulness of finding and treating diseases frequent in that area. For somebody from the industrialized world, they could only be found in medical textbooks.
I assumed that after having a good professional experience, Dr. Vilas would return to Barcelona. It is one of the most beautiful cities in Europe and, I thought, he would develop a brilliant career in his native city. I asked him about his plans for the future.
“I want to remain here,” he said calmly. “You see, there are times when one does things not because of the comfort they bring but for a different reason, a moral call if you wish. And that is the challenge that I found here.
“In Barcelona I would be irritated by a temporary lack of electricity or by an unchanging traffic light. Here I fight every day against death, and many times I lose the battle. But here I feel fulfilled. I know that in this place, despite its primitive conditions, my work makes a difference. I wouldn’t change it for anything in the world.”
Dr. César Chelala is an international public health consultant and a winner of an Overseas Press Club of America award.