An excerpt from
The Good Doctor Is Naked
Finding the Human Beneath My Mask
Author: Robert Hardy Barnes, M.D.
It was 1963, and blindness was rampant in Algeria, as in many other countries of the Third World. Much of the blindness was unnecessary, for its main causes — infection (most commonly trachoma), cataracts, and trauma (injuries) — were conditions about which something could be done. Injuries could be decreased through education, infection could be treated, and cataracts removed.
The young Arabs in the truck were working with volunteers from the World Health Organization (WHO), an agency of the United Nations. WHO was leading a campaign against unnecessary blindness. There were notices on telephone poles and the sides of buildings: People should not neglect red eyes; if they are untreated, the result could be blindness. As the truck made its rounds, stopping every so often, men and women clustered around it to get a tube of an antibiotic eye ointment. Sometimes, if supplies were available, they also received a supply of multi-vitamins and a bar of soap; skin infections of all kinds were common, and cleanliness could prevent some of them.
I spent a month in Algeria heading a team of five Seattle doctors sponsored by Care-Medico and the State Department. In 1962, the French had pulled out of Algeria following nearly eight years of bloody war, and Algeria was independent after 132 years of French rule. When the French left, so did most of the doctors, nurses, and technicians, the vast majority of whom were French. Fourteen million people were abandoned without adequate medical care. In the face of this emergency, countries around the world, including the United States, called on volunteer health care professionals to help.
I was moved by the plight of the Algerians and excited by the idea of putting together a medical team. June shared my excitement and looked forward to the adventure. We arranged for a grandmotherly neighbor who had baby-sat for us many times to move into our house and take care of Tucker, Debbie, and Julie, then ten, twelve, and fourteen years old. June committed herself to learning French and for six months prior to the trip, she received tutoring from a young Algerian neighbor woman. June learned French well, and once we got to Algiers her ability to understand it over the phone proved invaluable. She also played an important role in the outpatient clinic where I worked, interviewing patients and recording their names, ages, and medical complaints.
Other teams of doctors were going to Algeria, but ours was the only one whose wives came along because Algeria was at war with its neighbor, Morocco, over the ownership of oil fields in the Sahara Desert. It turned out that we were never in danger, and June and I agreed that our Algerian adventure proved to be one of the highlights of our life.
Our team included Dr. Duncan, an orthopedic surgeon; Dr. Lyda, an ophthalmologist; Dr. Dodds, an anesthesiologist; and Dr. Ramsay, a general surgeon. Although I was a specialist in Seattle, I filled the need for a general practitioner on the team. We held numerous planning sessions together and grew to know and respect each other by the time we met up for our month in Algiers. Our ages ranged from early forties to mid fifties, and we were full of energy and excited about the adventure in North Africa.
For me, Algeria proved to be the first of several experiences during the 1960s that changed my consciousness. For one thing, Algeria brought home to me the fact that a great part of the world's population lives in conditions most Americans would find shocking. Third-world doctoring is radically different from the way we practice medicine in our own country. In Algeria I learned first-hand about the importance of public health issues, something I've been interested in ever since.
Every First-world physician who volunteers in a developing country knows that he or she can treat many diseases and reduce some of the widespread pain and suffering; yet, despite their skills, there's a limit to what even the best doctors can do because of underlying health standards, poor sanitation, and lack of health education. The key to improving world health standards lies in the area of public health — in the prevention of diseases — and not in the hopeless race to keep up with illnesses that could have been prevented. In Algeria, for example, we saw young children with home-made crutches dragging their paralyzed feet and legs through the dirt — evidence of polio, a disease that had been eradicated in the Western world ten years earlier. We saw a great many people afflicted with other diseases, infections, and congenital defects that would have been prevented or treated routinely in our home countries.
The hospital where we worked was a modern, 1200-bed facility built by the French. In leaving it behind, the French had taken the medical supplies and destroyed much of the equipment. They tore out the telephones and cut the lines. They rendered the elevators inoperable, so the hospital staff had to climb as many as four flights of stairs. An appeal by me to the U.S. Ambassador got us some military field telephones, and a few of us on the staff used them to stay in touch with each other, but for most people the only means of communicating from one room to another in that very large building complex was to go in person or send a messenger.
Sanitary conditions in the hospital were poor. Patients lay on beds that were not clean, under sheets that were not changed regularly and often gray from dirt. In some wards, men urinated out the windows because the toilets sometimes didn't function and even when they did, there weren't enough of them. Patients threw banana peels, apple cores, and other food waste out the windows, and as a result there was a persistent stench along the base of the building's exterior walls. Because the windows had no screens, there were flies everywhere.
One sunny afternoon, as I was making ward rounds with Red Ramsay, the general surgeon, we came to the bed of a teen-age girl who had abdominal surgery a day or two before. The Algerian nurse accompanying us pulled the girl's well-worn sheet down for us to examine her abdomen, and a mouse scurried out from under the sheet at the foot of the bed. The girl shrieked.
Our everyday business in the hospital and its adjacent clinic included cases of malnutrition, gastrointestinal parasites, seriously infected wounds and burns, and tuberculosis — enough cases of tuberculosis to keep a separate, 600-bed hospital filled most of the time. We treated soldiers wounded in the Moroccan war and toddlers with esophageal burns from drinking a caustic cleaning solution.
On another day, I made my way through a corridor packed with about twenty people who were crying aloud and praying. They were the relatives of a six-year-old boy who was hit by a car and underwent emergency surgery. We couldn't save him because we didn't have enough blood for a transfusion.
In fact, we rarely had adequate blood supplies because there were no blood centers. Sometimes we were able to beg for a supply from a Russian-run hospital across town, but we frequently ended up throwing away much of what the Russians gave us, either because the blood came from a donor who was anemic or because it was contaminated with malaria or some other infectious disease. As a result, numerous emergency patients died from injuries that should not have been fatal.
A typical day for me began in the early morning when our American team gathered outside the hotel where we were staying and drove to our medical complex in a van painted with the Care-Medico logo. I would arrive at the hospital wearing my white coat and walk up a dirt pathway lined on both sides by a double queue of squatting patients waiting to be admitted to the outpatient clinic. Inside, I sat on a stool in the middle of a large room flanked by two interpreters — no desk, no charts. There were three examining tables in the corners, each closed off by a hospital curtain. June sat in a small reception area at the entrance to the room, taking notes on each patient's symptoms. When it was time for me to see the next patient, one of the interpreters called out to him or her, and the patient crossed the floor to take a chair facing me.
None of the patients spoke English, and so each one told his or her story to one of my interpreters, who in turn filled me in on the patient's symptoms. I listened to each story and made a quick judgment. Some I directed to one of the curtained areas and asked them to wait a few minutes for me to come and examine them. In the case of women, for whom physical examination by a man was a culturally sensitive issue, a female Algerian nurse always assisted me. Some I sent to the lab for tests. For some I just prescribed a medication or multi-vitamins, oftentimes on the basis of a guess. The attending nurse then went to the hospital pharmacy and returned with the medicine for the patient. I was hardly a miracle worker, but when June and I returned home to Seattle our priest praised us in church as "our missionaries." I felt very proud at the time, although in retrospect it seems ironic to have been called a missionary.
And there were times when our task seemed to brush up against the miraculous. One day, for example, an Arab with a gray beard shuffled into the clinic, holding the hand of his ten-year-old granddaughter. Over a million Algerian fathers had been killed during the war of liberation, so grandparents played a big role in rearing the children. An Arab grandfather can be an impressive person, and this one was just so. He had on a long robe that flowed down to his sandals, and his weathered face was topped by a turban wrapped around his head. He had been blind for years but heard through the grapevine that the American doctors might be able to help him.
Dr. Lyda examined him, although he almost didn't have to because the whiteness of the old man's pupils visibly reflected the opaque lenses of his eyes: cataracts. I watched as Dr. Lyda's wife, a volunteer like June, helped Grandfather onto the operating table, still wearing his turban and robe, and clipped his eyelashes. He had a lovely, peaceful face and it was clear that he was excited about the possibility of regaining his vision. Dr. Lyda focused the bright surgical light on one eye, and a local anesthetic was applied. Then the doctor used an instrument to retract the upper and lower lids, carefully cut a moon-shaped incision over the upper part of the pupil, inserted a pair of tweezers down into the eye behind the pupil, pinched the opaque lens, and pulled it up and out of the eye. He took a small, curved needle with fine thread and sewed the incision together. Lyda laid a bandage over the eye and taped it in place. Grandpa stayed on the gurney as sandbags were placed on each side of his head. An interpreter told him he would have to lie perfectly still for several days in the hospital and could return after a week to be fitted with glasses.
He came back to the clinic again with his grandchild, the bandage still covering his eye. Dr. Lyda took the bandage off, cleaned the skin around the eye, checked the incision, and peered through the pupil to the retina. All seemed well.
Now the crucial moment arrived. The doctor put in place a pair of eyeglasses with thick lenses held by a silver wire frame. There was a moment of silence as the old man looked around at the ceiling, at me, and the doctor. He saw his granddaughter for the first time in her ten years. He threw his arms up in the air and shouted, "Allahu akbar! Allahu akbar!" — God is great — and then he covered his face with his hands and fell to his knees in prayer.
Edited by David W. Paul
The rusty, dilapidated truck lumbered along the dirt road on the outskirts of Algiers. Two young Arabs sat in the back of it, their legs hanging over the tailgate. They took turns shouting to the passersby through a cardboard bullhorn, crying out in their guttural, throat-clearing language, "If you have red eyeballs, come get free medicine."
