Thou Shalt Take Thy Father To Africa

I always wanted to be a doctor.

Dr. Ed, B.C. (Before Camden),
a young man on the
 verge of greatness

A second career choice did not exist.  As the middle child of Jewish parents there weren't many acceptable career choices.  There was doctoring or lawyering or, if you were a little dim,   Podiatry.  Most of the lawyers I'd met were  bottom scraping tools of humanity.  Luckily I came from a family of medical men--father, brother, uncles, cousins--nearly all my relatives were involved in medicine in some aspect except for the few who were lawyers. As a family we generally shunned them and only interacted with them at weddings and funerals and when we had to.  

There were three men who were my earliest medical heroes and the driving forces behind my career choice:  Chad Everett (better known as Dr. Joe Gannon on Medical Center), Hawkeye Pierce (MASH) and my dad, Dr. Ed Travels of Camden, New Jersey.  I could not call myself a reasonable son without dedicating a blog to the man who helped make my earliest medical dreams into a memorable career.  Dr. Ed-dad-this blog is for you.

Dr. Ed ran a family practice in Camden, New Jersey.  Camden in the 1970's took one of the worst financial nose-dives in history of the state of New Jersey.  It went from a middle American, working-class, mixed ethnic city to being one of the roughest 70's and 80's ghettos in America.  Dr. Ed's office by the time he reluctantly left Camden was smack in the middle of a part of town that makes post-war Beirut look like the Central Park Botanical Gardens.  It was so scary that  police wouldn't  go there in less than pairs.  Not wanting to be the last rats on a sinking ship, Dr. Ed's medical peers started to leave the city in droves during the 1970's.  

Dr. Ed didn't leave.  

As a boy I remember his friends coming by our house and asking him:  "Ed, why don't you leave that shithole?"  He would answer, "Because I'm all they've got."  And it was true.  Dr. Ed had opened his office in  the 1960's and twenty-five years later he had several hundred  patients who filled his office every day often waiting three hours to get his treatment and advice.  He never rushed anyone.  Like a true old school doctor he'd look a patient dead in the eye-with a cigarette in his mouth-and lecture the patient on the dangers of smoking.  And he'd be effective.  Those were  the days when doctors were immune to the ailments of normal mortals. I've heard this is no longer the case. 

Dr. Ed had a true, palpable sense of responsibility and concern for his patients that is being systematically washed out of medical practices these days.   He was the last of a line of Old School General Practitioners who were trained to handle every medical condition.  He did everything from office surgery to Internal Medicine to Psychiatry. He delivered babies and even delivered the babies of those he had once delivered.  When the rest of the doctors abandoned their patients and headed to the suburbs Dr. Ed could not bring himself to do that.  He truly was all they had and he truly loved being that guy.  He was a legend in Camden.  In the middle of that horrific neighborhood where every house and apartment was busted and abandoned, Dr. Ed parked his Cadillac right on the street and no one ever touched it.  In a city that looked more like a war zone than a neighborhood, he got a pass.

I loved going to Dr. Ed's office when I was a child.  After getting out of his car the odor of old sewage and urine was so bad that I'd hold my nose until I was safely inside the waiting room.  That stench  grew worse in the Camden streets year after year.  I  wondered how the people living there ever got used to it.  Inside the office  I remember the smell of alcohol disinfectant and the latest flowery perfume of dad's secretary.  Dr. Ed was always  thirty minutes late by the time he got to the office.  His waiting room was already  twenty patients deep.  I would have to run the gauntlet of hugs and fawnings from the old black ladies sitting patiently waiting for their appointments.  Once inside the inner sanctum of his office it was time to play with every piece of equipment in the treatment rooms.  I'd take apart the otoscopes and stethoscopes, make houses out of tongue depressors and make towering medicine bottle pyramids and knock them over.  Doctoring seemed like a good time  with a lot of great toys.  Fortunately it still does.

Look!  A mountain!  In Africa!

I was sad for Dr. Ed when he finally retired his practice.  I knew how important it was for him to be needed, trusted and to be a wise adviser.  His generation of doctors were treated like Gods with golden words.  There were no internet diagnoses or public pharmaceutical advertisements giving advice on drugs and diseases.  You just asked your doctor and didn't question it even when he had a cigarette in his mouth.  After nearly thirty year he finally, reluctantly, decided to leave.

Liberian Refugee Clinic:  There's more at the door

I have a theory that in our lifetime we should do at least one obligatory, grand gesture for our parents.  It should be something larger than life and preferably something they wouldn't do for themselves.  In 1998 I decided it was time for Dr. Ed's grand gesture.  I recalled that some of my most memorable medical days were working alongside Dr. Ed when I was a fourth year medical student doing a training rotation in his office.  For Dr. Ed's outrageous adventure I wanted to return the favor and bring him to work  in my office.  But not my Beverly Hills office.  I wanted to take Dr. Ed all the way to my small, dirty, Malaria-ridden clinic in the middle of a Liberian Refugee Camp in Ghana, West Africa.  I knew how badly Dr. Ed missed being in the game--making  decisions, giving advice and keeping people alive.  I wanted to give him one more crack at it.

In 1990 thousands of Liberians left Liberia during one of Africa's most vicious civil wars.  President Charles Taylor, a Bentley University educated man, had worked his way up through the government ultimately becoming president by slaughtering the current President, Samuel Doe.  (Charles Taylor had previously been removed from the Liberian government for acts of embezzlement, but in the scope of African politics this kind of infraction is no worse than a few parking tickets. Infractions like this are no deterrent towards being supreme leader.)  His was the rebel government made famous for making their political points by amputating the arms of men, women and children.  They'd send the victims  back to their villages to spread his fearful message:  If you have no hands, you cannot write your vote.  The result was mass exodus out of Liberia.  As Liberians scattered in all directions in West Africa many made their way to Ghana.  A stretch of land was made available outside the capital city of Accra.  Initially the camp was designed to be temporary home to ten thousand displaced Liberians while the government was sorted out.  At least twice this number showed up.  In 1997 the United Nations, in an expected act of United Nationsism, withdrew all  support and medical care from the camp because Charles Taylor promised to be a reasonable terrorist and gave "scout's honor" that he would hold an honest general election.  The refugees were certain that execution awaited them in Liberia and stayed in the camp.  In 1998 I was medical director of a Los Angeles-based charity group asked to set up a working temporary clinic that had been vacated the year previously by the UN.  By then there were 30,000 Liberians living in Buduburam in a camp that was designed to hold less than one third of that number.  For Dr. Ed, if this meant being back in the game, it was like being flung in the World Series.  Compared to Buduburam, Camden was a walk in the park.

Is this culturally inappropriate or just funny?

We met our group of charity workers at Dulles Airport in Washington, DC.  Dr. Ed was sixty-eight at the time.  There were a few other members of the group close to his age, but he took the role as Elder Statesman.  He would hereafter be deferred to as the expert in all matters of life experience. That put a smile on his face that I'd not seen since he'd left practice.  He felt needed again in a way that all doctors need to be needed to feel normal.  This was Dr. Ed's first trip to Africa (I would take him on two other charity trips later to Swaziland and Ethiopia), but I didn't see any of the apprehension from him that I'd experienced during my first trip.  I'm a planner and a big fan of good info and recon about a  destination before I get there.  Most of my destinations have significant biologic and physical threats.  Dr. Ed slept peacefully during the ten hour plane ride to Ghana. He hadn't a single concern for what we were stepping into.  He's always had a way of going head-first into situations, for better or worse. It defined him.  I figured he had bigger stones than me, but then again he should.  He's my father.

Sweaty Doc

The camp was a mix of dust, dirt and cement structures with  corrugated sheets of metal for roofs.  Our clinic was in the front of the camp.  It was a  blue concrete structure separated into four rooms.  Each room had single light bulb and an ineffective ceiling fan.  We'd pulled wooden tables into each room and set up a make-shift pharmacy of the hundreds of pounds of medicine we'd carried in from America.  It was ninety degrees outside without a cloud in the sky. It was five degrees hotter in the clinic.  I set Dr. Ed up in an examination room and assigned two local Liberian women, Fatuh and Annie,  to look after him.  I told them to keep him hydrated and make sure he took a break when he needed one.  They doted on him like two attentive daughters and called him "Faddah."  He liked that.   It was 9:30 AM by the time we  got everything prepared for the patients.  

Dr. Ed asked, "OK, what do we do now?" 

I pointed out the window to the four hundred patients lining up outside the clinic.  "We start with them." 

Dr. Ed instructing Dr. Erik on the fine art of
 making rubber glove balloons 

I gave Dr. Ed a quick primer on some of the diseases he didn't see in Camden--the basics like Malaria, Dysentery and Filariasis (nasty long worms that live in the skin and muscles).  I was paying back old teaching debts from the old days in his office and it felt good.  

We worked all day without a break.  When Dr. Ed found an interesting case or one that stumped him he'd send one of the daughters in to find me.

"Faddah say he have somting to show you, doc Erik."

When you are a bad child the doctor will eat your lollipop.

I'd work my way through the sweaty, impatient crowd to get to his room and he'd give a passionate, technical presentation of the case to me like I was a visiting professor.  Then he'd refer back to cases he'd seen through the years and tell me how they used to do it in the old days.   He had that renewed gleam in his eye that I hadn't seen since Camden.  He was at home in this kind of environment--desperate, difficult and challenging.  He was back in the game.  Every father and son have special topics in life that they can bond over.  Most  talk about cars or sports or Ponzi schemes.  My dad and I had Malaria and Filariasis.  Those were some of the best bonding moments we'd ever had.

Dr. Ed:  Deep in the Game

By the end of the first day I saw about seventy-five patients and dad had seen fifty.  We quit when it got too dark for the single fifty watt light bulb  to be effective.  Our support crew got everyone out past the crowd and onto a large rented bus. We started the hour long trip through the slow, dusty roads back to Accra.  When we arrived at the hotel we were  hungrier than we were sweaty and tired. We skipped showering and went to dinner.  That night we ate  Fufu, boiled spinach and fried plantains. At the end of the long wooden dinner table the Old Farts Club (OFC) convened and Dr. Ed held court. They talked about the day, the sad and horrible cases and how it made them feel.  I suggested that a successful day of hard work demanded an equally successful night of blowing off some steam at a local Accra nightclub.  I said that it might be better that  the OFC get a good night's rest and get ready for more of the same tomorrow.  I was met with glares looked like I was in for an geriatric lynching. Mr. Henry, my dad's geriatric partner-in-crime said, "Look here, Doc, we were kicking stuff up while you were still in diapers.  Give us 5 minutes to shower and lead the way."

Macumba rules!

My Ghanaian friend Big Tony (he gets his own story) said we must go to Macumba.  It is close and has great music and dancing. Ten of us went out that night (well represented by five OFC members).  

Macumba was a nearly pitch black lounge at the end of a long dark flight of stairs, past a doorman as big as a Ghanaian house.  Inside I could make out a distinct mix of three different groups of people:  foreign businessmen, prostitutes from five different African countries and one wayward group of charity workers (us).  It was like the barroom scene from the first Star Wars movie.  The music, as promised by Big Tony, was an incredible mix of Ghanaian "high life", Jamaican dancehall and Ivory Coast "Zoblazo."  I had never heard a  more pristine,intense music mix  in any other club in the world.  I sat down with the OFC at a table in front of the dance floor.  We all ordered  sixty-four ounce bottles of Ghanian Star Beer (arguably the best beer in Africa).  The dance floor was packed with curvy women from all over West Africa wearing clothing that were two sizes too small, providing the  the least possible coverage.  I looked over at Dr. Ed and Mr. Henry and reminded them that it was okay to blink once every five minutes.  They just laughed and pretended they didn't hear me.  After the second Star Beer jet lag and  battle fatigue took hold.  I was spent.  It was time to head back to the hotel.  The OFC  laughed at my suggestion to go home. These old men called me a light weight.  I let them have their moment, but reminded them that this job was a marathon not a sprint.  We'd see who's still standing by the end of the week.  They only agreed to leave after I'd promised we could come back to Macumba the next night after work.  Big Tony said he knew a better place.  

The OFC Players Club

We worked for nearly two weeks at the refugee camp.  Each day more and more patients showed up after hearing there were doctors and nurses working in the abandoned clinic. The lines got longer; the crowds got bigger. We treated over two thousand patients during that trip.  Many patients had nothing physically wrong, but wanted to speak to someone about the horrors of their lives since they'd escaped Liberia.  Dr. Ed's medical memory got a jump start during this trial by fire. I watched him savor every minute of being the King of the Clinic again. Dr. Ed and I  drank a few Star Beers, saw a lot of good nightlife in Accra (highly recommended) and made some lifelong Ghanaian friends .   I was happy for him--happy to get him back in the game.

Proper doctoring in Africa requires proper attire

I know the day will come when I have to quit medicine and hand the torch to a young doctor who thinks he knows more than me.  I try to talk myself into believing that I'll be okay with that change in life and that I'll go contently into retirement. In reality I know I will miss the action.  I will miss being needed and respected for what I do and I will miss my perception of being a small part of man's greater good.  These days I  bring my son to work with me in my remote Indonesian jungle clinic.  It's becoming his favorite place to be after school.  He's only five, but he's already mastered the Otoscope and knows the business end of a stethescope.  I'm don't know what he's going to want to be one day, but  for now  doctoring seems like a good time with a lot of cool toys.  One thing I know: after all the places I've been  he's going to have to come up with the mother of all obligatory grand gestures.