Since 1830 France had occupied Algeria and had made it the granary and essential part of La France d’Outre Mer versus Al Jaza’ir, an independent Algeria, with a population of over 11 million Arabic-speaking Muslims, mostly Berber tribes. Algérie Français represented the million-strong French settlers.
The Algerian rebels were led by the National Liberation Front (F.L.N.) and the Algerian National Movement (M.N.A.). In 1962, the war was over in North Africa. The bloody fight for independence had started with a general strike on January 28, 1957. The cease-fire on March 19, 1962, was negotiated by General Charles de Gaulle, the President of the French Republic (against the resistance of the French General Jacques Massu and his paratroops in Algeria). The first election for independent Algeria was on July 1, 1962, and Ahmed Ben Bella became the first president.
But Algeria, an area of 2,381,741 square kilometers, was in ruins, in a state of chaos the cities deserted, the villages, the rebel strongholds, destroyed and burned. All the French had left; they had returned to the motherland. The native population, with an illiteracy rate of eighty percent, was impoverished, unemployed. Hunger and disease were rampant. There were no doctors, no nurses, no medical equipment, no pharmaceutical drugs; nor were there teachers, civil servants, or technicians. The children, who accounted for over 40% of the population, suffered most. The young state needed help, desperately. International organizations such as the Red Cross, the Quaker Service, and the Service Civil International, had gone in immediately.
Thus it came about, in September 1962, that I, a future pediatrician from Erlangen, Germany, joined the Service Civil International as a volunteer doctor and found myself in a battered French fort near the Berber village of El Khemis, in the barren Tell-Atlas mountains in Western Algeria near the border with Morocco.
The conditions were primitive in this chantier de l’amitié where other European volunteers helped repair, or build new houses for Algerian refugees. The days were hot, the nights cold, with rain often dripping through the shattered roof. We slept on the ground. And every night we each had to inspect our mattress to be sure that no scorpions were hiding under there, or worse in the sleeping bag. Sometimes there was still shooting going on at night. We were protected by the F.L.N. I was the only doctor in a large rural area with ten villages where I was responsible for organizing out-patient clinics. The Algerian refugees regrouped because of military conditions, also lived in camps of tents or gourbis, huts made of grass, branches, and tent squares. Many patients, about 100 a day, mostly women and children suffering from respiratory and intestinal infections, malnutrition, trachoma, skin diseases, and, of course, tuberculosis, came to our daily clinique in the fort, where an English nurse and a Swiss girl assisted me.
I was successful in extracting several rotten teeth from the mouths of the two wives of the village chief nearby (fortunately, I had brought dental instruments with me from Germany), thus my reputation as El Tabeeb (The Doctor) was firmly established, and I was often called out, even at night.
One evening, I had to make an emergency call, to a sick baby with convulsions, I had been told. It was difficult driving the Volkswagen minibus on a dirt road down a steep ravine. Darkness had set in. Jackals jumped out of the way in the headlights. My young interpreter knew the way. Then we had to leave the minibus and climb down a rocky path. We saw three shabby tents. A man with a turban, the father, came out; he had been waiting for us.
– “As-salamu aleikum” (Peace be upon you).
– “Wu-aleikum as-salam”( Peace be with you as well).
More men came. They greeted me respectfully, shaking hands, then touching their chests, their foreheads, their mouths. We entered the tent.
“Where’s the sick child?” I asked.
The father pointed to the back, to a bundle of rags piled up on the carpet. But I could not proceed. I had to sit down with the men. The women in the background had prepared tea in the meantime. They offered me a tiny glass of hot, sweet mint tea, and I had to exchange some polite words in French, or Arabic. Then I uncovered or unwrapped the child, a baby girl of about 9 months. She was more or less unconscious, had a high fever, and a stiff neck. There were also scattered bluish-red spots on the skin of her chest and her lower legs. “Menigococcal meningitis” I thought, and immediately gave her an intramuscular injection of one million units of Penicillin G. Then I took an Nｰ1 needle from my bag. The other men closed in, watching quietly. Ali, the interpreter, was next to me with a candle. The father assisted, holding the child bent forward. I did a lumbar puncture. The drops of the cerebrospinal fluid came, but it was not clear, it was purulent, even partially cloudy. To at least do something to decrease the inflammation I injected through the needle 5 ml of 10 mg prednisolone in solution. The condition of the child, however, did not improve. I gave her another Penicillin injection. I knew the chances of saving this child were very slim. What else could I do? There were no facilities around for intensive care in a hospital. I told the father about the dim outlook and promised to come back in the morning.
The next day I found the family unchanged.
“Where’s the child ?” I asked full of apprehension. The father was calm. He pointed up to heaven. “She’s there,” he said, “C’est le destin”, it was the will of Allah.
I felt miserable. I hadn’t done a good job. The father put some walnuts and pomegranates into my pockets to express his gratitude. I had to sit with the men again and drink tea. I looked around and saw the ‘awful’ fertility which prevailed here within the walls of dirt and poverty. The many children (the dead baby would have made the twelfth in this family, and both father and mother not yet old), the hen with her chicks, the goat with the kids. I thought maybe it was better that this baby did not survive, or live with possible brain damage. I began to understand ‘Islam’ which means submission, surrender ( to Allah).
There was another sick baby. One afternoon I was returning alone from an out-patient clinic in a battered village near the Moroccan border. Others had refused to go with me because of the mines. I had to drive the Volkswagen minibus very slowly, intent on watching the area ahead of me. There were still thousands of light mines along this dirt road along the border. They had been planted by the French army to prevent the rebels from crossing with supplies from Morocco into Algeria. Sometimes I stopped and threw rocks in front of me in order to explode the mines, in particular when their washed-out upper surfaces became visible.
After driving for an hour, I passed a group of three gourbis with a donkey, some chickens, and a black goat outside. There stood a young mother, her head and face covered, holding a bundle in her arms, timidly waving to me.
So I stopped, and took the baby into the shade of the tent, unwrapped and examined it. It was a boy, about four months old. Skin and lips were very dry and hot; folds persisted when the skin was squeezed, the fontanel was sunken in, the eyes were wide open. Watery diarrhea everywhere in the patchy diapers. The baby was in a stupor; it could no longer suck at its mother’s breast anymore. The diagnosis was clear: Hyperpyretic enteritis with severe dehydration. ‘ In a few more hours, maybe a day, the baby would be dead.
Fortunately, I had some equipment in the car. Plastic stomach tubes, some teaspoons, a container with water, sugar, salt, and an empty bottle. I remembered the primitive salt-sugar oral rehydration solution: eight teaspoons of sugar, plus one teaspoon of salt in one liter of boiled water. I also had an empty 20 ml plastic syringe which I filled with the solution I had just mixed.
The mother had the baby in her arms. I wetted the thin plastic tube and gently put it through the nose into the stomach. The mother was terrified when she saw the tube disappearing into her baby’s nose. Then I attached the syringe and slowly injected the salt-sugar solution. It worked. The infant didn’t vomit, nor did it choke. I repeated the stomach injections several times over the next half-hour. Then I took the mother and her baby to the fort to have the rehydration procedure repeated at intervals. The next morning the fever was gone; the baby was alert again trying to drink. At noon, he could suck at his mother’s breast. In the evening, I drove them both home to their tent. The mother was still shy, but grateful. When I left she gave me two eggs and some figs. I could not refuse them.
In the following 36 years as a pediatrician and oncologist, I saw many infants and children die, but I also saw many who survived, even from terrible diseases like leukemia and cancer. This was due to modern medicine, new drugs, well-equipped hospitals. However, no recovery from imminent death to life, and solely through my own hands, remains more vivid in my memory than this poor little baby outside a shabby Berber tent somewhere in North Africa.
