Dr. Robert Wenninger, M63
By Kristin Livingston
It was as though his story was lifted from a novel: upon graduation from Tufts University School of Medicine, Dr. Robert Wenninger, M63, took a Jeep down to the Panama Canal Zone for a general surgery residency. A patient in his care died due to injuries sustained from an automobile accident, but from that tragedy came Wenninger’s future: over time he and the patient’s widow fell in love, married, and moved as missionaries to Zambia, where the couple raised her four children and their new six-week-old daughter to love savanna living. Mukinge would also be the start of Wenninger’s career as obstetrician, coroner, and everything in between, including CEO of a bush hospital, for 32 years.
In the summer of 1962, Wenninger was awarded a Smith, Kline, and French Fellowship to spend 10 weeks in Thailand at Manorom and Saiburi mission hospitals. "It was a life-changing experience," he says. "For the first time I realized how different medical practice was in a developing country." For instance, the use of coconut water as a successful IV solution. After Thailand, he completed his first "round-the-world trip," including a stop in India. "While in New Delhi I contracted Shigella sonnei dysentery and was violently sick and alone in a hotel room without any drugs. Next day I dragged myself to the airport for a flight south to Hyderabad where a Tufts preventive medicine professor, Dr. Edwin Brown, was teaching at the Osmanian Medical College." Dr. Brown patched Wenninger up with antiobotics and sent him on his way, a week late, for his final year at Tufts.
“Like kids in a candy store”
The biggest draw for Wenninger when practicing in Africa was the everyday excitement of stepping through the Mukinge Hospital doors. “You never knew what case was going to come in,” he says. In his experience, once trained, many African doctors stayed in the city to practice, leaving huge rural populations without professional help.
Fortunately, he delighted in treating a wide variety of cases and says he “felt bad” for colleagues who only spent short terms at Mukinge before heading back to the States. “They couldn’t believe it,” he says of the many specialty hats they wore while at the hospital. “They were actually practicing medicine all day long, and they didn’t have to worry about insurance forms or malpractice suits. It was like kids in a candy store.”
The overall philosophy at Mukinge, where drugs had to be ordered at least six months in advance, was “to do the most useful things that we have knowledge to do and that are already available for the most people possible.” This required constant movement from specialty to specialty, urology to orthopedics, general surgery to plastic and reconstructive surgery, and so on. Handling unusual cases, he says, wasn’t their forte, but they did what they could.
One particular patient he remembers with fondness was a young man with jaw cancer. Wenninger removed the malignant tumor and part of the jawbone, and replaced it with part of a rib bone. “He’s healthy to this day and we still talk.”
Bare necessities for a world of treatment
Success sometimes came out of a combination of chance and best judgment, especially when the hospital lacked an anesthetist and proper equipment like cardioscopes. “I operated on a bunch of newborns with congenital abnormalities, these little six-pounders,” he says. “Trying to create a protected airway while controlling the anesthesia in a rural African hospital was sometimes dicey.”
Wenninger treated hundreds of children, but rarely delved into geriatrics. “Life expectancy wasn't nearly as long as it is here. I don't think I diagnosed a myocardial infarction in all the years I was there,” he adds. “It's a different world, a different kind of population, a lot of infectious diseases, a lot of malaria. We had 50 houses for leprosy patients when we first got there, but that phased out over the years. Leprosy disappeared from Africa and it's a very minor thing now, only an occasional case.”
Yet with every success, there was always a balance of loss. And in the early 1980s, the loss eclipsed almost everything.
From 1983 to 1986, Wenninger says “we had a lot of unrecognized problems with younger people. They were dying off.” Before long, HIV/AIDS was everywhere. “We had an enormous number of cases with all of the opportunistic diseases, especially tuberculosis. We had almost closed our TB ward in 1986, but when HIV came, TB just took off like a rocket. We ended up with thousands in Zambia and hundreds in our area of HIV patients.”
In the early days of HIV/AIDS, there “wasn’t much treatment,” he says. “We had a whole world of HIV to deal with, and preventive medicine to organize. There was also a tremendous amount of misinformation.”
According to Wenninger, there were bigger opportunists than TB to contend with. “The witch doctors and herbalists and other alternative medicine people with all of their traditional methods, they ended up capitalizing on HIV and offering their own solutions.” Without a concrete cure, Wenninger and his staff couldn’t say that these alternate treatments wouldn’t work. “It opened the door for the charlatans to just tell people, ‘They don't have this kind of medicine because they are Western people and it's an African disease.’
“It was a complicated time, trying to blow the whistle for different high-risk groups and pay attention to prevention.”
Since 1981, HIV/AIDS has led to nearly 31 million deaths worldwide. “The drugs didn't come out for treatment until close to the end of the ’90s and we didn't actually hand out pills for patients with HIV until the 2000 era,” he says. “It came pretty late.”
Even now, he says, there is reluctance in some parts of Africa to use the drugs. “There's the financial problem,” he explains, “but it's also not very easy to get rural African patients to be compliant; the idea of taking medicine every day for an indefinite period of time really doesn't mesh with their concept of disease. They don't understand treatment for diabetes and hypertension where you can control it, but you can't cure it. We had a problem with that.”
The Family Wenninger
Dr. Robert Wenninger, M63, with his wife, Carol
Outside of the hospital, Wenninger led a quiet, happy life with his wife, Carol, the hospital bookkeeper for 28 years (“which in Africa,” he says, “is like being a full-time magician”), and their five children. They built a home that over time acquired reliable electricity and a telephone. The children spent many hours exploring nearby woods, visiting with other expat playmates, reading trilogies like The Lord of the Rings aloud over family vacations, or, in the boys’ case, hunting with dad.
Mukinge Hospital housed at least 200 patients at a time—tough to treat, but even tougher to feed. Roaming the bush to hunt for the family and hospital became the norm and a source of relaxation for Wenninger. “Domestic animals carried fatal diseases which did not affect wild animals,” he says. “So, I hunted—antelope, warthog, and cape buffalo mostly.” A colleague hunted elephant and hippopotamus at times, either of which “could easily feed every patient, the staff, and the nursing students for a week.”
Looking back on those days and nights in the bush, he says, “It was just an enormous place where elephants and rhinoceros and zebra and antelope and everything else just wandered free. Miles and miles of country, where you could spend a week by a river with a hippopotamus snorting away at night and all the African night sounds and lions around.”
The hardest transition for the family was returning the States after three decades, especially for the youngest daughter. “She had a lot of Africa in her,” he says. But the family still keeps in touch with many from Mukinge.
“Zambia may be far away, but it’s still home.”
Kristin Livingston, A05, can be reached at email@example.com.
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