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Making a Difference

Review by Rose Morrison

Moon Madness: Dr. Louise Aall, Sixty Years of Healing in Africa
Alan Twigg
Ronsdale Press

Author Alan Twigg, Order of Canada, is well-known to British Columbian writers and book enthusiasts. He received the Governor-General’s Award for Literary Excellence in 2016 and is acclaimed, among many other things, for his eighteen books and many services to the literary community. When asked why he chose to write Moon Madness, he reputedly said, “Because I wanted to write about a good person.”

Moon Madness is a biography of Dr. Louise Aall, who spent most of her career as a physician healing, helping, and carrying out research in East Africa while supporting a medical clinic in Mahenge, Tanzania. Readers may be attracted by the book’s title; they will find its content equally engaging.

In early 1963, Dr. Aall, a resident psychiatrist at the Swiss institute for Epilepsy in Zurich, is thinking about her future when one of her contemporaries, Dr. Wolfgang Jilek, stops by her office to invite her to visit a restored thirteenth-century castle with him. Aall accepts: he seems like a good person; and this is what normal people do, isn’t it? She does not recognize that, despite the many experiences and adventures she has already packed into her life, this is the start of a new kind of adventure and a major turning point in the thirty-two-year-old’s life.

Moon Madness begins in 1931, with Aall’s birth to parents Lily and Anathon who are esteemed academics living comfortably in Oslo. Anathon co-founded the philosophy department at the University there; he is also a distinguished psychologist. Lily is a celebrated ethnologist. The Aall family name has been significant in Norway’s history for a few generations.

Twigg relates that the Aall children had a privileged but sheltered upbringing with little opportunity to socialize in their early years. Several factors influenced Louise’s personality as she grew up. The children were home-schooled until their mid teens. Independence was encouraged and their education was selective. Their father liked to teach them through stories and fables; and both parents encouraged reading, although when Aall was of university age, she could not gain admittance to the University of Oslo because of her low mathematics score. She was the serious child who wanted, and tried continually, to impress her parents; often without the desired effect. She and her brother Cato became skilled outdoor enthusiasts who, when the family moved to their safer country home during WW II, would ski eight hours to get to Oslo. As teenagers, the pair also went on a two-month cycling trip to the Arctic to visit their grandfather’s birthplace. A salient event occurs with the death of her father. Aall was close to him, and at twelve years old she was the only one who could calm and comfort him during his last illness. Possibly her mother’s dire warnings that romantic and sexual relationships could destroy a young woman’s hopes and ambitions had the most enduring influence on Aall; she resolved to make herself look unattractive to men. The picture of young Aall that Twigg presents is that of a healthy outdoors girl; a loner, smart but not wise, independent yet socially gauche, well-read yet naïve; and adverse to any man outside her family circle. Later, Aall offers that she was also very proud.

Moon Madness is full of interesting events and adventures. The adult Aall experienced and accomplished so much that this reviewer, having read the book twice, still finds the chronology that Twigg includes helpful. Aall knows in her teens that she wants to become a medical doctor; and she studies medicine at the University of Tubingen in Germany from 1951 – 1954. This is a happy time. Her uncle helps with expenses, and her brother invites her into his social circle. “I was like a flower,” she says, “blossoming because I was able to talk to everybody.” To add to her self esteem, her mother is proud of her medical student daughter. Aall comes across books on Tanganyika (present-day Tanzania), then reads about pastor David Livingstone and his friend Stanley; her imagination is fired with thoughts of Africa. Her interest intensifies when she attends Dr. Albert Schweitzer’s 1953 Nobel Peace Prize lecture about his hospital work in what is now Gabon. His reverence for life philosophy reminds her of her father.

As the story advances, so does its momentum. This is partly because it is eventful, and partly because of Twigg’s skilled writing. What began with the account of an unusual girl’s upbringing in Norway, develops into the story of a riskily brave doctor who dedicates her career to helping and healing in places where many would not want to go. Aall, a life-long learner, goes on to study at Saarland University, where she learns the importance of treating the whole patient, body and mind, from French physicians. Following that, she completes a higher medical degree in Zurich. She develops a close, but not physically-intimate friendship with an unassuming young man who is like her soul mate; when he passes away she is affected greatly. Seeing him die, she knows that she will never be afraid of sitting with dying people. Having mourned, she completes a tropical medicine certificate in Zurich, and meets Rudolf Geigy of the Geigy pharmaceutical company. She agrees to work at the small hospital he has established in Ifikara, Tanganyika, and while there, to conduct some research for Hoffman La Roche.

This trip to Africa in 1959-1960 is the first of many for Aall: Moon Madness describes them all—the culture, living and working conditions, and the high incidence of epilepsy in Tanganyika. Aall makes it her mission to care for epileptics, who are usually cast out of their communities; and to research epilepsy in this region of Africa. In 1960-1961the Red Cross summons her to co-manage a larger hospital in the Congo, during the civil war. After receiving a Red Cross medal for her work, she flies to Gabon and works as pediatric assistant to Dr. Schweitzer. Impressed by Schweitzer’s culturally-sensitive, unconventional methods, she decides to specialize in psychiatry. This goal is reinforced when, in 1962, she requests the World Health Organization’s involvement with epilepsy in Africa, and is summarily dismissed as a mere medical doctor by a sexist World Health Organization official. A later attempt will also get ignored. At times, Moon Madness, reads like Verghese’s novel Cutting for Stone, which includes reporting of political unrest, terrible working conditions, poor people with serious maladies, danger, earnest doctors and nurses, and romance.

This review opened with thirty-two-year-old Aall sitting in her office at the Swiss Institute for Epilepsy, mulling her next steps. A pharmaceutical company has made her an offer: will she return to Tanganyika, all expenses paid, to collect more of the tree bark that medicine men use in treating symptoms of epilepsy? She has serious doubts; should she go to Africa alone again? There are safety concerns; and she’s often been lonely. Will she regret not having any family life? A few days after their visit to the castle she confides in her new friend Dr. Jilek. He asks if she’d like him to go with her to Africa. Surprisingly, she accepts without even knowing his first name. The couple marry later that year.

Now there are two to share the adventures. The newly-weds immigrate to Canada, study cultural psychiatry at McGill University, and write their Canadian medical accreditation exams. Aall publishes the first paper that identifies head-nodding syndrome in children who later become epileptic. Twigg relates how “her treatise is largely ignored … fifty years later the phenomenon will be verified and studied, with no recognition of her pioneering work.” Settling in B.C.’s Fraser Valley this unstoppable couple’s service and accomplishments continue. From 1966 to 1977, writes Twigg, they are the only psychiatrists in the upper Fraser Valley. Both Jilek and Jilek-Aall write books; and both are Professors emeriti at the University of B.C. In 1979 the couple adopts their daughter Martica.

Despite setbacks and disappointments, the work at Mahenge, Tanzania, which Aall and Jilek continuously support, goes on, helped from Canada by individuals and organizations such as Ken and Nancy Morrison’s Provision Charitable Foundation, and by committed medical personnel in Tanzania. In 2019 Dr. Dan Bhwana, now clinic director at Mahenge Epilepsy Clinic, visits Jilek-Aall at her Delta, B.C. to consult with her and receive her valuable medical records regarding epilepsy. Moon Madness recounts all of this and is a wonderful, inspiring, and sometimes heart-breaking read.

Rose Morrison is a frequent contributor to PRRB.

This review first appeared in Pacific Rim Review of Books #26