Book Review  |   August 2011
Toubab: An American Doctor in West Africa
Article Information
Book Review   |   August 2011
Toubab: An American Doctor in West Africa
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 513. doi:
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 513. doi:
The Gambia is a poor, small country in West Africa in which day-to-day life is a challenge. Healthcare services available there are only a fraction of the services available in even the smallest towns in the United States. I imagine that conditions in most of Central Africa are similar to those in The Gambia. In 2006, David Levine, DO, a family physician from Washington State, volunteered for 1 year to provide medical care for the people of this country. The life journeys that eventually led Dr Levine to Africa help us understand why he did this. As is clear from reading his book Toubab: An American Doctor in West Africa (originally published in 2008 and republished with amendments in 2010), Dr Levine has a huge social consciousness. In the book's introduction, he writes of his early experiences as a physician doing volunteer work at the Hôpital de Luperón in the Dominican Republic in 1992: 

I washed my hands in old-fashioned porcelain basins, sewed up lacerations from motorcycle accidents, and helped treat endemic typhoid fever. I went into mountain villages with a “flying squad” of nurses, doctors and dentists. It was in the villages that I really began to see some of the difficulties in getting health care to people in poor and isolated conditions. How do you diagnose without lab and X-ray? What good is a diagnosis when there's no chance of follow-up? What if there isn't medicine? What good does it do to treat chronic problems on a hit-and-run basis or even for a month if there isn't long-term intervention?

Toubab means white person in the language of West Africans. Dr Levine's book is in the form of a diary that tells the fascinating story of what he, as a toubab, experienced in Africa. He was assigned to the emergency department of the major hospital in The Gambia. His text relates numerous insightful experiences of friendships, cultural collisions, sickness, frustrations, heartbreak, anger, happiness, and much more. A couple examples follow: 

[Stunning to me were] the depth and breadth of the chasm of ignorance of the average Gambian about illness. A friend will report to me, “My auntie is in the hospital.”


“Oh,” I say, “what is wrong with her?”


“She is sick.”


“What is her sickness?”


“I don't know. She is just sick.”


Or, “My auntie died in the hospital.”


“What did she die of?”


“She was sick.”


The older people may or may not know the term malaria. It will be rare that they will be aware it is transmitted by mosquitoes. They do know it becomes more prevalent in the rainy season.


It is 9/11 and I am a Jew living in a Muslim country. Few people here know that I'm Jewish. They will ask if I am Muslim and when I tell them I'm not they assume I am Christian. Here, you are one or the other. The idea of being secular is puzzling. If I tell them I am Jewish there is no reaction. None of them have any experience of Jewishness; of Anti-Semitism.... Toward me, there is only kindness or, alternatively, a target from whom to gain advantage or cadge money. I am a toubab, and a non-Muslim. That is category enough.

Toubab is embellished with many black-and-white photographs of people and scenes from The Gambia. These pictures strongly connect the reader to the story in Dr Levine's journal. 
Dr Levine continues to help the people he worked with during his year in The Gambia. He has established West Africa Medicine and Education (WAME), a nonprofit program to help support medical care and general education for West African children. The book notes that all profits from the sale of Toubab will be donated to WAME. Buying this book will help these kids survive a difficult life. 
My recommendation is to buy Toubab and read it, and then try to picture yourself living in such poor conditions. You will leave Dr Levine's story with a greater appreciation for what we have in the United States, despite all the distractions that we're experiencing in medicine today. 
   Editor's Note: Toubab: An American Doctor in West Africa is available by contacting Dr Levine at Dr Levine notes that the $25 price of the book includes shipping costs, and all proceeds will go to his nonprofit charity, West Africa Medicine and Education.