Abstract
Surgeon, controversial writer, and polymath
The death of Imre Loefler, at the age of 77 will be mourned in many quarters. He was a polymath, well versed in philosophy, history, ecology, and wildlife conservation, as well as medical education and surgery. His memory was prodigious. In his heavily accented speeches and in over 1000 precisely argued articles and scientific papers, he challenged the status quo in many differing fields. His audiences and his influence extended far from his home in suburban Nairobi.
Imre Joseph Pál Loefler was born in Budapest in 1929. His father was a civil servant. One grandfather was a classics teacher, the other a publisher and book collector whose library became an important factor in Imre's development. His grandmothers were Austrian and Bavarian so the home was bilingual. Within the ranks of the extended family were Uncle Joseph, an archbishop (later the Primate of the Catholic Church in Hungary), Uncle Victor, a general, and Aunt Paula, an Ursuline nun, who was the first woman to hold a PhD from a Hungarian university and tutor to the children of the Duke of Eszerhazy. The general, but even more so, the nun, had great influence on the boy.
His early schooldays were unremarkable; his only enthusiasm, scouting, he attributed to his desire to escape from home and his mother's religious moralising. In 1944 he was enrolled in an army cadet school. Unfortunately, with the Russians no more than a few kilometres from Budapest, all the cadets were soon taken by the German army, put into German uniforms, and sent to the Polish war front. After six months he escaped and made his way to Germany, where the Americans captured him in May 1945. In the prisoner of war camp he helped in a modest “clinic” and there performed his first operation, the incision of a buttock abscess.
On discharge from prison in Regensburg he found work in a US army hospital preparing histological slides. He cultivated contacts in the officers' mess and became a successful black marketeer dealing in cigarettes, spirits, and chocolate. Those idyllic months ended when his parents found him through the Red Cross and took him back to school in Budapest. Although he matriculated well in 1948, he was refused entry to medical school by the communist government because of his “bourgeois” background. Within a month, he escaped from Hungary, on foot across the Austrian border, and returned to Regensburg. There he worked as a coal miner until he could afford to enrol in its medical school. Soon after entry he won the prestigious national scholarship, Die Studienstiftung des Deutschen Volkes, with free tuition, a salary, and the chance to study philosophy and history alongside medicine. It was here that he gained his grounding in Aristotelian and Socratic philosophy sitting at the feet of, among others, Erwin Schrodinger, Karl Popper, and Pablo Casals.
At 22 he married Edith, a dental student. Three children quickly followed and with them, penury once again. Taxi driving at night provided money and the chance to read his textbooks by the strong light that he rigged in the cab. He graduated in 1954 and entered surgical training in Dusseldorf two years later. He gained his speciality diploma in 1961. Reading British and American journals, he thought that German surgery had been left behind, mainly because of the way the profession was organised. He decided to retrain in the United States. Having passed the ECFMG examination, he became an intern at the Good Samaritan Hospital, Cincinnati, Ohio, and completed his surgical residency there.
Inspired by the reputation of Makerere University in Uganda, he tried to arrange an African assignment but found that neither his German nor American diplomas were registerable by the colonial government. Eventually, in 1964, he and Edith gained work, he as surgeon and she as dentist, to Virika Mission Hospital, Fort Portal, Uganda. Here he matured as a surgeon and, in the mountains, hills, and plains of western Uganda acquired what was to become a life long interest in wildlife.
In 1967 he was invited to join Professor Sir Ian McAdam's department of surgery in Mulago, Uganda's teaching hospital, as a senior lecturer and he threw himself wholeheartedly into the teaching and clinical work. His ward rounds were quickly established as a great teaching vehicle, especially his evening rounds on emergency day. His habit of checking the admissions later in the evening was a cause of frequent embarrassment to the interns when, the next morning, the ward round revealed that Imre knew more about the admissions than did they. In 1969 he- and Edith separated.
In 1970 he was appointed the foundation professor of surgery to Zambia's new medical school in Lusaka. In Zambia he married Valli. They bought a hundred acres of land, built a house, and developed a farm around it. They were happy years. Valli provided a comfortable home and acted as secretary for his increasing literary output. They shared a love of birdwatching safaris, and Imre learned to fly. He became an honorary game warden and was involved in anti-poaching activities.
Workwise, these were the most challenging years of his career. The University Teaching Hospital, lavishly built with many medical specialties, was not well suited to the needs of a developing nation and its polyglot staff, recruited from many countries, did not coalesce into efficient teams. Nevertheless, Imre founded an efficient department of surgery firmly based on the Mulago principles of service, teaching, and research. He was a lucid and stimulating teacher in the wards, lectures, and operating theatres, and on emergency days his students had to be driven off at 1 am to get a little sleep before the 7 am intake rounds. Many students enthusiastically accompanied him to up-country hospitals, where he was able to demonstrate the practical applications of their acquired knowledge. His logical mind gained him an enviable reputation for sorting out difficult clinical problems but he was outspoken critic of inefficiency and incompetence. Zambia at that time was a “frontline state.” There were tensions and jealousies within the medical school and his peregrinations, always with his birding binoculars, were “suspect.” Imre was expelled from the country in 1975.
Gerald Neville, Nairobi hospital's senior surgeon, invited Imre to join him there. He was to spend 31 years there until he retired in 2006. He soon became a very busy surgeon but for many years would spend every Monday flying to remote hospitals to operate and teach. Dogged by continuing aspersions about his qualifications, he travelled to Scotland to sit and pass the fellowship examination of the Royal College of Surgeons of Edinburgh. The Nairobi hospital, a private institution, gave Imre very few teaching opportunities but he established the library and founded the hospital journal, The Proceedings of Nairobi Hospital, which he edited for nine years.
As a council member of the Association of Surgeons of East Africa (ASEA), he was responsible for Zambia becoming the first additional member country in 1974. Later, as chairman he played a large role in developing and monitoring surgical training throughout the region and remained a very active in the work and development of the Association of Surgeons of East Africa up to the very end. He was the one, last year, who moved the motion for the ASEA to transform into the College of Surgeons of East, Central and Southern Africa. He devoted personal resources to the work of the ASEA, flying his plane to all corners of the region and provided tremendous support to the Ngora hospital project of ASEA, which he visited frequently and sometimes gave joy-ride flights to village people in the area.
He and Val divorced in 1983, and he married Martha Okanga a few years later. This was to become the most productive period of his life. Together Martha and he explored their passion for birding, conservation, and flying; with he as pilot and she as navigator they competed in many air rallies and safaris. When chairman of the Aero Club of East Africa he invented the, now very popular Kenya Navex and the Preston rally, which followed the pioneering routes of Chevalier Preston between Nairobi and Salisbury (Harare). From 1998 to 2005 he was chairman of the East African Wildlife Society, and, during this time tried to give a new direction to conservation, believing that people would conserve wildlife only when they received direct benefits from so doing. His advocacy of consumptive utilisation of wildlife by, for example, sport hunting, farming, trophies, etc, threw him into conflict with the many non-governmental organisations concerned with animal welfare. It was an argument he was close to winning at the time of his death.
He was now publishing more. He had a weekly column in the East African Standard, which was usually polemical and disturbing, engaging always with topics affecting his fellow Kenyans (he had acquired Kenyan citizenship in the '80s) such as governmental inefficiency and corruption, deforestation, land erosion, the declining water supply. He crossed swords with the Catholic Church for its views on abortion, birth control, and AIDS and weighed frequently into Africa's root cause for its underdevelopment—namely, its burgeoning birth rates. In his popular Soundings column for the BMJ he consistently stuck to his editor's brief—to be as splenetic as possible. His essay was the first winner of the Wakley prize, established by the Lancet in honour of its founder. He produced many book reviews; those of surgery were always from the viewpoint of a surgeon working in a poor environment and one who believed all surgical practice should be based on the basic principles underlying wound healing, management of infection, and repair of tissues. He decried the advent of the superspecialist and of new procedures that depended on technically complex techniques that were not attainable, or appropriate, outside of the metropolitan hospitals of the West. This viewpoint was repeatedly and forcefully made in many articles and contributions to surgical meetings.
Quite deservedly he gained recognition by his peers and he was invited to lecture throughout Africa, Europe, the US, and Australia. In 2005, in recognition of his speaking and writing, the Satima Foundation was established in Kenya to promote essay writing and rhetoric among his fellow Kenyans.
Prostate cancer was diagnosed in 2000. He had surgery and later, when secondaries appeared, chemotherapy and radiotherapy. He faced his fate with the rational view of the agnostic he was, continuing to work, fly, write, and travel extensively almost to the end. Imre has left a memorable and important mark on surgery, wildlife conservation, and, through his articles in the Kenyan press, on the growth of participative democracy in that country.
He is survived by his wife, Martha, and his children, Andreas (an orthopaedic surgeon in Sydney), Nelly (a potter in South Africa), Dorothea (a language teacher in Stuttgart), and Andrea-Claudia (a teacher of political science in Cottbus, Germany).
Imre Joseph Pál Loefler, former surgeon in private clinical practice Nairobi (b 26 March 1929; q Regensburg, Germany, 1954; FRCS Ed), died from prostate cancer in Nairobi on 11 March 2007.