East African Doctors.
This study of the modern medical profession in East Africa is concerned with the various struggles that African medical workers have endured for the past 130 years.
Beginning with the arrival of the Europeans, along with various diseases such as tuberculosis, syphilis and gonorrhoea which were unknown to African peoples, Ilfie charts the progress of Africans who sought the skills of modern medical practice. He defines four main periods.
In the first, health care for Africans was left to the various missionary societies. Missionaries had begun work on the coast in the mid-nineteenth century and later penetrated the interior. But the various missionary societies placed different emphasis on the importance of medical work. Some insisted that every mission station was to have a resident European doctor; others took little interest in health, including their own.
For the first 50 years, the first period, entry into medical practice for any African was restricted to the role of auxiliaries, performing simple menial tasks and learning by practical apprenticeship.
Africans distinguish themselves
Against the odds, many African's distinguished themselves. Notably, many African medical workers were initially themselves patients who had undergone treatment and stayed to help other patients. Others were promoted from the mission hospital's household staff.
One European doctor, J.W. Arthur, writing from Kikuyu, Kenya in 1913 describes the efficiency of African assistants; "They have been trained to nurse cases, give medicine, attend to proper feeding, take temperatures, apply poultices, give enemas, inject hypodermically and go through all the regime of a nurse's work at home..... They sterilise dressings for operations, prepare basins, instruments, operating tables, and the patient himself. At the operation they can give chloroform, assist me in the actual operation, or even do it themselves in minor cases. They are sent from time to time to see cases in villages and return to report to me the seriousness or otherwise of them. They know, to a certain, extent weights and measures and can make up medicines and ointments from simple prescriptions."
World War One, which pitted German East Africa against the British Allies in Africa, is described by John Illife as 'a medical disaster'. He notes that the Allies employed some quarter of a million troops against 15,000 German soldiers. The Allies lost over 4,000 in action and around twice that figure to disease, The Germans lost one in six of their men but all these figures are dwarfed by the African casualties. Perhaps one million were pressed into porterage and other labour and they lost up to one in four of their number mainly to malaria, dysentery, malnutrition, exhaustion and sheer neglect.
The African Native Medical Corps were formed to serve in the military campaigns. Even those African's who escaped conscription suffered, with most European doctors and their African medical staff joining up. Great movements of populations bred epidemics, and throughout the region cases of tuberculosis, bilharzia, malaria and venereal diseases spread rapidly.
The worst crisis was in 1918 in Northern Uganda where a severe famine coincided with widespread smallpox and then an influenza pandemic.
It was not until 1924 that the post WW1 colonial governments supplemented practical apprenticeship with a formal training programme for Africans, leading to the establishment of the Makerere College medical school and Mulago Teaching Hospital in Kampala, Uganda. Late in 1927, three of the first four students passed their final examinations to begin a two year hospital internship. By 1934, 34 had completed the course successfully. Of these 34 graduates, although two were Zanzibaris, none were yet from Kenya or Tanganyika.
The second period defined by the author concerns these graduates' battle for professional recognition and equality. Newly qualified Senior Native Medical Assistants, later to be termed African Assistant Medical Officers (AAMOs) - doctors in all but name - were blatantly exploited. They were paid one sixth of a European doctor's salary and generally given lowly duties, posted to remote districts in poor housing. Tension over these grievances grew steadily, and at the outbreak of WW2 not a single African doctor appears to have joined the allied forces. One wartime development was that a small number of AAMOs were apparently able to enter responsible positions within major hospitals, initially as auxiliaries to European doctors, conducting research studies.
Eria Muwazi was one of the most prominent, whose research demonstrated that kwashiakor, commonly identified as congenital syphilis by European doctors, was in fact the result of protein deficiency. Muwazi was also to hold an important teaching role at Mulago Hospital as the senior African in the hospital, in effect the registrar.
Africans enter private medicine
Africans first entered private medical practice in Uganda in 1951 where the Uganda Director of Medical Services estimated that a private doctor could, depending on how mercenary he was, quadruple his government salary. Between 1951 and 1955 the number of Makerere-trained doctors in government service fell from 55 to 45.
Private practise also spread to Kenya where the first practitioner, Samson Mwathi, opened his surgery in Nairobi. He later travelled to the USA, in 1958, studying family planning and chest complaints and returning home visited Lisbon, Ghana, Nigeria and the Belgian Congo. By 1960, there were some 23 African private medical practitioners in Uganda, half a dozen in Kenya and two in Tanganyika - encouraged by advances in chemotherapy, rapid urbanisation and the formation of an elite African clientele.
But East African doctors could not escape politics. Tanganyika gained independence in 1961, Uganda in 1962, and Kenya and Zanzibar in 1963, and East African doctors took over the institutions of colonial medicine. Within 20 of independence, East Africa was producing two hundred doctors a year, a 10 fold increase, and Medical Schools opened in Dar es Salaam and Nairobi.
The immediate post-colonial period forms the third period of this study, and explores in detail how Kenya's adoption of capitalism and privatisation, Tanzania's chaotic socialist experiment and Uganda's descent into civil war of the Obote and Amin years, all impacted the medical profession.
The fourth and final period deals with the last two decades and the challenges posed by the AIDS pandemic. East African doctors in Uganda were among the first in the world to confront the heterosexual AIDS epidemic and pioneered a grass roots approach to the control of the disease by focusing on the sexual behaviour of high risk groups such as prostitutes and truck-drivers.
The author makes the point that although East African doctors were, and still are, unable to conduct research into the microbiology of AIDS for lack of funds for the specialised equipment required - the crucial epidemiological research that is has been possible to undertake draws heavily on the traditions established at Makerere 50 years ago.
John Iliffe is a Professor of African History at the University of Cambridge, and formerly Reader in History at the University of Dar es Salaam.
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|Article Type:||Book Review|
|Date:||Nov 1, 1999|
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