The Evolution of Modern Medicine in a Developing Country: Ghana 1880-1960.
The outbreak of plague in 1908 gave the Governor of the Gold Coast Colony the opportunity to establish the administrative base for sanitary reforms in the Colony where the coastal towns were unplanned and dense with poor dwellings. For the first time an administrator of the Colony made sanitation, including a good water supply, his top priority. He was to die while on leave four years later after a visit to Panama to learn how methods to control malaria and yellow fever could be applied to the Gold Coast. His efforts were helped by a committee, which recommended that the West African Medical Service should make medical officers responsible for sanitation in their districts. Sanitary reform could not come too soon: as early as 1881 the London Daily News had castigated the colonial government for its total neglect of all sanitary laws, excusable apathy and wilful violation of the laws of health. But then, as now, the demands on government for financing its health service exceeded the resources it could call upon. And this has been the story throughout. Careful husbanding of the increasing revenues from cocoa made it possible for Governor Clifford to begin the reforms which the visionary Guggisberg drove forward in the 1920s.
Stephen Addae has written an absorbing book. As a physiologist he knows that evidence from experiment is more significant than the evidence of theory, and so his account of the changes and chances of an emerging and now a truly Ghanaian health service is fair and factual. He recounts without rancour the racial prejudice in the medical profession from the time when the Sierra Leonean, C. F. Easman, resigned as Chief Medical Officer in 1897, until the end of the Second World War. The West African Medical Service stated that applicants should be of European parentage, a condition that was challenged both by the Aborigines' Rights Protection Society in 1913, and by Governor Clifford himself, who, in Addae's telling words, openly and generously challenged the principle of African exclusion in that same year. Although Clifford won six places for African medical graduates, few places were filled because there were not the secondary schools to supply the students. It was left to Guggisberg, again, to promote secondary education and thus to build the platform for the excellent secondary education of subsequent years. Although Addae points out that the north of the country was sadly neglected in much of the progress that the coastal belt and Ashanti enjoyed, the Medical Field Units, established to combat common infectious diseases, were a model of their kind and were particularly active in the north. They grew strongly under the first Ghanaian Government which shifted the balance decisively towards a health service that made prevention its dominant policy. An accompanying increase in the number of Heath Centres, which the influential and far sighted Maude Committee had proposed in 1952, put in place the basis of a decentralized and effective service, which was effective beyond the coast and beyond Kumasi, whose people had long been recognized as far more progressive and aware of preventive health than those in other areas. The Nkrumah government could not afford the capital cost of hospitals, so that its rural health policy was both wise and pragmatic. In retrospect, it is sad that a medical school, strongly argued by Guggisberg as early as 1923, was not established until the 1960s, because it would not only have produced doctors who were sorely needed but would have been a catalyst for speedy change in attitudes and practice. But now it is a different story, because local graduates have, in their turn, been able to train others so signally since the medical schools of Accra and of Kumasi have been active. There are. short biographies of distinguished Ghanaians and portraits of some of the early pioneers, including the woman medical officer, Cicely Williams, who gave to the world the Ga word which means `the deprived one'--Kwashiorkor.
Stephen Addae's book is absorbingly interesting and refreshingly fair; unlike the gold fields of Ashanti, one does not have to dig deep for its riches.
Tropical Health and Education Trust, London
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|Article Type:||Book Review|
|Date:||Oct 1, 1998|
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