SIS 490 D: GHANA STUDY ABROAD PREPARATION

Spring 2005 3:30-4:50 Thursday Music 213 http://faculty.washington.edu/ellingsn/Ghana_Prep.html

Prof. Linda Iltis 111 Thomson 9-11:30, 1-4:00 MTWF 543-0231 iltis@u.washington.edu

Prof. Ter Ellingson 28D Music 9-10:30 TW 543-7211 ellingsn@u.washington.edu

Early Ideas about Preparations for Living and Health Care in Africa

Preparations for Living in Ghana, 1898

Kemp, Dennis

1898 Nine Years at the Gold Coast. London: Macmillan.

[2] My first care after securing the necessary medical certificate was to prepare my outfit. As this may be of interest to the reader, I may as well give a general idea of the same, omitting any reference to the needless and expensive items with which I burdened myself… [3] In making up the outfit list the ordinary light summer clothing may well form the basis of calculation… Eighteen months of a West African humid atmosphere, together with well-known, though scarcely approved, methods of the native laundry-man, will be quite equal to three years of wear and tear in England. Flannel or merino should always be worn next the skin. A good helmet and white cotton umbrella are, of course, indispensable – lighter hats may be worn late in the afternoon. Inclination has often led one to wear the loosest and lightest clothing. But it must be borne in mind that the “tailor makes the man” in the coast towns of Africa, as well as in England. In preparing for the rainy season it may be worth while to say that as much rain falls in a day at the Gold Coast as falls in Manchester in a rather wet month. And what more need one say? – except that care must be taken that the waterproof cloak is stitched, or it may, as mine has done, fall to pieces. Due care must be given to the requisites of bed-covering. Blankets are necessary, particularly in the wet season, and in case of fever. Pyjamas are invariably worn; and the flannel belt, which I have found of great service in warding off dysentery. Sponges, bath-towels, etc., will suggest themselves. Ironware for the kitchen, hardware, plate and cutlery for personal use must [4] be furnished. In ordering these bear in mind that visitors drop in occasionally. In our free and easy life we have sometimes borrowed from the traveller: but it may chance that although your servant has been unusually skillful in breaking your ware, your visitor will not have the necessary articles on his person, so that it is well to be provided with at least a change. Do not forget the table linen a neatly arranged table helps to tempt the appetite, which is often fastidious. In traveling take enameled ironware: not that it is pleasanter to use, but your cook sometimes “forgets” to see that the table requisites are safely packed; and your carrier, after resting on the traveling-case, is greatly surprised to find a general smash, and you feel – well, you may fill in the rest as your fancy dictates. Whatever else is overlooked take care to provide yourself with a good filter. “Maignens” are the most serviceable I have had in use. It is well to be supplied with provisions from England. The number of houses engaged in this particular trade is legion. Crosse and Blackwell are always most obliging in executing orders. The local stores do not keep the greatest variety, and for other reasons it has been found an advantage to import direct. Chlorodyne, anti-febrin, and quinine should be kept in every home. Antibilious compounds are worth, in my judgment, two “guineas a box.”

Books are needed in Africa as much as in England. [5] But they suffer from the damp air – covers come to grief in a very short time. Cockroaches and white ants “inwardly digest,” even though they do not “read, mark, and learn,” the contents. A few inexpensive knick-knacks help to make a great contrast to the bare walls of some quarters one has visited.

Health Care in Ghana, 1898

[35] I have hesitated in introducing the subject of personal health in this chapter. On the one hand I am tempted to hasten on to furnish an account of missionary work; on the other hand I feel that the subject of personal existence at the Gold Coast is, if possible, of greater importance. Let me therefore give an account of the mode of life, and also respectfully offer a suggestion as to the preservation of health….

As Cape Coast is only four degrees north of the Equator there is very little difference between the length of day or night at any part of the year. Hence it was our practice to rise at six o’clock. Our earliest exercises were at the bath: it must be mentioned, however, that the majority of [36] our fellow countrymen prefer their “tub” later in the day – after business hours. It is usual to take a cup of cocoa, some very light food, and fruit, at seven o’clock; and a substantial meal at eleven. Medical men who have not seen our poultry and farm-yards abroad warn us against eating carneous food in the tropics. But those who have partaken of our joints have no fears respecting harmful results; their only concern is whether the tough, leathery substance can possible contain any nourishment at all. Dinner is at half-past seven. Fruit is not, as a rule, taken late in the day. Although the variety of fruit is not as great as in England, there is usually a fair supply of pineapples, bananas, oranges, mangoes, limes, alvacodor pears, guavas and pawpaws.

And now a word or two as to the preservation of health. Here I may, at least, express the hope that the Government, the English merchants and our missionary society will, ere long, follow the excellent example of the Basle and the French Roman Catholic Societies, and allow no European worker to occupy a solitary station. In numberless ways companionship is unspeakably beneficial, but especially in time of sickness. The late Professor Drummond has said “that there is a stage in African fever – and every one must have fever – when the watchful hand of a friend may make all the difference between life and death.”

My remarks are simply those of a layman, but [37] of one who has enjoyed on the whole very fair health, and who has had the privilege of ministering to the fever-stricken patients on scores of occasions, both with and without medical aid. The first suggestion is, avoid needless exposure to sun and rain. The heat, perhaps, is not as great at the Gold Coast as in some other tropical countries, but the effect upon a system which is more or less saturated with malaria may be far more deadly. Our native friends tell us that they incur quite as much risk in coming to England as we do in visiting their country. I can well understand that our cold is quite as trying to their constitutions as is their heat to us; but they altogether leave out of account their malaria, which is as “pestilence walking in darkness, and destruction wasting at noonday.”

After exposure which has resulted in wet clothing, change the latter with the least possible delay, taking care to rub yourself with a rough towel. On these occasions take five or ten grains of quinine – the exact quantity will depend upon your general use of it. There are those who are able to boast that they can dispense with the drug for five or six months at a time. Others take small quantities frequently – in the wet season, daily. A medical friend, of considerable experience and success, tells me that fifty grains, taken during three consecutive days once a month, gives a sudden and salutary check to all malarial tendencies.

It is of the utmost importance to avoid remaining [38] in the vicinity of newly turned-up soil. It is important too not to over-estimate one’s strength, or under-estimate the treachery of the climate. Many an inexperienced man has boasted that he “never felt better in his life,” and has hinted that he was quite prepared to stay at his post for four or five years; but has very speedily found, to his sorrow, that he was reckoning without his host, – he has either been invalided home or his remains have been taken to the cemetery.

If one has been accustomed to live without stimulants, it is advisable not to take them unless specifically prescribed by the medical attendant. Some men, indeed, have paid the penalty of over-indulgence by an early death; but the number of these is not proportionately great. On the other hand, even the most carefully regulated lives succumb to the terrible fever. The most scrupulous total abstainers are of opinion that alcohol, in one form or another, though perhaps not necessary in this land, cannot always be dispensed with yonder. But the man who has not grace to control his appetite should certainly avoid the Gold Coast; for in that thirsty land the temptations naturally are very great: and without the restraining influences of wife, mother, or sister, a man’s life may become such as to cause those of his old home to blush.

In addition to the precautionary suggestions may I advise generous living, plenty of work – not to the extent of exhaustion – and regular exercise as [39] the means to be employed for the preservation of health? But your magnificent constitution, your indomitable pluck, the exercise of your most prudent judgment will not ensure absolute immunity from the malaria. Suppose I give an account of my own “seasoning”! The experience then gained may be of service to others. The attack, which was the most persistent and painful that I had, came upon me during my fifth month of residence. It was on a Sunday morning, the violent pains in my head and back made me heartily with that I had not to preach. But it was not until some hours later, when my worthy colleague suggested the advisability of taking my temperature, that it was discovered that the clinical thermometer registered 102º. How much higher the temperature might have risen, or how much more difficult it would have been to have grappled with the attack, but for Mr. Hall’s timely suggestion and help, it is, of course, impossible to say. There is no doubt that it would have been a much more serious matter. Of course the doctor was summoned. “Doctor not at home!” It was quite a new experience for us. But we proved that “a little knowledge is not necessarily “a dangerous thing!” the first business was to secure the action of the liver, which had become torpid, and at the same time to open the pores of the skin – nature’s safety-valves. B ut they were very obstinate – as the always are in such cases; and although the temperature of the bedroom was at 75º – it was in [40] the wet season and consequently cool – I was miserably cold. In addition to the flannel sleeping-suit, there were three blankets and a rug placed over me, and two hot-water bottles at my feet, and then to supplement the tumblers of exceedingly hot lime-juice, my friend insisted on my taking the most vile drug that man ever invented – Warburg’s Fever Tincture. All this was done to arrest the temperature, which rose to 104º before the doctor arrived. Mr. Hall had the satisfaction of knowing that his methods were perfectly in accordance with medical knowledge; and for this the thanks the Didsbury College authorities, who arranged the medical course for the missionary students. Those days were days of heroic doses of quinine. I took three hundred grains in five days before the temperature was reduced to its normal condition.

Native friends were very kind; some of them insisted on taking nights on duty. I shall ever be grateful for the kindness shown on that occasion. Our worthy factotum was as gentle as a woman in his movements. During the stages of convalescence friends sent presents of fruits, and on the first Sunday after recovery no fewer than sixteen visitors called – including six soldiers, who came to wish me “very much good evening!”

One remarkable feature about a malarial fever is the suddenness of a change for the better, or worse. One day one hears that so-and-so has an attack of fever; the next day he is dead, the next morning [41] buried. Or the man who was down with a dose yesterday is attending to his papers in his bedroom to-day, and expects to be in his office to-morrow. Or again, an invalid is put on board a vessel in apparently dying state; it is feared that he will not live to see Sierra Leone or Grand Canary: but, to the surprise of every one but the invalid – and he has not bothered his head about such a trifling matter – he does linger and live, and by the time he gets to Liverpool he is quite himself again; and then comes the unkindest cut of all: “What in the world have you come here for?”

Health Care in Africa, 1922

Lugard, Frederick

1922 The Dual Mandate in British Tropical Africa. Edinburgh and London: William Blackwood & Sons, 1922. 5^th ed. London: Frank Cass, 1965.

[152] A few brief words to the newcomer to the tropics, before he has had time to acquire experience, or to benefit from the advice of the doctor, may be of use: –

Wear light flannel next to the skin, and use a cummerbund [sic]. Never be separated from your mosquito-net – a small one can be carried on the saddle, – and see that it is well tucked in at night, and that your feet or hands do not lie against it while asleep. Wear some head-covering when under an insufficient roof or in a verandah, and on no account go into the sun without a hat, even for a moment. When marching on foot, wear thick woolen socks and roomy boots. Bathe in warm water. Be moderate in eating and drinking; always eat something before going to work, and eat frequently, but not largely at one time. Eat fresh food, even though unappetizing, in preference to tinned food. Obtain all the vegetables [153] and fruit you can, but eat sparingly of uncooked salads. Boil all drinking water and milk bought from the natives. Take five grains of quinine daily, preferably in liquid form – tabloids sometimes become so hard that they pass through the system without dissolving. If unavoidably exposed to mosquitoes, take an extra dose on alternate days for ten days. Personally, see to the cleanliness of all cooking utensils by frequent inspection. See that your clothes are not washed in water used for this purpose by natives.

Segregation and Health, 1922

[148] The question of the segregation of Europeans and natives is one which merits a word here. We have learnt that malarial germs – and at times those of yellow-fever also – are present in the blood of most natives, especially of native children, and their dark huts and insanitary surroundings foster mosquitoes, by which these diseases are conveyed. Doctors, therefore, urge that Europeans should not sleep in proximity to natives, in order to avoid infection.

We do not go to Africa for our health, and every other consideration must give way to the discharge of duties, which in some cases – such as the headmaster of a school, the keeper of a prison, missionaries, and others –must of necessity render the observance of this rule impossible. But where segregation is compatible with work and duty, commercial firms, no less than the Government, incur a moral responsibility not to expose their employees to infection which can be avoided.

With this object in view, new townships are divided into European and native reservations, separated by a non-residential area 440 yards in breadth, cleared of high grass and scrub. Europeans are not allowed to sleep in the native reservation, and natives, other than domestic servants and other necessary employees, may not reside in the European quarter.

The belt of clear ground which intervenes between the two quarters forms an effective fire-guard from bush-fires, and the conflagrations, so frequent in the dry zone, of the inflammable huts and enclosures of the natives, which also harbour rats and other vermin. It may be used for recreation and parade grounds, railway and public works department [149] yards, cemeteries, &c., and even for buildings in which Europeans or natives do not sleep, provided that they do not form connecting links for the spread of fire, or resting-places for mosquitoes. They should for this reason never be allowed on the side on which the native reservation is located. In old townships these principles can only be introduced very gradually; and in order to avoid difficulties in the future, much care and foresight must be exercised when granting long leases in places which may eventually expand into a township. Europeans should never be permitted to reside in a native city, or close to but outside a township.

Such in brief is “the policy of segregation” which Lord Milner considers to be desirable no less in the interests of social comfort and convenience than in those of health and sanitation. It is obviously applicable only to large centres of population, and since Europeans and natives must necessarily be in close association during the day-time, it affords at best a very partial safeguard against insect-borne diseases, for which the only real cure is the extermination of the mosquito – or the rats which harbour the plague-flea – alike in the native as in the European quarter, and the isolation of persons suffering from insect-borne diseases.

The policy has given rise to bitter controversy, and the allegation by both British Indians and Africans that it is merely a manifestation of racial arrogance and prejudice. This is, I think, in part due to a misapprehension, in part to an attempt to carry the policy to extremes. On the one hand the policy does not impose any restriction on one race which is not applicable to the other. A European is as strictly prohibited from living in the native reservation, as a native is from living in the European quarter.

[150] On the other hand, since this feeling exists, it should in my opinion be made abundantly clear that what is aimed at is a segregation of social standards, and not a segregation of races. The Indian or African gentleman who adopts the immunity from infection as segregation may convey, should be as free and welcome to live in the civilized reservation as the European, provided, of course, that he does not bring with him a concourse of followers. The native peasant often shares his hut with his goat, or sheep, or fowls. He loves to drum and dance at night, which deprives the European of sleep. He is skeptical of mosquito theories. “God made the mosquito larvae,” said a Moslem deputation to me; “for God’s sake let the larvae live.” For these people sanitary rules are necessary but hateful. They have no desire to abolish segregation.