THINGS THAT MATTER
Sun, 07/17/2016 - 12:00am
Health Care Delivery – Past, Present & Future (Part 1)
(An edited synopsis of a lecture delivered as part of the DLP Lecture Series: “Celebrating Fifty Years of Independence”, on June 29th, 2016, at Almond Bay.)
In order to talk about health care delivery today and in the future, I want to say a bit about the past, so that we can appreciate just how far we’ve come, because for our first three hundred years, health care was either totally absent, sadly lacking or often little better than having no care at all! There was certainly no equity, although it’s debatable whether the well-to-do benefited from the care of that era, other than enduring their pains and suffering in a comfortable bed.
In the pioneer days there was little care of any kind. The first adventurous physicians had little at their disposal, and perhaps experimented with the unfamiliar tropical plants. A typical medicine chest would have contained a variety of plant products such as cloves and nutmeg, oil of turpentine, chemicals such as mercury, for syphilis, and just two active substances – opium for pain and ipecacuana to induce vomiting.
Throughout most of the two centuries of slavery, there were a few doctors, a few quacks and midwives, and a great deal of what today is called alternative medicine, relying on a range of herbs, poisonous concoctions and old wives’ tales.
Plantations used the services of doctors to treat their slaves, many on a retainer from several plantations. The doctor would visit once a week, to see the patients in the pest house as it was called. They were contracted at a fixed rate per slave on each plantation, but whether those visits were better than the local herbalist or quack’s nostrums is debatable!
Western medicine 300 years ago actually included advice on diet and exercise, but for really sick people, the urge to do something was great – a choice between purging to treat abdominal pain and fever, inducing vomiting to treat nausea, and bleeding to treat every cause of swelling, of which there were many – heart failure, vitamin deficiency and beri-beri, and elephantiasis – due to a parasite carried by the mosquito, causing hugely swollen legs – known in Guyana as Barbados leg and in Barbados as Guyana leg!
Bleeding was popular, to get rid both of fluids and the supposed poisons in the system. And some people were bled to death – like George Washington, who was bled to death for a feverish cold!
There was a famous doctor from the British Virgin Islands, Dr. John Lettsom, who became a society doctor in London, and there’s a wonderful ditty about him:
I John Lettsom purges, bleeds and sweats ‘em
If after that they choose to die, I John Let’s em …
And then there’s the whole range of African plants that came with the slave trade, used by the African healers. A favourite of mine is the little garden shrub – Pentas lanceolate – with its red, pink, violet or white clusters of tiny flowers. It was used in Africa to treat everything from diarrhoea to malaria, worms and snake bite. In fact, the pentas plant is full of active chemicals, so it would have been a bit like taking ten bottles of different tablets from the pharmacy and taking some of each!
One particularly potent African plant that came with the slave trade is the castor oil, Ricinis communis, which all of us over 60 well remember … the laxative given us by our mothers on the first day of holidays … with noses held and perhaps rewarded with the bribe of a sweetie!
Many other plants had reputations but no specific virtues, and some were actually poisonous…. such as the poison, ricin, in castor oil, which crops up in James Bond and is used for nasty murders. Fortunately, most herbal medicines at least did no harm.
The anthropologist Dr. Jerome Handler has written a great deal about the slaves’ use of herbal medicines, and the late Iris Bannochie, widow of Dr. Harry Bayley, did the classic study of plants still in use in Barbados in the 1940s.
An important period in Barbados was the middle of the 18th century – known as the Age of Reason - when two brilliant figures emerged - the Reverend Griffith Hughes, rector of St. Lucy, and Dr. William Hillary, a Quaker doctor.
Rev. Hughes produced an enormous book, “The Natural History of Barbados - In Ten Books”, with a remarkably good description of the common diseases in Barbados. His description of dry bellyache was accurate and his diagnosis of the cause - rum – was correct, as it was then distilled in lead pipes. The lead damaged the nerves, caused lethargy and even coma, and constipation … hence colicky pain in the gut, without diarrhoea, and hence the name dry bellyache.
Professor Handler discovered the slave burial site at Newton Plantation, and analysis of the lead content of bones from those graves found the highest concentration of lead ever reported in human bones, indicating a chronic, high level of ingestion of rum by the slaves, and a great deal of lead!
I mentioned the promotion of healthy diet and exercise. Dr. Hillary lived and worked here from 1747 to 1759 and produced a brilliant book The Epidemical Diseases of Barbados. His description of the jaundice we now know to be leptospirosis, and of tetanus, of yaws, and his seminal description of tropical sprue, make him one of the great doctors of the 18th century.
An annotated 4th edition of his book has been published by the UWI press, with notes and introduction by Dr. Edward Hutson and me. Dr. Hillary was our first serious medical researcher. He also believed many diseases were caused by the weather, and he left us a cultural legacy that getting wet by the rain could give you a fatal chill!
He criticised the silliness of wearing “a thick rich Coat and Waistcoat” in Barbados, under which he saw “men melting, preferring the character of a Fop to that of a Man of Sense”. AND, he advised an abstemious life, exercise in moderation, and a sensible diet … 300 years ago!
My last point about health care in the slave era was the transformation in the period of amelioration. With loss of lives in the great hurricane of 1780, the growing humanitarian movement to abolish the slave trade, and the simple economic advantages of looking after the health of slaves, health care efforts increased, with slave hospitals and more doctors.
The prescription for a hospital was “a spacious, airy building, well ventilated, with separate rooms for men and women” - golden rules for every hospital. The only slave hospital surviving in Barbados is on the site of Blackman’s plantation, close to the demolished great house.
This is where the Grantley Adams School stands. I believe this is by far our most important, most precious relic of the terrible institution of slavery, and from the point of view of our health care story, it stands out. Sadly, a fire destroyed the roof a few years ago, and the building is now growing bush of every kind, awaiting repair. (It was announced after the lecture, by the Chairman of the School Board, that the decision to restore it has finally been made by the Ministry – hurray!)
I come now to the 19th century and two major events. First, the cholera epidemic of 1854, taking some 22,000 lives…. “water, water,” they cried, “and not a drop to drink …” And it took seven years to pipe water from the Newcastle spring in St. John into Bridgetown.
But it was to take another 150 years before most households had piped water … until now, when many are again without … especially in the North East, and most especially in St. John, where most water came from for decades! There’s no equity here, is there!
The second big event was emancipation. Many planters felt they no longer had responsibility for the health of the free, and health care, such as it was, evolved onto the parish vestries (the committees of landowners who set rates of taxes and operated local government services, from poor relief and health care to primary schools and road building.) But the big deal was the building of the General Hospital in 1841 –mostly with donated funds!
This provided a three tier care system … free wards (now occupied by the ambulance service), the shared-care five shilling wards, where my grandfather died of septicaemia after losing a leg in a factory explosion – the wooden building now falling apart; and in 1939 the Tercentenary Ward – one pound a day, for the private patients – the tangible trophy celebrating 300 years of Parliament.
Professor Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website: profhenryfraser.com