THINGS THAT MATTER: UWI and Health Care in the Caribbean – Part 1

On October 10th I had the honour of contributing to the celebration of the 70th Anniversary of the University of the West Indies (UWI) by giving a public lecture titled: The UWI and Health Care in the Caribbean: Successes, Challenges and Opportunities. A particularly poignant aspect of the lecture was giving it in the Henry Fraser Lecture Theatre, on the design of which I worked with architects Gillespie and Steel. It was also an emotional event because of my close association with the University and the Medical Faculties for 56 of our 70 years.

To understand the huge contribution of the UWI to the development of health care in the Caribbean one has to understand the paucity of health care over the three centuries since the settlement of these islands, and the appalling conditions at the time of the widespread riots / revolutions / uprisings across the Caribbean in the 1930s. Today’s column provides the historical context for establishing the University as a College of the University of London, and the planners’ emphasis on medical education.
Health care in the Caribbean can be roughly divided into eight periods:

The first decades of settlement – from 1627 in Barbados
The first hundred and forty years of slavery – 1640s to 1780
The amelioration period – 1780s to 1830s
Post Emancipation – 1838 to 1840s
The Epidemic era - 1850s
Early public health measures including piped water – 1860s to 1930s
Post 1937 to Independence – 1937 to 1966
The Modern era – Post 1960s

These colonies were pioneering or frontier societies, with primitive housing and social organisation and no such thing as organised health care. Doctors were few and far between and only the wealthy planters and merchants would have had access to care. The first adventurous physicians would have had little at their disposal, and even their familiar simple herbal remedies would not have been available.

With the establishment of the sugar industry and the oppressive slave society, care of the slaves became an obvious need for the planters. Most plantations established “sick houses” for confining those with infectious diseases and obvious illness rendering them unfit for work, and for delivery of babies. Doctors were hired on an annual basis to visit the plantations and patients in the sick houses, at a fixed rate per slave.

Much has been written about the medical care of the slaves, and the balance between the “orthodox” medicine of the English trained physicians (with only a few useful drugs) and the preference of the slaves for the “simples” with which they were more familiar and more comfortable. Many plants believed to have medical benefits were brought from Africa, and at least probably did no harm. Important examples were the little flowering plant from Africa and now familiar in our gardens – the Pentas lanceolata, one of their “cure alls”; and the castor oil plant, Ricinus communis. The dramatic action of purgatives was obvious proof of efficacy, and castor oil’s reputation lasted. Everyone of my generation was painfully familiar with a dose of the offensive castor oil on day one of vacation from school!

But the token medical care of the slaves left much to be desired. The Period of Amelioration – from the 1780s was heralded by recognition that the slave trade was bound to end – for both humane and economic reasons. This brought about major changes in the care given to slaves. Beginning in the 1780s the planters made efforts to improve health care. Pregnant mothers were facilitated, and the horrid sick houses were replaced by hospitals. Some of the best of these splendid buildings survive in Jamaica, at Kenilworth and Good Hope. Plantations employed doctors to visit twice a week or daily. It became crucial to provide care and encourage reproduction. In fact Barbados was the first and perhaps the only West Indian island where births well exceeded deaths by the end of the eighteenth century.

I have only been able to identify one former slave hospital in Barbados, at the Grantley Adams Secondary School in St. Joseph, close to the Blackman’s Plantation Great House, demolished to extend the school. The leading medical authorities of the 1780s recommended that the slave hospital be close to the Great House, to be closely supervised by the owner or manager. The building at Grantley Adams followed the prescription of separate wings for male and female patients, with good ventilation from huge windows. Sadly it was gutted by fire some ten years ago and the last Ministry of Education has ignored repeated requests for restoration as an art workshop and an important relic of the slave era on the slave route.

In the early years after emancipation the health of the freed slaves would have suffered greatly because the planters no longer felt responsible for them. By 1839 in Barbados the urgent need for a hospital was recognised, and public subscription, supplemented by a grant from Government, built the General Hospital on the property of Mr. Jemmott – expanding the 17th century former residence of the son of the Earl of Carlisle, proprietor of Barbados. It was a great early example of a PPP – a public private partnership.

Infirmaries in each parish harboured the most indigent and infirm, and 30 years later the Mental Hospital, now the Psychiatric Hospital, was built at the Jenkins plantation. The St. Michael Infirmary was expanded with massive buildings in the 1880s. Each parish vestry provided help for the most needy with modest “poor relief”. Similar changes occurred in other Caribbean islands, at different stages in the nineteenth century.

But conditions of the freed slaves were scandalously poor. Two major epidemics spread across the Caribbean – yellow fever and cholera – taking thousands of lives. In 1854 the cholera epidemic arrived in Barbados from Jamaica and Antigua, and wiped out more than 20,000 in Barbados alone. The appalling lack of clean water was a major factor in those deaths, as our people relied on dirty ponds, a few springs and rain water. One good outcome was the piping of water. In Barbados it took seven years to effect plans to pipe water into Bridgetown from a spring at Newcastle (in 1861) and later from Codrington and then Bowmanston

Social conditions in what I call the dark century, from emancipation in 1838 to the riots of 1937, remained scandalously inhumane. Workers were still earning a shilling a day everywhere, and health statistics were appalling. Hospitals were over a hundred years old and totally inadequate, with no modern equipment such as X-ray machines, and a severe shortage of health care personnel. There was only the most basic public health provision, and infectious diseases were rampant – tuberculosis, typhoid, syphilis, yaws, elephantiasis, rheumatic fever, pneumococcal pneumonia and streptococcal infections; and in most of the region, malaria. There was widespread malnutrition and high neonatal, infant and maternal mortality.

These were the conditions highlighted by the Moyne Commission to the Caribbean after the riots, from Jamaica to Guyana, in 1938 / 39. The report helped to inform the decision to establish a university and to prioritise medical education. (Next week, Part 2: Successes)

Bouquet: To a new eatery, at the Garrison. The magnificently restored and expanded Band Stand Manor on the corner of Dayrell’s Road, by Schmidt’s gate, now hosts the splendid Wrapsody Café, Bistro & Wine Bar. It’s open from 7:30 in the morning, Monday to Friday, serving breakfast, and I’ve just sampled their amazing savoury muffins with my cappuccino. Mmmm! There’s more to come! It will really bring life into our UNESCO World Heritage site. Drop in and indulge …

(Professor Fraser is Past Dean of Medical Sciences, UWI, Professor Emeritus of Medicine and Clinical Pharmacology and President Emeritus of the Barbados National Trust. Website: profhenryfraser.com)

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