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January 17, 2019

Advent of the global health industry in Africa

Such a Time of it They Had by Raymond Downing is an unsual historical chronicle of modern medicine in Africa. Downing is an American physician who, together with his wife, has worked in many African countries. He looks at the origins of global health through the lives of pioneer European medical missionaries and explorers in Africa, starting in the early 1800s.

The underlying theme of Downing’s consideration is solidarity - to what extent do Western health campaigns seek to work in harmony with the citizens and local environment. He intersperses history with stories of his own experiences of 30 years working on the continent.

For European forerunners in the 19th Century, keeping troops alive was vital and helped to propel the research of tropical illnesses. Hundreds of Europeans died from malaria, dysentery and other diseases that are easily prevented and treated today. The African casualty was much higher. Quinine, arsenic and bloodletting were widely used before microscopes and medical parasitology became part of standard medical procedure.

In the book we see the confluence between missionary evangelisation, geographic exploration and medical work, all of which serve to advance the cause of European imperialism. Later, the health of African people becomes important primarily to ensure an able-bodied workforce for white settlers and the colonial administrations. Abolishing African practices, under the guise of superstition, was strategic to introducing Western medicine and thinking.

Downing compares the traditional African approach to illness through wholesome analysis of the patient to European diagnosis that increasingly relied on conventional systems. He looks at the varying attitudes or prejudices of European doctors towards their African patients, tropical diseases or even the profession itself. Dutch doctor Johannes van der Kemp married a freed slave woman in South Africa. The 1952 Nobel Peace Prize winner was Dr Albert Schweitzer of Germany. His medical legacy was a “primitive, unsanitary village-hospital” he built in Gabon and where he did not train any African professionals.

Africa was fertile ground for colonial-era Europeans to discover new diseases and cures, and gain celebrity recognition in their home countries. “Today Western scholars need African data to boost their careers and make a name for themselves,” writes Downing.

But there are examples of physicians, both famous and lesser known, working to uplift the common man whatever their personal agenda. The Rockefeller Foundation’s funding of bilharzia research in North Africa the early 20th Century is one of the first examples of private philanthropy in global health campaigns.

I like the narrative style of writing, with anecdotes and dialogue that keep the book accessible even to a non-scientific reader. As a cultural historian, Downing recounts the daring and sometimes despicable ventures that preceded today’s global health industry. 

He does not give answers to all the conundrums presented within but leaves much food for thought. Instead, he intends for us to reflect on whether or not the same attitudes and agenda still drive the interaction between the West and Africa two centuries later.


Rating: 5/5

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