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Training for Development
673
LEADING ARTICLES
THE LANCET LONDON
2
OCTOBER
1965
Training for Development ANY change in one fragment of a cultural pattern may affect the whole structure. In this country, improved housing has sometimes worsened the lot of slumdwellers, because they did not know how to adapt themselves to the new environment or because they could not afford to live in a garden suburb on slum wages. Dr. FENDALL this week describes and illustrates the close relation of health to agriculture in the emerging countries, and shows that neither can be developed independently of the other. Development, he insists, must be in the hands not of specialists but of people with a grounding in several kinds of applied science. Perhaps it would be still better, if time could be found, to set out with an arts degree and follow it with postgraduate training in technology; for the reformer must be a philosopher as well as a scientific jack-of-all-trades. He has not only to introduce mosquito control, contour ridging, or crop rotation; he must understand how these things affect the daily life of ordinary people, in order to make the changes acceptable to them. Beliefs about health and sickness are akin to religion, and interference with the use of land may be more passionately resisted than physical assault. In colonial days, successful reform came not so much from technical experts as from the men and women who best understood the people and their culture: the nun, pausing on her way from cookery class to antenatal clinic to check the slope of a new drain, or the district commissioner, a historian, grappling simultaneously with fertilisers, road maintenance, and a vaccination campaign. In 1952 the problems of Malaya seemed to be military, but the distinguished soldier invited to solve them did so largely by his personal interest in agricultural reform, which brought him into contact with the remotest villagers. Paradoxically, independence does not necessarily make reform easier. Foreign officials were expected to have eccentric ideas; compatriots are not, and more even than their predecessors those now in charge of rural development need the widest knowledge and understanding they can get. A congress held at Lusaka two years ago, of which the proceedings have now been published,! grew from a medical meeting to include sections of physical, biological, and social sciences as well as of medicine. Among the medical papers were some important local epidemiological studies: on redblood-cell defects,2 trauma,3 leprosy,4 bilharziasis,5 and hookworm disease.Two speakers discussed blindness, 1. Science and Medicine in Central Africa Edited by G. J. SNOWBALL. Oxford: Pergamon Press. 1965. Pp. 980. £10. 2. Bernstein, R. E. ibid. p. 729. 3. Ross, W. F. ibid. p. 749. 4. Griffiths, P. G. ibid. p. 763. 5. Forsyth, D. M., Bradley, D. J., Phillips, J. ibid. p. 799. 6. Sturrock, R. F. ibid. p. 829.
and their conclusions were not always the same. PHILLIPSreported that traditional remedies caused some 40% of all blindness in the Luapula valley and indeed throughout Zambia. AWDRy,8 on the other hand, did not believe that they caused more than 4%, and ascribed most cases to measles or smallpox. Now, this is a very wide discrepancy, especially since the two agreed on most other points. For instance, a visitor from Britain a few years ago suggested that river blindness was common in the Luapula valley, because most of the blind lived on the river banks where Simulium flies were breeding. PHILLIPS then showed that nearly everyone, blind or not, lived on the river banks, and that the flies were not of the species which carries oncocerciasis: in fact, there was no river blindness at all. AWDRY fully confirmed this, and like PHILLIPS he found that 83% of the blind had been so since before the age of 10 years. The disagreement over cause seems to arise from different assessments of what the patients said. According to AWDRY, 56% gave the cause as measles and 20% as smallpox. He admits that they may confuse the two diseases, but in principle seems to accept their statements. PHILLIPS investigated more than 50 kinds of medicine commonly put into sore eyes. They included copper ore, soot, various acid plant extracts, crushed shells, urine, and the juice of chillis. To be sure, the children often had measles, yet remedies such as these seem a likelier cause of their corneal opacities. But it needs more than expert medical knowledge to get village herbalists to talk about their remedies, let alone hand over samples for analysis. PHILLIPS has spent most of his life among the people of Africa, and can talk freely with them of matters that are not discussed with strangers. For the rest, the Lusaka congress considered widely divergent topics. There were consecutive papers on waterborne sanitation, sand, triangulation, pneumoconiosis, roller bearings, and telephone cables. In another session delegates heard about termite mounds, phenyloxidase in cockroaches, the migration of fish, and the utilisation of urea by sheep; in a third, public examinations, female crime in Lusaka, and the work of a mobile eye clinic. Many of the papers were admirable in themselves (and none the worse for having to make sense to people trained in other disciplines), but the greatest value of the congress was that it took place at all. If the university being established in Lusaka bears the lessons of this meeting in mind it will the better perform the function that Dr. FENDALL rightly asks of it. The Commonwealth Medical Conference, to be held in Edinburgh from Oct. 4 to 13, is to concern itself not with technical aspects of medicine but with the ways in which the medical resources of the Commonwealth can best be used. In particular it will discuss education and the supply of teachers. The needs of all countries are not identical, and in discussing the universities of emerging countries the conference will do well to consider Dr. FENDALL’S plea for men trained to see beyond the confines of any one branch of science. 7. 8.
Phillips, C. M. ibid. p. 13. Awdry, P. ibid. p. 709.
LEADING ARTICLES
THE LANCET LONDON
2
OCTOBER
1965
Training for Development ANY change in one fragment of a cultural pattern may affect the whole structure. In this country, improved housing has sometimes worsened the lot of slumdwellers, because they did not know how to adapt themselves to the new environment or because they could not afford to live in a garden suburb on slum wages. Dr. FENDALL this week describes and illustrates the close relation of health to agriculture in the emerging countries, and shows that neither can be developed independently of the other. Development, he insists, must be in the hands not of specialists but of people with a grounding in several kinds of applied science. Perhaps it would be still better, if time could be found, to set out with an arts degree and follow it with postgraduate training in technology; for the reformer must be a philosopher as well as a scientific jack-of-all-trades. He has not only to introduce mosquito control, contour ridging, or crop rotation; he must understand how these things affect the daily life of ordinary people, in order to make the changes acceptable to them. Beliefs about health and sickness are akin to religion, and interference with the use of land may be more passionately resisted than physical assault. In colonial days, successful reform came not so much from technical experts as from the men and women who best understood the people and their culture: the nun, pausing on her way from cookery class to antenatal clinic to check the slope of a new drain, or the district commissioner, a historian, grappling simultaneously with fertilisers, road maintenance, and a vaccination campaign. In 1952 the problems of Malaya seemed to be military, but the distinguished soldier invited to solve them did so largely by his personal interest in agricultural reform, which brought him into contact with the remotest villagers. Paradoxically, independence does not necessarily make reform easier. Foreign officials were expected to have eccentric ideas; compatriots are not, and more even than their predecessors those now in charge of rural development need the widest knowledge and understanding they can get. A congress held at Lusaka two years ago, of which the proceedings have now been published,! grew from a medical meeting to include sections of physical, biological, and social sciences as well as of medicine. Among the medical papers were some important local epidemiological studies: on redblood-cell defects,2 trauma,3 leprosy,4 bilharziasis,5 and hookworm disease.Two speakers discussed blindness, 1. Science and Medicine in Central Africa Edited by G. J. SNOWBALL. Oxford: Pergamon Press. 1965. Pp. 980. £10. 2. Bernstein, R. E. ibid. p. 729. 3. Ross, W. F. ibid. p. 749. 4. Griffiths, P. G. ibid. p. 763. 5. Forsyth, D. M., Bradley, D. J., Phillips, J. ibid. p. 799. 6. Sturrock, R. F. ibid. p. 829.
and their conclusions were not always the same. PHILLIPSreported that traditional remedies caused some 40% of all blindness in the Luapula valley and indeed throughout Zambia. AWDRy,8 on the other hand, did not believe that they caused more than 4%, and ascribed most cases to measles or smallpox. Now, this is a very wide discrepancy, especially since the two agreed on most other points. For instance, a visitor from Britain a few years ago suggested that river blindness was common in the Luapula valley, because most of the blind lived on the river banks where Simulium flies were breeding. PHILLIPS then showed that nearly everyone, blind or not, lived on the river banks, and that the flies were not of the species which carries oncocerciasis: in fact, there was no river blindness at all. AWDRY fully confirmed this, and like PHILLIPS he found that 83% of the blind had been so since before the age of 10 years. The disagreement over cause seems to arise from different assessments of what the patients said. According to AWDRY, 56% gave the cause as measles and 20% as smallpox. He admits that they may confuse the two diseases, but in principle seems to accept their statements. PHILLIPS investigated more than 50 kinds of medicine commonly put into sore eyes. They included copper ore, soot, various acid plant extracts, crushed shells, urine, and the juice of chillis. To be sure, the children often had measles, yet remedies such as these seem a likelier cause of their corneal opacities. But it needs more than expert medical knowledge to get village herbalists to talk about their remedies, let alone hand over samples for analysis. PHILLIPS has spent most of his life among the people of Africa, and can talk freely with them of matters that are not discussed with strangers. For the rest, the Lusaka congress considered widely divergent topics. There were consecutive papers on waterborne sanitation, sand, triangulation, pneumoconiosis, roller bearings, and telephone cables. In another session delegates heard about termite mounds, phenyloxidase in cockroaches, the migration of fish, and the utilisation of urea by sheep; in a third, public examinations, female crime in Lusaka, and the work of a mobile eye clinic. Many of the papers were admirable in themselves (and none the worse for having to make sense to people trained in other disciplines), but the greatest value of the congress was that it took place at all. If the university being established in Lusaka bears the lessons of this meeting in mind it will the better perform the function that Dr. FENDALL rightly asks of it. The Commonwealth Medical Conference, to be held in Edinburgh from Oct. 4 to 13, is to concern itself not with technical aspects of medicine but with the ways in which the medical resources of the Commonwealth can best be used. In particular it will discuss education and the supply of teachers. The needs of all countries are not identical, and in discussing the universities of emerging countries the conference will do well to consider Dr. FENDALL’S plea for men trained to see beyond the confines of any one branch of science. 7. 8.
Phillips, C. M. ibid. p. 13. Awdry, P. ibid. p. 709.