Health in Transition in a historical perspective

1
Health in Transition in a historical perspective

• Objectives
• To provide a historical basis for an
  understanding of the organisation and
  functioning of health care systems in low-income
  societies today.
• To discuss various theories of illness
  transmission in a historical perspective.
• To discuss the relationship between between
  biomedicine and indigenous medicine.

2
Missionary health services

• In 1799, John Vanderkemp (1748-1811) became the
  first medical missionary in Africa sponsored by
  the London Missionary Society
• David Livingstone (1813-73), a scottish physician
  served in the middle of the century as a
  missionary in what is now called Botswana.
• In the late nineteenth and early twentieth
  century Albert Sweitzer (1875-1965) established
  the hospital in Lamboréné in French Equatorial
  Africa.
• In Asia, missionary work by physicians started in
  China and Canton around 1840.

3
Historical Overview

• 1985-1912 Medical services in East Africa were
  mainly considered necessary for Europeans to
  protect themselves against tropical hazards.
• Later, during colonialism, a strong labour force
  was considered neccessary, thus health services
  were provided to certain parts of the local
  population.

4
Early European Traditions

• Humoralism a system of medicine that considers
  illness to be the result of some disturbance in
  the natural balance of the humours, within the
  body as a whole or within one particular part.
• Hippocrates (c. 450-370 BC) On Airs, Waters and
  Places.
• Galen (AD 129 c.200)
• Four humours phlegm, bile, black bile and blood
• Four qualities cold, wet, hot, dry and four
  seasons

5
Environment and Miasma

• The concept of miasma bad air transmit disease.
• The sources of bad air could be stagnant marshes
  and pools, vapours from a variety of sources
  including corpses of humans and animals, sick
  persons, excreta, spoiled foodstuff and
  exhalations from the ground.

6
Medical topography

• The medicine of places. With a focus on a
  specific locality, a wide range of elements in
  the surroundings and the environment which could
  impinge on health and disease were described.

7
Contagion and Infection

• Infection meaning to put or dip into
  something leading to inficere and infectio,
  staining and dyeing.
• Impurity/Pollution is a basic element in all
  three concepts miasma, contagion and infection.

8
Unorthodox Medical Theoriesin Europe

• Homoepathy
• Naturopathy
• Magnetic healing
• Chiropractic

9
Non-western Medical Systemsgreat traditions

• Chinese medicine (origin 8-900 BC)
• Indian medicine
• Ayurvedic (origin 400 BC)
• Arab-Islamic medicine (origin 5-700 AD)

10
Missionary Medicine

• Four claims for medical work
• It carried on the work of Christ himself
• It could penetrate heathen and even Muslim
  societies
• It demonstrated the validity of Western rational
  explanation over African superstition.
• The hospital instilled time sense, work
  discipline and sobriety.
• (source Ranger 1992)