WHERE THE DOCTOR IS IGNORANT

by Martin Walsh

A page from the Cambridge Expeditions Medical Handbook

Flat on my back, beneath the Galaxy, I fear

This burning in my groin is gonorrhoea.

-- Tony Harrison, Manica

When I first went to Tanzania in 1980 my portable medical library comprised the Ross Institute's Preservation of Personal Health in Warm Climates and the Cambridge Expeditions Medical Handbook. The former, aka the Little Red Book, betrayed its origin in a milieu in which the nervous disposition of one's wife and the behaviour of one's servants were common concerns -- more, certainly, than they were to a 22 year-old explorer of the nether regions of Ujamaa (later in life, though, I could have done with an update). The Cambridge Handbook was much more useful, though its diagnostic tables tended to induce hypochondria. Instead of reading possible diagnoses from the combination of symptoms, it was much easier to pick on the worst disease and imagine the symptoms that were listed under it. And so every crick in the neck mirrored meningitis and every instance of colic conjured up appendicitis. Although this is a hazard associated with all self-help health guides, the Handbook's crude diagrams and simple matrices seemed designed to maximise the inflation of illness and a category of anxiety that the Little Red Book didn't cover.

The cover of the 1979 edition

I first heard about the virtues of Where There Is No Doctor, the English version of David Werner's Donde no hay doctor, from my ethnographic guide Alison Redmayne. I didn't buy a copy until sometime later when I was living in Mombasa. I was persuaded of its efficacy when a sister-in-law living with us in Kibokoni fell ill with shingles, and her head ballooned in an alarming way, and began to resemble a cross between a football and a scaly pufferfish. None of us knew what the cause of this was, and she resorted to a variety of local remedies, including smearing her head with a concoction of herbs. However, after a quick read of Where There Is No Doctor, I was able to confidently declare that she had no need to waste any more money on waganga ("traditional" doctors), because the swelling would go down of its own accord, and the scaliness disappear. As you might expect, no one took any notice of me, but she did indeed get better as I had smugly predicted she would. I've lost count of the number of times I've made use of the book, and for some years I've kept a second copy in Zanzibar so that I don't have to carry it back and forth. One day in Dar es Salaam I found a dog-eared copy of the Swahili translation, Mahali Pasipo Na Daktari, and mama watoto (the missus) has been using it ever since.

The Swahili version, c.1984

Never mind where there really is no doctor, the state of medical training in East Africa is such that you need all the help you can get even in places where there is someone with that distinguished title. I'll save the story of my imaginary blood clot -- imagined by some of the finest doctors in Kenya -- for another occasion. I'll also refrain from detailing all the horrors suffered by loved ones, far too many of whom haven't survived to tell the tale themselves. But you get the drift. Over the years Alison Redmayne has performed heroics in ministering to the sick in and around Iringa and Mufindi, and has been an indefatigable campaigner against bad practice in the hospitals and clinics of this particular corner of Tanzania. Talking about this with her one day around the turn of the millennium, I quipped that Where The Doctor Is Ignorant would be a more accurate title for our favourite medical guidebook, at least in the local context. This is not to denigrate the good work that many doctors and medical agencies do in East Africa, or to downplay the difficult conditions in which they strive, often with rudimentary facilities and inadequate medical supplies. But lack of adequate medical knowledge is a serious and widespread problem, and can't be denied.

The full text of Where There Is No Doctor can now be downloaded for free from the website of Hesperian Health Guides, together with other community health guides, including Where Women Have No Doctor and Helping Health Workers Learn. These and other resources are also available in a variety of languages, which can be seen at a glance on Hesperian's Resources by Language page. Unfortunately Mahali Pasipo na Daktari, the Swahili version of Where There Is No Doctor, is no longer in print: indeed there are no Swahili resources on the Hesperian site. That's a pity. An updated translation of this and other books, especially if well distributed and accompanied by relevant training, would go at least some way towards filling the medical knowledge gap in Tanzania and other parts of the region where Swahili is widely spoken.

References

Davies, T. W. Undated [c.1979]. Cambridge Expeditions Medical Handbook. Cambridge: Cambridge Expeditions Medical Scheme.

Harrison, Tony 1987. Manica. In Selected Poems (2nd edition). London and Harmondsworth: Penguin Books. 31-34.

Ross Institute 1978. Preservation of Personal Health in Warm Climates. London: Ross Institute of Tropical Hygiene. [first published in 1951]

Werner, David Undated [c.1984, 2nd printing]. Mahali Pasipo Na Daktari... Kitabu cha Mafunzo ya Afya Vijijini. Dar es Salaam: Rotary Club of Dar es Salaam.