Recollections of five tours in West Africa

Abstract

The condltion a under which a Medical Officer in the West African Medical Service carries out his duties, are not such as permit of his performing a detailed and prolonged investigation of disease, unless h© happens to be stationed in one of the larger towns, where work is more domiciliary, and where laboratory equipment and material for investigation are readily available, and even then medical duties may be so exacting as to preclude any chance of confining his attention to special work.

In the administration of the Service, Medical Officers are appointed to districts with residence at central stations, and sudden calls to outlying parts are frequent, either to attend an urgent case of illness, or to investigate an outbreak of disease, already epidemic or liable to become so. This lack of continuity in service was accentuated during the war when quite one third of the staff was on Military duties in other countries, and, with no new arrivals to replace the vacancies caused either by death or other factors, the work of the remaining individual members was greatly increased, and the service was only maintained by a general prolongation of tours and a curtailment of furloughs.

I do not put this forward as an excuse for this Thesis, but merely as an illustration of the difficulties under which this Service has laboured since its inception, and of the disadvantages, which it has overcome and is overcoming, in its mission of carrying into the heart of West Africa the benefits of European science.

In the smaller outlying stations, the only instrument of precis© investigation available is a microscope, but stains deteriorate at such a rapid rate that their use is restricted, and results obtained are often unreliable.

During my first tour I was sent to one of these stations in the Northern Territories of the Gold Coast, end the microscope I found there was an excellent instrument, but there was no suitable place to use it, except upon the rough table in that part of the mudhouse used as a dining room, where it was exposed to the tornadoes of the rainy season, which came on with startling suddenness and frequently swept the microscope and all the surrounding impedimenta Into the compound, and to the heat and dust storms of the Harmaitan season, which penetrated into the barrel of the instrument and obscured the lenses.

With the aid of Labour from the Prison, I set about building a small laboratory of mudwalls and thatched roof, with rough-hewn wooden benches and shelves. A small compact soldering set was a somewhat lucky inclusion among my kit when I left England, and with this I fashioned a rough still cut of Kerosene tins, which provided me with abundant distilled water, more reliable than that received by the irregular supply from headquarters. I was also able to make a rough incubator, but the only medium I could make was a simple broth and my supply of test tubes was extremely limited.

For staining purposes I prepared a stain with Methylene Blue and Eosin powders according to the proportions used in Wright's formula, and used the hobs of the mud stove in the kitchen for ths heating part of the operation. With this improvised stain, which had frequently to be dried in the sun before making a fresh supply with Methyl alcohol, I got better results in blood work, than with any of the other prepared stains kept in bottles or supplied in tablet form.

Investigation of Malaria could not go much beyond the examination of blood slides, and one conclusion I came to was that it was extremely difficult to find parasites in smears from the peripheral blood, either in the young growing forms or as crescents, even when the subjects, from which the smears were taken, showed all the characteristic signs and symptoms of Malarial infection. Out of close upon two hundred and fifty examinations made during this tour I only found crescents in three cases.

Work under such difficulties could not be productive of much result, but it afforded infinite pleasure in a lonely life, where one's ordinary duties engrossed only a small portion of the day.

Laboratories are however doing good work in the larger towns under trained observers, but they have to depend almost entirely upon the material available in the towns, in which they are located, and upon occasional specimens from the more accessible of the stations.