PUBLIC RECORD OFFICE
Reference :-
TLC.O. 885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
24 PUBLIC RECORD OFFICE, LONDON
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1. Selection of Unit of Area of Operation.
The first attempt at complete eradication of ankylostomiasis in foreign fields in which the International Health Commission has co-operated was in British Guiana. It had its beginning in the early months of 1914.
Following a visit of Mr. Wickliffe Rose, Director-General of the International Health Commission, to that Colony in October, 1913, a working-plan and budget were prepared by the Surgeon-General, with the assistance of Dr. J. E. A. Ferguson, Medical Officer of Peter's Hall District, and submitted to the Inter- national Health Commission. The plan and budget having been adopted, it was determined that the area of operation in this preliminary campaign should be a medical district.
Peter's Hall District, just south of the city of Georgetown, was selected. This district is approximately eight miles long and from one to three miles wide, with a population of 14,000 people, exclusive of the indentured labour of the sugar plantations.
In this territory there are very few isolated dwellings. The people live in a chain of villages, varying in size from 200 to 4,000 inhabitants, lying along the east bank of the Demerara River.
We were not to deal with the indentured plantation labour, as this feature of the problem was being handled effectively by the District Medical Officer, Dr. J. E. A. Ferguson, the cost of this work being borne by the-plantation owners. On 9th March, 1914, I arrived at Georgetown, and was cordially received by the authorities as the representative of the International Health Commission.
Being familiar with the methods in use by the Rockefeller Sanitary Commis- sion in combating hookworm disease in the United States, I was not long in recog- nizing that there were features of this problem in British Guiana not hitherto met with, either in the work done in the United States, or in the local effort to control the disease among the indentured coolies, because :-
1. In the United States we had to deal with a fairly intelligent population of whites and blacks only, and with sanitary conditions uncomplicated by tropical rainfall and temperatures; while the transmission of the disease from individual to individual is prevented during a considerable portion of the year by the low temperatures of the winter season and the wearing of shoes.
2. The local effort to control ankylostomiasis in the Colony had been confined to the indentured labour of the sugar estates the rather docile East Indian coolies, who, under the necessary plantation discipline, were easily handled in making the required examination and administering treatment.
Our problem was to eradicate ankylostomiasis in Peter's Hall District, where the following conditions obtained :—
1. Populated:
(a) By East Indians who had served out their indentures, and who, together with the remainder of the population, were no longer subject to, nor tolerant of, discipline.
(b) By Portuguese, who seem especially susceptible to the disease, showing
a large proportion of severe infections, but who, unfortunately, were often indifferent to our efforts to help them.
(c) By Chinese, who were disinclined to take medicine unless suffering acutè
pain.
(d) By "coloureds," who, on the whole, were intelligent and generally
favourable to our campaign.
(e) By "blacks," of whom the more ignorant and illiterate class gave us
the most trouble.
2. Re-infections were the rule rather than the exceptions at all seasons of the year because of the heavy rainfall, tropical temperature, absence of shoes, and the insanitary habits of the people.
It must be obvious that the task of unifying these very diverse elements of population and creating an active common interest in the eradication of a disease about which they were uninformed was no small undertaking. Without precedents to follow, it was determined to begin experimentally on a small scale, and to test and develop methods by which our task could be accomplished.
To this end Peter's Hall District was divided into three areas varying in extent, and having, respectively, populations of 8,000, 3,500, and 2,800.
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A more careful survey of the territory and the conditions to be met led us to limit our operations still further. At first, they were restricted to one village near the centre of the district. This village, Agricola, had a population of 1,335 and presented average conditions. In the beginning our progress was naturally slow, but as success made us more and more confident the campaign was extended to other villages until the whole of the area was under treatment.
Our experience here led us to arrive at the following conclusions with refer- ence to what should be a unit of area of operation": a territory with:-
(a) Legal or natural boundaries.
(b) An aggregate of population of not more than 15,000, and fewer if sparsely inhabited. This is probably the maximum which can be properly handled by one Medical Officer and clerical force.
(c) A central office, situated near the centre of the district, where most of the clerical and microscopical work may be done, and where the large record-books may be kept, as it would entail much loss of time and expense to move the central office outfit from village to village during the progress of the work.
Wherever possible, a map of the area of operation should be made, of such size as to permit the indication of villages, isolated dwellings, schools, water- courses, roads, drainage trenches, water reservoirs, and all other details which are This was done, as far as was connected in any way with the work in hand. possible, in Peter's Hall District. The map was of great value to the Supervis- ing Medical Officer and staff, as it gave a more definite picture of the task with which all were dealing.
2. Publicity and Educational Measures.
In Agricola village there were 1,335 people who had never heard of ankylos- tomiasis. They were to be informed about the disease and to become so interested in it that they would voluntarily submit themselves for examinations, and be willing, if found infected, to take treatment until cured.
Announcements of our selection of this village as the first point of attack Here also were set forth a state- were made in the daily papers of Georgetown. ment of our purposes, of the symptoms of the disease and methods of contracting it, of the ease with which it could be cured, and of the beneficial results of treatment.
Sheets containing the foregoing information were printed and scattered throughout the area, with the additional statement that when Agricola should become free from the disease other villages along the east bank would be served in like manner, if they so desired. It was arranged to have some notice of the work appear once or twice a week in the daily papers of Georgetown, these notices being printed free of charge.
The opening lecture on ankylostomiasis was arranged for, special seats being reserved for His Excellency the Governor, the Medical Officers of the Colony, heads of Government Departments, the two resident Bishops, the clergy of George- town and the near-by villages, plantation-owners and managers, village officials, The attendance was far and school-teachers, all of whom were especially invited. beyond the capacity of the building.
The speaker was introduced by Surgeon-General Godfrey, and delivered a lecture on ankylostomiasis. The magic-lantern, with the usual complement of slides, was used, and in a general way it was shown how we hoped to serve the best interests of the people by treating them and curing them of the disease. Several typical examples were shown to the audience at the conclusion of the lecture. J. E. A. Ferguson, District Medical Officer, also presented a number of interesting cases, bringing out forcibly the intimate relationship between ankylostomiasis and the maternal death-rate at childbirth.
Dr.
Following these demonstrations, Surgeon-General Godfrey pledged us the hearty support of the Medical and Sanitary Departments of the Colony. His Excellency the Governor, Sir Walter Egerton, spoke very favourably of the campaign, express- ing his gratitude for the help given by the International Health Commission, and at the close of his remarks proposed a vote of thanks to the Commission and their representative, which met with a hearty response from the audience.
The presence of the Governor-General, the Surgeon-General, the prominent officials, the Bishops, the clergy, and many others of wide influence, necessarily gave the campaign a great impetus.