Sir Wilfred Grenfell: an athletic missionary

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[A new case of cutaneous myiasis from South America via the larva Dermatobia hominis (L. Jr.)]

A case of cutaneous myiasis produced by D. hominis in a 26-year Polish missionary, who spent 3 months in Peru in 1990 is presented. Practical indications helpful in the diagnosis of this parasitosis are given together with data concerning occurrence and biology of D. hominis.

Dentistry in Dohnavur, 1955-1992

In October 1955 I arrived here in Dohnavur, India, as a young, reluctant dental missionary! My first hurdle was to learn the language--Tamil--said to be one of the most difficult languages in the world. For the first year I was given one hour 'off' language study to do dentistry. In that hour I began to see our large family, which then numbered about 900. In the second year, still in a room with only the dental chair and a foot engine for temporary use, I spent half the time in dentistry and continued to learn Tamil the rest of the time. The dental surgery was built, and the equipment that I had brought with me from UK had been installed, and on December 17, 1957, we had the dedication of the dental surgery and I had the joy of having my parents with me from the UK for that special day.

Mortality trends of American missionaries in Africa, 1945-1985

Mortality trends of missionary staff serving in sub-Saharan Africa were tracked for the period 1945-1985. For 1945-1970, when more complete incidence data were available, the missionary death rate was approximately 40% lower, after adjustment, than would be expected in a comparable US population. This trend persisted through 1985. Between 1945 and 1970, the largest number of fatalities was attributable to malignancy, atherosclerosis, accidents, and infectious disease, and the greatest mortality risks, compared with the US experience, were from homicides, the complications of pregnancy, and infections, notably malaria, hepatitis, and polio. Beginning in the late 1950s, motor vehicle accidents became the leading cause of death. Since the 1960s, accidental causes of death have been approximately 50% higher than in the US, and homicides have been four times higher. During this same period, the infectious disease death rate decreased to approximately that within the US. Currently, the leading causes of mortality are motor vehicle accidents, malignancy, and atherosclerosis, followed by other accidental causes, notably aircraft mishaps and drownings. Viral hepatitis is presently the leading infectious disease cause of death. Other contemporary lethal infections include malaria, rabies, typhoid, Lassa fever, and retroviral infection. It was concluded that missionaries in sub-Saharan Africa had a death rate approximately half that expected in a comparable domestic control population. Preventive strategies, particularly relative to accident and infectious disease prevention, could effectively reduce mortality risk further.

Gastric and colorectal cancer in the rural Indian subcontinent: a survey of patients attending mission hospitals

37 missionaries working in India, Nepal, Pakistan, Bangladesh and Bhutan completed questionnaires regarding their clinical practice during the year 1980. Information was collected on the frequency of both gastric and colorectal cancers. More than 500,000 out-patients were reviewed and over 100,000 inpatients treated. A total of 291 gastric tumours and 169 colorectal carcinomas were diagnosed. Surgery was performed in 82% of the hospitals but only 36% had a histology service. In India and Pakistan there was no significant difference between the incidence of gastric and colorectal neoplasms. The relative risk of developing gastric rather than colorectal cancer in Bangladesh was 8 (95% confidence limits 4.5-14.2) and in Nepal the relative risk was 4 (95% confidence limits 2.0-7.0). A significant variation in the occurrence of cancer was observed between countries. Nepal had the highest and Pakistan the lowest numbers of both gastric and colorectal tumours. It seems likely that local environmental factors, such as diet, play a significant role in the development of these tumours.

Persecution and martyrdom of nurses in selected regions of Asia during the period 1900-1978--Part 2

The persecution and martyrdom of nurses identified in selected regions in Asia since the beginning of the twentieth century is discussed. Many missionary workers lost their lives in China during the Boxer rebellion in 1900. The persecution and martyrdom suffered by nurses working in China at the time is described followed by an account of the events which led to the deaths of nurses working in Korea, Thailand, Vietnam, Laos and East Pakistan during the early and latter half of the twentieth century.

They gave their lives: a tribute to the known and unknown nurse martyrs of our time--Part 1

An interest in the development of nursing from early Christian times and the persecution of women in the Early Church has led to this study of nurses and martyrdom. Historical research using secondary sources was undertaken to identify and describe the experiences of nurse martyrs with special reference to the present century. Martyrdom does not belong to the past as generally believed. The twentieth century is recognised as a century of Christian martyrdom unparalleled since the earliest Christian times. Women have been major contributors to the missionary calling and during the course of the nineteenth century many woman missionary societies were founded. Education and health care go hand in hand with the Christian message. While a few examples of nurses who suffered martyrdom in the mission field have been recorded, it is necessary to examine the events which led to their death. This article pays tribute to known and unknown nurse martyrs. Subsequent articles describe the suffering of nurse martyrs identified in selected world regions.

A survey of the health of British missionaries

The results of medical examinations carried out on 212 missionary personnel from one missionary society returning on leave to the UK are presented. The great majority of missionaries worked in developing countries. They served in 27 countries altogether and for a total of 488 person years. The commonest illnesses reported overseas were malaria (87.3 per 1000 person years at risk), diarrhoea (63.5), anxiety (63.5), depression (41.0) and giardiasis (38.9). More illnesses were reported from West Africa (698 per 1000 person years at risk) than from any other region. Ten people (4.7%) were repatriated for health reasons and 10 relatives also returned as a consequence. Sixty per cent of those returning did so because of psychiatric illness. The highest rates of immunization achieved were for yellow fever (100% of those travelling to affected countries), tetanus (93%), polio (85%), typhoid (71%) and tuberculosis (53%). The results of urinalysis (100% of adults), full blood counts (78% of adults) and stool tests (74% of all people) are reported. The study shows that the history and psychiatric examination are an important part of the medical examination of people returning from overseas. Physical examination and urinalysis did not contribute much information, although the full blood count and absolute eosinophil count were useful tests.

Risk factors for malaria among British missionaries living in tropical countries

Thirty-two episodes of malaria (10 confirmed by laboratory tests) were reported by 162 people living in 18 developing countries under the auspices of one British missionary society. Malaria was endemic in all countries involved, and a total of 367 person-years were observed. The overall incidence rate for malaria was 87.3 per 1000 person-years at risk. Important factors identified were residence in West Africa compared with elsewhere (relative risk (RR) = 13.0, P less than 0.001), being in the 20-39 year age group (RR = 3.2, P less than 0.002), history of gastroenteritis (RR = 3.1, P less than 0.002) and living in a rural area (RR = 1.7, n.s.). Chemoprophylaxis was taken by 119 people (73.5%).

High incidence of viral hepatitis among American missionaries in Africa

Protestant missionaries (n = 360) serving in sub-Saharan Africa between 1967-1984 were studied to determine the risk of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection. Personnel were serologically screened for antibody to both the hepatitis A virus (anti-HAV) and the surface antigen to the hepatitis B virus (anti-HBs) prior to departure, periodically during service abroad, and upon completion of their African tour. Rates of seroconversion were used as measures of the incidence of infection. Prior to service, 16% of the staff had anti-HAV and 3% had anti-HBs; post-service rates were 42% and 26%, respectively. Over 90% of the staff with greater than 20 years of service were seropositive for anti-HAV. For both viruses, the infection rate was highest during the first 1-2 years of service, when 28% of those susceptible to HAV and 11% of those susceptible to HBV became infected. Over the next decade, the median annual attack rate was 5.4% for HAV and 4.2% for HBV. Differences in the missionary HBV infection rate among the various African nations served tended to reflect differences in the magnitude of chronic HBV carriage among indigenous population groups. We conclude that missionaries to sub-Saharan Africa are at enhanced risk of both HAV and HBV infection, and that all should receive passive immunization with immune globulin and active immunization with hepatitis B vaccine.

Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals

39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh. India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data were collected about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease. More than 386,000 out-patients and over 56,000 in-patients were treated with an estimated 12,272 cases of bloody diarrhoea, 7,310 of amoebiasis, 2,113 of typhoid and 872 cases of intestinal tuberculosis, 74 cases of inflammatory bowel disease were diagnosed, of which 56 were ulcerative colitis and the remainder were said to have Crohn's disease. Surgery was performed in 28 hospitals, but only 10 (26%) had a histology service. Inflammatory bowel disease appears to be a relatively more common cause of diarrhoea in the Indian subcontinent than in sub-Saharan Africa (z = 5.47, p less than 0.001). The proportion of patients with bloody diarrhoea who have ulcerative colitis Crohn's disease was similar throughout the region. The rate of cases having ulcerative colitis rather than Crohn's disease was greater in India (z = 3.1, p less than 0.005), and in Bangladesh (z = 3.2, p less than 0.005), than in Pakistan (z = 1.28, NS) or Nepal and Bhutan (z = 0, NS). The relative risk of Indians developing ulcerative colitis rather than Crohn's disease is 2.6 (95% confidence limits 1.4-4.8, NS). This may reflect diagnostic difficulties in distinguishing Crohn's disease from intestinal tuberculosis, but it may also shed light on similar differences now being reported in migrant groups in Western Europe.

Are missionaries at risk for AIDS? Evaluation for HIV antibodies in 3,207 protestant missionaries

Serum specimens (n = 6,045) obtained from 3,207 Protestant missionaries serving in 57 countries, including 28 African nations, between 1967 and 1984 were assayed for antibodies to the human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmatory testing. Seventy sera (1.2%) from 51 missionaries (1.6%) were ELISA positive; however, on Western blot confirmatory testing none was diagnostic of HIV infection. Twenty-two (43%) of the Western blot tests were read as indeterminate, with band p17 occurring with the greatest frequency (57%), followed by p24 (23%), either alone or in combination. The significance of these equivocal results is unclear, but they do not appear to be a consequence of exposure to either HIV or the related retrovirus HTLV-I. Based on this seroprevalence survey, we conclude that missionary staff and their families were not at high risk of HIV infection between 1967 and 1984, even when serving in regions of high HIV endemicity.

Role of nongovernmental agencies in vaccine delivery

Zaire, a large central African country with a population of more than 30 million, has had much experience with nongovernmental agencies in its health sector. Of special importance have been missionary groups that established health facilities and conduct "mobile" health activities in rural areas. They established efficient communications and supply networks, and because they could refrigerate vaccines, they were among the first groups to deliver vaccines in rural areas. Expansion of Expanded Programme on Immunization services to rural areas was only made possible through the efforts of nongovernmental agencies.

Inflammatory bowel disease in rural sub-Saharan Africa: rarity of diagnosis in patients attending mission hospitals

One hundred and eighteen missionaries working on 75 mission stations or hospitals in 24 sub-Saharan African countries provided information about their medical practice in the preceding year of 1981. Details were collected of the total number of patients seen and admitted during the year, and the number of cases of bloody diarrhoea, typhoid and inflammatory bowel disease. Over 1 million outpatients and about 190,000 inpatients were treated. These included 12,859 cases of bloody diarrhoea, of whom 1,914 had typhoid. Twenty-two cases of inflammatory bowel disease were also reported. Histological support was least available in West Africa and only 25% of hospitals had access to this facility. Nevertheless, the frequency with which inflammatory bowel disease in sub-Saharan Africa is difficult and limited by access to diagnostic facilities. It is likely to be some time before reliable estimates of the incidence and prevalence of Crohn's disease and ulcerative colitis in the rural African population can be made.

The contribution to medical work and nursing by the pioneer missionaries of the D.R.C. Mission in Nyasaland (Malawi) from 1889-1900

Although the first, pioneer missionaries of the D. R. C. Mission were not fully qualified medical doctors, they played a big role in introducing western medicine among the indigenous population and in this way countered the practice of the witch-doctors. With their limited knowledge of medicine, they knew enough to treat the indigenous people, their fellow missionaries as well as other people like government officials, planters and hunters in the central province, where they were stationed. They managed to save lives and started with health education to motivate the people to think and live more hygienic lives and thus uplift the standard of health of the country. One cannot but have admiration for their courageous perseverance and faith and the skilful way in which they applied their medical knowledge in the absence of a fully qualified medical doctor.

Missionary health: the great omission

North American mission boards were surveyed to identify and prioritize missionary medical problems and determine initiatives for improving health. Malaria was the most common nontrivial medical complaint, and viral hepatitis the most serious. Nevertheless, only 72 percent of boards recommend malaria prophylaxis, 57 percent ascribe to regular immune globulin use, and 31 percent advocate hepatitis B immunization. Sub-Saharan Africa was considered the region of the world where missionary health was most in peril. Besides strategies to minimize the risks of malaria and hepatitis, recommendations for improving missionary health include greater use of rabies and typhoid vaccines; increased attention to mental health concerns and accident prevention, particularly seat belt use; increased health education regarding both clinical issues and public health principles; improved scheduling for relaxation and family time; and greater availability of comprehensive health services before departing, while abroad, and upon returning from an overseas assignment.

Background to the development of health services in Nigeria

This paper concentrates on three main issues. First a brief overview of the nature of the politics, economy and health in Nigeria prior to colonialism. It is important to know, for instance, how medicine was organized prior to the advent of modern medicine. I think our understanding of pre-colonial Nigeria is important because it enables us a better grasp of the changes which were later introduced by imperialists. The second issue will be the imperial penetration of Nigeria by Britain. Imperialism took several forms ranging from the activities of Christian missionaries to the eventual colonial rule over the various kingdoms and empires which were in the region. The effects of the imperialist activities on the transformation of Nigerian society and particularly the introduction of the capitalist productive forces wil be discussed, with the view to examine changes in the organization of health and medicine. The last issue to be considered in this paper will be the role of imperialism in class formation in Nigeria. Emphasis will be first, on the social and economic condition of colonial physicians who came from England and then how they were related to the colonial state and colonial health policies. From this premise, we can examine the historically specific circumstances under which Nigerians were trained as physicians and how they (Nigerian physicians) got involved in the politics of nationalism. We will then discuss how the First and Second World War gave energy to Nigerian nationalist movements. The paper ends by stating that the Nigerian nationalists who had struggled and secured Nigeria's political independence eventually became Nigeria's ruling class which now controls the post-colonial state.