The British Empire Library


In and Out of Africa

by Bill Barton

Green Mountain Doctor: Memoirs of a Government Medical Officer in Basutoland in the Nineteen Sixties

by Colin Smith


Courtesy of OSPA


Review by Dr. Neil Squires (Senior Health and Population Adviser West and North Africa Department and Africa Greater Horn Department, DFID)
These two books, written by doctors recalling their time spent as District Medical Officers in Africa, have given me pause to reflect on my own time spent as a DM0 in Malawi, and to consider how the experience of these doctors in the 1950s 1960s and my own experience in the early 1990s, all funded in some way by the British Government, compare with the focus and objectives of British development assistance today.

Whilst there have been considerable improvements in the health status of African populations since the 1950s and 1960s, with a reduction in infant and child mortality and an increasing life expectancy, progress has been slow. Conflict within the region has been a major barrier to progress, however HIV/AIDS is now the biggest obstacle to further improvements in health. Since the beginning of the 90s, as the impact of HIV/AIDS has increased, the rates of health improvement have stagnated, and even reversed in Southern and Eastern Africa. Those jobs that were once occupied by British doctors working for the Colonial Service or, more recently, with Voluntary Service Overseas, and well described by both Barton and Smith, are now largely occupied by African doctors. African doctors continue to face the challenges described by Drs Barton and Smith, often working in an even more resource constrained environment than 40 years ago, and both books therefore provide a useful insight into some of the problems faced by health workers trying to deliver healthcare in Africa today.

Green Mountain Doctor, and In and Out of Africa contain remarkably similar accounts of the challenging, exciting and often frightening early experiences young doctors have faced in the past and continue to face today. Green Mountain Doctor, as Cohn Smith states in the preface, is a story about a 'green' doctor, not a green mountain, the frightening experiences are having to manage difficult cases with inadequate training or experience. Bill Barton, who went on from his first posting in Kenya to spend a large amount of his working life in Africa, gives an equally vivid account of the challenges of the early years, arriving in Kenya in 1946. Although both men went on to follow quite different career paths, with Cohn Smith returning to practice in the UK after His posting in Basutoland and Bill Barton moving from Kenya to Zanzibar and Dubai, and then on to work for the World Health Organisation and the London School of Hygiene and Tropical Medicine, the detailed accounts of those early years of clinical experience demonstrate the significant mark that experience had on both authors' lives.

Both Barton and Smith went to Africa with very little practical experience, certainly with inadequate experience to handle with confidence many of the challenges they faced. My experience in Malawi in the 1990s was similar, and from my continuing role as a health adviser for the Department for International Development, it is clear that African doctors starting their clinical practice in district hospitals throughout Africa continue to face similar challenges. The accounts of Barton and Smith make it clear that individuals can rise to these challenges and often provide an effective service, but this is far from ideal. Medicine should no longer be dependent on the regular heroic acts of individuals rising to a challenge, it should be built on a strong system of sound, evidence based procedures and protocols which are regularly monitored. So, whilst we should applaud the small acts of heroism performed by doctors like Bill Barton and Colin Smith, and the continuing dedication of African doctors working in difficult circumstances with few incentives, our objective should be to ensure that doctors and other health care professionals do not have to continue working in an unsupported way, surviving on nerve, skill and a large measure of luck.

I enjoyed reading both of these books, which are well written accounts of experiences which continue to have relevance and resonance today. Both books, which started lives as accounts written for an audience of immediate friends and family, de,serve the wider readership of anyone interested in the recent history of medical practice in Africa.

British Empire Book
Author
Bill Barton
Published
2000
Pages
370
Publisher
Blaisdon Publishing
ISBN
1902838025
Availability
Abebooks
Amazon
British Empire Book
Author
Colin Smith
Published
2000
Pages
160
Publisher
Colin Smith
ISBN
0953889505
Availability
Abebooks
Amazon


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