20150910 DW Debate: Dr David Strangway - Medical research in angola 1900 - 1967
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Dr. David Strangway was the keynote speaker at Angola’s 4th National Conference on Science and Technology. His presentation, made on Thursday, September 10 2015, was titled "Medicine and Medical Research in the Angola Highlands, 1900-1967". Dr. Strangway grew up in Angola in the 1940s and 1950s. Dr. Strangway is a renown Canadian academic and scientist and member of Development Workshop’s international advisory board. His father and mother came to Angola in 1927 and spent 40 years working in the fields of medicine, public health, nutrition and agricultural. His presentation was based on research that he is carrying out using public access archives in Angola, Portugal, Canada and the USA together with his own family records dating back to when his family worked in Angola. Dr. Strangway demonstrated evidence of the pioneering research that Congregational and later United Church medical practitioners did, dating back to the late 19th century. Early investigation into chronic tropical diseases such as malaria, sleeping sickness, leporacy and tuberculosis were done by his parents. Dr. Strangway demonstrated statistics on the dramatic reduction in mortality that was achieved in the 1950s when his parent’s hospital at Chissamba in Bie Province began to have access to new modern medicines. Dr. Strangway’s mother worked on nutritional research and local herbal medical plants. His father not only built the 140 bed hospital and 83 village clinics, but conducted a remarkable 40,000 surgical operations over his 40 years in Angola. The presentation was followed by comments from the conference chairperson and the floor noting that despite progress in medical research and vaccination campaigns, diseases such as malaria and tuberculosis are still chronic in Angola
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20150910 DW Debate: Dr David Strangway - Medical research in angola 1900 - 1967
- 1. LUANDA, 9 – 11 SEPTEMBER 2015 DEVELOPMENT AND THE HISTORY OF MEDICAL SCIENCE CHISSAMBA, BIÉ 1927 – 1967 DAVID CIKOMO STRANGWAY, PHD, FRSC, OC MEDICINE, MEDICAL RESEARCH AND DEVELOPMENT IN THE ANGOLA HIGHLANDS 1900-1976 REPUBLICA DE ANGOLA 4TH NATIONAL CONFERENCE ON SCIENCE AND TECHNOLOGY
- 2. HISTORY OF ANGOLA • One chapter must be on the medical and medical research by protestant missionaries • History of the work of a man and wife • Dr. & Mrs. Strangway medical work and medical research 1927 – 1967 • Work done in Chissamba, Bié Province • Theirs was a life dedicated to the people of Angola • This is their story of medical science
- 3. CURRIE OF CHISSAMBA (1886 – 1911) 1891 – 40 PATIENTS/DAY 1893 – 300 PATIENTS/DAY – HELEN MELVILLE – NURSE ARRIVES FIRST REPORT OF DISEASES IN THE HIGHLANDS - 1894 • Pneumonia 12 • Bronchitis 20 • Malaria • Intestinal many • Bilious 3 • Hematuria 4 • Scurvy 4 • Venereal disease 8 • Abscesses 5 • Gunshot wounds 2 • Dysentery many • Influenza Epidemic • Tape worm 1 • Ascites 3 • Whooping cough 2 • Measles 2 • Conjunctivitis many • Rheumatism many • Goitre many • Burns many • Tooth decay many • Diarrhea many
- 4. SECOND REPORT ON DISEASES OF THE HIGHLANDS • -DR. WELLMAN IN CAMUNDONGO (NEAR KUITO) • -1896 – 1906 • -PUBLISHED EXTENSIVELY
- 5. WELLMAN – 1904 REPORT ON ANGOLA HIGHLANDS DISEASES • Malaria – extensive • Filariasis – rare*, but considerable later • Craw Craw – now known to be itchy skin due to Filariasis • Sleeping Sickness – only on the coast and the north • Bilharzia – not in Highlands • Pinworm, Hookworm, Round Worm, Tape Worm • Amoebic Dysentery, Chronic Diarrhea • Yellow Fever – only on the coast • Jiggers – widespread *widespread cause of river blindness
- 6. WELLMAN – 1904 REPORT ON ANGOLA HIGHLANDS DISEASES (2) • Tuberculosis – mostly eliminated by drugs • Pneumonia – common • Leprosy – improved treatment over the decades • Goitre – reduces as salted fish available • Onyalai (utue unene) – Vitamin C deficiency • Tropical Ulcers • Yaws • Snake Bites • Ticks, Lice – Relapsing fever, later curable • Manioc poisoning
- 7. WELLMAN – 1904 REPORT ON ANGOLA HIGHLANDS DISEASES (3) • Eye Troubles – cataracts, contagious sore eyes every 2 or 3 years • Small Pox – 2 epidemics in 7 years – started vaccinations • Chicken Pox – 2 epidemics in 7 years • Mumps – 1 epidemic in 7 years • Influenza – 1 epidemic in 7 years • Epilepsy – often associated with severe burns • Hernias – very common • Gun Shot Wounds • Many food deficiency diseases described in subsequent years
- 10. This was father’s outpatient clinic.
- 11. BED PATIENTS IN CHISSAMBA • First hospital beds in 1903 • New hospital built in 1920’s • Strangways to Lisbon • Learn Portuguese; Diploma in Tropical Medicine • Strangways arrive in 1928 • Learn Umbundu • Hospital grew to 50 beds by 1931 • 1953 – 90beds • 1955 – 100 beds • 1965 – 140 beds • Bed patients • 1931 – 262 • 1966 – 3344 • Many nurses trained
- 13. OPERATIONS PERFORMED IN CHISSAMBA 1931 – 1967 • 1931 – 198 • 1966 – 2155 • Growth was possible by training many competent assistants • Reports he could do an appendix in 5 minutes • Patients from all parts of Angola • Also Belgian Congo, Namibia, Zambia, Zimbabwe • Many cataracts • Many hernias • Increasing ulcers Total operations – 40,000
- 14. OPERATIONS
- 15. TOTAL TREATMENTS AT CHISSAMBA Consultations, treatments, injections, etc. •1903 – 5600 •1926 – 20,663 •1931 – 45,201 •1937 – 53,661 •1946 – 82,908
- 16. Malaria •1880 – Malaria parasite identified •1881 – Malaria connected to mosquitos •1884 – Blackwater Fever established as extreme malaria •1898 – Complete life cycle of mosquito Treatment: quinine, atabrine, chloroquine Relapsing Fever/Tick Fever •Carried by ticks •Very common/high mortality •Recognized by Wellman •Antibiotics effective
- 17. Smallpox •1901 – Smallpox epidemics (2), many died – One village vaccinated, none die •1913 – 100’s of vaccinations •1929 – vaccinations, 100/day •1930 – smallpox wide-spread •1936 – smallpox wide-spread – Need for vaccinations widely understood •1965 – thousands of vaccinations Poliomyelitis •1953 – 10,000 doses of Sabin vaccine •1962 – 50,000 doses of Sabin vaccine Bubonic Plague •Rare •Only case was my mother •Treated with chloromycetin Whooping Cough •Very prevalent in early years •Very little after 1953 due to pertussis vaccine •1965 – 2010 vaccinations
- 18. Leprosy •Leprosy wide-spread •Treatment - chaulmoogra oil before 1950 •DDS - sulfone treatment after 1950 - very effective cure •Peak number of treatments in 1960 •Many early detections responded fast •Treatment in 83 village clinics •Reduction in cases after 1960 due to cures
- 19. LEPROSY CASES
- 20. Filaria/River Blindness •First detections in Angola •Major research carried out •Carried by gnats near running water •Treatment with hetrazan •1950 – 220 cases identified •1953 – 700 cases •1962 – 1500 patients identified and cured •Related to elephantiasis Cataracts Large numbers of cataract operations that restored sight
- 21. My father talking with witch doctors after doing cataract surgery on them.
- 22. Pneumonia •Widespread in early years •Common in dry season •1940 started dagenan treatment •By 1944 sulfa drugs cured almost all pneumonia cases Tuberculosis •Wide-spread •Treatment in villages •1955 - 600 TB patients - Preparing to acquire x-ray machine •1962 – rampant •1965 – B.C.G. vaccine – 3244 •1966 – 114 cases
- 23. Maternity •1965 • Prenatal consultations 1219 • Hospital births 327 • Midwives in villages 51 •only difficult cases in hospitals •Cattle herd for milk for babies • 100 l/day •75 tons powdered milk imported from Canada • 100,000 l/year
- 24. Cardiovascular •Only one case in 40 years •Hypertension rising – up to 30% Diabetes •Very rare (by 1962 only 4 had received insulin) Peptic Ulcers •Incidence increasing dramatically Sickle Cell Anemia •Trait found in 21% of population •Extensive research
- 26. LABORATORY TESTS
- 27. Nutritional Work - 1 •Early Superstitions • No milk • No eggs • No spotted fish/cause of leprosy •Locust invasions frequent (1897, 1931, etc.) •Destroyed crops led to starvation •Locusts themselves edible
- 28. Nutritional Work - 2 •SCURVY • Widespread • Shortage of citrus fruits •UTUE UNENE • Extreme form of scurvy • Treatment developed • Massive doses of lemon/orange juice • Direct injection of lemon juice •ONYALAI • First identified by Wellman 1904 • Strangway identified as extreme ascorbic acid deficiency • Cure same as above •Extensive research •1966 – 849 cases of malnutrition
- 29. Nutritional Work - 3 •GOITRE • Half of patients in early days • Reduced occurrence over 40 years • Probable causes – increased iodine • Access to salted fish - bacalhau • Access to sea salt •KWASHIOKOR (and OEDEMA) • Protein deficiency • Causes red hair • Readily curable with diet • Extensive research • In one sample in 1962, 44% show red hair • Enlarged livers •PELLAGRA • Widespread niacin/vitamin B3 deficiency • Extensive research • Cornmeal bran and germ layers winnowed out
- 30. 1944 Three major observations 1.Many patients from all parts of Angola e.g. Chokwe, Luena 2.Pneumonia decreased substantially; treatment with sulphas worked 3.Patients mauled by leopards and crocodiles - wounds now packed with sulphas mean no deaths due to infections
- 31. This is the laboratory and infectious diseases ward.
- 32. Some Final Observations •Forty years of medical science and the development of Angola •Life expectancy from 8 years to 45 years •Re-entry visa in 1949 difficult • Opposed by local doctors • Re-entry visa in 1962 difficult • Portuguese objection to Protestant missions •On departure in 1967 - Street in Silva Porto (Kuito) named •Hospital budget in 1961 $20,000