They [the health workers covered in the book] all knew what was obvious: that the practice of medicine extends beyond the body, that disease cannot be addressed in silo, apart from the environment and its people. They are all looking beyond the body for the causes of the disease and beyond the pharmacy for the solutions. And many of the technological solutions work. But every Wolseley-like [Wolseley is one of the people covered in the book] battle against disease has its causalities and they can be substantial…When the control we exert is misplaced, the massive power of biomedicine is either dangerous or reduced to smoke and mirrors. Pages 299 – 300.

Book Review of Such a Time of It They Had: Global Health Pioneers in Africa by Raymond Downing, MD. 352 pages. Paperback $12.63; Kindle $3.50

     Wow, Such a Time of It They Had: Global Health Pioneers in Africa, is wonderfully unique history book which I encourage you to read. The author, Ray Downing, a medical doctor with thirty years of medical practice in Africa, lives 20 miles down the road towards Uganda from us and I know him well.

     As an undergraduate in college I majored in African History and have kept up with much of the literature on sub-Saharan African history. This book is so different from say, Thomas Pakenham’s 738 page book, The Scramble for Africa: White Man’s Conquest of the Dark Continent from 1876 to 1912, which did not have one reference to a sub-Saharan African in all those pages; perhaps this is excusable since the African didn’t have any say in how the Europeans carved up the continent. Ray’s book, on the other hand, tries to ferret out the interesting interactions between the 19th and early 20th century medical doctors and the Africans they were living with. There are 19 chapters covering these early medical practitioners; some, like David Livingstone (who comes off well) and Albert Schweitzer (who comes off poorly), are well known, but most I had never heard of. Here is one of many examples:

One of the pictures that Ray described in his book that I looked up on the internet. This is a 1888 picture of Thomas Healze Parke and a pigmy slave he bought in the Congo for “a handful of beans, twelve cups of rice, and six cups of corn.” She became his cook, carried his food, nursed him when he was sick, fed him “roots, leaves, fungi, insects, etc. etc.” from the forest when he was starving (thereby saving his life), and showed him the plants that made the deadly poison for poison arrows and its antidote. Although Parke at one point said that she was worth any four of his men, he never mentioned her name.

     An interesting aspect of the book, which I have never seen in a “history” book, is the reflections in bold type on the similarities between the past and the present. I particularly enjoyed the parts where the prejudices of the old folks, which are now so easy to dismiss, are compared to the “prejudices” that still exist among many people today. I also liked the parts comparing the Africans’ “superstitions” to the colonialists’ “superstitions.”

     Ray’s thesis, assumed throughout the book, is that public health/family medicine is much more than just bio-medicine, the conventional truth of Western medicine as brought to sub-Saharan Africa. This bio-medicine excludes spirituality, the social context, and local culture. Through this lens, the book weaves the many biographies in such a way that shows how this played out in the 19th and early 20th centuries.

     I also like that, rather than state a conclusion, the reader is often left with questions for him/her to think about. For example, is all the time, energy, and funds spent on AIDS counterproductive in Africa because the same funds spent on other health problems would have been better used to promote a healthier society, and thereby saving more people?

     One addition I would have liked is some pictures. The descriptions of the various people are fine, but then to look at the real picture is better. In some cases I looked the name up on the internet and clicked on the pictures of the person. When I asked Ray about this he said that he was planning a revision to the book which would include pictures.

     The reader of this book would also learn about the history of doctors and their medicine as it developed from the low status of barber/doctors who did the blood-letting common before the development of modern medical practices to the highly scientifically trained doctors of today.

     Thanks, Ray, for writing this book.


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