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 ANGOLA4TH NATIONAL CONFERENCE ON SCIENCE AND TECHNOLOGY

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

CURRIE OF CHISSAMBA (1886 – 1911)

1891 – 40 PATIENTS/DAY1893 – 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

SECOND REPORT ON DISEASES OF THE HIGHLANDS

• -DR. WELLMAN IN CAMUNDONGO (NEAR KUITO)• -1896 – 1906• -PUBLISHED EXTENSIVELY

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

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

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

This was father’s outpatient clinic.

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

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 ulcersTotal operations – 40,000

OPERATIONS

TOTAL TREATMENTS AT CHISSAMBA

Consultations, treatments, injections, etc. •1903 – 5600•1926 – 20,663•1931 – 45,201•1937 – 53,661•1946 – 82,908

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

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

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

LEPROSY CASES

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

My father talking with witch doctors after doing cataract surgery on them.

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

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

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

LABORATORY TESTS

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

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

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

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

This is the laboratory and infectious diseases ward.

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