RAJ BOODHOO
World War I had just ended. Governor Sir Henry Hesketh-Bell, KCMG (1916-1924) decided to deal with the critical sanitary conditions of the island. Malaria had become endemic since its outbreak in 1867. It remained a killing disease for the next hundred years. Once a holiday resort for British officers in India, the island became notoriously insalubrious, no longer a safe place for visitors. Several other diseases broke out: influenza in the 1890s, plague in 1899 and again in 1921, and ‘Spanish Fever’ in 1919. Apart from these infectious diseases, Mauritians suffered from ankylostomiasis (hookworms), dysentery and tuberculosis. The rate of mortality was among the highest in the empire. Drainage works of waterlogged areas, breeding sites of anopheles, as recommended by Ronald Ross in 1908, had been suspended during the war years. Diseases affected the work force, hence the economy of the sugar-island. Blockades during the war had caused shortage of foodstuffs, resulting in price rise. People living in unhygienic conditions in the slums of Port Louis and in sugar-estate camps, were exposed to infections. Manure, spread in cane fields, made of human faecal matters (dry-earth), produced at Roche Bois, and near several other big villages and sugar estates, was another cause of great concern. Governor Hesketh-Bell stated that such a horrible practice was not to be seen anywhere in the empire.
The end of the war brought a brief prosperity due to excessively high prices of sugar on the world market. Out of the revenue, Hesketh-Bell created the ‘Improvement of Sanitation and General Development Fund,’ and he applied to the Secretary of State for the services of an expert to advise the government on a thorough re-organization of sanitation and medical services. He was aware that all British experts were not praised; some of them were reviled through the press by a section of the population, and, although he sympathized with the slogan ‘Mauritius for Mauritians’, he nevertheless stated that expertise in tropical medicine and sanitation was missing and vested interests were rife among certain officials.
Dr. Andrew Balfour, appointed by the Secretary of State, arrived on 31 March 1921. He was Director-in-Chief of Wellcome Bureau of Scientific Research, an eminent authority having a ten-year long experience in tropical diseases at Khartoum in Sudan. During the Great War, he had served as Lieutenant Colonel in the Royal Army Medical Corps. Balfour spent six months in Mauritius. Accompanied by Dr. A. T. Castel, he travelled by car over 10,000 miles throughout the island, surveying slums, slaughterhouses, shops, grain stores, Indian villages, sugar estates, railway stations and schools. He wrote nine exhaustive reports, stressing ‘the great pressing need for sanitary reform.’ Regarding Port Louis, Balfour declared that the municipality did not have the means to deal with all its responsibilities; he was against the dual control of sanitation, by the government and by the municipality. He recommended the appointment of a medical officer especially for Port Louis, the removal of unhygienic slums and the construction of rat-proof granaries. He recommended the use of motor vehicles instead of mule-carts for scavenging and night soil services in the busy streets of the capital. To curb the spread of malaria, Balfour urged the continuation of drainage works initiated by Ronald Ross in 1908, neglected from lack of funds and by the intervening war, and he also advised a new study of local anopheles to explain the complexity of malaria transmission.
Balfour outright condemned the use of human manure in cane fields, stating that no colony had recourse to such a practice, except Mauritius. This could be the cause of hookworm, dysentery and other health problems. When the International Health Board (IHB) of Rockefeller Foundation proposed to investigate into hookworm disease, Balfour urged the governor to accept the offer. A survey by IHB experts and Mauritian health officers showed how hookworms infected a large section of the population. IHB and the government, shared the expenses to sanitize the soil, treat infected people with medicine from the U.S., and guided the community in the construction of pits and the use of privies. Campaigns started in schools; children were treated with chenopodium (botrys) before classes started.
Balfour stated that Mauritius was an ideal place for research in tropical disease. The Swettenham Report of 1911 had disapproved the Bacteriological Laboratory at Réduit, as being too expensive to run. Balfour recommended, instead, its expansion. He proposed that the staff, apart from performing routine tests of water, milk and foodstuffs, could be trained to carry out research in tropical medicine. Diagnosis of diseases can only be guesswork without research in the laboratory. Balfour observed that hospitals and dispensaries were understaffed, that few doctors resided in the countryside, and that poor people died without medical care. He recommended the recruitment of Indian doctors to treat Indians in the island and to instruct them in their own language about the importance of hygiene. He declared that there was a need for trained sanitary inspectors well versed in sanitary science to promote a better health system. Balfour stressed the importance of health education of the people. He held conferences in cinema halls, set up exhibitions and urged schoolteachers to explain the importance of hygiene to children. He suggested the setting up of a museum for educational purpose. Before his arrival in the colony, he had started to work on the creation of the Wellcome Institute Museum at Euston Street, London.
At his last conference in September at Pathé cinema hall in Curepipe, chaired by the governor himself, and attended by numerous doctors, Balfour presented his findings in numerous pictures using a lantern projector. Balfour left Mauritius on 1 October 1921. Back in England, he gave a lecture on health issues in Mauritius at the Royal Society of Tropical Medicine. In 1923, Balfour was appointed as Director of the London School of Hygiene and Tropical Medicine (LSHTM), where several Mauritian born doctors were admitted for training.
Governor Hesketh-Bell was committed to executing the recommendations of Balfour. The task was daunting and seemed practically impossible, especially in a volatile political situation, where a group of politicians supported the ‘Retrocession (Back-to-France) Movement’. He took drastic measures in spite of strong protests from some quarters. He resisted the sending away of ships supposed to be carrying diseases to quarantine stations. He approved the recruitment of Indian doctors in spite of threats by local doctors to go on strike in hospitals. Again, in spite of strong protests, services such as scavenging, night soil and water supply were transferred from the Municipality of Port Louis to the Government. Anti-malaria drainage works and provision of quinine resumed, a model village and quarters for railway workers were built at Plaine Lauzun. Victoria Hospital opened in 1922, Leprosy Hospital at Powder Mills at Pamplemousses in 1924, and Montagne Longue Hospital in 1926. An anti-tuberculosis campaign initiated in 1926. A new sewerage system in Port Louis and the latrine system in the rural areas were planned. All ‘Engrais’ or human manure making plants were forced to close down by 1924. A new anti-malaria campaign was initiated by M.E Macgregor, entomologist from Wellcome Field Laboratory, Surrey. However, a museum to promote health education, as suggested by Balfour, was never built.
Hesketh-Bell and Balfour left behind a legacy that endured for several decades. They had inculcated an efficient form of health management, paving the way for successive governments to bring further improvements, such as building a new grain store in the 1930s, and setting up the long overdue Central Health Laboratory at Candos in 1958.
Today, as far as advances in medical science and technology are concerned, we are a world apart from the situation in 1921. However, COVID-19 has reminded us that infectious disease can occur at any time, in any part of the globe. Would the present pandemic be a catalyst for change? How is the next hundred years from now going to be invented? Would there be more efficient emergency programmes? How could enormous inequalities of health between rich and poor countries be solved? How would the threat of global warming, which can cause the outbreak of other infectious diseases, be addressed? What would be the situation in 2121? Only time will tell.
References
Adapted from ‘Infectious Disease and Public Health Mauritius 1810-2010’ ELP, 2019.
Balfour, A. Report on Medical and Sanitary Matters in Mauritius, London, 1921.