Medicine in the Tropics (Firestone Tire and Rubber Co., 1948)

Medicine in the Tropics (Firestone Tire and Rubber Co., 1948)


[Drumming] [Narrator:] On the great western bulge of Africa is Liberia, Africa’s only Republic. During the past quarter-century, Liberia’s importance as a rubber-producing nation has gained for her stature and recognition throughout the world. In Liberia today are millions upon millions of rubber trees, the majority of which produce more latex than any other trees anywhere. To operate the immense plantations on which these trees are grown requires the combined skills and labor of tens of thousands of workers, the health and well-being of whom are vitally essential to the welfare of the nation as a whole. Safeguarding the health of their rubber workers is both an economic necessity and a moral obligation. In a very real sense, the development of research in, and practice of, tropical medicine in Liberia is a by-product of her ever-expanding rubber industry. As rubber is vital to Liberia’s economy, so is an adequate medical program essential to her progress and prosperity. In order to understand the nature of the medical program that is today underway in Liberia, one must first examine the country itself. Located barely above the equator, on the edge of the vast rainforest of Equatorial Africa, Liberia’s climate is humid and generally warm. The rainfall is heavy, between 90 and 160 inches each year. The abundant streams and rivers resulting from this heavy rainfall keep the numerous valleys fertile and verdant and provide favorable conditions for the growing of almost any crop. Even the three or four month dry season fails seriously to retire Liberia’s abundant agriculture. For even then, there are usually enough showers and light rains to maintain favorable growth. With a climate so ideally suited to agriculture,
it is not surprising to find Liberians an agrarian people living close to the land and engaged in pursuits that are intimately related to the necessities of everyday living. Most Liberians are tribespeople who work and live very simply. Their daily activities are devoted largely to taking care of their immediate needs. In these respects they are typical of native inhabitants of many tropical climates. Agriculture is inherently easy because of the soil’s fertility and the fact that crops are not severely restricted to seasons. Even on casual inspection of the landscape, it is evident that here almost anything will grow. On the one hand, this lush productivity resulting from the climate and rainfall is a blessing. On the other, it is a threat. A menace and a liability. For the same conditions that make for an abundance of vegetables, forest products, and flowers are also favorable to the growth and development of the micro-organisms that cause ruinous diseases. For example, while some of Liberia’s streams are pure, others play a grim role as carriers of malicious dysenteries and many other waterborne diseases. To help prevent these and to reduce the continuous hazard of malaria, Liberia’s sanitation program today calls for almost incessant spraying of surface streams and the land around them. Before the advent of the Firestone Rubber Plantations, swamplands and stagnant pools provided ideal breeding places for anopheline mosquitos, the carriers of malaria. Today with a broad medical and sanitation program in progress, this stagnant water is methodically drained to prevent the formation of larvae breeding pools. Foliage and trees along rivers and streams are cleared in order to fight trypanosomiasis or African sleeping sickness, at its source. This kind of growth provides shelter and breeding areas for the tsetse or glossina flies, several species of which are the carriers of this baffling and frequently fatal disease. Agricultural projects, such as the growing of rubber trees, also aid in the elimination of the tsetse fly breeding areas. Today in heavily populated plantation areas, water is impounded, filtered, and chlorinated to make it usable for cooking and drinking. Preventive measures like these are doubly important on the rubber plantations because of the congestion that accompanies both working and living. On the plantations, thousands work together in close proximity. In the interior, many native villagers are frequently overcrowded. Once it takes hold, almost any disease becomes a potential epidemic. It is with this realization that sanitary preventive measures, like the daily inspection of latrines, have been instituted on the plantations and are rigorously enforced. But by far the most effective preventive factor is immunization. For example, twice yearly the resident population of the Firestone Plantations, numbering about 40,000, is vaccinated against smallpox, which is endemic to much of Liberia. Each native village has at least one dresser station, staffed by trained medical orderlies who administer first-aid, care for minor ailments, and make simple diagnoses. The orderlies also make mass surveys of diseases. Here they are making preliminary tests for African trypanosomiasis, or sleeping sickness, by examining the cervical glands in the back of the neck. Unless acutely ill, tribespeople rarely seek medical aid. An unbalanced diet accustoms them to fatigue and low metabolism, and few are able even to recognize the presence of early symptoms of disease. This plantation worker complaining of an acute abdominal pain which he has suffered for four days, has come to his local dresser station only because the pain is intense. The orderlies, unable to diagnose the case adequately, send him to the plantation base hospital for further examination by an American doctor. Once daily, or more frequently if necessary, a hospital bus whose route covers all plantation dresser stations transports such patients to the base hospital. To the hospital come many abdominal cases. Physical illnesses such as hernias, sprains, bruises, and fractures are common. Partially, this results from an unbalanced diet, which is frequently deficient in proteins. [Narrator:] Patients referred to the hospital by the local station orderlies are examined first in the outpatient department of the hospital. The native medical personnel on the Firestone Plantations are about one hundred in number. All of them have been trained by American doctors and nurses who direct the hospital staff. In the outpatient department, a competent American doctor examines the abdominal case and diagnoses it tentatively as amebic abscess of the liver. After diagnosis, the doctor orders the patient admitted to the hospital for surgical treatment. In the early part of the medical program, natives were dubious of what they termed foreign doctors. But their doubts and fears were dispelled as a result of cures effected and the obvious efficiency of modern medical techniques and equipment. From the outpatient department, the abdominal case is admitted to the surgical ward in this base hospital. First, blood samples are taken, from which blood counts and blood tests will be made. The blood tests themselves are made in the hospital laboratory by skilled native technicians. The laboratory facilities in the Firestone Hospital in Liberia are completely modern in all respects. An x-ray examination is made to confirm the preliminary diagnosis. The pattern of common diseases is such that the preliminary diagnosis is generally accurate, but there have been instances where x-rays have altered the early diagnostic examination. In this case of abscess of the liver, surgery was considered advisable. Equipment, sterilization, and medical skills attendant upon surgery in the Firestone Hospital
compare favorably with those existing anywhere. The extremely high percentage of successful surgery attests to the validity of modern medical techniques in primitive surroundings. Amoebiasis, here undergoing operative treatment, is highly prevalent in most tropical countries. A waterborne disease, it is a development of chronic amoebic dysentery. The surgical objective is that of draining the hepatic abscesses. Amoebiasis affect an average of 40 to 50 percent
of the entire native population because of polluted water. The phrase “tropical medicine” indicates cosmopolitan medicine. It comprises the great majority of diseases common to the temperate climate, and in addition, a relative few which are peculiar to the tropics. The deep tropics are the most abundant of all pathological laboratories. After surgery the patient is removed to the convalescent ward, where the care he receives differs little from that offered in hospitals in Des Moines, Hartford, Tucson, Portland, New Orleans, or San Diego. The plantation hospital is staffed by American doctors and nurses and is supplement ed by native personnel, most of whom have learned readily and function devotedly at a highly competent level. The cases most frequently encountered in the general wards are malarias, schistosomiasis, carried by water snails, yaws, hernias, goiters, intestinal worms, dysenteries, filariases, traumatic injuries, and pulmonary, bone and skin diseases. In pleasant, easy surroundings the patient recovers rapidly. The period of convalescence for this type of operation is usually ten to fourteen days. During the time he is convalescing, the patient also receives intensive medical therapy. When discharged, this young man is an ambassador of goodwill for modern medicine in the tropics. For back in his tribal village he will report good food, good care, and a speedy recovery. As elsewhere, many diseases encountered in the tropics require isolation. The beds in this isolation hospital on the Firestone Plantations are frequently filled with such highly contagious diseases as smallpox and tuberculosis. Of these, smallpox is the more common. Here are three typical cases. In this case the disease is in an early stage,
as indicated by the cutaneous lesions or skin eruptions. This case, a middle-aged woman is more advanced. This is a confluent hemorrhagic type of smallpox
and is characterized by the formation of large pustules over the entire skin surface. This case was reported late and terminated fatally. The third case, a young boy, is recovering from the disease. The depigmented areas are typical of the recovery stage. In the general hospital are always a variety of diseases, some cosmopolitan, some exclusively tropical. Here is a rare case of sarcoma of the clavicle, a cancerous bone tumor. Following the failure of surgical and x-ray treatment, the patient died. Elephantiasis, a complication of filariasis, is an almost exclusively tropical disease. This elephantoid scrotum, weighing 42 pounds, was successfully removed by surgery and the patient discharged mentally and physically improved. Here is a rare clinical example of gynecomastia,
the development of a female mammary gland in a man. This developmental anomaly was corrected surgically with complete success. A dangerous disease largely confined to tropical Africa is trypanosomiasis, or sleeping sickness. Unless treated early, this disease is usually fatal. Here, a medical technician punctures a lymph gland of a native worker whose listless appearance and enlarged cervical glands are symptomatic of sleeping sickness. In this particular case, the glandular smear subjected to microscopic examination revealed the trypanosomes which identify this disease. Besides being a public health problem, certain types of trypanosomiasis constitute a major economic drawback because they destroy draft animals and other valuable livestock. For more routine public health measures,
some forty dispensaries staffed by hospital- trained attendants serve the population of the plantations. Evidence of the success of the entire medical program it found in the confidence is has engendered. Many who once feared the techniques and paraphernalia of modern medicine are today willing and eager to accept its benefits. Much of Liberia’s progress in medicine and public health is due to the industrial statesmanship of Harvey S. Firestone, founder, and Harvey S. Firestone, Junior, now head of the worldwide Firestone organization. A gift from that organization enables the American Foundation for Tropical Medicine to establish in Liberia a permanent research center for service to tropical medicine generally. Mr. Firestone’s approval of the model for this Liberian institute was a milestone in tropical medicine. World-famous medical authorities and educators have agreed to assist the American Foundation for Tropical Medicine in directing the Liberia institute. Continued research, increasing facilities, and the application of the best available skills are vitally important to life and progress both in the tropics and out. For tropical medicine, whose scope at first glance may appear limited, is actually of basic importance to all peoples and all economies. The work already accomplished in Liberia has extended the horizons of general medical knowledge. Progress in tropical medicine means progress for business, for science, for humanity. The goals are the maximum that can be attained.
Better health, better housing and food, improved agriculture and trade, adequate water supplies, and general sanitation. Yes, even better transportation and more efficient labor. In short, the objectives of tropical medicine are those of all medicine. Healthier and happier people. Living better with a firmer grasp of the present, and confidence in the future. A future which the skills of modern medicine will have made increasingly secure. [THE END A Firestone Plantations Company Production]

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