Such a Time of It They Had Podcast

This is the beginning of a new adventure and an incredible story..Dr. Raymond Downing, one of the deep thinkers about, and a working doctor in the field, has written extensively about the state of global health.  Now we get the story.  The book, Such a Time of It They Had - Global Health Pioneers in Africa has just been published. The book is available at all of the usual places and sources.  But now in a new experiment, we present the audio version not in an expensive audio setting, but in a a weekly podcast.  I will be the announcer/narrator and sharing the story with you, and Dr. Downing himself will also be sharing his own personal narratives within each episode and chapter.  We look forward to hearing from you as we learn from you, and seek every week as we go chapter by chapter, to provide an experience of both story, inspiration, and personal reflection.  And here is the introduction by Dr. Raymond himself Stan Hustad

Ch 1 Mingling with Savages It is a gift to be simple, and Dr Johannes van der Kemp had that gift. Maybe it was because he was over 50 when he started his global health career. Maybe it was the tragedy in his own life. Maybe it was that the medicine of his day had so little to offer. Whatever the reason, he was not ashamed of his true simplicity - “to bow and bend” - and that bowing and bending gave him a chance to live in solidarity with the people he came to serve. Or at least try to. Not many of his contemporaries respected what he was doing, and the legacy of his simplicity and solidarity was… well there is no legacy. Still, I invite you to at least hear the story of Dr. van der Kemp, the man who mingled with savages.  

Ch 2 Inauspicious Global Health Ventures... Dr Mungo Park was a Romantic surgeon from Scotland, passionate to explore the Niger River, the one that flows past the fabled city of Timbuctu. Dr Joseph Ritchie was a Romantic surgeon from England, who wanted to explore the same river, approaching it from the north - that is, across the Sahara Desert. In the process, both lost - or perhaps ignored - their first calling: to care for those who were ill, to at least bring them comfort if they could not cure them. In those days, there was very little romantic about the surgery of the day: it had separated itself from barbers only one generation earlier. But exploring was very romantic - and so was dying young. Both died young without ever finding out where the Niger River went, and without contributing anything to the global health of their day. These were early global health ventures, inauspicious beginnings to the profession. Lord have mercy. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/    

  Episode 4 - Ch 3 … And an Auspicious Invention When I was growing up, we knew of Dr David Livingstone as one of the most famous African explorers. The same apparently was true in my father’s day: as a 12 year old child he read of Livingstone in a book called Missionary Heroes in Africa, dated February 14, 1928. We all knew how Henry Morton Stanley supposedly “found” the lost Livingstone in eastern Africa, greeting him with the words “Dr Livingstone I presume.” We also heard the tales of how, when he died while exploring, his African friends buried his heart in Africa, and carried his body back to England. But one of the keys to understanding any global health worker is knowing where they came from. Livingstone was Scottish. He was part of a tradition: Scotland produced a disproportionately large number of explorers; we have already met Mungo Park. And Scotland boasted one of Europe’s premier medical schools in Edinburgh. Livingstone didn’t go there, but van der Kemp did - and we will meet other Scottish doctors later in these stories. Livingstone, though he seemed to function best when working alone, came from a distinct Scottish tradition. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/  

Ch 4 Trials and Errors My wife Jan’s father, J. Dale Armstrong, was a third generation American Scot; his father was a blacksmith in southern Illinois. When Jan read the stories about Livingstone, she immediately recognized her father: determined, stubborn, tight-fisted. A few of the stories she told me about him are as painful as some of what we hear here about Livingstone. Livingstone was clearly no fun to live with. But ironically he seemed to understand and relate well with African friends: remember his conversation with the rain-maker. And, whether we now decry or laud his efforts, he prepared the way for many more European missionaries and settlers to enter Africa. He was an enigma - and some of the confusion begins to clear when we remember what his culture was and where he came from. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Ch 5 The Not-So-Great Playmaker The Helmores and the Prices were two young missionary families who became victims of one of Livingstone’s grandiose plans that went badly wrong. There were no medical workers in these young families, but their stories illustrate clearly one of the first tasks global health workers faced in Africa: preventing the high mortality of missionaries, explorers, and eventually colonists. Despite the difficulties and setbacks of their task, members of these two families preserved a careful record of their final journey in diaries and letters. Their own words show us people who, though not immune to frustration, demonstrated nobility - the kind that has nothing to do with class. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Chapter 6 In the pre-colonial and colonial periods, the British conducted their war against disease in the same way they conducted their conventional wars: conventionally. Certainly not as guerilla warriors, and not even with the um-pa-pa of a Sousa-style march, but with the stately determination of the Grenadiers. Doing things orderly, the right way. Fully believing their way - in fact their civilization - was the only right way. And, when it came to fighting both enemies and disease, the British relied on the latest science of the day, employed by doctors and engineers. They identified all the variables they knew about, and tried to control each one. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Today, global health workers I meet in conferences and in the field are mostly women. But this was not true of our global health pioneers. Jane Elizabeth Waterston stepped into this almost exclusively male endeavor, determined to challenge Gilbert and Sullivan’s satirical stereotype of a little maid from school. But before long she discovered some problems far deeper than gender stereotypes. She discovered what global health workers are still discovering: that we all have trouble getting along with each other. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Chapter 8 Who Among You is Human? In the late 1880s, several explorers followed Henry Morton Stanley up the Congo River to rescue Emin Pasha. When they returned to Europe, they found red carpet receptions in Brussels and London, including audiences with royalty. High society. They likely danced to Strauss waltzes in these receptions. Yet these explorers were returning from a disastrous journey. Two thirds of their 1000 African porters deserted or died, with most of the deaths from starvation. I wonder if any of the fêted survivors were bold enough to request the Strauss Waltz, the Cries of Mephistopheles from Hell? They had experienced hell, a hell of their own making, in the Congo. And yet, in this imperial heart of darkness, it was a pygmy who reminded us all of what it means to be human. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/

Chapter 9 Straddling the Centuries Dr. Robert Moffat, our next global health worker, feels contemporary in his style, even though he worked in East Africa at the turn of the previous century. His parents were Scottish missionaries in South Africa; he went to Medical School in England; his first assignment was in colonial Kenya, then Uganda - and by the time he was 40, it was time to go home. But where was home? He tried Britain, Rhodesia, Brazil, and France - but none of these were home. He ended up, in his eighth decade, on his brother’s farm in Rhodesia. I wonder if Moffat heard Danny Boy when it first came out in 1913. He was 47 then, his first wife had just died, and War was imminent. Danny Boy says “The pipes are calling…” calling you to come home. Danny Boy says “Come ye back…” Come back where? For some global health workers, even today, home is nowhere - and everywhere. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

When Europeans began living in, and eventually colonizing, African and Asian territories, many tried to live as they did in Europe. Victorian ballroom music could have been their music. Of course they were surrounded by people who lived differently, as they had lived for a millenia - which to the Europeans was poor. The result was that they, the Europeans, lived apart, like gods - as Ronald Ross described the way his parents lived in India. Since that was the life he knew, Ross started his career the same way, as a medical officer in India, living apart, golfing, fishing, writing poetry and romance novels. He eventually became a respectable world-renown scientist, doing much of the original research to establish the cause of malaria. But old ways of living die hard; his memories of living apart crept into his own recommendations for malaria control. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

We could use the British National Anthem for most of our pioneers, as most were British. Possibly we should use hymns for our medical missionaries, as they would likely claim that their spiritual motivations outstripped their political ones. But our difficulty in this chapter is that we feature two doctors whose religious beliefs were at opposite ends of the Christian spectrum. Which hymn would we choose? What they did have in common was a deep commitment to the latest medical science of the day. They carried this science within their versions of Christianity, seeing it as an outgrowth of their faith. Fair enough. But that is exactly the thinking of “God Save The Queen”: the third stanza says “Thy choicest gifts in store on her be pleased to pour…” There was a clear assumption that God had, and should, favor Britain over other peoples. Likewise, with our two Christian doctors, there is an unstated assumption that God favored medical science over all other forms of healing, especially ones they found among the people they worked with. It appeared, in fact, that their loyalty was to the gospel of science. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Scott Joplin heard about, and perhaps even saw, a collision between two locomotives in Texas, and memorialized the event in his classic style in the Crush Collision March. Someone recently called it the best silent film villain song he had heard; someone else imagined a robber getting away while the damsel in distress was about to be hit by the train.  The real story is more bizarre. The villain here was the MKT Railroad who staged the collision as a publicity event in Texas in 1896. It was witnessed by 40,000 people, 3 of whom were killed when the boilers of the two locomotives exploded during the collision. Americans do some pretty crazy stunts. Henry Morton Stanley was working for an American newspaper when he “staged” the finding of Livingstone, who did not think he was lost and was not interested in being found. In this chapter, the American Creighton Wellman begins his career as a medical missionary, and performs some amazing feats among the “natives” - much of it sleight of hand. Then he returns to the US, and his self-promotion and deception start ballooning. He created the template for smoke and mirrors in tropical medicine. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Now, is it really fair to use Gilbert and Sullivan’s satire of British military bureaucracy to introduce serious global health research? This was real research, uncovering complex life cycles of parasites and their vectors, knowledge necessary to control these diseases. This was not smoke and mirrors; the new knowledge was true, verifiable today. The problem with research then, and today, is the games every researcher must play to get funding, to get attention, to get a name. We still struggle with whose names to put on the published paper, and it what order. There are plenty of door handles to polish, plenty of exams to pass, plenty of partnerships to develop. And sometimes, as at the end of this song, the casualty is no longer thinking for ourselves. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

John D Rockefeller started funding global health in 1910, and 3 years later set up the Rockefeller Foundation - long before there was a WHO or USAID. The Foundation is still funding global health today. Rockefeller made his money from energy, necessary for the massive industrial progress of the 20th century. This George Gershwin tune, the theme song for the 1939 New York World’s Fair, capsulizes the optimism of this technological age, which by the middle of the century was making rapid progress in medicine. It was the dawn of a new day, they felt; “Better times, here to stay, as we live and laugh the American way.” They just didn’t mention the dark sides.  Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .  

Dr. John Gilks was “one of the least-liked but perhaps most efficient colonial officers” in the Kenya Crown Colony. Efficiency was certainly important - but being least liked did not help him with the task facing him. He needed to convince Kenyans that the government was doing something for them so they would be compliant healthy workers on settler farms. And what better way than to attack a very visible and easily treatable disease of the skin: yaws. But his problem was not only being least-liked; there was also his competition: the medical missionaries, who he felt were getting more attention. That’s tough competition, considering their Patron. Though it is unlikely that Gilks knew much about the music “back home” in the 1920s, it is a tempting thought that if he had listened to it and relaxed a bit, he may have been more likable - and more effective. It might have even prompted him to listen to the music of the people whose hearts and minds he wanted to win - and maybe they would have won his heart. But we can’t rewrite history. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Several years ago the medical school I worked for in western Kenya began a massive door to door Home Counseling and Testing program for HIV. It seemed unique: we hadn’t done this extensive screening for any other major chronic disease. It was part of a “population health” approach that was new, perhaps even cutting edge in public health. Except that it wasn’t new. In the 1920s a French doctor, Eugene Jamot, pioneered this approach to detect sleeping sickness in what was then French Equatorial Africa. The French were very proud of him for this, and called this technique “Jamotique”. But his program backfired, as we will see. At our medical school in Kenya they didn’t call the program “Jamotique”, they called it HCT - home counseling and testing. They had likely never heard of Jamotique. Was it that they didn’t know history? Or that they didn’t know French? Or perhaps both? And will they, some years from now, find their program backfiring? Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .  

Was it a hymn that prompted Dr Clement Chesterman to become a medical missionary in Congo? And if so, which hymn? This well-known gospel song says “Bear the news to every land/ Climb the steeps and cross the waves.” A call simply to go. Other hymns described the “heathen” people that missionaries would find there as “oppressed”, “forever weeping”, “groping to find light”, and “in blindness bowing down to wood and stone”. There was even a vignette of child sacrifice. One mid 19th century hymn tried to understand these “heathen” practices:    “Still God looks on human faces Heavenward turned, but not to Him; Slaves in bondage, worse than of fettered limb.” Why did this writer think that the human faces were not turned to God? Most missionaries had no idea how to tell the difference between superstition and God-given traditional understandings of life. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Artists are some of the first people to tell us when something is wrong - wrong with our lives, wrong with the world. This music, written by Stravinsky in the second decade of the 20th century, is clashing, jarring; telling us something is wrong; seeking not to please and sedate us, but to disturb and awaken us. Yet it was written at a time when industrial and technological progress were on a steep upward curve. Why is he raining on our parade? Some of the progress was truly helpful: think of medical research. But within medicine there was a desire not only to treat disease, but to improve normality. Eugenics viewed many biological and social problems as being genetic, and sought to improve the human race by selective breeding. And, in its worst moments, by eliminating the people that were ruining the gene pool. This chapter recounts some research that took eugenics to a new low, proposing that the entire black race had sub-optimal genes and needed improvement. This proposal deserves clashing and jarring music. Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

WTC Berry is a nearly unknown global health worker whose family had the foresight to encourage him to write his memoirs as therapy for a stroke. Berry had the honesty to tell us that his influence for going to Africa was watching a movie portraying the adventure of working for the colonial service. One of the actors in that movie, Paul Robeson, had the bravery to declare that the movie was an embarrassment to him and that he hated the way it - and he - portrayed Africans. In this song, Robeson’s character praises not Africans, but the colonial governor Sanders. And finally, Berry had the foresight to title his memoirs Before the Wind of Change, and leave unresolved the ambiguity of what he felt about that wind.  Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

Dr. Albert Schweitzer, at one time the best known of all our global health pioneers, came to Africa in 1913. His time overlapped with Cook, Macvicar, Gilks, Jamot, Chesterman, and Berry - and he died - in Africa - after two-thirds of African countries had gained independence from their colonial masters. He is still revered as a theologian, an expert on Bach, and a recipient of the Nobel Peace Prize. But what of his legacy in Africa? If he is remembered at all, it is as a gentle self-assured old European man practicing the piano in the village of Lambarene in Gabon, a man who loved plants and animals.  Send me your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/ .

There was a famous American Broadcaster who always finished his daily broadcast with a signature line, "And now you know the rest of the story" As a former missionary and ongoing radio broadcaster I had heard some of the classic descriptions of "Mission in Africa".  So I embraced this project and looked forward to giving voice and hearing to this story... As I told Dr. Ray when he approached me about this project, "If it is important it must be heard".  And now you have heard the story, and I would encourage you to go now and read it. This has been more than a project, but the rest of the story spoke deeply to me in so many ways.  Yes, good and great and well-intentioned men and women can do much good, but alas there is always a "rest of the story.   Now Dr Ray takes over in full to finish the story and gives us ways to see that the story of them, is in many ways a story about us?  And in classic words, "Let him who has ears, let him hear."  I trust your hearing has changed you, as it has me in speaking. Stan Hustad Narrator  Send Dr Ray your reactions at raymondvdowning@gmail.com. Visit my website at https://globalhealth757.wordpress.com/