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Public Health in Papua New Guinea 1870–1939

Public Health in Papua New Guinea 1870–1939 Public Health in Papua New Guinea 1870-1939 By Margaret Spencer. Brisbane: Australian Centre for International & Tropical Health & Nutrition, 1999, 295pp, ISBN 1-86499-365-0. RRP $25. Reviewed by Terry Nolan School of Population Health, The University of Melbourne, Victoria Reviewed by Anthony J. Radford Radford & Associates, Adelaide, South Australia Sir Gustav Nossal writes in his dedication to this unique book that it “will appeal to students, to concerned parents, to decisionmakers in the health field and to a wide lay readership”. Gordon Ada and David Issacs have recognised that there has been a lamentable gap in the availability of a comprehensive and accessible form of something that explains and interprets vaccination. The book begins by giving primer-level instruction in infectious disease and the ontogeny of vaccines and vaccination leading into the modern vaccines in use and their mechanism of action. This is all presented in a way that is readily accessible to an educated lay reader, but at the same time is of sufficient technical detail for the health professional or student. Issues of vaccine safety and the concerns that surround adverse effects of vaccines are also dealt with in an up-to-date and comprehensive way. Recent data that attempts to understand better how parents make decisions about whether to vaccinate their children are reviewed and the context and influence of the anti-immunisation lobby is explored. The second half of the book deals with new approaches to vaccine development and vaccine delivery. In particular, the modern challenges of vaccines against HIV malaria and chlamydia are , explained. Finally, the book takes a broader view of how the vaccination approach as a form of immunotherapy is being exploited in relation to its potential for control of all auto-immune diseases, cancer and human fertility. Together, Ada, as one of Australia’s most widely recognised and accomplished biomedical scientists in the field of immunology, and Issacs, as a clinical immunologist and paediatrician, are well equipped to bring together and integrate brilliantly data from the wide range of diverse fields of biomedical and social science that have an impact on vaccination. This is a book that should be part of every medical student’s primary textbook library. In addition, every general practitioner should use this as both an informative basis for their day-to-day work and as a reference. The price of being comprehensive is that the book is probably somewhat too long to sell to a mass audience; unfortunately, it is unlikely to be the blockbuster it deserves to be! Nevertheless, many interested and concerned parents will find value in the areas addressed in this book, and it should help them in their decision-making around vaccination of their own children. Few people publish after age 80. Fewer still complete and publish their PhD at that age, but Margaret Spencer, an entomologist who spent 25 ‘discontinuous years’ in the country of her research, has done so. Spencer covers the period from the arrival of missionaries in 1870 and spans German, British and Australian colonial jurisdictions. She analyses the issues and activities of the various administrations and Christian missions providing health services to the most linguistically and culturally diverse communities in the world, which experienced (and still do) the highest infant, child and maternal morbidity and mortality in the Pacific. The services were “affected by the considerable constraints of insufficient finance, unfamiliar terrain, unfamiliar peoples and unfamiliar diseases” (xiii), and lack of communication militated against effective logistic support. Until the turn of the century New Guinea was a virgin immunological template. Spencer reviews how the development of towns, mining and plantations provided foci of people that facilitated spread and maintained epidemics, introduced by foreigners, and the subsequent potential dispersal into indigenous villages from the growing settlements and by labourers on their return home. Serious epidemics, which sometimes resulted in a mortality rates of one-in-three and decimation of some villages, are well covered. Effort concentrated on preventing, delaying or controlling the introduction of the epidemic diseases of cholera, dysentery, plague and smallpox, but had little effect on venereal diseases and tuberculosis. Most legislation addressed quarantine and sanitation measures and also related the diet of labour-lines and basic health services. With only quinine for malaria and moderately effective medications for leprosy and yaws, management was largely by isolation. The one trump card available was smallpox immunisation, followed later by immunisation against influenza, bacillary dysentery and whooping cough. As conditions improved, several authors noted the superior physique of plantation labourers compared with that of villagers, where the effect of malnutrition and malaria was more difficult to reverse. On both sides of the island, hospital costs were shared by government employers and labourers, who had to pay 5% of their wages in Papua (cf. 1.75% of ours!), while in New Guinea a portion of the head tax defrayed health service costs. Health expenditure varied from 10% to 35% and was greater than for any other 2001 VOL. 25 NO. 2 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Book Reviews sector. Numbers did not justify, and resources precluded, wide dispersal of doctors. Initially “all Administration officers acted as dispensers of medicines and providers of treatment” (p48). Spencer details the recognition of the need for appropriate training, not only for doctors and medical assistants, but also for government officials and labour managers. In New Guinea, emphasis was placed on medical tultuls – a cadre of indigenous ‘barefoot doctors’ (decades before the Chinese experiment) for village work, while in Papua it was directed more to producing medical assistants. A medical and dental school had to wait for another three decades. One chapter is devoted to the “... very large amount of medical work ... achieved at Christian mission stations” (p39) and the “circles of care” that emanated from them. Their services were often more extensive and more popular than the government alternatives, for which they received significant subsidies. They concentrated on primary medical care, maternal and child health and nurse training, exerting “a wide effect ... [they] came to be exemplars of the principles of personal and community hygiene” (p45). The Rockefeller Foundation funded a campaign against hookworm, one of the few diseases apart from those of the skin for which effective medicine was available. During the 1930s, major epidemics were much reduced, with the exception of polio, and the deadly trio of pneumonia, dysentery and increasingly tuberculosis (responsible for up to a third of hospital deaths). The debate about personal prophylaxis for malaria with quinine continued throughout the period. Although effective as prophylaxis, it was deemed neither feasible nor desirable to do so. The cost alone was three times the health budget. Prevention by control of mosquito breeding sites was instituted as the scientific knowledge about the vectors increased. Both the Commonwealth Department of Health and the (recently resurrected) Australian Institute of Tropical Medicine in Townsville played major roles in advice, survey work and staffing. The dichotomy, even antagonism, between and within the two sectors is well analysed – a difference in administrative cultures that persisted for decades. “Although the problems were [similar] … and the methods adopted to meet them were substantially the same” (p237), the services to address them developed virtually entirely separately. The book would have flowed more easily if it had been presented as two stories with a concluding ‘compare and contrast’ chapter, rather than criss-crossing the island in alternating chapters. Spencer (see especially Chapter 16) gives an interesting review of the debate over the role that Australia might, or should, play in the overview/overseeing of health issues and services in the Pacific, and this is probably the deepest assessment of the 1920s and 1930s period. A policy of gradualism was espoused, with the recognition of the need to improve diet and social conditions, as well as medical services. She also highlights the international recognition of scientific research and development of medical services in early Papua New Guinea, particularly the work of Koch, Cilento (whose excellent summaries appear as appendices), Strong and Cumpston. Spencer’s book is, in part, a response to some of the conclusions of Denoon.1 She concludes that the health services were neither just for the colonialists nor for the labourers working in their commercial endeavours, nor entirely “… to make the welfare of the native population paramount over every other consideration; to do these things without money beyond what could be collected locally and such sums as Australia might be disposed from time to time to grant”. (quoting Lett 1944:99) “possibilities [that] were explored and tried, or discarded” (xiii). This is a very affordable, readable and informed account. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Public Health in Papua New Guinea 1870–1939

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Publisher
Wiley
Copyright
2001 The Public Health Association of Australia Inc
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.2001.tb01848.x
Publisher site
See Article on Publisher Site

Abstract

Public Health in Papua New Guinea 1870-1939 By Margaret Spencer. Brisbane: Australian Centre for International & Tropical Health & Nutrition, 1999, 295pp, ISBN 1-86499-365-0. RRP $25. Reviewed by Terry Nolan School of Population Health, The University of Melbourne, Victoria Reviewed by Anthony J. Radford Radford & Associates, Adelaide, South Australia Sir Gustav Nossal writes in his dedication to this unique book that it “will appeal to students, to concerned parents, to decisionmakers in the health field and to a wide lay readership”. Gordon Ada and David Issacs have recognised that there has been a lamentable gap in the availability of a comprehensive and accessible form of something that explains and interprets vaccination. The book begins by giving primer-level instruction in infectious disease and the ontogeny of vaccines and vaccination leading into the modern vaccines in use and their mechanism of action. This is all presented in a way that is readily accessible to an educated lay reader, but at the same time is of sufficient technical detail for the health professional or student. Issues of vaccine safety and the concerns that surround adverse effects of vaccines are also dealt with in an up-to-date and comprehensive way. Recent data that attempts to understand better how parents make decisions about whether to vaccinate their children are reviewed and the context and influence of the anti-immunisation lobby is explored. The second half of the book deals with new approaches to vaccine development and vaccine delivery. In particular, the modern challenges of vaccines against HIV malaria and chlamydia are , explained. Finally, the book takes a broader view of how the vaccination approach as a form of immunotherapy is being exploited in relation to its potential for control of all auto-immune diseases, cancer and human fertility. Together, Ada, as one of Australia’s most widely recognised and accomplished biomedical scientists in the field of immunology, and Issacs, as a clinical immunologist and paediatrician, are well equipped to bring together and integrate brilliantly data from the wide range of diverse fields of biomedical and social science that have an impact on vaccination. This is a book that should be part of every medical student’s primary textbook library. In addition, every general practitioner should use this as both an informative basis for their day-to-day work and as a reference. The price of being comprehensive is that the book is probably somewhat too long to sell to a mass audience; unfortunately, it is unlikely to be the blockbuster it deserves to be! Nevertheless, many interested and concerned parents will find value in the areas addressed in this book, and it should help them in their decision-making around vaccination of their own children. Few people publish after age 80. Fewer still complete and publish their PhD at that age, but Margaret Spencer, an entomologist who spent 25 ‘discontinuous years’ in the country of her research, has done so. Spencer covers the period from the arrival of missionaries in 1870 and spans German, British and Australian colonial jurisdictions. She analyses the issues and activities of the various administrations and Christian missions providing health services to the most linguistically and culturally diverse communities in the world, which experienced (and still do) the highest infant, child and maternal morbidity and mortality in the Pacific. The services were “affected by the considerable constraints of insufficient finance, unfamiliar terrain, unfamiliar peoples and unfamiliar diseases” (xiii), and lack of communication militated against effective logistic support. Until the turn of the century New Guinea was a virgin immunological template. Spencer reviews how the development of towns, mining and plantations provided foci of people that facilitated spread and maintained epidemics, introduced by foreigners, and the subsequent potential dispersal into indigenous villages from the growing settlements and by labourers on their return home. Serious epidemics, which sometimes resulted in a mortality rates of one-in-three and decimation of some villages, are well covered. Effort concentrated on preventing, delaying or controlling the introduction of the epidemic diseases of cholera, dysentery, plague and smallpox, but had little effect on venereal diseases and tuberculosis. Most legislation addressed quarantine and sanitation measures and also related the diet of labour-lines and basic health services. With only quinine for malaria and moderately effective medications for leprosy and yaws, management was largely by isolation. The one trump card available was smallpox immunisation, followed later by immunisation against influenza, bacillary dysentery and whooping cough. As conditions improved, several authors noted the superior physique of plantation labourers compared with that of villagers, where the effect of malnutrition and malaria was more difficult to reverse. On both sides of the island, hospital costs were shared by government employers and labourers, who had to pay 5% of their wages in Papua (cf. 1.75% of ours!), while in New Guinea a portion of the head tax defrayed health service costs. Health expenditure varied from 10% to 35% and was greater than for any other 2001 VOL. 25 NO. 2 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Book Reviews sector. Numbers did not justify, and resources precluded, wide dispersal of doctors. Initially “all Administration officers acted as dispensers of medicines and providers of treatment” (p48). Spencer details the recognition of the need for appropriate training, not only for doctors and medical assistants, but also for government officials and labour managers. In New Guinea, emphasis was placed on medical tultuls – a cadre of indigenous ‘barefoot doctors’ (decades before the Chinese experiment) for village work, while in Papua it was directed more to producing medical assistants. A medical and dental school had to wait for another three decades. One chapter is devoted to the “... very large amount of medical work ... achieved at Christian mission stations” (p39) and the “circles of care” that emanated from them. Their services were often more extensive and more popular than the government alternatives, for which they received significant subsidies. They concentrated on primary medical care, maternal and child health and nurse training, exerting “a wide effect ... [they] came to be exemplars of the principles of personal and community hygiene” (p45). The Rockefeller Foundation funded a campaign against hookworm, one of the few diseases apart from those of the skin for which effective medicine was available. During the 1930s, major epidemics were much reduced, with the exception of polio, and the deadly trio of pneumonia, dysentery and increasingly tuberculosis (responsible for up to a third of hospital deaths). The debate about personal prophylaxis for malaria with quinine continued throughout the period. Although effective as prophylaxis, it was deemed neither feasible nor desirable to do so. The cost alone was three times the health budget. Prevention by control of mosquito breeding sites was instituted as the scientific knowledge about the vectors increased. Both the Commonwealth Department of Health and the (recently resurrected) Australian Institute of Tropical Medicine in Townsville played major roles in advice, survey work and staffing. The dichotomy, even antagonism, between and within the two sectors is well analysed – a difference in administrative cultures that persisted for decades. “Although the problems were [similar] … and the methods adopted to meet them were substantially the same” (p237), the services to address them developed virtually entirely separately. The book would have flowed more easily if it had been presented as two stories with a concluding ‘compare and contrast’ chapter, rather than criss-crossing the island in alternating chapters. Spencer (see especially Chapter 16) gives an interesting review of the debate over the role that Australia might, or should, play in the overview/overseeing of health issues and services in the Pacific, and this is probably the deepest assessment of the 1920s and 1930s period. A policy of gradualism was espoused, with the recognition of the need to improve diet and social conditions, as well as medical services. She also highlights the international recognition of scientific research and development of medical services in early Papua New Guinea, particularly the work of Koch, Cilento (whose excellent summaries appear as appendices), Strong and Cumpston. Spencer’s book is, in part, a response to some of the conclusions of Denoon.1 She concludes that the health services were neither just for the colonialists nor for the labourers working in their commercial endeavours, nor entirely “… to make the welfare of the native population paramount over every other consideration; to do these things without money beyond what could be collected locally and such sums as Australia might be disposed from time to time to grant”. (quoting Lett 1944:99) “possibilities [that] were explored and tried, or discarded” (xiii). This is a very affordable, readable and informed account.

Journal

Australian and New Zealand Journal of Public HealthWiley

Published: Apr 1, 2001

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