Dear Editor,
The history of health and disease in Guyanese historiography is a neglected area of research. It is for this reason that Dr Ramesh Gampat’s recent two-volume book, Guyana: From Slavery to the Present (Volume 1: Health Systems and Volume 2: Major Diseases) is a major advancement in knowledge about public health ideas and systems since the time of African slavery and Indian indenture in Guyana. Previous books and papers have touched on aspects of Guyana’s public health systems and diseases, and more recently a very limited number of peer-reviewed papers relevant to health and disease have been published, although study designs and methods, diminish enthusiasm for quality and significance. However, to my knowledge, no previous book has been entirely devoted to the subject of health and disease stretching from slavery to present. Dr Gampat’s book is a major work. It is supported with a rich repository of endnotes, references, quotes from historical documents, policy ordinances, tables and charts, analyses and interesting perspectives. There is an attempt throughout the book to demonstrate how diseases were radicalized; Volume 2 contains three chapters on malaria and another that calls attention to the public health implications of gold mining, the use of mercury and malaria.
Dr Gampat, who hails from the Essequibo coast, is a distinguished economist who has worked and travelled extensively in Asia as part of his previous work with the United Nations Development Programme. This book has benefited considerably from his economist lens applied to public health. An interesting element of the book is that it offers an insight into rudimentary epidemiological techniques and scientific research in British Guiana. Dr Gampat’s book not only provides an excellent historical survey of events, policies, interventions, and issues related to colonialism and culture, it also challenges established assumptions and raises new questions.
The book amply highlights the filth, poor sanitation, diseases, high adult and infant mortality rates prevalent during slavery and indenture, and the ongoing problems today. Rubbish was dumped into rivers as is still the case today. Governor after governor passed ordinances to deal with health crises, but it was only in 1847 that a rudimentary form of medical care took root in the colony. That year Ordinance No 4 required planters to bear the cost of medical care for plantation immigrants. This led to the construction of hospitals on estates that resulted in a more systematic approach to medical care. The next major advancement came with the setting up of state hospitals in Georgetown (Demerara), New Amsterdam (Berbice) and Suddie (Essequibo). A dietary scale was also introduced, one of which was labelled the “coolie diet.”
Using innovative quantitative estimation techniques, Dr Gampat tried to estimate the nutrient content of the plantation hospital diet as well as the diet of indentured Indians using the USDA database of foods and nutrients. While I think it is a very innovative approach, several methodological issues plague this estimation. Nevertheless, to my knowledge this is the first time such an estimate has been done and it should provide a window into the caloric and nutrient composition of British Guiana’s plantation hospital diet and the diet of Indians at least up to the end of Indian indenture in 1917.
There are also clues in Dr Gampat’s book about how health was used by the colonial authorities and plantation medical doctors to stigmatize voiceless indentured Indians. During the 19th and 20th centuries Georgetown’s milk supply was a public health issue. Indian vendors, who controlled the milk industry, were seen as filthy and contaminating the milk supply with “sewage” that caused disease. Once again it was the Europeans who were the experts, their audience Europeans, and the “coolies” inert objects of scrutiny and investigations. This narrative was important because it shifted attention away from the “abysmal sanitation” problems in Georgetown that were the underlying reason for diseases. Milk supplied by the Indians became the convenient scapegoat.
An interesting aspect of the refinement of public health during colonialism in British Guiana was the several policy attempts to improve the health systems. Commissions of inquiries documented incompetent medical personnel and breaches of medical practice on several plantations. Medical transparency in the form of data collection and analysis were a feature of plantation medicine. “Registers” and “casebooks” were important sources of data. Disease incidence and prevalence rates, although crude, were made available. These records would also provide insight into how diseases were viewed prior to the advent of the germ theory of disease in the 1890s. We now know that improvements in sanitation and nutrition, not medications and surgical interventions, then, as is the case today all over the world, are the main drivers of disease etiology, disease prevention, and longevity.
In a desperate effort to reduce high mortality rates, especially infant mortality in Georgetown, a sewerage disposal system was built. This move is an example of innovative infrastructural public health advancement. This sewerage system was designed by Howard Humphrey and Sons and was first commissioned in 1929, discharging in the mouth of the Demerara River. The sewerage network remains largely unchanged today since it was first completed in 1929. This is a sad reminder of public health “progress” since independence.
In today’s post-colonial Guyana, medical practice is largely devoid of epidemiological investigations across the health-care spectrum, including, for example, for malpractice, exposure to harmful diagnostic radiation, utility of diagnostic testing, and data systems. The lack of scientific research relating to health and disease in Guyana today is terribly unfortunate considering that people like Dr George Giglioli in the 1920s to 1960s did pioneering research to identify the mosquito species that carry malaria, conducted trials with DDT against malaria, and played an important role in attempts to control malaria with DDT.
Both Volumes 1 and 2 of Dr Gampat’s book have demonstrated that colonial power not only sought
capitalistic enterprise and natural resources, it also used imported “souls” in the British Guiana expansion and consolidation scheme. In the process, diseases had to be attenuated and sanitation improved. Colonial rule also eventually led to structural changes linked to public health improvements. It is unfortunate in 2015, our “modern Guyana” has the same, unchanged, sewerage system built in 1929 (in Georgetown), virtually no public health epidemiological research, and no known system to account for quality of care or medical malpractice. I only hope that the health system becomes more transparent and data become publicly available for analysis and hypothesis testing. Only when the data is allowed to speak can advances be made. Dr Gampat’s book is also a timely reminder of this public health need. Public health professionals, epidemiologists, economists, physicians, nursing professionals, historians, and academics would find Dr Gampat’s book very important. The book is available on the world-wide web from such places as Amazon.com.
Yours faithfully,
Dr Somdat Mahabir