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Idly trawling through the internet, you happen upon a short black and white film-clip about Nigeria on YouTube.
The clip suddenly fills your mind with visions of what the Nigerian health system was like seventy years ago.
The narrator is an English Medical Officer who introduces himself as ‘Faulkner’.
As the film opens, Faulkner informs his viewers that his first introduction to the Nigerian system is in Lagos where he has a meeting with the Director of Medical Services, Dr Samuel Manuwa. The date is shortly after the Second World War.
In the footage, Dr Manuwa is a middle-aged man in long-sleeved shirt and tie. He looks quietly authoritative behind his large desk. He welcomes his visitor and proceeds to instruct him on his assignment. The office of the Director of Medical Services is located in a stately old colonial building somewhere on the Lagos Marina.
Faulkner is reporting for duty with another English doctor, whose name is Langdon.
Dr Manuwa rises from his seat and goes to large map of Nigeria mounted on the wall. He explains to each of the men, pointing at the map, the different locations to which he has posted them.
The Nigeria Medical Service, he explains, is decentralized through Regional Offices to Districts, each of which is supposed to have a District Medical Officer. Dr Langdon is to take over a field unit covering a vast swathe of territory in the north of the country. Faulkner, for his part, is deployed to Calabar as District Medical Officer.
The day after the meeting with Dr Manuwa, the two doctors depart Lagos for their new bases. Dr Langdon sets off by train, from Iddo Station, to travel six hundred miles to the North. His travel is guaranteed to be in a reasonably good degree of comfort, riding in a first-class cabin with leather upholstery and tea service, as is appropriate to his station.
Pausing, you reflect that the little snippet showing safe, comfortable travel by rail from one end of Nigeria to the other more than seven decades ago makes nonsense of top government officials in 2019 celebrating with fanfare the ‘commissioning’ of a short stretch of the same railway, as though it were a new invention.
Faulkner and his young family – a wife and a little son named Jonathan, travel to Calabar by air from Ikeja airport. He is going to take responsibility for a service area of approximately four thousand eight hundred square miles, bigger than some countries in Europe.
He finds Calabar – the centre of his assignment in the Creeks District, interesting. The focal point of his work is St Margaret’s Hospital – the General Hospital of the day. There are a few ancillary facilities for maternity cases and infectious diseases dotted around the District.
Dr Faulkner has a one hundred and forty beds at St Margaret’s Hospital, Calabar. He is assisted by thirty-six orderlies, ten nurses, and one European-trained State Registered Nurse who serves as Matron.
The doctor who works in Nigeria, says Faulkner, in his commentary, is Physician, Surgeon, Social Worker, all rolled into one. There is, of course, no anaesthetic equipment, and operations are conducted by spinal injection, pentothal or ‘open drop’ method. Hernias are the majority of surgical cases he sees, and he observes that appendicitis and other surgical conditions common in England appear to be rare in Calabar.
Mrs. Langdon, the doctor’s wife, enjoys running the life of colonial gentry in the family’s spacious residence, abundantly supplied with uniformed Calabar servants.
There is drama when there is an outbreak of cerebrospinal meningitis at the village of Big Qua. Dr Langdon dashes there hotfoot, to be met by the Medical Officer and the District Commissioner, who are already there. Meningitis, the doctor observes, often occurs in epidemic proportions around December, fueled by the heat and dust. The villagers are made susceptible by hookworm-induced anaemia and malaria.
We see footage of Faulkner meeting once again with Langdon – the Medical Officer posted by Dr Manuwa to the field unit in the North of the country. Langdon and his field force of indigenous carriers, many of them trekking barefoot, arrive after walking a long distance through the bush to help to contain the meningitis epidemic in Big Qua.
Dr Faulkner enjoys the social life of the expatriate Englishman in Calabar. In the evenings he and his wife entertain at home on go to the club, where there are ‘more than one hundred and fifty people’ – meaning expatriates.
For perspective, it is necessary to remember that 1948, the year of the film, is the year University College of Ibadan is started. The commissioning of the first Teaching Hospital in Nigeria – the University College Hospital Ibadan, where indigenous doctors would be trained, is a further ten years down the line. Back in Dr Faulkner’s home country itself, the healthcare of the common people is being given a massive boost because the United Kingdom has just introduced a National Health Service. This will provide cost-free access to healthcare for all citizens at the point of need, in effect achieving a Universal Health Care that Nigerians would still be hankering for more than seventy years later.
Dr Faulkner and his fellows enjoy great perquisites, such as a week’s holiday for every month of a tour of duty.
Despite the cushy perquisites, it is a tough, demanding life. Under the direction of Samuel Manuwa, they would lay the groundwork for a colonial health system that is surprisingly comprehensive in its coverage, despite the paucity of boots on the ground. Post-Second World War Nigeria, it emerges from the film, is a relatively safe and well-connected country, with a railway system linking North and South, a working telephone and telegraph service, and a maximized utilization of scarce manpower.
Dr Faulkner, every two weeks, undertakes a tour of all the Health Centres and Dispensaries within his vast territory. He supervises what the ‘paramedical’ staff are doing. If, in his judgment, a particular patient needs close attention, he would take him back with him to St Margaret’s Hospital in Calabar.
Manuwa would later become the Inspector General of Medical Services of Nigeria, a title that, in 2019, no longer exists. It places him very high up in the protocol list of the nation, a reflection of the authority enjoyed by doctors in the scheme of things in 1948.
Manuwa, the first Nigerian to obtain the Fellowship of the Royal College of Surgeons, would be instrumental in the founding of University College Hospital, (UCH)Ibadan. He would also, down the line, be elected as President of the World Federation for Mental Health.
And finally – it is good to reflect on St Margaret’s Hospital, Calabar, a hospital founded by the colonialists in 1897, half a century before Dr Faulkner’s tenure as District Medical Officer. Sad to say, it has been earmarked for demolition by the Cross River State Government. In 2017 a petition-drive was started to persuade Governor Ayade to allow the structure to be retained as a historical monument. The jury, as they say, is still out on the matter.