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East African Doctors: A History of the Modern Profession
John Iliffe. East African Doctors: A History of the Modern Profession. African Studies series, no. 95. Cambridge: Cambridge University Press, 1998. xi + 336 pp. $64.95.
Professor Iliffe describes this timely scholarly study as a "collective biography of East African Doctors" and "not a contemporary sociology of the East African medical profession" (p. 1). It is likely that social scientists will turn here for source material, and they will note the approach to the complexity of professionalism that is central to the book: "the essence of professionalism is ambiguity. It embraces specialized knowledge, altruistic service, thirst for power, and blatant self interest" (p. 3). One might be tempted to emend the adage to "history and (sociology) are biography writ large."
The coverage runs from the earliest training of African staff during the colonial period in the 1870s to the present. The two world wars led to an acceleration of the training, utilization, and emerging professionalism of African personnel. The competitive roles of traditional healers, tribal dressers, hospital attendants, and other paramedics all affected the quest for professional status of a growing body of trained physicians. The book emphasizes the influence of the disruption of the Ugandan government on governmental health services and competing private practice, and the political development of capitalism in Kenya and socialism in Tanzania. [End Page 421]
Makerere Medical School in Uganda is recognized as a training ground for leaders of medical education, practitioners, and political figures in East Africa. There were good years and bad years. The author has clearly set limits to his historical review. My experience as a teacher at Makerere (where I have been a visiting professor, chairman of medicine, and external examiner) leads me to the criticism that his study is faulted by his failure to examine more carefully the features of Makerere education and training during the "golden years," which may now be reflected in the competence of the locally trained African physicians to perform effectively alongside the teams of foreign AIDS scientists. Further, it is regrettable that the rigorous standards of the master of medicine program (M.Med.) were not reviewed, and that the opportunity was lost to interview the recently deceased Sir John Ellis, the preeminent British medical educator, who was a frequent external examiner at Makerere and was instrumental in the Medical Research Council's recognition of the M.Med. degree as equivalent to British higher degrees.
The author would have benefited from a medically trained associate. For example, he would have been more knowledgeable about kwashiorkor, the protein-deficiency disease that is so prominent among Buganda infants because matoke, the plantain, is protein-deficient and the weanlings get so little groundnut sauce--whereas the neighboring Tesot, whose staple is protein-rich millet, are free of the disease. He might have looked more critically at newspaper articles and government reports, such as the claim that "the new Mulago [Hospital] was swamped by Kampala residents with minor complaints" (p. 137). Hospital records of admission diagnoses and deaths--as well as census figures of double crib occupancy and floor cases due to a lack of beds for the critically sick on the adult wards--would have supported the suspicion that such reports were politically tainted. On balance, however, this is a first-rate book, and Professor Iliffe has made an important contribution with his thoughtful analysis and careful presentation of more than five hundred citations.