Fundamento para muestreo de sangre para medición de los biomarcadores

Influenza arrived in the Gold Coast at a time when the country was totally unprepared to deal with the disease. The demands of war had reduced medical staff in civilian hospitals to skeleton levels. The sheer scale of the pandemic forced the colonial and local authorities to undertake everything reasonable to combat the pandemic. Generally, the measures

undertaken by local authorities comprised the provision of medical and nursing relief, food and other supplies, arrangements for burial of the dead and increasing the capacity of hospitals and transport of the sick. This work was usually done through voluntary organised committees (Ministry of Health, UK (1920)). Containing and stopping the disease spread was tried on many occasions through various measures. However, since colonial physicians did not really understand the disease in terms of what was causing the influenza it was difficult to arrest its progress or treat its victims.

Public health measures, such as quarantine and other preventive measures were implemented but failed to contain the outbreak. The medical officer in Accra, upon being informed about influenza on the S.S. Shonga, quarantined the vessel, but ended this after cases were found elsewhere. In other circumstances, quarantine worked. For example, authorities at a prison camp in Saltpond quarantined 13 of the 30 prisoners who had influenza. They were put in a large, dark cell and given a mild diaphoretic and expectorant mixture, and all recovered.²⁶ The rest of the prisoners did not develop influenza. In Kumasi, the capital of Ashanti, the medical officer proposed quarantine in many areas of the town after the disease struck.

However, it was too late and did not work. The Chief Commissioner of Ashanti and his Provincial Medical Officer wanted to stop railroad passenger traffic into Kumasi, or at least to halt third class passengers and inspect all others (Patterson, 1983). However, closing the roads and the courts had no effect. The attempts to cordon off the northern territories from Ashanti did not receive support among the natives. Nevertheless, quarantine and segregation were implemented to the extent that, not only did they close schools and ban public meetings, but they also restricted police and clerical workers from doing their duties. In the northern territories and Ashanti, the administration constructed fences around infected towns, placed markets outside their borders and directed traffic to alternative trade routes.²⁷ The volume of trade and the probability that police barriers would be avoided made such a policy totally impractical (Patterson, 1983).

The most serious attempt to maintain quarantine was at Lome, then under British occupation, although neither the Senior Medical Officer at Lome nor the local military commander had much hope that quarantine would work. Even so, strenuous measures were taken to protect

26 PRO, CO 98/30 MSR, 1918 pp9.

27 MSR (1919), Report on Ashanti for 1918, Gold Coast, Government Press, Accra; See Grischow (2006).

the city and the troops being trained there.²⁸ As noted by Patterson (1983), the fifty-seven known cases, plus the suspected cases, were isolated; road and rail traffic was halted; ship passengers were subjected to medical inspections; schools and churches were closed;

meetings were banned; troops were confined to barracks; and medical advice was dispensed through the chiefs. In Larwa, Tumu and Wa, one third of the patients were relocated to new huts on the fringes of the infected villages, and larger towns and villages were completely cordoned off (Grischow 2006). Food, water and necessary supplies were placed outside the camps and only the attendants could come out to collect these items for the patients inside. In many circumstances, chiefs were instructed to build isolation camps, ban large meetings including funerals, block the movement of infected people, burn their clothes and fumigate their houses.²⁹

There were also attempts by district commissioners to protect their constables and station workers by keeping them out of towns (Patterson, 1983). These actions were based on the idea that infected persons posed a serious danger to others, and because colonial officials believed that the disease spread along lines of communication (Grischow, 2006). It was not until later, when they began to consider that influenza could not be stopped that quarantine faded. The officials in Accra also realised that quarantine measures were useless and needlessly disruptive and should not be attempted any further (Patterson, 1983). Despite giving up strict quarantine, local officials sometimes continued to restrict gatherings and most schools were closed. Justification for this, especially in schools, was to restrict transmission among students and allow vacated school buildings to be used as emergency hospitals. The efficacy of closing schools, borders and gatherings is still debatable even today. The manner in which quarantine was implemented stimulated an issue of social order which will be discussed in Chapter 9.

Due to the war there were also few doctors and health officers and very little care for a large fraction of the influenza victims; recruitment was not possible.³⁰ The staffing situation was particularly grim during the pandemic, as evidenced by Governor Clifford’s frantic telegram

28 SMO, 12 October, 1918; See Patterson (1983).

29 Dalziel (1920), Memorandum on cerebrospinal fever in the Northern Territories of the Gold Coast and Ashanti: Gold Coast Sessional Paper 6 of 1919-1920, Government Press, Accra; See Grischow (2006).

30 Gold Coast Departmental Reports (1919), Report on Ashanti for 1918, Government Press, Accra.

informing the colonial office in London that no medical professionals were available to respond to the pandemic.³¹ In addition to skeletal levels of medical staff, there are no records to suggest decentralisation in administering control measures. Colonial administrators did not engage chiefs or traditional healers for managing and controlling the disease as an alternative to offset the shortage of medical staff and ineffective drug therapy.

In many parts of the country, the already dysfunctional and dislocated public health system contributed to the poor colonial response to the pandemic. Medical aid was unavailable, or one medical officer would look after a large group of patients.³² In the northern territory, one medical doctor covered more than three districts at once, even when he was not well.³³ A few medical officers were available for the Eastern Province, but did not have a government doctor. Medical officers were stationed at Tamale, Wa and Gambaga. No medical officers were stationed in any of the other districts, of which there were eight, excluding Yendi. One medical officer was stationed at Yendi because of its strategic trade position and vibrant market system serving the southern parts of the protectorate; also because it was the capital of Dogomba in the Northern Province of the Gold Coast, once a Germany territory. The acting provisional medical officer expressed concern that seven of those stations had Europeans and that there was a desperate need for medical officers to oversee the Europeans’ welfare.³⁴

The Principal Medical Officer in Accra attempted to temporarily recruit private native practitioners to be posted in other towns, but the few physicians who were approached refused the assignment, pleading family responsibilities and other pressing business (Patterson, 1983). Others declined the assignment or refused to serve in other parts of the country because there was too much money to be made in Accra at that time. African physicians were less likely to be relocated or even work overtime because of the deep resentment against discriminatory practices within the colonial medical service (Patterson, 1983; Gale, 1973).

31 Grischow (2006); Principal Medical Officer to Colonial Secretary, 20^th October, 1918, NAG Acc no. 2753/58.

32 Gold Coast Departmental Reports (1919), Report on Ashanti for 1918, Government Press, Accra, 1919.

33 The Zuarungu Diary, 5 December 1918, NAG ADM 56/1/223.

34 PRO, CO 98/32, Northern Territories Annual Report For 1919, Gold Coast: Government Press, Accra, 1920.

While the colonial administrators tried to do all they could to respond to the outbreak, very little could be achieved. The lack of medicines equally frustrated their efforts. The available medical officers in different territories of the Gold Coast appealed for effective medicines and for instructions on how to treat influenza, but neither their colonial administrators nor the colonial office in London had much to offer (Patterson, 1983). The best advice given was that people should avoid contact with influenza victims and stay in their houses. The sick were equally advised to stay inside rather than moving about in the breeze (Patterson, 1983).

Cough medicine, if available, could be given if required, but it was obviously ineffective.

What worked best, as noted by the medical officer for Ashanti, was ensuring that patients were kept comfortable. However, patients were not always cooperative. For instance, in Tumu District, people insisted on walking around in the sun with high fevers, refusing to lie down for fear that they would die.³⁵ Many people supposedly moved about in search of miracle medicines. Patients were seen consulting African healers and private physicians, but their expertise was equally ineffective.

In the long-term the authorities became aware that little could be done. Although this was the case, the government was heavily criticised in the Legislative Council (an arm of the government) for not doing more to educate the public. Many Ghanaians were highly critical of the medical department’s performance, especially in Keta, where they publicly accused the government of callousness; and many others were bitter about the shortage of physicians (Patterson, 1983). The colonial administration was denounced for its lack of interest in training African physicians, its poor contribution to the health of the native population, and its discriminatory practices which protected European physicians and populations.³⁶