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(b) Prevention of diseesea of affluence essociated with increese in gtandard of living
snd elteration of lifestyle will involve major emphasis trt individual and community decisioi
making.
The perspective will be developed by looking backwards and highlighting certain
problem conditions that give an understanding of the extent of ill heelth anO its causes and
insighis into nethods developed for dealing with these. Sorne of the changes thet have
become important - migration, urbanization, sociel change end health consequLnces will be
described together with factors relating to the future. Finally the question will be ssked
whether the World Health Organization goal, 'rHealth for All Uy tfre year 2000r', is likely to
be achieved.
The past
5-M- Lambert, author of 'rA Drctor in Paradiser', commenced working for the
Rockefeller Foundation on their programme of hookworm eradication in papua NLw Guinea
from l9I8 to 1921 and then between 1922 nd l9l5 in other parts of the pacific including
Fiji' the Gilbert and Ellis Islands, Tmga, Western Samoa; the Cook Islands and lhe Solomon
Ielands (Lambert, f94f). This book contains a wealth of knowledqe concerning the people of
these eountries and their health status and how ef f ective Jommunity bsed treatment
programmes were undertaken with Chaulrnoogre oil and a laxative for hookworm infections
tnnrytogtome duodenale) and also for yaws using intravenous salvarsen.
Dr Lambert put f orward and tested an important hypothesis thaL related ro the
devastating effect which visitors from outside had in production of virgin and first encounter
epidemics and their intensity. This can be well illustrated from two exlracts from this book.
He was in Papua in 1921, visiting a Catholic Mission Station where Kuri were the
indigenous people. Father Chabot said: "before the mission carne this district had dwindled to
less then two thousand. TfE Kuris would have .disappeared if we had not discouraged
cennibeliemr infanticide and abortion.r' '{ wondered if the good priests were not fooling
themselves. Abortion end infanticide may reduce a population, but cannibalism and continued
tribal warfare may be blessings in hideous disguise. They keep the tribes apart. Werfare is a
sort of rough quarantine. In times of peace strangers wander in and out, and bring infections
with them. Native races die off not through theii own suicidal customs, but throu-gh diseases
introduced from the oulside world.'r
In New Guinea he was in charqe of the Rabaul Hcpital for a period in l92l and [he
following extract iltustrates how hiJ knowledge of the fear of mutilation which the New
Guinea natives had was used by him to help control Lhe treatment of influenza epidemic
patients.
'11 had returned from field work and found the native hospitat filled with flu cases;
many were dying in the collapse from pneumonia. The sudden deaths among seemingly mild
cases puzzled rne, until I probed the cause. Our native attendants hated to loie sleep;-ar roon
as they were snoring, the sick rnen, hot with fever, would sneak out from a side door and go
down to lie in the sea and cool off under the stars. They would sneak back Lo bed and die of
shock.
I put a stop to all that.. NaLive attendants had told them how I slit open dead men's
bellies. (l had performed thirty post mortems to determine the average native content of
whip-worms). My ogreish fame had spnead among a simple folk who *oJto far rather lose a
life tharr a leg. To them I was master of life and death - and the post-mortern table.
Therefore I profited by my foul reputation and marched through the ward brandishing a
'-.large amputation knife, and as I passed along rows of quaking cots I shouted: 'Supposu yor-no
atop elong bed, you sons of bitches, suppose you no takim medicine good feller, now you die
finish' me cuttim belly belong altogetherr.ne cuttim heart, nre cutt-im wind, ne cufiim gut
belong you feller. But suppose you good feller altogether, now you die finish, rE no cutt-im
you.ttt
He spoke to them very sternly and his mana was zuch that no more night wandering
occurred. This clearly illustrates the extraordinary "power" of the doctor in zueh societiei
and the insights they must have of the people and their customs and beliefs.