Progress through Progress through CooperationCooperation

The Rockefeller The Rockefeller Foundation and Foundation and

International HealthInternational HealthSoma Hewa

2004

History Through the History Through the Camera LensCamera Lens

The following slide show presents two contrasting stories in the history of Sri Lanka:

• The impact of the British colonial labor practices on the health of South Indian migrant workers on the plantations, and the people of Sri Lanka in general.

• The role of Rockefeller philanthropy in the development of public health in Sri Lanka during the first half of the 20th century.

A Group of Workers in A Group of Workers in India Waiting to Leave for India Waiting to Leave for

Sri LankaSri Lanka

When the British established the plantation economy in Sri Lanka in the late 19th century, they recruited labor from Southern India. By the late 19th century, about 100,000 workers plus their families arrived annually in Sri Lanka.

Sri LankaSri LankaAn Island Nation, South of An Island Nation, South of

IndiaIndia

Workers came by boats to the northwest coast of Sri Lanka; from there, they walked for about two weeks to the plantations in the central part of the island.

Migrant Workers on a Tea Migrant Workers on a Tea EstateEstate

in Sri Lanka in Sri Lanka

Entire families worked on the plantations, and children started working as early as six years of age. Because of the economic interests of the planters and the abundance of cheap labor in India, planters were reluctant to provide even the most basic facilities for these workers on the plantations.

Typical Living Quarters (Lines) Typical Living Quarters (Lines) of the Migrant Workers on the of the Migrant Workers on the

Tea PlantationsTea Plantations

The workers lived in barrack-like “lines,” and as many as 12 people lived in a room 8 by 10 feet. The most unhealthy aspect of these living conditions was that the lines were not provided with latrines. The planters maintained that the “workers would not use them” even if they were built.

A BirdA Bird’’s Eye View of a Lines Eye View of a Line

There were no windows in the rooms and the verandahs were boarded up to keep out the drenching monsoon rains, a practice that also kept out much needed light.

A Tea FactoryA Tea Factory

A tea factory built with solid materials with large windowson the hill side of central Sri Lanka.

Several Families of Migrant Several Families of Migrant WorkersWorkers

in Front of the Linesin Front of the Lines• Note the muddy

surroundings in which the barefoot children were playing.

• Without adequate sanitary facilities, the workers and their families encountered a wide range of parasitic and infectious diseases.

• Of these diseases, hookworm infection (Anchylostomiasis) was the most widespread on the plantations.

Hookworm InfectionHookworm Infection• Hookworms are tiny parasites about one-half of an inch in

length. Although parasitic in the bowel, the worms enter the human body through the pores of the skin when they come in contact with soil polluted by human excreta.

• Victims of hookworm infection suffer from under-nutrition, anemia, and lassitude. Drained of blood, they are too weak to resist new infections, which usually cause their death.

• By the late 19th century, hookworm infection was a common health problem in many of the British colonies.

The hookworm disease was endemic in the darkened regions of the map.

A Severely Infected WomanA Severely Infected Womanon a Tea Estateon a Tea Estate

This 20 year old woman is at the last stage of the disease showing considerable swelling of her entire body.

Severely Infected ChildrenSeverely Infected Childrenon a Tea Estateon a Tea Estate

These two young children are at the last stages of the disease.

First, the victims become severely swollen and then they become emaciated and die.

Deaths from Hookworm Deaths from Hookworm DiseaseDisease

Island Wide vs. PlantationsIsland Wide vs. Plantations

Year

Deaths Per Million

The Rockefeller FoundationThe Rockefeller FoundationMen of VisionMen of Vision

John D. Rockefeller, Sr. Frederick T. Gates Wickliffe Rose

“Disease is the supreme ill of human life, and it is the main source of almost all other human ills – poverty, crime, ignorance, vice, inefficiency, hereditary taints, and many other evils.” Gates, 1912

The International Health Board The International Health Board (IHB)(IHB)

““Henceforth, Thy Field is the Henceforth, Thy Field is the WorldWorld””

• In the early 20In the early 20thth century, John D. Rockefeller, century, John D. Rockefeller, Sr. became interested in hookworm disease Sr. became interested in hookworm disease when it was a major health problem in the when it was a major health problem in the American South.American South.

• Rockefeller and his advisor, Fredrick T. Gates, Rockefeller and his advisor, Fredrick T. Gates, devised a plan to address the problem with a devised a plan to address the problem with a $1 million contribution.$1 million contribution.

• The experience in the American South The experience in the American South encouraged them to extend the work to other encouraged them to extend the work to other countries, and the IHB was born.countries, and the IHB was born.

• Wickliffe Rose, secretary of the IHB, Wickliffe Rose, secretary of the IHB, developed a plan to take the hookworm developed a plan to take the hookworm campaign to the British colonies, where the campaign to the British colonies, where the disease was rampant.disease was rampant.

Rockefeller PhilanthropyRockefeller Philanthropyin Sri Lankain Sri Lanka

• The IHB began its hookworm control campaign The IHB began its hookworm control campaign in Sri Lanka in 1915.in Sri Lanka in 1915.

• The planters and the Colonial government The planters and the Colonial government initially opposed American involvement in the initially opposed American involvement in the Island, but later conceded when they were shown Island, but later conceded when they were shown the economic benefits of a healthy labor force.the economic benefits of a healthy labor force.

• The Rockefeller doctors carried out treatments The Rockefeller doctors carried out treatments on the plantations and insisted that the planters on the plantations and insisted that the planters should build adequate sanitary facilities for the should build adequate sanitary facilities for the workers in order to prevent re-infections.workers in order to prevent re-infections.

• The planters showed very little enthusiasm for The planters showed very little enthusiasm for the project as shown in the shoddy construction the project as shown in the shoddy construction of latrines. of latrines.

A Latrine Constructed During A Latrine Constructed During Hookworm Campaign on a Tea Hookworm Campaign on a Tea

PlantationPlantation

Latrines constructed with temporary materials lasted only a few weeks resulting in recurring soil pollution and re-infestation with hookworms.

Latrines Built During Latrines Built During TreatmentTreatment

Another example of latrines built with jute bagging and jungle sticks in a tea estate. The tea factory is seen behind the latrines.

Re-Infection of HookwormRe-Infection of HookwormBecause of the Lack of Proper Because of the Lack of Proper

LatrinesLatrinesRate of Re-Infection

Because of the high rate of re-infection due to the lack of cooperation on the part of the planters, the IHB withdrew from the plantations in 1922, and began its work in the surrounding villages and towns.

The IHB in Towns and Villages: The IHB in Towns and Villages:

A Hookworm Demonstration A Hookworm Demonstration OfficeOffice

• Educational campaigns to prevent hookworm infection relied on demonstrations, public lectures and films.

• Local support was the key to successful public health campaigns in towns and villages.

Communities Supported the Communities Supported the IHB IHB

A Group of Village HeadmenA Group of Village Headmen

These men received certificates of merit for their role in hookworm treatment programs in their

communities.

Kalutara Health Unit Office, Kalutara Health Unit Office, 19261926

Encouraged by the local support, the Rockefeller Foundation established a community-based primary care program known as Health Units. The first health unit, established in 1926 at Kalutara, provided training for public health personnel for the RF’s programs in South and South-East Asia.

Dr. S. F. Chellappah

Dr. W. P. Jacocks

Authors of the Health Unit Program in Sri Lanka

Standing: Dr. de Simon,Dr. Jayatilleke,Dr. Fernanado.

Sitting: Dr. Kuriyan, Dr. Sweet, Dr. Docherty, Dr. Gottlieb, and Dr. Jayaram.

The Health Units program was developed by Sri Lankan and Rockefeller doctors in view of local health needs. It received broad public support, and was later introduced to other countries in the region.

Local and Foreign DoctorsLocal and Foreign DoctorsInvolved in the Health Units Involved in the Health Units

ProgramProgram

Mothers and Children Mothers and Children Attending a Clinic at the Attending a Clinic at the

Kalutara Health UnitKalutara Health Unit

Health Unit activities included the collection of vital statistics, health education, control of communicable diseases, immunization of children, hookworm treatment, malaria control, school hygiene, maternal and child welfare, and a range of public sanitation services in local communities.

The Malaria Control CampaignThe Malaria Control Campaign

One of the major programs sponsored by the Rockefeller Foundation was malaria control work. Malaria was a scourge in Sri Lanka during the early 20th century.

From a Community Project to a From a Community Project to a National InstituteNational Institute

The Kalutara Health Unit was expanded in the 1960s with modern facilities creating the National

Institute of Health Sciences (NIHS)

National Institute of Health National Institute of Health SciencesSciences(NIHS)(NIHS)

Today, the NIHS is the premier training center of public health personnel for Sri Lanka’s primary

health care services.

TrainingTrainingCommunity Health ServicesCommunity Health Services

ResearchResearch Medical Medical ServicesServices

Background research materials:Background research materials:

Soma HewaSoma HewaColonialism, Tropical Disease and Imperial Colonialism, Tropical Disease and Imperial

Medicine: Rockefeller Philanthropy in Sri LankaMedicine: Rockefeller Philanthropy in Sri LankaUniversity Press of America 1995University Press of America 1995

Written and Produced by:Written and Produced by:

Soma HewaSoma HewaAudio Visual DesignAudio Visual Design

Elizabeth Moravec HewaElizabeth Moravec Hewa

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

Photographs and other archival materials courtesy of:Photographs and other archival materials courtesy of:The Rockefeller Archive Center, New YorkThe Rockefeller Archive Center, New York

National Institute of Health Sciences, Sri LankaNational Institute of Health Sciences, Sri Lanka