December 14, 2017

Speak! She Is On Her Ears

The extraordinary Gold Coast life of Dr. Cicely Delphin Williams (2 December 1893 – 13 July 1992)

When you open your heart to be cleaned by fingers that are not yours and it does not happen, life snores. That was the life of Dr. Williams for two continuous years. She had entered Oxford University as a 19-year old. She deferred her course and traveled to her native Jamaica to be with the parents after massive, quick succession earthquakes and hurricanes hit the Caribbean nation. But in 1916, she returned to Oxford as a medical student. She got to study medicine because there was dearth of male physicians due to World War I. When she had qualified and worked for two years, the war was over. Male physicians were returning home and it meant that female physicians like her were effectively unemployed.  In 1928-1929, she took and completed a course at London School of Hygiene and Tropical Medicine. All the while, waiting on the Colonial Medical Services to post her home, to Jamaica.

The wait came to an end. Well, not to the expected end. Against her hopes, she was posted to Gold Coast, now Ghana as ‘Woman Medical Officer concerned with maternal and child health’. Her role was to ‘handout advice in clinics, and treat acutely ill infants in hospital’. In her two year work at Queen Elizabeth Hospital for Children, Hackney, she specialized in pediatrics. She was to work as any physician would but her grade was meant to put her below male physicians and also, restrict what she could do. She came to the Gold Coast in 1929.

Earlier in 1915, Dr. F.V. Nanka-Bruce, a Gold Coast physician had alerted the colonial Government about the high rates of maternal and child mortality in the colony. He spoke of the need for a specialist hospital that would tackle this problem. A decade after, in the reign of Governor Sir Gordon Guggisburg, Her Highness Princess Marie Louise, granddaughter of Queen Victory, queen of the British Empire visited the colony and laid the foundation stone for a specialist facility. The facility was commissioned in 1926 and was named after her.

It was at the Princess Marie Louise (PML) Children’s Hospital that Dr. Williams was to work and serve the people of Accra.  She quickly endeared herself to the people. At a point, police had to be called in to control the mothers and patients when she opened a new facility at Koforidua. Such was her renown in the Gold Coast.   Even though she was critical of certain traditional practices, she studied and listened to the people carefully. She loved and treated them with compassion. She was strong-willed and tough in what she wanted to do.

At PML, she introduced proper record keeping. She sent nurses to visit patients in their various communities.  She also initiated programmes to educate mothers on nutrition and proper childcare.  She sought to combine preventive care with curative practice. Her superiors viewed it as she working outside her job. Her unifying theme was the need for civilization which was enlightened but paternalistic as Guggisberg’s.

In 1931, she noticed that children were getting sick for no clearly defined reason. The children were showing symptoms of a wasting disease. She began to conduct research into possible causes. She ruled out food poisoning and infection through insect vectors. She began performing post-mortem surgery on the deceased children.  There was no antibiotics available. She was infected with haemolytic Streptococcus bacterium at a point.

She consulted medical textbooks on her findings. It jumped at her that nothing like that had ever been described before. In 1932, she published her report in a department periodical. Startled by the findings, her teacher at Queen’s Hospital advised her to submit the findings to the more prestigious journal, Archives of Disease in Childhood. She did and got her article published in 1933. Her article included photographs of children that had distribution of darkened and peeling skins.

Dr. H. S. Stannus who had worked earlier in Malawi and was considered an authority on nutritional diseases in Africa responded. He said that Dr. Williams was in error. The latter had associated the disease with maize diet. Dr. Stannus said that what Dr. Williams was seeing was pellagra.

Dr. Williams had heard Kwashiorkor from nurses, and mother and grandmothers.  They explained to her to that it was a ‘disease of the deposed child’ which occurs when a mother weans a toddler abruptly on the arrival of a new baby. The people had known the disease and called it by its right name for a very long time. Armed with this, Dr. Williams gathered further sixty cases in a Lancet article published in 1935. She again included micrographs of liver and skin. For the first time ever, Kwashiorkor was introduced to the medical lexicon and she contrasted it with pellagra. Again, Dr. Stannus responded. He was not particularly enthused about the ‘native’ word.

Dr. Williams then went on to look for cure. She wrote ‘As maize was the only source of the supplementary food, some amino-acid or protein deficiency cannot be excluded as a cause’ in her 1933 paper. She tried various diet combinations. What achieved modest success was Nestle’s tinned milk. She was on a drive to promote. The governor was, however, disinterested because Nestle is not a British company.  Dr. Williams would later in her career, change her mind about tinned milk.

Following an argument with Dr.  G. S. Selwyn-Clarke, the then Deputy Director of Health Services, Dr. Williams was transferred from the Gold Coast to Singapore. Dr. Williams had admitted a patient with non-infectious tubercular peritonitis. The deputy director decided to exclude the patient. It was faced with protest from Dr. Williams.

Whilst Dr. Williams was on vacation in England, when she had gone to complete her MD thesis after six years in the Gold Coast, the news reached her. She departed from the Gold Coast without her belongings and medical notes.  Really, it was more ideological war than it was about the patient.

It would take more than two decades for the medical world to acknowledge her ‘discovery’ as a new disease. That was even to lend a new debate. Dr. Williams would chuckle and say ‘these men in Harley Street couldn’t believe you unless you wore stripy trousers.’