The Blessings of Medicine? Patient Characteristics and Health Outcomes in a Ugandan Mission Hospital, 1908–19701

Abstract

Summary This article sheds new light on the impact and experience of western biomedicine in colonial Africa. We use patient registers from Western Uganda’s earliest mission hospital to explore whether and how Christian conversion and mission education affected African health behaviour. A data set of 18,600 admissions permits analysis of patients’ age, sex, residence, religion, diagnoses, duration of hospitalisation and treatment outcomes. We document Toro Hospital’s substantial geographic reach, trace evolving treatment practices and highlight significant variation in hospital-based disease incidence between the early colonial and early postcolonial periods. We observe no relationship between numeracy and health outcomes, nor religion-specific effects concerning hygiene-related infections. Christian conversion was associated with superior cure rates and shorter length of stay and with lower incidence of skin diseases and sexually transmitted infections (STIs). However, our findings indicate that STI incidence was linked to morality campaigns and that clinicians’ diagnoses were influenced by assumptions around religious groups’ sexual behaviour.

Historical Legacies and African Development

“…5 Innovations in digital camera processing, computing technology, and text analysis allowed historians to collect historical micro data; for example, missionary marriage and baptism registers, military records, soldier recruitment rolls, wages, hospital patient records, and colonial tax-collection archives. See, among others, Frankema and van Waijenburg (2014), Jerven (2014), Moradi (2009), Meier zu Selhausen and Weisdorf (2016), and Doyle, Meier zu Selhausen, and Weisdorf (2018). 6 Fuchs-Schundeln and Hassan (2015) offer a thorough overview of natural experiments in macroeconomics; Diamond and Robinson (2010) provide a collection of historical natural experiments.…”

Sex and the mission: the conflicting effects of early Christian missions on HIV in sub-Saharan Africa

“…Two links emerge. First, missions are tightly linked to the development of modern medicine in sub-Saharan Africa, which may have helped contain the epidemic through: (i) the investments themselves, as medical centers persisted [Doyle et al (2018)] and medical campaigns aimed at diffusing information, family planning, screening, and distributing anti-retroviral may have helped contain the disease and (ii) the early treatment against other STDs that increase the risk of HIV contagion may have similarly done so. Second, missions, as they changed religious and cultural practices, may have affected HIV.…”

“…4 Second, even without infrastructure persistence, a healthier population in the past can have slowed the spread of HIV because other sexually transmitted diseases (STDs), such as syphilis, greatly increase the likelihood of contagion. 5 These diseases were already known, public health campaigns were designed to prevent them, and treatments against the disease or their symptoms started improving from the early 20th century [de Sousa et al (2010), Doyle et al (2018)].…”

“…Medical missionaries, in fact, were extremely active in the diagnosis and treatment of many conditions, in particular STDs. Exploring the specific case of the Uganda mission-hospital, Doyle et al (2018) present the continuous efforts to diagnose and treat syphilis and other related STDs both for Christians and non-Christians, throughout the colonial period and after independence, when the missionary hospital was nationalized. The missionary doctors' efforts in the containment of STDs are likely to have mattered, as STD-related genital ulcers have been shown to be catalyzers of the early spread of the HIV epidemic [de Sousa et al (2010)].…”

Who Writes African Economic History?

“…Doyle et al (Doyle et al 2019) reveal, for example, how African patients were over-diagnosed with sexuallytransmitted diseases.…”