Leader Stirling
Leader Stirling | |
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London Hospital |
Leader Dominic Stirling (19 January 1906 – 7 February 2003)
Early life: 1906–1929
Leader Stirling was born in England in 1906, the first of 4 siblings. His was of a family of ancient Scots and also of doctors, including his uncle Harold Leader, who was a children's physician, his great-uncles Henry Pye-Smith and Rutherford Pye-Smith, and the cousins Charles Pye-Smith, a surgeon, and Jack Pye-Smith, all Physicians of the
Medical training: 1924–1929
The 5 year medical course consisted of 1 year of pre-medical studies at the East London College, now
Early career: 1929–1935
Dr. Leader Stirling's first job was as a Clinical Assistant in the Children's Out Patient Department at the London Hospital. After 3 months he got another position as a Clinical Assistant to Surgical Out-patients at that same institution for 3 more months, when he finally got a Resident Appointment at the London Hospital, as a House-Surgeon to the sixth Assistant Surgeon,
After his House-Surgeon job, Stirling took a ten days locum in a 1000-bed mental hospital, his first experience with the field. He would later help develop the first national mental health service in Tanzania. He then continued his work at the London Hospital as a Receiving Room Officer, then House Physician, and ultimately Resident Accoucheur, the most senior resident appointment. He deemed himself "very, very lucky"[2] for he got all the House Appointments he wanted and, hence, completed 3,5 years of his early career as a junior staff at the London Hospital.
In 1933 Leader Stirling left the London Hospital to work in a private practice in South London as a surgeon. He then worked as Outpatient Surgical Officer at a nearby hospital from his private practice for a brief time, when he finally decided to "continue the upward climb on the ladder of specialization". (of specialisation).
Missionary career: 1935–1969
Arrival in Africa
3 months after his decision to join the UMCA, Leader Stirling landed in
The Masasi Mission Hospital was "in a primitive state"[2] according to Dr. Stirling, the structure being a thatched hut of rammed earth with no running water. However, they had a laboratory and an operating theatre, and would treat around 300 patients on a normal day's work. On a year they would have 1,000 new admissions and 5,000 new outpatients.[2]
Dr. Frances Taylor and Dr. Leader Stirling then divided the area and while the first would be based in Masasi, Stirling would relocate to Lulindi.
Lulindi: 1935–1949
Lulindi was then a very isolated African village with the nearest Post-Office being 24 miles away and with no proper medical infrastructure. Leader Stirling would live here in the next 14 years, from 1935–1949. In that time he built the Lulindi Hospital and the Newala Hospital, being the sole doctor in these two and also the Luatala hospital. He also built numerous Dispensaries, a Nursing School and started a Scouting group.
Lulindi Hospital
The building of the 80 bed hospital took 3 years to complete. This hospital was in memorial to the late Dr. Culver James, whose legacy provided much of the funds. Dr. Stirling was intimately involved in this development, since he drew the scale-plans, selected a site, marked the foundations, employed brick makers, brick carriers, brick burners and
The Lulindi Hospital facilities in 1946 included a surgical theatre, an outpatient department, a maternity block, a laboratory, a pharmacy, patient wards, store-rooms, nurses' and dressers' rooms, a hospital chapel, an x-ray machine and a built-in wood stove for sterilisation.
Newala Hospital
Simultaneously with the construction of the Lulindi Hospital, he also designed and built the
Dispensaries
Leader Stirling also established and maintained a chain of 20 dispensaries to fill the lack of medical infrastructure in the region comprehending "almost to the coast and right down to the Mozambique border, the furthest a hundred miles from Lulindi".[2]
Visits to Nairobi
Leader Stirling was also invited two times to visit the capital of Kenya, Nairobi. In his first visit in 1940 he was invited to discuss the brink of an epidemic of malaria, brought by troops during World War II and unknown to Nairobi until then given it sits 5,500 feet above ocean level. Soldiers sent to Addis Ababa also brought back home syphilis.
He was then summoned in 1942 by a friend to help with a plague epidemic.
Mnero: 1949–1964
14 years after his arrival in Lulindi Stirling converted to Catholicism and had to leave the UMCA. Leader Stirling learned the Catholic faith at age ten, which he considered his true faith, but joined the
Leader Stirling's departure was reckoned by the UMCA as "'a very great loss to the medical work of the diocese; but we owe him many thanks for his fourteen years of work with us.' And not only for his medical work, for he had also done a great deal of building and done very much to strengthen and establish over a wide area the Scout movement which was providing itself an asset of ever-increasing value in the diocese.".[7]
Stirling joins the Benedictine Mission and is sent to found a new hospital in Mnero; Mnero Diocesan Hospital. The hospital was founded in the early 1950’s, next to the Benedictine Mission of Mnero. The mission itself was built in 1914, and was one of the earliest places of Benedictine missionary activities in (the former) Southern Tanganyika. This time, though, he has the help of an architect builder from the mission. This meant he could dedicate himself more to the medical work which, in 1958, he describes as follows
I had been working single-handed for nearly 24 years, and now had to deal with eighty beds always full, several hundred outpatients daily, a weekly leprosy clinic of 400, teaching and administration of a nursing school and its hostel, general administration of the hospital, visiting a dozen remote dispensaries, and performing up to twenty operations per week. My day began at 5 am and I was hard at it until bedtime, about 11 pm.
— Leader Stirling, Africa: My Surgery
The first Medical Director of Mnero Hospital, Dr. Leader Stirling, led the construction of the hospital. Thereafter, Dr. Stirling worked for 14 years in the hospital
Besides the Hospital, Leader Stirling also built a male Nurse School, started yet another Scouting group and starts his political career.
Upon the arrival of a new Matron to the hospital in 1964, Leader Stirling was accused of trying to be "forcing the pace of Africanization"[3] in the hospital. The quarrel led to his resignation in that same year.
Kibosho: 1964–1969
Leader Stirling departed Mnero to Dar es Salaam and met the Bishop of Moshi who appointed him to a position in Kibosho, at the slopes of the Kilimanjaro where he was supposed to start a new hospital. This time he had little involvement in the construction of the hospital, made entirely out of local effort, and his job "was to bring the buildings into line with medical requirements. (...) and then I had to organize the equipment and the staffing.".[2] After working in Kibosho for 5 years and staffing the hospital entirely with locals, including a local doctor, Leader Stirling moved to Soni, a village in the Usambara Mountains.
Soni: 1969–1973
At Soni Leader Stirling settled in and would work as a part-time visiting surgeon to two local hospitals: Lushoto Government Hospital and Bumbuli Church Hospital, in the latter he was also part-time professor at the Medical Assistant Training School.
In 1973, following his ever-increasing political involvement, he was placed on a Presidential Commission moved to Dar es Salaam, then capital of the country. This meant the end of his formal medical practice. He would return to the practice of medicine after his retirement at age 75, although informally and sporadically at the request of those who came to him at his house.
Political career: 1958–1980
Parliamentary: 1958–1975
"How on earth had I got there, and what happened to the obscure missionary doctor? Well, even if he had unavoidably become a little less obscure, he was still doctoring and still a missionary; in fact it was his activities as a missionary doctor that had landed him in this quite unexpected situation. If you have been doctoring in an area for twenty years and more, you are bound to come to share your patients' interests, to understand their troubles, and to join hands in trying to overcome their difficulties."
—Leader Stirling
Leader Stirling first experience with politics was at the age of 18. During a school debate he made a "burlesque political speech" which prompted his schoolmaster to jokingly say that "Stirling will undoubtedly become a politician". He never thought that he would follow that career, though, as his father would say that "politics is a dirty game". However, in 1958, at the age of 52, Stirling made his first public speech in Mnero, being the chairman of this event Julius Nyerere.[2] This meeting was historic, being the opening of the campaign that would lead the Southern Province of Tanganyika to elect its first representative to Parliament.
While his speech was actually to support an Indian colleague running for that district, Leader Stirling was also running for Parliament for the
Tanganyika gained independence in 1961 and the "Parliament of Freedom" ended its 5-year course in 1965. Leader Stirling had recently moved to Kibosho, where he wasn't popular enough to run and also too distant from Mbeya. His political career might have come to a halt if it wasn't for the fact that the University of Dar es Salaam appointed him to run for a National Seat. He was elected and would keep his Parliamentary seat until 1980 after winning subsequent elections.
For being seen by his peers as someone with "a nose for irregularities and discrepancies",
"While the health services of this country are so meagre – and meagre is, I may say, a polite word – we should be ashamed to cut one cent from the medical estimates, police or no police. I said our services are meagre. What comfort, Sir, is a fine Hospital (in) Dar es Salaam to the people who are dying out in the bush, twenty, thirty, forty, even fifty and more miles from the nearest doctor? Of course they don't all die. I remember one man who crawled on hands and knees (15 miles) into a hospital with only one foot: he said the other foot had dropped off in the road …… I remember a boy with a broken thigh-bone, carried doubled up in a piece of sacking, without even a splint, suspended on a pole, 50 miles to the nearest hospital. Sir, I could go on like this all day, but I would rather spare the House. But let no-one begin to think that we have reached a point where we can cut one cent in reduction of our health services. I would remind the House, Sir, of ….. things that are so common they have become taken for granted. Malnutrition – a nasty word, ——— Parasitic diseases, ——— In many areas the incidence of hookworm infestation is between 50 and 100 per cent of the population. The same is true of bilharzia —— These are the great debilitating, energy-sapping, initiative killing diseases —— As for malaria, the conditions in the greater part of our country are such that the indigenous population simply cannot live without it ——— and tuberculosis in the present condition of the country is a killing disease. The Health Estimates mean life and death in this country; they must not be reduced!"
—Leader Stirling, speech during his first parliamentary years
Minister of Health: 1975–1980
Leader Stirling describes his function as Minister of Health as being "generally expected to be a fairly constant stream of new legislation to improve the national health or whatever his responsibility happens to be. I did in fact introduce a number of bills to improve nutrition, hygiene, drug supply, medical research and so forth.".[2] Indeed, while Minister, Leader Stirling started the Tanzania National Tuberculosis and Leprosy Program,[2] unifying the scheme of treatment and extending it to the whole country. This program is still in place.[10] He also implemented reforms in the mental health scenario of the country, equipping all major hospitals of the country with psychiatric units. As a result, non-criminal mentally ill individuals who were put in prison because there was not enough mental asylums in the country were transferred to the nearest government hospital "imprisonment for being simply mentally sick, with no criminal charge, is now a thing of the past in Tanzania".[2]
During his time as parliamentary he would support government funding of Church Mission Hospitals, which were being neglected. When appointed Minister of Health this issue was resolved by unification of the healthcare system bringing together religious and governmental health facilities. In 1978 Tanzania had more than 3,000 dispensaries and approximately 140 hospitals in total, while having around 8,000 villages. Their aim was to have one dispensary in every village. This scheme of rural medical assistance was adopted worldwide.[4] Another measure of public health policy was to unify the Nursing registry, which was separated between home-trained and foreign-trained (mainly England-trained) nurses.
Leader Stirling attended to the International Conference on Primary Health Care in
In 1979 he idealised and lobbied for a bill that would regulate and nationalise the small private practice in then socialist Tanzania. The bill met some resistance due to widespread ignorance about its contents. He recounts that when election time came, urban "crypto-capitalists" had financed an effort to secure his defeat.[2] Hence he was, for the first time in 22 years, defeated at a Parliamentary election and went into retirement at age 75.
Medical work
Leader Stirling had a vast experience with all sorts of illnesses and medical problems during his work in his 3 hospitals. He was also responsible in organising hospital work and routine. Eventually, he developed his unique modus operandi which he describes as:
The hospital was open 24 hours a day and there was always someone to receive a patient, even in the middle of the night. However the full working staff were on duty from 8 am until the day's load was dealt with, which was usually about 5 or 6 pm but might be later. The nurses of course came on and off in shifts, but the doctor and the medical assistants had to be more elastic, and their daily programme was subject to all manner of unexpected variations both inside and outside the hospital. Actual out-patient sessions were daily except Sunday, when only casualties were dealt with. In-patient rounds were three times a week, always in the afternoon, plus a quick round on Sunday morning to make sure nothing was going by default when most of the staff were off duty. (...) At 8 o'clock, after staff prayers, I would start to walk all round the rows of seated patients, sorting them out as I went. In this way every new patient could see the doctor, the old cases being left to an assistant unless I wished to see them again. (...) On operating days, normally twice a week, I had to delegate the screening of patients to a Medical Assistant, but he would recall any doubtful cases for me on a subsequent day. (...) With regard to the in-patients not only did I make a point of seeing every patient on admission and three times a week, but insisted that something, either investigation or treatment, must be done for every patient every day.
— Leader Stirling, Africa: My Surgery
Surgical
As a medical missionary Leader Stirling performed several different types of surgeries.
Plastic surgeries were frequent for chronic ulcers, burns,
He was also able to align local customs with modern medical norms in the case of circumcision surgeries, which were performed by untrained tribal leaders with little to no antiseptic precautions before his intervention.
To overcome the lack of proper infrastructure and equipments, Leader Stirling made instruments out of simple materials: "screw-drivers made ideal supracondylar traction pins, sewing cotton became perfect ligatures. Thomas splints were contrived from bamboo, extension cord from plaited palm leaves with stones as traction weights. For intravenous infusions he used triple-distilled water, to which he added salt and glucose. When plaster of Paris ran out, he made his own from locally quarried gypsum."[4]
Leader Stirling also noted local differences between the places he worked. While Mnero and Lulindi were geographically close, Kibosho had a very different climate and population. Hernia, hydrocele and elephantiasis "which for thirty years had been my daily surgical chore"[2] were less common in Kibosho than in the south villages.
Clinical
Even though surgery was his speciality, Leader Stirling had to deal with all sorts of medical problems working as a single doctor. Indeed, he affirms that surgery was a small part of his work.
Besides tropical diseases he also dealt with pneumonia, meningitis, septic infections, measles, whooping cough and even cancer.
Once again there were geographical differences in the occurrence of diseases. Kibosho had more worms, stomach trouble, high blood pressure and rheumatic fever while having less of bilharzia and leprosy relative to the south villages of Lulindi and Mnero.
Nurse training
Soon after his arrival in Africa, Leader Stirling saw the need and opportunity for nurse training in Tanzania. In 1935 there would be usually only one doctor and one to two nurses per hospital, all imported, except on the big centres.[2] There were already 4 schools in the country to train "dispensers", now called medical assistants, but no nursing schools. The challenge to training nurses was that local school heads would hold onto their brightest students, encouraging them to go into teacher-training, under the impression that teaching was the only honourable occupation for an African woman.
It was with the help of an experienced British nurse, Miss May Bell, that he started a nursing school in Lulindi, which was in later years transferred to Masasi and was still running in 1987, when he published the book.[2] Mrs. Thekla Mchauru was the first woman to complete the course, qualifying in 1940 and becoming a registered nurse, the first Tanganyikan woman to do so. Miss May Bell and Leader Stirling's syllabus, based on the British model, was later adopted by the government and implemented all over the country's nursing schools.[3]
At Mnero Leader Stirling also got involved in nurse training. Soon after the Mnero Hospital was built in the early 1950s, the Bishop gave him orders to start a new male nursing school. In 1959 they switched their training to Rural Medical Aids since there was a higher shortage of those professionals and, thus, became one of the only two Rural Medical Aids School in the country along with a governmental one.
Scouting
Leader Stirling started his long career in Scouting at the age of 11.[3] After some years off, he got back to it in medical school when he first assisted and then led one of the two troops of Toynbee Hall.[2] He also started a new troop while working in private practice in South London.
In 1937 he helped
In 1948 he was appointed Commissioner for Training, spending the following 15 years training Scoutmasters for the whole country and in 1952 he ran his first Wood Badge course. Soon after the country's independence he was elected Chief Scout of Tanganyika, in 1962,[3] and held this position for 10 more years.[11]
He attended to the great
Personal life
Leader Stirling became a Tanzanian citizen following the country's independence, in 1961. This was also required by his Parliamentary position and meant he had to relinquish his British citizenship, for Tanzania did not allow dual nationality.
Soon afterwards he married his first wife Regina Haule, an African nurse, in 1963,[4] while living in Mnero. They moved to Kibosho in 1964 and a year later his mother paid the couple a visit, at the age of 88, her first visit to Africa. Unfortunately his wife died in 1972 of septicaemia[4] when the couple was living in Soni.
Not long after widowing, Leader Stirling married his second wife Anna Chilunda, an African nurse trained by his nursing school in Lulindi, but also a widow Princess.[4] He became the stepfather of her 6 children.
Leader Stirling was a devout and involved Catholic. Besides his missionary work, always linked to a religious institution and inspired by his faith, he founded and held the Chair of the Tanzania Christian Association and was also advisor to the Christian Social Services Commission.[12] He also mentions meeting with the Pope.[2]
References
- ^ a b "Leader Stirling", "Times Online", 8 April 2003, accessed 15 December 2010
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag Stirling, Leader. "Africa: My Surgery". Churchman Publishing: Worthing and Folkestone, 1987.
- ^ a b c d e f g h i j k Stirling, Leader. "Tanzanian Doctor". McGill-Queen's University Press, Montreal, 1977.
- ^ a b c d e f g h i [1]"Plarr's Lives of the Fellows Online", 26 October 2005, accessed 14 December 2013
- ^ Stirling, Leader. "Heroes of the Faith in Tanzania; Seven witnesses from the Central African Mission". Benedictine Publications Ndanda-Peramiho, 1997.
- ^ Anderson-Morshead, Anne (1897). The History of the Universities' Mission to Central Africa, 1859-1909.
- ^ a b c d e f A.G. Blood "The History of the Universities' Mission to Central Africa; Vol. III 1933–1957". The Universities Mission to Central Africa, London, 1962.
- ^ Lyimo, Karl (26 June 2013). "Tanzania: Whither the domestic sisal industry, pray?". Daily News. Archived from the original on 24 July 2013. Retrieved 26 May 2015.
- ^ "Sisal farming [Sisal, SISO scheme, Best practices]". Katani Limited. Retrieved 26 May 2015.
- ^ [ntlp.go.tz/],"Tanzania Tuberculosis and Leprosy Programme", accessed 11 December 2013.
- ^ "Leader Dominic Stirling", "British Medical Journal", accessed 16 December 2013
- ^ Events of 2003, Leader Stirling obituary, "Nyangao Hospital", accessed 16 December 2013