Early Nairobi Surgeon’s Diary

Links to the following article, which has appeared in multiple places, were sent in by various alumni. We are publishing the article, in its entirety as it appeared on Facebook's 'History of Kenya' page. We have no way to vouch for the authenticity of the information contained therein, however, it will give you an idea of the many challenges faced by Kenya's early pioneers....... and yet this busy man had the vision and found the time and funds to do something about the education of his community. Remarkable.

In 1902, an outbreak of bubonic plague was reported in Nairobi. As part of extreme measures to stop the outbreak, the Indian Bazaar, which was in those days situated somewhere close to the Nairobi Railway Station, was ordered razed down.

Ironically, a Goan doctor who recommended the cleansing of the Bazaar himself lived there. His name was Dr. Rosendo Ayres Ribeiro.

Following successful containment of the plague, the Indian Bazaar was rebuilt at a new site a mile and a half away from its original location, this new location being the city’s Biashara Street today.

Dr. Ribeiro, after whom Dr. Ribeiro Parklands High School in Nairobi is named (he donated the land on which the school was built), was the first doctor to set up a private medical practice in this bustling town, which also hosted the headquarters of the British East African Protectorate (EAP).

May I point out that another Goan, Dr. Luis Lobo, was the first Indian doctor to set up a private practice in British East Africa Protectorate. He arrived and settled in Mombasa in 1898 and went ahead to set up the practice immediately afterwards.

He was joined by Dr. Ribeiro, who arrived on the mainland in May 1899. Within six months of his arrival, Dr. Ribeiro set up a private practice in Nairobi.

Dr. L.A. da Gama was the next Indian doctor to settle in Kenya, in 1903. Like Dr. Lobo, he decided to set up a practice in Mombasa. Indeed, Dr. da Gama was the first Indian doctor in Kenya registered to practice in East Africa under the Medical Registration Ordinance that came into effect in 1910.

According to Anna Greenwood and Harshad Topiwala, authors of the book Indian Private Doctors In Kenya: 1895-1940, Dr. da Gama already had a qualification from the University of Bombay that entitled him to the afore-mentioned registration. Contrariwise, Dr. Lobo and Dr. Ribeiro were licensed, as opposed to registered, to practice medicine.

In a previous post, I pointed out that Dr. Ribeiro was a veterinary doctor (well, he had a soft spot for four-legged creatures in particular). It turns out that I was mistaken. Dr. Ribeiro was actually a specialist Surgeon and an MRCS (Member Of The Royal College of Surgeons). In his practice, he had an assistant, one C. Lobo.

Of the three afore-mentioned doctors, Dr. Ribeiro was the most eccentric. A tamed zebra, by which bizarre means he visited the sick around Nairobi, made him famous all over.

He attended to patients of all races without discrimination. Some of them were Somalis. Indeed, he is the one who discovered the bubonic plague among two of his Somali patients.

In his memoirs, the surgeon paints a picture of how the novelty of western medicine clashed with cultural practices and religious beliefs of various communities in Kenya.

But before we touch on Dr. Ribeiro’s memoirs, it is also good to understand how central Nairobi was like in the period after 1902.

Firstly, the dusty Victoria Street (Tom Mboya Street today) was the hub of European commerce. For supplies and auxiliary labour, the Europeans relied a great deal on Asian skills available at the nearby (and new-ish) Indian Bazaar. Indeed, a lot of European businesses expanded with the assistance of pioneer Indian merchants.

The Asian community operating from the Bazaar served all races without discrimination.

Majority of the Indians, being vegetarians, wanted nothing to do with Somalis. Well, according to Sociology expert and writer Gavin Kitching, a number of Somalis had set up butcheries and meat supply businesses for hotels and individuals alike. I do not know where exactly in central Nairobi the Somalis pitched their businesses, but it is very unlikely they rented premises within the bazaar in my view as this would have offended vegetarian Asians.

On the edges of the bazaar towards River Road existed various African businesses. Some African women rented premises near the bazaar to provide all manner of services, mostly domestic, but including prostitution.

So we had a bustling town built upon marshy ground, a melting pot of cultures and races, commerce of all kind including that of the flesh and, inevitably, a lot of sick visitors to Nairobi.

In the course of his professional work in the nascent city, Dr. Ribeiro, whose wife was white, recorded numerous encounters between disease on the one hand, and cultural and religious beliefs on the other. Some of his accounts were published in 1954 – three years after he died – in the British Medical Journal.

I found that in his chronicles, Dr. Ribeiro categorized Somalis as being Asian.

“The Asians form a very complex group of peoples, consisting of Hindu, Mohammedans, Goans, Arabs, Seychellois and Somalis”, he wrote.

He decried the overcrowding in Asians’ dwelling places, as well as the diseases they were predisposed to, owing to their living circumstances.

“The Hindus make up 52% of this group (of Asians) and are subdivided into Sikhs, Punjabi, Marathas, Cutchis, Banniahs and Patels. With the exception of the Sikhs, they are generally vegetarian, and much of the disease among them is due to poor nutrition, particularly among the women, whose diet is totally inadequate, thus producing avitaminosis and anaemia. Overcrowding is general. I have often seen a family of six, eight or even ten living in one room. It is not to be wondered that members of the family are constantly ill”.

The doctor wrote on:

“I was once called to attend a case of obstructed labour. The patient was in a little tin shed, which consisted of a single room where 14 people had been living. The woman in labour was 30 years old, and she had already had six children. This was her seventh baby. I had to rotate and apply forceps with the aid of two small electric torches and an open-flame nightlight while my wife gave chloroform.

The Patels, Banniahs and Cutchis, although sometimes quite well off, are particularly guilty of living in over-crowded premises, because they love to amass money. They are vegetarian, and even in the severest cases of anaemia they refuse liver injections and any form of meat or fish extract by injection or orally”.

Dr. Ribeiro also made observations about the Sikh community. He noted that they were fond of drinking milk and, in contrast, brandy, “with the inevitable consequences”.

He further observed that Ismailis, whom he referred to as “Khojas”, were well off economically and medically. The Khojas had highly organised businesses and offered among themselves free medical camps.

The rest of the Muslims were referred to as “orthodox Mohammedans”. And according to Dr. Ribeiro, “they were not as advanced as the Khojas. Their women, owing to the custom of purdah, lacked enough air and exercise as they were mostly confined indoors”.

He noted that the Muslim community was generally fond of extremely greasy and rich food, “which is apt to produce dyspepsia and obesity”.

One observation that seemed to baffle him was that Asian Muslims preferred Christian doctors to any others, “sometimes even in preference to one of their own faith”.

He did not write much about his own community of Goans. However, he did record that their limited diet of rice, curry and highly spiced overcooked meat caused dyspepsia and poor development of their children, “who tend to be undersized and rachitic, sometimes showing extensive dental caries”.

But if Dr. Ribeiro was succinct in his assessment of fellow Goans, he was generous, and blunt, about Somalis.

Excerpts:

“The Somalis are the most backward of this group of peoples because they have no written language of their own and very few of them can read or write any language at all. They are mostly cattle-herding nomads in the country and garage hands when living in the city. They are notoriously addicted to the drug myrrha (as he spelt the word, obviously meaning khat/miraa/veve/kangeta), which helps them to live on a very meagre diet. They are very quarrelsome and often inflict injuries on one another which need medical attention. Jealousy, combined with hallucinations from too much myrrha, is a potent factor for crime such as cutting the nose and ears, or slitting the genitals of a wife who is suspected of unfaithfulness.”

“They are strict Mohammedans. I had a woman brought to me from a district 30 miles away for tooth extraction when she was very ill from hemorrhage due to difficult labour caused by locked twins. When I suggested to the relations that I would like to treat her for this condition first, they declined emphatically and told me that midwifery was not a man’s business at all, even if he was a qualified doctor.”

Dr. Ribeiro, it appears, was concerned and made a follow up on the Somali woman’s condition.

Wrote he: “I was told later that the woman died, and that her relations shrugged their shoulders and said that it was the will of Allah.”

In those days, some communities practiced both male and female genital mutilations. Dr. Ribeiro was regularly approached by Somalis, being Muslim, to circumcise males. Females, too, he noted.

Further, among females, the circumcision involved either removing the labia minora alone, or both the labia minora and clitoris.

“I always advise them to have only the labia minora retrieved and to leave the clitoris alone”, the doctor wrote.

We get a glimpse of the cantankerous nature of Somalis in the early 1900s from the good doctor’s writings. Members of the community, he observed, sometimes committed murder with knife or poison. For the latter, “the seeds of Datura Stramonium ground and mixed with coffee were often used”.

For the foregoing reasons, the doctor exercised caution when it came to issuing a death certificate for a Somali.

About this he wrote the following:

“I had a Somali come to me for a certificate of death for a man I did not remember treating within a month. He insisted that I had treated him for this last illness, and as proof produced a bottle of medicine with my label on it. The date on the label showed that the medicine had been dispensed three years earlier. It was just as well that he was illiterate….”

It is evident from the doctor’s recollections that there was a community of natives of Seychelles in Nairobi.

According to the surgeon, the Seychellois were “generally poor…..the males work in the garages and the females as nannies. At night they supplement their income by other means. One often sees congenital syphilis among them….”

Dr. Ribeiro, of course, did not only attend to Asians, Seychellois and Somalis. He also attended to Arabs, Kamba, Agikuyu and other natives. And he wrote extensively about his experiences with patients from these communities.

On Swahilis and Arabs, he noted that they were mainly found at the coast, but a few had settled in Nairobi. According to the doctor, many of them were involved in trade of hides and skins.

“Consequently”, the doctor observed, “one sees anthrax and a variety of skin diseases among them. They are very susceptible to venereal diseases. l have seen them with chancres and gonococcal discharges as well as other venereal granulomatous diseases at the genitals, anus, rectum, the armpit, groin, and even the navel. It seems that male and female prostitution is quite the accepted thing”.

An interesting point penned by the doctor was that the best learning experience for any medical student would come from treatment of diseases afflicting Africans.

African patients, including the Baganda, travelled hundreds of miles to see him and even in his absence, would wait patiently, refusing to see any other doctor even if supplied for free by the government.

“They will sometime walk into my surgery with double pneumonia or a septic abortion in extremis and, to one's surprise, recover against all odds”, he wrote.

About communities from Uganda, the doctor noted that venereal disease was very extensive, describing sex to them as being “their greatest cult”.

“….their women enlarge their labia minoras to four or five times their normal size by stretching them regularly from childhood onwards. These people often need special treatment to their labia minora, which become infected”, he observed.

Dr. Ribeiro was also called upon to undertake corrective circumcision of members of the Agikuyu, Meru, Embu and Kamba communities.

“They are Bantu-Hamitic and so practice circumcision of both men and women, the same as Somalis, although they are not Mohammedans”, he recorded.

In these communities, circumcision was exclusively performed by the elders, both male and female circumcisers. Not even a qualified doctor could carry out the exercise. It was only when the wound became septic or refused to heal, the doctor observed, that natives agreed to consult a doctor, “but sometimes they come for trimming or repair because of excessive mutilation”.

The doctor dealt with numerous cases of failed traditional treatment attempts.

He wrote that it was “only when the witchdoctor has failed with his tricks - and one of them consists of making tiny cuts with a small sharp knife on the skin of the part he thinks diseased - that they come to the city for treatment”.

All was well if an African patient got cured. But if he succumbed to his condition, his or her kin would blame the doctor’s injection and medicine.

The Wakamba suffered from kala-azar, which led to enlarged livers and spleens of the affected. The doctor noted that Kambas got pneumonia and secondary anaemias quite easily. It was not uncommon, he wrote, to see them with deep chronic ulcers on their legs. He attributed the pot-belliness of Kamba kids to either helminthic disease (of parasitic worms) or a maize diet.

The community’s practice of teeth-filing and use of poisoned arrows also made it to the good doctor’s notes. This is what he wrote.

“The Wakamba are a tribe who use poisoned arrows when hunting game. The poison is a decoction of the leaves, flowers and twigs of a shrub called accaconthera, which grows wild in great abundance, and contains a very lethal cardiac glucoside. These people file their teeth into fine sharp points. Eventually, caries invariably destroy these teeth, leaving only the stumps, which become septic. The Wakamba will go only to a qualified doctor for removal of these stumps, and to no one else, because, since their witchdoctor, who is called a ‘Muganga’, originally filed these teeth, only another ‘Muganga’, although a foreign one, has the right to take them out and treat them”.

Speaking of teeth, if you are Luo and have lived on fish for much of your life, then yours must be very strong teeth if the observations of Dr. Ribeiro are to be factored. The doctor noted that Luos had teeth that were “large and very strong, much stronger than those of any other people whose teeth I have removed…”

Regarding the Maasai, they were susceptible to pneumonia. The doctor pointed out that those who were affected the most seldom adjusted themselves to the variations of temperatures within a 24-hour period.

All tribes, the doctor noted, suffered from malaria and it was quite common for him to see small children with enlarged spleens, “sometimes occupying such a large part of the abdominal cavity”.

Reading Dr. Ribeiro’s notes, which were recorded over a number of years, one gets a sense that his daily routine was hectic, one in which he woke up early in the morning and retired late in order to attend to his patients.

He described the way African patients travelled long distances to consult their doctor. Many patients preferred to be done by 4 o'clock in the afternoon so they could start the journey back to their respective homes.

“One has therefore to do as much as one can for them, in the minimum of time and for very little money, for the average African cannot afford the fare for frequent visits, and can pay for only one or two consultations”, he wrote.

“He must have treatment that will either cure the disease or tide him over till his next pay-day. As a rule, they will not take any medicine which did not come from the surgery of the doctor himself, and will often demand that he administers the first dose with his own hands”, he further noted.

Like is the case with some communities today, superstition, poverty and ignorance undermined medicine in the early years of the last century.

A Sikh child from a family that Dr. Ribeiro regularly attended to, and whose arm had been burnt over a charcoal brazier was taken to his clinic. The doctor was on that particular day not available, so the child was rushed to another (unnamed) doctor.

Dr. Ribeiro explained what transpired.

“This doctor called in a surgeon, and between them they decided that the burn needed skin-grafting. They explained this to the father, and told him that they would have to cut the skin from the back of the child. The father immediately picked up the child and ran out of the surgery. He consulted me later and told me that he could not understand treatment which made one injury into two….”

Some African patients, on the other hand, were reluctant to give blood for examination, especially if drawn from a vein. They feared the drawn blood could be used against them in black magic.

In one recording, Dr. Ribeiro blamed what he called anti-European political propaganda for the attitudes held by some African communities. He described the fear among the Agikuyu in particular of being injected.

The rumour among members of this central Kenya community was that the Europeans were trying to exterminate them and their cattle with injection. Some turned down treatment for fear that the colonial government had instructed doctors to give them poison.

Needless to say, the lack of proper infrastructure in those early colonial days hampered the practice of medicine in several ways.

According to the doctor, a typical clinic made little use of modern accessory aids “for the simple reason that finance, time and distance make laborious investigations involving highly technical apparatus an impossibility”.

By his own description, Dr. Ribeiro’s surgery was simplified into an office, a sitting-room, an examination room and a dispensary.

As more and more surgeries launched their practices in Kenya, he observed that many of them kept a separate room for Africans because “their children soil the floor, and because some of the women, especially the Maasai, use mud and castor oil on their clothes, according to ancient customs….”

For his services, Dr. Ribeiro was in 1932 conferred an OBE by Britain and the award of Commander Of The Order Of Benemerencia from the Portuguese government in 1947. He died in 1951, aged 80. His remains were interred at the City Park cemetery in Parklands.