David Morley (1923-2009) and WGH Ilesha

There are many reasons for me to blog about David Morley (1923-2009), who perhaps more than any other western scientist has done more towards the development of paediatrics and child health in Nigeria, Africa and possibly the whole developing world. His work started at the hospital where I was born many years after he worked there, where I later studied, and afterwards stayed back to work: Wesley Guild Hospital, (WGH) Ilesha.

His former colleague and fellow professor of International Child Health at UCL, Andrew Tomkins reflects on his life in the Guardian UK:

When David qualified in medicine in 1947, one in four children in developing countries died before their fifth birthday. As a young doctor in a mission hospital in Nigeria, he established that effective treatment for such children should not revolve around hospitals but community-based healthcare and technologies, some of which he developed himself. His findings had a great impact on governments and agencies worldwide, and many have subsequently adopted that approach. He also set up training courses for medical staff and a charity, Teaching Aids at Low Cost (TALC).

These included a robust scale for weighing infants in the community, parent-owned Road to Health Charts and a simple mid-upper arm circumference (MUAC) tape for detecting severe malnutrition. He set up the Tropical Child Health Unit (TCHU) at the Institute of Child Health (ICH), London, which formed the basis for the present Centre for International Health and Development

Three missionary doctors working in the Wesley Guild Hospital in Ilesha, Nigeria, obtained research funding from the West African Medical Research Council and the Methodist Missionary Society to help tackle the limitations of traditional (western) clinical services when applied in the developing world. Andrew Pearson, David Cannon and John Wright recruited David to do the work and, in 1953, he set up an extensive health and nutrition study of 413 children in Ilesha. It was the first of its kind and produced very influential publications.

Earlier this year, a month after his death on 2 July 2009, bloggers at the Nigeria Health Watch invited Bryan Pearson, publisher of Africa Health to write an obituary of David Morley. He wrote about how the missionary doctors at WGH Ilesha had brought the problem they strove to solve upon themselves by increasing patient population “having negotiated a deal with their new regional governor, Obafemi Awolowo, to provide free health services for under 18s.” The full obituary is here. This is an excerpt:

A full longitudinal study was initiated and over the next 18 months all children born into the community were registered and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special ‘Under Fives Clinic’ was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children’s records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%.

By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesha and Imesi-Ile in 1960.

 And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye’s efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.

There are other obituaries from the Telegraph and the Independent both in the UK. I doubt that any Nigerian daily has reported his death or published an obituary. We are often far too caught up in our politics of misrule to have time for that.

It is well worth mentioning though that the special ‘Under Fives Clinic’ still runs as Wesley Guild Hospital under Oyeku Oyelami, (professor of Paediatrics and Child Health at OAU Ile-Ife) without regard for Nigeria’s numerous public holidays or strike actions, continuing to benefit thousands of children and their families in Ilesha and its environs.