WEBVTT 00:00:00.000 --> 00:00:07.140 [Drumming and music] 00:00:07.140 --> 00:00:11.590 [Firestone Presents...] 00:00:11.590 --> 00:00:15.780 [Medicine in the Tropics, A Vogue Wright Production] 00:00:15.780 --> 00:00:23.910 [Drumming] 00:00:23.910 --> 00:00:26.570 [Narrator #1:] Any practice of medicine and research in the tropics 00:00:26.570 --> 00:00:30.570 requires a new examination into the cause and nature of disease, 00:00:30.570 --> 00:00:32.130 and in terms of treatment, 00:00:32.130 --> 00:00:34.790 a different concept regarding the indigenous people 00:00:34.790 --> 00:00:38.550 and the application of medicine to their specific needs. 00:00:38.550 --> 00:00:41.510 More often than not, the freshly-recruited medical worker 00:00:41.510 --> 00:00:44.930 learns that he must reexamine the relations between people 00:00:44.930 --> 00:00:50.840 and the relations to their environment that he had grown to accept as constants. 00:00:50.840 --> 00:00:55.170 The climate, in all its aspects, creates conditions often completely different 00:00:55.170 --> 00:00:58.510 from those known to the uninitiated worker. 00:00:58.510 --> 00:01:02.880 The important issue of malnutrition and its direct and indirect relationships 00:01:02.880 --> 00:01:07.690 to disease may lead him to an analysis of agricultural problems. 00:01:07.690 --> 00:01:11.100 The way of life of the indigenous people may be so foreign to him, 00:01:11.100 --> 00:01:15.570 that he must virtually become psychologist, anthropologist, and social worker. 00:01:15.570 --> 00:01:20.530 On the other hand, the prevalence of insert-borne parasitic diseases makes imperative 00:01:20.530 --> 00:01:23.610 a knowledge of the basic biological sciences. 00:01:23.610 --> 00:01:26.860 Thus, any study of tropical medicine must be prefaced 00:01:26.860 --> 00:01:30.640 by an emphasis on both the ecological nature of the region 00:01:30.640 --> 00:01:32.940 and the way of life of the people. 00:01:32.940 --> 00:01:34.020 In this instance, 00:01:34.020 --> 00:01:41.150 we will examine the practice of medicine and medical research in the Republic of Liberia. 00:01:41.150 --> 00:01:44.530 Liberia lies in the Tropic Zone on the West Coast of Africa, 00:01:44.530 --> 00:01:51.220 stretching from a point 280 miles north of the equator to a point 650 miles north. 00:01:51.220 --> 00:01:53.370 The land level rises from the coastline 00:01:53.370 --> 00:02:01.170 to 4000 feet in the mountain foothills some 150 miles inland. 00:02:01.170 --> 00:02:05.370 Liberia has been aptly characterized as a watershed area. 00:02:05.370 --> 00:02:09.510 The annual rainfall ranges from a maximum of 200 inches along the coast 00:02:09.510 --> 00:02:12.630 to 70 inches up country. 00:02:12.630 --> 00:02:16.720 The numerous rivers and their tributaries overflow during the rainy season, 00:02:16.720 --> 00:02:20.320 when the temperature will fall to a low of 50 degrees. 00:02:20.320 --> 00:02:24.050 The annual mean maximum temperature is 86 degrees, 00:02:24.050 --> 00:02:30.330 the mean minimum is 71 degrees, and the average annual humidity is 82 percent. 00:02:30.330 --> 00:02:33.580 In the dry season when the Harmattan Winds redden the sky 00:02:33.580 --> 00:02:35.930 with the sands of the North African deserts, 00:02:35.930 --> 00:02:39.120 the shade temperature rises to the high 90s. 00:02:39.120 --> 00:02:44.510 Under these conditions, mycotic infections of the skin are highly prevalent. 00:02:44.510 --> 00:02:48.570 Most of Liberia was originally covered by tropical rain forests. 00:02:48.570 --> 00:02:53.630 Large areas have been cut over to meet the needs of a primitive agriculture. 00:02:53.630 --> 00:02:56.680 Yet the resultant sporadic cultivation has allowed 00:02:56.680 --> 00:03:01.300 second growth forests to repossess the land. 00:03:01.300 --> 00:03:04.420 The temperature range and high humidity are determining factors 00:03:04.420 --> 00:03:08.180 in the development of insect vectors of disease. 00:03:08.180 --> 00:03:15.630 On the other hand, the life economy of some insect species is such an intricate complex of physiological requirements, 00:03:15.630 --> 00:03:22.650 that any slight environmental change can upset the delicate equilibrium on which survival depends. 00:03:22.650 --> 00:03:26.700 Such are the risks attending extreme specialization, 00:03:26.700 --> 00:03:30.000 as is the case with the female tsetse fly. 00:03:30.000 --> 00:03:34.510 In the reproductive cycle, the most specific of conditions are required: 00:03:34.510 --> 00:03:36.190 a permanent stream of water, 00:03:36.190 --> 00:03:39.380 a sandy bank into which she inserts the larvae, 00:03:39.380 --> 00:03:41.270 a fairly constant temperature, 00:03:41.270 --> 00:03:46.480 and a low canopy of vegetation producing nearly 100 percent humidity. 00:03:46.480 --> 00:03:53.320 In those areas of Liberia where the heavy jungle growth has been replaced by commercially-productive rubber trees 00:03:53.320 --> 00:03:55.760 with their high branches and thin foliage, 00:03:55.760 --> 00:03:58.820 the tsetse fly has disappeared. 00:03:58.820 --> 00:04:02.990 Many of the people's daily functions of survival constitute mechanisms 00:04:02.990 --> 00:04:06.450 by which they are exposed to parasitic infection. 00:04:06.450 --> 00:04:11.500 A single body of water is often the village's source for fishing, bathing, and drinking. 00:04:11.500 --> 00:04:16.370 Thus, they come in contact with many of the insect and snail vectors. 00:04:16.370 --> 00:04:25.540 [Music] 00:04:25.540 --> 00:04:29.360 Life in Africa may appear to be lackadaisical to foreign eyes. 00:04:29.360 --> 00:04:35.470 Much infection seems due to an absence of precaution and a lack of interest in bettering their lives, 00:04:35.470 --> 00:04:41.250 but the land and the climate are determinant factors conditioning concepts of hygiene. 00:04:41.250 --> 00:04:45.390 Life is far from easy, not to be plucked from the nearest tree. 00:04:45.390 --> 00:04:48.240 The currents keep the fish away from Liberia's coast, 00:04:48.240 --> 00:04:53.520 and often a successful catch is made no closer than 80 miles off shore. 00:04:53.520 --> 00:04:57.810 The torrential rainfall in the wet season leaches the soil. 00:04:57.810 --> 00:05:02.060 The high soil temperature and the photoperiodic constancy, 00:05:02.060 --> 00:05:04.390 12 hours night and 12 hours day, 00:05:04.390 --> 00:05:09.020 curtail the growth of most grains and vegetables that come from cooler climates. 00:05:09.020 --> 00:05:11.260 When rice and casaba are to be planted, 00:05:11.260 --> 00:05:14.290 the heavy forests must be cut down. 00:05:14.290 --> 00:05:19.630 Without fertilization, each crop of rice exhausts the already weakened soil. 00:05:19.630 --> 00:05:21.760 As it must lie fallow for six years, 00:05:21.760 --> 00:05:26.310 new jungle areas must be cleared. 00:05:26.310 --> 00:05:28.670 Then, at the end of the six year period, 00:05:28.670 --> 00:05:31.190 the original plot is covered with scrub. 00:05:31.190 --> 00:05:32.190 The cycle begins anew, 00:05:32.190 --> 00:05:36.360 and the laborious cutting back of the jungle never ceases. 00:05:36.360 --> 00:05:39.050 The dearth of protein is compounded by the unsuitability 00:05:39.050 --> 00:05:41.730 of the soil to support forage crops, 00:05:41.730 --> 00:05:47.850 and the presence of various livestock diseases, including trypanosomiasis. 00:05:47.850 --> 00:05:51.670 With arrow or gun, the hunter finds little success, 00:05:51.670 --> 00:05:54.520 or as small as the Liberian population is, 00:05:54.520 --> 00:05:59.880 it has grown beyond the limit of its diminishing forests to support wild game. 00:05:59.880 --> 00:06:02.860 With this limited diet, the shortage of protein, 00:06:02.860 --> 00:06:05.750 and the mother's insufficient supply of milk, 00:06:05.750 --> 00:06:09.930 the child's defense against infection is critically impaired. 00:06:09.930 --> 00:06:15.000 Tools are primitive, and no matter how greatly we may admire the skill of the metal craftsman, 00:06:15.000 --> 00:06:18.070 long and tedious hours of labor are required 00:06:18.070 --> 00:06:22.070 to fashion the most simple implements and objects. 00:06:22.070 --> 00:06:25.610 A division of labor is obvious and clearly defined, 00:06:25.610 --> 00:06:29.850 but both sexes find the fruits of their labor minimal and uncertain. 00:06:29.850 --> 00:06:31.630 In such primitive societies, 00:06:31.630 --> 00:06:36.670 superstition exists to conjure up answers to daily and seasonal mysteries. 00:06:36.670 --> 00:06:40.710 In place of procedures born of an orderly appraisal of data, 00:06:40.710 --> 00:06:45.390 the necessary understanding of nature is absent. 00:06:45.390 --> 00:06:48.160 Because there is no knowledge of the cause of disease, 00:06:48.160 --> 00:06:51.850 the full disposal of sewage beyond the limits of water source contamination 00:06:51.850 --> 00:06:53.710 is not practiced. 00:06:53.710 --> 00:06:55.830 Because rivers are everywhere accessible, 00:06:55.830 --> 00:06:58.300 wells are seldom sunk. 00:06:58.300 --> 00:07:01.290 In the unobjective terms of what is observable, 00:07:01.290 --> 00:07:04.500 conclusions have been drawn that well water is stale. 00:07:04.500 --> 00:07:07.590 In a noble attempt to relate tropical cause and effect, 00:07:07.590 --> 00:07:13.690 it is often believed that the degree of coldness of well water is the cause of colds. 00:07:13.690 --> 00:07:18.680 Thus, the existence of superstition is not due to an unwillingness to learn, 00:07:18.680 --> 00:07:22.160 and a parting with ancient ways begins when the process 00:07:22.160 --> 00:07:25.870 and the result become predictable. 00:07:25.870 --> 00:07:29.390 Until generations of individuals have learned from experience, 00:07:29.390 --> 00:07:32.650 the mystical authority of the witch doctor will prevail. 00:07:32.650 --> 00:07:36.880 Clay will continue to be used as both a cosmetic and a skin ointment. 00:07:36.880 --> 00:07:40.950 Disease will fester in isolation until it is sought out, 00:07:40.950 --> 00:07:44.850 and no matter how friendly is the image of the friendly devil dancer, 00:07:44.850 --> 00:07:50.250 he will for some time continue to represent the equation between primitive man's 00:07:50.250 --> 00:07:57.410 lack of knowledge and nature's apparent caprice-like behavior. 00:07:57.410 --> 00:07:59.560 Against this background of primal need, 00:07:59.560 --> 00:08:04.150 research and medical organizations and agencies are at work in Liberia, 00:08:04.150 --> 00:08:06.700 scraping away the surface of myth, 00:08:06.700 --> 00:08:13.470 building anew on the solid ground of need, an objective understanding of scientific process. 00:08:13.470 --> 00:08:15.770 Emanating from the government of Liberia, 00:08:15.770 --> 00:08:18.040 and led by its energetic president, 00:08:18.040 --> 00:08:20.270 the Honorable William V.S. Tubman, 00:08:20.270 --> 00:08:25.750 there exists a program of ever-increasing medical facilities and public health projects. 00:08:25.750 --> 00:08:30.180 The National Public Health Services under the direction of Dr. Jay N. Togba 00:08:30.180 --> 00:08:32.820 provides and operates hospitals, dispensaries, 00:08:32.820 --> 00:08:36.940 and conducts training programs for nurses, technicians, and sanitarians. 00:08:36.940 --> 00:08:38.660 As this trained force grows, 00:08:38.660 --> 00:08:44.020 and the resultant education creates a new demand for modern medicine, 00:08:44.020 --> 00:08:53.480 an increasing number of Liberian students will take up the study of medicine in the schools of Europe and America. 00:08:53.480 --> 00:08:56.510 The endeavor of the national Public Health Services is furthered 00:08:56.510 --> 00:08:59.690 through cooperation with various international agencies. 00:08:59.690 --> 00:09:02.320 In cooperation with the World Health Organization, 00:09:02.320 --> 00:09:06.930 they have inaugurated a campaign to eliminate malaria and yaws 00:09:06.930 --> 00:09:10.420 and with the United States International Cooperation Administration, 00:09:10.420 --> 00:09:13.230 they are conducting a program of technical training, 00:09:13.230 --> 00:09:16.470 in addition to an anti-malaria campaign. 00:09:16.470 --> 00:09:22.220 Among the first medical efforts in Liberia were those of the various denominational missions. 00:09:22.220 --> 00:09:27.040 In the almost completely isolated villages, long before the penetration of roads, 00:09:27.040 --> 00:09:30.050 they set up their hospitals and dispensaries, 00:09:30.050 --> 00:09:36.750 and the personal histories of these medical pioneers constitute a saga of man's faith, ingenuity, 00:09:36.750 --> 00:09:42.400 and unfaltering energy; a saga seldom equaled in the history of human dedication. 00:09:42.400 --> 00:09:46.410 [Music] 00:09:46.410 --> 00:09:52.490 Operating on another level of motive are the two large commercial operations in Liberia. 00:09:52.490 --> 00:09:58.310 The Firestone Plantations Company has been growing and processing rubber since 1926. 00:09:58.310 --> 00:10:04.850 [Music] 00:10:04.850 --> 00:10:08.280 In recent years, the Liberia Mining Company has found success 00:10:08.280 --> 00:10:10.980 in the extraction of high-grade iron ore. 00:10:10.980 --> 00:10:15.310 These two companies employ close to 30,000 Liberians, 00:10:15.310 --> 00:10:21.090 and provide them and their families with housing, community, and medical facilities. 00:10:21.090 --> 00:10:24.250 Such medical programs extend beyond the direct results 00:10:24.250 --> 00:10:27.980 of treating and immunizing the employees and their families. 00:10:27.980 --> 00:10:30.010 Viewed only negatively, 00:10:30.010 --> 00:10:34.030 an epidemic among this labor force could cause havoc to the economy 00:10:34.030 --> 00:10:35.480 of the country. 00:10:35.480 --> 00:10:44.730 But, as the first step lies in the protection of the body of men, 00:10:44.730 --> 00:10:49.670 an even more emphatic contribution is born in the mind of men. 00:10:49.670 --> 00:10:54.040 They are operating the vehicles and machine tools of the industrial world. 00:10:54.040 --> 00:10:58.090 They are learning the agricultural science of plant breeding and grafting, 00:10:58.090 --> 00:11:01.970 and they are maintaining the chemistry of rubber processing. 00:11:01.970 --> 00:11:13.180 It is this skilled labor force that represents the population that is Liberia's future. 00:11:13.180 --> 00:11:16.990 Analyzed positively in the light of these occupational developments, 00:11:16.990 --> 00:11:22.230 the Liberians' increasing dependence on and knowledge of the world of medicine 00:11:22.230 --> 00:11:27.040 becomes an attendant factor in Liberia's social and economic growth. 00:11:27.040 --> 00:11:31.300 Serving as the fulcrum of health and sanitation of the Firestone Plantations, 00:11:31.300 --> 00:11:34.280 two hospitals maintain over 200 beds, 00:11:34.280 --> 00:11:37.130 staffed by 11 physicians and 75 nurses, 00:11:37.130 --> 00:11:41.480 lab technicians, and orderlies. 00:11:41.480 --> 00:11:44.880 Due to the high level of mechanization in the mining process 00:11:44.880 --> 00:11:47.320 and the consequently-limited labor force, 00:11:47.320 --> 00:11:49.540 the Bomi Hills Hospital is smaller, 00:11:49.540 --> 00:11:55.520 but its facilities and services are equal to the best to be found in Africa. 00:11:55.520 --> 00:11:59.720 Bomi is especially plagued with a heavily silted water supply, 00:11:59.720 --> 00:12:02.870 and as a check on its modern filtration system, 00:12:02.870 --> 00:12:07.540 a bacteria count is maintained at all major distributive points. 00:12:07.540 --> 00:12:12.180 In both operations, prevention takes precedence over treatment. 00:12:12.180 --> 00:12:19.120 [Music] 00:12:19.120 --> 00:12:24.380 Sanitation and hygiene in the company villages constitute the basis of prevention, 00:12:24.380 --> 00:12:32.070 but the education and vigilance of the villagers themselves is a prerequisite to that goal. 00:12:32.070 --> 00:12:35.540 Under the guidance of directives developed by the medical staff, 00:12:35.540 --> 00:12:39.400 each of the plantation villages possesses a trained sanitarian 00:12:39.400 --> 00:12:43.650 who is periodically checked and upgraded through examinations. 00:12:43.650 --> 00:12:49.380 The sanitarian maintains a continuity in the method and effectiveness of sewage disposal, 00:12:49.380 --> 00:12:53.690 and in general, is custodian to the health needs of his community. 00:12:53.690 --> 00:12:58.850 The new pattern of symmetrically-designed villages takes hold with the residents. 00:12:58.850 --> 00:13:04.070 Seeing the benefits of drainages, planned and maintained thoroughfares, and recreation areas, 00:13:04.070 --> 00:13:11.880 they also come to accept new and improved types of housing that radically depart from the traditional and inadequate hut. 00:13:11.880 --> 00:13:19.110 [Music] 00:13:19.110 --> 00:13:24.410 As the changing seasons bring changes in the density and species of insect vectors, 00:13:24.410 --> 00:13:28.120 insecticide spraying teams move through the villages, 00:13:28.120 --> 00:13:32.320 and even with new residents who have had little experience with medicine 00:13:32.320 --> 00:13:36.960 and no knowledge of the relationship between insect vectors and disease, 00:13:36.960 --> 00:13:42.740 the very elimination of the pests from the houses represents a newfound peace. 00:13:42.740 --> 00:13:53.670 [Music] 00:13:53.670 --> 00:13:57.420 Thus, the fullest performance of these medical programs is obtained 00:13:57.420 --> 00:14:01.710 by bringing prevention and treatment to the local working and living areas. 00:14:01.710 --> 00:14:08.080 In addition to maintaining nurses at the hiring centers, and clinics in the heavily-populated factory area, 00:14:08.080 --> 00:14:13.220 the plantation doctors conduct regular frequent clinics at 36 dispensaries, 00:14:13.220 --> 00:14:18.010 strategically located across the 100,000 acres of the plantation. 00:14:18.010 --> 00:14:20.780 [Music] 00:14:20.780 --> 00:14:23.500 With such a program, illness is identified early. 00:14:23.500 --> 00:14:26.720 Guidance in the diet and care of the newborn is provided, 00:14:26.720 --> 00:14:31.440 and the people learn that the practice of modern medicine is a methodical procedure, 00:14:31.440 --> 00:14:36.850 composed of objective knowledge, and requiring only their understanding and cooperation. 00:14:36.850 --> 00:14:41.730 They learn that the results of modern medicine tend to be orderly and stable, 00:14:41.730 --> 00:14:50.100 and nonviolent and non-dramatic in contrast to the life or death prescription of the country medicine man. 00:14:50.100 --> 00:14:55.000 Basic to all this activity, on both the public and private level, is research. 00:14:55.000 --> 00:15:02.510 In that singular interest, the Liberian Institute of the American Foundation for Tropical Medicine was, in 1946, 00:15:02.510 --> 00:15:07.380 incorporated in the state of New York as a private nonprofit organization. 00:15:07.380 --> 00:15:11.760 In 1951, on a land grant from the government of Liberia, 00:15:11.760 --> 00:15:14.650 the present structures were completed with funds provided by 00:15:14.650 --> 00:15:18.800 Harvey S. Firestone, Jr. as a memorial to his father. 00:15:18.800 --> 00:15:23.710 Support of the institute comes from annual gifts made by American business corporations 00:15:23.710 --> 00:15:25.810 operating in the various tropical areas, 00:15:25.810 --> 00:15:27.410 including Liberia, 00:15:27.410 --> 00:15:32.620 and by research grant funds provided by the United States Public Health Service. 00:15:32.620 --> 00:15:40.310 The Institute's basic goal is to contribute to the more successful prevention and treatment of topical disease. 00:15:40.310 --> 00:15:46.050 In such terms, it has successfully endeavored to fulfill a four-point program. 00:15:46.050 --> 00:15:50.910 [Music] 00:15:50.910 --> 00:15:52.010 1. Study and collect data 00:15:52.010 --> 00:15:53.190 2. Train technicians 00:15:53.190 --> 00:15:58.240 3. Provide an international center where scientists from all countries may study and work 00:15:58.240 --> 00:16:03.630 4. Provide data for other research and medical centers 00:16:03.630 --> 00:16:06.200 Attracted to this opportunity from all over the world, 00:16:06.200 --> 00:16:09.550 scientists study the insect vectors and methods of control. 00:16:09.550 --> 00:16:13.680 While an outpatient clinic is maintained by the Institute, 00:16:13.680 --> 00:16:21.460 the nearby plantation hospital sets aside beds for institute case studies requiring hospitalization. 00:16:21.460 --> 00:16:25.420 Numerous villages serve as laboratories of treatment and control, 00:16:25.420 --> 00:16:29.950 and throughout Liberia, the Institute carries out collaborative projects 00:16:29.950 --> 00:16:34.350 with such groups as American universities, the World Health Organization, 00:16:34.350 --> 00:16:37.140 and the United States Public Health Service. 00:16:37.140 --> 00:16:40.670 In view of the variety and density of disease, 00:16:40.670 --> 00:16:49.470 all of Liberia is available for medical study. 00:16:49.470 --> 00:16:54.910 [Typical Tropical Diseases in Libera] 00:16:54.910 --> 00:16:56.250 [Leprosy] 00:16:56.250 --> 00:16:57.480 [Neural Leprosy] 00:16:57.480 --> 00:17:01.630 [Narrator #2:] Neural leprosy has two manifestations, macula-anesthetic leprosy; 00:17:01.630 --> 00:17:09.930 a depigmentation of skin patches 00:17:09.930 --> 00:17:20.620 and mutilization with loss of digits. 00:17:20.620 --> 00:17:24.360 Nodular leprosy is often referred to as lion face. 00:17:24.360 --> 00:17:31.590 [Nodular Leprosy] 00:17:31.590 --> 00:17:34.270 In Liberia, there are several leprosaria, 00:17:34.270 --> 00:17:39.000 supported by the National Public Health Services and various missions. 00:17:39.000 --> 00:17:44.510 Here, at the Ganta Methodist Mission, under the direction of Dr. George W. Harley, 00:17:44.510 --> 00:17:46.930 the discharge rate has been greatly accelerated, 00:17:46.930 --> 00:17:50.720 with the use of the new therapeutic agents. 00:17:50.720 --> 00:17:54.980 The incidence of leprosy in Liberia is not known. 00:17:54.980 --> 00:17:57.510 Until more extensive studies are carried out, 00:17:57.510 --> 00:18:01.120 there can be no certainty of existing data. 00:18:01.120 --> 00:18:05.470 While the few agencies in this field are contributing a valuable service, 00:18:05.470 --> 00:18:08.330 the impression must remain that no progress in control. 00:18:08.330 --> 00:18:12.970 [inaudible] 00:18:12.970 --> 00:18:14.700 ...made. 00:18:14.700 --> 00:18:19.930 However, the cooperative reaction of the patients, their obvious desire for the drugs, 00:18:19.930 --> 00:18:24.050 and the attendant growth of an interest in and understanding of disease, 00:18:24.050 --> 00:18:51.270 reveals that given data and facilities, the disease can be eradicated. 00:18:51.270 --> 00:18:57.360 [YAWS, A non-venereal treponematosis of the tropics] 00:18:57.360 --> 00:19:01.640 Yaws is widely prevalent among the Liberian population. 00:19:01.640 --> 00:19:05.820 In the early stages, it is essentially a disease of the skin. 00:19:05.820 --> 00:19:14.410 Later, it becomes systemic, and the most troublesome late lesions are those of the bones, joints, and plantar surfaces of the feet. 00:19:14.410 --> 00:19:21.640 Goundou, an exostosis of the facial bones. It is considered by most authorities to be a tertiary lesion of YAWS. 00:19:21.640 --> 00:19:28.680 [Goundou] 00:19:28.680 --> 00:19:35.860 Plantar or crab YAWS. This condition, which is characterized by the development of papillomata 00:19:35.860 --> 00:19:38.070 under the thick skin of the sole, is very painful. 00:19:38.070 --> 00:19:39.940 [Crab YAWS] 00:19:39.940 --> 00:19:45.090 Eventually, the overlying skin breaks down, and ulcers form. 00:19:45.090 --> 00:19:50.320 Because it is highly contagious, the disease is one of the most difficult to eradicate, and the 00:19:50.320 --> 00:19:53.340 incapacitating degree of pain causes a heavy loss 00:19:53.340 --> 00:19:57.490 to the manpower of the country. 00:19:57.490 --> 00:20:01.490 Osteitis results in saber shins and deformities of the arms and fingers. 00:20:01.490 --> 00:20:04.540 [Saber Shins] 00:20:04.540 --> 00:20:07.820 Collaborative projects on the treatment of YAWS are being conducted by 00:20:07.820 --> 00:20:11.000 the National Public Health Services of Liberia, 00:20:11.000 --> 00:20:13.040 the World Health Organization, 00:20:13.040 --> 00:20:18.430 and the United Nations International Children's Emergency Fund. 00:20:18.430 --> 00:20:26.420 [Onchocerciasis, a filarial worm of the subcutaneous tissues] 00:20:26.420 --> 00:20:31.410 The filarial worm is transmitted by a species of fly of the genus Simulium, 00:20:31.410 --> 00:20:37.960 commonly called the black fly, which breeds in rapidly flowing streams. 00:20:37.960 --> 00:20:40.950 Infection causes onchocercal dermatitis; 00:20:40.950 --> 00:20:43.550 shown here with a superimposed pyogenic infection. 00:20:43.550 --> 00:20:56.720 [Onchocercal dermatitis] 00:20:56.720 --> 00:21:02.270 And fibrous nodules. And in some instances, eye lesions. 00:21:02.270 --> 00:21:06.390 [Onchocercoma] 00:21:06.390 --> 00:21:28.020 Here, a nodule in the pelvic region is being removed. 00:21:28.020 --> 00:21:32.040 Onchocercosis is now considered by the World Health Organization 00:21:32.040 --> 00:21:36.090 to be the most urgent medical problems in Africa. 00:21:36.090 --> 00:21:38.570 [Bancroftian Filariasis] 00:21:38.570 --> 00:21:43.580 Bancroft's filariasis is due to a filarial worm parasite, 00:21:43.580 --> 00:21:46.920 Wuchereria Bancrofti, which invades the lymphatic system. 00:21:46.920 --> 00:21:48.870 [Filarial Elephantiasis] 00:21:48.870 --> 00:21:54.170 It is transmitted by a number of mosquito species very prevalent in Liberia. 00:21:54.170 --> 00:21:58.670 It is this parasite that gives rise to elephantiasis. 00:21:58.670 --> 00:22:02.700 Also, lymphangitis, adenitis, and other clinical conditions. 00:22:02.700 --> 00:22:06.570 [Filarial Lymphangitis] 00:22:06.570 --> 00:22:08.260 [Tuberculosis] 00:22:08.260 --> 00:22:11.190 Without the aid of a survey, which would be difficult, 00:22:11.190 --> 00:22:14.230 the prevalence of TB is not known. 00:22:14.230 --> 00:22:19.750 It is recognized as widespread in Liberia, as in most underdeveloped countries. 00:22:19.750 --> 00:22:23.690 Isolation hospitals are provided by the National Public Health Services, 00:22:23.690 --> 00:22:27.970 utilizing specific chemotherapy. 00:22:27.970 --> 00:22:30.350 [Keloid] 00:22:30.350 --> 00:22:32.310 The well-known tendency of the African 00:22:32.310 --> 00:22:52.410 to develop keloid growths is well exemplified here. 00:22:52.410 --> 00:22:54.870 Part of the growth was surgically removed, 00:22:54.870 --> 00:23:01.170 and it can be seen as recurring around the edges of the excision. 00:23:01.170 --> 00:23:03.260 [Ainhum] 00:23:03.260 --> 00:23:06.920 Ainhum is a disease characterized by spontaneous amputation 00:23:06.920 --> 00:23:11.250 of the fifth and occasionally the fourth toe. 00:23:11.250 --> 00:23:16.360 It is brought about by constricting fibrous bands developing at the base of the toes. 00:23:16.360 --> 00:23:20.020 The disease is most prevalent in West Africa and Brazil. 00:23:20.020 --> 00:23:24.100 The cause is unknown. 00:23:24.100 --> 00:23:27.410 [Tropical Ulcer] 00:23:27.410 --> 00:23:31.510 Ulcerative processes of the skin, especially on the legs, 00:23:31.510 --> 00:23:42.630 are very common and in some instances, difficult to cure. 00:23:42.630 --> 00:23:46.780 [Trypanosomiasis (African Sleeping Sickness)] 00:23:46.780 --> 00:23:53.860 African sleeping sickness is caused by the protozoan parasite trypanosoma gambiense, 00:23:53.860 --> 00:23:59.160 which is transmitted by the tsetse fly, Glossina palpalis. 00:23:59.160 --> 00:24:04.890 In its late stages, the disease is characterized by disorders of the central nervous system, 00:24:04.890 --> 00:24:08.720 usually resulting in lethargy and a stuporous condition. 00:24:08.720 --> 00:24:28.720 However, the hyper-reactivity shown by this patient can also occur. 00:24:28.720 --> 00:24:30.570 [Smallpox] 00:24:30.570 --> 00:24:35.330 Smallpox has recurred in Liberia periodically in devastating epidemics. 00:24:35.330 --> 00:24:37.470 Although there has been some vaccination, 00:24:37.470 --> 00:24:41.010 the entire population is by no means protected. 00:24:41.010 --> 00:24:50.280 Until there is 100 percent vaccination, the threat of a recurrence exists. 00:24:50.280 --> 00:24:51.950 [Music] 00:24:51.950 --> 00:24:58.590 [Narrator#1:] The research work of the Liberian Institute of the American Foundation for Tropical Medicine extends beyond its 15 labs, 00:24:58.590 --> 00:25:03.090 lab animal houses, and workshops; all Liberia is its laboratory. 00:25:03.090 --> 00:25:08.560 Liberians eager to improve their country's strength take their own individual first step, 00:25:08.560 --> 00:25:10.750 and train as technicians. 00:25:10.750 --> 00:25:18.090 As the scientists possesses two methods of control where a carrier is involved: to destroy the transmitting vector, 00:25:18.090 --> 00:25:21.860 and to treat and prevent the effects of the parasite in the host, 00:25:21.860 --> 00:25:26.720 so too does he depend on the problem being attacked on more than one front. 00:25:26.720 --> 00:25:32.750 The basic conditions that weaken the body and cause susceptibility must also be eradicated. 00:25:32.750 --> 00:25:37.140 [Music] 00:25:37.140 --> 00:25:41.240 The Institute recognizes that one problem basic to treatment 00:25:41.240 --> 00:25:43.270 is the malnutrition of the people; 00:25:43.270 --> 00:25:46.840 a lack of protein in the diet. 00:25:46.840 --> 00:25:53.210 To help combat this scarcity, the Liberian Government, the United States International Cooperation Administration, 00:25:53.210 --> 00:25:56.850 and Firestone, are establishing fish ponds. 00:25:56.850 --> 00:26:30.570 [Music] 00:26:30.570 --> 00:26:39.400 The creation of such a supply of protein for each inland village is the final goal. 00:26:39.400 --> 00:26:42.090 With Liberia's climate ideally suited for tree crops, 00:26:42.090 --> 00:26:45.610 it is only natural that the work of the many rubber, 00:26:45.610 --> 00:26:48.240 coffee, and cocoa botanists is leaving a deep mark. 00:26:48.240 --> 00:26:51.470 Taking advantage of this profound cultural wedge, 00:26:51.470 --> 00:26:57.680 an ICA agronomist shows a tribal chief the increased resistance and productivity 00:26:57.680 --> 00:27:00.240 of a new variety of palm nut tree, 00:27:00.240 --> 00:27:03.250 the oil of which is an important food source. 00:27:03.250 --> 00:27:08.210 The move is on to educate a change from the growing of dry rice 00:27:08.210 --> 00:27:11.670 to the less toilsome and higher-yielding swamp rice, 00:27:11.670 --> 00:27:15.480 and the growing presence on the plantation and demonstration farms 00:27:15.480 --> 00:27:18.580 of mechanical tools, is producing an interest, 00:27:18.580 --> 00:27:22.390 which promises far-reaching results. 00:27:22.390 --> 00:27:37.630 [Music] 00:27:37.630 --> 00:27:40.750 On the medical side of health by drug and surgery, 00:27:40.750 --> 00:27:44.490 the stories of scientific treatment emanate from the plantation hospitals 00:27:44.490 --> 00:27:46.570 to display a folklore of magic; 00:27:46.570 --> 00:27:54.260 a tale spellbinding with its facets of sleep-producing aromas, 00:27:54.260 --> 00:27:59.250 painless incisions, 00:27:59.250 --> 00:28:04.790 and quick recovery. 00:28:04.790 --> 00:28:07.070 With such an enviable social position, 00:28:07.070 --> 00:28:11.150 the physician gains an opportunity to begin at the beginning, 00:28:11.150 --> 00:28:19.560 and the expectant mothers look forward to the scheduled prenatal clinics. 00:28:19.560 --> 00:28:21.940 But to the continued progress of this activity, 00:28:21.940 --> 00:28:24.190 research is always fundamental. 00:28:24.190 --> 00:28:26.870 In the malaria work of the Liberian Institute, 00:28:26.870 --> 00:28:30.490 a complete knowledge of the life habits of mosquito vectors 00:28:30.490 --> 00:28:32.110 and their relation to malaria, 00:28:32.110 --> 00:28:36.720 is an essential prerequisite to the establishment of a control program. 00:28:36.720 --> 00:28:40.840 In the laboratory, thousands upon thousands of mosquitoes are annually reared and used 00:28:40.840 --> 00:28:42.920 in a variety of studies, 00:28:42.920 --> 00:28:45.190 including experimental infections 00:28:45.190 --> 00:28:47.650 and the determination of the genetic factors 00:28:47.650 --> 00:28:51.100 in acquired tolerance to insecticides. 00:28:51.100 --> 00:28:56.060 To determine the fluctuations in specie population and density throughout the year, 00:28:56.060 --> 00:29:00.860 collecting trips are made daily to numerous localities over extended periods. 00:29:00.860 --> 00:29:02.830 To attract and capture the mosquitoes, 00:29:02.830 --> 00:29:05.830 teams of collectors set up portable hut traps, 00:29:05.830 --> 00:29:09.670 in which they spend rather fitful nights. 00:29:09.670 --> 00:29:33.600 [Music] 00:29:33.600 --> 00:29:37.060 By their growing understanding of the methodology of science, 00:29:37.060 --> 00:29:39.260 these technicians gain some added strength 00:29:39.260 --> 00:29:43.780 in resisting the normal desire to swat the little pests. 00:29:43.780 --> 00:29:48.380 [Music] 00:29:48.380 --> 00:29:53.290 Schistosomiasis or bilharzias is prevalent in large areas of Liberia. 00:29:53.290 --> 00:29:58.060 Institute surveys have shown close to 100 percent infection in some regions. 00:29:58.060 --> 00:30:02.920 The two species of schistosomes in Liberia, haematobium and mansoni, 00:30:02.920 --> 00:30:04.720 are carried by snails. 00:30:04.720 --> 00:30:09.000 Work is in progress to test methods of destroying the snail vectors, 00:30:09.000 --> 00:30:15.120 and to determine the effects of various drugs on the parasite. 00:30:15.120 --> 00:30:16.750 Across country at the mines, 00:30:16.750 --> 00:30:21.680 an institute staff member examines a group of children for enlargement of the spleen, 00:30:21.680 --> 00:30:26.600 to determine the effectiveness of a residual insecticide spraying program 00:30:26.600 --> 00:30:29.250 in the eradication of the insect carrier. 00:30:29.250 --> 00:30:34.760 Incidentally, umbilical hernias, such as this one, are very common among African children. 00:30:34.760 --> 00:30:39.300 However, a large proportion of the incidence disappears in adult life. 00:30:39.300 --> 00:30:59.830 [Music] 00:30:59.830 --> 00:31:04.530 Trypanosomiasis, sleeping sickness, is another disease prevalent in Liberia. 00:31:04.530 --> 00:31:07.090 The incidence, however, is not known. On a tour upcountry, 00:31:07.090 --> 00:31:11.030 the Institute's director, Dr. Max Miller, 00:31:11.030 --> 00:31:14.220 pays a visit to the clan chief of a group of villages 00:31:14.220 --> 00:31:20.070 to secure his cooperation and permission in locating cases of the disease. 00:31:20.070 --> 00:31:22.270 Old acquaintances exchange gossip, 00:31:22.270 --> 00:31:26.520 news of local crop conditions traded for a report on a local youngster, 00:31:26.520 --> 00:31:28.960 working as an institute technician. 00:31:28.960 --> 00:31:34.430 Then, with the ease of established trust, the chief leads the doctor to a nearby case, 00:31:34.430 --> 00:31:38.580 and the excited retinue, eager for a demonstration, follows. 00:31:38.580 --> 00:31:44.470 African sleeping disease is a disease of major importance to the health of Liberia. 00:31:44.470 --> 00:31:48.960 The Institute's work at the present time is mainly restricted to the testing of drugs 00:31:48.960 --> 00:31:52.230 and a limited surveying of the incidence of infection. 00:31:52.230 --> 00:31:54.480 As additional funds become available, 00:31:54.480 --> 00:31:59.130 research can be extended to a degree commensurate with the need. 00:31:59.130 --> 00:32:01.350 This case is an advanced one. 00:32:01.350 --> 00:32:04.890 The stage of infection is demonstrated by extreme lethargy. 00:32:04.890 --> 00:32:08.380 Walks only with the greatest difficulty and assistance. 00:32:08.380 --> 00:32:14.400 If left alone, he would show no interest in food, and die of starvation. 00:32:14.400 --> 00:32:17.300 The extreme emaciation obviously reveals 00:32:17.300 --> 00:32:20.530 that the case is rapidly progressing to the last stages. 00:32:20.530 --> 00:32:24.660 Because he is unable to perform the most elementary personal hygiene, 00:32:24.660 --> 00:32:34.300 he is covered with a skin infection, and is irritable when disturbed. 00:32:34.300 --> 00:32:37.450 An experiment in administering a malarial drug 00:32:37.450 --> 00:32:42.050 and the consequent blood surveys, moves into its ninth month. 00:32:42.050 --> 00:32:45.450 Two groups of villages serve the investigation. 00:32:45.450 --> 00:32:47.330 All the population of one-half the villages 00:32:47.330 --> 00:32:51.620 have been given monthly suppressive doses of anti-malarial drugs, 00:32:51.620 --> 00:32:56.020 while the population of the other half have taken placeboes, sugar pills. 00:32:56.020 --> 00:32:57.940 At the time of drug administration, 00:32:57.940 --> 00:33:03.870 a survey is made to determine the malaria parasite rate in the entire population group. 00:33:03.870 --> 00:33:06.780 In the light of the growing interdependence of nations, 00:33:06.780 --> 00:33:10.720 the necessary trading of energy for skills, skills for resources, 00:33:10.720 --> 00:33:14.640 and resources for a participation in all the wealth of man's achievement, 00:33:14.640 --> 00:33:17.620 there can be seen a kinship between the smallest, 00:33:17.620 --> 00:33:21.770 most unconscious endeavor, and the greatest need. 00:33:21.770 --> 00:33:26.960 Although the success of the survey is dependent on the village receiving the suppressives, 00:33:26.960 --> 00:33:31.350 it is no less indebted to the people taking placeboes. 00:33:31.350 --> 00:33:41.260 [Music] 00:33:41.260 --> 00:33:46.260 If the development of backward areas has become fundamental to the growing needs of all people, 00:33:46.260 --> 00:33:51.630 the eradication of tropical disease lies in the category of first things first. 00:33:51.630 --> 00:33:55.150 As evidence of the Liberian Institute's function, facility, 00:33:55.150 --> 00:33:57.010 and opportunity to this end, 00:33:57.010 --> 00:34:00.170 scientists from all over the world are drawn to it. 00:34:00.170 --> 00:34:04.910 They work in a country that is friendly to our concept of human dignity. 00:34:04.910 --> 00:34:10.570 For the Institute's very existence provides the example of American business abroad 00:34:10.570 --> 00:34:12.830 contributing to the health of man. 00:34:12.830 --> 00:34:16.950 By its ready acceptance of change when the benefits are clear, 00:34:16.950 --> 00:34:20.310 the population reveals its desire to progress, 00:34:20.310 --> 00:34:24.350 and the government, too, is anxious to make a dynamic contribution, 00:34:24.350 --> 00:34:27.340 because it recognizes that it cannot increase its voice 00:34:27.340 --> 00:34:30.290 among the nations by only clipping the coupons 00:34:30.290 --> 00:34:33.490 of the country's growing wealth. 00:34:33.490 --> 00:34:41.040 With this wealth of opportunity and cooperation, it is easy to see the pattern necessary in the development of the backward areas. 00:34:41.040 --> 00:34:46.350 [Music] 00:34:46.350 --> 00:34:47.750 [The Problem:] 00:34:47.750 --> 00:34:56.210 There is a great prevalence of disease, an absence of proper foods, 00:34:56.210 --> 00:35:02.560 and a lack of knowledge concerning the realities of the world the people live in. 00:35:02.560 --> 00:35:06.180 [Music] 00:35:06.180 --> 00:35:07.690 [The Solution:] 00:35:07.690 --> 00:35:09.590 Cure the disease. 00:35:09.590 --> 00:35:13.900 [Music] 00:35:13.900 --> 00:35:16.640 Free the people for productive enterprise, 00:35:16.640 --> 00:35:20.570 and the indigenous people will eagerly seek the knowledge necessary 00:35:20.570 --> 00:35:23.950 to further enrich their lives. 00:35:23.950 --> 00:35:26.810 [Music] 00:35:26.810 --> 00:35:28.660 [The Need:] 00:35:28.660 --> 00:35:32.190 The Liberian Institute's dedication to seek inexpensive methods of treatment and prevention 00:35:32.190 --> 00:35:34.350 attacks the core of the problem. 00:35:34.350 --> 00:35:39.480 To this end, the Institute should receive widespread support. 00:35:39.480 --> 00:35:41.750 With the new intercourse of trade, 00:35:41.750 --> 00:35:44.940 the dark continent's resources of soil and climate 00:35:44.940 --> 00:35:49.190 are only available as the health of the people is secure. 00:35:49.190 --> 00:35:54.120 In point of fact, the health of the world can benefit by so small, 00:35:54.120 --> 00:35:58.880 so unknowing a contribution as that being made by the Liberian people 00:35:58.880 --> 00:36:02.540 in both the test village and the control village. 00:36:02.540 --> 00:36:06.920 In one of the blood samples held against the African light, 00:36:06.920 --> 00:36:11.290 the image of all the world's well-being can be seen. 00:36:11.290 --> 00:36:13.080 [Music] 00:36:13.080 --> 00:36:23.103 [The End, A presentation of Firestone Plantations Company, Copyright MCMLVII]