Intended for healthcare professionals


Out of Africa

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:785
  1. Imre Loefler, editor
  1. Nairobi Hospital Proceedings, Kenya

    Flying across eastern Africa most Mondays for almost 30 years, the surgeon-pilot observed how population growth and environmental destruction went hand in hand, and how the increase in energy use—local and global—changed geography.

    He monitored how the glaciers on Mount Kenya and the Ruwenzoris were receding and how the snows of Kilimanjaro were melting. He saw the forests disappearing, the wetlands vanishing, and the rivers either drying up or in raging flood, carrying the fertile red soil out into the sea, and he noticed the steady advance of the desert.

    He saw huts, houses, villages everywhere, tracks, roads, and highways, and he flew over huge tracts of land assigned to monoculture: tea, coffee, sugar, wheat, maize, pineapples, and flowers, most destined for export. He flew over struggling subsistence farms, getting increasingly smaller.

    Landing at the hospital early in the morning he would be confronted with multitudes of sick people lining up for surgery. He had to decide whether to treat the sickest or the ones with the best prognosis—usually the utilitarian argument won.

    Over the years the epidemiology presenting to him changed. There were the old diseases, mostly infectious; then came the trauma epidemic, first road crashes and then violence; next were the cosmopolitan cancers; and recently, with Western lifestyles, and sugar, sodas, salt, refined fats, and the lack of exercise, the degenerative diseases.

    The population pyramid also changed. More children, children everywhere, wonderful, bright, joyous children, but, in ecological terms, acting like locusts nevertheless…Eventually AIDS began to nibble at the pyramid: the children would be attended by the grandparents. But the surgeon-pilot was not there to philosophise, he was there to give advice, to teach, to mend…to radiate hope.

    On his way home in the evening, when the cumulus clouds in the west became golden and then purple, the lakes silver, and the silhouettes of the mountains cast variegated shadows over the land, the surgeon-pilot's heart was filled with elation, while his mind was preoccupied with the state of Africa, the continent overwhelmed by rapid technological change and heading for unimaginable stresses caused by environmental dislocation.

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