Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation Steven Palmer

Abstract

presents a comparative history of the inauguration of six hookworm program sites by the Rockefeller Foundation's international programs in Central America and the British Caribbean in the early 1900s. He does a thorough job of establishing how hookworm entered these areas, and he sets the regional background as the Rockefeller Foundation moves in to expand its laboratory-based public health programs. A reader will find particularly interesting Palmer's examination of Britain's colonial politics and tropical medicine culture in the region during the Rockefeller initiatives, informing the reader of the histories of the non-Hispanic nations that are less well known than the Hispanic countries. This book imparts interesting points of comparison between U.S. public health principles and British tropical medicine standards. Many of the programs initiated by the Rockefeller Foundation ended within 15 years and Palmer shows that even in the early 1900s, programs had to be adapted to the local frame of mind and not imposed from the top. He analyzes the view of "local historical dynamics" finding that projects flowed "from the ground up" (p. 4) rather than the more common discourse of the Rockefeller staff imposing alien programs and information. Politics played a part in the dismissal of the programs when locals began to execute programs and anti-American sentiments rose. One of Palmer's findings examines how nationals accepted the Rockefeller Foundation's International Health Division's industrialized implementation of a hookworm treatment program through the introduction of intensive promotional methods and technology to standardize the delivery of health care. Health care workers will be interested to read Chapters 2 and 3 because they describe the establishment of the programs in the different countries and the intimacies of hiring, training, employing, and evaluating the staff in the various sites. Rockefeller personnel were trained in the U.S. southern states where hookworm campaigns were sponsored by the Foundation, whereas native staff was trained in the local field. The dispensary method was put aside to allow a faster, maximum outreach program of home visiting to give weekly treatments, a method which differed from the low-dose, daily treatment suggested by the British colonial program. Palmer does an excellent job of describing the animosities that arose from all of the groups: differences between the science of the British colonial medical establishment and the newly arrived U.S. doctors and the contention between the anti-imperialist local physicians who wanted to manage their public health programs without the assistance of the imported U.S. physicians. Beginning in Chapter 3, Palmer uses the term nurse to describe workers within the various hookworm programs. I am curious to know more about how he chose this gendered and educationally defined term within this context. Although during various historical periods , anyone who has cared for the sick has been called a nurse; within the context of the Rockefeller Foundation public health milieu and the British colonial system, the term nurse typically referred to females trained in hospitals. It is unfortunate that Palmer does not delve deeper to describe the background and education of these nurses who appear to be males, perhaps informing the reader of the new material on the history of men in nursing.