WORKING IN THE GAMBIA

Dr Elizabeth Poskitt, Medical Research Council, on 14 March 2002

Lunchtime Lecture

After working in Uganda, Dr Poskitt spent five years running the UK Medical Research Council's Dunn Nutrition Research Field Station in Keneba, The Gambia, West Africa.

The MRC first established a malarial research station at Keneba in 1949 because it was in a remote (for a tiny country like The Gambia) region. Records of births, deaths and health have been kept for the populations of Keneba and two neighbouring villages since the MRC first came to the area, creating a unique research database. In 1974 the unit became a field station for the MRC Dunn Nutrition Research Centre in Cambridge. Since that time research at the unit has centred around problems of nutrition, growth and health, particularly for children and pregnant and lactating women.

Dr Poskitt talked about everyday life in a unit situated at the edge of a village where most people live by subsistence agriculture, without electricity. Their water came from village pumps or an uncertain tapped supply developed primarily for the research cattle of the International Trypanotolerance Research Unit in the village. The MRC unit (about 80 Gambian staff and three or four European staff on contract and frequent visiting research scientists and students on short visits from Europe and America) has electricity generators and water from a borehole. (Many villagers, although without electricity, run television sets from old car batteries re-charged on the Unit's generators). The Unit had no telephone until late 1998 although there was short wave radio communication with the main MRC unit at the coast. The Unit was only just out of range of a mobile telephone transmitting station making it occasionally possible to get through to Europe (and elsewhere) by `mobile' after dark, provided one climbed up the Unit's water tower or, alternatively, held the aerial at arm's height, standing on a chair, on a table, on the verandah, at a `hotel' 10 miles away through the bush.

Unit research proposals were always `vetted' by the Gambian Ethical Committee (consisting of government, MRC, and lay members) before they could be implemented. They were further vetted by the village elders at meetings under a mango tree beginning with Muslim prayers and often ending with a distribution of cola nuts, courtesy of the MRC. The elders frequently expressed their disappointment that research was so often with women and children, rather than with the old men who needed to be kept healthy `in order to maintain the village population'! It was a Muslim society with men allowed up to four wives, divorce quite common and frequently huge differences in age between man and wife. Sadly many young men deserted the villages to go to the Coast in the hopes of profitable work.

Agriculture is largely `women's work' although many men work hard preparing the fields at the beginning of the growing season, and harvesting the ground nuts which are the (not very profitable) cash crop. Rice is a main staple along with millet and maize. Rice growing is entirely women's work and is very tough work since the fields are often several miles from the villages and rice needs tending more or less daily.

The Gambia has dramatic seasonality with nine months of totally dry and extremely hot (regularly up to 45°C) weather and then three months of heavy rain - and the single growing season. Seasonality is traditionally reflected in patterns of food scarcity and plenty with individual weight loss and weight gain associated with the seasons. Studies over the years have shown significant seasonal falls in maternal weights and birth weights in association with late pregnancy occurring during the rainy season. The previous year's harvest has been consumed so families are often very hungry, women are working hard in the fields, and diseases such as malaria, pneumonia and diarrhoea are prevalent. Nutritional supplementation (1000 kcal/d extra as locally made biscuits administered by Traditional Birth Attendants) of pregnant women eliminates the seasonal variation in birthweight, with reduced rates of low birth weight and fewer stillbirths and deaths in the first week of life - all thoroughly desirable outcomes.

Other recent work has shown very low calcium intakes from the local diet. Yet bone mineral density for body weight of adult Gambian women is similar to that of European women. Moreover the women lose bone mineral at the same rate as European women in middle and old age, but have no symptoms of osteoporosis and no problem with hip or other fractures. This suggests that levels of activity (the women continue farming even in old age) are more important in determining the distribution of calcium in bones and thus the strength of bones, than the actual calcium intake - a lesson perhaps for our inactive western civilisation.

Dr Poskitt talked not only about research at the Unit but also about everyday life of the villagers; projects within the village for helping community development; and the challenging and sometimes entertaining problems that arose running the Unit, dealing with staff and clinical problems, and maintaining good working relationships with the community. She felt strongly that it had been a privilege to have had the opportunity to live, work and be a part of a society so different from our own.

Dr Elizabeth Poskitt