Leader Stirling

The 5 year medical course consisted of 1 year of pre-medical studies at the East London College, now Queen Mary College, where he basically studied zoology. During his first year he was also a surgical dresser in the London Hospital when he had his first hands-on experiences with medical practice. In 1925 he began his second year of medical school, now studying at the London Hospital, which was followed by 3 years of clinical course. He graduated from medical school on July 1929, qualifying MRCS and LRCT in the same year.[5] He graduated MBBS, and later, in 1993, was elected FRCS, a very honourable and rare happening.[4]

3 months after his decision to join the UMCA, Leader Stirling landed in Zanzibar, then the port of entry to Tanganyika. The UMCA mission in Zanzibar had been well established by another notable missionary, Miss Annie Allen, in 1878.[6] He continued to Masasi, where he could be of more use, to join Dr. Frances Taylor, who was covering 10,000 square miles by walking 20–30 miles a day on foot[3] to practice medicine. She was, according to the Bishop of the mission, "perhaps the most over-worked person in the diocese".[7] His arrival was met with great enthusiasm by the mission: "the most joyful thing that has happened medically for a very long time".[7]

The Masasi Mission Hospital was "in a primitive state"[2] according to Dr. Stirling, the structure being a thatched hut of rammed earth with no running water. However, they had a laboratory and an operating theatre, and would treat around 300 patients on a normal day's work. On a year they would have 1,000 new admissions and 5,000 new outpatients.[2]

Dr. Frances Taylor and Dr. Leader Stirling then divided the area and while the first would be based in Masasi, Stirling would relocate to Lulindi.

Lulindi was then a very isolated African village with the nearest Post-Office being 24 miles away and with no proper medical infrastructure. Leader Stirling would live here in the next 14 years, from 1935–1949. In that time he built the Lulindi Hospital and the Newala Hospital, being the sole doctor in these two and also the Luatala hospital. He also built numerous Dispensaries, a Nursing School and started a Scouting group.

The building of the 80 bed hospital took 3 years to complete. This hospital was in memorial to the late Dr. Culver James, whose legacy provided much of the funds. Dr. Stirling was intimately involved in this development, since he drew the scale-plans, selected a site, marked the foundations, employed brick makers, brick carriers, brick burners and bricklayers, and cut suitable trees into planks.[2] He then had the help of the mission carpenter in making windows and doors and local masons on trimming stone for foundations and floors. For this project he also had the assistance of his uncle, a civil engineer, and his brother-in-law, a military engineer who corresponded with him from England. Besides the more technical chores, Leader Stirling also had a "small manual component"[2] in the building of the hospital, completed in 1938. Since the initial installations were not enough, in 1946 Leader Stirling added four new wards, store-rooms and nurses' and dressers' rooms, "completing his plan for the main block, including the hospital chapel.".[7]

The Lulindi Hospital facilities in 1946 included a surgical theatre, an outpatient department, a maternity block, a laboratory, a pharmacy, patient wards, store-rooms, nurses' and dressers' rooms, a hospital chapel, an x-ray machine and a built-in wood stove for sterilisation.

Simultaneously with the construction of the Lulindi Hospital, he also designed and built the Newala Hospital. For this he had the help of Sister Anne, who supervised the construction of the 50 bed building.[3] Built in one of the highest populated areas of Tanzania,[3] the hospital began to receive 300 patients daily, increasing to 400 and later more than 500.

Leader Stirling also established and maintained a chain of 20 dispensaries to fill the lack of medical infrastructure in the region comprehending "almost to the coast and right down to the Mozambique border, the furthest a hundred miles from Lulindi".[2]

Leader Stirling was also invited two times to visit the capital of Kenya, Nairobi. In his first visit in 1940 he was invited to discuss the brink of an epidemic of malaria, brought by troops during World War II and unknown to Nairobi until then given it sits 5,500 feet above ocean level. Soldiers sent to Addis Ababa also brought back home syphilis.

He was then summoned in 1942 by a friend to help with a plague epidemic.

14 years after his arrival in Lulindi Stirling converted to Catholicism and had to leave the UMCA. Leader Stirling learned the Catholic faith at age ten, which he considered his true faith, but joined the Church of England as a student due to influence of friends.[3] However, after some time in Africa he became convinced that locals should hear "the faith once delivered to the Saints",[3] and not a European reformed faith. After hearing his formal request for reunion of the Churches was ignored by the 1948 Lambeth Conference, he and 5 more missionaries left the UMCA. A.G. Blood, however, only mentions the departure of 3 missionaries at that time, writing that Dr. Leader Stirling and Fr. Birch left the Anglican Church following Canon Denniss, the Priest-in-charge in 1949: "all three had given good service but had become unsettled by events in the Church outside the diocese.".[7]

Leader Stirling's departure was reckoned by the UMCA as "'a very great loss to the medical work of the diocese; but we owe him many thanks for his fourteen years of work with us.' And not only for his medical work, for he had also done a great deal of building and done very much to strengthen and establish over a wide area the Scout movement which was providing itself an asset of ever-increasing value in the diocese.".[7]

Stirling joins the Benedictine Mission and is sent to found a new hospital in Mnero. This time, though, he has the help of an architect builder from the mission. This meant he could dedicate himself more to the medical work which, in 1958, he describes as follows

I had been working single-handed for nearly 24 years, and now had to deal with eighty beds always full, several hundred outpatients daily, a weekly leprosy clinic of 400, teaching and administration of a nursing school and its hostel, general administration of the hospital, visiting a dozen remote dispensaries, and performing up to twenty operations per week. My day began at 5 am and I was hard at it until bedtime, about 11 pm.

— Leader Stirling, Africa: My Surgery

Besides the Hospital, Leader Stirling also built a male Nurse School, started yet another Scouting group and starts his political career.

Upon the arrival of a new Matron to the hospital in 1964, Leader Stirling was accused of trying to be "forcing the pace of Africanization"[3] in the hospital. The quarrel led to his resignation in that same year.

Leader Stirling departed Mnero to Dar es Salaam and met the Bishop of Moshi who appointed him to a position in Kibosho, at the slopes of the Kilimanjaro where he was supposed to start a new hospital. This time he had little involvement in the construction of the hospital, made entirely out of local effort, and his job "was to bring the buildings into line with medical requirements. (...) and then I had to organize the equipment and the staffing.".[2] After working in Kibosho for 5 years and staffing the hospital entirely with locals, including a local doctor, Leader Stirling moved to Soni, a village in the Usambara Mountains.

At Soni Leader Stirling settled in and would work as a part-time visiting surgeon to two local hospitals: Lushoto Government Hospital and Bumbuli Church Hospital, in the latter he was also part-time professor at the Medical Assistant Training School.

In 1973, following his ever-increasing political involvement, he was placed on a Presidential Commission moved to Dar es Salaam, then capital of the country. This meant the end of his formal medical practice. He would return to the practice of medicine after his retirement at age 75, although informally and sporadically at the request of those who came to him at his house.

Leader Stirling first experience with politics was at the age of 18. During a school debate he made a "burlesque political speech" which prompted his schoolmaster to jokingly say that "Stirling will undoubtedly become a politician". He never thought that he would follow that career, though, as his father would say that "politics is a dirty game". However, in 1958, at the age of 52, Stirling made his first public speech in Mnero, being the chairman of this event Julius Nyerere.[2] This meeting was historic, being the opening of the campaign that would lead the Southern Province of Tanganyika to elect its first representative to Parliament.

While his speech was actually to support an Indian colleague running for that district, Leader Stirling was also running for Parliament for the TANU party representing Southern Tanzania. He was elected in 1958, unopposed, but would have to run again in 1960, as one part of the agreement of independence was the formation of a more representative Parliament. Racial quotas were still in place and the District of Mbeya and Chunya was in need of a TANU candidate to represent its whites. Leader Stirling then ran for that district, even though Mbeya was 700 miles away and the roads were in bad condition. He won his second election against a European coffee-farmer in 1960. He would manage both activities as a parliamentary and missionary doctor since his "24 years of single-doctoring" were over at Mnero.

Tanganyika gained independence in 1961 and the "Parliament of Freedom" ended its 5-year course in 1965. Leader Stirling had recently moved to Kibosho, where he wasn't popular enough to run and also too distant from Mbeya. His political career might have come to a halt if it wasn't for the fact that the University of Dar es Salaam appointed him to run for a National Seat. He was elected and would keep his Parliamentary seat until 1980 after winning subsequent elections.

For being seen by his peers as someone with "a nose for irregularities and discrepancies",[2] he was involved in several committees and commissions, to the point of being placed in 27 committees simultaneously.[3] In 1973 he was placed on a Presidential Commission and called by the President's Office to live in Dar es Salaam, then capital of the country. His work on this commission was peripatetic and aimed on the retrenchment of public expenditure. He travelled several thousand miles and visited 60 Districts and Regions for irregularities. At that same time he was chairman of the Health Committee of the National Planning Commission and chairman of the Board of the National Food and Nutrition Centre. He was also the chairman of the Special Commission of Inquiry into deaths in the sisal industry, historically a very important industry in Tanzania.[8][9] He informs that his report on the poor labour conditions brought improvements.[2] Another position he held was chairman of a Commission to investigate the National Provident Fund, early Tanzania's social security program. The commission eventually was made a board of trustees which granted him a permanent chair. After 6 months on this position a new government was formed and he was appointed Minister of Health by President Julius Nyerere in 1975.

Leader Stirling describes his function as Minister of Health as being "generally expected to be a fairly constant stream of new legislation to improve the national health or whatever his responsibility happens to be. I did in fact introduce a number of bills to improve nutrition, hygiene, drug supply, medical research and so forth.".[2] Indeed, while Minister, Leader Stirling started the Tanzania National Tuberculosis and Leprosy Program,[2] unifying the scheme of treatment and extending it to the whole country. This program is still in place.[10] He also implemented reforms in the mental health scenario of the country, equipping all major hospitals of the country with psychiatric units. As a result, non-criminal mentally ill individuals who were put in prison because there was not enough mental asylums in the country were transferred to the nearest government hospital "imprisonment for being simply mentally sick, with no criminal charge, is now a thing of the past in Tanzania".[2]

During his time as parliamentary he would support government funding of Church Mission Hospitals, which were being neglected. When appointed Minister of Health this issue was resolved by unification of the healthcare system bringing together religious and governmental health facilities. In 1978 Tanzania had more than 3,000 dispensaries and approximately 140 hospitals in total, while having around 8,000 villages. Their aim was to have one dispensary in every village. This scheme of rural medical assistance was adopted worldwide.[4] Another measure of public health policy was to unify the Nursing registry, which was separated between home-trained and foreign-trained (mainly England-trained) nurses.

Leader Stirling attended to the International Conference on Primary Health Care in Almaty (former Alma-Ata) from which originated the Alma Ata Declaration. He met with the Minister of Health of the Soviet Union during this event. In 1980, on his last year as a Minister, he chaired the Commonwealth Health Ministers meeting prior to the World Health Assembly in Geneva.[2]

In 1979 he idealised and lobbied for a bill that would regulate and nationalise the small private practice in then socialist Tanzania. The bill met some resistance due to widespread ignorance about its contents. He recounts that when election time came, urban "crypto-capitalists" had financed an effort to secure his defeat.[2] Hence he was, for the first time in 22 years, defeated at a Parliamentary election and went into retirement at age 75.

As a medical missionary Leader Stirling performed several different types of surgeries. Trauma surgeries were very common to repair blade wounds, in cases of violent attack or "not from fighting but from carelessness",[2] since local culture would allow children to play with knives and people had the custom to carry those weapons on top of their loincloths.[2] Besides those cases, beast attacks were a recurrent happening, with crocodiles, "lion, leopards, hippopotamus, wild boar, buffalo, baboon, hyena, and even the little bushbuck."[2] being the perpetrators. He would also correct difficult fractures and poliomyelitis deformities using orthopaedic techniques.

Plastic surgeries were frequent for chronic ulcers, burns, hare-lip, vesico-vaginal fistula, trachoma, various scars and most importantly elephantiasis, to which he devised a new bloodless operation.[4] He was also innovative in being one of the first to drain paraplegia-causing tuberculous abscesses.[4] Removal of tumors and even teeth were also performed, along with hernia repairs.

He was also able to align local customs with modern medical norms in the case of circumcision surgeries, which were performed by untrained tribal leaders with little to no antiseptic precautions before his intervention.

To overcome the lack of proper infrastructure and equipments, Leader Stirling made instruments out of simple materials: "screw-drivers made ideal supracondylar traction pins, sewing cotton became perfect ligatures. Thomas splints were contrived from bamboo, extension cord from plaited palm leaves with stones as traction weights. For intravenous infusions he used triple-distilled water, to which he added salt and glucose. When plaster of Paris ran out, he made his own from locally quarried gypsum."[4]

Leader Stirling also noted local differences between the places he worked. While Mnero and Lulindi were geographically close, Kibosho had a very different climate and population. Hernia, hydrocele and elephantiasis "which for thirty years had been my daily surgical chore"[2] were less common in Kibosho than in the south villages.

Even though surgery was his speciality, Leader Stirling had to deal with all sorts of medical problems working as a single doctor. Indeed, he affirms that surgery was a small part of his work.[2] Tropical disease would in fact take most of his time. Examples of those are malaria (the most common),[2] yaws, bilharzia, hookworm infestation, leprosy, and ulcers of the leg (acute or chronic) "the biggest constant problem".[2]

Besides tropical diseases he also dealt with pneumonia, meningitis, septic infections, measles, whooping cough and even cancer.

Once again there were geographical differences in the occurrence of diseases. Kibosho had more worms, stomach trouble, high blood pressure and rheumatic fever while having less of bilharzia and leprosy relative to the south villages of Lulindi and Mnero.