River Blindness Revisited

While teaching at the University of Ghana I developed a hypothesis of cyclical advance and retreat of riverine settlement reflecting variations of intensity of onchocerciasis, or river blindness. It appeared in the Geographical Review, illustrating the legitimate role that geography can play in the health sciences and offering a contribution in medical geography (Hunter 1966b). However, events were beginning to stir in the wider international arena to alleviate the dislocations of land abandonment due to river blindness, an obstacle to economic development. In 1968 a United Nations meeting in Tunisia concluded that a large-scale Simulium (blackfly) control scheme was feasible for the West African Savanna Zone, encompassing seven countries. The next step was to establish a Preparatory Assistance Mission to African Governments (the PAG Mission). The World Health Organization (WHO) was appointed the executing agency, and the World Bank identified funding support. Robert McNamara, U.S. Secretary of Defense and later president of the World Bank, supported the idea of reclaiming lands for agriculture. The PAG Mission was to submit plans for a twenty-year Onchocerciasis Control Programme (OCP) to the WHO by October 1973. Out of the blue I received a telephone call from A. A. Buck M.D. of the PAG Mission at WHO headquarters in Geneva, Switzerland. Dr. Buck asked me to work as a consultant in Ghana for two months, between my teaching commitments at Michigan State University, and provide field-based evidence for planning purposes. A former professor at Johns Hopkins University, Dr. Buck had worked in tropical epidemiology in South America. Another member of PAG Mission was B. B. Waddy M.D., a retired Gold Coast Medical Officer known for promoting issues of onchocerciasis. Both men had read the Geographical Review article. In June 1972 I departed for Geneva, where I received a briefing and a list of objectives, and I traveled to West Africa for fieldwork. By early August I submitted my consultant's report (Hunter 1972). As a geographer I concentrated on preparing a set of large maps of blindness and settlement, including historical information on population retreat, for the OCP'S planners and technical staff. I started by mapping the left bank of the Red Volta River, opposite Nangodi, the small traditional state already reported in the Geographical Review. Figure 1, prepared for this article, shows the location of the study area in northeastern Ghana. For the OCP I drew field maps based on topographic sheets that first showed stages of local dislocation, then expanded to portray a broad regional picture of the impact of onchocerciasis. This scale of demonstration covered the whole Upper East Region, where the same basic processes of displacement by onchocercal disease operated. Dr. Waddy urgently asked me to "rescue" records of the discontinued program of Medical Field Units (MFU), which he formerly directed. These included onchocerciasis skin-snip surveys conducted among extensive groups of village. The surveys would give planners rough clues as to the prevalence and intensity of onchocerciasis. I pursued these old MFU records with enthusiasm, but without success, at the Ministry of Health in Accra, the capital of Ghana. However, when visiting district headquarters of the former Northern Region of Ghana I struck gold, finding dusty bundles of survey forms in locked, half-forgotten, mud storerooms, some of which were serving as rats' nests. Not authorized to remove any records, and without electric power or a copy machine, I hired office clerks in situ who were happy to manually transcribe the information, including the village and name of each person examined. The length of my consultant's report--343 pages--was due largely to inclusion of skin-snip data and infrastructural planning information, as requested. Four years after I submitted this initial report who decided to reissue a short--43 pages--version for wider in-house use, comprising the text verbatim and all of the maps in reduced, page-sized format (Hunter 1976). …