I too was a great admirer of Maurice King and I have just written the following tribute in the International Child Health Group e-bulletin, which may be of interest to HIFA members.
My copy of Medical Care in Developing Countries is dated October 1969, 3yrs after its first publication and a year after my graduation from medical school, signifying my early interest in the topic of the book. My first spell of working in Africa was from 1971-74, and I was fortunate in being introduced to Professor David Morley by my uncle David, a paediatric surgeon at Great Ormond St Hospital, to advise me before travelling to Zambia where I was to work in a district hospital. David became a lifelong friend and adviser and he immediately said to me ‘You must meet Maurice King’, and there and then wrote out a letter of introduction. King had recently been appointed to the chair of Social Medicine at the medical school Lusaka, and we met when I arrived with my wife as a raw ingenue doctor, in a general medical officer post. Thereafter he offered wonderful support and his book (and later ones on nutrition and primary child health care) proved to be a lifeline. Taking a public health as well as clinical approach, the book was prescient and contained many of the concepts outlined in later publications by David Morley, David Werner, David Sanders, Paget Stanfield, Michael Marmot and others.
What made it so important for me? First pointing out the major differences in health care when the doctor patient ratio is 1:100000 rather than 1:1000; that the main determinant of health in such countries is poverty; that even limited skills can make a huge difference to health care; that patients should be treated as close to their homes as possible. Second, that primary care is the key to all care and must be of a high standard, and services should be organised from bottom up; that health needs must be related to people’s ‘wants’; that skilled staff have a duty to teach less skilled ones, and the role of the medical auxiliary is critically important. And thirdly, medical care and the local culture are closely linked. These tenets made a huge impact on me and I came to embrace the concept of the ‘community diagnosis, as illustrated in the book in relation to Kwashiorkor.
'Community diagnosis' gave me a lifelong interest in social determinants which are equally relevant in the UK as they were in Zambia. ‘Medical care’ also covers in detail topics such as protein calorie malnutrition, TB, Diarrhoeal disease, the under fives clinic, immunisation and maternity care, and much more. There are few omissions in this book and it was well described at the time as the bible of health care in low income countries - later to be joined by Paediatric Priorities in the Developing World (Morley) and of course Where there is no Doctor (Werner). All these great books illustrate the need for basic information on health to be as widely disseminated as possible – the central themes of HIFA and CHIFA in the present day. One could fault the books as being products of colonialism, and in the present day the authors reside in the countries they write about – at that time, this wasn’t possible.
Maurice went on to be a mentor for many years and I also greatly respected and worked with his wife Felicity Savage King, a foremost proponent of breast feeding who believed in tackling the threats from commercialisation of infant feeding which are ever present to this day.
Let’s remember Maurice and Felicity’s work and continue their great work, in partnership with colleagues from low income countries.
Tony Waterston
Retired consultant paediatrician, Newcastle upon Tyne and former chief moderator of CHIFA (Child Health Information for All)
HIFA profile: Tony Waterston is a retired consultant paediatrician who worked mainly in the community in Newcastle upon Tyne, UK. He spent 6 years working in Zambia and Zimbabwe and directed the Royal College of Paediatrics and Child Health Diploma in Palestinian Child Health teaching programme in the occupied Palestinian territories. He was an Editor of the Journal of Tropical Pediatrics and is on the Executive Committee of the International Society for Social Pediatrics. His academic interests are child poverty, advocacy for child health and children's rights. He was the lead moderator of CHIFA (HIFA's sister forum on child health and rights) until November 2024. www.chifa.org tony.waterston AT newcastle.ac.uk
