Professor David Morley was a pioneer in Tropical Child health
I planned to start my first interview with him on his seminal contributions in Tropical Child Health. Before I could start asking him any questions, he made a profound confession that he was an average student of missionary parents and had to adjust to changes and challenges in his educational career. He was desperate to diffuse an impression that he had achieved something substantial or outstanding because of his abilities. He recalled his association and collaboration with many colleagues who according to him were more persistent and better path finders.
He disappeared for a short while interrupting the conversation to appear with a tray. The tray had a book and a spoon with cups of coffee for both of us. He mentioned that it was time for his second cup of coffee in the morning. He served me coffee in a mug which had an association with his time in Nigeria from 1956 to 1961. He got that mug from his colleagues in the Wesley Guild Hospital, a Methodist Hospital, from where he returned to join the London School of Tropical Medicine and Hygiene in 1961.
What was in the tray were a spoon and a book.
David quickly moved on to the story of this plastic spoon he designed in 1958, which was introduced to the rest fo the world in mid sixties. The story of this spoon was fascinating and sounded like a thriller.
At the Wesley Guild hospital he used to come across children die of gastroenteritis and dehydration. About seventy percent of children died of dehydration and jot because of gastro-enteritis. Often children came in severe dehydration and peripheral circulatory shock because of which he could not save children. It made a lot of sense to me while listening to this sad story as severe dehydration was the major cause of children dying in the hospital where I was trained for my undergraduate studies from 1967. At one time there would be about thirty children with dehydration in the paediatric wards, our of which at least half would die as they arrived in the hospital too late.
Having found this terrible catastrophe, David set out to visit homes of people in the villages to find the practices which people followed when astro-enteritis set in. It was a practice for people to starve children to stop vomiting which led to deprivation of food and fluid for several hours even put a week. The antibiotics which some children received was not enough to stop the progression of the disease although infection was treated.
David was original in his thinking. He got in touch with his colleagues in London who were working on nutrition and got their advice to formulate a mixture of salt and sugar in water at home so that parents could start feeding children with this mixture as soon as diarrhoea illness started. His advice was six teaspoons of sugar and half teaspoon of salt in 1000 ml of boiled and cooled water. This 'Do it yourself' approach had a practical problem. Most homes in the villages did not have measuring spoons to make the measurement fairly constant.
It was this need which prompted David to think of a cheap and convenient spoon that he could introduce to every home to prepare Oral Dehydration Solution . His prescription was that family gives their children about 200 ml of that fluid even hour during the time of diarrhoea illness, even before they went to hospital for medical attention. He found that 80 percent of children in villages had at least three diarrhoea illness in a year which lasted for a week or so during which time fluid and food were normally restricted. David concluded that the prevalence of malnutrition in about 85 percent children in the villages could be attributable to illness such as diarrhoea.
David used to visit village homes with plastic spoon in his pocket to distribute to parents. Later he got it provided for parents at the hospital and village clinics.
But the resistance to give Oral Rehydration Solution (ORS) was considerable. Even the health practitioners which were many in villages discouraged this. That was the beginning of forming Rehydration Therapy teams in villages so that they would go form house to house to illustrate how the solution is made. They would drink the solution themselves to show the village folks the safety of the solution.
David was genius in designing. He got a spoon designed which had two spoons on both end-the larger one for sugar and the smaller one for salt. Although he had to wait till 1965, to have it marketed widely through the charity he established in London on his return, Teaching Aids at Low Cost (TALC), the design and prototype was in existence by 1958.
David paused for a while at this stage. I knew that he was moved to recall the story further because it was an overwhelming occasion for him to have found the immediate result of his innovation. The diarrhoea death declined from about forty children in a month to two or three over a period of six months. David was convinced that it was not the antibiotics that saved them, but the early rehydration begun at home. He made it a practice to advocate for giving a replacement of about 200 ml of the ORS after every episode of loose stool.
While this was already making significant trust in his approach to help children in the community, he introduced the habit of weighing children in the community clinics at least once a month till they were five years old. Most women in the villages were illiterate. It was this which prompted him to think about making a chart which would plot the weight and height and have it retained by parents for them to keep following the progress of health in children. This was the beginning of the concept of Road to Health chart which later became widely known as Growth Monitoring, popularised by the UNICEF and WHO.
I knew this part of the story as Dr Willian Cutting was a collaborator to evolve this chart as an internationally accepted tool, when he was working in India around the same time in a mission hospital in Andhra Pradesh. Dr Cutting later joined David to work in the Tropical Child Heath unit in London.
I found that David was a good narrator with anecdotes and references of many people to whom he was grateful for. He referred to all he was able to do as others contributing to let hem happen.
The second item in the tray he brought was this book he co authored on his return form Nigeria almost like a summary of several experiences he had in Nigeria. This book is pictorial and its in an easy to read and understand mode in presentation.
He autographed and presented a copy to me. I was surprised by his generosity, that too at the first formal meeting with him.
This is one of the books I have used extensively because it is just illustrations with short statements and full of line drawings.
I used this book as a resource in my learning and planning to compose the curriculum for training in the post doctoral Fellowship Programme in Developmental Paediatrics at CMC Vellore.
The handbook shown below that was published in 1998, borrowed the line drawing approach to illustrate how a play based observation on the developmental sequences of infants and pre-school children can be done in a home setting. It was published at the time of the first intentional conference of Developmental Paediatrics held at CMC.
I sent a copy of this handbook to David when it was published in 1998, which was duly acknowledged. He had just retired from his position at the institute of Child Health. Hearing about the progress ASHIRVAD made in signing a Memorandum of Understanding with the Christian Medical College, Vellore to start the specialty of Developmental Paediatrics, he insisted that I visit the Institute of Child Health to share experiences of beginning a new specialty for the first time in India.
David was exuberant in his enthusiasm to encourage me to pursue the development of this specialty. t He often encouraged his friends to visit us when they came to India.
When I went to London in the summer of next year, to give a talk at the institute of Child Health, David came travelling in the train although he was only three weeks after his knee replacement surgery. I was moved to see him in the audience. He was older but not less in his enthusiasm and warmth. He recalled the series of conversations we had together to which he referred to as important in his understanding of child development. He approached child development by advocating for prevention of illness, promoting vaccination, growth monitoring, etc. He commented me for approaching child development through the optic of restoring wellness and offering rehabilitative plan for children.
A the end of that first fifty minutes conversation, David walked out with me and left me outside the conference room, where I was about to start the day with a seminar.
At the end of that meeting in 1986, what stayed on with me was an experience of being with a humble professional of outstanding orientation in pursuing a vision for children and their wellness. He did everything to make a difference locally and globally. The forty five years or so he spent actively in global child development initiatives have had a profound impact.
I visited Nepal to conduct a workshop in child development for Paediatricians in 1996 at the invitation of Kathmandu Paediatrics Association. Seven out of the forty who attended were influenced by the approach of David that they had established Growth monitoring, use of ORS to prevent dehydration and immunisation services in the Under Five clinics. They had just started using Measles vaccination for under five children in a limited way at that time.
One can use one's professional years to pursue success for oneself or pursue the cause of people in need to make a substantial difference. David chose the latter through out his professional career. David left us with an example of a pioneering pursuit in his life!
M.C. Mathew( text and photo)
He disappeared for a short while interrupting the conversation to appear with a tray. The tray had a book and a spoon with cups of coffee for both of us. He mentioned that it was time for his second cup of coffee in the morning. He served me coffee in a mug which had an association with his time in Nigeria from 1956 to 1961. He got that mug from his colleagues in the Wesley Guild Hospital, a Methodist Hospital, from where he returned to join the London School of Tropical Medicine and Hygiene in 1961.
What was in the tray were a spoon and a book.
David quickly moved on to the story of this plastic spoon he designed in 1958, which was introduced to the rest fo the world in mid sixties. The story of this spoon was fascinating and sounded like a thriller.
At the Wesley Guild hospital he used to come across children die of gastroenteritis and dehydration. About seventy percent of children died of dehydration and jot because of gastro-enteritis. Often children came in severe dehydration and peripheral circulatory shock because of which he could not save children. It made a lot of sense to me while listening to this sad story as severe dehydration was the major cause of children dying in the hospital where I was trained for my undergraduate studies from 1967. At one time there would be about thirty children with dehydration in the paediatric wards, our of which at least half would die as they arrived in the hospital too late.
Having found this terrible catastrophe, David set out to visit homes of people in the villages to find the practices which people followed when astro-enteritis set in. It was a practice for people to starve children to stop vomiting which led to deprivation of food and fluid for several hours even put a week. The antibiotics which some children received was not enough to stop the progression of the disease although infection was treated.
David was original in his thinking. He got in touch with his colleagues in London who were working on nutrition and got their advice to formulate a mixture of salt and sugar in water at home so that parents could start feeding children with this mixture as soon as diarrhoea illness started. His advice was six teaspoons of sugar and half teaspoon of salt in 1000 ml of boiled and cooled water. This 'Do it yourself' approach had a practical problem. Most homes in the villages did not have measuring spoons to make the measurement fairly constant.
It was this need which prompted David to think of a cheap and convenient spoon that he could introduce to every home to prepare Oral Dehydration Solution . His prescription was that family gives their children about 200 ml of that fluid even hour during the time of diarrhoea illness, even before they went to hospital for medical attention. He found that 80 percent of children in villages had at least three diarrhoea illness in a year which lasted for a week or so during which time fluid and food were normally restricted. David concluded that the prevalence of malnutrition in about 85 percent children in the villages could be attributable to illness such as diarrhoea.
David used to visit village homes with plastic spoon in his pocket to distribute to parents. Later he got it provided for parents at the hospital and village clinics.
But the resistance to give Oral Rehydration Solution (ORS) was considerable. Even the health practitioners which were many in villages discouraged this. That was the beginning of forming Rehydration Therapy teams in villages so that they would go form house to house to illustrate how the solution is made. They would drink the solution themselves to show the village folks the safety of the solution.
David was genius in designing. He got a spoon designed which had two spoons on both end-the larger one for sugar and the smaller one for salt. Although he had to wait till 1965, to have it marketed widely through the charity he established in London on his return, Teaching Aids at Low Cost (TALC), the design and prototype was in existence by 1958.
David paused for a while at this stage. I knew that he was moved to recall the story further because it was an overwhelming occasion for him to have found the immediate result of his innovation. The diarrhoea death declined from about forty children in a month to two or three over a period of six months. David was convinced that it was not the antibiotics that saved them, but the early rehydration begun at home. He made it a practice to advocate for giving a replacement of about 200 ml of the ORS after every episode of loose stool.
While this was already making significant trust in his approach to help children in the community, he introduced the habit of weighing children in the community clinics at least once a month till they were five years old. Most women in the villages were illiterate. It was this which prompted him to think about making a chart which would plot the weight and height and have it retained by parents for them to keep following the progress of health in children. This was the beginning of the concept of Road to Health chart which later became widely known as Growth Monitoring, popularised by the UNICEF and WHO.
I knew this part of the story as Dr Willian Cutting was a collaborator to evolve this chart as an internationally accepted tool, when he was working in India around the same time in a mission hospital in Andhra Pradesh. Dr Cutting later joined David to work in the Tropical Child Heath unit in London.
I found that David was a good narrator with anecdotes and references of many people to whom he was grateful for. He referred to all he was able to do as others contributing to let hem happen.
The second item in the tray he brought was this book he co authored on his return form Nigeria almost like a summary of several experiences he had in Nigeria. This book is pictorial and its in an easy to read and understand mode in presentation.
He autographed and presented a copy to me. I was surprised by his generosity, that too at the first formal meeting with him.
This is one of the books I have used extensively because it is just illustrations with short statements and full of line drawings.
I used this book as a resource in my learning and planning to compose the curriculum for training in the post doctoral Fellowship Programme in Developmental Paediatrics at CMC Vellore.
The handbook shown below that was published in 1998, borrowed the line drawing approach to illustrate how a play based observation on the developmental sequences of infants and pre-school children can be done in a home setting. It was published at the time of the first intentional conference of Developmental Paediatrics held at CMC.
I sent a copy of this handbook to David when it was published in 1998, which was duly acknowledged. He had just retired from his position at the institute of Child Health. Hearing about the progress ASHIRVAD made in signing a Memorandum of Understanding with the Christian Medical College, Vellore to start the specialty of Developmental Paediatrics, he insisted that I visit the Institute of Child Health to share experiences of beginning a new specialty for the first time in India.David was exuberant in his enthusiasm to encourage me to pursue the development of this specialty. t He often encouraged his friends to visit us when they came to India.
When I went to London in the summer of next year, to give a talk at the institute of Child Health, David came travelling in the train although he was only three weeks after his knee replacement surgery. I was moved to see him in the audience. He was older but not less in his enthusiasm and warmth. He recalled the series of conversations we had together to which he referred to as important in his understanding of child development. He approached child development by advocating for prevention of illness, promoting vaccination, growth monitoring, etc. He commented me for approaching child development through the optic of restoring wellness and offering rehabilitative plan for children.
A the end of that first fifty minutes conversation, David walked out with me and left me outside the conference room, where I was about to start the day with a seminar.
At the end of that meeting in 1986, what stayed on with me was an experience of being with a humble professional of outstanding orientation in pursuing a vision for children and their wellness. He did everything to make a difference locally and globally. The forty five years or so he spent actively in global child development initiatives have had a profound impact.
I visited Nepal to conduct a workshop in child development for Paediatricians in 1996 at the invitation of Kathmandu Paediatrics Association. Seven out of the forty who attended were influenced by the approach of David that they had established Growth monitoring, use of ORS to prevent dehydration and immunisation services in the Under Five clinics. They had just started using Measles vaccination for under five children in a limited way at that time.
One can use one's professional years to pursue success for oneself or pursue the cause of people in need to make a substantial difference. David chose the latter through out his professional career. David left us with an example of a pioneering pursuit in his life!
M.C. Mathew( text and photo)
