Portuguese were the first to begin health-care colonialism

Here come the Portuguese

It was 1498 when Vasco-da-Gama set sailing around Africa, and reached Southern part of India by sea. By this time, Portuguese or its agents had set-up small island colonies en-route. By 1510 they had colonized lands in Goa, Mozambique, Muscat, Angola. Soon the empire would also spread from Brazil in South America to Macau in Eastern Asia.

As Portuguese were the first to settle in far-away lands. They also pioneered health-care colonialism, by gradually introducing subjugation of native and superiority of European medicine systems. This was done in mid-1500s itself, when medicine in the West was yeet to find its feet. Britishers came much later in 1700s, followed by the French in the 1800s.

Their own systems

It was in 1290 that the Portuguese King Dinis established a University. This had faculties in arts, law, and medicine and came to be known as University of Coimbra. In early 1500s, Portuguese introduced a system of medical licensing in their own country. They also started with a a hierarchy of medical positions (such as chief physician or a chief surgeon), down to the municipal level. The same systems were to be lateer introduced across the empire, wherein only Coimbra trained graduates would occupy the highest medical positions.

Estado-da-India

Portuguese established Estado-da-India (or the State of India), that included all the territories in Asia, and Eastern Africa, initially as Kozikode, and later Goa as its capital. This was in 1505, and went on till 1962, as Portuguese continued to retain many of their colonial possessions for the 450 years and more.

Portuguese started to set up medical facilities in Goa, as it was the seat of power of Estado-da-India, and Viceroy would be stationed here. By 1550, it had four hospitals, namely Misericórdia Hospital (later known as Todos-os-Santos Hospital, administered by catholic brotheerhood), Piedade Hospital (run by the senate), the Poor Hospital (run by the Jesuit missionaries) and the Royal Hospital (administered by the crown, mostly for military patients). As would later happen in the other European empires, the medical personnel that did arrive sporadically in the colonies worked almost exclusively in the service of the colonisers. I

Scarcity of Physicians and Surgeons

Despite being a preferred colonial destination (as compared to West Africa) only occasional Coimbra trained doctors were willing to stay.In absence of available Coimbra trained doctors, local population as well as colonizers often consulted Indian providers (Vaidyas, or Brahmins). Treatments were few, and colonizers often died due to tropical diseases. Colonizers were also new to the diseases in the tropics. In fact two of the Portuguese viceroys died in Goa itself.

Distrust was such that decrees were issued by the Portuguese Kings from time to time. Such as in 1563 “there should be no Brahmins in my lands since they are prejudicial to Christianity and the increase there of“. Another one in 1567 “‘let no man of faith be treated by an infidel physic’ nor resort to midwives and barbers.” and an observation in 1585 that “many infidel, especially heathen doctors’ were consulted by the city’s population.”

On one hand, Portuguese were actually learning local healing ways, such as Garcia da Orta who wrote texts about Indian medicinal plants in 1560s. On the other hand mortality and need for subjugation made them suspicious of the natives. Despite hospitals being built, Portuguese doctors would either not endure long sea journeys, or stay put in the colonies. Ships would drop supplies for others to use.

Medical Licensees for the natives

The distrust and failure to import doctors from Portugal, led to a closer scrutiny of native indigenous providers. In 1604 Manuel da Fonseca was appointed as Chief Physician for Estado-da-India. He started a system to issue “license” to practice, with a rationing and after inspection or evaluation of credentials. By 1690, about a 100 licenses were issued, around 80 of these to indigenous providers, who were charged a fees and frequently inspected. This was a beginning of subjugation of the native health system, which was deemed inferior and superstitious.

Beginnings of Western Medical Education in India

As desperate attempts to attract Portuguese physicians were not working, colonialists started with an idea to introduce courses or training in medical studies. First such course began (by Cipriano Valadares) at the Royal Hospital in Goa in 1703, and lasted till 1713. A surgery course (by Francisco Manuel Barroso da Silva) lasted from 1789-1823. By the beginning of 1800s, about 190 students had graduated from these courses. This was the first time, European medicine was taught in Asia. Similar initiatives were also taken up by the Spaniards in their colonies, and later by Portuguese in Brazil. However, across the colonies, Lisbon trained doctors continued to be preferred for higher positions, than those who were trained in Goa, or Brazil.

On December 1, 1842, the Escola Médico-Cirúrgica de Nova Goa was formally inaugurated, offering courses in medicine and pharmacy. Admission to the medical school required candidates to be over 16 and well-versed in Latin, grammar, philosophy, and drawing. Starting with an initial batch of 8 students, it rose to eminence in the Portuguese-speaking world. Subsequently, it was known as Goa Medical College.

European Medicine moves to Africa

While Portuguese settlers and colonial institutions initially used indigenous healers and local materia medica, they later moved on to to repress them. In late 19th century, Portugal developed “tropical medicine” as a tool for colonial expansion and legitimacy. Hospitals were set-up in Angola and Mozambique.

Beginning 1860s the Goa medical school also started publishing its own medical journals. Education became regular, with professors from Lisbon teaching medicine to the students. Over time its alumni held prestigious positions, including chief doctors in Bombay, physicians at the Court of Pune, and medics in Sawantwadi and other Portuguese colonies such as in Mozambique and Angola.

Europeans start treating the natives – Tropical Medicine

Once colonial authority was well entrenched, tropical medicine became a curiosity. The School of Tropical Medicine and the Colonial Hospital of Lisbon was founded in 1902.

Diseases such as sleeping sickness, Onchocerciasis, Elephantiasis, and Leishmania were discovered, their causes and treatments delineated. This made Africa, Brazil, and other far off locations lucrative for many. Europeans started treating the natives, and this medicine became more attractive than indigenous systems.

The Portuguese medical colonialism was adopted by other colonizers. Over the years, systems changed and initial blend with the local culture and remedies was lost. Four centuries of influence took its toll. As now we are again looking at a hybrid system, trying to make baby-steps for giving an equal chair to the indigenous systems on the colonized medical table.