The health care system of colonial Kenya

Karpov Grigory Doctor of History Senior Researcher, Institute of Africa, Russian Academy of Sciences 123001, Russia, Moskovskaya oblast', g. Moscow, ul. Spiridonovka, 30/1 gkarpov86@mail.ru Other publications by this author

 The healthcare sector in the colonial era of Kenya's history, from the early 1890s to 1963, belongs to one of the most interesting aspects of the region's past. Medicine originated and rose in East Africa virtually from scratch, without recourse to any local medical practices and with the complete dominance of Western techniques. The chronic shortage of resources allocated to this area of the life of local society predetermined the priorities of its development, when concern for white settlers and reducing the risks of mass epidemics in general were at the forefront.

From the very first years of active interaction of Europeans, Indians and Africans in Kenya, it became obvious that these groups of the population understood the basics of personal and public hygiene, as a result of which the ideas of segregation quickly gained popularity. Since 1908, neighborhoods have been allocated in cities for racial separation. From 1900 to 1913, a series of decisions were adopted restricting the movement of Indians and Africans under the threat of imprisonment for up to one month^{[1, p. 82]}.

Domestic contacts between indigenous people and migrants from Europe and South Asia, of course, could not be stopped. Infections and diseases obviously knew no ethnic boundaries. The colonial administration was forced to think about the health of Kenyans. This human reserve was needed by the Empire in the economy and military sphere. Health care at the local level in accordance with the principle of "indirect management" ("British Indirect Rule") was imputed to local authorities, native councils operating since the mid-1920s. Already by the turn of the 1920s-1930s, it was noted that all local authorities, without exception, showed genuine interest in improving the health of residents of their territory and spreading sanitary standards among the general population ^{[2, p. 1703-1704]}. 

Kenyan realities obliged the medical department to resort to completely non-trivial solutions in the field of organizing the health system and promoting the basics of hygiene. The standard approach, involving the opening of a wide network of hospitals and the training of narrow-profile specialists, was hardly feasible in those conditions.  In 1937 in Nairobi, for example, only four hospitals were operating on a permanent basis – for Europeans (31 beds), for Africans (256 beds), an infectious diseases hospital (149 beds) and a psychiatric department (256 beds)^{[1, p. 142]}. The funds were allocated mainly to achieve at least a minimum level of available pre-medical care in the field. Not always everything went smoothly, coercive measures were practiced, at some points it was necessary to make undoubted concessions to the native population.

The state of affairs at the beginning of the XX century .The climate in East and West Africa itself, coupled with a lack of information about local diseases and methods of their treatment, led to the fact that these territories at the turn of the XIX–XX centuries were often referred to in the reports of colonial officials as the "grave of a white man" ("White Man's Grave")

^{[1, p. 42]}. The first white settlers in Kenya had to recall the seemingly long-defeated ailments in Europe, including smallpox and plague.

Information about the state of affairs in this area was received from case to case and was not comprehensively analyzed. For example, during the five years of construction of the Ugandan Railway (1896-1901), it was recorded that 15% of South Asian and local workers at this facility went through hospitalization. There were periods, for example, January 1897, when up to 50% of the entire staff was on the sick list. Malaria, fever, dysentery, and various skin diseases spread in waves among the staff. 20% of the Indians recruited for the construction site were repatriated to their historical homeland in an incapacitated state (disabled), 8% died. There were no hospitals and hospitals on the construction line, only temporary tent medical camps were organized. In 1898-1899, the mortality rate of 1 thousand per 20 thousand people per year was considered low ^{[1, p. 59]}. According to data for 1923, out of 14.4 thousand people employed in the construction and maintenance of railways, 511 died, and 5.3 thousand were hospitalized, respectively ^{[4, 1997, p. 70]}.

The rural population of Kenya suffered mainly from malaria, anemia, sleeping sickness and intestinal parasites. The total spread was yawning, leading to deformity of the limbs.  At the beginning of the XX century, up to 90% of the population of coastal and upland areas of colonial Kenya was affected by this chronic disease. Clinical lesions were recorded in 20-40% of carriers, disability reached 10%. Kikuyu called yaws "mukari" ("mucari") and considered it a completely ordinary phenomenon ^{[3, p. 422]}.

The First World War contributed to the growing interest in the health of Kenyans on the part of the military. In 1915, the first mass conscription of young people in Kenya showed that 40% of them were not fit for service for medical reasons, even taking into account the fact that the native authorities did not send an obviously unsuitable contingent to the assembly points ^{[3, p. 418]}. In 1917-1918, out of 16.7 thousand Kikuyu reservists who were tried to mobilize to make up for losses, 10.9 thousand were immediately discharged for medical reasons, and of the remaining approximately one in five (17%) was returned to home after a 100-mile march to Nairobi due to elementary physical disability ^{[4, p. 75]}.

Even healthy fighters had every chance to lose it without taking part in hostilities. The main losses of colonial units on the African front were associated with poor supplies and the usual unsanitary conditions. By 1917, it became clear that malaria, dysentery, penetrating fleas, tick-borne and "sun fever" incapacitate much more personnel than the actions of the enemy ^{[1, p. 48]}.

After the end of the First World War and the stabilization of imperial finances in 1920, it was decided to expand the financing of state medicine in the colony. The emphasis, meanwhile, was placed on caring for colonial employees, European settlers and urban residents. Infectious diseases were considered the main threat here.  The administration of the colony showed no real interest in the health of rural residents and local workers. The excess of cheap labor force formed the illusion of its infinity. The sick Kenyans were quickly replaced by their fellow tribesmen. Until 1920, there was an average of one medical officer per 300 thousand natives, who could not show up "on the ground" in his location for years. And it was a multifunctional specialist whose duties included monitoring the state of affairs in hospitals, organizing and conducting outpatient treatment, fighting epidemics, observing sanitary standards in settlements and markets. Of course, such a full load was beyond the power of doctors, following official instructions was of a formal nature ^{[3, p. 419]}.

Since the late 1920s, as part of the fight against tropical diseases, the colonial Government has launched programs to examine the health and immunize local residents through vaccinations. Only since the turn of the 1920s and 1930s, when the first detailed results were received, the true depth of the problem became clear. There were whole areas in the country, especially on sugar plantations, where Kenyans never felt well throughout their lives, constantly suffering from one or more diseases. The mortality rate of children under the age of one year reached 40% and was considered commonplace, with cataclysms (drought, famine, epidemic) it could be about 100%. A study of the inhabitants of Western Kenya in 1931-1932 revealed the incidence of malaria up to 17%, trypanosomiasis – up to 10%, schistosomiasis – up to 100%, tuberculosis – up to 18%, stool studies gave 78% positive samples for at least one parasite^{[2, p. 1710]}.

The urbanization that began after the First World War, together with the demobilization of the military, provoked the spread of venereal diseases, primarily syphilis. Until 1930, it was rare, by 1940 its share had increased to 36% of all patients in cities. In rural areas, the proportion of infected reached 20%, precedents of congenital syphilis began to be recorded. The spread of this disease by ethnic groups was not uniform. For example, in Nairobi, 45% of women infected with this disease were of Somali and Sudanese origin, 25% belonged to Nandi and Luo, 10% were Maasai and Kamba, 10% were Kukuyu, respectively^{[3, p. 431]}.

Dealing with health issues, the colonial authorities quite naturally became interested in the diet of the local population since the 1920s. The direct link between nutrition and health status has been known to Western specialists for a long time. The amount of calories consumed by the natives, as it quickly turned out, was quite satisfactory, meanwhile, questions arose about the trace element base. In the 1930s, the term "colonial malnutrition" became widespread, denoting a calorie intake on the verge of going hungry with a lack of vitamins in combination with some traditional dietary restrictions (not always understandable from a rational point of view) for certain age and gender groups ^{[4, p. 50]}.

The farmers' diet (kikuyu) has been described as predominantly vegetarian, with an emphasis on grains, fruits and oats. Bananas, legumes and potatoes were present in the daily diet. The peasants did not neglect animal products (milk and meat), although they were not in the daily diet. The table of Maasai cattle breeders included mainly protein dishes based on milk, blood and meat in various versions. Differences in weight and size were found between these ethnic groups, namely, the former were on average five inches shorter and about 23 pounds lighter than the latter. The most common diseases did not coincide either. The former often had constipation and arthritis, the latter were more susceptible to malaria, intestinal disorders, bronchial infections and tropical ulcers, respectively. Mild anemia, caries, orthopedic problems (not critical bone deformity) took place everywhere^{[4, p. 51]}.

The fact of the unsatisfactory state of health of almost all colonized peoples was obvious to the British authorities. East Africa and, in particular, Kenya was no exception here. Even at the beginning of the colonization of this region, it became clear that the indigenous population suffers from many different diseases and cannot count on even primitive medical care. However, the awareness of the scale of this problem and the understanding that now it needs to be closely dealt with came to local officials only at the turn of the 1920s and 1930s.

Kenyan medicine of the 1920s-1950s. Since the 1920s, the gradual formation of the health system proper began in Kenya.

The bet was made on the dissemination of basic hygiene standards and prevention. This approach implied several parallel programs, namely: 1) training of junior and middle-level local medical workers from among the natives; 2) providing primary care at the community and village level; 3) combating vectors (mosquitoes, tsetse fly, rats) of infections (malaria, sleeping sickness, etc.); 4) promoting basic knowledge about hygiene and sanitation; 5) vaccination^{[2, p. 1703]}.

Until 1920, there were no public health facilities in the reserves for Kenyans at all. By 1932, 14 hospitals had been opened there, more than 100 outpatient clinics were working, including Europeans (a total of 17 doctors, nine nurses, six sanitary inspectors). Each outpatient clinic functioned as a department of the nearest regional hospital, the head of which ("European Medical Officer of Health") reported directly to the Director of the Department of Health in Nairobi^{[2, p. 1705]}.

There was a systematic increase in government funding. In 1922, the budget of the medical service was 177 thousand pounds per year, there were 39 European employees, the number of dispensaries did not exceed 20, visits were not recorded. In 1924, the budget was even reduced (to 124 thousand pounds), the staff of Europeans decreased to 32, but the number of dispensaries increased (to 62), hospitals served 29.6 thousand patients, and outpatient clinics – 151 thousand, respectively, a total of 189 thousand visits were recorded. In 1932, the budget grew to 219 thousand pounds, 109 hospitals worked, 54 European specialists, inpatient patients were admitted – 31.3 thousand, outpatient patients – 261.7 thousand, and total visits counted 646 thousand, respectively. In 1947, the budget exceeded 478 thousand pounds, the number of European staff was 54 people, inpatient patients – 156 thousand, outpatient – 801 thousand, total visits – 1.3 million, respectively ^{[2, p. 1706]}.  

From 1922-1923 there was a steady increase in the number of African specialists. The director of the medical Service in the 1920s, John Gilks, paid great attention to this issue. Especially for this category of workers, full-time positions of cleaners, clerks, nurses, nurses, "local sanitary Assistants" ("Native Sanitary Assistants"), "laboratory assistants" ("African Laboratory Assistants"), etc. were introduced. In 1931, a school "Jeans" ("Jeanes School") was opened in Nairobi for Kenyans") with a two-year training program in such specialties[Chaiken, 1998, p. 1707].

Kenyan colonial medicine practiced employing women as junior medical staff and midwives. This was especially true in coastal areas, where there was a noticeable proportion of Muslims, causing sexual segregation in the provision of all types of services. In 1935, courses were organized in one of the maternity hospitals in Nairobi ("Lady Grigg Maternity Centre"), where specialists in obstetrics were trained. Since the late 1940s, professional nurses and nurses have been trained at the training center ("Mary Griffiin Nurses Home"). In the 1930s, more than 1 thousand local residents worked in state medical institutions, albeit not always in high positions. The field of obstetrics became a kind of outlet for Kenyan women, where they could claim a decent social position ^{[5, 2005]}.   

Strong in body and spirit, medical workers participated in the so-called "medical safaris". These were raids by European doctors in the most remote settlements to provide diagnostic and therapeutic services. They were conducted on an ongoing basis, with a monthly rotation of specialists, sometimes in the form of hiking expeditions. After the completion of work with patients, an open meeting ("baraza") was usually held with broad segments of the population, where the basics of hygiene were promoted.  The practice of demonstrating to everyone through a microscope the eggs of intestinal parasites in the contents of cesspools had a stunning effect. The use of mobile dispensaries equipped on the Land Rover platform since 1950 has significantly increased the effectiveness of such activities ^{[2, p. 1709]}.

Large-scale vaccination campaigns were conducted to localize and prevent outbreaks of dangerous diseases. The authorities acted in this direction promptly and consistently, if necessary – forcibly. In response to smallpox outbreaks in 1930, all residents of Mombasa (70 thousand people) were vaccinated without exception, in 1949 – Kisumu (45 thousand people), the entire Central (426 thousand people) and Southern Nyanza (633 thousand people), and in the whole country only for the period from 1940 to 1945 G. – about 1.4 million people, respectively. In the late 1950s, after 37 cases of polio were registered, 60 thousand children north of Nairobi received oral vaccination, and in 1960, another 152 thousand children in Southern Nyanza, respectively. During the 1950s, vaccinations against tuberculosis and typhoid fever became the norm everywhere in the country. The production of vaccines was established in Nairobi, when there were not enough of them, additional doses were brought from the laboratory in Dar as Salaam ^{[2, p. 1711]}.

Since 1922, injections of drugs based on bismuth and arsenic have been used to eradicate yaws. By the 1930s, the number of recorded and treated cases went to tens of thousands of people. Since the 1950s, when penicillin-based drugs began to be used, it became possible to talk about the victory over this skin infection ^{[3, p. 430]}.

Preventive measures have become widespread. Shrubs were cut down, malaria swamps and reservoirs were drained, pesticides were used, straw huts infected with plague fleas were burned, fines were imposed for violating sanitary standards. The production and installation of concrete slabs for bathrooms was subsidized. Supervision of slaughterhouses, public toilets, markets and shops was introduced. For rural residents, samples of properly (from the point of view of hygienic standards) arranged houses, granaries, barns, cattle sheds were erected at fairs. The Colonial Medical Service organized training courses for "water technicians" who were engaged in lining drinking water sources and restricting access to them for livestock. Special training was given to rat boys, who were paid piecework for catching and destroying rodents ^{[2, p. 1711]}.

As a result of the study of the diet of indigenous people, the higher biological value of animal protein was recognized (in spite of the vegetarianism movement gaining momentum in the West). The myth of the greater benefits and balance of traditional nutrition in comparison with the food of modern European citizens at that time, saturated with industrially processed products, has been debunked. A daily cup of milk, if it was possible to organize such an element of the diet, worked wonders for every child in kindergarten and elementary school. Literally within a few months, Kenyan children gained weight, anemia disappeared, and academic performance increased ^{[4, p. 58]}.

By the 1950s, we can talk about the completion of the formation of the Kenyan public health Service. It included a network of local primary care stations, outpatient clinics and hospitals in large settlements. Enormous experience has been accumulated in the fight against tropical diseases. Compliance with sanitary standards and vaccination have become ubiquitous. Huge progress has been made in the fight against almost all infections. The control over the system was carried out by the colonial administration, leading positions were occupied by persons of European origin, local residents who received appropriate training were widely involved in local work.

Contribution of South Asian specialistsThe presence of Indian doctors in East Africa has been known for a long time.

Since 1883, a certain Parsi, Dr. Nariman, worked at the court of the Sultan of Zanzibar. In 1890, at least three Parsis and two Goans (in addition to three Europeans) practiced in this archipelago. Seven Europeans, 341 Africans (including 270 porters) and 41 Indian specialists took part in the 1891 walking expedition exploring the route for laying railways in Kenya ^{[1, p. 54]}.

In British India, the training of doctors for the colonies was established. In 1939, there were 10 specialized colleges and 27 medical schools in this part of the Crown's possessions. Their graduates on a competitive basis, without taking into account caste, could train at European universities. Newly minted doctors from South Asia were sent to work on the possessions of the Empire ^{[1, p. 36]}.

The use of Indian doctors in Kenya was due to the growth of the corresponding emigration. Workers and builders from India were involved in the construction of the Ugandan railway (up to 20 thousand people). In total, about five people from India accounted for one European medical specialist at this infrastructure facility.

Since the early 1920s, meanwhile, the focus of the activities of doctors from South Asia began to shift from the public sector to the private sector. Only during the period from 1920 to 1923, 44 (out of 72) Indian doctors left the Colonial Medical Service. However, even in 1936, up to a third of all hospitals for the local population were actually run by Indians. In fact, in the 1920s and 1930s, all rural Kenyan medicine was based on them ^{[1, p. 121]}.

Specialists from South Asia were cheaper for the budget than Europeans. In the 1920s and 1940s, the rate of a doctor from Europe ranged from 400 to 600 pounds per year, and from South Asia – from 70 to 200 pounds per year, respectively. In addition, guarantees and compensations were provided for the former – the provision of public housing, superannuation allowances, transfers for family members. Natives of India had nothing like this ^{[1, p. 100]}.

Paid medicine has become a field where many doctors from South Asia were able to find their vocation in their new homeland. The Indian community was the second largest racial-ethnic group in colonial Kenya, second only to the indigenous people in this respect. In 1895, there were about 2 thousand people from India, in 1940 – at least 50 thousand, and in 1948 – about 100 thousand, respectively. The British did not particularly favor non-European colleagues on the shop floor. For example, according to the "Ordinance on Practicing Physicians and Dentists of 1910" ("1910 Medical Practitioners and Dentists Ordinance"), a higher status was established for medical education and degrees obtained in the UK compared to formally identical education and degrees awarded in India. It was only since 1935 that Indian doctors were allowed to join the "British Medical Association", its East African branch ^{[1, p. 7]}.

The pioneers of private South Asian medicine in Kenya were the Goans. The first clinic was opened by them in Mombasa in 1898 . Until 1920, there were officially only seven private Indian doctors. By 1932, their number had increased to 40, in 1940 - to 50, in 1960 - was at least 200, respectively. Almost all of them were graduates of medical educational centers in Bombay, one in three came from Goa. In the late 1920s, their first professional structure appeared in Kenya - the "Indian Medical and Dental Association" ("Indian Medical and Dental Association"). By the turn of the 1930s and 1940s, doctors from British India formed an influential social group in Nairobi and Mombasa ^{[1, p. 7]}.

The financial component in the work of private doctors, of course, dominated, although there were precedents for charitable activity. There are cases when they did not take a fixed payment, but according to the capabilities of customers. In 1921, in Mombasa, it was specialists from private medicine who founded the "Social Service League", one of the first public structures in Kenya focused on working with the Indian poor. The first maternity hospital was opened in Nairobi in 1934 at the expense of the South Asian community ^{[1, p. 5]}.  

Indians played a huge role in the initial, most difficult, stage of the formation of Western medicine in East Africa. They took on the work with the contract labor force, raised rural healthcare, acted as patrons. Interestingly, the dominance of the European approach in this area was not indisputable. For quite a long time in Kenya, four medical systems coexisted and complemented each other – Islamic, traditional Indian (Ayurveda), Western and local African (various indigenous practices).

Related socio-cultural issues

Employees of the Colonial Medical Service were also involved in solving issues beyond the scope of their main activities. Most of the practitioners were general practitioners, who, roughly speaking, were treated with all the "sores". Health issues here intersected with cultural, social and economic aspects.

The tradition of universal, normally mandatory for all Kikuyu girls, "female circumcision" in Kenya (the rite of "irua") shocked Europeans. Of the possible variants of this operation, the most traumatic and dangerous ones were practiced – excision and infibulation. The authorities learned about this phenomenon largely by chance when patients in serious condition with corresponding injuries began to arrive at the hospitals at the missionary stations. One of the first such cases was recorded in 1904 at the medical center of the Scottish Church^{[6, p. 48]}.

There was no need to talk about any hygiene, anesthesia and special tools during the irua. The maximum that those who underwent the procedure could count on was washing wounds with water and changing herbal dressings.  The fundamental importance of this rite for the entire social and family life of Kenyans negated all the arguments of doctors about the risks and adverse consequences. The admission of European specialists to its holding was unthinkable. Even the initiative of teaching the initial basics of surgery to the direct performers of the operation (as a rule, elders) failed. This tradition had too deep roots, it persists to the present ^{[7, p. 590]}.

European medicine in Kenya has also capitulated heavily to kat, a light drug of plant origin that grows in most of mainland Africa. By its effect on the body, this stimulant is similar to amphetamine, a synthetic psychoactive substance. Western doctors immediately noted the side effects of its use - appetite suppression, apathy, drowsiness, decreased ability to concentrate and mental activity. With prolonged use, diseases of the gastrointestinal tract and digestive system developed, including stomatitis, gastritis, cirrhosis of the liver, constipation. It was revealed that this product caused especially great harm to the health of Somalis^{[8, p. 377]}.

Khat was an integral part of the culture of agricultural communities, for example, meru, and with the development of the economy and transport infrastructure became an important component of the colonial economy. On the ground, it often acted as a hard currency, they were repaid loans, paid for goods and services, up to the per capita tax.  Its production and sale brought huge profits to the budget. In the 1940s and 1950s, the scale of the use of kata began to cause concern at the state level, but all attempts by the authorities to ban this drug were unsuccessful. The lack of obvious harm from it, together with a lack of knowledge about its real pharmacological properties, prevented the widespread opinion among indigenous people (and even many Europeans) that it is no more dangerous than tea, coffee, tobacco or gin. Since the turn of the 1950s and 1960s, khat has actually been used freely and everywhere in Kenya ^{[8, p. 382]}.

Doctors in Kenya have been indirectly involved in solving ethical issues, in particular concerning animal cruelty. Of course, it is difficult to suspect the British themselves of excessive humanism in relation to the local fauna. Hunting among the English aristocracy in the colony was considered almost an obligatory kind of activity. But what was the point of beating a harmless piglet to death, skinning a daman alive, or feeding a leopard in a puppy cage, remained completely incomprehensible to the colonizers. They were irritated by the unreasonable and inexplicable callousness of the Kenyans, which they demonstrated to our younger brothers ^{[9, p. 1097]}. 

To change this model of behavior of Kenyans, propaganda and education methods were first used. In 1912, the "East African Society for the Prevention of Cruelty to Animals" ("East African Society for the Prevention of Cruelty to Animals") was established. Since the beginning of the 1920s, the first restrictive regulations came into force (prohibited the use of nose rings for bulls). For obvious facts of animal cruelty, landowners were sentenced to fines, African workers were flogged.  It didn't help much. Until the end of the colonial period, the British authorities were unable to reverse the situation in this area ^{[9, p. 1104]}.

There were, of course, difficulties with the perception of advanced treatment methods by the local population, in particular, vaccinations. For Kenyans, diseases were an integral part of the environment. Vaccination at first seemed to them an unnecessary interference in the general world order, and this applied to both people and pets. Periodic, once every 5-10 years, the loss (50-60%) of livestock from the plague was, of course, an unpleasant event for cattle breeding tribes, provoking famine and migration, but it did not look extraordinary in the eyes of the same Maasai or Kalenjin. The prejudice against vaccination of children and adults was overcome quite quickly. In the cattle breeding sphere, such events were considered unnecessary until the 1950s and 1960s. Calves that received natural immunity were even valued higher in local markets than vaccinated ones ^{[10, p. 49]}.

The hobby of eugenics, which was quite widespread in the West in the 1920s and 1930s, did not bypass Kenya. Moreover, in East Africa, on concrete living examples, it was possible to find evidence of its validity that was obvious to adherents of this doctrine. In 1933, the "Kenyan Society for the Study of Race Improvement" was established, on the basis of which thematic public lectures were held ^{[1, p. 70]}. There were not many active members of this organization (several dozen people, with a total European community of more than 15 thousand), although some metropolitan psychiatrists and local doctors were active propagandists of ideas about the racial superiority of Europeans over locals and South Asians. After the Second World War, this trend, of course, came to naught^[11].

Thus, we see that the appeal to European doctors on issues beyond the scope of medicine was not always justified, rarely went smoothly, often on the verge of conflict with the tribal establishment. Almost all such cases did not end with any positive outcome. However, they could not refuse to participate in such activities, because in the East African realities of the first half of the XX century.  they were one of the few carriers of current scientific knowledge, European ethics and moral values.

ConclusionThe health care system of colonial Kenya originated at the turn of the XIX–XX centuries.

The leading role in its emergence and development was played by the colonial authorities and European specialists. A significant influence on this process in the early 1900s-1920s was exerted by doctors of South Asian origin, who laid the foundations of private medicine.

By the turn of the 1950s and 1960s, a complex of primary care stations, rural outpatient clinics and hospitals operated in the country. Its structure resembled the network of paramedic stations created in the Russian Empire after the launch of the Zemstvo Reform of 1864, as well as the system of paramedic-obstetric stations and district hospitals deployed in the USSR.

The population of Kenya for the period from 1926 to 1950, at least doubled and reached a figure of at least 5.2 million people.  Against this background, the overall staff of the medical service was very modest. The number of European doctors working at the moment never exceeded 100 people, there were about the same number of Indian doctors, African specialists numbered in the range of 1-2 thousand, respectively. The budget allocated for this area ranged from 200-400 thousand pounds per year.

The health care system was racially segregated. The care was primarily carried out in relation to Europeans, whose share in the total population has never exceeded 1%. Local realities, where there was no medicine as such before the arrival of the British, dictated frequent recourse to coercive measures. Here are the origins of unconditional and openly demonstrated paternalism towards Africans, whose knowledge and experience in this field were very conditional in comparison with European achievements.

The limited (during the World Wars – an outright shortage) of human and financial resources did not prevent the British authorities from achieving tremendous success in this area. By the end of the colonial era, plague, smallpox, cholera, onchocerciasis, yellow fever and recurrent typhus were almost completely eradicated in Kenya, the spread of tuberculosis, leprosy and sleeping sickness was localized. The methodology of drainage and drainage of stagnant reservoirs to reduce the population of malaria mosquitoes has been tested. Vaccinations have become the norm for the indigenous population, the risks of neonatal tetanus and polio have been reduced. Systematic propaganda work was carried out to spread sanitary norms and the basics of personal hygiene. It was possible to identify a direct relationship between malnutrition, parasitic infections and anemia. The opening of medical schools made it possible to establish the process of training personnel from among local residents. The basis accumulated during this period was subsequently successfully used by the Kenyan authorities for the development of the healthcare sector in the era of independence.