The following slide show presents two contrasting stories in the history of Sri Lanka: 1) The impact of the British colonial labor practices on the health of South Indian migrant workers on the plantations, and the people of Sri Lanka in general. 2) The role of Rockefeller philanthropy in the development of public health in Sri Lanka during the first half of the 20th century.

1. Progress through
Cooperation
The Rockefeller Foundation
and International Health
Soma Hewa
© 2004

2. History Through the Camera Lens
The following slide show presents two contrasting stories
in the history of Sri Lanka:
• The impact of the British colonial labor practices on the
health of South Indian migrant workers on the
plantations, and the people of Sri Lanka in general.
• The role of Rockefeller philanthropy in the development
of public health in Sri Lanka during the first half of
the 20th century.

3. A Group of Workers in India
Waiting to Leave for Sri Lanka
When the British established the plantation economy in Sri Lanka in
the late 19th century, they recruited labor from Southern India. By the
late 19th century, about 100,000 workers plus their families arrived
annually in Sri Lanka.

4. Sri Lanka
An Island Nation, South of India
Workers came by
boats to the
northwest coast
of Sri Lanka; from
there, they walked
for about two
weeks to the
plantations in the
central part of the
island.

5. Migrant Workers on a Tea Estate
in Sri Lanka
Entire families worked on the plantations, and children
started working as early as six years of age. Because of the
economic interests of the planters and the abundance of
cheap labor in India, planters were reluctant to provide
even the most basic facilities for these workers on the
plantations.

6. Typical Living Quarters (Lines) of the
Migrant Workers on the Tea Plantations
The workers lived in barrack-like “lines,” and as many as 12
people lived in a room 8 by 10 feet. The most unhealthy
aspect of these living conditions was that the lines were not
provided with latrines. The planters maintained that the
“workers would not use them” even if they were built.

7. A Bird’s Eye View of a Line
There were no windows in the rooms and the verandahs
were boarded up to keep out the drenching monsoon
rains, a practice that also kept out much needed light.

8. A Tea Factory
A tea factory built with solid materials with large windows
on the hill side of central Sri Lanka.

9. Several Families of Migrant Workers
in Front of the Lines
• Note the muddy
surroundings in which the
barefoot children were
playing.
• Without adequate sanitary
facilities, the workers and
their families encountered a
wide range of parasitic and
infectious diseases.
• Of these diseases, hookworm
infection (Anchylostomiasis)
was the most widespread on
the plantations.

10. Hookworm Infection
• Hookworms are tiny parasites about one-half of an inch in
length. Although parasitic in the bowel, the worms enter the
human body through the pores of the skin when they come in
contact with soil polluted by human excreta.
• Victims of hookworm infection suffer from under-nutrition,
anemia, and lassitude. Drained of blood, they are too weak to
resist new infections, which usually cause their death.
• By the late 19th century, hookworm infection was a common
health problem in many of the British colonies.
The hookworm disease was
endemic in the darkened
regions of the map.

11. A Severely Infected Woman
on a Tea Estate
This 20 year
old woman
is at the last
stage of the
disease
showing
considerable
swelling of
her entire
body.

12. Severely Infected Children
on a Tea Estate
These two young
children are at
the last stages of
the disease.
First, the victims
become severely
swollen and then
they become
emaciated and
die.

13. Deaths from Hookworm Disease
Island Wide vs. Plantations
Deaths Per Million
5000
4500
Island
4000
3500 Plantations
3000
2500
2000
1500
1000
500
0
1900 1905 1907 1909 1911 1913 1915
Year

14. The Rockefeller Foundation
Men of Vision
John D. Rockefeller, Sr. Frederick T. Gates Wickliffe Rose
“Disease is the supreme ill of human life, and it is the main source of almost all
other human ills – poverty, crime, ignorance, vice, inefficiency, hereditary taints,
and many other evils.” Gates, 1912

15. The International Health Board (IHB)
“Henceforth, Thy Field is the World”
• In the early 20th century, John D. Rockefeller, Sr.
became interested in hookworm disease when it was a
major health problem in the American South.
• Rockefeller and his advisor, Fredrick T. Gates, devised
a plan to address the problem with a $1 million
contribution.
• The experience in the American South encouraged
them to extend the work to other countries, and the
IHB was born.
• Wickliffe Rose, secretary of the IHB, developed a plan
to take the hookworm campaign to the British
colonies, where the disease was rampant.

16. Rockefeller Philanthropy
in Sri Lanka
• The IHB began its hookworm control campaign in Sri
Lanka in 1915.
• The planters and the Colonial government initially
opposed American involvement in the Island, but later
conceded when they were shown the economic benefits
of a healthy labor force.
• The Rockefeller doctors carried out treatments on the
plantations and insisted that the planters should build
adequate sanitary facilities for the workers in order to
prevent re-infections.
• The planters showed very little enthusiasm for the
project as shown in the shoddy construction of latrines.

17. A Latrine Constructed During Hookworm
Campaign on a Tea Plantation
Latrines constructed with temporary materials lasted only a few
weeks resulting in recurring soil pollution and re-infestation with
hookworms.

18. Latrines Built During Treatment
Another example of latrines built with jute bagging and jungle
sticks in a tea estate. The tea factory is seen behind the latrines.

19. Re-Infection of Hookworm
Because of the Lack of Proper Latrines
Rate of Re-Infection
100
90 Because of the high
80
rate of re-infection
due to the lack of
70
cooperation on the
60
part of the planters,
50 the IHB withdrew
40
from the plantations
in 1922, and began its
30
work in the
20 surrounding villages
10 and towns.
0
3 Months After 4 Months After 7 Months After 20 Months After
Treatment Treatment Treatment Treatment

20. The IHB in Towns and Villages:
A Hookworm Demonstration Office
• Educational campaigns to
prevent hookworm infection
relied on demonstrations,
public lectures and films.
• Local support was the key to
successful public health
campaigns in towns and
villages.

21. Communities Supported the IHB
A Group of Village Headmen
These men received certificates of merit for their role in hookworm
treatment programs in their communities.

22. Kalutara Health Unit Office, 1926
Encouraged by the local support, the Rockefeller Foundation
established a community-based primary care program known
as Health Units. The first health unit, established in 1926 at
Kalutara, provided training for public health personnel for
the RF’s programs in South and South-East Asia.

23. Dr. S. F. Chellappah Dr. W. P. Jacocks
Authors of the Health Unit Program in Sri Lanka

24. Local and Foreign Doctors
Involved in the Health Units Program
Standing:
Sitting: Dr. de Simon,
Dr. Kuriyan, Dr. Jayatilleke,
Dr. Sweet, Dr. Fernanado.
Dr. Docherty,
Dr. Gottlieb, and
Dr. Jayaram.
The Health Units program was developed by Sri Lankan
and Rockefeller doctors in view of local health needs. It
received broad public support, and was later introduced to
other countries in the region.

25. Mothers and Children Attending a Clinic
at the Kalutara Health Unit
Health Unit activities included the collection of vital statistics,
health education, control of communicable diseases, immunization
of children, hookworm treatment, malaria control, school hygiene,
maternal and child welfare, and a range of public sanitation services
in local communities.

26. The Malaria Control Campaign
One of the major programs sponsored by the Rockefeller
Foundation was malaria control work. Malaria was a scourge
in Sri Lanka during the early 20th century.

27. From a Community Project to a
National Institute
The Kalutara Health Unit was expanded in the 1960s with modern
facilities creating the National Institute of Health Sciences (NIHS)

28. National Institute of Health Sciences
(NIHS)
Today, the NIHS is the premier training center of public health
personnel for Sri Lanka’s primary health care services.
Community Health Services
Training
Research Medical Services

29. ACKNOWLEDGEMENTS

Photographs and other archival materials courtesy of:
The Rockefeller Archive Center, New York
National Institute of Health Sciences, Sri Lanka

Background research materials:
Soma Hewa
Colonialism, Tropical Disease and Imperial Medicine: Rockefeller
Philanthropy in Sri Lanka
University Press of America 1995

Written and Produced by:
Soma Hewa
Audio Visual Design
Elizabeth Moravec Hewa