From Barefoot Doctors to Professors of Medicine in 75 Years

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From Barefoot Doctors to Professors of Medicine in 75 years – A Brief History of Modern Medicine in Yemen 1940-2015

This book briefly outlines the story of the healthcare systems and modern medical education in South-Western Arabia. It covers events and developments at the cusp of modernity and nation and state-building in a period spanning colonial conquests of late nineteenth century and nationalist administrations of the mid-twentieth and very early twenty first centuries. In medical care East and West, tradition and modernity do not appear to clash but co-exist almost harmoniously. In two case studies the author briefly sketches out the role of a traditional midwife and documents the substantive role of the Hadhramis, famed for their almost legendary stories of migration, in the processes of medical education in the region. It ends by telling of the modern day story of migration and diaspora creation by the more adventurous of the newly-created medical elites who migrated to forge successful careers in many parts of the world.

From Barefoot Doctors to Professors of Medicine in 75 years A Brief History of Modern Medicine in Yemen 1940-2015

Although in English it looks to break new grounds by accessing Arabic sources.

A D E L AU L AQ I

UK ÂŁ10.00

A D E L AU L AQ I

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From Barefoot Doctors to Professors of Medicine in 75 years A Brief History of Modern Medicine in Yemen 1940-2015

A D E L AU L AQ I Published by Eidat Shams

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Front cover photograph: Abdulla Mohammad Aulaqi using a modern microscope. He joined the Keith Falconer Mission Hospital in 1942. A trained compounder of medicines of the day, his main post was in-charge of the hospital and expeditions pharmacy. He was skilled in laboratory diagnostics, especially in the use of the modern compound microscope and a wound dresser. He taught many ‘barefoot doctors’ his various skills, including instructing the author in microscopy and modern wound dressing. Photo: Adel Aulaqi c.1961.

Published in the United Kingdom in 2017 by Eidat Shams Medical History Publishing, Chesham, Bucks.

Copyright © 2017 Adel Aulaqi e-mail: adelaaulaqi@gmail.com All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the author and publisher except for the use of brief quotations in a book review.

Every effort has been made to gain permission for the use of images in the book. Any omission will be rectified in future editions. References to sources on the internet and websites were correct at the time of writing ISBN: 978-0-9956619-0-5 Design & typesetting by Hawkes Design & Publishing Ltd – www.hawkesdesign.co.uk

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About the Author

Adel Aulaqi, 2017

Adel Aulaqi was born in Crater, Aden Colony, completed secondary education at Aden College, and studied medicine at Edinburgh University (1961-67). Soon after qualifying MBChB he obtained a post-graduate diploma in Tropical Medicine and Hygiene in 1969 and gained the surgical fellowship (FRCSEd.) from Edinburgh Royal College of Surgeons in 1972. He then served as a full time general surgeon in the UK followed by a spell in Aden, where between 1978 and late 1982, he served as Director of Medical Services and Surgeon-in-Charge of the Medical Division of the Aden Refinery.

On returning to the UK, between 1983 and 1995, he joined the Pharmaceutical Industry initially as medical adviser for the Middle East and Africa and culminating in taking charge of the Phase IV Clinical Trials program in the Clinical Research Division (CRD) of the Wellcome Foundation in Beckenham (UK). In 1995 he returned to full-time clinical work by joining the Accident and Emergency Department at Wexham Park Hospital, Slough, UK, where he additionally taught emergency clinical medicine, A&E surgery as well as clinical audit and clinical research methodology to junior and middle grade training clinicians and nurses. On partial retirement in 2005 he continued to work part-time till April 2015. In 2008 he was awarded the MA in History from the School of Oriental and African Studies (SOAS), London University, for his study of colonial South Arabian Medical Services covering the period between 1937-1967. His publications include various essays, a number of research papers and Wellcome books on clinical medicine and surgery and a number of English-Arabic translations of literary works. More recently, in 2014 he authored Chapter 12 on the then current Health Care system in Yemen in the successful book ‘Why Yemen Matters: A Society in Transition’.

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Dedication

To all the true heroes of this story; those who ushered in modern medicine into South Western Arabia and those who, with equal conviction, resisted and kept faith with tradition to give us today’s rich and varied mix.

To all the pioneers of all backgrounds and from many parts of the world, who gave their all, and transformed it.

To all those who cared passionately about the health of others, served and gave so much of themselves.

Especially to all the many unsung heroes who served silently as the backbone of the service in all its hues and phases, the ones here I call in love and gratitude ‘barefoot doctors’. Without them modern medical care would have not existed or would have been much the poorer.

To the very many who studied medicine or one of its branches so as to serve in the land of their birth, but whose dreams were to be fulfilled only as migrants in foreign lands.

In love, admiration and gratitude for his teachings, to my father who embraced modernity and now represents one of the earliest of the ‘barefoot doctors’.

To my maternal grandmother who accepted the challenge of modernity but went on to resist it and continued to safely, and expertly, deliver babies in the traditional way but equally wisely embraced the new when needed.

To my mother who was always there.

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Contents

List of Maps ..............................................................................................................................6 List of Figures ...........................................................................................................................6 Preface.......................................................................................................................................7 Acknowledgements ...................................................................................................................8 Introduction ...............................................................................................................................9 I

PAST HEALTH-CARE SYSTEMS...............................................................................22 1. Before the British Arrived...........................................................................................23 2. Health under the British in Aden and the hinterland...................................................28 3. Health in Imamate Yemen till 1962 and in YAR to 1990............................................34 4. Healthcare System in the PDRY 1967-1990..............................................................36 5. Healthcare in Unity .....................................................................................................37

II MEDICAL EDUCATION IN THE 20TH AND 21ST CENTURIES .........................39 6. Medical Education in Yemen ......................................................................................40 7. Clinical Research and its Dissemination in Yemen.....................................................42 III THE BRAIN DRAIN: CHALLENGE AND OPPORTUNITY ..................................60 8. Migration and Brain Drain..........................................................................................61 IV THE ROLE OF HADHRAMIS .....................................................................................65 9. Special Place of Hadhramis in Medicine ....................................................................66 10. HRC and Medical Research and Healthcare ..............................................................67 11. Conclusions .................................................................................................................68 Appendices I. On Hadhrami Identity .......................................................................................................71 II. Significant Yemeni Academic Medical Journals...............................................................73 Notes .......................................................................................................................................74 Further Reading.......................................................................................................................82 Index........................................................................................................................................87

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List of Maps Map 1.

Map 2.

Map 3.

Map 4.

Map 5.

Map 6.

Map 7.

Map 8.

Map 9.

Map 10.

Aden Colony Boundary Plan 1938.

South Western Arabia: Aden and its Protectorate & Yemen.

Aden and its Major Hospitals.

Aden Colony c.1960.

International Boundaries Aden Protectorate, Yemen, Saudi Arabia and Oman c.1960.

Federation of South Arabia c.1965.

FSA Arabic map 1965.

PDRY Six Governorates 1976.

Hadhramaut 2010.

Republic of Yemen Administrative Districts in 2011.

List of Figures Fig 1.

Fig 2.

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Fig 37.

Fig 38.

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Annual Output of Citable Medical Documents for Arab Countries 1996-2015.

Recently-opened high street shop in Aden.

Traditional and modern medicines sold freely in groceries.

Mariam Obeid.

Dr. Ahmed Saeed Affara.

Keith Falconer Mission Hospital walled in compound.

Keith Falconer Mission Hospital garden and Church.

Church of the Scottish Mission.

Aden Civil Hospital.

Aden Civil Hospital TB Ward.

Aden Civil Hospital Private Patients and Purdah Wards.

Possibly the surgical wards of Aden Civil Hospital.

Aden Queen Elizabeth Hospital, 1965.

Ambulances based at the QEH, 1965.

Public Health Authority Offices Crater Aden, 1955.

Aden Refinery Hospital, 2008.

Al-Hawta Lahej Hospital, 1965.

List of Registered Medical Practitioners and Dentists, 1961.

Lodar Hospital, 1965.

Musseimir Health Unit, 1965.

Khora Health Unit and Dispensary, 1965.

Mukairas Health Unit and Dispensary, 1965.

Saeed Ali Al-‘Amoudi.

Public affidavit of competence for Saeed Ali Al-‘Amoudi.

Saeed Ali Al-‘Amoudi Nursing certificate, 1953.

Saeed Ali Al-‘Amoudi described as ‘Doctor of the village’.

Abdulla Hassan Basharaheel al-Fadhli, 2007.

Nursing certificate of Abdulla Hassan Basharaheel al-Fadhli.

Mohammad Hassan Ba-Naf‘a, 2007.

Nursing and Higher Nursing Certificates of Mohammad Hassan Ba-Naf‘a.

Health Assistant Treating Eye Infection in the Protectorate Health Service.

Saeed al-Taribi Hadhrami Health Assistant.

Dr. Fidel Castro with PDRY President Salmeen in Aden.

Views of Hadhramaut Medical School.

Aden Medical School & Entrance.

Yemeni Medical Journal.

Hadhramaut Journal of Medical Sciences.

Facebook Page al-Kafa-at al-Yemeniah al-muhajirah.

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Preface

A few years ago a group of Hadhramis of the East African Diaspora conceptualised the creation of a Hadhrami Research Centre (HRC) to be based in Mukalla. The driving force behind HRC came to be in the capable and tenacious hands of my friend Muhammad Bin Dohry. Muhammad invited me to discuss the project and its scope with him. A few years later HRC became a reality and Muhammad kindly invited me to be an Associate Member and to contribute to the launch of the Centre in March 2015 in London. I was delighted to contribute with a talk very much close to my heart and by drafting a chapter on the same topic for a book of some twelve chapters on the topics covered at the launch of HRC. My chapter was ably and patiently edited by Dr. Noel Brehony and Mr. John Shipman. I also took full note of the very helpful final copy editor’s notes. At this copy editing stage I came to realise that the Chapter would fit a great deal better as a stand-alone, much expanded publication, for it was the only material that dealt with medical, educational and technical health matters and seemed out of place amongst the other topics that dealt with Hadhramaut and its diaspora. The book, edited by Dr. Noel Brehony ‘Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration’ was published by I B Tauris and launched in SOAS (London) on the 25th of April 2017.

To date the journey taken by the processes of caring for the sick was a long one, tortuous, and faltering at times and the transformation it created will most likely never end. Many gaps in the story remain to be filled and much of its history remains to be researched, unearthed and documented. Islamic Arab hospitals existed for a few centuries in many major populated centres in Arab lands; but what kind of hospital existed in the region of South Western Arabia before the arrival of the British is not answered here.

These pages briefly cover a large canvas of gradually evolving transformations over some two centuries. It starts by taking a look at what medical care would have looked like before the British arrived to rule over a large part of South Western Arabia and other Europeans were invited to help in Imamate Yemen; then Traditional Islamic and Arab medicine would have reigned supreme.

Transforming the medical system was very unhurried especially in Aden’s hinterland. During colonial rule (1838-1967) it gradually embedded, and towards the end of the era it flourished in centres such as Aden, but left a legacy of financial and expert shortcomings and difficulties for successor regimes to overcome. Successor regimes built on this colonial legacy but ambitiously went further. They implemented further transformations by instituting university medical education that soon included clinical research locally. Much remained to be achieved to try and catch up with modernity in health services that could remotely look like self-sufficiency. The missing gaps in specialist medical and surgical care and in diagnostics and ancillary services were filled in by travel abroad and utilising overseas facilities. This inadvertently led to an expensive form of tourism recognised as ‘medical tourism’. One of the unintended consequences of modernity in the fields of medical research is the emergence of research into some of the long-established traditional Islamic and Arab medicines by utilizing modern technological methodologies.

Hadhramis have always been part of the fabric of South Arabian and Yemeni society and can also claim to play a major role in health care and medical education. The final chapters of the book touch upon Hadhrami contributions to these topics and broadly suggest roles for HRC in the fields of medical research.

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Acknowledgements

I am indebted to patient help and guidance received from numerous friends and colleagues, too many to name all. Yemen became a difficult place to visit to access material for the book; therefore especial thanks go to Muhammad Bin Dohry, Professors Abdulla A W Nasher, Abdulla al-Sayyari, Mohammad Al-Bar, Amin Bawazir and Dr. Watheq al-Aulaqi and Faiq al-Aulaqi.

All offered invaluable source material.

My everlasting thanks to Doctor Reem Mubgar of Aden University for her generous help with historical statistics and to my niece Doctor Maha Mustafa Musarreg for her generous constant support and patient advice over many years on various aspects of health care in Yemen but also especially of this book. Maha and Reem were of the 1993 batch of medical students to graduate as doctors from Aden Medical School.

The late Mr. John Shipman has been a great friend and support. He kindly spent many hours editing and enriching the chapter, now this book, with his deep understanding of Hadhramaut and the Hadhramis. Thanos Petouris’s encouragement and critical enquiry leave me eternally thankful for his constant challenges and critical comments.

Sophie Honeybelle made the task of artwork here appear an easy one, thank you Sophie.

I am grateful to Dr Noel Brehony, Editor of ‘Hadhramaut and Its Diaspora’, for his patient endless support at the chapter stage, especially during my illness. I am deeply indebted to my designer Pete Hawkes for helping bring this small book into reality, for meticulous copy editing and all with great humour.

Thank you Heena for constant encouragement and support.

Very special thanks to KS/KB who serenely kept the faith.

To those who gave me of their thoughts and help and I have not mentioned please forgive me and accept my silent thanks.

So many have helped make the book a reality, but they bear no responsibility for any errors here; all errors are entirely mine.

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Introduction

This is a story of transformation in a location half way between West and East. My friend, the indefatigable Mohammad Bin Dohry, brought into reality the Hadhramaut Research Centre (HRC), an entity based in Mukalla. Its main mission is to advance academic study of Hadhramaut in-situ. He worked under almost impossible circumstances in Yemen as the momentous events of the Arab Spring visited it. Some years ago at one of our regular meetings in the Park Café in London’s Russell Square, Mohammad persuaded me to contribute to the launch of HRC in London1. We agreed I would talk about a subject close to my heart, that of the development of the Health Care system(s) and medical education in Yemen. The paper was to be relevant to Hadhramaut too. I warmed up to the idea and added that I should glance at the role of the Hadhramis in these fields in the context of their migration. To complete the story I needed to explore the potential future roles for the HRC in the interlinked fields of health care and clinical research particularly in Hadhramaut and generally in the Yemen. Mohammad Bin Dohry’s aim was to publish a book composed of chapters covering the topics in the various papers delivered at the launch. After a highly successful launch of HRC in London I sensed that my paper, with the necessary modifications, would be more suitably published as a book2.

This book is not a discursive reflection on the philosophy, rights or wrongs of tradition, modernity, imperialism, colonialism or what David Arnold described as ‘Colonizing the Body’ or indeed the mind. It is about the transformation of the health care services, including the development of modern medical education in South Western Arabia over the past one hundred years and the role played by the Hadhramis in both. All transformations often arise from an inheritance that is no longer fit for purpose and in the process of changing give rise to some unforeseen consequences and legacies. The transition into the modern health care and educational systems brought health benefits, for example Aden became malaria-free, tuberculosis and trachoma became much more easily treated, advanced surgical procedures were now quite accessible to the average citizen in Aden. However, the transformation also came with undesirable limitations, such as poor career chances. The latter prompted the able, the ambitious and the frustrated new generations of medical and technical talent to migrate. Without readily available detailed analyses one cannot conclude if such migration is to the detriment of Yemen, but it most likely would have been. It is described here in Chapter 8 ‘Migration and Brain Drain: Challenge and Opportunity’. Hadhramis have been major players in this story.

We would be very much mistaken if we uncritically assumed that medical care in Southern Arabia did not exist or had remained static over the past century and a half. Before the British arrived in Aden in 1839 inhabitants would have sought and received various forms of traditional (folk) medical care as the mainstay of treating or managing all illnesses. It then co-existed with the new, rather slowly introduced, government hospital and charitably-built and maintained basic dispensaries which offered modern western medical care systems for the civilian population. Such dispensary clinics would be perhaps a pale equivalent or a remote predecessor of the general practice of today.

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Over the past century peoples of this region of South Western Arabia (see Maps) mixed the well-familiar traditional medical care with whatever was new, and modern medicine that they could access. The success of modern medicine generated demands for its extension not only to the protectorates but also by royal request to the Imam’s own family in the north.

Modernity marched on. Medical care in the region continued to evolve especially during the relatively peaceful and stable period between 1940 and 2011. Independence from colonial rule in 1967 in the South brought elements of catch up with the rest of the world as did the overthrow of Imamate rule in the North. Western-based modern university medical education was instituted in medical faculties initially in Aden followed by Sana‘a and, more recently, Mukalla.

It was cautiously accompanied by ambitious projects in the early stages of clinical research (medical research on humans). A few self-motivated researchers were fired up by the desire and struggled to be heard and to publish their research internationally.

The bitter conflict in the Yemen over the last few years (2011 to date) has naturally adversely affected this rapid progress, slowing it down almost to a halt. It also made it extremely hard for any researcher for a topic such as the one for this book, to conduct field work safely and obtain relevant robust and verifiable data on the status of the health care service and clinical research.

Nuggets of reliable information from various trustworthy sources have enabled this book to venture to paint a picture of the current health care system up to the point when painful, disruptive and destructive hostilities broke out around 2011, intensified in 2014 and remain unresolved today at the end of 2017.

The original data for this book was collected over many years for the MA degree in History at the School of Oriental and African Studies3. The topic covered the development of the health services (1937-1967) in Southern Arabia under British Colonial and Protectorate rule; it focused on the services in Aden Colony. Between 2012 and 2014 further data were collected for a Chapter on health care systems in the whole of a now united Yemen4. The chapter stressed the need for a strong State, well-funded and implemented commitment to caring for all citizens equally well and to care especially for those unable to use the private sector locally or abroad.

It called for modernising the medical care standards.

Encountering modern medicine in India and South East Asia impacted on the rich philanthropic migrant Hadhrami thought. After making good and learning of new modern ways to heal the sick some would naturally have wished to translate that into improving the lot of their kith and kin in the motherland.

The available evidence indicates the emergence of a modern health service in Hadhramaut was initiated by the individual rich migrant Hadhramis, followed by pioneering individual Western physicians with limited input from the Colonial British political residents and advisors.

Many years later Hadhramis played a significant role in the overall Yemeni health care system and university medical education especially of the post-1967 independence era. Local career limitations and personal ambition encouraged or drove young Yemeni medical and technical talent to migrate. This included many talented Hadhramis and such migration of talent became a recognisable feature of the new Yemen.

Hadhramaut, its people and their descendants have been subjects of study for a considerable time. Virtually no major aspect of country or life has been neglected. From the strictly scholarly

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INTRODUCTION

academic investigation to the travel and observational visits, photographic recordings, studies and explorations, Hadhramaut and Hadhramis received attention by foreign and local authors (see Further Reading).

Such close scrutiny possibly endowed the place and its people with a certain aura of distinctiveness and a rather attractive but debateable suggestion of an ‘exceptionalism’5. The challenging question of Hadhrami identity is beyond the remit of this book, the topic is well discussed in ‘Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration’ and for the sake of some clarity in the use of the term Hadhrami, I make, an admittedly limited, brief, personal and pragmatic attempt at saying what I understand by Hadhrami (Appendix6). Like many, though we (through maternal blood line) may be of partly Hadhrami origins, yet we do not claim a Hadhrami identity.

The topic of Hadhrami migration continues to attract special attention. Some twenty scholars presented new research papers at the launch of HRC; the majority of these are included in the recently published book ‘Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration’7. Despite an arguable distinctiveness/exceptionalism of the Hadhramaut and the Hadhramis, the realities of geography, and the very close societal and politico-economic interconnectedness and interdependences, the Hadhramaut and its peoples are inseparably linked to the land and the peoples in their vicinity. Today Hadhramaut and the Hadhramis are part of the Republic of Yemen. Within the Republic Hadramis play major roles in every aspect of the country’s politics, economics, education and state and private institutions; they form an inseparable part of the fabric of Yemeni society and infrastructures. Throughout this book I throw some light on the less familiar areas of the role of the Hadhramis in medical education and the topic of modern day migration of medical and technical talent; two subjects worthy of further detailed exploration.

The early years of the twentieth century saw health services initiated and shaped by charitable work of rich influential migrant Hadhrami families; later on reshaped by the health policies of regimes first in Aden until 1990 and then Sana‘a. But, the well-educated Hadhramis have always played significant roles in framing and implementing these policies. Simply for its high aims HRC needs to succeed in preparation for a return to ‘normality’ when the current war and internal conflicts end and the rebuilding processes begin in earnest. In response to a request by the organisers of the HRC launch in London I broadly offer a few potentially achievable suggestions on a future role for HRC in the fields of medical research.

The book argues and proposes that, with carefully-considered approaches, the Hadhramaut Research Centre could pursue an academic role in the future development broadly of the Yemeni and specifically Hadhrami medical and health care fields.

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Map 1. Aden Colony Boundary Plan 1938

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Map 2.

South Western Arabia: Aden and its Protectorate & Yemen

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MAP S

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Map 3.

Aden and its Major Hospitals

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MA P S

Map 4. Aden Colony c.1960

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Map 5. International Boundaries: Aden Protectorate, Yemen, Saudi Arabia and Oman c.1960

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MAP S

Map 6.

Federation of South Arabia c.1965

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Map 7.

FSA Arabic map 1965

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MAP S

Map 8.

PDRY Six Governorates in 1976

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Map 9.

Hadhramaut 2010

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Map 10.

Republic of Yemen Administrative Districts in 2011

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MAP S

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PART I

Past Health-Care Systems

In this section I take a look at the then available local varieties of medical care the average person would have received before the British arrived in 1839 till 1937, when Aden became a British Crown colony. The period between 1937 and 1967 saw the rapid growth of Western medicine in the colony and its very slow introduction and development in the Aden Protectorates. I also include a brief look at the way people sought healing in Imamate Yemen till 1962 and in its successor republic, the Yemen Arab Republic (YAR) to 1990, when unity with the South came about. The successor to British colonial rule in South Arabia, the People’s Democratic Republic of Yemen (PDRY), inherited a largely socialist model of health care on which it built and expanded.

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CHAPTER 1

Before The British Arrived

Medical care in the region was never in limbo, for a system of traditional folk medical care had existed for centuries. Traditional medicine is “the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness”8.

Thus many such systems exist across the globe. In South Western Arabia ruler and ruled would have sought health, well-being and treatment for all ills in what was readily available to hand.

Time-honoured treatments inherited by peoples of the Arab regions would have been passed on as Arab then Islamic to encounter modernity at every new stage in history. Folk medicine would also have transformed itself with the then current times as it does today; men and women were, and continue to be, healers by traditional methods.

Naturally people fell ill, got injured, and broke their bones, suffered toothaches, kidney and bladder stones and eye infections and cataracts among numerous other afflictions. Women had straightforward or complicated pregnancies, delivered their babies in their own homes, assisted by experienced traditional midwives. Children got sick with common illnesses of the day, measles, chickenpox, gastro-intestinal infections and tuberculosis. They were treated with received wisdom of a time-honoured knowledge that, and for a considerable time, the fittest of yesterday’s people survived. They carried the fire of life and handed it over to the modern generations who, often in awe and some horror, compare and contrast what they have today with what their ancestors had. The sick would then have consulted the ‘experts’ of the day and got treatment for all their ills, including illnesses of the mind and psyche. This time-honoured system came to be called ‘traditional Arab medicine’. It was by no means perfect but, much as modern medicine is not perfect today, treatment by traditional approaches was the way to seek help at the time.

Traditional Arab medicine is an ancient multifaceted health care discipline. Its pre-Islamic roots lay in the belief of supernatural forces such as evil spirits and the evil eye that were treated with amulets, talismans and spiritual spells and other animistic practices. The Quran and the Prophet Mohammad (PBUH) rejected such approaches to health and well-being as they invoked powers beyond those of God. Islamic Arab medical practice thus emerged based on the legacy of pre-Islamic medical (plant and herb usage) and surgical practice. The three Quranic and Prophetic disciplines, plus the continued usage of old traditional remedies, now formed the new Islamic Arabic traditional medical practice. However, healing based on mysticism, superstition and animistic practice continues today in many places and communities in many

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parts of the world, including in parts of the Yemen. Practitioners of these arts also deal with the mind and treat what we would recognise today as psychological and psychiatric illnesses by the touch of the healing hand, suggestion and by offering protection from the evil eye with magical charms, talismans and the application of mystical healing9, 10.

Serjeant extracted sections on some thirty natural folk remedies from a sixteenth century treatise by Muhammad Baḥraq (Muhammad Bin Omar Bin Mubarak Baḥraq Al-Hadhrami H.869/A.D.1465 – H.930/A.D.1524). Serjeant gave examples that included brief information on the uses of materials and plants for healing or prevention of illness and concluded the treaties described material clearly taken from Hadhrami ancient practice. Examples included crystal to increase milk yield in suckling mothers, fenugreek to stop breast (suckling mother) milk production, galls to treat haemorrhoids, burnt pumpkin-rind to heal circumcision wounds, anointing with henna to prevent smallpox affecting eyes, gall-dye to treat ringworm and onion rubbed on alopecia to treat it. Rosewater for headaches, inhaling ground Shihri incense to stop sneezing, masticated sieved cumin drops treated eye infections, pounded saffron mixture with rosewater dried up watering eyes and cinnamon cooked in water with a little resin alleviated vomiting11.

Ali Salem Batheeb lists 116 Yemeni medicinal plants many of which grow wild or are cultivated across various parts of Hadhramaut; these included most of the medicinal plants mentioned in Baḥraq’s document still in use today12. The value of Bathheeb’s book lies in that the author has drawn on the classic work of Yemeni scholar King Al-Mothafer Youssef bin ‘Amr bin Ali Rasoul, the second Rasoulid king’s (1222-1297 C.E.) “al-mu’tamad fi al-adwiyah al-mufradah” who in turn had based it on classical traditional Islamic and Arabic medical material13. Batheeb also specifies the Yemeni regional agricultural sources for each of the plants; Hadhramaut proves to be a rich source for many of the 116 plants listed by Batheeb.

Asmahan Al-Alas expounded on the role of women in folk medicine including the use of plants, incense, perfume, and foods as medicines. Women also practised surgery in the use of scarification and cupping to expel poisons, female circumcision and ear piercing for beautification. Women practitioners and female participants conducted complex zar in its various forms and rituals led by women for women accompanied by music of drums and tambourines as psychological therapy to release and expel whatever oppressed or possessed the woman undergoing treatment. Traditional midwifery was and remains a female-dominated domain14.

Islamic Arabic traditional medical practice is rich in medical and surgical subspecialties such as midwifery, and non-invasive bone setting, barber surgical treatment of wounds and snake-bites with cauterisation and plant leaf poultices and routine detoxification by bloodletting. It is a practice of treating illnesses based on centuries of experiential development, astute observation and practical application. To learn and practise the art of healing was and remains through apprenticeship and experience. Practitioners come to be seen as successful as they gain fame for their expertise.

Islamic or Arabian medicine has been well-described; one of its major branches is Quranic medicine which refers to the use of the Holy Quran as the source for treatment and healing, another is Prophetic medicine, which pertains to the words (Hadith) and practice of the Prophet

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Muhammad (PBUH) in respect of health, hygiene and treatment of sickness and disease15. The latter has generated a category of writings, stood the test of time and is thriving today, although hints of potential misuse by certain practitioners have been raised in the plethora of Quranic therapy clinics in Yemen16. Cupping (hijamah), one of the commonest treatments used for many disorders including asthma, poisoning, depression and other psychological ailments, is still practised in the Yemen today. Learning the art of the various aspects of traditional medicine in Yemen and neighbouring Arab countries was, and continues to be, essentially by apprenticeship.

Until the advent of modern western medical education training to become a traditional midwife was predominantly family-based and mostly, if not entirely, by aptitude. Interested daughters or close female relatives learnt the art from a practising midwife, often mother, grandmother or mother-in-law or a close family member. One such renowned traditional midwife was Mariam Obeid (see sketch in Photographs section). She had learnt her craft quite early in her teens from her mother-in-law. When deemed proficient she practised delivering babies across the whole of Aden Colony, mainly in Crater Township. She delivered quite a few, if not most of her own grandchildren. One of those was born with the birth (amniotic) sac membrane still intact, a wellknown birth complication that could lead to death or great developmental problems in the affected baby. With her deft confident fingers she tore it open to let the new born take his first breath. She passed the craft on to at least one of her daughters. Mariam died suddenly, probably from a heart attack. She passed away at breakfast following a short nap having spent the whole day and night helping a lady deliver her child safely into this world. She was in her mid-fifties, the mother to some twelve living offspring, and grandmother of many grandchildren she helped bring safely into the world; it was fifteen years after she saw the author and numerous others safely into this world.

Traditional midwives home deliver babies normally for no expected fees. But tradition dictates certain simple gifts as payments in kind; clothes or a dress known as kiswah, money or meat or nothing at all dependent on the ability of the family, its circumstances, financial status and sometimes on the sex of the new born, for boys may generate greater generosity.

Traditional midwives also practised and taught the normal care of the newly-born and management of post-partum clinical problems as well as the management of common ailments of babies and sick mothers. They treated abdominal disorders by massage techniques or with medicinal herbs and plants, or if need be used thermal branding for conditions such as persistent distended abdomens or other unresolved gastro-intestinal clinical disorders.

Although traditional midwifery in Yemen is today a dying art and its practice is predominantly replaced by modern hospital-based care, home delivery still exists and is now carried out by qualified trained specialist nurse midwives or often lady doctors (gynaecologists).

But the practise of traditional midwifery is still the norm in some remote villages of Yemen.

In Aden the ability to set broken limb bones, manipulate dislocated joints back to normal alignment (all part of what would be known as orthopaedics today) and carry out physiotherapy and massage by the time-honoured traditional methods continues as the specialty of one talented, almost legendary, family whose offspring inherited the gifts. They lived in their namesake desert village of Masa‘bain just in the outskirts of Sheikh Othman town. Many other traditional bone setters exist across the rest of Yemen. It is a gradually dying art that is being replaced by trained orthopaedic surgeons and qualified physiotherapists and osteopaths.

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Islamic and Arabic Medicine is also about hygiene, body cleanliness for prayers and about prevention of sickness and maintenance of well-being. Pre-prayer ritual ablutions five times a day are inviolate essentials of being a practising Muslim. The medicinal qualities of foods, especially vegetables and herbs, are common knowledge passed down the generations.

Turmeric is used for its believed anti-inflammatory properties, ginger for the same and additionally for sickness and to reduce blood sugar levels and okra to reduce blood sugar levels, in Type 1 and 2 diabetics, parsley for its vitamins and positive immune moderating effects.

Many parts of plants are used for cleansing and hygiene including the traditionally homeprepared water-based paste of crushed or powdered leaves of the Christ’s thorn tree, (Zizyphus spina-christi (L.), Sidr.) (Arabic). It is still used today by females to cleanse body parts and especially hair particularly for weddings and at the end of the menstrual period. Neatly cut segments of roots mainly of the Tooth Brush Tree (Salvadora persica (L.), Gracin (the Arabic Miswak or Sawak) are used for daily oral and dental hygiene; it is a mechanical cleanser and tooth whitener with antibacterial actions. Like all tooth brushes the unhygienic sharing of the same Miswak by others is a bad risky habit and could be a source of infection especially by the Hepatitis B virus.

The training of practitioners, herbalists and healers in the art and practice of traditional Islamic and Arab medical care was and continues to be by apprenticeship. The expertise is often handed down on to sons. Practitioners offered their healing services in venues, mostly shops, kiosks or own homes (see Photographs section).

Women are also trained by apprenticeship in the arts of healing physical, psychological and medico-cultural behavioural conditions. In the old system, now no longer practised, newly wed novice teenage girls and their equally novice teenage husbands were prepared for their wedding day’s bewildering intense emotional and physical experiences and demands by an educationalist. The Mukadiah was a mature, well-respected and implicitly trusted experienced woman. Duty and honour-bound to keep secrets, she carefully and sensitively tutored the very young teenage newly-weds and guided them on their wedding night. She stayed with them in the same room as they consummated the marriage on their first night together. As modern education became the norm such early teenage marriages became frowned upon and the role of the Mukadiah died out17.

Over the past few decades a few traditionally established items and products (plants, herbs, vegetables, honey) underwent evidence-based clinical research methodology to claim positive beneficial medicinal effects. Of these, honey received fairly extensive clinical investigations and reviews18. Such research, development, manufacture, patient information and packaging in the Islamic and Arab traditional medicinal products is in its early stages. It is hampered by prohibitively high costs or simply by the acceptance of time-honoured established usage. Today some specific clinical therapeutic indications have been studied in a lamentably few traditional medicinal treatments. They received costly investigation by academic modern methodologies in the search for data of proven clinical efficacy and establishing undesirable side and adverse effects in much the same as the obligatory investigation of modern day drugs for national and international licensed use19. Saudi Arabia is one Middle Eastern country that has stringent licensing controls.

In the West such tradition had been modernised, manufactured and re-packaged and mostly relabelled as the all-inclusive ‘alternative therapies’. These encompass an almost endless array

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of treatments and therapies, from the plant-based, to homeopathy, to oil essences and physical practices of osteopathy, chiropractic (by hand touch) and ‘craniopathy chiropractic’ and the wonders of treating emotional aspects of disorders with the non-touch Reiki, meditation, the practise of mindfulness and the application of spiritual healing by various means all to heal and promote health. This alternative healing industry, in an endless search of health, perhaps longevity, well-being and happiness, is thriving but remains in need of stronger evidence-based approaches. The practise of modern-day medicine and its various components are strictlyregulated. Through compulsory pre-registration legislation all new drug entities (from invention to marketing) undergo expensive, prolonged, well-defined and complex research and development (R&D) stages to establish and define each final product’s efficacy, boundaries of safety and strict limits of licensed usage as a treatment.

In today’s Yemen both Western-based (imported) and Arab-Islamic-based traditional therapies co-exist, seemingly harmoniously 20, 21, each with its clinical and cost benefits, limits, shortcomings and misuse or abuse.

Such laudable new developments over the last few decades have been in investigating the clinical efficacies and limitations of Islamic and Arabic traditional medicines by applying modern scientific methodologies and in formally teaching the topic to medical and pharmacy students in some medical schools and academic institutions in a number of Arab and Islamic countries22. In Yemeni universities such research exists, is rather limited and is conducted either by dedicated individuals working alone or collaboratively with a few European institutions with some support of the World Health Organisation (WHO).

A benefit of this renewed interest in Islamic and traditional medicines has led to a vast whole new genre of printed material and digital publications. Traditional Arab and Islamic herbal and plant knowledge is increasingly presented in books (Arabic and many other languages) that act more like pharmacopeia and compendia than standard medical or pharmacology textbooks (see Batheeb and Hehemyer, in Notes).

In today’s poor, war-torn country with the worsening Yemeni economic situation the sick have turned to even more readily accessible cheaper herbal and other traditional medicines.

Such treatments undoubtedly have their valuable place in the maintenance of the health of the many with limited income. However, such benefits must be balanced against the potential risks to the unprotected/uninformed consumer. Such risks are associated with the absence or paucity of efficacy and safety studies and the grave dangers of unregulated, irresponsible or unethical, unproven clinical usage, fraudulent manufacture, importation and sales of products purported to be traditional folk medicines.

The Arabs and Muslims pioneered the creation of hospitals for the care of civilians. Before the First World War a military hospital existed in Sana‘a while another was planned for Hudeidah. It is conceivable that Aden in its various heydays would most likely have had hospital or hospital-like entities but convincing evidence for such structures in the period under study here is not readily available.

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CHAPTER 2

Health under the British in Aden and the hinterland

Through scientific endeavour and exploration, British medicine was a part of the colonial expansion. It was intricately based on the predominant concept of the pre-eminence of the noble civilising mission of colonised backward peoples in Africa and Asia. South Arabians received this modernising exercise formally through a slowly evolving government or private health care system and informally through medical care via missionaries.

This was a time of new scientific discovery and re-shaping of health systems not in the colonies only but in the United Kingdom too. The National Health Service was metamorphosing as the intense scientific exploration in the tropics evolved, leading to the invention of many disciplines including ‘Tropical Diseases’.

In 1839, following the arrival of the British in Southern Arabia, Western colonial models of medical practice brought in from India23 were slowly and determinedly instituted, though the pre-eminence of traditional medicine was not entirely superseded. There were considerable differences between the healthcare provided in the relatively prosperous Aden (the centre) and impoverished rural areas (the periphery).

The first central general ‘modern’ hospital was built by voluntary subscription in the Crater district of Aden in 186024. It was run by British Indian medical professionals for Aden’s civilian population. Tuberculosis was the main disease to occupy most beds for long periods. A good diet and enforced bed rest were the mainstay of the illness. Hunter’s detailed account of Aden in 1877 described three sites where medical aid was available gratis to the general public: The Civil Hospital, the Prince of Wales Charitable Dispensary and the European General Medical Hospital and Dispensary. Hunter also detailed costs and funding of these sites; the most significant was the Civil Hospital.

“The Civil Hospital. — This hospital is situated in the centre of the town (Crater), and is in charge of the civil surgeon, who is always a commissioned officer of the Indian Medical Department. He resides in the Crater, and affords medical assistance to all government servants living in the locality. The Civil Hospital was built by voluntary subscription in 1860; the establishment is kept up by Government at an average outlay of (Indian Rupees) Rs. 20,000 per annum and the municipality contribute from Rs. 3000 to Rs. 4000 yearly towards the support and maintenance of this hospital, which is conveniently located for the inhabitants [see photographs]. It accommodates fifty patients without overcrowding.”

Throughout the life of the hospital (as a district general hospital, 1860-1958) the expatriate senior medical staff showed interest in publishing on unusual cases encountered in Aden. The earliest such clinical paper from this hospital was published in 187725. They also trained local

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ancillary medical staff to meet essential needs of the service in basic medical care, particularly in nursing and in the paramedical fields of the day in laboratory technology, microscopy and instrument sterilisation and surgical theatre technology, as well as anaesthesia and pharmacy.

Far from being ‘barefoot’ in the literal sense, many of these became the highly respected teachers of the next Adeni26 generation involved in the health care service.

Change came in 1929 when Sir Stewart Symes, (Aden Resident, 22 April 1928 to 7 March 1931) considered that Aden’s entire medical services were poorly administered; needed better financial coordination and those for the civilian population were of woefully poor quality. This was during the prolonged difficult times of revision and distancing of the relationship between Aden and the Indian Raj27. He took the matter seriously and demanded of the Bombay administration a complete re-appraisal, re-organisation and infrastructural rebuilding programme. In 1930 Phipson reviewed and detailed in his report the status of Aden’s health services. He offered guidance for further improvements and developments. In his Foreword to Phipson’s report, Bernard Reilly, then Chief Commissioner, Resident and Commander-in-Chief of Aden applauded the Report as a basis for further developments of the health services of what was to become Aden Colony28.

With freedom from the Raj, increased prosperity and greater income from the port, the Crown Colony of Aden flourished and could pay for a gradually further and better developed modern healthcare service. Such change accelerated after 1937, so that by the mid-1950s the transformation was obvious and its value to the population of Aden Colony and the Protectorate was manifest. Aden’s curative medicine at the major government and Missionary hospitals was of an internationally high standard and essentially free at point of delivery. General practitioners, ophthalmologists and dentists also offered private care. At this stage Aden’s protectorates health care was quite under-developed. However, seriously sick citizens of the Protectorates could benefit from the Aden services either by making the journey on their own volition or, better still on the recommendation of the local health assistant, by being lifted by the Royal Air Force (RAF).

Convincing epidemiological data for Aden Colony was alarming. Infant mortality (239 per 1000 live births in 1943 fell to a still worrying high figure of 119 by 1960). Equally alarming was maternal mortality (7.3 per 1000 live and still births in 1948 fell to 1.44 in 1960). Nonhospital infant and particularly maternal morbidity were equally worrying. Such statistics prompted the introduction in the early 1940s of formal birth registration, a maternity and childbirth service based on British models; initially run by a couple of British midwives. The new service, initially accepted by Jewish and Hindu women, took some time to be fully accepted by exceedingly shy and reticent Arab women who preferred home births. But over time hospital deliveries became the norm29.

This evidence highlighted and challenged the weaknesses and risks of the accepted wisdom of centuries old methods of traditional health care in Aden. Statistical data gathering developed into means of gathering knowledge for policy-making, control of funding and aimed for better medical, health and social management of the Aden Colony population. Practising traditional midwives, including our example Mariam Obeid (see Photographs section), had to take tests of proficiency in delivering babies. Many passed with flying colours on their first test and were issued with written certificates and as such licences to continue to practise their traditional

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domiciliary midwifery services in the community. Others did not bother to sit the tests and continued to practice their home deliveries. But with time, working through a back door, devious system of reporting on the birth of new born babies, the modern process of a medicalised obstetrics was eventually established; thus midwife and obstetrician hospital deliveries became familiar events in Aden30.

For such a fundamental transformation in maternal and baby care to be realised necessitated the employment of trained British colonial service career nurse midwives and obstetricians to eventually lead, at some future date, to locally qualified and hospital-trained nurse-midwives.

The colonial medical services decided to develop a hospital-based service and declined domiciliary management, as purdah would limit its full value. To many that was woefully inadequate and the process of development of indigenous staff proved painfully slow31.

Nursing and medical posts in government hospitals and dispensaries were held by dedicated British or Indian doctors and nurses in the colonial service, many of whom were held in high regard for their skills. For Arabs and other Adenis to join they needed proficiency in the English language and an education that would enable them to work alongside the incumbent Englishspeaking British and Indian staff. Those with aptitude were trained as technical assistants in the various departments, pharmacies and laboratories of the few existing hospitals.

By the 1920s the Sheikh Othman Keith Falconer Mission Hospital (KFMH) and the government Civil Hospital in Crater were training Arab assistants in basic nursing, wound dressing and basic modern hygiene of the day. Drug compounding, microscopy and chloroform anaesthesia administration soon were carried out by competent technical assistants. These men and women assistants and first nurses could now be considered as the origins of the first ‘barefoot doctors’. In 1952 I safely and effectively received full chloroform general anaesthesia by one such pioneer. Ali Abdo of the KFMH was such a veteran technical assistant, who for many years had trained in basic nursing care and wound dressings. But he specialised in administering chloroform inhalation anaesthesia and as a surgical theatre technician as well. Ahmed Fare’ at the same time was responsible for the workings of the surgical theatre including instrument sterilisation and assisting at surgical operations. For many years these assistants were the backbone of a slowly developing service. Further transformation took a considerable time to develop; it came with strict selection for higher training in nursing, medicine and its ancillary technologies. It often demanded much local training followed by qualifications from higher institutes abroad. It did not start systematically until after 1945 and realistically not until successfully completing British-based secondary education.

Although many Adenis, including some of Hadhrami origin and others from the protectorates, were sent to the UK or Cairo, Beirut and Baghdad to study medicine or were trained in nursing and medical ancillary services locally, there were not enough of them to fully maintain the system after Britain left in 196732. The situation was exacerbated by the departure of key British-linked and colonial staff. In the early post-independence years of the People’s Republic of South Yemen (PROSY) and its successor the People’s Democratic Republic of Yemen (PDRY) expulsions and flight of talent and fears for the worst in the event of return home placed the health system under immense pressure.

Aden’s curative services were open to all patients in the protectorates (the RAF was exemplary in urgently transporting the seriously ill) but healthcare was poorly developed

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outside Aden. Among the exceptions were the few major towns of the relatively advanced Hadhrami sultanates; modern healthcare was however still inadequate in much of the rural areas of both the Eastern Aden Protectorate (EAP) and the Western Aden Protectorate (WAP).

Freitag33, in touching upon the erratic nature of medical provision, highlighted the role of the al-Kaff family and, later, the German Dr. Eva Hoeck as pioneers of health care. Dr Hoeck spent seven years (1950–57) in Hadhramaut, almost entirely in Shibam and, despite the paucity of local facilities, built a small local hospital but bemoaned the fact that more women had not made greater use of her services. She and an Italian doctor in Tarim collaborated in conducting surgical procedures. Eva Hoeck remains a beacon of pioneering work in Hadhramaut34. She was replaced in Shibam by a second German, Dr. Helene Marie Duhm, who later married the celebrated Dutch diplomat and traveller, Daniel Van der Meulen.

Migration to the East (India and Singapore in particular) brought Hadhramis in contact with more modern medical care than that which existed in the motherland. Enlightened and philanthropically able Hadhramis realised the benefits of transforming medical care starting in a few important centres. Sayyid Abdul-Rahman Bin Sheikh Al-Kaff was the first to introduce modern medicine to Hadhramaut when on returning from his base in Singapore in 1915, he was accompanied by the Indian physician Dr. Jalaluddin Ahmed. The latter opened the first clinic in Tarim and was soon followed by Dr. Abdul-Hadi al-Gailani, who imported modern medicines and equipment. In 1925 the first purpose-built charitable hospital was established and by 1936 it had been modernised into a multi-discipline hospital with X-ray diagnosis. In 1947 the al-Kaffs paid for a clinic for women and children in Tarim which Dr Marion Serjeant volunteered to open and run.35 She set up a similar clinic in Mukalla in the following year. The first trained Hadhrami physician, Dr Abdalla bin Jaffer bin Mansoor Al-Kathiri, who graduated from the College of Surgeons, Dublin, returned to serve in Say’un in 1947. Dr. Abdul Qader bin Abdalla bin Hasan Al-Kaff after qualifying in medicine in Cairo started to work in Tarim in 1963.36 Until then the Kathiri sultanate had been dependent on Indian and Italian doctors; and on locally trained male health assistants.

Sultan Saleh bin Ghaleb bin Awadh al-Qua̔yti (ruled 1936–56) hired an Indian doctor to open a small clinic in Mukalla (in Beit Hameed) to carry out basic general practitioner duties.

Dr. Ranade was the only available physician in 1944, running Mukalla’s sole hospital which catered for men only.37 Two years later, there was a significant improvement when surgeon Dr. Ankalikar and supervisor Saif Ali Baba Ali trained a number of males (Ahmed Mahfoodh Al-Muhairi, Hussein Ba-Raeedah, Salem Abdulla Ba-Hwaireth, Hassan Bin Qassim and Omar Muhammad AlHaddar) in nursing, operating theatre technology, the use of laboratory equipment for diagnosis and the understanding of drugs with particular reference to eye diseases (especially trachoma) and their treatments. These health assistants (who, like their compatriots and counterparts in the Western Aden Protectorate, are fondly and respectfully described here as ‘barefoot doctors’) were then posted to rural areas in the Qua̔yti Sultanate38 where they were soon treating some thousands of patients annually and pioneered the introduction of modern medicine39. By 1953 the British Residency in Mukalla established four levels of medical/nursing training for male applicants in the Qua̔yti, Kathiri and Wahidi states. Under the directorship of Dr. Corkill40,

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Adviser to the Protectorate Health Service (1951-62), candidates could qualify as nurses, senior nurses, health assistants and reach the top post of Health Inspector. In 1964, shortly before independence, the last major general hospital during British presence was opened in Say’un.

Before the establishment of the Federation of South Arabia in 1959, sparse modern European medical practice in the WAP was mostly in the hands of a few Christian missionaries. One exception was in Lahej, where Sultan Ali Abdul-Kareem al-Abdali (1952–59) employed two Pakistani physicians, a male and a female, in al-Hawtah clinics and hospital.

The KFMH was the brain-child of a scholar, an Arabist and Scottish proselytiser whose mission was to preach the words of the Gospel through the munificent act of healing the sick.

In December 1886 with Glaswegian physician and colleague, a Dr. Baruch Stewart Cowen, Ion Keith Falconer set up the Mission Hospital in Skeikh Othman on the border between Aden and the Western Aden Protectorate (WAP) [see Maps section]. It became a government fundaided (for services rendered) private concern essentially funded by the Scottish Mission in Edinburgh, Scotland. On the tragic death of Keith Falconer (from acute malaria on the 11th May 1887, untreatable at the time) Dr Cowen kept the mission and hospital going until his resignation in the spring of 1888; he worked with his replacement, another Glaswegian, a doctor Alexander Paterson. The hospital struggled with a few short-term locum doctors (including a couple of Syrian doctors) until in the late 19th century and early decades of the last century a Dr John Cameron Young (1892/3-1926) served as the dynamic long-serving physician in the KFMH. He built the hospital to become an eighty-bed, three floor structure, opened in 1909 and thus began to fulfil Keith Falconer’s vision to serve the Gospel through the offer of medical care to the community in Aden and the adjacent territories of WAP. It became a respected reality and lasted as a hospital till 1967; it still stands today but not serving as a medical facility. Years later it came to be known as the Affara Hospital in honour of Dr. Ahmed Saeed Affara (see Chapter 6). Dr. Young was followed by Dr. Patrick W. R. Petrie (1926-1946). Both established and oversaw the medical and Christian missionary work of the Scottish Mission in Aden. The hospital trained its own first five local medical assistants. Petrie also designed and arranged for the training of carefully selected (by their own tribal leaders who encouraged such development) intelligent tribal health assistants to work in their own tribal areas. These ‘barefoot doctors’ became the foundation for healthcare in the WAP41. The hospital also ran a mother and child clinic, taught healthy feeding of babies and gave free milk.

The missionaries also ran a much respected school including a much sought after youth club for those especially from the North who did not have access to colonial educational facilities.

The school produced quite a few leaders, thinkers, a pharmacist, a doctor, let alone the teachers, musicians and sportsmen. Veteran Adeni, Nageeb Yabli, teacher, journalist and historian serialised a number of articles Men in the Memory of History in Aden’s newspaper Al-Ayyam before it was shut down by then President Saleh in 2009. Yabli named these men and through their stories detailed the long-lasting influence the Sheikh Othman missionary school had.

The Scottish missionaries thus won the trust of the people of Aden and beyond. Unusually, but not surprisingly, for the astute Sherief of Beihan, ruler of the then remote WAP Emirate of Beihan, twice formally requested the Scottish Mission in Aden to have a resident missionary doctor in his capital city of Beihan al-Qisab. The potential risk of conversion of some of his

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subjects did not deter him. Folklore has it that in answer as to whether he would fear any conversion to Christianity of some of his tribal members he reportedly responded: “You do your best. Thank you. All I wish for is good health care for my people.”42 The Missionaries served in Beihan formally from September 1952 till 1964 to briefly return in 1965 and finally leave in 1967 when Britain left the area.

In the rest of WAP tribal leaders consented to and encouraged visits by medical missionary teams who, often accompanied by at least one armed soldier from the Levies, periodically rotated their visits and reached far-flung villages. Well-equipped mobile medical units reached base camp in established Health Units. Here they laid the foundation of a system where they would visit and offer free health care to nearby villages. From base camp they would also visit the more remote villages to treat the sick. On departure a few weeks later, trained health assistants continued the running of the service. In his geographic area each health assistant might see up to 50,000 patients per annum43, (see photographs of Protectorate Health Units and of Health Assistants and Certificates). Difficult cases were transferred to Aden, to either the Mission Hospital in Sheikh Othman or the Civil Hospital in Crater or the Queen Elizabeth II Hospital (QEH) after it opened in 1958. In late April 1954 H.M. Queen Elizabeth laid the foundation of the 490 bed hospital named after her. From the humble beginnings of the metaphorical ‘barefoot doctors’ and pioneers across the Protectorates of Aden and those tutored in the colony, in some seventy five years, emerged the physicians, surgeons, professors, academics and technocrats who now practised in Yemen or migrated and competed well in the intensely competitive international arena, mostly in the West.

Dr. Corkill44 created and developed the Federal health service and prepared it for merger and integration with the services of the Aden State. By 1962 state healthcare received much greater attention and the services expanded fairly rapidly. New hospitals were built at al-Hawtah in Lahej and al-Makhzan, in Abyan and rural dispensaries were established in all the federated states. The training of male and female nurses and ancillary medical staff was now undertaken at these hospitals. Large tracts of rural areas were still woefully without modern health care facilities but access to the available hospitals was now better facilitated through the expertise of trained health workers working on foot or by car, or at the rural health clinics (see Photographs section).

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CHAPTER 3

Health in Imamate Yemen till 1962 and in YAR to 1990

To do this section justice a far more detailed description and analysis on both aspects of the country’s medical care systems of the traditional as well as modern medicine, are needed than can be offered here. Cheaper and more accessible than modern-day hospital care, traditional medicine provided and continues to offer a popular service in north Yemen45. Western medicine was introduced mainly through special requests by the incumbent Imam for the services of visiting European and some Syrian physicians, and British nurses to primarily treat members of the ruling family. Basic clinics were set up to cater for ordinary Yemeni citizens. Bidwell used travellers accounts to describe Sana‘a in the period 1510-1962; some mentioned hospitals, apothecaries and pharmacies and significantly the presence of Western medical expertise46.

This, to some degree, mitigates the harsh image of an utterly isolated Yemen. By 1938 Italy had seven diplomats and twelve doctors in Yemen, the British also had a presence with a few doctors and nurses (they were replaced by French ones in the war around 1940) and there was a resident medical mission of Russians47.

Renzo Manzoni visited Sana‘a three times between 1877 and 1880 and noted that the city was changing (modernising) through Turkish influence. There was a magnificent immense two storey Turkish garrison hospital built in European style; it had a pharmacy and mortuary.

Determined preacher Zwemer (1891), first American to visit the city, described it as a 200-bed hospital, added that the town had a Greek pharmacist and commented that the Turks also offered some technical education to the local people.

Around 1899 the German explorer Hermann Burchardt visited Sana‘a and described it as a city of some 50,000 population with an official weekly newspaper in Arabic and Turkish, a military school, two civilian and one industrial schools; the latter taught Arab boys trade craft.

In addition to the military hospital there was a State Apothecary as well as a civilian one; the female half of it was run by Jewish women. Financing such social services would have come from awqafs (endowments) often administered by a government Ministry of Endowment. By 1906 George Alexander Richardson, a member of the Indian Medical Service based in Hudeidah, visited Sana‘a and reported that the military hospital and State Apothecary had been wrecked during the siege of the city by Imam Yahya.

In 1937 the Imam had opened in Sana‘a a government fund-starved civilian 200-bed hospital, and appointed as Director his trusted former slave to manage its affairs. Sixty beds were under the care of British doctors (Drs. Patrick Petrie and Dr. Mrs Eleanor Petrie assisted by the missionary Scottish leading nurse in-charge Miss Louisa J. F. Cowie and her small team of assistants); sixty beds were supervised by Italian surgeon (Dr. Rossi) and eighty beds were reserved for the army under the care of two Syrian doctors48. The latter had vexatious medical supply difficulties and restrictions imposed by the Director. Petrie’s supplies came from the Keith Falconer Mission Hospital in Sheikh Othman (Aden) whilst the Italian contingent was

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backed by the Italian government49. One can surmise that the Director would have hoped the needs of the army patients would somehow be met by the kindness of the British and Italian contingents.

Dr Hoeck in ‘Doctor Amongst the Bedouins’ wonderfully illustrated her life in Ta̔izz when between 1947 and 1957 she looked after female members of Imam Ahmed’s family. Equally evocative is Claudie Fayein’s classic ‘A French Doctor in the Yemen’50, written after she had spent eighteen months travelling and practising medicine. Hoeck’s and Fayein’s acute observations illustrate and document part of the history of medical practice of the day in Imamate Yemen.

Until the YAR was set up in 1962, modern government medical care for ordinary citizens was sparse, urban-based and inadequate for the needs of a population of five million. The Egyptians were instrumental in helping, between 1962 and 1970, establish a modern stateowned universal health-care system – though it was almost exclusively confined to the major cities51. Sana‘a University (founded in 1970) did not start medical studies until 1982.

In contrast with the policies of the PDRY, the YAR facilitated and quite lightly regulated private enterprise in the healthcare services; a plethora of privately-owned hospitals, clinics, laboratories, clinical investigation centres and pharmacies were rapidly established. The private purely curative sector thrived whilst the unprofitable vital preventive services remained inadequately served in the hands of a cash-starved state. The situation improved in the 1980s, when funding for preventive medical services and programmes was provided by international agencies and Non-Governmental Organisations (NGOs). However, project implementation as such could be frustratingly slow. Motivated NGO project managers described the frustrations of encountering the limits of translating the theory of ‘developmentalism’ into practice in Yemen’s complex realities. To minimise or avoid such frustrations a few ‘developers’ highlighted the need for a pre-project sound knowledge of the local culture and a large dose of pragmatism at the various stages of project implementation52.

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CHAPTER 4

Healthcare System in the PDRY 1967-1990

The PDRY believed in the principle that free universal health care for all citizens was an inalienable constitutional right, and it invested in higher education and medical services. The medical faculty at Aden University was established in 1970. All health-related social services (curative and preventive) expanded quickly, perhaps too thinly, to reach every part of the country; Hadhramaut and the Hadhramis, especially the political elite, were an integral part of this system from its inception. Although the regime did not permit private enterprise it judiciously supported medical care abroad for patients recommended for such treatment53.

However, the PDRY’s policies and repression in the late 1960s and early 1970s drove many talented professionals out of the country, including some of the best doctors – many originating in Hadhramaut or born to established Hadhrami families in Aden. Yemeni professional colleagues, who studied in the West, remained in Europe, migrated to Canada or the USA or after brief periods in the PDRY left permanently for the West, Saudi Arabia, the UAE and other Gulf states. Their successful careers later in life show what the PDRY and the Republic of Yemen lost.

Aden’s new allies from Cuba (see 1977 visit photograph of Presidents Castro and Salmeen) and the other states of the Soviet Bloc replaced the loss, gave scholarships and opened their universities to PDRY students. The People’s Republic of China (PRC) won popular plaudits for the performance of the surgeons and specialists it sent to the al-Sh‘ab Hospital in Crater.

It was the original Colonial Maternity Clinic and Hospital referred to above, now converted into a general district hospital which also catered for midwifery and gynaecology.

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CHAPTER 5

Healthcare and Unity

The characteristics of the PDRY and the YAR, their relations with each other and the flawed unity agreements are significant pre-determinants of events that unfolded after unity in 1990.

The oft-declared aim to unite was punctuated by episodic acute brief wars (1972, 1978 and 1979) and a military invasion of secessionist southern Democratic Republic of Yemen (DRY) in 1994. Each entity had an overall slow economic development but admirably tried to outbid each other by creating competing educational institutions designed to eventually lead to selfsufficiency particularly in manpower for the health services. Ideologically they remained far apart, one Marxist (where in PDRY deeply-rooted tribal socio-political qualities, though severely curtailed by legislation, nevertheless remained potent). The other remained trenchantly tribal with leanings to a supremely centrally-controlled neoliberal outlook. PDRY had a relatively well developed state administrative and legal systems and offered universal educational and health care services. YAR and PDRY were net exporters of people54 whose remittances were vital for both economies. Indeed soon after unification Yemen supported Saddam’s invasion of Kuwait and precipitated the expulsion by Kuwait and Saudi Arabia of nearly one million Yemenis with disastrous consequences on Yemen’s economy. The annual loss of remittances was hardly compensated for by the availability of oil in Yemen.

At unity, both industrial sectors in YAR and PDRY were relatively weak but, to each, agriculture was of significance, forming 28% and 16% of gross domestic product respectively.

Both states spent heavily on armament and both depended heavily on external aid for further development and the construction of hospitals and health care funding. PDRY, YAR and RoY have always depended on donations. A plethora of health care facilities were built through Gulf, UAE, Kuwait or Saudi funds. In 2013, Soqotra had its main hospital in Hadibou fully rebuilt and refurbished by Abu Dhabi.

With a combined population of 26.18 million in 2014, a GDP of $35.95 billion in 2013, a GDP growth of 4.2-4.8 that slowed significantly to about 0.3%55 and as an inflation of 11.0% became a great deal worse in 2014, Yemen was heading for very difficult economic times, if not an economic disaster.

By merging the two health care systems, RoY inherited a rather messy amalgam that impacted adversely on the poor Yemeni citizen56 including Hadhramis. Good expert reports were commissioned to consider the status and future of Yemen’s health services; all offered sound advice and suggested sound achievable restructuring solutions, however, these remained largely unimplemented57, 58.

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I have described elsewhere the current challenges facing healthcare in Yemen as a result of these problems: “Despite some undoubted improvements in Yemen’s health system, Yemeni citizens lack a robust health service that is caring, modern, equitable and free at the point of delivery. There is also an absence of affordable private care for those who would choose to use it. Although Yemen’s constitution admirably guarantees healthcare for everyone, implementation has proved to be elusive. Yemen’s core health policy has increasingly been to depend on the private sector to deliver curative health care. Government strategy on the general question of health insurance remains unclear. I have also outlined strategies for dealing with these problems”59.

The following chapters will focus on three vital aspects of healthcare in Yemen: medical education and its transformation especially after 1940 and till 2015. Secondly, they will consider clinical research, publication and dissemination of locally-generated knowledge. Finally, they will outline an unfolding, fairly new, hardly studied post-colonial migration story of Yemeni educated talent, leading to what could be described as brain drain.

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PART II

Medical Education in the 20th and 21st Centuries

In this section I consider the story of the transformation in medical education and clinical research in South-Western Arabia over the last seventy five years (1940-2015). These chapters deal with recognised institutional education in all the disciplines to produce medical and ancillary staff. It does not relate to educating the population in health matters.

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CHAPTER 6

Medical Education in Yemen

From the late 19th century to date centuries old traditional medicine and non-medicalised birth and child rearing in Yemen co-existed with a slowly emerging but far reaching modern medical practice. Training in the arts of the traditional is by apprenticeship wherever the practitioner can teach whilst that in new basic nursing and laboratory technology (using the microscope and conducting simple blood and urine testing) and simple X-ray technology took place in hospitals and the few private General Practitioners (GP) clinics. A number of Arabs and other nationalities in Aden pioneered and had pride of place by being firsts in newly-established medical fields.

The first Arab from the area to qualify in medicine was Dr Ahmed Saeed Affara, who took his degrees at Edinburgh in 1938. As noted above, medical training was provided in the UK, Europe or a few Arab centres. Between 1967 and 1975 such training shifted to countries in the Soviet Bloc, including Cuba.

Independence brought local medical education and associated clinical research in Yemen as fairly recent closely interconnected events. Yemen’s state medical schools were established in Aden in 1975, Sana’a in 1984 and in Mukalla in 1996. Today Yemen has ten formally recognised universities, of which Aden, Sana’a, and Hadhramaut have medical and associated faculties.

In the PDRY, the Aden Medical School produced its first batch of 56 male and female doctors in 1982. With friends, professors and teachers from Cuba, a group of dedicated physicians and surgeons in clinical practice at Aden’s QEH, renamed Gumhouriah Hospital, laid further foundations of medical education as detailed by Abd al-Wakil Ismail Al-Suroury, in his rich source Qiraah mujazah fi tarikh mustashfa al-jumhuriat. He lists names of Arab doctors who were involved in the initial phases of medical education in PDRY. They included Doctors Amin A. A. Nasher, Abdulla Abdul Wali Nasher, Abdulla S. Hattab, Abdulla Ahmed Maisari, Mohammad A. Huraibi, Ahmed Sa’eed Sadaqa, S. S. Badr, A. A. Basahai, M. K. Shamsuddin, pharmacist Ali O. Sallami, and a handful of Hadhrami medical pioneers Hussein M. al-Kaff, Saeed Ba-Gunaid, Mohammad Ali Al-Bar, Ahmed Ali Al-Bar, Abdul-Qader Al-Bar, AbdulQader Al-Kaff, Fawzeiyah Abubakr Ba-Ubaid, Aneesa Aboud, and Zain Ba-Fadhel. Some have retired, a few have migrated but many are still active in medical education60.

Since unity in 1990, the high demand for places and the rapid unplanned expansion of student enrolment into Sana’a University has resulted in overcrowded classes, overstretched staff and amenities, structural deterioration, inadequate educational materials and equipment and major problems in the absorption and employment of graduates in the country. Shortages of posts for qualified doctors drove many of them to establish or work in private GP clinics from the 1990s. My research in 2010-2012 confirmed that recently qualified doctors, especially women, took to running private pharmacies and then struggled to obtain essential higher postgraduate qualifications to advance their careers. All this created a fertile environment that encouraged the migration of talent.

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Today, schools and faculties in medicine, nursing, pharmacy and dentistry are wellestablished61, but remain overwhelmed by the scale of demand despite the fact that many Yemeni undergraduate and post-graduate students have to study in other Arab countries, especially Egypt. Indeed, demand is so high as to pose significant risk62.

A report commissioned by then Minister of Health Dr Abdulla Abdul Wali Nasher and carried out by medical educationalists from Liverpool in 2000 concluded what remains valid today:“First, medical education in Yemen is at a critical juncture. If urgent reforms are not undertaken, the system will break down. The students within the system at present are unlikely to reach an acceptable standard of clinical skill at graduation. There is an overwhelming need to reduce the number of students in the system. Secondly, it is essential that a National Medical Council should be established to take responsibility for defining and maintaining standards in education and on the graduates and finally, there is an unhealthy division between those doctors delivering service and those undertaking teaching. Academics within clinical disciplines must have clear clinical responsibilities for patients within the hospitals. Ministry of Health doctors should accept that teaching students is an intrinsic part of their duties� 63.

More recently, a researcher evaluated the educational delivery in Hadhramaut’s Medical School and, perhaps too harshly, found it short of the desired or expected standards, rightly criticising the system rather than individual physicians64.

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CHAPTER 7

Clinical Research and its Dissemination in Yemen

A few definitions of relevant terms may help here. ‘Medical’ relates to the broadest of aspects, branches and disciplines in human medicine and general medical care. ‘Clinical’ refers to the diagnosis and treatment of medical conditions and is distinguished from the theoretical and basic sciences on which medical knowledge is based. Research in all these fields applies precise scientific methods to produce unbiased evidence-based data and establish validity of findings.

Researching medical and health issues is essential to generate and expand knowledge, leading to discovery and innovation, guiding development, implementing the appropriate policies and instituting change that result in a healthy productive society with a good quality of life. To ignore essential medical research is to a country’s own detriment.

During colonial rule academic work appeared in epidemiological surveys or case reports.

Throughout the life of the Civil Hospital in Crater senior medical staff showed interest in publishing unusual cases encountered in Aden. The earliest such clinical paper publication from this hospital was in 187765.

Medical surveys and reports were commissioned and used as essential guides to health care policy66; Fawdry described the changing pattern of disease in Aden in the years 1946–64, whilst ophthalmologist Lyall surveyed the incidence of the common serious eye disease trachoma in 2,850 school children in Abyan, Wadi Hadhramaut, Mukalla, Bayhan and Kamaran Island. In his personal account, Grima, from his vantage point of a physician seconded (from the RAF) to the Federal Army of South Arabia (1962-1965) lucidly describes the wide variety of ailments and injuries (including breech delivery of a baby and tackling an outbreak of smallpox) amongst a panoply of diseases not normally encountered in standard western medical training. He encountered these mostly solo under harsh conditions with non-existent medical services in isolated parts of South Arabia67. These amongst many others are now invaluable material evidence of the status of health services at the time for the vast majority of people in rural South Arabia in the late 1960s. Searching for ways to improve was very much on the minds of the emergent new republics both in the South and North.

Medical journals are essential for education; they form a platform for publication and dissemination of new knowledge. The Yemeni Medical Journal (YMJ) was inaugurated in Aden in 1975; it published the earliest indigenous clinical papers. Most early editions of the YMJ contained descriptive accounts and single case studies, all focussed on enhancing medical knowledge and educational training beyond university studies. It ceased publication after unity.

After 1990, medical research and publishing became essential ingredients of medical education and career progression. Each medical faculty publishes at least one journal bi-annually or annually (see Appendix II).

For modern medical theory and practice Yemenis rely heavily on reliable internationallygenerated published research findings. To inform and transform health care policy, indigenous

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Yemeni medical research would need to systematically explore the local peculiarities of health and disease. It would need to account for causes of morbidity and mortality and to investigate how to challenge, confirm or refute traditionally accepted health delivery systems of care beyond the dogma of an ‘established routine’. It would need to be based on reliable evidence-based knowledge68.

Yemeni medical research output in peer-reviewed international journals is meagre; Yemen is number 204 of 224 in the international league tables for academic publications69. Professor Amin Bawazir, in charge of post-graduate research in Aden Medical School, noted in a personal interview in November 2015, that Yemeni academia annually grants some fifty masters and doctorate degrees based on well-designed and well-conducted medical research and dissertation material that is readily publishable locally and, possibly, internationally. Real or imagined fear of rejection and anticipated difficulties in access to international journals leave the majority of such works unpublished. Collaborative research generated in Yemen with the aid of international agencies and co-authored with internationally-published names seems to offer better access to international publication.

Types of Clinical Research Method Medical research method is classified respectively as primary or secondary based on the search for, gathering and establishing of new data or by the use of available data previously collected through primary research. The differences rest in the gathering of sources.

Primary research, graded from strongest to weakest investigations involves: • • • •

Experimental studies (basic research and research and development) Randomised controlled clinical Trials Randomised cross-over clinical Trials Randomised controlled laboratory studies

Secondary research (often described as Observational studies), also graded from strongest to weakest studies, encompasses: • • • • •

Cohort Studies (include incidence or longitudinal investigations) Case-control studies Ecologic (aggregate) studies Cross-sectional studies (include prevalence and ‘Survey Monkey’) Case series design studies

Most of Yemen’s clinical research output to date is in the secondary fields. It is driven by elite pioneer academics who survive, despite harsh non-conducive financial and political environments. Two approaches generate most medical research papers in Yemen: the mandatory theses for post-graduate degrees or the obligation on academics to produce and publish for career maintenance and advancement.

The vast majority of academic output is produced in government institutions by appointed academics whose status, income and career are dependent on published research. Between 2000

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and 2005 Yemeni academics published 275 papers from the three medical institutions in Sana’a, Aden and Hadhramaut70. In 2013 Zaid Shamsan surveyed the status of academic scientific output in Yemeni medical schools and sought the views of leaders in academia. He found it to be of limited quality and significance, attributing this to a lack of state political will, persistent financial constraints and constant uncertainty of funding for research as well as the insecurity of tenure and poor salaries of academics71. It also remains difficult to assess academic output from the private sector due to the sharing of clinicians between the private and state services.

The same issues affect research in areas of specialist disciplines. Ma’an Saleh, reviewed the research in psychological medicine and noted: “Research in psychology and mental health is not well developed, mainly because of a lack of research capacity and the absence of research institutions in psychology and other mental health-related fields. Most of the research in psychology is carried out at Yemeni universities by graduate Masters and Doctorate students and teaching faculty … Lack of sustainable funding remains one of the biggest drawbacks to undertaking research”72.

Despite the dearth of material, such work is to be applauded for the effort required to produce it in difficult circumstances. Yemeni medical research output is more often than not shared and disseminated in conferences, seminars, via newsletters or through publication in the handful of local medical, scientific and technical journals and periodicals. A few successful authors publish, often collaboratively, in substantive journals73. Today’s important Yemeni academic journals publish in English with abstracts in Arabic or vice versa.

Since 2009 information on the qualitative and quantitative output of Yemeni medical journals is accessible at sites which publish helpful league tables. It shows that Yemen has some way to go to catch up with its neighbours (Table 1 and Fig 1). All things being equal, the next natural step for Yemeni medical and scientific academia would be to carefully consider how to contribute more effectively in the highly demanding international arena.

This necessitates a look at the elements which constrain medical and health academic research.

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Table 1. Subject Area: Medicine. Region: Middle East. Period: 1996-2014.

Source and copyright: Medicine, Middle East 1996-2014, Country Ranking SCImago http://www.scimagojr.com Accessed 11/10/15 at 10:30. H Index is Journal’s number of articles (h) that have received at least h citations over the whole period. Yemenis self-cite in nearly 90% of published documents. 10% of their document output is cited by others. This manifests in a low H Index.

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Fig 1. Total number per annum of Published Medical Documents comparing Yemen with its neighbours up to 2014. Adapted from SCImago Research Group. Accessed 11.10.2015. Source and copyright: http://www.scimagojr.com/compare.php?un=countries&c1=YE&c2=SA&c3=EG&c4=JO &area=2700&category=0&in=it

Constraints of Yemeni Medical Research Overall advanced medical research is constrained in Yemen and some of its neighbouring states by political instability and insecurity. However, Bazarbachi and his co-authors at the American University in Beirut suggest that “lack of freedom and democracy and dearth of funding, as well as the brain drain and the difficulty of publishing research of local interest in high impact journals, all contribute to the low performance of biomedical research in the Arab world”74.

Restrictive and discouraging systems under which Arab researchers and academics work are the main factors limiting research output, not in the lack of intellectual capacity of the researchers.

Yemen suffers such factors more than most from its lack of wealth and a government that seems not to value research as a useful tool for prosperity. The main constraint is not the availability of talent – as the many people of Yemeni origin holding respected positions abroad demonstrates – but is a system that is not conducive to research75. The situation is unlikely to improve without

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fundamental change. One requirement may be to shift the mind-set of politicians and bureaucrats. For example, a previous Yemen Minister of Health, Dr. A. A. W. Nasher, relates that a civil servant declined to release a few hundred dollars to purchase an essential piece of equipment for an international collaborative clinical trial because he could not envision how the trial would benefit Yemen. After much delay the trial was completed using a UK-donated analyser and the collaborative paper was published internationally. Such obstruction borne out of ignorance is not an uncommon occurrence.

Aden University has identified four core areas that need to change to address the quantitative and qualitative shortcomings in academic research. Firstly, there is a need for a supportive state policy, coupled with adequate funding; secondly, a better remuneration structure for academics and researchers; and thirdly a policy to prevent loss of talent. Finally, to overcome current limitations in supervisory roles, academia should establish appropriate continuous training in research methodology76. Other academics have advised the government should make available adequate research funding for state universities and offer transparent procedures to access national, international and philanthropic funding. It should pay special attention to continuous training in conducting demanding research across new and unexplored fields. It might be better able to retain talent by doing more to provide security of tenure and to inculcate a pervasive research-oriented culture. A counsel of perfection might also suggest the creation of appropriately designed and equipped research facilities, with readily accessible current reference material and easily obtainable information on resources and how funding may be acquired.

A clear policy and practice of ‘pushing the boundaries’ would encourage greater primary research. Academia and health services also need to produce evidence to show how they are raising standards in the curative and preventive health sectors. Researchers continually battle with an opaque ethical approvals process for clinical research projects. A readily accessible, transparent and robust ethical approval system needs to emerge as an established component of all academic research in need of ethical approval.

Such an approach will not totally stop migration of ambitious talent but will most likely mitigate the constant depletion of talent.

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Fig 2. Recently-opened high street shop in Aden advertises on its wall traditional medicinal and beauty products. The advert promotes traditional cosmetics, health and therapeutic oils, honey and herbal products for health and well-being. Moroccan mud sold as skin cleanser; gold dust, Hadhrami henna and herbal soap for beauty. Photo: A. Aulaqi, 2012.

Fig 3. Traditional and modern medicines are sold freely in groceries. The large poster in red advertises ‘Al-Ameer Cream for Treating Piles’. Herbs and spices are sold for normal daily use as condiments. Plant products are sold for skin and hair cleansing and beauty.

Modern medical products for fevers, colds and coughs can also be procured in the shop.

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Fig 4. Mariam Obeid. Traditional midwife who carried out home deliveries. Sketch: A. Aulaqi.

Fig 5. Dr. Ahmed Saeed Affara is the first South Arabian physician and highly competent surgeon to train in Europe.

He qualified in Edinburgh in 1938. Photo. Courtesy of Mohammad Hameed.

Fig 6. Keith Falconer Mission Hospital is north-facing and self-contained. The high mud-brick wall has its top covered with imbedded glass pieces to deter intruders.

The wall encloses the main hospital (80 beds), a building of a few rooms for private patients, the church, a water well and various buildings that housed missionary doctors, nurses and preachers and local Arab employees.

The main (Eastern) gate would be closed soon after sunset around 6.30 pm.

Fig 7. Keith Falconer Mission Hospital, northfacing view, surrounded here by a lush garden.

The Church, next to the well, is on the right side of the image.

Photo: A. Aulaqi,1961.

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Fig 8. Church of the Scottish Mission in Sheikh Othman was boarded up after the missionaries left Aden in 1967. It was converted into a domestic home some time after this photograph was taken by the author in 1977.

Fig 9. Aden Civil Hospital Buildings. Source: Phipson, 1933.

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Fig 10. Aden Civil Hospital TB Ward. Source: Phipson, 1933.

Fig 11. Aden Civil Hospital Private Patients and Purdah Wards. Source: Phipson, 1933.

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Fig 12. Possibly the Surgical Wards of Aden Civil Hospital. Source: Phipson, 1933

Fig 13. Aden’s Queen Elizabeth Hospital. Source: Federal Public Relations Department, 1965. A. Aulaqi’s Collection.

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Fig 14. Ambulances, modelled on UK’s St.John’s Ambulance Service, based at the QEH. Source: Federation of South Arabia Public Relations Department, 1965. A. Aulaqi’s Collection.

Fig 15. Public Health Authority Offices in Crater, Aden 1955. Source: unknown

Fig 16. Aden Refinery Hospital. Source: ARC PR, 2008. A.Aulaqi’s collection.

Fig 17. Al-Hawta Lahej Hospital. Source: Federation of South Arabia Public Relations Department, 1965 A. Aulaqi’s collection.

Fig 18. List of Registered Medical Practitioners and Dentists in the Federation of South Arabia (Ordinance 1961) Published 1964. A. Aulaqi’s collection.

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Fig 19. Lodar Hospital. Source: Federation of South Arabia Public Relations Department, 1965. A. Aulaqi’s collection.

Fig 20. Musseimir Health Unit. Source: Federation of South Arabia Public Relations Department, 1965. A. Aulaqi’s collection.

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Fig 21. Khora Health Unit and Dispensary. Source: Federation of South Arabia Public Relations Department, 1965. A. Aulaqi’s Collection.

Fig 22. Mukairas Health Unit and Dispensary. Source: Federation of South Arabia Public Relations Department, 1965. A. Aulaqi’s Collection.

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Fig 23. Saeed Ali Al-‘Amoudi earliest Pioneer Health Assistant. Shuqrah, Abyan Protectorate and FSA Health Service. Photo A.Aulaqi, 2007.

Fig 25. Saeed Ali Al-‘Amoudi Nursing certificate, 1953.

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Fig 24. Public affidavit of competence for Saeed Ali Al-‘Amoudi.

Fig 26. Saeed Ali Al-‘Amoudi described by his Sultan as ‘Doctor of the village’.

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Fig 28. Nursing certificate of Abdulla Hassan Basharaheel al-Fadhli.

Fig 27. Abdulla Hassan Basharaheel alFadhli, one of the early Health Nursing Assistants in the Protectorate and FSA Health Services. Photo A. Aulaqi, 2007.

Fig 29. Mohammad Hassan Ba-Naf‘a was recommended by his tribal ruler to become a qualified Nursing and Senior Nursing Assistant. After a long spell as a ‘Barefoot Doctor’ he owned a pharmacy in which he continued to work until he retired recently. Photo A. Aulaqi, 2007.

Fig 30. Nursing and Higher Nursing Certificates of Mohammad Hassan Ba-Naf‘a.

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Fig 31. A Protectorate Health Service Health Assistant treating an eye infection. Source: Dr. Sydney Croskery.

Fig 32. Saeed al-Taribi.

Hadhrami (1925-2010) Health Assistant in Say'un, is attributed with being an early Hadhrami pioneer He brought health care to his villages and became an acknowledged example for dedication to his profession.

Fig 33. Dr. Fidel Castro with PDRY President Salmeen in Aden, March 1977.

R to L: Saeed Abdul-Khair Al-Nuban, PDRY President Salem Rubay‘ Ali, Cuban President Dr. Fidel Castro, Dr. Abudulla saeed Al-Hattab Ba-Hattab and Cuba’s Ambassador to PDRY.

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Fig 34. Views of Hadhramaut Medical School. Source: Hadhramaut Journal of Medical sciences, June 2013.

Fig 36. Yemeni Medical Journal. The first dedicated academic medical journal in South-Western Arabia. Photo A. Aulaqi.

Fig 35. Aden Medical School & Entrance.

Source: Google Images.

Fig 37. Hadhramaut Journal of Medical Sciences.

Fig 38. Facebook Page al-Kafa-at al-Yemeniah al-muhajirah.

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PART III

The Brain Drain: Challenge and Opportunity Chapter 8 briefly explores the complex and fascinating perennial topic of human emigration from the South Western region of Arabia. Through the centuries the prime incentive to migrate had been the search for livelihood predominantly by manual labourers and commercial and trading entrepreneurs. A distinct change occurred in the post-colonial and post Imamate era.

Politics, poverty and personal ambitions all combined to become prime reasons for migration.

Modern higher and university education became readily accessible locally. Now, in addition to the basic search for livelihood abroad, political dogma, institutional corruption, regime instability and poor economic management of the newly created states all precipitated a new kind of migration, that of the newly-educated elite and technical talent.

It seems a bizarre paradox that the more the state needed its costly home-grown talent (in technology, science and medicine) to remain and contribute to the prosperity at home the more brains migrated. The topic of Yemeni Brain Drain would benefit from much closer study.

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CHAPTER 8

Migration and Brain Drain: Challenge and Opportunity

Since time immemorial this region of South Western Arabia has seen migration as a common phenomenon. Yemeni, in particular Hadhrami, migration to seek livelihood has occurred in waves, initially by unskilled or skilled labour; in the process they were effective in the spread of Islam. In time migration to India, South East Asia, East Africa, Sudan and Egypt was blocked by colonial powers for political reasons. Hadhramis also migrated extensively to various countries in the Arabian Peninsula. In particular large Hadhrami Diasporas prospered in the Kingdom of Saudi Arabia (KSA), Kuwait, the Gulf States, Qatar and Bahrain. Some returned to reside in the Republic of Yemen during the communist regime in Aden77.

The factors that encouraged or precipitated migration of talent varied over the years. New medical and technological talent tutored in western medicine took time to emerge and develop in Southern Arabia and separately in Imamate Yemen. After independence in the South and revolution in Imamate Yemen by the late 1960s, although relatively small in numbers, such talent was of vital importance to the further development of the region.

The recently published ‘Hadhramaut and its Diaspora’ discusses the patterns of Yemeni, in particular Hadhrami, emigration but less is known about the migration of professional people, including those who have returned temporarily or permanently to their homeland or elsewhere in Yemen78. In the latter half of the 20th century to date most migration of talent was precipitated or encouraged often by violent regime or leadership personality changes, none more so than in the early years after change from colonial to Marxist rule in the South. New waves of migration of the well-educated skilled intellectuals and professionals (doctors, nurses, engineers, skilled technicians and teachers, lawyers and educated entrepreneurs) came about in small but vitally significant numbers of individuals leaving soon after independence from British colonial rule.

To health care managers, the loss of one irreplaceable nurse or doctor or technician bore the magnitude of mini disasters79.

Over the past 75 years sons and daughters of the metaphorical ‘barefoot’ forebears emerged as today’s Yemeni professors and academics as well as the highly competent professional who now practised well in the intensely competitive international arena. Given a good chance many would wish to contribute to Yemen’s prosperity and practise in Yemen too.

Of those who left South Arabia in the 1960s many studied in the West, preferentially the UK; the majority returned to repay ‘duty and debt’ to family and country80. Many found the system suffocating and oppressive, especially if one was not affiliated to the single ruling party. For the professional, life became difficult; Hadramis were no exception, more so those who resisted because of their belief or status in Islam81, 82.

In the 1970s and 1980s qualifying in medicine and medical sciences came to be delivered increasingly locally or in the USSR and associated countries particularly Russia, East Germany, Cuba and Bulgaria. Return home (PDRY) was the norm, but permission to leave was difficult.

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A determined individual would leave, but would consider himself a migrant who may not see family or country, perhaps ever again.

The familiar Hadhrami migration during this period has been well-described83, 84. However, migration of the professional, its patterns (returned temporarily or permanently to the homeland or its surrounds), numbers and categories await detailed research.

Hadhrami internal migration to Aden deserves special attention; it explains today’s strong presence and deep involvement of Hadhramis in this port city. A well-established phenomenon for a considerable time saw modern waves of migration take place early in the 18th century towards South East Asia and East Africa. Hadhrami migration in the mid20th century changed direction towards the Arabian Peninsula, including the Gulf States, Kuwait but mostly to the KSA and the various districts of the Yemen85. It manifested either as part of their migration through Aden sea port or as an internal immigration from rural to town. Hadhrami boys who aspired to a modern profession initially migrated and boarded to receive secondary education in Abyan, Aden and the Sudan; eventually most ended up in Aden. Here they forged a life or, driven by ambition, economic or political factors proceeded to migrate further afield to join his (or later on her) predecessors, family or friends. In the decades of independence (1967 to date) many held significant posts in politics, academia and medical education, clinical and epidemiological research as well as in the fields of energy and agriculture.

An oft-quoted characteristic of Hadhrami migration is that of a special cohesion in al-mahjar (the Diaspora, outside of the homeland). Hadhramis in Aden retained their cohesion to a large extent, and their influence in these fields is undeniable, yet awaits much greater academic attention86. Bin Azoon and Bamatraf describe the centuries-old history of presence in Aden87, 88 of a distinctive Hadhrami community; including the establishment in 1947 of the Hadhrami National Society. Its activity was banned by statute in 1968 soon after independence. It was reestablished in April 1992 as The Hadhrami Charitable Society. The Hadhrami community in Aden did what Hadhramis do best at times of hardship; in August 2012 their Hadhrami Charitable Society in Aden distributed food and funds to those forcefully evicted from Abyan.

Their charitable work involved feeding the needy, supporting the sick with medicines and funds and sponsoring visiting specialist surgical medical camps in a number of centres in Hadhramaut.

They also collaborated with other charitable groups in Shabwa and Aden89.

Bafadhil’s erudite report90 succinctly explained the complex causes and waves of migration to East Africa. He also recognized the familiar human and socio-political complexities and legacies experienced by the offspring of mixed marriages, the Muwalladeen. It is one of the dilemmas of identity, belonging and of retaining a generationally weakening connection with the Hadhramaut homeland91. Aljaidi, on the other hand, viewed 20th and 21st centuries Hadhrami migration as continuance of the centuries old tradition; the causes and end-results may have differed, but he saw it as an essential part of Hadhrami renewal. For many if not most, continued linkage to the homeland remained paramount92. However, Naif Nussair explored the idea of Hadhrami ‘unity’ amongst its diaspora, especially in the Arabian Peninsula. He deduced that the more recently migrated intelligentsia may be increasingly less cohesive than the previous migrant generations. He was disappointed to find members of the new diaspora to be drifting

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away from the ‘motherland’ Hadhramaut. He pleaded for unity amongst Hadhramis wherever they may be and urged them to better connect with and serve the homeland93.

The hurriedly executed unity between North and South Yemen in 1990 was re-imposed by a war in 1994 that the North won. It ultimately brought into play new political power configurations which engendered another wave of migration of talent. The new realities heightened tribal cultural affiliations, North-South societal differences and in turn fostered kinship and tribal nepotism and corrupt practices. These manifested in forms of inequality between citizens, particularly in appointing individuals to sought-after posts in major centres of learning. In turn this frustrated the careers of many, who mostly seemed to be academics of Southern identity, and hindered their potential academic achievements in the Yemen. Poor state salaries forced many to seek supplementary employment in the private sector where one could earn a substantial income sometimes at the expense of their primary appointment in the state sector. Real or perceived nepotism and the injustice associated with corrupt appointments to career posts led to frustration and disillusionment in the fairness of state institutions. Paucity and limitations of academic clinical research in the Yemeni medical private sector also encouraged the talented to migrate for better and fairer opportunities. Personal ambition to achieve and the self-confidence in one’s ability to compete in the far more taxing demands of services in foreign lands, drove many to take up these opportunities abroad. All these elements resulted in a Yemeni brain-drain particularly by Hadhramis94. Nevertheless most if not all talented Yemeni migrants profess their dream that one day they would be able to be of help to Yemen.

The transition into the modern health care and educational systems brought the benefits of self-reliance, but its unresolved limitations prompted the ambitious and frustrated new generations of medical and technical talent to migrate. Common sense would suggest it but without detailed studies it cannot be reliably concluded if such migration is to the detriment of Yemen.

Members of the diverse Yemeni diaspora may have left Yemen in fear, anger or frustration yet most if not all retain a palpable connection with the land of their birth or their parents’ birth.

Soon after the demanding events of the Arab Spring (2011) took place in Yemen, serious concern for provision of state health care and medicine manifested. Young and older migrants in UK sent food and funds for displaced people in all affected areas. Members of the Hadhrami diaspora in the Arabian Peninsula created their own NGOs to help relieve the new limitations by providing funding and medications directly to those in need into the whole of Hadhramaut but especially via Mukalla95.

In a 2013 report the RoY’s Ministry for Expatriates emphasised that some 30,000 highly qualified Yemenis resided abroad; the majority in KSA and other Gulf States. Of these the majority were almost certainly Hadhramis. Drawn by much better salaries and excellent clinical and technical facilities such professionals today occupy good posts in the medical and associated technical fields. The report estimated that Yemen loses some $24 million every year as a result of this migration96.

In 2016 Yemen’s Minister for Health Services also reported on the ‘Yemeni Brain Drain’ and its effects and recognized the success of the migrants in medicine and related health

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services. He acknowledged the need for the Yemeni government to do more to stem the loss of talent. He proposed neoliberal approaches on how to involve the diaspora more closely in Yemeni medical affairs97. In the present turbulent situation it is most unlikely that his suggestions will encourage wholehearted diasporic involvement98, 99 (see image of Facebook page in Photographs section).

Rashid al-Hadad reported on an apparent renewed interest in the topic of ‘Yemeni Brain Drain’. He named a number of the tens of prominent scientists, hundreds of specialists and thousands of doctors and teachers, all seemingly prosperous across the globe100. Unlike the old Hadhrami migrant the link between the modern technical migrant and his/her home may be strongly emotional and may even involve remittances, yet being technologically involved with Yemen seems tenuous. Many suggest the system seems unable or unwilling to accommodate what the successful migrant can offer101.

Anecdotally I sought to explore this through direct personal communication with a small cohort of highly successful consultants and Professors in many branches of Medicine and Surgery of Yemeni origin practising in Middle Eastern and Western countries (UK, Canada and USA, and some countries previously in the Soviet Bloc). Such Yemeni loss can be seen as gains for the individual migrant and for the host countries. The long history of success of the Hadhrami diaspora in the Arabian Peninsula was highlighted by the scholar A’aedh Al-Qarni102 and in a report by ‘World Business on Tuesday’, 3 April 2007103. Perhaps the real loss to Yemen, if ever calculated, may never be quantified beyond the pecuniary; the worst may most likely be in the even less explored realm of human emotions.

Much easier said than done; Yemeni officialdom needs to act smartly and wisely to win what the many Yemenis, especially the talented Yemeni professionals in the diaspora can offer.

Many had been reluctant to leave their Yemeni home but needed to find secure places where their talent could flourish and was better appreciated. Although Facebook Pages should be viewed with some caution the Al-Kafaat al-Yamaniah fil-mahjar throws strong light on the large number of Yemeni talent residing abroad; many are in the medical fields and most profess, all things being equal, they wished to help out in Yemen104.

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PART IV

The Role of Hadhramis

In this section I discuss the special contribution made by Hadhramis to medicine in Yemen, and broadly look at potential roles for HRC in the idea of research in the medical fields, and end with a few concluding remarks.

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CHAPTER 9

Special Place of Hadhramis in Medicine

Hadhramis have always been part of the entire fabric of Southern Arabian society and contributors to its development, modernisation and transformation105. Bin-Azoon explored the long intricate history of Hadhrami migration to Aden106. Many Hadhramis emigrated abroad via Aden but several chose to remain in Aden. Before 1967 Hadhrami boys, who aspired to a modern profession, initially obtained their secondary education in Abyan, Aden and the Sudan but most eventually ended up staying in Aden. Some settled in the colony whilst others, driven by ambition or economic or political factors, emigrated often to join their predecessors, families or friends. In due course many Hadhramis have held top positions in the PDRY and RoY in politics, academia and medical education, clinical and epidemiological research as well as in the fields of energy and agriculture107. In 2015, the then Aden University’s President, Abdulaziz Bin Habtoor, paid tribute to those who contributed to the university’s progress over the years since its creation in 1970. Amongst these he named the many Hadhramis who had held senior posts in medical education108. The influence of Hadhramis in Aden, who retained their community cohesion to a large extent, is undeniable yet awaits much greater academic attention109.

Bin Azoon and Bamatraf describe the centuries old Hadhrami presence in Aden110, 111. Their community cohesion was manifest in the Hadhrami National Society set up in 1947. It was banned soon after independence but re-established in April 1992 as the Hadhrami Charitable Society. The charitable work of the Hadhrami community has involved feeding the needy, supporting the sick with medicines and funds, sponsoring visiting specialist surgical medical camps in a number of centres in Hadhramaut and collaborating with other charitable groups in Shabwa and Aden112.

In August 2012 the Hadhrami Charitable Society distributed food and funds to those forcefully evicted from Abyan by AQAP. In the period following the tumultuous events of the Arab Spring serious concerns have been raised over the adequacy of provision of health care and medicine. Members of the Hadhrami diaspora in the Arabian Peninsula, as in other parts of the world, created their own NGOs to help relieve the situation by sending funds and medications directly to those in need across the whole of Hadhramaut, especially via Mukalla.

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CHAPTER 10

HRC and Medical Research and Healthcare

In drafting this chapter, I have tried to keep in mind what research can most benefit Yemen and what the HRC might do to help medical research in Yemen in general and Hadhramaut in particular. The spectrum for its potential involvement in health, medical services and clinical research is almost impossibly wide but, with the appropriate expertise, it could reasonably develop a niche in its intellectual aspects and consider that it should do the following: • Become a resource centre for effective debate that generates strategic research ideas and renewed thinking. It can focus on difficult broad issues of medical research that may be too uncomfortable for the established state and private institutions in health care and medical systems to consider, on pain of potential retribution by an interested establishment.

An example would be the question of ‘How to promote Primary Clinical Research in the region?’.

• Create a pool of inspiring teachers, well-trained researchers and aspiring students of both sexes to explore, teach and advise on the potential directions of new medical researches.

• Help foster a culture that promotes well-directed, well-designed and rigorously conducted academic research to answer well-thought-out questions to solve vital and relevant (to Hadhramaut and Yemen) medical and health problems.

• Generate a new field for the study of the professional (medical, scientists, technologists) Hadhrami migrants and their endeavours, stories and achievements.

• Harvest experience gained by Hadhrami medical and scientific talent in the diaspora to progress medical research in Yemen.

• Teach to support medical education in the fields of clinical research methodologies and the detailed practicalities of clinical research project management.

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CHAPTER 11

Conclusions

It took the best part of a century to irreversibly establish and institutionalise modern Western medicine and its practice in South Western Arabia. Simultaneously, the previously dominant centuries’ old, conceptually and practically different traditional (Islamic, mostly Arab) medicine, survived, adapted and continues to flourish today.

The two systems will most likely co-exist for the foreseeable future; each offers a different approach to healing the sick. In many disciplines the two complement each other whilst in others, such as in obstetrics and gynaecology and in managing diseases of children, modernity is slowly but surely displacing tradition. Here a fuller use of modern medicine is constrained by the overall poor state economics and by the iniquitous distribution of wealth amongst the Yemeni population. Remote rural areas, poor access to modern education and lack of modern health facilities disfavour the poor and the rurally isolated communities.

On the other hand traditional medicine is also quite slowly modernising itself in its own right. In Yemen a few long-established medicinal products are undergoing scientific investigation to establish and better define their medicinal characteristics, clinical efficacies, toxicity profiles and limitations to usage and to elicit their clinical adverse and side effects.

In the nineteenth century the Arab world, especially South Arabia, Aden in particular, began a new era of interacting with Western political, economic invasion and cultural expansion and colonial consolidation. Soon after arrival in 1839 there followed an initial period of colonial military and security consolidation of Britain’s position in its new possession of Aden to secure its borders, water and food supplies. By 1860 a new phase of intervention in the health and lives of indigenous civilians began, entailing the introduction of a Western hospital-based curative medical practice plus a separate public health preventive medicine. British and Indian physicians and technologists implemented these far-reaching changes; limited mostly by the paucity of available funds of the East India Company.

By the second half of the nineteenth century the new health care system was embraced by the local population for difficult illnesses and diseases, like consumption (tuberculosis), which untreated would have had high transmissibility, morbidity and mortality. At the time treatment was rest and food and by medication when it became available years later. However, where people saw an invasion of cultural norms and where the traditional method or the use of long-established culturally-accepted medicinal or surgical treatments or performance of rituals such as that of zar were believed to be better than Western medicine, the process of change was resisted. Midwifery was a good example where hospital-based delivery was for a considerable time resisted by expectant Muslim women and traditional midwives. They preferred home delivery by the familiar traditional Arab/ Muslim (Daiya/Qabilah also known as Giddah in Aden) to hospital childbirth.

Hindu and Jewish women, familiar with Western medical paradigms, on the other hand, took to the medicalised pregnancy and child birth much earlier than Arab women. To the north, Imamate

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CONCLUSIONS

Yemen resisted such an invasion by Western ideas, but eventually sought modern medicine whilst retaining much stronger traditional treatment models than in the colonised south.

By the mid-twentieth century in the South, under British rule, the new centralised modern State health care machinery was fully established. Here this system was also fully adopted after independence as a natural republican social service for all citizens. In the North, on the other hand, the state health care was always mixed with a strong private health sector service.

Hadhramis, in the South before unity and following North-South unity contributed greatly to these modernising processes.

Current Yemeni health care services and medical research are the products of history and the inherited successive ideologies and state policies of the last century and a half. Traditional Arab and Islamic medicine continues to thrive and co-exists with a strong western medical discipline.

Local university medical education and scientific research in Yemen are relatively young new fields having commenced in the very early 1970s. Yemenis to date have had some notable success in instituting respectable medical schools and education; if anything they may have taken on too many students and may have produced too many graduates in relation to Yemen’s capacity to absorb and fully employ them. However, Yemeni academia also faces many challenges, particularly in the young fields of clinical research and in publication of their work internationally. Such challenges have contributed to the migration of some talented Yemeni physicians and scientists, many of whom had better success in their fields abroad.

Much capable indigenous academic talent exists in Yemen or is dispersed abroad. However, the financial and policy constraints on researchers and research institutes limit Yemen’s clinical research and its output. Whilst ambitious governments and societies recognise the true value of academic research in general and clinical research in particular, such recognition is not appreciated to a sufficient extent among Yemen’s ruling elite.

Like some of its Middle Eastern neighbours, advanced medical research in Yemen remains constrained by frequent regional conflicts and political instability. The findings of Bazarbachi and his co-authors aptly describe the situation in Yemen and his analysis supports the main thrust of this book; the restrictive and discouraging systems and the conditions under which the Yemeni researchers and academicians work leave a lot to be desired. Yemeni research is constrained significantly by a state policy that seems not to value research as an essential tool for prosperity; a policy that is in need of close scrutiny and revision Yemen and the Yemeni diaspora could learn from the centuries-old Hadhrami experience of diaspora-homeland linkages. Perhaps for strong emotional and rational reasons, Yemen needs its diaspora as members of the diaspora need their Yemen. Many in the diaspora are well versed in academic research and its publication internationally. The vast majority profess their wholehearted desire to effectively contribute to Yemen’s success in academia locally and internationally and participate to its socio-economic prosperity. What hinders such mutually beneficial collaboration is not entirely clear; it seems to be multifactorial and on both sides.

Whilst this may benefit from detailed analysis, it does not stop one suggesting closer links between academics in Yemen and those in the diaspora for mutual collaboration and benefit.

The research for this chapter found too few female physicians and surgeons willing to share of their perceptions, experiences and views that would have enabled the author to offer a more

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realistic and rounded view of the current role of female researchers and academicians. It is an area worthy of closer study; there is much need to explore the existing Yemeni female talent in the diaspora. The changing dominant cultural system needs to further recognise, treasure, foster and promote excellence in both sexes equally.

HRC has much scope to get involved with intellectually and practically to help improve health and medical research and its output. I have suggested where it might start. HRC as it stands cannot be directly involved in the practical execution of clinical trial research but it can become the cauldron for new ideas and perhaps help stimulate the provision of funds and facilities for specialist education and research in the relevant medical fields in Yemen generally and Hadhramaut and the diaspora specifically.

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APPE NDIX I

On Hadhrami Identity

The term ‘identity’ is such a complex, nebulous and difficult to define concept, yet it contains a potent recognisable emotional force with benefits, detractions and limitations. See also ‘Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration’.

The Cambridge English Dictionary defines ‘identity’ in terms of: “who a person is, or the qualities of a person or group that make them different from others”.

Self-identity may be defined through long established sociological, anthropological psychological and theoretical analytical research methods. All explore and utilize the complex origins of notions, characteristics, beliefs, and expressions of the self (individually or as a group) and concepts of belonging; they are often anchored in a historical paradigm. One could identify with multiple and non-exclusive identities. A Hadhrami of origin could acquire other identities: Hadhrami, Kenyan and British or bearing one of many other Arab identities quite harmoniously. Each identity often has calculated benefit but equally with unavoidable tensions emerging at times of war or hardships for example.

An individual’s identity emerges during one’s biographical journey and experiences, through one’s identifications with significant others, primarily with parents (rightly or wrongly predominantly via paternal lineage and the Y chromosome for males) and with other individuals, namely relatives, real or invented ancestors and existing or ancient tribal linkages.

Self-identity also encompasses perceived linkages with ‘groups’. Such personal biographies are most often closely related to a specific geographic area. They give a person or a group a sense of belonging (territorial, spiritual and others). Carrying a recognizable prefix (Al- and Ba) to a name or a common surname linked to a family, a tribe, a region, a well-defined geographic area, such as historical or modern-day Hadhramaut, conveys strong belonging or at least a claimable ethnic or social linkage.

In many respects, to identify one-self and accept identification as Hadhrami, irrespective of place of birth or racial mix leads one to consider one is dealing with an individual or a group who would be sociologically defined as having Hadhrami identity. Like all Arabs, being Hadhrami is paternally defined i.e., scientifically through the inheritance of the male Y chromosome.

One can argue that many Hadhramis gain a sense of positive self-esteem from their Hadhrami identity and through association/affiliation with Hadhrami kinship groups. This furthers a sense of community and belonging. Without a doubt, from the plethora of works of old and new literary authors, poets, singers and song writers and the communal activity in social clubs, past and recent undoubted patronage of the youth winning scholarships for higher education, for example, one can weave a picture of a clear Hadhrami identity. Additionally, close personal experience permits one to sense and appreciate that Hadhramis, be they from the homeland (Hadhramaut), in the diaspora or as Muwaladin (in all its various meanings), an

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understanding of pride felt by Hadhramis in this belonging, as well as in the manifestation of implicit responsibility for such identity through material and emotional efforts to invest in the well-being of the geographic area called Hadhramaut or in Hadhrami people. Wherever Hadhramis may be, they often demonstrate forms of social cohesion in employment, in the gatherings in their social clubs and in the characteristic support groups at all times, but especially at moments of need. At times of difficulties the first port of call of a Hadhrami would be upon the philanthropy of the well-off and technocrat groupings irrespective of being a muwalad or otherwise.

An exciting potential modern method for approaching the study of identity lies in the domains of genetics. Today, one may turn to the modern technical/laboratory method to establish an individual’s or a group’s identity. More recently it is feasible to trace an individual’s ancestral lineage through bio-anthropology and the genetic inheritance markers. One such is the AncestryTM DNA test which uses microarray-based autosomal DNA testing. This surveys a person’s entire genome at over 700,000 locations, all with a simple saliva sample, so goes the advertisement for the test. However, genetic kinship testing is not without its problems and limitations that come with it being highly technical, giving results which need complex detailed explanations; these may not be readily available through the commercial company which carries out the test, often at an initial reasonable price (£79-129 per test). Kinship testing, different from but like paternity testing, is fraught with some difficult ethical dilemmas, privacy issues, let alone eventually being possibly prohibitively expensive as it requires a great deal of other corroborative additional material evidence to piece together the fuller story of kinship.

Chromosomal mutations, blind spots on the chromosome and technical margins of error may complicate the findings.

Perhaps most interestingly and theoretically, one can suggest DNA profiling to identify ‘who is a Hadhrami?’. However the serious question would remain as to what end this would serve in the context of this book? Today, realistically, for the purposes here and in-view of lack of such evidence this method almost certainly will not be of help in defining who is a Hadhrami.

For our present purpose we are left realistically with defining a Hadhrami, with a large dose of common sense, as “one who calls himself/herself a Hadhrami, one who defines his/her identity as such; it adds greater strength to this claim should he/she also be recognised and accepted as Hadhrami by others”.

For the purpose of this book I drew on personal knowledge and direct contact with the individuals or groups referred to here. I was also put in contact with Hadhramis by individuals known to me as Hadhramis who are also palpably proud to possess that identity. Here I take modern-day Hadhramis who are still living in today’s area called Yemen (particularly Hadhramaut and Aden) as well as those who have only recently (in the last 75 years) migrated out of a Yemen in its various recent entities. They initially hailed from today’s Hadhramaut towns or villages or have only recently moved to centers such as Aden, but still retain close social or family connections and manifest practical caring for the well-being of Hadhramaut and its social constituents. None here denied being Hadhrami.

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APPENDIX II

Significant Yemeni Academic Medical Journals

Note: The recent ongoing conflict since 2011 till today in 2017 may, to a larger or lesser degree, have limited the publication of some if not all of these few journals.

• ‘Journal of Natural and Applied Sciences’ uajnas.com/?page_id=6.

Refereed journal, publishes research papers three times per year on Applied Basic, Medical, Biological, Engineering, Technological, Agricultural and Environmental Sciences.

• ‘The Yemeni Journal of Science’ www.ysrf.org.ye/yjs/yjs.htm Describes itself as an international scientific journal published semi-annually by the Yemeni Scientific Research Foundation (Sana‘a University). It publishes original papers, review articles, case studies, and information technology in all facets of science.

• ‘Yemeni Journal for Medical Sciences’ https://ust.edu/ojs/index.php/yjmp Published by Sana‘a University of Sciences and Technology. A multidisciplinary, peer– reviewed, open access journal, published once a year (November) for the Faculties of Medicine, Pharmacy & Dentistry.

• ‘Journal of Tropical Nephro-urology, Yemen’ www.academia.edu/.../Journal_of_Tropical_Nephro-urology_Yemen_L...

Local Editor: Husain al-Kaff. A specialist Journal publishes on renal and urological topics.

Hadhramaut’s major science and medical journals • The bi-annual ‘Hadhramaut University Journal of Natural & Applied Sciences’ (Majalat Jamiat Hadhramaut lil-uloom al-tibiiyyah) incorporates publications on Medical and Life Sciences, Engineering and Technological Sciences and Environmental and Agricultural Sciences.

• ‘The Hadhramaut University Journal of Medical Sciences’ is a bi-annual refereed journal published by the College of Medicine in Mukalla.

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Notes 1

Adel Aulaqi ‘How Healthy is Health Research in Yemen? Role of HRC toward Healthcare Research’ Paper given at ‘Rediscovering Hadhramaut’ HRC Conference, LMEI (SOAS, London). Saturday, 7th March 2015. http://www.hadhramautresearchcentre.com

2

Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration Ed. Noel Brehony, (I B Tauris, London, 2017).

3

Un-published MA (History, SOAS) Dissertation Adel Aulaqi, ‘The Development of Health Services in Aden Colony and its Protectorates, 1937-1967’ (2008) 4

In this book I am building on research into the then current state of medicine in Yemen in Ch. 12. Adel Aulaqi, ‘On the Edge: the challenges of Yemen’s Healthcare System’ in Helen Lackner (ed), Why Yemen Matters (London, 2014), pp. 235-250 5

Thanos Petouris, ‘Hadhrami ‘Exceptiolaism’: attempts at an Explanation’, in Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration (London, 2017) pp. 41-66.

6

See Appendix II. Hadhrami Identity.

7

Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration.

8

World Health Organization, http://www.who.int/topics/traditional_medicine/en/

9

Cynthia Myntti, ‘Notes on Mystical Healers in the Higariyy’. In (Ed) Robert Bertram Serjeant and Robin Leonard Bidwell, Arabian Studies. Cambridge University Press, Cambridge [England]; New York, 1990. No. 42: 171–176.

Cynthia, Myntti, ‘Hegemony and healing in rural North Yemen’, Social Science and Medicine, 27, (1988), pp. 515-520.

Cynthia Myntti, and j-M Pelt. A Survey ‘Traditional Medicine and Traditional Healers in North Yemen’, Traditionelle Heilkundige 5 (1986), pp. 133-144.

10

Francine Stone. ‘Healing’, Ch. 8. Ethnography. Francine Stone (ed), Studies on the Tihāmah : The Report of the Tihāmah Expedition 1982 and Related Papers. (Burnt Mill, Harlow, Essex, England. Longman, 1985), pp. 118-120.

APA Citation: Tihamah Expedition. & Stone, Francine. (1985). Studies on the Tihamah : the report of the Tihamah Expedition 1982 and related papers. Burnt Mill, Harlow, Essex, England: Longman.

11

Folk-Remedies from Ḥaḍramawt. Author(s): R. B. Serjeant Source: Bulletin of the School of Oriental and African Studies, University of London, Vol. 18, No. 1 (1956), pp. 5-8 Published by: Cambridge University Press on behalf of School of Oriental and African Studies. Stable URL: http://www.jstor.org/stable/610125 Accessed: 06/02/2010 06:55.

12

Passim Batheeb, Ali Salem, Al-nabatat a-tibbiyah fil Yaman. (Maktabat al-Irshad, Sanaa, 1991). Medicinal plants in Yemen.

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13

‘King Youssef Bin Rassoul al-mu’tamad fi al-adwiyah al-mufradah’ (Manuscript) Corrected and indexed by Mustafa al-Saqqa . (Dar al-Qalam, Beirut, 1951).

14

Al-A‘las, Asmahan A‘qlan, al-Mawrūth al-thaqāfī lil-marʼah al-ʻadanīyah.( al-Hayʼah alʻA ̄ mmah lil-Kitāb Sana‘a, 2010), pp. 120-127.

15

See Further Reading: Arabic Publications Abdul-Bassit Muhammad Sayid, ‘Practice of Herbal and Prophetic Medicine Therapeutics’, pp. 29-96. Sayid refers to the work of Ibn Qayyim Al-Jauziyah’s 1292-1350 AD) ‘Al-Tibb al-Nabawi’ or ‘Healing with Medicine of the Prophet’ (in Arabic). It is recognised as most comprehensive and authoritative. At least four translations into English exist today.

16

Ahmed Dawood (author), Amal Al-Yarisi (photographer). Treatment with the Quran: Medicine or quackery? | Yemen Times. www.yementimes.com/en/.../Treatment-with-theQuran-Medicine-or-superstition.htm Accessed 21:35 09/01/2017.

17

Farook Aman, ‘The Role of Mukaddiah on the Wedding Night!’ canadiandream.cbet.ca › Articles 21 Feb 2017. Accessed 19/04/2017 at 10:30.

18

Tahereh Eteraf-Oskouei and Moslem Najafi ‘Traditional and Modern Uses of Natural Honey in Human Diseases: A Review’. Iran J Basic Med Sci. 2013 Jun; 16(6): 731–742.

19

Al-Rawi, S., & Fetters, M. D. (2012). Traditional Arabic & Islamic Medicine: A Conceptual Model for Clinicians and Researchers. Global Journal of Health Science, 4(3), 164–169. http://doi.org/10.5539/gjhs.v4n3p164

20

Passim Batheeb, Ali Salem, Al-nabatat a-tibbiyah fil Yaman. (Maktabat al-Irshad, Sana’a, 1991). Medicinal plants in Yemen.

21

Passim Ingrid Hehmeyer, Hanne Schönig, and Anne Regourd (eds), ‘Herbal Medicine in Yemen: Traditional Knowledge and Practice, and Their Value for Today’s World’ (Islamic History and Civilization. Vol.96. BRILL, Leiden. Boston, 2012).

22

Al-Bar, Mohammad Ali. ‘The Revival of Prophetic and Herbal Medicine’, The Fountain Magazine. Issue 14 / April – June 1996. www.fountainmagazine.com/Issue/.../TheRevival-of-Prophetic-And-Herbal-Medicine. Accessed at 11:00 13/03/2017.

23

David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in NineteenthCentury India (University of California Press Berkeley, 1993).

24

Frederick Mercer Hunter, An Account of the British Settlement of Aden in Arabia (Frank Cass & Co. Ltd. London, 1968), p.145.

25

E. Colson (Surgeon-Major) TWO CASES OF PERFORATING WOUND OF THE ABDOMEN, WITH PROTRUSION OF INTESTINE; RECOVERY. URINARY FISTULA; OPERATION; RELIEF. Published: 05 November 1887. DOI: http://dx.doi.org/10.1016/S0140-6736(00)30909-6 Accessed 25/06/2017 at 23:56

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26

Through the decades, especially in recent times, the identity of who is an Adeni has proved difficult to crystallise. Sometimes it generated divisions whilst at other times it proved a most potent cohesive and distinctive symbol of those who ‘know’ they belong to it and to the clearly identifiable geographic location of Aden.

27

Robert J. Blyth, ‘When One Comes to Details, Difficulties Bristle’: The Aden Transfer, c.

1917-21. Chapter 7 in The Empire of the Raj: India, Eastern Africa and the Middle East, 1858–1947. Cambridge Imperial and Post-Colonial Studies Series (Palgrave Macmillan UK, 2003), pp. 170-198.

28

B. R. Reilly, Foreword, in Edward Selby Phipson. ‘A Medical Survey of Aden 1933’, (Aden: Cowasjee Dinshaw & Bros.’ Press, 1934).

29

Sidney Croskery, Whilst I Remember, (Dundonald: The Blackstaff Press, 1983).

30

Ibid. pp.72-84.

31

Muna Saeed Fareh Mohammed Nursing services and training in South Arabia during the late British colonial period: 1950-1967 MSF Mohammed – 2016 – e-space.mmu.ac.uk [PDF] mmu.ac.uk pp109, 163, 196, 197. Accessed 01/05/2017 at 10:00. Thesis in PDF electronic copy in hand.

32

Abd al-Wakil Ismail Al-Suroury, Qiraah mujazah fi tarikh mustashfa al-jumhuriat altalimi wa waqi tattawwur muhnat al-tamridh fi al-yaman khilal al-fatrat 1958-2000 (Aden, 2001). Table 1, p.21.

33

See Health in Index in Ulrike Freitag, Indian Ocean Migrants and State Formation in Hadhramaut: Reforming the Homeland (Leiden, 2003).

34

Eva Hoeck, Doctor Amongst the Bedouins, English translation by Mervyn Savill (The Adventurers Club, London, 1963), pp. 85–191.

35

‘Caring for health and building hospitals’ in www.al-kaff.com/ www.alkaff.com/ar/QaspAlsapq.aspx?MainType. Accessed 8/9/2015 and 22.09.2015 at 10:00 and private correspondence with John Shipman on 08/09/2015.

36

Awadh Suleiman Mubarak Ba-Moumen, Arabic ‘Medical Service’ Chapter 7, Social Services, al-Ailaf fi tarikh bilad al-Ahqaf. Second Edition, (Aden, 2013), pp. 202–03.

37

Doreen Ingrams, A Time in Arabia: Life in Hadramaut (London, 2013), pp. 144–7.

38

Omar Awad Bawazir, Ra-id al-harakah al-tamrithiah al-tarbawiyah fi Hadhramaut: Ahmad Mahfoudh Saʿid al-Muhairi. Najm al-Mukalla, 8 September 2012. www.mukallastar.com/news/2012/39862.html. Accessed 28/09/15 at 22:00.

39

Abd al-Rahman Bin Sa’ad, al-‘amm Sa’id al-Taribi shakhsiah ya’irifuha al-gami’i fi Say‘un wa wadi hadhramaut. a’mila ka-awali fannee mukhtar fi mustashfa Say‘un munthu akthara min nisfi qarn min al-zaman. www.mukallatoday.com/Pages/Details.aspx?ID. Accessed 2nd January, 2016 at 14:00.

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40

Norman Lace Corkill, 1898-1966, nutritionist and zoologist with interest in snakes. See profile on him and his medals on web page www.http://adenairways.com accessed 28/7/2007.

41

John Shipman, ‘Doctor in Arabia: Patrick W. R. Petrie (1903-1986)’. The British-Yemeni Society Journal, (London, Vol. 13 2005), pp 34-47.

42

Paraphrased in reminiscing between the author by Dr. Bernard Walker, KFMH Physician and Missionary.

43

Between 2005 and 2006 the author interviewed four retired Health Care Assistants/Health Care Inspectors for a Dissertation for MA in History (SOAS).

44

Norman Lace Corkill.

45

Peter E. Pormann, and Emilie Savage-Smith, (eds) Medieval Islamic Medicine. (Edinburgh University Press, Edinburgh, 2007), pp 175-176.

46

Bidwell, R. L. ‘Western Accounts of San‘ā’ 1510-1962’, Chapter 9 in Robert. B. (eds), San‘ā’ an Islamic City. (Reprinted, Melisende UK Ltd, London, 2013), pp 108-121.

47

Ibid. p. 117.

48

John Shipman, ‘Doctor in Arabia:P.W.R. Petrie (1903-1986)’ The British-Yemeni Society Journal, Vol. 13. (London, 2005). And John Hewitt, ‘First Footsteps in Yemen-1947’ The British-Yemeni Society Journal, Vol. 12, (London, 2004), pp.10-17.

49

Daniel van der Meulen, Faces of Shem (John Murray, London, 1961), p.152.

50

Claudie Fayein, A French Doctor in the Yemen (R. Hale, London, 1957).

51

Passim Abd al-Minim Muhammad Ali, Tatawwur al-khidmat al-sihhiyah bil-Yaman 19621967 (Al-Qahirah al-Hadithah lil-Tiba‘ah, Cairo,1971). He also gives an excellent description of the health services inherited by the YAR in 1962.

52

Timothy Morris expresses the anguish of many in his The Despairing Developer (London, 1991). Marina de Regt offers a touching account in ‘Pioneers or Pawns? (New York, 2007).

Marta Colburn’s narrative in ‘The Republic of Yemen: Development Challenges in the 21st Century’ (London, 2002) provides valuable statistics and clear insightful analysis.

53

Translated from Arabic Government document. Health in ‘Features of Evolution of Democracy in Yemen in Twenty Years’ (Dar Al-Hamdani for Printing and Publishing, Aden, 1987), pp. 191-193.

54

For past migration and established Yemen communities in UK see Fred Halliday, Britain’s First Muslims: Portrait of an Arab Community (London: I. B. Tauris, 2010) and Mohammad Siddique Seddon, The Last of the Lascars: Yemeni Muslims in Britain, 1836-2012 (Kube Publishing Ltd. Markfield, UK. 2014). For more recent migration see Caparico, Sheila, Civil Society in Yemen: The political economy of activism in modern Arabia (Cambridge Middle East Studies 9. Cambridge University Press. Cambridge, 2006), pp. 34, 40, 48, 113-4, 119.

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55

World Bank data.worldbank.org › Countries and Economies Accessed 02/11/15 15:40

56

Aulaqi, A, ‘On the edge: the challenges of Yemen’s health care system’ Chapter 12 in Helen Lackner, (ed), Why Yemen Matters (London, 2014).

57

See Abdalla Nasher, ‘Strategy for Reform: Executive Summary’, Ministry of Public Health, Sanaa Republic of Yemen, October 2000.

58

Adverse Drug Reactions Reporting is an essential aspect of modern health care. In Yemen these go mainly unreported. Mohammed Ahmed Alshakka et al ‘The Need of Pharmacovigilance Activities in Yemen’ by Global Journal of Medical Research: B Pharma, Drug Discovery, Toxicology and Medicine. Vol 14 Issue 4, Version 1.0 Year 2014,

59

Adel Aulaqi, Chapter 12, pp.235-250.

60

Abd al-Wakil Ismail, Al-Suroury, Qiraah mujazah

61

Abd al-Wakil Ismail Al-Suroury, Nashat jami῾at adan wa tatawuruha: thlathyn̔aman min al-tahdith wa al῾ata wa al-tanwir (Aden, 2006), pp.133.

62

Passim Sam Leinster, John Bligh and Ian Marshall, Report on medical education in the Republic of Yemen, (2000).

63

Ibid.

64

Educational and Medical services in ‘Out of Hadhramout: Al Mukalla Reviewed’ hadhramouts.blogspot.com/2008/07/al-mukalla-reviewed.html. One man’s visit in 2008 and up-dated in 2011.

65

E. Colson (Surgeon-Major) DOI: http://dx.doi.org/10.1016/S0140-6736(00)30909-6

66

Passim Patrick Petrie and Kenneth Stanley Seal, A Medical Survey of the Western Aden Protectorate 1939-1940 (Colonial Office, Middle East No.66. December 1963, London, 1943).

67

Franco Grima, Warriors of Arabia: Memoirs of a Medical Officer in Aden and Beyond, (Privately published, Malta, 2009).

68

Iain Murray-Lyon ‘A Medical Perspective on the Yemen’ British Yemeni Society Journal, (Vol. 5 London, December, 1997), pp. 20-22.

69

Martin McKee, David Stuckler and Sanjay Basu ‘Where There Is No Health Research: What Can Be Done to Fill the Global Gaps in Health Research?’ PLoS Medicine | www.plosmedicine.org 2 April 2012 | Volume 9 | Issue 4 | e1001209.

70

‘Abstract of Yemeni health medical research 2000-2005’ www.mophp-ye.org/arabic/docs/bookresearsh.pdf Accessed 8 February 2015.

71

Zaid Shamsan, ‘Waqi al-bahth al-ilmi fi jamiat hadhramaut lil-ulum wa al-taknalojya’ www.marebpress.net/articles.php?id=21562&lng. (2013) Accessed 30 November 2014 at 21:38.

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72

Ma’an A. Bari Qasem Saleh, ‘Psychology in Yemen’ in Home//Office of International Affairs//Psychology International Newsletter//Psychology in Yemen May 2008 www.apa.org Accessed 20 February 2015 at 14:45.

73

Abdulla Abdul Wali Nasher, Abu Bakr Abdalla al-Qirbi, Mohammad AbdulGhafoor, Catterall A , J.W Iain ‘Khat chewing and bladder neck dysfunction. A randomized controlled trial of alpha 1-adrenergic blockade’. 1995 May;75(5):597-8.

74

Ali A. Bazarbachi, Samia J. Khoury and Mohamed H. Sayegh, ‘Biomedical Research in the Arab Region’ Published online 20 November, 2014. - natureasia.com www.natureasia.com/en/nmiddleeast/article/10.../nmiddleeast.2014.263 Accessed 19.02.2016 23:45.

75

Rashid Al-Hadad. ‘Bil-ism al-’uqool al-Yamaniah taqudu al-’alam: ’asharat al-ulama wa miaat al-khubara wa alaaf al-attiba wa al-mu’alimeen y’amalun fi al-kharij’ http://adenalhadath.net/news_details.php?sid=5635 16 January 2015, accessed 10 November 2015 22:30’.

ʿAida Mukred. ‘Tatweer al-bahth al-’ilmi bil-gami’aat al-yemaniah fi dhawu al-khibrat al’aalamiah al-hadithah’, Paper given at Fourth Scientific Conference of the University of Aden 11-13 October 2010, Aden. http://uniaden-adc.com/5thConference_papers/conference_papers.

76

77

Saggaf Ali al-Kaff, Arabic ‘Hadhrami migration’ in Hadramout Through Fourteen Centuries. (Osama Bookshop, al-shamiah house for printing, publishing and distribution. Beirut, 1990), pp. 116-137.

78

Hadhramaut and its Diaspora Yemeni Politics, Identity and Migration Ed. Noel Brehony, (I B Tauris, London, 2017).

79

Adel al-Aulaqi. British Yemeni Society Journal, Vol 16. (London, 2008). 26-33.

80

From own personal notes and private communications with migrated friends and colleagues.

81

Saggaff Ali Al-Kaff ‘Hadhrami migration’, pp. 116-137.

82

Sayyeds and religious men were targeted for harsh treatment. See Thanos Petouris, ‘Faysal al Attas, the Maoist Sayyed’, Br-Yemeni Society Journal Vol. 22, (London, 2014), pp. 22-40.

83

Sagaff al-Kaff Sagaf Ali El Kaff, ‘Hadhrami migration’, 116-137.

84

Ulrike Freitag, ‘The diaspora since the age of independence’, in Ulrike Freitag and William Clarence-Smith (eds), Hadhrami traders, scholars, and statesmen in the Indian Ocean, 1750s-1960 (Leiden: Brill 1997), pp. 315-329.

85

Ulrike Freitag, ‘The Emergence of the New Elites and Demise of Empire’, in Indian Ocean Migrants and State Formation in Hadhramauut: Reforming the Homeland. (Brill. Leiden.

Boston. 2003), pp. 450-529.

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86

Abdulla Saeed Bahaj, ‘Hadhramis role in developing and modernising Aden and Southern Arabia 1888-1990’. Al-Mukalla al-Yaoum 18/06/2012. 18/06/2012. www.mukallatoday.com/pages/Details.aspx?ID...c. Accessed 17/11/15 at 13:05.

87

Passim Mohamed Abdel Qader Bamatraf, Al-Hijrah al-yamaniah (First Edition, Yemeni Ministry of Expatriates Affairs, Sanaa, 2001). Although the title carries the identity of Yemeni, the book deals with Hadhrami Migration by a significant Hadhrami author.

88

Suleiman Faraj Bin-Azoon, Hijratal Hadharem ela Adan: Dirassah maidaniah li-sillatihim be-mautininhim al-aslee wa I’laqatihim al-ijtimaa’iah. The author deals with the long history of migration of Hadhramis to Aden through a field study of their connection with the original homeland and their social relationships. Source: January | 2014 | Hadhrami Diaspora www.hadhramidiaspora.org/2014/01/19 https://www.academia.edu/5632021/_1.

Accessed 24/09/2015

89

Mohamed Awad Bawazir, (Arabic) ‘Historical research of the Hadrami National Association in Aden since its inception in 1947and its successor, the Hadhrami Charitable Society, in Aden since its re-establishment in April 1992’. Research paper was submitted to the scientific symposium on the history of Aden held on May 15, 1999 in Aden University. www.alhadramia-aden.org/index2+.htm. Accessed on 21.09.2015 at 18:30.

90

Abdillah Bafadhil, (Arabic) ‘Yemeni migration to East Africa up to mid-twentieth century’, posted on Hadhrami Diaspora Website www.hadhramidiaspora.org/.../... A Although the title takes the all-encompassing identity label of Yemeni its focus is on Hadhrami migration to East Africa.

91

Freitag, F. Indian Ocean Migrants. pp. 6, 50-51, 228-229, 233, 256-257, 267, 307-308).

92

Abdualla S S Alijaidi, Al-awdhaa’ al-ijtima-e’yah wa-athaqafiyah wal-iqtisadiah wassiyasiyah fi hadhramaut 1918-1945. (Dar al-Wifaq, Aden, 2009), pp. 146-152.

93

Naif Nusair, (Arabic) ‘Al-wihdah al-Hadhramiyyah…al-qadeem al-mttajaded’.

Reflects on the ever recurring old chestnut of renewing the call for Hadhrami unity and supporting the Homeland. mukallatoday.com/Pages/Details.aspx?ID=1757. 21/11/2102.

Accessed 17/11/2015 at 13:00.

94

Although can be problematical the Facebook Page Al-Kafaat al-Yemeniah fil-mahjar “Talented and Competent Yemenis in al-mahjar” https://www.facebook.com/search/606119776137140/stories-hashtag throws some light on the large number of Yemeni talent residing abroad; many are in the medical fields.

95

Personal communications with Mr Muhammad bin Dohry, Chairman, Hadhramaut Research Centre.

96

Rammah Al-Jubari, reported on the anxieties of Yemeni officialdom about the recognised chronic and acute problems of the migration of talent.

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Dr Nassib M. Al-Maljam, Director General of Medical Services, Ministry of Public Health and Population. ‘Scientific, medical and health competencies in the Diaspora and its role in development in Yemen: a working paper presented to the workshop on migrant scientific talent at the Third General Expatriates’ Conference in 2009’. www.26sep.net/newsweek.php?lng=english...1506 26 September News.Thursday 08 April 2010, page 6. Accessed 26.09.2015 21:15.

98

Al-Kafaat al-Yemeniah fil-mahjar ‘Talented and Competent Yemenis in al-mahjar’ https://www.facebook.com/search/ 606119776137140/stories-hashtag 99

Personal communications with colleagues and friends in the Diaspora.

100

101

Rashid Al-Hadad.

Al-Kafaat al-Yamaniah fil-mahjar

102

Dr. A’aidh Al Karani. (Arabic) ‘Al-Hadharem wa-sina῾at al-najah’ in Asharq AlAwsat Newspaper, Tuesday 03 May 1430 April 28, 2009 Issue 11 109. Dr Karani describes the Hadhramis as a people who craft and manufacture success wherever they may reside.

103

‘The world’s successful diasporas’ Bulletin. www.managementtoday.co.uk/news/ .../the-worlds-successful-diasporas. Accessed 22.09.2015 at 14:50.

104

Al-Kafaat al-Yamaniah fil-mahjar.

105

Abdulla Said Ba-Haj, ‘al-hadharimah wa-dawruhum fi tanmyat wa tahdith Adan wa aljanub al-arabi min aami 1888 ila aami 1990’ in Al-Mukalla al-Yaum 18/06/2012. www.mukallatoday.com/pages/Details.aspx?ID...c. Accessed 07/11/15 at 13:05. Bahaj illustrates how the Hadhramis played a pivotal role in developing and modernising Aden and Southern Arabia for well over a century from 1888 to1990.

106

Suleiman Faraj Bin-Azoon, Hijrat al-hadharim ila Adan.

107

Aidarous Zaki, ‘al-profesoor Bin Habtour: 6 a῾wam min al-῾atta al-qiyadi fi riasat jamiat Adan’ 1 January 2015. www.aden-univ.net/ Accessed 2 October 2015 at 09:45.

108

Source:13 January 2011. Celebrating the Fortieth Anniversary of Founding Aden University.

Accessed 28 June 2017 at 12:10. http://www.aden-univ.net/ConfDetails.aspx?Confid=9

109

Abdulla Said Ba-Haj, al-hadharimah wa-dawruhum fi tanmyat wa tahdith Adan

110

Muhammad Aldulqadir Bamatraf, Al-Hijrah al-Yamaniah.

111

Suleiman Faraj Bin-Azoon, Hijrat-al Hadharem ela Adan.

112

Mohamed Awad Bawazir, (Arabic) ‘Historical research of the Hadrami National Association in Aden since its inception in 1947and its successor, the Hadhrami Charitable Society, in Aden since its re-establishment in April 1992’. Research paper was submitted to the scientific symposium on the history of Aden held on May 15, 1999 in Aden University. www.alhadramia-aden.org/index2+.htm. Accessed on 21.09.2015 at 18:30.

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Further Reading Abushouk, Ahmed Ibrahim and Ibrahim, Hassan Ahmed (eds), The Hadhrami Diaspora in Southeast Asia: Identity Maintenance Or Assimilation? (BRILL, Leiden. Boston, 2009). Twelve selected papers given at the 2005 Kuala Lumpur Conference. The papers address the question of the Hadhrami Identity in Southeast Asia from various perspectives, and investigate the patterns of the Hahdrami interaction with diverse cultures, values and beliefs in the region.

Special attention is also paid to the Hadhrami local and transnational politics, social stratification and in Southeast Asia.

Alfree, P. S. Hawks of the Hadhramaut (Robert Hale Ltd, 2013).

Arai, Kazuhiro, Arabs who traversed the Indian Ocean: the history of the al-`Attas family in Hadramawt and Southeast Asia, c. 1600 - c. 1960 (Manuscript, SOAS Library, 2004 Berg, Lodewijk Willem Christiaan van den Le Hạdhramout et les colonies arabes dans l'Archipel Indien. (BATAVIA Imprerie du gouvernement, 1886).

Boxberger, Linda On the Edge of Empire: Hadhramawt, Emigration and the Indian Ocean, 1880S-1930s (S U N Y Series in Near Eastern Studies‫و‬2002).

Brehony, Noel (Ed) Hadhramaut and its Diaspora: Yemeni Politics, Identity and Migration.

(I B Tauris, London, 2017).

Caton-Thompson, Gertrude The Tombs and Moon Temple of Hureidha: Hadhramaut.

(Society of Antiquities, London, 1944). Gertrude Caton-Thompson worked with Elinor Gardner and Freya Stark on an excavation of the Moon Temple and adjacent tombs at Hureidha, 1937-8. It is believed that Stark derided Caton-Thompson’s field work in Stark’s A Winter in Arabia. It led to disruption of their relationship.

Freitag and William Clarence-Smith Hadhrami traders, scholars, and statesmen in the Indian Ocean, 1750s-1960s, edited by Ulrike, (Leiden: Brill 1997).

Freitag Ulrike. Indian Ocean Migrants and State Formation in Hadhramauut: Reforming the Homeland.(Brill. Leiden. Boston. 2003).

Hartwig, Friedhelm, Hadramaut und das indische Fürstentum von Hyderabad : hadramitische Sultanatsgründungen und Migration im 19. Jahrhundert. (Würzburg : Ergon, 2000) Hadramaut and the Indian principality of Hyderabad: Hadrami foundations of sultanate and migration in the 19th century. (Würzburg : Ergon, 2000).

Hans Helfritz Land without shade; translated from the German by Kenneth Kirkness (London, Hurst and Blackett, 1935).

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Hehmeyer, Ingrid, Schönig Hanne and Regourd, Anne (eds), Herbal Medicine in Yemen: Traditional Knowledge and Practice, and Their Value for Today’s World. (Islamic history and civilization (IHC); vol.96. BRILL, Leiden. Boston, 2012).

Ho, Engseng, The graves of Tarim : genealogy and mobility across the Indian Ocean (2006).

Hunter, F. M. and Sealey, C. W. H. An Account of the Arab Tribes in the Vicinity of Aden.

(Government Central Press, Bombay, 1909) Reprinted New Impression by A Wheaton & Co Ltd, Exeter, 1986). A detailed ethnographic report (including large tracts on Hadhramaut) was prepared for use by the British administrators and army in Aden and its Protectorate, first published in 1886. After corrections and additions from time to time by various officers of the Aden Residency until September, 1907 the 1909 edition was published.

Ingrams, Doreen A Time in Arabia (J. Murray, 1970).

Ingrams, W. H. Aden Protectorate: a report on the social, economic and political condition of the Hadhramaut. (H. M. Stationary Office, London, 1937).

Ingrams, Harold Arabia and the Isles. (John Murray, London, 1942). de Jonge, Huub and Kaptein, Nico (eds.) Transcending borders: Arabs, politics, trade and Islam in Southeast Asia. International Workshop on South-East Asian Studies (12th : 1997 : Leiden, The Netherlands, KITLV Press, 2002). English, Conference Proceedings edition.

Lekon, Christian Time, space and globalization: Hadhramaut and the Indian Ocean rim 1863 - 1967 Edited by Hans-Heinrich Nolte. (Gleichen: Muster-Schmidt Verlag, 2014).

Meulen, Daniël van der Hadhramaut das Wunderland : eine abenteuerliche Forschungsreise durch das unbekannte Süd-Arabien (Hadhramaut the wonderland: an adventurous exploratory journey through the unknown South Arabia) 1948.

Meulen, Daniël van der. 1947Aden to the Hadhramaut, a journey in South Arabia.

(J. Murray, London, 1947).

Mobini-Kesheh, Natalie The Hadrami Awakening: Community and Identity in the Netherlands East Indies, 1900–1942 (Southeast Asia Program Publications, 1999).

Peskes, Esther Al-ʻAidarūs und seine Erben : eine Untersuchung zu Geschichte und Sufismus einer òhaòdramitischen Sāda-Gruppe vom fünfzehnten bis zum achtzehnten Jahrhundert.

(Franz Steiner Verlag Wiesbaden GmbH (Dec. 2005). Explores Sufism in Hadhramaut.

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Prose and poetry from Hạdṛamawt / edited, collated and corrected with an introductory preface by Serjeant, R. B. (London: Taylor’s Foreign Press, 1951). (Würzburg: Ergon-Verl., 2011).

Rodionov, M. A. The Western Hạdṛamawt : ethnographic field research, 1983-91(Halle (Saale) ; Orientwissenschaftliches Zentrum, der Martin-Luther-Universität, 2007).

Rodionov, M. A. Etnografiia zapadnogo Khadramuta : obshchee i lokal’noe v etnicheskoi kul’ture. (Moskva : Rossiiskaia Akademiia Nauk, 1994).

Serjeant, R. B South Arabia Hunt. (Luzac & Co, London, 1976). South Arabian Migration Movements in the India Ocean: the Hadhrami Case c.1750-c.1967 : a 3-day conference to be held on 27-29 April 1995 : abstracts and papers Hadhramaut and Hadhrami Diaspora Conference. Published 1995, (SOAS Catalogue).

Souvorov, M. N. and Rodionov, M. A. (Co-Editors) Cultural anthropology of southern Arabia: Hadramawt revisited = Kul’turnaia antropologiia iuzhnoǐ Aravii : Khadramaut (St Petersburg : [S.n.], 1999).

Stark, Freya Madeline A winter in Arabia (J London; John Murray, 1940).

Stark, Freya Seen in the Hadhramaut (John Murray, London, 1938).

Stark, Freya Madeline The Southern Gates of Arabia: a journey in the Hadhramaut (John Murray, London, 1936).

Wrede, Adolph von Reise in Hadhramaut, Beled Beny ‘Yssà und Beled el Hafschar herausgegeben, mit einer Einleitung, Anmerkungen und Erklärung der Inschrift von ‘Obne versehen von Heinrich Freiherrn von Maltzan. (Braunschweig : Friedrich Bieweg, 1873).

Travel in Hadhramaut.

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Arabic Publications and English Translation

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Index

Career .................................................9, 10, 36, 40, 42, 43, 63 Castro..............................................................................36, 58 Cauterisation.........................................................................24

Abdo, Ali ..............................................................................30

Children ........................................................23, 25, 31, 42, 68

Abdulla A W Nasher...................................................8, 40, 47

China.....................................................................................36

Abdulla al-Sayyari..................................................................8

Christ’s thorn tree, Sidr.........................................................26

Advisors ...............................................................................10

Cinnamon .............................................................................24

Affara, Dr Ahmed Saeed ......................................................49

Circumcision.........................................................................24

Africa, East .................................................................7, 61, 62

Corkill, Dr. Norman Lace ..............................................31, 33

Ahmed, Dr. Jalaluddin ..........................................................31

Cowen, Dr. Baruch Stewart ..................................................32

al-Abdali, Sultan Ali Abdul-Kareem ....................................32

Cowie, Louisa J. F. ...............................................................34

Al-Alas, Asmahan.................................................................24

Cuba....................................................................36, 40, 58, 61

Al-Bar, Mohammad..........................................................8, 40

Cupping ..........................................................................24, 25

al-Gailani, Dr. Abdul-Hadi ...................................................31

Delivery: Home ..............................................................25, 68

al-Hadad, Rashid ..................................................................64

Developmentalism, developer ..............................................35

al-Hawtah hospital..........................................................32, 33

Dispensary ..................................................................9, 28, 55

Ali, Saif Ali Baba .................................................................31

Drug: Compounding .............................................................30

Aljaidi, Abdualla S ...............................................................62

Duhm, Helene Marie ............................................................31

Al-Kafaat al-Yamaniah fil-mahjar........................................64

Economy...............................................................................37

Al-Kaff, Dr. Abdul Qader bin Abdalla bin Hasan ................31

Egyptians ..............................................................................35

Al-Kaff, family .....................................................................31

Ethics, ethical, approval ...........................................27, 47, 72

Al-Kaff, Sayyid Abdul-Rahman Bin Sheikh ........................31

Evil eye .................................................................................23

Al-Kathiri, Dr Abdalla bin Jaffer bin Mansoor ....................31

Expert report .........................................................................37

Al-Qarni, A’aedh ..................................................................64

Fare’, Ahmed ........................................................................30

al-Quayti, Sultan Saleh bin Ghaleb bin Awadh ...................31

Fayein, Claudie.....................................................................35

Al-Suroury, Abd al-Wakil Ismail..........................................40

Federal health service ...........................................................33

Alternative: therapies, healing........................................26, 27

Federation of South Arabia (FSA)......................17, 32, 53, 55

Anaesthesia, chloroform.......................................................30

Fenugreek .............................................................................24

Animistic ..............................................................................23

Folk: medicine. medical care....................................23, 24, 27

Ankalikar, Dr Vaman Vishwanath ........................................31

Freitag, Ulrike.......................................................................31

Apothecaries .........................................................................34

French .............................................................................34, 35

Apprenticeship....................................................24, 25, 26, 40

Galls......................................................................................24

Arab Spring ................................................................9, 63, 66

General Practitioners ......................................................29, 40

awqafs...................................................................................34

Grima, Franco.......................................................................42

Bafadhil, Abdillah.................................................................62

Gulf States ..........................................................36, 61, 62, 63

Baḥraq, Muhammad .............................................................24

Gynaecologist .......................................................................25

Bahrain .................................................................................61

Hadhramaut and its Diaspora............................7, 8, 11, 61, 71

Bamatraf, Abdel Qader ...................................................62, 66

Hadhrami National Society ............................................62, 66

Barber ..................................................................................24

Hadhrami Research Centre, HRC...........................................7

Batheeb, Ali Salem ...............................................................24

Hadith ...................................................................................24

Bawazir, Amin .................................................................8, 43

Healing: alternative, healers, herbalists

Bazarbachi, Ali A............................................................46, 69

mysticism, mystical ...........22, 23, 24, 26, 27, 32, 68

Beihan, Sherief of, al-Habili...........................................32, 33

Health Units..........................................................................33

Beit Hameed .........................................................................31

Health, Assistants, Tribal ...............................29, 31, 32, 56,58

Bin Azoon, Suleiman Faraj.............................................62, 66

Henna..............................................................................24, 48

Bin Dohry, Muhammad ..................................................7, 8, 9

Hijamah ................................................................................25

Bin Habtoor, Abdulaziz ........................................................66

Hoeck, Dr. Eva ...............................................................31, 35

Birth: registration, home...............................25, 29, 30, 40, 68

Honey .............................................................................26, 48

Blood-letting.........................................................................24

Hudeidah.........................................................................27, 34

Bombay administration ........................................................29

Hunter, Frederick Mercer .....................................................28

Bone: setting, setters.......................................................24, 25

Hygiene.......................................................................5, 26, 30

Brain drain ..........................................9, 38, 46, 60, 61, 63, 64

Identity..........................................................11, 62, 63, 71, 72

Branding ...............................................................................25

Incense ..................................................................................24

British ....7, 9, 10, 22, 23, 28, 29, 30, 31, 32, 34, 35, 61, 68, 69, 70

Indian Raj .............................................................................29

British Residency..................................................................31

Infant: mortality....................................................................29

Burchardt, Hermann .............................................................34

Islamic: Arabic, Medicine, Practice...7, 23, 24, 25,26, 27, 68, 69

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Journals: Medical................................................42, 44, 46, 73

Pumpkin-rind ........................................................................24

Kathiri sultanate....................................................................31

Qatar .....................................................................................61

Kingdom of Saudi Arabia (KSA) ........................................61

Quayti Sultanate ...................................................................31

Kiswah ..................................................................................25

Quranic medicine..................................................................24

Kuwait ......................................................................37, 61, 62

Ranade, Dr. ...........................................................................31

Laboratory ....................................................29, 31, 40, 43, 72

Rasoul, Al-Mothafer Youssef bin ‘Amr bin Ali....................24

Lahej ........................................................................32, 33, 53

Regimes ............................................................................7, 11

Malaria..............................................................................9, 32

Reilly, Bernard......................................................................29

Manzoni, Renzo....................................................................34

Remittances ....................................................................37, 64

Mukadiah ..............................................................................26

Republic of Yemen: RoY..................11, 21, 22, 30, 36, 37, 61

Masa‘bain .............................................................................25

Richardson, George Alexander.............................................34

Maternal: mortality, morbidity .............................................29

Ringworm .............................................................................24

Medical tourism......................................................................7

Rossi, Dr. ..............................................................................34

Microscopy .....................................................................29, 30

Royal Air Force: RAF ..........................................................29

Midwifery, Traditional, Modern, Medicalisation......24, 25, 30, 36

Russian, Soviet Bloc...........................................34, 36, 40, 64

Midwife: Daiy, Qabilah, Giddah....................................49, 68

Saffron ..................................................................................24

Missionaries........................................................28, 32, 33, 50

Sana‘a .........................................10, 11, 27, 34, 35, 40, 44, 73

Mohammad, Prophet: Prophetic .....................................23, 24

Say’un.............................................................................31, 32

Morbidity ..................................................................29, 43, 68

Serjeant, Dr. Marion .............................................................31

Mortality ...................................................................29, 43, 68

Serjeant, Robert B ................................................................24

Mubgar, Dr. Reem ..................................................................8

Shabwa ...........................................................................62, 66

Mukalla.....................................7, 9, 10, 31, 40, 42, 63, 66, 73

Shamsan, Zaid ......................................................................44

Musarreg, Dr. Maha Mustafa..................................................8

Sheikh Othman .......................................25, 30, 32, 33, 34, 50

Muwalladeen ........................................................................62

Shibam ..................................................................................31

National Health Service, NHS..............................................28

Shipman, John ....................................................................7, 8

Non-Governmental Organisations, NGO .............................35

Smallpox.........................................................................24, 42

Obeid, Mariam .........................................................25, 29, 49

Snake-bites ...........................................................................24

Obstetrician...........................................................................30

Socialist ................................................................................22

Okra ......................................................................................26

Soqotra..................................................................................37

Onion ....................................................................................24

South Western Arabia ...........................7, 9, 10, 13, 23, 61, 68

Ophthalmologists..................................................................29

Sterilisation: surgical instruments ..................................29, 30

Orthopaedic ..........................................................................25

Superstition...........................................................................23

Osteopath ........................................................................25, 27

Surveys ...........................................................................42, 72

Paramedical ..........................................................................29

Symes, Sir Stewart................................................................29

Parsley ..................................................................................26

Syrian physicians..................................................................34

Paterson, Dr Alexander.........................................................32

Taizz......................................................................................35

People’s Republic of China, PRC.........................................36

Tarim.....................................................................................31

Perfume.................................................................................24

Tooth Brush Tree, Gracin, Miswak, sawak...........................26

Petrie, Dr Patrick W. R. ..................................................32, 34

Trachoma ....................................................................9, 31, 42

Pharmacy......................................................29, 34, 41, 57, 73

Transformation .........................................7, 29, 30, 38, 39, 66

Philanthropy .........................................................................72

Trachoma ....................................................................9, 31, 42

Phipson, Edward Selby.......................................29, 50, 51, 52

Treatise .................................................................................24

Physician: female..................................................................68

Tuberculosis..........................................................9, 23, 28, 68

Physiotherapy .......................................................................25

Turmeric ...............................................................................26

Pioneer ..................................10, 27, 30, 31, 33, 40, 43, 56, 58

Turkish..................................................................................34

Plants ........................................................................24, 25, 26

Van der Meulen, Daniel ........................................................31

Poison .............................................................................24, 25

Villages ...............................................................25, 33, 58, 72

Policies..........................................................11, 35, 36, 42, 69

Vomiting ...............................................................................24

Political: residents, advisors .................................................10

Wahidi...................................................................................31

Population.....................................9, 28, 29, 34, 35, 37, 39, 68

World Health Organisation, WHO........................................27

Poultices ...............................................................................24

X-ray...............................................................................31, 40

Pre-Islamic............................................................................23

Yabli, Nageeb .......................................................................32

Protectorate:

Young, Dr John Cameron .....................................................32

Eastern Aden (EAP). Western Aden (WAP) ..................31, 32, 33

Zar ..................................................................................24, 68

Psychological medicine ........................................................44

Zwemer, Samuel M ..............................................................24

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From Barefoot Doctors to Professors of Medicine in 75 years – A Brief History of Modern Medicine in Yemen 1940-2015

This book briefly outlines the story of the healthcare systems and modern medical education in South-Western Arabia. It covers events and developments at the cusp of modernity and nation and state-building in a period spanning colonial conquests of late nineteenth century and nationalist administrations of the mid-twentieth and very early twenty first centuries. In medical care East and West, tradition and modernity do not appear to clash but co-exist almost harmoniously. In two case studies the author briefly sketches out the role of a traditional midwife and documents the substantive role of the Hadhramis, famed for their almost legendary stories of migration, in the processes of medical education in the region. It ends by telling of the modern day story of migration and diaspora creation by the more adventurous of the newly-created medical elites who migrated to forge successful careers in many parts of the world.

From Barefoot Doctors to Professors of Medicine in 75 years A Brief History of Modern Medicine in Yemen 1940-2015

Although in English it looks to break new grounds by accessing Arabic sources.

A D E L AU L AQ I

UK ÂŁ10.00

A D E L AU L AQ I