Austrian Doctors in the British Caribbean

By Priyasha Saksena

In this post, I examine how the regulatory instrument of registration became a useful mechanism to expand the availability of healthcare personnel in times of “crisis” by examining the recruitment of European doctors by the governments of British colonies in the Caribbean.

The British medical register was, as Douglas Haynes notes, a “gateway to the empire” as imperial service was linked to the possession of a British medical qualification.[1] Although this requirement enabled the creation of a largely homogenous profession, it also created a recruitment crisis. Scholars have noted that staffing the Colonial Medical Service (CMS) was a struggle on account of low pay and the perception of a lack of prestige. As a result, doctors were often recruited both locally and from other parts of the empire (particularly British India) to fill in the gaps, even though such workers were often relegated to lower positions.[2] Difficulties in recruitment were exacerbated by the outbreak of the Second World War since almost all available personnel were drafted into the military; after the war, most British doctors were absorbed into the newly-established National Health Service in Britain rather than the CMS.[3]

For some British colonies, the solution lay in the recruitment of European doctors, many of whom were struggling to find stable work in post-war Europe. Austria proved to be a particularly fertile ground of recruitment. Although some colonies (such as Jamaica and Trinidad) refused to accept Austrian candidates (claiming to have sufficient local recruits or because of their lack of British qualifications),[4] others were more open, albeit with some restrictions (the Bahamas, for instance, insisted on recruiting doctors “of pure Austrian descent”).[5] After security screenings, many applicants were found to be “undesirable” (because of either Nazi or communist links),[6] but officials ultimately prepared a list of eight candidates who were suitable for colonial service.[7]

Apart from security concerns, doctors with overseas qualifications faced hurdles in practising medicine in the British colonies since colonial governments required medical officers to have a qualification that was “registrable in the United Kingdom.” Between 1945 and 1948, approximately 30 foreign medical officers were appointed to the CMS, the majority of whom were Polish doctors on the temporary register that had been created by the General Medical Council (GMC) to enable qualified overseas-qualified doctors to practise medicine (in limited capacities) in Britain for the duration of the war.[8] Recruiting doctors directly from Austria, however, posed a problem since none of them were on the GMC’s temporary register. Colonial officials instead sought a way out through local legislation. In the Bahamas, authorities relied on a saving clause in existing legislation that permitted registration of foreign doctors “if the Governor in Council may so determine” while in British Guiana, an existing ordinance provided for “temporary registration of any person who is employed or has been selected for employment in Government Medical Service.”[9] Other colonies, however, could not find ways in existing legislation. Therefore, St Lucia and Dominica passed special legislation to enable such recruits to practise.[10] The Leeward Islands amended its Medical Act “to permit state of emergency to be declared to allow registration of medical officers with foreign qualifications.”[11]

A shortage of healthcare workers was, therefore, considered to be a situation that required exceptional measures to be taken. Colonial officials, much like their counterparts in Britain, relied on the flexibility of the term “emergency” to expand the availability of healthcare personnel in the British Caribbean.[12] This long history of reliance on overseas medical labour continues to raise critical questions about ethical and sustainable recruitment in the contemporary world.

 

[1] Douglas Haynes, Fit to Practice: Empire, Race, Gender, and the Making of British Medicine, 1850-1980 (Rochester, NY: University of Rochester Press, 2017), 15.

[2] Anna Greenwood, “Introduction: Looking Beyond the State,” in Beyond the State: The Colonial Medical Service in British Africa, ed. Anna Greenwood (Manchester: Manchester University Press, 2016), 1–18.

[3] Florence Ejogha Nkwam, “British Medical and Health Policies in West Africa, c1920-1960” (PhD diss., SOAS University of London, 1988), 165–203.

[4] Telegram from J. Huggins, Governor or Jamaica, to the Secretary of State for the Colonies, 13 December 1948, TNA/CO/877/32/5; and Telegram from J. Shaw, Governor of Trinidad, to the Secretary of State for the Colonies, 19 January 1949, TNA/CO/877/32/5.

[5] Note by A. G. Denton-Thompson, 3 February 1949, TNA/CO/877/32/5.

[6] Note by [?], 28 March 1950, TNA/CO/877/32/5.

[7] Note by R. Reeves, 20 May 1950, TNA/CO/877/32/5.

[8] Memo on recruitment of foreign doctors, 15 October 1948, TNA/CO/877/32/5.

[9] Note by [?], 7 February 1949, TNA/CO/877/32/5.

[10] Telegram from R. D. H. Arundell, Governor of the Windward Islands, to the Secretary of State for the Colonies, 28 December 1948, TNA/CO/877/32/5.

[11] Telegram from Earl Baldwin, Governor of the Leeward Islands, to the Secretary of State for the Colonies, 19 November 1948, TNA/CO/877/32/5.

[12] For more on how the language of “emergency” has shaped the British medical register, see Marie-Andrée Jacob and Priyasha Saksena, “The Changing Natures of the Medical Register: Doctors, Precarity, and Crisis,” Social and Legal Studies (2023), https://doi.org/10.1177/09646639231178878.