Patricia Horne is an Irish medical doctor who worked in Nigeria during in the 1950s, at one of several medical missionary hospitals managed by Irish Catholic religious orders.
Horne came from a medical family. Her grandfather, Andrew Horne, was a founder and first joint master of Holles Street maternity hospital, Dublin. Her mother Delia Moclair was also a medical doctor, having studied at Queen’s College, Belfast. She was the senior assistant master of Holles Street when her boss’s son came to work in the hospital. Her father (also Andrew) was, Patricia believes, the last Royal Army Medical Corp (RAMC) officer to leave Gallipoli. He became an assistant master at Holles Street and later went into private practice at the family home on Merrion Square. Delia Moclair Horne gave up work when they married in 1925.
Horne always wanted to be a doctor, and more particularly, a surgeon (which was still considered by many as an unsuitable job for a woman). Many female doctors of her generation found it tough to get posts in Ireland, but Horne got a job working as a surgeon in Cashel. At her mother’s insistence, she also did a Diploma in Public Health. Laura Kelly’s research on Irish women in medicine between the 1880s and 1920s has shown that these early women doctors found it difficult to get jobs outside the fields of public health and general practice; perhaps Delia considered that a DPH would expand her daughter’s employment opportunities.
When Horne was nine years of age, she had heard a Holy Ghost Father talking passionately about the medical missionary work in Nigeria, and this whetted her appetite for working abroad. She applied for positions with government public health operations in Hong Kong, Africa and India, but her father insisted that if she went overseas it would be with Irish nuns. His opinion was informed by the difficulties he himself experienced with the RAMC in Gallipoli; he felt that if she got sick the nuns would look after her.
Horne, then 28, chose a two-year contract with the Holy Rosary Sisters as their doctor in a mission hospital in Nsukka, Nigeria, beginning in January 1957.
The trip proved an adventure from the very start. A few days out of Liverpool the ship went through an atrocious storm and 17 fishing trawlers were sunk nearby. Horne eventually landed in Port Harcourt and then travelled up the Nanny River in a small boat for several days to Nsukka. After a couple of weeks of induction, she became the sole doctor in the hospital, working seven days a week.
Despite the hardships of missionary life, Horne was given a bungalow of her own and a cook. She was thrilled that her cook, Francis, had been trained by a French engineer’s wife, stating that “the French were great for using all the bush food and doctoring it up”.
Working conditions in Nsukka were rather different to those at home. Horne performed operations under the light of two Tilly lamps. The theatre windows had to be kept open because of the humidity and the vapours from the lamp kerosene, meaning that flies and mosquitoes could get in. Lack of running water was another obstacle to be overcome: the staff and patients’ families collected water in buckets from the local river. It was then boiled and filtered. “I had two buckets of water on a Monday [for personal use], and then the other days I had one bucket of water.”
The major diseases that Horne treated in Africa were tuberculosis and yaws. She was familiar with tuberculosis from home but described yaws – a spirochete infection of the skin, bone and cartilage – as “absolutely awful, frightful. They’d have sores all over the person and if the mother had yaws on the face the baby would pick it up. It was a terrible, terrible, infection”. During her time in Nigeria, yaws was almost wiped out locally, due to a massive World Health Organisation (WHO) treatment programme with penicillin that covered 46 countries and 50 million people. When the programme was stopped in the 1970s, the incidence of yaws increased once again.
For Horne, obstetrics was the most harrowing element of her work in Nigeria because of the local conditions. The Holy Rosary Sisters had several maternity nursing homes in Nigeria, but only the more difficult cases would be sent to hospital. If hospital staff saw, in the distance, a woman being carried in on a plank of wood, they knew it would be a difficult obstetric case, as the woman was unable to walk.
Patricia had a logical argument for preferring symphysiotomies as a delivery method to caesarean sections in the case of difficult births. While she could and did perform caesarean sections, she argued that the difficulty with ‘caesars’ was that, after leaving the hospital, the mother might not receive proper care and the uterus could rupture with disastrous consequences. Many patients lived several days’ travel from a hospital and would likely die. As a result Patricia came to the conclusion that symphysiotomies, which offered a quicker recovery and resulted in a smaller open wound, were the better option for difficult births. In her descriptions of obstetric challenges, she emphasised that the medical team made choices to give both mother and child the best possible chance of survival.
Almost as soon as she arrived in Nigeria Horne learned the ‘stab’ method, from an Irish doctor working with the Medical Missionaries of Mary. She thought it much kinder to the patient than the ‘open’ method she had learned training in Ireland. After the operation, the patient was bound for about 10 days, which she considered key to avoiding post-operative problems with the bladder or pelvic instability.
On her return to Ireland a back injury meant that she had to give up surgery. She changed specialties to psychiatry and played a key role in the remodeling of St Davnet’s in Monaghan from an in-care to a community residential facility. But Horne still felt the call of Africa and headed off to work in Zambia for six years after retiring age in Ireland. Here she found that the battlefront of disease had changed from yaws and tuberculosis to AIDS.
Interviewing Patricia Horne, it’s hard to remain immune to her zeal for life, and her concerns for her patients; her work is much more of a vocation to care for her fellow humans than a career. Her first overseas work in Nsukka in 1957-59 was a formative part of her life journey.
Her telling of the story also brings to life part of the wider history of the work that Irish people, lay and religious, did on missions and non-governmental aid organisations in Africa in the 20th century. It breathes life into the purpose of those mission collection boxes.