Dr J. Malcolm Bolton
Flying doctor in Malaysia who later, with the WHO, assisted in the final eradication of smallpox
Monday 02 October 2006
John Malcolm Bolton, medical practitioner: born London 2 July 1924; MBE 1964; died Woking, Surrey 31 July 2006.
J. Malcolm Bolton was the driving force in the development of a comprehensive medical service for the indigenous minorities of Malaya (Peninsular Malaysia), from its inception in 1955 during the "Emergency" until 1972.
With a few coastal settlements, his practice mainly comprised a huge area of the interior, sparsely occupied by ethnically diverse peoples speaking some 18 different languages or dialects and differing widely in history, custom and traditions, now known collectively as Orang Asli.
He next joined the World Health Organization, where he was similarly forceful and imaginative in public health programmes including the final eradication of smallpox. He concluded his career with the Papua New Guinea medical service, in New Britain.
Bolton was quiet, modest and retiring but, when he felt his policies were the best to fulfil a medical objective, his determination crushed all obstacles in its path. He never married, and lived simply and frugally, but was generous to his family and friends, and to the dozens of young people around the world whose education he sponsored. He had the manner of the absent-minded professor, but adopted all useful modern technology as soon as it appeared. Wherever he went, he learnt to speak the local language. He scorned idleness and inefficiency, but, to those in whom he found intelligence, dedication and the aspiration to serve, he gave his fullest support and, in some cases, lifetime loyalty and friendship.
John Malcolm Bolton was born in London in 1924, the only son of Douglas Bolton, an engineer who was professionally renowned for his formulae for calculating electricity tariffs, and Molly (J.M.) Bolton, secretary to Beatrice and Sydney Webb, and long- serving member (and chairman) of London County Council. This family background of Fabian socialism, coupled with traditions of the Methodist Church, provided the foundation in adult life for his personal ethic of private and public service.
He was educated first at King Alfred's School in Hampstead, a very progressive establishment for those days where, he maintained, pupils were encouraged to do exactly what they liked - which in his case was nothing. He then went to St Marylebone Grammar School, until the Second World War came and evacuation took him to Berkhamsted School, in Hertfordshire. He decided to become a doctor, qualified at the Middlesex Hospital and, on joining up for his delayed National Service, was sent to Malaya, where the Emergency was in full swing. He was attached as MO to a Malay regiment, learnt Malay and fell in love with the people and their country.
Demobbed and back in England, he gained two further qualifications, in obstetrics and in hygiene and tropical medicine, and then, in response to an advertisement by the Colonial Medical Service, accepted the post of Senior Medical Officer in the (then) Department of Aborigines, Malaya. It was the start of the most remarkable period of his life.
Bolton sailed east in the MS Willem Ruys and reached Kuala Lumpur in December 1955. The Emergency was not over, although talks between Chin Peng and Tengku Abdul Rahman had begun. During this critical period in Malaysian history, the Orang Asli had been forced into an unenviable position in the struggle between the British (later Malayan) administration and Communist insurgents.
When the resettlement programme and New Villages began to succeed in the lowlands, the conflict moved to the upland interior of the Peninsula, the homelands of most Orang Asli. Initially, in order to break the Communist supply lines, the more accessible communities were resettled in fenced and guarded camps. The results were disastrous for the health and welfare of those interned. In overcrowded and insanitary conditions, precluded as they were from their customary way of life as swidden farmers and gatherers and traders in jungle produce, and fed an unfamiliar diet, morale deteriorated and death rates were horrendous - exceeding 200 per 1,000 in one camp. Demoralised and disaffected, those who could escaped and returned home, where they were liable to fall under Communist control.
In 1953, General Sir Gerald Templer identified "the jungle people" as the most serious outstanding problem of the Emergency. Richard Noone, newly appointed head of the Department of Aborigines, was placed in charge of a campaign to win the hearts and minds of the Orang Asli, by bringing these communities under direct administration. A military unit was formed, the Senoi Praak, and, by 1955, 13 manned military forts were established in the remote (and roadless) hilly interior of the country.
Crucial to the hearts-and-minds campaign was the provision of effective healthcare. Malcolm Bolton's recruitment was a first step. Stationed for his first five years at a small, 12-bed medical centre attached to the district hospital in Kuala Lipis, Pahang (with a subsidiary 12-bed centre at Ulu Selayang, in the Gombak valley, Selangor), he responded to the opportunity. Based on the existing air-supply system, he instituted a "Flying Doctor Service", personally visiting all the posts every month to administer to Orang Asli who lived in the vicinity and to the soldiers stationed there. This was the first time that biomedical practices and treatments had been delivered directly into Orang Asli localities, and marked the beginning of a sustained healthcare service designed specifically for that community.
From the start, Bolton recognised the social and psychological and, hence, therapeutic importance to his patients of being treated by members of their own community. He appreciated the confidence that the Orang Asli had in their healers (bomoh) and acknowledged that "traditional" healing could complement and foster the introduction of standard medical practices. Accordingly, in 1957, he instituted training courses whereby groups of bomoh were brought to the medical centre and taught the principles of simple hygiene and first aid. They were then returned to their villages with a badge and, more importantly, basic medical knowledge, a first aid kit including panadol, vitamins and anti-malarials (each type of pill distinctively coloured) with the promise of continuing support.
Having inherited a medical staff of 28, none of them from the community, he set a recruitment policy of preferment for Orang Asli. The first three medical trainees were accepted in 1957; from 1959 all new vacancies were filled by Orang Asli, and by 1968 there were 143 men and women serving as medical orderlies, nurses and midwives.
In the second Malaysia Plan (1961-66) funds were allocated specifically for expansion of the Orang Asli medical service. Having been provided by RAF and RAAF, the air support was taken over by RMAF. By careful cost control, including the training of an itinerant Orang Asli construction team, Bolton increased the number of jungle medical posts accessible by air from 18 to 57, plus 59 evacuation aid posts with helicopter landing pads.
In addition to the Flying Doctor Service he organised other mobile health teams, including doctors, dentists, dispensers and X-ray technicians, to make regular visits to all medical posts. He also devised efficient medivac procedures for emergency cases. As the road network expanded across the country, he built up a small fleet of ambulances - the drivers, of course, being Orang Asli.
In 1960, when the decision was made to concentrate resources at the hospital at Gombak, he moved house to live on site as the sole resident medical officer. He endeavoured to make the expanding hospital friendly and "family- orientated". He encouraged relatives to accompany their sick to the hospital, where they too were given food, lodging and a medical check-up. Not only were individuals more willing to accept hospitalisation, it was also possible to treat the nuclear family as a unit against communicable disease.
His publications in professional journals at this time show the variety of medical research that he organised, conducted and personally collated, and subsequently drew on to incorporate into his health programme. Thus, when research showed that the rural Orang Asli were a reservoir of malaria infection, he enlisted World Health Organization (WHO) support to organise an extensive control campaign.
His vision transformed this entire service - his dedication being recognised by the award of both Malaysian (Ahli Mangku Negara - AMN, 1962) and British honours (MBE, 1964).
In 1973, Bolton transferred to the WHO, first as medical officer and team leader of a project for the development of basic health services and training of medical auxiliaries in the Maldive Islands. Here, his days were filled with dangerous journeys in rough seas to outlying islands. He treated patients all day and into the night day after day, then got into the little boat for yet another rough voyage to the next island. On one he treated 504 people out of a population of 707, and on another he treated 566 out of a population of 671. On one island, he wrote in his daily diary, "I see more patients; those whom I do not see start shouting."
After these visits he would return to his office and analyse his notes, so that plans for dealing with the health problems of the island people could be made. During 18 months in the Maldives, he recorded in his diary that he treated 24,750 people outside Male and 1,785 inside the capital.
In early 1975, he took up a post as public health administrator and epidemiologist in the Smallpox Eradication Programme in Dacca, Bangladesh. The global programme was reaching its climax: India by then was almost smallpox-free, and Bangladesh was well on the way. Bolton's work consisted of visiting suspected smallpox cases and vaccinating everyone else in the area. Noticing how widely train transport was used, he arranged for vaccinators to walk through the trains vaccinating everyone who could not show a scar. Since poor people who could not afford a ticket would travel on the tops of the trains, he put vaccinators there too - and paid them twice the normal rate as danger money.
He then took a post in the smallpox programme in Ethiopia, where he did similar work in the hill villages. At one point, in three days his team gave 6,398 smallpox vaccinations and 4,471 BCG immunisations against TB. Its leader, D.A. Henderson, wanted Bolton to stay with the programme, but he chose to accept a post in a maternal and child health project in Bohol, Philippines, because he felt it presented a different challenge.
There he rented a pretty house by the sea and made a lovely garden. After the frantic pace of his earlier postings he could relax a little, and was able to indulge three of his passions - gardening, swimming and photography. After two years, he transferred to Manila, assisting in the planning of rural health services.
In June 1981, still with the WHO, Bolton was posted to Papua New Guinea as team leader of a Health Services Project. At the age of 60, in 1984, he left the WHO and joined the Papua New Guinea Health Services as Assistant Secretary of Health in the Province of East New Britain. He finally retired in 1987, although he remained in demand for consultant assignments around the world, particularly in Vietnam. Having become a Malaysian citizen in 1970, he settled into his apartment at the hill resort of Genting View, Pahang.
In retirement, his routine was to swim each morning, tend his flower garden and play badminton in the evening. For all his life he kept a daily diary and, in the past few years, he spent much time editing the pages covering his career in Malaysia, and incorporating pictures from his huge photographic archive, with a view to publishing an autobiographical memoir. He also maintained a diligent correspondence (fervently adopting the laptop and e-mail) with former colleagues all over the world.
In 1990, he bought an apartment in Woking, as a vacation home. He spent some time there each year, latterly for dental and medical attention, and it was there he died. At his funeral, a moving tribute from members of the Orang Asli community was played as a powerpoint presentation transmitted electronically from Malaysia. It was a poignant farewell from people born in the jungle hills, whose lives had been transformed - and, in one case, saved - through the dedication of this quiet, self-effacing but charismatic medical man.
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