Reflections on the adaptation to the heat of the tropics

"The skin is an organ that, with amazing efficacy, protects us not only from many of the physical hazards of life, but also enables us to function in the diverse environments that exist on our planet"

John has recently arrived in Moïssala, Chad, where he's working at an Médecins Sans Frontières / Doctors Without Borders (MSF) malaria unit.

Acclimatisation to the heat of the tropics is an interesting phenomenon.

Arriving here in Chad in mid-May as one of the team of Médecins Sans Frontières doctors preparing to work at the Moïssala hospital during the peak of the malaria season, one met with temperatures, just before the start of the rainy season, that were at their most elevated of the whole year, certainly higher than forty degrees on many days.

Initially one perspired, but quite rapidly there ceased to be signs of visible liquid on the skin and one seemed aware that each pore of one’s body was open and that the water that one drank abundantly was evaporating through these open pores at the same rate that it was being swallowed. Essentially one's skin was behaving like an unglazed porous pot and this system was working with amazing efficiency, as quite rapidly the sensation of overwhelming heat receded and one felt much more comfortable.

Clearly for those who have not adapted to extreme heat, a significant part of the discomfort is related to the excessive sweating that drenches the body without having the efficient cooling effect of a controlled and adapted transpiration.

After several weeks of this controlled transpiration one appreciated a change in one’s skin which looked and felt different.

We take our skin for granted as it is always present and visible. Perhaps we forget that the skin is the largest organ of our body; an organ that with amazing efficacy protects us not only from many of the physical hazards of life, but also enables us to function in the diverse environments that exist on our planet.

Many, supported by the advertising of wealthy enterprises, believe that the correct manner to care for the skin is to apply to its surface a variety of substances, the cost of which increases exponentially each year.

In reality, by observing my own skin during this period of adaptation, I am convinced that like the muscles of our body, in order to function at its best, rather than to have unctions applied to it and live a life of indolent passivity, the skin must become an active organ.

For our muscles, a life of indolent passivity does not improve their function and it is the same for the skin. To improve our muscles we organise a program of fitness that increases progressively the work that we demand of these structures. Our muscle function improves and with it our sense of wellbeing.

For the skin, always living in a controlled temperature, never venturing beyond the central heating and the air-conditioning provokes on this structure the same effect as does always taking the bus or the car and avoiding all forms of physical activity on our muscles.

To keep fit, the skin, like the muscles, needs to be made to work, as mine has been made to work here in Chad.

The transpiration of litres of fluid each day has effectively washed my skin from within as well as demanding of it an effort comparable to that which we demand of our muscles when running a marathon, and, although I say it myself, the skin actually looks good, as if satisfied to know that it is a structure that has proved its competence, like any scholar following a successful examination result.

Furthermore I feel good within my skin perhaps knowing that I am not surrounded by a structure that is sloppy and indolent, but rather a structure fit and ready to take on the world.

Of course, the Romans attached great importance to making the skin work and throughout their empire were situated what we prosaically call “Roman baths,” a term that gives the impression that they were merely some form of wash house for our forebears. Certainly this was not the case, for a well-designed “Roman bath” was a series of chambers varying from the cold room “frigidarium” to the hot “caldarium”, with many variations between these two extremities.

Once the “work out” for the skin had been completed the layout of the Roman bath was such that there were facilities where business could be transacted, courtship conducted or where one could just relax and read or chat. Surrounded by their “fit and competent skin” our Roman predecessors were ready to take on the world as they did very successfully.

So popular were the “baths” of Roman times that a census of the year 354 AD recorded an inventory of 952 “baths” in the City of Rome, the largest in the city being the baths of Diocletian capable of accommodating 3000 persons!

As I transpire peacefully here in Chad I will reflect upon the benefits of this process that were so well known to my Roman ancestors.

Top image shows a family in the heat of the day at Takawa Health Center, 20 km from Moïssala