Niilo Hallman

Abstract

Influential paediatrician with an international outlook. Born on July 15, 1916, in Kuopio, Finland, he died on Jan 13, 2011, in Helsinki, Finland, aged 94 years. As a man much respected by his own community, the death of Finnish paediatrician Niilo Hallman naturally prompted accolades from his fellow countrymen. Less predictable to those unfamiliar with Hallman's career were a clutch of tributes from further afield. “A kind person and a good friend of Nigeria and Africa”, said Professor Theodore Okeahialam of Imo State University Teaching Hospital at Orlu in Nigeria. “One of the pillars of international paediatrics”, according to Professor Raphael Oruambo of the Niger Delta University's College of Health Sciences. “A friend of African paediatricians and a passionate advocate for African children”, wrote another Nigerian practitioner. What prompted this high esteem was Hallman's interest in rural health in Africa, first established when he advised on the creation of maternal and child health clinics in northern Nigeria. That was in the 1970s and it was a concern that stayed with him. Hallman graduated from the University of Helsinki in 1943 and served as a medical officer in the Finnish army during World War II. That he would specialise in paediatrics had always been apparent, according to his son Mikko, himself a paediatrician. It was what he cared about. In 1947 Hallman took up a fellowship at Harvard Medical School and the Children's Hospital in Boston, USA. His interests were scientific as well as clinical. While still a medical student he had begun a PhD on the citric acid cycle. At Harvard he turned his attention to electrolyte balances in the pathophysiology of the nephrotic syndrome. This led to a continuing interest in paediatric nephrology, and also in medical genetics. Back in Finland the application of his knowledge contributed to the establishment of several continuing studies that led to the description of a number of single gene diseases more prevalent in Finland than elsewhere: the “Finnish disease heritage”, as it's known. In 1957, he was appointed professor of paediatrics at the University of Helsinki where he also became the director of the new children's hospital, and remained so until his retirement in 1983. He was instrumental in building up the regionalised Finnish hospital system, says his son, and also the arrangements for paediatric care that were influential beyond Finland. A now retired friend and colleague of Hallman's, Kelsey Harrison, was professor of obstetrics and gynaecology at Ahmadu Bello University Teaching Hospital in Zaria. They first met in 1973, a year after Hallman had first visited Nigeria to discuss the maternal and child health centres that were being proposed for this region of the country. “He wanted to convince people in the rural areas that better health could be achieved in this setting”, Harrison recalls, describing Hallman as “a catalyst of change”. Having seen what was required he returned to Finland to arrange for a paediatrician and two public health nurses not only to work in the first location, the Malumfashi area, but to live there as well. “They were teaching medical students, auxiliaries, and lab technicians how to operate in rural areas”, Harrison says. “It was important that the Finnish team lived among the local people.” The scheme worked well, and more health centres were built. Harrison also reports a personal debt of gratitude to Hallman. Zaria was home to a groundbreaking maternity survey initiated by Harrison in response to what he rightly saw as intolerably bad conditions in which to bear children. Over 3 years he collected data on more than 20 000 livebirths that, when analysed, revealed the role of non-obstetric and obstetric factors in maternal mortality and morbidity. The resources needed to do that analysis came from WHO, which went on to fund the work and, in 1987, to launch the worldwide Safe Motherhood Initiative. What Harrison did not learn until years later was that Hallman, working behind the scenes, had played a part in galvanising WHO's interest in the project: “He was a very far sighted man. But he didn't like to put himself forward too much. He believed that Africans should be seen to be doing things for themselves.” Hallman continued working for national bodies well into his old age, notably the Mannerheim League, the largest child welfare organisation in Finland, and the Finnish Foundation for Paediatric Research. Seriously injured during a fall on some ice, he spent his last 2 years badly incapacitated. “But he maintained his good spirit until the end”, says his son Mikko.