Annual report of the Department of Public Health / Union of South Africa.

  • South Africa. Department of Health
Date:
[1945]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the Department of Public Health / Union of South Africa. Source: Wellcome Collection.

    56/72 (page 38)
    to read and write. The functions of this club take place in various homes of the area and the club is thus penetrating to all types of the community. Co-operative Store.—Inspired by a member of the Unit’s staff a group of people are discussing ways and means of establishing a local co-operative store. Beer Feasts.—The main form of recreation of the adult community remains the Beer Feast and drunkenness is an important public health problem. It is hoped in some future report to include an analysis of the incidence of alcoholism. The solution to the problem lies in the pro¬ vision of other forms of recreation which will be more attractive than sitting and drinking beer. This reason alone justifies the provision of recreation facilities by a health unit. Library.—The library established at the Unit continues to receive donations and slowly but surely increasing use is being made of the literature available. It is hoped that one room will be set aside as an adult reading and infor¬ mation room when the new building programme is completed. Non-personal Service. Housing.—Advice is given regarding any new huts or larger homes that are being constructed. Such advice is for the present mainly concerned with increasing the height of the walls and enlarging the window space. Sanitation.—Health assistants advise and assist in the construction of compost pits and latrines in home , as well as in schools of the area. Water Supplies.—All houses not using water obtained from a spring source are encouraged to make use of sucn water rather than that fiom streams and rivers which are heavily polluted. Food Production—(a) The Unit continues with its “ Grow more Vegetables ” campaign and despite the unfavourable season 1944-45, the general standard was fair. An increasing number of people are joining the vegetable seed co-operative buying group, and the Unit’s garden is also increasing its production of seed for local distribution. (b) The vegetable garden itself serves an ever more important function at the Unit. Not only is it most-useful for teaching purposes but its production now assists the Unit in the treatment of expectant mothers, lactatirg women, pre-school and school children. The garden is a tribute to the use of compost fertiliser together with simple soil conservation and anti-soil erosion measures. This year a citrus orchard was started by the planting of three dozen citrus tiees and it is hoped to increase this number year by year until the Unit has a fairly substantial orchard providing such fruits for use in treatment of various groups of the population. Few of our services have had a more satisfactory reception from the people than has our vegetable garden programme, and it has been one of the most successful techniques established by the.Unit. Food Distribution.—The use of food as medicine has far more satisfactory therapeutic results than has any single vitamin or mineral used as a specific and the clinics of the Unit thus make considerable use of food in therapy. In this way the division between medical practice and health practice disappears and a comprehensive programme concerned with the individual or family or community as a whole, can be instituted. The success of this approach in the nutritional sphere is having its effects in all other activities of the Unit leading to the practice of social medicine. I Impendhle Family Welfare Service. The first of the Sub-Units has been started in the Impendhle area. The start has been a small one. On 1st December, 1944, a Medical Aid was stationed in the Impendhle, district in the area of Zithingwana. This is regarded as a temporary measure until such time as nego¬ tiations have been concluded regarding permanent sites for the Units to serve the Impendhle, Underburg and Southern Polela areas. The foundations being built should, however, be used by the future complete Unit either by stationing a medical aid there or health assistants and a district nurse. The Zithingwana area was a useful one in which to commence because— (1) The Magistrate, Impendhle, was able to arrange temporary accommodation for the aid with an African Minister of the Bantu Presbyterian Church. (2) There was a large school in the area. (3) The area was fairly near Impendhle where the medical officers of this Unit conduct a weekly clinic. On 1st January the medical aid commenced an intensive family welfare service to a limited number of homes. The methods used are the same as those established in the Polela area. On a map of the area each home was plotted and given an address. Following this a census, genera] and educational, was carried out of each home, and a study of the economic conditions of each family as well as methods of refuse disposal, housing and water supplies was commenced. An immunization programme, confined foi the present to smallpox vaccination and typhoid endo- toxoid has also been carried out. Persons from this area attending the weekly clinic at Impendhle have their records filed in family files thus allowing for cross reference between the aid’s field records and the clinic’s findings. In addition the school was visited regularly by the medical aid and the children were examined by the medical officer and aids. The school premises and the school meal have also been investigated and recommendations made to the school authorities. Health Indices. Personal—Polela Intensive Family Welfare Service Area. An intensive study has been made of 733 houses falling within the scope of this welfare service. Space does not permit of publication of the detailed results but the following general remarks are of interest. In assessing the survival rate of each particular year group as it advances in age we have a technique which more accurately reflects the trend than does an annual mortality rate alone. The survival rate or its opposite, the mortality rate, often depends as much upon the previous experience of the group as it does upon its experience during a parti¬ cular year. Assessment of the influence of the previous experience of a particular age group is made possible by the type of analysis presented above. In assessing the clinical condition of an individual a clinician always obtains a history of previous experiences from the patient. The technique applied here is similar in that it attempts to outline the history of certain groups of the population. Frost has used it in the analysis of the history of tuber¬ culosis of various age groups in the United States of America, and it is our belief that the use of this method will throw much light on the incidence of various diseases of later childhood and adulthood. The above remarks are illustrated by some of the trends already being suggested in this introductory analysis. In comparing the survival rates of the cohort born in 1942 and that of 1943, we find that the survival rate after the first year in the former was as low as 80’85 per cent., whereas in the latter it was 91 • 18 per cent. The respective figures for the second year of life experience was 94*74 and 96*77. The figures are very limited and no conclusions can be drawn as yet. What is required is the continuation of the method from year to year, including more and more persons. The example is quoted as an indication of the possible use of such developmental tables. The incidence of congenital syphilis is high in each group, a little more than 1 in every 5 (20*55 per cent.) of the total being diagnosed as such. The figures for tuberculosis are an urgent reminder of the need for the protection of young children from infection. The services given by the Health Unit are inadequate. The incidence of whooping cough shows a sudden rise after the first year of life, with a mean annual case rate of 59*26 per 1,000 children. Upper respiratory diseases, infectious skin diseases and gastro¬ enteritis are extremely common affecting as they do between 40 and 50 per cent, of the children and often on more than one occasion, the annual case rate per 1,000 varying between 180 and 230. Perhaps the most interesting feature of the analysis is the fact that so few children pass through their early years without having one or other or several diseases. In the group born between 1940 and 1942, only three children