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

  • South Africa. Department of Health.
Date:
[1944]
Catalogue details

Licence: Public Domain Mark

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

    19/26 (page 17)
    outine visits by Health Assistants to all the homes in certain areas nd is not merely a follow-up system of cases who present themselves ,t the clinics. The difference between these two methods is of the itmost importance, for in this system the home is regarded as the ocus of the service while in the follow-up system the clinic is the focus, he home being visited only after a patient has attended for treatment! n the latter system the home is only studied once there has been a reakdown in the health of one or more members of the family, whereas he routine home visit allows for analysis of conditions under which , family is living before someone of that home has felt ill enough to go o a doctor or clinic. In this way various factors which might produce llness can be assessed and changes encouraged which might improve lealth standards and thus prevent disease. Considerable perseverance 3 required, for at each visit not only changes in previously recorded indings must be noted, but additional factors must be analysed. This liffers from the more usual survey methods, as experience has shown hat attempts to carry out anything in the nature of a complete survey if home conditions are not only impracticable but also undesirable. Recording of such surveys is often of a static nature and, while useful or survey purposes, is not desirable for the practice of social medicine ry a Health Unit. In one home immoral behaviour of a woman might >e the outstanding social defect, in another alcoholism, in yet a third ack of education or false beliefs regarding health and disease. It is hese personal aspects which concern our Unit, and no simple survey •ecord sheet can convey these human traits without noting their develop - nent, cause, influence on others, and future prospects. Thus our ield workers have continually to bear these facts in mind and much ime of the medical officer in charge is spent in directing the programme >f these home visitors in regard to individual families under their care. The work of the past four years has given us sufficient evidence to ndicate that the method is correct and that with increasing skill a service 8 developing which is not only radical in approach but is radically iffecting the lives of the people it serves. Tor the satisfactory carrying rat of this system, adequate training of field personnel of both sexes s essential, as is also a system of supervision and recording of data vhich allows not only for co-ordination of home and clinic services, rat which includes a filing system of a dynamic nature. The clinic -earn was strengthened during the year by the appointment of another tledical Aid and a probation Medical Aid, as well as a Native Woman lealth Assistant and three probation nurses who are receiving training ,s Women Health Assistants in addition to their duties at tne clinics • Progress has been made in a number of ways during the year. The ntensive family welfare plan now includes some 5,000 persons, an ncrease of about 2,000 since 1943. The increase in nursing staff has mabled much more work of a personal nature concerning women and hildren to be undertaken and a pre-school child centre has been estab- ished. In the field of nutrition the school feeding scheme has enabled :he Unit to provide a daily meal in several schools in the area, while he weekly nutrition clinic has been expanded to include recreation, [n connection with mental hygiene, steps are being taken to counteract raperstitious beliefs and attitudes which are detrimental to health. Several other similar developments are contemplated. The weekly welfare clinic for mothers with their babies and young hildren has been continued. It is confined to healthy children and is nly attended by those who are referred after medical examination. Jhildren are weighed, examined for signs of care or lack of care, such as leanliness and state of nails, and the mother is asked about feeding labits and general behaviour. Following this, the nurse-in-charge ratlines the feeding requirements for the next week and, when necessary, ;ives the mother food supplements, such as dried milk or vitaminised til. When the mothers and children have been attended to individually I general lecture is given by a member of the staff and questions are ncouraged. It has become increasingly evident that the health habits of the average schoolchild in this area are very poorly developed. This is due ,o the low standard of personal hygiene in the average home. By the ime a child goes to school, often not before it is 8 to 10 years old, it s in many cases too late to remedy the habits which have Deen formed it home. Furthermore, standards of hygiene in the schools themselves ire often very deficient. For these reasons it was decided to test out he possibilities of a pre-school child centre where children would ittend regularly, as is done in the case of nursery schools. A young narried woman who was once headmistress of a school was appointed is supervisor of the centre. The number of children admitted was imited to a maximum of 25. The aims of this centre are to develop outine habits encouraging discipline, personal hygiene and mental levelopment, while at the same time routine examinations including ;rowth studies and laboratory tests are undertaken. Physical develop- nent is encouraged through games and physical training, and tne mprovement of nutrition, biological knowledge is imparted while attempts are made to counteract superstitious beliefs by incorporating nany bantu concepts in the form of nursery rhymes, fairy tales and ;ames. The development of the artistic senses is encouraged through nusic, singing ana art. Prophylactic measures are taken against nfectious diseases, and disorders and diseases which do occur are treated. The short period during which the Unit has been practising social aedicule has indicated its value for in many respects the families of he area have been stimulated to help themselves in maintaining health. L'he rapid progress made in the area is due largely to the intimate knowledge which the Unit has developed regarding the lives of so many if the people it seeks to serve. This knowledge has encouraged and stimulated the personal interest of the staff in the day-to-day problems >f the people, with the result that the Health Unit has come to be part if their daily lives, influencing an ever increasing number of their ictivities in health and sickness, at school, at work, and in the home. Attention has been drawn in previous annual reports to the need or an increased production of foodstuffs and to the efforts which the btn^ricultuml Much of the work of rehabilitation Department and tho tt •? an<* co'°P®ra^on between the Agricultural inSffie denree TiS 'l centra! and is taking place in an ever T7Cii,.^ g dgree; The work not only stimulates the planting of new rieties of vegetables but even the production of such well accepted foods as pumpkins, potatoes and beans shows a marked increase in s £ a °tits The Unit offered to assist the Department of Education with the school feeding scheme and as a result a combined school meal service LaaYtTTed Tfv]S a,dministered % a committee consisting of the head teachers of the schools with the medical officer in charge of the Unit as chairman. This committee meets once a month and discusses the past month s meals as well as plans for the future month. The medical officer buys the necessary food and the Department of Education has authorised the building of a communal store-room at the Unit’s headquarters to store food for all schools within the combined service. The numbers attending at the various clinics continue to increase. In connection with venereal disease, the average number of attendances per case lias also increased. Enquiries made regarding the source of infection in venereal disease showed that the majority of the men, whether single or married, were infected while they were away from their homes either working in towns or for farmers. . The majority of women were infected at their homes by their husbands who had recently returned from work in the towns. In the women only a small proportion of cases were due to adultery. The Unit has continued to encourage the use of pits for the making of compost and for the disposal of animal, household, and garden refuse. Surveys of water supplies continue and from the information gained, the control of water-borne disease will be facilitated. Protection of springs is advised but this work requires more skill than the majority of Natives in the area possess and the work will have to be done either by the Unit or some other responsible body. Transvaal. Attention was drawn in the last Annual Report to the establishment of the Second Health Unit at Bushbuckridge in the Pilgrims Rest district of the Eastern Transvaal. In developing this Unit those difficulties have been encountered which are to be expected in trying to inculcate new and progressive ideas into a conservative and simple people in whom tradition and custom are deeply ingrained. The task has therefore been an uphill and difficult one. Progress has, however, been made with the instruction of suitable Native Health Assistants at Bushbuckridge, and the posting of these men after training to strategic points in the area, where they can best-exert their influence on their own people. The principle object of the Unit is the prevention of disease and the attainment of a better standard of living for the Native people through instruction in matters of simple hygiene and dietetics. Emphasis is laid on the need for the Natives to help themselves to attain better conditions and better health by growing suitable fruits and other crops for their own consumption, and by improving the hygiene of their own homes. The w-ork is of such a nature that it must obviously be some considerable time before much in the way of tangible results can be expected but there are indications that some of the Natives are beginning to appreciate the value of what is being taught them. Health Centres. Although the report of the National Health Services Commission had not been published by the end of the year under review, the Government had set aside a sum of £50,000 during the current financial year for the establishment of a number of health centres. A standing committee, on which the Department is represented by the Secretary, has been set up and given executive powers to proceed with the matter, and active steps are being taken to ensure that this development takes place along the most suitable lines. In establishing these centres it is obvious that particular attention must be paid to the health needs of the Native population. 4. Infant Welfare. Tables 29 and 30 show the infantile mortality rates for Europeans, Asiatics and Coloureds respectively. The European and Coloured rates have fallen again this year but the Asiatic rate has increased. Among Europeans the infantile mortality rate was higher in urban than in rural areas, the rates being 50• 50 and 40-83 per 1,000 respec¬ tively. The rate was higher amongst male than amongst female European infants, being 53-9 per 1,000 male births compared with 40-3 per 1,000 female births. Of the 2,780 European infant deaths, 21-36 per cent, were due to diarrhoea and enteritis, 16-65 per cent, to broncho-pneumonia, and 16-33 per cent, to prematurity. These were the three main causes of death. 16-2 per cent, of the total European infant deaths occurred on the day of birth while 48- 8 per cent, occurred within the first month. There were 1,356 (1,192) stillbirths during the year; -the rate may be given as either 22-55 (20-79) per 1,000 total births or as 23-07 (21-05) per 1,000 five births. Corresponding figures for last year are given in brackets. Both the number and the rate*have increased this year. Stillbirths and early infant deaths are largely due to similar causes and the prevention of both lies mainly in improved nutrition of the expectant mother, increased and better ante-natal and mid¬ wifery services and prevention and treatment of venereal disease. One course for non-European Health \ isitors is being conducted in Johannesburg during 1944. During 1943, courses were conducted at Cape Town and Johannesburg. In Cape Town 10 candidates entered and 3 passed the examination. In Johannesburg 8 entered aiul 4 passed the examination the first time, 3 re-wrote and 2 of these were successful. Thus a total of 9 non-Europeans qualified as Health Visitors during the year under review.