African deaths in an urban community in Northern Rhodesia
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Abstract
On humanitarian as well as on economic grounds the immense wastage of
human life in developing countries must be brought under control as rapidly as
possible. It is desirable to make some suggestions on the methods to be adopted
with particular reference to Northern Rhodesia.
The present poverty of developing countries renders it certain that health and other services can be inaugurated and developed only on the basis of finanoial help from the Government in power: in turn, the political oomplexion of such Government will play a major part in determining the exact form of the resultant services. The political concepts may well over-rule the traditions of the past.
Nevertheless, to obtain the best results from the money to be expended, preliminary surveys of morbidity and mortality are necessary. The results of such surveys should be assessed objectively without reference to traditional ideas and such objective assessment may require a radical re-orientation of thought (Davey 1959). Brockington (1958) has pointed out that what is good in the United Kingdom and the United States of America is not necessarily good in the developing countries: more valuable information can be obtained from the experiences of other countries in the similar stages of development rather than from the more highly developed and wealthier countries.
In order to make the best use of the available professional and technical knowledge the first essential is the integration of services (Kershaw 1958, Adeniyi-Jones 1958) without disproportionate stress being placed upon medical services alone. The South African Medical Journal (1955) points out that "The remedy for the bad health conditions obtaining amongst South African non Europeans is social-economic uplift" - sentiments echoed by Luke (1955) when quoting the Gluckman Commission that the main causes of ill-health among such people are poverty and ignorance. This point has been further stressed by Davey (1954) when he stated "Poverty and ignorance are the basic causes of many important diseases in the tropics and though medicine may alleviate the symptoms, only administrative action on a wide front will provide a sound and lasting cure".
Any programme must take into account the available resources both of the country itself and the more developed countries which are willing to offer assistance: in particular if locally trained staff are not available, the type of service may be governed to some extent by the type of expatriate professional man available for service. For instance Jelliffe (I955b) has pointed out the deficiencies of the present training in pediatrics when applied to developing countries.
In order to obtain the co-operation of the indigenous people it is probably necessary to base the services on hospitals resulting in comparatively greater stress being laid on health services in urban areas rather than in rural areas (Adeniyi- Jones 1958). Nevertheless, the fairly steady movement of persons to and from urban centres whioh will increase as communications improve, will ensure that the knowledge is disseminated throughout the country. In Northern Rhodesia in particular, the development of clinics in urban African townships, with easy access to the major urban hospitals, would probably provide the most satisfactory and effioient method of initial development. Sachs (1959) has given a detailed assessment of an experiment in integrated ourative services indicating how the use of clinics reduces the pressure upon more expensive hospital services: this idea has been further emphasised by Zwart (undated).
At the same time as clinic development takes place, improvement in conditions which do not require the particular co-operation of the indigenous population, can be effected. Hennessey (1955) has emphasised that "An adequate standard of housing is one of the primary essentials of health1', but it has been pointed out by Fendall (1959) and Stroud (1959) that the standard of house required varies in different social localities. In addition to housing, Baity (1958) has stressed the need for improved environmental hygiene in developing countries.
In so far as the medical services themselves are concerned, Piatt (1954) and Williams (1955 a) have both stressed the place of w>men in the development of services and their influence on the economics of the home and the food supply. It is through Maternity and Child Welfare Services that the main attack on malnutrition can be developed (JelliJfe 1955^and for this purpose more detailed knowledge of all aspects of local conditions are necessary (Thompson 1955, lancet 1955)*») In combating malnutrition the closest co-operation is necessary between many departments and the Joint F.A.0./W.H.0. Expert Committee on Nutrition, (1950) has stated "Almost every practical programme of nutrition has aspects which fall within the fields of interest of ooth F.juO. and W.H.O. Collaboration must, therefore, be flexible and no sharp dividing lines of responsibility can be drawn".
Williams (1955 b) and Keeny (1955) may speculate on the manner in which to approach these problems, but mortality and morbidity surveys, with a keen assessment of the results obtained, provide the basio essentials upon which services must be inaugurated or developed. It is hoped that this survey may have contributed something to the basic knowledge required for the improvement of services and the prevention of unnecessary misery suffering and death.
The present poverty of developing countries renders it certain that health and other services can be inaugurated and developed only on the basis of finanoial help from the Government in power: in turn, the political oomplexion of such Government will play a major part in determining the exact form of the resultant services. The political concepts may well over-rule the traditions of the past.
Nevertheless, to obtain the best results from the money to be expended, preliminary surveys of morbidity and mortality are necessary. The results of such surveys should be assessed objectively without reference to traditional ideas and such objective assessment may require a radical re-orientation of thought (Davey 1959). Brockington (1958) has pointed out that what is good in the United Kingdom and the United States of America is not necessarily good in the developing countries: more valuable information can be obtained from the experiences of other countries in the similar stages of development rather than from the more highly developed and wealthier countries.
In order to make the best use of the available professional and technical knowledge the first essential is the integration of services (Kershaw 1958, Adeniyi-Jones 1958) without disproportionate stress being placed upon medical services alone. The South African Medical Journal (1955) points out that "The remedy for the bad health conditions obtaining amongst South African non Europeans is social-economic uplift" - sentiments echoed by Luke (1955) when quoting the Gluckman Commission that the main causes of ill-health among such people are poverty and ignorance. This point has been further stressed by Davey (1954) when he stated "Poverty and ignorance are the basic causes of many important diseases in the tropics and though medicine may alleviate the symptoms, only administrative action on a wide front will provide a sound and lasting cure".
Any programme must take into account the available resources both of the country itself and the more developed countries which are willing to offer assistance: in particular if locally trained staff are not available, the type of service may be governed to some extent by the type of expatriate professional man available for service. For instance Jelliffe (I955b) has pointed out the deficiencies of the present training in pediatrics when applied to developing countries.
In order to obtain the co-operation of the indigenous people it is probably necessary to base the services on hospitals resulting in comparatively greater stress being laid on health services in urban areas rather than in rural areas (Adeniyi- Jones 1958). Nevertheless, the fairly steady movement of persons to and from urban centres whioh will increase as communications improve, will ensure that the knowledge is disseminated throughout the country. In Northern Rhodesia in particular, the development of clinics in urban African townships, with easy access to the major urban hospitals, would probably provide the most satisfactory and effioient method of initial development. Sachs (1959) has given a detailed assessment of an experiment in integrated ourative services indicating how the use of clinics reduces the pressure upon more expensive hospital services: this idea has been further emphasised by Zwart (undated).
At the same time as clinic development takes place, improvement in conditions which do not require the particular co-operation of the indigenous population, can be effected. Hennessey (1955) has emphasised that "An adequate standard of housing is one of the primary essentials of health1', but it has been pointed out by Fendall (1959) and Stroud (1959) that the standard of house required varies in different social localities. In addition to housing, Baity (1958) has stressed the need for improved environmental hygiene in developing countries.
In so far as the medical services themselves are concerned, Piatt (1954) and Williams (1955 a) have both stressed the place of w>men in the development of services and their influence on the economics of the home and the food supply. It is through Maternity and Child Welfare Services that the main attack on malnutrition can be developed (JelliJfe 1955^and for this purpose more detailed knowledge of all aspects of local conditions are necessary (Thompson 1955, lancet 1955)*») In combating malnutrition the closest co-operation is necessary between many departments and the Joint F.A.0./W.H.0. Expert Committee on Nutrition, (1950) has stated "Almost every practical programme of nutrition has aspects which fall within the fields of interest of ooth F.juO. and W.H.O. Collaboration must, therefore, be flexible and no sharp dividing lines of responsibility can be drawn".
Williams (1955 b) and Keeny (1955) may speculate on the manner in which to approach these problems, but mortality and morbidity surveys, with a keen assessment of the results obtained, provide the basio essentials upon which services must be inaugurated or developed. It is hoped that this survey may have contributed something to the basic knowledge required for the improvement of services and the prevention of unnecessary misery suffering and death.
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