TOW COUNCIL OF BENONI. 1 ___________ _

PUBLIC HEALTH DEPARTMENT.

P. 0 . Box 522,

BENONI.

6th November, 19 39.

The Secretary,Royal Sanitary Institute,P. 0 . Box 452,CAPE TOWN.

Dear Sir,

NON-EUROPEAN HEALTH ASSISTANTS : COURSE OF TRAINING.

At the suggestion of the Secretary for Public Health I send, for the consideration of the Council of the Royal Sanitary Institute in South Africa, a draft plan of my proposals for the inauguration of (1) courses of training, and (2) an approved certificate, for non-European Health Assistants.

I . GENERAL. The plan is based upon the course of training given by the Municipality of Pietermaritzburg in 1934, and (more closely) upon the course given by the Municipality of Benoni in 1937. In each of these courses training lasted for 5 months, was full-time, and the students were required to have the preliminary qualification of Junior Certificate or its equivalent. The training included at least 2 hours a day, over the five months, of theoretical instruction, followed by 4 hours of practical instruction under the supervision of the Medical Officer of Health and. carried out by the Health Inspectors of the Department. Written tests (in English) were set weekly. No charge was made by the Municipalities in question to the students, and students who were Maritzburg or Benoni residents received., from their respective Municipalities, free board and lodging during the period of the courses. The final examination, written and oral, in Pietermaritzburg in 1934 was carried out by Drs. G.̂ -. Park Ross and F.W.P. Cluver of the Union Health Department; and in Benoni in 1937 by Dr. H .S . Gear of the Union Health Department. In both instances about 6Qf0 of passes was registered. A copy of the certificate issued by the Town Council of Benoni to the successful students is enclosed. A set of the lecture notes for the Benoni course is available if required; this series merely gives a general idea of the theoretical instruction given - as in practice the lecture notes were used merely as a basis upon which the lectures were built up. The practical instruction included building construction, latrine and refuse control, disinfection, the following up of contacts and cases suffering with infectious disease, vermin control, health education, etc., etc.

xhe primary approach in the training of these students was along the lines of practical public health woi’k, with the idea of giving them sufficient practical and exact knowledge to enable them to serve (1) as useful assistants to European Health Inspectors working among non-Europeans, and (2) as teachers of simple health and hygiene facts among their own fellows.

No attempt was given to train these men up to the standard required for the Health Inspectors' examination of the Royal Sanitary Institute, even though the course was a full-time course lasting 5 months as compared with the part-time course (mostly evening study) which is all that is required over 2 years

for the/

for the full Royal Sanitary Institute course of training. In practice it is found that becuase of the inadequacy of his preliminary scholastic education and general social background, even the Native holding the Junior Certificate is not really ready to absorb satisfactorily the instruction necessary for the Health Inspectors' certificate of the Royal Sanitary Institute. A ’ stepping stone1, of an essentially practical nature is required, and this, it is claimed, is provided by the Health Assistants’ course. In this connection it' is of interest to note that one of the Native Health Assistants - Enoch Nyamende - from the Pietermaritzburg course proceeded to the Health Inspectors course, and duly achieved the certificate - the first Bantu to do so - while all the successful candidates in the Benoni course are sitting for the Health Inspectors1 examination in June 1940 after having attended the 2 years course run by the % twatersrand Technical College at the Benoni Municipal Location Clinic during 1938-1939.

I I . NEED FDR HEALTH ASSISTANT S .

The incidence of preventable, fatal, crippling, and disabling disease among the non-European peoples of this country is disclosed, in every annual report issued by the Union Health Department and ea.ch Medical Officer of Health. Much of this sickness is due to the ignorance of the people, especially among those who have recently come to live in contact with urban conditions. and. are caught up in the mesh of an attempt to copy European methods of existence. It is not anticipated that this natural urge to 'enjoy' town life and the modern habits of urban civili­sation on the part of the non-European population can be stemmed.It remains to ensure that these people are taught to make the most, from the point of view of communal and. individual health, of their environment.

Quite apart from measures adopted to provide more suitable living conditions (houses, latrines, etc.) for these people, a very great deal can be done to raise the level of the individual and the communal health through education. In offering such education (an essentially personal matter) to them, the European at once comes up against the difficulty that his whole social outlook is different from that of the non-European, and the language difficulty is a real one when attempting to gain the confidence of the superstitious Native.

If , therefore, it is possible to train non-Europeans to such a degree that they will understand and be able to pass on the facts of our proved knowledge of hygiene and sanitation matters to their fellows - using the same language and approach as their fellows - then a great advance should be achieved in our attempt to make the non—European peoples health conscious and, ultimately, healthy.

Experience in Pietermaritzburg andBenoni has proved that sidi trained non-European workers can gain the confidence of their people and. can enormously improve the reaction of the non-European people to their environment. Without any rehousing scheme being brought to finality - but largely as the result of educational and follow-up activities undertaken by the Native Health Assistants employed by the Benoni Town Council under the immediate control of the Location (European) Health Inspector - the death rate for Location Natives in Benoni which was 37.78 for the period. 1932 - 1936, has steadily fallen until it is now 19.61 At the same time the Native appreciation of the significance of the infectious diseases has steadily increased. That this improvement is solely due to the activities of our trained non-European Health Assistants is not claimed., but it is claimed that much of the advance made has been the result of their individual and intelligent work.

I I I . A DRAFT/... .

I I I . A DRAFT PLAN FOR THE TRAINING- AND EX-AM I NATION OF NOH-EURQrE-N K E^ lTTIT ~ A fi SI fj f aN f S»

1. The only courses of training to be recognised to be those carriedout by Technical Colleges in co-operation with organised Health Departments (as proposed below), in which the training will be according to a^schedule laid down by the Royal Sanitary institute in ^outh Africa in co-operation m th the Union Government, and in which the final certificate of "non- iiurooean Health Assistant11 will be granted only to non- Europeans who have completed such an approved course and have satisfied examinora appointed by the Royal Sanitary Institute in an oral and written examination set by the Royal Sanitary Institute,

2. That no student be admitted to the course unless he or she canproduce the Junior Certificate or an equivalent certificate.

3. That the approved course shall include theoretical and practicalinstruction as roughed out in Appendices t,Afl, nB'1, " C , and that such instruction shall extend over a period of at least 4 months of full-time training.

4. That in each of the larger urban areas, as and when there maybe a demand for a course of training from an adequate number of suitable students, the Royal Sanitary Institute should request the Technical College in that area to provide fac­ilities for such a course in active co-operation with the Local Municipal Health Department.

5. That the necessary fees to cover the cost of the course beipaid by the students to the Technical College running the course, but that Municipalities be requested to provide the facilities for practical instruction free of charge, and that the Union Native Affairs Department be requested to consider the provision of Bursaries to enable suitable students - who would otherwise be financially unable to take the course - to enter,

6. Tha.t the intention of the course shall be to produce HealthAssistants who, on achieving the certificate, are sufficiently trained to assist health inspectors in their work in non- European areas, and to spread among their fellows exact information regarding the prevention of disease and the creation of health.

During the past two years I have received, over 100 applications from non-Europeans who wish to take such a course, so there is no likelihood of a lack of applicants for instruction. It may be said that the field of employment for such men, when certif­icated, is almost non-existent. This is, at present almost true; but with an increasing demand by the Municipalities of the Union for such trained men in the future, together with the employment by the Union Health Department of such men in the rural areas (as a valuable addition to the work of Native Medical Aids), I anticipate that if Health Assistants are trained in limited numbers the demand for their services will increa.se - especially if the Union Health Department is prepared to recommend their employment in Native areas and. Locations.

I have, therefore, as a Member of the Royal SanitaryInstitute to ask the Council of the Institute in South Africa togive urgent consideration to the proposals made in this letter, and especially to consider -

(1) The/

(1) The recognition and approval by the Institute of a course of training for non-European Health Assistants as now procosad;

(2) The inauguration of an examination by the Institute for those who have satisfactorily completed such a course;

(3) The provision of a certificate (non-European Health Assistants) for those who satisfy the Institute's examiners in such an examination „

Should you require further information, including a typed set of lectures given to the Benoni class in 1937, regarding the training of this nature already given, I shall be glad if you will refer to the Acting Medical Officer of Health, Benoni, during my absence from south African on military service.

I would finally remind the Council of the Institute in South Africa that an increasing number of non-Europeans is demanding the course of instruction for the Health Inspectors' certificate of the Institute* That many of these students will probably gain the certificate; and that comparatively few of these men are really fitted - from the training vihich the Institute at present requires from a candidate for its certificate - to serve as practical Health Inspectors. But that this difficulty could be overcome if the Institute provided the "stepping stone" n&w outlined in this proposed non-^ropean Health Assistants Course.

Yours faithfully,

MEDICAL OFFICER OF HEALTH0

ENCL.

/mm.

APPENDIX "A?

draft plan o f in s t r u c t io n to be r eq u ired

IN _ THEITON-TOO? EAN HEALTH ASSISTANTS COURSE OF fjplAINING" TO BE APPROVED BY THE^RqYmJ

SaNI TAHY IN SIITUTE.

1. Full-time course to extend over at least 4 months.2. Lectures to a total of 170 hours to cover the syllabus

suggested in Appendix !,B:|.3. Practical work to a total of 350 hours to cover the syllabus

suggested in Appendix ,!C11, and to be carried out in an approved Municipal Health Department or under the immediate control of the Union Health Department in rural arease

APPENDIX 11 Bn .

DRAFT PLAN OF LECTURES TO A TOTAL OF 170 HOURS.

1. ANATOMY OF SKELETON, JOINTS AND MUSCLES.2. NERVOUS SYSTEM*.3. BLOOD AND CIRCULATION.4. RESPIRATION.5. DIGESTIVE SYSTEM^ TEETH. THE USE OF POOD AND DRINK. DIET.6. EXCRETORY SYSTEM, HEAT-REGULATION.7. REPRODUCTIVE SYSTEM,8. FIRST AID INSTRUCTION ( 3 .A, RED CROSS SOCIETY'S NATIVE COURSE).9 . MILK AND DaIRIESo

10. MEAT AND ABATTOIRS,11. VEGETABLES, CEREALS, FOOD SHOPS, MARKETS.12. HEALTH AFFECTED BY FOOD. PRESERVATION OF FOOD.13. DISEASE. INF ECU CU S DISEASE* INFLAMMATION.14. BACTERIA. ENTRANCE INTO BODY. IMMUNITY.15. COMMONER INFECTIOUS DISEASES. NOTIFICATION. INCUBATION PERIODS.16. ENTERIC FEVER. ENTERITIS. DYSENTERY.17. MEASLES. WHOOPING COUGH. PNEUMONIA.18. TUBERCULOSIS.19. PLAGUE. TYPHUS. MaLARIa .201 VENEREAL DISEASES. LEPROSY. SMALLPOX AND VaCCINa TION.21. DISINFECTION.22. FLIES.23. RODENTS.24. MOSQUITOES.25. BUGS, LICE, FLEAS, ETC.26. DEVERMINISATION.27. ACTION OF PHYSICAL AGENTS CN HEALTH. CLIMATE ETC.28. PERSONAL HYGIENE.29. REQUIREMENTS OF A HEALTHY DWELLING.30 ̂ REFUSE DISPOSAL.31. LATRINES INCL. WATER CARRIAGE SYSTEM.32. WATER SUPPLY.33. VENTILATION,34. BUILDING CONSTRUCTION.35. HOUSE DRAINAGE.36. LOCATION PLANNING „ SLUM CLEARANCE.37. SCHOOL HYGIENE,38. maternal and infant w elf a r e .39. ACTIVITIES OF aN ORGANISED HEALTH DEPARTMENT.40. VITAL BOOK-KEEPING.41. HEALTH EDUCATION.42. REPORT _ MAKING.43. ATTITUDE TOWARD THE PUBLIC.

(These 43 lectures to be spread suitably over 170 hours).

APPENDIX ’’C11/ . . . .

DRAFT PLAN OF PRACTICAL WORK TO A TOTAL OF 35Q HOURS.

All practical work to be under the supervision of a Municipal Health Department and to be directed in person by a MeSioai Officer of Health or a Health Inspector,

Routine sanitary inspection; housing and sanitary surveys; routine sanitary service duties; building plans and the supervision of the erection of baildingsj erection and control of latrines, wells, and refuse receptacles; inspection and control of food supplies — shops, markets, etc; routine enquiries and follow-up work in connection with Infectious disease? attendance at venereal disease, tuber­culosis, and maternal and infant welfare clinics; disin­fection and disinfestation; vermin control (flies , mos­quitoes, rodents, etc .); school hygiene; the keeping of daily records, the making of reports, and intensive instruction 3n health education work including the preparation and delivery to the J^est of the class of talks on health and hygiene subjects, the preparation of pamphlets, etc,etc.

(This gives a g.?ne_ral idea of the work which would be spread over a total period of 350 hours).

- - - 0O0 -

/ t o .6th November, 1939„

Collection Number: AD1715

SOUTH AFRICAN INSTITUTE OF RACE RELATIONS (SAIRR), 1892-1974

PUBLISHER: Collection Funder:- Atlantic Philanthropies Foundation

Publisher:- Historical Papers Research Archive

Location:- Johannesburg

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