A SURVEY IN (SOUTH WESTERN TOWNSHIP) ON THE AVAILABLE HEALTH SERVICES JOYCE T. NCALA Tutor, Baragwanath Hospital

OPSOMMING ’n Opname van beskikbare gesondheidsdienste in Soweto is deur telefoniese en persoon- like onderhoude gemaak. Demografïese en sosiaal-ekonomiese inligting oor die gebied, soos oppervlakte, klimaat, bevolking, fasiliteite vir omgewingshigiëne, werksgeleenthede, onderwys en opvoeding word gegee. Die algemene gesondheidstoestand en -probleme word genoem en daarop volg ’n be- spreking van voorkomende, bevorderende, kuratiewe en ondersteunende gesondheids­ dienste. Dienste vir bejaardes word spesifiek toegelig. INTRODUCTION sight, hearing, smell, taste and touch temperature ranges between 17,5°C (1, P 67-70). and 20°C (6, p 13). Hot summer days Survey research, also known as de­ There were however a few difficul­ are sometimes accompanied by morn­ ties encountered in obtaining data: ing and afternoon rains. The soil is scriptive research, is the method where­ fertile because there are flowers, by data is collected, recorded and — obtaining exact figures was the vegetables and peach trees in most analysed. (8 p 57). The scope of this main problem with certain inter­ yards. The political climate is much survey was the health services of views — only approximate figures better than in 1976-1977. Community Soweto. The purpose was to obtain a were given; councils operate under WRAB and complete picture of the community of — telephone discussions were rather take charge of certain duties according Soweto; to update knowledge con­ too brief; to the Community Councils Act 125 of cerning health services in order to — there is no register for the voluntary 2977 (6, p 148). teach adequately; and being a citizen organisations in Soweto — most Soweto is outside the industrial area of Soweto, data collected is for the groups operate in for but there is a big dry cleaning factory good of my family. all citizens. under construction near Merafe Station. Soweto Bakery in Orlando is METHOD already in operation. The neighbour­ RESULTS ing farmers supply residents with fresh The method used for collecting data eggs, poultry, sheep, goats, cattle was a survey by telephone and per­ Demographic and Socio- Eco­ vegetables, milk, fruit and mealies at sonal interviews with the following: nomic Information reasonable cost. — the West Rand Administration Soweto is a large area with a dia­ There are two highways between Board (WRAB) Public Relations meter of approximately 1440 km (3; Johannesburg and Soweto. The com­ Officer; square miles) and is zoned as a black munication system includes tele­ — the Baragwanath Hospital’s Public urban area for all ethnic groups. It is phones which is a newly available ser­ Relations Officer; situated about 35 km south-west of vice for anybody who wishes to have a — a Senior Administrator of the Johannesburg and it takes 15-20 min­ telephone installed. There is also pub­ Urban Bantu Chambers, Soweto; utes to drive from the city centre to lic and private transport. Construction — the H use-keeper, Soweto Food Soweto. Soweto is bordered by and maintenance of roads and bridges Gardens, Mofolo South; secondary urban areas namely, Diep- fall under the National Roads Act (54 — the Secretary and the Senior Social kloof and Noordgesig to the east; farm of 1971) (6, p 141). Worker at Happiness House for the areas which separate Soweto from the Soweto is densely populated with Care of the Aged, Johannesburg; Randfontein area to the west; Dob- more than a million people. According — the White City Jabavu Methodist sonville to the north and to to the 1980 census the population was and Anglian Church self-help ser­ the South — Soweto is composed of 800 000. However, this figure does not vices; eighteen areas namely; Chiawelo; agree with the impression of the people — the Senior Administrator of the Dlamini; Moletsane; Senoane; Tladi; and those in authority. The following Department of Plural Affairs, Molopo; Emdeni South; North and factors may have contributed to an Johannesburg; Extension; Naledi; Zondi 1 and 2; incorrect figure: — the Public Relations Officer of the Central Western Jabavu; White City — the misconceptions that some peo­ Protea police station, Soweto. Jabavu; Rockville; Umzimhlophe; ple always have about a census; Orlando East and West; Dube; Mofolo — many people stay in Soweto illegal­ To augment verbal reports, much Village South and North; Klipspruit; ly because of influx control; information was obtained from avail­ Jabulani and Zola 1, 2 and 3. — most gangsters, as found in all able books and brochures related to the The area has a healthy climate major cities of the world, do not subject researched, and through sub­ which favours outdoor living in all work and therefore hide during the jective observation using the senses of seasons. The mean annual surface census period;

Vol 4 No 2 CURATIONIS 45 — some assistant researchers seemed atmospheric pollution is determined Environmental education whereby to be in a hurry, some copied in­ by the Atmospheric Pollution Preven­ students are made conscious of their formation from house permits; tion Act 45 of 1965. To aid in the environment, has been adopted in the — it is suspected that there are also prevention of atmospheric pollution, entire system of education, from many people from Zimbabwe and trees are planted in all open spaces. primary school to university. Regular Mozambique who adopted Zulu There are no dumping places within educational tours bring pupils into surnames and stay in Soweto il­ reach of human dwellings. All recrea­ close contact with nature (6, p 306). legally. ______tional centres and other public places are supplied with big rubbish bins The Organic Soil Association of Soweto has mainly sub-economic which are emptied twice a week. ’s Operation Grow help houses without electricity. Electricity Streets, parks and recreational Soweto people by distributing seeds, is being installed and it is hoped that centres are cleaned by a cleaning team seedlings, tools and fencing materials by the end of 1981 all houses will be employed by WRAB. All premises are to all who wish to start a garden. The electrified. This will help to prevent inspected every three months by in­ aims are to beat soaring food costs and the air pollution caused by coal stoves. spectors from WRAB. Fumigation is to dramatically improve the environ­ There are no slum areas if the area is done frequently, especially in hostels. ment. viewed against the Slums Act 66 of Food Gardens Unlimited, based in 1975 (6, p 145). Some houses are over­ Black education is provided by the Melrose, runs educational projects crowded — probably as a result of the Department of Education and Train­ providing self-help, health and nutri­ cultural belief in extended families for ing. Free compulsory education has tion education as well as creative moral support. It may not be surpris­ been introduced recently under the activity in Soweto (5, p 9). ing to find fifteen people living in a Education and Training Act 90 of four-room house. 1979. Soweto is served by more than Health education talks are also 285 schools (primary, secondary, tech­ given to various groups by health per­ To give a complete picture of the nical and teachers’ colleges) with a sonnel and voluntary workers (from socio-economic status of the people of combined enrolment of more than private or industrial organisations). Soweto, is not an easy task. This is 185 000 pupils (6, p 197). Changes in attitudes and eliminating difficult for an area with a large In 1980 the State and State aided certain misconceptions concerning number of heterogenous ethnic schools, from lower primary to senior disease and bacteria are the main elements, with different levels of secondary in the whole Johannesburg themes. People are taught to seek early socio-economic development. The area had an enrolment of approxima­ treatment, irrespective of their per­ inhabitants are however becoming in­ tely 192 937 pupils. This shows that sonal herbalists. The community is not volved in the process of providing there is a marked increase in the totally barred from going to indigenous adequate housing and thus improving proportion of children at higher healers, but they must realise the im­ the quality' of their lives. The in­ educational levels. Nevertheless, portance of receiving early medical troduction of the 99-years leasehold counselling programmes at schools treatment from their nearest clinics. system in 1978 enables Black people to have to be approached so as to also be Unemployment figures are unrelia­ obtain loans from building societies of value to early school leavers (3, p ble because these are provided for the and other financial institutions against 24). the registration of a bond. The urban whole Johannesburg area. According Blacks therefore have the right to oc­ There are 70 clubs for men, women to information from the Department cupy a site for residential, professional and children, six libraries and more of Co-operation and Development or business purposes (6, p 197). than 17 000 shops in Soweto. There are 1 517 people were unemployed during 303 churches of 70 religious denomina­ September 1980. Those who received Water supply is controlled by the tions, three big sport stadiums, 345 social security during September 1980 Rand Water Board. Control of water sports fields, three athletic tracks, 42 in the whole area of Johannesburg pollution is under the Department of tennis courts, two golf courses and 39 were as follows: Water Affairs, according to the South playgrounds in full use. There are 64 — old age pensioners: 16 228; Africa Water Act 54 of 1956 (6, p 302). crêches under WRAB and private — blind pensioners: 305; The Department of Health, Welfare organisations (6, p 197). — persons receiving disability grants: and Pensions and various provincial 6 719; administrations also have a legal There is one early learning centre at — war veterans: 108; power to control water pollution. Moletsane run by a private organisa­ — lepers: 2. Water consumption in Soweto is very tion which admits babies from the age high. According to information given of six months. The centre concentrates The total number of aged in Soweto by the Urban Bantu Chambers on the care and education of the pre­ cannot be estimated because eldery 15 838 239 960 kilo liters of water were school child. For teachers and parents people leave Soweto once they are consumed in Soweto between April interested in early childhood pensioned and others are self-support­ 1979 and March 1980 (financial year), education free consultation services ing. The Commissioner for Child at a cost of R8 million. Water is used are also available for all population Welfare registers approximately ten to mainly for household purposes. There groups every Tuesday afternoon at the fifteen new foster care and main­ is no water consumed by farm-animals, Johannesburg Society for Early tenance cases per day. nor irrigation except for small gardens. Childhood Education (5, p 10). Employment opportunities in The control of the eco-system takes Soweto include positions for males and A sewerage system is used in all into consideration all social problems females working for WRAB, the traffic areas of Soweto. Dry refuse is placed in which may affect health. For instance department, fire station, bottle stores, dust bins which are emptied free of low literacy levels lead to unem­ shops, PUTCO and backyard em­ charge twice a week. The Factories, ployment, poverty and ill health. The ployment such as welding, sewing and Machinery and Building Works Department of Education and Train­ shoemaking. The installation of elec­ Act 30 of 1941 will apply to the few ing has full-time teachers who teach at tricity is being done by more than 5 000 factories which will be in operation. night schools. Classes are offered from employees who are mainly on contract Legal machinery for the control of sub-standard to matriculation level. for a year.

46 CURATIONIS Vol 4 No 2 HEALTH AND HEALTH SER­ Centre in Johannesburg. Their con­ Curative Services VICES tribution includes immunisation, visits Health services for the community General to tuberculosis cases, defaulters and are provided mainly by Baragwanath contacts. A special clinic is provided Hospital which is the largest Black Strong liquor is Soweto’s main social for the treatment of venereal disease, hospital covering 173 acres and in­ problem. According to the WRAB including treatment for pregnant cluding the St. John Eye Hospital, a public relations officer, WRAB bottle women with W.R. positive blood tests. midwifery section, a general section, stores sold 18 784 719 liters of beer Health education talks are given on doctors’ quarters, a nurses’ residence during the first six months of 1980. The nutrition, environmental health and and the nursing college. The hospital profit per night from weekend stokvels the importance of immunisation. treats more than 980 000 out-patients (parties) is as high as R500,00. Spirit Family planning programmes include annually. There are 68 wards and the sales came up to 304 421 litres between the insertion of intra-uterine devices hospital has nineteen of the best January and June 1980. The abuse of and prescription of other contracep­ equipped surgical theatres in the liquor may therefore contribute to in­ tives. country. There are 2 714 beds, inclu­ creasing antisocial behaviour which sive of midwifery, general and clinic includes rape, abuse of drugs, murder Services for the rehabilitation of beds. All ward-sisters are Black and and theft. Related figures are not given mentally retarded children are provi­ the hospital is the major post-registra­ to the public, according to the Public ded by the Mental Health Society of tion training centre for Black nurses. Relations Officer, Pro tea police station the Witwatersrand. The criterium for Baragwanath Hospital is the biggest (Soweto police headquarters). Another admission to a day centre is that the specialist hospital in the country and it social problem is the thousands of child must be habit-trained. Free is known world-wide (6, p 197). litres of various home brews which are transport is provided to and from the According to the Public Relations consumed and which may be poisonous centres. Various forms of handcrafts Officer, the smooth running of the or lead to ill health. are taught. Voluntary workers also hospital’s services is supported by 3 800 help with the instruction of children. registered nurses including matrons, The general nutritional status in There is one workshop for the phy­ tutors and sisters. Enrolled nurses, Soweto is fair. Babies who gradually sically handicapped at Orlando East, enrolled nursing assistants and lose weight get a free milk supply and which is run by WRAB. student nurses bring the total number vitamin syrups from the immunisation to 4 185. There are 485 doctors and clinics. Pensioners with no other Veterinary services are given free of dentists of all population groups. The means of finance receive food parcels charge. Animals are taken to the Pets total number of paramedical practi­ from the Social Welfare Department Free Hospital (WO 1337) which is run tioners, including pharmacists, in Johannesburg and from church by the People’s Dispensary for Sick radiographers, physiotherapists, organisations. School childdren buy Animals. speech therapists, occupational thera­ fresh fruits and other foods and re­ pists, dieticians and technicians is 387. freshments from Zozo shops (mobile Voluntary health support services The administrative and general staff refreshment stalls) and vendors. are operated in Soweto and from number 610 and daily paid workers Johannesburg, for instance by the (security guards, cleaners, labourers, According to Baragwanath hos­ Cripple Care Association, the Child messengers, porters and kitchen staff) pital’s Public Relations Officer the Welfare Society, South African Red 1 967. The Chief Superintendent is in average birth weight ranges between Cross Association and many other overall charge of the hospital with the 2,5 and 3,1 Kg. The hospital’s average groups. help of deputy superintendents. Lines daily delivery is between sixty and of communication for all workers are seventy babies with a total of 26 000 Health education is given by all through the sectional heads namely, babies per year. In spite of the efforts nursing staff in the clinics, hospital and nurses under the matrons, tutors by the Department of Health, district. All nurses doing a basic di­ under the principal, administrative Welfare and Pensions, in co-operation ploma in nursing, enrolled nurses and staff under the secretary . with other parties, the birth rate for enrolled nursing assistants get The training of professional nurses Blocks remains high. Traditional guidance on health education. as primary health care workers con­ values are undoubtedly responsible for Voluntary workers are also trained tributes to the effective use of services. this trend. The rise in birth rates, cou­ by professional nurses and give health More people attend clinics because pled with a sharp decline in the education according to the needs of primary health care nurses belong to mortality rate, will contribute to the families visited. Voluntary workers do various ethnic groups. There are no population explosion (6, p 24). not wear a uniform and are not language problems and therefore no sophisticated and are therefore ac­ interpreters are needed. Nurses are The utilisation of immunisation cepted with greater ease by the com­ also delegated to district services for programmes is satisfactory or nearly munity. chronically ill patients who have been 100%. No Soweto children are admit­ discharged from the hospital. ted to nurseries and schools without Mental health services for all groups Ambulance services operate between their immunisation cards. Utilisation consist of after-care services in five the ten clinics and the hospital and are of services by sick people is no problem Soweto clinics. The Department of available for emergency help. Clients as most people attend the clinics or are Health, Welfare and Pensions supplies who need ambulance services from referred to the hospital. There are few nurses, doctors, a clinical psychologist home, can contact the nearest fire private medical practitioners. and medicine. The Mental Health station. The fee paid for an ambulance Society of the Witwatersrand offers ranges from R1,00 to R2,00. Control of communicable diseases is accommodation. The Department of Services for the Aged the joint responsibility of the Johan­ Co-operation and Development sup­ Among the numerous health ser­ nesburg City Health Department and plies social workers and the Govern­ vices in Soweto, are the services for the the Transvaal Provincial Administra­ ment Garage offers transport. Psy­ aged which are provided by the tion. City Health Department nurses chiatric services in Soweto are still at Johannesburg Council for the Care of have their Head Office at the Civic the infant stage. the Aged and other organisations. September 1 981 CURATIONIS 47 There are four social clubs in diffe­ Some supermarkets sell meat — more transport means obtaining rent areas which operate between lOhOO packets at a special price to those with health services without delay; and 12h00 on Mondays and between buying concessions. The Cripples’ Care — more schools as well as compulsory llhOO and 13h00 pm on Tuesdays, Association of Transvaal offers home education will lead to a rise in Wednesdays and Fridays. These visits, transport, counselling, treat­ literacy levels. The opening of centres are within walking distance for ment, training, orthopaedic appliances centres for higher education, the aged. The senior citizens who wish such as artificial limbs, supervision and namely teachers’ colleges, will help to use public transport, make use of after care, wheel chairs and recreation to meet the required teacher to Putco services at minimal cost. where possible and assistance in ob­ pupil ratio of 1:35. Various services such as handcraft, taining employment. Lions Interna­ music and teas are provided in the tional run a hearing aid bank for clubs according to the special interests indigent aged with hearing defects. of the members. CONCLUSION Soup kitchens are operated and THE FUTURE The health care delivery system in second-hand clothes are sold for a Soweto tries to enable Soweto citizens nominal amount on pension pay-out Health service projections include (individuals and families) to obtain days. The old age home is still in the ten day-hospitals to be built, eight initial and continuing health care of planning stage but applications for poly-clinics to be converted into day- appropriate quality. Health services admission can be made at the Bantu hospitals with about twenty beds each, are co-ordinated with social and Presbyterian Church, Moroka Town­ one general hospital near New Canada related services to help individuals and ship. Station and one psychiatric hospital. their families to face day-to-day pro­ Other facilities for the aged are made Financing of health services is blems. available by WRAB for instance rent provided by the Transvaal Provincial remissions which are provided in part Administration, the Department of Services should be centralised in or full, depending on the financial and Health, Welfare and Pensions, the order to have an equal distribution of other circumstances of the particular City Health Department and health personnel and workload. There individual and his family. Special voluntary donations on an individual should be a balance in promotive, grants, clothing and blankets are basis. Few Soweto citizens are under preventive, curative and rehabilitative provided on merit. medical aid schemes. Significant health services. developments that will have a positive Other services are provided by effect on the health of the community Baragwanath Hospital such as clinic include: There is also a need for the provi­ and dental services, a free ambulance sion of services to deal with urgent service, and an eye clinic at the St. — the introduction of comprehensive problems. A crisis clinic is necessary, John Hospital where free tests and free health services which will help co­ especially during week-ends when glasses are given to pensioners. ordination of services and may lead murder, attempts of suicide, rape, .Spectacles can also be obtained from to more effective use of available family quarrels and abuse of alcohol Project Bright Sight which is run by health services; are common. Lions International. Artificial limbs, eyes and teeth are supplied free by the — self-help services such as the Soweto Depending on progress and com­ Department of Health, Welfare and food gardens will help to curb the munity motivation there may be no Pensions through Baragwanath Hos­ rising cost of food; smoke clouds in Soweto in ten years pital. District nursing services are also time. Strangers will touch with given free to pensioners and other — changes in the system of education warmth and not hositlity. Trees, indigent persons. will meet the advances in tech­ lawns, flowers and showhouses will nology and unemployment figures add to the beauty. A bright and Various other organisations also will decrease; hygienic environment means healthy provide care for the aged namely: the people. Anglican Mothers Union who visit — houses, hospitals, schools and pensioners, give food, clothes and factories which are to be built will blankets; the Black Housewives increase employment opportunities League who supply refreshments at and may contribute much to rais­ some pension pay-out points and give ing the morale of the community; BIBLIOGRAPHY Christmas parties; the Black 1. Braden, C.J.; Herban, N.L. Community health: a system — if all or most Soweto citizens would approach Appleton Century Crofts. New York. 1976. Reformed Church in South Africa and accept and practice family 2. Brandejs, J.F. Health information: Canadian the Roman Catholic church who give planning, there could be a decrease experience North Holland Publishing Company. Amsterdam. 1976. help to their distressed aged. in the population explosion which 3. National Institute for Personnel Research, Council for is being faced; Scientific and Industrial Research: Careers Coun­ The Black Sash provides a free selling. Vocational Information Services in Johannesburg. advice service to Black people who — general economic development 4. Notter, L.E. Essentials of Nursing Research Springer have difficulties with reference books means health, because money can Publishing Co. New York. 1974. 5. Opportunity 1980-1981 Johannesburg Council for Adult and pass law problems. Services for be used to increase facilities and Edication, . blind aged Blacks are not available in increase the income of the popula­ 6. Department of Foreigh Affairs and Information. South Africa 1980/1 Official Yearbook of the Republic of Soweto but those in need can use tion; South Africa. Chris van Resnburg Publications. various services available to the blind Johannesburg. 1980. 7th edition. nationally, for instance braille 7. Stewart, T.H. An Introduction to Public Health But- — installation of electricity will help terworths. Durban. 1971. watches, braille printing machines and those on life-saving machines, air 8. Treece, E.W.; Treece, J.W. Elements of Research in books on tapes in Bantu languages at pollution problems will be partly Nursing The C.V. Mosby Company, St. Louis. 1977. 9. Searle, C. Survey of Health Needs of a particular area. the South African Library for the solved and the crime rate Tutorial letter no. 102-1980 UNISA Publication. Pre­ Blind in Grahamstown. decreased; toria. 1980.

48 CURATIONIS September 1 981