CEYLON HEALTH UNITS* By W. P. JACOCKS, m.d., Dr. p.h. Advisory Health Officer to the Department of Medical and Sanitary Services, Ceylon Introduction m No unusual difficulty is now experienced planning a suitable public health organization are for a municipality. Numerous models available for study throughout the world. The question is only one of meeting the budge demands. , _ In rural sections the situation is differed j The means of raising revenue are often unsatis- the distances to be traversed are Srea, ' factory; th communications are frequently bad; and_ general educational, financial and sanitary levels are low. On the other hand, rural area contain the greatest number of people an^ fe they are the main sources of wealth of world, their sanitary environmental condition- should be promoted. i The establishment of health units in rural an semi-rural areas in Ceylon and India nf, aroused considerable interest among he. le workers and the In this artic general public. u^ the organization of an official unit in Ceylon described. Health units The health unit scheme presupposes t-h^ fundamental public health principles are unl versally applicable. Local financial and otne conditions should be taken into consideration* and the procedures which are followed sh?n be based on common sense and on a recogni^ ' of what is useful, reasonable and practical The object is to bring to rural areas the benen of health protection which are now enjoyed ^ large towns and cities. This end is accomplish? dividing rural areas into suitable distric. by y and introducing therein small but complete trained bodies of workers who remain PerI1% nently in the delimited area and undertake public health problems. Their activities eI\ c? brace health education, general sanitation, lection, tabulation and study of vital and m? bidity statistics, control of preventable endem and epidemic diseases, vaccination and PreXere tive inoculation, maternity and infant welia work, school health work, and adult hygiene- More than 600 of these organizations now in all of the functioning parts w-?r,g'' namely, Ceylon, India, the Straits Settlemen the the South PaC! ? Siam, China, Philippines, ' the West South Amerl1 Islands, Europe, Indies, ' Central America, Mexico, the United Sta and Canada. Ceylon ^ The island of Ceylon is 20 miles south-e^ of India. It contains 25,322 square mil?s * caxM The activities reported in this paper were apU out under the auspices of the Government of Ceyl0ll jjef the International Health Division of the Rockc Foundation. : JACOCKS 333 June, 1933] CEYLON HEALTH UNITS units amounted to 12,702 giving a birth rate of 36.7, as to with 33.1, the rate for the 35 principal towns according the 1931 census, has a compared of populationof the Island. (Statistical collection in health units is 5,312,548. It lies within the to the collection in the 35 towns (6-10 north wholly tropicsmore comparable than coastal latitude) and embraces a wideto the collection in the Island as a whole.) plain and a narrow band of foothillsDeaths and death rates.?The deaths in seven of the total a crude death rate of as surrounding a central mountainous area, ineunits 7,668 giving 22.1, compared with 29.6, the rate for the 35 principal towns lnpredominating race?Sinhalese?are Buddhisof the Island. religion; the one and one-la total of infant millions remaining Infant mortality.?A 1,807 deaths are seven the an infant lans. Hindus, Mohammedans and Uiirist-occurred in of units, giving mortality- The as with 187 for the 35 principal diseases arerate of 142, compared principal preventable towns of the Island. malaria, infection hookworm and other in- testinal by Maternal mortality.?There was a total of 229 deaths parasites, enteric fever, dysen cn,among mothers at childbirth in seven of the units, leprosy, plague and tuberculosis. Cholera andgiving a maternal mortality rate of 18, as compared with smallpox rarely occur. 31.3 for the 35 principal towns of the Island. In for still-births are available normal the is Still-births.?Figures only and times, country prosperousfor the urban areas of the different health units. There progressive. estates of coconut and Large tea, has been a total of 86 still-births, giving a still-birth rubber are ( the principal sources of wealth.rate of 54, as compared with 73.4, the figure for the Ceylon has been in contact with western35 principal towns of the Island. countries and since the 16th and is well Maternity, infant pre-school hygiene.?The century number of health centres has increased from 22 in 1930 advanced in education. Vernacular and |ish Lng-l.o 35 in 1931. The number of child-welfare clinics held secondary schools are located throughoutis 1,276 as compared with 843 in 1930. At these centres JheCo Island, and good colleges are found 489 expectant mothers paid 1,259 visits, as against 136 ombo, Kandy and other large towns. expectant mothers and 561 visits in 1930; 1,313 infants A as 892 infants and visits medical full ion paid 9,917 visits, against 6,142 local college gives prepara in 1930; 1,360 pre-school children paid 8,476 visits, as practice, but those entering the publie 874 children and visits in 1930. wealth service against pre-school 6,198 lealth must offer, in addition, pu Forty-eight trained midwives attached to the health qualifications obtained abroad. units made 53,129 ante-natal visits to 8,538 expectant .The ^ at the rate of 5.8 visits and Director of Medical and oanitaiy mothers per mother attended vices is in at the delivery of 4,985 mothers, paying them 34,582 charge of all curative and iv piemen post-partum visits at the rate of 6.9 visits per confined 1J2 Distributed throughout the country ar case. Eleven public health nurses visited 10,450 homes all hospitals (9,436 beds) and 603 dispensaries,paying a total of 15,810 visits. staffed by doctors and Communicable diseases.?1,746 cases of communicable government-employed diseases were and were apothecaries. There are few reported 1,727 investigated; Private comparatively 2,911 doses of anti-typhoid vaccine were but their number is in- administered; creasing. practitioners, 10,670 vaccinations against smallpox were done in six of the units by health unit Hookworm The | inspectors. public health branch has 28 medical treatmentsI amounting to 17,689 persons were carried out officers of in all the health. For the most part,, the units. is School hygiene.?There are 313 schools with a school c^ntry divided into districts each ?der a medical population of 54,473; of this number 5,669 were medi- officer of activities consist of the health whose cally examined; 4,027, or 70 per cent, were found to promotion of sanitation and the cont be defective with a, total of 8,376 defects, or 2.1 defects c?mmunicable diseases with the ai per defective child; 1,647, or 19 per cent of the defects tary found, were corrected. a inspectors. A district medical Wlt arSe Latrine construction.?135 public latrines in all the area and a small staff of offi(^r units received 8,235 172 defects were found only touch the I inspections. of the necessary public and 8 public latrines were newly built during the year. health work fringe insPec^snX still and in Ceylon this type of work, Latrine construction was carried out in all the units; under conditions 71,924 dwellings are provided with 29,886 latrines at necessar'y existing mmany the rate of one latrine to 2.4 houses. the now to During year Provinces, considered gr^ 1,853 new latrines were constructed, as against 1,713 in and is i i ^Its healtf > 1930. and 1.239 were altered to sanitary type, as against rapidly as being replaced by a^at? facilities permit. 994 in 1930. are with 255 one Health unit to 313 schools provided latrines, i.e., work, adjusted local:needs, latrine to 1.2 schools. During the year 19 schools that fas commenced in in 1926. In Dece - ber 1932, Cevlon were without latrines were provided with them. eight health units were m operation Public health education.?Public health education embracing 856 means 152 440 000 square miles and containing has been carried out by of lantern lectures, j 16 o people. The following data 145 lectures without lantern, cinema lectures, 684 this in: 215 work are taken in from school talks, 1,324 village talks, clinic talks; 4 health report of part weeks an estimated the of Medical and Sani- and baby reaching population of tary Department or 34 per cent of the health unit Services : 152,000, population: 325 conferences with health unit staffs have been held and training in health habits introduced in 14 schools s Personnel?The type of units. ^h^7?rrl\-nd c?ntinued as in the different oricinallv planned and the personne employed is as ^ to these detailed } medical foTows medical officers of health, In addition activities, 20,101 houses officer, 51 oanitarv inspectors, 12 public health were surveyed; 1,594 consultations and 123 adult ? were 133 SSTncl, mid?ives, 9 clerks, 8 peons, and 1 orderI.es examinations given; public wells received 2,616 labourers A ^as 197 1,041 tea and coffee each of the hookworm dispenser attached to inspections; bakeries, boutiques, Part of units for vSSe periods during the latter 194 eating houses, 11 aerated-water manufactories, 66 < the year. meat stalls, 83 fish 174 83 in 1931 The eighth unit was organized too stalls, vegetable stalls, dairies, ?<? for its laundries, 170 cattle 3 manufactories and Births and figures to be included.