Health Education In Bophuthatswana

Van die bestaan van die mens af is gesondheidsvoorligting op d ieeen of ander wyse beoefen. Hierdie vorm van gesondheidsvoorligting wat deel van ’n kultuur vorm om hom self te bly handhaaf, kan miskien nie met die moderne omskrywing van gesondheidsvoorligting vergelyk word nie. Hulle is egter stewig vasgelê en maak verandering moeilik. Die Departement van Gesondheid en M aatskaplike W elsyn het in April 1975 tot stand gekom. Dit het ’n model van omvattende gesondheidsorg aanvaar, maar nie ’n bepaalde beleid oor gesondheidsvoorligting gehad nie. Gesondheidswerkers sou met die bestaande program m e voortgaan en personeel aanmoedig om meer belangstelling in die aspek te toon. Gem eenskapsvoorligting en im m uniseringsdienste — ’n afdeling binne die departement wat die werksaamhede van die gesondheidshelpers beheer het, het die organisasie van gesondheidsvoorligtingswerksaamhede as een van hulle doelstellings gehad.

F ORM S o f health education have been practised for as long as man has been in existence.These forms o f health education that are part o f a culture to ensure its survival may not be com parable with a modern-day definition o f health education.They are, nevertheless, firmly entrenched and make change difficult.
Traditional 'health education' in Bophuthatsw ana was normally passed on by the mother-in-law and had to be obeyed.W omen belonging to the traditional tribal councils were responsible for the establishm ent of and adherence to village norms.This education was aimed at teaching people what to do to provide themselves with fortification and pro tection against witches and evil spirits who could cause mishap, illness or other ill-omens.During times o f family crisis e.g. the birth o f a baby, marriage, illness, accident or death, the family was especially vulnerable and needed pro tection.A horn containing charm s was hung in the house and its ability to protect the family and house was especially respected.
Today many o f these preventive measures are still being practised, although am ong the well-educated families it is done secretly.Charm s are given by witchdoctors for protec tion and fortification and may be worn, placed in a m otorcar, in the area where food is cooked or in a special room.A dherence to these practices is often reinforced in the religi ous teachings o f the separatist churches.Dutch patent m edicines, especially the burning o f Duiwels-struik have special protection powers to prevent cross-infection.W estern medicine o f which Health Education is a part, is accepted.There is a saying that a person is an elephant and therefore he takes all herbs.This means that both the tradi tional health education teachings and those belonging to scientific medicine are acceptable.
Unfortunately the message o f some o f the health educators has not always been well understood.K w ashiorkor is called 'p ap siek te' and the belief is growing that porridge is bad and should not be used.It is being replaced by potatoes and rice.Meat is necessary to prevent kw ashiorkor.An unnatural em phasis has been placed on the importance o f meat, to the neglect o f the use o f other proteins that are cheaper and as effective.Lists o f good foods that make for healthy living are given with no instruction on how to plan a diet.Potato salad with m ayonnaise, fried potatoes and mashed potatoes and beans may be served at the same meal together with 'T in g ' (sour sorghum porridge).Clinic services have only been considered suitable for the poorer classes.Valuable information given at the clinic goes unheeded as it does not reach the com m unity leaders.Many educated people would consider it beneath their dignity to visit a clinic for advice.
Health Education in Bophuthatsw ana before the estab lishm ent o f the Departm ent of H ealth and Social W elfare W ith her know ledge o f some o f the traditional practices mentioned above the district nurse sought to spread sound health education know ledge to both the urban and rural people.This was done informally through face-to-face con tact with the patient or formally through lectures given to groups o f m others, com m unity m em bers or waiting patients.
Although not scientifically planned or controlled it was not e n tire ly u n s u c c e ss fu l.T he n u m b e r o f c h ild re n w ith diphtheria o r w hooping cough began to decrease, antenatal attendances and hospital or clinic deliveries increased.The com m unities began to appreciate the im portance and benefits to them o f good m other-and child-care.Hospital nurses iso lated from their com m unities, involved in curative services, were not so aware o f the need for health education.N everthe less much know ledge was passed on during the course o f giving patient care.
District nurses also encouraged com m unity developm ent projects.Tribal m others' groups were started.These mothers together with the nurse worked together to build dam s, creches and m aternity depots.

The New Departm ent
The D epartm ent o f H ealth and Social W elfare was estab lished in April 1975.It adopted a com prehensive health care model but it did not have a specific policy statem ent on health education.H ealth w orkers were to continue with their exist ing program m es and to encourage staff to be more interested in this aspect.C om m unity education and immunization ser vices, a division within the departm ent which controlled the activities o f the health assistants had the organisation o f health education activities as one o f their goals.Among the subjects to be included were: family planning, dietetics, environm ental hygiene and mental hygiene.
This division also had in its control a mobile health educa tion unit w hich travelled around Bophuthatsw ana assisting with general health education program m es, health needs and health exhibitions.
The division clearly stated that it did not " o w n " health education, but that its objective was to co-operate towards building a healthy nation.It further saw its function as that o f a watchdog to see that expensive unscientifically planned programm es were not undertaken.This group has dissem i nated a large am ount o f health knowledge and many booklets and pam phlets have been distributed.

Survey o f Health Education done by Regional Hospitals in 1977
The nursing division had no real knowledge o f what role health education played in the nursing services.A question naire originally drawn up by the D epartm ent o f Health, Pretoria, was sent out to the matrons o f 9 (nine) regional hospitals.
The questions asked were as follows: Question 1: W hat were the health education priorities for 1977?W hy were the subjects chosen and who were the target groups?Question 2: W hat health education projects were under taken?Information was to be supplied on the aims o f the projects, the methods used, the materials produced or used, the personnel involved, the geographical areas covered, the target group numbers involved, the approximate costs and the results.Q uestion 3: W hat health education m aterials and/or facilities are available?Question 4: W hat training was provided for the workers utilized for health education?Question 5: W hat problems were encountered with health education?Question 6: W hat suggestions have you to make with regard to health education?Six out of the 9 regions responded and 16 com pleted questionnaires were received from hospitals and clinics.The questionnaire was not well understood by all, especially by nurses at clinic level.This made the analysis o f the information very difficult.Some o f the most significant points are set out.Question 1: Priorities for health education naturally varied from area to area and covered all aspects o f nutrition, tuber culosis, typhoid fever, diarrhoea and the problem o f babies bom without the help o f the midwife.The reason for choos ing their priorities was not understood and in many instances the purposes o f the health education were given.Only two substantiated their reason for choosing their priority by indi cating the high incidence o f the disease in the hospital or region.Question 2: This question was again not understood.Indi vidual lecture subjects were given as projects undertaken.Dem onstrations were given and visual aids used.Numbers contacted were varied from small groups to larger com munities.Costs were not known and the evaluation o f results was based on general suppositions e.g.aims achieved.In some instances no evaluation was done and in all instances no defined criteria were used.Question 3: A variety o f visual aids which included flannelgraphs, poster films, and charts were available.The hospitals had access to more sophisticated materials than the clinics.Question 4: No training was given to workers doing health education.Lectures given by student nurses in training were supervised by the teaching unit.Question 5: Many problems were encountered: some o f the main ones are listed below: -people w on't change -ignorance -lack o f money for health education -poor roads -shortage o f staff -those who do n 't attend clinics are not reached -insufficient supply o f visual aids -antenatal cases don't come early enough -language used in the pam phlets is unsuitable -lack o f enthusiasm -no time -more beer halls and bottle stalls than clinics -more literature required for distribution -voluntary w orkers want to be paid -only the very young, scholars and the aged are con tacted, the young adult group are missed.Question 6: A wide range o f suggestions were given which included: -running feeding schemes -getting help from milk com panies -legalizing schoolfeeding schemes -giving lectures at general m eeting places e .g .the M agistrate's court -stim ulating com m unity involvement -holding com petitions -training of qualified persons as health educators who can draw up program m es and supervise work -providing health education facilities and materials -providing more staff From the information gained it can be deducted that: -health know ledge is being spread -health education program m es are not scientifically planned, im plem ented or evaluated -except for w hat is given in basic training health workers are not trained for this task -many problem s have been encountered in doing health education -valuable suggestions for im provements or change have been made.M uch more em phasis m ust be given to health education.Guidance and expertise are needed at regional level.

F o r m u la tio n o f a H e a lth E d u c a tio n P o lic y fo r Bophuthatsw ana
The departm ent felt the need for a policy on health educa tion to be form ulated so that it could be effectively integrated into all aspects o f health w ork within the com prehensive care system.It was recognised that many o f the comm on health problem s were preventable and much chronic ill health could be avoided if people w ere to accept the concept o f health as a valued asset.
As it did not have sufficient expertise the departm ent asked the South African National Council for Health Education to assist them with proposals for planning and policy-m aking.The proposals made used an integrative approach based on the com prom ise model recom m ended by the W orld Health O rganisation.
The following principles were used in form ulating the proposals: -every health w orker should be a health educator -a core o f professional health workers, that is, doctors, nurses and a health inspector should undergo post graduate training in health education.-health education should be based on sound educational principles -a medical doctor should preferably lead the team -com m unity developm ent and participation should be promoted The plan envisages the establishm ent o f a national health education unit which would provide the follow ing service: 1.The provision o f an overall policy for the organisation o f the health education services.2. The initiation o f special community education projects.
These projects would deal with the most important en vironm ental, personal and preventive health problems.3. The organisation o f refresher courses and in-service training for health workers.4. The establishm ent o f an audio-visual centre.5. Liaison with the mass media.6.The evaluation o f the health education field services.7. The execution o f relevant health education research.8.A plan for health education in the peripheral clinics.
Professional staff who have specialized in health educa tion were not available to establish such a unit.It was felt that interested people should first be found and sent for training.It was further decided that a pilot scheme based on the principles previously described should be undertaken in one o f the regional areas.This would enable the departm ent to evaluate the effectiveness o f such an approach and to iron out problem s before policy and a national unit were established.

Pilot Project
A pilot project is being com m enced this year.The area chosen had already done considerable groundw ork and had sufficient staff interested in being involved.Two com m ittees have been set up.These are: 1.An Advisory Com m ittee; consisting o f personnel from the Department o f Health & Social W elfare and the region.2. A pilot project com m ittee; This consists of: -a doctor as team leader.He will devote half o f his tim e to health education.-a senior sister who will also devote half o f her time to the project.-a health inspector -a health assistant This com m ittee and other team m em bers who will be involved will be responsible to train them selves and to call in specialists from outside to com e and help.

G eneral Objectives
The general ofjectives have been set by the Advisory Com m ittee.These are: -to assess the health needs o f the local com m unity -to establish priorities within the budget and what can be done with available resources -to institute a program m e o f health education.
The specific objectives will be established by the pilot com m ittee.The com m ittee will be involved in establishing liaison with the com m unity.
Co-operation with the D epartm ents o f Agriculture and Education will also need to be established as m any o f their personnel are directly or indirectly involved in health educa tion.
The comm ittee will design a plan that is scientifically based and that can be evaluated for quality as well as quan tity.The com m ittee will consult with resource persons in the Republic o f South A frica where necessary.
They will decide on a com m on approach to problem solving and will plan the training program m e necessary for those to be involved in the project.A budget will be drawn up and will provide for needs for additional staff including secretarial help, equipm ent and resource books.The project will be evaluated in two years time.

Health education in the rest o f Bophuthatsw ana
The other regions will continue with their program mes as previously organised.Radio talks by the Radio Doctor, Koko Nurse Alina and the health assistants will be broadcast.The pilot com m ittee will be asked to handle any correspondence resulting from these talks.An increased interest in health education will be encouraged.A tw o-w eek health education module is included in the training o f advanced clinical care nurses; 18 are trained every year.

Conclusion
A beginning has been made to establish a soundly based health education programme that is integrated into all aspects o f health care.A long road lies ahead.Goals are long-term and will require change and the training of doctors, nurses, health inspectors and health assistants.Policy will have to be established and funds budgeted for this work.The results that can be achieved are a community that will take responsibility for its own health, a better use o f limited resources and a reduction in the incidence o f some common preventable diseases.
ACKNOW LEDGEM ENTS I wish to acknowledge with thanks the permission granted by the Secretary o f the D epartm ent o f Health and Social Welfare to write the article and fo r permission to use information from departm ental reports on health education.