Briefs continued from page 1231
hygienist monitors the environment through periodic physical examinations, the OM specialist monitors workers in order to find those who are succumbing to certain illnesses and provide proper treatment before others become critically ill. Being interested in the general well-being of all employed persons, he conducts pre-employment physical examinations in an endeavor to see that each person is physically and mentally fit for the assigned position and that no one is placed in ajob in which he would be incapable of performing to the best of his ability or would be harmful to himself or fellow employees.
Long Range Goals As a specialist in public health and with the aid of the nursing staff, the OM physician attempts to obtain better compliance of safety and health regulations via continuous health education programs of management and labor. He works with industrial relations and personnel departments in obtaining contracts flexible enough so that handicapped or temporarily disabled workers also may find work within their current capabilities, even if it means crossing traditional worklines or infractions of seniority rights. He works with the benefits department in pointing out employees in need of certain health benefits or compensation. Thus, he works towards fulfilling the United Nations objective of, "A job for all those wanting and able to work." Through programs on health main-
tenance, health risk identification and prevention, pre-retirement physicals and counseling, the OM physician assists private physicians in discovering early signs of potentially serious illnesses. Results are sent to private physicians, at the patient's request, for follow-up and appropriate specialist referral. Thus, the employee may be spared suffering a long, painful, and costly illness and the employer, huge medical bills and the employment of an extra employee while the other recuperates. The occupational medical specialist is an observer, examiner, and adviser to industry. He reviews accident and compensation cases and is always on the alert for patterns and trends pointing to new or old problems. He tries to eliminate or diminish the number of industrial accidents or illnesses. He reviews absentee and sickness records looking for causal relationships. Where indicated, he sets up troubled employee programs for valued employees to help them discover causes and solutions to their problems so that they may again become productive to themselves, the employer, and the community. The end result of a smoothly running, well-managed occupational medicine program where everyone cooperates is a reduction in overall costs of production, repairs, insurance, absenteeism, and employee turnover. Such programs are cost effective and in the long-run save thousands of dollars for industry and years of pain and suffering for afflicted workers. Everyone profits in a healthy environment.
Diversification Within the Field of Occupational Medicine There are many types of occupational medical specialists, just as there are of surgeons. This is to fit the various needs of different industries, from aerospace to coal mines and from restaurants to zoological gardens. Some work as independent consultants, some have clinics specializing in trauma and pre-employment examinations. Others deal exclusively in health risk identification, and some work with mobile health units providing a full range of industrial hygiene as well as medical and laboratory services. Some work for the government or in research to find better ways of detecting and treating occupationally induced diseases. Large plants and factories have in-house medical departments and some unions have their own clinics and consultants. Professors of occupational medicine are performing a vital role by passing on their knowledge and experience to others so that they may avoid the mistakes of the past, profit from discoveries of the present, and work for a better future. Regardless of the branch of occupational medicine, the aim is basically the same: to detect the detectable; prevent the preventable; eradicate the eradicable; treat the treatable; rehabilitate the rehabilitable: and ensure a healthy environment in which all men may continue to work and grow.
Apartheid: Focus on Health George B. Dines Washington, DC
This paper focuses on health in the Republic of South Africa and calls not only for technical warfare against disease, poverty, and bigotry but also for attention to predisposing causes of disease and ill health among the African majority. Apartheid-the legally enforced racial segregation of blacks from whitespermeates the total structure of South Africa's existence. The Republic of Mr. Dines is Assistant Director for Program Management, Office of International Health, Department of Health, Education, and Welfare. Requests for reprints should be addressed to George B. Dines, 810 Downs Drive, Silver Spring, MD 20904.
1232
South Africa is a country where the white Afrikaners number only four million of the blacks' 18 million, where there are 2'/2 million coloreds and 800,000 Indians, a country where there is every reason for the growing fears of the white Afrikaners that the threat of violence is eminent.' In the apartheid social drama, sickness and disease
have a strong claim among the Africans (Bantu); it is one of their arch villains. It is bad enough that any man, black or white, should be unhealthy, for this cuts him off from the fullest accomplishment of his abilities. It is, perhaps, worse that any man should be poor in a nation so rich, for this condemns him to a life of pain, despair, and helplessness. But in South Africa, what surely is worse is that the system dictates that a man who happens to be born African should be unwell, since this position Briefs continued on page 1233
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979
tional systems, and insecurity of tenure, coupled with the ever present threat of banishment to an ethnic "homeland."
Briefs continued from page 1232
prevents him from doing anything about his poverty or his condition. Most African men, women, and children in the "homeland" settlements are habitually unwell. Many are unwell from the day of their birth to the day of their death. Most of the sick are sick with more than one disease. It is a cause for grave concern that, left to their own devices, most of the sick have no prospect of ever being not sick, given the social, physical, and psychological environment and a diet that makes it hard for them to stay healthy. Disparate disease rates among South Africa's racial groups show clear links with the inferior socioeconomic and educational status of the country's majority population. It is estimated that 620,000 Africans are arrested yearly for "pass law" crimes. An average of at least 150 African babies are born each year in prison. Over 4,000 other African infants suckled at their mother's breasts as they innocently served out their parents' sentences. Many other social side effects of apartheid add to the stress on urban Africans: lack of recreational facilities, inferior educa-
Health Care in the African Homelands The main killers of African children, aside from prenatal complications, are pneumonia, dysentery, diarrhea, tetanus, measles, anemia, meningitis, nutritional deficiencies, and bronchitis. Low incomes and living conditions for the Africans leave them vulnerable to disease, a situation incongruent with the vast economic wealth of the Republic. For example, more than 55,000 Africans died from tuberculosis in one year compared to 824 whites during the same period, according to official Ministry of Health figures in 1970.2 Tuberculosis is a major killer of the malnourished. Regrettably, malnutrition is all too familiar to the African babies of the "homeland" reserves who are reported to have only a 50 percent chance of ever reaching the age of five. Yet, white infant mortality rates compare with those of most industrialized nations. Such startling rates are considered by most health experts to be reli-
able indicators of a community's level of health. Higher incomes would undoubtedly break the links between massive poverty, malnutrition, deficiency diseases, and death. But apartheid denies the Africans the right to negotiate wages in a way open to whites. Two thirds of all urban Africans live far below a monthly "poverty income level" set at Rand (R) 75 (US $105) in 1972. Disease follows in the wake of such poverty; the resultant burden falls especially upon the poorest: nearly 800 Africans had leprosy in 1970 compared to two whites, four coloreds, and one Asian. In the same period, 4,000 Africans contracted typhoid, compared to 60 whites, 231 coloreds, and 32 Asians.2 Budgeted expenditures for health services during 1976-1977 are shown in Table 1.3 As of 1977, expenditures on health by the South African government increased by 234 percent over the prior six years. Costs for services rendered specifically to blacks were not available although it is reported that in the "total" public sector, approximately $28.79 (US) is spent on health services per year per person. Although Briefs continued on page 1234
VVen
N~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I
.,j
A~~~~~~~~~~~~~~~~~~fy~~ 4~
~
~
~
~
~
~ ~ ~
~
~
#~~~~wsP
n~~IfQfI
omn
§..
~~~~~~~~~~~~~~~~~~~~~osej
ea
0IaEandroga~~~~~~~~~~~~~~~~~~~
.5~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~erae :7 ~~
~ ~ ~ ~ irol
eeuuaQ
nIitahe,*
i
sInsvr
American Artist~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~i d v
i#
isyw
Briefs continued from page 1233
Table 2. Health Maintenance Costs
Controlling Activity
Table 1. Health Expenditures
1976/1977
Agency Department of Health Provincial Administration Homelands Total
Central Government Maternal Hospitals Tuberculosis Hospitals Provincial Administrations Cape Natal Orange Free State Transvaal Black Homelands
$134,754,000
533,435,000 69,858,000 $741,047,000
the government's statistics would have one believe that the increase in expenditures for health services is inclusive of all racial groups, there remains a huge disparity as illustrated by Table 2.3
The Black Physician There is a shortage of African physicians in South Africa because they lack prior education and money to support themselves. Most important is the fact that they were once barred from all but one medical school. Over a 25-year period, only 225 black physicians received their licenses to practice medicine; that number is slowly in-
Cost/Patient/Day (US $)
creasing, however. An advertisement reflecting the wide disparity among pay scales was carried in several professional journals. The announcement indicated that colored and Asian physicians were being sought at a salary rate of 76 to 81 percent of that paid to white physicians, while an African physician's salary would approach only 74 to 64 percent of the scale for white physicians. In cash terms, the State recruited white medical officers in 1972 at a maximum annual salary of R 8,100, coloreds or Asians at R 6,600, and Africans at R 6,000. Even greater pay dis-
4.64 6.09 20.96 18.98 23.66 18.76 9.90
crepancies exist for non-white nurses, radiographers, and physiotherapists: a white student nurse earned a maximum of R 1,920, coloreds and Asians R 1,170, and Africans R 840.4
Segregated Health Services Sick black patients make considerable demands on their segregated hospital and clinic facilities. Most of these hospitals have bad reputations. They are often overcrowded, unsanitary, deBreifs continued on page 1235
1YLENOL EQUIPOTENT TO ASPIRIN REGULAR STRENGTH 1 _e
Clinically substantiatedl-3 that mg for mg TYLENOL provides effective analgesia equivalent to aspirin
I Roundtable on Analgesics. Patient Care (Feb.) 1972, p 21. Lasagna, L. Data on File. McNeil Laboratories, 1974. 3. Goodman, L.S., and Gilonan, A., eds.: The Pharmacological
Basis of Therapeucs, ed 5 New d oerk,The Macmillan Companyd 19cn, p.34
325
o n
mg tablets
acetaminophen
u in Rxanaleesia non The loo ical st choice
Do not exce edowmnends dowe IMoh aWhn andwaebminophen n brge ovrdos eecanCus#swiusadnwe fctL
,,~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~. '
,.,
..........
...........
............. ,......
_
....................
~~rt}~DvOL-YS ^I~SOmg
......I
...F . . ^ .. . . . .. .. . .... ...... ... .. . . . |
i
I_
1
.q_n.
z
EXTASTRENGTH TYLNLE_,
-,
FOR INC:REASED POTENCY
| ".two 500mfg units (1000 mng) of acetamwinophen produced significantly |greater analgesia than did two 325 mg units (650 mg) of acetaminophen'"
|4 Ho9krnson J H ill etal Curr Ther Res 16:194 (March) 1974
0 McN 1978
. _ JX
^ _ |E| E._S
...
g
ficient in medicines and supplies, and staffed by insensitive medical staffs. In 1972, ten hospital beds per thousand existed for non-whites. In the "homelands," where health standards are the lowest, the figure dropped to 3.48 beds per thousand. Statistically, about 43 percent of all beds in South Africa in 1972 were allocated to the white minority (17 percent of the population). Other than the massive local health delivery system in Soweto, the least provision is made in "homelands" for those with the greatest need for health services.5 When comparisons are drawn for the various racial groups, ratios show that access to qualified medical services is a function of race and not the availability of the best resources in this racist country. From medical school operating theatre to ambulance services, racial segregation dominates the country's entire health network. In 1962, the government ruled that its "policy" be extended to blood
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
i
ETYLSTENOLH EXTR-SRNT
|acetaminophen
The logical 1stchoice
O o notexed recommede dosg. Both aspirin and aemnoen in large ovedose can cause erosadverseefcs
Briefs continued from page 1234
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.......
classification. The labelling of blood donations is but one more indication of the unscientific attitude underlying the apartheid concept. Such acts of moral, economic, and social injustice make the Republic of South Africa the last bastion of the most pronounced and institutionalized form of racism to be found anywhere in the world today.
Conclusion The tragic dilemma in which the African finds himself when seeking segregated health services is clearly seen in drastically disparate rates of disease incidence, the acute and worsening shortage of health personnel, and the archaic and inadequate "arrangements" necessitated by apartheid. For millions of blacks, the qVality of health care is so poor that they may easily find themselves worse off because of their contact with the system. Now at last, fierce winds of change have begun to blow and the sun has begun to set on the rigid apartheid system. Every effort must be made to eliminate social conditions which provide
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979
in
500 mgc p ue m ap'e
non-Rxc analgesia
McNeil Consumner Products Company (d s Fort Washington, PA 19034 tMNI
the breeding ground for disease, suffering, humiliation, and poverty in the African "homelands." With the assistance of the United Nations, the World Health Organization, and enlightened governments at home and abroad, measures must be taken to control nutritional deficiencies, occupational and communicable diseases, and accidental injuries in the vast mining complexes. With extensive changes in the socioeconomic and human conditions, many of these problems can be resolved in our generation, before the final sunset.
Literature Cited 1. Quinn S: The Afrikaner's burden. Washington Post, March 4, 1979, p B 1 2. Gray TJ: Apartheid: Disease of human relations. World Health, July 1976, pp 3-4 3. Rensburg CV: The health of the people: A review of the health services in the Republic of South Africa in the mid-seventies. Johannesburg, 1977, pp 47-48 4. True facts about medicine in South Africa. S Afr Med J (Suppl), July 1974 5. Faber DA: A closer look at South Africa. South African Scope, 1975, p 7
Briefs continued on page 1236 1235
hygienist monitors the environment through periodic physical examinations, the OM specialist monitors workers in order to find those who are succumbing to certain illnesses and provide proper treatment before others become critically ill. Being interested in the general well-being of all employed persons, he conducts pre-employment physical examinations in an endeavor to see that each person is physically and mentally fit for the assigned position and that no one is placed in ajob in which he would be incapable of performing to the best of his ability or would be harmful to himself or fellow employees.
Long Range Goals As a specialist in public health and with the aid of the nursing staff, the OM physician attempts to obtain better compliance of safety and health regulations via continuous health education programs of management and labor. He works with industrial relations and personnel departments in obtaining contracts flexible enough so that handicapped or temporarily disabled workers also may find work within their current capabilities, even if it means crossing traditional worklines or infractions of seniority rights. He works with the benefits department in pointing out employees in need of certain health benefits or compensation. Thus, he works towards fulfilling the United Nations objective of, "A job for all those wanting and able to work." Through programs on health main-
tenance, health risk identification and prevention, pre-retirement physicals and counseling, the OM physician assists private physicians in discovering early signs of potentially serious illnesses. Results are sent to private physicians, at the patient's request, for follow-up and appropriate specialist referral. Thus, the employee may be spared suffering a long, painful, and costly illness and the employer, huge medical bills and the employment of an extra employee while the other recuperates. The occupational medical specialist is an observer, examiner, and adviser to industry. He reviews accident and compensation cases and is always on the alert for patterns and trends pointing to new or old problems. He tries to eliminate or diminish the number of industrial accidents or illnesses. He reviews absentee and sickness records looking for causal relationships. Where indicated, he sets up troubled employee programs for valued employees to help them discover causes and solutions to their problems so that they may again become productive to themselves, the employer, and the community. The end result of a smoothly running, well-managed occupational medicine program where everyone cooperates is a reduction in overall costs of production, repairs, insurance, absenteeism, and employee turnover. Such programs are cost effective and in the long-run save thousands of dollars for industry and years of pain and suffering for afflicted workers. Everyone profits in a healthy environment.
Diversification Within the Field of Occupational Medicine There are many types of occupational medical specialists, just as there are of surgeons. This is to fit the various needs of different industries, from aerospace to coal mines and from restaurants to zoological gardens. Some work as independent consultants, some have clinics specializing in trauma and pre-employment examinations. Others deal exclusively in health risk identification, and some work with mobile health units providing a full range of industrial hygiene as well as medical and laboratory services. Some work for the government or in research to find better ways of detecting and treating occupationally induced diseases. Large plants and factories have in-house medical departments and some unions have their own clinics and consultants. Professors of occupational medicine are performing a vital role by passing on their knowledge and experience to others so that they may avoid the mistakes of the past, profit from discoveries of the present, and work for a better future. Regardless of the branch of occupational medicine, the aim is basically the same: to detect the detectable; prevent the preventable; eradicate the eradicable; treat the treatable; rehabilitate the rehabilitable: and ensure a healthy environment in which all men may continue to work and grow.
Apartheid: Focus on Health George B. Dines Washington, DC
This paper focuses on health in the Republic of South Africa and calls not only for technical warfare against disease, poverty, and bigotry but also for attention to predisposing causes of disease and ill health among the African majority. Apartheid-the legally enforced racial segregation of blacks from whitespermeates the total structure of South Africa's existence. The Republic of Mr. Dines is Assistant Director for Program Management, Office of International Health, Department of Health, Education, and Welfare. Requests for reprints should be addressed to George B. Dines, 810 Downs Drive, Silver Spring, MD 20904.
1232
South Africa is a country where the white Afrikaners number only four million of the blacks' 18 million, where there are 2'/2 million coloreds and 800,000 Indians, a country where there is every reason for the growing fears of the white Afrikaners that the threat of violence is eminent.' In the apartheid social drama, sickness and disease
have a strong claim among the Africans (Bantu); it is one of their arch villains. It is bad enough that any man, black or white, should be unhealthy, for this cuts him off from the fullest accomplishment of his abilities. It is, perhaps, worse that any man should be poor in a nation so rich, for this condemns him to a life of pain, despair, and helplessness. But in South Africa, what surely is worse is that the system dictates that a man who happens to be born African should be unwell, since this position Briefs continued on page 1233
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979
tional systems, and insecurity of tenure, coupled with the ever present threat of banishment to an ethnic "homeland."
Briefs continued from page 1232
prevents him from doing anything about his poverty or his condition. Most African men, women, and children in the "homeland" settlements are habitually unwell. Many are unwell from the day of their birth to the day of their death. Most of the sick are sick with more than one disease. It is a cause for grave concern that, left to their own devices, most of the sick have no prospect of ever being not sick, given the social, physical, and psychological environment and a diet that makes it hard for them to stay healthy. Disparate disease rates among South Africa's racial groups show clear links with the inferior socioeconomic and educational status of the country's majority population. It is estimated that 620,000 Africans are arrested yearly for "pass law" crimes. An average of at least 150 African babies are born each year in prison. Over 4,000 other African infants suckled at their mother's breasts as they innocently served out their parents' sentences. Many other social side effects of apartheid add to the stress on urban Africans: lack of recreational facilities, inferior educa-
Health Care in the African Homelands The main killers of African children, aside from prenatal complications, are pneumonia, dysentery, diarrhea, tetanus, measles, anemia, meningitis, nutritional deficiencies, and bronchitis. Low incomes and living conditions for the Africans leave them vulnerable to disease, a situation incongruent with the vast economic wealth of the Republic. For example, more than 55,000 Africans died from tuberculosis in one year compared to 824 whites during the same period, according to official Ministry of Health figures in 1970.2 Tuberculosis is a major killer of the malnourished. Regrettably, malnutrition is all too familiar to the African babies of the "homeland" reserves who are reported to have only a 50 percent chance of ever reaching the age of five. Yet, white infant mortality rates compare with those of most industrialized nations. Such startling rates are considered by most health experts to be reli-
able indicators of a community's level of health. Higher incomes would undoubtedly break the links between massive poverty, malnutrition, deficiency diseases, and death. But apartheid denies the Africans the right to negotiate wages in a way open to whites. Two thirds of all urban Africans live far below a monthly "poverty income level" set at Rand (R) 75 (US $105) in 1972. Disease follows in the wake of such poverty; the resultant burden falls especially upon the poorest: nearly 800 Africans had leprosy in 1970 compared to two whites, four coloreds, and one Asian. In the same period, 4,000 Africans contracted typhoid, compared to 60 whites, 231 coloreds, and 32 Asians.2 Budgeted expenditures for health services during 1976-1977 are shown in Table 1.3 As of 1977, expenditures on health by the South African government increased by 234 percent over the prior six years. Costs for services rendered specifically to blacks were not available although it is reported that in the "total" public sector, approximately $28.79 (US) is spent on health services per year per person. Although Briefs continued on page 1234
VVen
N~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I
.,j
A~~~~~~~~~~~~~~~~~~fy~~ 4~
~
~
~
~
~
~ ~ ~
~
~
#~~~~wsP
n~~IfQfI
omn
§..
~~~~~~~~~~~~~~~~~~~~~osej
ea
0IaEandroga~~~~~~~~~~~~~~~~~~~
.5~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~erae :7 ~~
~ ~ ~ ~ irol
eeuuaQ
nIitahe,*
i
sInsvr
American Artist~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~i d v
i#
isyw
Briefs continued from page 1233
Table 2. Health Maintenance Costs
Controlling Activity
Table 1. Health Expenditures
1976/1977
Agency Department of Health Provincial Administration Homelands Total
Central Government Maternal Hospitals Tuberculosis Hospitals Provincial Administrations Cape Natal Orange Free State Transvaal Black Homelands
$134,754,000
533,435,000 69,858,000 $741,047,000
the government's statistics would have one believe that the increase in expenditures for health services is inclusive of all racial groups, there remains a huge disparity as illustrated by Table 2.3
The Black Physician There is a shortage of African physicians in South Africa because they lack prior education and money to support themselves. Most important is the fact that they were once barred from all but one medical school. Over a 25-year period, only 225 black physicians received their licenses to practice medicine; that number is slowly in-
Cost/Patient/Day (US $)
creasing, however. An advertisement reflecting the wide disparity among pay scales was carried in several professional journals. The announcement indicated that colored and Asian physicians were being sought at a salary rate of 76 to 81 percent of that paid to white physicians, while an African physician's salary would approach only 74 to 64 percent of the scale for white physicians. In cash terms, the State recruited white medical officers in 1972 at a maximum annual salary of R 8,100, coloreds or Asians at R 6,600, and Africans at R 6,000. Even greater pay dis-
4.64 6.09 20.96 18.98 23.66 18.76 9.90
crepancies exist for non-white nurses, radiographers, and physiotherapists: a white student nurse earned a maximum of R 1,920, coloreds and Asians R 1,170, and Africans R 840.4
Segregated Health Services Sick black patients make considerable demands on their segregated hospital and clinic facilities. Most of these hospitals have bad reputations. They are often overcrowded, unsanitary, deBreifs continued on page 1235
1YLENOL EQUIPOTENT TO ASPIRIN REGULAR STRENGTH 1 _e
Clinically substantiatedl-3 that mg for mg TYLENOL provides effective analgesia equivalent to aspirin
I Roundtable on Analgesics. Patient Care (Feb.) 1972, p 21. Lasagna, L. Data on File. McNeil Laboratories, 1974. 3. Goodman, L.S., and Gilonan, A., eds.: The Pharmacological
Basis of Therapeucs, ed 5 New d oerk,The Macmillan Companyd 19cn, p.34
325
o n
mg tablets
acetaminophen
u in Rxanaleesia non The loo ical st choice
Do not exce edowmnends dowe IMoh aWhn andwaebminophen n brge ovrdos eecanCus#swiusadnwe fctL
,,~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~. '
,.,
..........
...........
............. ,......
_
....................
~~rt}~DvOL-YS ^I~SOmg
......I
...F . . ^ .. . . . .. .. . .... ...... ... .. . . . |
i
I_
1
.q_n.
z
EXTASTRENGTH TYLNLE_,
-,
FOR INC:REASED POTENCY
| ".two 500mfg units (1000 mng) of acetamwinophen produced significantly |greater analgesia than did two 325 mg units (650 mg) of acetaminophen'"
|4 Ho9krnson J H ill etal Curr Ther Res 16:194 (March) 1974
0 McN 1978
. _ JX
^ _ |E| E._S
...
g
ficient in medicines and supplies, and staffed by insensitive medical staffs. In 1972, ten hospital beds per thousand existed for non-whites. In the "homelands," where health standards are the lowest, the figure dropped to 3.48 beds per thousand. Statistically, about 43 percent of all beds in South Africa in 1972 were allocated to the white minority (17 percent of the population). Other than the massive local health delivery system in Soweto, the least provision is made in "homelands" for those with the greatest need for health services.5 When comparisons are drawn for the various racial groups, ratios show that access to qualified medical services is a function of race and not the availability of the best resources in this racist country. From medical school operating theatre to ambulance services, racial segregation dominates the country's entire health network. In 1962, the government ruled that its "policy" be extended to blood
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
i
ETYLSTENOLH EXTR-SRNT
|acetaminophen
The logical 1stchoice
O o notexed recommede dosg. Both aspirin and aemnoen in large ovedose can cause erosadverseefcs
Briefs continued from page 1234
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.......
classification. The labelling of blood donations is but one more indication of the unscientific attitude underlying the apartheid concept. Such acts of moral, economic, and social injustice make the Republic of South Africa the last bastion of the most pronounced and institutionalized form of racism to be found anywhere in the world today.
Conclusion The tragic dilemma in which the African finds himself when seeking segregated health services is clearly seen in drastically disparate rates of disease incidence, the acute and worsening shortage of health personnel, and the archaic and inadequate "arrangements" necessitated by apartheid. For millions of blacks, the qVality of health care is so poor that they may easily find themselves worse off because of their contact with the system. Now at last, fierce winds of change have begun to blow and the sun has begun to set on the rigid apartheid system. Every effort must be made to eliminate social conditions which provide
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979
in
500 mgc p ue m ap'e
non-Rxc analgesia
McNeil Consumner Products Company (d s Fort Washington, PA 19034 tMNI
the breeding ground for disease, suffering, humiliation, and poverty in the African "homelands." With the assistance of the United Nations, the World Health Organization, and enlightened governments at home and abroad, measures must be taken to control nutritional deficiencies, occupational and communicable diseases, and accidental injuries in the vast mining complexes. With extensive changes in the socioeconomic and human conditions, many of these problems can be resolved in our generation, before the final sunset.
Literature Cited 1. Quinn S: The Afrikaner's burden. Washington Post, March 4, 1979, p B 1 2. Gray TJ: Apartheid: Disease of human relations. World Health, July 1976, pp 3-4 3. Rensburg CV: The health of the people: A review of the health services in the Republic of South Africa in the mid-seventies. Johannesburg, 1977, pp 47-48 4. True facts about medicine in South Africa. S Afr Med J (Suppl), July 1974 5. Faber DA: A closer look at South Africa. South African Scope, 1975, p 7
Briefs continued on page 1236 1235
