79
The
Mentally Handicapped Child
A PLAN FOR ACTION JEANNE MALES, B.A., M.PHIL., A.B.Ps.S. Senior Clinical Psychologist, St Lawrence’s
Hospital, Caterham, Surrey
HOPE in this paper to discuss some aspects of a for action for mentally handicapped children, or at least some philosophical approaches which should underline such planning, first for the individual and then overall. I do not hope to outline all the plans made by various groups in the past months as the National Development Group booklets are available to all, the Court report to the more affluent and so on, and I shall only make reference to them. At the heart of the matter are our clients they must be central to all the planning that is carried out. It is therefore essential to say a few things about them. Our clients are children who are mentally handicapped. In considering their needs it is necessary to understand that they are first and foremost children and that therefore their needs are primarily those of all children. The National Development Group in the pamphlet Mentally Handicapped Children: a plan for action says: &dquo;These children are children first and mentally handicapped second&dquo;. This is indeed how they should be viewed. In the past it has often appeared to be the case that plans have been made for &dquo;the mentally handicapped&dquo; as if appropriate action could be taken for a group of people without concern for individual needs. This is of course changing but it must change further, in the following respect. Mentally handicapped children must be regarded not only as children when plans are made, but as children who, like all others will grow up into adults. I do not therefore intend to limit my comments this afternoon entirely to mentally handicapped children, as it is also imperative to plan for their future adulthood. Mentally handicapped children are often attractive and relatively easy to cope with, and pull hard at one’s emotions, but adults handicapped in this way have a very different public image which is far less attractive. Mentally handicapped adults with adult physical and emotional needs are often neglected because it is difficult to be sure of the direction planning should take for them, and plans are often not put into action because staff in hospitals, hostels and group homes are unsure as to how far such needs should be met. Some years ago I read some guidelines about the
plan
-
-
of mentally handicapped people in which it was stated that mentally handicapped adults are best treated as if they are children. I hope that attitude is finding less and less support as years go by. Mentally handicapped children do not grow up to be large size mentally handicapped children, but to be mentally handicapped adults. They may be childlike but they are rarely childish. In order to explain this, I should like to refer to definitions of these words. care
Childlike
-
having good qualities
of
a
child,
innocence, frankness, etc. Childish Of, proper to,
a child ... improper for a grown person. It is often true that mentally handicapped adults are childlike in the wonder they show of the world around them and the fascination with which they view new experiences. This may be the result of deprivation of experience in the past, which may occur at home as well as in residential care. -
COMMUNITY CARE WHAT
for the future? One of the most discussed ideals at present is that of the move away from hospital to community care for mentally handicapped people: indeed this has been discussed once more in the national press this week. The case for community care is felt particularly strongly in respect of children and the National Development Group clearly states that mentally handicapped children should not be admitted to hospitals unless all agree that they need the specialist treatment available. I do not think I know of any professionals in the field who would want admissions to occur unless those criteria were met. However, at present the strength of the &dquo;community care lobby&dquo; appears to be hampering the development of hospital care while it is still necessary. While there are few facilities in the community for the care of mentally handicapped children and poor support services for families who care for their handicapped children at home, short and long term care has to be provided in many cases by the older long stay hospitals and these have to be given the resources to make their facilities suitable for the needs of children. The adverse publicity given to more institutional forms of care does not assist those who are caring for people under these circumstances: 50,000 people cannot be discharged overnight and without adequate support and facilities, it becomes impossible to provide the level of care and degree of normality that everyone agrees mentally handicapped people deserve. Unless these basics are provided individuals cannot approach the level of independence required for most types of community life: this requires training which in turn must demand extra resources if it is to be achieved. One of the most encouraging things about all the work of the National Development Group is its emphasis on the individual. It is always difficult for planners to look at problems in these terms but the emphasis of the National Development Group has OF
planning
consistently
... _
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
80
consistently
been
on
individual assessment, individual
treatment programmes and so on, at all age levels. The
implication of this approach is that services for mentally handicapped people must in the future take more notice than ever before of an individual’s needs, be they educational, physical, emotional or social. This approach inevitably involves allowing mentally handicapped people a real element of choice, and allowing this to children as they begin to grow up, as well as to adults. In my own experience I have heard children who are approaching school leaving age make very definite decisions about how they would like to spend their working life, and this must be accounted for, even if it is perhaps unpopular with planners, professionals, and parents. We must be prepared to provide for the best interests of the individual, whether he be in
hospital or community care. Truly individual assessment by a therapeutic professional team must take all
these needs into account and must abandon the individual professional needs which sometimes gain most
importance.
We must plan for people first, who are secondly mentally handicapped: they are people with individual feelings and emotions and practical needs, and these must be considered individually if the service that is provided for mentally handicapped people is a caring
service.
What action should be taken overall? It has been
long since recognized that the major problem in mental handicap is an educational one and this approach is frequently being contrasted with the older custodial system that existed. Mentally handicapped people have, one would hope, benefited greatly from this change in attitude and subsequent change in approach. What I should like to propose is that for the future benefit of mentally handicapped children and adults this educational approach should become much
broader. The National Development Group and the Campaign for the Mentally Handicapped and other pressure
groups for the mentally handicapped is putting increasing demands on the community by expecting
mentally handicapped children to stay at home and by expecting increasing community based provisions to be made. There must, therefore, be a far greater attempt to educate the community at all levels so that they may understand the true nature of mental handicap. Without this approach, the concept of comin many cases the community care may well die munity cannot care because of ignorance and misunderstanding. I should like to use some examples. St Lawrence’s Hospital has been a central feature of the Caterham community for just over 100 years and has consistently made efforts to involve the community in the hospital, at least in recent years. It is not an isolated it is within an urban area in commuting distance from London. One wobld expect therefore for the residents of Caterham to be perhaps unusual in their awareness and one would hope their understanding of mental handicap. I should like to give a description of three incidents that have occurred this year, which readers of Parents Voice will have seen discussed in Geoff Harris’ article Can the Community offer this service? (1) A letter was received from a Member of Parliament who had himself received a complaint from a constituent that it was unsafe to take a child to the local park because of the residents from the hospital for the mentally ill. It was clear that the complainant did not understand the difference more
-
hospital,
between mental illness and mental handicap despite the hospital’s attempt to involve the public. (2) The local hairdresser’s salon complained that because residents from the hospital were using the salon other clients were unwilling to patronize it. (3) The local tea-shop asked that mentally handicapped people should be discouraged from eating there as they were adversely affecting custom. And these incidents occurred in a community which as I have already suggested has had more exposure to the realities of mental handicap than many others. If our own local community cannot care, can others? The need for education should become priority if a move away from the seclusion of mentally handicapped people is going to become successful.
THREE APPROACHES TO EDUCATION HAVING I hope persuaded you of the need for such an approach, how should the situation be tackled from the practical point of view? I would suggest three major ways. First, practical first-hand experience of mental handicap. It is well known that practise and experience of a task is a powerful educational weapon, and combined with an input of information it can be most effective. Thus voluntary service departments in hospitals and in the community may be used to great effect as educational departments. The voluntary service department at St. Lawrence’s Hospital is a relatively large one: approximately 450 volunteers take part in a variety of activities throughout the hospital. One hundred of these are school-children on half-day release schemes linked with social studies courses, and 150 are young people attending after school and at weekends. The rest are adults. It is interesting to note that about 10 per cent of the young people who volunteer carry on into one of the caring professions, but far more about 25 per cent continue in some form of voluntary work when they start work or become university students. The voluntary service department, which does incidentally make an effort to teach about mental handicap as well as use pairs of hands, is having an effect on young people’s understanding of handicap-
ping conditions.
As you can see, we have started with the young, and further way of achieving this aim is by direct contact with schools, and this is my second point. At St Lawrence’s Hospital we are at the very beginning of an experimental educational programme with schoolchildren in which we survey the children’s opinions about mental handicap, carry out a teaching programme with them, and follow it up with direct contact with the hospital. We have been so far surprised by the maturity of approach of some teenagers towards mental handicap, and by the amount of interest shown if information and study afternoons are made available. We have already carried out a pilot study at one school and of 711 young people surveyed, 80 per cent had at least some idea of the nature of mental handicap. Less than this, about 57 per cent were keen to know more and there was general interest in the presentation of information and questioning by the children. The third approach to education is via the media. It has been notable in the past, but perhaps becoming less so now, how the media has concentrated its attentions on the sensational aspects of mental handicap and has largely ignored the efforts and achievements of mentally handicapped people and the people who work with them. Clearly the sensational and negative aspects of mental handicap are of interest to the public but so a
keen
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
81 would be the positive aspects if these were thoroughly described. The achievements of mentally handicapped people &dquo;against all odds&dquo; in many cases are quite remarkable, but the burden lies with the professionals to publicise these achievements. The abilities of Joey Deacon which were displayed in his book Tongue Tied have done much to give mental handicap a human face. More recently the creative artwork of George Ellis, whose one-man exhibition opens next week, shows a great deal of how a man with multiple handicaps can break through the constraints traditionally placed upon him by an institution. These individuals can themselves educate the public via their own creative media, but once given this sort of positive information the press will use it. We can, then, it seems to me, begin to educate
WASTE DISPOSAL IN DEVELOPING COUNTRIES Continued from page 78
refuse
Lagos.
receptacles
with
covers
to all the
society
major ways: by encouraging voluntary contact with schools (and surely also groups) and by using the press to publicise
in three
service, by direct
with other the good as well as the bad. Without a caring community, community care will not be successful: without knowledge the community cannot care.
BIBLIOGRAPHY
DEACON, J. (1974) Tongue Tied. N.S.M.H.C.
HARRIS, G. (1978) Can the Community offer this Service? Parents Voice 28 (2) 4-6. The World of George Ellis: Creativity in an Institution (1978). Exhibition held at the Hertfordshire College of Art & Design, St.
Albans, 27.10.78-11.11.78.
National Development Group (1977). Mentally dren : A Plan for Action. Pamphlet No. 2.
Handicapped Chil-
contractors may prove more efficient if
premises in
2. The local authority should purchase more refuse collection vehicles based on actual need and institute a regular collecting schedule for the whole of Lagos and its environs. The schedules, timetable and dates must be well publicised to ensure cooperation of the public. 3. In the planning stage of new estates the expertise of Community Physicians must be sought and obtained on all health related matters. 4. For new estates it is recommended that service lanes be provided for use of refuse collection vehicles to facilitate collection with little or no obstruction to flow of traffic. 5. If the perennial traffic congestion in Lagos continues to hinder day collection of refuse in some districts it may be worth while to operate special night shifts particularly for these districts. Further research is needed to find out the most suitable time of the day for refuse collection in different parts of Lagos. 6. Mass health education of the public through all available media and by voluntary agencies should be embarked upon immediately. 7. Legislation on environmental sanitation norms, and imposition of penalties on defaulters. 8. If there is no apparent improvement in the collection services after taking the above measures, it may be advisable to contract out the refuse collection and disposal service. The service rendered by the
handled in a business-like manner. 9. Further research is necessary on many aspects of refuse collection in Lagos in which information appears lacking e.g. the relationship in terms of labour costs of storage at the source of production and the use of centralized vehicle collection points. There are no reliable statistics on the optimum size of a collecting gang or crew in relation to the size of vehicles. The relationship of collecting frequency to cost, and cost in terms of manpower and finance is not fully known. ACKNOWLEDGEMENT WE WISH to thank Mrs A. A. Williams
(Interviewer) Department of Community Health, Lagos University Teaching Hospital for assistance rendered in the early part of the study and Mr E. O. Ewumi for the statistical analysis of the data. REFERENCES 1 CEMINO, J. A. (1975). ’Health and Safety in the solid waste industry’ Am. J. Pub. Hlth. Vol. 64, No. 1. 1975, pp 38-46. 2 FEDERAL OFFICE of STATISTICS, LAGOS, NIGERIA. Housing conditions in selected Nigerian Towns: Survey 1970-71. 3 HANKS T. G. (1967). ’Solid Waste Disease Relationships’ A literature survey Public Health Service Pub. No. 999 — UIH — 6, 1967. Cincinnati, 4 MORGAN, R. (1968). ’Family Units in Lagos’ (Unpublished). 5 NATIONAL SAFETY NEWS (1969). ’ Refuse Collection in Data sheet No. 6. 8, 1969. Municipalities’ 6 OLUWANDE, O. (1970). Personal Communication. 7 WHO (1974). Technical Report Series No. 553, 1974. 8 WILLIAMS, G. A. (1971, 1973). Medical Officer of Health’s Reports 1971 pp. 1-10. 1973 pp 2-5. —
—
—
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
The
Mentally Handicapped Child
A PLAN FOR ACTION JEANNE MALES, B.A., M.PHIL., A.B.Ps.S. Senior Clinical Psychologist, St Lawrence’s
Hospital, Caterham, Surrey
HOPE in this paper to discuss some aspects of a for action for mentally handicapped children, or at least some philosophical approaches which should underline such planning, first for the individual and then overall. I do not hope to outline all the plans made by various groups in the past months as the National Development Group booklets are available to all, the Court report to the more affluent and so on, and I shall only make reference to them. At the heart of the matter are our clients they must be central to all the planning that is carried out. It is therefore essential to say a few things about them. Our clients are children who are mentally handicapped. In considering their needs it is necessary to understand that they are first and foremost children and that therefore their needs are primarily those of all children. The National Development Group in the pamphlet Mentally Handicapped Children: a plan for action says: &dquo;These children are children first and mentally handicapped second&dquo;. This is indeed how they should be viewed. In the past it has often appeared to be the case that plans have been made for &dquo;the mentally handicapped&dquo; as if appropriate action could be taken for a group of people without concern for individual needs. This is of course changing but it must change further, in the following respect. Mentally handicapped children must be regarded not only as children when plans are made, but as children who, like all others will grow up into adults. I do not therefore intend to limit my comments this afternoon entirely to mentally handicapped children, as it is also imperative to plan for their future adulthood. Mentally handicapped children are often attractive and relatively easy to cope with, and pull hard at one’s emotions, but adults handicapped in this way have a very different public image which is far less attractive. Mentally handicapped adults with adult physical and emotional needs are often neglected because it is difficult to be sure of the direction planning should take for them, and plans are often not put into action because staff in hospitals, hostels and group homes are unsure as to how far such needs should be met. Some years ago I read some guidelines about the
plan
-
-
of mentally handicapped people in which it was stated that mentally handicapped adults are best treated as if they are children. I hope that attitude is finding less and less support as years go by. Mentally handicapped children do not grow up to be large size mentally handicapped children, but to be mentally handicapped adults. They may be childlike but they are rarely childish. In order to explain this, I should like to refer to definitions of these words. care
Childlike
-
having good qualities
of
a
child,
innocence, frankness, etc. Childish Of, proper to,
a child ... improper for a grown person. It is often true that mentally handicapped adults are childlike in the wonder they show of the world around them and the fascination with which they view new experiences. This may be the result of deprivation of experience in the past, which may occur at home as well as in residential care. -
COMMUNITY CARE WHAT
for the future? One of the most discussed ideals at present is that of the move away from hospital to community care for mentally handicapped people: indeed this has been discussed once more in the national press this week. The case for community care is felt particularly strongly in respect of children and the National Development Group clearly states that mentally handicapped children should not be admitted to hospitals unless all agree that they need the specialist treatment available. I do not think I know of any professionals in the field who would want admissions to occur unless those criteria were met. However, at present the strength of the &dquo;community care lobby&dquo; appears to be hampering the development of hospital care while it is still necessary. While there are few facilities in the community for the care of mentally handicapped children and poor support services for families who care for their handicapped children at home, short and long term care has to be provided in many cases by the older long stay hospitals and these have to be given the resources to make their facilities suitable for the needs of children. The adverse publicity given to more institutional forms of care does not assist those who are caring for people under these circumstances: 50,000 people cannot be discharged overnight and without adequate support and facilities, it becomes impossible to provide the level of care and degree of normality that everyone agrees mentally handicapped people deserve. Unless these basics are provided individuals cannot approach the level of independence required for most types of community life: this requires training which in turn must demand extra resources if it is to be achieved. One of the most encouraging things about all the work of the National Development Group is its emphasis on the individual. It is always difficult for planners to look at problems in these terms but the emphasis of the National Development Group has OF
planning
consistently
... _
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
80
consistently
been
on
individual assessment, individual
treatment programmes and so on, at all age levels. The
implication of this approach is that services for mentally handicapped people must in the future take more notice than ever before of an individual’s needs, be they educational, physical, emotional or social. This approach inevitably involves allowing mentally handicapped people a real element of choice, and allowing this to children as they begin to grow up, as well as to adults. In my own experience I have heard children who are approaching school leaving age make very definite decisions about how they would like to spend their working life, and this must be accounted for, even if it is perhaps unpopular with planners, professionals, and parents. We must be prepared to provide for the best interests of the individual, whether he be in
hospital or community care. Truly individual assessment by a therapeutic professional team must take all
these needs into account and must abandon the individual professional needs which sometimes gain most
importance.
We must plan for people first, who are secondly mentally handicapped: they are people with individual feelings and emotions and practical needs, and these must be considered individually if the service that is provided for mentally handicapped people is a caring
service.
What action should be taken overall? It has been
long since recognized that the major problem in mental handicap is an educational one and this approach is frequently being contrasted with the older custodial system that existed. Mentally handicapped people have, one would hope, benefited greatly from this change in attitude and subsequent change in approach. What I should like to propose is that for the future benefit of mentally handicapped children and adults this educational approach should become much
broader. The National Development Group and the Campaign for the Mentally Handicapped and other pressure
groups for the mentally handicapped is putting increasing demands on the community by expecting
mentally handicapped children to stay at home and by expecting increasing community based provisions to be made. There must, therefore, be a far greater attempt to educate the community at all levels so that they may understand the true nature of mental handicap. Without this approach, the concept of comin many cases the community care may well die munity cannot care because of ignorance and misunderstanding. I should like to use some examples. St Lawrence’s Hospital has been a central feature of the Caterham community for just over 100 years and has consistently made efforts to involve the community in the hospital, at least in recent years. It is not an isolated it is within an urban area in commuting distance from London. One wobld expect therefore for the residents of Caterham to be perhaps unusual in their awareness and one would hope their understanding of mental handicap. I should like to give a description of three incidents that have occurred this year, which readers of Parents Voice will have seen discussed in Geoff Harris’ article Can the Community offer this service? (1) A letter was received from a Member of Parliament who had himself received a complaint from a constituent that it was unsafe to take a child to the local park because of the residents from the hospital for the mentally ill. It was clear that the complainant did not understand the difference more
-
hospital,
between mental illness and mental handicap despite the hospital’s attempt to involve the public. (2) The local hairdresser’s salon complained that because residents from the hospital were using the salon other clients were unwilling to patronize it. (3) The local tea-shop asked that mentally handicapped people should be discouraged from eating there as they were adversely affecting custom. And these incidents occurred in a community which as I have already suggested has had more exposure to the realities of mental handicap than many others. If our own local community cannot care, can others? The need for education should become priority if a move away from the seclusion of mentally handicapped people is going to become successful.
THREE APPROACHES TO EDUCATION HAVING I hope persuaded you of the need for such an approach, how should the situation be tackled from the practical point of view? I would suggest three major ways. First, practical first-hand experience of mental handicap. It is well known that practise and experience of a task is a powerful educational weapon, and combined with an input of information it can be most effective. Thus voluntary service departments in hospitals and in the community may be used to great effect as educational departments. The voluntary service department at St. Lawrence’s Hospital is a relatively large one: approximately 450 volunteers take part in a variety of activities throughout the hospital. One hundred of these are school-children on half-day release schemes linked with social studies courses, and 150 are young people attending after school and at weekends. The rest are adults. It is interesting to note that about 10 per cent of the young people who volunteer carry on into one of the caring professions, but far more about 25 per cent continue in some form of voluntary work when they start work or become university students. The voluntary service department, which does incidentally make an effort to teach about mental handicap as well as use pairs of hands, is having an effect on young people’s understanding of handicap-
ping conditions.
As you can see, we have started with the young, and further way of achieving this aim is by direct contact with schools, and this is my second point. At St Lawrence’s Hospital we are at the very beginning of an experimental educational programme with schoolchildren in which we survey the children’s opinions about mental handicap, carry out a teaching programme with them, and follow it up with direct contact with the hospital. We have been so far surprised by the maturity of approach of some teenagers towards mental handicap, and by the amount of interest shown if information and study afternoons are made available. We have already carried out a pilot study at one school and of 711 young people surveyed, 80 per cent had at least some idea of the nature of mental handicap. Less than this, about 57 per cent were keen to know more and there was general interest in the presentation of information and questioning by the children. The third approach to education is via the media. It has been notable in the past, but perhaps becoming less so now, how the media has concentrated its attentions on the sensational aspects of mental handicap and has largely ignored the efforts and achievements of mentally handicapped people and the people who work with them. Clearly the sensational and negative aspects of mental handicap are of interest to the public but so a
keen
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
81 would be the positive aspects if these were thoroughly described. The achievements of mentally handicapped people &dquo;against all odds&dquo; in many cases are quite remarkable, but the burden lies with the professionals to publicise these achievements. The abilities of Joey Deacon which were displayed in his book Tongue Tied have done much to give mental handicap a human face. More recently the creative artwork of George Ellis, whose one-man exhibition opens next week, shows a great deal of how a man with multiple handicaps can break through the constraints traditionally placed upon him by an institution. These individuals can themselves educate the public via their own creative media, but once given this sort of positive information the press will use it. We can, then, it seems to me, begin to educate
WASTE DISPOSAL IN DEVELOPING COUNTRIES Continued from page 78
refuse
Lagos.
receptacles
with
covers
to all the
society
major ways: by encouraging voluntary contact with schools (and surely also groups) and by using the press to publicise
in three
service, by direct
with other the good as well as the bad. Without a caring community, community care will not be successful: without knowledge the community cannot care.
BIBLIOGRAPHY
DEACON, J. (1974) Tongue Tied. N.S.M.H.C.
HARRIS, G. (1978) Can the Community offer this Service? Parents Voice 28 (2) 4-6. The World of George Ellis: Creativity in an Institution (1978). Exhibition held at the Hertfordshire College of Art & Design, St.
Albans, 27.10.78-11.11.78.
National Development Group (1977). Mentally dren : A Plan for Action. Pamphlet No. 2.
Handicapped Chil-
contractors may prove more efficient if
premises in
2. The local authority should purchase more refuse collection vehicles based on actual need and institute a regular collecting schedule for the whole of Lagos and its environs. The schedules, timetable and dates must be well publicised to ensure cooperation of the public. 3. In the planning stage of new estates the expertise of Community Physicians must be sought and obtained on all health related matters. 4. For new estates it is recommended that service lanes be provided for use of refuse collection vehicles to facilitate collection with little or no obstruction to flow of traffic. 5. If the perennial traffic congestion in Lagos continues to hinder day collection of refuse in some districts it may be worth while to operate special night shifts particularly for these districts. Further research is needed to find out the most suitable time of the day for refuse collection in different parts of Lagos. 6. Mass health education of the public through all available media and by voluntary agencies should be embarked upon immediately. 7. Legislation on environmental sanitation norms, and imposition of penalties on defaulters. 8. If there is no apparent improvement in the collection services after taking the above measures, it may be advisable to contract out the refuse collection and disposal service. The service rendered by the
handled in a business-like manner. 9. Further research is necessary on many aspects of refuse collection in Lagos in which information appears lacking e.g. the relationship in terms of labour costs of storage at the source of production and the use of centralized vehicle collection points. There are no reliable statistics on the optimum size of a collecting gang or crew in relation to the size of vehicles. The relationship of collecting frequency to cost, and cost in terms of manpower and finance is not fully known. ACKNOWLEDGEMENT WE WISH to thank Mrs A. A. Williams
(Interviewer) Department of Community Health, Lagos University Teaching Hospital for assistance rendered in the early part of the study and Mr E. O. Ewumi for the statistical analysis of the data. REFERENCES 1 CEMINO, J. A. (1975). ’Health and Safety in the solid waste industry’ Am. J. Pub. Hlth. Vol. 64, No. 1. 1975, pp 38-46. 2 FEDERAL OFFICE of STATISTICS, LAGOS, NIGERIA. Housing conditions in selected Nigerian Towns: Survey 1970-71. 3 HANKS T. G. (1967). ’Solid Waste Disease Relationships’ A literature survey Public Health Service Pub. No. 999 — UIH — 6, 1967. Cincinnati, 4 MORGAN, R. (1968). ’Family Units in Lagos’ (Unpublished). 5 NATIONAL SAFETY NEWS (1969). ’ Refuse Collection in Data sheet No. 6. 8, 1969. Municipalities’ 6 OLUWANDE, O. (1970). Personal Communication. 7 WHO (1974). Technical Report Series No. 553, 1974. 8 WILLIAMS, G. A. (1971, 1973). Medical Officer of Health’s Reports 1971 pp. 1-10. 1973 pp 2-5. —
—
—
Downloaded from rsh.sagepub.com at FLORIDA INTERNATIONAL UNIV on June 8, 2015
