Health in Pietermaritzburg (1838-2008)

Julie Dyer

Description

This is a history of the health of the people of Pietermaritzburg, a developing city in Africa and capital of the province of KwaZulu-Natal in South Africa.

The book covers a period of about 170 years: from a time when a few explorers of European extraction started to settle themselves in a rural southern African valley, through the process of building and establishing a colonial town, followed by an apartheid city, and then a large multiracial and democratically governed metropolis of over 600 000 people.

It shows how this process of creating and inhabiting a city changed people's health, for better or worse; and looks at the impact of the built environment, the physical environment, the social and economic environment, and the policy and legal environment on health status.

The book examines the history of public health as affected by the process of urbanisation, combined with the peculiar form of social engineering that took place in South Africa, particularly during the Apartheid years.

Sujets

• Afrique du Sud
• KwaZulu-Natal
• Pietermaritzburg
• Urban
• Africa
• History
• Health
• Apartheid
• History of Africa
• Social sciences
• South
• Urban economics
• South Africa under apartheid
• South Africa
• Sociology
• Republic of South Africa
• Histoire

Informations

• Publié par: Natal Society Foundation
• Date de parution: 22 novembre 2012
• Nombre de lectures: 0
• EAN13: 9781991225627
• Langue: English
• Poids de l'ouvrage: 15 Mo

Extrait

Dr Julie Dyer was Medical Ofîcer of Health for Pietermaritzburg

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HEALTH IN PIETERMARITZBURG (1838 –2008)

A HISTORY OF URBANISATION AND DISEASE IN AN AFRICAN CITY

Julie Dyer

HEALTH IN PIETERMARITZBURG (1838–2008):

A history of urbanisation and disease in an African city

Julie Dyer

S F

Occasional Publications of the Natal Society Foundation PIETERMARITZBURG 2012

Health in Pietermaritzburg (1838–2008): A history of urbanisation and disease in an African city.© Julie Dyer 2012

First edition published in 2012 in Pietermaritzburg by the Trustees of The Natal Society Foundation under its imprint “Occasional Publications of The Natal Society Foundation”.

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without reference to the publishers, the Trustees of The Natal Society Foundation, PO Box 11093, Dorpspruit 3206 Pietermaritzburg, South Africa.

Natal Society Foundation website: http://natalia.org.za/

Editor: Christopher Merrett Assistant editors: Peter Croeser & Phila Mfundo Msimang Layout artist: Jo Marwick Graphic artist: Mthokozisi Chilli Zwane Printed and bound by: Interpak Books (Pty) Ltd, Pietermaritzburg

ISBN 978-0-6398040-5-7 (paperback)

CONTENTS

Abbreviations ............................................................................................ iv Foreword .............................................................................................. v Preface .............................................................................................. vii Chapter 1 Introduction: overview of Pietermaritzburg ........................ 1 Chapter 2 Health service provision ...................................................... 43 Chapter 3 Infectious diseases and epidemics ....................................... 70 Chapter 4 Sanitation, food and water-borne disease ............................ 94 Chapter 5 Diet and nutrition ................................................................. 134 Chapter 6 Murder, violence and accidents ........................................... 153 Chapter 7 Refuse, rodents and vector-borne disease ............................ 171 Chapter 8 Housing, hostels, overcrowding and  pulmonary tuberculosis ........................................................ 190 Chapter 9 Social development and health ............................................ 246 Chapter 10 Chronic disease and cancer .................................................. 267 Chapter 11 Air pollution and respiratory disease ................................... 283 Chapter 12 Sexually-transmitted infections, HIV and AIDS ................. 305 Chapter 13 Infant, child and maternal mortality ................................... 322 Chapter 14 Conclusions .......................................................................... 347 Medical Ofîcers of Health, Pietermaritzburg.....61..3.................................... Appendix A: Data tables for îgs 1.5, 1.9 and 6.4...................................... 362 Selected bibliography ................................................................................ 366 Glossary .................................................................................................... 371 Index ......................................................................................................... 375

iv

AEMS ANC APT ARV ATICC CINDI CNS COAD COSATU CPSA CSIR CVA DBAB DHS DOTS DSB DWEP HIV IFP IMR JOC LAC LHC MMR MOH MOTT NATA NGO NIC NIO NRC PACSA RDP SANTA STD TRC UDF UNISA VDRL WHO WR XDR

HEALTH IN PIETERMARITZBURG (1838-2008)

ABBREVIATIONS

ambulance and emergency medical services African National Congress artiîcial pneumothorax anti-retroviral AIDS Training, Information and Counselling Centre Children in Distress Network Central Nervous System Chronic Obstructive Airways Disease Congress of South African Trade Unions Communist Party of South Africa Council for Scientiîc and Industrial Research Cerebrovascular Accident Drakensberg Bantu Administration Board District Health System Directly Observed Treatment: Short course Development and Services Board Domestic Workers and Employers Project Human Immunodeîciency Virus Inkatha Freedom Party infant mortality rate Joint Operations Centre Local Affairs Committee Local Health Commission maternal mortality rate Medical Ofîcer of Health Mycobacteria Other Than Tuberculosis Natal Anti-Tuberculosis Association non-governmental organisation Natal Indian Congress Natal Indian Organisation National Reference Centre Pietermaritzburg Agency for Christian Social Awareness Reconstruction and Development Programme South African National Tuberculosis Association sexually-transmitted disease Truth and Reconciliation Commission United Democratic Front University of South Africa Venereal Disease Research Laboratory World Health Organisation Wassermann Reaction extreme drug resistance

FOREWORD

v

DR JULIE DYER has written a fascinating and important book, and it is an honour for me to make a few introductory remarks about it. Histories of human societies have many aspects, many layers of interest and signiîcance. Few issues could be more important than that of health, for without a fair degree of health no society can keep going, let alone reproduce itself and grow productively. Histories and analyses of public health and of the prevalence of certain diseases are not uncommon in the First World, but in Africa they are rare. An intelligent history of health conditions in a city like Pietermaritzburg is bound to tackle the precise circumstances in which diseases occur and are dealt with or not dealt with, and this involves examining the ever-changing social, economic, political and environmental context. All this Dr Dyer has done carefully, knowledgeably and interestingly. The 170 years that she covers are momentous, as they constitute the period of colonialism, apartheid and post-apartheid. As she shows, questions of public health were from the îrst profoundly affected by the assumptions of the dominant race group; and later, under apartheid, by the legislation in which these assumptions assumed a rigid form. This book offers us a signiîcant and neglected portion of the broader social and political history of South Africa. But it is also very much more than that. Without in any way underplaying the shameful realities of the race prejudice that operated for most of the 170 years, the book brings out the details which are at times more complex. In the apartheid era, for example, the white municipal medical authorities of Pietermaritzburg were usually somewhat more sympathetic to Africans than the National Party legislators would have wanted them to be. The book is enriched by two of Dr Dyer’s attributes. The îrst is that she is a medical doctor and thus able to deal with diseases with precision and to divide them up into relevant and signiîcant categories. She was, in fact, for some years in the post-apartheid period the Medical Ofîcer of Health of what is now the enlarged Msunduzi Municipality. She therefore has an insider’s feeling for the numerous facts and statistics that she has unearthed. She is of course to be commended for the careful research work which has gone into the making of this book. Her second attribute is that she was brought up and qualiîed in Britain. She comes indeed from Shefîeld, one of the northern industrial towns from which many people emigrated during the course of the nineteenth century.

vi

HEALTH IN PIETERMARITZBURG (1838-2008)

The dual perspective offered by her British background and her current South African awareness and commitment has enabled her to make many fruitful and fascinating comparisons. She is able to show for example, by the use of relevant statistics, that in the second half of the nineteenth century life in Pietermaritzburg was considerably easier and healthier for a British immigrant than it would have been if he or she had decided to stay on in smoky and insalubrious industrial Britain. She also makes the point that in later years the descendants of the immigrants allowed conditions quite as bad as those of industrial Britain at its worst to develop among the African population of the area. It wasn’t all plain sailing in Pietermaritzburg, even for whites. Diseases came and went, the socio-economic situation was constantly changing, facilities didn’t always keep pace with population growth, and so on. The story that Dr Dyer tells is intriguing and challenging in all its details, and she is often able to put it into a national and international perspective. When Pietermaritzburg began, all the records tended to focus on whites. Then gradually Africans came onto the scene, together with Coloured people and Indians. In the end the whites were outnumbered. Apartheid was an attempt, for a while largely successful, to cut the population into sections, and to remove Africans from municipal jurisdiction, so that a city like Pietermaritzburg appeared on paper to consist almost entirely of whites and Indians. But of course the Africans were there all the time, living mainly in Edendale, just outside the ofîcial city boundary. The ending of apartheid meant the ending of artiîcial barriers between people. For the îrst post-apartheid years the authorities struggled to extend health services to everyone, with success: in 2002 Pietermaritzburg was (partly as a result of Dr Dyer’s own efforts) the îrst South African city to achieve equity in the provision of clinics. But it hasn’t been an easy task, and it has been made far more difîcult by the fact that in these years the HIV/AIDS pandemic has been at its height. Medical people, historians, sociologists, economists and the general reader should all be interested in this book. COLIN GARDNER Former Speaker of Msunduzi Municipality

PREFACE

vii

THIS IS A HISTORY of the health of the people of a developing city in Africa. It covers a period of about 170 years: from a time when a few explorers of European extraction started to settle themselves in a rural southern African valley, through the process of building and establishing a colonial town, followed by an apartheid city, and then a large multiracial and democratically governed metropolis of over 600 000 people. It shows how this process of creating and inhabiting a city changed peoples’ health, for better or worse; and looks at the impact of the built environment, the physical environment, the social and economic environment, and the policy and legal environment on health status. It examines the history of public health as affected by the process of urbanisation, combined with the peculiar form of social engineering that took place in South Africa. The political environment is not considered in great depth as this is covered in many other works. It is only referred to where relevant to developments around people’s physical health and well-being. Due to the historical nature of this book, and the peculiarities of South African history, various terminology that may now be considered by many as antiquated and inappropriate, if not completely insulting, is used to refer to people. Much thought was given whether the original racial descriptions should be used, or whether they should be amended and adapted to present- day standards. As this book relies heavily on historical material, it has been decided to use the original terms where appropriate and, of course, in quotations, although standardisation has been applied in general for the sake of clarity: Whites, Asians, Coloureds and Africans.  For example, the term Coloured appears originally to have meant non- European. Then it appears as the term for mixed race, in line with the apartheid meaning with which people are familiar today, followed in the 1920s by a term not used today − Eurafrican. The original inhabitants are described variously as Bantu, Native, African or indigenous; and those of Indian origin as Asian, Indian or originally the now offensive term Coolie. Under the Population Registration Act of the apartheid era all South Africans were categorised as White (formerly European), Coloured, African or Indian. Whichever term is used it is hoped that no offence will be taken at its usage, as certainly none is intended. The primary sources used for this work are the annual reports of the Medical Ofîcer of Health of Pietermaritzburg from 1908 to 2002; thePietermaritzburg

viii

HEALTH IN PIETERMARITZBURG (1838-2008)

Corporation Yearbook, published annually from 1908 to 1991; and the annual reports of the Medical Ofîcer of Health of the Local Health Commission from 1946 to 1974.

I would like to express my gratitude to John Morrison and Kammy Naidoo of the Bessie Head Public Library in Pietermaritzburg for assistance with references, and Ron Hulley for providing a copy of L.B. Jensen’sSouvenir of Maritzburgpublished by S.A.P. & Co [circa 1910], the source of many of the photographs in this book. I am grateful to Christopher Merrett for editorial input and compiling the index; to Peter Croeser and Phila Mfundo Msimang for additional editorial work; to Chilli Zwane for redrawing the graphs; to Anesh Roopan for the map of Msunduzi Municipality; and to Jo Marwick for lay-out and typography. Finally, my thanks to the Trustees of the Natal Society Foundation for publishing the book.

Julie Dyer, September 2012

1

INTRODUCTION: OVERVIEW OF PIETERMARITZBURG

IN 1936 THE MEDICALOfîcer of Health (MOH) for Pietermaritzburg, Dr C.C.P. Anning, made a remarkable statement: ‘the infantile mortality rate is the lowest for any town in the world’. Sixty-îve years later most of the measurements of health status for the city, for example life expectancy, were in a state of rapid decline. Behind the ups and downs of the health of Pietermaritzburg lies a fascinating story of urban development and deliberate neglect, of social engineering and deadly epidemics, and of those who sought to inuence these in one way or another. The health of the people of Pietermaritzburg is entwined inextricably with the development of the city, from its beginnings over 170 years ago to the bustling urban metropolis it has become at the start of the twenty-îrst century. The story of the urbanisation that occurred on a formerly pastoral and nomadic, sub-tropical African landscape goes hand in hand with changes in the health of the people who lived there. However, as with many aspects of South Africa, and indeed most former colonies, it is a story of more than one people – those who were part of the original indigenous population and the people who came to Pietermaritzburg from Europe, India, Mauritius and other parts of the sub- continent. The impacts of urbanisation on these various communities over the years were different in many ways and sometimes diametrically opposed. The story of the urbanisation of the early settlement of Pieter Mauritsburg illustrates the good and the bad, the best and the worst of the effect on the public health of the development of a European-style, racially segregated city in Africa. It is necessary to start with an overview of the story of Pietermaritzburg – how did it originate and why? A brief sketch of the history of the city, including a summary of the state of health at different periods, provides the background against which to describe speciîc aspects of public health in the following chapters.