A short review is presented of the service and academic commitments and activities
of the Department of Community Health in the three divisions of the
Epidemiology and Biostatistics
The problems being experienced by the Department at present and the implications
thereof, due to the absence of responsibility and service to an own
community, environment and health service are discussed. Training without
service is sterile and the student cannot relate his knowledge to personal experiences,
observations and actual situations and problems.
A review of existing and future health and training realities is given. The most
important realities are summarised herewith:
(a) The population of the RSA will by the year 2 000 be 50 million and by
202080 million. The RSA can only carry a population of 80 million. To
reduce the growthrate, it is essential to restrict the number of children
per woman to 2,1 and to improve the quality of life.
(b) The ratio of elderly to youth will be 1:5 by the year 2000 and 1:2 by 2040
compared to 1: 10 at present.
(c) Road accidents claimed 8 3751ifes during 1985 and the RSA has 16 times
more deaths per 100 km travelled than the USA although the accidents
per 100 km travelled are the same.
(d) The old world diseases of Malaria, Bilharzia, Leprosy, Tuberculosis etc
still plague the world and are in fact increasing: During 1985 11 322
malaria cases and 53 910 cases of Tuberculosis were notified in the RSA
and there were 1 229 deaths due to measles during 1985. There are 12
million known cases of leprosy in the world.
(e) In certain areas of the RSA 4% of children suffer from severe malnutrition
and 22 - 25% are underweight for age.
(f) In National States up to 50% of Medical Posts are vacant and para-
Digitised by the University of Pretoria, Library Services
medical personnel are a luxury. Although the RSA has sufficient doctors
for its population, there is a maldistribution of doctors. The reasons for
this are discussed and include: Academic isolation of workers in rural
areas; curricula are not directed at problems and needs of Africa; insufficient
health and school facilities and deficient infrastructure in rural
(g) General Medical education and practical training programmes are to a
large extent irrelevant to the problems and needs of Africa for both
developed and developing communities. After completion of his/her
studies, many students are not familiar wit!;, rural conditions and do not
identify with the problems of the communities. Too little emphasis is
placed on primary health care, appropriate technology and self-help to
prepare student to practice rural medicine with confidence. These statements
may equally apply to other Faculties.
(h) Black secondary science teaching is in a crisis due to acute shortage of
trained teachers. The result is a continued lowering of the matriculation
standard and pass rates, insufficient inflow of suitable candidates to
universities and therefore insufficient flow of teachers to schools.
The responsibilities of the university of student training, research and
service rendering are discussed with regard to the challenges presented
by the health and training realities in Southern Africa ie create opportunities
outside the campus for full-fledged, appropriate, real life training,
research, service and experience; relevant education directed
towards the needs of the whole community; balanced training/exposure
of students in high technology and primary health care/appropriate
technology, self-help etc; involvement with all community activities by
rendering of service as part of training.
As a solution the following is proposed: A massive service and training
outreach programme by the whole university towards all population
groups of the community, as part of the students' compulsory training
and in co-operation with other universities and the private
sector. Universities must accept that: Training involves service and
responsibility to the Community.