JUNIE 1974 F I S I O T E R A P I E 9 NOMPUMELELO D.R.C. MISSION HOSPITAL PEDDIE CISKEI P H Y S IO TH E R A P Y DEPT. J . G . P E L S E R , M .C .S .P . P e d d i e is s i t u a t e d c l o s e t o t h e n a t i o n a l l o a d b e t w e e n King W i l l i a m ’s T o w n a n d G r a h a m s t o w n . T h e H o s p i t a l is a b o u t a n u l e f i o i n P e d d i e , , i l s o o n t h e n a t i o n a l r o a d , as o n e t r a v e l s f r o m P e d d i e t o G r a h a m s t o w n . T h e Af r i c a n p o p u l a t i o n i n t h e d i s t n c t t o t a l a p p i o M m a t e l y 4 2 0 0 0 . A t p i e s e n t t l i e i e a r c a b o u t p l u s - m i n u s 8 0 0 E u r o p e a n s r e s i d i n g i n t h i s d i s t r i c t . T h e h o s p i t a l i t s e l f a b e d a c c o m m o d a t i o n o l 2 2 0 i n c l u d i n g a C h i o n i c i vi si on o f 7 2 b e d s . Tn 1 9 7 4 w e s h a l l h a v e t w o l u l l ­ ti me m c d i c a l o f f i c e r s , a n d t w o o t h e i d o c t o r s i n p r i v a t e pract i ce, a l s o h e l p i n g a t t h e h o s p i t a l . O n e o f t h e p u v a t e p r a c t i t i o n e r s is a n A f r i c a n . In a d d i t i o n w e h a v e t w o E u r o p e a n s i s t e r s . 13 q u a l i f i e d A f i i e a n s i s t e r s , a p h y s i o ­ t h e r a p i s t , a n o c c u p a t i o n a l t h e r a p i s t , a s e c r e t a r y , a l a d y i n - c h a r g e o f l a u n d r y w o r k a n d t h e k i t c h e n , a w o i k ’s m an ager, a n d a s p i r i t u a l s o c i a l - w o r k e r i n o u i s e r v i c e . T h o s e l i s t e d a f t e r t h e A f i i e a n s i s t e r s a i e al l a t p r e s e n t E u r o p e a n s . B e s i d e s t h e s e m e n t i o n e d , o n e s h o u l d n e v e r forget t h a t w e a r e b e i n g a s s i s t e d b y m a l e a n d f e m a l e nurses, o f f i ce s t a f f , l a b o u r e r s a n d w o m e n w o r k i n g o n the d o m e s t i c s i d e . A d j a c e n t t o t h e h o s p i t a l p r e m i s e s , is a n o l d a g e h o m e whi c h a ls o a c c o m m o d a t c s a v a r i e t y o f p h y s i c a l l y h a n ­ d icapp ed X h o s a p e o p l e , r u n b y t h e C i s k c i G o v e r n m e n t . A few c l i n i c s a r e a l s o s u p e r v i s e d f r o m t h e h o s p i t a l a n d are used t o s e r v e t h e o u t l y i n g a r e a s o f t h e d i s t r i c t . In 1966 w i t h s e v e r a l o r t h o p a e d i c c a s e s b e i n g t r a n s f e r r e d from u r b a n h o s p i t a l s t o o u r c h r o n i c d i v i s i o n , t h e d o c ­ tors s o o n r e a l i s e d th e n e e d o f a p h y s i o t h e r a p i s t t o s t a r t a p h y s i o t h e r a p y d e p a r t m e n t . In J a n u a r y , 196 7 , I s t a r t e d the w o r k o f f i c i a l l y , w i t h n o e q u i p m e n t a n d a v e r y s m a l l space. A t fi r st w e h a d a s p a c e o f 2 0 ft . b y 10 ft. in w hich w e w e r e e x p c c t e d t o p e r f o r m a l l o u r p h y s i o ­ t h e r a p y t r e a t m e n t s . T h e o c c u p a t i o n a l t h e r a p i s t c o u l d o n ly c o n f i n e h e r a c t i v i t i e s t o w a r d w o r k , a n d p a c k i n g ^ a c e w a s s a d l y l a c k i n g . A t t h a t s t a g e i t w a s d i f f i c u l t t o o b t a i n a G o v e r n m e n t subsidy f o r t h e e r e c t i o n o f a p h y s i o t h e r a p y a n d o c c u ­ p a tio n a l d e p a r t m e n t . B o t h t h e M i s s i o n a n d H o s p i t a l B oards g a v e p e r m i s s i o n f o r u s t o l a u n c h a f u n d f o r this m u c h n e e d e d p r o j e c t . W i t h f e r v e n t p r a y e r , a p r o ­ fou nd f a i t h in G o d , a n d h a r d w o r k w e s e t a b o u t th is task. W e a c c e p t e d t h i s a s a c h a l l e n g e a n d d e s p i t e c e r ­ tain o b s t a c l e s s u c c e s s w a s a c h i e v e d . S e v e r a l p u b l i c bod ies, c h u r c h e s a n d i n d i v i d u a l s w e r e a p p r o a c h e d f o r d o n a tio n s a n d s u p p o r t i n o t h e r w a y s , s u c h a s a d v i c e in p l a n n i n g t h e w h o l e p r o j e c t . G e n e r o u s f i n a n c i a l s u p ­ port fr o m t h e P e d d i e R e d C r o s s S o c i e t y , t h e M i n e L a bour O r g a n i s a t i o n ( o r t h e N a t i o n a l R e c r u i t m e n t C o r ­ p o r a tio n ), t h e S . A . N a t i o n a l C o u n c i l f or ' t h e C a r e o f C rip p les, c e r t a i n s e c t i o n s o f t h e D u t c h R e f o r m e d C hurch, a n d i n t e r e s t e d i n d i v i d u a l s e n a b l e d u s t o e r e c t a p r e f a b r i c a t e d b u i l d i n g , t o a c c o m m o d a t e f a c i l i t i e s f o r p h y sio th e r a p y a n d o c c u p a t i o n a l t h e r a p y . T h e p h y s i c a l m e d i c i n e d e p a r t m e n t c o n s i s t s o f t h e f o l ­ l o wi n g r o o m s : a n of f i c e f o r t h e p h y s i o t h e r a p i s t ; of f i ce f o r t h e o c c u p a t i o n a l t h e r a p i s t , a c u b i c a l f o r e l e c t r o ­ t h e r a p y t r e a t m e n t s , a g y m n a s i u m f o r e x e r c i s e s s i z e (35 ft. x 2 0 f t . ) , a l a r g e h a l l for' o c c u p a t i o n a l t h e r a p y , and o t h e r f a c i l i t i e s s u c h a r e c r e a t i o n a n d p r a c t i s i n g o f A v i e w f r o m t h e a ir o f th e h o s p i t a l , w it h th e O ld A g e H o m e in th e b a c k g r o u n d . P h y s i o t h e r a p y D e p a r t m e n t o n t h e r ig h t . w a l k i n g ( s i z e 7 5 f t . x 3 0 I t . ) a n d l a t e l y a s m a l l c o m ­ p e l t m e n t w h i c h s e r v e s a s a k i o s k a n d a k i t c h c n f o r t h e o c c u p a t i o n a l t h e r a p i s t h a v e b e e n a d d e d . T h e d o n a t i o n s w e r e s u f f i c i e n t t o p u r c h a s e t h e n e c e s ­ s a r y e q u i p m e n t f o r o u r t r e a t m e n t s . A m o n g o t h e r s w e h a v e t h e f o l l o w i n g e q u i p m e n t a v a i l a b l e : A s h o r t w a v e d i a t h e r m y a p p a r a t u s , a t r e a t m e n t u n i t f o r e l e c t r i c a l m u s c l e s t i m u l a t i o n , a n u l t r a - s o u n d m a c h i n e , t w o i n ­ f r a r e d l a m p s , v a r i o u s t y p e s o f w a l k i n g a i d s , i n c l u d i n g l o n g p a r a l l c l - b a r s . a s t a t i o n a r y b i c y c l e , a s e l f - c o n s t r u c t c d s u s p e n s i o n a p p a r a t u s , w i t h s l i n g s , r o p e s , s t r a p s a n d s p r i n g s ; t w o e x e r c i s e m a t s , m e d i c i n e b a l l s a n d w e i g h t s . A s e c o n d - h a n d s h o r t w a v e d i a t h e r m y a p p a r a t u s w a s r e c e n t l y d o n a t e d t o t h e h o s p i t a l . It w a s a l s o p o s s i b l e t o p u r c h a s e t h e e s s e n t i a l e q u i p m e n t f o r o c c u p a t i o n a l t h e r a p y t r e a t m e n t . E v e n a f t e r s e v e n y e a r s o u r w o r k is st i l l m a i n l y f i n a n c e d b y t h e k i n d d o n o r s w h o h a v e h e l p e d u s i n t h e p a s t . A l t h o u g h M i s s i o n H o s p i t a l s a r e s u b s i d i s e d a h u n d r e d p e r c e n t b y t h e D e p a r t m e n t o f S t a t e H e a l t h , t h i s is o n l y i n t h e o r y , a s f a r a s i t a f f e c t s u s . T h e t y p e o f p a t i e n t s b e i n g t r e a t e d a t t h i s h o s p i t a l c a n b e d i v i d e d i n t o t h r e e m a i n c a t e g o r i e s : 1. P a t i e n t s w ' h o a r e t r e a t e d f o r a s h o r t p e r i o d o n l y . 2. L o n g - t e r m c a s e s . 3. P a t i e n t s w h o r e m a i n i n o u r c h r o n i c s e c t i o n e i t h e r f o r a v e r y l o n g t i m e o r p e r m a n e n t l y . T o e n a b l e t h e p h y s i o t h e r a p i s t t o p a y m o r e a t t e n t i o n t o t h e a c u t e a n d s u b a c u t e c o n d i t i o n s , w e h a v e t a u g h t m c d i c a l o r d e r l i e s t o c a r r y o u t s o m e b a s i c a n d s i m p l e r o u t i n e t r e a t m e n t s , u n d e r v e r y s t r i c t s u p e r v i s i o n . I f t h i s m e t h o d is n o t a p p l i e d , i t wi l l m e a n t h a t t h e c o n ­ d i t i o n o f t h e s e p a t i e n t s w i l l j u s t d e t e r i o r a t e . I f e m ­ p h a s i s is n o t l a i d o n t h e m a i n t e n a n c e o f p a r a p l e g i c s , h a c m i p l e g i c s , q u a d r a p l c g i c s a n d c o n d i t i o n s o f m u l t i p l e a r t h r i t i s , it w i l l b e a n i n s u l t t o t h e a d v a n c e d s u r g i c a l , m e d i c a l p h y s i c a l t r e a t m e n t s g i v e n e i t h e r l o c a l l y o r i n o t h e r u r b a n c e n t r e s . A m o n g t h e o r t h o p a e d i c a n d n e u r o l o g i c a l g r o u p , t h e f o l l o w i n g c o n d i t i o n s o c c u r q u i t e f r e q u e n t l y : F r a c t u r e s (i n s o m e c a s e s c o m p l i c a t e d f r a c t u r e s ) ; j o i n t a n d m u s c l e i n j u r i e s ; T . B . S p i n e ; d i f f e r e n t p a t t e r n s o f p a r a l y s i s r e ­ s u l t i n g f r o m s p i n a l a n d c e r e b r a l c o n d i t i o n s ; a n d b u r n s . B u r n s o c c u r o f t e n a m o n g y o u n g c h i l d r e n , e s p e c i a l l y i n t h e w i n t e r , w h e n t h e y s e e m t o f a l l i n t o t h e f i r e o r p u l l a p o t o f b o i l i n g w a t e r al l o v e r t h e m . H a e m i p l e g i a r e s u l t m a i n l y f r o m c e r e b r a l v a s c u l a r h a e m o r r h a g e o r h e a d i n j u r i e s . D u r i n g t h e m a i n h o l i d a y p e r i o d s , s u c h R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 10 P H Y S I O T H E R A P Y JUNE, 1974 MAKE YOUR DAY A LITTLE EASIER! You physios are a hard-worked group, we know. In the day’s work, environment and c o m f o r t b e c o m e m o r e a n d m o r e important — and while there’s not much we can do to help fix the background in which you work, you’ll find a comfy, practical working rig in the new special- purpose uniform we’ve designed with you in mind. It’s a continental style dress, with Bermuda-type shorts to match. A side vent in the skirt and the generous cut, mean that you’ll work more easily, and feel comfortable right through the hard day. Your option o f short or long sleeves, in drip-dry, hard-wearing fabric . . . white or saxe blue. Sizes 3 2 to 42. Elegance and efficiency . . . what more could you ask ? 4th Floor, Pritchard House, 83 Pritchard Street, JOHANNESBURG. Telephone 2 3-4 4 0 5. 87 M arion Avenue, Glenashley, DURBAN. Telephone 8 3 -7 2 2 6 . Fully illustrated catalogues and price lists o f our full range are available free to you. Just drop us a postcard (P.O. Box 7£2, Johannesburg) or telephone 2 3 -4 4 0 5 any time, including nights, weekends and holidays. W e’re also happy to execute phone orders, o f course. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) C hristm as, stick fights a r e th e o rd e r o f th e d a y and aSfew of th e m finish u p w ith v e ry se v e re in ju rie s. 3 Our o rth o p a e d ic s u rg e ry is u su a lly c a rrie d o u t a t fue F re re h o s p ita l in E a s t L o n d o n o r a t th e M o u n t ro k e M e th o d ist M issio n H o s p ita l n e a r K in g W illiam '"; Town. Q u ite s o o n a f te r th e o p e ra tio n h a s b een p e r­ formed, a n d th e su rg e o n is satisfied t h a t th e re a re n o further c o m p lic a tio n s, th e y a re tra n s fe rre d b a c k to us for tre a tm e n t a n d r e h a b ilita tio n . M a ln u tr itio n a n d v ita m in deficiencies, d o c au se p a rtia l ralysis, g e n e ra l w e ak n e ss, m u sc le in c o -o rd in a tio n a n d nostural d e fo rm itie s. A s fa r as we c a n d e te rm in e , th e reasons fo r m a ln u tritio n o c c u rrin g a re d u e to ig n o ra n c e 0f hygenic living a n d th e ty p e o f fo o d t h a t th e y sh o u ld eat and in a d d itio n to th is o f c o u rse , th e re is th e p r o b ­ lem of larg e fa m ilie s a n d finance. H o w e v e r, th e D e ­ partm ent o f S ta te H e a lth h a s s p o n s o re d th e h o sp ita l to launch a c a m p a ig n o f h e a lth e d u c a tio n a n d fa m ily planning. T o e n s u re success, c o -o p e ra tio n fro m th e Jvhole c o m m u n ity is v ita lly e sse n tia l. B ro n c h ie c ta s is , a te lec ty sis, e m p h y s e m a , lu n g abscesses A d c h ro n ic b ro n c h itis seem to be th e m o s t c o m m o n ly " f e r r e d fo r P h y s io th e ra p y tre a tm e n t, a m o n g lu n g c o n ­ ditions. O w ing to s e v e ra l re aso n s, lu n g T .B . is still a great p ro b le m . A fte r th e T .B . d ru g s h a v e b e en a d m in is ­ tered fo r a w h ile, so m e o f th e s e cases a re re fe rre d fo r postural d ra in a g e a n d b re a th in g exercises, s h o u ld th e re also be a d d itio n a l lu n g c o m p lic a tio n s. D uring th e last fe w y e ars, th e re h a v e b e en se v e ra l conditions o f T .B . m en in g itis. O n ly a fe w h a v e re ­ covered sufficiently to lea d a n o rm a l life a g a in . I f o n ly these p a tie n ts w o u ld be b ro u g h t to th e h o s p ita l in the early stages, m o re fa ta litie s c o u ld be p re v e n te d . We can c o n firm th e findings re v e a le d in an e a rlie r publication o f th is jo u r n a l, t h a t in c o rre c t b re a th in g is a very re a l p ro b le m . T h is a p p e a rs to be s tra n g e , as many o f th e m w a lk lo n g d ista n c e s e v ery d a y o f th e ir lives. A fte r p e rse v e rin g f o r a w hile, la te ra l c o sta l breathing im p ro v e s tre m e n d o u s ly in m a n y p a tie n ts , h o w ­ ever, d ia p h ra g m a tic b re a th in g is n o t so e a s v a n d som e do n o t ev er m a n a g e t o d o it p ro p e rly . T h e sta b b e d chest, as seen o n n u m e ro u s o c ca sio n s in u rb a n h o sp itals, is a ra rity in o u r a re a . I c an o n ly re ca ll a fe w h a e m o - p n e u m o th o rax cases b e in g re fe rre d to m e d u rin g th e last tw elve m o n th s . T he m ain p ro b le m a b o u t b re a th in g e xercises is th a t one has no g u a ra n te e t h a t th e p a tie n t d o e s th e m on h is or h e r ow n. A lth o u g h it is in c re d ib le , w e h a v e d is­ covered th a t o n c e th e y d isc o v e r th e be n efit o f stre n g th ­ ening, m o b ilisin g , f u n c tio n a l a n d w a lk in g e xercises, th a t .ney a re in sp ired to c a rry th e m o u t m o re re g u la rly , th a n is the case w ith b re a th in g e xercises. A ll o f u s a re fu lly aw are t h a t e xercises given d u rin g a p h y s io th e ra p y tr e a t ­ ment p e rio d , in th e m a jo rity o f c o n d itio n s, is n o t enough. R e c o v e ry w ill a lw ay s d e p e n d to a la rg e e x te n t on th e c o -o p e ra tio n o f th e p a tie n ts th em se lv es. G e n e ra lly , th e o c c u p a tio n a l th e ra p is t a n d I do o u r d e p artm e n tal w o rk in th e m o rn in g a n d u n d e rta k e th e ward w o rk in th e a f te r n o o n . I f a p a tie n t sh o u ld r e ­ quire tre a tm e n t m o re t h a n o n c e d a ily , o u r p ro g ra m m e is flexible e n o u g h to m a k e p ro v isio n f o r th is. A p a ra p le g ic sp o rts c lu b h a s b e en s ta rte d , a n d h a s been ru n n in g f o r m o re th a n tw o y e a rs. A p p ro x im a te ly 14 p a tie n ts in th e c h ro n ic d iv isio n a re tra in e d in field events su c h as s h o t p u t, ja v e lin , a n discus. T a b le ten n is has also p ro v e d to be p o p u la r w ith a few o f th e m . O ur p a tie n ts in th e g e n e ra l h o s p ita l w h o sta y f o r long periods, a re a ls o e n c o u ra g e d to p a rtic ip a te in th e s p o r t­ ing events. T h e o c c u p a tio n a l th e ra p is t, w ho a ls o h a s to h a v e A frican a ssista n ts u n d e r h e r, is re sp o n sib le f o r tea ch in g actions o f d a ily living, e d u c a tio n a l g a m e s f o r th e c h il­ dren, v a rio u s fo rm s o f f u n c tio n a l a sse ss m e n t a n d tra in - ln8 , re c re a tio n a n d h a n d w o rk . U n d e r re c re a tio n is j UNIE 1974 1 1 in c lu d e d , film show s, sp o rts a n d th e e n c o u ra g in g o f re a d in g b o o k s f r o m o u r sm a ll lib ra ry . T h e k itc h e n p r o ­ vides a n e x c e lle n t o p p o rtu n ity fo r th e te a c h in g o f c o o k ­ ing, iro n in g a n d o th e r d o m e stic a ctivities. O n e o f th e p a tie n ts re sid in g p e rm a n e n tly in th e c h ro n ic d iv isio n o f o u r h o s p ita l, a q u a d ra p le g ic , w ith v e ry little m u s c u la r f u n c tio n in b o th u p p e r lim b s, is stu d y in g f o r his ju n io r c ertificate. Y e ars a g o a n in ju ry w h ile p la y in g ru g b y , re su lte d in a lesio n a t th e se v e n th c erv ica l v e rte b ra e . A fte r tr e a tm e n t a t th e C o n ra d ie H o s p ita l, he w a s tra n s fe rre d to P e d d ie , o n a c c o u n t o f h is fa m ily n o t b e in g in a p o sitio n to lo o k a f te r h im a t h o m e . O u r o c c u p a tio n a l th e ra p is t m a d e a n a d ju s tm e n t f o r h im to c o p e w ith a n e le c tric a lly o p e ra te d ty p e ­ w rite r, e n a b lin g him to d o a ll h is w ritte n w o rk . I t is h o p e d t h a t h e w ill f u r t h e r h is e d u c a tio n as f a r as p o ssib le . T h e O .T . D e p a r tm e n t is. a lso re sp o n sib le fo r m a k in g a d ju s tm e n ts e n a b lin g p a tie n ts w ith p e rm a n e n t d isa b ilitie s to b ru s h th e ir ow n te e th , sh a v in g th em se lv es, h a n d lin g e a tin g uten sils to fe e d th em se lv es a n d ev en to w rite w ith a n o rd in a ry pen. T h o s e w h o sta y h e re f o r a c o n s id e ra b le length o f tim e o r p e rm a n e n tly in th e c h ro n ic d iv isio n , can ta k e p a r t in a m in ia tu re s h e lte re d e m p lo y m e n t schem e. A m o n g o th e rs th e y ta k e p a rt in sew ing, k n ittin g , w e av in g o f ru g w o o l m a ts, le a th e r w o rk su c h as p u rse s a n d B ib le c o v ers, b o ttle b ru sh e s a n d sh e e p skin s e a t c o v ers fo r m o to r c ars. T h e la tte r seem s to be im m e n se ly p o p u la r a n d a t th e m o m e n t w e h a v e a lo n g w a itin g list o f o rd e rs . T h e y use off-cut sh e e p sk in s, w hich a re o b ta in e d fro m a ta n n e ry . In th e tw o d e p a rtm e n ts , o u r p u rp o s e is to a p p ro a c h th e p a tie n t as a w hole. B y th is w e m e a n th a t w e do h e lp h im w ith h is s p iritu a l, so c ia l, e c o n o m ic , p s y c h o lo ­ g ica l as w ell as h is p h y sic a l p ro b le m s. I t h a s h a p p e n e d in th e p a s t th a t fa ith in C h ris t h a s a c te d a s a solid f o u n d a tio n f o r p a rtia l o r c o m p le te re c o v e ry . W h e re n e ce ssa ry , we try to assist lo n g -te rm p a tie n ts w ith th e ir fin a n c ia l p ro b le m s , m a in ly d e riv e d fro m d o n a te d fu n d s. I f o n e b e a rs in m in d t h a t so m e p a tie n ts a re in h o s p ita l f o r lo n g p e rio d s , w ith y o u n g c h ild re n still a tte n d in g sc h o o l, a n d a m o th e r h a v in g to k e ep th e p o t b o ilin g on h e r o w n , fin an c ia l a n d o th e r b u rd e n s c a n im p e d e effective r e h a b ilita tio n . W e assist th o s e w h o a re p e r m a ­ n e n tly d isa b le d to a p p ly f o r sp e c ia l r a d io lis te n e r’s licences. E m p lo y m e n t o f th e d isa b le d , is o f c o u rs e a n e x ­ c e e d in g ly g r e a t p ro b le m , e sp e c ia lly in th e h o m e la n d s. A fte r lo n g n e g o tia tio n s w e su c c essfu lly p la c e d tw o r e ­ h a b ilita te d p a tie n ts w ith th e h a n d c r a f t c e n tre , a t S a d a , n e a r Q u e e n s to w n . Som e- o f o u r p a tie n ts w h o re c o v e re d e ith e r fu lly o r n e a rly fu lly , h a v e b e e n re -e m p lo y e d by th e ir p re v io u s e m p lo y e rs , h o w e v e r, th e y w e re o n ly h e lp e d in view o f th e fa c t t h a t th e y c o u ld m a n a g e w ith c o m p le te in d e p e n d e n c e . T h e r e is a f a c to ry n e a r K in g W illia m ’s T o w n , w h e re th e m a n a g e m e n t h a s ta k e n step s to e m p lo y so m e p h y sic a lly h a n d ic a p p e d A fric a n s, b u t th is is o n ly a d ro p in th e p ro v e rb ia l o c ea n . F r o m tim e to tim e w e h a v e c o m e a c ro ss c h ild re n w h o a re d isa b le d , e ith e r o n a c c o u n t o f c o n g e n ita l c o n d i­ tio n s , o r by s u b s e q u e n t in ju ry o r disease. S e v e ral o f th e s e c h ild re n a re e d u c a b le . U n fo r tu n a te ly , b e c a u se o f lac k o f b e in g a b le to g e t to s c h o o l in d e p e n d e n tly , th e y a re d e n ie d th e o p p o rtu n itie s o f re ce iv in g a n o rm a l e d u ­ c a tio n . T h e o n ly s c h o o l f o r th e p h y sic a lly d isa b le d in th e T ra n s - a n d C iskei, is th e Ik w e si L o k u s a S c h o o l in U m ta ta . T h e ir w a itin g list is so long, th a t th e re is n o ju stific a tio n f o r m a k in g a n y a p p lic a tio n . O n ly re c e n tly I h a v e b een in fo rm e d o f a sc h o o l b e in g p la n n e d f o r th e C isk e i in th e n e a r fu tu re . In d e a lin g w ith A fric a n p a tie n ts , I h a v e d isc o v ere d th a t to m a k e o n e ’s tr e a tm e n t m o re effective, it is e sse n ­ tia l to fo llo w c e rta in p rin cip les. F o r in sta n c e , a basic k n o w le d g e o f th e lo c a l A fric a n la n g u a g e d oes h e lp to F I S I O T E R A P I E R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 1 2 b rid g e th e g a p , a n d in itia te s th e con fid e n ce o f th e p a ti e n t in th e d o c to r, n u rse , p h y sio - o r o c c u p a tio n a l th e ra p is t. E u ro p e a n s w h o a re p e rm a n e n tly e m p lo y e d in o u r g ro u p o f m issio n h o s p ita ls , a re re q u ire d to fo llo w a s h o r t c o u rse in X h o s a . A b a sic k n o w le d g e in A fric a n c u sto m s is in d e e d a v a lu a b le a sse t. O n e so o n finds t h a t th e r e is a differe n ce b e tw e e n m a n y A fric a n s w h o c o m e f r o m th e h o m e la n d s , a n d th o s e w h o h a v e b een b o r n o r h a v e liv e d fo r a lo n g tim e in th e cities. O n m a n y o f th e u n e d u c a te d B a n tu a n d to a le s se r e x te n t th e e d u c a te d B a n tu , th e w itc h d o c to r seem s to h a v e a s tro n g in fluence. A c c o rd in g to c e rta in e x p e rts th e re a re signs o f th is d e c lin in g g ra d u a lly . I h a v e k n o w le d g e o f a fe w o f o u r p a tie n ts , h a v in g o n ly b e en tre a te d p a r ­ tia lly su c c e ss fu lly in p a st, w h o h a v e g o n e to a w itch d o c to r w ith d isa stro u s c o n se q u en c es. F o r tu n a te ly this h a s n o t h a p p e n e d v e ry fre q u e n tly a n d d e sp ite w h a t so m e p e o p le m ig h t say, y o u d o g e t e n o u g h g ra titu d e to m a k e w o r k a t these h o sp ita ls m o re th a n w o rth w hile. W e a re p e rm itte d to tr e a t E u ro p e a n s in th e d istric t as o u t-p a tie n ts , p ro v id e d th e y c an p a y a m in im a l fee. I h a v e h a d se v e ra l re fe rre d to m e o v e r th e la s t few y e ars. W e d o n o t p re te n d to b e a sh o w w in d o w f o r p h y sic al m e d ic in e tr e a tm e n t in H o m e la n d h o s p ita ls a n d in fa c t I th in k w e c a n still le a rn a tre m e n d o u s a m o u n t. W ith lim ite d re so u rc e s a t o u r d is p o s a l in th e b e g in n in g , w e h a v e trie d to b u ild u p th e w o rk a n d w e can n o w c o n ­ tin u e o n a so lid ly la id fo u n d a tio n . A ll o f us- on th e m e d ic a l a n d a d m in is tra tiv e staff, c o u n t it a priv ile d g e to a ssist w ith th e s p iritu a l a n d o th e r a ctiv itie s in o u r sp a re tim e . T h e w o rk is n o t a lw ay s a p a th o f roses, b u t th e r e a re m o re th a n sufficient tim e s f o r re jo icin g a n d re w a rd s . I f th e re w e re n o c h a lle n g e s to be o v e r­ c o m e , life w o u ld in fa c t be d u ll a n d u n in te re s tin g . A fte r all, i f o n e is a C h ris tia n , o n e w ill n o t seek re w a rd on e a r th f o r a n y th in g , b u t c o n tin u e to serve. V A C A N C Y W O R K M E N ’S A C C I D E N T A N D R E H A B I L I T A T I O N C E N T R E , D U R B A N A p p lic a tio n s a re in v ite d fro m 'registered P h y s io ­ th e ra p is ts f o r th e fo llo w in g p o sitio n s : ’ (1) S e n io r P h y s io th e ra p is t S a la ry scale: R 3 450 x 150 — 4 350 p lu s 15 p e r cent. A p p lic a n ts s h o u ld h a v e w id e e x p e rie n c e in tr e a t­ m e n ts o f T r a u m a cases. T h e successful c a n d id a te w ill b e in c h a rg e o f a m o d e rn , w e ll-e q u ip p e d d e ­ p a r tm e n t d e alin g m a in ly w ith tra u m a tic c o n d itio n s. (2) B a sic G r a d e P h y s io th e ra p is t S a la ry sc a le : R 2 400 x 150 — 3 6 00 p lu s 15 p e r c en t. C o n d itio n s o f E m p lo y m e n t U n ifo rm s a re su p p lie d . G e n e ro u s lea v e a n d sick leave c o n d itio n s a p p ly . A lea v e b o n u s o n P u b lic Service c o n ­ d itio n s is p a y a b le . P e n sio n a n d M e d ic a l A id sc h e m e s a re a v a ila b le . S a la rie s w ill b e re la te d to e x p erien c e . A p p lic a tio n s to : T h e S e c re ta ry , W .A .R .C ., 150 C a to R d ., D u rb a n . “ CHAIR OF MEDICAL REHABILITATION” at the UNIVERSITY OF DURBAN WESTVILLE D r. B a sil V . S c h u lze , p rin c ip a l P h y sic ia n -in -c h a rg e 0f M e d ic a l R e h a b ilita tio n S ervices in N a t a l a n d Senior C lin ic a l L e c tu re r a n d H e a d o f th e su b -D e p a rtm e n t of P h y s ic a l M e d icin e in th e F a c u lty o f M e d ic in e o f th« U n iv e rs ity o f N a ta l in D u r b a n h a s b e en a p p o in te d L ] th e n e w ly c re a te d C h a ir o f M e d ic a l R e h a b ilita tio n J t h e U n iv e rsity o f D u rb a n -W e stv ille . T h is c h a ir is the first o f its k in d in th e c o u n try . P ro f e s s o r S c h u lze w as b o rn in E a s t L o n d o n a n d edu­ cated in th e E a s te rn P ro v in c e . H e o b ta in e d th e M.B., C h .B . d e g ree s a t th e U n iv e rsity o f C a p e T o w n in 1945 a n d a f te r c o m p le tin g a y e a r as a n in te r n in Medicine a n d S u rg e ry a t th e K in g E d w a rd V I I I H o s p ita l in Dur­ b a n , h e le ft to f u r t h e r h is stu d ies in E u ro p e . H e sp e n t six y e a rs in E n g la n d d o in g sp e c ia list study in P h y s ic a l M e d icin e a n d R e h a b ilita tio n first a t the U n iv e rs ity o f B risto l a n d th e n a t th e U n iv e rsity o f Lon­ d o n . S u b s e q u e n tly h e w a s o n th e staff o f G u y s Hos­ p ita l a n d St. T h o m a s ’ H o s p ita l in L o n d o n a n d in 1950 w a s a p p o in te d C o n s u lta n t to th e W in d s o r G ro u p of H o s p ita ls in th e L o n d o n re g io n o f th e B ritish National H e a lt h Service. In 1953 h e re tu rn e d to S o u th A fric a a n d settled in D u r b a n w h e re h e h a s h e a d e d N a t a l ’s p ro v in c ia l medical r e h a b ilita tio n service sin c e its in c e p tio n . P ro fe s s o r S c h u lze w h o h a s tra v e lle d exte n siv ely in E u ro p e , A fric a a n d th e F a r E a s t h a s u n d e rta k e n many a d v is o ry a ssig n m en ts in h is field o f m ed ic in e . H e re­ c e n tly h a s d e v o te d m u c h o f his a tte n tio n to problems, o f m e d ic a l r e h a b ilita tio n in S o u th e rn A fric a a n d fo llo v ^ ing re q u e sts f o r his a d v ic e m a d e to th e R e p u b lic s D e p a r tm e n t o f F o re ig n A ffa irs b y th e G o v e rn m e n ts of S w a z ila n d a n d L e s o th o a n d b y th e C h ie f o f th e Portu­ g uese M ilita ry M e d ic a l S ervices in M o c a m b iq u e , h e has v isite d th ese c o u n trie s w ith in th e la s t y e a r to assist w ith lo c a l 'n e e d s . H e h a s p u b lis h e d p a p e rs o n d iffe re n t a sp e c ts o f his su b je c t a n d re c e n tly c o n trib u te d th e c h a p te r o n “ Myalgia a n d A rth ritis ” in th e te x t-b o o k “ C lin ic a l M e d icin e in A fric a n s in S o u th e rn A f r ic a ,” p u b lis h e d in L o n d o n in 1973 b y L iv in g sto n e . H e w as in tim a te ly in v o lv e d in th e e s ta b lis h m e n t of th e first a n d , u n til v e ry re c e n tly , th e o n ly training s c h o o l f o r b la c k p h y s io th e ra p is ts in S o u th e rn Africa. T h is , a m o n g h is m a n y o th e r a ctiv ities, h e h a s fostered since its in c e p tio n in 1964. D u e a lm o s t e x clu siv ely t o h is d e te rm in a tio n , th e pre­ se n t d ip lo m a c o u rse w as re p la c e d as f r o m th e beginning o f 1974 b y a f o u r y e a r c o u rs e le a d in g to th e degree B.Sc. (P h y s io th e ra p y ). T h is w ill p ro v id e th e first and o n ly U n iv e rsity P h y s io th e ra p y d e g re e tra in in g avail' a b le ex clu siv ely to b la c k s o n th e A fric a n c o n tin e n t. JUNE, 197