March, 1949 P H Y S I O T H E R A P Y Report on Occupational Therapy IN A N O N - E U R O P E A N H O S P I T A L B y M is s D . S olkhon, M .C .S .P . A t the s u g g e s t i o n o f H i s E x c e l l e n c y th e G o v e r n o r f N o r t h e r n R h o d e s i a , O c c u p a t i o n a l T h e r a p y w a s ° n i m enced at th e A f r i c a n H o s p i t a l, L u a n s h y a , in h d y 1948- T h e L u a n s h y a M a n a g e m e n t B o a r d p r o ­ mised to a s s i s t w i t h a g r a n t o f £50 a y e a r an d the aims w e r e : ( 1 ) T o p r o v i d e d i v e r s i o n a l o c c u p a t i o n f o r the patients. (2) T o tea ch n e w c r a f t s a n d f o s t e r th e old o ne s, in a r e g io n w h e r e c r a f t s m a n s h i p a n d a. r e s p e c t fo r m a n u a l l a b o u r a r e fa s t d y i n g out. (3) T o e x e r c i s e m i n d a n d li m b s an d t h u s a s s i s t in t h e r e h a b i l i t a t i o n o f th e p a ti en t s. A l t h o u g h s t a r t e d on a s m a ll scal e, th e w o r k has g r o w n , a n d t h e r e is a m p l e s c o p e f o r f u r t h e r d e v e l o p ­ ment. A s f a r as p o s si bl e, u se h a s b e e n m a d e o f local m at er ia l s and la b ou r . F o r e x a m p l e , g r a s s f o r b a s k e t s and m at s is b r o u g h t in f r o m th e b u nd u in the m i n e w oo d l o r r i e s ; old t y r e s a r e s t r i p p e d to p r o v i d e c or d for fi s hi n g ne ts a n d h a m m o c k s , a n d th e r u b b e r u se d for shoe r e p a i r s ; d i s c a r d e d fu se w i r e f r o m th e m i n e is utilised in the m a k i n g o f t r a y s , ta b le m a t s , etc., and bamboo fo r f u r n i t u r e is c o l le c t e d b y p a t i e n t s r e c e i v i n g h o o k - w o r m tr e a t m e n t . In addition, w o o l is so ld to w o m e n p a t i e n t s at a reduced price, p r o v i d i n g t h e y k n it u s e f u l g a r m e n t s , such as v e s t s f o r t h e i r ch il d r e n . R e c e n t l y , l e a t h e r w o r k has b e e n s t a r t e d , c h i e f l y b e c a u s e m o v e m e n t s such as p u n c h i n g h o le s a n d t h o n g i n g p r o v i d e e x c e l l e n t e x er c is e fo r th e h a n d m u s c l e s . T h i s is i m p o r t a n t in vie w of the l a r g e n u m b e r o f h a n d i n j u r i e s t r e a t e d in the w a rd s. O n t h e i r o w n in i ti a ti v e , th e N a t i v e s h a v e made p r im it iv e lo o m s on w h i c h t h e y w e a v e b el t s o f o ri gi na l d e s i g n f r o m d y e d s t r in g . I t is h o p e d that soon t h e y w i ll p r o g r e s s to u s i n g lo o m s w h i c h provide e x e r c i s e s f o r th e l e g s a.s w e ll as th e ha n ds . T h e pa ti e nt s a r e s h o w i n g an i n c r e a s i n g i n t e r e s t in the w o r k , a n d m a n y m o r e w o u l d t a k e p a r t in it if the n e c e s s a r y s u p e r v i s i o n w e r e a v a i la b le . W i t h o n l y one b o y to te a c h a n d s u p e r v i s e , it is i m p o s s i b l e to en ga ge m o r e t h a n 25 p a t i e n t s d a i l y in it, t h a t is e x ­ cluding the w o m e n . T h e E u r o p e a n s u p e r v i s i o n amounts to 1V2 h o u r s w e e k l y as, in t h e s h o r t ti m e available, p h y s i o t h e r a p e u t i c n e e d s t a k e p r i o r i t y . T h i s means th at the A f r i c a n s te a c h t h e m s e l v e s , an d the lesults ar e o f t e n o r i g i n a l a n d i n t e r e s t i n g . A n o t h e r point of i n t e r e s t is that, g i v e n a f i n i s h e d a r t i c l e an d tlie cor re ct m a t e r i a l s , th e A f r i c a n c an u s u a l l y m a k e ail excellent c o p y o f it. Tt has been fo u n d t h a t th e b e s t m e t h o d o f s e ll i n g ie articles m a d e is f o r t w o b o y s to g o f r o m h o u s e 0 house e v e r y w e e k - e n d , w i t h a s i g n e d p r ic e- li st , ji a v e r a g e o f £3 is c o l le c t e d w e e k l y , an d ‘V ac c° u n t s a r e k e p t b y th e S u p e r i n t e n d e n t 1! • - i ^ 0SPital, w h o p a y s o ut bill s f o r the 'a e n a ls , etc. A l t h o u g h , a t fir st, u se w a s m a d e o f th e 'in'1/111” 61116111 ® oarc^ g r a n t f o r t h e p u r c h a s e o f too ls ( m at er ia ls to th e e x t e n t o f a b o u t £35, it is s a t i s ­ f a c t o r y to n o t e th a t the d e p a r t m e n t is n o w s e l f - s u p p o r t i n g a n d s h o u l d h a v e no ne ed fo r f u r t h e r fi n a n c ia l ai d e x c e p t o c c a s i o n a l l y p e r h a p s , f o r the p u r c h a s e o f w o o l f o r th e w o m e n . A s a r e w a r d f o r t h e i r l a b o u r s the p a t i e n t s a r e ■gi ven e i t h e r a p a c k e t o f c i g a r e t t e s e v e r y tw o d a y s ( p r i c e 3d.) o r ten b o il ed s w e e t s . I n a d di tio n , f o r a fi n i s h ed a r t i c l e t h e y r e c e i v e 3d. o r 6d. a c c o r d i n g to its size. O c c a s i o n a l l y n e w B a n t u r e c o r d s a r e b o u g h t out o f th e fu n ds . W h i l e th e p a t i e n t s w o r k , th e s e a r e p l a y e d o n a g r a m o p h o n e p r o v i d e d b y th e M a n a g e ­ m e n t B o a r d . T h e g r e a t ne e d n o w is f o r v o l u n t a r y E u r o p e a n h e l p e r s w h o w i ll v is it o n c e o r t w i c e a w e e k an d t e a c h n e w c r a f t s , s uc h as c a r v i n g a n d w e a v i n g . T h e i d e a l o f h a v i n g e v e r y p a t i e n t a d m i t t e d to h o s p i t a l e n g a g e d on u s e f u l w o r k is still f a r fr o m , b e i n g at ta i n e d . Farming O ut T h i s l e t t e r w a s i n c lu d e d in th e S o u t h A f r i c a n M e d i c a l J o u r n a l d a te d 1 5 t h J a n u a r y , 1949. T h e S o u t h A f r i c a n M e d i c a l a n d D e n t a l C o u n c il is c o n c e r n e d a b o u t “ f a r m i n g o u t ” o f r e g i s t e r e d p r a c t i ­ ti o n e r s b y l a y p e r s o n s an d o r g a n i s a t i o n s . I n o r d e r to g i v e full c o n s i d e r a t i o n to t h e m a t t e r th e C o u n c il c o n v e n e d a m e e t i n g o f pu bli c a u t h o r i t i e s , c h a r it a b le , r e l i g i o u s a n d n o n - p r o f i t e a r n i n g public o r g a n i s a t i o n s , t o g e t h e r w i t h ' r e p r e s e n t a t i v e s o f th e S o u t h A f r i c a n M e d i c a l an d D e n t a l A s s o c i a t i o n s . T h e m a t t e r w a s fu l l y d i s c u s s e d a n d th e C o u n c il c o n s i d e r e d a de fin iti on o f “ f a r m i n g o u t ” w h i c h w a s s u b m i t t e d b y th e M e d i c a l A s s o c i a t i o n o f S o u t h A f r i c a . T h e C o u n c i l h a s a g r e e d to th e de f in i ti o n o f “ f a r m i n g o u t ” ’w h i c h w a s s u b m i t t e d b y th e M e d i c a l A s s o c i a ­ tion, s u b je c t to c e r t a i n a m e n d m e n t s . T h e d e fi n it io n w a s a p p r o v e d b y the C o u n c il in th e f o l l o w i n g f o r m :— “ A p r a c t i t i o n e r s h a ll n o t a c t a s a m e d i c a l o r d e n t a l o ff i c e r in a n y c a p a c i t y to a s o c i e t y , c o m p a n y , a s s o c i a t i o n , h o s p it a l o r o t h e r in s ti tu ti o n , i n c o r - «. p o r a t e d o r u n i n c o r p o r a t e d , p u b li c o r p r i v a t e , ' in w h i c h f e e s f o r his s e r v i c e s a r e c h a r g e d a g a i n s t or' in r e s p e c t o f p a ti e n t s , u n le s s s uc h f e e s a r e p a id o v e r to h im .” T h e C o u n c i l r e s o l v e d not to f r a m e an e t h ic a l rul e b ut d e c i d e d t h a t it w o u l d c o n ti n u e , a s in the pa st , to d ea l w i t h ea c h c a s e on its m e r i t s . T h e C o u n c il , h o w e v e r , w i s h e s to d r a w y o u r a t t e n ­ tion to th e f o l l o w i n g rul e o f th e C o u n c il w h i c h is on e o f th e a c t s on th e p a r t o f m e d i c a l p r a c t i t i o n e r s an d d e n t i s t s o f w h i c h c o g n i s a n c e m a y be t a k e n :— “ P e r m i t t i n g h i m s e l f to b e e x p l o i t e d in a m a n n e r d e t r i m e n t a l to th e pub li c o r p r o f e s s i o n a l i n t e r e s t . ” T h e l e t t e r is s i g n e d b y W m . I m p e y , R e g i s t r a r o f t h e S o u t h A f r i c a n M e d i c a l a n d D e n t a l C o u n c il a n d is d a t e d 3 1 s t D e c e m b e r , 1948. [ I t is noted that although the Council is opposed * to exploitation, it has resolved not to fram e an ethical rule w ith regard to “ farm ing out.” T h e S .A .S .P . might* be well advised to consider the adoption o f a similar type o f rule fo r the protection o f physiotherapists.— E ditor, “ P h ysio th era p y .” ] jUblished by the Journal Committe of the South African Society of Physiotherapists, 5 3 /4 Pasteur Chambers, 6 treet' Johannesburg, and printed by J. G. Inee and Son ( P t y . ) Ltd., 20, Frederick St., Johannesburg. 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. )