Page Eight P H Y S I O T H E R A P Y September, 1948

CRIPPLE CARE IN SOUTH AFRICA
. B y  L Y D I A  E R L A N K ,  B .A . (Social Science).

S ecretary for the National Council for the Care of Cripples in South A frica.

W h e n  w e  think of the handicapped in our c o m ­
munity, it is esse nti al that w e  should re m e m b er  that 
cripples do not con stitute a group  on the ir own, but 
form a nor mal and in te gra l part o f  the life and 
activities o f  a n y  society. A s  such th e y have a rig-ht to 
our in terest and assistance.

T h e  problems o f  the handicapped a r e  b asi cal ly the 
proble ms  o f  all people, exce pt that in the cas e o f  the 
handicapped, the problems t ake  on a more accentuated 
form.

T o  help the cr ippled to the best of our ability, it is 
essential that w e  should believe that b y  mea ns of 
prevention, e a r ly  specialist treatm ent, thorough a f t e r ­
care, prope r tr a i n i n g and selective placement, he will 
be able to fill his position in the co m m u ni ty as co m ­
pe te ntl y as the ne x t person.

T h e  de vel opm ent  o f  ortho pae di c se rv ic e s  in South 
A f r i c a  cl e a r ly  illus tra te s that m os t fo rm s  o f  social 
respon si bi lit y a re  accepte d b y  the public an d G o v e r n ­
ment  on ly a f t e r  ha vi ng  first been realised and 
developed b y  some individual or small group  o f 
persons.

T h e  first pe rson to take an active in te re st  in our 
cripple problem, and to act in a m at e ri al  and positive 
w a y,  w a s  L o r d  Nuffield, w ho in 1937 m ade  his m a g n i ­
ficent g if t of £100,000 to So ut h A f r i c a  for the de ve lo p ­
me nt  o f or th opa ed ic  services. T h is  led to the fo r m a ­
tion in 1939 of the N a ti on a l Council for the C a re  of 
Cripples wit h the object o f e st abl ish in g a complete 
or thopaedic se rv ice  for the c o u n t ry  and to corre late  
and co- ordinate the w o r k  done in this field.

D u r in g  the past nine y e a r s,  w hich w a s  a difficult 
period on account of w a r  conditions, the Council has 
been suc c es s fu l in e st a bl ish in g a fr a m e w o r k  fo r a 
complete or tho pae di c service. B e f o r e  1939 w o r k  for 
cripples  w a s  limited to cer ta in areas. It w a s  tackled 
on a .national basis onl y a ft e r  that year.

T h e  N a t i o n a l Council, w it h  the aid of generous 
Nuffield gr an t s , stimulated the erection o f orthopaedic 
homes and w a r d s  in hospitals w h e r e  cripples can 
receive the pres cr ib ed  tre at m e nt  fo r months, and 
even ye a r s,  if ne ce ss a ry . A lt h o u g h  still inadequate, 
the basis has been laid. I t  now  requ ires extension.

Ac co m m od at io n fo r cas es  su f fe ri n g fr om  bone 
tuberculosis, the main cause o f  crippling, is sa dly 
inadequate, m a in ly  due to the indecision o f the 
C e nt ra l G o v er n m e n t  and P r o v i n c e s  in re g a rd  to the 
question o f re sp ons ib il ity  fo r cas es  s u f fe ri n g  from 
surg ical tuberculosis.

T h e  Council realised that the provision o f  o r t h o ­
paedic beds w ith ou t specialised ortho pae dic  t r e a t ­
ment  w a s  no solution. Orth opa ed ic w o r k  has to be 
p e rf or m e d b y  pe rsons spec ial ly trained in this branch 
o f  sur ger y.

A  g r a n t  w a s  allocated to each o f the U ni v e rs it ie s  
of Cap e T o w n  and the W it w a t e r s r a n d  for the 
esta bli shm ent  o f  L e c t u r e s h ip s  in orthopaedics, and a 
fu rt h e r g r a n t  w a s  made fo r the esta bli shm ent  o f a 
t ra i n i n g  school for E u r o p e a n  nu rse s at Ca pe  To w n.  
B u r s a r i e s  w e r e  g r an t e d  for p os t- gra du at e tra in in g in 
ortho pae dic  s u r g e r y , and so f a r  seven doctors have 
qualified as or tho pae di c su rg eo ns  un de r this scheme,

while 3 1  nurses, with the as si s t an ce  of Nat ion al 
Council bu rsa ri es , have completed the ir studies in 
ort hopaedic nursing. A r r a n g e m e n t s  a re  b ein g made 
fo r the e s ta bli shm ent  in the T r a n s v a a l  of a similar 
cou rse for N a t i v e  nurses.

T h e  N a t io na l Council has also made it possible for 
five ortho pae dic  technicians to unde rgo  a fi v e - y e a r 
tr a i n i n g course at the G o v er n m e n t  L i m b  F a c t o r y . 
T h e s e  pe rsons a r e  doing a g r e a t  w o r k  b y  m a k i n g  the 
applian ces  and limbs to put the cripples " o n  their 
fee t.”  T h r o u g h  the e fforts o f the Na ti on al Council, 
the S o c i e t y  o f  Ortho pae dic and S u r g ic a l T ech ni cia n s 
o f  So ut h  A f r i c a  w a s  form ed  wit h the ob ject of 
a d v an ci ng  the int ere st s of or thopaedic technicians in 
the country.

G r a n t s  have also been made fo r ot h e r purposes. T he  
Council, rea lising  the in estimable val ue of the p h y s io ­
th era pi st in this g r e a t  service, re c en t ly  made available 
a g r a n t  o f i 300 for the tra in in g of such a person.

V o ca t io n al  T r a i n i n g  C e nt re s for .E u r o p e a n s  and 
Co lou re ds  at Stelle nb os ch and Cap e T o w n  res pe ct iv e ly  
are b ein g planned, and it is hoped that building will 
be st ar te d in the not too dista nt future. T h e s e  in s ti ­
tutions will provide the n e c e s s a r y  facilities for E u r o ­
pean and Coloured cripples to become fu lly trained 
fo r w h a t e v e r  e m plo ym ent  their residual abilities and 
in te res t will allow.

A  national s u r v e y  of cripples is b ein g conducted 
to ens ur e that e v e r y  cripple recei ves  the treatm ent 
and a ssi st a nc e  to wh ich  he is entitled. So ci al  w o r k e r s  
attach ed  to the va ri ou s cripple care assoc iat io ns are 
doi ng a gr e a t  w o r k  in helping cripples to find their 
niche in the community.

O rth op ae di c clinics a re b ein g established th r o u g h ­
out the c o u n t ry  and the ideals o f  the Na ti on al Council, 
viz., that cripples should receive tre atm ent  in the v e r y  
e a r l y  st a ge s  and that  s a t is fa c t o r y  aftfercare should be 
ex ercised, a re m at erialising. T h e  scheme, though still 
in its in fan cy,  has a lr e a d y  shown magni fi cen t results.

T h e  tre a tm e nt  o f the crippled and eq uip ping  them 
fo r life is not o n ly  a social s e r v i c e ;  it has an 
economic aspect. T h e  cripple w h o s e  life is chan ged  
fr om  one o f dependence to one o f  use fu lne ss  becomes 
an a s se t  to the S t a t e  instead of a liability, and as such 
it is on ly  logical that the rehabilitation o f the cripple 
should receive liberal G o v er n m e n t  support.

W e  hope tha t it w ill not be lo ng b ef o re  Sout h 
A f r i c a  will realise the truth o f  the fo llo w in g e x tra ct  
fr o m  the "C ri p pl e d  C hi ld ’s Bill  o f  R i g h t s ”  adopted 
at the Sec ond W o r l d  C on fe r e n ce  on the problem of 
the c r i p p l e :

“ In brief, not o n ly  for its own sake, but fo r the 
benefit o f  s oci et y as a whole, e v e r y  child crippled 
has the right to the best bod y w hich mode rn science 
can help it to secure, the best  mind which modern 
education can provide, the best tra in in g which 
mode rn voca tion al gui da nc e can give, the best 
position in life w h ic h his phys ica l condition, p e r ­
fected as best it m a y  be, will permit, and the best 
op p or tu ni ty for spiritual de velopment w hic h its 
env ir onm ent  a ff or d s.”

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