Kupugani by M . G . D O B E Y N . A s P h y s io th e ra p ists we a re n o t d irectly c o n c e rn e d w ith n u tritio n , o r th e diets re q u ire d by th e p a tie n ts we tre a t b u t th o se o f u s w h o w o rk in N a tiv e H o s p ita ls c a n n o t fail to b e stru c k b y th e evidence o f w idespread m a ln u tritio n , w hich lies b e fo re us in every w ard. K w a s h io rk o r is n o w a n o tifia b le disease, a n d the p u b lic no w k n o w w h a t a d re a d fu l th in g it is, a n d h ow sim ply it c an be p re v en ted . T h e re a re , how ever, stages o f m a ln u tritio n w hich a re n o t so o b v io u s a nd frig h tfu l, b u t w hich w eaken a p a tie n t’s re sistan c e to in fec tio n o r in ju ry a n d cau se ill- h e a lth w hich is e q u a lly p re v en tab le . A s th e W o rld H e a lth O rg a n isa tio n ’s th e m e fo r th e year 1963 is th e “ H u n g e r D ise a se o f M illio n s,” a n d as it affects S o u th A frica w ith frig h te n in g inte n sity , th e self-help schem e o f “ K u p u g a n i” b eco m es o f p a r a m o u n t im p o rta n c e . M rs. Biggs, o f P ie te rm a ritz b u rg , a g re a t w o rk e r fo r “ K u p u g a n i” , ex p la in ed w h a t th is schem e w as to th e A n n u a l C o n g re ss o f th e N .C .W . (S.A .). S o m e th in g o f w h a t she said n o w follow s: A b o u t a y e a r a g o M r. N eil A lcock suggested t h a t n u tr i­ tio u s g o o d s a t a c h e a p e r p rice sh o u ld b e m ad e availab le to th e p o o re r m em b e rs o f th e com m unity.- M a n y foods in th is c o u n try a re e x p o rte d , o r processed,- a n d th u s b ecom e im possible o r to o expensive fo r th e lo w e r incom e g ro u p to buy. T h e q u e stio n w a s: H o w to b rin g food a t th e low est cost to th o se in n e e d ? M a n y have b een c h ro n ic ally u n d e rfe d fo r y e ars— b u t only re cently h a s th e p u b lic as a w hole realised w h a t was h a p p e n in g to th re e -q u a rte rs o f th e p o p u la tio n . T h e N u tr itio n C o rp o ra tio n o f S o u th A frica , (now k n o w n as “ K u p u g a n i,” w hich m ea n s “ L ift Y o u rselv es u p ” ) cam e in to being. I t is n o t a c h a rita b le o r a w elfare body, as its n a m e indicates. T o set u p a K u p u g a n i b o d y th e g ro u n d w o rk m u st be carefully l a i d ; th e leaders o f th e c o m m u n itie s co n su lte d a nd ta lk e d t o ; a n d once th e ideas have b een d istrib u te d a nd assim ilated th e n th e fo o d is d is tr ib u te d ! D e p o ts a re estab lish e d by th o se w illing to h elp a m o n g them selves, a s c h a n n e ls th ro u g h w hich th e fo o d is so ld . It m ay be th e h e a d m a s te r o f th e local sc h o o l, a c lergym an w ith a c h u rc h h a ll, o r even th e h o u se o f a lea d in g m em b e r o f th e c o m m u n ity . F o o d s w hich a re m a in ly used a re th o se in w hich th e re is a n a g ric u ltu ra l su rp lu s. E a c h a re a m u st use its ow n su rp lu s, a n d th e c o st to th e c o n su m e r m u st a lso c o v er th e c o st of tra n s p o rt. P ie te rm a ritz b u rg , as a n e xam ple, uses m ilk. It is b o u g h t fro m th e fa rm e rs a t 20 c ents a g a llo n , a n d sold a t 25 c ents a g a llo n as m aa s in ru r a l areas. T h e a d d itio n a l 5 cen ts pays fo r th e tr a n s p o r t o f th e m ilk. 450 g a llons a re used e ac h w eek in f o u r differe n t a rea s. T h e d e m a n d is g re a t— a n d it is only th e lack o f tr a n s p o r t w hich p re v en ts th a t d e m a n d from b e in g m et. In a d d itio n t o u sing th e a g ric u ltu ra l su rp lu se s v a rio u s firm s h ave d o n e re sea rc h in to th e p ro b le m o f u n d e r-n o u ris h ­ m en t, a n d th e ir p ro d u c ts a re also used. T h e P ro -n u tro , a n o u ris h in g b isc u it, fortified so u p p o w d e rs, a n d d rie d m ilk p o w d e r a re a ll u sed in th e schem e. T h e re is in a d d itio n a G o v e rn m e n t schem e fo r dried skim m ilk th ro u g h th e local a u th o ritie s. I n so m e a re a s it is n o t d istrib u te d as th e local a u th o ritie s a re to o sm all— o r th e re a re n o n e . B u t “ K u p u g a n i” c an get w hole o r dried m ilk, very c h e a p ly o u t to these areas. Page 12 A “ K u p u g a n i” b o d y w orks in this w ay: F irstly “ K u p u g a n i” place a n o rd e r fo r th e re q u ire d fo o d stu ffs, a nd c h annel it o u t to e ith e r: (a) W elfare O rg a n isa ­ tio n s ; (b) M ission S ta tio n s o r D e p o ts , su c h as th o se d e s­ c ribed earlier. M u c h o f the food is used in sc h o o l feeding, th ro u g h sc hool b o a rd s and teachers, at a c o st o f 1 c ent p e r d a y p e r child. In a d d itio n to th e sale o f food H e a lth E d u c a tio n is a definite req u ire m e n t. If food e q u a ls h e a lth , a n d p ro te in fo o d s a re to o expensive, th en h e a lth e d u c a tio n m u st be given o n h ow to use the p ro d u c ts a v ailable. A fric a n m en a re th e ones w h o need th is e d u c a tio n , as th ey a re fa r too conservative to a llow c h an g e s to b e m ad e in th e ir diets! If, th erefo re, these fo o d stu ffs w ere used in in d u stria l feeding— in w o rk s c a n te e n s, a n d a lso sold ov er th e c o u n te r, a nd if, in a d d itio n , H e a lth E d u c a tio n ists gave talk s to th e m en in th e ir lu nch b re a k s, th is co n se rv a tism c o u ld b e b ro k e n dow n. T h e re a re 23 K u p u g a n i bo d ies th ro u g h o u t S o u th A frica , a n d 53 centres. A s an exam ple, 26 sch o o ls in J o h a n n e s b u r g , no w h ave school feeding th ro u g h th is “ self-help m e th o d .” ® In Z u lu la n d a n interesting schem e is b e ing developed by “ K u p u g a n i,” th ro u g h the “ M ealie B o a rd ,” u sin g o n e o f th e m an u fa c tu re d p ro d u c ts as a fortified g ravy o ver the p o rrid g e. A w h o le tribe, th ro u g h a n a rra n g e m e n t w ith a n e n ­ lig htened chief, is being tested, w a tched a n d w eighed o ver 3 m o n th s . T h e M ealie B o a rd is m a k in g c h e a p m ealie m eal a v ailab le, provided a fortified so u p p o w d e r is used as gravy. A t th e e n d o f this perio d th e h e alth o f th e trib e sh o u ld , as a w hole, have im proved. December, 1963 Book Review M o d e m F irs t Aid a nd A ccident Prevention by C h iru rg ic u s. P ublished by Cape & Transvaal P rinters, L td ., Cape Province. O fficially a p p ro v ed by th e M edical A s so c ia tio n o f S o u th A frica. S u p p o rte d and financially assisted by the N a tio n a l C o u n c il fo r th e C are o f C rip p le s in S o u th A frica. P ro c e ed s a re in aid o f the N a tio n a l C o u n c il fo r the C a re o f C ripples in S o u th A frica. A n A frik a a n s E d itio n is also availab le: M o d e rn e E erstehulp en V oorkoraing van O ngelukke. T h is is a sm all b u t v a lu a b le b o o k w hich sh o u ld b e o f a& m u ch use in th e P h y sio th e rap y d e p a rtm e n t as in th e h o m e j Em ergencies h a p p en everyw here a n d m u c h c a n be d o n e by th e first p erson to see th e c asu alty b e fo re th e d o c to r a rriv e s on the scene. T h e clo ser th e c o -o p e ra tio n betw een th e F irs t A id e r and those w h o finally tre a t him , the b e tte r will b e th e chances o f survival fo r th e c asu alty . I t is in this s p irit o f desire to assist b o th th e v ictim a n d th o se w ho help him th a t this b o o k h as b een com piled. I t is w ritte n in sim ple term s, easily u n d e rs to o d by everyone, a n d c a n be readily referred to. C oncise n o te s a n d c lear p ic tu re s a n d diagram s add to th e v a lu e o f th is b o o k . T he c o n te n ts c over general in fo rm a tio n o n F irs t A id , D ro w n in g , S hock, H a e m o rrh a g e , S n a k e b ite , P o iso n in g , A ccidents, B u rn s, H o u sehold p ro b lem s, th e T ra n s p o rtin g o f the I n ju re d , H ead injuries and even F irs t A id in A to m ic W arfa re. A fte r studying th e v a rio u s c h a p te rs a n d m ak in g m ental n o te s as to w hat sh o u ld b e d o n e if c o n fro n te d w ith a n y o f th e described em ergencies th e re a d e r sh o u ld b e a ble to be o f real assistance to the c a s u a lty as well as th e d o c to r. In a n em ergency, w ith th is b o o k a t h a n d m ost accidents c o u ld be adeq u a te ly coped w ith u n til e x p ert assista n ce o r a dvice w as received. T h e aim o f th e b o o k is direc te d as a su p p le m e n ta tio n o f th o se F irs t A id M a n u a ls a lre a d y pu b lish ed b y St. J o h n ’s o rg a n is a tio n , th e R ed C ro ss Society a n d th e N o o d h u lp lig a . P H Y S I O T H E R A P Y 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. )