HYGIENIC SERVICES

Well-organized hygienic services are to be found only in the big colonial cities. Under the direction of a physician of the Colonial Health Service, they are an important factor for the maintenance of good health. Having been allocated the task, in the public interest, of foreseeing and combating the deadly epidemics of the beginning of the 20th Century, they are provided with special structures. They do not intervene in the treatment of illnesses that are dealt with by the dispensaries and hospitals of the town. However, their prerogatives in the domain of prevention lead them to make a distinction between the tasks the hygienic service is directly responsible for and the multidisciplinary programmes for the decontamination of towns, in which the physician intervenes only indirectly as the initiator and then the controller of the resulting effects on public health.

In rural areas, hygiene remains a matter of great importance but whatever the bush doctor can do is limited by the fact that he has little scope for action. The prevention of the most troubling diseases is confided to the service for combating tropical endemics.





THE STRUCTURE OF AN URBAN HYGIENIC SERVICE

The hygienic service of a big city (very often the capital of a colony) is directed by a high-ranking colonial physician, with an assistant physician and one or more auxiliary doctors. They have at their disposal native workers, some in regular service, others, more numerous, divided into teams which scour the city and its suburbs.

In these times of frequent and deadly epidemics, the abnegation and efficacy of these workers, whose mission is to prevent or diminish the carnage caused by plague, cholera or yellow fever, wins for them well-deserved respect and consideration from the population.

The technical services consist of :

- A dispensary for vaccinations and diverse consultations, including the control of prostitutes.

- A biology laboratory where blood samples from individuals but, above all, from disease-carriers such as rats, flees and mosquitoes, are analysed.


A Centre of Hygienic Service

Disinsectisation of a house (Senegal)

- A disinfection centre with sterilizers and equipment that can be used in houses.

- A centre for rat extermination with hoop nets and instruments for disinfecting sewers, ships, etc...

- A large number of vehicles equipped for spraying disinfectants, spreading manure. Mobility is the key, each team working in a precise area according to an established programme.

- Health control at frontiers, in harbours and airports.

- The headquarters of the hygiene brigade with its files and charts. Inspection in houses is confided to officially designated and uniformed agents, with ranks in a hierarchy, who can report unsanitary conditions to the authorities. The fear of fines helps to make their work more efficient.

 




TASKS THAT ARE THE DIRECT RESPONSIBILITY OF A HYGIENIC SERVICE

The aim of the activities of a hygienic service is the detection and prevention of endemic diseases. Uninterrupted vigilance is required because the threat of the outbreak of certain diseases is permanent in densely populated towns with suburban zones insufficiently equipped to protect the community.

The hygienic services are responsible for vaccinations against :

- Tuberculosis with BCG, in collaboration with the urban maternity hospitals and the PMI centres.
- Smallpox, in collaboration with school medical services.
- Yellow fever, at the same time as the anti-smallpox vaccinations.
- Measles and, from 1974 onwards, against the six diseases that the extensive programme of vaccination (PEV) seeks to control.

They are also responsible for the detection and prevention of such permanently threatening diseases as :

- Malaria, with chemoprophylaxis and the extermination of mosquitoes.
- Plague.
- Treponemal diseases.
- Trachoma in schools.

Finally, they have to detect and prevent intermittent diseases which are still dangerous :

- Cerebrospinal Meningitis.
- Cholera and other diseases linked to "the faecal peril".
- Rabies with the capture of stray dogs.


Vaccination at the Hygienic Service Centre





INDIRECT INTERVENTIONS IN THE DECONTAMINATION OF TOWNS

The meaning of the word "hygiene" evolves in the course of the 20th Century. After the Second World War, a difference is made between two domains. The first, concerning the prevention of transmissible diseases in the individual (his or her body and the environment in which he or she lives) retains the name "hygiene" (food hygiene, personal hygiene...) and remains the responsibility of the Health Service. The other, concerning the community to which they belong, is called "decontamination" (the collection of rubbish, mains drainage, centres for water purification, etc...). Several public services contribute to its functioning and, in general, it is under the responsibility of the municipality.


Disinsectisation of an area

Only this one is entitled to regulate how the city develops, to give building permits... Water supplying, fountains, public lavatories and their maintainance, garbage collecting and processing, etc... are all part of its responsability.

Large building sites and the draining system are managed by the public works office. As for health education in schools, fight against prostitution, drug addiction and deliquency, they are the domain of Education, the Police and Justice.

However, the hygienic service is far from being absent. Its representatives have a voice in all the commissions that deal with this subject, warn of risks to health - present or potential - and make recommendations. After that, since they are guided by investigations and the statistics provided by dispensaries, they are the best qualified officials to evaluate the results of the actions taken.

There is no great colonial city, from Saigon to Antananarivo, from Abidjan to Brazzaville, whose decontamination - and, as a result, living conditions - have not benefited from the orientations and vigilance of the local hygienic servicel.




PUBLIC HYGIENE IN RURAL AREAS

The native healers themselves offer this recommendation: "the maintenance of good health begins with cleanliness". Water, brooms and soap - three elements which, available and used as advised, are the basis of well-being for each person and the community.

In colonial times, hygiene is recognised as a priority. "We shouldn't hesitate to let those who complain of the lack of medicines cry out their indignation while, by digging wells, by making people live in the most hygienic surroundings, by organising the destruction of waste material and the burial of faecal matter, they render invaluable services to the communities they wish to give drugs to" wrote Bouffard* in 1934 in the Ivory Coast. As a general rule, a circular from the governor decrees the measures to be observed to assure "village and individual hygiene". Apart from the Health Service (agents of different public services being scarce in rural regions), the administrator leaves the responsibility of all the tasks that need to be performed to the physician practising in the area.

- The first task is the provision of drinking water. Here, rivers and ponds are more or less dirty and the authorities get down to sinking wells. Wherever the Guinea Worm is prolific, the physician recommends that surface water be passed through sand or charcoal filters, ingeniously fabricated with the pottery of the country and entirely efficacious.


The draining and stabilizing of a canal for laying on water

- Good sanitary conditions in dwellings and in villages may necessitate the abandonment of ancestral customs. In the North and Centre of the Ivory Coast, until the 1920s, the most common are "dwellings so low that, crouching down, one can touch their rooftops. Natives crawl into them on their stomachs to sleep". One can imagine the degree of promiscuity that prevails and to what extent this sort of hut is "particularly predisposed to the dissemination of contagious germs". They must be replaced by rectangular dwellings which are spacious, well-ventilated and with hard floors in villages that are clean and even charming and attractive. The African physician, a graduate of the Dakar school, who works to set up this innovation is no other than Houphouet-Boigny, the future President of the Ivory Coast. Nevertheless, in spite of the required standards of hygiene, the cultural obligations must be taken into account. It is a long-term job and must be accomplished without brutality or tactlessness.

- The faecal peril remains present because of the practice of defecation and the emptying of chamber pots on the surface of the ground. The population is taught to keep these waste products far from sources of water. What's more, when the environment permits, public latrines and septic tanks are constructed.

- Other directives are concerned with deposing household waste at a distance and burying it, the maintenance in hygienic conditions of jars to contain drinking water, the draining of stagnant pools, etc...

Every bush doctor has, besides the nursing staff, one or two agents who take care of hygiene, precursors of the "bare-footed doctors", responsible for keeping the villages clean and educating the populations in matters of hygiene... with the possibility of imposing fines if they fail to toe the line !


Page publiée le 11/01/2017.