DEFECTUOSO FUNCIONAMIENTO DE LA ADMINISTRACIÓN DE JUSTICIA

What follows starts by providing key findings and discusses issues in relation to diseases and the ill health of the population.

5.1.1 Diseases and out breaks

Data from the ONA and the British Red Cross BRC archives show that in the 1950s and the 1960s, numerous common diseases were present in SA. These diseases included: Malaria, skin infections and sepsis arising from trauma or infections. Furthermore, Bilharzia was common mainly in remote areas, which explains why this disease had not been dealt with intensively. However, according to the archival records, there were a number of other diseases that are thought to have been imported from abroad as a result of the colonial presence and the consequent trade and flow of people. Smallpox has for instance, always been regarded as a colonial legacy (Lasker, 1977) ;(Phua, 1989) (Lal, 1994). This disease, according to the above records, existed mainly in Aden, probably due to its industrial and mercantile activity. Records also show that 1859 cases of smallpox were reported in the year 1952 alone; thereafter, minor outbreaks in Lahej and the Lower Aulaqi states were reported, but quickly dealt with. Yet, although some smallpox conditions did exist prior to the 1950s, there is no evidence to suggest that this disease existed prior to the British colonial presence, bearing in mind that the British existed in SA since 1883. Writers who are either interested in public health in the colonies or in health services in the colonies (Manderson, 1987) (Mohamed, 1999) (Mukherji, 2011) assert that colonies suffered from smallpox and that the colonial administrations should be accountable for this.

In an annual Medical and Health Report produced by the colonial administration (ONA,1953), which was accessed in the ONA, it is mentioned that Tuberculosis

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(TB) was a common disease in the colony of Aden. According to this report, in 1952 TB wards in Aden continued to function in a satisfactory way and the disease’s death rate had been falling steadily in the years preceding the report. The report mentions an urgent need to appoint a full time TB officer; the need was to invoke the assistance of the World Health Organisation (WHO) to undertake a TB survey of the colony of Aden. This report made no mention of the rest of SA, which implicitly highlights the unique status of Aden as a crown colony to the colonial administration. The Medical and Health report (ONA, 1954) presents a document written by a person called Moller, states that the WHO and the United Nation Children’s’ Fund (UNICEF) had undertaken a Bacille Calmette-Guérin (BCG) vaccination campaign in Aden which started in January 1952. This campaign was coordinated by Dr Cochrane, who was the Director of the Health Services in Aden at that time. The campaign targeted merely one fourth of the population of Aden half of whom were children of school age (ONA, 1953). The campaign report made no mention of other targeted regions but reported that female attendance was poor.

In the 1954 issue of the Medical and Health Report (ONA, 1953:17) a mention was made of the appointed “TB officer, Dr G. Ashe”. The report concluded that appointing a TB officer had led to better coordination in the treatment of TB cases. Nevertheless, from the records it is evident that TB continued to be the main health problem that caused the most concern. However, it is not clear from the records what other preventive measures were undertaken by the government to overcome this health problem apart from the TB vaccination campaign. The government did put some sort of curative measurements in place, such as the establishment of TB wards. Yet the chance to eradicate the disease would have been better if the colonial administration had considered preventive measures rather than curative measures, as the latter made little difference other than to perhaps give rise to increased concerns about TB as a disease. In reality, any solution to the TB problem was very much connected with poor housing and poor sanitation in addition to low levels of health education; these three broader factors have been discussed in an earlier chapter.

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In 1956 there was a small outbreak of Cerebro-Spinal Meningitis. According to the Medical and Health Report 1956 (ONA, 1956), there was a previous outbreak of this disease but no mention was made of when this occurred nor how serious it was. The above mentioned report had also concluded that within this year there was no outbreak of any major epidemic diseases. Nevertheless, the health standards of the community was maintained at its previous levels. This may be due to the fact that there had been no change in the services that may well have underpinned the improvement of the health of the population, services such as housing, and sanitation.

5.1.2 Maternity and Childcare

The records accessed from the ONA archive suggest that the high maternity and child mortality rates were a prime concern to the British colonial administration in the 1950s and 1960s. The colonial administration’s attempts to improve the wellbeing of the mothers and babies might also be part of the broader efforts to win the hearts and minds of the local population. The motives behind the broader shift in the colonial government towards the health of the public in general were discussed previously in the earlier chapter, focusing on maternal and child wellbeing is likely to be part of this shift.

This study has found that in the year 1952 sick babies, who were mainly diagnosed with malnutrition, were called marasmic23 _{babies when they were} seen by medical staff. Yet, according tothe Medical and Health Report (ONA, 1953) there was a general impression that there was a slow steady rise in the numbers of healthy infants in the colony. Provision for sick and marasmic infants at that time, according to the report, was a major problem. However, it is not clear what the difficulties were nor how they could be overcome. But it would be reasonable to assume that the problems could be anything from difficulties in having a health professional attend those babies at early stages,

23 _{Marasmus: is an extreme form of malnutrition and emaciation (especially in children) which can}

result from inadequate intake of food or from malabsorption or metabolic disorder (The Free Dictionary accessed on the 18th _{March 2014)}

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to poor communication with the parents, to not having the appropriate and adequate trained staff to attend to this group of patients.

Nevertheless, the same report concluded by stating that the unit where those children were seen did not meet the demands, and this could perhaps be the main problem or one of the main problems towards the provision for sick and marsmic infants in Aden.

There is a gap of knowledge in the health of children of other age groups; the health reports that have been viewed in this study tend to focus mainly on mothers and babies. Nevertheless, it was reported that in 1955 children attending out-patient clinics had doubled in the previous five years, but the colony’s infantile death rate was still high.

“And will remain high until the attitude towards children changes”.

Medical and Health report (ONA, 1956: 26) This comment makes me wonder who actually wrote these annual reports and what their backgrounds were. It is not actually clear what the words the “attitude towards children” actually means and this opens up room for a lot of speculation. One question, which arises, is: was it the families’ attitudes towards their children or the attitude of the administration towards the provision of proper health services to children? However, the most likely assumption is that it was the latter, as the state takes the ultimate responsibility of social welfare including maternity and child welfare.

The Medical and Health report reported that neonatal deaths in hospital were 25 per thousand of which 75 per cent were in premature infants. Stillbirths in hospital amounted to 42 per thousand of which 33 per cent were due to prematurity, and the hospital maternal death rate was 4.1 per thousand total births (ONA, 1956: 26). The efforts of the colonial state and measures to improve maternity and child health were not clearly mentioned in any of the health reports of the colony which were examined in this study; although a

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mention was made of the very high demand for medical and nursing professionals. In or about the same period of time, a similar focus did exist across the British Commonwealth, but many scholars such as; Summers, 1991; Geiger et al., 2002; Jennings, 2006 and Van Tol, 2007 believe that differences in the policies and the practice of maternity and child care in the colonies did also exist.

Women’s health issues in the period of time that is the concern of this study were centred on gynaecological, maternal and childbearing issues. In the 1957 Medical and Health Report, a table contains figures on admissions to the Maternity Clinic during the period 1953-1957. It shows that a large proportion of the births taking place at the hospital are abnormal ones and that during the year 1957, 34 abdominal sections were performed, which included 21 Caesarean Sections (ONA, 1957: 19). The report stated that the maternal death rate was very much higher in the colony of Aden than that which applied to the colony as a whole. This is in spite of the fact that no mention was made of maternal death rates in the rest of SA. The reason for such high maternal death rates was thought to be due to the larger number of abnormal cases arriving at the hospital in dire obstetrical distress. Admissions to the maternity hospital 1953-1957 included 1505 Arabs, 490 Indians, 406 Somalis, 29 Jews and 70 other races (ONA, 1957:19). The latter information leads one to the conclusion that this hospital served mainly the non- British women, and also raises many questions, among which is: what sort of measures were there to prevent the increase of maternal deaths? and: what were the maternity death rates among British women in the colony during the same period? Other questions include: What sort of nurses looked after both groups of women and were there any particular personal specifications for the nurses who looked after each group? Another related issue concerns the equity of the provision of nursing care in a colonial setting like SA. This latter point will be considered in a later section of this thesis.

According to the government medical reports, there were many obstacles towards caring for this group of patients:

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and overcrowding, are the main factors”

Medical and Health Report (ONA, 1955: 26)

In addition:

“Early marriage frequent child bearing and interference by ignorant grandmothers all play their part”.

Medical and Health Report (ONA, 1955: 26)

Echoes of conflicts between colonial health care professionals, nursing professionals in particular, and the traditional medicine practitioners are another dimension of the complicated issues such as class, race, and gender which arise in colonial settings (Sweet and Digby, 2005).