ABROAD
South Africa: Research Worker's Paradise
would be the mothers of babies with kwashiorkor. There are features of black child-rearing that must be good and in danger of loss; even the practice of carrying babies on the back (all black babies seem to know about the art of holding on almost from birth) must be an enriching experience, and of course the mother knows at once if the baby on her back is unwell. There is an urgent need to gather data now, so that the effects of change on black personality may be understood and hopefully prevented. It is a sad sight to find all the patterns of white neurosis in educated black patients; surely this need not be. Turning to Walker's paper, which deals mainly with the survival outlook for middle-aged persons from the different populations in South Africa, one is again struck with the immense interest in patterns of dietary and environmental change for black and Indian populations. The white population is not so remarkable as a research object. Like their American counterparts, white South Africans suffer from the consequences of their dietary sins: overweight, lack of physical fitness, hypertension, coronary disease, and so on. The author points out that the growth of children is not entirely determined by diet. White children are tallest, but some black girls, although not so tall as white girls, are heavier. On the other hand, Indian students, even from homes where there is ample food, are shorter and lighter than white students. Similarly, his studies suggest that ultimate attainable longevity of populations may be programmed ethnically. A comparison of survival of middle-aged persons of different races shows that whereas the limit of longevity for whites seems to have been reached, there is a group of long-lived blacks who have survived the hazards of youth—infections, marasmus, violence, and so on—and who by the age of 50 years have a better expectation of life than their white counterparts. Unfortunately, this survival differential between black and white is likely to decrease in the future as the blacks fall victims to degenerative diseases. One curious feature at present is that middle-aged blacks are if anything a little more prone than whites to cerebral haemorrhage if they live in an urban setting, whereas they have not as yet managed to damage their coronary arteries to the extent of their white contemporaries. Another research subject? Thus angina pectoris and myocardial infarction are still rare among the black population, although they are slowly becoming commoner. One disturbing feature that calls for further investigation is the poor survival figures for middle-aged Indians in South Africa; they fare no better than their half-starved brothers in rural India in spite of a vastly better environment and nutritional state. Evidently with a rise in prosperity, Indians overreact to noxious environmental factors. Here is another unanswered question; why should this be so? I would fully agree with these authors that South Africa is a paradise for research workers, and, what is more important, their research in both psychiatry and nutrition might be beneficial to all mankind, unlike some research I could name. (STANLEY S. GILDER, 110 Nuffield St., Rietondale, Pretoria, Republic of South Africa)
" I N SOUTH AFRICA we have a veritable paradise for research in epidemiology and the changing patterns of disease" (WALKER ARP: Survival outlook for middleaged populations in South Africa. 5 Afr Med J 48:2053, 1974). "There exists today in this country [South Africa] a unique opportunity to observe the functioning of a society that is in transition from a preindustrial to an industrial way of life. Before the change is complete, every facet of it should be studied" ( A M E S FR, DAYNES W G : Some impressions of family life in Tsolo (Transkei). S Afr Med J 48:1961, 1974). Walker is writing from the standpoint of a nutritionist and pointing out that the whole world could benefit from study of the nutritional problems of a country with various races in "pure culture" but with changing patterns of eating. Ames and Daynes write from the psychiatric angle in an article designed to record facets of family life in an area, the Transkei, that now belongs to black Africans but is also in rapid transition. Certainly, these two articles deal with areas of primary importance not only to the locale but also to any part of the world where change is rapid—and where is it not? The investigation of family life in the Transkei from the woman's point of view (and I would think that the Xhosa women of that area do not differ greatly from the Tswana women who consult me every day, or the Zulus, or Venda, or any of a dozen races of Southern Africa) already shows the effects of education and industrialization. Ames and Daynes interviewed in depth small numbers of educated (nurses and hostel wardens) and uneducated Xhosa women. The striking thing that emerges is the strength of character and independence of the educated black woman; her sense of responsibility for her children contrasts sharply with the irresponsibility of the male, whom she regards with a mixture of indulgence and exasperation. That he will be unfaithful in marriage she accepts, whereas of course he does not accept infidelity from her. One tragic feature of South African life is that, because of the pressure of economics, many married couples do not live together continuously, a situation that scarcely makes for stable family life but does strengthen the woman's hand. The educated Xhosa woman, unlike her uneducated sister, accepts contraception (but laughs at the idea that her husband should be responsible for it) but frowns on illegitimacy and abhors abortion. She breast feeds, often for over a year, but stops at once if she becomes pregnant again. This makes weaning a painful process for the child, in particular if it is a boy, who tends then to be rather thrust out of the family circle, a rejection that may sow the seeds of irresponsibility. In a special category are the babies with kwashiorkor. They come to the clinic, miserable scraps of humanity with a perpetual whine, and it has been suggested that their protein lack is far less important than their rejection by the mother at weaning. In fact, they are almost a black counterpart of the white battered baby (black families do not batter their babies). A good subject for research 588
April 1975
• Annals of Internal Medicine • Volume 82 • Number
Downloaded from https://annals.org by Tulane University user on 01/14/2019
4
South Africa: Research Worker's Paradise
would be the mothers of babies with kwashiorkor. There are features of black child-rearing that must be good and in danger of loss; even the practice of carrying babies on the back (all black babies seem to know about the art of holding on almost from birth) must be an enriching experience, and of course the mother knows at once if the baby on her back is unwell. There is an urgent need to gather data now, so that the effects of change on black personality may be understood and hopefully prevented. It is a sad sight to find all the patterns of white neurosis in educated black patients; surely this need not be. Turning to Walker's paper, which deals mainly with the survival outlook for middle-aged persons from the different populations in South Africa, one is again struck with the immense interest in patterns of dietary and environmental change for black and Indian populations. The white population is not so remarkable as a research object. Like their American counterparts, white South Africans suffer from the consequences of their dietary sins: overweight, lack of physical fitness, hypertension, coronary disease, and so on. The author points out that the growth of children is not entirely determined by diet. White children are tallest, but some black girls, although not so tall as white girls, are heavier. On the other hand, Indian students, even from homes where there is ample food, are shorter and lighter than white students. Similarly, his studies suggest that ultimate attainable longevity of populations may be programmed ethnically. A comparison of survival of middle-aged persons of different races shows that whereas the limit of longevity for whites seems to have been reached, there is a group of long-lived blacks who have survived the hazards of youth—infections, marasmus, violence, and so on—and who by the age of 50 years have a better expectation of life than their white counterparts. Unfortunately, this survival differential between black and white is likely to decrease in the future as the blacks fall victims to degenerative diseases. One curious feature at present is that middle-aged blacks are if anything a little more prone than whites to cerebral haemorrhage if they live in an urban setting, whereas they have not as yet managed to damage their coronary arteries to the extent of their white contemporaries. Another research subject? Thus angina pectoris and myocardial infarction are still rare among the black population, although they are slowly becoming commoner. One disturbing feature that calls for further investigation is the poor survival figures for middle-aged Indians in South Africa; they fare no better than their half-starved brothers in rural India in spite of a vastly better environment and nutritional state. Evidently with a rise in prosperity, Indians overreact to noxious environmental factors. Here is another unanswered question; why should this be so? I would fully agree with these authors that South Africa is a paradise for research workers, and, what is more important, their research in both psychiatry and nutrition might be beneficial to all mankind, unlike some research I could name. (STANLEY S. GILDER, 110 Nuffield St., Rietondale, Pretoria, Republic of South Africa)
" I N SOUTH AFRICA we have a veritable paradise for research in epidemiology and the changing patterns of disease" (WALKER ARP: Survival outlook for middleaged populations in South Africa. 5 Afr Med J 48:2053, 1974). "There exists today in this country [South Africa] a unique opportunity to observe the functioning of a society that is in transition from a preindustrial to an industrial way of life. Before the change is complete, every facet of it should be studied" ( A M E S FR, DAYNES W G : Some impressions of family life in Tsolo (Transkei). S Afr Med J 48:1961, 1974). Walker is writing from the standpoint of a nutritionist and pointing out that the whole world could benefit from study of the nutritional problems of a country with various races in "pure culture" but with changing patterns of eating. Ames and Daynes write from the psychiatric angle in an article designed to record facets of family life in an area, the Transkei, that now belongs to black Africans but is also in rapid transition. Certainly, these two articles deal with areas of primary importance not only to the locale but also to any part of the world where change is rapid—and where is it not? The investigation of family life in the Transkei from the woman's point of view (and I would think that the Xhosa women of that area do not differ greatly from the Tswana women who consult me every day, or the Zulus, or Venda, or any of a dozen races of Southern Africa) already shows the effects of education and industrialization. Ames and Daynes interviewed in depth small numbers of educated (nurses and hostel wardens) and uneducated Xhosa women. The striking thing that emerges is the strength of character and independence of the educated black woman; her sense of responsibility for her children contrasts sharply with the irresponsibility of the male, whom she regards with a mixture of indulgence and exasperation. That he will be unfaithful in marriage she accepts, whereas of course he does not accept infidelity from her. One tragic feature of South African life is that, because of the pressure of economics, many married couples do not live together continuously, a situation that scarcely makes for stable family life but does strengthen the woman's hand. The educated Xhosa woman, unlike her uneducated sister, accepts contraception (but laughs at the idea that her husband should be responsible for it) but frowns on illegitimacy and abhors abortion. She breast feeds, often for over a year, but stops at once if she becomes pregnant again. This makes weaning a painful process for the child, in particular if it is a boy, who tends then to be rather thrust out of the family circle, a rejection that may sow the seeds of irresponsibility. In a special category are the babies with kwashiorkor. They come to the clinic, miserable scraps of humanity with a perpetual whine, and it has been suggested that their protein lack is far less important than their rejection by the mother at weaning. In fact, they are almost a black counterpart of the white battered baby (black families do not batter their babies). A good subject for research 588
April 1975
• Annals of Internal Medicine • Volume 82 • Number
Downloaded from https://annals.org by Tulane University user on 01/14/2019
4
