"We sow the seed": perspectives of health educators at the Institute of Family and Community Health in Durban in the 1940s and 1950s.

Abstract

Health education is critical to the success of a community health program. Yet the majority of research on health education is conducted from the point of view of programme designers or evaluators. Where health educators themselves are the focus, data is often generated through surveys, questionnaires, field notes, or quantitative measures. Narrative accounts by health educators describing their activities and their perceptions of programme efficacy are thus a neglected line of inquiry. My thesis examines one group of health educators who trained and worked with Sidney and Emily Kark at the Institute of Family and Community Health in Durban during the 1940s and 1950s. The importance of health educators in the Institute's project has often been acknowledged by key figures like the Kark, but few scholars have highlighted the contributions of these paraprofessionals. As catalysts of change and disseminators of knowledge, their role was encapsulated by health educator Neela Govender: "So many things people can do to [become] aware of health problems, and how much they themselves could be responsible for their own health ... that's not something they can forget. They will pass it on to another generation, or influence each other. We sow the seed, and it must grow, and spread". In focusing on the health educators' role, I seek to integrate perspectives of "history from below" to enhance previous analyses that concentrated on doctors and government administrators as the main architects of the Institute of Family and Community Health. To this end, I have collected testimony of health educators as a valuable source of historical evidence, which not only uncovers a foot soldier's view of what the Karks called a "practice of social medicine" but also illuminates various social, political, and economic contexts underpinning health education in South Africa. This study used oral history techniques to explore how retired health educators perceived their experiences at the Institute. It thematically analysed their narratives to gain a sense of their training, goals, methods and working conditions in segregationist and apartheid-era South Africa. My interview subjects were predominantly women whose work reflected the centrality of maternal, child, and family health to the Institute. As intermediaries between the clinic and the community, they were integral to the Institute of Family and Community Health's investigation of the links between health and culture. The themes of race, gender and culture were as pertinent in the mid-twentieth century as they are today in the delivery of health services; health educators' narratives might provide insights into how such conceptual factors influence the operation of community health programs in contemporary South Africa. The ways in which the Institute's health educators became active agents in the face of oppressive circumstances also contain potential lessons for their counterparts currently struggling to address an HIV/AIDS epidemic with inadequate resources and governmental support.