A history of public health policy in Lesotho, Southern Africa, 1900-1980.

摘要

Scholarly writing on Lesotho has underplayed the medical dimension of the country's history. This dissertation documents the history of western medicine in Lesotho focusing on the evolution of public health policy from 1900 to 1980. The study is based on primary archival material and secondary sources.; The first efforts of the colonial state to manage public health in Basutoland began in the 1880s. The study describes how medical authorities in Basutoland sought to contain the outbreaks of typhus fever and bubonic plague between 1917 and 1924. It shows how that experience forced health authorities to institute public health measures and to collaborate with their counterparts in South Africa. Yet, the epidemic of tuberculosis did not provoke similar collaborative efforts. Discussion of tuberculosis confirms the paradox that because of its insidious nature, TB lends itself to official neglect more easily than epidemics whose virulence can be measured more directly by deaths in their immediate aftermath.; The discussion highlights the ambiguities resulting from increased popular knowledge and awareness about diseases. Increased knowledge improved the notification system, making it possible for diseases previously unknown to find their way into official records. On the other hand, popular awareness about diseases promoted the spread of quack medicine. To keep quackery at bay and to maintain the standards of colonial medical practice, the state adopted the Medical, Dental and Pharmacy Proclamation of 1921 and involved the traditional institutions in the management of public health.; Post-World War II advances in medical knowledge changed the practice of colonial medicine. A shift from a small-scale, community-based health care system to a large-scale, allopathic hospital-based disease management system was one such change; the internationalization of health care is another. These shifts not only alienated chiefs and traditional doctors from the mainstream of public health management, but they also pushed some of the medics in the employ of the government to the margins of that system. Further, the concern about nutrition became part of policy formulation. The study concludes that while internal considerations were important in the formulation of public health policy in Lesotho, the process has been predominantly conditioned by external factors.