WELFARE DEPARTMENTS

the PUBLIC HEALTH DEPARTMENT.

Organisation.

THE PUBLIC HEALTH OF THE DISTRICT is looked after by two agencies, viz. the Public Health Department of the State and the local bodies like the District Local Board, the municipalities and the village panchayats.

At the head of the Public Health Department is the Director of Public Health, who has his headquarters at Poona. The District Health Officer represents the Public Health Department and is the head of the district in all public health matters. He is directly under the Deputy Director of Public Health, Bombay Division, Poona.

The District Health Officer investigates the causes, origin and spread of diseases both epidemic and endemic and adopts preventive measures to control diseases such as cholera, smallpox, plague, guinea-worm, influenza, etc.; undertakes routine immunisation and disinfection measures for prevention of epidemics; organises sanitary measures in fairs and festivals; inspects sites for school buildings, village extension, wells, burial grounds, etc; expresses opinion regarding their suitability from health point of view; and advises municipalities, village panchayats and village authorities about health, sanitation, water supply and drainage. He also inspects primary health centres, maternity and child health, family planning and leprosy centres; looks to school and industrial hygiene; recommends issue of licences for cinema theatres and other places of public amusement to the licensing authorities after satisfying himself that the various sanitary provisions are fulfilled; inspects factories and mines in the capacity of ex-officio Inspector of Factories or Mines to enforce the sanitary regulations and also carries out health propaganda with the help of his subordinate staff.

He keeps himself informed as far as possible of all influences affecting or likely to affect injuriously the public health in the district and takes necessary steps. His subordinate staff consists of: (1) Epidemic Medical Officer, (2) Medical Officer in charge, Primary Health Centre, (3) Medical Officer in charge, Leprosy Hospital, (4) Subsidised Medical Practitioner in charge, Primary Health Units, (5) Eight Sanitary Inspectors, and (6) Two Leprosy Assistants and others.

There are two special officers for Malaria Eradication Programme in the district, who, with an adequate staff under them, function from Ratnagiri and Sawantwadi, and maintain a close liaison with the District Health Officer.

Functions of Public Health Officers Epidemic Medical Officers.

The main duty of the Epidemic Medical Officer is to control epidemics and in non-epidemic times to adopt preventive measures against possible outbreak and also to render medical relief in rural areas. The Epidemic Medical Officer, Ratnagiri, is provided with a van. On the first report of an outbreak of an epidemic, he rushes to the places to carry out mass inoculation or vaccination, disinfection and disinfestation, protection of water supply and domiciliary treatment.

The district of Ratnagiri is divided into six circles and one Sanitary Inspector is placed in charge of each circle.

Sanitary Inspectors.

The sanitary inspector is responsible for all public health matters in the charge, including control of epidemics. He conducts regular vaccination inspection. With the intention of improving the standard of vaccination and sanitation in rural areas, Government has a scheme to replace the existing vaccinators by persons holding Sanitary Inspector's qualifications. The latter are to be styled Sanitary Sub-Inspectors,

The primary duty of vaccinators is to carry on vaccination in their respective charges. They also assist in carrying out anti-epidemic measures and sanitary works in villages with the help of the sanitary squads under them. The main duty of these squads is to improve the sanitation of villages which have no panchayats. They construct soakage pits, manure pits, trench latrines, and drain and fill pits and also clean the surroundings of schools, wells, etc.

Mukadam.

The mukadam supervises and guides the squads in their work. In times of epidemics, the services of the squads are utilised for adopting anti-epidemic measures under the supervision and guidance of sanitary inspectors and epidemic medical officers.

Medical Officer incharge, Primary Health Centre.

The Medical Officer in overall charge of the Primary Health Centre is responsible for all services rendered by the staff of the Centre such as medical care, control of communicable diseases, improvement of vital statistics, maternity and child health, school health, family planning services, health education and improvement of environmental sanitation in villages in an area having a population of 60,000 approximately.

The Medical Officer is helped by a health visitor or a nurse-cum-midwife, a compounder, a sanitary inspector or sub-inspector in the discharge of his duties.

The Subsidised Medical Practitioners are in charge of primary health units.

The duties and functions of subsidised medical practitioners incharge of Primary Health Units are the same as those of Medical Officers of Primary Health Centres but they work for a population of 20,000.

Health Visitors and Midwives.

They are mainly responsible for maternity and child welfare activities. They carry out institutional and domiciliary deliveries; take care of ante-natal and post-natal cases, infants, toddlers and pre-school children and train dais. They also take active part in other services rendered by the primary health centre like nursing of the sick, family planning, health education, nutrition and school health services.

Family Planning Field Worker.

The family planning field worker is responsible for the family planning programme in the area of the Health Centre. Her main work is to carry out survey of family size, educate the people on the need of family planning, register the cases, prescribe suitable contraceptives, follow up the cases and refer any case for operation if agreed upon by the party and if necessary. These services are rendered in the houses as well as in clinics.

The Medical Officer incharge D.M. Petit Hospital.

The Medical Officer in charge, D. M. Petit Hospital, Ratnagiri, is in overall charge of the hospital, which is meant for indoor treatment of leprosy patients. It has 100 beds for institutional treatment of leprosy cases. Two, survey, education and treatment units for leprosy, one each at Dapoli and Chiplun, were established since 1959 and from the enquiry made by the Leprosy Assistants attached to these units, it has been found that many persons suffer from leprosy in the district.

Leprosy Assistants are non-medical workers trained in leprosy work. They are appointed in the survey, education and treatment units attached to the dispensaries and work under the supervision of the Medical Officer in charge of dispensary. They carry out survey, education and treatment of leprosy patients and follow up the contacts in the areas allotted to them.

Obligatory duties of the local bodies.

Public vaccination and execution of measures necessary for public health are obligatory duties of the municipalities in urban areas and of the District Local Boards in rural areas. The District Health Officer advises these bodies in respect of public health and sanitary problems.

Municipalities.

There are seven municipalities in the district of which one is a borough municipality and the rest are district municipalities. The municipalities receive grant-in-aid from Government towards the employment of qualified health officers and sanitary inspectors. The sanitary inspectors bring to the notice of the Medical Officer, (where there is one), or the Chief Officer of the municipality the defects noticed by them during their rounds and the Medical Officer or the Chief Officer takes action according to the power vested in him by the bye-laws.

District Local Boards.

There is no Health Officer or Sanitary Inspector in the employ of the District Local Board. There are 27 vaccinators who are Government servants. A fixed contribution is received from the District Local Board towards the pay of these vaccinators and contingent charges are borne by the Board. Rest of the expenditure is borne by Government. In villages having panchayats, sanitation is looked after by the panchayats. The sanitary arrangements made by the village panchayats are inspected by the Officers of the Public Health Department and the defects noticed by them are brought to the notice of the President, District Local Board. The village panchayats are empowered to levy taxes to enable them to meet the expenses towards improvement of the village, purchase of medicines, drugs and disinfectants, lighting, water supply, etc. In villages which have no panchayats, the District Local Board deals directly with complaints relating to sanitary conditions, water supply, etc.

Chief Diseases.

The following table gives the number of deaths due to chief diseases in Ratnagiri from 1951 to 1958: -

The chief diseases noted to exist in the district are leprosy, malaria, tuberculosis, guineaworm and smallpox.

Malaria.

The malaria survey of Ratnagiri district was carried out by the Malaria Organisation, Bombay State, during the period from May, 1950 to April, 1951.

In all, 172 villages were visited for spleen survey. Out of 11,226 children examined, 318 were found positive, giving the cumulative spleen rate for the district as 2.8 per cent. The children's blood examination was restricted to the highly endemic area. Out of 41 positive smears, 27 were of P. vivax and 14 were of P. falciparum. Total A. culicifacies collection was 2,231. Out of these, only one was found to be positive. A fluviatilis, though not found infected, was certainly a vector of importance in Sawantwadi and Kudal talukas. Certain sections of Sawantwadi and Kudal talukas were found to be malarious, and the rest of the district was completely free from the incidence as judged by spleen rates. D.D.T. spraying was, therefore, to start with, restricted to Sawantwadi and Kudal talukas. It commenced in the year 1950. From the year 1953, the taluka of Mandangad was also taken up for D.D.T. spraying under the Malaria Control Programme. In the year 1956, when the D.D.T. spraying operations were extended to hypoendemic areas, whole of the district was brought under spray. So far, the anti-malaria work was being carried out through the District Health Office. On 1st April 1959 this district was allotted two full-fledged Malaria Education Units, one stationed at Ratnagiri and the other at Sawantwadi. These units are sanctioned under National Malaria Eradication Programme in which the creation of hypoendemic units is proposed. Each unit is fully staffed according to the pattern of the National Malaria Eradication Programme and is allotted four trucks and one jeep for transport etc. The population covered by Ratnagiri and Sawantwadi units is 8,51,618 and 8,60,346 respectively. The incidence of malaria has been brought to a negligible level as judged by spleen rates, child parasite rates, infant parasite rates and morbidity statistics. The further plan is to eradicate malaria through chemo-therapeutic methods and intensive D.D.T. spraying under National Malaria Eradication Programme.

Tuberculosis.

Many persons from the district go to Bombay and work in factories and mills over there. Due to incongenial atmosphere in the factories their resistance capacity deteriorates. As a result they get tuberculosis infection. Naturally the district has too many tuberculor patients. The B.C.G. vaccination programme is being carried out in the district by the mobile B.C.G. teams of the Public Health Department.

Guineaworm.

The disease is highly prevalent in the northern part of Ratnagiri district as the water supply in this part is mainly from step wells, tanks and gundas (open wells without parapet walls) and infected persons, due to ignorance, freely contaminate the water supply and help the spread of the disease. Step wells are being converted into draw wells. Arrangements to disinfect water supplies with repeated and heavy doses of bleaching powder are made.

Epidemics.

In urban areas it is the statutory duty of the municipalities to provide special medical aid and accommodation for the sick when epidemics occur and take such measures as may be required to prevent the outbreak, or to suppress and prevent the recurrence of the disease. In rural areas, the primary responsibility for dealing with out-breaks of epidemics rests with the District Local Board. The Board is required to set apart annually a lump sum equal to the average of the amounts spent during the preceding three years for expenditure in connection with epidemics. The grant is placed at the disposal of the Director of Public Health for emergency measures. The Collector is empowered to take action in consultation with the Director of Public Health, if he finds the measures taken by the Board arc inadequate. Similar powers have been conferred on the Collector in respect of urban areas also. The District Local Board is helped in its task by the District Health Officer, and the staff under him. The services of Dispensary Medical Officers and Subsidised Medical Practitioners are also utilised.

The incidence of cholera and smallpox during the eight years i.e. from 1951 to 1958 is given below:-

Cholera.

Ratnagiri district has been almost free from cholera for years together.

Smallpox.

The district is very prone to smallpox in epidemic form. The disease is controlled by means of vaccination.

Plague.

There was no out-break of plague in this district since 1949.

Primary Health Centres.

Five primary health centres are established at Kotwade and Pawas in Ratnagiri taluka, Wawe and Talen in Khed taluka and Dabhol in Dapoli taluka in Ratnagiri district.

The staff at each primary health centre consists of a Medical Officer, a Health Visitor or a Nurse-cum-Midwife, four midwives, a Sanitary Inspector, and other subordinates. The centre covers a population of 60,000 approximately. Each centre has three sub-centres under it where a midwife is posted.

As already stated before, the Primary Health Centres provide basic health services in rural areas. They carry out preventive, curative as well as maternity and child health services and thus play a vital part as a medium of service among the village population.

Maternity and Child Health Centres.

There are two maternity and child health centres one at Dapoli in Dapoli taluka and other at Kudal in Kudal mahal, working under the supervision of the Medical Officer in charge of District Local

Board dispensaries. Each centre is staffed with two nurse-cum-midwives and serves a population of 20,000. They carry out intensive maternity and child health work amongst a selected population.

Family Planning Centres.

To check the uncontrolled growth of population and improve the standard of living, family planning centres were set up in the district. One such centre is located at Khanu in Ratnagiri taluka and the other is at Kankavli in Kankavli mahal. The centres work in conjunction with the primary health centres at those places. Besides the above two rural centres, there is an urban family planning centre at Ratnagiri proper run by the Mahila Mandal with the help of the Public Health Department.

School Hygiene and Medical Inspection of School children.

The Epidemic Medical Officers and Medical Officers in charge of the primary health centres carry on occasional medical examination of school children during the course of their tours and distribute drugs for minor ailments and vitamin tablets to children suffering from deficiency diseases. Propaganda with the help of magic lantern or films is carried on to educate school children in personal hygiene.

Propaganda.

Health propaganda is carried out by all the health staff. Magic lantern lectures and health talks are given on subjects such as nutritious food, prevention of blindness, cholera, typhoid, etc. at the time of fairs and exhibitions. Public Health stalls are arranged where models and posters on health subjects are exhibited and educative films are shown by the propaganda van of the department.

Fairs.

Fairs are managed by the local bodies according to suggestions from the District Health Officer. Every year the following important fairs are held in the district.

The Kunkeshwar fair in Deogad taluka is being managed by the District Local Board and Ganapati Pule Fair by the Gram Panchayat, Malgund, with the help of the public health staff.

Whenever there is an epidemic in the surrounding area, in addition to other preventive measures, compulsory Inoculation or vaccination is enforced.

Famine Relief.

When famine and scarcity conditions are declared to exist in the district, the District Health Officer is under the general orders of the Collector in so far as medical and sanitary arrangements on scarcity and famine relief works are concerned.

Vital Statistics.

The compilation of statistics of births and deaths for the Ratna-giri district is done in the office of the Assistant Director of Public Health in charge of Epidemiology and Vital Statistics, Poona. In the municipal areas, the municipalities concerned maintain registers of births and deaths and forward monthly extracts to the Assistant Director of Public Health. In rural areas, the register is maintained by village officers and monthly extracts are sent by them to the taluka officers for transmission to the Assistant Director of Public Health.

Water Supply.

Piped water supply is available in the town and villages as shown below:-

(1) Khed Municipality, Khed.

(2) Dhamnar Divi, Khed.

(3) Ayani Tal, Khed.

(4) Parshuram Tal, Chiplun.

(5) Sangameshwar.

(6) Rajapur Municipality.

(7) Amboli Tal, Sawantwadi.

(8) Shiv Bk. Khed.

(9) Songaon, Khed.

(10) Chiplun Municipality,

(11) Pophali, Chiplun.

(12) Ratnagiri Municipality.

(13) Sawantwadi Municipality.

(14) Gharpi Tal, Sawantwadi.

In the remaining parts of the district, wells form the chief source of drinking water. Rivers in Khed and Chiplun talukas are also used as a source of drinking water. During summer there is scarcity of water in the talukas in the northern part of the district. The work of construction of new wells, repairs to old wells and conversion of step wells into draw wells is executed by the Block Development authorities.

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