In 1954, the medical department undertook with the cooperation of the World Health Organisation an extensive survey of the prevalence of tuberculosis in the urban areas.125 The survey team visited only urban centers: Burao, Borama, Amud, Erigavo, Gabileh, Mait, Hargeysa, and Berbera, but systematically surveyed only Burao and Berbera. In Burao, for instance, each street chosen for examination was marked, and every household in each street chosen for examination was given a number and painted with a sign at its entrance. Every effort was made to include both sectors of the town: the hut section, and the permanent stone-house section. During the medical examination, women were brought from the market, men from work, and children from school. In each household, the full name, age, sex, status of each individual in the family, and the total number of individuals in each household was registered. Each individual whether young or old was made to cough as vigorously as possible and then spit into a plastic box, which was then placed in a jar, and transported to the District Hospital where the sputum was examined with a microscope. The people’s cooperation with the survey team was more than satisfactory. According to the team, 95 percent of the people selected for the survey in Berbera, and 91 percent of the people selected for the survey in Burao, attended the examination. The survey team concluded that in both towns the rate of infection among all age groups was very high, as can be seen in the table below.
The methodology of the survey team was deeply flawed in several respects, however. First, the survey team did not re-test the people whose sputum showed acid-fast bacilli with an x-ray. Rather, they were satisfied with the microscopic test of the sputum. Second, the sputum was examined after three weeks, rather than one week. After one week, many other micro-organisms grow in the sputum other than tubercular bacilli. Third, the sputum was not appropriately transported nor kept in a cool environment. The jars were transported from the survey areas to the hospital in cars without refrigerators. The survey team pointed out all of these problems but lightly dismissed them. The team insisted that if the conditions were more favorable, they would have detected “an even higher number of positive sputa.”126 Yet the morbidity rate reported in the hospitals were rather meager: a total of 740 cases in 1955, 739 cases in 1956, 657 cases in 1957, and 808 cases in 1958.127 What worried the administration, nonetheless, was the possibility of the disease reaching epidemic levels in the overcrowded and insanitary conditions in the towns, and then spreading to the interior since there was constant traffic between the towns and the rural areas.
Meanwhile, the incidence of sexually transmitted diseases, in particular gonorrhea and syphilis, increased particularly during the war. Three factors were important in the incidence of the disease. First, the growth of the population of the towns; second, the increase in the number of prostitutes in the towns; and third, the increase in the number of soldiers during the war: major wars, as Kenneth Kiple put it, always increased the incidence of syphilis.128 One report, for instance, stated that “women are now infected [with VD] in every town where troops are stationed.”129 By 1946, the number of venereal diseases treated were 5,308 of which 2,929 were syphilis and 1,886 gonorrheas. Chancroid cases were uncommon, which indicates the recent spread of the disease. The “immediate cause of the rise of V.D. in recent years has been a great increase in prostitution. V.D. is mainly a disease of the towns where prostitutes and vagabond youths congregate.”130 For T. F. Anderson the “effects of the war on public health”131 had been profound. The “marked increase in prostitution and venereal diseases” was “perhaps inevitable when it is considered that a large number of alien and native troops employed by the Italians and ourselves have been quartered in the country for practically the whole duration of the war.” Foreign troops introduced venereal diseases among prostitutes, which then spread further among the young migrants as well as among the older male population. It is, as he put it, “one of the many social evils which has been occasioned by the war, and which will have a profound effect on the Somalis for many years to come.”132 By 1948 venereal diseases were “becoming a serious menace to the health of the people.”133 (Table 2) Venereal diseases “have increased alarmingly during the last decade,” according to John Hunt, “especially with the opening up of the Ethiopian frontier, increased travel by motor lorry, and the rapid movement of troops during the war.”134
From 1950 to 1959, the rate of syphilis infection declined, while the rate of gonorrhea increased. Although the 1951 medical report stated that “No significant conclusions can, however, be drawn from these trends,”135 an inference could be made about the cause of these trends. The departure of foreign troops was probably the main reason for the decline of syphilis. But even the obvious decline in figures (Table 2) must be tempered by the fact that a large number of people did “not come in for examination and treatment.” Unlike tuberculosis, which the people sought assistance for quickly, the control of venereal diseases faced two problems: “ignorance of the seriousness of the disease (gonorrhea) and reluctance and dislike for a proper examination.”136 Females particularly avoided “proper examination” since there were no female doctors in the territory, and female nurses were too few. Hence there was probably “many female cases who never attend for treatment and therefore continue to spread the disease.”137
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