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Psycho-social aspects of tuberculosis : a study of cases in a low income group in a selected area of Vancouver Tadych, Mary Philomena

Abstract

This study examines the psycho-social aspects of tuberculosis in a low income group in an urban setting. The locale chosen was Social Area Three of the City of Vancouver. Part of this area known as the "Strathcona District" was surveyed in 1947 by a University of British Columbia team, of which the writer was a member, as part of a demonstration slum clearance project. This group was specially selected to give clearer focus to the important "residual area" problem in tuberculosis control, namely, that large group of the tuberculous in whom the interaction of the emotional aspects of illness and defects in their material environment combine to make them the hard core of the tuberculosis problem and of many other social problems in the community. A general perspective for the study is drawn from tuberculosis and social work literature from North America, Britain and Scandinavia. The details of the study are based on the case records of seventy-nine people aged eighteen to fifty who were almost one hundred per cent of the diagnosed cases of active tuberculosis in the white races living in Social Area Three of Vancouver in August, 1948. The case list was compiled from the files of the public health .nurses of the Metropolitan Health Committee. The Social Service Exchange registrations of patients and their families were followed up and a total of one hundred and eighty seven case records were read. Information from home interviews with selected patients was also utilized. In terms of social characteristics the sample includes; (a) patients in family settings and, (b) unattached men living alone, who numbered one quarter of the group. The group as a whole were near the border-line income brackets, but might never have Become social liabilities but for their tuberculosis. The problems presented by the disease to the patient as an individual, to his family and to the community are then discussed. The importance of the personality of the patient as a factor in illness is stressed, and the role of the medical social worker in diagnosis and treatment is outlined. Illustrative case material is utilized. The study indicates that the three most important factors determining the successful management of tuberculosis are: (a) the existence of facilities for finding, treating and rehabilitating cases, (b) adequate ancillary social services for the treatment of the social aspects of the disease, (c) the degree of cooperation of the patient and his family in the treatment plan, which cooperation is largely determined by their degree of emotional maturity. The problem of patient non-cooperation is found to stem mainly from lack of sufficient services to meet primary human needs. Because of this lack the life experiences of most people in the group in their formative years had not been conducive to the development of the requisite emotional maturity for dealing constructively with the problems of chronic illness. There is evidence that the weakness of the rehabilitation services in British Columbia vitiates much of the excellence of other treatment facilities. The principle conclusion drawn from the evidence is that the prevention and control of tuberculosis are inextricably interwoven with many other social problems, including poverty, bad housing and family insecurity, which must be attacked in their entirety if advances in tuberculosis control are to be continued. Poverty, in particular, shows up its paramount importance in the perpetuation of tuberculosis as a major health and welfare problem. Specific recommendations are made regarding changes in legislation, medical services, medical social work, social assistance, rehabilitation services and voluntary social agencies services. Many of these recommendations would have valid application in the treatment of other chronic illnesses.

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