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A social work approach to the venereal disease problem in British Columbia : an analysis of the social problems involved in controlling the infected individual : with particular reference to recidivism at the Vancouver Clinic, Division of Venereal Disease Control, British Columbia Wyness, Enid Stewart

Abstract

Because the venereal diseases are acquired as the direct result of behaviour, this study takes as its focus the infected individual, and analyzes the venereal disease problem in British Columbia in terms of the incidence of infection, the treatment procedures as they affect the individual patient, and the unsavoury community conditions that facilitate promiscuous behaviour. The study reveals that in spite of the great advances that have been made in the medical treatment of gonorrhoea and syphilis, in 1948 in British Columbia, there was one case of venereal disease for every 250 people in the province. The ratio between male and female patients was approximately two to one, and gonorrhoea was four times as prevalent as syphilis. The community problem has always been concentrated in Vancouver, and in 1948, 76 percent of the facilitation reports received by the Division related to premises in Vancouver. In 1948, patients treated at the Vancouver Clinic accounted for almost half the total venereal disease population in the province, and a review of the new admissions to this clinic for the first six months of the year revealed that approximately every third patient had been previously infected. To determine why these people had failed to learn from the clinic experience, the medical records of each of the 215 men and 130 women in this repeater group were analyzed. While there was little specific information in the charts about these patients as people, in general the repeater group was made up of young adults who were living a rootless existence; they had no close personal relationships and most of them described their sex partners as casual friends or strangers. Broken marriages and marital discord were reported by a large proportion of these repeaters, and alcohol was an important factor in the acquisition of repeated infections. More than half the group were chronic repeaters. The majority of the male repeaters were unskilled workers and 40 percent of the women had no gainful employment. Among the female repeaters, approximately three out of four had police records; one out of three had had illegitimate children; and 19 out of the 130 were described as chronic alcoholics. For most of these repeater patients, the acquisition of a venereal disease was a relatively minor complication in their disordered lives. The study then reviews the facilities available in British Columbia for controlling the venereal diseases. The policy of the Division of Venereal Disease Control is outlined and the programme of the various sections of the Division are discussed. The development of the Social Service Section is described from its inception in 1936 when it was responsible for the epidemiological activities of the Division until 1949 when the case work skills of the members of this section were directed toward making the treatment process a more positive personal experience for the infected person. Studies relating to the psycho-social aspects of the venereal disease problem in other countries are examined. As with the Vancouver Clinic repeater study, these projects show that the promiscuous behaviour which results in a venereal infection is usually symptomatic of more serious social ills. The present set-up at the Vancouver Clinic, where case work services are now an integral part of the treatment process, is described. This shows the unique contribution that social work can make in a venereal disease control programme. Now at the Vancouver Clinic, at the time of a patient's first infection, he is helped to gain a better understanding of himself and of the cause-and-effect relationship between his infection and his pattern of behaviour. In this way recidivism is being reduced among those patients who are capable of taking responsibility for themselves. This study points out that treatment of the infected individual is not enough; it is society that is sick. The venereal diseases are rooted in poor human relations; to attack this problem, an expansion of the mental hygiene programme is recommended. To give every person his rightful place in the community, the development of more neighbourhood projects is advocated.

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