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EBOOK Community and Public Health Nursing Evidence For Practice 2Nd Edition Ebook PDF Download Full Chapter PDF Kindle
EBOOK Community and Public Health Nursing Evidence For Practice 2Nd Edition Ebook PDF Download Full Chapter PDF Kindle
Kiara Manosalvas, MA
Reseach Assistant II The Following & Mental Health Counselor
Teachers College
Columbia University
Chestnut Hill, Massachusetts
(Chapter 16, Violence and Abuse)
Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, NP-C, FAAN
Professor
School of Nursing
MGH Institute of Health Professions
Director, Global Health and Academic Partnerships
Brigham and Women’s Hospital
Boston, Massachusetts
(Chapter 6, Epidemiology: The Science of Prevention; Chapter 7,
Describing Health Conditions: Understanding and Using Rates)
Aitana Zermeno, BS
Research Assistant
Connors Center for Women’s Health and Gender Biology
Division of Women’s Health
Brigham and Women’s Hospital
Boston, Massachusetts
(Chapter 16, Violence and Abuse)
Reviewers
“The idea that some lives matter less is the root of all that is wrong in the world.”
Paul Farmer
“No matter what people tell you, words and ideas can change the world.”
Robin Williams
W
e are experiencing extraordinary changes in healthcare in this new
century; changes that call upon the most creative, analytical, and
innovative skills available. While the world has the resources to
reduce healthcare disparities and eliminate the differences in healthcare and
health outcomes that exist between various population groups across the
globe, accomplishing this is a long-term and complicated task. Improvement
in the social structure within which people live, and a redistribution of
resources so that all people have access to the basic necessities of life, require
an unprecedented global consciousness and political commitment.
Ultimately, reducing health disparities and promoting health equity occur
within the local community where people reside. Nurses are by far the largest
group of healthcare providers worldwide and, as such, have the ability and
responsibility to be change agents and leaders in implementing change in
their communities. They can be the primary participants in the development
of health policy that specifically addresses the unique needs of their
communities. Through implementation and evaluation of culturally
appropriate, community-based programs, nurses can use their expertise to
remedy the conditions that contribute to health disparities. People need to be
assured that their healthcare needs will be assessed and that healthcare is
available and accessible.
In the United States, public health has resurged as a national priority.
Through Healthy People 2020, national goals have been set to promote a
healthy population and address the issue of health disparities. The process of
implementing the Healthy People 2020 objectives rests with regional and
local practitioners, with nurses having a direct responsibility in the
implementation process. The nurse practicing in the community has a central
role in providing direct care for the ill as well as promoting and maintaining
the health of groups of people, regardless of the circumstances that exist.
Today, there are unparalleled challenges to the nurse’s problem-solving skills
in carrying out this mission.
Whether caring for the individual or the members of a community, it is
essential that nurses incorporate evidence from multiple sources in the
analysis and solution of public health issues. Community and Public Health
Nursing: Evidence for Practice focuses on evidence-based practice,
presenting multiple formats designed to develop the abstract critical thinking
skills and complex reasoning abilities necessary for nurses becoming
generalists in community and public health nursing. The unique blend of both
the nursing process and the epidemiologic process provides a framework for
gathering evidence about health problems, analyzing the information,
generating diagnoses or hypotheses, planning for resolution, implementing
plans of action, and evaluating the results.
CONTENT ORGANIZATION
It is the intention of Community and Public Health Nursing: Evidence for
Practice to present the core content of community and public health nursing
in a succinct, logically organized, but comprehensive manner. The evidence
for practice focus not only includes chapters on epidemiology, biostatistics,
and research but also integrates these topics throughout the text. Concrete
examples assist students in interpreting and applying statistical data. Healthy
People goals and measurable objectives serve as an illustration of the use of
rates throughout the text. Additionally, we have added brief learning
activities and questions throughout the text to allow students to apply the
Healthy People goals to real-life scenarios. Groups with special needs, such
as refugees and the homeless, have been addressed in several chapters;
however, tangential topics that can be found in adult health and maternal-
child health textbooks have been omitted. A chapter on environmental health
concerns has been included, along with a chapter on community preparedness
for emergencies and disasters. Also, a global perspective has been
incorporated into many chapters.
Challenges to critical thinking are presented in multiple places throughout
each chapter. Case studies are integrated into the content of each chapter and
contain critical thinking questions imbedded in the case study content. Also, a
series of critical thinking questions can be found at the end of each chapter.
(Please see the description of features below.) Considering the onus presented
by Mark Twain: “Be careful about reading health books. You may die of a
misprint,” every attempt has been made to present correct, meaningful, and
current evidence for practice.
Part One presents the context within which the community or public
health nurse practices. An overview of the major drivers of healthcare change
leads to a discussion of evolving trends, such as the emphasis on
patient/client-centered care, the effects of new technology upon the delivery
of care, and the need for people to assume more responsibility for
maintaining their health. Community and public health nursing as it presently
exists is analyzed and reviewed from a historical base, and issues foreseen for
both the present and immediate future are discussed. The nursing
competencies necessary for competent community and public health practice
are also presented.
A more in-depth discussion of the complex structure, function, and
outcomes of public health and healthcare systems follows. National and
international perspectives regarding philosophical and political attitudes,
social structures, economics, resources, financing mechanisms, and historical
contexts are presented, highlighting healthcare organizations and issues in
several developed countries. The World Health Organization’s commitment
to improving the public’s health in developing countries follows, with an
emphasis on refugees and disaster relief. With the burden of disease growing
disproportionately in the world, largely due to climate, public policy,
socioeconomic conditions, age, and an imbalance in distribution of risk
factors, the countries burdened by disease often have the least capacity to
institute change. Part One concludes with examination of the indicators of
health, health and human rights, factors that affect health globally, and a
framework for improving world health.
Part Two provides the frameworks and tools necessary to engage in
evidence-based practice focused on the population’s health. Concepts of
health literacy, health promotion, disease prevention, and risk reduction are
explored, and a variety of conceptual frameworks are presented with a focus
on both the epidemiologic and ecologic models. Epidemiology is presented as
the science of prevention, and nurses are shown how epidemiologic
principles are applied in practice, including the use of rates and other
statistics as community health indicators. Specific research designs are also
explored, including the application of epidemiologic research to practice
settings.
Part Three is designed to develop the skills necessary to implement
nursing practice effectively in community settings. Since healthcare is in a
unique state of transformation, planning for community change is paramount.
The health planning process is described, with specific attention given to the
social and environmental determinants of change. Lewin’s change theory,
force-field analysis, and the effective use of leverage points identified in the
force-field analysis demonstrate the change process in action.
Changes directed at decreasing health disparities must be culturally
sensitive, client-centered, and community-oriented. A chapter on cultural
diversity and values fosters the development of culturally competent
practitioners, and the process of cultural health assessment is highlighted.
Frameworks of community assessment are presented and various approaches
are explored. Management of care and the case management process follows.
The role and scope of home care nursing practice and the provision of
services is presented along with the challenges inherent with interdisciplinary
roles, advances in telehealth, and other home care services.
Although content on family assessment can be found in other texts, it is
an integral component of community and public health practice. Therefore,
theoretical perspectives of family, and contemporary family configurations
and life cycles are explored. Family Systems Nursing and the Calgary Family
Assessment and Intervention Model are provided as guides to implementing
family nursing practice in the community. Evidence-based maternal-child
health home visiting programs and prominent issues related to family
caregiving are also highlighted.
Part Four presents the common challenges in community and public
health nursing. The chapter addressing the risk of infectious and
communicable diseases explores outbreak investigation with analysis of data
experience provided by the case studies. Public health surveillance, the risk
of common foodborne and waterborne illnesses, and sexually transmitted
diseases are followed by a discussion of factors that influence the
emergence/reemergence of infectious diseases, examples of recent outbreaks,
and means of prevention and control.
The challenge presented by violence in the community is presented with
an emphasis on intimate partner violence and the role of the healthcare
provider. Because of the cultural variations in substance use disorder,
multifaceted approaches to the problem are discussed with the
recommendation that evidence-based prevention and treatment protocols for
substance use disorder are incorporated by community health nurses in all
practice settings. Meeting the healthcare needs of vulnerable and underserved
populations is another challenge. Health priorities for people who live in rural
areas; are gay, lesbian, bisexual, or transgender; are homeless; or live in
correctional institutions are reviewed.
The issues of access to quality care, chronic disease management,
interaction with health personnel, and health promotion in hard-to-reach
populations among these populations are also presented.
The environmental chapter demonstrates how to assess contaminants in
the community by creation of an exposure pathway. The health effects of the
exposure pathway can then be ascertained. Individual assessment of
contaminant exposures, interventions, and evaluations are also explored,
ending with a focus on maintaining healthy communities. The final chapter in
Part Four presents the issue of community preparedness. The types of
disasters along with classification of agents are described, disaster
management outlined, and the public health response explained. The role and
responsibility of nurses in disasters and characteristics of the field response
complete the content.
Part Five describes five common specialty practices within community
and public health nursing. All have frameworks that define practice and
reflect the competencies necessary for competent practice in a variety of
community settings. These include application of the principles of practice to
community mental health, school health, faith-oriented communities,
palliative care, and occupational health nursing.
OBJECTIVES
Observable changes expected following completion of the chapter
KEY TERMS
Essential concepts and terminology required for comprehension of chapter
content
CASE STUDIES
Vignettes presented throughout the content of each chapter, designed to stimulate critical thinking and
analytic skills
Examples of objective evidence obtained from research studies that provide direction
for practice
Practice Point
KEY CONCEPTS
Summary of important concepts presented in the chapter
COMMUNITY RESOURCES
List of resources that support the content of selected chapters
I didn’t fail the test, I just found 100 ways to do it wrong. Benjamin Franklin
Acknowledgments
PART ONE
The Context of Community and Public Health Nursing
Chapter 1
Public Health Nursing: Present, Past, and Future
Healthcare Changes in the 21st Century
Public Health Nursing Today
Roots of Public Health Nursing
Challenges for Public Health Nursing in the 21st Century
Chapter 2
Public Health Systems
Importance of Understanding How Public Health Systems are Organized
Structure of Public Healthcare in the United States
Functions of Public Health in the United States
Trends in Public Health in the United States
Healthcare Systems in Selected Developed Nations
Public Health Commitments to the World: International Public Health and Developing
Countries
Chapter 3
Health Policy, Politics, and Reform
Healthcare Policy and the Political Process
Healthcare Finances and Cost–Benefit
Access to Care and Health Insurance
Healthcare Workforce Diversity
Nursing’s Role in Shaping Healthcare Policy
Advocacy Activities of Professional Nursing Organizations
Current Situation of Nursing Political Involvement: Challenges and Barriers
Quality of Care
Information Management
Equity in Healthcare Access and Quality
Community-Based Services Associated With Healthcare Reform
Ethical Consideration
Health Advocacy and Healthcare Reform
Overview of the ACA Prior to the End of Obama Presidency
Health Services Research
Conclusion
Chapter 4
Global Health: A Community Perspective
Definitions of Health
Global Health Concepts
Women, Poverty, and Health
Sustainable Development Goals
Other Factors That Affect Global Health
Role of Nurses
PART TWO
Evidence-Based Practice and Population Health
Chapter 5
Frameworks for Health Promotion, Disease Prevention, and Risk Reduction
Introduction
Health Promotion, Disease Prevention, and Risk Reduction as Core Activities of Public Health
Healthy People Initiatives
Road Maps to Health Promotion
Behavior Models
Use of the Ecologic Model: Evidence for Health Promotion Intervention
Health Promotion and Secondary/Tertiary Prevention for Women Living With HIV/AIDS
Health Literacy
Health Literacy and Health Education
Health Literacy and Health Promotion
Role of Nurses
Chapter 6
Epidemiology: The Science of Prevention
Defining Epidemiology
Development of Epidemiology as a Science
Epidemiologic Models
Applying Epidemiologic Principles in Practice
Chapter 7
Describing Health Conditions: Understanding and Using Rates
Understanding and Using Rates
Specific Rates: Describing by Person, Place, and Time
Types of Incidence Rates
Sensitivity and Specificity
Use of Rates in Descriptive Research Studies
Chapter 8
Gathering Evidence for Public Health Practice
Observational Studies
Intervention (Experimental) Studies
PART THREE
Implementing Nursing Practice in Community Settings
Chapter 9
Planning for Community Change
Health Planning
Community Assessment
Systems Theory
Working With the Community
Social Ecologic Model
Health Impact Pyramid
Multilevel Interventions
Social Determinants of Health
Change Theory
Planning Community-Level Interventions
Collaboration and Teamwork
Evaluating Community-Level Interventions
Funding Community-Level Intervention Programs
Social Marketing
Nurse-Managed Health Centers
Chapter 10
Cultural Competence: Awareness, Sensitivity, and Respect
Culture and Nursing
Western Biomedicine as “Cultured”
Aspects of Culture Directly Affecting Health and Healthcare
Cultural Health Assessment
Chapter 11
Community Assessment
Introduction
Defining the Community and Its Boundaries
Frameworks for Community Assessment
Chapter 12
Care Management, Case Management, and Home Healthcare
Care Management
Case Management
Home Healthcare
Case Management, Home Healthcare, and Current Healthcare Reform
Chapter 13
Family Assessment
Introduction
Family Nursing Practice
Understanding Family
Family Nursing Theory
How Community Health Nurses Support Families
Community Health Nurses’ Responsibility to Families
PART FOUR
Challenges in Community and Public Health Nursing
Chapter 14
Risk of Infectious and Communicable Diseases
Introduction
Epidemiology of the Infectious Process: The Chain of Infection
Outbreak Investigation
Healthcare-Associated Infections
Public Health Surveillance
Specific Communicable Diseases
Other Sexually Transmitted Diseases
Prevention and Control of Specific Infectious Diseases
Chapter 15
Emerging Infectious Diseases
Introduction
Factors That Influence Emerging Infectious Diseases
Recent Emerging and Reemerging Infectious Diseases
Reemerging Vaccine-Preventable Diseases
Antibiotic-Resistant Microorganisms
Conclusions
Chapter 16
Violence and Abuse
Overview of Violence
Intimate Partner Violence
Mandatory Reporting of Abuse
Intervention
Human Trafficking
Model of Care for Victims of Intentional Crimes
Forensic Nursing
Chapter 17
Substance Use
International Aspects of Substance Abuse
Health Profiles and Interventions for High-Risk Populations
Impact on the Community
Public Health Models for Populations at Risk
Treatment Interventions for Substance Abuse
Goals of Healthy People 2020
Chapter 18
Underserved Populations
The Context of Health Risks
Rural Populations
Correctional Health: Underserved Populations in Jails and Prisons
Gay, Lesbian, Bisexual, Transgender, and Queer Community
Veterans and Health
Human Trafficking
Homeless Populations
Chapter 19
Environmental Health
Introduction
Human Health and the Environment
Assessment
Interventions
Evaluation
Environmental Epidemiology
Working Toward Healthy Environments
Children’s Health and the Environment
Environmental Justice
Global Environmental Health Challenges
Chapter 20
Community Preparedness: Disaster and Terrorism
Introduction
Emergencies, Disasters, and Terrorism
Disaster Preparedness in a Culturally Diverse Society
Disaster Management
MRC and CERT Groups
Roles of Nurses in Disaster Management
Bioterrorism
Chemical Disasters
Radiologic Disasters
Blast Injuries
Public Health Disaster Response
PART FIVE
Specialty Practice
Chapter 21
Community Mental Health
Cultural Context of Mental Illness
Definitions of Mental Illness
Scope of Mental Illness
Some Major Mental Illnesses
Evolution of Community Mental Health
Legislation for Parity in Mental Health Insurance Benefits
Roles and Responsibilities of the Community Mental Health Practitioner
Psychological First Aid
Chapter 22
School Health
Introduction
Historical Perspectives
Role of the School Nurse
Common Health Concerns
The School Nurse as a Child Advocate
The Future of School Health: Whole School, Whole Community, Whole Child (WSCC) Model
Chapter 23
Faith-Oriented Communities and Health Ministries in Faith Communities
Nursing in Faith Communities
History of Faith Community Nursing
Models of Faith Community Practice
The Uniqueness of Faith Communities
Roles of the Faith Community Nurse
Healthy People 2020 Priorities
Scope and Standards of Practice
The Nursing Process in Faith Community Nursing
Ethical Considerations
Education for Faith Community Nursing
Chapter 24
Palliative and End-of-Life Care
Nursing and Persons With Chronic Disease
Death in the United States
Nursing Care When Death Is Imminent
Palliative Care
Hospice Care
Caring for Persons at the End of Life
Nursing Care of Persons Who Are Close to Death
Complementary and Alternative Therapies
Chapter 25
Occupational Health Nursing
Introduction
The Worker and the Workplace
Occupational Health Nursing
Conceptual Frameworks
Occupational Health Nursing: Practice
Implementing Health Promotion in the Workplace
Implementing a Program: Example, Smoking Cessation
Epidemiology and Occupational Health
Emergency Preparedness Planning and Disaster Management
Nanotechnology and Occupational Safety and Health
Index
Part 1
The Context of
Community and
Public Health
Nursing
Chapter 1
I believe the history of public health might be written as a record of successive redefinings
of the unacceptable.
George Vicker
Some people think that doctors and nurses can put scrambled eggs back into the shell.
Dorothy Canfield Fisher, social activist and author
The only way to keep your health is to eat what you don’t want, drink what you don’t like,
and do what you’d rather not.
Mark Twain
CHAPTER HIGHLIGHTS
Healthcare changes in the 21st century
Characteristics of public health nursing
Public health nursing roots
Challenges for practice in the 21st century
OBJECTIVES
Outline three major changes in healthcare in the 21st century.
Identify the eight principles of public health nursing practice.
Explain the significance of the standards and their related competencies of professional public health
nursing practice.
Discuss historical events and relate them to the principles that underlie public health nursing today.
Consider the challenges for public health nurses in the 21st century.
KEY TERMS
Aggregate: Population group with common characteristics.
Competencies: Unique capabilities required for the practice of public health nursing.
District nurses: Public health nurses in England who provide visiting nurse services;
historically, they cared for the people in the poorest parish districts.
Electronic health records: Digital computerized versions of patients’ paper medical records.
Epidemiology: Study of the distribution and determinants of states of health and illness in
human populations; used both as a research methodology to study states of health and
illness, and as a body of knowledge that results from the study of a specific state of health
or illness.
Evidence-based nursing: Integration of the best evidence available with clinical expertise
and the values of the client to increase the quality of care.
Evidence-based public health: A public health endeavor wherein there is judicious use of
evidence derived from a variety of science and social science research.
Health disparities: Differences in healthcare and health outcomes experienced by one
population compared with another, frequently associated with race/ethnicity and
socioeconomic status
Health information technology: Comprehensive management of health information and its
secure exchange between consumers, providers, government and quality entities, and
insurers.
Public health: What society does collectively to ensure that conditions exist in which people
can be healthy.
Public health interventions: Actions taken on behalf of individuals, families, communities,
and systems to protect or improve health status.
Public health nursing: Focuses on population health through continuous surveillance and
assessment of the multiple determinants of health with the intent to promote health and
wellness; prevent disease, disability, and premature death; and improve neighborhood
quality of life (American Nurses Association [ANA], 2013).
Telehealth: Use of electronic information and telecommunications technologies to support
long-distance clinical healthcare, patient and professional health-related education, public
health, and health administration.
Social determinants of health: Social conditions in which people live and work.
CASE STUDY
References to the case study are found throughout this chapter (look for the case
study icon). Readers should keep the case study in mind as they read the chapter.
The Department of Health and Human Services (HHS) in a southeastern state has
begun implementing the recommendations from both the U.S. Institute of
Medicine’s publication The Future of the Public’s Health in the 21st Century and
the 10-year national objectives for promoting health and preventing disease in the
United States established by Healthy People 2020. A task force is developing a
new vision for public health in the state. Sandy is a program developer in the
state’s Department of Public Health, with the primary responsibility of assisting
local public health departments in developing, implementing, and evaluating public
health nursing initiatives. Sandy represents public health nursing on the task force.
(Adapted from Jakeway, Cantrell, Cason, & Talley, 2006).
The development of society, rich or poor, can be judged by the quality of its population
health, how fairly health is distributed across the social spectrum, and the degree of
protection provided from disadvantage as a result of ill health. World Health
Organization
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.