World Health Organization (WHO) · Technical Documents

Brief reports received from governments on the progress of their health activities

December 31, 1970 World Health Organization

Full text

ENGLISH ONLY

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AUSTRALIA REPORT ON NATIONAL HEALTH ACTIVITIES 1969-70 1.

NATIONAL HEALTH SCHEME

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The year 1969/70 saw the culmination of a comprehensive review of the medical benefits system when legislation introducing a new Health Benefits Plan was passed by Parliament in June 1970. Provided ~~der the plan are new levels of medical benefits, which came into operation on 1 July 1970 based on fees commonly charged by medical practitioners. The combined Commonwealth Government and medical fund benefits have been established at levels which provide contributors with substantially improved coverage against the cost of any type of medical service where the medical practitioner charges the common fee. Medical fund contributors are now required to meet only 80 cents of the most common fee for general practitioner surgery consultations and $1.20 of the common fee for a home visit by a general practitioner. The benefits increase for more costly services so that the difference between the benefits and the common fee 1s $5 for services for which the common fee is $40 or more. The patient's share of the cost of an operation and the services directly associated with it is limited to $5 where the doctors concerned charge the common fees. vfhere a fee is charged less than the benefits, the benefits payable will be limited to the amount of the fee. The new levels of benefits will be payable to all contributors irrespective of whether they have pre-existing or chronic illnesses and no limit will be imposed on the total amount of benefits payable to a contributor. A single table of medical benefits has operated since 1 July 1970 to simplify the scheme and to ensure that adequate insurance coverage is obtained. With effect from 1 January 1970 the Commonwealth Government introduced a subsidised medical insurance scheme which provided free health insurance for persons receiving unemployment and sickness benefits, for migrants during their first two months in Australia and for families with low incomes. With effect from 1 July 1970 graduated assistance was provided, towards the costs of contributing for health insurance, to families with weekly incomes only a little in excess of the eligibility limit for free insurance. Persons eligible for assistance under the scheme are entitled to full medical benefits and to hospital benefits up to the cost of public ward treatment. They may obtain higher hospital insurance coverage by paying the extra insurance contributions involved.

.,~

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lSubmitted by the Director-General of Health, 26 August 1970 •

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These amendments to the National Health Scheme are ~esigned to ensure that no member of the population is precluded from receiving hospital or medical treatment because of the cost such services. 2. MEASlES VACCINATION

As reported last year the vaccine proposed for use in measles vaccination campaigns during 1969 was withdrawn by the manufacturer. This action was taken as a result of serious complications possibly associated \'1i th its administration in respect of three children in the United Kingdom in 1969. No campaigns were conducted in Australia in the latter half of 1969 but, early in 1970, a measles vaccine using a different virus strain, known as the Schwarz strain, was imported and further campaigns have commenced.

...

3. RUBELLA VACCINATION The Commonwealth Government has agreed to make rubella vaccine available to the States and mass immunisation campaigns are being undertaken in some States and in the Australian Capital Territory and the Northern Territory. In general, it is expected that rubella vaccine will be given in immunisation cwnpaigns to girls below the age of puberty. The vaccine will also be made available to other women at risk. 4. Q,UARANI'INE

During the year under review the quarant1r~ble disease situation in the Pacific area was found to be such that travellers to Australia from an additional fourteen countries became exempt from Commonwealth smallpox vaccination requirements. These countries include French Polynesia, Hawian Islands, New Caledonia, New Hebrides, 'Samoa and the Tonga Islands. All these countries have been free from such quarantinable diseases as smallpox, cholera, plague and yellow fever for many years.

....

DRUGS OF DEPENDENCE

During the year activities in the field of social medicine have been extended with particular attention being given to the drug abuse problem. An Australia-wide system of monitoring licit transactions in narcotic drugs and other drugs of dependence was in~roduced

- 3 progressively during the year and now covers more than a thousand individual products involving some 300 000 drug movements each year.

VITAL STATISTICS 1968 1969 12 307 400 250 176

Estimated Mean Population •••••••• 12 043 000 Live Births ............................... .. 240 906 Crude Birth Rate per Thousand •••• 20.00 Total Deaths .••.•••••.•.•••..••.. 109 549 Crude Death Rate per Thousand •••• 9.10 Infant Deaths Under 1 year ••••••• 4 282 Infant Mortality Rate per Thousand Live Births ••••••••••• 17.77

20.33 106 496 8.65 4 482

17.92

21th WHO Regional Conwittee Manila 1 - 8th September 1970 Brief report Sanitary activities in Cambodia

" .. ''''.

The Government of Cambodia may record several successes in its efforts to meet the health needs of the country, in particular in the fields of : Preventive Medicine, Medical Care and Education and Training of health workers. In the campaign against communioable diseases, particularly malaria, tuberculosis, leprosis and yaws, field aotivities have been progressively extended to all provinoes where one or more of these diseases are prevailing, and integrated to the Basio Health Services. A strong support has been given by other Servioes of the Ministry of Health, namely Environmental Health Servioe, Health Eduoation Servioe, Epidemiology & Statistics Servioe, Laboratories Service •••• Mothers & Child Health has been intensively promoted, increasing the number of out-patient clinics' consultations and door to door visits, extending them to rural communities and aSSigning a always larger number of "rnral midwives~ at distriot and village level. To MCH has been recently attached a Nutrition & Alimentation Servi:e, in oharge of surveys on nutrition and basical alimentation in oarefully sel(~ted Pilot Zones. School Health Service, in addition to its activities for detecticn and control of illnesses, has been largely involved in H.E. of School children and students. ~

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In the frame of the HE campaign, several seminaries have been held for °p!"ie8ts of the local Buddhist cult, considering them as an ideal vehicle f:1r diffusion and popularisation of healthy practices of life among rural popt;.ation. The aotion taken in the ar'w" "'1'?ntioned fip-ldR hl"~ heen ","~I'lmpa ned by a constant effort to improve health infrastructure in the whola country; Jdical oare has been bettered and made available within easy reaoh by the buildlllg of new dispensaries, Health oentres and hospitals. Better levels of Education and Training of Health personnel have been attained by settling at a higher standard of education to obtain entry to the professional Sohool, and by reviewing the programs to matoh the requirements of their future service in the field. • ••• 2 ."110"

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Since the 18th of' March 1970, unfortunately, VC-W forces are agressing our country, so violating our national sovereignty, neutrality and independence and bringing to a st~dstill health activities. As a result Cambodia now face a situation of war, and VC-VN agressors have been destroying our Health Buildings, looting medical equipment and medicines, killing nurses and doctors, all in defiance of the Geneva Convention. The calamities of war. moreover, do not spare other public facilities as schools, colleges, universities, historical monuments which have been looted and sacked, where peaceful inhabitants, schoolchildren, priests, infants, women, old and even sick people have been slaughtered. The invasion which has been carried out in the aim of imperialistic expansion is the origin of fear, poverty and socio-economic disturbancies, whioh add more problems to the existing ones, particularly in the field of SOCial and Public Health affairs.~ In spite of all our efforts to come in help to the war victims, also with the assistance of friendly countries, the IRC, WHO and UNICEF, we still have to face number of problems, and the most urgently pressing are the scarcity of staft. the lack of medical equipment and medicines, most of the medical personnel, indeed, are mobilised for the medical care of displaced persons, ill peopl.e and casualties while other have been draft to serve under the Army Medical Service. The number of military and civilian war wounded is continuously increasing; to meet at the best their needs, we owe to strengthen the treating staff', bOth 10 the number of Me and nurses, to "rganise /ll()re surgical centres, to supply more' medical equipment and drugs, to establish post-operatory services, re-education and re-habilitation centres and Special Service. . To the problems of wounded are added those carried forward by the preseneo of refugees and other displaced persons, to whom we have to give a shelter, some means of subsistance, medical care, emergency aid and social and moral aSSistance. In a near future the Ministry of Health will face the task of re-building

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and ll't""Ggu:ipping c.f Health establishments destroyed by the war, replenishing the stocks of material and drugs, re-assigning staff and organising mobile units to reach as far as ppssible the rural population. Phnom Penh, 24th August 1970 The Chief of Delegation Dr. Pruoch Vann , .--'"

COUNTRY. REPORT REPUBLIC OF CHINA

1970

1. FAMILY PLANNING

Since the promulgat~ of the Regulation Governing the Implementation of Family Planning by Government in 1968 1 there has been increased support of the program from various government agencies especially in publicizing the idea and the service of family planning. Condoms have been added to the program and provided free to eligible couples since May 1, 1970. Pills are also provided free s~arting from the same date. During the past year (July 1969 June 1970),there.were 142,465 loop, 37,239 pills, and 13,375 condom acceptors, exceeding the annual target by about 10 per cent. Currently about 44 per cent of the couples whose wives are in the childbearing age (20 - 44) are practicing contraception. The birth rate continues to decline from 28.8 in 1968 to 27.7 in 1969. The program continues to attract visitors and trainees from other countries. 490 visitors in 148 groups were received between I J~ly 1969 and June 1970. Of them 15 persons were sponsored by WHO. 2. ENVIRONMENTAL SANITATION

The Institute of Environmental Sanitation submitted a revised 5~year Environmental Sanitation Program starting in July 1969 which incorported the UNICEF assisted Community Simple Waterworks and the WFP project on "Environmental Sanitation Improvement on Community Development". The UNICEF assisted project aims at providing pipe water supply to 60 communities (population 500 _ 2,500) each year while the WFP assisted project 1,725 COmMunities for sanitation improvement in the 5~year period. A gxeot significant achievement on improvement of environ.ental sanitation was mode during the year as follow:2.1 Community Simple Waterworks Construction. 57 more simple wat~rworks programmed for 1969 were completed bringing to the total of 378 simple waterworks in this Island, and other 60 systems programmed for 1970 are under construction. j .'

2.2

Sanitation Improvement on Community Development

project)

A total of 3,434 wells, 51 public latrines, 6,277 private 2 latrines, 657,541 m drainage, 923,334 m pavement and 89 activity centers were constructed under the community development project in 400 communities. 2.3

Refuse and Nishtsoil Disposal (0) 79 more trucks were procured for refuse and nightsoil 'collection transportation. (b)

Campaign on the provision of individual household refuse receptacles resulted in 143,766 more household procuring them. Pingtung night.oil treatment pilot plant was completed it. engineering design and has been prepared for bidding. Another nightsoil treatment plant (30 tons) for Kooh.lung City1s designing. 7 more compost plants are under engineering de.ign.

(c)

(d)

2.4 Air Pollution Control (a) (b) (0)

No. of cities and Hsiens under control: . 4' cities and 2 Heiens

No. of Air Sampling Stations: 32 stations Items of Analysis: 1) 'Dust fall 2) Total particulate 3) Smoke concentration 4)

S02 H2 S

'l1\e more significant of the observations is the reduction in dust fall from 108.03 tons/mile 2 to 51.97 tons/mile 2 in Kaohsiung 2 city, 68.80 tons/mile to 40.18 tons/mile 2 in Keelung City, 63.8 2 2 tons/mile to 39.88 tons/mile in Taipei County and 38.28 tons/lllilea 2 to 26.15 tons/mile in Taichung City. Technical guidance were also given to related premises. 2.5 Water Quality Control

.A total of 34,809 water samples from distribution systelllS of waterworks, 20,215 water samples fro. wells have been taken and analyzed.

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2.6

Sanitation Personnel Training

6-month course for 17 sanitQ~y engineering assistants, 3-month course for 33 sanitation workers, 6-week course for 10 water chemists, and l-week course for 244 simple waterworks operators have been conducted. 3. INDUSTRIAL HEALTH

The industries of Taiwan have been developed rapidly.

Up to

date, there are more than 30,000 registered factories, and 1,108,336 worke~s. In order to prevent industrial damages and occupational diseases, measures are to be taken as follows:3.1 ~

Industrial Health Sueervisor Training

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After completing the training, the supervisors were in charge ot i.proving working environments and health examinations, there were totaling nine training courses held last year and 272 persons completed training. 3.2 Inv•• tisetion and sU2!rvision of factory working environment

When first investigated, there , were 38.05% of factory working environment that needed improvement, after supervision, percentage ot improvement was 30"/0. 3.3 Industrial Health Education Audio-vi~aal

education and meetings were held for plant's owners and industrial health supervisors. This was to find out problems, seek solutions and 'to make mutual understanding. 3.4 Investisation and research of (a) ~cupational

Diseases;

Investigation of miner's pneumonokoniosis: 7,352 miners were examined by X-ray and found there were 616 abnormal, account for 8.37%. At present, advanced examination is coTTying out. Investigotion of metal fume poisoning: The workers employed in canneries and printeries were investigated their lead poisoning, '~.~,5 ':.nt:·:~ 5n~ 1<;\)::l;c.:::: w,:;r.c 9~lS:::>octeL leac"!. poisonine' :i..o. 20.4%. ~0:1 pE)Z"Gmc

(b)

were confirmed lead poisoning, accouq.t

(c)

The second yearly eye-sight examination of female workers in electronic companies: A comparative study between the results of the examinations in the past two years shows an increase of 11.8~/o in the abnormal cases, they being 29.66% in 1968 and 41.46% in 1969. 4.

COMMUNICABLE DISEASES CONTROL

Cholera Prevention .v

Cholera has been prevalent in various countries of Southeast Asia for years, in order to prevent any invasion of cholera, every intornational sea or airport continued to carry out atrict check up and examination for crew members, passengers. In 1969, 1,843 airplanes, 648 vessels, received quarantine

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services and 29,476 crew m.~ers cftd 81,727 passengers recieved survillance. As the result, a cholera carrier was detected from Viet-Nom on December 13, 1969. Necessary measures were immediately taken to cure the carrier. As a consequence, Taiwan has been free from the invasion of cholera. Specimens for examination were taken without exception from patients setting food poison or with vomiting and/or diarrhea, direct or indirect contacts of the patients, crew members and passengers who came from cholera infected areas, crew members aboard fishing boats and fishermen returning from an ocean voyage, and food or drinking water which they carried. The specimens examined were 59,577 in 1969. All specimens proved negative. In 1970, province-wide vaccination campaigns against cholera was continued to carry out. The number of persons vaccinated was 9,281,031 reaching sr/o of the total population. 4.2 Japanese Encephalitis Control

The number of Japanese Encephalitis cases and deaths in 1969 were 466 and 105 respectively. In 1968, 605 cases and 149 deaths ,were reported. In order to eradicate this disease, a plan to spray mosquitoes with insecticide was carried out in l,149 villages whe~e Japanese Encephalitis had. occurred; meanwhile, children over two years of age totaling 251,035 were immunized with mouse-brain vaccine. For the control of endemic diseases, 624,080 ml of Japanese Encephalitis vaccine were shipped to health bureau for vaccination use.

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Polio Control 'this 1e:the 4th year of the 5-yoor p.lon tor polio control

ainc. t1\. plen was started in 1966.i'or 1970, 0 total of 617 ,102 dOlI.. wen c:oripl..t~c1, reac:hing-93% of the total children at risk. The number of polioccse and death in 1970 were 84 and 44

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re.pectively, but in 1969 there appeared a trend of increa •• in polio ca ••• and c1eath., i.e. 150 and 70 r ••pectively. ~.~

Thi. program was carried out in 1959. Since then, the prograa hos progr.ssed quit. well, during 1969, a total of 365,605 children were completed 3 doses of D.P. mixed vaccine reaching 80% of the total childr.n at risk. The number.ot Diphtheria cases and d~thI JA 1~69 were 171 and 10 r ..pect£ve1y, c~pared with case. and deaths in 1968 i.e. 442 ond 10 re.pectively, There has been a trend ot decreas ••

Diphtheria

& Pertus.is Control

4.5 tuberculosis Control !Uberculosis is still one of the important public health preble.. ia ~, although its epidemiological situation is i.proving year oft. . year. TUberculosis mortality rate had declined fra. Z85 pe~ 100,000 population in 1947 to 34 in 1968. The prevalence rate ot X.ray suspects of tuberculosis among the popUlation aged 10 years and obo¥e was 2.8% and the rate of infectious cases was 0.5% (re.ults of the tkird ~.valence survey done in 1967/1968). A8 a result of the major steps taken, the accomplishments of

: ,..:-r

varioua tuberculosis activities during the period were remarkable as .hown in the following: (a) BeG vaccination: A total nuwer of 817,076 VGcciftClti. .

were made during the said period.

(.b)

Case finding: 1) Selective X-ray examinations were performed 2) SputUJll examination: 22,434 sputwa examinations ",.. . made. Registration of open cases: and treated. 7,092 cases were registered

(c)

- 6 4.6 Trachoma Control

Dr. Assaad, WHO adviser who visited Taiwan during April 24 to Hcay 6, 1970, had. suggested to select 2 IILinsll in Kong-san (Urban), Kaohsiung County, and 4 IILins" in Kao-hu (Rural), Yunlin County I for the assessment of trachoma campaign in Taiwan. Thus Dr. L.J. Yeh carried out the final examination as suggested. The results are shown below with comparison to those of past two years examination. 1970 1960 1968 1.4% Kong-san 19.6% 2.6% 24.0% 17.1% Kao-hu 69.9% (Including not determined)

According to above data, Dr. Assaad strongly emphasized the treatment to the highest prevalence areas such as in Yunlin County where so many people should go to other places to seek Hod..:s Ilnd it is quite possible to spread trachoma virus to the low prevalence areas by migration. Concerted efforts to attack the pocket areas were discussed and planned. 4.7 Hcalaria Eradication

Since the certification of achieved malaria eradication in 1965, malaria vigilance activities have been continued by the health services under the technical guidance of a malaria vigilance unit attached to the Taiwan Provincial lil1aria Research Insti.tute. The epidemiological situation in 1970 was characterized by the predominantly large number of imported cases. A total of 17 malaria cases were detected during this year (1 indigenous, 2 induced, and 14 imported . from abroad). Although intensified vigilance activit!e. were continuously performed in the area where the one indigenous case occurred, no secondary cases have been detected. 4.8. Smallpox Vaccine

Production scale for freeze-dried smallpox vaccine has been expanded to double during this year, and all smallpox VQccine is switched to dried form. For international contribution, we have donated 200,000 doses and 152,500 doses of the above men~ioned vaccine to WHO and UNICEP.

4.9

Venereal Diseases Control (0)

WHO consultant: The V. D. Control Center of Taipei City commenced its function since July 21, 1969. The Center is carrying out V. D. control activities and establishing an up-to. date V. D. laboratory.

(b)

Pilot study of "Penigin" vaginal tablet. WHO supplied "Penigin" vaginal tablet to the V. D. Control Center by free charge •. 504 bar girls voluntarily received the Penigin test. 25.2% (127 cases), of bar girls used Penigin systematically a8 instructed. According to the . preliminary report, the incidence of gonococcal infection is lower among bar girls having taken Penigin than thos. having not taken Penigin.

NURSING SERVICES

The revised C01lDll\U1i ty Nursing Manual was completed and distributed. (UNICEF assisted) Two public health nursing seminars were held. In-service education courses are in progress. Liaison nurses continue to give supervision and arrange staff education. For hospital nursing services, change from task orientated to comprehensive patient care and in-service education courses for senior personnel are in progress. Co.ordination of hospital and community nursing services have been strengthened by introduction of a referral systam in selected cases. WHO advisory services continue in hospital nursing services administration.

ORIGINAL: HONG KONG REPORT ON HEALTH ACTIVITIES 1.

ENGLISH

m 19691

GENERAL HEALTH

The general health of the population in Hong Kong is good. There have been great advances in infectious disease control and diphtheria and poliomyelitis no longer constitute serious problems. Since the commencement of the anti-measles vaccination campaign in December, 1967, the incidence of the disease has remained satisfactorily low. Between the months of July and October, 1969, Hong Kong had a short visitation of cholera. The disease was quickly brought under control by the application of vigorous public health measures and an energetic inoculation drive. While tuberculosis remains the major community health problem, the Colony is facing increasing problems due to disease of later life. Neoplastic disease, particularly cancer, diseases of the heart, hypertension and cerebro-vascular lesions were the leading causes of death followed by pneumonia and tuberculosis. 2.

VITAL STATISTICS

In 1969, the estimated mid-year population was 3 987 500 of whom approximately 82% are concentrated in the urban areas of Hong Kong Island and Kowloon. Approximately 3$% of the population are under the age of 15. The general state of health of the population is satisfactorily reflected by the Colony's vital statistics. The crude death rate at 4.7 per thousand of the population is extremely low. The birth pattern is continuing its downward trend and the crude birth rate is now 19.9 per thousand of the population. Infant mortality is steadily declining and is now 21.8 per thousand live births. Maternal mortality continued to show a reduction and the rate in 1969 was 0.15 per thousand total births.

COMMUNICABLE DISEASES

3.1 Cholera Since the last reported case of cholera in November, 1966,Hong Kong lSubmitted by the Director of Medical ru1d Health Services, 14 July 1970.

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remained free from the disease for more than two and a half years. The first case of cholera El Tor (Inaba type) in 1969 "las confirmed on 5th July. Thereafter, in the same month a further 5 cases were reported. Om imported case was reported in August and one local case was reported in September. The last case in 1969 was reported on 16th October, making a total of 9 cases including one imported case notified during the year. Vigorous efforts have contained this infection and prevented spread. 3.2 Diphtheria

As a result of annual immunization drives which have been in progress since 1959,- the incidence of the disease is now 1.6 per hundred thousand of the population. The disease affects largely children aged under 10 years. 3.3 Measles

Measles in Hong Kong showed a distinct biennial pattern with epidemi.cs occurring every second winter and spring. The last epidelnic was in the winter months of 1966/67. Since the end of December 1967 measles vaccine has been available at all GoveM1ment Maternal and Child Health Centres to children aged between 6 and 48 months. This age group is predominantly affected by measles in Hong Kong. The use of the vaccine prevented the epidemic of measles which would otherwise have been likely to occur in the winter of 1968/69. The measles vaccination drive is now on a year-round basis, the vaccine being available all the time at Government Maternal and Child Health Centres. 3.4 Pulmonary Tuberculosis

Pulmonary tuberculosis is still the major health problem in Hong Kong, though the mortality rate from tuberculosis has fallen markedly in recent years and most deaths are now among elderly men who die of the sequelae of the disease rather than from active tuberculosis. During the year notification rate rose slightly to 277.5 per hundred thousand of the population. It is believed that this rise does not represent a deterioration of the tuberculosis situation but rather the response of the general public to the mass health education campaign which resulted in people coming forward in large numbers for X-raY. Increasing emphasis is being placed on contact traoing, on home visiting and on health education in regard to tuberculosis. There are over 1 600 000 attendances per year at clinics of the Government Chest Service. About 95% of ne\'1borns are now being given BCG at birth, and BCG vaccination campaign is extended to school entrants aged about 6-7 years.

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3.5 Venereal Diseases The incidence of early infectious syphilis is now extremely low, ani the incidence of gonorrhoea is also low. It is encouraging to note that the incidence of venereal diseases in the teenage group of the population has not risen in the manner experienced in many other parts of the world.

Other infectious diseases are at a low level and do not constitute a major public health problem. 4. MATERNAL AND CHILD HEALTH SERVICES

There is an increasing public appreciation of the value of these services in the maintenance of health among infants and expectant and nursing mothers. 85.2% of all children born now attend at a Maternal and Child Health Centre and there is increasingly better appreciation by the expectant mothers of the need for regular antenatal care. Over 99% of births take place in institutions, either hospitals or maternity homes. Owing to the difficulties of domiciliary delivery under existing housing conditions, maternity beds are provided in health centres in addition to those available at hospitals. 5. HOSPITALS AND Our-PATIENTS SERVICES

At the end of 1969 there was a total of 15 835 beds available in the Colony, i.e. 4.0 beds per thousand of the popUlation. The bed position at the end of 1969 represented an increase of 96% over the bed provision of 1960. The development programme of the Medical and Health Department is making steady progress. At the end of March, 1970, 29 projects were being planned or built for the improvement and expansion of the medical and health services in the urban and rural areas. Projects completed during the year include the new Tan Shiu Kin Hospital, which provides casualty services as well as facilities for maternal and child health, social hygiene and maternity services, and the fifth of the five phases of the alteration programme of Queen Mary Hospital increasing the hospital bed capaCity to a total of 1086 beds. Other projects in progress include a new 1360-bed general hospital at Lai Chi Kok to be completed by 1972, a new mental hospital of 1300 beds also at Lai Chi Kok to be completed by 1974, and a new 600-bed convalescent block at Kowloon Hospital which is expected to be completed by October, 1970. Attendances at hospitals and general out-patient e.JZd l!'pecialist out-patient clinics continued to increase and reached a total of 8 060 095

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, - 4 in 1969. The Government now maintains 43 out-patient clinics as well as mobile dispensaries, floating clinics and a flying doctor service. In addition, Government also provides evening and public holiday out-patient sessions at nine clinics in the more densely-populated areas. Out-patients are charged $1.00 for each attendance, while hospital maintenance fees for private patients vary from $2.00 per day for third class wards to $45.00 for the first class wards. Patients suffering from or suspected to be suffering from one of the quarantinable diseases admitted to a Government Hospital are not charged for medical treatment or maintenance. No charge is made for patients admitted to the two infectious disease hospitals for the treatment of acute infectious diseases. Any inv~stigation or treatment on patients at tuberculosis, social hygiene or leprosy clinics is free of charge.

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6. FINANCE The actual expenditures of the Medical and Health Department for the financial year ended 31st March 1970 was $148 239 041. to·wh1eh'Lhould be added a further $57 732 380 disbursed in the form of subventions. Capital expenditure on medical projects under the Public Works non-recurrent head totalled $11 434 288. These amounts represented 10.70% of the Colony's total expenditure during the year. This does not include expenditure on environmental sanitation by the Urban Services Department and the District Administration of the New Territories.

',:"',

. (April 1969 - "1arch 1970)'

.1. OmJ\!Uz.\TIQ'N 0:" r':a!Ol-rJ\L l.!~D LOC..u. Hllar,7ri • "::~c~u \':~l... o :'0 Cha.n:;Cfl 1n tho o"f,;wniza~::on ",:·:::':·":":"v ~u .. ::..;....~ "whB pul-iod' urAer roviow &0 :::;.r as '::~u :j:-;:.:oct;;::.). &r.d hlUnicip&J. hetJ.th contol'$, of

.'Jk~,":NIs~iUi.'.i.'IO'N

the !·~iniztr-.f o~ ::o.:llJ-:,~ t.::'.~ tho health sorvice is c~r.co~":. . ~~.

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wh.ich thera are 832, cor.-;i:l~.;;.d out. thoir.rout1ne tuilct.:i.on3 44D local communitY health servico a.:;cnc:'o~.

~i:~iou ~or t~G ~~zc~

T;~v tot..: n ..t!.onal health bud(;:ot iMlud!r.~ ... .suo:oidy to tho 100&.1 eovor.J.;';:;l~t3 for tt... :i3C...lyOIli' 1969 WAS \'128 901 million,>wAGl"eaa it was ~'ll3 493

year

1968.

3. VIS:.!. STATISTICS popula;io:'la5 or 1 Cc·.,.:;.",:;~r 1969 ""as 102 022 COO. Tho C:l.vc3 so...e or t!.o vital t>,,;;.t.iatics dAta. tor tho calenQ~ yoa: 1-;::'9 .:mel a cOI:<parison with 1968. ~;-l~l o::;'.:.i:r.:;..tocl ;"c~~~o\li~·.;; t ..~le ni~·t~~·=;; ~al"

. 1969' 1 ~O

. ~~t(,j (por 1000 popula.tj,on) ::~..~:,o:

::w.•

18.6·'

159

1890 393 lB~,

:i..J .;.~;.~;

(,86 'j71,

::';'J,,~

(:;'0:- 1000 population)

6.8 143 287

693 ;38/. , .... 0.0

:;-.:,.::.ijo: ~~ty (~~r

1000 total livo-births) .

71.2

.....138: 817 68.4

lito oxpoct~cy ~t birth lor thoJap~~~s~ ?~op'lo, p~o?~ad of .'1Oho 1968 dO:~A, ir.dicatos 69.0,. y~arll to-: ...2.es sd 74.'30yoc::.'tl :V~· :::a::::.1o:::; t;"o cOl:lpa.......,.blo fi£Ul'Eis tor tho previous yoar 'Wore 68.91 7~c.:r3 tor ;.;LOl.;;s tu:;.i'l 74.::'5 years tor temales. ' . -' 0::;.

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:';,L.'::';~g t:1,) ~.u.ond~ yom- 1969, :( 236 303 visi~s wor~ m&da t.o t::o clinics .322 561. by c.'lilc!l"cn. Public .11ealt~'l. nurses. paid 3(1 357 ho::..o w-.d 82; 116 on chil~4'cn. At tIlt ~l'l.d of Ka.t-ch 19'"1C J tl~,,::,o "..:':'~·v .5.)V ~;;.tc.~'.i..u <lIla child health cont.".~s in t!-.e· r"..trcl. aroas· (536 cc~/..c.::,s i:. 1~70). :~~~n~ tno calondm- year 1969, 69 645 low weight bAbies were roportod,

Cluc4'o~e

1624

from that of 1968.

. ..

5. TUBERCULOSIS ••1 ·.. n~

CO~iTROr.··

. i\.;.:;'~·;'!A.04· > ~:'l;:;l~..J bci.~e o~..1;r 16 896, D. :..~t,~ or 16.8 p~ :00 000 popula:tvi..::.r.. (17 ?OS . -:o'::""::'.:i, .. :;",{~v 0.: l?S:;,'vr 1967). (Tliodata.tor·the calel:l.clo.r year 1969 c..:.,'o·not ·:ro'.. ;:;tG.ti~l':;!.,:.~ll., uv..ily,b10.) l)~:.-ina 1909, .~ ·599 000 po;."sons (4/.. 712

col;;r.d:..... yuo:: 1968, tile ••umb<::r 61' deaths from tut<Jrculos:';; c.oc::,e~acd ..: .

l<;~&) roceived houlth exU;'•• i.'1..::- ':'iOilS £O;t; cc.so-f'inc.i."lg purp~~c;~. . '';:.'l,j:''~ ..:.:~.;;;.;~ 3/j 144 000 (38~84 000 £0.. 1963) \:ere ox::.:ait.ed ~j photofluo~o;;ra;;j-~y~ ~\i~;j o4l.:.~-rir.~!.r.z r.·~tu tOl" 1969 waS O.O<j~ (O.ll~ tor 1968). A:Aon~ tn:;,z.;, t:.4~Ol" c.;:.:';:'....~c~;:.'... iv\J, 5 621 000 wu4'o vaccinat.ed wit,h BeG. :0-: J 4

~~,:",;,"~on:;

ceo

of ro~1stc..ad tub·:srcul':>sis patio:l.ts uo 0: tho Z;:'1ci. o-! :6;i 300 (1 249 509 fer 19M); 62.2~~ of which w()re activ.:: ;':"=':':;i -:,~ ,.. ..• .:..-." .' ... ~"''''v,-, ,....... '" l'o~·)~ £/ 5"~ ""_.... "~d'-''''' d-... • -.' 1·; .. ,-.,. ~t ... _ .. !";,: V /• v V.-.-"" _ _ _ ,.. .. ,..;,.s· •. ""' • .., •. .:.4 ... t~' ~ ., "d , \14r- .. w",.g vm'&O'''-_-....... J ,,-"""_ . ~:'':'.~\'1 lJ.4~; cli~ r..ot r()ceive complato ruec'!icol tre::-t."Uent and the re:;c.i:l::.l'; l.~:; ;;.:,..u.a, r.o':-:, bo t:....Q.cad. .wrinC the· S{&lhe pOl"iod, .199· 870 caGes ,.:aru newl.y l"~Gi,/;,e.red. "l:.,~' .J:.9'67, ttlO to~w. oxpOnd1t.ure on tub~:-culosis traatreG~t waS e~t-~t.oC: to C,;; ::"1, ~::'::::!.on '1\):. (112 biliion yon for 19(6). 'l'hisis. equivalent to 8.4% (9.4}.; :v...• 1966) of tl~utot.al llIl.-penditur& on modiaal care for all ki.'}.ds of :i.llne3S. 1.t. t;.o "roc. 0: calendar Y8m-1969, thore ware 185 909 beds allocated ·~o t~bcr c-.:.::"cs:i..::: .1);l.tionts Gnd tbe bed occuPG.'\cy rato was 67 •.8% (195 710 becls ;~ 70.0';. lo~ 1968). ' .. ' '" ' '. .

:..;;,'1 ........; :.

':~.~ ~~.~c.l ~..u.ub.')..

~~..,.....

fo"4.4_,,,~

Wo4~

"'.

J ••••

....

,6 •. LEPROSY

CC~TnOr,

7:·•.:: m~;..1;;o..• ot nowly ~.:lpoi"t('jd ca::;os lopro::;yh.:l.s boen' decNc..:;in.:; Y')a:'l:r.· ..;~ ... ::~.:: -:,~~u c~o:&dc:.r ya:;.r 1969, 61 'wo"'v ror~r'":ed (89 for .1968). 'l.\h~ ·to·~~ '~-':":'~""', of .·u?e..'tod lopr,o;;:r patients at tho .;nd or 1969 was 9779 '(9993 ~"r 1965) ~1::'·v: • .l l~Nvul.::nco .r..to of 1.((por 10 000 population (s.:.me tor 1963); 9164 .' P~:;::';;;~'i,;,; (1j;54 pationts for 1968) ~N ir.::;titutionaliz03d at 11 nat.ionsl ~o. . 3 p;:-i'r;,;;t" l(1Pr.os.3,l"ia•. rAO tot.al number of: bods availnbl$ in .thoselaprofiar1a. 1,:",..'012 950 and 2<10, re,spoct1voly. . '

• :<1

.. .. ~

. :..",;,.:: .',

.".:' '"

......

•

t~i.d to~~ r.ur.;~,or O~ parSOl':3 ,·iho rc ceived ir.:.&unizD.tion Qw.~inrr t!'lG c~..1o.~ci.:.: ::"::;,_.- 1969 \las :lS l'vllo\...~:3 224 000 for :imcl.lpo:q· 2 lOO 000 foru typ!10ili:-J;;';".:lty;hoi<l combined; l 780 '000 for cliphth~iaj} 5.90. 0b0 to;: c;ip(.tl:.c~1i,'l-:' •. · ',:;'OOp:i.l~;:; cou.:;h como>mod, and 2 7gg 000 tor polioilyelitis (.:l.ttGllUlltec'i VIlCCinlll). . rll

. .

.1' ••

1969 1 tho:;:'o 'WAO a tlar:~od doCl"vasO l..'l;m03t of the acuto conmU!lioablo ";;';;oa:;.;.;;. :':'oinciclonco of polio:lly'olitis 'Was drs.,tica:uy rOGucod. t1!""o;;, 7.;:0 '. :;:;cca.:;;.;:uJ. oral cAmin1st.rntion of Subin-typopolio::lyelitis vaccin~. In 1959,. o~:y!6 casco 'WBre roported. Tho dOOrOASe in polio~yolit1s cas~s dU;;'in~ tno ? ...;;t ;;"v"rc.l yOt:J:3 is as follow: 5606 for .the ye.:lr 1960, 2436 for 1961, 289 : ..'.,;: 1').62, 1.31 for 1963, $6 tor 1964, .76 for.19.6;, '33 for 1966, 24. for 1<)67,. ~~.: 20 for 1965~·. . .' :.';~,3i~.d only 2:30 cc.:>es lllclud!ng 203 ec.:..t,hs WG~O Npc~todj (:0;;- 1907, 1023 C...:;oo w.d 659 deaJ,,~:;). Th~ nUl"Mbor or par::;ons who Nco.ivad V01Ullt ..... -y :::....~11z"'tion. :,.'o;.'Jl:I.;:.mo:>G encophalitis dilring'1969 is e~timo.ted to bG o.boU"1i 49 million.. . '. 0.

?:~O nUI:Jbo~of Jap~osa. oncophalit~s casosgreo.tly decreaaed~o:;:?::i;'G:d ~~th

'':':.0 :.u;;;'vor or CASeS or dysentory has yearly decreaSed sir.cs 1960 except tor ~;;oalli:i.croase in 1966, an<i'12 933 oase3 wer.e reported. in 1969.

FOREIGNQU~\'TIN~SErt'1ICES .. , .

...

:,'

....

. D~":l.l~Z th~ccJ.ond.':l.r yoar 1969, 3.3 932 v;)s.sels (1 320 738 pOrSOl"ls) ~'1.d 2:, 993 uil'C;:;-a.ft3 (1'653 403 p(mlono) rucvived h",cJ.th 1n:::poct1on ..t the ti::.o of ;,,:,';,'~v;:;l f-::ol..~ ab:,06ld; 164 767 persons :w:~....o vl;l.cc1.r.atad ~iJ,01ns';; ·qua:'':'''lt::.r •.;..1Jl~ . ~::'CI~asvS bB1'orogo1ngi1brqad (this LUlIIbc.l.· 6SCc1udea. thdsG vtl.ccina;'"ed at pJ.C.CGO

,,,;,:·,v::-· t:::;;n tho CJ.Uartmtine st.ations); 1044 l.lhips were' grarltoo der..:.ttir...;· . .~~.'~~:fic~teG 4."ld 6701 ships reco1v:ed doratt~ exemption ctl:'1tifi9~te3. S.QilQ. ci~ol...:... C4S<.t3 was tound dUring the year 1969. Thea';) ~ CE.seswo:i:"U. im?Or"')c.

... :

. kJ of t.hu o~.d 0: l·l.:lrch 1969, 0. p&pulation ot 78 002 000 ( ..bYu'" 76.9~ ,,;: 'tho) t:vtc1 population) ..[('La covered h:r somo kind o! public' 'W..t,,::,· sU:p;,'".!.:! s~:JtO:Jl. ;.'u t:'t.l ond or l~nrch 1969, thoro were 126 cities op~l"ati:lg $~wa~e tNat.";:·..;;lt. l):ant~ ....d 'lo popl;,lat1on ot 13 271.000 ~1a.::l bo..a.!'ittod f'z-o.~ t::.etlci s,j~V'ic,":::. .. ".J.. the ondoi' ~·:o.rCh 1969, thoNverel03:) nightsoll triatmc:lt plil.'1t~:. At tho .::••d of Mac.'l '1.969, l4 population ot 76080 000 was CO'/O:-ed by t,ho\-:..~;t.ao dispo::.al. p:;-O~:"1~O, olth$r by incineration or compost~g ~thod~. . ~ho i..sect a,.""d rodent. control progrlllW,~'h:aupportGd by the co;;.;m..nity . o;;,;z.miee.tion.. ~has haem ~t1nued, and rout~e8anital"y inspections h...vCl beet.

cw."riod out

co~t!n~ou~~.

.. .

.. .~.' i, :1· ~,~~l.:::;!f~~~~";t~:i:;!/~~{(!i·~~~ ;>/:Jtf.i1r~:, y.~

-1.,-

-_.

-,..:0 to t~'lO CG;-,co.ltru'tion O~ PCOillo '.i:lto urb~V). E..r-:;~ ~..d ":.o:.;..v:/ ::..:.:ti.1.!stz-ipollution p~oblO:ns .of J~pe.n;ar& vIJ'r.y so:..~::'o:!s:··x;;,· . ?:,';:,v 'ro C01;0 \dt.'1 this G!:"U;.tiOll~ tho' B'c.:lic Lo.'W £0:-. l!!nvi~ontio:-.t·~ !'cl~:..:.'";,~o6i . C0~·."i;:'.;;::' W"::J cn;:.ct.;;d ill 1967;· and vc.ri<>us ldrid:l of oount3t't:ot;.zUl"eZl beil~;; .. .~ ....::-:.::. l~o:- i'J;'=t~,lo .. the. ::dr qu4llity otci:d~d for sulfur o;i;ic.es ',J~ (::;t::.bl::'::::~C. ::;: l<)i~9 ~ ,"-,,0· \J::.rly ill 19'/0, environr.:c:nt.al ql:ality E!t~c.<:,rds for c::..rl)on l:o:loxid~ ,t:::':';;':'v~v;l, thu clivi:::,or~t.al t ':,,:',::'.

are

"".~ w:...t",r <:uciity wo.!Jro 3.;)1; up. .sOi':,)· large urban or i . .'\Ciustrializodo.rous . ;·:;.:.v.:; ::::.:.:en dio:;ijnatod no opoci!'ic smoko oontrol DXeaeUllde~ t:cc 1.i:- Pollutio::l. . ;::.jl~t::o: :.0.. .:. ::.J.<: -.130 mLl.jo~ wator bodieD wore designated to ~. controlled by t:1v ':!:.:.tor ?ol.lutio:. Control L!lw. St1:1uias on tho va::tous kind or eUects ot ¢~wl:-;;;;-.:.icn:'al po11utio<1 a;oe also being, condllctecl •. '~':~O ::.d;linistro.tivo respom.ibil1ty for sow~ge disposal 6.'ld ito !~:;.c!litios .:>.::.3 o(';Cl'l.tu7.lvd over to t,llo Minist.-y of Construction since 21 June ].967 • •~vW;Dve::." I that XinistrJ still requiros to obtain the consent of t1:o ~:inioti;lr , 0:: Hauth lll'ldWelf'are when approving the construction.ot'IlGw<8GWtt.r8.£lO '1'ao'uitias and thier GA~onGion. .. .

"....

10.

FOOD Sl.NITATICN

o~:.var:;; 7.0 C::~al :'';;::~ c tot31

tho year 1969; 5409 tood i.'lSP()ct.()~S were st.ationed i."i S;!6 ~oalt::' \.1it112 857 605 food-hn..'ldl:ina:'e.stabliili'.....Eints. For the So3m~ :'.u;:;oo:- of i'ood poisoning Cllf~S reported 'W~:> ~360, ix;volvi:..~ 4'1 ::;(j{, p.:'ltier.ts c..nd l'':'i.lulting in 82 dO.:l.ths, Chc:uic:U, S:lllt:.otics to bo used Co;; :'vc,:~ ::.dcitivos a,ro fUlly controlled ~~dor an. &uthoriza.tion 0y.;'';CLl b3".thll Gcvc~-. ;.::.;.-;.. ,'.t. th~ ond oi".1969, 356 chcmico.l synthetic food e.dditivcs "TOl·ao.ut~1Ori:¢d.• ;.1. 0;;. ••1 lmri ot 1<)69, tho:".i were 717 slaughter..hou~es,lInd .10493 412 ~o.ls "'-.L·v ;:;~l:.t.ered and1nspected, durj,l;lg tho yQn.r~

:;;.:-inz t:..

ll.

N"UTRI'tICN

D~l'~~r; thG c.u.ondai- year 1969, 1 456 241 o~aes of i:dividllal n\:tt:;,~it:'O:l =~i~~.co w'lC 98 ~94 ~~oup ~eGGior.s, !:.clud~~ demonstrations b,y kitchen O~3~

. . . 0:-.,

~iv(jn

by tho nutr1tionatdf 0: the health ¢Ollt.ers';.. .

Gchool:.

"'... or

tho end of March 1970 , t:.ere were 257 nuthori9.0d dietit1a6l' t:.-a1ning 145 6~ llncon,,~ dietit,i4m3.

12. DENTALHEALTIi O.~o ~..u.'lch'od £.nO twonty-t"o h.,o.lth centors wore equipped with c.l)nt~ t •.ciliti,)'-l u.nd dentists,. .a:ld cont!:.uod to plaY' ..... ~portt\,."lt role irA "thlll ~~'';)V041t,;;.;IO dvnt<.l !loo.lth progr~e. Durir.g tho year 1969, 254 846 <ient.a: 110.:4'.:.:: [,;'Uieancv co~uulta.tion& were g1ven toj)re~t women . &nd 1 7$0 ;68 .ch::.l,~-un •

.. -..

. . ;";;.\

_._

.._.:....

......;.: .... ..'

..,

.,,\

.. :'

-~.

Co~.tinpt:.o o~rort.s 'Ware ma.do to ir.1?roVt) tho ~.ont&.l hoa,l!.h ll:,,<;;s;r.a.."7.m.a· .' .::.\,;:.~~~~ '(;:~o :io~ 1;969; iGcluding c:u-o of. the mental' 0000$. Tho nur.lo.~:.:" ot' ;.~c.. t~lho.cpituls,i:\ontlil bods; etc.,' D.~t.ho end orD~com~r 1969. as co;!;:iared ~;;:~A th.. Sal:le date in,1965, 1966, 1967 j 19P8 and 1969 is show 0010'1: ~.

. (: -,

......

!~un:.:;,aI: . ,.i _... , .•~.~~:a.v:lJ..

hOGpit~3 :·!ur.~b~;.~ ·o! PcY6!.io.trio t:-.it:l in ;;c~e ....o;.l

~ "

~. .. :') ~~

1967 SlS 429

. 29'''' ~':'\

J.0;9 .. "'~9 ~:;.

725 363

·7t;9 .399

85.3

ho·opitnls X-a.'I1bll,r of Mental beds ','

446

4T~ ~ 5:' 0 232 J; .

?:.cra aro ::lll."lY tho pr~grai~:;ei'or t::o or mental ho:>l.th guidGnce for tho public as wall fA.S.tor the l'ol...,.t~y :.."t,;.rd.:ld ci~ild"4en and ~ults.. . p~~oiuotion

164 OZ7 181 .759 201:823 ~ovornm£mtlll f ...ci.lit,ciJ carrying out counl4el:line (md home visit

211015 .

.... <;';"1e

'::..0

ot 22 local .i

boi."'lZ ;;:iven At 8,32 health conters, Undor the auspices and techn~.cal guiCl:.ncQ ' ~ontal

$ol'ViCie~

tor

St4iduMCI (m:.mental'p3.~i~"t;:; .

health centers.

14•. 'l~IC,'iL SERVICES

i-.--v 'who e~d o! the culendar yelJX' 1968, there vera 770,) hospitul:. (7;05 tc:' A totol bod capa.city of 1 003 6')8(96311" for 1967), SilCltling"':' . 'ii-'¢l'0i.i.313 198 hOl;pitals .a.~d 40 525 bo~s aga1."lstthooo &.v~ll,abl'Gi:L 1967.. . ':~.'i. tho C~lCi. of thecUlendar yeOI' 1968, thaN ",.,:"e 67' ')62 generalcl:"'''dcs (66 869 ~~~ 1957) and 29 4S9.dontal clinica (29153 for 1967), sho.r-ng an ~c~c~so of l093·~~nvr~ clinic.s and 3.36 de~tal cliuics. (Data for 1969 ~o not yot av~~bl~.

. 1~o7) vitI..

J.t. tho end of .'..00 calon<i.;u; yea::196S,thel.·e wor.e 113 630. phys:1.o1::.l'lc(il.2 '.' ':.,?~;.' ':0 OOOpopula.tion), 36 943 dentists C3 .. 6 per,lOCiOO ~opulc.tio;L)J' 743'30 ~~~'~~C:~t3 (7.4 per 10 000 population) a1d 2fh 575 nurso~ (26.6 per 10 000 liO~ul(..~!.o:.i). Thio ll10ans ~ ~crellDo of 19'/3 phY3!.ci;lf.S I Q,9 dcntict:l I 2235

.ph..::-;.mc;:';:;'''s and 13 500 nu:"sea.

I."l to cope ",ith the1r.c:"Q.:lSo traffic . accidont. a..d· or..crgo:.cy. meQic~ care systom "'ns Nvi~ed !... l~ebi~a.."Y 1964.' ).s .:;:. ;:,csul7., Co. :.c;~",o..k of tho a.ccidont andorlorgc.. cy medical Ot.r3 b,:l 'been esta.bli;;hoc throuehout tho countl"1i. at the e>ldof Mnl4C.~ 1970, the .n1.:l:1b.l\)r of. Such t ..cUitiu, either public or p~1vate, rOAcPed 4386 •... ' ~.:

¢l~dar

(Data. for. 1969 aro not· :rot ll.vD.il...ble)., .. '

~"l

an~ othGr.o.cciC:e~:ts;

the

... .

.! '

,"~,.::;.;I'!f"';·:';'t' ~ .?'~~ii:ti/):i:r.~:r::'~;,~·}~::#il,~~j;~ .·:~~~~i~;~<~ ~~·~.k·~:~ .; . ~i~:·l~ ·:~··.:~;:·i:.:::~~~~~:· ..

...

. .

...... :.

•

-6-

....... . " ,,: £.p;oU 19?O, there Q:'e S phys1cw. thera?~st tl"ai;.~ing ocho"ls ar.<! 3 trilinina cC!'loolo. Th.;~o arc r.O'W a total o~ ::.112 ~hj~iczJ. '~:.c:"4 ..::,;:';;~cc.."le :;08 OCcupt:l'"ion.u th",rapists. \tho have passed the na.tilm.u· ey.;J.::!.~...;.'.:.!.,J" 1'or .thoh- rospoctive prolossions unclE,%" tho Law for Physical ~:ho::..·api~t.l . G ~c·... ;> .... ,:..t);:'a4 !'h~T:lP::'::;t,

w.~ vC~~PQtional

TheraPists.

:~~~r.~ t~o. ca!onda: yoar 1909, 2075 p~'maceutieal ir.spacto~3 vicit~d 2:;:0 6C.s ph..u-maco\4ticol facUities (O\4toi' 0. total {)t 260 914 such f'aciliti.;:s),

;;;.:ch 0.0 <!:-.lJ $.d modical supply mo.nuf ..ctu:ox's, phc.rr.:(l.cioS al.:ld blooo. .b~'::;;. .'

· t:.1;1 ...o:;.£uros . ,< ...

~ho

cOl:kol

0:'" ~pho'!;tu...~e

In"epurations ::.rid

na.reot~c31itasalso

:riointo.in6d, bnd

::04" nlioX'cotic addiot.s wore also cu;-ried elit.

~.lp!,ly sorvice hOll i. ... the pc.st. dcpenc.od chie!'ly on t~o sc-c.::l:'ad b100& donors". Thin prp.ctico had cal,lsoo. not. .only oocial.ov.i2.s c-.:.t h.::.d aleo il'lC%"<::J.clld tha risk of oorum hopo.titi$ sona; t:ia :?op~ation~ ':'co

':h", blood

:'~Jl'Oril;:;sio:lill

the GG1-ioUSIlQ3S of the c.bo'Ve $it~:lt!.O;l. r:;.:;.co Il doc:'sio... blood <l.ol~o.tioriS turthel' to ~c:,,·...£1.lizG ttc: . b:'o~ .:.up~ly sorvice progrw::;no. Under tho natio,'l-wido Cc.::lp,:,::,,:r.~ !or vol~!-t~7 . · -;':oc.:! dcnati6n, tho rD.tio· of volu.'lt;.a-y dona.tion to tho tot~ dC:'l.c,'.:.ionsihc:.'c:::;cd '':'0 fi9.7~ ~l.U"inz tone yaur 1969, whilo it was SO.O~ in 1968 \1:1 ::'964, only 7.7;';). ·i •• "'.uttnst 1964

COVOi.·;:,;"vl~t"

NCO~!."in!!

clov~lopvoll:nt~Y'

.....

...

#::jO fi=tit, edition of tho ofticial Book on JapnneseSt~d~4 v1Cos~~tic ::....-:::.:~\;cli~:lt ·.\:.lS i>Ublisr.odin ~~st 19tfl. ';.')-:'3'

..." ;

cv~::'i:~·~<"c. i't3 uctivities. in o~der to e~sura tho :;C;£cty of o.~gs. !It!l.''ti.~~ "vhc :~~~~ J~~ 1969, ~pproxih~tely 300 L,for~~tion caras on dr~g ~dv~r~~ rc~ctio~s · ~'::'''''';; b~,,:l collected from' tho doctor!> of tho;:;e hospitus dos!:::n;;.tc<ito...~ dr".:.: :;:.,):::tv:'i:.J zc..vic:,:e. IJ:.;houah tl}i3 in!'orr.:.:..tion.,l.r~s not idor~tic;..l t.o t:le,C:vCl':>Q · ;;'·.,;;iC~::'vl~;; co!'inod b-I '.:HO.but merely tho so-o&cd sidG..;eftect~ )App:::-o;::...·i;;.~o . ~ .....i it~ doriv~t1vos

wonitorin;1 :;:rst~~ for o.dversc d:--.l::; ro;:'c·;.:i.on oS'i.o.blished. inltIsrch 1967

;~uc.::.~~io~s on the usa 0: praparAtio~s of~ti~l!l~~~to.~ dl'U~S(61ucoco~ticc ..ds, ;!!~c~y:i.::'ut:L2crie; indOhlut.haCin,. tlut'orsic c.;:id etc.), Chloroc.uine, Su1i'~ylllmid~

end plasmaexpandorD wore drawn up in DecOtloor 1969 •

...

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..•.

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.': ';:

,:~

...

. ".',,:

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.J~)~r·:~·.

..,

ON TIlE PROGRESS IN

IlEALTH

ACTIVITIES

MAIu'IYSIA

********.********************************

TWENTY-FII5T OF TIlE IV.H.D. OF TIlE

SESSION

IlEGIONAL COI,tIlTS 'llESTERN PACIFIC

1ST - '}rH SEPTEMBER, 1970

i,IANILA,

PHILIPPINES

00000000000000000000000000

,DIVISION

PLAlillIIIG A!ID

HESEAHCH

MINISTRX . ' OF" HEALTH

WJ.J.¥SL\, Kunla Lumpur.

lJRIEF

REFOra'

THE mOGRES." or REf;1TH ACTIVTIIfS nl lilJ.t.YSIA .' 000000000000000000000000000000000

Introduction I West ;'luleysin oonprises the .cloven Stotes of the foruer rederntion of F!cl.ayn. It is

51,000 sq •• miles and the terJperatur8 ranges from 70°!:' to .90°1'. The relntivo hurJidity is genernlly high. The nverage annual rainfall j.sl between 120 i(lobes .ond 16J inches. WIIS

In 1966 the estinnted

mid-yellrJ:!llll'lntioll 'II,

iJ,700,736 of which, ,\bout 1#,6 is .U!ldQr 14 yoars old. I

Public Health i.dministration

At the turn of tho century, '!lloost all the lOodiea!' nnel health services \'fore provided by Government. This accidental monopoly was, however, diluted by the settinG up Of estntes and "unos In recent yenrs, n fOll

hospitals by the rubber and r:u.ninG 'inclu&-trics'.

privntc hospit.als wore

estQ01fshed by mgsionnry codies crid othe'r o.rr;nnizntions.' Until 1932, the Goverrunent Henlth Services "Iere di vi(led into titO

depart' lents, one being

maintaincc by the Federated i.Ia1ay States (Perok, SelanGor, I!egri So::tJi1(:n, Pnlmne;) and the Unfederated Malay States (Johere, Kedah, Perlis, Kc1anton, Trengc;nnu), ani', the other by tho Straits Settlenents (FenanG, l!cl.accn). ncting exeoutivcly os ItDirector U

In 1932 the tv/o services L1crscd flith

a COilLl<m

professional head onpncity as uAdviserH

in the Straits Settlc:Jents c.ntl in un advisory

to the various Federated and Unfcdcrnted Llnlny States.

In 194G, tho FG4crntion "r :,!cl.aya !JgreelOont

decentralisod control to an extent :lhcr(;, exceptinG for sQrae fcdercJ. instituti:.:ms such US nentnl hespit'als nnd leprosarias, tIm executive control ove:' the s0rvice LeC(lLle fundanentally a State matter. In 1957, llith the declamticn '::f Independcneo, Health ;'ccmle a Federnl "latter, except for 1"lrG<ls.

certain prQv~nt_ive t.leasurcs in the ~,iunicipoJ.itiGS cnd othE:r Loe,".! Authority

On the farnation

of !.iulaysia in 1963, Health in Snrnwak becalJe a Federnl l:Jnttcr Ifhi.1"t in tho ,;t"to af Subah it reminecl n State r.1ntter until 1970. in this StatG in 1971. (;.p:oendix '[" I 011(\

Tho Central GovcrnDent 1'Ii1+ aSBune rcsponsibil'_ty for health - OZ-:';f.nisaU.ot; ~;:lUrt).

lIT.

Generul Heolth Situution

The general henlth of the populotion continues to il:lP"oVO

excopt for n snnll outbreak

of Chelera (El Tor) in early 1970, tho eountry has b~on free fron other qunrnntinnb1c diseases. IV. Population und Vital Statistics. : The Rate of Naturul lncro"s" is (,,rndual1y doclini"". Crudo i.iortu1io:,' and other Liortality

Hutes are staudily declininG und the fiGures for 1967 shol1 an nll-tinc loti rato.

'r/d}LI:

1 -

Population, Rnte of Natural Increase, Crude Birth ~!i..~~~il(lte and ~a i'ortality Bntos

YEt,1<

Population (nid-year)

Rate of Naturul Incr(:Q.s(;

Crude Ilirth date

Crude Death nate

Crude

Llortc.1ity :rod<llor

Rute

Neo_ Hatal 30 32

--1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 196G G Z78 75S(C) 6 498 '158 6 697 IE? 6 909 009 7 136 004 7 377 200 7 610 843 7 813 769 8039 030 8 297 33.7 32.3 32.4 31.4 32.7 31.0 40.2 43.3 42.2 40.9 41.9 40.4 39.4 39.1 36.7 37.3 35.3 35.2

Illfarrl;

fHaternal

12.4 11.0 9.7 9.5 9.2 9.4

76 00 6G

3.2 2.8 2.1 2.4 2.0 2.3 2,2 2.1 2.03 1.79

9 S

29 30

G9 Go

29 31

0 0 7 G

60 57 48

30.5 31.1 20.8 29.7 27.8

9.0 8.1 7.''1 .

25 2G

849

'1.6 7.5 7.6 !

50 48 45

6 5

8787 103 8788 736

Z7.7

24 N.f~.

r (c) " Census.

, u.,:•• I

5 H.j,.

1.60 N.A.

'V •

Devolopuent Plnns

The First Five-year DevelopLlont provided for nodest expansions to

Plan (1956 - 1960), lias frcLl00 before Independence. ",ade to the mdical, health and dGntal services.

In the Second

Five-year:)evclopnent Plan (1961 - 1965), ho\'!ev~r. c:xpmlSions on "" unprccooontcc\ scale Herc uuda to those s~rvicos and evury e!.lpmsis rl~S pl,'lced on the h.J:11th-nee:ds of the rtTcl. population. ~his

enphll.lis has been continued in tho Firlilb lJalaysia Developmnt a~n (1966 - 1970) •. Dy the end of 1969 the cost of expension of the services "hOlllteL: tu 1.~~250 r.lillion.In

mo 'a

Surl of I.li~ 26 million

has been allocated for further devclopl.lcnt ~l1Ll ioprov0:.lent of the :.lemecl, hoalth and t!orrl;al

servicG:S. VI.

Public Health

tiural Health Service f.bout

ff:f/, of the

popul~tiol1

live in the rurn! nrcus of the courrl;ry.

On Indopendcnce mre

than

7QOp

of the medicnl and houlth services '.'{ere ccmccntrntecl in the urbQl1 0:;.' scri_urbnn areas.

WrlS

therefore obvious thnt nny ntter:lpt to irJprov;J the horlth of tho nation would delJend. on

inprovclaents of the health services for the rural urQ~S '7here nost of tho heal-ch proble",s exist. The noin proGrnme in the promotion of health and snnitaticn in tho ru"eil areas VIas thrOUGh tho Rur'; Henlth Service, "hich involved the buildin:.: of an effocti vo nl/t ..florlc sub-centres nncl. Lri.dwives'clinics. of health centres,

·rhese fncilities provide both preventivo anG curntivc services,

includinp; d~ntBl-cnrc and "aturnnl ant! child henlth cnrc. onde in the hlpleLlentation of the llural Health Service'

The follol'1i1l[; tabla shows the p~sicnl progress

TI.IlLE 2 .. ProSress in tho buildinl3 progrn; :flO of l.:oJ.n Health CentreSJ Sub-Centrcs and riiUVlivos' Clinics r-------------r--~~--~--------·~--~_,--~~T-_,--_r--~~

--0.'_.,"", "" "" "'" "", "" "'" ''Xl> " " , ... ' " " "'" I . Wm 1-----------------~---+_---+----+_--~~---~--~--._+--_4--_+---+--.--: !'.I"in Health Centre (J _ .. _

""'1' ' '0)['."' ;I

1 3

12 39

15 52

1 15

.. 13

" 4

~lid~~~nios

Health Sub-Centre __

l=-__-=~~_26 !_~~ ~.__67J~~~_()1 (2;

1 _

2_1---'l_3~.

2 6

Jt4

175

_7_8-+_10_2_:,- 20

!__.

r40re th2n 3.6 T.ullion r'JI'::l people n.)\{ cr\j~,y t:~e ;::e:nG:Lits c:' r. ~c.sic pruvc.:1ti ve

:'.ll.j

curc.tive service.

In addition thoro nre 209 rJobile dispensaries operat.inG in Qre[tS not yet

covered by this scheme. Incrc:o.sed these units GS

COJ"e.

tor the rurnl people

IS r~flectod

by the incrca::;irc; worlc...loJ.cl 'Jf

shmm bolm': :

Tf\~',1E

;.ttendnnces at Henlth

(~entrGs,

etc.,

Home Visits and HotJe Deliveries .

1960 .Total Attendances at Health Centres Hooe Visits Hooe Deliveries

, 1')61 I 1962 1963 1964 1965 1966 II 1967 19G8 1969 72604~4

5136336 5114419 5(182426 6661069 6721261 6969894 6763719 7011507 7554035 843073 44759 941819 50119 961360 53246 11~7037

1292164 1484767 1480360 1630781 1319650 1851268 62561 61f555 G()105

59436

60009

7165()

74672

ii)

Publi c Hed t h Progrcu.u;Jes : n) Gunrnntinnble DisGoses In 1969 sporadic outbreaks of Cholera Ll Tor occurf'cd in the :.;to:!;es of ;loncrnG (1), TrenEl~cnu

(1) and Kel~nt;:!n (6G) 8.nd the nur,lber

Dr C[lS8S

tot~J.lc:d

70.

In 1970, Cc,sos of

J.~o CD-S0S

includinG 1 clenth

W2re

r(;cor·ded.

Tto c,utbret.::1: has been contnincd nnc..l

tUlder

control

and

no ftrr"tr,er cn..scs h;::.vc: ')een reported sinc,-, June, 1S?O.

opcrction::l. country.

Eo ChC!st Clinics r:ith wnrd f:..!c:'litics h,:1.VC be on

CSG:-'~.Jli::;l1r;(;. throtTGhout

the

The COGp01!8nets of the Control Proc;rc..Llne

a:~(;

The Trcini[l6 irosro''''''' to tr~in cliff"r,?;1t ccteoorics of tcCbLC: 1 personnel sufficient in ~"lT1bt;rs for the country-wide control c::::.JpaiGn 11~.'.s progrcs;-,cl.l :>at~sfo.ctorily and SOr.1e

2,403

po!'s('I11l1:..:1 h'l.VC

been trained;

ii)

The 3.C.G_. V,::.cci2.,';!ion 2.!3~rni'i.l"- to Pl'oti)ct th~ sClsccpt;i.blc Ilcnbers of the populotion

acainst t uborculosis hr.s roached the 2.B l:li.llion n3.rk by iii)

l.~c.y,

1S70;

!il.'!J:.nS0-:-fiE.1i!'§.JJriv0. usinr, mss t:Iininturc X_"rry units followcr.'. by bc.ctci'iolo(jicnl cXal:,in2tion of sput u::: of C;1ses showJimr; X-rcs Qonorl1alities on n. routine progressively rcd:Jc€;(: and crco::.ter ;tr'jJhasis is 'x;inC plnce(:' exnl.!im~tion of SpLLt Vl.1 of St;spoctod cnstJs of Tuberculosis. 0i;

bns:i.s is being

b:l.Ctcr'iclc,:;ic.1.1

There 0.1"3 definite indicc.tions that tho incidcclCO of t'Jb(~rcullJsis is on n d01Jffiwnrd tr0nd. /\ tuberculosis prevalence surv0Y has been Inu:i:c:lCd in

Ley, 1970

~nd is beinc; conduct"d

in 72 randot:1ly

sclocted population clu;;tcrs distributed

nIl over 1."1est i.inlnysin. 350 people.

Ench cluster ',jIill conpris() 75 households or :J.p:)roxilJ.1toly feGL1

Each Survey

COGposcd

of -

il. ii)

A ret:istro.l,iuD :,>ub-team; j.n LXQ",inntion sub-tenu; and

iii)

Ii FolloVl-up tean.

in The IlEP/'.lest !.Inlaysin is directed by tho Division of '-lalnriu nt the Einiscry of Health. A Stote Malnria Eradication Office is to be established in each Stato. This

is headed by n State r!:alariolof5~st who roceives overall ndministrntivc supervision froC! the Chief f.1cdicul and Health Officer, and technical nnd operationnl directions and supervision frOD LiEF Heodqunrters at the Ministry of Health. Malnriologlst supervises nll Jistrict :,1£05. The State

Sectors each .lith a stClndard population

of 40,000 - 50,000 are then to be established below tho District as field opCl'ational

W1its. The "1st stage" of the operation covered the 5 Districts with n population of 701,005 in Perlis, Kwnh nnd' Pennn., States. The 1st cycle of sprayinG stnrted on 11 July, 1968 Thc 2nd nnd 3rd cycles of spr"Ying lIore also

ond 'IaS completed by 20 February, 1969. coopleted in 1969.

Th~ 4th cycle of spraying startcd in Jnnunry 1970 nnd is expccted to

be cOLlpleted by June, 1970.

Geographical reconnnissance in all 11 Districts of the "2nd stnr,e" operational nro~s in Kedah ,md Penllng St"tes coverine; 0 population of 1,104,006 ""'s coupleted by JanQ~ry,

1969.

The 1st cycle of spray inc; in the hilly ~~:t.':!'!. aren covering a

population of 577,756 \Ins c""plcteu in th0 lnttar half of 1')6<) end the 2nd cycle of

spraying is now in pro6ress.

The sprnyinG in the plain cr.npGstri~. area. covorinG the

relOaininG population of 527,130 rall stort in July, 1970.

The

boogr~,phic!ll

reconnaissance in the "3rd

sti)(,;O,j

Qren of ·cho

~ix

Districts in

Northern Pcrak nnd Kelnntnn with n population of' 364,022 stnrted in :~ucust, 19(t), QIld is expected to be: conpletcd soon. Preparations nrc bcinr; Llc.de to st.c.I"'";;' the sprnying

operations in July, 1970. The "4th stnc;e>1 nren will include Centr:J.l PcrD-k, Southern jCclnntnn nnd the whole

of Tren[lgan,U colOprising 30 Sectors Dnd n tote.! population of 1,724,241.

ri'8pnrations

nrc beinr; r..nde tv stllrt the st0[,raphicnl rcconnc:iss0nce op8I'0.tions in the latt~r hnlf of 1970.

Satisfactory pr{)gress is beinG •.Inde in this pro"rCJ.rrle nnd systew.tic survays to elil.'linnte the disease continu0s. e) Filariasis: !lecular evaluation of the contre.l cur.lpcic;n hns reduced nnny of the Ileo.knosses in the progr=lo which is now proceeding satisfactorily. It is hoped tllnt the population

at risk, nOVl living in all known endemc orens "ill bo covered by this prOe;r(l!.lr.le. f) Leprosy Control : PlonninG for n Notional Control ?ro[jrar.ll.• Q has boen conplotc:cl and the pror;ro.Llllc VInS launched in 1968.

In the control progrnune,

er,lphasis will be plncec: on 6r.rly ambulatory

trt!o.tucnt of th\; discD.se thrOUGh an c.ctivc cf'.se-findinG schone. will be rt!!strictt:.yj to a.clnission of infectious cases for .'J,

Institld;icJDrl trcat;]cnt

liuitct: period to render the Tho Contrrli Leprosy

cases non_infectioti.s cnc. thc)sc requirinG rc-constructive surCGry.

hef)istry 11'15 been ostc.blished nncl four skin clinics ho.ve started in priority nrcns where

the incic.ence ~rf the

d.iS8:)SC

is hi2;h.

:\~ore skin clinics with adequntely trc.inGd stnff

will be opened ns the ru"o3rruJr:le e;nthers r.loLlcntun.

Other CoC'mmiccblc Diseoscs : The incidence of coranunic:.J.ble disE:ust.'s rrhich tlrc cndouic 1.n the country does not pOSU .:l

serious public heo'lth problen.

(So(.' Annexure II)

(4)

iii)

Irnnunisation Prograotle : lllOUl'1isntion GGainst Soallpox, i)iphthcrin, Tetanus and Fcrtusis is routinely perforf.lGd by every health centre and clinic.

t. tot.ol of 203,f396 pri[],cry snollpox

v"ccin~tions

ncre

perforned in 1969.

So"", 153,1CQ cbildren cor-pleted their cc-urse of Triple ,\ntir;en or Double

Antigen out of " total of 213, COO cmldren who

m,\

their first dese of the inoculation.

iv)

Environn<;nt:D. Snnitntion : The eleven sanite.tion pilot projects, one ~n

each Sto.te, are "'J)[1 the

prOt;rcs~inc

sntisfnctorily.

hctive coru,mnity participation hns been most

encour::~2ing

r~clin.tinc

influence nround st~)pliGS

these project ore as is progressi'lely enlarGing. tube wells orG being instnlled in these arcns. wnstes are beinc encournc;ed.

Safe and permncnt yrotcr

throUGh

Sanitary disposals of html[,n nnd c10r,lGstic

These nrec.s nre used for dCf.1.onstrnti0n as ..Joll us crninin5 areas i~very nssistnnce and en-

for public heo.lth l'Iorkers ~lnd interested IJclJbers 'Jf the c)!Tmnity. courosenont are baint; given to the and sale af latrint:: v) bow1~

setting-up of ;ori'latGly owned Ylorkshops for the mnnufacture f,Jr'

and superstructur(; nnd concrete rinGs

\"fell COi1struction ..

School lIeolth : f. joint School Heclth Cot:lf.ll.tteo '!lith tho tAlr.istry of Educntion has been svt-up to look

into the hC31th problerlS of school cmldrun '.Imeh nlltibcr ne less then 1,5 nillion. elate is being collectec:. before: the School Health PrOcraI;11:1C is Intmchod. 'Ii)

Bose-line

Health Plannin£ ' In order to provide a COlJprt3:hensi ve he'11th pr03rnLlLle throu.;h tho stl'uct m'ine; of successi ve c.)UtOnsLt elel.lents Df n tot.11 schone, on the basis of .svrvice, r."(t hc.:r th.::n by populetion groUpS, social clnss, or incono cntegor'J, has been estnblishcG. to look int.) the lonG-r~mGf; D.

HE,TTH P1[tmUna ,"III)) j~:13;:;,'.. ;C;1 ]~I.VISION ~lSpC'cts

plo..nninc

of' the ho,:.1:th services <lnd in o:.."C.ler tG sntisfy the hcr.lth

the evaluation and oodificntion of nIl curro.nt heclth needs nnJ dei.1.::nds of the people.

prOGr:'I:UJOS

Every existinc; hospitf'..ls in the oountry is heine; renovated :JJ1U exr:onclccl unci nncil1::.ry deportrJents

have been enlarGed to cope vlith the ever-increasinG c1ennnd for !aedicul cnr0. not only because of the incrensing popt:1::tiun but 8150 tlu.;; to Gore c.nd raedicnl trenti,1I::nt. The ov.)r~ll r.:Q:l'Q

This (lcl.lnnd is incrl.';D.sinS people t.:JJdnc to j;lodern

bed cc,pacity of Governnent hospitals h::s increased fran 20,337 in 1957 to 27,226

by the end of 1969. De;:l:md for rJ2dicnl ntt€nticn IS still on the incrcGsi..: .:::nc. !r. . s ~.L.lOst doubl(;(I since 1957 ~s

shown in Tnble 4. XMi1E 4

____~~~~~~~_£:E~~~:________ 1957 1967 450 073

Hospitr'.l .2dlllissicn (,nd [ret Qn;:t~nces nt

1960 491 653

1969 492 [191 5 705 091

Hospit,11 nd:,Iissiuns Hospitcl out-pdient trentL1~nt

271 490 3 281 9GG

I I

5 461 471

5 915 757

1,00 nillion out-patients

. !le:ric!es Governnent hospito.ls, tnerc are industrinl aM private hospitcls and f.1aternity houes with a total bcrl-complonent of 6,149 v:h-i ch handled 111, 706 during 1968. in-p~ti8nts <'.11(1

(5)

VIII.

Dentnl Service : Like the nedicul nnd henlth service, the dentnl services nrc beillG expanded prirmrily into the rural nreus. the inCrCrtS8

Or the 450 dentnl clinics 60

pCI'

cent is in the rurcu. urens.

Consequent to

in the nurJbIJr of dental clinics, attenunnccs have nlso increased ns follows _

TBIJ,E 5

Hunber of Dental Clinics and Clinic ,",ttendnnees

.-196C No.of Clinics Total nttendnnces

1961 230

1962 267

1963 269

1964 2W

1965 322

1966 395

1967 427

19613 I 450

1969 450 I

146

655 140 . 7541396 851168 ()49670 9281181 1032040 1131683 1 I i

11696C8 1427189 1634147

IX.

Tr~inin!3

?rogr.')QfJe :

Trnining progrr:.13JCS hnve Leon expandHd pari pnsu with the GXjY-'l1sion of the Llcdicnl and

health service.

The stnffillG position of nuxillim'Y [.lcmcnl and 1,onHh llOrkers 1ms inprovcd doctor~,

considerably but the country still f8.cGS on [lcute shortcijD of

dental surccons .'lncI

phnrr.lO.ccutic'll Ch80ists. Tho:: Fnculty of r,Tc:dicine Vlhich was estrlblishcd In 1963 proGucoL1 61 in 1<)69 und 65 in 1')70. t\'IO

~tch()!3

·of dootGrs,

j,ctivo consideration is ocine:

r~ivcn

to the enrly Qst.oblishllent of

f1 Jent~l School so that n pernnncnt solution will be found for the ncutc shortc.Ge of DentJl

Surgeons.

licknmilcdscr:u:mt: Thr;; GoiJ'ernr.lent ~f J.ln.lnysi2 ':lishes to ~l..... C(; an l'(;corcl its ap)rcci:-.ti'JI1 ()f

the mny r...nd

varied tl!chnicnl o.ssist;;..nce by wny of consult cmts, equip::1Gnt QEd schol;::u:'slli;)s undo nvru.lable by \i.H .. O.~ UJ'U.C.EoF. c.nd friendly forcirJ1 sovcrm.Kmts for the v:11"'"10u5 public honlth prO[rm.1;:.1CS

and in tho trnining of locnl officers.

i)urin~; 1969, the devvlapr.lOnt of fledicnl Gnd Hec.lth facilitiL:s continued in the St~te

of ;3~rDWo.k, rlithin th8 Gcnernl i.:stir.JfJt85 c·r EXpenditure and Qlso ns pnFv of th~ ])cv21opnent Estin::t~s

in the F'irst ;'blaysia [lInn.

Duildinr; ProgrnlJtle : This caters fior new buildinL~s includinG hospitnln t di:::;:)onsnrics, clinics,

IlGdicnl stores ~ml~

vnriety of' other ncdic(Ll bUllc~in~s and institutions.

All

stich buildings ~re constructed unc1~r tho First bnlnysin llnn.

ii)

f'ublic Heolth Frojects :

Drie;fly these o.r8 the So.r:.!wnk r·Jnlo.ria Errrdicntior. Projoct, Tuberculosis Control Project, nurnl HCQ.lth Improv\,jj]Gnt Scheue end. School Dcnt(\l Servico.

The

InttGr bw ppojects nrc covered l)y fUl""!lls provided under tho Pirst I.1nlvysin Pion.

iii) TrdniU3: In order to ke:ep pr~ce

':/ith the cxte:nsion of ncdicc.l nnc1 ho<,:"lt.h facilities

in the Stnte, th~ tr[.~ining of different c<'J.tcr::;orics of stoff hns boen continued within r;]n.l,:ysio. and nlso OVGrsen.s.

Building i)

State Hospital Kucmng , il oonsider""lo inoreuse in progress lias noticeable durinG tho year, [lnrticularly the

second h',lf of the yenr, ond the first phose is nOli expocted to conplcte in r.Ud 1970, to

provide the necossnry specinlist f.::.cilities for th8 State ns \'loll us gonero.l medical services for th~ 1st Division of Snr[lVluk. ii) Looil Hos~tals : The buildinr; ot Lmvns hospitals in the Stote to 4. expected to be conpleted by VlnS

cor.;pleted 'mrly in 1969, brinc;inc the nurlbor of 25 beded It 1S

Late in tho your work carmonco,l on thc fifth at IJuknh. SepteD~or,

1970.

iii) ,r

Dispensaries' No dispensary buildings were cor.lplotod in 1969.

iv)

~lnn~ous Iluildin§s

Three rurn.l he:.llth sub-c0ntres were cOl:tpletcd and

furthm," 2 ''lOre tmder construction.

Ilork storted on the r.;odicnl Store/Salt Iedisntion buildinG, ::md on the Dentol h&olth unit in Sibu. III.

"ublic Henlth Projects

i'ilalnrio. Eradication

This project st:'.rtod opcr:::tions in 19C:o, havine bocn converted fror.~ c. Llo'l8.rin control project which stance. in 1957 in n pilot trir.l nrcD. in the ruLl gndunlly extended to cover the "holo State by 1959. Up to 1964 pror;ross w~s very gOO(\, tho incidence boine rodc,cod fron 10-15% to 0.3-0.4%, nnI'Glil

bo.sin, :'"\nd which wns

with resulting very

Jenefici~l

re5ults to the I'urcl peoplQ :111,1

rur·~l

cconoqy of the State.

Since then, however, procress htis boen vcry slit,.;ht becr:.use of .:\uninistrntivc nnd logistic difficulties, nnd bocnuse of the prcblci.l of the border proviue nssistc.nco t:J the Project. ii) c.~{'cns.

'\";, E.O, and U.N.l ,e, E,F. bath

TU~.9.s.i.::...cotlt!:92-...:. This project stertod in 1960/1961, with Co:!.onbo Plcn aid frou Australia. in the urban nreas, the project ane! ';IOS

After a start Travelling

extonded into tho rural nrons in 1961>/1965. D.

othor difficultiBS, ho:-:ever, led to

chnncc in policy, and tho ncss direct D.C.G.

cnnpeic;n wmch storted in 196G had virtunlly been conpletcd by the end of 1969, when the nurlber of vnccinntions

si ven

since 1960 totalled 421,411.

Er:lphnsis vlill noV{ be placed on tl"enG!lcnt follml-up amI then cnse fintiing by r.ti.crospic ex::..r.ri.nution of sputUlJ Sf.1enrS, UNICEF and ,IIKJ a.ic.: \'lns continued durinG 1969, hnvinG stnrtcd

in 1967. iii) ~_~nlth Ir.prove'lCnt This project, desiGned t:; inprove e:t'lviroruJvntcl sanitation in r'llr:u villu;t3,S by health eclucntion to the people, the' solf help' provision of sr.lD.ll rclc.ti vc.ly so.fe rmter

supplies, tho constructi,)n

of hYGienic lc:.trim::s and of nO"lns

()f

refuse disposnl,

instruction in SnnitDry bird nnu ,lnin::!1 husbnndry, nnd in nutrition. supervisors hove so f.'1r been trained health sub-centres. fIJI"

47 rural health

this \'lor}:

~nd

opm"(':tu froLl sunIl buildinCG cnllcd tbi~

UNICEF nnd UHO both pro'Jiue nssist<:llCC to

project.

School Dental Service :

t. furthe" 10 dental nu"ses eonplated training in 196') end returned to brine the total nmber of school dentGl clinics up to 37, corine for the ttletll of 10,000 prinnry school chil(lren, UNICEF helped with tho supply of dental equipr.10nt for tho school climen.

~n2llJndClli.!2.2!.ealth Service: This servioe is runnod. by the 22 locnl authorities in the State, and is stnff~xl by district r.ri.dwives who receive a bra your traininG in the school in Sibu runned by the LiGman! Depnrtrnent. The departr:ent also provides professional auvice and supervision to tho niuHives and local councils. UNICEF continues to supply equipDent for clinics and r.ri.dyi ves and n!so skiDDed There are 97 clinics Btofi'ed L'Y 132 [ud"i ves.

r.ri.lk powder and vitooin capsules_ IV _ Traini.!!!) Apnrt frOD st(lff who require

university trnining, o.ml

D. f(AI

spccinliscd categories, training

for cost catee;ories of staff is nvoilnble in Snrnrlnk.

It is therefore possible to phon and r;etintain a progrm.t]0 of traini;JC to i.lntch the needs of increasing fn6ilities built under the Developr.1c:nt PIOJls for Hdnysic.. 'i'hc types of staff required

and the needs of the developine scrvJ.ce urc revi(;Yrcd fron tinG to tiLlC a.nd t:.hc syllnJuses altered flccordinDly. Tho need for such chances is well exenplifiec1 by the 3rouinL; need which is felt for 0.

a public health nurse for L1.& C.H. clinics rnthr:::t' thon

pure: Hr:ri.duife: 1 •

(8)

II!

Introduction

until the end of 1970, mmcnl ".nd ,\colth services nre Stnte responsibilities tUlder the control of thl2 Stecte IJinister of Hor.lth "aha is r8sponsi:Jlc to the Stntc Cabinet on policy rrlr...tters. The services nrc acluinisterod by the Director of the ~.1edicc.l Services.

Pleose see Ilppenr.1ix 'JI. over the YC£J.rs.

/ls c:::n be scon fron the table !:J.ortnlity rc.tcs nrc declininE

III,

Developocnt: Inpler:lontnti::m of developncnt projects under tho First period 19fiJ/1970. ;',~:11nysin

FInn continued during the

"sun of 5 [ullion Lbhysinn dollars wns budGctted for dcvelopnent in 1970.

Developraent projects inclucle construct.iO!1 of nen hospitels, dispensGrics, dentc.l clinics, nr-o.:l henlth offices, nnd village GroUl) ;:mL-ccmtrcs, cxtension/rcnovntion to existinG ones; and purchasE of vehicles. IV. }~lic He~th

(n)

Mntel'nnl~.hild lleo.lth Se~vJ:.~s. f.lnternnl nnd sub-centr~s r;.nd Chil(~ ilco.lt:l

SUl"'vices,

pro''li(~(:d Dxp~ml

throu::;h health centres, villaGe grJup There are at

LlDbilc clinic5 cor.tir:'UQ to

throuGhout the State.

present 13 heC11th centros rtnr~ DC) villll;:::c :.:;roup sub-centres.

Ir,1l'.lUniso..tion aGainst tuberculosis,

poliouyelitis·, c.1iphthori~, tc:.-.~m'Us, nho(JpillC couCh f!.nd sr.1:'111pox Qre c['.rried out. Of the 22,953 births rc[jstcrccl in SnJ::.h in 19GB, 4,731 took place in hospitnls and anothor 3,194 Wer() sHpervisod by rupc.:l hC:llt.h nursus. 15

The nnternnl Iilortnlity rate in 1967

1.15/1000 live births. :.luQ

:;hortm~0 of st~tfl'

ic hes not yet been possible to provide em or[3nnizcd

school hCil.lth service, but stnff frou hcnlth :centres clo visit schools to iOLlunise school children. (b)

~~1.:1.~aH£(l!:T.?iCE. The tmti-i:lQl;:,rin co..npciCn, rlhich coveL'S th:, nhole Stnte, has reduced. the E~1~ri3 CQses nUl~lb(;r

frOl.l nn

cstii.ln~cd

250,000 in 1958 to 9,200 in 1969.

cert~:in

probleo areas

trnnsr:Ussion continues, thouC;h on n lesser !1cnlc.

~c)

Tuberculosis _C-2..r:.t!~ ?ro§!.~~.:<: The Tubcrculosi2. Control c,mpaicn. PrOcr:1r.lLlG

stnrtl.'!l in 1960 with

lJD.SS

x-r:J.Y and

B.e.G.

By tho dnC: of 1969, tho control cctivities were nlreaccy coverinr; 7Cf;(, of the

estir./,.tccl Stnt8 populatiun.

..·,t prosent ccsc detection is done Loth by mnss x-rny c8Dpnign

end sputu!".l 8x2.:.;im~tion Gnd \.lire:ct. :J,C.G. inoculc.tion is Given to cmldr,m aged 15 years and below. In 1969 1,686 tubel'ctilosi3 C05CS

(includinG c. few ,",hich were non-puluonnry) were persons Here inoculnted with i3.C.G. in 1969,

dio.p;n()s(;:ll COl.lPC:1Te:d. nith 2,G52 i~. 1)0J.

5/~,7G0

conpnr8d vlith 7,500 in 1960.

(d)

Quarantinabl.e Diseases : No quanantinnlllc diseases Vlere reported in the whole of 1969.:.: In February 1970, there was nn out brenk of Ch()lcrn E1 Tor in iJnpnr District. Eleven cases Here diagnosed.

(e)

other Infe~ous Jiscascs I·lith rGcnrd to the prevalence of othur infectious diseasGs plense soe APPENDIX 'E'.

IJedi cnl Cure : Cura.tive s¢rvicGs nrc rr0vi(:cc1. fron 12 hospitQls \'!ith 1,1384 bvds end 28 stt::tic dispensaries with 278 beds. Three of t:i10 hospito.ls provide specio.list services. UUlJber of

patients adrri.tted into hospitnls nnd dispenscl'ics \Jore 51,229 in 1969 conpared with 20,296 in 196c. VI.

Dentnl Services There was conere! expnnsiol1 uf ti,e dcntr.l services working ot any one tiuc. In

1969 "ith 6 - 7 dentnl officers

There m"c nltoccthcr 13 school dentcJ. clinics in the Stc.te and 18

school dentel nurses.

33,393 attcnc1.cmces Vloro recorded ct general dental clinics and 32,025

at school dent-a1 clinics.

VII.

!;2ining: Training of the foUoHinc enGecopies of stoff nrc undertoken hy the State ,_ (n)

Stnff nurses Assistc.nt nurses

(ll)

Rurel HeGlth nurses Luoorc,tory toel:nicic.ns Junior tuberculosis end nnit-mlarinl ¥lorkers.

Other cQtetjorics of str:ff Ku~lc

G.e;.

public health inspoctors, and radiographers Qrc trained in

Lm:lPur.

(10)

' (j

l.mUSTER

DOOi,!USATION

OF HEALTH JlP~~DIX

tAt

..' "

--------1-

~ WI I

PAPJ,IMIT:HTdO: SECllET;.llI F'lLITICi,L SECilETiJlI

I I

,_I 'I TECHNIC,\1 JIVISION

;,mmIISTilllTIGH DIVISIOIl

r : I ,

, I I .. -- .... " ': : : : ... ~ ~-~'

PERHANENT SECRET,~RY H.F .5. Grnde II

DIRECTOIl-GEIiEli/,L MEDICAL SERVICES.' , Stoff • A' l

'" . ",. I'" DEPU':Y SECmlTf" rL H.l' ,5, Gr~da VI

r. ,

PRINCIHL fSST. SECRETARY H,,,:' .. S,, G~"ad~

r~-

(Sorvico)

,__

I I: , : i .

r,~" (.

SU?crsc~lc

~~.' .~,1

".' ) -

'C i "

r I J I'

-! I I t

DIHECTOR (Health)

,-40

--i.

_S_tlJlC_rS_C_cl_e_'C'

--!

DY:~:RE;~H_ .'. 'J ..•.•. - ....

I j I •

I· I

IPIln'~ lP;~ I

~·_:.\:,;rsl'"!:llc !F'

''''1 ~

SECf\!:l'i,KY H.F .5. Gr"de VIn (i,I1,,' ci ctro"imlL

ASST,

TREiSURY ACCOU NT i,NT ~!inis·:'ry

of Hecit 1. Uuleysia

i ! :

i j

;--;::'. [)J';{ECTOR

l··'~·',,~~~~nl~ ;~~J-I li~·FoS.Gr,JX·&

I Asst,5ecyt::f, H.F .S. T scni. (Gr.IX&X)(AdDi

L,sst.secretnry (Extcrnol Lioison) ,

Asst,So·crctnry (Fino. nee)

Asst .Secrotar::l (Stores and Contracts)

I Asst .SucrotaIj": (Sel',:cc)

--:---

I I I I I Asst:~ecret (tvhitley Council) I

! ,--'------, i' i :."~:.;:-. . ~~~i~,;T~~ t J H'

, !

' ASS~. [;IR~~'c;-m1.1-, I (Ar"l-I:l'lC~l" ') L..._"

LSu~nr;:c~~.G AS.sT. D.J.

DY. DIRECTOR C?I:l~lJis!'ase I? hl.C.rt .. ) '.Ff

J I h-

~~------------~I

S't."PCc'Os~nlo tilt

(HOS~~n~:~.-) DY.iJI:lSC'i'Crl (Hospi~ds) .

III ~;=~ I

Sup€rsGt:.le tr..,~

-, I

i }

St't9or:"c:-::.')

'.2' ---t i fI

I 1--,

DIRECTOil t (!lent,,})1_ Sw-·~:'::.".".,l :. q-; ; __

vI.

----1

___

~_'._W"'_.

~;]IC:~ O~;~ICE~1 \Su~Qr.:1tUT:'~~~·~-)

"l1IF'~Tn'''''"'-1L I __.J !

S·':-''':':$('[11 c ,~"

: '

~~~~::~~.~~.'~ ~. ~.'

I(~~~::,~~f~~:;;(:: I·

______ I , [n'" - 1 I v.i.....-w J l\..L.-,

I i I

I L

IrlECT'lR",

' ~

I (HoeL', Ec!u.)-'::;ul)~rscr:lle tEt

r-C::iJT:cE:;;:~,-:~:::,: ;-:~;-;:li;:;:.I.;-~

-I ~I J

St~.)Q:,s'J.:J.li':: I G:~

tll'yl .

SENIOil dCIlICAL KI:C0i0S OFFICER

Executive Officer (Finance) DII1ECTOR lreDIC,\1 SERVICES SARJlU.lK

Executive Officer (Service)

!- -

- ! _J I m'-RL-cT-JR-l_' I,nsL, i l I Superscnle'H' -l , DIRECrOR - , I .------', , ADVISER I (.PUboHeQLh 1

PiUNCIPi.L WiTnJlf

'------

: (rnst.for !;jed. Res.R. Ln-b., _

i,).

il;T""~!!-·'.:J

TUB&1CULCSIS 1- I SuperscnIe L, _____ ..1I ON

'D'

DJITED

1ST SEPTEl.illER, 19EIJ MINISTRY Of' HEiI1TH, iJil,ij'SIA, KUf.LA LUMPUR.

c .... ) ( )

Chnnnel of .unisterinl Direction ~h~~~~' ~~ n~~~~~~~~

DIIl£:C'l'Ol1 I£DICAL Si:1NICES SAIlAH Sgd~(R!lja zn.innl J\bidin b.Hj.Tachik) " - - - - - - - - ' Pemanent Secretnr,r, U'; .... --+_r I" Un

'+"

li""-IC.:.;:!O,-"E·"-,:C~E-.::;OF,,,, COMtl0N COlINUNIC,\8LE DI:'E"SES .:..:. \ 1%1 - 1969

Ii~

HST t

t~i.L;,YSIH

---..

AFFE;~IX

1 81

" - - ".. _ ..

1 961

I I

'1962

1963 ' I

196' ,

InCidence\

DISUSES

Ca ~es

I per 100000 pop.

!~ase:.:

COOLE" Cerebro-Spi na LFever Chickenpox

I I e'p

Inlidence per I Cases 100000

Incidence p')r

CJse~

I Incid.,cnce p'r

--,----,------+-----',.-.--... - -,---~.. Incid6nc<?~ Cases per CaSes

1965'

1966:

967

. 100000.. pop.

10UOOO pop. -

100000

-I 12 4027

- 1 - 1 0.17 5G.I,3

- 1 0.121 57.89 18.1U

153 I,

O~_"~ _~.• I,

pop. --f---

+' i

! Incid(J1Cei ,:-er

Casec

I I

! Inci~8ncei per 'I CaS8s

- ;-. ,

968 '-

+-'-~1 ,

;

1969

j'lnCidence! per

I I

Cases

100000!

%__ [ ' . _

..": OJ.

c. ____

9 4270

0.05

OJphl',"'"

100'

',""'eey

I,ll foe,,,)

I. I

Enteric Fevor

=1=-

j. Erysi"2 Li'_S__

L~~4_ _ 2:21,.J_.166~119.IIL _ Oil~19__ ~.'" >":77+_"'-'-1-'1.13 ~. 1_" ":1l. r I '~Oj '~" __ ; 1 --~rl--- -J-__ =- - I ~~~l---.'lo,' ~~_ L--. L_~G~___ r_ sL O.~6 _l. ____ ~-.-u:Ol ,r-: I I ! I 3111

13.5~ i

4780 I

1335

116O!

>.3.73_+ 1BJU_ _".6"_+....'06S

~ +.". I. I 62.96

--· . r -------.05 36;)

r- _-=_ " -::'11 .._ 0.01 I

~OP.t --1I

100000 pop.

t I

!'ncider:c per

100000 pop. ii.ii.

15 6 3/1,0

I " 0.0:'; 1Io.C1! 1 --+--_·_· - . ' - '---, -.-.-.-.-+--. -'-',5696

-, 0.07

N.. fi .. I'.) .. J\.

15.25 9S

1139 191,

"'~53_+HJ5_--').91_ 2:_~. 16 , 2 __

:,0.7e

-------···-i-----~----·-t-----•• .

70.89

. 1765\ 21.27

. . . . 968~ .:':'-7-i--~-~65J.l~~7i 3180

37.21,

f 803 .. 1533.

1,2.55 )2682 _9.14

. 3) ."' __ ti __

_30.20 __

J lUI,

-I I

567 1't84

jU. :. ,\. , '.'.

B7'_ ..".19

971

11.))

102"1 ' 1. 65 4

I 930

_.1

l__

4.1.0

~U5 _i ~+_~.1'6 2.24

I 2~-t 56

3.29

2~_+_._~3~_~.6~2__l_~~_O_.9_+_ .._. 3.:~_.t. ~_.·12_. 37 89

____

0.76

I -~~~-t-:~-~~~---L 7: _~_~_._90 I 1.17 I 175 _~ 2.21'_! ~99 __~~ 140.79 0.36

___

2..~. O.!_1_+~5 97

2~~L= ~ 23~_l_~:_~~_ -~~'11. :.~~_ j_ 3~~_~ _::,'i. j 1.17 _ :

I :

I t

0.05

L _~_

,:,.,.C;.

130.%

110m 70

131.94

10706 29

114GJ 145

J4(,. JJ

~ i

UB9 150 l1J.

J I

13B. 10 1.87

946) 146

1" 6•09 1.75

T' 53 !

_~~.~~_t.

.+ .~.41

___ ?7 LC)! __

J_~._?4 __ ..; _.3~_ .+

_0,_31

23_. { ".". II.A.

1.86 1.1,2

__ ~

1.56

0.95

0.68 0.29 19.13

111

I i

11.42 6.97

_~+~~ 420 5.06 _~~

! 0.62_4_~~ ~_O:_~7__ ~. _5.1___ ~'1.t1. ___ .

12 __

0.16 27.70

22 1455

O.26_L_~~__L~~ t .

___ --2~i-~~-L~-.i- ~~9 ______ ._ _ _ _

.~_O:l? _ ~_? ! ~.

it, ". _

, 49.3(,

2043

825

1C.56

560

i ~01

'4.70_. ___-c. _ _ _ 335 I 3.81 '31.5 _ . "_._ ._ •.. ______ _ .__ •..

i:.ri.

Source of InformatLn :i~R

HOllte

Ly f(oturn of

CODQUn

iC2b lo Oi seas es.

I,..c

. ',I,

AFFE,clX _.' UIC I 0EiiCE O~ COM NON !

13\.

CO~1l:!Uin ~!\BLE

[J 13

" .. Y E ;\ R DISEASES Cajes

1%1 1 96 3

E,IStS

I ij

HEST

tl.!!.bt YS I A

1969

1 96 1

,~!~~--------~~~--r-------~--~--------------------------r------------

1 96

2 \

__ , __ ~~___ L_1.,~_?~, enc e~

___ ~ ,-----___ 1Y_£7

. 1-- .• ---

~-~~~~~~~~~~~~i=~~~~~~~~~~==~l=~~t-" CHOLERA 1531 2.01 1--

Cerebro-Spi na l Fever

12 I

'lIZ 1 ,.56 • -----f------f-----4 ! .05

0.17

0.12

'f!

0.05

-----,~---l----1--"---'+" ,---.. -._, . 6 0.01 0.05 4 _-+-_____ 1t _ 0.01 -,--t------

0.01'

N. fl.

0.07

-I

2 2682

N.(1. j'·I.I-I.

Chicken pox

4'027

56. 1,3

4270

57.89

4780

62.96

3647

ir.u 47G

5696

70.89 17.91

1765! ,

--,-.

~~;

3180 _+_~7

.2:,._.

371,0 803

42.55 9.14

Diphtiieria )lIsentery (a II forms)

1683 ;3121

23.58 U.73

1335 2850

18.10

1160

15.25 37.9S

1139

iUS

1437

968:

11. Z7

1065

I 12.l. 7

567 1484

;"./\,

I 38.64

2888

I 2922 ( 37.1.1

2'+27

i<.~" I", ~- ~

I_Enteric Fevor ___ -+_g77112.29_~-~4~--t Erysi Vi las ~errosy

E71, 854 11.23 11.19 -1~~ __t------t-----t--.. --. ___ .. __ 0.01

; ...

0.10

,--, I 3.

n ..

314

4.40

243

'1 ~

f\.

:.' 11.

t'l.

SJurce of Information :,I\'O / ... ~ )

;'Iont ly Rdurn of Con~unic2ble Oisease~.

--------------------

SUi_~·..!fi;;Y Ot' ~,:EDIC/.L FiICILITI;:S IN S:'l.,;.!~I:J''''lK, /,0 :1.'2 31ST DECEI.~::::a,1969

at 1964 1965 I ()

Type of Service 1963 F /:

31st

Deconbor 1')67

1969

I T I

1966 E

! 196(J

.. 1 1969

.Hospitals Hospital Deds - Obstetrics

i------· 8

, ,

10 95

10 "'lOS

10 121 .

! --

11 125

I .

12 125 1313

TCT!IL

1,0. CP BEDS

1332 1654

1704 1C04 .

1()23

1.340

Dispensnri~s

_ 32 35

Fixed

42 11 72 J

43 14 73

il3 1il 05

42 15 97

Travellinc "lutcrnity nne! Child Health Centr~s

11 72

60 I i'

! E "

I S C

1 L (Pu~)lic ~ncl

I l-'ri v::lte)

;1ecisturBd Doctors

I I

57 '142 435 135 142 14il I

59 143 449

G7 139 409 163

G6 137 512

C,3 130 532 240

05 129 561 233

Registc.:rc.J 0entists

143 440 115 140

i<cgistered Vlidwi yes

Trained Nur"es i.ssist'lnt ;':urscs Hospital J\ssistnnts

1!lB 151 150

223 153 141

I )

151 154

164 160

164 185 I

147

1 2 3

Pcr 1,000 Did-yenr populction. Deaths under 4 'leeks per 1,000 live births. De~ths

under 1 year per 1,000 livc: births.

4 5

Denths 1-4 years per 1,000 persons nged 1-4 years. Nu;:\bcr of dCQths fron pueperol causes/i,COO live births.

· S/.3;tH

:r Nuuber of CDSGS of son\; infectious discnses notified or trenteu ns in-pn~iGn~~~ 19~~_=-~968~ ________ _

I. ?;:--EmJIX

'E'

;

1958 ---'.'- .

1999

1960

1961

1962

1963

1964

1965

1966

1967

1968 --

Typhoid

Pnracyphoid D['.cillc.ry dyso:T'ccry !lrloc:lic..sis c.~!SQntcry ."leotc Polioi.:ycli-:::'s

15 169 7 14 10

113

2-4

4 6 N.[~.

26 5 N.:.•

14 1 4l;-

20 10

39 20

31 22 85

79 135

73 184 2

4 CO 212

39 113 3

235 G

263 N.t...

213

157 26 5~)

159 5 5f, 22 20

184 8

7 31 31 20

Ii.l~O

TetGnus

31 11

22 31 11

39 33

41 13 192

50 45 179

50 23

39 12

Diphtheric !3hoapins CouCh

I I I ,

3'1

I I

I I I

I I

ORIGINAL: NEW CALEDONIA AND DEPENDENCIES

FRENCH

BRIEF REPORT ON THE PROGRESS OF 1 HEALTH ACTIVITIES FOR THE PERIOD 1969 - 1970 1.

POPULATION 92 94 100 no 085 inhabitants 300 inhabitants 572 inhabitants census

1967 1968 1969 1970 2. Years 1968 1969 Difference

ACTIVITmS OF THE HEALTH SERVICE Visits 213 190 238 419 +25 229 3. HEALTH EXPENDITURE the Hospital admissions 11 355 11 729 +374 Bed days

Patients 94 087 100 682 +6. 595

276 639 266 416 -10 223

Health expenditure is financed from two different sources: Territorial Budget and the French State Funds. The break-down for 1970 is given below: (a) Budget of the Territory Year ~n

US dollars) Health expenditure 4 727 718 5 022 268 +294 550 +5.86 Percentage 10.09 8.28 -1.81

Buiget of the Territory 46 848 392 60 615 828 +13 767 436 +22.71

1969 1970 Difference

ISubmitted by Medecin-General de 2e classe Rondet, Director of Health and Public Hygiene in New Caleconia and Dependencies, Noumea, 9 July 1970.

- 2 -

(b)

French State Budget Economic and Social Development and Investment Fund (ESDIF) US$200 000 1970 outlay

(c)

Total Health Expenditure (in US dollars) Regular Budget ESDIF Total 1970 Regular budget ESDIF Total L"lcrease (1969 Expenditure per inhabitant (1970 4. PERSONNEL

US$4 727 718 US$ 323 815 US$4 960 533 US$5 022 268 US$ 200 000 US$5 222 268 +US$ 261 735 49.32 51.92

(a)

Health Service 1 August 1969 Physicians Pharmacists Dentists Social workers State micwives Health assistants Nurses Office workers Operating staff Transport staff Total 36 2 1 2 4 25 207 45 241 1 July 1970 38 3 3 2 4 30 218 50 261 10 619

_...

---2 572

- 3 ( b) Number of physicians in a Department other than the Health Department: 3 (Youth and Sport Service, 11edical Inspector of Labour and Medical Consultant with the Family Allowance and the Workers' Compensation Fund). The number of physicians in the private sector was 24 on 1 January 1970.

(c)

OBSERVATION

The new maternity hospital has been completed; it has 65 beds and modern equipment, an operating suite with a post-operative recovery room.

.... _-

The MCH centre was inaugurated in rlJarch 1970 and is perfectly sui ted to the needs. On some days the attendance is quite large. The centre also includes a new X-ray unit. The Nursing School intake for its second year was 8 students. The second nursing instructor has been recruited. The quality of teaching in this school will make it possible to avoid recruitment in France. 6. SOCIAL DISEASE CONrROL

6.1 Leprosy On 1 January 1970, there were 914 registered leprosy patients. In 1969, 40 new cases were found. This disease remains a public health problem. 1.

6.2

~berculosis

The mass BOG vaccination campaign which was started a few years ago is continuing. There were 6175 vaccinations in 1969. Fifty new tuberculosis cases were found. In 1969, 10 865 X-rays were performed by the mobile team.

6.3 Mental D:!.seases The mental health unit has been operating for nearly two years with a full-time specialist. In 1969, there were 358 patients 40% of whom were children.

7. HEALTH SITUATION There was an influenza epidemic in New Caledonia and its dependencies

- 4in June of this year. people. There were few serious cases, except among old

INTERNATIONAL RELATIONS

Two public health physicians took part in a seminar on statistics which was organized by the South Pacific Commission in Noumea. A report on a comprehensive statistical survey on dental health in French Polynesia carried out over a period of five years was submitted by a statistician from French Polynesia who was invited to take part in the seminar as a consultant.

CONCLUSIONS do~m

The efforts undertaken over the past few years have not slowed 1969. especially in the field of tuberculosis and leprosy control.

ORIGINAL: ENGLISH

BRIEF PROGRESS REPORT - NEW ZEALAND 1970 1.

INTRODUCTION

When in May of next year the New Zealand School Dental Service holds its Golden Jubilee celebrations it will mark fifty years of solid achievement. Today a staff of 1339 dental nurses provide treatment to almost all schoolchildren up to 13 years of age and in addition to 60% of pre-school children. In 1923 there were only 29 dental nurses. In that year the ratio of extractions for every 100 fillings was 78.6. Today this ratio is 2.9. Figures for tooth mortality tell a similar tale; in 35 years the extraction rate has fallen from 88.2 to 13.9 per 100 children. Last year it was 12.6 per 100 and only 0.23 were permanent teeth. 2. COMlIlUNICABIE AND QUARANTINABIE DISEASES

In general the incidence of communicable disease has decreased although the rather high level of infective hepatitis has remained static. No quarantinable diseases were reported in New Zealand throughout the year, although a suspect case of smallpox which investigation proved to be negative, required prompt investigation. During the year the Department commenced a school Rubella vaccination campaign for children 5-9 years of age. The vaccine will also be available without charge to general practitioners to immunize those children reaching the age of 4-5 years and women of child bearing age.

ENVIRONMENTAL HEALTH

(

In October, the Government announced a new and enlarged sewerage subsidy scheme embracing not only sewage treatment plants but initial sewerage reticulation as well as truck sewers and outpools. Subsidies are based upon the actual cost of the work and are calculated at the rate of $1 for $2 after allowing for the local authority to contribute $5 per head of the present population.

lSubmitted by the Minister of Foreign Affairs, 4 August 1970.

- 2 -

RURAL roaI'ORS

The problem of encouraging and retaining doctors to practice in rural areas was examined by a committee during the year and recommendations providing for sUbstantial incentives aimed at giving the rural doctor a slight advantage over his suburban counterpart have been approved.

HEALTH SERVICES RESEARCH UNIT

During the year the Health Services Research Unit of the Department has worked with hospital boards on the improvement of manage,nent of public hospitals. This has included a study of the communication of patient information, the use of convenience foods, the handling of pharmaoeutioal needs in hospital boards and the establishment of rational bases for the development of in-patient accommodation.

ADMINISTRATION

Among structural changes in the Department's administration this year has been the establishment of an Arbitration Seotion within the Hospitals Division. This section will have the responsibility of assisting the Department's representative on the Hospital Service Committee in its negotiations with employee organizations on salaries and conditions of employment in the hospital service. A further change to provide unified administration of therapeutio drugs and narcotics has led to the enlargement of the Pharmaceutical and Drug Control Branch of the Clinioal Services Division and the disestablishment of the Food and Drug Branch of the Publio Health Division. Those functions of this branch related to pOisons have been transferred to the Occupational Health Branch.

7. AMAIGAMATION OF HOSPITAL BOARDS Leading on from its policy of recommending to Government the reduction in the number of eleoted Hospital Boards by amalgamation into more rational units, the Department is considering the delegation to these Boards of such responsibilities as some aspects of the annual licensing of private hospitals and ultimately the administration of social security medical benefits (excluding pharmaceutical benefits). This would then bring those aspects

• •

- 3 of medical care administration within the purview of local orientated and informed authorities. 8. MENTAL HEALTH ACT 1969

••

In last year's report mention was made of the action being planned to introduce legislation to enable the transfer of departmental hospitals to elected Hospital Boards. The empowering provision was contained in the Mental Health Act 1969 which came into force on 1 April 1970. To date considerable progress has been made in resolving the large number of issues arising from the proposed transfer. Negotiations between the Department and the interested organizations are continuing. A target date of 1 April 1971 has been set for the transfer although adherence to this date will depend on the successful outcome of negotiations and the passage of further empowering legislation. A further important provision of the Act is that it simplifies admission procedure to psychiatriC and psychopaedic hospitals so that in the majority of admissions no more formality is required than that necessary for admission to a general hospital.

PUBLICATIONS

Last year's report referred to the newly set up Committee of the Board of Health to enquire into drug dependency and drug abuse in New Zealand. The first report of this Committee, which was recently published, makes a major contribution to this difficult field, by examining in depth the present situation and formulating recommendations to deal with both current and future problems. Action by the Committee is continuing and a further report will be made when surveys now being conducted are completed. In March the Department, under the title of "A Review of Hospital and Related Services in New Zealand", published a comprehensive survey of hospital facilities in New Zealand including background information, general trends likely to influence forward planning and policy making, and the Department's forecasts and suggested lines of future development. 10. DEPARrMENI'AL ESTIMATES

The 1970/71 departmental estimates have been prepared on a planning, programming and budgeting basis. Two advantages of this

• • "- 4 system are that it will enable management to cost activities and measure actual, against planned performance, as part of a continuous control process, as well as delegate control to the person responsible for each particular activity. 11.

CONclUSION

The expenditure on health services for the financial year 1 April 1969 - 31 March 1970 was $202 690 767. This year, to meet increased costs and expansion of services the appropriation is expected to be $221 SOD 000, a rise of about $19M.

••

TERRITORY OF PAPUA AND NEW GUINEA

ANNUAL REPORT 1969-70

I, ' : I-

DEPARTMENT OF PUBLIC HEALTH PORT MORESBY

TERRITORY OF PAPUA AND NEW GUIN EA

ANNUAL REPORT 1969-70

DEPARTMENT OF PUBLIC HEAL TH PORT MORESBY

CONTENTS Foreword Director's Review Organization Administrative Division Management Health Services Pharmaceutical Services

v 1

5 5 8 9

(

Health Education Medical Services and Training Division Medical Services Mental Health Medical Training

17 19

25 27 37 38

.y-

Community Health Division Environmental Health Maternal and Child Health Tuberculosis Control Leprosy Control Malaria Control Dental Services District Health Reports Eastern Highlands Chimbu Western Highlands Southern Highlands East New Britain 57 61

41 46 49 51

Morobe Madang East Sepik West Sepik Central

74 75 77

62 64 66 68 69 71

78 80

1..

West New Britain Bougainville Manus New Ireland

Gulf Milne Bay Northern Western

82 83

'" III

Contents---continued

Appendix I Post-Graduate Training and Overseas Study, Meetings, Conference Attendances and Overseas Tours of Duty, Seminars. Appendix II Publ ications.

FOREWORD

It is my pleasure to present to you the Annual Report of the Department of Public Health. This Report, covering the performance of the Government and Missions in the field of Health, has been regularly presented to the public ~ince 1962. The most significant event during the year was the influenza epidemic. This showed that the limited health services of the Territory - about one tenth of that in a developed country - cannot effectively meet a widespread outbreak of a killing disease. Influenza has shown the need for changes in rural services. The most important of these have already been made to improve Aid Post Orderly services. These changes and the continuing expansion of services have further increased annual cost of health services to over $6 per head per annum. Money must come from the people to meet the health costs. A special study of medical charges is planned to determine the pattern most suitable for this country. Health workers are a team drawn from both Mission and Departmental Officers. The effectiveness of this team can only be increased by regular and close contact with the people as a partnership to bring eoonomic and social development. A study is under way to seek ways to improve this relationship. The Australian Government has agreed that the responsibility for Health policy will rest with the elected Territory representatives. This change of guidanoe is a major step in the development of our Health services and towards independence for this country. In this oontext, I would like to thank all who have contributed to good health in this country and seek your assistanoe to further develop your health service. I

DIRECTOR'S REVIEW Dr R. F. R. Scragg, M.D., D.T.M. & H., F.A.C.M.A. As the Ministerial Member has indicated, the year under consideration in this Report is the last year of Australian domination of policy decisions in the Health field. The pattern you see in this report is new as the health need changes year by year. While the manner in which we will achieve good health under national guidance may vary, the objective is unchanged. In the period up to the war, finance and staff were limited and services were restricted to the coastal perimeter. Following the war there Vias a rapid expansion of services and a dynamic change in their pattern. Health· first concentrated on treating the sick and meeting human needs. This was associated with increasing preventive activity directed against Tuberculosis, Malaria and diseases of children. This expansion from simple curative activity was also linked with research into the important health problems. In 1958 formal training programmes for nurses commenced and others followed. By 1963 the pattern of health services included strong programmes in Curative, Preventive, Promotive, Research and Training fields. The International Bank for Reconstruction and Development visited.the Territory in 1963, and judged that health needs must relate to the country's economic state and total development. It was fortunate that the training programmes were well developed as this has permitted continued expansion at low cost to meet increasing needs. The professional divisions have been reduced from six to two with an associated increase in positions in the administrative group. Professional divisions are responsible for the day to day affairs of the Department, while the Director links with the Minister. The regional organisation helped rapid district development but became too big and delayed administration through duplication. District Health Officers are now to be the final authority on district health matters reporting directly to Headquarters. Over the last two years influenza has severely affected most countries in the world. It has done this against the prediction of some epidemiologists and in the face of extensive vaccination programmes. New Guinea was no exception and the disease mortality was the highest recorded in recent years. While the overall mortality within the country was not excessive, the mortality in some areas of the Southern Highlands reached 2%. High mortality had been recorded in previous epidemics in similar mountain areas. The available health workers were not able to cope with the control and treatment of the disease and extensive assistance was provided by the armed forces 1

I I

personnel, and many others. At Aid Post level the limited su~~lie8 did not match the rapid build up of the disease and man~ people died. Poor communications prevented this information reaching sub-district centres and many of the deaths were only reported when a study of mortality was undertaken. Health called on the advice of many experts to ensure that everything possible was done to prevent :an expansion of the high mortality to other areas. At the same time areas that had not been affected were vaccinated. There is no clear evidence that vaccination was effective. A test was made on special long acting drugs and these appear to help in village treatment. For 1970 it has been decided that a major influenza vaccination programme will not be undertaken but that the weaknesses of the Aid Post system will be corrected. Health had long sought improvements in conditions for Aid Post Orderlies. As an aftermath of the epidemic, Aid Post Orderlies are now paid near orderly rates depending on hours they·work. Supplies of the important medicines - penicillin, chloroquine and suphonamides - have been increased so that the Aid Post Orderly can always treat most diseases that kill qUickly, provided the people seek his help. The Aid Post Orderly village pattern has other problems; trained between 1946 and 1955 they are no longer young men; the only training today is undertaken by Missions; the increase in population and sophistication demands a better qualified worker; improved communications make some surplus; and new drugs such as the 75 day leprosy injection need a new approach. A regular visit to each village should improve the quality of the Aid Post and ensure the maintenance ·of a healthy community. Health must devolve into the community. As well as Hospital a clearer relationship is needed with Councils, including a local government service and a link with mission medical services. A full review of all rural services will include a detailed study of the East Sepik District and will·te~t new concepts of ~nter-relationst finance and management. This will bring together those most interested to establish a national health pattern based on an effective rural community health service that will need a new type of rural health worker. ~o8rds

The new medical charges are not related to the cos t of the services or to gradual inflation. It is also confused by our necessary relationships with the intermediate charges sector of the Australian health benefit pattern. The Australian pattern is not likely to be the permanent one in this country. Only a small sector of the community can afford to pay private fees but all people sh~uld contribute something towards the cost of health services. The contribution should bear same relationship to the quality of service available. At present those people living in the main centres pay little .more 2

for public ward attention by specialists than those who receive attention from a nurse or an aid post orderly. ~ere have been clear indications of personal involvement of national staff. National Resident Medical Officers in hospitals are as concerned about the health of their patients as are the overseas specialists and registrars. The Residents can be found in the wards when their patients are in need of care regardless of normal duty hours. Trainee nurses are often willing to give of their own time to help those in their wards. This acceptance that "We Care" indicates a translation of the Australian attitude to service into the minds of the young men and women of this country. It indicates that the health profeSSions are becoming firmly rooted and that it is purely a lack of adequate numbers that is retaining the large overseas group of health workers. Career nurses are needed to ensure a decline in overseas officers. The advancement of national officers can be seen week by week in the Government Gazette and in institutions such as the Laloki Psychiatric Centre where all staff is national.

In the academic and research fields Health has continued a process of devolvement mentioned in previous Reports. The Institute of Human Biology is developing strongly and assisting in new research areas particularly venereal disease and goitre. Health Department staff are being seconded to the Institute to use fully the assistance of their experts to help solve special disease problems. During the year the decision was made to transfer the Papuan Medical College to the University. This decision is qualified by a continued association of the Public Health Department with the education of medical students to ensure that the pattern relates to Te=itory needs. The Papuan Medical College has served the people of this country well. It's graduates are moving rapidly to fill senior positions in the Department and have clearly shown that their quality is that of a University Graduate - capable Qf developing professionally to meet the requirements of an expanding profession. Health has always had a strong interest in the industrial and professional problems of its staff. Strong organisations are needed for these interests and to enhance the maturity of the professional groups. The well established Medical Society Symposium has increased in quality and has a maturity that will maintain its value within the profession. The Papua and New Guinea Medical Journal is now in its 13th volume and is prepared and edited by the Society. The Post Graduate Committee in Medicine has held its first Refresher Course and has taken the responsibility in this field from the Department. In some areas ethical problems have arisen between professional staff and members of the public. This problem is not new and exists in all countries. Training programmes of the department include the obligations of trained health workers to those whom they serve. 3

The understanding that all patients should be treated under a position of trust is being established. During the year New Guinea was represented at three International meetings by local doctors. These doctors were effective in presenting the health problems of this country to the many other Nations represented. As the responsibility for financing the health programme moves into the local tax structure, the Department is consolidating its relationship with W.H.O. and UNICEF. A full study by a UNICEF representative is to be made to define for them our pattern of health services and the way in which international assistance can help improve these services. -'

. j

The health professions are young and new in this country. Their members are still entrammelled by the complex cultural influences of their village societies. Individual mistakes and immaturity will show from time to time but the basis of a national health service is here; thousands of young men and women are either members or planning to enter. Health has been won for this country against great odds. Its permanence at a level that the country can afford dtpends now on the people of this country and on developments outside the field of health - primary schools; roads; community education; and the economic standing of the community itself. The planned achievements in these fields, will bring good health more cheaply.

ADMINISTRATIVE SERVICES DIVISION .,-Assistant Director-Mr L. M. Tomlinson, Dip. H. Ed. (London)

During the year major changes have taken place in the organisation of the department. These involved the abandonment of the structure based on seven organisational divisions and the gradual phasing out of regional administration. For the purpose of functional organisation the department has been divided into three main divisions :Division of Administrative Services. Division of Medical Services, Training and Mental Health. Division of Community Health. The creation of a separate division of Community Health had become necessary to co-ordinate all activities in this important field and so obtain a better use of available resources and to place the correct emphasis on its importance. The growing acceptance by communities of the need to assume some health responsibilities has been recognised and the Community Health Division will encourage the development of this community participation. Regional organisation was originally established to help strengthen preventive health measures and various health programmes in the field at a time when the department did not have enough experienced District Health Officers. This problem having been solved, the need for four intermediate headquarters largely disappeared. The Highlands and Papuan region organisations have been broken up and the nine districts in these two regions now operate directly under headquarters. Connected with de-regionalisation of the department was the transfer of regional personnel sections back to central staff section headquarters. Because of the considerable problems involved in these moves this change had not been completed by the end of the year. A notable advancement in the field of administration was the introduction of special project votes for the Port Moresby General Hospital and for Malaria Control Services. This type of vote has three major advantages viz : 1. Simplicity of accounting; all requirements are purchased against one vote instead of a multiplicity of votes. 5

The system encourages some degree of responsib~lity accounting. It facilitates the gathering of cost information relative to the position of the section holding the project vote.

With the growing sophistication of the general public, the need for some form of comprehensive Medical Benefits Scheme available to indigenes has become apparent. Investigations were started during the year into the most suitable form such a scheme should take to fill the needs for health insurance in this country. Another important sphere of health administration which has been the subject of a searching investigation during the year was hospital and institutional catering. The aim of these investigations was to improve the food provided to public section patients and to students in training institutions and, at the same time, to rationalise catering in intermediate wards and staff messes. It is felt that considerable saving could be achieved if available facilities and resources are put to the best use, for instance by having only one kitchen and one mess for each hospital, as far as practicable. Expert advice on this subject was sought from Mr. K. Jones, Catering Consultant of Commonwealth Hostels Limited, who visited the Territory for an on the spot examination of the department's catering problems. Localisation in the clerical force of the department progressed further during the year with Mr. Taumaku Morea and Mr. Aisi Aila being promoted to the positions of Clerk Gr. VI, the highest grade so far achieved in this department by a local officer clerk. There is also an indigene Clerk Gr. IV and several Clerks Gr. III, at departmental headquarters. In addition, the department has a number of officers studying for qualifications which will enable them to progress to high level clericai -positions. Nine are studying at the Public Service Training Centre, two of them doing a course for Diploma in Administration and seven doing the Stage II Course, the successful completion of which is equivalent to Victorian Leaving Certificate. Finally, three local officers are at the University of Papua and New Guinea on a three-year scholarship course in Arts. STAFF: At the close of the year the total strength of the;Department was 7,145 (which includes 281 staff of mission-staffed Administration specialised hospitals), compared with a total of 6,874 at the end of the previous year. The following tables give analyses of the staffing organisation: 6

Category Local Staff Officers Administration servants (including 780 students and trainees) Labourers Aid Post Orderlies Nursing Aides Total Local Staff Overseas Staff Permanent Officers Contract Officers Temporary Employees Part-time Employees Total Overseas Staff GRAND TOTAL

30.6.69 3,111 967* 517 1,170 264 6,029

30.6.70 3,159 1,175* 517 1,146

-ill

--173 249 424 ...1§.

6,271

201 220 393

..l1

ill. 6,874

ill 7,145

· .-

* Includes 281 staff of mission-staffed Administration hospitals. STAFF BY CATEGORIES AS AT 30th JUNE 1970 Medical Practitioners Dental Officers & Dental Assistants Nurses-Registered or Enrolled Health Extension Officers Health Inspectors Pharmacists Pre-School Teachers Other Classified Medical Staff Administration Servants Labourers TOTAL 154 66 607 149 28 13 37 4,313 1,175

-ill. .L.lli.

The overseas staff in the Department increased by 19; there was a rise of 48 in the number of Local Officer Public Servants. Seven hundred and eighty students are undergoing training in various courses in departmental training institutions, including 76 medical students. Four medical graduates from Australian universities commenced their year of residency in Territory hospitals. 7

FUNCTIONAL ORGANISATION 1970 DIRECTOR MEDICAL BOARD PORT MORESBY HOSPITAL ADVISORY BOARD NURSING COUNCTT. MEDICAL SERVICES & TRAINING Medical Services Hospitals Aid Poets Spec. Medical Services Radiology Pathology Radiotherapy Physiotherapy Hospital Nursing Service Ambulance Services Mental Health Community Mental Health Forensic Ethnopsychiatry Field.Surveys Training Transcultural Psychiatric Research Preventive Psychiatry

PAPUAN MEDICAL COLLEGE FACULTY BOARD

I I

ADMINISTRATION Management Personnel Accounts Buildings & Land Property & Equipment Transport Communications Health Services Statistics Epidemiology Library International Health Legislation ~harmaoeu~ical

COMMUNITY HEALTH Environmental Health Quarantine International Health Communicable Disease Control Industrial Health Food Inspection Waste Control Goitre Control Maternal & Child Health Field Clinics Training School Health Family Planning Nutrition Pre-Schoola Tuberculosis Control Field Surveys Tuberculosis Hospitals Domiciliary Treatment

Servioes

~ ...

Medical Supply Services Hospital Pharmacies Pharmaceutical Inspection X-Ray and Equipment Maintence Artificial Limb Factory

•

, f'

•

Hedical Training Undergraduate Courses: Nurses Health Extension Officers Nursing Aides Hed. Technologists Radiographers Health Inspectors Post-basic Courses: Hidwifery In-service training

HEALTH EDUCATION Services Training Research Broadcasts Audio-Visual Aids

Leprosy Control Field Surveys Leprosy Hospitals Domiciliary Treatment Halaria Control Spraying Operations Evaluation Training Dental Services School Dental Services General Dental Services Dental College

DISTRICT

HEALTH

SERVICES Aid Posts Health Centres Mission Liaison Local Government Council Liaison Dental Services Leprosy Control

Local Hospital Services Local Health Services Field Surveys Environmental Sanitation Health Education Tuberculosis Control Pre-Schools School Health Services

ACCOUNTS.

Total Administration expenditure on health and allied services increased in 1969/70 by $1,611,932, an increase of 9.84% from 1968/ 69. Revenue raised by the Department increased by $112,015, a 31.8% increase over the previous year. The increased revenue is a result of the first full year of public section hospitalisation charges and increased dental service charges. TAllLE I. COMPARISON AND ANALYSIS OF EXPENDITURE

(Based on Department of the Treasury figures) 1968/69 8,126,366

1969ho 8,799,614

Salaries:

Wages and Overtime

CHANGE + 8.28%

Administrative Expenses: Travel, Patrolling, Library, Office Equipment, and General Administrative Expenses. 1,498,994 Hospital and Medical Services: Drugs, stores, training and education materials, dental supplies, hospital an~ medical equipment. Mission Medical Services: {i} Grants to Mission General Hospital Medical Staff (ii) Subsidies to Leprosy and Tuberculosis Hospitals -Hygiene and Malaria Control: Malaria eradication, assistance to local government council health services, environmental sanitation General Services: Disease surveys Consul tants, Maternal and Child Health, ~e-schools, blood transfusion. TOTAL DEPARTrJIENTAL EXPENDITURE:

(b)2,623,992 (b)+42.87% (c)+ 5.70%

1,545,243

1,735,701

+12.32%

486,606

508,491

+ 4.30%

375,830

404,5 8 9

184,140

182,876

- 0.68% +16.68% (c)+ 8.22% ,(

12,217,179 (b)14,255,2~3

IDENDITURE BY OTHER DEPARTMENTs AND !GENCIES ON BEHALF OF THE PUBLIC

HEALTH.

General stores, issues and rations Capital Works buildings, water supplies and sewerage. Maintenance of water supplies, sewerage, hospital engineering Institute of Human Biology Grant TOTAL ADMINISTRATION EXPENDITURE ON HEALTH SERVICES (a) (b)

1,011,616(a) 2,221,213 843,945 821 000 161218122~

2,665,184 955,438 1121 000 111220 188 2

19.99% 13.21% 22. 2 9% 2·84~

Included in Administration expenses 1969/70. Includes $1,034,266 general stores issues and rations, previously shown as extra departmental expenditure. % including general stores issues and rations charge.

....

(c)

TABLE II

FUNCTIONAL ANALYSIS OF DEPARTMENTAL EXPENDITURE (also includes General Stores items (a) ) Adminis- Q.ommunit;y: tration Health Medical Services 8,253,789 57.9% Medical Training 1,126,165 7.9% ~

Expenditure % of Total

727,028 5.1%

4,148,281 29.1%

14,255,263

100%

TABLE III REVENUE RAISED BY DEPARTMENT OF PUBLIC HEALTH Hospital and Medical I"

281,624 6,411 12,346

12 66 L61

12 61L68 595,707 6,656 14,487 316 1850

332,528 13,233

12 68 L62 6,254

12 62L1 0 442,880 5,316 15,843 4 64,030

Sale of Medical Stores Dental TOTAL REVENUE

300,381

32 2 101 2

HOSPITAL BUILDING PROGRAMME: Stage 2 of the new Laloki Psychiatric Hospital, Port Moresby, was completed. $158,340 was expended on the hospital buildings and $34,181 on staff accommodation. Construction of the new District Hospital at Alotau, Milne Bay District, commenced in January. It is scheduled for completion in December 1970 at an estimated cost of $60,000. Graduate nurse accommodation hostels were built at Lae and Port Moresby hospitals at a cost of $63,711. Reconstruction of two hospital wards at the Walter strong Wing, Port Moresby General Hospital, was carried out at a cost of $54,778. Maintenance carried out on existing hospital buildings amounted to $152,350 and a further amount of $37,000 was spent on hospital engineering services. During the year a total amount of $125,000 was spent at thirtyfive Territory centres on improvements to hospitals. This money was supplemented by Community contributions which in several cases equalled the Administration grant. These included Papua Alotau Laloki Saiho Popondetta Kerema Ningerum Port Moresby 4'

New Guinea Kundiawa Gembogl Laiagam !lfoun t Hagen Erave Ialibu Komo Margarima Tari Kainantu Aseki Menyamya Aiome Usino Angoram Dreikikir Lumi Nuku. Raihu Telefomin Vanimo Kavieng Namatanai Lorengau Kieta Rabaul Nahavio

MEDICAL STATISTICS: This section deals with the preparation of statistics for hospital reports, special surveys and provides statistical assistance and advice. Hospital statistics are based on an annual sample number of approximately 40,000 inpatients discharged from Administration hospitals. The following tables are extractions from the 1969 computer print-out:LEADING CAUSES OF DEATH IN ADMINISTRATION HOSPITALS for years ended 31st March 1968 and 1969. Underlying Cause of Death All causes Pneumonia Enteritis and other Diarrhoeal Diseases Malignant neoplasms, including of Lymphatic and Haematopoietic Tissue Malaria Immatuxity Meningitis Tuberculosis, all forms Accidents, poisonings and Violence Diseases of Heart Malnutrition Other causes Deaths Number ~ 1968 1968 1969 1969 2,864 100.0 100.0 2,796 17.2 19.5 480 558 10.2 284 11.9 341 182 143 142 142 128 116 89 82 1,008

136 128 140 129 108 120

94 94 1,016

6.5 5.1 5.1 5.1 4.6 4.1 3.2 2.9 36.1

4.7 4.5 4.9 4.5 3.8 4.2 3.3 3.3 35.5

LEADING CONDITIONS TREATED IN ADMINISTRATION HOSPITALS for years ended 31st March 1968 and 1969. Principal Conditions Treated All new conditions Pneumonia Enteritis and other Diarrhoeal Diseases Malaria Normal Delivery Bronchitis Skin Infections (excludes chronic skin ulcer) Laceration and open wounds Fractuxes of Limbs T:uberculosis Chronic Ulcer of Skin Other conditions 13

Number % 1968 1969 1968 1969 126,360 125,727 100.0 100.0 11 .3 14,193 13. 1 16,534 12,611 11,334 7,911 6,342 5,590 4',821 2,601 2,439 2,284 53,893 10,732 11,167 8,295 6,650 5,5 8 8 4,645 2,616 3,313 2,328 56,200 10.0 9.0 6.3 5.0 4.4 3.8 2.1 ,1.9 1.8 42.7 8.5 8.9 6.6 5.3 4.4 3.7 2.1 2.6 1.9 44.7

AVERAGE NUMBER OF BEDS OCCUPIED IN ADMINISTRATION HOSPITALS FOR TEN LEADING CONDITIONS for years ended 31st March 1968 and 1969l Number tl~

Principal Conditions Treated All conditions Tuberculosis Leprosy Pneumonia Enteritis & other Diarrhoeal Diseases Normal Delivery Skin Infections (excludes chronic skin ulcer) Malnutrition Lacerations and open wounds Fracture of Limbs Chronic ulcer of skin Other conditions

, I

% of all beds 1969 100.0 22.4 17.1 6.5 3.6 3.1 2.6 2.6 2.4 2.3 2.0 35.3 1J_6J~~

6,754 1,511 1,157 439 245 211 177 176 160 155 138 2,385

1968 6,868 1,711 1,044 362 211 228 175 223 173 175 152 2,359

% of beds other than TB or Leprosy 1969 1968

00.0 25.7 15~2

10.7 6.0 5.2 4.3 4.3 3.9 3.8 3.4

5.3 3.1 3.3 2,6 3+2 2.5 2.6 2.2 34.4

8.9 5.1 5.6 4.3 5.4 4.2 4.3 3.7

Pneumonia continues to be the greatest single cause of death in Administration hospitals (17.2% of all deaths) and is the third main reason for bed occupancy (after tuberculosis and leprosy). The number of deaths of pneumonia declined during the year from 558 to 480. This decline does not reflect a reduced incidence'of the disease. In fact the number of cases treated rose from 14,193 to 16,534. Deaths from diarrhoeal disease fell from 341 to 284i although the number of cases treated rose from 10,732 to 12,611., An increased number of deaths occurred from malignant neoplasms (136 to 182), malaria (128 to 143) and tuberculosis (108 to 128). The following figures show the death rate per 1000 patients treated: .12£2. .1.2.§§. Increase or. Decrease Pneumonia 29.0 39.3 26.2% Diarrhoeal Disease 22.5 31.8 - 29.2% Malignant neoplasms 12.6 11.5 +

9.6%

Tuberculosis and leprosy combined account for almost 40% of bed occupancy.

PHARMACEUTICAL SERVICES Superintendent-Mr V. Ph. M. (Prague)

RaIna,

The Section provides a complete medical supply service to Administration and Mission hospitals throughout the Territory. The preparation of specifications, setting of standards and ordering of supplies is handled centrally by the headquarters office. The Superintendent of Pharmaceutical Services is a member of the Pharmaceutical Advisory Committee, which conducts a continuing revision of the departmental Medical Stores Catalogue and evaluates trends in drug usage for planning and budgeting purposes. Pharmacists of the Section carry out inspection duties under relevant drug legislation. The storage and distribution of medical supplies, which include surgical instruments, major medical apparatus, scientific and laboratory equipment and dental supplies, is handled by six medical depots situated at Port Moresby, Lae, Rabaul, Wewak, Madang and Mount Hagen.

An X-ray and electro-medical apparatus maintenance service is provided by a well-equipped modern workshop at Port Moresby. Technical officers from the workshop travel extensively on repair and maintenance assignments. A modern artificial limb factory is established at Lae, and in addition to limb prostheses, provides protective footware for leprosy patients. Hospital pharmacies are established at the four main hospitals at Port Moresby, Lae, Rabaul and Goroka. Pharmacies in the smaller hospitals at Wewak, Madang and Mount Hagen are supervised by Supply Officers (Pharmaceutical), managing the medical depots. The Pharmaceutical Services Section comprises a total of 98 positions, of which 89 were filled at the end of the year. Considerable 'difficulty was experienced in recruiting pharmacists to replace two officers who resigned. Out of 13 senior stores positions of Storeholder and Foreman Storeman, eight were occupied by local officers. Ordering procedures were further streamlined during the year, resulting in a reduction in the numbers of purchasing indents raised, although the value of purchases increased Significantly. The Section's resources were fully extended during the Influenza Epidemic of October 1969, when $308,000 worth of Influenza Vaccine and other medical supplies were purchased and distributed to patrols within three weeks. The most notable purchase concluded during the year was that of a Cobalt Therapy Unit which is to be installed in Lae when the'new Radiotherapy Centre is completed. 15

STATISTICAL DATA

... 1262-Z 0 12 68 - 62 1,684 1,754 $1,440,000 $1,752,000 20,144 21,574 1 , 116 841 282,507 329,731 841,782 717 ,405

Purchasing Indents raised Value of Purchases Requisitions Processed Issues by ship (in au. tons) Issues by air Issues by road (in lbs. ) (in lbs.)

12 6Z-68 2,022 $1,260,000 19,393 827 322,763 433,421

Dispensary, Port Moresby General Hospital

HEALTH EOUCATION Consultant-Dr E.

Wright,

M.B., B.S., D.P.H., D.T.M. & H.

A system of health education to suit the needs of the Territory has been developed and this covers all aspects of the health education services including training, material production and principles and practices in health education. In this system stress is placed on the need for good public relations and community goodwill in gaining community co-operation in special public health programmes and in the acceptance of beneficial health practices. There is a central health education organisation providing for training, research and services. Several districts have district health educators and steps are being taken to have one district health educator and five health education orderlies working full time on health education activities in each district. During the past year there has been an increasing measure of activity in health education work done by nurses, health extension officers and other workers in the basic health services. Health education activities have also been increased in special health and disease control programmes such as malaria control and family planning. The Department gives assistance to community organisations carrying out health education and seminars and training courses are provided as required. The localisation of the health education services is an important objective and, to date, 4 over~eas officers have been replaced by local officers. The third course of studies leading to the diploma in health education of the Institute of Health Education, Port Moresby, was commenced in 1970. This course covers a period of one academic year and caters for persons who desire to study health education and who have a basic qualification in health discipline or teaching. Marked progress has been made in school health educ.ation and "the Department of Education has worked in co-operation with the Department of Public Health to provide health education syllabuses for primary schools. Health syllabuses have been drafted for the six primary grades and teachers' guides have been printed for primary grades one and two. It is expected that teachers' guides for primary grades three and four will be printed during the 1970/71 financial year and for the final two grades during the following year. 17

A full time lecturer in health education is now working at the Port Moresby Teachers' College and lecturers in health education are being prepared for work in other teachers' colleges. Radio broadcasts are a regular feature of the health education services and several health sessions a week are broadcast from Administration radio stations. A weekly health education programme for primary schools is broadcast by the Australian Broadcasting Commission. At present, work is being undertaken to develop spelcial health education teaching system or teaching kits covering all of the major health programmes and disease problems in the Territor~. A catalogue has been prepared illustrating a wide range of teaching materials produced by the section. There is a big demand for this material from within the country and from overseas.

~ "

An interesting project in clinical health education has been initiated in connection with a nutrition education programme being carried out by the Port Moresby General Hospital. The benefits of good nutrition for children are demonstrated in the hospital wards and the mothers attend the Institute of Health Education for education in nutrition and child care. The system of health education developed in the Territory continues to attract attention overseas and, during the year, several visitors came to the Territory to study the health education services of the Department.

•

DIVISION OF MEDICAL SERVICES TRAINING AND MENTAL HEALTH . I

First Assistant Director-Dr W. D. Symes, P.St.]., M.B., B.S., D.P.H., D.T.M. & H., F.A.C.M.A.

This Division includes Medical Services, Medical Training and Mental Health. Medical Services. The demands from Members of the House of Assembly, Councils, and communities for improvements to rural medical services exceed by a long way the available resources of the Health Department. The most frequent requests are for doctors, new buildings, and ambulances. Many requests are well founded in terms of eXisting medical care facilities, area development, and the rising expectations of the people. The 1969/70 expenditure of the medical service section was $3.50 per person. This is, 57.9% of the total administrative expenditure on health services. Health cannot expect a larger proportion of the National Budget because of other important national needs •••• education, economic development, roads and so on. More money cannot be provided from the Health budget for medical care if training and disease control programmes are to be carried out effectively and efficiently. The rate of improvement of medical care services can be increased only by the better use of resources, localisation, and a greater contribution from the people (revenue, grants from councils). Councils and communities do help to improve their hospitals and the level of assistance increases each year. Community assistance attracts subsidies. But communities will have to give more if they want their hospitals to improve at a faster rate. At the same time, the Health Department realises the importance of giving communities a say in the management and development of their hospitals and health services either through Hospital Boards or Council Health Committees. ~

Medical Training. The completion of a basic health course can never be a learning end point for any health worker. Apart from formal postbasic courses, continuing education programmes are essential for all health workers •••• and particularly important in this country to increase the rate of localisation within the Health Department. The Matrons Conference was one step of an Action Plan to improve the inservice education of 19

nurses in large Territory hospitals. In the coming year inservice education will be a priority programme for Medical Tra~ning. Health workers must graduate from courses trained to meet the health needs of this country •••• needs which are changing every year. Curricula revision is a continuing process to cover new needs and to improve the foundation of vocational knowledge on which health workers can build 'their careers. Everyone wants Territory health workers accepted by other countries for courses and structured work experiences and for these countries to recognise our health courses. Fortunately recognition depends more on the general educational attainments of health workers and the length of courses than on course content. Therefore Territory health workers will not be penalised by taking a course developed to meet the health needs of this country. Mental Health. The progressive policy of establishing psychiatric units in general hospitals carries many advantages. Patients treated close to their homes can maintain contact with friends and relatives. As well they remain in an environment they know. These two advantages contribute to the recovery of these patients. The intergration of the mentally ill with patients suffering from other diSeases helps to remove the stigma of a mental illness and improves the standard of care for. mentally ill patients. There is only one psychiatrist for the whole Territory. The department failed to recruit a second psychiatrist during the year, probably because there is an international shortage of these specialists. A minimum of three psychiatrists are require~ to meet Territory needs for the treatment and rehabilitation of persons with mental illnesses and for effective programmes to prevent mental disease and improve mental health.

MEDICAL SERVICES Assistant Director-Dr P. S. Enders, M.D. (Innsbruck), F.A.C.M.A.

The principle function of the Division of Medical Services is the provision of effective medical care at aidposts and hospitals throughout the Territory. This necessitates working closely with the Mission medical services and local government councils as well as such organisations as the Red Cross Blood Transfusion Service, st. John Ambulance Association and Brigade and, for emergencies, the Civil Defence organisation. Aidposts have been categorised according to workloads and the salary of all aidpost orderlies increased. Aidpost orderlies are expected to work longer hours and the Health Department can require them to look after more people and provide greater assistance to field health programmes. Increased quantities of medical supplies have been purchased to meet the threat of an influenza epidemic later this year and also to give more penicillin and other lifesaving drugs to aidposts. AIDPOST CLASSIFICATION* HOURS EXPECTED TO WORK EACH WEEK More than 30 hours 20 - 30 hours Less than 20 hours Unclassified AID POST SUPERVISORS Number of Orderlies 373 669 50 148 24

ITOTAL *

1264

The classification of aidposts will be reviewed periodically. A committee examined the range of drugs, dressings and medical equipment needed by aidposts.

Outpat ient tTeatment, Nonga Base Hospita l

Legislation is being drawn up to allow large Territory hospitals to establish Hospital Boards, having wide community representation and specific responsibilities for management, planning, and other spheres of hospital administration. Health Department policy is directed to increased community participation and responsibility for their hospital services, whether this be through a Council Health Committee in rural areas or a Hospital Board for the larger Territory hospitals. The medical'requirements of large industrial projects strain health reserves. A 280 bed hospital is planned for Arawa (Bougainville) and there is a continuing movement of health staff to this area to meet the medical needs created by large scale mining and rapid development. A Committee with some private members is preparing an overall development plan for the Kainantu hospital to cope not only with the usual subdistrict demands for medical care but also the additional demands of the proposed Ramu Hydroelectric Scheme. During the year $125,000 was spent on the improvement of rural hospitals. Allocation depends on need but priority is given to areas where the community or council supplements Health funds. "'The department recognises the need to improve all district hospitals in the Highlands with the exception of Goroka. Current priority for hospital development is Mendi. Tenders have been called for the construction of a Radiotherapy Centre with a modern Cobalt Unit at Lae. Public patients now pay fees of $2 as inpatients and 20 cents per outpatient attendance at 20 more hospitals gazetted during the year under the Hospital Charges Ordinance. Intermediate patients are charged $8.40 per day ($10.40 per d~ if entitled to the Commonwealth benefit) but patients with an income of less than $4,000 per annum pay $3.60 per day. Apart from imposing more realistic hospital charges, the new fee scale should encourage more Papuans and New Guineans to seek intermediate level hospitalisation. Many factors influence the distribution of doctors in the Territory. For example training needs, population denSity, u,rbanisation, communications, the need for Base Hospitals with specialist medical staff, and the type and level of area development. Any consideration of the persons per doctor table must take into account the service provided by Base Hospitals at the four main Territory oentres to other areas of the Territory.

{f-

RATIO TOWN & DISTRICT PORT MORESBY CENTRAL DIST. LAE - MOROBE DISTRICT GOROKA - EAST. HIGHLANDS DIST. RABAUL - EAST N. BRITAIN DIST. REMAINDER OF TERRITORY TOTAL

DOCTORS

POPULATION

NO.OF ** DOCTORS

POPULATION URBAN

TO!rAL

RATIO

RURAL

32 13

41,848 16,546 4,826 10,561

104,483 192,520 199,206 99,369

146,331 209,066

1:4,573 1:16,082

14 14 120 193

204:,03 2 1:14,574 109,930 1:7,852

***

1,515,627 2,184,986

1,515,627 1:12,630 !

1:11,321

* ** ***

1966, Bureau of Statistics. Administration, Private Practitioners, Missions, Armed Services Includes Headquarters medical staff.

Many doctors do not want to work in the rural areas for professional and personal reasons. The department is experiencing diffic-' ulty in attracting doctors to rural posts and cannot meet the increasing demands for upgrading rural medical services. This situation is not likely to improve in the near future and it is imperative that the policy of requiring doctors to serve in rural areas for at least two years after registration be continued. Any shortage of doctors for rural areas places a greater burden on health extension officers, maternal and child health nurses and other health auxiliaries • . Miss B. Guise was appointed Assistant Matron to the Port Moresby General Hospital, which now has a Chief Executive Officer, Mr. loG. Forster, in place of a Medical Superintendent.

Medical Services are concerned not only with the treatment of the sick but also with the full economic and social rehabilitation of patients and with hospital programmes to prevent disease through health education of patients and guardians.

MENTAL HEALTH Chief-Dr B. G. Burton-Bradley, M.D., F.A.N.Z.C.P., F.A.C.M.A.• F.R.A.I., D.T.M. & H.

The care of patients with mental illnesses extends to their full rehabilitation in the community. Eesides treatment, this Section is concerned with the prevention of mental disorders and the improvement of individual and community mental health. Laloki Psychiatric Centre: During the year 71 patients were admitted to the Centre and the average length of stay was 136.5 days. The therapeutic value of Self-Help is used to improve facilities. Roy Worthy House, named after a deceased officer of the Section, is one self-help project on the bank of the Laloki River which functions as a "half-way" house. Patients stay for 3 - 6 months before discharge and run the unit themselves. They follow a village way of life but can do carpentry and other things in a well-equipped workshop. Rotary built the basic structure of the new Recreational Hall which was completed by the patients. This building is used for spontaneous art therapy which is popular with the patients who make traditional artifacts also. These activities help patients to get better. A chapel being built by youth groups from various churches is nearing completion. A modern 30 patient ward with kitchen and dining facilities was completed during the year. The Centre is staffed by local officers. Periuheral Psychiatric Units: The Section aims to care for patients as close as possible to their home areas •••• and within general hospitals so as to intergrate psychiatry with other professional disciplines. A 25 bed Psychiatric Unit has been opened within the Port Moresby General Hospital and the Goroka General Hospital Unit is now fully operational. There is a third unit within the Angau Memorial Hospital and the Nonga Ease Hospital treats mentally sick patients. Patients prefer to be admitted to the Psychiatric .Ward of a General Hospital which admits all kinds of sick people. These units are used for the teaching of nurses, medical students and other health workers. Training: Ten nurses are taking the one year post-basic Psychiatric Nurse Course, including two female nurses - the first to be admitted to the course. Eleven nurses have graduated from the course since it started in 1967 and three are in charge of peripheral psychiatric units. Lectures and case demonstrations are held regularly for student nurses and medical students. Mr. Pokerup Narakou, the 25

Psychiatric Nurse in charge of the Goroka unit, is stu~ing occupational therapy for 6 months with the New South Wales Department of Public Health. other MatterSI Forensic ethno-psychiatry is increasing in the Territory as the courts and law enforcement agencies seek psychiatric opinions more frequently. Expert testimony takes into account, custom, language, and social organisation. Kokoda Ward at the La10ki Psychiatric centre admits mentally sick prisoners. The Assistant Director (Mental Health) joined the Culture and Mental Health Programme of the East West Centre, University of Hawaii, for nine months during the year. He is conducting a study of hypochondriasis among some urban groups in Port Moresby. The Section is concerned with the total welfare of patients with early full rehabilitation as a family unit and productive member of society.

Varied occupational therapy at the Psychiatric Unit Port Moresby General Hospital.

J (

DIVISION OF MEDICAL TRAINING Asistant Director-Dr K. K. Beri, B.C.K., B.Sc., M.M.B.S., D.P.H., F.R.S.H., F.R.I.P.H.H.

Only 151 young men and women entered the Territorial and Group 'B' nursing courses this year. At the present time the Health DepartIl].ent requires an intake of 200 student nurses each year to meet current and future needs and to maintain and improve nursing standards in this country. More nursing aides have been employed at Territory hospitals to minimise the effect of this shortfall in recruitment. Recruitment methods are being re-examined with the aim of attracting more young men and women to nursing courses. NurSing Education. The Nursing Council of Papua and New Guinea conducted the 1970 Final Examinations in General Nursing. Of the 135 candidates, 103 passed with 7 distinctions, 21 student nurses were awarded supplementary examinations in September, and 11 were unsuccessful. For the first time, a Nursing School/Hospital assessment accounted for 25% of the total marks for the examination and candidates could request additional time to complete the written paper. Student nurses from the Territorial and Group 'B' Nursing Courses take the Nursing Council final examinations. The Territorial course requires an education standard of Form I for girls, and Form II for men. Young men and women must reach Form III (minimum) to be accepted for the Group 'B' course. This group take a more advanced course in general nursing than the Territorial group. All Group 'B' candidates passed the Nursing Council examination and received 4 of the 7 distinctions awarded. Working with the Nursing Council, the Health Department carried out a Job Activity Sampling Study at selected hospitals and health centres. The study showed objectively the work actually done in this country by student nurses, nurses and other ward staff. Objective data is now available for a complete review of. nursing education and to improve the nursing services. The Master Plan (illustrated) shows the extensive nature of the nursing education review required to ensure nurses are prepared to meet the nursing needs of this country. The ~ Matrons' Conference held at Port Moresby was one step in a continuing Action Plan to improve inservice education in Territory hospitals. Topics suc~ as the rostering.of nurses, supervision, assignment of duties, and communication were centred on the Conference Theme, "Better Utilisation of Nurses". Recommendations included: the introduction of the imprest system in all hospitals for linen and 27

· "'.

r- .....

drugs to relieve nurses of non-nursing duties; a merit r~ting system for nursing staff as a tool for staff development; a Nur~ing School/ Hospital committee to improve communications between se~ice and education sections of nursing, refresher courses for nur~es who have been away from nursing for a long period; and an active effort to implement patient-centred nursing. These and other conference recommendations are being studied by the Health Department. Nursing aides continue to be trained at 11 hospitals and 78 nursing aides successfully completed Health Department examinations during the year. Matron J. Porter, formerly Principal of the Lae School of Nursing, was appointed Superintendent of NurSing Education and transferred to Port Moresby. Mr. B. Morlim after gaining the Diploma in Nursing Education at the New South Wales College of Nursing, was appointed Principal of the Port Moresby School of Nursing. Miss T. Lokoloko is now taking the Nursing Education course at the New South Wales College of Nursing. Paramedical Training The first and third years of the Health Extension Officer course are conducted at the Paramedical Training Centre, Madang, where health inspectors are trained also. Trainee health extension officers go to the Community Health Practice Institute for the second year of the course and health inspector students work for six months with selected health inspectors during their three year course. There are 57 health extension officers and 23 health inspectors in training. A working group reviewed the Health Extension Officer course to develop a curriculum more related to Territory needs. Among many changes, a new subject "Disease Control" (150 sessions) was introduced to ensure a better theoretical and practical understanding of the important work of health extension officers in the field of disease prevention. One recommendation being considered is the need for a training health centre in the Madang sub-district, another was the need to evaluate the educative value of the second year of the course .at the Community Health Practice Institute, and the group stimulated the rewriting of lecture notes for the course. After completing studies in the Phillipines and Thailand, Dr. L. Rovin wa~ appointed Acting Principal of the Community Health Practice Institute. The Institute provides experience and training in "Rural Medicine" for medical students, resident medical officers, and trainee health extension officers. 28

....

Medical Technology and Radiography. These three year cour~es are conducted by the Pathology and Radiogy departments, respect~vely, of the Port Moresby General Hospital. Three medical technologists and 3 radiographers graduated during the . year. There are 7 medical technologists and 7 radiographers in training. The Examination Board for the Medical Technologist course is carrying out a review of course content and teaching methods • 10

HEALTH COURSES Conducted by DEPARTMENT OF PUBLIC HEALTH

COURSE Malaria Courses Dental Technician Territorial Nurse Group ']3' Nurse Dental Nurse w 0

STUDENT INTAKE 1970 32 4 129 22 10 23 16 7 7 6 7 28 291

TOTAL NUMBER OF STUDENTS 30.6.70. 27 9 388 54 21 57 23 22 9 22 21 77 730

NUMBER OF GRADUATES 64 3 89 14 4 16 7 3 3 2 6 211

Health Extension Officer Health Inspector Medical Technologist Radiographer Preschool Teacher Dental Officer Medical Officer TOTAL

Twenty-three Territorial Nurses will sit for the Supplementary Examinations to be held in October. There are 132 students enrolled at 4 Mission Training Schools. Fourteen nurses from two mission schools graduated.

--to

., PLAN 2 b) :;;

MASTER RATINGS ~

EVALUATION OF PRESENT NURSE TRAINING COURSE IN RELATION TO THE PAPUAN-NEW GUINEAN & SOCIAL-CULTURAL ASPECTS

CATEGORIES OF NURSE RWUIRED

''''~1~~.j\ ~n :0 ~ "1<

0p o 1

*'~ ~ ~ 0 -t ~G'~ ~~~ts '-q

\\'\1-;.. 'G, .~ Sr,~ "11>0 <"b "oX ">CQ

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_ 1 0 P,N.G HEALTH EXTEN5.iCN

OFF!cE~~ ~ lb, ~3'@

C"" .

'-CI"(r:.

1<_ y-r'Se

DEVELOPMENT OF OBJECTIVE FOR EACH CATEGORY & JOB DESCRIPTION -

~ 1

'%,01' 'f;; z'O~ "' ~8'&

~a~

DEFINITION & CLARIFICATION i

'~It? lb '% \ "'~.s,,,.'t 3 "'~ ~~% ~ \ \ "~~ ~ REPRESENTATIVE ",.s U' \ "

°2

~~ ~

s.,s.;>:

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:>V11vGJS)

1b 2

OF CONTRIBUTING OBJECTIVES FOR EACH CATEGORY & JOB SPECIFICATION

"'''~~ ~~

DEVELOPMENT

OF:

~i~

z '"

CURRICULUM OBJECTIVES CURRICULUM CONTENT

~lb \ 'G:;) 1

SELECTED

AREAS

f'APUAN & NEW GUINEAN (INCLUDING MISSIONS)

0 ~ HEALTH AND NURSING NEEDS

MORTALITY

@~ ld 3 4

~ ~

sPIT{.\,\.. MtIoJOft \-\0

MOR~OSi~:HS1\CS rY ~\Si~\C.'S "',-

STUDIES

l ~ ~ @~ ~@ C~ W~O &6) @ e 2 \ 2 ~ '

~@ CHARGE 95TERS }.I

OS9''"C S'",,,,,,\O" >.\....... S\ R,-4. ~\jrt .A<;J.,'f. ,<;'\~~ ",0

@/ ld

~~c.. . . '(\~\9 cj..~? \~".:.

,,#

,..'

~o Q<0

".. '" &

~ ~«; rf~ $"~ Q'<'

'" 0&<J t¥ 0 cJ~

,,\.1/° •

~ ~

<t7 / /

/1\ ~ ~

\ , '1';,-;"(,

Jl§ f{JQ'J

"'~"'

'1l '-$-

~ '" ..J

1,'

'1: &.-."-91:')'~' \

li:

DOCrORS 'OSPt'4l.

~ ~ ~, V ~

rr4{ SfC/:/f?"«1R 11r'

",9

0'99

809

11/;1

E!i5 a 1< o'i a ~ ~?

\\1--0 "->~;s2:%'4<~~~~~i' '-. ~ ~ '\ "i:."'~~ r(f>~~'" '"'" ~ 1l~;. ~ "'(;'()' \

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REPRESENTATIVE AREAS SELECTED EX PATRIATE GROUP (INCLUDtNG MISSIONS)

~~<?). % '1

0" '%~o._ -'(5'

~., <t~ ,~lC3 .C'1y

~~ ~~ 1c

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GENERAL INFORMATION

RESOURCES

LONG RANGE PLANNING FOR FUTURE IMPROVEMENT

& OVERALL EVALUATION OF NURSIt-t3 EDUCATION

PAPUAN MEDICAL COLLEGE Dean-Dr I. Maddocks, M.D., F.R.A.C.P., D.T.M. & H.

The Papuan Medical College was begun in 1960 to train Assistant Medical Officers for Papua and New Guinea. By 1964, when the first graduates passed out, the objects of the five year course of study was to produce fully qualified doctors, and the term "Assistant" was discarded. Graduates were required to complete two years of supervised resident experience before registration. With the establishment of the University of Papua and New Guinea in 1965 it was anticipated that the Medical College would develop as a Faculty of Medicine. This was finally approved in April 1970, after agreement had been reached on the joint supervision of costs and curriculum by the University and the Administration. From January 1971 medical undergraduate training will be fully within the University under four Departments of the Faculty of Medicine, each headed by a Professor. During 1969, 73 students were enrolled for Medicine, 47 in the Preliminary Year and First Year at the University, 26 in the later years at the Medical College. Six students graduated in December 1969. In 1970, 77 students were enrolled, of whom 49 were at the University. During 1970 difficulty was experienced in recruiting a Lecturer in Pathology and the College was fortunate in receiving assistance from Melbourne Pathologists who filled the position in rotation, for six-week terms. The secondment of teaching registrars in Obstetrics, Surgery and Medicine from Melbourne and Sydney hospitals continued during the year. The contribution made by the registrars to training of students and residents, and the close relationships established with their home hospitals has been greatly appreciated. Since 1964 the Medical College has been supported by regular annual visits (of two weeks duration) by Consultants in all the major disciplines. During 1969 Professor R.R.H. Lovell (Medicine), Professor C. Dixon (Preventive Medicine) and Professor M. Taylor (Physiology) completed their three-year terms as Consultants. A Teaching Methods workshop was held at the Medical College in September 1969, under Professor N. Kagan and Dr. R. Weidersheim, W.H.O. Consultants. The workshop involved Medical College Staff and also teachers of paramedical, technical and nurSing trainees. The College held a number of successful "Open Days" in which High School students or parents and friends of medical students were invited to see the College buildings and view displays of equipment and materials prepared by staff and stUdents. 32

PORT MORESBY GENERAL HOSPITAL Chief Executive Officer-Mr 1. G. Forster, L.H.A.

The Hospital and Services. The 500 bed Port Moresby General Hospital is the largest Territory hospital and is the Base Hospital for the Papuan Region. The full range of general and specialist services i t provides must also meet the needs of the 60,000 people of Port Moresby; certain Territorywide specialised services, such as radiotherapy, histopathology; and the Tumour Registry are based in the hospital. The Work Done. Selected Statistics: Port Moresby General Hospital 1st January 1969 - 31 December 1969. STATISTIC IN1'ATIENTS OUTPATIENTS SURGERY OBSTETRICS Admissions Daily Average Attendances general outpatients Attendances special clinics Operations Total deliveries Complicated deliveries Major Gynaecological Operations Tests and examinations Coronial autopsies Other autopsies All tests for cancer Radiographic examinations Treatments carried out Treatments carried out Inpatients Outpatients Patients assisted Prescriptions dispensed 33

NUMBER

12,350 375 142,818 13,761 3,861 1,628 551 67 42,611 105 70 2,600 20,292 591 5,459 1,045

PATHOLOGY

RADIOLOGY RADIOTHERAPY PHYSIOTHERAPY

OCCUPATIONAL THERAPY PHABl1ACY

3,194

MEDICAL RECORDS

Records extracted for research

5,000

Inpatients were cared for in 8 public and 3 intermediate wards staffed by 64 trained nurses, up to 46 nursing aides, and over 80 student nurses available for ward work. There is a resident medical officer, either on duty or close call, for outpatients, who is "backed - up" by residents, a registrar and specialist in each major speciality. Five hospital specialists and 5 lecturers specialists of the Papuan Medical College conduct 21 specialist outpatient sessions each week. The casualty/outpatient Department is staffed by 10 trained nurses, including 5 male nurses, 9 student nurses and 9 other staff. The medical staffing pattern of the major hospital dep~tments Medicine and Surgery •••• is two specialists supported by two registrars and two resident medical officers. Ophthalmology, Radiotherapy and Radiology Departments have a specialist only. Obstetrics, child health, anaesthetics, and pathology have specialists registrars, and usually resident medical officers. The Health Department wants to recruit a second obstetrician and pathologist for the hospital, and, if possible, a casualty/outpatient registrar. There are 12 - 13 resident medical officers at the Port Moresby General Hospital. The actual number fluctuates with roster variations. Ancillary services make an important contribution to patient care. Medical Records: Thirtyfour staff maintain a comprehensive record system with a new record being opened for each admission. Post records of illness are important for the good medical care of patients readmitted to hospital and for research leading to better methods of patient care. Occupational Therapy: The therapist and her assistant have an important role in the rehabilitation of patients and, in particular, for the morale and well-being of long term patients. Physiotherapy: Two physiotherapists and a physiotherapy technician provide services which prevent complications and assist the recovery and full rehabilitation of patients. Radiotherapy: The specialist is assisted by a radiographer seconded from the Queensland Radium Institute. Pathology and Radiology: The majority of the 11 medical technologists and 6 radiographers in these departments are local officers. Routine blood grouping and cross-matching services in the hospital are provided by the Red Cross Blood Transfusion Service. During the year 2,396 pints of blood and 1,783 bottles of blood products were provided by this service. Training: The Port Moresby General Hospital is the only Territory Hospital for medical stUdents. These students are taught in the hospital wards and outpatient clinics during the clinical years of their course. 34

There are 17 medical students taking clinical instruction in the hospital in 1969 and 19 this year. student nurses and trainees in other paramedical fields all make a major contribution to the service function of the hospital. In the 1970 training year the number of trainees entering courses were in some cases insufficient for the hospital service needs. COURSE NURSING TERRITORIAL NURSING - B RADIOGRAPHER PATH.TECHN. The Hospital Board FIRST YEAR STUDENTS AT 30.6.70 39 22 TOTAL NO. IN COURSE 1970 129 FINALISTS GRADUATING DURING 1969.70 ) IN JUNE ) 39 1970 ) ) 14 ) IN DEC. ) 1969 ) )

NO OF YEARS OF COURSE

3 years 4 months 3 years 4 months 3 years 3 years

6 5

9 19

4 3

r+-

The Hospital Advisory Board, which was appointed in 1967, continued to meet monthly until the implementation of the Griffith Report which provided for legislation setting up a larger Board of Management. Since February 1970, the responsibility for day to day management rests with the Management Committee, headed by a non-medical chief executive officer. Areas in which the Board took an active interest and contributed to departmental thinking included:- staffing problems, particularly the shortage of nurses, the implementation of the Griffith Report, and legislation setting up a larger Board of Management. The Management Committee arranged for the construction of a shelter for the guardians of hospital patients. This building has been funded by money raised by the Board and work is expected to commence before the end of 1970. The Administrative and Nursing Services. From January 1969 to March 1970, the operations of the administrative services of the hospital were reviewed by an organisation and methods team of the Public Service Board. This team also carried out a Job Analysis and Nursing Activity Study for the Nursing Council in September/October, 1969. The Buildings. Capital improvements were made to 3 wards in the Walter Strong Wing to upgrade existing facilities and provide .additional bed space in . new buildings of improved design and construction. One new unit thus 35

produced is a 25 bed ward with facilities for intermediate and public short stay psychiatric patients. This unit, an integral part of the hospital, is also used in psychiatric nursing training. A new 16 room accommodation block for trained nursing staff is almost finished, and an accommodation unit for single male nurses has been extensively renovated. Contracts have been let for additional married accommodation for local officers. Hospital staff have been actively involved in the planning of a new building containing a casualty/outpatient block and a 3 storied ward block.

COMMUNITY HEALTH DIVISION Senior Consultant-Dr D. P. Bowler, M.D., M.R.C.P., D.T.M. & H.

During the year a Division of Community Health was established within the Department. The aim and objectives of this Division are to draw together the several different field activities of the Department - the malaria services, tuberculosis and leprosy control, environmental health, dental health, and maternal and child health in order to develop an integrated and economic field service for the Territory. The Community Health Division has not only the restoration of health in sick individuals as its aim, but also undertakes programmes designed to protect and maintain the health of village communities throughout the Territory - immunization programmes, malaria spraying operations, clean water supplies, and the proper disposal of waste.

.-., -

Community Health demands an integrated approach by health workers, and for this reason the training of community health nurses who will be multipurpose workers and workers of first contact, is an important objective of this division. The community health nurses will play an increasingly important role in all aspects of community health programmes, and in the domicilary treatment of patients suffering from leprosy and tuberculosis. Working through district organisations, and with the maximal involvement of Councils, and missions medical services, a unified district community health organisation is envisaged. This will involve the development of rural health centres and the increased utilisation of aid posts and their staff. The establishment of an efficient· epidemiological programme is an essential part of the community health division, and the distribution of quarterly epidemiological summaries based on Territory and world wide figures was commenced during the year.

ENVIRONMENTAL HEALTH Consultant-Dr J. L. Jameson, M.B., B.S., D.T.M. & H., M.P.H., FA-C.M.A.

Increased activities have occurred in this field owing to the increase in the number of health inspectors. Rapid population increases in urban areas have required the extension of reticulated water supplies. As tank water supplies have proved inadequate, additional supplies have been obtained from underground sources or from streams. This has resulted in increased testing of water to ensure safety, and the recommendation where necessary of water purification treatment. Three additional areas of land have been set aside for garbage depot sites in Port Moresby, and a considerable improvement has been effected in garbage disposal by the institution of properly executed sanitary landfill. The cost and problems associated with nightsoil collection have been investigated and strong recommendations made for the provision of sewerage whenever possible. Continued efforts have been made to improve rural water supplies by the construction of protected wells, and the provision of more durable water supply tanks. Legislation: The Trade Licensing Ordinance was passed in 1969, thus permitting the formation of a Sanitary Plumbers, Drainers and Gasfitters Licensing Board. The Quarantine Ordinance, and the Public Health Ordinance of New Guinea and asso~iated Regulations had their amendments consolidated and were reprinted. Health Inspection: The addition of 6 newly graduated local health inspectors from the Madang Paramedical College has permitted more activity in this field. For the first time, health inspectors have been stationed at Mendi, Kundiawa and Kainantu and an additional senior health inspector at Kieta. Quarantine: No cases of quarantinable diseases were detected. All shipping and aircraft arriving from countries other than Australia, New Zealand and British Solomon Islands are subject to quarantine inspection. The Territory's policy of requiring all people from Asian' 38

·f·

countries to have a valid International Certificate for cholera is justified by the continued presence of cholera in ~any of these countries. All arrivals, other than those from Australia, New Zealand and B.S.I.P., are also required to possess a valid International Certificate of Vaccination against smallpox. Influenza: The major problem that confronted the Department during the year was a severe outbreak of influenza (A2 Hong Kong 68) which affected many parts of the Territory between July and October. The epidemic was particularly severe in the Highlands, and in the Madang and Morobe districts, where mortality due to complications of influenza were high. Most of the deaths associated with this epidemic were due to pneumonia, the presence of malaria, and a low nutritional state. Social factors also influenced the death rate. More than 2,000 deaths were recorded as being due to influenza or its complications. The number of cases of influenza is not known. During the epidemic some 340,000 doses of influenza vaccine were given, but the value of this in controlling and preventing the spread of the virus was not clearly demonstrated. It was found, however, that daily treatment patrols through the affected villages, utilising antibiotics and antimalarials were extremely effective in preventing deaths from complications. Venereal Disease: During the year an outbreak of syphilis was reported from Goroka in the Eastern Highlands, and it became clear that an epidemic of this disease was developing. The disease was reported along the line of the Highlands highway between Lae and Mount Hagen. A venereal disease control unit has been set up in Goroka, and an intensive treatment and health education programme instituted in areas along the Highlands highway. There has been an increase in the number of cases of gonorrhea reported in the Territory, and there are now venereal disease clinics at Port Moresby, Lae and Goroka. Venereal Disease Notifications 1969/70 Donovanosis 512 Goitre Prophylaxis: The present policy is to discontinue mass injections until such time as evaluation studies have been completed by the Institute of Human Biology. 39

"t-

Gonorrhea 2,464

Syphilis 90

In areas where injections have been repeated at regular intervals, health staff no longer consider goitre a public health problem. The Department will continue to make iodised oil available to persons suffering from goitre and to pregnant women living in "goitrous" areas.

Local Government Councils: There are 145 local government councils involved in the Department's assistance to Council Health Services. This scheme provided for the involvement of local government councils in the payment of health workers' salaries, environmental sanitation projects, health building projects, and the provision of land/sea transport. Councils are subsidized according to the stage to which the council has been graded by the Commissioner for Local Government. Council vehicles drove approximately 53,600 miles for health services, which consisted in the main of transporting maternal and child health personnel to village clinics.

MATERNAL AND CHILD HEALTH Consultant-Dr D. P. Bowler, M.D., M.R.C.P., D.T.M. & H.

This Section of the pepartment of Public Health provides a comprehensive health service for mothers and children throughout the Territory, embracing educative, curative, and preventive medicine. There are 42 main centres and 9 rural health centres which hold 3,310 clinics. The clinics are staffed by 151 local nurses, and 50 expatriate nurses. Of the 42 main centres, all the rural health centres and 25 clinics are staffed entirely by local nurses; and the expatriate nurse is assuming the role of an adviser. During the year there were 161,184 attendances of children under one year, 333,765 attendances between one and five years, and 30,199 attendances of children over five years. There were 40,050 antenatal attend~lces, and maternal and child health staff delivered 2,240 babies. School health is an essential part of the maternal and child health service, and although there are separate school health teams in Port Moresby, Rabaul, Lae, Mount Hagen and Goroka, the mobile maternal and child health teams regularly visit schools in their areas. Other health workers - such as health extension officers conduct school health examinations. During the year 77,214 were enrolled, 53,146 examinations made and 46,158 treatments given. The home visiting service has increased its activities and during the year 3,068 homes were visited for the first time and there were 5,375 revisits. 311 children were seen who were referred from hospital, and a total of 11,477 children and 8,503 adults were given attention. Family planning is fully integrated within the maternal and child health service, but an increase in the number of acceptors for some form of contraceptive is dependent on the recruitment of full time family planning workers. During the year 1,689 women sought advice on family planning, of these 1,366 were offered a form of contraception, either the Lippes Loop (1,295 acceptances) or an oral contraceptive (71 acceptances). Further surveys on women living in urban areas were carried out to determine attitudes and motivation towards family planning.

.•

An important part of the work of the maternal and child health section is the close liaison maintained with religious missions undertaking maternal and child health work. There are 212 mission centres subsidised by the Department for their work and nearly all undertake village clinic work in addition to work at the mission station. In many ins tances maternal and child heal th work is undertaken by trained 41

nurses who have graduated from their own mission training schools. There are trained local nurses working with the missions as well as 166 expatriate nurses. During the year there were 220 maternal and child health trainees at 10 mission training schools. Of these 34 graduated with both child health and midwifery certificates, 24 passed the child health examination and 37 the midwifery. There were 272,503 attendances of children under one year and 767,861 between the ages of one and five years, at the mission stations undertaking maternal and child health work. In school health 50,070 children were enrolled of which 37,143 were examined and 127,579 treatments given. This years figures reveal that the Maternal and Child Health Section and the Mission are seeing 50.5% of the total population of children between 0 - 5 years of age. 34.2% of the total number of children at school are being examined and 42.8% of the total number of pregnant women are receiving antenatal advice.

Health Education among the Mothers

Helping Mothers to help their families

". Pre-school children at lessons

Working together in Pre-school

Pre-school Services: There are 47 pre-school centres in Papua and New Guinea attended by 1,821 children between the ages of three and six years. The pre-school centres in the Territory are classified as "A", "T" and "s" type. "A" type centres, of which there are 17, provide a programme for English speaking children; 735 children attended these centres during the year. "T" type centres provide a Territory orientated programme for children speaking English as a second language. There are 19 "T" type centres and these were attended by 820 children. There are 1~ "S" type centres, which axe smaller units staffed by approved but generally untrained supervisors. Children of all races attend these centres, and 266 children were enrolled. The pre-school section is staffed by 22 overseas and 15 locally trained teachers. The Mail Box scheme provides a pre-school service for families on outstations and supplies parcels of books and ideas for activities suitable for pre-school age children. An enrolment fee is charged for this service. There are 21 students undergoing training, 6 in first year, 8 in second year and 7 in third year. This course is designed to train local girls as pre-school teachers, capable of managing centres throughout the Territory. Under the scheme of Commonwealth co-operation in education, one Fijian student is participating in the course.

/. ~

TUBERCULOSIS CONTROL Consultant-Dr S. C. Wigley, M.B., B.S., M.R.C.P.

The work of the Section has been wide-spread in all districts during the year. Control activities were carried on in 11 districts including the four Highlands districts, all Mainland districts, New Ireland, East and West New Britain and Bougainville districts, and in the Milne Bay, Northern and Central districts of Papua. 75,690 tuberculin skin-tests were done, and 414,977 vaccinations with B.C.G. vaccine were performed. 67,110 70mm micro-film examinations were completed. The figure for vaccination includes a small number done by maternal and child health units. The following table indicates the trend of the work done in the past three years. Year 1967/68 1968/69 1969/70 Tuberculin Tests 66,965 72,917 75,690 B.C.G. Vaccinations 159,733 293,246 Micro-films 84,932 72,055 67,110

l14,977

It can be seen that there has been a substantial increase in the number of vaccinations done in the community. As in the past, the emphasis in this segment of the work has been on ensuring the protection of the Highlands communities, new-born babies anq school children. There has been a steady fall in the number of x-ray examinations done over the period. The machines are ageing, and need replacement. The x-ray section, for many reasons, is performing at less than 50% of full efficiency. In addition, in the Islands ares" the lack of available transport has hindered movement of the unit. The patient load has dropped by 200 to 3,069 during the year. This gives no cause for congratulations or complacency. An increase in the efficiency of case-finding, (i.e. x-ray) programmes will result in an increase in the number of patients found in the coming year. Approximately half of the patients are managed as out-patients, receiving their treatment in the fully supervised, intermittent outpatient therapy programmes. The quality of supervision of these programmes is acceptable in most rural areas, but that in the urban areas leaves much to be desired. Plans are in hand to improve this. More patients were discovered in the Highlands during the year, and the most strenuous efforts are being made to follow up suspected persons, and the contacts of tuberculous patients, in order that the disease should be firmly controlled in the district. Efforts are 46

••

being made to ensure that the movement of tuberculous patients is supervised very closely. Port Moresby demonstrated again its preponderance in the treatment programme. It is providing a service for one eighth of the Territory patients, and almost 40% of the Papuan case load. The prevalence of tuberculosis needing treatment in the 'shanty' settlements is high and gives rise to concern. It is proposed to initiate plans to deal with this problem. The Central Laboratory in Lae, (sponsored by N.A.P.T.A.), is expanding its activities. The technologist has had training in mycobacteriology, and he is devoting his attention to the perfection of smear examination techniques, and culture work, to the end of improving the quality of specimens sent for examination from the periphery, and the quality of the work in the laboratory. 8,283 slopes were prepared during the year, 5,144 smears were examined (4,219 - 1968/ 69), 5,180 cultures were made (3,070 - 1968/69), and 64 drug sensitivity studies were done. Sensitivity studies will not playa big part in the work of the laboratory at this stage of its development. Field training of officers of the section continued during the year. A medical officer with much experience in the community managment of tuberculosis was appointed to the control of the Mainland activities, and one medical officer proceeded to New Zealand to continue his post-graduate education in Public Health Medicine.

Hand exercises for leprosy patients

Foot ulcer care, leprosy patients

LEPROSY CONTROL Consultant-Dr D. A. Russell, M.B., B.S., D.P.H.

The Territory leprosy control programme is conducted through the regional leprosy control units at Port Moresby, Mount Hagen and Rabaul and the leprosy control units at Madang, Wewak, Maprik and Lumi. The programme is committed to the greater promotion of domiciliary treatment and health education regarding leprosy and the prevention of deformities and injuries. Case finding surveys have been conducted in all districts. The various missions engaged in leprosy work have taken an increasing part in this feature of the control programme as well as in the follow-up of patients on domiciliary treatment. Initial trials were completed in the Karimui area of the Highlands on the use of a long acting, injectable sulphone. This drug appears to have great promise. Only five injections are needed each year, and the response to treatment is excellent. A trial to test the feasibility of this method of treatment in a district health organisation is to be undertaken in the East Sepik district. During the year some 242,020 persons were examined and 575 new cases of leprosy were recorded by survey units. During the same period the number of patients in the various colonies and hospitals totalled 1,460. There were 1,812 admissions and 1,882 discharges from the institutions. There are 8,408 patients receiving regular domiciliary treatment in various areas of the Territory. These figures show a greater turnover of patients referred to institutions and is in keeping with the policy of promoting the treatment of leprosy in general institutions as well as the colonies and for the minimal practical period necessary. The Leprosy Surgery Unit at Mendi was closed in the early part of this year, due to the transfer of the specialist surgeon, Leprosy Reconstructive Surgery Unit, Madang, to Port Moresby and of the Surgeon from Mendi to Madang. Leprosy surgery has been carried out at Madang, Port Moresby, Balimo, Ubuiya and Rabaul where a total of 272 operations were performed during the year (140 in Papua - hand 62, foot 52 and others 26. 132 in New Guinea - hand 37, foot 70 and others 25). 49

The Surgeon at the Togoba Ransenide Colony has also visited other centres including Yampu and Mambasanda where 124 operations (53 hand, 30 foot and 41 others) were performed. There has been a definite falling off in the number of patients requiring surgery in the Madang area. Analysis of the surgical figures also indicates that foot drop correction has remained the most common single procedure. In the hand, curiously enough, no operation was performed for medium nerve palsy in New Guinea as opp~ osed to 12 such in Papua. Subsequent observation will show whether this was due to an unusual concentration of such cases in the Milne Bay area or because similar cases in New Guinea had been operated on in previous years. In-service training in leprosy for Administration and mission personnel has been conducted by the regional leprosy control units and the leprosy reconstructive surgery unit at Madang. The following is a summary of the Leprosy Control Unit statistics: New Cases Detected 1~6~-1~ZO

Total Cases Registered to ~1.~.1~ZO 8,383 1,656 1,480 1,28 4 860 669 860

Highlands Port Moresby Rabaul Madang Leprosy Mission, Tari Wewak, East Sepik LUmi, West Sepik

469 249 115 188 78 58 154

• 50

•

MALARIA CONTROL Consultant-Dr A. D. Parkinson, M.B., B.S.

The malaria programme is the biggest single activity within the Department, and approximately 10% of the health budget is applied to the malaria programme. During the year malaria operations were maintained in fifteen of the eighteen districts, and efforts have been directed at consolidation of existing programmes rather than extension to new areas. During the year a detailed reassessment of the whole programme was commenced, and further developments will depend on the results of this review. , .r

Residual spraying with the insecticide D.D.T. continues to be the major weapon in the attack on malaria, and during the period 1969/ 1970, 212,398 structures were sprayed. International authorities, including the World Health Organisation have clearly demonstrated that D.D.T. is safe, and remains the cheapest insecticide. Some resistance to the residual spraying of houses developed during the year, and a total of 9,068 structures were not sprayed (4.26%), due to locked houses, refusals of permission to enter. This problem has been vigorously tackled by improved public relations, 'and an intensified health education campaign. The problem of unwanted side effects of residual spraying was studied intensively, particularly the bed bug problem. Pilot trials have demonstrated that this problem can be controlled by the addition of Malathion to the D.D.T. charge, and this will be extended to all areas under spraying operations. In view of the importance of the effect of malaria on economic development programmes, closer liaison was established between such ventures and the malaria service. There are 1,020 employees engaged on the malaria programme in the country, made up as follows:Local Officers Overseas Officers Casual spraymen 387 48 585

All laboratory supervisors and four- of the fourteen district supervisors are local officers. There are ten overseas district supervisors. 51

Training in the 1969/1970 period was undertaken at the National Training School at Kundiawa. The following courses were held:Passes Failures No. of courses Area Supervisors Team Leaders Assistant Team Leaders Laboratory technicians

3 2

12 16

3 4

34 2

6 0

The field section of training at Kainantu has been disbanded, and all training is now carried out at Kundiawa. Three advanped courses in malaria were attended in Manila by Departmental staff, and the Health Department was represented at the 6th Asian Conference on Malaria. A Seminar on malaria for Public Health Administrators was held Two advisers from the World Health Organisation and other eminent malariologists gave papers, and were available for advice and conSUltation. in September 1969 for senior health officers.

A training conference was held in December 1969, when training programmes were reviewed, and a training manual was rewritten.

Malaria-house spraying

DENTAL SERVICES Consultant-Mr D. A. Anderson, B.D.S.

The Dental Health Services continued to expand and consolidate in order to undertake treatment for all sections of the community, throughout Papua and New Guinea. The School Dental Health Service is the basis of the Dental Health Service and promotes free preventive and curative services for Primary School children. The dental needs of the remainder of the community are undertaken by the general service, which is carried out on a fee-for-service basis. This service, except for strict relief of pain, is dependent upon the resources available to the dental service. The backbone of the school dental health service is the Dental Nurse/Assistant with Dental Officers being available for referral of treatments beyond the scope of the Dental Nurse/Assistant. There are 46 fixed clinics and 3 mobile clinics located throughout the Territory. These clinics are presently staffed by fourteen Dental Officers, 52 Dental Nurse/Assistants, 12 Dental Technicians and 34 Dental Orderlies. Dental charges were reviewed during the year and new legislation was approved by the House of Assembly. The Dental Charges Ordinance (1969) came into effect cn the 15th January, 1970, allowing the Department to charge for dental treatment under two separate schedules, depending on the level of the patient's family income. Fees may now be collected from all sections of the community, other than those enrolled in the School Dental Health Service. The Director of Public Health, or his delegate, has power to waive charges so that no patient is denied necessary treatment. The Dental Health Service has benefited greatly from the appointment of Dr. J. Johnston as Principal of the Port Moresby Dental College. The College has been without a permanent Principal since mid-1967.

Dr. Johnston, formerly of the University of Otago, ~ew Zealand and the University of Lagos, Nigeria, was appointed Principal in March of this year and brought to the College the stability necessary for the production of first grade dental operators. The first meeting of the Academic Board of the Port Moresby Dental College was held in April 1970, under the chairmanship of Dr. Johnston. Members of the Board consisted of representatives from the Department of Public Health, the Papuan Medical College, and 54

the University of Papua and New Guinea. Four Dental Nurse/Assistants graduated during the year, and a further four are repeating the final six months of their clinical year. There were no dental officer graduates as the final examinations due to be held last December were deferred for six months, owing to difficulties caused by staff shortages and clinical facilities. Three Dental Technicians graduated, one of whom was from the Army. Extensions to the Port Moresby Dental College were commenced during the year. When completed, one demonstration surgery, two extraction surgeries and an oral surgery theatre will be available. These facilities to be used for dental instruction will, at the same time, provide general, specialist, and consultative dental services to the population of Port Moresby and to the community. The three mobile dental clinics, donated by service clubs last year, have proved very successful in the School Dental Service in the Port Moresby area. Daily and weekly maintenance on the vehicles has been carried out by dental staff so that they have been fully utilised, with no time lost through unserviceability •

....

.oral surgical demonstration for Final Year Dental Students

DENTAL

STATISTICS

SCHOOL

SERVICES

GENERAL

SERVICES

67/68 Initial Examination Revision Examinations Extractions

68/69 38 ,000 42,300 9,900 41,600 33,800 85,600

69/70 40,583 45,790 9,059 42,277 34,744 87,493

67/68

68/69 33,400

69/70 41,849

43,100 34,500 8,900 33,000 30,000 79,500

24,800 13,000 5,200 33,800

29,500 16,800 3,900 38 ,200

27,568 16,558 5,234 42,810

'" '"

Restorations Periodontal Treatments Total Attendances

•

,""

Eastern Highlands District District Health Officer-Dr R. Taureka, Dip. C.M.S. (Suva)

The Eastern Highlands District, with a population of 220,239, covers an area of 5,000 square miles, at an altitude varying between 5,200 to 8,000 feet, with an average rainfall of 95 inches per annum and temperatures ranging between 40 0 - 80 0 F. During the year a major influenza epidemic occurred which claimed approximately 231 lives, mostly between the ages of 0 - 1 and the aged. Only a very few areas were not affected and in these an influenza vaccination programme was carried out by foot and helicopter patrols. Of the estimated 18,181 of the population not affected, a total of 13,886 were given two injections of influenza vaccine ten days apart. An intensive antivenereal disease programme was commenced during the year. Initially the programme covered all schools and government institutions. A venereal disease control unit has been set up staffed by two health extension officers whose work it is to trace, and to treat contacts with venereal disease. Cases of syphilis are continuing to be admitted to hospital at an accelerated rate.

The total attendance at maternal and child health clinics in the Eastern Highlands for the year was 125,651. Family planning was carried out at 4 clinics. There are a total of 7 mission operated maternal and child health clinics, 94 aid posts run by the Department of Public Health, and 2 rural health centres. School dental services covered a total of 23 schools within the district, with a total of 3,831 children enrolled in this Service. The Goroka Hospital, serving Chimbu, Southern and Western as well as the Eastern Highlands, is a two storey construction with a 267 bed capacity. The total number of outpatients treated during the year was 46,864 with a daily average of just on 129. The standard of radiography has been improved by the installation of a new scrpening unit together with a micro-film unit. The Australian Red Cross Society (Papua and New Guinea Division) provides an efficient Blood Transfusion Service in close association with other services in the Goroka Hospital. A total of 4,201 blood donations were taken to provide 2054 transfusions. Malaria detection services continue to operate in all hospitals in the district. A total of 4,174 blood slides were examined with a total of 487 positive. 57

Maternity Ward, Goroka Hospital

Activities during the year '. I'

Villages sprayed Plantations sprayed Mission Stations sprayed Agricultural Stations sprayed Anti-malaria drugs distributed to Total structures sprayed

655 42 21 4 96,951 persons 105,416

Leprosy Control in the Eastern Highlands is supervised by the Regional Leprosy Control Unit based at Mount Hagen. There are 1,049 registered cases of leprosy in the district and 31 new cases were diagnosed during the- year under review. Plans are underway to set up a leprosy unit at Goroka. Tuberculosis control activities carried out by the Unit during the year were most encouraging. A mass BCG vaccination programme has been carried out throughout the district, except for isolated areas which are being done gradually by extended patrols. This has included the checking of all labour recruitments before they are transported down to the respective coastal plantations, in which the Unit works in close co-operation with the Highlands Labour Scheme. The results have been gratifying and the number of new cases registered for the year was extremely low. Number of x-rays during the year Mantoux and BCG given in hospital Mantoux BCG Mass BCG vaccination BCG through maternal and child health activities 193

4,248 2,109 42,}61 1,133

The School of Nursing, Goroka General Hospital, prepares male and female general nurse trainees in the Territorial Nursing Syllabus and female nurse aides. It carries a tutorial staff of five. Full use is made of the hospital medical and paramedical staff to provide instructions in all aspects of medicine, surgery, psychology, and physiotherapy to the full extent of the trainees requirements. Staff of the Teachers' Training College, Goroka, attend the school two hours each week to conduct lessons in English and Mathematics. There are four pre-schools operating in the district. The latest addition being at West Goroka. Integrated attendance has been the aim of both Goroka and West Goroka pre-school centres, as it is at Kainantu. 59

Missions are still playing an active part in the Health programme particularly in the maternal and child health field. The Swiss Mission at Obura has taken over the duties previously undertaken by an administration aid post. The new buildings were a joint Mission and Council effort. The Four Square Gospel Mission at Fore has set up a new permanent maternal and child health clinic. There are 14 mission stations receiving subsidy for health work, 10 at aid post level, 2 at maternal and child health level and 2 at both maternal and child health and aid post level. The growing interest of the Local Government Councils and the people of the Eastern Highlands district in health, is shown by the number of projects financed by them in the past year. There are eight Local Government Councils and during the year a total of $40,516 was spent on health projects in the area by them, including a new ward, several permanent aid posts, and a maternal and child health clinic in the Sighere Rural Health Centre at a total cost of $2,026, of which a 25% subsidy was paid by the Department. The amount spent by individual Councils was as follows Watabung Asaro Goroka Henganofi Kainantu Lamari Okapa Lufa $ 9,654 23,114 400 2,853 372 2,693 1,430

The Asaro Local Government Council purchased a new Toyota 4 x 4 L.W.B. and has had this converted to an ambulance/general purpose vehicle. The Lufa Council completed a gravity fed water scheme covering the council centre, Lufa station and hospital plus 8 villages. Funds for this scheme from the Local Government Council and Rural Development amounted to $3,000. The self-help from the local people was valued at. $2,000.

Chimbu District District Health Officer-Dr C. O. Bell, M.B., Ch.B., D.P.H.

This small district is one of the most rugged and densely populated districts in the Territory of Papua and New Guinea. The total population approximates 187,000, giving a ratio of 1 to 530 per square mile. Communication is by air to outlying areas and by an ever increaSing network of roads. Extensive cash cropping makes the district a prosperous one. The Administrative headquarters are at Kundiawa on the Highlands highway and from this important communication centre the district Health Office controls 4 sub-district hospitals at Gumine, Gembogl, Kerowagi, and 94 aid posts. In accordance with Departmental planning and ideas from East Africa and India, health planning in the Chimbu district is concentrating on the siting of Rural Health Centres as semi autonomous units allocated on a population density basis and distance of a population from a major medical centre. '~f-.

During the latter part of 1969 a major influenza epidemic swept through the district. A total of 365 deaths were recorded from an infected population of 157,000. The low death rate of 0.23% was mainly due to the curative services provided by the medical patrols in the villages at the height of the epidemic. A district malaria service which operates from the Malaria Training School, Kundiawa, together with the high altitude, serve to protect and keep the incidence of malaria extremely low among the 160,000 people living there. Anti-tuberculosis activity in the district is preventing introduction of this disease from lowland districts. A comparison chart is shown below in support of this. Full Therapy N.A.H.Prophylaxis Full Therapy Q..J?. g. New cases since 1.4.1969 1 5 9 Prior to 1.4.1969 6 .1l ..2.

B.C.G. vaccinations

1969/70

79,852

Leprosy, an important disease in remote areas of the Chimbu, is steadily being controlled. The extended trials for long acting drugs are being carried out in the Karamui area by the School of Public Health, Sydney University, and the Leprosy Section of the Department. Leprosy new cases since 1.4.1969 total 71, which brings the total number of cases throughout the district to 1,143. 61

Maternal and child health activities continue their high standards of care and infant vaccinations. A total of 35,889 triple vaccinations were given in the past year. The Dental Section recorded a total of 2,021 new enrolments for the year with 1,159 revision examinations on treatments being given. In areas with a high prevalence of iodine deficiency (goitres and cretinism) 24,000 iodised oil injections were given.

The Chimbu Councils are very "health minded" and, led by the Kerowagi Council, provided solid financial backing for hospitals, rural health centres and other Health projects in the Chimbu district. Capital improvements in the last year included 4 new wards and extensive improvements to existing structures at the Kundiawa Hospital. New wards were added to the Hospitals at Gumine and Gembogl and a new milk room and diet kitchen at Gembogl. The new Kerawagi Hospital is moving steadily to completion and a Rural Health Centre at Kup, Kerowagi area, is in the course of erection. Plans are completed and construction advanced for a Dental Office complex, Kundiawa hospital, and a District Health Centre, Well Baby Clinic and pre-school are all in the planning stage for Kundiawa town. The construction of a sanitary depot for Kundiawa town is underway. A health inspector, a third Doctor at Kundiawa and clerical district staff have improved the staffing situation this year. ;

Western Highlands District District Health Officer-Dr I. D. Welch, M.B., B.S., D.P.H.

This is a mountainous district of 9,600 square miles, with altitudes ranging from below 1,000 feet to over 12,000 feet, Communications depend mainly on patrols, light aircraft and four wheel drive vehicles. Apart from the District Hospital at Mount Hagen there are 6 other Administration hospitals, 2 rural health centres, 5 mi~sion hospitals, 2 leprosy hospitals and 178 aid posts of which 45 are staffed by missions. 62

The most important occurrence for the year was the influenza epidemic which, combined with an unusually severe wet season, caused 1,088 deaths throughout the district, with the highest mortality being in areas above 6,000 feet. Out of an estimated population of 320,000 the death rate was 0.32%. The malaria control unit, which has currently seven project areas in the attack phase, covers the Wahgi and Nebilyer Valleys, the Bai-

yer River Basin and the Kambia. The tuberculosis control unit continued mass B.C.G. coverage and case detection. The Mantoux conversion rate trial continues at Laiagam. The Regional Leprosy Control Unit for the Southern, Western, Eastern Highlands and Chimbu district is based at Mount Hagen. This unit liaises with the two Leprosy Colonies in the Western Highlands District and the Leprosy Mission in the Southern Highlands District. There are 4,156 registered leprosy cases in the district and 37 new cases were diagnosed to 31st March 1970. Maternal and child health workers were most active throughout the year. The following table gives an indication of the work being carried out: p~

~.mG~

MISSIONS 158 3,028 11,852 2,143 571 1,999 23 3,154 1,583

No. of No. of No. of No. of No. of No. of No. of No. of No. of

clinics held each month babies enrolled under 1 year babies enrolled over 1 year ante-natal enrolments births in hospitals births noted in villages Schools visited children enrolled children examined

23 824 3,196 451 461 782 12 1,804 662

Training courses for nurse aides and aid post orderlies continues. The Administration, Mount Hagen Hospital, had 18 nurse-aides in training. The various missions in the district had a total of 24 nurse-aides and 76 aid post orderlies in training. ~

Research in the Jimi River area into the incidence of goitre and mentally retarded children was carried out. The School Dental Service saw a total of 6,757 registered school children and 4,219 general service patients.

Financial assistance from Local Government Councils totalled $18,600. The Wapenamanda Local Government Council donated $6,000 for 63

radiographic equipment to the Immanuel Luthern Mission Hospital at Mambisanda. An amount of 87,000 was allocated to hospital improvements at Laiagam, Wabag, Kol and Baiyer River Baptist Mission and a further 85,600 to 7 new aid posts. There are 2 pre-schools in the district with an enrolment of 77 children.

Southern Highlands District District Health Officer-Dr H. W. Vickers, B.Sc., M.B., B.S., D.P.H. The district, geologically, consists of a limestone plateau eroded into a system of rivers draining towards the Gulf of Papua. The plateau is broken in several places by volcanic mountain peaks. Below ~,500 feet above sea level, the population is kept sparse by the high infant mortality from Malaria. Above 7,500 feet there is no permanent habitation because frosts destroy the staple food, sweet potato. Sandwiched between these levels live approximately 190,000 out of a total population of 210,000. The population pressure arid the traditional system of land tenure, means that traditional farmers refuse to live in villages and insist on building their houses on their garden land. This causes difficulties in establishing environmental sanitation projects, organizing immunisation patrols and affects the epidemiology of enteric and droplet infections. The secondary road link from Mount Hagen to the eastern half of this district is now fairly reliable. Construction of the highway link has now entered the Ialibu sub-district. The Tari-Koroba area still depends entirely on aerial supplies. Influenza caused 899 deaths in this district. The majority of these were in the Mendi sub-district. The high mortality was associated with wet conditions and below average temperatures, and a lack of communication between people sick in their houses and Health personnel. Vaccination of 45,000 people, free use of penicillin and extensive. outside help, reduced both mortality and morbidity in other sub-districts. Seventeen children suffered paralysis in an outbreak of poliomyelitis in the Tari sub-district early this year. A total of 20,000 children received a dose of vaccine, and this appears to have successfully aborted the epidemic. 64

•

The Department of Public Health, in conjunction with the Local Government Councils, has undertaken a fairly extensive building programme over the past four years, to provide simple permanent materials clinics at the various sub-district headquarters. This programme is continuing, with work this year at 7 stations, concentrating in particular on Tari. A site is being prepared for the new District Hospital at Mendi. Staff at Mendi has been increased by the addition of a health inspector and four nurses. Tari now has two medical officers and three nurses. Staffing at Ialibu has remained static. The School Dental Service had a total of 2,577 attendances for the year, with a further 1,673 adult patients treated. The Tuberculosis Section gave 34,674 BCG vaccinations. Patients with active tuberculosis were treated at the Erave Hospital. Leprosy control is carried out by the Leprosy Mission Control Unit. The Reconstructive Surgery Unit was closed early this year when the surgeon was transferred to Madang. Leprosy surveys have been carried out in the Nipa, Margarina and Tari Basin areas where 50,150 people were examined for leprosy and 78 new cases were re~ istered. There are 15 maternal and child health clinics operated by various Christian missions. These also do maternal and child health patrols. The Department has commenced a maternal and child health service at Kagua to serve accessible population of 23,000. The only major area now unserved by these patrols is in the Pangia subdistrict. There are only 67 aid posts and poor roads make this one of the most serious health service deficiencies in this district.

East New Britain District District Health Officer-Dr A. A. Becker, M.D. (Szegid), D.P.H.

The East New Britain District covering 7,000 square miles of the island of New Britain has a population of approximately 115,000. The majority of these live in the Gazelle Peninsula Which is well supplied with good roads and good communications with Rabaul. Rabaul, which is the Administration centre for the East New Britain district as well as the New Guinea Islands area, provides medical services at Nonga, and in the town itself. The ~onga Base Hospital has approximately 400 beds and a daily average of 253.17 public patients and 24 intermediate patients; 75,000 outpatients were treated at the hospital and the town clinic during the year; 990 minor and 698 major operations were performed. The hospital provides specialist services in surgery, medicine, ophthalmology, gynaecology and obstetrics, and anaesthesia. The medical officers stationed at Nonga, apart from the specialists mentioned above include resident medical officers undergoing training in various specialised departments and casualty work. The Nonga School of Nursing has 155 students: 42 in the first 37 in the second year, 36 in the 3rd year and 33 finalists. There are also 7 girls undertaking a twelve months Post-Graduate Training Course in Midwifery. ye~,

The Kokopo sub-district hospital at Butuwin has a daily average of 26.05 and catered for 13,000 outpatients attendances during the year. The Pomio Hospital on the south coast has approximately 40 beds. There are two fully staffed Council Rural Health centres at Tapipipi and Vunapaka. The Catholic Mission has a large hospital at Vunapope and other hospitals at Paparatava, Uvol, Evora and Napapar. The United Church has a 50 bed hospital at Vatnabara on the Duke of York Islands and also an obstetrical training centre for nurses. Gaulim, in the Gazelle Peninsula is another hospital conducted by this mission. The Seventh Day Adventist Mission has a small clinic at Kambubu. Bitapaka is the district Tuberculosis Hospital and is staffed by the Roman Catholic Mission. It has 450 beds, and this year has 66

•

~d who have previously been treat=~s are 1n the Gazelle Peninsula 1stance away from their homes.. in New Ireland a considerable

accepted leprosy patients whose ho

BOG vaccinations and took 3,727 micro-film x-rays. For the past 12 months the first stage of the Community Health Centre in Rabaul has been constantly used for maternal and child health clinics, which are carried out daily. Maternal and child health in the East New Britain district provides through the Public Health Department, 103 clinics, and, with the Missions, another 108 clinics, making a total of 211. The maternal and child health and mission sisters supervise the health of over 15,000 children in 353 villages in the district. The total number of hospital confinements in the last year was 3.309. whereas the total number of village confinements was 449. It can be seen from this how the people of East. New Britain accept the maternal and child health instruction and facilities afforded. The three maternal and child health mission training schools 'produced 14 graduates this year, who have been posted mainly to Mission stations. Only one new station has been opened in the past year, this was at· Marunga. The population covered by the services of the missions and the Public Health Department through the maternal and child health sector was over 87,000. Extensive immunisation campaigns were carried out in the district. The School Dental Service for the district had a total of 7,013 attendances for the year, and a further 4,209 received treatment under general services. The building of the second stage of the Community Health Centre in Rabaul commenced in April of this year and it is hoped that it will be completed in October. This will provide much needed accommodation for a new Town Clinic and dental and other auxilliary services, which have been scattered about the town of Rabaul in unsatisfactory buildings for many years •.

The Tuberculosis

Control

Section gave 1,300 mantoux tests, 5,412

West New Britain District Health Officer-Dr

District J. de la Cruz,

Dip. Med. Sch. (Suva), D.P.H.

West New Britain District has an area of 6,760 square miles consisting of Talasea, Hoskins and Kandrian sub-districts, with an overall population of 53,000 of which 4,000 are in the Oil Palm Project area. The new District Headquarters are now at Kimbe, a newly developed town which links Talasea and Hoskins by road. There are three sub-district hospitals which are located at Talasea, Cape Gloucester and Kandrian. Land has been set aside for a District Hospital at Kimbe and building plans are currently being drawn up. The construction of the 1st stage will commence in early 1970/71. During the year the Talasea hospital, which is still the District Hospital for West New Britain, had recorded 652 admisSions, 663 discharges and 11,643 outpatient attendances. There are 4 rural health centres in the district of which three are fully staffed. The Ewassi Rural Health Centre in the East Nakanai, which is being built on a community basis especially by the Nantambu Memorial Foundation, will be completed this ye~ and will be staffed by the Department. The Oil Palm resettlement area is served by the rural health centre in Nahavio and the Catholic Mission hospital at Valoka. Missions of various denominations have eleven small hospitals in the district and their main activities are centred in the field of maternal and child health. There are 40 aid posts in the district, three of which are run by missions, the balance being administered by the Department of Public Health. The Tuberculosis Control Section gave 188 Mantoux tests, 2,462 BeG vaccinations and took 1,132 micro-film x-rays. The Malaria control programme has been progressing successfully without any complaints and without encountering any resistance from the people. Malaria teams are based at Talasea, Cape Gloucester and Kandrian •. Six-monthly spray rounds have been successfullW carried out. The only problems confronted were inadequate means of sea transport. Medical patrols have been continuous throughout the year as means of communication at village level but are quite inadequate especially in the wet season. A vaccination campaign with triple antigen has been completed in the Kandrian sub-district with 683 third doses of vaccine being administered. In this particular area all maternal 6B

and child health work is carried out by the Administration, as the missions are unable to gain access. Village sanitation and hygiene work was continued through medical and health patrols conducted by field staff and hospital staff. There is only one dental nurse clinic in West New Britain district and this is at Talasea. The total number of schools registered in the School Dental Service is 10, with a total of 1,457 registered pupils. The total number of initial examinations was 467, revision examinations 1,384 and attendances 1,851. The general service total attendance for treatment was 165 patients.

Bougainville District District Health Officer-Dr A. Toua, Dip. Med. Sch. (Suva), D.P.H.

The Bougainville District, which includes Bougainville and Buka Islands, Feads, Nissan, Cartarets, Mortlocks and Tasman Islands, has a total population of approximately 75,000 people scattered in an area of 4,100 square miles, in the Solomon Sea. The main island of Bougainville has a rugged terrain with volcanic ranges, the highest peak being 8,500 feet. The major portion of the population is found along the east coast where the villages, plantations and towns are accessible by sea and air transportation. The District Headquarters is in Kieta which controls five hospitals, one rural health centre and 81 aid posts and one Leprosarium at Torokina which is managed by the Roman Catholic Mission. The Kieta Hospital provides medical and surgical services for the district and acts as the Base Hospital. The various religious denominations control 23 medical centres including two general hospitals with training facilities for maternal and child health nurses. The major field health services are conducted from Kieta, Sohano, Buin and Wakunai hospitals, supported by Tearouki, Moratona and Torokina hospitals. During the year the Administration maternal and child health services have conducted clinics with 2,455 enrolments, 714 antenatals, 517 confinements and 2,854 triple antigen, 636 CDT, 868 Tetanus Tox--oids, 4116 BCG injections and 40 doses of oral sabin. The Tuberculosis Control Section gave 1,211 Mantoux tests, 4,422 BeG vaccinations and took 369 micro-film x-rays. The number of leprosy patients in the district increased by 6 new cases, bringing -the total registered to 297. 69

The school medicals have been carried out jointly bV the Administration staff and the mission sisters. The three dental assistants stationed at Kieta, Sohano and Buin are responsible for the school dental services as well as the treatment of adult patients. The School Dental Service for the district had a total of 4,900 attendances for the year, and a further 2,474 people received treatment under general services. Malaria control programmes are being centralised at Kieta under a District Supervisor, who is assisted at sub-district levels by three area supervisors. The activities of health inspector are centred in Kieta but extending to cover other sub-districts. Health education activities are carried out in the field by the health education officer, maternal and child health teams, aid post orderlies and health education orderlies. The interest shown by the Local Government Councils have been increasing as indicated by the improvements on the quality of aid posts and developments of Council Health Committees. The demands on the standard of health services are increasing due to the rapid increase in the development of the Copper Mining Project and other primary industries within the district. Main achievements during the year are 1. 2. ~.

New intermediate wing with intensive care, maternity, operating theatre and x-ray unit attached at Kieta. New dental clinic at Buin. Control of Panguna Hospital by Department of Public Health which provides a medical officer and sisters. Increase in the number of doctors, sisters and health inspectors to cope with the increasing demand around Kieta.

The major problem arising from the rapid industrial development of the area has been a sharp increase in mortality arising from accidents, both at construction sites and on roads, due to the greatly increased traffic without a corresponding increase in the quality of the roads or traffic control. 8 deaths occurred in one construction accident and in one road accident alone 7 people died.

Manus District District Health Officer-Dr H. Danomira, Dip, Med. (P.M.C.)

The Admiralty Islands, of which Manus Island is the prinoipal island, oover an area of 800 square miles with a population of 23,704 people. Inoluded are the Western Islands about 200 miles to the west, with a population of about 450 Micronesians plus imported labourers working on coconut plantations. Health services are carried out from the Administration hospital at Lorengau, the Naval Base Hospital at Lombrum (20 miles away), the health centre at Baluan, three Christian mission hospitals and 26 aid posts. A feature of the aid posts is that none is unstaffed and these frontline health workers are given the chance of spending 6 weeks at the hospital at Lorengau to do refresher oourses. Both the Administration and the missions oarry out maternal and child health services. Out of Lorengau the team visits 21 clinios regularly, weather permitting. Of these only five clinics can be reached by truck. The team has to spend one week out visiting the off-shore islands and three days visiting the villages inland. Daily clinics are held from Lorengau to nearby villages and islands. Similarly the malaria control service has to depend on the weather and the availability of transport to oarry out its spraying as scheduled. The rebuilding of the District Hospital at Lorengau, commenced in 1967, has seen the construction of one maternity ward and three general wards, a kitChen/mess and store. The final stage, which consists of administration block, outpatients, laboratory, x-ray. theatre and dispensary, was commenced this year and is scheduled to be completed and occupied before the end of 1970. A special mention has to be made of the Western Islands. At the moment health services are carried out by orderlies at two aid posts. With a distance of 200 miles away, a medical emergency takes at least 48 hours to reach Lorengau. Last year the population came into contact with the crew of an Indonesian trading boat that ran aground on these islands. The risk of introducing alien diseases to this small population group is therefore great. Because of the lack of fresh water on these small atolls,the malaria team has to use sea water for mixing DDT. The spraying is resented by the islanders. The Tuberculosis Control Section gave 120 Mantoux tests, 1,328 BCG vaccinations and 3,500 - 70 mm x-rays. The number of leprosy patients in the district increased by 8 new cases, bringing the total registered to 283. 71

The School Dental Service for the district had a total of 383 attendances for the year, and a further 1,360 patients received treatment under general services.

.....

New Ireland District District Health Officer-Dr A. Tarutia, Dip. Med. & Surg. (Fiji), D.I.H.D., D.P.H.

The district comprises the long narrow island of New Ireland, the New Hanover Island, the St. Mathias Group to the north, and the smaller islands of Tabar, Lihir, Tanga and Feni off the east coast of New Ireland. A mountain range extends almost the full length of the main island. Most of the population live in the coastal areas where road communications are good. Lack of shipping hampers communications with the people of the off-shore islands. The District Hospital is at Kavieng, and the Administration maintains 3 further hospitals at Taskul, New Hanover Island and a subdistrict hospital at Namatanai. This latter hospital has been in the stage of reconstruction for the last two years. The wards of permanent materials have just been completed, and work ha~ commenced on the casualty department, dental section and laborat6ry. The final stage, which is the office and theatre block, will be completed by the end of 1970. A local medical officer has been posted to Namatanai - the first for 15 years. The new hospital, with a Doctor in charge, will be an asset to the population in the sub-district. Christian missions staff the Anelaua Leprosy Colony, and in addition conduct 6 major and 3 minor hospitals, all of which receive Administration subsidies for maternal and child health services. There was a total of 104 maternal and child health clinics conducted during the year of these 67 were run by Public Health Department and the remaining 37 by the various missions. A total of 25,511 children between the ages of 0 - 5 years were seen and there was a total attendance of 878 for antenatal clinics. The Local Government Councils in New Ireland contirtue to expand their role of activities which the Administration subsidises. Many temporary aid posts buildings have been replaced with permanent brick buildings. Water projects, wells and water tanks in rural areas continue to upgrade the standard of living in villages. The Administration has 35 permanent aid posts in the district, all of which are fully staffed. 72

The Health Committee continues to operate in conjunction with our District Health Education Officer, who organises and conducts short courses for the Council Health Committees. A New Catholic Mission Hospital has been opened on Lihir Island and a new maternity ward at Mapua, built by the Council and staffed by the Catholic Mission, is almost complete. Recently, 30 leprosy patients from Anelaua were repatriated to Bitapaka on New Britain. Most of them were from the Duke of York Island and East New Britain. No accurate figures of the incidence of leprosy in the district are available, but it does not appear to be a significant problem. New Hanover in a recent survey of 9,000 people had 14 new cases. Tuberculosis patients rece~v~ng treatment at Taskul, Kavieng, Namatanai, Lemakot and Kimadan Hospitals, are being satisfactorily supervised. The fourth mass survey is currently in progress but is behind the set schedule. Mantoux and BCG surveys were recently carried out on New Hanover. Micro x-rays were taken on cases with a positive mantoux. A total of 75 patients under treatment and 8 new cases were registered during the year. Malaria remains the most important public health problem. The off-shore islands are sprayed by the marine team except for the mainland of New Hanover and Tigak Island which are sprayed by Kavieng teams. The Kavieng teams are currently doing sprayrounds at intervals of 8 - 9 months. School dental examinations continue to operate and have been extended to other schools which were not previously covered. The Kavieng pre-school has had a successful year. A lot of work and enthusiasm on the part of the Committee has resulted in the completion of extensions to the building. There are 7 pre-schools in the district with a total of 54 children enrolled. With the arrival of a new medical officer in Kavieng a large number of surgical cases have been dealt with locally, thus reducing the number of patients transferred to Rabaul. Nursing aide training programme continued this year with 10 students undergoing training. It is planned to start a Plantation Managers' course yearly, as more people become eligible to enter this course.

Morobe District District Health Officer-Dr L. A. Malcolm, M.D., M.R.C.P. (Edin.), D.T.M. & H., F.A.C.M.A.

The Morobe District with a population of 2~O,OOO covering 12,700 square miles is divided into two mountainous areas by t~e flat Markham Valley plain. Good road communications provide access to Bulolo and Wau and the Markham Valley, but the mountainous nature of the remainder of the district makes communications as difficult as anywhere in the Territory. Health services, apart from major centres, are based on aid posts and aid post supervisors at small health centres. Community and Local Government participation in health service management has been the main emphasiS in health policy in this district. Malaria spraying operations in the Markham Valley and around the town of Lae have resulted in a dramatic reduction in the: level of parasitaemia of village people. In some areas entomological surveys are now failing to find anophelines. A total population of 47,000 people is covered by this service. Tuberculosis control surveyed 2~,076 people in the Lae, Erap, Menyamya and lower Watut areas during the year. 575 new patients were located mainly from the urban area of Lae. Leprosy is a problem essentially localised in the Kabwum area of the Huon Peninsula and 54 inpatients and 166 outpatient"s are being treated at Etep. Maternal and child health services expanded into Kabwum and Kasonombe with monthly visits, and Want oat was opened as a permanent station clinic. Services were provided by 1~ Administration and mission centres, with an enrolment of 16,519 children. Health Education activities included 5 refresher courses for aid post orderlies, aid post supervisors and Council Health Committee members, during the year. The School Dental Service, with two dental officers and 5 dental assistants treated a total of 9,989 children enrolled in 68 schools. Five 'A' type and two'S' type pre-schools in the district have an enrolment of ~20 children. Councils have continued to receive advice and assistance from the hygiene section and ~4 wells and water supply projects were 74

completed by councils and 214 project inspections made. Research into growth and development and nutrition of New Guinean children has shown that although town children are reasonably well nourished, and growth rates satisfactory, growth rates are retarded at the village level, especially in the Highland areas. Medical and health services are provided by 14 Administration and mission health centres, and 153 Administration, 43 Council and 20 mission aid posts. Angau Memorial Hospital at Lae provides general and specialist medical services to the district. A decline has been noted in the daily average of public inpatients over recent years to 267, but there has been some increase in the number of admissions, 6,207 for 1969/70, indicating a more rapid turnover. A further 20 girls graduated from the Angau School of Nursing during the year and enrolments increased to 107. Nurse aides in training total 41 with 11 gradUations. The Territory Artificial Limb Factory at Lae produced and fitted 128 new limbs and manufactured 2,900 pairs of crutches and 285 pairs of protective footwear for leprosy patients, as well as attending to the maintenance and manufacture of hospital equipment. The Morobe District was severely affected by the influenza epidemic in September-November, 1969, and an estimated 580 persons died from the direct effects of the epidemic.

Madang District District Health Officer-Dr M. V. Dunjey, M.B., B.S., D.P.H.

This district of 10,800 square miles, has a population estimated at 160,000. It is divided by the Ramu River into an inland mountainous area and the coastal Adelbert and Finisterre mountains. The district also includes several islands. Roads are under construction from the district headquarters at Madang to Lae and also along the north coast to Eogia. When completed, these roads will do much to open up areas for health services. Madang District Hospital has 240 beds and provides specialist, surgical and physician services. Other large hospitals in the district are the 400 bed Lutheran Mission hospital at Yagum, with specialist surgical facilities and the Administration tuberculosis and leprosy hospital run by the Seventh Day Adventist Mission at Hatzfeldhaven. 75

There are 11 Local Government Councils in the district of which conduct a total of 30 aid posts. A further 11 aid posts are run by the Administration and 19 by missions. ~

....

The maternal and child health service in the area holds 239 clinics (64 Administration and 115 mission). A total of' 141,215 children between the ages of 0 - 5 years were seen during the year, ~,218 being new enrolments. The tuberculosis control section continued treating patients at centres. Surveys covering all Manam Island and Madang town were completed. Following a wide-spread publicity campaign over the local radio and in local cinemas, over 75% of the Madang town population attended the mobile x-ray unit. The unit is at present active in the surrounding villages of Madang. Work carried out by the unit during the year includedl 9,500 Mantoux tests 14,000 BCG vaccinations 12,300 Micro...films Ninety-five newly diagnosed patients were commenced on outpatient therapy and twenty-one on inpatient therapy.

main

The Leprosy Reconstructive Surgery Unit based at Madang performs operations throughout the Territory: 2~4 hand and foot operations were performed by the unit. The leprosy control unit also examined 22,000 people and found 200 new cases. Of the total 1,300 cases on the district register, 430 are receiving domiciliary treatment. A malaria control programme continued on Manam Island, and preoperational surveys were completed in the Bogia sub-district and in the Bundi-Ramu area. The School Dental Service had a total of ~,046 attendances, and a total of 1141 general service treatments were given for the year. The Institute of Human Biology in association with the International Biological Programme has been conducting research programmes on Kar Kar Island, and is currently transferring to Goroka. The nurse-aide school at Madang General Hospital graduated 10 students and has a present enrolment of 32 students. The Paramedical Training Centre has a total of 61 students enrolled for first and second year training as health inspectors and health extension officers. The Madang District, particularly in the Highlands areas, was severely hit by the influenza epidemic, with over 200 confirmed deaths reported. More than 30,000 influenza vaccinations were administered. 76

District

East Sepik District Health Officer-Dr P. o. D. M.B., B.S., L.R.C.P., B.Sc.

Pharoah,

•

The estimated population or 172,000 in the East Sepik District is concentrated along the coast, the coastal hills and along the banks of the Sepik River and its tributaries. There are large areas with only a scantly, widely scattered population. Many people in the upper reaches of the Sepik River have only recently been contacted. In November 1969 the influenza epidemic was at its highest peak in the district. From an estimated 157,931 cases there were a total of 128 deaths. No effort was spared in the distribution of injections and other medical aid until the epidemic was under control. In the field of preventive medicine special emphasis has been placed on malaria control. Over the past year there has been a marked fall in the parasite rate in almost all the sectors covered by spraying. Entomological investigations being carried out at Kreer and Patigwa villages have revealed some interesting trends and further work is in progress. The district malaria laboratory has been transferred from Maprik to Wewak to provide a more centralised service. Preliminary malaria surveys have been completed in the Grass and Pora Pora census divisions. An increasing resistance to spraying by the people gives some cause for concern in an otherwise successful year. It is estimated that 134,800 of the population is protected.

An extra member of staff for leprosy control has made it possible for a systematic patrolling in the Wewak and Ambunti sub-districts to be carried out. This has resulted in 14 new cases being recorded for the year. The tuberculosis control unit, though stationed in Wewak, also serves the West Sepik, and in the past year has worked in that area, completing surveys in the Lumi and the Telefominsub-district. Work has been hindered on some occasions by mechanical trouble with the mass X-ray unit. During the year the following work was carried out: B.C.G. vacoinations Mantoux surveys X-ray 70 mm micro-film 17,738 8,042 4,441

Maternal and child health services are provided by three Administration and 17 mission stations. During the year a new mission clinic was established at Yassip. The total number of clinics held for the year was 29,580 by Administration and 109,630 by the various missions with a total attendance of 31,301 and 117,960 respectively. 77

There are 120 aid posts in the district run by the Administration. Medical services at Dreikikir have been improved with the building of two new wards. A large portion of the funds were provided by the Local Government Council. A new health centre at Wosera is partially completed, and should be fUnctioning in the near future. It will serve a population of 18,000 and will be most effectively utilised when bridges are completed on the all-weather road link with Maprik. Local Government Councils in the district have installed one well in Maprik and four in Wewak. There are 2 pre-schools in the district with a total of 91 children enrolled and are staffed by one locally trained officer and one overseas officer, respectively. Dental services increased with the commencement of a clinic in Angoram. Twelve schools have been enrolled with this clinic, bringing the total number of schools covered by the school dental service in the district to 58 and the number of attendances to 8,979. The general service had a total attendance of 2053 patients for the year.

West Sepik District District Health Officer-Dr M.B., B.S.

L. Foote,

The west Sepik District covers an area of 19,700 square miles, and has a population of over 100,000. The District borders on West Irian, and is for the most. part rugged with few roads, so that almost all oommunication is by air. There are 7 Administration hospitals, 1 rural health centre at Aitape, 58 aid posts, and a mission hospital at Anguganak, providing health servioes in the area. During the last year patient statistios for these establishments were as followsl Total Admissions Total Outpatients Daily Average Inpatients 8,276 37,641 510

As a result of reoent disoussions it is envisaged that Raihu hospital, whioh at present treats only leprosy and tuberbulosis oases, will shortly accept all general patients from the Aitape area. This will allow the Aitape rural health centre to function purely as a 78

Outpatient Department, West Sepik District

centre from which malaria, leprosy, dental tuberculosiS and health education patrols can move into the surrounding areas. Leprosy remains a major health problem within the district. Extensive patrols have been carried out in the Lumi sub-district and are currently being undertaken in the Aitape sub-district. Malaria control continued with spraying activities over the whole of the coastal strip and inland to Imonda. The attitude to spraying varies from community to community, with acceptance by the majority, but with an occasional request for the withdrawal of spraying teams. Dental services increased with the establishment of a clinic at Vanimo staffed by a dental aSSistant/nurse. There are now 3 dental assistants in the district who are all engaged in a patrol programme which covers 38 schools and approximately 5,410 pupils in 41 schools. Maternal and child health services are conducted entirely by missions within the district, where they have established 19 clinics, and reach approximately 70% of the population. Malnutrition remains a serious problem in the Amanab and Lumi sub-districts. This is reflected in the toddler mortality rate, which is one of the highest in the Territory. There has been a steady trickle of refugees into tht district from West Irian over the past twelve months. Quarantine and surveillance measures have been maintained and no communicable diseases have been detected. The influenza epidemic affected about one third of the West Sepik population, but the mortality rate remained low except" in the South West Wapei. The disease did not affect the more highly populated areas of the Lumi and Telefomin sub-districts but the v~lue of the mass immunisation campaign, and the restrictions on travel within the areas, could not be assessed.

Central District District Health Officer-Dr C. G. Mills, M.B., B.S., D.P.H.

This district extends over 12,000 square miles and has a population of approximately 150,000. Of these, some 58,000 are resident in Port Moresby, the district headquarters. Communications are mainly by air as there are only sub-district roads, which do not link the main centres. The exception being Kwikila which is linked with Port Moresby by trafficable road. 80

Port Moresby General Hospital provides general services for Port Moresby and specialist services for Papua. A separate report is given elsewhere for this hospital. Urban Port Moresby is served by 3 large clinics which treat approximately 18,000 patients a month. Seven smaller aid post type clinics and a special maternal and child health clinic, which undertakes home visiting and family planning, also provide services in the surrounding area. These clinics are in the process of integrating the tuberculosis, maternal and child health and general sections to form part of the community health services. A total of 132,253 children between the ages of 0 - 5 and 1,830 antenatal patients were seen in the 141 clinics of which 103 are run by the missions and 38 by the Department of Public Health. The venereal disease clinic, under the supervision of the Port Moresby General Hospital, sees approximately 100 new cases per month, mainly donovanosis and gonorrhea, although syphillis is seen in two or three cases per month. During the influenza epidemic in 1969, 23,705 first injections and 20,000 second injections of influenza vaccine were given. The death rate was extremely low. Service clubs have assisted in expanding the Janousek Clinic at Sogeri, which now has six beds and a dental unit. A dental clinic has been completed at the Hagara School. Staffing of these clinics is a problem at present. The Local Government Council has improyed the health centre at Kupiano, and improvements are at present underway at the Bereina health centre. Gemo Island leprosy and tuberculosis hospital has been connected to the Napa Napa power supply and considerable improvements have been carried out on buildings and equipment. The tuberculosis control section continued its good work in the district and the following tests were completed: 70 mm. x-rays Mantoux Skin Tests 11,971 6,793

.~.

The total number of leprosy patients in the district now stands at 487, 51 of these being new cases recorded this year. A new building has been completed for the Council Health Services to provide training for council employees in the maintenance of wells and pumps, and in the broader aspects of environmental sanitation. Bores have been successfully sunk by this service at 3 schools, and wells have been constructed in 2 urban settlements. A co-ordinated quarantine service has been established to investigate pressing problems. A survey of living conditions on vessels registered in Port Moresby is currently under way, and a survey of rats and rat trapping has been completed. 81

Similar difficulties to those in other districts ~ve been encountered by the malaria control units. Complaints have been received that DDT brings bed bugs and rats, kills cats and dogs, and makes houses look dirty. Investigations are being carDied out and there have been some personal requests from the people to have their houses sprayed with the new spray. On the other hand encouraging results of the spraying activities show that in recent surveys, the parasite rates have dropped considerably. There are 13 pre-schools in the district with an enrolment of 588 children, staffed by 7 overseas officers and 4 locally trained staff.

•

Gulf District District Health Officer-Dr B. G. Walker, M.B., B.S.

The Gulf District, with an area of approximately 15,000 square miles, is one of the largest in the Territory, but has a relatively small population of only 67,000 people. Its proximity to Port Moresby and the poor quality and swampy nature of the settled areas are the main reason for a 30% absentee rate in the coastal villages. The heal th services are hampered by the almost complete reliance on water transport. There are only 60 miles of road in this District which is nearly four times the size of Bougainville. Medical patrols have been active throughout the whole district and full. and comprehensive reports made on all areas visited. The influenza epidemic called for extended medical patrols for vaccination and treatment. The Administration District Hospital is at Kerema with three smaller establishments at Kukipi, Ihu and Kikori. The dental aSSistant/nurse made 2,272 initial examinations and gave 1,987 treatments within the school dental service. Of these, 493 were given under general dental service. There are no malaria control units in the district at present and work in this field is confined to the treatment of fever. A malaria diagnostic unit visited Kerema during the year aad 487 slides were taken. A tuberculosis survey team from Port Moresby visited the Kikori area and has just completed a BeG vaccination programme. A health education campaign was carried out in the Guaregare and upper Kikori census division. Environmental hygiene inspections are carried out regularly by medical patrols and immunisat~on and health 82

education talks given at each village visited. On one such tour alone, 28 village.s were visited. The response to such inspections and talks has been heartening and brought forward an increased interest by the villagers into their own living conditions. The missions provide a large portion of the treatment services for leprosy and tuberculosis patients, both in their hospitals and by domiciliary treatment. Maternal and child health services are taken to the Administration and missions to almost all the coastal villages in the district. There were 133 monthly clinics held during the year of which 94% were conducted by missions. Mission services include a large hospital at Kapuna with a daily average of 100 patients and five minor hospitals run by nursing sisters. Kapuna hospital undertakes training of maternal and child health nurses and aid post orderlies. There are a total of 45 aid posts in the Gulf District, all of which are in operation. Of these 15 are staffed by missions, 8 by Council employed orderlies and the remainder by Administration personnel. Four new aid posts are under construction and expected to be opened shortly. Council participation in health work has been considerable. At Kukipi there is anew hospital ward under construction by the East Kerema Local Government Council and at the Kapuna Hospital a new ward has ~een built. In addition financial assistance has been provided towards the erection of a Rural Health Centre at Kikori. Between the seven Local Government Councils in the district, 8 aid posts have been built; water tanks installed in 9 villages, and a total of 19 wells have be.en put down.

Milne Bay District District Health Officer-Dr G. E. Mellefont, M.B., B.S., D.T.M. & H.

The Milne Bay District.has a land area of 7,800 square miles and a population of approximately 104,000 people. It is a marine district with the population settled over 160 named islands and many more smaller islands and atolls. The isolated nature of many parts of. the district presents a major transport and communication problem to the health authorities. 83

There are 6 Administration hospitals in the district, a further

3 mission hospitals, an Administration leprosy hospital operated by a mission at Ubuia and a tuberculosis hospital at Kwato. Missions also maintain several smaller establishments run by nursling sisters. The Administration provides 68 aid posts, the missions 10 and Local Government Councils 20. There is one pre-school in operation with an enrolment of 25 children. A district health educator, district malaria supervisor, health inspector and tuberculosis control officer are stationed at the new district headquarters complex at Alotau. The district health office is expected to be moved from Samara! to Alotau in the near future in order to consolidate the whole district health services. The influenza epidemic in 1969 was kept under control in the district by constant surveillance and 6,000 influenza injections were given. Local Government Councils have made considerable contributions to the health services of the district. Their activities have involved the improvement of water supplies and the establishment of 20 aid posts serving approximately 100 villages •. A mass x-ray programme for the detection of tuberculosis was carried out in the Losuia sub-district during 1969 and 6,210 - 70 mm. x-rays were taken. A comprehensive leprosy detection survey is at present going on in the district.

The main programme in the district is the malaria control programme, which has been in operation for a number of years, and provides protection to the whole population. The allocation of a second trawler to the district has greatly facilitated work in this field. Maternal and child health work has played a major role in health activities during the year. Clinics were organised from 19 centres and covered 443 villages. More than 50,000 infants were examined at these clinics. There were 6,038 children enrolled in the School Dental Health Service in the Milne Bay District. It is to be noted that for six months of the year there was no dental officer in the district and as a consequence School Dental Services in the Samarai and Alotau sub-districts have suffered. During the six months of operation 2549 initial examina.tions and 4,220 revision examinationsl were done 84

•

by the School Dental Service. for general services.

A further 1,534 patients attended

Northern District District Health Officer-Dr F. M. Aisi, Dip. C.M.S. (Suva)

The Northern District has a total area of 9,000 square miles and an estimated population of just over 60,000. An all-weather road runs from Popondetta, the district headquarters, to Kokoda, but communications with other parts of the district are limited by the mountainous or swampy nature of the area. The district is served by a 75 bed District Hospital at Popondetta, 3 sub-district hospitals at Tufi, Ioma and Kokoda, a maternal and child health training centre at Saiho and the Embogo Chest Hospital, which is financed by the Administration and staffed and managed by mission workers. In addition to these Administration provided services, Christian missions maintain a 50 bed hospital at Oro Bay and 5 minor hospitals run by nursing sisters. Close liaison is kept with the local government councils, who provide 17 of the 45 aid posts throughout the' district, and are involved in the construction of wells and other water supplies. The Administration maintains 22 aid posts and religious missions 6. There is one of 21 children.

"s"

type pre-school in the area with an enrolment

The malaria control service continued to provide total coverage through its spraying activities. A certain amount of opposition to spraying activities was encountered, but was successfully overcome by health education workers. Leprosy surveys were carried out in the Saiho, Popondetta-Northern Coast and Oro Bay census divisions: 20,524 people were examined and a total of 37 cases of leprosy confirmed. A tuberculosis survey was commenced in the Popondetta-Kokoda area. Results are not available as the survey is still in the follow-up stage. Influenza struck the district in October 1969, but there were few deaths. 85

With the arrival of two dental personnel, dental services were extended to adequately cover the whole district. The staff strength of the section is now three. There were 2,365 initial examinations and 57 revisions making a total of 2,931 children examined under the School Dental Service together with 1,436 total treatments for general services. A health eduoator was also posted to the district early in the year. Maternal and child health work from Saiho expanded to cover Kokoda and villages along the main road. The missions have 6 clinics and greatly assist in ooping with vaocination programmes. The following statistics relate to maternal and child health work during the year: Number of clinics held Child attendances Ante-natal attendances Immunizations TA CDT Tetanus BCG Sabin

2,099 82,312 5,511 4,979 1,174 1,471 1,728 3,342

Western District District Health Officer-Dr P. M.B., B.S.

J. Moody,

A large part of the 37,000 square miles of the Western District is savannah and gra3sland which is subject to drought during the dry season and extreme flooding in the wet period. The remainder of the distriot comprises broken foothills rising toward the main Central Range which towers to 14,000 feet. Soils in the district are of low fertility. The population is only 65,000. There are extensive river systems, 'the Fly River being navigable by craft of considerable size for over 500 miles. Roads are practically non-existent and communications poor. All areas were covered in the influenza vaccination programme, including the Star Mountains which are 2 - 9,000 feet apove sea level. The District Hospital is located at Daru, the administrative centre of the Western District. This 164 bed hospital has a daily 86

average of 105 inpatients. Sub-district hospitals are located at Balimo, Morehead and Ningerum.

An amount of $4,000 has been allocated from the Hospital Improvements Vote for the building of a new administrative block and ward at the Ningerum hospital. There are 60 aid posts in the district - 16 run by various Christian missions, 12 by Local Government Councils and 32 by the Department of Public Health. Medical patrols are conducted regularly and in the Ningerum area alone 141 villages were visited and actual treatments given totalled 1,499. Dental patrols are undertaken regularly and included in these were the following centres - Kiunga,Ningerum, Ruminginae and Atakamba. The dental assistant at Daru has a total of 2,032 primary school children from 11 schools in the distriot registered in the school dental service. Regular 12 monthly examination and treatment to all school children in the area is conducted as well. He has also carried out examination and treatment of 829 other patients for the year. The pre-school operating at Daru has a daily average of 21, and there are increasing requests for extensions to this service. Maternal and child health work is hampered by lack of staff and transportation. The United Church is proposing to establish a maternal and child health service in the Oriomo/Bituri area, which would serve some 1000 people. There is a Mission Hansenide hospital at Mapoda in the Balimo sub-district. The Mission hospital at Ruminginae hospital takes leprosy patients and the Awaba hospital has a special clinic for their treatment. The total number of leprosy patients in the district now stands at 520. Fifty-one of these being new cases reoorded this year. The Mission hospital at Balimo has daily average of 130 inpatients and is steadily expanding. Work is almost completed on a new ward and a new kitchen/laundry block is to be commenced in the near future. Patrols were sent out from Daru, visiting 9 Morehead Local Government Council areas, 4 Kiwai Local Government Council areas, 2 Orioma/Bituri Local Gove~ent Council areas and 4 Primary T Schools, in an endeavour to find suitable well sites and to instruot on and inspect, sanit~tion. Five plaoes were selected for border well projects in the Morehead Local Government Council area. These to 87

be commenced at the beginning of the dry season. A well and pump were installed at Kadawa Village, in the Kiwai Local GQvernment Council area, and is in operation.

APPENDIX I

POST GRADUATE AND POST ~ASIC STUDIES. Master Degree in Publio Health, Harvard University, Dr. A Radford. Diploma of Public Health, University of Otago (N.Z.), Drs. D Johns, J.M. Lewis and K. Wari. Diploma of Tropical Medicine and Hygiene, University of London, Dr. J. Ono4. Diploma of Tropical MediCine, Mahidol University, ~angkok, Dr. L. Rovin. Certificate of Public Health, University of the Philippines, Quezon City, Dr. L. Rovin. Certificate Course in International Nutrition, Nutrition Research Laboratories, Hyderabad, India, Dr. J.O. Tuvi 4 • Diploma Course in Nursing Administration, College of Nursing of Australia, Melbourne, Matron B. Parker. Diploma Course in Nursing Education, N.S.W. College of NurSing, Miss T. Lokoloko4. STUDY COURSES. Combined course on Parasitology, Entomology and Epidemiology for Senior Technical Staff, Manila, Mr. P. Varo 4 • Environmental Health, Manila, India, Malaysia, Mr. N. Oven4. Malaria Eradication for Professional Staff, General Course, visiting Manila and India, Dr. C.O. Be1l 4 • Malaria Eradication, Manila, Mr. P. Varo 4 • National Health Planning Course, Manila, Mr. K. Adair4 • National Health Planning Seminar, Manila, Dr. D.P. Bowler4. Paediatric Course, Medical School, MakerereUniversity, Kampala, Uganda, Dr. J.O. Tuvi4. Pre-School Work in Australia, Churchill Fellowship, Miss Eunice Wainunai. Senior Professionals Course, Manila, Dr. A.D. Parkinson4 • STUDY TOURS. Advanced Radiography, Brisbane General Hospital, Mr. U. Sisia. Health Inspection, Lismore City Council, N.S.W., Mr. T. Rima. Malaria Control and Malaria Eradication Training Programme Discussion, Honiara, B.S.I.P., Dr. D. Parkinson. Maternity Nursing Techniques, Hawaii, Miss R. Vele. Medical Photography, Brisbane General Hospital, Mr. J. Silip. Medical Technology (Pathology) Training, Royal Children's Hospital, Melbourne, Mr. N. Garo3. Nursing Administration, Hawaii, Miss J. Godfrey1. Occupational Therapy (on-the-job training), visiting Mental Hospitals and Institutions in N.S.W., Mr. N. Pokerup4. 89

2•

Respiratory Diseases, Hawaii, Mr. M. Naru 1• Theatre Nursing Training, Royal Perth Hospital. (W.!,.), Miss J. DosL Theatre Procedures, Hawaii, Mr. H. Maku 1. Therapy Radiographer Training, Royal Brisbane Hospital, Mr. A. Benjamin. 4. SEMINARS, MEETINGS, CONFERENCES. Alcoholism and Drug Dependence, 29th International Congress, Sydney, Dr. J.L. Jameson. Australia and New Zealand Association for the Advancement of Science 41st Congress, Adelaide, Dr. R.F. Anders and Dr. R.F.R. Scragg, and Australian Bio-Chemical Society, Annual Meeting, Melbourne, Dr. R.F. Anders. Asian Malaria Conference, 6th, Kuala Lumpur, Dr. J.L. Jameson 5 and Dr. A.D. Parkinson. Australian Cancer Society, Committee and Council Meeting, Melbourne, Dr. P. Reay-Young. Australian Dental Congress, 19th, Brisbane, and National Dental Associations from Commonwealth countries in the South East Asian and West Pacific Region, Meeting of Representatives, Brisbane, Mr. R. Kila 2 • Australian Post-Graduate Federation in Medicine, An~ual Meeting, Canberra, and National Health and Medical Research Council and Public Health Advisory Committee Meetings, Canberra and Hobart"Dr. R.F.R. Scragg. Australian Pre-School Association, Annual Meeting, Canberra, Miss D. Willis. Australian Society of Anaesthetists, Annual Meeting, Brisbane, Dr. D.J. Foley. District Medical Officers' Conference, Honiara, B.S.I.P., Dr. D.P. Bowler. Drug Dependence, National Standing Control Committee Meeting, Canberra, Dr. J.L. Jameson. Economic Development Seminar, Latrobe University, Melbourne, and Epidemiology of H~ertension in the Pacific Meeting, Wellington, Dr. I. Maddocks • . Family Planning Association of Australia, National Medical AdviSOry Council, Sydney, Dr. D.P. Bowler. Mechanism of Hypertension, Conference, National Heart Foundation of Australia, Canberra, Dr. I. Maddocks. National Student Nurses Conference, 9th, Darwin, Misses J. Unia and E. Kove.

Nursing Education Conference, Australian Nursing Registration Authorities, Melbourne, Sister J.A. Porter. Nursing Studies Seminar, 2nd, Manila, Matron E. Kettle 4 . Quarantine Conference, Sydney, Dr. J.L. Jameson. Royal Australian College of Physicians, Dunedin, (N.Z.), Dr. I. Maddocks. Royal Nursing Federation, 5th National Convention, Hobart, Miss D. Masere. Town Planning and building methods, Regional Seminar of the South Pacific Commission, Honiara, B.S.I.P., Dr. A. Toua. World Health Assembly, 22nd, Boston, Dr. A. Tarutia. World Health Assembly, 23rd, Geneva, Dr. J.~. Tuvi. World Health Organization Regional Committee Meeting for the Western Pacific, 20th Session, Manila, Dr. R. Taureka. 5. COURSES AND CONFERENCES IN PAPUA AND NEW GUINEA. Diploma in Health Education Course of Studies. Institute of Health Education, Department of Public Health, Port Moresby. District Health Officers' and Health Extension Officers' Conference, Port Moresby. Malaria Seminar for Administrators' Port Moresby, conducted by Dr. J.P. Ray and Dr. Van der Gughten, visiting W.H.O. consultants. Malaria Training Conference, Port Moresby. Matrons' Conference on in-service Education. The 1st, Port Moresby. Papua and New Guinea Branch of the Australian Pre-School Association, 8th Conference and Workshop, Port Moresby. Refresher Course in Medicine for recent graduates, Papuan Medical College, Post Graduate Committee in Medicine, Port Moresby. Workshop on Methodology, Nursing Education, Port Moresby, conducted by Sister Paulina R.S.C. of St. Vincent's Hospital, Sydney. Workshop on Teaching Methods, Papuan Medical College, Port Moresby, conducted by Dr. N. Kagan and Dr. R.M. Wiedersheim, visiting W.H.O. consultants. Sponsored by 1.

Center for Cultural and Technical Interchange between East and West, Honolulu, Hawaii, U.S.A. The Commonwealth Foundation, through the Australian Dental Association. Commonwealth Training Scheme. World Health Organization Fellowship. World Health Organization. 91

4· 5.

APPENDIX II

BOWLER, D.P. Pediatric Problems in Developing Countries. Commemoration Volume.

Dr. S.T. Achar

BURTON-BRADLEY, B.G. (1969) "Papua and New Guinea Transcultural. Psychiatry: I HistoricaJ. Precursors" Aust. and N.Z. Journ. Psychiat. 3:124. BURTON-BRADLEY, B.G. (1969) "Papua and New Guinea Transoul tural Psychiatry: II The First One Thousand Referrals" Aust. and N.Z. Journ. Psychiat. 3:130. BURTON-BRADLEY, B.G. (1969) Journ. Psychiat. 3:251. "Anxiety in New Guinea" Aust. and N.Z. Is the

BURTON-BRADLEY, B.G. (1910) "The New Guinea Prophet: Cultist Always Normal?".Med. J. Aust. 1:124. HOLLmAY, D. (1969) Bulletin 19:29.

"The Laloki Psychiatric Centre" South Pacific

MYLIUS, R.E. Te Pina Springs. Health and Society in a New Zealand Rural Area New Zealand Med. J. 10, 182-188. MYLIUS, R.E. The Right to Medical Care.P.N.G. Med. J. 12, 1, 20 - 23. MYLIUS, R.E. Traditions and the Modern World. P.N.G. Med. J. 12, 2, 56 - 58. MYLIUS, R.E. Toward Social Health. P.N.G. Med. J. 12, 3, 104 - 106. WIGLEY, S.C. Tuberculosis and New Guinea - Dogma and Dilemma. Presidential Address to the Papua and New Guinea Scientific Society; Proceedings of the P. & N.G. Sc.Soc. 1969. (In the press). WIGLEY, S.C. Tuberculosis and New Guinea - Infection Rates, and Epidemiological Problems. Abstract in the Proceedings of the Annual Meeting of the Austra'lian" Society of Geographical Pathologists. August 1969. WIGLEY, S.C. Post-vaccination (B;C.G.) conversion reactions in a tube~cu1osis free community. Abstract - Papua and New Guinea Med.J.Vol.13 No.1. 92

WIGLEY, S.C. A little light on Darkest Africa (including a review of Tuberculosis Control in Developing Countries). P. & N.G. Med.J.Vol.1~ No.1.

, I

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;

ENGLISH ONYX REPUBLIC OF KOREA BRIEF REPORT ON HEALTH SITUATION IN 19691 1. GENERAL SITUATION

During the period of the First Five-Year Economic Development Plan and the Second Five-Year Economic Development Plan, the Government has made steady progress in the field of health aJ.J.d social welfare, and is now preparing the Third Five-Year Economic Development Plan which will begin in 1972. Accordingly, the Government had made every possible effort to build a foundation for expanded health activities based on the strategy of acute communicable disease control, maternal and child health services linked with family planning, tu~erculosis and leprosy control, laying the basis for an expanded health centre network, intensively emphasizing local health servic"es with the utilization of qualified and trained health workers. The general progress of the health and medical services in 1969 Was as follows: 1.1 Health Personnel and Medical Education a) Heal th and Medical Personnel Licensed Physicians •••••••••••••• Dentists •••..•.. .••.••.. Nurses ....•...•..•...••• Midwi ve s •..........•.••• Pharmacists •.••.•••..••. Her-b medical doctors •••. ~ .................... O'.....

13995

2043 13 057

6 188 14850 2 89:5 53 886

Number of Medical Schools and Annual Graduates Institutions Medical schools Dental schools Pharmaceutical schools Nursing schools Herb medical school Public health school No. of Schools 12

---14 46 1

No. of Annual Graduates

780 100 u8 60

I 132

Submitted by the Ambassador of the Republic of Korea, Manila,

24 August 1970.

- 2 '

1. 2

---a)

K~dical

and Health Facilities No. .o . . . . . . . . . . . . .o .... '. . . . . . . . . . .. . . . . . . . . . . . . . . .o .................. ..

Facilities Hospi t~s .o • • Clinics ........ .o

234

5 221 1 228 2 413 192 1 342 No. of beds 23 227 1 174 2 146 1 035 27 582 PROBLEMS

Dental clinics .............................. .. Herb doctor's clinics •••••••.• Health centres •..••.•••.••.••. Health sub-centres

Type of control General hospitals Mental hospitals •.••••.••••••• Tuberculosis hospitals ••••.•.• Epidemic diseases ••••••••••••• Total 2•

tlJ!l.jDR HEALTH

2.1

Acute Communicable Disease Control

Tnough the incidence of acute communicable diseases has been remarkably reduced during the last decade, there still remains the problem of water-borne infections, mainly typhoid fever and dysentery. In 1969, the Republic of Korea suffered from a cholera epidemic during which period 1538 cases with 137 deaths were recorded. The last epidemic of cholera in the Republic was in 1964. There has been no report of smallpox, typhus fever and relapsing fever since 1960. Japanese encephalitis is one of the major killing disease in the Republic of Korea. Each year more than 2000 cases among children with a 20 to 30% fatality rate is being recorded. With the assistance of the \florId Health Organization, the Gov'ernment of the Republic of Korea started the project of Japanese encephalitis vector study and mousebrain vaccine field trial in 1969. The problem of typhoid fever is far from being solved. More than 5000 cases of typhoid fever were reported in 1969 alone. The provision of a sanitary water supply will be given a high priority by the Government in the future, this should eventually be effective in. reducing the incidence of water-borne infection.

.. a) No. of cases Cholera Cases Deaths b) 1

- 3 -

J .B. Encephalitis

Typhoid Fever

538 137

No. of persons vaccinated against the diseases Smallpox •.••••••••••••• Typhoid fever ••••••••.• D.P.T. .........................

••

2742380

8966155 854 797

Encephalitis ••••••••••• Diphtheria •.••••••••••• Cholera .•...•...••.••.• Poliomyelitis •••••••••• Typhus .........•..•...•

78088 543 713 25991 092 962 651 203485

2.2 Chronic Communicable Disease Control 2.2.1

Tuberculosis Control

The tuberculosis problem in Korea is quite serious in terms of a high prevalence of infection and morbidity as revealed by the prevalence survey in 1965. Early in 1962 when the Korean tuberculosis programme commenced, staff was short, facilities inadequate and central direction weak. Within eight years or so the programme has developed to the present state in which tuberculosis services have been extended to every corner of the communities through the general health service units; 1757 fUll-time workers are participating. The total epidemiological impact of this programme is difficult to assess at this moment, but the second prevalence survey in 1970, five years after the first one, should be able to disclose to what extent the prevalence rate of tuberculosis has been reduced by control efforts during this five-year period. During the past three years, the quantity of accomplishment has greatly increased in all phases of the programme operation mainly due to the Government's emphasis placed on tuberculosis control with a resultant increase in tuberculosis budget. Of course, much remains to be improved in both quantitative and qualitative aspects of the programme, and this will be realized by reorienting certain aspects of programme operation and strengthening the training and retraining as well as supervision of the field workers.

• - 4 2.2.1.1 BCG Vaccination During the year 1969, 2 023 386, 40% of the total pre-school children were vaccinated. This was mainly the combined result of decentralization of BCG work and simultaneous BCG and smallpox vaccination drives in spring and autumn. This practice has already become an established routine service in all health centres and subcentres in Korea; 1 050 560 school entrants were tuberculin tested and 849 918 children were vaccinated. 2.2.1.2 Case-finding In 1969, 24 313 infectious cases were discovered asa result of 665 750 prim~J sputum tests, although the annual target requires 30 000 cases to be discovered. In contrast to sputum case-finding, X-ray examination still constituted the major part of case-finding activities at the health centres. 1 433 623 persons were X-rayed and those discovered as suspect amounted to 58 440 which represent 2.0%. These findings indicate that X-ray examination must have been given to non-priority groups, although it has been repeatedly emphasized that such a service should be delivered to high yield groups, such as symptomatic patients, older people, especially males, eto.

•

•• "

2.2.1.3

Domiciliary Treatment

During 1969, 86 746 patients were registered and 74 561 discharged, leaving a total of 179 254 at the end of the year. The treatment programme seems to be the weakest link in tuberculosis control in Korea. The number of patients under treatment at the health centres at the end of 1969 amounted to 179 254. The drug supply has never been interrupted during the past two years, and owing to the increased drug budget of the Government. the four kinds of drugs were abundantly available everywhere. Only 39.9% were under INH treatment alone. 2.2.1.4 Achievement in Tuberculosis Control BCG Vaccination: School children Pre-school children •••• Total .......................... ..

............

849 918 2 023 386 2 873 304

X-ray Examination: No. examined •••.••••••• No. of cases found ••••• Discovery rate ••••••••• 1 433 623 58 440 4.1%

- 5 Case-finding by sputum Examination: No • examined •. " ... /I • • • • • • • • • • • • • • •

66.5

750

No. of cases found •••••••••••••••• Discovery rate .. e.lI. • ••• • •• •••• ••••

24313

3.7tf,

Domiciliar.1Treatment: No. of patients newly registered ......... II. • • • • • • • • • •

86 746 179 254 74 561

No. of patients under treatment at the end of the year •••••••• No. of patients discharged •••••••• 2.2.2 Leprosy Control

Twelve mobile clinic teams, 9 governmental teams and 3 voluntar.1 teams, were decentralized from the Central Government to provincial governments in Januar.1 1969 and these teams are being operated in each province with pre-medical workers assigned in 102 Gun health centres. To treat the lepers, five national leprosy hospitals were divided into 2 groups; one group consists of three resettlement villages and the other of the National Leprosy Centre in Sorokdo Island and Yongho Branch Office in Pusan City. '!he registered and estimated number of lepers in Kote a is as follows: Estimated ••...••.••••••••••••

Registered Undetected .................. .

....................

80000

39 000 41 000 160 000

Total ....................... .

2.3 Family Planning Programme Initiated in 1962 the Korean national family planning programme is based on policy and supported by a yearly allocation of fUnds approved by the General Assembly. The programme is organized, administered, and evaluated through the Ministr.1 of Health and Social Affairs, the 11 provincial governments, the 192 county and city health centers, and the nation's 1 473 township and small city offices. There are some 2380 full-time workers, mostly females, engaged in carr.1ing out the programme. This is a ratio of about 1 worker per 1250 eligible couples in rural areas and 1 per 2980 in the cities. In addition, there are 10 mobile units, which provide information, clinic and follow-up services in remote areas. The Planned Parenthood Federation of Korea is most active in support of the national programme providing assistance in all areas; administration, training, public information, research, and evaluation.

, ;

- 6 All FP services: public information, contraceptive supplies (condom) and clinic services (IUD, vasectomy) are offered free of charge. Clinic services are provided by some 1100 (IUD) and 500 (vasectomy) private physicians who have received special training and are authorized to provide this service. The physicians are paid a subsidy fee of about $1.10 per insertion and $3.30 per vasectomy. Additional fees of about 18 cents for IUD and 35 cents for vasectomies are paid for routine follow-up examinations. Vasectomy acceptors receive about $3.00 compensation for work time lost. Medical treatment and/or care is provided free for all acceptors experiencing minor or major difficulties. The overall objective of the programme is to reduce the annual rate of population growth from about 3% in 1961 to 2% by the end of 1971. We estimated that in order to reduce the natural increase rate to 2% by 1971, about 45% of child bearing age group would have to be practicing family planning by 1971. Specific targets of the froe government service are: 750 000 IUD wearers, 150 000 vasectomies, and 150 000 monthly users of traditional contraceptives, mainly condom, and 350 000 oral pill regular users in the government programme. That is about 35% of married couples, an additional 10% will practice through their own resources. Targets and achievements of the programme in 1969 and 1970 are as follows: Supply of Contraceptive (monthly) 150 000 147 773 98.5 150 000

IUD Target 60 Achievement 300 000 285 500 95.2 300 000

Vasectomy 20000 14 457 77.3 20 000

Oral pill (monthly) 320 000 169 297 52.9 320 000

% 70 1

Target

2.4 Maternal and Child Health Through technical guidance, the formulation of recommendation measures and policies to improve the standard of health of mothers and childre~ and research and stUdies, the Government has ~mproved this service.

- 7The rates related to M.C.H. Services Infant Mortality Rate 1-4 Year child Death Rate Infant-child Morbidity Rate Maternal Mortality Rate 20-44 Year Women Mortality Rate 58.2% (by 1966) 7.6% (by 1966) 16.4% (by 1969) 9.1/10 000 (by 1969) 12.1% (by 1969)

Leading cause of infant and toddler death ('56-'65) Order Cause of death 1 2 3 4 5 6 7 8 9 10 Prematurity Tetanus neonatorum Pneumonia Diarrhea and Enteritis Birth injury Malnutrition Convulsion Measles Congenital Malformation Dysentery 11 All Other 12 Unknown

~ 15.8 15.8 9.1 6.1 5.5 4.8 4.2 3.6 3.0 2.4 17.6

Order 1 2 3 4 5 6 7 8 9 10

Cause of death Pneumonia Encephali tis Diarrhea and Enteritis Accident Measles Malnutrition Pertussis Meningitis All Others Unknown

~ 17.2 11.8 10.7 10.7 9.7 5.4 3.2 3.2 22.6 5.4

Leading cause of maternal death Order 1 2 -"--

Cause of death Toxemia Haemorrhage Infection Ectopic Pregnancy All Others Delivery attendant rate by urban and rural (Source: Nat. Kyung-puk University, 1969)

~ 41.0 23·0 13.0 4.9 18.0

3 4 5

Classification Urban Rural

Physician 24.6% 3.6%

Midwife 24.6% 2.4%

Others 50.8% 94.0%

- 8 Achievement and Target of M.C.H. Programme During 2nd 5-year Plan Period (1967-1971)

Year No. of birth Sub total Delivery Attendance by Medical Profession I .

67-71 l~

67 1 013 000 159 045 (15.7) 6312 (0.6) 152 397 (15.1 ) 152 -

69 997 000 245 973 (24.7) 76 739 (7.7) 169 234 (17.0 ) 500 _.

70 989 000 322 141 (3 2 .6) 144 000 (14.6 ) 178 141 (18.0) 700

71 980 000 367 517 137.5) 180 000 (18.4 ) 187 517 (19.1) 800

986 000

1 007000 195 399 (19.4) 34 627 (3.4 ) 160 772 (16.0) 300 ----

No.

1 290 915 (25.9 ) 441 674 (8.9 ) 848 397 (M.O) ---

% No.

Government Participation Self-Supported

% No.

% -----.~.----

No. of M.C.H. Workers in rural -------~--

----

The Government is providing qualified midwives for the care of the health of mothers and children throughout the country, particularly in the rural areas where 94% of rural births were still attended by lay women. The Government had envisaged to establish 1913 MCH clinics, one of every district and township where a trained midwife would be assigned. Since 1969, there were 500 midwives assigned to the district and townships and July of 1970, there will be a total of 700 midwives employed by the government.

•

I..

•

.."

, ,-~

. . - 92.5 Sanitation 2.5.1 Water Supply At the end of 1969, 123 simple water supply systa~s were established in rural areas to cover 262 388 population, and 101 174 primary school children are benefited by the completed 200 school water supply systems. There were 190 000 public wells and 495 000 private wells throughout the country, and 19 night-soil digestion tanks for excreta disposal, capacity of 100-1000 MIT. 2.5.2 Food Sanitation 225 food additives were standardized until 1969. In 1969, there were 69 630 enterprises concerned with food: 191 015 manufacturing factories and 50 615 restaurants. Compared to 1965, they have increased by 140% and 119% respectively. In order to make close inspection and effective control for food quality 719 food inspectors were assigned throughout the country.

-. ORIGINAL: ENGLISH

PORTUGUESE TIl'lOR REPORT OF THE ACTIVITIES OF THE PUBLIC HEALTHlSERVICE AND ASSISTANCE DURIOO THE YEAR OF 1969

ASSISTANCE ACTS 1967 1968 281 7 1 023 570 6 23 125 164 796 785 523 457 014 800 1 768 ~ 314 037 8 444 1 028 535 640 796

Patients under ambulatory treatment Hospitalized patients Treatments Injections Surgical operations Laboratory examinations Vaccinations Radiographic examinations 2. RURAL

270 6 1 016 600 5 15 161

515 058 019 945 075 634 534

7 344 36 294 185 587 2 786

1 601

HEALTH SERVICES

In the "Hospital Central Dr. Carvalhol1 a small Rehabilitation and PhysiotherapY Service was set up. A small Intensive Care Unit will be opened in the near future. In 1969 building of the following rural health institutions (some of which are already built and equipped) was started: - 4 rural posts for consultations and the treatment of outpatients (Be-Bui, Batugade, Soibada e Railaco). - 6 rural sanitary posts (Cailaco, Baguia, Vemasse, Bazar-Tete, Lacle e Tilomar). General repairs and improvements were carried out in the Rural Hospital of Ainaro and in the rural sanitary post of Venilale. During 1969 about 1000 contos (US$33 000) were spent on technical equipment. In the same year around 2000 (US$67 000) were spent on the construction of health buildings.

lSubmitted by the Chief of the Health Services, 8 June 1970.

• - 2 -

3. PUBLIC HEALTH

3.1 School of Public Health - 24 119 students received medical assistance. - 16 209 children were vaccinated, mostly against smallpox. However, 4639 kindergarten schoolchildren received vaccines against diphtheria, tetanus and pertussis. 15.9% of the tuberculin tests \'lere positive. - 71.Q% of the sohoolchildren received BOG vaccination.

3.2 Service of Health Education Weekly radio talks were transmitted by the Timor radio station in both Portuguese and Tetun (local dialect). Copies of the talks were given to the rural nurses in order to facilitate their work in rural sanitary education. In October 1969 there was a public exhibition showing some of the public health activities. '

3.3 Nutrition Service During 1969 screening, research and treatment of endemic goitre were continued in Fatu-Berliu. Iodated salt was given to the population. The percentage of goitres examined in that area was 4.48%. A ,diet table was approved for all the hospitals in Timor.

3.4 Public Health Campaigns Campaign against blind!1ess Number of cases examined: Refractive errors Conjunctivitis Strabismus Diseases of the cornea Diseases of the lacrimal glands Cataracts Glaucomas Pterygions

41.4% 15.3%

7.7% 4.8% 2.7%

3.4% 3.1% 2.7';{,

Eighteen cases were submitted to surgery. Fifty per cent. of the major opcr~t1o!1G \lere fOl' catnvacts and 33% were enucleations. Ear, nose and th.-roat campaign Total number of children screened 4 259 Patients examined in the clinic 960

- 3 Results: Cerumen Otitis media Acute and chronic tonsilitis Auditory and obstruction Foreign bodies Otosclerosis Tympanosclerosis Number of patients submitted to surgery - 24: tonsillectomy, and 12 for shifted nasal septum. 4. 4.1 Malaria As previously stated, malaria is the number one disease in the Province. Considering the total population of the Province and the number of malaria cases diagnosed in our health institutions - most of them without laboratory confinaation - there was, during 1969, an incidence of 106 per 1000 inhabitants. The disease number two is tuberculosis, with an incidence in 1969 of 2.2 per 1000 inhabitants. He have continued the malaria surveys to collect information on the splenic and par<:lGitologicnl indices among schoolchildren. During 1969, results obtained: 5968 children \~ere

11.4% 5.7% 2.7% 1 % 0.9% 0.9% 0.9% 12 of them for

FIGHT AGAINST COMMUNICABIE DISEASES

screened and the following

Splenic index

-..,P1asmodiometry: Number of positive cases

) Male ) ) Female -

8.79 (13.56) 5.85 (10.51)

) Male ) ) Female Total ......•..

307 (201) 174 {1:28} 481 (359) 8% (10%)

Percentage ••••

, - 4 ) Ma.l.e

-----.--

59 (63) lj{) (58) 8 (5) 7 (3)

P. vlvax

) ) Female ) Male ) ) Fema.l.e -

P. malariae

P. fal cip arum

) Male ) ) Fema.l.e -

2lj{) (133) ~

127 (97)

(Numbers \,lithin brackets were obtained in 1968) To prevent malaria in the school population 238 000 antimalarial drugs, mainly daraprim, were distributed (in 1968 only 160 000). In 1969 the Province spent on antimalarial drugs $470 123 (about U3$15 670) against $213 649 (U3$7 121) in 1968 and $193 118 (U3$6 437) in 1967. We are going to give a small package containing tablets of daraprim, free of charge, to every passenger arriving in Portuguese Timor by air, sea or land, warning them of the existence of malaria in the territory and indicating the prophylactic dose both for adults and for children. Instructions are written in Portuguese and English. 4.2 Tinea imbricata (cascado or tokelau) We continue to use the same therapeutic mentioned in the last report, still on an experimental basis, but with good results. Griseofulvine is used, but in a single weekly dose of 6 tablets, during the same period of four months. Clearing of the lesions appears by the 5th and 6th weeks. 4.3 Leprosy The province has under treatment 909 patients with Hansen's disease which represents 155 per thousand inhabitants. The indeterminate group is, by far, the most frequent including 82,% of the cases examined. The percentage of lepromatous cases and tuberculoid cases is 8% and 9.9%, respectively. The therapeutic schedule used, more often, is the administration, every fortnight, of 5 c~of sulfone by injection (people are reluctant to take it by mouth).

- 5 -

FINANCIAL RESOURCES

Cost of the Health Services in the last three years: 1967 - 15 708 contos (US$524 000) 1968 - 15 636 contos (US$521 000) 1969 - 22 000 contos (US$734 000)

:tAPfCHT UlTCClN'I' 'li;:s Wi;::;";: '~'41';; (IE:mUS 1)Alrs 1.£ DO;UU:l1J;: :U~ L,A ~)A.;,'·:;~ .D.-.: L,A l~,~IL_~:l':.'JJTC .,}) VI~~fj.l 'N.dJ~ 3211: 1;•. :;"69 '

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<:'\.u ~Ti 3t_~,T::.:.~ '.1\l:r~.:'. i <'f \ ' ,:,,:,;,;,&'3 :.. ~ 2 a '·:'t;t~ l!l<i!.~n·~cr:x;e :{~ m,{:i,~e l.Ji \fOCi-U .,.1:11', rHH)(JJ.'t ;\ l' u.n;l\~e pr~ke:kl1 tH ';' ;:;11BC (';o'£i~ll(j;',llt llci.~l(lU;: i ... 61ioI'a,ti6n;: 0.;;,n's .litf,$rut:.tp:J dt)r:t;:,,~;. :., ' r~ts.t cltill:::eC"tlrit~1 1:') :.nnrlue .113 ~c~·:;o~.;lol e'!; ",e ".:)./ ""11, QO,.;tL,u.o:; i 'a, ·fnflfiL:.~10,G"': :Jlll'l l·.~ illS,t ~:l...: 1;,t) ')~~:(;i1 t 1c H lJi'\U~~;;u..~r~lcs do :1f~:..:'l ~~... " • :Uft--:si -~t1.D;ti:O·\:. S;':.,:tit -'l~J"e ,

,':,

r;.

\:ESTERN S'lMOA REI'OHT

PHOGHD30 OF TIIG lll:llL'rH ACTIVUIES

1970 IN'rHO[)UCTION : ':.Jestern Samoa has bf.en indcDcndent since 1 Janu:try 1962. It connists of c,

sroup of VOlCMic islands in Lhe !:lid Pacific, lying

south of the equator bet',ieen 10° and 15° nnd '.lest of th(; date line and 9 0 •

7°

T}le total aren is 1 133 Squar0 miles with a population of

131 377 in accordance ',lith the laGt census on 21 Novcmbur 1966. estimated mid year popuLLtion for 1970 is 146 000 calculated on u ".<.

The

yearly increase of 3.5%. of Polynesiatl origin. years of age.

The nopul;.,tion of ':!cstern Srunoa is about 95%

In 1966 51.3 per cent of Dopulation was under 15

The ap"ro:"riatcrl 0x~)enditure for bhe Health Dep'u'tmcmt for

"',:

1970

WClS

t:,~S745

030 ",hieh is 11.8% of th\: total government QxpeneJiture.

GIlTER-AL REVIJ1\'J: The elation in February 1970 broueht a eor:l~)letf:

ch:mgo of

Government and the LeGislo.tivG Assembly chose o.s the nen Prime Minister the former Assif.:tant Medical Superintendent of the Apia General Hosn.it::"l,

Dr Ledo!i 'l'upua Tru.~a8ese.

Hon. Fuima.ono Moaso}Je has b0en ,'J.p'winted r;.s

the Minist"l' of HC2..1th and he reprc.sentc:d ',;Qstern Samoa at the '..forld Heo.1 th nnscmbly in Hr;v 1970. The TOil lIianCcGement Functlonal Cor;lTnittee ',78,8 formed as an

a.dvisory cOl'llllittee to the Minister of Health; the nevI Minister decided to keep it functioning but not to sit :~s

ehairy,nn of thc Committuc.

The

Cowni ttee b.. 1.8 bvcm rC-IVlIll0d NutiowJ.l HenlthitdvisOIY COW!'LL ttee ,'end it 110.8 been considering health policioo n:J well as rk1.tiono.l he;:'.lth nl,.l1ninr:". and cst:,blished 2 ::lUb-cofmnittees fOL'

thonc :rurposes.

FollowinG the report of the UNj'.mO Mission a 1'u')ulation ::tudy and ]>'DJ1Iily Plrl,nnin,,; :md the~.r

recoI;]mendation Ca.bimlt decided on 8 July

1970 that the report be accepted in nrinciple ;).l1d agreed that :m offieLl.l requ(;st be mqde for the services of with br,ckground experience in mc~tcrnQ.~_ f1,

health administrator

and child health and fcunily

plnnnine;; this eX!lert to :J.Ssist the H<oalth De;or·.rtment in ]'lbnning, coordin:,tion iJUd i;lp18f.lE:ntation of f::;.;;ily plr'nning ',vi th,w tf"', frnw;, of

'Lhe he[:.l th services.

- 2 .•

(.1.)

N:1tiun:J Healthf,u:vices DuvolopTlent PJ:'0,jUCt (lOG cLrn SU.\o:.., 05(JOProject)

Tho project ',Iocr:; xe-dGfin0d cmd broaden it:;; ~1eO',)e of .'1ctivitic:l to be a H8tion;],1 Health Services Ikvclopmcnt Project and the Mast0rpIn.!). of OJl():r','tiO~l cov0ring the ch~'nec:;; w.:,[o conc:\.udcd in 1969 bd\l8UIl liRO, UNICl:'F cmd tho Govcrnm,nt of '::0Gt'lrn SilIiloa, UNICJlF becomln,:s

thejloxty to the proj0ct and the oth,:;r UIO (mlICL:F) as:;ist0d !)rojectll including the in tier-country projects. The mc~<ior '~ojCG l;s

'becoming the p:J:rticipGting

emllhasic Vias l)b.ced during the yeDX in 2 r!'yCjas:

strengthening of the or,~anization Cl,nd ;1dJJlinistrr~tion in the national level on the one hand and the acti vHies . in the demonstration di utrict for the district level on the other bCtnd.

(b)

l:btional Health L'1bordory Services (Jestern S8Jil0a 0504 Project)

The ATlia Lalrratoz"J hets been expMded and u1)-grmled to thE; Nr:.tiom.l Health LnuoJ.cctory in July 1968 to dc'w. .. ith both clinic,'),l alld public health laboratory serviceD tOGether with the activities of the training centres for health \7orke:r's and nurse ctudents in health labol.:1.tory tc-c!'niques. I t is di vid ed into

3 sl.otions:

clinical,

pathology, microbioloey and hygiene examin;1tion.

The extended '..,,,xt of

the oentral laboratory hi,s b €len nearly COl;lploted md units of h::l€L1otology, service imit and reco.tion and record unit hnve r:l0ved int0 the new sprtce is e::t:rly ,hme 1910. -,.

'This transfer has resulted in

reliuvine; the main L1.boratory (upstairs) from comfort by over-orcNding <md disorder in the former s'[y'.cc for the Ha(:!:l..1.tology and Service TTnitG

'""'

and 11:\s also provided ample room for. the, ab-ove mentioned units. Tile rClaainin;; renov"tion 'mrk in the Etreet floor is still in progress ::md "dcUtion",l funds for rcrlOvation of U'lsto.irn has been :tpproved in the SUllplementnry Esthntcs for 1910. A regional labor::ltory bns ll:en cEto.blished at the base

hos ',iV.\l for Savi.1ii in May 1969.

Ulucr:F 3u'plies for the

b,hor~l tory

ware reccive:d on 4 June 1970. (c) Fil,'lrin,sis Control T'ro.j<lct (,Ic~,I.(,rCl 8,'.::')~:, 0')01

."ro:jr;ct)

- 3 since b8 t :inning of 1 nO, formed 'by tho vill",:c Villnfi;C' drugs ",dminis tr',tion tC:~'IS h~"IC boen comnittee:, iICJ{:I(m's

Itn interlllive he:o.lth educ,tio~l pIO,';I"',mrae, with Gr'I~)IL:'-8is filnril",sis control, vi llo.eo level, A total of 1 025 drub ciitJinistr:1tlon t8::unS h:we been formed covcriD6 an ostim,~tod ll0'lul,~tion \fr,E]

lrmnched, by ol'iy',nisinc public l:ladings :; t thE;

12~

715 perSOllS. \1,:1.8

The COiUTJenCeraent do.[;e of tho CC'JTl]:\'J.ign

eC\I1:lnrked for July .Ie hu~C:

1970 but due to ufL.-woidable circumsknces, ho.ve been postponod. to launch the cnn;y:dgn by Novembur 1970 d tht btest. FC1CtS in }'ilnriasis Control in 1jostern S:tnoa,

1•

Cor.mlOncement of ,,'110 Assisted Project - July 1965.

,[i' ilmiasis

Control 1365.

2. ~-

First DrUG 1.dmini3h'-..tion C<va,ni[,"l1 Infectioll r,~te in n'Jl

JUILG

b(,fore drue control - 19.1}{.

4. 5. 6. (d)

Infec-Gion rate in '108(luitocs before drug control _ 2. L)'j. Infection ro.te in ,Y~l :'.ncr first filf!Xi:wis oamp:,ign-1.f;Jr:. Infoction I'elte in mosgui toes r,\ftor first fj,l0l'ir',sis campn.ign - 0.082%. Hos:,ital Administ:r""tion Project Crcst(~rn 3,,..10;], 0505 Project)

ThE: revised excho.nge of letter for this 'Jroject hr>.s just bee: sent to the Governnent for signature. or Hos,,~it[1.l

'1'11.is included one '.IHO Consul kmt hospi~r:,l

ildnini:3tr:l.tor for 6 raonths and 2 l'ello'IJships to r;tudy

administration abroad for 3 ElOnths each. The \dIO Consultantship .1i11 be implGmented in the later ":1X-G of

1970.

The consul t!1JJt is to assi3t

jxl.

improving h08Tlital scrviCGU and

f.Jal1ager.lcnt and in ',lanninG the expanston of hosnitals of the country.

(e)

COLlTIunity ('""ter SU!)'lly P:r:o,iect

li'uture develoI)ment in 'Jelltern Samoa depends to a conlltd2rablc extent u"Jon the availa.bility of an :uluquate \later sU"J1)ly for dome~tic and agricultural purposes. In the c03.l-Gal nr(;us, the increase in population will strain the present SU,'TJlies even further, rmd inland development cannot bounder-tdcon on a 1:-1Xge scale vlithout :In ;).8:':,UL'cd. water su,),,'ly. '1'h(; GoV(:rnr,1ent recognizes thC:-.t a nilJ:1b r;r of (li~c(,aB';:: C;:lIl

- 4given ,)riority to the dev(:lo~mcnt

of vlate:r sU,lplies.

With

asr;ist~t1lco

from

"HO cmd UHICIF, the SR.fotu \\'atcr Di:]trict system has lbeen constructed [((10,

is novi sl:rving C!levcn villa(;e::: with

tot8,l population of noro than

000.

'<I1IO has alGo assisted in providing short-term consult::U1ts to tr,-,~,tnent,

advise on ,later for ATJia.

cmd on tho feasibility of

scvrerace

~l::i.t1

'rhe Governl lent now propos(:s to improve the ex5.sting inade'Ju,\t8 water sW1ply f;:Lcilitiul scrvi'1G the WC[;t-coast of Upolu. ACCO:i, ding to the census 1966 the population in tlds area waS 24 642 distributed alon[; the coastline. A tri ,!:,[II'ti te <18Teer.Jent bct;leen Government, liHO und

lJ1rICEF has been sifi,ned to implement and d0velop the project according to thetechnicc.l rilethods and procedures recoBl1Jcnded

by -,mo.

";:.".

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1970

Source World Health Organization