INTRODUCTION:
Several factors contribute to the complexity of the problem of providing an adequate health and medical service in Northern Australia:
- The environment favours the endemicity of the major tropical disease.
- A large component of the population is of native race living at a very low standard of sanitation under conditions likely to contribute to the high endemicity of endemic disease, if introduced.
- The safety of future settlement will be jeopardized by the endemicity of disease in an unenlightened native component brought into close association with an expanding white community.
- The region lies adjacent to and is in frequent communication with areas of South East Asia where major tropical diseases are highly endemic.
- The sparse white population is widely scattered in tiny settlements separated by great distances and is quite unable to sustain the cost of providing a health and medical service adequate to cope with the problems of the region.
- The region is so remote as to have no access to medical aid from outside sources.
The situation demands:
- A system of effectual quarantine human, animal, plant and entomological to prevent the introduction of new communicable diseases and the means of their dissemination.
- The progressive and complete eradication of environmental and communal conditions contributing to the maintenance of endemic diseases.
- The eradication of existing infections.
- The prevention of the establishment of foci of infection in the native race likely to serve as enduring sources of re-infection for the mixed community.
- A highly organised medical and hospital service competent to meet all emergencies in an extensive and isolated region.
NORTHERN TERRITORY MEDICAL SERVICE
To meet this situation the Commonwealth has established a Medical Service of full time salaried officers including medical practitioners, dentists, nurses, pharmacists and ancillary services provided with base, satellite and special hospitals Infant Health and special Clinics, aerial and motor ambulance transport and radio communications.
The objective is three fold:-
- To prosecute a sustained campaign to exclude new infections, to eradicate disease and to raise sanitary condition of the area to a standard hostile to the survival of infection.
- To provide the highest possible standard of medical and dental service to the European and native population without permitting costs imposed by distance to prevent access of the patient to these services.
- By these means to render the region less unattractive to settlement by white women and to provide a sense of security for women and children so that the growth of a stable local population may be fostered, social and economic standards raised and miscegenation discouraged. The greatest emphasis must be placed upon prevention of disease.
The importance of this aspect is not readily understood by the local population whereas the impetus towards improvement in therapeutic services will be constantly maintained by a critical and vocal community.
The method of approach has been by:
- Prevention:
(a) Medical Surveys: – Systematic medical examination of the mass native population, to be continued until the native himself attains an awareness of disease sufficient to prompt him to seek competent advice and treatment.
(b) Detailed surveys of all natives on missions, settlements and pastoral properties in private and public employment.
These surveys permit-
- Delineation of the distribution of disease and the prompt application of corrective measures of sanitation;
- Prompt treatment of disease;
- Elimination of the carrier by treatment, if necessary in isolation;
- Recognition, recording and review of contacts;
- Immunisation of the susceptible;
Special attention has been given during surveys to the control of leprosy, hookworm and tuberculosis. Natives have been submitted to mantoux testing, followed by radiological examination of the mantoux positive and B.C.G. immunisation of the mantoux negative.
(c) Preservation of case history records for the review of cases whether seen in consultation or in the course of surveys.
(d) Standard measures for the control of leprosy, malaria and hookworm practised by the Northern Territory Medical Service have been submitted to the National Health and Medical Research Council and approved for Interstate application.
(e) Supervision of employment of natives directed towards –
- preventing their employment by infected persons;
- preventing the employment of infected natives;
- ensuring the medical fitness of the native employee for the type of employment proposed,
Control of employment was easily effected when aboriginal protection was a function of the Medical Service. It has become more difficult since the creation of a separate Department of Native Affairs but the development of a satisfactory liaison routine is receiving attention.
(f) Control of Migration:
Prevention of the introduction and dissemination of endemic and other communicable disease is attempted by-
- Inspection of overseas arrivals by the quarantine service.
- Medical examination (including chest radiography) of mission and settlement staffs prior to commencement of duty.
- Routine medical examination of indents in the pearling industry.
- Co-operation with the Department of Native Affairs in restricting the movement of natives suffering from communicable disease.
(g) Diet Reform:
The Nutrition Section of the Department of Health has recently undertaken dietary surveys amongst natives in the Northern Territory and Western Australia. Attention has been directed to dangerous and undesirable deficiencies in the diets hitherto favoured in certain localities and a model diet scale adapted to local resources has been issued for the guidance of Superintendents of missions and stations. Ration issues on missions and native settlements are being kept under supervision by medical inspectors and officers of the Native Affairs Department.
(h) Hygiene:
When missions, native settlements and camps are inspected the sources of water supply, methods of waste disposal, the handling and storage of food and other routine sanitary measures are examined. Model regulation for the sanitary conduct of such camps are in course of preparation.
To improve the standard of housing available for native races enquiry has been made by an officer of the Commonwealth Experimental Building Station into the practicability of using local materials and labour to reduce building costs. By this means it is hoped that adequate accommodation of acceptable hygienic standard may be provided, notwithstanding the high cost of building conventional types of dwellings. In pursuit of this objective early in the year a demonstration of pise construction was given in Darwin by this officer and the opportunity was taken to train selected groups of natives from a number of centres in the Northern Territory and Western Australia in the building method.
(i) Environment:
Special surveys have been conducted by entomologists of the School of Public Health and Tropical Medicine, Sydney, and recommendations made for the control of dangerous disease vectors particularly in the vicinity of aerodromes.
(j) Health Education:
The School of Public Health and Tropical Medicine, Sydney, conducts each year a course in tropical hygiene and camp sanitation for the instruction of persons proceeding to the Territory as missionaries or officers of native settlements. The course has recently been revised to afford the maximum of effective instruction for the safe conduct of settlements under Australian conditions.
- Training of natives as vernacular tutors in hygiene has been commenced.
(a) Base hospitals with full medical and nursing staff and ancillary services are established at Darwin and Alice Springs for the treatment of both European and native patients.
(b) Satellite hospitals under the control of a medical officer are established at Tennant Creek and Katherine. These include wards for general medical and surgical treatment for both European and native patients but cases requiring specialist attention may be transferred to a base hospital.
(c) Specially designed medicine chests are issued by the Northern Territory Medical Service to centres of population, their scope being determined by the presence or otherwise in the locality of persons trained in nursing or first aid and their accessibility to a medical officer.
- 12 A category chests have been issued to stations where a trained nurse is permanently in residence.
- 148 B category chests have been supplied to localities where no trained nurse is in residence, but where a responsible person is in ready communication with a medical officer.
- 78 C category chests have been supplied to small groups in the care of inexperienced persons out of communication.
(d) Aid Posts:
Missions, native settlements and larger pastoral holdings are being encouraged to establish suitable aid posts and where practicable to provide trained or experienced staff for the care of minor maladies under the direction of medical officers in touch by telegraph or radio communication.
(e) Ambulance Transport:
Five motor ambulances are maintained by the Service – at Darwin (2), Alice Springs (1), Katherine (1) and Tennant Creek (1).
Four aerial ambulances, the property of the N.T.M.S. are operated by T.A.A. as a flying doctor and ambulance service from Darwin. These comprise 2 D H Dragons, 1 Miles Gemini and 1 Drover. An additional Drover is under construction. At present flights from Alice Springs are made under charter with Connellan Airway.
(f) Communication:
It is the policy of the Service that every centre of population should provide itself or be provided with –
- a wireless transmitting and receiving set in communication with Darwin or Alice Springs;
- a landing strip suitable for the safe operation of Service aircraft.
At present radio communication is to some extent unco-ordinated, certain centres in the Territory calling base stations in Queensland and Western Australia. Careful study has been made of the problems involved and plans for a better communication system will shortly be discussed at a conference of interested parties.
(g) Infant Health:
Outside Darwin, Infant Health Clinics are conducted by qualified sisters on hospital staffs. A special health nursing and social worker has been appointed in Darwin to conduct pre-natal infant health clinic apart from the hospital and to visit native mothers in their homes instructing them in mothercraft and endeavouring the inculcate a high standard of domestic hygiene, infant care and nutrition. A similar appointment is planned at Alice Springs.
(h) New Works:
The development of the Service has necessitated the provision of additional hospital accommodation in various centres.
- Darwin: A special tuberculosis ward at the Darwin Hospital has recently been completed.
- Work has commenced on the erection of a new leprosarium at an estimated cost of £205,000.
- Alice Springs: The erection of a new native ward is planned at Alice Springs Hospital; the existing native ward being converted for occupation by Europeans.
- A tuberculosis ward is also planned to be erected at the Alice Springs Hospital.
- Tennant Creek: A native ward for Tennant Creek Hospital is expected to be completed this financial year.
COMMONWEALTH COOPERATION
The Commonwealth is vitally interested in these social and health problems –
(a) in general because of their implications in defence and their bearing upon the tardy economic development of an extensive and vulnerable area; and
(b) more particularly because of Social Services Department disbursements in respect of native children and Health Department expenditure in the form of medical and hospital benefits for the treatment of preventable disease.
The Commonwealth within the limitation imposed by its constitutional powers and responsibilities would welcome Commonwealth-State co-operation improving the health and social standards of the native population.
It is suggested this might be attempted by close liaison between the Commonwealth Department of Health and the State Departments of Health and Native Affairs. The Commonwealth Department of Health maintains or has access to a number of sources of expert advice including the School of Public Health and Tropical Medicine, the Nutrition Section of the Institute of Anatomy and technical experts of the National Health and Medical Research Council. It could undertake the study of social and health problems arising from the maladjustment of the native population and after consultation with State officers submit reports and recommendations to the Council of Native Welfare at future meetings.
If the Council is agreeable to this course, it might consider the desirability of charging the Commonwealth Department of Health with this function and accrediting as its liaison officer for this purpose a medical officer nominated by the Director-General of Health.