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Dr Cecil Cook

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Health in Northern Australia

PRELIMINARY

The problem of the health of natives in Northern Australia as elsewhere in the Commonwealth, is one with that of the general community and a programme for native medical care must be closely integrated into the health organisation for the whole population. Unless this is done two separate and complete medical and health services must be provided, a device involving the following serious disadvantages:-

  • Duplication of staff at a time when and in a place where it is difficult to obtain and retain sufficient staff of a suitable quality.
  • Dissipation of effort.
  • Impossibility of close co-ordination at lower levels
  • Inevitable conflict of interest and personality at all levels
  • Restriction of the individual field within narrow confines in an environment where it is already difficult to maintain enthusiasm and professional interest except by wide diversity of activity.

Health administration in the North demands the following basic routine in the interests of the health of the Commonwealth no less than that of the local community.

  1. Effectual quarantine: human, animal, plant, entomological.
  2. Close medical supervision of the individual:

(a) Careful recording and review of patients suffering from, and carriers of, certain communicable diseases to prevent – 

  • New infections
  • Recurrence
  • Carrier state
  • Employment whilst uncured, in occupations or localities likely to occasion recurrence or to involve danger to contacts

(b) Careful recording and periodical review of contacts of certain communicable diseases to assure:

  • Timely recognition of onset and protection of others.
  • Exclusion of subject from occupations and environments reducing his resistance or otherwise endangering himself or persons in contact with him.

(c) Medical screening of migrants

  • To prevent unsuspected introduction of communicable disease.
  • To warn against employment in an industry or environment conducive to aggravation of a pre-existing condition.

(d) Routine medical review of indentured labour.

(e) Maintenance of immunisation state against certain communicable diseases.

In respect of the white population most of these activities require only the enlightened supervision of the individual and of the family by the “family doctor.” The native, and to a less extent, the hybrid being ignorant of the implications of disease and the social responsibility of the carrier will for a time at least require special methods of approach.

(f) Medical surveys of the population.

(g) Careful and organised study of progress and health during pregnancy puerperium infancy and childhood to identify any environmental or other influence requiring correction or further study.

  1. Identification and delineation of endemic areas of disease and recognition of lines of communication.
  1. Supervision and control of migration through endemic or potentially endemic areas.
  • Surface transport
  • Air transport
  1. Eradication of endemic disease and elimination of risk of endemicity by-
  • Therapy and personal control
  • Exclusion of certain persons from certain forms or places of employment
  • Improvement of water supplies – source storage and distribution
  • Safe excreta disposal system
  • Safe methods of waste disposal
  • Control of insect vectors of disease
  1. Availability of Prophylactics
  • Specific drugs
  • Insect repellants
  • Biological
  • General
  1. Supervision of Public Works, employment camps and temporary settlements to prevent – 

(a) Creation of temporary conditions contributing to epidemics in camps themselves

(b) Creation of permanent conditions aggravating or precipitating endemicity in the locality.

  1. Diet, Evaluation; Initiation of measures, where necessary to improve by local endeavour.
  1. Study of industrial hazards, environmental as well as conventional and formulation of remedial or palliative measures.
  1. Improvement of housing
  1. Education in – 
  • Personal responsibilities to the communities
  • Hygiene personal and communal
  • Aetiology of tropical and other communicable diseases
  • General and special disease prophylaxis
  • Dietetics
  1. Rehabilitation – Convalescent, cripple, leper, blind
  1. Native Health. – Special needs in respect of the native population are:-

(a) Maintenance of Kinship Record

(b) Maintenance of individual medical History

(c) Complete periodic medical review by mass survey

(d) Sustained observation of natives in and about white settlements effected by notation on medical history on every occasion of official notice

(e) Control of migration

(f) Control of Employment (See Annexure A)

(g) Control of Camps (see Annexure B)

  • Missions of Government Stations
  • Employment
  • Casual

ANNEXURE “A”

Health Control: employment of Natives

  1. Pre-employment medical examination compulsory
  1. Classified approval for employment

(a) Family

  • Nurse
  • Household
  • Outside

(b) Bachelor

  • Household
  • Outside

(c) Messenger

(d) Industrial

(i) Rural

1. Local

2. Itinerant: drover, etc.

(ii) Artisan

  1. General
  2. Specific – Food handler, etc.

(iii) Casual

  1. Medical approval of employer
  1. Medical approval of  conditions of employment
  • Accommodation
  • Transit
  • Sanitation
  • Diet
  • Industrial hazards
  • Education
  • Amenities

ANNEXURE “B”

Health Control of Mission and Government Native Stations.

  1. Siting

(a) Policy – tribes concerned. e.g. should detribalisation be commenced, accelerated or prevented?

(b) Economic possibilities:- pastoral, agricultural, horticultural, etc.

Do these promise – 

  • Adequate diet in newly imposed mode of life
  • Adequate opportunity for re-education of native

(c) Disease risks of environment – 

  • Imported: exposure of Station to infection by persons and agents brought or drawn to it by new settlement
  • Indigenous : Threat of local conditions, as existing or as modified by settlement, to aggravate disease risk.
  • Drainage necessities and possibilities

(d) Water Supply: Adequacy for sustained occupation; potable quality protection.

(e) Food Supply: Imported; actual and potential local; adequacy in quantity and quality for sustained occupation, and for temporary accessions of population

(f) Accessibility: for medical and administrative supervision and for supplementary stores

  • Road
  • Marine
  • Air
  1. Personnel

(a) Health: Freedom from communicable disease active latent or predisposition

Adequacy: in number and competence to conduct station efficiently

  1. Accommodation.

(a) Adequacy for permanent and for temporary accessions of population

(b) Quality

(c) Disposition

(d) Disease risk: Ventilation, infestation, over-crowding

(e) Education value

(f) Fire risk

  1. Sanitation

(a) Water supply

(b) Excreta disposal

(c) Waste disposal

(d) Insect vectors of disease

(e) Environmental control of disease

  1. Diet.

(a) Quality of food

(b) Quantity of food

(c) Possibilities of supplementing by – 

  • Local production
  • Imported supplies
  1. Medical.

(a) Provision proposed for constant supervision

(b) Facilities for care and treatment of sick

(c) Proposed hospital provision

(d) Facilities for control of communicable disease by – 

  • Exclusion of carriers by therapy and personal control
  • Supervision of convalescents and contacts
  • Isolation of infected

(e) Reduction and elimination of industrial hazards

(f) Proposed measures for supervising and improving child health

  1. Education.

(a) In Communal responsibility – 

  • Property sense
  • Sanitation

(b) Disease control – personal and communal hygiene

(c) Child Management

(d) Production and sustenance

(e) General