The Requirements of Health Administration in North Australia – 1929 [EN 3/29)

Report to the Federal Health Council 

A combination of diverse factors complicates health administration and the provision of medical services in Northern Australia. In the Southern States, the functions of health administration are mainly concerned with the sanitation of a white community of relatively high density living in an environment not greatly dissimilar in climatic and economic circumstances to that under which the parent stock is living. In Northern Australia on the other hand the concern is the sanitation of a small and scattered white population living in climatic conditions alien to the parent stock in more or less intimate contact with inferior indigenous or imported coloured races under conditions predisposing to infection with diseases foreign to the South. Whilst the sparsity of the population might be argued to render preventive medicine unnecessary, the position is further complicated by the national adoption of the “White Australia” policy, which embraces the ideal of establishing a large white population in the area at present so lightly inhabited. It follows that this area must be kept free from endemic diseases, in order that settlement may be encouraged, that the cost of eradication of such diseases may be avoided and that it may not become a focus for the dissemination of endemic disease to other parts of the Continent hitherto free.

Briefly stated, the complicating factors are:-

1. Climatic conditions are favourable to the life cycle of various parasites causing or carrying endemic diseases.

2. The primitive conditions of life, particularly in rural districts in camps devoid of even elementary sanitation, favour dissemination of endemic and infective diseases.

3. The preponderating aboriginal. The aboriginal has no system of medicine or practical sanitation in his civilisation. It is incumbent upon the white race directly or indirectly responsible for the introduction of so many new factors of morbidity and mortality to make good this deficiency in the interests of both races. The exploitation of cheap aboriginal labour renders such service a matter of economic importance. The prevalence of Malaria and Venereal diseases in aboriginals is a perennial menace to the white settler. Contact between aboriginals and foreign carriers of diseases must be controlled to prevent dissemination by the migration of the former.

4. The introduction of Japanese, Malays, and Kopangers in connection with the Pearling Industry, furnishes a source for the introduction of endemic diseases for the endemicity of which this country is favourable. New immigrants must be examined and, if necessary, subjected to treatment and kept under surveillance.

5. The wide field to be covered, the sparsity of the population, the high cost of transport and the difficulties of speedy communication, all contribute to the difficulty of effective application of measures of sanitation.

6. The white population is so small that the cost to the individual obtaining treatment and sanitation supervision is relatively high. Under any other system than that of a national service, whereby the Revenue derived from towns may be devoted to reducing costs in the country, it may be prohibitive. The cost of obtaining a Medical Officer’s services at Anthony’s Lagoon, Borroloola, or Halls Greek, may exceed £500, when a private practitioner must be obtained, notwithstanding that he may arrive too late to render service. This difficulty of securing medical attention militates against settlement by women in rural districts, and throws white males into closer contact with the aboriginal, thus retarding moral, physical and economic development and contributing towards the wide dissemination of disease.

7. A strong prejudice against the suitability of this region for white settlement still exists in the South. Close study of the acclimatization of the individual for the correction of detected contributory faults in the habits of the community are required. The expenses of such work, unless the medical resources of the country are mobilised, is likely to be prohibitive.

The policy of the Commonwealth in North and Central Australia, therefore, has been to develop medical service on a system which permits:

1. The provision of adequate and skilled medical attention to all sections of the population at a minimum of expense;

2. The control of interracial relationships with a view to limiting the dissemination of disease per medium of the aboriginal;

3. Systematic surveys of the incidence of disease in the aboriginal and measures for their control and treatment. Re-examination of aboriginal employees is a matter of routine;

4. Examination of immigrants with a view to the exclusion of endemic diseases;

5. Regular re-examination of Pearling Indents with a view to the detection and eradication of communicable diseases;

6. Control of migration and treatment of persons carrying endemic diseases;

7. Study of the acclimatisation of and the effects of environment upon the individual with a view to detecting and remedying the causes of invalidity in these Territories.   Ante Natal and Infant Welfare Clinics have been established, School Children are submitted to regular inspection and detailed records are kept of all cases attended;

8. The provision of a Maternity Hospital and the prohibition of unregistered midwives;

9. The establishment of free Tuberculosis and Venereal Diseases Clinics, and the development of a routine method of eradicating sources of infection; and

10. The application of Routine methods of eradicating Leprosy from all Races.

The considerable amount of work entailed in the proper effective application of these principles would entail great expense if attempted by other than full time medical Officers. The Commonwealth has provided for four full time Medical Officers to do this work in North and Central Australia and it is found that the whole time principle has further advantages, viz.,

1. The Administration is able, by offering an adequate salary to obtain the service of a better class of Officer than was attracted by the small subsidies formerly offered.

2. Being full time Officers, shirking of official duty, cannot be explained away on the ground of the prior claim of general practice.

3. Fees for medical attention being paid into Revenue, it has been possible to institute a Medical Benefit Fund enabling all persons, for a small annual subscription, to obtain free medical attention and hospitalisation. The Revenue thus collected is expected to go far towards defraying the cost of providing the service even in sparsely populated districts.

4. Being wholly under the control of the Administration, a Medical Officer may be transferred as occasion demands, for relief or other purposes without any complaint that his practice is likely to be adversely affected. Being controlled by a Chief Medical Officer, the work of all Medical Officers is co-ordinated so that a maximum value is derived from the co-relation of data ordered to be collected.

Conditions in the Kimberley district of Western Australia are similar to those in North Australia and an extension of the North Australia Medical Service to the Kimberleys is recommended. It is suggested that the ideal should be the provision of a Medical Service similarly constituted to function in the whole area of the Commonwealth north of the 20th parallel and West of the Queensland border, but including Camooweal, which plays the part of a commercial centre for the Barkly Tableland District of North and Central Australia. It is realised that this proposal savours of unification but it is submitted that were the service provided under agreement between the affected States and the Commonwealth, its functions could be so ordered that independence of action would be reserved for the States. It is suggested, therefore, that the States concerned should agree:

1. That in certain parts of these States, conditions in respect of medical and sanitation service are wholly different to those prevailing elsewhere and that in those various portions, conditions are actually analogous to those found in the Territories of North and Central Australia.

2. That the special conditions there prevailing should be met by co-operative action, and that those should take the form of uniformity of Health Legislation in these areas and in the provisions of a full time medical service on the lines of that provided by the Commonwealth in the Territories.

It is recognised that there are obstacles rendering the establishment of such a service difficult, but it is felt that they are not insuperable if the affected parties are actuated by a spirit of co-operation. Finalisation must take time, but it is suggested that this principle should be adopted, and in the meantime the following preliminary steps might be taken:-

1. The Health Legislation affecting the Territories of North and Central Australia and the States of Queensland, and Western Australia more particularly as it affects the area of those States north of the 20th parallel, should be reviewed by an Officer appointed to do so by the Federal Health Council with a view to achieving uniformity.

2. The Medical Officer at Camooweal should be a Medical Officer of the North Australian Service on the terms already outlined to the Department of Home Affairs. The necessity of this provision has been the subject of a separate memorandum to the Department of Home Affairs, and it is understood that both the committee of the Camooweal Hospital and the Medical Officer himself are agreeable to the proposals there put forward.

3. That the Government Medical Officers at Wyndham, Derby and Broome in Western Australia be required to examine Pearling Indents and aboriginals in their districts in accordance with the system obtaining in North Australia. Records of the results of these examinations should be kept and copies forwarded to Darwin for correlation with those of North Australia.

4. That the States should agree that, when opportunity offers, a Medical Officer of the North Australia Medical Service working on the North Australian border may be authorised to cross into the adjoining State and continue his investigations there at the cost of the State concerned. It is suggested, further, in this connection that when a Medical Officer is available, a thorough survey of the coloured population, Asiatic and Aboriginal, in the Kimberleys might be made by the North Australia Service, the cost to be borne by the Government of Western Australia.

5. That a monthly interchange of reports of the prevalence of Infectious Diseases in Queensland, North Australia and Western Australia should be instituted, on the lines of that issued weekly by the Commonwealth Department of Health for the Pacific Seaboard States.

6. That the Chief Medical Officer, Darwin, periodically report fully to the Commissioner of Health, Perth, outlining steps taken in North and Central Australia towards eradication of endemic disease, which it is desired should be supplemented by co-operation on the State side of the border so that if he thinks fit, the Commissioner may instruct North West Medical Officers accordingly.

7. That as vacancies occur for Medical Officers in North Western Ports of Western Australia, occasion should be taken to appoint Officers on same terms as North Australia.

Cecil Cook Chief Medical Officer