NAPIER HOSPITAL

Hawke's Bay Tribune, Volume XXV, Issue 232, 17 September 1935, Page 5

NAPIER HOSPITAL

ISOLATION WARD PLANS Tenders New To Be Called

SITE OF OLD ROB JOHNS WARD

Plans for the new isolation section at the Napier Hospital are finalised, and with the specifications will be submitted to tenderers. This block was the subject of an informative report by the medical superintendent, Dr. J. J. Foley, to the Hawke’s Bay Hospital Board yesterday. The board conferred with Dr. R. A. Shore, assistant - Director - General of Health, at Napier yesterday, and at the meeting in the afternoon It decided to re-affirm a previous resolution that the block be erected on the site of the old Robjohns Ward.

In his report, Dr. J. J. Foley, medical superintendent, said, “In compliance with the board’s request for a report on an isolation ward, I feel that it is first of all necessary to indicate the characteristic features of an infectious disease block distinguishing it from other wards of a hospital. Although authorities may not entirely agree by what manner or means such diseases should be dealt with after admission, all are unanimous in appreciating the infectivity of these cases and the necessity for proper isolation and an exacting nursing technique to avoid cross infection where many types of complaints are dealt with by the same staff. THE PUBLIC GOOD. “There are two reasons why an infectious case is admitted to hospital: Firstly, in the interest of the patient to treat the complaint; secondly, in the interest of the public, to isolate the patient during the period of infectivity. Admissions to isolation are virtually prisoners for the public good and have no choice in the matter; other medical or surgical cases have absolutely free will in their choice of stay, notwith-

standing the severity of their illness, and to keep such a one in hospital against his or her will is an infringement of his civil rights and is unlawful.

“A patient may be dying from a cut throat or a perforated bowel and may refuse medical aid. To force surgical attention in such a case would be common assault.

“A patient suffering from diphtheria, however, can be compelled to enter hospital by reason of the Public Health Act, and such cases are sometimes brought to hospital under compulsion. Again, patients in isolation are confined to the building until their period of infectivity is over. This occasionally leads to prolonged periods in hospital of a patient otherwise perfectly well.

“No infectious disease can be treated in a private hospital. All classes of the community must enter the same institution. THE BUILDING. “An infectious disease block sfiould not have easy access to the outside world. Its inmates must be truly isolated, and as the majority of the patients are children, certain mechanical devices must be used to achieve any success. The servicing part in such a block comprises a considerable portion of the building, which puts it in a category quite apart from any medical or surgical ward. Besides its own operating theatre, isolation must be provided with full facilities to militate against cross infection among patients. “It is admitted by medical men that any type of infection can be nursed in any ward with absolute safety and with no fear of cross infection. This depends on a nursing technique which must be ideal. In a public institution one has to be content to work with a staff comprised of ordinary people working in an ordinary way and the dictum that a fool is born every minute finds no exception in the nursing profession. THE PATIENTS. “As already stated, any age, class or creed, must enter the same institution. The majority of the patients arc, however, young children who enjoy a forced stay away from their parents and this is characterised by much weeping and wailing for several days with each fresh admission. This must not infrequently be an ordeal for convalescent adults if by reason of circumstances they must stay in the building, with no redress and no means of es J cape. “Further, many infectious diseases arc ambulatory for some weeks before getting their freedom, and this necessitates plenty of balconies on which such patients can exercise, or at least some open air spaces, otherwise they must be strictly confined to their cubicles.

“Lastly, the incidence of infectious diseases is always uncertain. Epidemics travel in definite waves and visit us from time to time. No building can bo expected to cater for an epidemic, but some consideration must be given tv the possibilities of a little room for erection of temporary accommodation when these occasions actually arise. Again, I have my suspicions that unless isolation is ideally situated with modern appointments, parents reluctantly risk having their children sent to hospital, and either conceal the patient'at home or delay calling in’ medical aid till dangerous complications threaten life. “It was this aspect of the case that compelled me some months ago to issue through the Press a warning to parents who neglected sore throats in young children. The only explanation at the time, and it still applies, is that parents •are most reluctant to send their children to the hopeless arrangements with which we have been struggling for the last three years. THE SITE. “There is the space between Coleman ward and the upper end of Shelas Bobjohns’ site. A build

ing here complies with she desideratum of keeping all structures on the same level, is central, adjacent to all services, and from an administrative and maintenance point of view appears to have advantages over structures placed some distance away. Prior to 1931, a single ward occupied this site, and although it overshadowed the upper end of Shelters, it had nothing comparable to a servicing block which forms a cardinal feature of an infectious ward. The upper end of Robjohns Ward was built on high pillars, being swung out over a gully. It was a single floor structure which fell flat during the ’quake. Unfortunately, the ridge along which the hospital is spread is very narrow about this region, and this is well seen by the big drop behind Shelters. An infectious disease block could come no nearer to Coleman Ward than the original Robjohns Ward, as there is here a much-used traffic way by which funerals leave the hospital mortuary. “To build an infectious diseases block on Robjohns site is no small proposition if this is to be isolated to the gjiblic, who at the same time must have free access to the mortuary or to Coleman Ward. The question is, can an isolation with its servicing blocks and balconies for convalescent patients, be built on this site without encroaching too much on Shelter* and avoid the edge of the gully. There is no doubt the site is ideal for a small ward, but it is difficult to understand how a block of buildings making provision for men, women and children, and requiring about twice the floor space of the original ward which occupied most of the site, can be built here and give ideal isolation conditions, and at the same time maintain suitable approaches for ambulance, eto “From a mathematical point of view it can be done, but as a hospital proposition it would be difficult, leaving no provision for occasional temporary accommodation during epidemics, and necessitating high elevation of the part adjacent to the gully. If this is the site on which the building must go, then to give infectious cases any breathing space, means shifting at least the upper half of Shelters, and this opens up another problem. “Again, the present mortuary is the impromptu arrangement of some of the under structure of the original Robjohns Ward, and has been in use since the hospital returned to the hill from the racecourse. The question of the most suitable site for a morgue should be considered as part of the problem of hospital buildings, and has a particular bearing on the question of isolation going on the Robjohns site. THE ORIGINAL SITE. “No discussion will be entered into as regards this site. There is plenty of room for an ideal building with adequate means of isolation. It is near the Nurses’ Home, and probably can easily be serviced from the main kitchen by the use of a special food trolley. The question of where to build an infectious disease block is a most important one for the whole district, and I have no doubt will be weighed very deliberately and not judged from plans nicely drawn on paper. “Some slight mistakes have been mads in the reconstruction work carried out since the ’quake, but I have every confidence that there will be no mistake with isolation, be it on the present Shelters site; its original home, or the nurses’ tennis courts.’’ Board members discussed the point of whether the Robjohns site or the original site would be the better one for the new block. After listening to Dr. R. A. Shore, Director of the Division of Hospitals, it would resolved on the motion of Mr C. Lassen, that the board’s previous resolution of June 24 last be re-affirmed, to the effect that the isolation block be built on the site of the old Robjohns Ward.