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11. Public Health Services Although lying within the tropics, the Cook Islands are singularly free from the common diseases prevalent in other tropical lands. Malaria is also unknown, but filiariasis is endemic, and this and tuberculosis provide the main health problems of the •Group. The objective of the health services, to improve the health of the oommunity, is being pursued by a system of village sanitary inspection and group medical examination, •combined with modern treatment of disease in dispensary, clinic, hospital, and sanatorium. The health services are headed by a Chief Medical Officer, and include another European Medical Officer, seven Assistant Medical Practitioners (Native), and six Mosquito Inspectors. Hospital and sanatorium staff include two European Matrons, three European Sisters, and a number of trained Native nurses. The Chief Medical Officer has his headquarters in Earotonga, and Assistant Medical Practitioners are stationed in Earotonga (2), Aitutaki (1), Atiu (1), Mangaia (1), Manihiki (1), and Penrhyn (1). The other islands are supplied in most cases with Native Nurses, but are regularly visited by Medical Officers from Earotonga. A general hospital and a tuberculosis sanatorium'are maintained in Earotonga. In the outer islands, dispensaries with accommodation for a few patients are operated by the Assistant Medical Practitioners. All Natives receive free medical and surgical treatment in their villages, in hospital, .and in the sanatorium. All school-children and all Native in-patients at the hospital .and sanatorium receive free dental treatment. The training of personnel to allow for steady expansion of the health services proceeds satisfactorily. Three students are at present training at the Central Medical School, Suva, for positions as Assistant Medical Practitioners, and, of these, two are expected to graduate at the end of 1948 and then be available for service in the outer islands. One Native nurse completed training in Earotonga during the year, while eighteen others ;are still undergoing the course. One Native boy is being trained as a dispenser and another as a laboratory technician. A child-welfare organization covering all phases of maternity and child-welfare work operates in Earotonga, Mangaia, and Aitutaki under the supervision of the Chief Medical Officer. The organization is controlled by a European Sister in Earotonga, .assisted by trained Native nurses in Mangaia and Aitutaki. Eegular clinics were held during the year and periodical lectures were given to the Child Welfare Committees in each village. Interest in the work was stimulated by a series of baby shows and inter-village competitions. Little systematic school-hygiene work was done during the year, but one survey -of 1,145 children was made. Height and weight tables were compiled from the survey •of this group and other data on nutrition and hygiene were recorded. The general health of the people throughout the Group was satisfactory during the year, except for the continued high incidence of tuberculosis and an epidemic of whoopingcough which swept the lower age groups from April to July. Apart from the maintenance of the sanatorium to effect remedial measures, active steps were taken to locate and isolate fresh cases of tuberculosis and attention given to preventive steps by way of improving diet and living-conditions. The whooping-cough epidemic was widespread and the mortality rate, although not accurately assessed, was estimated to be high. The age group from one to five years was the group which sustained the maximum degree of infection, and the infant-mortality table reflects the serious effects of the epidemic in the lower ages. The endemic disease of filariasis is being countered by mosquito-control measures, and the activities of the six Inspectors engaged in this work in Earotonga were extended to the other islands. A minor outbreak of paratyphoid fever occurred during the year. In this connection, steps are being taken to overhaul the arrears of work in improved water-supply and soil sanitation resulting from the dislocation of the war years. In the field of nutrition, food-supplies were adequate and a relative shortage of imported foods during the hurricane season was beneficial, in that it caused more reliance to be placed on native foods.

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