Annual Report to Inspector-General of Hospitals

Kai Tiaki : the journal of the nurses of New Zealand, Volume X, Issue 4, 1 October 1917, Page 189

Annual Report to Inspector-General of Hospitals

H. Maclean

On The Nurses' Registration Act, 1908; The Midwives' Act, 1908; and Part 111, Hospitals and Charitable Institutions Act, 1908.

Nurses' Registration Act. I have the honour to report as follows : — During the year 1916-1917 two examinations were held by the State. 196 candidates sat for examination of whom 166 were successful m passing and their names were placed on the Register. 38 nurses were registered from overseas. No large contingents of nurses have left New Zealand for War Ser vice s inc e last report ; but some nurses have been sent with each reinforcement, and a contingent of 25 nurses was sent m response to a request from Headquarters, London, m January, 1917. There are now 430 nurses on the Army List of whom 13 have been enrolled m England, and it has been found necessary to have a Matron m charge of all these nurses at Headquarters, London. Miss Thurston, Matron of Christchurch Hospital, who was on leave from that Hospital m order to take charge of the Walton-on-Thames Hospital for New Zealanders, was appointed to that position. All the New Zealand Army Nurses, many of whom for the first two years of the War worked under the War Office m Imperial Hospitals and Ships, have now been called to join their own service, and it is unlikely that very many more will be required to staff the New Zealand Hospitals m England and France. Since my last report ten more nurses have been awarded the Royal Red Cross : Misses Price, and Thurston, Ist Class ; Misses Annie Buckley, Fanny Speedy, Kathleen Davies, Emily Hodges, Elizabeth Nixon, Fanny Wilson, Marie Wilkie, and Jean Gilmer, 2nd Class. Besides these, Sisters Cora Anderson, Vida Mac Lean, Mary Beswick, Jean Haste, Annie Mackay, Isabel Mcßae, Gladys, Metherell, Edith Popplewell, Edith Wilkin, Margaret Tucker, and Agnes Wood have been mentioned m despatches. I regret to record the death of a New Zealand Nurse, Sister Lind, who, being m England when the war broke out, was very early sent to France under the French Flag Nursing Corps organised m England for the service of our brave Allies. Sister

Lind contracted phthisis on barge duty m France and died on the voyage home m the " Maheno." Apart from this sad loss, no New Zealand nurses have lost their lives on Active Service since my last report. The two hospital ships, " Maheno/' and Marama " have been recommissioned. The Matron of the "Maheno" 2nd commission, Miss Bicknell, having returned to her work m this Department, Miss Bagley has taken her place with a fresh staff of sisters. The " Marama " staff with Miss Brooke, first matron of the "Maheno" was composed of some members of the first commission of the " Maheno " supplemented by newly-enrolled sisters. The various military hosjDitals m the Dominion have been staffed by returned sisters and during the early part of the year, owing to sickness m the Camps, absorbed also some private nurses. In the latter part of the year the work m these hospitals was greatly decreased. With regard to work m Civil Hospitals : the nursing staffs have been fairly adequate and there has been less urgent call for staff -nurses and sisters. The War has brought forward many young women of a desirable class for training as nurses who had otherwise not thought of this career. The tendency of the Hospital Boards to increase the salaries offered, and the many avenues of work now opening out before trained nurses has also improved the future prospects of the profession. Owing to the shortage of Medical Practitioners, nurses have been called upon m country districts to do much on their own responsibility with regard to the treatment of the sick, which formerly lay outside the scope of their work. For this work it has, unfortunately, been very difficult to obtain suitable women, and many country districts are now without either doctor or nurse. During the year, there has been established under the Education Department, a system of school nurses on the lines of the London County Council. Five nurses have been appointed at present to initiate

the work and are stationed at Wellington, Wanganui, Auckland, Christchurch and Invercargill. Native Health Work awd maori Nurses. The development of this work has been retarded through so many nurses being away on account of the war. A nurse was appointed to the Wairoa District, and a Native Nurse has been sent to the Rawene District, and one to relieve the District Nurse m the Waikato District while she goes through her midwifery training. Three Maori pupils have entered for- training at the Auckland and Napier Hos2)itals respectively. The Maori Native Health Nurse at Otaki resigned her position when Nurse Ethel Lewis returned to that District after nursing service m Serbia, where she did very special service and received a decoration from King Peter . Nurse Lewis has again been granted leave for Active Service. District Nurses. During the last year m the hospital districts m remote parts it has been realised how valuable a service of District Nurses, fully qualified m general and midwifery nursing, may be. Owing to the shortage of doctors, there have been many calls for well-qualified and experienced nurses with which it has been impossible to comply. Such nurses need experience beyond their ordinary training, and are very hard to find. After the war, there will be many returning from Active Service with the requisite experience and it is hoped to largely extend this branch of nursing work. It will be necessary to make the position more attractive to nurses by offering larger salaries, and by providing comfortable accommodation. A district started during the year is Warkworth where a small cot- ' tage hospital has been built and a wellqualified nurse established. In South Westland, where there has been no doctor for a considerable period, a nurse was appointed but she found the conditions of life very difficult. Plunket Nurses. This branch of Health work remains much as last year with the addition of two nurses and the opening of two new branches at Masterton and Hamilton. To help the

nurses established at Nelson and Wanganui and at Timaiu, which are large districts, a Karitaue baby's nurse has been posted as assistant to the Plunket Nurse. This work is also hampered by the scarcity of the right kind of fully-qualified nurses, and during the war many nurses with midwifery training only have been appointed to positions. It is found that with the year's training at St. Helens or other maternity Hospitals, and six months at Karitane, these nurses make excellent Plunket Nurses. Useful observations have been made by the nurses on the conditions of health and provision for maternity rrursing m some of the country towns. The Society is endeavouring to largely extend its activities and to appoint a wellqualified nurse to superintend the work geneially. Mid wives Act, 1908. During the year there have been two examinations of midwives. 66 candidates sat for examination. 62 passed and are now registered. 15 were registered from overseas. The lack of a high standard of training under the Midwives' Acts for England and Scotland points to the necessity of amendments to the New Zealand Act, which allows a too open door for the admission of midwives to the register whose course of training is far below the standard imposed on the midwives trained m the Dominion and m Australia. This is an injustice to the New Zealand midwives, which should be rectified as soon as possible. When the Midwives' Act was first passed m 1904 it was, owing to the shortage of midwives, inadvisable to shut out any women from the Register who could show even fairly satisfactory training, but with the ever increasing number of pupils being turned out year by year from the State Maternity and other training schools this is no longer necessary. State Maternity Hospitals. In the St. Helens Hospitals, Auckland, Wellington, Christchurch, Dunedin, and Gisborne, 1,072 cases wvvv, confined during the year ; 1,046 children were born alive, and 44 still-births. There were 8 maternal deaths, and 28 deaths of infants. There were also attended 519 outdoor cases. No deaths of mothers, and no deaths of infants.

Sixty-five pupils have been trained during the year, and 61 registered ; 48 are now m training. With the exception of the Townley St. Helens, Gisborne, the personnel of the hospital staffs remains as last year, and continues to give the utmost satisfaction to the Department . At Townley St. Helens, the Matron, Miss Logan, was obliged to resign on account of ill-health, the sub-matron carrying on, pending the appointment of a new matron. The Medical Officer, Dr. Williams, left on Active Service, and Dr. Reeve is now m charge. A property was recently purchased m Invercargill for the purposes of establishing a St. Helens Hospital for that district, and, as soon as some necessary additions are made, will be opened. A property adjoining the St . Helens Hospital, Auckland, has been purchased, and this addition to the site will allow of the erection of a new hospital and the conversion of the present hospital into a Nurses' Home. The building of the new hospital at Christchurch which was deferred on account of the war is again under consideration. The present building is quite inadequate for the increasing work and the lack of suitable accommodation for the nursing staff renders administration exceedingly difficult. The St . Helens Hospital m Dunedin , while owing to the existence of the Medical School Maternity Hospital m the same town, its accommodation has not been seriously overtaxed, still is greatly m need of improvement, especially m regard to convenient and suitable sanitary arrangements. A new hospital should be erected and the present building used as a Nurses' Home. In connection with the work of the St. Helens Hospitals which is of so much value m the saving of maternal and infant life, an attempt has been made to extend the benefits of the hospitals to more than those who actually enter for treatment or are attended m their homes by St. Helens nurses . Arrangements were made during the year and widely and continuously advertised that advice would be given to expectant mothers at certain hours at the hospitals by the medical officers and trained staff. Circulars were sent to the

members of the medical profession m all centres, inviting them to send their patients to have those observations made regarding their state and fitness for the trial before them, which, by timely treatment, would save so many lives. It was recognised that frequently symptoms were overlooked by private practitioners owing to lack of time (especially during the war) and opportunity to observe their patients during pregnancy. Patients sent by doctors for such examination and advice were not to be treated as hospital patients, but to continue the patients of their private medical attendants. While these ante-natal clinics have been attended by a fair number of women and undoubtedly some good has been accomplished, it is to be regretted that the medical profession has not taken advantage of this offer of help. It is intended during the forthcoming year to take other steps to spread the benefits of these State Maternity Hospitals throughout the Dominion, and Hospital Boards which have not already done so are also being encouraged to establish maternity wards m connection with the General Hospitals. The latest of these additions is the Wairau Maternity Hospital at Blenheim which was opened, fitted up and managed under the Board by two St. Helens Nurses m a most successful way. It already shows need of extension to meet the needs of this large district. The Picton Hospital Maternity Ward is still doing excellent work, and additions are contemplated. A St. Helens Nurse is m charge. The Rawene, Mangonui and Kawa Kawa Maternity Wards are doing good work. The Hawke's Bay Hospital Board has also purchased a property and the necessary additions and alterations are being made. Another means of extending these benefits is by those nurses who go out and establish private maternity hospitals. (Some particulars are given below). Private Hospitals. There is not much to report concerning the private hospitals of the Dominion since last year. No new ones of any importance have been established.

Some interesting returns have been obtained from those nurses who have established private maternity hospitals. There are now 35 of these hospitals m centres and m country districts, conducted by nurses trained m the State Maternity Hospitals. Their average has been 58 confinements per annum, and these range from 178 m one hospital to 3 and 4 m small ones which are not entirely for midwifery cases. General enquiries as to the work of infant life-saving apart from actual midwifery elicited some interesting replies. Most of the nurses seem to have the opportunity of giving useful ante-natal advice and securing medical treatment, if necessary, for their intending patients . This undoubtedly is one reason of the few serious cases and very few deaths m private maternity hospitals conducted by well-trained nurses, who quickly recognise the signs that without treatment or early assistance m labour would lead to trouble. The after-work of the nurses m connection with the babies born m their establishments is of great value m the saving of infant life, as the majority encourage the mothers to bring the babies periodically for advice regarding feeding and general treatment or recommend them to get the Plunket nurses to give them the same advice. The chief bar to the success of the private maternity hospitals owned by nurses is the lack of capital to enable them to make a good start m building or renting of suitable houses, m which the cost of adding necessary sanitary appliances is very high The cost of living having gone up, the usual fee, three or four guineas, does not give much profit for the arduous work, often without sufficient help.

The competition of unqualified women, who, to add to their husbands' earnings, like to take m a few cases, is also a detriment to qualified maternity nurses settling m country districts. An amendment of the law, allowing anyone to receive one case at a time without a license, is necessary to protect the interests of the trained midwife and ensure to the expectant mother, not always alive to her own interests, the best attention at this period, so important to herself and her child. Reports show how appallingly ignorant many women are of what they need, and their willingness to pay for and put up with attendance and surroundings far from what they should have. To assist qualified midwives willing to start maternity homes m such country districts, Hospital Boards, and through them the Government, should be prepared to give subsidies when necessary. Massage. The Bill for Registration of Masseuses has not yet been made law, but the establishment of a recognised course of training by the Dunedin School of Massage is having the good effect of providing a number of well-trained masseuses and a few masseurs for the work m the Dominion. When the Bill does become law, these will be ready for registration. A few of these trained masseuses have been taken on for service during the war, on the hospital ships and at military hospitals. As more of our wounded and disabled soldiers return there will be much need for this branch of work.

Assistant Inspector and Matron-

in-Chief, N.Z.A.N.S.