TUBERCULOSIS AMONG THE MAORIS.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 4, 1 November 1929, Page 196

TUBERCULOSIS AMONG THE MAORIS.

It is a recognised fact that pulmonary tuberculosis has spread to an alarmingextent among the members of the Maori race. It has become a marked factor m the deterioration of their physical wellbeing, and. especially among the young, a frequent cause of death.

The mass of the Maori population lives m remote districts inaccessible to doctors and inspectors, and m many cases medical certification of death is not made. Thus reliable information is not obtainable. It may be pointed out, however,

that statistics relative to Maoris compiled for the quinquennium 1920-25, showed that during the five years 857 deaths of Maoris were recorded as due to tuberculosis of the respirator}- system, and 103 to other forms of tuberculosis. These figures correspond to annual rates of about 28 per 10,000 for pulmonary tuberculosis, and 32 per 10,000 for all forms of tuberculosis, as against corresponding rates of 5 and 6.5 respectively for the general population.

The susceptibility of the Maori to tubercle infection is mainly due to his general adoption of European modes of living, the increasingly large proportion of those of mixed blood, the lack of natural immunity to disease, and m other cases, to his extreme poverty.

In their native state the Maoris dressed rationally, lived m comfortable whares, indigence was unknown, and their lives were for the most part spent m the open air.

In their adopted state of civilisation, life 'has become complicated by the necessity of providing European food, clothes, and homes, not to mention the many luxuries that make even greater appeal than necessities to the pleasure-loving natures of the Maoris.

The economic problem has forced many into miserably poor and unhealthy homes, often overcrowded together m swampy or other unsuitable situations. They are unable to procure the necessary nourishing foods specially needed }}y young children. Insanitary personal habits, indiscriminate expectoration, passing cigarettes from lip to lip, congregating and sleeping m small unventilated rooms, all contribute to a general debility which makes them fall an easy prey to the übiquitous tubercle bacillus.

The nurse who works among the Maoris has to contend against these conditions while endeavouring to impress upon the minds of all the ever-present danger of tubercle infection. They have all seen cases, and know only too well the significance of the symptoms of weakness, wasting and chronic cough, Unfor-

tunately they have not the wholesome fear of the disease that helps to protect the average European. Left to themselves they are seldom m a hurry to seek advice or medical aid. Little or no attempt is made to protect others from infection. It is the custom of the whole family to sleep around the sick one, who may be moved from place to place even when m the last stages of the disease. To gain the confidence and co-operation of the patient and his relatives is the object of the visiting nurse, who has to deal with the case m his own home. To arrange that the patient sleep alone — preferably m a tent or on a verandah — to secure faithfulness m the care and disposal of the sputum, to see that special utensils are reserved for his use, and that he has suitable food and clothing. This means patient reiteration of facts, together with endless argument and explanplanation.

Poverty, superstitious fear, dread of regulations and restrictions, carelessness and ignorance, create almost insuperable obstacles m inducing the Maori to consult a doctor, enter sanatoria, or go into a hospital for observation or treatment.

Apart from the unmistakable or proven case of tubercle infection are the many whose early history of debility and chest troubles, poor general physique. or known exposure to infection, mark them as probable victims. The bottle-fed under-nourished infant who catches cold easily, the weakly-pre-school child — frequently suffering from either septic tonsils, discharging ears, or suppurating glands — the youth and girl of thin anaemic type with chronic cough, the mother debilitated by hard work and frequent pregnancies, the man striving against fatigue and increasing disability, constitute a large class needing constant supervision and advice.

The native health nurse would be materially assisted by a system of compulsory medical examination of all suspected or incipient case's and known contacts. By this means a record of presumptive tubercular cases would be kept, supervision exercised, and retardation or

progress of the disease noted. The ideal would be the segregation of all proven infective cases, thus forming an effectual safeguard against further dissemination of the disease amongst the race.

A case illustrating the reluctance of the Maori to report chronic illness happened recently. School children reported that a girl of 18 years of age had died at a settlement three miles from the town. Going to investigate I found this girl had been ailing for about two years, and had been taken ten months previously to the home of a married sister near Auckland. She had gradually become weaker and was brought back to her own home six weeks before she died.

Her people were of the Ratana religion, and though I saw and spoke with various members of the family, and visited for some time a home nearby, no one told me of the presence of the sick girl.

The only excuse they could offer was that the girl had always refused to allow them to call m either a nurse or a doctor. They themselves did not realise how serious her condition was.

The case had to be reported to the police, and the Coroner ordered a postmortem examination which proved death to be due to pulmonary tuberculosis. No precautions as regards infection had been taken during that girl's long illness, and she had spent the time m at least three different homes. (I might add that since that inquest I have had many calls for mostly trivial reasons from that settlement for, above all else, the Maori dreads the post-mortem examination of his dead and will even go the length of calling the nurse when she knows her visit will safeguard him).

Meanwhile the nurses continue to labour to arouse m the Maori some measure of enthusiasm for better and more healthful ways of living. For it is by preventive rather than salvage work that the Public Health nurse hopes to foster and maintain a higher health standard, and so win for the Maori a greater physical resistance against tuberculosis and allied diseases.

We might also add a greater appreciation of, and co-operation with the means provided for his assistance m the matter of preserving the health of his family and his race. Miss Bagley : Tuberculosis work m New Zealand so far has only been touched as far as the nursing service is concerned. We only have three nurses doing solely tuberculosis work, that is work m between a tuberculosis clinic and the patient's own home. It is very desirable that we should have more clinics and more nurses m the large centres at any rate. Probably the work that is being done by school nurses with regard to child contacts is going to be as far-reaching" m the future as any effort made m the way of preventive work as regards tuberculosis. Much more is needed among the older members of the population, and for the prevention of the spread of infection from patients who are not sanatorium cases, more work is required ; work that can only be carried out by trained nurses satisfactorily. You will see from the paper that has been read on Tuberculosis amongst Maoris that that is handled, as far as possible, by the Maori Public Health nurses. It is a question of whether a good deal of the nursing work might not be done by district nurses. Now the Round Table is open for remarks from nurses. Miss Lambie : " As regards the situation of tuberculosis m New Zealand, although New Zealand has a higher bed rate than any other country, we have about five thousand 'cases m the community that have to be cared for. We want special tuberculosis nurses, that is nurses attached to a clinic, but it seems to me that the care of the actual case will largely fall on the district nurse. The clinic nurse can only act as a specialist to advise as regards the specialist's point of view. The actual daily care of the chronic patient must be carried out by the district nurse. There is another point which Miss Smaile touched on. That is the education of the public towards tuberculosis.

There is no doubt that the nurse m contact with a patient can consider the feeling's of her patient and his approach or relationship to the general public very considerably. For instance, m a home with regard to the dishes used for the patient. It is very trying to an individual to have to keep the dishes separate. It is not only inconvenient but it is difficult for the housekeeper m the home to do that. Now. if the dishes used by that patient are boiled a sufficiently long time, there is no need to keep them separate. In that way the patient is not distinguished from everyone else. Then as regards the use of handkerchiefs. It is very difficult m a home to get a supply of rags, and of course it is very inadvisable for an}' person who is healthy and well to wash the handkerchiefs. In New Zealand we do not use paper m the way we might. The ordinary white paper serviette can be bought for over one hundred for a shilling. Dr. Lythe advised patients to use a rubber pouch m which to place their handkerchiefs. All these things help to make him less conspicuous among the general public. Miss Moore: " One thing that was not mentioned is the After-care Committee." In Great Britain and also m Paris for tuberculosis they have an After-care Committee, and through that Committee the public are educated to the fact that tuberculosis is curable as well as preventable, and that Committee is of great value to clinics. I was very much impressed with their work m Paris. The Municipality had a large block where people from the slum areas were placed. A street could be given over to a nurse. The nurse visited all those contacts and educated them m after care. Some of them had been there for eight years until they were sufficiently recovered to earn their own living, and not one of those families ever returned to the slum areas again. Children during the day were put on the Paris walls, where they had every facility and care.

If patients are discharged from sanatoria, it is difficult for them to carry out the treatment and get into work, hut this After-care Committee follows them up, and often has a position waiting for them. We have not gone far enough m New Zealand with the facilities we have. I believe we could exterminate the disease." Miss Hilditch: " I would like to say I was particularly struck m the United States with the After-care Committee, and suitable workrooms under good conditions where men and women were employed who were suffering from the same condition. It seems an uneconomic way to restore them to health and then return them to conditions that are absolutely unsuitable." Miss Bagley : " I am sure that an After-care Committee could do very valuable work everywhere, and it would be a great advantage if we could have such a committee m all centres. Probably m the days to come when our Association is much larger and much more active, the Trained Nurses* Association might be able itself to move m that direction/* Miss Inglis : " In Wellington there is a residential nursery where children are taken up to five or six years old, three or four children being taken from one family, while the mother is m hospital. It is an immense boon. The mother has not friends coming to her and saying one child is doing this and one doing that. Every nurse knows what effect that has on the mother. This nursery is run by the Women's National Reserve m Wellington, and is one of the finest things they have done." Miss Wright: " This is my experience of the child contact. In our work it may be a month before we get to that home. In one case the father and the two boys were sleeping m a back room and the mother who was tubercular, had the little girl sleeping with her. It seems so dreadful. If we had a T.B. nurse, they would be visited earlier."

Miss Cherry: ''Another instance where the mother has been m sanatorium for quite a long time. There are three small children ; the father is at work daily. The little girl is taken care of, but the boy of ten is cooking the meals; the little boy of six returns home daily at three o'clock ; there is no one m the home until the bigger boy comes home." Miss Lambie : 44 All children are referred to the School Medical Officer, but all cases will not come to the clinic. The number of cases coming to the clinic will vary. Some doctors will prefer to keep their cases under their own observation, and will not send them to the clinic. You cannot compel people to come to the clinic. The School Nurses's work, m some cases could be turned over to the Clinic Nurse, but there will always be a large amount of work that will fall to the School Nurse. Miss Bagley : "In order to carry out tuberculosis work m its entirety, there requires to be splendid co-operation between the clinic, district and school nurses, and perhaps I should add, the sanatorium." Miss North : " I might tell you something of what Dr. Turbit has found amongst the Maoris. There is no child better physically to-day than the child m Maori schools. They are far above the white child. Dr. Turbit made very interesting research over white schools and Maori schools m the same area, and found these children the healthier of the two. Anaemia was prevalent among the white children, but little among the Maoris. Another aspect we found was that tuberculosis was most prevalent m the adolescent period of the Maori girl and boy. There is a scheme on foot to try and help the Maoris to get a sanatorium for themselves. It is very difficult to get the Maori to stay m hospital. The scheme is this — the Hon. A. T. Ngata has been approached by a great number of our chiefs m regard to this matter. The local

districts have an interest from the Government — some thousands — and it has been suggested that they give so much to the upkeep of the sanatorium if it eventuates. It would be an interesting thing if we can only get the Maori to do something m regard to the health of his own race." Mrs. Devereattx : " While we are on this subject, I would like to ask if it would not be possible to get more Maori girls ready to act as nurses. Miss Bagley : " Applications from Maori girls for nurse training are always sympathetically considered, and there are always a number of Maori nurses m training, and we always have a certain number acting as Maori Health Nurses. Applications from educated Maori girls come up before us from time to time, and the

Department always makes an effort to get such suitable Maori girls trained. I think probably just within the last year or two there have been somewhat fewer such applications." Other papers were read, but space does not permit their insertion m this issue. Mrs. Kidcl: I would like to propose a very hearty vote of thanks to the writers of the very interesting papers we heard to-night and at the Round Table on Public Health Nursing. Carried by acclamation. Miss Bagley : ( I would like to again thank Miss Nutsey on behalf of us all. and to emphasise the remarks our President made to Miss Nutsey and her staff for the loan of the nurses' sitting-room, and all their wonderful kindnesses to the Conference/