Annual report / Medical Department, Fiji.

  • Fiji. Medical Department.
Date:
[1965]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report / Medical Department, Fiji. Source: Wellcome Collection.

    13/48 (page 7)
    66. The Laboratory serves as the hospital laboratory for the Colonial War Memorial Hospital and also as a Central Laboratory for the carrying out of more complicated investigations for some of the Department’s units throughout the Colony; it also acts in some measure as a Central Labo¬ ratory for other territories within the South Pacific Health Service, since most of these do not have the facilities for carrying out investigations such as histological examinations. 67. The Laboratory has facilities for carrying out a wide range of investigations and there are few occasions, except for those demanding virological examination, when help from larger centres is necessary. 68. The Pathologist is responsible for most of the medico-legal work in the Colony as well as for supervising the instruction of students taking the Laboratory Technicians’ Course; he is responsible also for teaching Pathology, Bacteriology and Forensic Medicine to the medical and dental students of the Fiji School of Medicine. 69. There was a slight fall in the number of investigations carried out at the Suva and Lautoka Laboratories during the course of the year; there was, however, a marked increase in the number of post mortem examinations carried out on behalf of the Police, the number of per¬ formed at Suva rising from 84 in 1964 to 101 in 1965. Details of work carried out at the three Laboratories will be found in Table XIV in the Appendix to this report. 70. The Wellcome Virus Laboratory was completed early in 1965 and the first Virologist from Otago University arrived in the early part of the year to commence work. 71. This Laboratory, which was built and equipped by funds provided by the Wellcome Trust is staffed by the University of Otago whilst recurrent expenses are provided jointly by the Tropical Medicine Research Board, University of Otago and the Fiji Government which last acts as administering authority for the scheme. PSYCHIATRIC SERVICES 72. St. Giles’ Hospital completed its first year of operation with a Specialist Psychiatrist in charge of the hospital. For the first time in its history the hospital is now free from overcrowding; in spite of a 12-8 per cent, increase in the number of admissions from 185 to 239, the daily average number of patients fell to 105 during 1965 an average occupancy rate of 97-5 per cent. 73. This reduction in occupancy reflects a deliberate policy of rapid discharge which was followed in order to accelerate the turnover of new admissions and to reduce the number of chro¬ nically ill patients in the hospital. During 1965 no less than 70 per cent, of patients admitted were discharged within three months of their admission, the modal duration of stay being just over one month for men and just under one month for women. 74. This policy has not, however, been without its difficulties. One of these has been the resulting increase in the percentage of re-admissions as compared to new admissions; indeed, during the year nearly two-thirds of the total admissions to the hospital were patients who were admitted for second or subsequent time. This phenomenon has been examined by the hospital staff and certain factors stand out. Of the 149 re-admissions, 68 were found to have been re-admitted in the course of the illness which had been continous since its onset. These patients were, or should have been, under continual out-patient supervision. It was estimated that of these 68, approxi¬ mately one half deteriorated due to lack of out-patient after-care. 75. The other 81 who were re-admitted were found to fall broadly into two classes. In 65 cases the re-admission was considered to be due to a new and unpreventable episode of illness whilst in 16 cases the re-admission was due to the course of a concurrent disease. Taking both groups together it was considered that responsibility for re-admission could be apportioned as follows:— i. Breakdown in admission arrangements .. .. 2 9 li. Premature discharge from hospital iii. Inadequate after-care iv. The natural history of the disease 64 149 76. After further consideration of all the factors involved it was found that approximately 50 per cent, of failures of treatment could be attributed in some measure to the failure of the ade¬ quate after-care. Part of this failure was thought to be due to an insufficient realisation on the part of medical personnel of the need for active and continued follow-up of these discharged patients, but part of it must undoubtedly be laid at the door of inadequate social services and general com¬ munity help which are inseparable from the organization of a developing country. 77. During the year a pilot study was made to determine whether the diagnostic criteria generally accepted in the United Kingdom are acceptable in Fiji. All of the 243 patients who were discharged were discussed by the hospital staff at the time of discharge and a series of diagnostic and descriptive terms were finally involved. A provisional classification of the 243 discharged patients is as follows:— Schizophrenia • • •• .. .. .. .. 71 “ Fiji Syndrome ” .. .. .. .. .. 34 Mania . • • • • • • • • • • • • 64 Depression and other affective disorder .. .. 23 Abnormal personalities (including two alcoholics) .. 6 Mental deficiency (including three with epilepsy) .. 15 Epileptic confusions and furies .. .. .. .. 8 Toxic and metabolic psychoses .. .. .. .. 6 Senile and other dementias ... .. 9 No psychiatric abnormality .. .. .. .. 7