Report / Medical Department, Fiji.

  • Fiji. Medical Department.
Date:
[1970]
Catalogue details

Licence: Public Domain Mark

Credit: Report / Medical Department, Fiji. Source: Wellcome Collection.

    11/80 (page 3)
    Schools of Nursing. The twenty-five doctors and five dentists in private practice throughout Fiji do not receive a Government subsidy of any kind and patients pay their private practitioner directly for the service provided. 3.2.2. For Medical administrative purposes, Fiji is divided into four Divisions, each being headed by a Divisional Medical Officer. The four Divisions are of varying size (see map), and are further divided into subdivisions and these again into a number of medical areas. The “ area ” is the basic medical unit but is further divided into Nursing Districts, the nurses in charge of these districts being responsible directly to their Medical Officer stationed at the area health centre. 3.2.3. Because of their size and for administrative purposes, the two major Divisional Ffospitals—that is the Colonial War Memorial Flospital in Suva and the Lautoka Divisional Hospital, as well as the three special hospitals of St. Giles’ (Psychiatric), P. J. Twomey Memorial (Leprosy) and Tamavua (Chest) have been placed under the administrative control of senior clinicians, who act as medical superintendents. They are directly responsible to the Director of Medical Services. 3.2.4. The chain of responsibility is so arranged that not only is there the closest integration of curative and preventive medicine but also of medical, nursing and environmental health work. The subdivisional medical officer is an important middle link between the Divisional Medical Officer in the upper echelon and the Area Medical Officer at the lower end of the scale. The Subdivisional Medical Officer is also responsible for co-ordinating the work of the public health nurses and the health inspectorate at the subdivisional level. To this end, subdivisional staff meetings are held each month and information is passed both up and down the communication chain. 3.3. Establishment 3.3.1. The staff of the Medical Department provide, in addition to in-patient treatment at the various special, divisional, subdivisional and area hospitals, a general practitioner service through the out-patients departments of hospitals and health centres. It is the out-patient service which has been placing increasing demands on the medical and nursing staff and a number of centres were inadequately staffed during the year. 3.3.2. In the sphere of preventive medicine, the medical officer has been greatly assisted in his “ follow¬ up ” work by an augmented establishment of “ district” and “ zone ” nurses. Although the implementation of the concept had slow beginnings, it was working generally well by the end of 1970. Under this scheme a public health nurse/midwife cares for a population of 2,000 in rural areas and 10,000 in the urban areas. However, the latter ratio was found to be too low, despite the difference in responsibilities in urban and rural areas and adjustments are now in progress to assign a nurse to every 5,000 people in the urban areas. These public health nurses visit all the villages and settlements in their district at specified times, taking stock of the general health of the population as well as visiting and advising registered cases of tuberculosis, leprosy, acute rheumatism, mental and diabetic patients on their domiciliary treatment. A documented record is kept on a “ Family Record Card ” of all women in the 15-44 age group. The Card provides a continuous record of their family planning status, of antenatal visits and deliveries, as well as a record of the immuni¬ sation status of their children. 3.3.3. The shortage of pharmacists in the Depart¬ ment has continued inspite of a number of newly qualified pharmacists returning to Fiji. These have been attracted to the private sector because of better remuneration. The Junior Pharmacy Course formerly conducted by the Fiji School of Medicine was discon¬ tinued some years ago because there was no difficulty for suitable local candidates to gain places at training institutions overseas. A number of candidates are known to be studying overseas at the moment and it is hoped that the recruitment position will improve in 1971. 3.3.4. The exodus of trained technicians in radiograph and laboratory technology noted last year continued during 1970 and steps have been taken to increase the number of students admitted to the relevant training courses in 1971. 3.3.5. To cater for the increasing public demand for health services, particularly on the curative side, the establishment of personnel shown at Table I of the Appendix, indicates an increase of 5 per cent, over the 1969 figure. (This does not include unestablished workers). However, while the recruitment of staff other than doctors has been largely satisfactory, the medical staff situation leaves much to be desired. This was partially due to the fact that only two Fiji students graduated in medicine and surgery from the Fiji School of Medicine in 1970 but also because the recruit¬ ment of doctors from the United Kingdom has become more difficult despite the allowance, over and above the Fiji salary paid by the Overseas Development Adminis¬ tration of the British Government. The delay in recruitment from the United Kingdom is thought to be due in no small measure to the recent introduction of the very much improved salaries and conditions of service of doctors serving in the United Kingdom Health Services. The shortage of doctors in Fiji during the year was so acute that Government approved an approach to the Indian Government for the second¬ ment of doctors from the Indian Medical Service. Arrangements for such recruitment were completed towards the end of 1970 and it is hoped that the first secondments will take place in early 1971. 3.3.6. All four posts of Divisional Medical Officer were held by graduates of the Fiji School of Medicine, three of whom possess the Diploma in Public Health of the Otago Medical School, New Zealand. The shortage of Consultants is also acute and recruitment of these specialists from overseas is also difficult. The resultant difficulty was temporarily overcome by the temporary appointment of medical officers to these positions on an acting basis. Some of these doctors who held sub¬ stantive registrar appointments are scheduled for further specialist training overseas in 1971. This situation as well as the likelihood of the retirement of additional consultants in the near future, and the poor response to overseas recruitment is likely to cause serious difficulties in 1971. 3.3.7. A number of local graduates have been given the opportunity to study overseas for higher qualifi¬ cations under the in-service training scheme but even if successful, their services will not be available in Fiji for some years, and services have to be maintained in the interim period.