Fiji’s Anti-TB Campaign is Not Just a Matter of X-Rays

THERE is increasing speculation

in Fiji among those interested in the welfare of the Fijians as to progress being made in the anti-TB campaign.

For reasons best known to the Fiji Health Department, very little appears to have been done in the way of informing the man in the street of the magnitude of the problems involved in eradicating the disease from the Colony.

On the face of it, a clear state ment of some of these problems would appear wise.

Although, so far as we know, no figures on the incidence of the disease throughout Fiji have been published, it may be taken for granted that it is widespread.

To the public who imagine that all that has to be done is to X-ray the population, determine immedi ately who has, and who has not the disease, then to get busy with a needle and a supply of Wonder Drugs, the seemingly lengthy delay in doing anything is aggravating.

But here, in plain language, are some of the problems: THE actual X-raying of the popu lation presents quite a prob lem on outlying islands —but even when the photos are taken they do not provide a “yes-no” answer. A great number of people

have suffered TB of the lungs and other lung infections without being aware of it. The disease has become arrested or has healed of its own accord—but the X-ray shows the damage.

By investigation and observation it must be determined whether or not these people still have TB in an active form. With the Fijians it is believed that a high percentage show “shadows”—signs of past or existing infection. Are all these people to be kept under close ob servation for six months or more?

Some only become infectious oc casionally. This can only be deter mined by sputum examination at intervals over a lengthy period.

They should be held in a sana torium during this period, but im agine the accommodation required for this purpose.

Having sorted the unfit from the fit there comes the treatment.

There is not to-day, and possibly never shall be, a drug which alone will cure pulmonary TB. If the Disease is caught very early—and that is not the case at the com mencement of an anti-TB drive — the patient may require only a few months of bed-rest together with other forms of treatment —surgery, injections, or localised partial (and temporary) collapse of a lung. But if the disease has been established

for a year or two and is in a dor mant form, common in Fiji, th< treatment will certainly be pro< longed if surgery cannot be re: sorted to —which is very frequentl; the case in Fiji where both lung; are affected. If one lung only ii involved, the surest “cure” is per 1 manent collapse of that lung by sur gical means.

If both lungs are involved, per haps one extensively, that one ma, be permanently collapsed and tin other one temporarily collapsed. O both may be temporarily collapsec The point here is that a consider able programme of surgery by ver skilled surgeons would be caller for, though the period of hospital! isation might not be more than few months. But with partial col lapse methods the treatment mai well continue for many years, witi out-patient attendance weekly c fortnightly at a clinic —often after very lengthy period of hospitalisa tion.

Treatment clinics would eithe have to be established on ever major island, or these long-tern patients, quite capable of wor while under treatment, would hav to remain away from their horn islands and in the vicinity of clinic.

Those who know the dispositioc of the Fijian are well aware that very high percentage of patient: once released from a sanatoriun would never again appear for the.; regular treatment—injections of aj between chest-wall and lung to kee the infected lung collapsed an rested. The alternative: trains medical staff to make a person:, weekly round of every village t round up and treat the defaulter] Then what of the advanced cas«; in a highly infectious condition These people are frequently to a appearances in reasonably goo health. They move about, are ofte capable of work —but many of the:; also spit indiscriminately in the: houses or in the market place. The may be the primary source of fu:j ther infection.

If all these were rounded up : Fiji they would occupy a great des of expensive accommodation an would cost a great deal to keep ; isolation. They are untreatable, cs perhaps never be rendered non infectious, and may well live for ■ long period of years. And unlea they are rounded up they will as most certainly continue to infea others, especially children.

Whether Fijians who have pass*? middle age and are set in the ways, can actually be educated forms of hygiene and self-isolatio: so that they can look after them selves and not infect others, seen extremely doubtful. The only soM tion appears to be the establish ment of colonies or villages of thee chronics where they could very wt\ look after themselves. It means u;i

ooting them from home and imily. The survey figures probably ill show a large number of such ases.

Or are these chronic cases to oc apy all present available sana jrium and hospital space while lose early cases, who can be cured, re forced to perhaps go without Tective treatment?

This latter is, of course, a prob m in many countries.

The Fiji Health Department un aubtedly has a considerable prob m on its hands—in providing ained staff, in education of the ijians as to the things involved in dding themselves of this scourge, id in making the weighty decisions ; to policy. Aware of these matters, le man in the street may be less ipatient with the seeming slow jss of the anti-TB campaign in le Colony.