[?]Nions Differ Over The

Cook Islands’ Fight Against Tr

By W. H. Percival

3 article by Mr. J. P. shortall. which was published n the July issue of PIM and ed “Ministerial Sensitivity to rse Newspaper Publicity" tins some inaccuracies, over lifications, and misleading tnents in the latter half ag with the TB campaign in took Islands. b primary objects of the mass iture X-ray survey are to n an accurate figure of TB snce in the Cook Islands, i in the past has only been ed at, and concurrently, to out a programme of Mantoux ig and BCG vaccination. The nation of negative reactors es, as far as possible, the non irance of new cases. 3 secondary object of the amme, which cannot be ;d out until the first is com i, is the treatment of new thus discovered. 3 July article stated that •e is no such follow-up and funds have been made ible.” the current financial year is being used for the iase of drugs and for treat of TB cases—more than one a half times the amount during the previous year. ier funds will no doubt be L should the necessity arise. ; follow-up programme was nto operation last November the mobile X-ray team id in the Cooks, and has gone I continuously since then. early February, when the is of the new cases came in, Health Department placed additional orders for drugs.

I are now being received. A ving was added to Rarotonga’s orium last year bringing the capacity to 64 by December, ional TB cases were admitted ;he hospital, and this practice mes. The remainder of the active cases are being put home treatment, ore domiciliary treatment can arted it is necessary, in the •ity of cases, to educate the its in the need for isolation, .ete rest, cleanliness, etc. . this is understood and co tion is obtained the treat can go ahead. This is being and a small number of its have commenced home nent at Aitutaki. It is ted that Mangaia will follow n a few weeks time, i July article went on to -“At the present moment are 90 cases of TB awaiting

treatment on Aitutaki alone. Of these, half are dangerous, active cases, living in crowded conditions inevitably infecting others. There is —or was in June—a waiting list of over 200 cases to enter the only sanatorium at Rarotonga. Some have waited two years. Some have died. But even if they could get into the sanatorium there would

be no medical supplies to treat them at present."

It is true that there were 90 TB cases at Aitutaki in June, But only 34 of these were awaiting home-treatment—39 were suspects only who were due for further checks, and 5 were ex-sanatorium patients. That makes a total of 78. The remaining 12 were found to be non-tuberculous. Shortly after Mr. Shortall’s article was written some of the cases were placed on home-treatment.

Manea Tamarua, GIMP in charge of the sanatorium, has evolved a plan where patients are kept a comparatively short time at the sanatorium before being, placed

me-treatment, thus ensuring iximum use of beds available, rune the number of people ig admission to the sanatorium 0, not over 200 as stated By August 27 the figure sen to 47. The number of tients, i.e., on waiting lists, ups, suspects was 364 up to 27. 6 of the 143 on the waiting ve died at home, and 7 have t the sanatorium. Most of who died had not been ; 2 years as implied in the irticle. They were mainly ed cases when discovered and ould be done to help them, tatement that drugs were ailable at the sanatorium at me is completely untrue, mass X-ray unit goes on y round the Group,” said [y article, “telling the people ave TB—which may worry of them to death but will ittle other effect,” statement is a misleading ith, implying that the are told that they have TB •e then abandoned. What 7 happens is that, in the slands, the people are given suits only when the final re sent out together with or treatment, so that home jnt can be started as soon iitions are reasonably satis- People are also advised,

both in Rarotonga and the outer islands, about what they can do to help their own recovery.

Talks were given at all Rarotongan villages by the CMO Dr. T. T. Romans, and in the outer islands by CIMP’s, outlining the nature of TB, the purpose of of the Mass X-ray survey, and how they could help themselves while awaiting drug treatment.

This advice frequently arrests the progress of the disease, and was the basis of all TB treatment before such drugs became available.

“The medical department in the Cooks freely admits that when the unit makes it second round in a year or so few will turn up for X-rays,” said the July article.

This is not the official opinion of the Cl Health Department and can only reflect unofficial and personal views.

“It is also agreed that the housing situation for home-treat ment is satisfactory in only about 2 per cent, of all cases diagnosed.”

The 2 per cent, can only be a guess, and although the statement is generally true initially conditions are voluntarily improved in all cases where treatment begins.

The general implication of the July article seems to be that huge Sanitoria should be built to house all cases and suspects who are found during the survey. This

scheme is regarded by responsible authorities as “fantastic.” There would be a huge capital cost, extra staff would have to be obtained and trained, the annual maintenance expenditure that would follow would be enormous. And both buildings and staff would quickly become redundant.

In view of these facts the follow up programme must consist of home-treatment, aided by educa tion and the best possible use of the available sanatorium accom modation.

Editorial Note

r.E reader has now been presented with two versions of the TB problem as it applies to the Cook Islands and may take his

choice. The only comment PIM would like to make is: • When the founder of this publication first visited the Cook Islands in 1913, tuberculosis was regarded as the scourge of the group and its incidence and spread were attributed in large measure to unsatisfactory housing. (Which was a point made 43 years later by Mr. Shortall). • In respect of the limited resources of the Cook Group, the large-scale provision of TB Institutions may be regarded as “fantastic” nonetheless we take leave to doubt the efficacy of home treatment upon which the Cook Islands seem to rely in the fight against the disease and in this connection sought expert advice, thus; It is compulsory in New South Wales for everyone over 14 to be X-rayed for TB every two years. The TB Division of the Department of Health and the Anti-TB Association of NSW conduct surveys regularly within boundaries allotted to them under the Health Act.

A doctor in the Health Department said vhat since the surveys were instituted in 1953 many new cases of tuberculosis had been discovered.

A few years ago, the Department found d.vfi culty in placing all these new patients in suitable institutions. But now the position was completely reversed, and there were ample beds throughout the State.

The doctor said that the Department pre ferred to treat patients in institutions rather than in the home.

"We think every patient should be in an institution for a certain period," she said.

"We always think institution care is better than domiciliary (home) care."

If New South Welshmen cannot be regarded as making a satis factory job of home-nursing their TB cases, it is scarcely likely that

Cook Islands Maoris will mas better fist of it. However, h treatment is better than no t ment, and if that is all that be done in Cl there is no moo be said on the subject.