Medical Services in New Zealand and The Pacific
VII: Medical Services in the Pacific
VII: Medical Services in the Pacific
At the outbreak of the war the RNZAF was a training service only. In October 1940 a small Reconnaissance Flight was established in Fiji, and in August 1941 an Aerodrome Construction Unit went to Malaya for a short but hectic period.
Japan's rapid drive south early in 1942 made it imperative for the RNZAF to develop an operational force and, at the same time, to continue training its agreed quota of aircrew personnel under the Empire Air Training programme.
There were initial delays involving both personnel and equipment in this programme of expansion, but despite difficulties the force page 223 grew steadily so that, by December 1945, 8000 personnel were in the Pacific zone and more than 12,000 had served a term of duty there.
In July 1942 No. 9 (Bomber Reconnaissance) Squadron arrived in New Caledonia, moving to Espiritu Santo in March 1943. In October 1942 No. 3 BR Squadron began operations from Espiritu Santo and a month later a detachment of this squadron operated from Guadalcanal.
The first actions fought by fighter squadrons took place in April 1943, when Guadalcanal was being hard pressed and subjected to many daylight bombing raids. Actions were also fought over Rendova and Munda in June 1943. During the landings on Vella Lavella New Zealand fighter squadrons gave support to 3 NZ Division. By the time that Japanese air power had been driven from the Solomons area, the fighter squadrons had to their credit 99 enemy aircraft confirmed shot down and 14 probably destroyed.
In November 1943 a flight of bombers began operations at Munda, and by the end of 1943 there were 4400 ground staff in the Pacific area. In April 1944 a bomber-reconnaissance squadron was based on Bougainville, while in October 1944 squadrons were based at Emirau and Green Islands, and in 1945 at Jacquinot Bay in New Britain.
General Organisation of Force
Aircraft and Aircrew: Four types of operational squadron were formed: (a) Fighter – Kittyhawk and Corsair; (b) Bomber-reconnaissance – Hudson and Ventura; (c) Flying boat – Singapore and Catalina; and (d) Dive-bomber – Dauntless.
The operational zone extended to the Equator and was concentrated mainly about the New Hebrides-Solomons and the Admiralty Islands area, with New Caledonia, Fiji and Tonga as important bases. All aircraft were flown by RNZAF crews from New Zealand or the United States to the operational zone.
Two transport squadrons (DC3s) based in New Zealand operated throughout the zone and were responsible for shifting masses of personnel and freight. To a large degree they made the RNZAF independent and enabled it to practise continuous reinforcement and rotation of personnel.
Servicing Units: All non-flying personnel were formed into Servicing Units. Each unit contained 300 administrative, technical page 224 and medical personnel, and was intended to be able to keep one squadron of aircraft fully operational and at the same time to be capable of fending for itself under operational conditions. The difficulties experienced by No. 3 BR Squadron and its servicing unit (Flight Lieutenant Fenwick1 was the medical officer) in establishing themselves in Espiritu Santo in October 1942 revealed deficiencies in the original organisation, but as the campaign progressed modification of the establishment of the units, better liaison with the United States Forces and an improved supply position enabled these objectives to be achieved.
Smaller Units: Frequently it was necessary for servicing units to be split into sections to maintain detached flights of aircraft serving short-term commitments in widely separated localities. Other small specialist units (e.g., sawmilling and radar) varying from ten to a hundred personnel frequently served in isolated posts.
Tour of Duty
From the outset it was accepted that tropical conditions would limit the period for which personnel could serve efficiently in the Pacific zone. It was an important duty of the Medical Branch to assess the effects of climate and disease on aircrew and ground staff and to advise how long their hours of duty should be.
Non-flying Personnel: Originally the time was set at twelve months overseas, of which a period of three to six months was to be in a forward zone. As lines of communication lengthened it would have been impossible to maintain this rate of relief and replacement, but as living conditions were improved and sickness was lower than expected the time of duty in forward zones was progressively extended to eighteen months. Many personnel served two such terms without ill-effect.
Aircrew: The term of duty for aircrew was more flexible and varied according to operational conditions. Fighter pilots in forward areas had tours limited to six to eight weeks, while crews of flying boats and bomber-reconnaissance squadrons were frequently away from New Zealand for six to twelve months without relief.
Stations in the Fiji-Tonga-Norfolk area remained under Air Department control throughout. The senior medical officer in Fiji was responsible to DMS (Air) for local supervision of the three stations on the island, and at one stage also acted as SMO to New Zealand and Fiji army units. In May 1943 Army eventually provided sufficient medical officers for these units to be self-supporting and the RNZAF officers were then released from these part-time duties, which at one stage seriously interfered with their own station duties.
No. 1 Islands Group was established in April 1943 to relieve Air Department of all routine administrative work in the rapidly expanding New Hebrides-Solomons theatre. Wing Commander Hardwick-Smith1 was appointed the first SMO to the Group and he built up a staff which coped with all medical postings, equipment and repatriations in the zone. The SMO remained subordinate to DMS (Air) in policy matters, but in practice had a degree of authority which allowed most actions to be reported in retrospect.
Medical officers in forward areas reported either individually or through their local senior member to the SMO, who forwarded each month consolidated statistical and factual reports to DMS (Air).
The organisation worked smoothly despite the long distances which frequently separated forward units from their Group Headquarters. This was largely due to the fact that individual medical officers were encouraged and prepared to accept local responsibility without too-ready reference to Group.
Medical documents went forward with all personnel and remained in the medical section of the units, where procedures were in accord with usual practice. Effective co-operation was given by most United States units in supplying case records of casualties evacuated to their medical services. The subsequent arrival of Army units in the zone, with different procedures both internally and in relation to disposal of records from United States sources, led to serious confusion through misdirection of documents for some time, and was a strong argument for having a standard practice in all New Zealand formations operating in the same area.
Medical Selection of Personnel for Overseas Units
Medical Teams with Overseas Units
Medical Officers: An ideal aimed at, and periodically achieved, was that one medical officer should be attached to each servicing unit and should care for its personnel and the aircrew of the squadron serving with it. In most instances at least two servicing units were stationed at the same airstrip, so it was frequently the practice for one officer to be responsible for two units. This was a practicable burden for short periods and helped to solve the problem of the most economical use of medical officers, but was in marked contrast with the United States practice of having one or two medical officers to each maintenance unit and one flight surgeon to each aircrew group.
Others: The medical team with each servicing unit, in addition to the medical officer, consisted of four medical orderlies, one hygiene orderly and four general duties men attached for hygiene and malaria control work.
The equipment consisted of a tented 10-bed sick quarters and medical equipment and supplies drawn to a special scale designed to enable most medical and minor surgical cases to be dealt with for a period of about one to two months without restocking. Once overseas the units depended on replacements drawn through United States services, which were always ready to meet demands. The equipment was good and adequate. Only two comments can be made.
First, the tented sick quarters were necessary for mobility but were uncomfortable and difficult for patient and staff because of page 227 the need for individual mosquito nets. The Indian pattern tent provided for earlier units had much to recommend it over the American pattern which later became standard issue. The American type was hotter and emanated a particularly unpleasant odour when under direct sunlight. This was not a minor point for a malaria patient under mosquito netting. However, when a unit had established itself it was often possible to move the station sick quarters to a Quonset hut or similar mosquito-proofed building to the great advantage of patients and staff.
Second, the equipment was packed in a haphazard collection of wooden crates. As it was, there was not much packing and unpacking required in this campaign, but under less static conditions it would be a serious disadvantage if more robust, more conveniently sized and more distinctively marked containers were not provided.
To cope with the increasing number of personnel in Base Depot at Espiritu Santo from mid-1943 onward the station sick quarters was expanded to forty beds, designated No. 2 Hospital and given extra medical complement, which in December 1943 included two nursing sisters. No. 3 Hospital was later established at Guadalcanal and nursing sisters were posted there in April 1944, and also to Fiji and Norfolk Island, which had well-equipped sick quarters. The hospitals served chiefly their own stations but could cope with medical cases beyond the scope of station sick quarters in forward areas. Many medical orderlies were good nurses, but the great advantage of having trained sisters on the staff was readily apparent in the increased scope and quality of the work which their presence permitted. Had they been more readily available and had living conditions permitted, they would have been of great value in all station sick quarters of twenty beds or more.
Except for a short period at Green Islands in 1944 no surgical facilities were provided at station sick quarters or RNZAF hospitals. Urgent cases were evacuated to the nearest Allied surgical unit and non-urgent cases, together with cases beyond the scope of the station sick quarters, were evacuated by air to the nearest US Navy base hospital. Cases earmarked for repatriation to New Zealand were staged through Base Depot, where they could be retained for further treatment or investigation or readily evacuated by air to New Zealand.
In general, the medical services of the Allied base hospitals were very good. By our standards there was occasionally an over-zealous page 228 application of intensive 'processing' which could lead to a man being an unnecessary time from his unit, and occasionally to unpleasant sequelae. However, the chain of evacuation was not always rigid and a medical officer often had a choice of medical units to which he could refer his cases. Many medical officers lamented the lack of surgical facilities in the RNZAF medical services, but unless many units had been concentrated in one area where casualties from enemy interference could be expected, the amount of work would not have been enough to support a surgical establishment or maintain competence in its staff.
Evacuation of Casualties
This was made easy by an excellent air-transport service between the most forward units and New Zealand, augmented if necessary by an emergency flying-boat service which could reach all outlying units. The nature of the campaign enabled base hospitals to be at all times no more than a few hours' flying time to the rear.
From early 1943 onwards small radar units of ten to forty men were established increasingly in remote places. One or two medical orderlies were attached to each unit and were responsible for general medical, hygiene and anti-malarial duties.
A few of these units were ideally situated but others were in most miserable surroundings. In all cases the isolation and the exacting and irksome routine of their work made minor maladies loom large in the life of the men. In 1943 a medical officer was appointed to full-time duty with these units, and although much of his time was occupied in transit it was found that his periodic short visits did much to improve efficiency and morale as well as to reduce serious sickness.
Airstrip Casualty Procedure
On all airstrips a tent or Quonset hut was located centrally and equipped to provide resuscitation and first aid. The forces operating from the strip provided medical teams of one officer and one or two orderlies with an ambulance or specially equipped jeep, and at all times during flying one team was on duty prepared to deal with casualties.
Special Problems concerning Fitness of Aircrew
The first duty of the medical team with an operational unit lay with the aircrew. No less than the ground staff, they were subject to sickness and had to be protected in every possible way. This entailed amongst other things the provision of the best type of sleeping quarters, supervision of strict lights out, and atebrin prophylaxis. If they became sick they had to be treated and returned to their squadrons at the earliest possible moment.
The medical officer also had a more onerous and an almost wholly individual responsibility to the aircrew. He was the one best able to detect and abort the earliest signs of fatigue, or to notice the insidious onset of functional disorders which in an individual might be serious but in a squadron could be disastrous.
To do this properly the medical officer had to know his aircrew individually and had to spend much of his time with them. In many squadrons the operational commitments were not strenuous and personnel served tours of duty of up to six or nine months without relief, so there was little difficulty in assessing the character and fitness of the individuals. In such squadrons the operations became much akin to routine training flights and the conditions were in many respects like those in any New Zealand station. The aircrew in such stations frequently fretted for more activity, but it was only occasionally that any problems arose.
In forward zones where active operations were going on and the need for supervision by a medical officer was more pressing, there were fewer opportunities for doing this adequately. A fighter squadron might move to a new station one evening and next day start on a series of stiff operational flights. Under such circumstances the medical officer had to spend all the time that he could spare from his station duties with the squadron. This meant sleeping in the same quarters, being about when they took off and being in the crew-room when they returned. He needed perhaps to divide his time between two squadrons operating from different strips and using different crew-rooms. Problems of trivial importance or perhaps heralding a more serious complaint would be introduced either casually at a meal or only in strict confidence. For this reason it was best that the medical officer should have some private retreat close to their quarters where aircrew could find him at certain hours.
It was to ensure this continuous close medical supervision and a specialised knowledge of aviation medicine that the United States Forces posted a flight surgeon to every operational squadron. He and the Intelligence Officer were the only non-flying members of a permanent team. Their training was good and many did excellent work, but others found that their greatly reduced medical responsibilities were most restrictive and irritating. Certainly, some showed a degree of inertia that could not fail to react on their aircrew. To a degree the same applied to medical officers attached to American maintenance units for they had no stimulus from contact with aircrew. Though our system could not provide the continuity of medical care to the squadrons and occasionally put too much work on a single officer who had to look after two servicing units and two squadrons, it worked well in practice. By more specialisation the services provided to aircrew might be improved, but not to the extent that would warrant medical officers being attached to all squadrons as well as to servicing units. Perhaps the ideal would be to have one or two flying personnel medical officers on unattached duty with all squadrons in an operational theatre.
The morale of the aircrews was good, and, as demonstrated by the fighter squadrons in New Georgia in 1943, was best when opposition was strongest. Here a daily programme of long fighter sweeps had to be modified only because of heavy losses and physical exhaustion.
Several factors went to make up a high morale. Nearly all aircrew had some years of flying experience behind them. They had squadron leaders of considerable operational experience and were confident in their aircraft and their own ability. They seemed dependent on only two other factors – a good rescue service if they were shot down, and a good medical service if they were rescued. As far as was possible these were provided.
The 'Dumbo' flying-boat service with crews, often including a medical officer, who were prepared to land if necessary within a few hundred yards of an enemy shore, was always standing by or actually flying near a zone of known activity. Its many remarkable feats of rescue proved its efficiency.
Food: Another factor which affected both health and morale was food. Almost all our supplies were obtained through the United page 231 States Forces. They provided a highly organised supply system which depended basically on dehydrated and canned food, augmented at all bases by large refrigerated stores for meat.
The climate had subtle effects on both appetite and palatability. A piece of prime New Zealand mutton, having passed through the refrigerated chain, could be nauseous when served hot at midday. The effect on the palate of some of the American rations was no more appetising, and though they were designed to provide all supplementary factors in abundance, the fact that they were not eaten in large enough quantities accounted for some cases of vitamin deficiency.
Attempts were made to supplement the diet by fresh food, chiefly vegetables, flown from New Zealand. They were appreciated, and though they deteriorated so fast that wastage was high, and they reached only base areas, the effort was worth while.
The experience demonstrated that in this zone reliance must be placed almost entirely on canned and dehydrated rations, and though keeping qualities are important, due regard must be given to palatability. 'Carter's spread' was a horrible example. It was a high-melting-point butter substitute with excellent keeping qualities but so unpleasant to eat as to be almost universally shunned. Tinned New Zealand butter was no better because it deteriorated rapidly and foully. Some samples of modified New Zealand butter which were provided for trial were pleasant and had sufficient keeping qualities to warrant further investigation.
Hygiene and Sanitation in Camps
Camp Sites: The siting of airstrips was necessarily governed by tactical and topographical factors so that the surrounding terrain was frequently poorly suited for establishing camps. The natural handicaps of dense growth and heavy rains had to be competed with, and camps built in coconut plantations were, in general, the most habitable.
Tents were used until camps were well established, and though we lagged well behind the United States Forces in providing more permanent quarters, our sawmilling units did very valuable work in providing material for improving living conditions. In time most base camps were provided with at least partially timbered quarters, and here living conditions were good.
Water caused no concern, owing to the excellent provision from American mobile distillation plants. Most men found that despite the heat and sweating there was no great thirst for plain water. Drinks with a bitter taste were more refreshing and fruit juice and extracts were in demand. At one station some sixty men were page 232 rapidly prostrated due to traces of cadmium liberated from a galvanised drum by the preparation in it of a highly acid fruit drink.
The liberal water supplies enabled showers to be provided, and even at stations where sea-bathing was possible they were popular and undoubtedly helped to reduce the incidence of skin rashes.
Garbage and Sewage Disposal: The fly nuisance was ever present but could be controlled if preventive measures were carried out faithfully. Pit latrines were netted and were burned out twice daily with dieselene oil, and garbage was either dumped at sea or incinerated. Complete incineration was difficult owing to the heavy rainfall, and the dumping practice had many advantages. It needed to be carried out with some regard to local tides and currents, and failure to do this, together with what seemed the quite inexcusable use of jetty latrines by some United States units, made otherwise safe beaches unfit for swimming.
Screening, traps, and the liberal use of various types of pyrethrum dispensers controlled flies about the messes but never abolished them, so that isolated cases of gastro-enteritis were always present. That there was no major outbreak of fly-borne disease showed that control measures were for the most part adequate.