Medical Services in New Zealand and The Pacific
I: Medical Arrangements
I: Medical Arrangements
NEW ZEALAND was on the alert regarding developments in the Pacific for many years before the outbreak of the Second World War, and reports submitted to the Government by the Chiefs of Staff indicated a possible threat to British possessions in the Pacific by Japanese aggression. When, on 3 September 1939, New Zealand declared war on Germany, a Pacific Defence Conference had already been held and a policy based on its recommendations decided upon. In fact, the first party of 2 NZEF, a detachment of a special force known as A Company, was then at sea, en route for Fanning Island.
On 10 June 1940 Italy declared war on the Allies. Fifteen days later French resistance collapsed. The possibility of Japan joining the Axis powers loomed more threateningly, and the New Zealand Chiefs of Staff decided that it was time to reinforce the Fiji defences. Arrangements were made with the Fiji Government for the accommodation and control of the force, including the Fiji Defence Force, then being trained by New Zealand personnel, and the formation of the proposed force was commenced by the withholding of men from the Third Echelon. These troops and a section of the 4th Reinforcements were drafted into a brigade group, at first known as B Force and later given the official title of 8 Infantry Brigade Group.
The brigade's engineer unit being of the reinforcements and untrained, 18 Army Troops Company, detailed for the Middle East, was temporarily held back as an advanced party for Fiji. From 23 July to 11 August the Brigade Commander and the officer commanding the B Force engineers visited Fiji, the former to make a detailed appreciation of the territory that his force was to defend and the latter to plan defences and camp construction. The Medical Corps was then called on for assistance, and during September Major J. Russell Wells1 of 7 Field Ambulance, the brigade's medical unit, was also sent to Fiji to investigate health conditions.
1 Lt-Col J. R. Wells; Ashburton; born Waihola, Otago, 28 May 1893; surgeon; medical officer, NZMC, 1917–19; 8 Bde Gp Sep 1940–Mar 1941 (7 Fd Amb and OC Mil Hosp); medical officer, 2 NZEF, 1941–42; HS Maunganui, Dec 1942–May 1943; SMO Waiouru, Burnham, and Papakura Military Camps, 1943–45.
On 27 September, at Berlin, Japan signed a ten-year alliance with Germany and Italy. War in the Pacific became an immediate threat and preparations for the despatch of the force to Fiji were pushed ahead. With the calling up of the 4th Reinforcements at the beginning of October, 8 Brigade was mobilised, with headquarters at Ngaruawahia. Eighteenth Army Troops Company embarked for Suva on 9 October to engage in preliminary camp construction.
Formation, Training and Departure of 7 Field Ambulance
In New Zealand the organisation of 7 Field Ambulance proceeded rapidly. Personnel assembled at Trentham during the first four days of October. Thorough training was out of the question, however. Not only did the men have too short a period in camp, but the regular instructor was fully engaged with a course for medical officers. However, an NZMC sergeant and young medical officers attending the course gave assistance whenever possible and managed to impart some information and the elements of infantry drill. All ranks were sent on final leave on 16 October, and the unit left for Fiji in the Rangatira in three drafts with the units of 8 Brigade on 28 October, 11 November and 19 November. In view of the task ahead, namely providing a medical service for a force that was split into two sections operating 180 miles apart, the establishment allowed was above that of an ordinary field ambulance. The strength of the unit on embarkation was 281, comprising Headquarters 112, A Company 56, B Company 56, and ASC attached 57.
Major Wells was sent to Fiji in September as medical officer to the advanced party of B Force with instructions to obtain from the Medical Officer of Health at Suva information on all matters affecting the health of troops – climate, diseases, purity of water supply, drainage, nature of soil at site of proposed camps, and nature and amount of fresh fruit and vegetables available. Valuable assistance and advice was given to him by the acting director of medical services in Fiji, Dr McPherson, and the medical officer of health, Dr Baxter.
The climate was found to be wet and humid with an average rainfall of 120 inches a year. On the western side of the island of Viti Levu, however, there was less rainfall (60 inches) and a lower humidity. Typhoid fever occurred sporadically, more especially in the Indian settlements and native villages. Bacillary dysentery occurred at certain seasons of the year and at times assumed epidemic proportions. Hookworm, yaws and filaria were all endemic page 5 and prevalent in the native population. As regards venereal disease, syphilis was practically non-existent, but gonorrhoea was fairly prevalent, more especially among the half-caste population. Mosquitoes were numerous and were responsible for a considerable incidence of dengue fever. Anopheline mosquitoes were not indigenous to the area and malaria did not occur.
Generally, all sources of water supply, except deep wells, which were not common, were regarded as unsafe for drinking without treatment. For the main Samambula camp water was to be drawn by pipeline from the Suva reservoir and was quite suitable for ablution purposes but perhaps not for drinking. The water supply for Namaka camp on the west coast 152 miles away was to be pumped from a nearby river, filtered and chlorinated. Both camp sites chosen were on rising ground with good drainage, and their elevation enabled them to benefit from exposure to the winds. In view of the prevalence of typhoid, dysentery and hookworm, and the necessity to minimise the fly nuisance and the risk of food con- page 6 tamination, the Force Engineer, Lieutenant-Colonel McKillop,1 agreed to recommend the installation of septic tanks and underground drainage at both camp sites. This proposal was strongly supported by the local medical authorities. Fly-proofing of all food storage space, kitchens and messrooms was to be adopted as the buildings were erected.
It was decided that all milk would have to be pasteurised before delivery, otherwise condensed or dried milk would have to be provided. Tinned milk had mostly to be used. Fresh vegetables were produced only in limited quantities, but arrangements were made for large-scale production at a camp farm at Namaka camp. It was thought that potatoes would have to be imported from New Zealand.
Drill uniforms were found to be satisfactory, but it was recommended that several pairs of shorts and open-necked shirts be supplied as they were much more comfortable and generally suitable. Canvas stretchers were supplied for beds. At Samambula 28-men huts were erected, while at Namaka the men were housed in tents, with messrooms, cold storage and cookhouses in wooden buildings. The wooden huts at Samambula were constructed along the ridges so as to be well ventilated by the winds. Drying rooms were erected, but actually the men made use of native laundries.
It was decided by the DGMS to establish two hospitals for the care of New Zealand troops. The larger of these was to be situated at Tamavua, Suva, and would accommodate two hundred patients (this was reduced to 140 before construction commenced in February 1941), as well as providing complete medical and surgical facilities.
1 Col E. R. McKillop, CMG, OBE; Wellington; born Invercargill, 26 Jul 1895; civil engineer; 1 NZEF1915–19; Staff Engineer, HQ B Force (Fiji), 1940–41; Deputy Commissioner, Defence Construction Council, 1941–45; later Commissioner of Works.
When A Company of 7 Field Ambulance disembarked at Suva on 2 November a section took over the hostel, where it was soon ready to admit patients, and the remainder of the company marched some four miles to Samambula camp. Here they were quartered in bell tents with wooden floors, which later were to give place to huts. Though the camp site had been drained it was still muddy. A mile of road had been formed around the area by the engineers, and a mile and a half of six-inch piping laid from the Suva reservoir to the camp. The town power supply had been connected to the camp and electric power was supplied to the cookhouses and key buildings. Regimental aid posts were set up in the camp by 7 Field Ambulance to deal with the sick parades.
A measles epidemic had delayed the calling up of the 4th Reinforcements in New Zealand and the infection had broken out among the troops on board the Rangatira. The few patients were speedily isolated and every effort made to prevent the spread of the disease, to which the native Fijians possessed little immunity, and which had caused heavy mortality amongst them in the past. Later a small isolation hospital and a venereal disease hospital were run by A Company at Samambula camp.
B Company of 7 Field Ambulance travelled with the second flight of 8 Brigade, disembarking at Lautoka with 30 Battalion on 13 November and moving to Namaka, some 18 miles from the port, where a camp was established. Here a small camp hospital was set up in a building already on the site, pending the construction of hospital buildings six months later, and RAPs were established.
The main body of 7 Field Ambulance under Lieutenant-Colonel Davie1 arrived at Suva with 29 Battalion on 22 November. Lieutenant-Colonel Davie became SMO of the Force as well as CO of the ambulance, and Major Wells was appointed OC of the company running the Suva hospital. Some twenty-three sisters under Matron Thwaites2 came with this draft and were attached to the hospital and quartered in a nearby private boarding house.
1 Lt-Col P. C. Davie, ED, m.i.d.; born NZ 6 Jul 1887; surgeon; medical officer RAMC, 1915–18; CO 7 Fd Amb (Fiji) Oct 1940–Oct 1941; OC NZ Tps HS Oranje 1941–42; CO 2 Fd Amb (NZ) 1942–43; died Dec 1949.
Sunburn, sore feet and bronchial trouble were the commonest minor ailments, but as the men became acclimatised their incidence decreased. Unfortunately, as far as the hospital was concerned, the effect of this improvement was more than counteracted by the influx of new patients from the third draft, some of whom were suffering from tonsillitis and measles. By 24 November the number of patients had increased to 68. In order to deal with the increased numbers of measles cases, the projected isolation annexe, consisting of an operation tent and a YMCA marquee with holding capacity of 32 acute cases and 72 convalescents, was opened at Samambula on 27 November. There was increasing danger of an epidemic, and both Suva and Namaka were put out of bounds to the troops.
Difficulties continued. The drug supplies, inadequate from the beginning, were rapidly depleted, and the strictest economy had to be exercised. The number of patients increased until lack of accommodation added its problems. Units were requested to send in only their most urgent cases. On 23 December the hospital staff was quartered in the old, and condemned, government buildings in order to provide room for more patients on the verandahs where the staff had been sleeping.
Seventh Field Ambulance expanded and improved its organisation, and although still short of many requirements, considerable progress was made. On 28 January 1941, Major Talbot,1 an eye, ear, nose and throat specialist, arrived from New Zealand and was attached to the hospital at Suva. Two more ambulances arrived for the unit and at the end of the month other equipment came to hand, including a diathermy set and inductotherm machines. The dispensary still lacked adequate supplies of drugs and dressings.
An optician in Suva carried out spectacle repairs, a physiotherapy department was set up and an operating room was equipped.
Lack of medical supplies reached a very serious state and had an epidemic broken out, or hostilities begun, 7 Field Ambulance would have been unable to cope with the situation. The eye, ear, nose and throat specialist was unable to perform his work because he lacked equipment, and the SMO was so badly in need of certain equipment that he bought it locally out of Sick and Wounded funds before authority was granted from New Zealand. However, the position was slightly eased on 21 February, when the Matua arrived from New Zealand with twenty-five cases of supplies.
At the temporary hospital in Suva X-ray equipment was installed in May but the eye, ear, nose and throat department was still awaiting further equipment from New Zealand. A request was made for blood plasma from New Zealand or the United States, as the SMO considered that the local blood bank would be insufficient for prolonged hostilities.
A convalescent depot was established at Nukulau Island on 23 January. Nukulau was a little island off the mouth of the Rewa River and 12 miles from Suva; it was formerly a quarantine station for overseas visitors to Fiji, and had recently been used as a military camp. A medical officer with a staff of eleven orderlies was placed in charge of the convalescent camp. The depot opened with twenty-seven patients who were transported from Suva by launch. Conditions were almost ideal on Nukulau. The staff and patients occupied a large, airy hut and there were facilities for tennis, baseball and cricket. A shark-proof net off the beach made swimming safe. Discipline was strict, but nevertheless the depot was very popular.
There was no increase in the average number of hospital patients in February, but there was a sharp increase in the attendances at RAPs for treatment of septic sores.
At the end of February forty-eight men were reboarded and returned to New Zealand. Commenting on the large number of unfit men, the SMO stated that many of the men were obviously suffering from conditions existing at the time of their enlistment.
The work at the Suva hospital was a strain on the nursing staff and during the month the nurses took turns in having a few days leave at Nandarivatu. Nandarivatu, in the north of the island and 2000 feet above sea level, was an ideal spot for a rest cure, its climate being much better than that of the lower levels. Convalescent officers were also sent there.
Many men were returning to New Zealand every month medically unfit; during March over 120 returned. The Fiji Joint Defence Committee discussed the construction of a Convalescent Depot for 1000 men at a hill station in Fiji. It was considered that the serious wastage of manpower caused by the return of soldiers to New Zealand could be considerably reduced if personnel were given a fortnight's leave in such a camp each year.
Preparations for Emergency
Much preparation was made for an emergency. The hospitalisation of Fijians, Indians and Europeans, army and civilian, was worked out to the last detail. The New Zealand medical officers were to take complete charge and were to be assisted by the local doctors. The local resources were analysed and sites for hospitals and dressing stations planned, consideration being given to the transport difficulties that would arise; barges were to be commissioned immediately on the outbreak of hostilities.
The Fiji Public Works Department prepared twelve ambulance frames that fitted on to local motor trucks, of which about sixty were made available. The whole of February was given up to intensive training. Combined night operations with the troops were carried out on different occasions.
The Samambula section of 7 Field Ambulance carried out training during January. Besides revision of stretcher drill, splinting, bandaging and first aid, there was practice in establishing, organising and equipping a gas centre. Instruction was given in the decontamination of mustard gas cases, the gas proofing of dugouts and the administration of oxygen. Route marches were routine until boots wore out and could not be repaired or replaced. Some officers found that a higher standard of fitness could be achieved by replacing route marches with an exercise involving taking men up some of the many hills in the vicinity of Suva and through jungle, and it was felt that the knowledge of the country thus obtained would have been useful in the event of an enemy landing.
On 20 February, the date fixed for combined operations at Gamboni in the north of the island, a hurricane set in, but not before A Company had got about 50 miles on the way. B Company, which had had earlier notice of the hurricane's approach, stood fast. A Company was recalled by a motor-cyclist and all save one man were retrieved by nightfall, though not without considerable difficulty from swollen rivers and falling trees, telegraph poles and wires. When the company did return to Samambula it was to find that one of its two large sleeping huts was completely flattened, the roof having been carried several chains away. Communication with Nukulau convalescent camp was entirely cut off for forty-eight hours because of the storm and high tides.
When the hurricane warning was received at the temporary hospital at Suva the marquee was dismantled and the patients were crowded into the wards in the main building; some had to be accommodated in a nearby church. Conditions were very trying page 11 during the height of the storm; the electric power failed and by mid-afternoon it was so dark that nurses and orderlies were using hurricane lamps; sacking was packed in every crevice of window and door, but the rain still drove through and saturated everything.
From 3–12 March 140 members of 7 Field Ambulance carried out manoeuvres at Gamboni. On 4 March the tented camp was well established when a practice hurricane alarm was given; in fifteen minutes the camp was struck and packed ready to move. The tents were re-erected in quick time and a special squad demonstrated the erecting and setting out of an operation tent. During the manoeuvres strenuous cross-country marches were carried out and wounded were evacuated from steep, bush-clad hills. Bomb-proof shelters and advanced dressing stations were established and camouflaged, and throughout the exercise mock air-raid alarms were given. At times the manoeuvres were so realistic that civilians passing in their cars along the road offered to carry patients to hospitals.
The field ambulances learned a number of lessons from the brigade manoeuvres; RAPs were best established near roads because stretcher-bearers soon became exhausted carrying patients long distances; paths were needed for walking wounded; aid posts required plenty of direction signs; all ambulances should carry the same type of stretchers as they were useless if the stretcher did not fit; there must be good communication between RAPs, ADS and hospitals.
On 29 May 119 members of the New Zealand Medical Corps were replaced by 116 others from New Zealand. Other replacements by fresh troops from New Zealand were effected from time to time. Many of those who returned to New Zealand went to the Middle East as reinforcements.
At first there was no surgeon at Namaka camp so patients who could travel were transported to Suva for operation. If a surgeon had to be sent to Namaka he took two days to travel there and back by road, but later the use of air transport enabled the return journey to be done in one day. On 24 May 1941 the hospital opened in its new building on the south side of the camp.
The new building had six wards, each of eight beds, with two single-bed side wards; an operating theatre was also provided, although it was some time before it was fully equipped. Nurses were brought over from Suva for emergency duty. The building which the hospital vacated became a dental clinic and battalion RAP.
The plans for this hospital were not finalised until January when the DGMS, Brigadier Bowerbank, visited Fiji. A start was made with its construction on 10 February on the Tamavua heights, some five miles from Suva. The revised plans provided for a 140-bed hospital which could easily be expanded to 200 beds. The factors of cost and ease of administration entered into the decision to reduce the size of the hospital, and the sick rate in the small force then in the Suva area did not warrant a larger hospital. On 14 August the patients and equipment were transferred from the temporary hospital in Suva. Within a few hours the hospital was running very smoothly and by the end of the month the number of patients had risen to 88. With the increased facilities at the new hospital the force was no longer dependent on the Suva Public Hospital for the use of X-ray equipment and operating theatre, and it was able to carry out its own bacteriological work.
Besides a well-equipped hospital with hot and cold water throughout and a freezing plant with separate compartments for the meat, butter and milk and vegetables, there were up-to-date nurses' quarters. The officers' and men's quarters too were comfortable. A good parade ground was provided and tennis courts were constructed.
Appointment of ADMS
Because of the additional medical work Colonel McKillop1 was appointed ADMS in October. In the administration of medical services the ADMS dealt with matters concerning health, hygiene and sanitation, while the CO Field Ambulance dealt with the administration of the field ambulance, the hospitals and defence matters.
1 Col A. C. McKillop, m.i.d.; Christchurch; born Scotland, 9 Mar 1885; Superintendent, Sunnyside Hospital, Christchurch; medical officer, 1 NZEF, 1914–16; CO 1 Gen Hosp Jan 1940–Jun 1941; ADMS Pacific Section, 2 NZEF (Fiji), Aug 1941–Jul 1942; ADMS 1 Div (NZ) Aug 1942–Mar 1943; died Christchurch, 5 Aug 1958.