Medical Services in New Zealand and The Pacific
III: Health of Troops
III: Health of Troops
In September 1941 Lieutenant-Colonel Davie made a survey of the medical services and health of the troops in Fiji in the ten months from November 1940. At the Girls' Grammar School from 2 November 1940, and then at Tamavua from 14 August 1941, the military hospital had provided full medical and surgical services. Throughout it had had the valuable co-operation of the Colonial War Memorial Hospital.
The hostel at the Grammar School had been built to take about thirty-five girls, and there were difficulties when on occasions more than a hundred patients had to be accommodated. The average number in hospital over the ten months was 78. Patients had to be on verandahs screened by canvas curtains or in tents, from which they were driven into the main building by rain. The use of tents enabled cases of diphtheria, dysentery, mumps, and measles to be isolated, but nursing, especially at night and in rainy weather, was difficult.page 15
In the new buildings at Tamavua conditions were very much better. At an elevation of 500 feet the buildings were cooler, and the layout of the hospital was good from the functional point of view. The hospital normally was able to provide for 140 patients, but 250 could be treated without overcrowding, and the quarters for the NZANS and Headquarters Company of 7 Field Ambulance were very good. The only real disadvantage was the much greater prevalence of mosquitoes in the new situation. Forest and partially cultivated land lay close to the hospital site and everyone needed a mosquito net, whereas often these could be dispensed with at the old hospital. Unfortunately no blackout arrangements were incorporated in the design of the new hospital. It was necessary to arrange for window screens for the operating theatre block, the orderly room, the admission and discharge room, some examination rooms, and at least one ward to enable work to be done efficiently at night under war conditions.
Up to 24 September 1941 the number of patients admitted to the military hospital was 2136, the principal infectious diseases being measles 169, ringworm 105, dysentery 47, mumps 38 and diphtheria 12. Cases of measles and mumps often arrived with fresh troops from New Zealand. Surgical cases totalled 306. There were 50 admissions to the hospital at Samambula camp for venereal disease, including only one case of syphilis. Two deaths had occurred, one following an anaesthetic and one a case of meningitis following mastoid disease. The average strength of 8 Brigade Group during the period was about 3000; the average number of patients in medical units was 135, or 4.52 per cent of the troops.
The number of troops medically boarded during the ten months was 280 out of a total of 6000 troops sent to Fiji by that time. It was felt there was need for greater care in the preliminary examination of troops in New Zealand, especially as regards such conditions as flat feet and varicose veins.
There was a fairly high incidence of men reporting sick, but this was due to the requirement that all men receiving even very minor injuries had to report to the RAP so as to prevent septic sores. It was recognised that plenty of hot water for ablutions was the chief factor in the prevention of septic sores, and it was felt by Lieutenant-Colonel Davie that more hot water should have been supplied to the camps. Cold showers were provided throughout; hot showers had been turned down on the question of expense. Septic sores were found to be the greatest single cause of incapacity for training. Fungus infections affecting hands, feet, groins and axillae were also common.
The military hospital of 50 beds at Namaka was staffed by sections of B Company 7 Field Ambulance, and had an average daily page 16 bed state of 23. Nursing sisters were brought over by air from Tamavua for emergency duty from time to time. Venereal disease patients were evacuated to the CD hospital, Samambula, but in six months there were only four cases of gonorrhoea from Namaka camp. Climatic conditions were better on the Namaka side of the island, it being noted that when a battalion was changed from Samambula to Namaka there was an immediate reduction in its daily sick parades.
Major Talbot found that eye and ear conditions did not reduce efficiency in Fiji to any marked degree. However, the hot and humid climate was favourable to middle ear infections, and some ears that had been ‘dry’ for long periods became active, and chronic nasal sinus conditions were troublesome. Soldiers with such infections usually had to be employed at Base or returned to New Zealand. Otitis externa was prevalent in the climate of the Pacific, but could be effectively treated during a period in hospital. Although trachoma is endemic in the Fiji Islands, no cases of trachoma were found in either white soldiers or civilians. There was very little trouble among the New Zealand troops from heterophoria, or from functional asthenopia. An idea that ‘glare’ in a tropical country would need to be counteracted by the wearing of tinted glasses was at first widespread among the troops. As a matter of fact, glare is no more of a problem in Fiji than it is in New Zealand. The country is, at least on the Suva side, green, and the sky often cloudy, as would be expected with an annual rainfall of from 75 to 150 inches. The idea died out by the use of persuasion and explanation. Very little conjunctival infection occurred. Eye and ENT admissions for eight months totalled 148, while there were 515 out-patients.
Sanitation and Hygiene
Accommodation was reported by Lieutenant-Colonel Davie to be satisfactory in all camps, the ventilation of huts being good. Bedbugs had appeared in the camps on occasions but regular inspection and effective treatment eliminated them. All sewage was water-borne and disposal was very satisfactory. Garbage from the eastern area was carted to the town dump, while that from the western area at Namaka was buried in a Bradford tip on the outskirts of the camp. Cookhouses were fly-proofed. Mosquito control work was carried out and all men in both areas slept under mosquito nets. At Samambula water was drawn in ample quantity from the town supply, while at Namaka water drawn from a stream was filtrated and chlorinated. Some of the troops washed their own clothes but most sent them to a dhobi. Fijians and Indians were employed in camp cookhouses and on general sanitary work. They page 17 were medically examined and no men with hookworm, venereal disease or tuberculosis were employed.
The native Fijian forces came under the supervision of the NZMC with the assistance of some Government medical officers on full-time duty; this enabled a closer supervision of both men and camps to be made. All the Fijians had to wear boots or sandals in the camp as a preventive against hookworm. Prophylactic ablution huts were also constructed in their camps. Although there was no malaria in Fiji, special precautions were taken when aeroplanes arrived from malaria-infected areas.
Fresh vegetables and fruit were supplied in good quantity and condition, but the condition of some of the tinned vegetables supplied gave rise to some concern in September 1941. Frozen mutton arrived in good condition, and local beef supplies were reasonably satisfactory. The hospital dietitian gave lectures to quartermasters and sergeant cooks on the making up of dishes with the food available, the care of food and the avoidance of waste.
General preventive measures undertaken were:
Inspection of dairy factories for the selection of milk and butter. This entailed visiting some factories that could compare with some of the best in New Zealand.
Bakeries and butchers' shops were inspected in Suva and hygienic conditions were improved.
Cafeterias and restaurants open to the troops were inspected periodically.
Japan Enters War
Immediately following the unprovoked attack by Japan on Pearl Harbour on 7 December 1941, extra battalions were sent from New Zealand to build up the strength of New Zealand troops in Fiji to two brigades. There was a period of feverish activity in improving the defences of Fiji as the Japanese swept down through the Solomons and into the north of the Gilbert and Ellice Islands.
The medical requirements of 8 Brigade had to be adjusted in accordance with the tactical situation in Fiji and the build-up of the force to over 12,000 men. The defence problem was one of repelling beach invasions at certain points, the principal areas being near the two military hospitals, Tamavua and Namaka, on the east and west sides of the island respectively. A coastal road encircled the island, the distance between Suva and Lautoka being 180 miles one way and 150 miles the other.page 18
Two companies of 7 Field Ambulance were immobilised at Tamavua and Namaka as hospital staffs. They were to act as main dressing stations in the event of hostilities. This left only one company free to form advanced dressing stations, and this company alone had the necessary transport to render it mobile.
In the reorganisation it was arranged that the Tamavua military hospital be established as a separate hospital of 140 beds, expandable to 200, and that Namaka military hospital be similarly separately established with accommodation of 50 beds expandable to 100 beds. This latter unit was also to control and staff a hospital at Lautoka for the Civil Construction Unit, which had been sent from New Zealand to complete the airstrip at Nandi, and also to serve the expanded RNZAF units.
To form a complete field ambulance apart from the hospital staffs, two companies were sent from New Zealand to supplement the one remaining mobile company of 7 Field Ambulance. Extra regimental medical officers were also provided for the extra combatant units sent to Fiji. Two small hygiene sub-sections were also despatched from New Zealand – one for each end of the island. Although ten nursing sisters and some reinforcements reached Fiji in February, the remaining reinforcements for the new organisation did not join 8 Brigade until 12 March 1942. Seventh Field Ambulance was then reorganised as a complete field ambulance at Samambula, while Tamavua hospital became a separate unit. The company of the ambulance which was at Namaka remained on the western side, and with the addition of considerable reinforcements in February had become 22 Field Ambulance and serviced the newly formed 14 Brigade.
As the eastern and western areas of the island were practically separate as regards administration, and would have been entirely so if hostilities had commenced, plans were pushed forward for the erection of a larger hospital at the western side to replace Namaka hospital. This small hospital was overcrowded as it had to receive and treat all cases in its brigade area, and in addition it was badly sited on the edge of the extensive aerodrome, which would have made its position untenable in the event of hostilities. The new hospital, with a 300-bed capacity, was erected on slightly elevated ground on the bank of the Sambeto River, some miles away, but owing to the return of the force to New Zealand in July it was never used by the New Zealanders.
At Tamavua members of the field ambulance worked three eight-hour shifts a day for many weeks tunnelling out a 250-bed hospital shelter in the soapstone beneath a hill across the road from the Tamavua hospital. It was completed under the supervision of page 19 engineers as a major project in the defence scheme. Shelters and slit trenches were also dug out at Battle Headquarters at Tamavua village, as well as RAPs round the area of Suva's defences, which were to be manned in the event of attack by New Zealanders and members of the Fiji Defence Force.
In his monthly report for May 1942 the ADMS stated:
The general health of the service personnel is good but far too many men are sent here who are quite unfitted for service in the tropics. It has been the custom in New Zealand to fill drafts with Grade II men when Grade I men were not available. This system should be discontinued: no man should be sent for service here unless he is absolutely fit. On no account should a man suffering from skin trouble be sent to Fiji: a large number of men suffering from acne, more or less quiescent when they left home, have had to be boarded. Men suffering from slight varicose veins, varicocele and other minor disabilities that cause little trouble in New Zealand, have symptoms very markedly increased and spend so much time excused duty or on light duty that they have to be boarded. No man who has a head injury or a nervous breakdown should be passed for service over here. A very large number of cases have been boarded for asthma, some of whom reported at the time of original examinations that they were subject to that disability.1
The ADMS again stressed the necessity for hot showers for the men and a better laundry service. The natives did not cleanse garments properly and he suggested that a brigade laundry should be set up. Septic sores had increased with the scratches the men received in jungle training and the ADMS recommended that each man should be provided with an antiseptic of some sort to apply immediately to even the slightest injury. Everything was being done to provide protective foods for the troops but Vitamin ‘C’ was a problem.
The ADMS reported in June that a few cases of anxiety neurosis had lately appeared and a special board had been set up to examine forty men attached to Suva Battery. A large proportion were found to be definitely mentally enfeebled and should never have been passed for service. The ADMS considered it unreasonable that such men had been sent to units which contained native troops. He stated that he agreed with the ‘Anxiety Neurosis Committee, 2 NZEF ME’ that a psychiatrist should be attached to the mobilisation camps in New Zealand.
In the early months of 1942 Japanese submarines were active around Fiji, and when the Allied defences collapsed in the Far East and the enemy's thrust reached the southern Solomons, considerable anxiety was felt about the adequacy of the Fiji defences. In April the New Zealand Chiefs of Staff advised Cabinet that another division was required for Fiji, and as America was considering sending troops to New Zealand the situation should be placed fully before that country. When New Zealand pointed out that to send another division would cripple the defences of the Dominion, the United States suggested that it should take over complete responsibility for Fiji and Tonga and the New Zealand garrison could return to the Dominion. This proposal was agreed to by the British, Fijian and New Zealand governments and in June troops of 37 United States Division began to arrive in Fiji, which was transferred to United States command on 18 July 1942.
Eight thousand New Zealand troops returned to the Dominion in July and August and about 2000 remained at the request of the United States. These men were in anti-aircraft and commando units.
It was hoped by the Americans that the New Zealand troops thus relieved would be made available for amphibious training with 1 Marine Division in anticipation of joint offensive action to the north-west.
Americans Take Over
On 14 June the Civil Construction Unit hospital which had recently been used by Namaka hospital as a convalescent depot was closed and the building was handed over to an American medical unit. The next day seventeen stretcher cases from the Namaka hospital were taken by ambulance to Suva, where they embarked for New Zealand. The walking patients of the hospital left for Suva on 16 June and all equipment and stores were handed over to 142 US General Hospital.
On 17 June 141 patients from Tamavua hospital, 81 patients from Namaka hospital, and 38 boarded personnel embarked at Suva. The medical staff, including 35 nurses, of 71 US Station Hospital arrived in the middle of the month, and on 28 June the Tamavua hospital was officially handed over to the United States medical staff.
In July the hospital and field ambulance staffs returned to New Zealand with other troops to undergo reorganisation as 3 NZ Division and be prepared for service elsewhere in the Pacific.
1 The complaint of the medical services in Fiji with regard to the inadvisability of sending troops from New Zealand with minor disabilities such as flat feet, varicose veins and varicocele, and with previous history of head injury, is in keeping with similar complaints from the Middle East and later from New Caledonia. These complaints tended to cease when medical officers realised that the real problem was one not of any organic disability but of psychoneurosis, which became more marked in a debilitating climate and in periods of inactivity.