Maori T.B. Investigated

In 1935 Dr H. B. Turbott, new Assistant Director-General of Health, made a study of tuberculosis amongst the Maoris of the East Coast, Nurse Wehipeihana assisting him in his research. This study revealed that we were up against a very big problem. As a help to over-come infection in the homes he recommended the use of T.B. huts in order to keep sick cases out of the homes and so prevent the spread of infection amongst the rest of the family. It is certain that, where properly used, these T.B. huts do save a lot of infection, and they are still available and used for this purpose. The principle of using the huts is sound when treatment is refused or is not likely to lead to a real cure of the disease.

Though chest clinics had been operating in the South Island for quite a number of years prior to 1935, it was not until that year that chest clinics for the country districts of the North Island were begun. There had, of course, been chest clinics in the main centres, but there was nothing for the smaller places. However, in 1935, Dr Hugh Short and myself began these country chest clinics. We tried to do what is now done by at least 8 doctors and the clinics were admittedly inadequate, but at least it was a start. The size of the problem of T.B. amongst the Maoris was soon apparent, as Dr Turbott had discovered. To cope with Maori tuberculosis was to be a very big task. In 1944 the chest clinic service began to be more adequate. Dr Short went to Hamilton to do chest clinics for the Waikato, Bay of Plenty, Rotorua and Thames districts and I took over the East Coast, Wairoa, Hawkes Bay and Wairarapa districts. Soon after this Dr Priest went to Wanganui to do the West Coast (North Island) and Main Trunk areas. Later Dr Webb went to North Auckland, Dr Tyler took over the Rotorua and Bay of Plenty districts and I handed over the northern half of my district to Dr Simpson. The value of the Chest Clinics has, as a result, been greatly increased. Much greater individual cure of cases has been made possible. In addition, B.C.G. Vaccination, a most valuable form of protection, especially for infants and children exposed to infection, has become much more readily available and has already shown its very great value. It would be a good thing if all Maori children had B.C.G. Ask the District Nurse about it.

Effect of Chest Clinics

It is an interesting fact that, soon after the augmented Chest Clinic service became available, the Maori death rate from tuberculosis began to fall rapidly. In fact, when shown on a chart, it is most spectacular, an almost vertical drop. From 1920 till 1945 the figure had remained well over the 300 per 100,000. After 1945 the rate fell rapidly. By 1954 it was down to 78 which is less than the European rate for 1900. It looks as if the figure will continue to fall, though one cannot say if it will fall as rapidly as it has done in the last few years. However, this big drop in the death rate is a most hopeful augury.

But the Maori death rate is still too high. It is still about seven times as great as the European death rate and the Maoris have still a long way to go before they catch up. There can be no slackening of the efforts to conquer tuberculosis. It is no use being satisfied with present results and resting on our oars. That can only lead to disaster. It is only by team work on the part of the doctors, the nurses and the Maori people that T.B. amongst the Maoris can really be brought under control. The doctors can supply the specialised advice and treatment, the nurses can help by home visits and guidance, but the Maori people themselves have a great part to play by seeking to attain better standards of living, and by co-operating with Chest Clinics and with the advice given by the doctors and nurses.

Importance of Early Treatment

Though a very great deal can now be done for those who have tuberculosis, it is most essential to co-operate fully with the advice given by the doctors and nurses if the best results are to be obtained and if the spread of infection is to be checked as rapidly as possible. Sometimes the advice is not taken at all. Sometimes it is only half-heartedly carried out. In either case the results can be disastrous. Even within recent months, I have seen three tragedies occur because my advice about treatment was not carried out. Disease which could have been cured has become quite incurable. Furthermore infection for others is very likely to persist. Both of these circumstances need not have arisen if only advice about treatment had been accepted at the beginning.

I want to say, and say it most emphatically, that the modern treatments for tuberculosis, faithfully carried out, can and do achieve absolute miracles of healing in the right kind of case. But it takes time; it requires whole-hearted co-operation; it means doing what the doctor thinks best. It is no use going into hiding or trying to put things off, or making some half-hearted compromise about treatment. The best time for treatment and the opportunity to use the best kind of treatment may be lost for ever. The only wise thing to do is to accept the doctor's decision about the treatment needed and the place where it is best carried out. When this is done we are very unlikely to see the sad tragedies I have mentioned. On the other hand, we are likely to see most marvellous healing of disease. This is especially true of early cases. When the disease is chronic and has been present for a long time before the patient is first seen, the results cannot be so good. But even then we can patch up somewhat. In early disease, however, the results are often amazingly good. In some cases the disease seems to disappear entirely.

This leads me to my next point, the need for early discovery which is a very important factor in the control of tuberculosis. Now early discovery is really important because treatment of early disease is so very successful and because the risk of infecting others with tuberculosis is greatly reduced. A great part of this early discovery lies in two things. Firstly there is the use of X-rays. Secondly there is a need to pay heed to what I call the Warning Signals.

X-Rays

It is very important to go for X-rays when asked to do so. The X-ray may be for a follow-up X-ray, for example, after a pneumonia, for an X-ray as a contact of some other case, because your doctor wants an X-ray done or because the District Nurse thinks you should have one. People with a chronic cough ought to ask for one to be sure there is nothing serious present. Your private doctor or the District Nurse can arrange this. An X-ray is actually a valuable form of health insurance. If nothing is found, you have an easy mind. If there is something wrong, the sooner it is seen to the better. I have an X-ray myself every year. I hope that in time this may be possible for everybody. It is certainly well worth while as a means of wiping out tuberculosis.

There is one special form of X-ray I must mention, what is known as Mass Miniature Radiography, M.M.R. for short. Very small films are taken which sort out the doubtful chests. A bg film is then taken to get better detail and the person with the suspicious chest is referred to the Chest Clinic so that it can be decided if treatment is needed. The Taranaki Mobile X-ray unit has been working for quite a long time now and it has proved most successful in finding cases of tuberculosis and other chest diseases. This unit owed its inception to a gift of £1000 by the Taranaki Maori Trust Board. The Health Department is getting more of such X-ray units to go round the countryside. Now for a Mobile X-ray Unit to do its job properly EVERYONE in the settlement ought to roll up, including Grandma and Grandpa! I have seen quite a lot of T.B. in Maori children where the grandmother or the grandfather was the source of the trouble. If

only half the settlement turns up, the work of the Mobile Unit is largely spoilt. Please try to see that everyone rolls up.

Now X-rays will reveal nearly all the cases with lung tuberculosis. In some it will be chronic. It may not be possible to help these people very much but they can be shown how to limit the spread of infection, in itself a great help in reducing the number of new cases. In other cases the disease will be recent and early. Treatment is almost certain to prove highly successful. With each visit of the Mobile X-ray Unit there should be fewer and fewer cases of new tuberculosis to be found and these new cases will almost all be helped tremendously by our new treatments for this complaint.

Warning Signals

So you can see that a wide use of X-rays will in itself help the Maori people very greatly in solving their T.B. problem.

The second point I wish to make is the need to pay heed to the Warning Signals. These are:

Any cough lasting for more than a month.

Any blood in the spit.

Persistent tiredness and lack of energy.

Steady loss of weight—getting thinner and thinner.

A wet pleurisy, especially in a young person.

Shortness of breath when the heart is not at fault.

Profuse sweating during the night.

An afternoon temperature which is not otherwise explained.

Sometimes anaemia (lack of blood) and chronic indigestion are symptoms which show up.

Now it may not be T.B. which is causing the trouble, but it is a wise step to make sure. There ought to be an X-ray as an ordinary medical examination may not reveal the presence of disease. The important thing is not to waste time before going to the doctor. The earlier T.B. is seen to, the better. It means a speedier and more successful result. With our new treatments the disease may indeed disappear entirely if treated soon enough. It also means that the risk of infecting others, usually the folk in the home, is very greatly reduced. Now both aims—quick recovery and diminished infection—are very desirable and in themselves will help greatly to solve the T.B. problem amongst the Maori people.

There are lots of other things I could write about on this subject of tuberculosis. Some were dealt with in a 1953 number of Te Ao Hou. In my own booklet on T.B. which has recently been revised there is a section on Tuberculosis and the Maori people. If you are interested your