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WORLD HEALTH ORGANIZATION

Regional Office For TheWestern Pacific

ORGANISATION I4ONDIALE DE LA SANTE

Bureau' Regional Pour LePacific Occidental

REGIONAL COMMITTEEMEETING

RC/3/WP/TD/ 2

Third SessionSaigon25 - 30 September :x.952

TECHNICAL DISCUSSION S

The Education and Training ofMedical and Public Health Personnel.

THE EDUCATION AND TRAINING, OF MEDICAL AND PUBLIC HEALTH PERSONNEL IN THE COLONY OFDoginition SARAWAK

1, The Medical Department of this' Coloryr is administered by the Director,of Medical Services, .who is responsible for 'all organised public health servicesto the public, and for the education and training of Medical and Public Healthpersonnel.

2. Private Medical Practitioners and others

In addition, service is rendered.in..the.larger towns of the'Colony byprivate medical practitioners, of which there are [Ib in the Color{yy) 6 of whomlive in Kuching, the capital.

These practitioners have only an indirect influence on the public inmedical and health matters, though.'somc.are always ready to serve on localadministrative councils 'and to 'take' classes `in1`ir'st Aid.

There are also various charitable institutions, chiefly! of ' ;a, religiouscharacter such as Mission Clinics and small hospitals ( as at Kenowit and Mukah)and the Sibu Benevolent Society where the public-'reeeivos treatment for diseaseand, indirectly , much medical and health instruction.

The private practitioners come under the control of the Director ofMedical Services in that they have toIsubscribe'to.thee Medical RegistrationOrdinance and are r , ? gi by th,-, Medical Board of the Colony which isrepresentative both 4316 - ;rnmont -,rd' unoPficial medical opinion.

The Sarawak Oilfi^1d^ Company supports a good hospital at Miri.Whilst this hospital is primarily for employees on the oilfields yet thegeneral public arc admitted for treatment and this influence is far reachingin this area.

3. Hospitals and Dispensarics

Government

There are four hospitals in the territory atHospital

Beds Doctors Sisters Assts . Nurses AssistantNurses

Kuching 400 .4.. 3 56 .28 23Si^anggang ` . . - 4 : 4 Q 1 - 2.:. 2Sibs 1;0 1 1 7

59

Miri 60 1 .. 2 -

3

3. Medical personnel. The General Hospital, Kuching, represents

the only organisation for medical training of hospital and health

assistants and nurses., Here lectures and. demonstrations are given

by doctors and by a full-time "Sister Tutor". 'There is a wellplanned lecture and demonstration room very well and'modernlyequipped with library, demonstration charts. and models and demon-

stration kitchen. There is some, more indefi-n:te, training ofhospital staff:given.by thordoctors in charge of the other hospitals.

The Organisation at the Kuching Hospital-will always form the.,basis of any enlargement of the present scheme.

4. Health personnel - the appointment of anitary Superintendent"is on the establishment and this officer remains in Medical HeadquartersinKuching. He is responsible:::for the technical training of the juniorhealth staff -so to bring them to a `sufficiently high standard to enablethem to take advanta?e of the course -held at the University of 'Malagain Singapore. which leads to.the,Diploma of the. Royal SanitaryInstitution. In - 'addition, , more 'senior .personnel receive refreshercourses in Hygiene and sanitation from time to' time. Much trainingis given.;by the. Health Officer, :Kuching, and by the Chief HealthInspector to the inspectorate staff.

5. Maternity and Child Welfare - training in this subject is givenby a lady medical. officer and,. the Health. Sister at the Child WelfareClinic in Kuching, and,in Maternity work at', the General Hospital,Kuching:

6. Tuberculosis a-Chest-Clinic was formed in Kuching- .. in .1951 andis a nodal point from which training..ln,Tuborculosisis commencing.

6. Details ; of . Training

Hospital Assistants

The standard ,of; ,education required before applicants are consideredfor-the appointment of Hospital Assistant.'.s at least Standard VI or StandardVII. During their training they work on the Male Medical and Surgical Wards,also the Male Chronic Wards and the T.B. Wards. On passing the PreliminaryExamination after the first year they nave operating theatre and pathologicalexperience. The:: latter,: is given to enable Hospital Assistants to do theirown simple microscopical examinations,. when they are posted to outstations or.travelling dispensaries.

The period. of-training is. approximately 3 years during which time theyreceive theoretical tuition-from medical officers, a qualified Sister Tutorand practical tuition from Hospital Supervisors or a trained Nursing Sister.On completion of their .training they are posted to *up of the outstthtiorihospitals, static dispensaries, or to a travelling dispensary.

Nurses

Thiod of 'trai'ning for Nurses is 4 years which includes 1 year's.dwife^'Y. training,'

The Nurses and hospital. Assistants have exactly th6 same training 'and'sit the; same.examinations. Owirlg to lack of staff it is impossible to give theNurses any experience on the Male Wards, On completion of their training they,too, are sent out to outstation Hospitals, but not to Dispensaries.

Prcnotion is given on the recommendation of the Matron.

The grades ar$ Senior Staff Nurse, which is equivalent to Junior Sister,Staff horses and trained Nurses..

Assistant Nurses

These are girls vzith Standard III + V Education.

.. 4

Their:dutieQj_are to. u,ntain,.general cleanliness in the Wards.make beds, wash and feed patients,. and,taice temperat.ire$.

The training: is on a,prartical basis only and they do notreceive . lectures.

Midwives in Training

These are girls usually with a very low standard of education andwith little or no knowledge: of English.

Endeavours are made to recruit from outstations and outlying kampongs1. order that, when they .have.completed their training, they can return totheir home and practise. inidwifery.•there.

The training is,:two years; during this time they work on the maternitywards under the supervision of a Nursing Sister and specially trained StaffNurses. Owing to the language difficulty they receive lectures from the StaffNurses and,. on the completion,of one. ye ar t s - training, they sit a d .OralExamination by the Medical Officer-in-Charge of the Maternity Ward.

During the second year's, training they work for approximately 9 monthswith the existing Domiciliary Midwifery Service, and attend clinics in theinf aunt -.Welfare: !Department. : .

`At the end of the,; second yg4r. they have both.a Practical acid OralExamination and successful candidates are given'a certificate.

Student.: Nurses and. Hospital..Assistants. in. Training

0 1Curriculum of Training

Lecture List By .whom given:

No.Sub j ect

Anatomy34

Sister .Tutor .Physiology 16 n fr

Theory.f:Nursing 14Hygiu ne 20 r+

First Aid 8

Bandaging practicalPractical nursing as many as possibir

Preliminary Examination.

Surgery 14 DoctorMedicine 14Gynaecology 6Senior Nursing - Theory 12 Sister. Tutor

`ii- H - Practical as manor • as possible +r r+ .Midwifery', 10 Mi.dwifexy Sister,Children's Nursing 6 Children's Ward Sister

Materia madica 6 (probably) -To be startedDietetics 6'

-.5-

Examinations

The Preliminary Examination is taken as soon as all junior subjectshave" been passed At the end of-each course of lectures.; i.e. as soon asposs'i'ble after the first year has been, completed.

The Final Examination is.taken after 3 years have been completed if allthe Senior Examinations have been' 4..

Final Midwifery' is.: taken::at the completion 'of the. 4th year..

The Preliminary' and Final Examinations are held in April and Octobereach year, and include Theory and Practice in all the above subjects.

Good, varied, practical experience is obtained in the ward r anddepartments,

The average standard of education of candidates is Standard VII,although a higher. one is preferred, but. difficult to obtain. Suitablecandidates are insufficient.,.espec.ally with regard to nurses. Numbers vary,usually about 50 in training.

1. Training of Health Visitors consists of:

4 years, general nursing training including midwifery training.

General nursing training with midwifery 'is followed by one year's workin Maternity and Child Welfare Clinics. This includes antenatal and postnatalcare #a inf h 'welfare, consultations, home, vi.siti.ng, group talks and demonstrations.Attenaahces at'T B. Clinics, ' minor` ailments treatment, vaccination clinics,Educational standard of the Health Visitor is 7th Standard in the local schools.

The tr<i.ning. schemm follows fairly closely that used in the UnitedKingdom with, however, marry.adaptatirons necessary to local conditions. Lecturesare given by a European Health Visitor and instruction at clinics by a EuropeanLady Medical Officer.

2.. Training of Assistant'Health Visitors

These are girls who have achieved as a rule about 3rd Standard, orsomewhat higher local school grading. They have a knowledge of English bothspoken and written..

Training consists of 1 year's midwifery which includes hospital anddomiciliary deliveries and attendance at cases for 10 days after delivery inthe home.

This year is followed by 3 months training in childrents wards andnine months (longer if necessary) in the Maternity and Child Welfare Clinics.Lectures are given by a European Health Visitor and trained local staff.

Midwives

Average education about 3rd Standard. No knowledge of written or spoken..English is necessary.

Training is for 2 years. This includes delivery of cases in hospitaland on district. Midwives in training attend Antenatal sessions in the Maternityand Child Welfare Clinics. As they do not all speak or write English, lecturesare given by trained local staff.

Laboratory Training

The General hospital', Kuching, supports a very good pathological and.bacteriological laboratory. A is,' at present, weak on histological techniquebut the -Seni'or Laboratory :Technician is being sent to the. United Kingdom forfurther training this year. The Laboratory,is very well equipped.

Hospital assistants receive adequate training in laboratory work, andare trained to take charge of laboratories in the smaller outstation hospitals.

Observations

The real difficulty. in the training of junior medical and healthpersonnel is that applicdnts•wishing to join do not have a sufficiently;, highgeneral standard of - education..: This standard is well below Junior and, certainly,

Senior Cambridge. level which means .that some applicants, particularly for thenursing side, do not have a sufficient knowledge of English to enable themeasily to acquire that technical knowledge which should be imparted to them intheir hospital and health training.-: Consequently..some .fail at the hurdle of;examinations and become discouraged . For the majority the effort to master theEnglish language tires them with.the consequence that they-cannot take fulladvantage of the: technical training..given

-Another disadvantage is that, with'the'poor supply of recruits, to theservice, young trainees have to carry on with their routine ward or health work

whilst at the same time attending lectures: and studying.

The intake of recruits is:lowered by the more favourable financialrewards possible with outside commercial firms, and the Department is also ata disadvantage in that staff in other departments get much more tune..off. .

A combination of these f ators means.... that. the Department receives onlythose=recruits who either have avocation towards this work (and those are fewin number), and those whose parents were previously in medical and health.work.

The vast majority of the remainder are those unable to get jobs elsewhere. -