Medical Services in New Zealand and The Pacific
CHAPTER I — With the New Zealand Brigade in Fiji
With the New Zealand Brigade in Fiji
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.
II: General Conditions in Fiji
The establishment and maintenance of the force in Fiji was beset with numerous difficulties. Conditions of army life were such that the troops began to voice complaints which received press publicity in New Zealand early in 1941. Brigadier Bowerbank had been on a visit of inspection to Fiji from 16 to 21 January, and the report he made on 30 January received the close attention of War Cabinet. Complaints seem to have been concerned with general discomfort and deficiencies without any particular reference to health and medical conditions, but Brigadier Bowerbank was able to give the background against which the complaints had to be set.
The troops had arrived in November 1940 at the beginning of page 13 the rainy season and the period of the hottest weather and preparation for their reception had just commenced. Work on the camps was still in its initial stages, and though this was pushed ahead by the engineers, it was some months before completion and comfortable conditions could be expected. Under such conditions some degree of confusion and considerable discomfort was inevitable, and was noticed by troops who had previously trained in completed and permanent camps in New Zealand. The discomforts could be divided into two groups, those which were inevitable under active-service conditions and those which were avoidable. It could not be denied that there were conditions in the latter category.
One of the justifiable complaints was in regard to uniforms. The troops had been issued with only two pairs of shorts and two shirts. In a tropical country like Fiji where men sweat profusely and get wet through frequently, it was necessary for the clothing to be washed frequently. This resulted in rapid deterioration of the cloth, and Brigadier Bowerbank reported the clothing to be in a deplorable condition despite care and attention by the men. Again there did not appear to be sufficient systematised recreational training. Fiji, with its tropical climate, did not permit of the same continuous arduous military exercises as in New Zealand, and consequent inaction led to boredom and a tendency to deterioration in the soldier's physical and mental fitness. Admissions to medical units, however, showed that the health of the troops had not lapsed but had been consistently good. Diseases of the alimentary and respiratory systems predominated.
Other reports indicated that lack of equipment and of highly trained instructors led to dissatisfaction. From the medical point of view, it was considered that combatant officers and NCOs did not give sufficient attention to elementary camp hygiene. In the early months persistent efforts had to be made by medical officers to convince them that general hygiene and cleanliness was entirely a unit responsibility. The main difficulty was to convince them of the menace of flies and the need also to control the breeding of mosquitoes. As a vector of infective disease the mosquitoes were not serious threats, as there was no malaria on Viti Levu, although dengue and filariasis were endemic, but their bites often gave rise to septic sores.
The incidence of septic sores, which sometimes developed into large and indolent ulcers, was a persistent problem. The ADMS, NZ Army Headquarters, Colonel Wilson,1 reporting on an inspection of B Force in February 1942, stated that medical officers who had been longest in Fiji considered that lack of adequate laundry facilities was the most important factor in causing these septic sores – far more important than the provision of hot showers. Facilities for the washing of clothes and blankets had been improved to some extent since the early days, but provision was still far from adequate. The sores were most prevalent in the hot humid weather of the rainy season, when they also increased among natives. Vitamin deficiencies were suspected to be causative factors.page 14
Transport was inadequate in the whole of B Force and medical units were handicapped as well as other units, as regards both ambulance cars and trucks. In the early months not a single water cart was available in Fiji, despite the endemicity of typhoid and dysentery. On operational manoeuvres 400-gallon tanks were carted round on trucks, and bleaching powder was thrown into these. Stretchers, general medical stores and theatre instruments were also still required at the time of Colonel Wilson's visit. Such deficiencies were the natural result of an inadequacy of stocks in New Zealand, where replenishment of supplies was so dependent on overseas sources. By comparison the equipment of the medical staff of an American Air Force unit was nothing short of marvellous.
Despite the difficulties the medical unit (7 Field Ambulance) rendered efficient service, successfully carrying out the functions usually performed by several medical units, which speaks much for those who staffed the units.
1 Brig I. S. Wilson, OBE, MC and bar, ED, m.i.d.; Wellington; born Dunedin, 13 Jul 1883; physician; medical officer BEF Fd Amb, RMO 1 Bn Scots Guards, Guards Fd Amb, 1914–18 War; wounded, Somme, 1916; ADMS, Central Military District, 1935–39; ADMS, Army HQ, Sep 1939–Feb 1944; acting DGMS, Army HQ, Feb–Jul 1944; CO 2 Gen Hosp Oct 1944–Jul 1945.
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.