STATE SCHOOL DENTAL SERVICE.

Shannon News, 22 June 1928, Page 4

STATE SCHOOL DENTAL SERVICE.

it would set a standard that may be followed in other parts of the country. THE ANSWER. "Mr Hyde," he continued, "put a very specific question when he asked: Could they have a nurse? I have 260 applications on my list and I am not in a position to consider the allocation of the nurses until the end of the year. You can't have one in Shannon and one in Levin, hut I will consider the whole question, and bearing in . mind the claims of the different localities, I will see whether we can allot you one clinic. . . I cannot shower them here, there and everywhere. It simply can't be done." Having reared a family and being a dentist himself he was sympathetic with local desires and the claims of the district were not new to him, though it was his first visit to Levin as a "Minister of the Crown, because they had a very good advocate in Mr Linklater. The Mayor, who had had to go away, had also done him the honour to meet him on behalf of the citizens earlier in the dav. APPLICATION SIX YEARS AGO. Mr F. G. Roe said Levin had first made an application for a dental nurse in 1922. The Minister said he could not hold out any hope of a subsidy for the local scheme such as speakers had suggested. He had to go to the Treasurer for all he required. Mr Roe: Can the Government run the dental clinic at £1 a head a year? Dr. Pomare, when Minister of Health, told us he could not do it for that. The Minister: Our experience is that dentists do not look on the work as profitable. They will not be bothered with it. ' DENTISTS AND PROFITS. Mr Mackenzie took exception to the suggestion that the profession only looked at the mater from the monetary return. There were dentists who did not take that into consideration. Because this district had helped itselv it seemed wrong that it should now be in -the background. "If we had not helped ourselves we might have had a better claim," he added. Mr Linklater: The Minister does not say that. Mr Hyde made it clear that he had only asked for one clinic, but two or three buildings. The Minister acknowledged the point. THANKS TO THE MINISTER. I • Mr Hutchings said that perhaps it was not realised what had been done here. If the Government had a few more men like the local dentists ii would be able to do a great deal. They had got £SO from the Government on two occasions, but if they had got £.IOO it would be very cheap propaganda for the Government as it would meet the needs of 1000 children. "We are indebted to the Minister for his practical and illuminating address and feel quite sure that if the Government can do anything to help us it wnl do it," Mr Hutchings proposed a hearty vote of thanks to the Hon. Mr Young for his visit and adress. This was carried by hearty acclamation. COST OP STATE SERVICE. In acknowledging the vote, Mr Young said he thought Mr Mackenzie would admit that there were much more profitable forms of dental work than attending to little children and that was all he meant. It did not cost the Department £1 per head of the children dealt with, probably under 10s per head, though he. had not the exa'ct figures. He thanked the deputation for their reception. The Minister for Health left subsequently for Palmerston to open the Plunket Soeietv'a rooms there.

EXTENSION TO THIS DISTRICT DESIRED.

Representations to the Minister for Health.

Sympathetic Consideration Promised.

PEESONNEL OF DEPUTATION,

There were present, besides the Hon. J. A. Young, Messrs J. Linklater, M.P., A. W. Hutchings (chairman), K. J. Foss (headmaster), F. G. Boe, H. G. Kerslake, W. Davie, J. W. Procter, and W. Smaill (Levin District High School Committee), A. E. Hyde (chairman), and A. H. Hill (Shannon School Committee), F. C. Meyer (Reikorangi), A. G. Bodley (chairman of the Ohau Committee), J. H. Taylor (Koputaroa), T. D. Clifford and Willis (Manakau), L. H. Atkins (member of the Wellington Education Board), and D. S. Mackenzie, of Levin. THE MINISTER WELCOMED.

Mr Linklater extended a hearty Avelcome to the Minister on his first official visit to Levin. He said the value, of dental fitness and its effect on health generally was well understood. In Levin they had had very efficient service in the past from the scheme inaugurated by Mr Mackenzie, but it was thought that the time had arrived when, in addition, there should be a State dental clinic. He felt sure the claims of the district Avould receive favourable consideration. LEVIN'S CLAIM.

Mr A. W. Hutchings, said he hardly need remark that they were very pleased to have the Hon. Mr Young in I Levin, as it was not very often they ' had the pleasure of entertaining a Minister of the Crown. He also congratulated him upon his advancement to Cabinet rank. All realised that the Government was doing a considerable amount in the interests of public health, and it was specially pleasing to know that they were developing a dentijjj. scheme for the children, since all authorities agreed that dental health had a vital bearing on physical well-being. Following on correspondence and meetings with the school committees in the district from Paekakariki to Foxton, it had been ascerj tamed that there were 2200 children in that area and that their parents were ' all keen to get what they could in the way of dental efficiency. Mr Hutch--1 iivg's mentioned that the Levin District | High School Committee, in the past three years, had raised a sum totalling £1399, all of which was contributed by the parents in various ways, and was devoted to the following objects: Grounds improvement £220, library £SO, annual picnic £3lO, dental scheme (five years) £733, infant room £SO, commercial classes £36. He quoted this to show that the local people were keen to help themselves, and as further evidence of this, he added that for some considerable time there had been a scheme of dental service in operation here under the local dentists. Quite a number of people were willing to pay a certain amount for the service, the cost being £1 per head for one or two children, £2 7s 3d for threa,, £3 for four, and £3 10s for five children of one family. In that connection they had received two subsidies of £SO each from the Government and it had enabled the fees to be reduced for the larger families. It was now'felt that, with such a iarge district, something more must be done in regard to the dental requirements of the children, who "were the citizens of the future, and they were therefore approaching the Minister in the hope that he would do what he could for them.

SHANNON'S SUGGESTION. Mr A. E. Hyde, Chairman of the Shannon School Committee, said the committee had been going into the question of a dental clinic for some time and they gathered that the Education Department would give a subsidy of £2 for £1 raised locally for the erection of buildings and provision of equipment and that this would mean that any centre desiring a clinic would have to raise £9O, which, with the £IBO I given by the Department, would be sufficient. They were hoping to get an

I assurance from the Minister that, if they erected dental surgeries in Shan- ! non and Levin and if passible in Otaki, a dental nurse would be available. He understood that one nurse could attend to 800 children, but was aware that it was difficult to obtain a nurse. He pointed out that this was an important district, carrying a large population, and they felt justified in asking for treatment similar to that received by children in the cities. One I of the Dominion's great troubles was centralisation and if city children were receiving benefits that country child- ' ren had not received, it was going to encourage centralisation. The smaller schools round Shannon were prepared

An official visit was paid to Levin on Tuesday by the Hon. J. A. Young, Minister of Public Health, at the invitation of the Levin District High School Committee, for the purpose of receiving a deputation on the subject of an extension of the State dental service to this coast. The Minister reached Levin by car from Wellington at 10.30 a.m. and was met by Mr J. Linklater, M.P., and taken to the Levin school, where he was received by Mr A. W. Hutchings, chairman of the Committee, Mr E. J. Foss, headmaster, members of the Committee, and representatives of neighbouring committees. After a brief inspection of the school, the party adjourned to the Oxford Rooms, where they were the guests of Mr Linklater at morning tea. After the claims of the district had been fully stated to him, the Hon. Mr Young explained the difficulties in the way of the Department, but promised to consider the representations made sympathetically when the time came for a further allocation of dental nurses.

to paj' their quota of the cost if a clinic was erected in Shannon, and they wished to know if the Department would provide the necessary dental nurse. HELPING THOSE WHO HELP THEMSELVES. Mr D. S. Mackenzie complimented the Minister on the great success his Department had achieved in dental reform. The Minister and himself, as dentists, probably knew better than many present that the only way to combat dental disease lay in the combinaof (1) early treatment, (2) the practice of oral hygiene and (3) whereever possible the dissemination of at least a rudimentary knowledge of dietetics. Although he could not speak too highly of what the State was doing and unhesitatingly said that no reasonable person could expect more for nothing than the State was giving, he submitted that an even better service might be provided if only the people might be induced to help themselves a Itttle, as many in this district had done for nearly ten years. By the making of small payments it was found possible not only to attend to the primer classes, but to carry the treatment right through the primary school by. fully qualified dentists. In using that 'term he did not seek to cast any aspersion on the trained nur-' ses who were performing such signal service, but it was nevertheless an advantage or should be to have people doing any class of • work, dental or; otherwise, who were in possession of the highest qualifications possible. The dentist visited every school required, and goes to the children. They were not brought to him, a very important point as time and efficiency. The children were under school discipline, in local surroundings and the surgery environment was absent. This was done at regular four-monthly intervals to do such work as was necessary and possible in the school. That he should make not longer intervals than four months was, in his experience, the crux of the whole problem. He asked whether this necessity was endorsed and practised in the Department's work. Some patients in the local scheme had been through the dentist's hands thirty times. He believed that upon the observance of this practice hinged the success of any school dental service, no matter how efficient it might be in every other respect. If the State could be induced to come in and fulfil its true mission, the encouragement of self-reliance by way of subsidy, as it had done here in the past, it would permit the local authorities to aid such cases as in their opinion merited it. To provide a good efficient service based on past experience, he believed, it would be a mistake for one dentist to undertake the care of more than 1000 children. The first year or two would be very strenuous for him, but in five years it should be well within the bdunds of possibility to have a standard of 90 per cent, fitness in the local primary schools. In this he spoke from experience and not at random. Many of them held that an efficient service was due to the children and to make its acceptance universal it must be reasonable in cost and to get this all concerned should be inclined to make concessions in the interests of the whole community. The local scheme ■ had worked well and was working well and if approached in the right spirit could be introduced, he believed, without conflict with the dental profession. He was bold enough to say that it possessed the nucleus of as fine a school dental service as could be desired and eminently met the needs of self-reliant people. Any imperfections certainly I did not lie in its conception, but I

might rather be found in its execution, which admittedly, so far as the speaker's capability was concerned, could .easily be bettered. The people of this district were now contemplating whether to press for a State service, which was unquestionably well-conducted and free, but possessed decided limitations, or whether to bestir themselves and provide their own service, which was not free but was wide in its appliea-. tion and entirely controlled locally. Whatever happened the profession could be relied upon to help if wanted.

MANAKAU'S SUPPOKT. Mr T. Clifford, representing the Manakau Committee, said it would be a great benefit if they could get this dental service, without the disadvantage of travelling to- the bigger centres. He felt sure his district would help to further the scheme. They had

been well served by Mr Mackenzie for a number of years and were well satisfied iu that respect. TRAVELLING EXPENSES.

Mr J. H. Taylor, a member of the Koputaroa Committee, apologised for the absence of the chairman, Mr Broadbelt. Their trouble was that they had to pay for the children to travel to a centre. They would prefer a system by which the dentist eould come to the school, but whatever the system was they were quite willing to work in Avith it. They wanted country children to get as reasonable treatment as the children of the cities. They were entitled to that or if anything a little more. Country children had to put up with far more to get to school and he thought the Government should lean towards them a little. LOCAL SCHEME SHOULD BE SUBSIDISED.

Mr F. C. Meyer, of J .h? Reiltbrangi Coinitt.ee, and the representative of the furthest back centre in the district, expressed the that the claims put forward were too modest in comparison with their requirements. His Committee feared that, in the establishment of the clinics, they .might lose the present system by which the dentist came to the school. They felt that they should get some support to further establish that system by way of subsidy to enable indigent parents to join up. The present scheme Avent further than a clinic as it dealt with children through the whole of their school life instead of up to eight years. The expense of the subsidy would not be more than would establish a clinic in each centre. Still/they in the back country did not want to do anything that would be a hindrance to local people getting their requirements. A BURNING QUESTION. '

Mr L. H. Atkins, a member of the Wellington Education Board, said he had been in close touch with the district and knew that this question had been quite a burning one for some time past. The service given by Mr Mackenzie had given much more satisfaction than was expected of it at the outset, as in Mr Mackenzie they had a man capable professionally and a good organiser. The State scheme had become a national affair and something more than the mere treatment of children's teeth. Country people felt that they were not quite fair treatment as they not only had to travel up to twenty or thirty miles, but to bear the expense of travelling. It was only fair to them as taxpayers that they should receive consideration. He felt sure the Minister would be able to do something for the district in a way that would best suit its needs, especially as he had a great deal of expert knowledge at his command. MINISTER'S REPLY.

The Hon. J. A. Young, in reply, expressed his pleasure at meeting the deputation because it was in the discussion of these problems that they reached a solution. While in this case they might know the solution, there were other things required such as time and money before they met the position. So far as this problem was concerned, the Government, had tackled it and now they were in it they must se it through. New Zealand rendered services to its they were in it they must see it through. try in {he world so far as dental health was concerned. They had all sorts of active work in progress in co-opera-tion with such bodies as the Plunket Society, the Red Cross and the St. John Ambulance Association. They endeavoured to give the child the very best start possible in life, the State's solicitude even extending to the pre-natal period. No country could show such an excellent record as New Zealand in regard to the first year of the child's life. The child born in New Zealand had a far better chance of growing up than in any other country. Twenty years ago, out of every 1000 live births, 88.8 of the badies died in their first year. In 1927 they were down to 38.74 infantile deaths per 1000 births. That was a good record, but they were not satisfied with it because more was to be done iu this direction.

ACCESS TO HEALTH. His conception, of the duties he had been entrusted with was that he had to do his best to give everyone —youth or adult —access to health. They recognised that without a healthy mouth the child had no access to good health. While it was important to have bodily cleanliness, it was more important, to have clean mouths before they ate their food. It had been discovered that the degeneration of the teeth was ! as bad in New Zealand as in any other country, and when Sir James Parr was Minister, it was decided to use the dental service established for the army during the Avar as the nucleus of an organisation to reach out to the general population. They had first to train ,their staffs and when they first started they incurred the hostile criticism of the dentists. To-day they had no greater advocates and supporters than the members of the dental profession because they had found that the knowledge the young people were gaining of the benefits of dental serviee in their own feelings and general health would enable them in later life to appreciate the value of further treatment. The State service was really propaganda work for the dental profession.

NURSES' WORK EFFICIENT

Continuing, the Minister said he considered their first duty was to the children in the State schools. Every child should have access to the service provided the State was in a position to give it, but those under the direct control of the State should have first call.

I wish, to assure the dentists of New Zealand that, so far as the work done in the clinics is concerned, the girls are trained for that work just as well as any dentists. The training is more thorough in the scope of the work that is to be undertaken than ithat given to the student going for a degree in dentistry. No such wide field was necessary for hese dental nurses. They did not do

gold fillings or make artificial dentures, but they did simple necessary efficient dentistry which any man or woman could go through life upon. If people wanted any luxurious additions they must be prepared to pay for it. These young women went through a thorough and intensive two-years' course, had to pass an examination and when th»y were turned out of the school they were highly qualified to do their work. They knew something also the child psychology, in which all dentists were not as skilled as Mr 'Mackenzie appeared to be —and it was found that women were more adapted to work with children than men. DEMAND OUT-REACHES SUPPLY.

When the speaker came into office, they were training twen'y girls ; every year, and he had hoped to increase this number to forty. At present they had out in the field 84 dental nurses, all with over two years' service, and ten dental officers ulu dii supervising work.

We have 66 tralrioo- : i the school in Wellington—-35 in their.'first year and 31 in their second year. The latter will he available next April provided they qualify.

That does not say they would be able to establish 31 clinics, becaus* there were always some dropping out through sickness, marriage, or other unexpected factors. A total of 41,009 children were receiving treatment outside of the training school, and 14,000 from the training school in Wellington, making a total of 55,000. It would take ten years to train sufficient dental nurses to deal witft the whole of the children as between 300 and 400 nurses would be required. On the present basis of increase in the number of trainees it was going to take 6$ years. It ' might be possible to increase the number of trainees, but it could not be done in a day. They must have a staff of 400 nurses available.

While, there would be 31 nurses possibly available, next April, there are at present about 260 applications for dental clinics. "Now you can see where our trouble is.

JUST TREATMENT OP TOWN AND COUNTRY. "We have demands from the industrial centres where they say the standand of health is low, and I know exactly the conditions in the back cciuntry because I have represented such a dis-s trict. While the people in the towns may complain' of indigent circumstances there are' people in the country with just as much, or more, claims to consideration. We are endeavouring as far as possible to reach out to the country districts.

I have kept what I consider is a fair balance. There has been'no especial favouring of the town as against the country." LOCAL SELF-RELIANCE. Continuing, the Minister congratulated the local people on their public spiritedness in regard to their school as revealed hi the figures quoted by Mr Hutehings, and he wanted to do a fair thing. They found in practice that the number of children treated by a nurse fell short of 1000. They got a lot of applications from children by reason of the fact that the advice given by the Department was not carried out. Besides doing the actual work for the children they were carrying on an extensive propaganda in regard to dental hygiene, suitable food and simple instruction in regard to the care of the mouth.

WHERE DECAY FOLLOWS NEGLECT. "Whether it is because the. Department gives this service for nothing or not, there is a good deal of decay that is simply the result of neglect. We are thinking seriously that, after we have once put a child's mouth in order, and it is allowed to neglect the advice given, it is not fair that that child should be kept on, and keep other children from getting atte/ntion."

CONDITIONS OF CLINIC ESTABLISHMENT.. Wherever clinics were .established, the Department eharged no fee to the parents; but they did expect the local committee to co-operate and do its part to obtain a building free of cost. The Education Department co-operated to the extent that wherever £1 was collected locally they would give a subsidy of £2 up to £2OO. Thus a total of £3OO was available and the Health and Education Departments would co-oper-ate in providing plans of a suitable type of building. The care and maintenance of the building was the responsibility of the local people. His ! experience was that they could do too much for people and he agreed with Mr Mackenzie in the need for people helping themselves. They found that better service could be given by concentrating the work than by sending nurses or dentists round the country. The nurses visited the schools, charted the mouths of the children and then took the charts back to the centre and decided what should be done. That was better than a dentist having to spend a great deal of time packing and unpacking his instruments and travelling about in working hours. They were at present watehing a rery interesting experiment in Masterton, where they had had a, dental clinic for some years.. They were bringing in the children from distances of foijty miles to Masterton and it was w T orking very well. The Department expected