H;—3la,

The hospital is open to the doctors of the district, of whom there are three. About half of the confinements are conducted by the Matron, who calls in the Medical Superintendent in the case of abnormalities. The Matron, under instruction of the Medical Superintendent, gives nembutal. For women who do not engage a doctor the Matron conducts a regular ante-natal clinic, when necessary referring any case to the Medical Superintendent. Cases entering from the surrounding district are generally attended ante-natally by their own doctors, who, in the case of abnormalities, send in reports to the hospital. The fees are £3 3s. a week and £4 4s. for a single room. If a patient's husband is a member of the Buller Medical Association, the contribution of £1 Is. per annum to that association entitles her to free hospital treatment at Kawatiri. Unmarried women are admitted to and treated in this hospital under exactly the same conditions as married ones. Evidence went to show that there was need for improved accommodation. Denniston. With the Township of Burnett's Face this district has a population of over a thousand people. Denniston is situated on the brow of Mount Rochfort plateau, 2,000 ft. above sea-level. Access is obtained by a steep and winding though good road. Burnett's Face is about a mile farther along the summit of the hill. Practically the whole of the male population is engaged in the coal-mines. There is a hospital here containing four maternity beds which is conducted and financed by the Medical Association, who receive a subsidy of £250 per annum from the Buller Hospital Board and £100 from the Westport Coal Company. The resident doctor is Medical Superintendent, and there is a staff of Matron and trained obstetrical nurse. The ante-natal work is conducted at the hospital by the Medical Superintendent, who is also present at all confinements. Chloroform and ether are given in the final stages of all confinements. No confinements are conducted in the homes. The fees charged are £3 3s. for the confinement and the doctor's fee is £2 2s. In the opinion of the Committee the whole formed a satisfactory unit and made' good provision for the requirements of the two places. The medical fee was considered inadequate. Granity, Ngakawau, Millbrton, and Stockton. These four settlements form a group of townships with no hospital accommodation. There is a doctor stationed at Millerton and one at Ngakawau, but only one qualified nurse in the district. At the present time, since the homes in the townships are unsuitable, practically all the women have to go to Westport for their confinements, and it is admitted that the maternity hospital service available there is good and superior to anything which could be provided locally. There are, however, distinct disadvantages in this service in that the distance to hospital is considerable, there is added expense to the husband and other relatives when visiting the patient in hospital, and, perhaps most important of all, it is impossible for the patient's own doctor to attend her at confinement. Karamea. The Committee was impressed with the urgent need of more adequate facilities for maternity care in Karamea, north Westland. At the end of the road, sixty-five miles north of Westport, the nearest town of any size, with an approach over a long hill, and situated in an area which is liable to be cut off by flooding, this is indeed one of the most isolated districts of its size in New Zealand. The population is about eight hundred, concentrated mainly around the Township of Karamea. For many years the residents, largely through the contributions of a local Medical Association, subsidized by the Buller Hospital Board, have maintained a doctor in the district. There are two qualified maternity nurses and one nurse registered under the Act living in the district, but none of these women is practising nursing as a whole-time occupation. With a doctor available, the maternity needs were reasonably well covered, and the majority of women were confined locally. It was recognized, however, that the private homes were not really suitable and that a maternity home was desirable. For a time one of these nurses maintained a small maternity home, but for various reasons, including insufficient financial support, she was forced to close it. During the last two years there has been considerable difficulty in retaining a doctor, and for some time there has been no medical practitioner in the district. With no doctor, no maternity home, and no midwife in Karamea the women have been forced to go to Westport for their confinements. In some cases this has entailed a long and costly period of waiting in Westport before confinement ; in other cases it has meant a sudden journey under trying circumstances.

4—H. 31a.

49