92

IV. SOCIAL ADVANCEMENT A. Health 1. Western Samoa, although a tropical country, is basically healthy. It lacks the most serious scourges of the tropics, such as cholera, yellow fever, and malaria. The most prevalent diseases to-day are hook-worm, yaws, and filaria, which are almost universal, and such diseases of bad sanitation as typhoid, dysentery, and infantile diarrhoea. In addition, tuberculosis presents a major problem, and pneumonia and other chest diseases, and diseases of children, caused by faulty feeding, are frequent. Occasional epidemics occur, such as influenza and mumps, but these lack the seriousness of the epidemics which decimated the population periodically in earlier days. The death-rate and infant-mortality rate are lower than in most other Pacific islands areas, though they are still high by western standards. The people are generally of fine physique, and their dietary level seems on the whole fairly satisfactory. 2. The missions introduced the first systematic medical work along western lines. The German Administration began the development of a public-health service, and this was continued vigorously by the New Zealand authorities. Hospital services are free to all Samoans, except that the families provide food and bedding for in-patients; small charges are made for medicines. Public-health work has consistently been the largest item of public expenditure, usually comprising about one-quarter to one-fifth of the total expenditures. 3. As of 1947, the public-health programme of the Territory has become part of the South Pacific Health Service. The Service covers the other Island Territories administered by New Zealand, as well as the British Crown Colony of Fiji, most of the other British jurisdictions in the area, and the Kingdom of Tonga. Its establishment is the result of an agreement signed the previous year between the Governments concerned, and it formalizes and extends co-operative arrangements which have been developed among these jurisdictions over almost a twenty-year period. The Agreement sets up a South Pacific Board of Health, under the chairmanship of a medical officer as Inspector-General, to advise and co-ordinate the various public-health programmes, to plan visits and inspections, and to initiate and encourage medical research. The Board will provide a pool of competent medical officers, both from the United Kingdom and from New Zealand, and also a pool of nurses from the latter country. It will also continue the work of the Central Medical School at Suva, Fiji, in which South Sea Islanders, including Samoans, are trained as medical practitioners and the Central Leper Hospital at Makogai, Fiji, to which lepers are sent from Western Samoa. 4. The local Health Department is headed by a Chief Medical Officer. It maintains a well-equipped central hospital at Apia, with separate wards for Europeans, Samoans, and Chinese, and also thirteen small district hospitals for Samoans. The district hospitals consist for the most part of a small central dispensary, with several Samoan-style houses as wards. Periodic inspections are made of village health and sanitary conditions, and village women's committees have contributed importantly to public-health work, including infant care. Mass treatments for hook-worm and other common diseases are given periodically in the villages. Medical and dental work is being carried into the schools, and hygiene is also taught as a subject. Medical inspections are made