A—4

Problems of a somewhat similar kind are anticipated in regard to the building-up of the Samoan staff. The proposed new organization of the Department requires thirty-six Samoan medical practitioners at the present level of population, and the number should be increased by two per year to keep pace with population growth and normal retirement. In fact, there are twenty-four S.M.P.s in the service, of whom three are at present on secondment. There are seven students in training at the Central Medical School in Suva who will be coming on to the strength during the next few years. These new men will not bring the staff to full strength, but the importance of the S.M.P.'s work (and the prestige it carries) at least gives ground for hope that, with satisfactory conditions and salaries, it should be possible to ensure an adequate flow of recruits to the profession. The position in regard to nurses is more difficult, as in many other countries. The proportion of loss during training and after its completion is high, owing to marriage and other causes. In the last nine months of the current year the Department lost six Samoan nurses and dressers in training and eleven Samoan staff nurses. As against this, it gained by taking on again former staff nurses who had married. A number of these are willing to re-enter the service—mainly as District Nurses in the districts" where they reside. Apia Hospital Apia Hospital is the central unit in the Territory's medical services. It possesses the main laboratory and x-ray diagnostic services and the most extensive facilities for major surgical work. All the European medical officers are attached to it, as is the dental officer. Improvements in transport facilities make it possible for a higher proportion of the more serious cases to be brought to Apia for treatment. The administrative offices of the Department are at the hospital, and it is the main centre from which stores and supplies are distributed to out-stations. All the Samoan staff, apart from Samoan medical practitioners, are trained there. The work of rebuilding the hospital, which has been in progress for several years, was continued during 1948-49. Details of the buildings erected are given in the section of this report dealing with public works. District Organization The present reorganization provides for a consolidation of the former medical districts. This is made possible in many cases by improvements in road communications. There are now five medical districts, in addition to the central district served by Apia Hospital. Each district will be in charge of a senior "Samoan medical practitioner and each will have a main district hospital and subsidiary dispensaries where population requires it. Standard plans for dispensaries, wards, sanitary blocks, and staff accommodation in district hospitals have been prepared and a commencement has been made with the construction of some of the buildings. Of the thirteen existing district dispensaries, ten will be retained as dispensaries, with out-patient and minor surgery facilities and a capacity of ten to twelve in-patients. The remaining three will be improved so as to offer full emergency surgery facilities and to provide for twenty-five in-patients. In addition, it is proposed to build a new main district hospital in Savai'i, in the district. Mobile Clinics A scheme to provide a fleet of suitably equipped composite vehicles for the use of the health services was put into operation this year and the first of them is already in use. The use of this vehicle enables Samoan medical and dental practitioners and their assistants to visit villages as a health team, and their activities have had a marked effect on the health of the villages visited. It is proposed to equip two additional vehicles this year.

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