196. Selection of cases is undertaken at the Government Chest Clinics, in consultation with the medical staff of the Grantham Hospital and Ruttonjee Sanatorium when patients are to be admitted to beds not under the control of the Government Tuberculosis Service. In this way diagnostic services are not duplicated; on the other hand there is flexibility in that patients in need of admission who are not attending Government Chest Clinics may go direct into both the Grantham Hospital and Ruttonjee Sanatorium. For example private cases may be referred direct to the Grantham Hospital for admission to fee-paying beds, and the University Clinical Units, along with organizations maintaining beds in the Ruttonjee Sanatorium, have the facility of direct admission to that Institution.
Beds in Government Hospitals
197. The 182 beds are maintained in the Queen Mary Hospital (52), the Lai Chi Kok Hospital (88) and the St. John's Hospital (42) at Cheung Chau. The beds in the Queen Mary Hospital are devoted mainly to specialist investigations and surgery. During the year 26 major surgical procedures were carried out of which 31 were resections. At Lai Chi Kok the beds are used primarily for pulmonary cases under medical treat- ment. Al Cheung Chau medical treatment is given for patients with pulmonary disease and for certain others whose condition has been stabilized elsewhere but who require further therapy under hospital conditions.
Medical Social Work
198. The Almoner staff of the Tuberculosis Service is provided by the Principal Almoner under whose general direction the medical social work in all Government institutions is carried out. The Tuberculosis Almoner, assisted by a staff of 7 Assistant Almoners and 31 Tuberculosis Workers has her headquarters at the Wan Chai Chest Clinic where she works under the clinical direction of the Senior Tuberculosis Specialist. 199. Owing to the difficulty in the recruitment of suitably qualified staff during 1958 there has been a greatly increased pressure on this section of the organization. During the year medical social work was carried on in seven institutions with a total of 1,016 beds; in addition it was necessary to provide staff for one new chest clinic and to meet the demands inherent in the rapidly increasing number of out-patients now under treatment. As the number of total attendances increased by some 50% the total burden was very heavy. To meet the demand in- creasing use is being made of the services of the Tuberculosis Workers.
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200. During the year the total of new cases of tuberculosis inter- viewed rose to 10,208, an increase of 1,622 over the previous year. Admissions to hospital, which are arranged by the Almoners, rose by 433 and ward rounds of all hospitals were made at regular intervals. Administrative work in connexion with X-ray surveys is the responsi bility of the Tuberculosis Almoner who maintains liaison between organizations requesting surveys of employees, the Radiological Service which maintains and operates the M.M.R. service and the Chest Clinics where the clinical assessments are done and the survey reports issued. 201. The Tuberculosis Almoner had at her disposal a sum of $250,000 for the assistance and rehabilitation of tuberculous patients and their dependants. Patients under treatment may receive one pound of milk powder each week as appears necessary and 59,709 lb of powder were distributed at a cost of $94,529. For patients who have had to give up work in order to undergo treatment, weekly financial grants can be made according to need. During 1958 a total of 233 families were assisted for varying periods at a cost of $115,580 and the average weekly grant made was $21.45. Rehabilitation grants totalling $990 were made to seven patients. Domestic help was provided, mainly for the care of children, to 28 families at a cost of $7,110. In addition 251 patients were assisted by financial grants from the Samaritan Fund, Assistance in kind was given by the distribution of 1,929 CARE parcels, 1,000 lb. of rice und 30 gallons of cooking oil.
202. An important part of the work of the Almoners' section is to try and ensure the regular attendance of patients under treatment and to issue PAS/INAH tablets. As the number of patients receiving treatment at the end of the year was 13,733 this latter responsibility entailed a very great amount of detailed work. The work was made casier during the year by the supply by the manufacturers of tablets in suitable packs instead of in bulk as formerly.
203. The visiting of irregular attenders and defaulters is undertaken by the Tuberculosis Workers. The Tuberculosis Workers are not trained nurses and do not undertake any nursing duties. They work principally on the social side and are responsible to the Tuberculosis Almoner, through the Senior Tuberculosis Workers, for their respective districts. Within each district the Tuberculosis Worker maintains contact between the chest clinic and an average of over 2,000 patients. This ratio is far from satisfactory but despite this a great deal of valuable work was done.
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