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PUBLIC RECORD OFFICE

To Te To Ti

Reference :-

C.O. 885

4

No. 3.

MEMORANDUM

Communicated to the COLONIAL OFFICE by W. R. KYNSEY, Esq., M.D., C.M.G.,

Principal Civil Medical Officer, Ceylon.

NURSES FOR THE COLONIES.

1. There are, I believe, about 37 Crown Colonies, their inhabitants differing in race, language, customs, and religion, so that the question of supplying them with nurses is a very large one, and should be best considered by each separately, I have only had experience of one Colony, Ceylon, and the remarks 1 venture to make refer to it The subject specially, but I have no doubt my experience will be useful to others. naturally divides itself into :---

(1.) Nurses for Government general hospitals which receive surgical and medical

pauper and paying patients.

(2.) Midwives for lying-in hospitals and pauper cases outside. (3.) Nurses for private practice.

2. Nurses for General Hospitals.-When I took up my appointment in Ceylon there were no trained nurses in any of the hospitals, and no attempt had been made to supply them. The sick were attended to by male orderfies, and elderly women of the ayah class, who could neither read nor write. The first attempt to remedy this defective system consisted in the appointment of a highly-trained lady superintendent and an assistant from England, with the object of establishing a school for teaching nursing. The selection of these ladies was left to the Crown Agents, and Captain, now Sir, M. Ommanney, K.C.M.G., took a great deal of interest in the matter, and the result was that two excellent nurses were sent out. The next thing was to procure women for training, and we had great difficulty in inducing persons of sufficient ability and education to enrol themselves for the purpose of learning nursing. We eventually accepted young women from the Anglican and Roman Catholic orphanages. We made good selections, and, on the whole, they did well. In this way we trained a large number during the first three years, and some of them are still in Government service. Towards the end of this period our firet real difficulty commenced. The lady superintendent wished to return home, as she felt the loneliness of the life, and her assistant married. Their places were filled up, and in the course of some six or eight years I had, I think, five lady superintendents. Each left without disagreement with the Goverument or the Depart- ment, the cause assigned being loneliness of the life or marriage, and I lost a large

I number of the trained pupil nurses from the latter cause.

here remark that the life of nurses in a Crown Colony is very different from the life of nurses in an English This hospital. There is little or no society for them, and no ladies' committee. constant change of superintendents, and the great difficulty of obtaining intelligent probationers, disorganised the system, and we were almost in despair about its ron- tinuance when an offer was made to the Government by the Roman Catholic Archbishop 10 supply nursing sisters for the Colombo Hospital from a French community. This was accepted. At first a lady superintendent with six sisters were appointed; now we have 12 sisters who do all the day and night nursing of the hospital, containing about 250 This system beds, nearly always full. They are, of course, allowed native assistants. was afterwards extended to the Kurunegalla Hospital, and subsequently to Kandy, where there are Anglican sisters supplied through Dr. Copleston, the Bishop of Colombo. In all the large hospitals throughout the island probationers are trained who supply the smaller hospitals with matrons and nurses.

may

I am quite satisfied with this system, and have no hesitation in expressing the opinion that, as regards the patients of the Ceylon hospitals, it is the best and cheapest that can be introduced. There are many advantages in having religious sisters for Colonial hospitals. Their devotion to duty is beyond praise. If a sister is incapacitated temporarily or permanently her place can be easily and early supplied, and marriage, which I look upon as the most disorganising element in all a cular nursing systems, is, of course, out of the question. This remark is not confined to Ceylon, but applies to the hospitals in England, where one seldom sees a nurse of middle age.

It must appear strange that in a British Colony we should employ nurses of a French sisterhood, and an explanation is demanded. I believe I am correct in asserting that no English Roman Catholic religious nursing community will send its sisters abroad, and it is with much difficulty that the Bishop of Colombo has been able to supply one hospital

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with Anglican sisters. The Roman Catholic sisters consist of French, Flemish, and English, and one great advantage they have oyer all other nurses is the facility with which they acquire a colloquial knowledge of the native language, which is of enormous advantage to the Sinhalese, Tamil, and Portuguese patients, many of whom cannot speak a word of English. It is wonderful in what a short time a foreign nursing sister will be able to acquire a fair knowledge of Tamil or Sinhalese, adding much to her usefulness in attending on the sick.

3. Midwives for Lying-in Hospitals. There is an excellent lying-in hospital at Colombo of 24 beds, established about 15 years, in charge of a highly-qualified midwife, where there are upwards of 200 confinements yearly. Four probationers are constantly undergoing a course of six months' training in practical midwifery, and this number is found sufficient to supply midwives for the large towns. Each probationer has to pass a searching examination before a board of medical officers, of which the lady doctor is a member, before she is granted a certificate to practise as a monthly nurse. I have experienced no difficulty in obtaining intelligent and well-educated students for the midwifery class, and I am confident that in future it will be even more popular than it is at present.

4. Nurses for Private Practice.-Several of the nurses trained in the Colonial hospitals have taken to private practice, and some trained nurses from England have arrived and settled and are doing well. There is an excellent nursing institution in the planting districts, established and managed by a committee, which is doing good work in supplying nurses for private patients. I am convinced it is a mistake to allow hospital nurses to undertake private nursing under any circumstances, as it is not fair to the sick and leads to disorganisation of the nursing staff.

On the whole, we are fairly well off for nurses in Ceylon, but, if funds were available, I should be glad to establish a nursing institution for the training of nurses for private practice, and it is likely it will be in my power to do this in connexion with the Lady Havelock Hospital for Women, which will be opened in a few months, and the General Hospital, Colombo. I believe if such an institution were established and properly worked many of the high-class natives would qualify as trained nurses for hospital and private practice.

5. In conclusion, I am of opinion that trained nurses can only be provided for Colonial hospitals:

(1.) By means of a staff of nurses from a nursing sisterhood for large hospitals and native patients, preferably from a religious community, for the reasons set forth above, and by their aid training probationers for service in the smaller hospitals;

or

(2.) By means of a lady superintendent of nurses with one or more assistants. Their whole time should be employed in a large hospital in supervision and in training probationers.

W. R. KYNSEY,

23167.

SIR,

No. 4.

DR. GRIEVE to COLONIAL OFFICE. (Received January 1896.)

Viewpark, Laswade, N.B.,

January 1, 1896. I HAVE the honour to acknowledge receipt of your letter of the 27th ultimo,* referring to a proposed discussion by medical officers on the supply of trained nurses in tropical Crown Colonies, and very much regret that the state of my health is such as to prevent my attendance at the meeting on the subject as requested.

2nd. I may mention that when I left British Guiana this matter was receiving attention and a scheme was in process of organisation by which, under non-official control, English trained nurses were to be brought to the Colony and their services place at the disposal of the residents at a fixed tariff. This, I understand, was afterwards carried into effect but was given up after e comparatively short trial. I am not aware of the cause of the failure to continue this very desirable service but the Rev. Canon José, Georgetown, who

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