Working of the Government Chest Service
48. The Government Chest Clinics provide ambulatory chemother- apy services for the great majority of cases of tuberculosis, bospital admission being reserved for emergencies, cases requiring investigation, and those requiring second-line drugs or surgical intervention. Increas- ing attention is being paid to the public health aspects of tuberculosis 75 Health Auxiliaries whose main duties consist of contact tracing and home visiting are attached to the Chest Service. These Health Auxiliaries are supervised by one Health Sister and six Health Visitors. Newly diagnosed cases of tuberculosis have all aspects of the disease thoroughly explained to them by Health Visitors and receive explana- tory leaflets. Regular attendance for out-patient chemotherapy is regarded as being of paramount importance, and considerable emphasis is placed on the follow-up of defaulters and on cosuring that contacts are examined. The clinics also provide medical social work, contact tracing and supervisory services, and undertake surveys of selected groups such as Government employees and prisoners, in co-operation with the Radiological Service. In other cases a regular financial grant can be made where the family depend on the patient's earnings and no other way can be found to maintain the dependants during his hospitalization.
49. During the year attendances at Government Chest Clinics were at the high level of 1,603,777. At the end of 1969 there were 3,702 cases on daily Streptomycin/PAS/INAH, 10,796 cases on PAS/INAH tablets and 1,099 on second-line drugs.
After intensive investigation twice weekly fully supervised Streptomycin 1G with Isoniazid 750 mgm was introduced to replace the monthly issue of PAS/INAH tablets at all the full-time chest clinics. This new regimen has several advantages, the most important being that the patient is actually seen to take his drugs.
51. The high incidence of primary and secondary drug resistance in Hong Kong has been demonstrated by research undertaken in conjunc- tion with the Medical Research Council of the United Kingdom. The results of these investigations indicate that the level of drug resistance in Hong Kong is possibly the highest in the world, 40% of the organisms investigated showing resistance to one or more of the first-line drugs commonly used in ambulatory chemotherapy. Recent investigations confirm that this high level of drug resistance remains approximately the same.
The B.C.G. Campaign
52. In Hong Kong with its density of population and comparatively high prevalence of tuberculosis B.C.G. has a vital role to play in the prevention of the disease. The B.C.G. Campaign is directed towards two main age groups, the new-born and the school entrants aged about 6-7 years. During the year 95% of the new-born were given B.CG. Bearing in mind that the remaining 5% usually have some contra- indication to B.C.G. (for example, prematurity) this represents an almost 100% coverage of eligible babies, perhaps the highest coverage in the world. Consideration is now being given to extending B.C.G. coverage to school leavers. The decline in infant mortality from tuberculosis which has resulted is shown in Figure 7.
FIGURE 7
TUBERCULOSIS MORTALITY & B.C.G. VACCINATION OF NEW-BORNS 1955 – 1969 (MORTALITY RATES EXPRESSED AS PERCENTAGE OF 1995 RATES)
VIELDIU
4
IM
ט
53. For school entrants there are 10 inoculators divided into 5 teams engaged in tuberculin testing and the administration of B.C.G. It takes approximately two years for all schools to be covered.
54. The work of hospitals dealing with tuberculosis cases is reviewed elsewhere in this report.
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