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for these diseases. Health education programmes are needed, however, to provide knowledge
concerning the nature of the disease process but should avoid attracting undue attention to what
is after all only a part, even if an important part, of total life experience. Lectures are given to youth
organisations, senior school children and at Brunei University within the context of human biology
and social studies.
Health Control Unit
The year 1970 was the fiftieth anniversary of the appointment of medical inspectors of aliens.
An Order passed in 1920 introduced medical inspection whereas previously there had been no
effective medical examination of immigrants other than the normal quarantine control for all
persons entering the country. Further legislation in 1953 and 1962 extended medical inspection
of aliens to commonwealth immigrants, but exempted dependent wives and children under 16
years. In 1968 the requirement that aliens could be landed conditionally upon reporting to the
local Medical Officer of Health was extended to commonwealth immigrants.
A major purpose of these medical inspections is to prevent any risk of introduction of disease
which may endanger the health of people in this country. It must be conceded that a medical
inspection will not identify all such diseases, and the appearance in recent years of a variety of
diseases not previously prevalent in this country suggests the need for a review of control procedures.
The medical inspections are also intended to avoid abuse of the National Health Service and to
prevent seriously ill persons being admitted whose social problems would create excessive cost
to the community. London (Heathrow) Airport heads the list of approved ports and airports at
which commonwealth immigrants and aliens may arrive, and during 1970, 44,611 immigrants
and 8,488 aliens were medically inspected.
The total number of cases of smallpox notified to the World Health Organisation in 1970
was the lowest on record. Vigorous eradication programmes were in progress in a number of
countries where smallpox was previously prevalent. The implications of this observation for Port
Health control required continuing examination. During 1970 the introduction of the Boeing 747
aircraft on certain routes showed the need for a general reappraisal of existing methods when
such aircraft are introduced on routes subject to health control.
Staff
It is not always appreciated that the development of Local Authority Health and Social
Services is restricted at least as much by scarce resources of manpower as it is by shortage of
finance. National problems do not necessarily preclude local solutions and vigorous measures
were taken during the year to alleviate what had become acute problems in some areas of the
work. By the end of the year proposals had been submitted for the solution of the most urgent
problems and the appointment of key professional staff added impetus to the forward progress
of the Department.
Community Nursing Services
The receipt of Circular No. 13/70 from the Department of Health and Social Security gave
added encouragement to the review of the nursing management structure which was already
being undertaken. By the end of the year an additional appointment of Chief Nursing Officer had
been agreed, together with a management structure which provided formal recognition of specialist
duties already being undertaken in the health visiting and domiciliary nursing services.
Reference is made in the body of the report to the attachment and liaison schemes with
family doctors which are already in existence. The implementation of the Council's current health
centre building programme, together with revisions in the nursing management structure should
provide the ideal conditions in which this important concept of the community health team can
flourish.
The publication of a report by Sir John Peel concerning domiciliary midwifery and maternity
bed needs, concluded that all births should take place in hospital. At the present time 23 6% of
births in Hillingdon take place outside hospital and the objective of total institutional delivery
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