PROVINCE OF BRITISH COLUMBIA
Seventy-fifth Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31
1971
Printed by K. M. MacDonald. Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
-,■ 1972
• ■ ■
DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE
(HEALTH BRANCH)
The Honourable Ralph R. Loffmark, Q.C.
Minister of Health Services and Hospital Insurance
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
J. A. Taylor
Deputy Minister of Health and Provincial Health Officer
G. R. F. Elliot
Director, Bureau of Special Health Services
A. H. Cameron
Director, Bureau of Administration
K. I. G. Benson
Director, Bureau of Local Health Services
D. Mowat
Director, Division of Tuberculosis Control
G. Wakefield
Director, Division of In-patient Care
E. J. Bowmer
Director, Division of Laboratories
H. K. Kennedy
Director, Division of Venereal Disease Control
J. H. Smith
Director, Division of Occupational Health
C. E. Bradbury
Director, Division for Aid to Handicapped
J. H. Doughty
Director, Division of Vital Statistics
A. A. Larsen
Director, Division of Epidemiology
Mrs. M. Green
Director, Division of Public Health Nursing
F. McCombie
Director, Division of Preventive Dentistry
W. Bailey
Director, Division of Environmental Engineering
R. G. Scott
Director, Division of Public Health Inspection
M. A. Kirk
Senior Consultant, Division of Public Health Education
Miss P. Wolczuk
Consultant, Public Health Nutrition
E. M. Derbyshire
Pharmaceutical Consultant
H. J. Price
Departmental Comptroller
Office of the Minister of Health Services
and Hospital Insurance,
Victoria, British Columbia, January 17, 1972.
To Colonel the Honourable John R. Nicholson, P.C, O.B.E., Q.C., LL.D.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:.
The undersigned respectfully submits the Seventy-fifth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1971.
RALPH R. LOFFMARK
Minister of Health Services and Hospital Insurance
The Hon. Ralph R. Loffmark, Q.C.
Minister of Health Services and
Hospital Insurance
Department of Health Services and Hospital
Insurance (Health Branch),
Victoria, British Columbia, January 11, 1972.
The Honourable Ralph R. Loffmark, Q.C.,
Minister of Health Services and Hospital Insurance,
Victoria, British Columbia.
Sir,—I have the honour to submit the Seventy-fifth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1971.
J. A. TAYLOR, B.A., M.D., D.P.H.
Deputy Minister of Health
I. A. Taylor
Deputy Minister of Health and
Provincial Health Officer
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The Health Branch is one of the three branches of the Department of Health
Services and Hospital Insurance, together with the branches of Mental Health Services and the British Columbia Hospital Insurance Service. Each is headed by a
Deputy Minister under the direction of the Minister of Health Services and Hospital
Insurance.
In the Health Branch, the Deputy Minister of Health and the Directors of
the three bureaux form the planning and policy-making group. Under them the
divisions provide consultative and special services to all public health agencies
throughout the Province. The chart on the previous page shows the organization.
Direct services to the people in their communities, homes, schools, and places
of business are provided by personnel of local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organizations which,
though not under jurisdiction of the Health Branch, co-operate closely and receive
special services and financial assistance from the Provincial and Federal Governments. The remainder of the Province is covered by 18 health departments, known
as health units, which are under the jurisdiction of the Health Branch. Each unit is
complete in itself and serves one or more population centres and adjacent rural areas.
TABLE OF CONTENTS
Pace
Introduction 9
Communicable and Reportable Disease
Health and Our Environment
Specialized Community Health Programmes.
Community Health Nursing
Home Care
Maternal and Child Health
School Health
Preventive Dentistry
Nutrition Service
Public Health Education
Vital Statistics
Extended Care
Aid to Handicapped
Laboratory Services
Emergency Health Service.
Pharmaceutical Consultant Service..
Council of Practical Nurses
Publications, 1971
13
18
24
29
31
35
36
38
42
44
45
47
48
50
52
55
56
57
Tables—■
I-
II-
III-
-Approximate Numbers of Health Branch Employees by Major Categories at the End of 1971 58
-Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1971) 58
-Comparison of Public Health Services Gross Expenditures for the
Fiscal Years 1968/69 to 1970/71 60
IV—Training of Health Branch Staff Proceeding Toward a Diploma or
Degree in a Public Health Specialty 61
V—Training of Health Branch Staff by Means of Short Courses 61
VI—Reported Communicable Diseases in British Columbia, 1967-71
(Including Indians ) 6 3
VII—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1964-71 63
VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1970 to August 1971, Inclusive 64
IX—Public Health Inspectors' Time-study 65
X—Statistical Summary of Public Health Inspectors' Activities, 1969-
71, for 17 Provincial Health Units 66
XI—Report of Direct Service by Auxiliary Workers to Public Health
Nursing Programme, September 1970 to August 1971 66
XII—Summary of Service Provided in Three Areas by Employees' Health
Services Staff, 1971 67
XIII—Enrolment in Public and Private Schools in British Columbia, June
1971 67
Tables—Continued paoe
XIV—Number of Pupils Receiving Basic Immunization Prior to Entering
Grade I, September 1970 67
XV—Pupils Referred for Health Services 68
XVI—Registrations Accepted Under Various Acts 68
XVII—Case Load of the Division for Aid to Handicapped, January 1 to
December 31, 1971 69
XVIII—Statistical Report of Tests Performed in 1970 and 1971, Main Laboratory, Nelson Branch Laboratory, and Victoria Branch Laboratory 70
XIX—Emergency Health Service Medical Units Pre-positioned Throughout British Columbia. 71
XX—Licensing of Practical Nurses 71
Seventy-fifth Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31, 1971
Although this is the Seventy-fifth Annual Report of the Public Health Services of
British Columbia, services designed primarily to protect the health of the people of
the Province had their origin through legislation introduced just over one hundred
years ago. As originally established, it was essential to deal with epidemics of infectious diseases, such as smallpox and typhoid fever, which are now almost unknown
entities in the disease incidence of the Province. However, throughout the years
changes in the patterns of living have tended to create new forms of potential health
hazards requiring new approaches in preventive medical practices in the interests
of health protection for each community. While there have been many gains as a
result of past endeavours, there is little doubt that the range of demands and needs
is ever-increasing in a rapidly multiplying population. The programmes required
now tend to concentrate attention toward improved social functioning for the communities. Health is no longer an entity in itself—if it ever was—but a means of
attaining optimum well-being in the physical, social, and biological environment in
which man must live. It invades the domains of human behaviour and it focuses
on the individual, the family, and the community. In such a context, public health
is not just a complex collection of functions, but a comprehensive entity involving
the total health of populations and their social cultural groupings. Health affects
and is affected by a multitude of factors, wherever people live. Consequently, over
the 100-year period the narrow public health concept of the past to control and
prevent the spread of infectious disease has been broadened toward a comprehensive
community health programme to minimize the hazards that may generate morbidity
and mortality among the people.
The best means of providing such a programme is through a well-organized
network of local health services to cover the entire Province. As its major responsibility, therefore, the Health Branch has endeavoured to encourage the development
of adequate health services at the local area which was best accomplished through
the organization of health units, each of which operated under the guidance of a
union board of health. This provided a community contact through which continuous surveillance of the local health needs and problems could be assessed to
permit control measures to be designed to deal with them. Frequently the staff at
the local level requires specialized consultative and analytical assistance which is
made available to them through the divisions maintained at the Provincial level in the
headquarters of the Health Branch. This report relates the significant features that
have occurred during 1971 in serving the health needs of the Province.
THE PROVINCE AND ITS PEOPLE
The area of the Province is about 366,000 square miles. The population
growth prevalent over the last two decades is being maintained as there was an
increase of 63,000 people this year to provide a total approaching 2,200,000, which
is almost double the count recorded 20 years earlier. Over the Province as a whole
J 10 PUBLIC HEALTH SERVICES REPORT, 1971
this gives a population density of 6.0 persons per square mile, but the topography
of the country makes uneven distribution of the population inevitable. Economic
and climatic factors add their influence to promote a concentration of persons in the
southwestern corner of the Province, where almost one-half dwell in the metropolitan areas of Greater Vancouver and Greater Victoria.
Preliminary data compiled from the vital statistics records filed in 1971 reveal
certain features of the population for the year. The birthrate at 16.1 per 1,000
population exhibited the lowest point to be attained in over 30 years. It marked a
resumption of the downward trend which started in 1958 to be continued without
interruption until 1968 when the rate reached a low of 16.8. The following year
the rate was 17.1 and in 1970 a slightly higher rate of 17.2 was recorded. Associated with the decline in the birthrate there was a decline in the proportion of births
classified as illegitimate, from 13.9 per cent in 1969 and 1970 to 12.3 per cent in
1971. This marked the first reversal of the substantial climb in this ratio, which has
been evident since 1961.
More marriages were performed and while the preliminary rate was unchanged
from the 1970 figure of 9.4, this is significant in view of the fact that it is the highest
registered since the early 1950's. Nonetheless, it is considerably below the peak
rate of 12.5, established in 1941.
While the crude deathrate in 1971 was above that of the previous year, being
8.1 per 1,000 population as compared with 8.0 in 1970, the latter rate was a record
low for the Province and this year's rate is the next lowest ever recorded. It is one
of those crude indicators utilized in assessment of health status of the people generally and the effectiveness of the total health services. Examination of that mortality
rate by disease classification also reveals some rewarding figures. There was a further downward trend in the number of persons dying from heart disease per 100,000
population with the rate of 262, over 15 per cent below the 1969 rate of 310 and
almost 25 per cent below the 1965 figure of 349. This may well be a reflection of
the treatment facilities now available in intensive-care wards established in many of
the hospitals which is promoting survival for patients who formerly would have
died. Similarly, cancer mortality exhibited a decline this year at a rate of 150 compared with 155 in 1970. It represents a return to the somewhat lower rates of the
early 1960's. Deaths occasioned by cerebral vascular disease have been declining
fairly steadily since 1960. The rate of 85 for each 100,000 people in 1971 was the
same as that for 1970, which in turn was the lowest rate recorded in recent years.
The preliminary infant mortality rate per 1,000 live births this year was 18.7.
This was above the record low established in 1970 at 16.9 but is still one of the
lowest rates achieved by the Province. It is also an encouraging statistic in view of
the weight assigned to it in assessing the quality of health services available in the
fields of maternal and child health.
Deaths due to accidents were somewhat above those for 1970, at a rate of 79
per 100,000 population as compared with 71 the previous year. This figure for the
current year is among the highest recorded for many years. Somewhat over a third
of them are recorded as due to motor-vehicle accidents, a lesser proportion than that
of a year ago, while a higher proportion resulted from falls this year than last, 14
per cent compared with 13 per cent in 1970.
In this whole field of accidents, mention might be directed to the considerable
effort that is often required to assist the patient. Frequently because of the nature
and extent of the accident, air evacuation to larger centres of medical and hospital
care for specialized treatment services becomes necessary. During the year over
INTRODUCTION J 11
100 air evacuations were undertaken, approximately 58 per cent of them in aid of
accident victims (22 per cent due to motor-vehicle accidents and 36 per cent due to
other forms of accidents). In addition, 24 per cent of the air transport trips were
required for advanced medical conditions, 8 per cent for complications of pregnancy,
5 per cent in the interests of newborn infants. This is a service of tremendous value
to citizens of this Province, only available because of the generosity of the Canadian
Armed Forces whose flight personnel undertake these mercy flights, often at odd
hours in hazardous flying conditions in very isolated areas. There is little doubt that
while each trip is very much appreciated at the time by both the physician and the
patient, there is often little understanding of the number of people involved in
making the arrangements, the number of flights provided each year, the man-hours
it entails, and the flying risk that is often encountered in it. It is a service that, in a
mountainous coastal province such as this, requires different types of aircraft and
highly skilled personnel; too often the impression is left that an air evacuation service can be simply and easily organized. It is unfortunate that so many of these
flights have to be undertaken because some individuals refuse to adopt precautions
to avoid an accident.
While there were no serious outbreaks of communicable disease there was a
disturbing increase in incidence of diphtheria with 11 reported cases. It displays
the need for continual vigilance in respect to communicable infections with maintenance of a thorough immunization programme which realistically should prevent
such incidence. In the field of venereal disease, infectious syphilis has been maintained under reasonable control. Unfortunately, however, the same statement cannot be applied to the incidence of gonorrhoea which has been rising within recent
years at an alarming rate. The increase has varied between 20 and 25 per cent each
year since 1968 and is parallelled by the incidence of nongonococcal urethritis. It
remains essentially a disease of the young people, among whom extraordinarily persistent case-finding methods are being devoted to track down sources of the disease.
The number of cases of active tuberculosis increased slightly, 475 cases being
located. The rather low level of cases being determined raises questions about the
case-finding methods since it becomes increasingly costly to maintain the present
methods. It indicates the need to examine critically case-finding techniques in
modification of nonproductive methods with increased emphasis toward more productive procedures. Then, too, with the newer techniques in treatment, questions
can be posed about the need to maintain tuberculosis sanatoria for specialized care
of these patients. It may well be that they could be absorbed into the mainstream
of health care without danger to the community. It is a subject that is to be more
thoroughly examined in the months ahead.
The individual reports of the various divisions reflect the operations of the
Health Branch and elaborate in more detail on some of the points contained in this
introduction.
S u s
3 mi 5 a-S
c o .2
■
COMMUNICABLE AND REPORTABLE DISEASE
J 13
COMMUNICABLE AND REPORTABLE DISEASE
Again this year there were no serious outbreaks of communicable disease in
the Province.*
RUBELLA VACCINATION PROGRAMME, 1970/71
In September 1970, Provincial health units and municipal health departments
throughout British Columbia began a programme of vaccinating children between
the ages of 1 and 12 against rubella. This vaccination campaign had a double purpose. It was intended to be the start of a long-range programme to make all girls
in the Province immune to rubella before they reached child-bearing age and it was
intended, also, to meet the threat of an expected major outbreak of rubella during
the winter of 1970/71. It was feared that such an epidemic might affect many young
pregnant women who were still susceptible to the disease. Most cases of rubella
occur in the l-to-12 age-group and it was felt that if a high proportion of these
children were immune, the likelihood of an epidemic would be greatly diminished.
What motivated the project is the fact that rubella, which was once considered
to be a simple childhood disease, is now known to cause very serious consequences
in the babies of women who contracted the disease during the early stages of their
pregnancy. Vaccine for the programme was provided jointly by the Provincial
Health Department, local municipal authorities, and a number of service clubs and
foundations who made contributions to the fund. In a few areas of the Province
the vaccine was sold to parents at cost.
The Health Branch administered the programme and it distributed a total of
295,896 doses of vaccine. In addition to this, about 14,000 doses of vaccine were
sold by retail pharmacists on the prescription of private physicians. The programme
was continued in 1971 with the vaccination of further children between the ages of
1 and 12.
The present level of immunity against rubella in British Columbia is considered
to be reasonably good, and there is good evidence that the immunization programme has been useful in reducing the number of cases, in that a very high proportion of reported cases occurred in children who were older than the age-group
just immunized. The peak incidence in past outbreaks has always been among
younger children.
The desirability of a long-term vaccination programme against rubella can
only be resolved through experience and further research.
DIPHTHERIA
The disquieting increase in the incidence of diphtheria reported last year has
continued. All of the 11 reported cases this year came from the lower mainland.
Most were in elderly males living alone and most were immunized. Virulent diphtheria organisms were found in discharging wounds and ears in 40 instances, rather
than in their customary location in the patient's throat. The importance of maintaining a high level of immunity against diphtheria among children cannot be
overemphasized.
FOOD POISONING
Food infection by organisms of the Salmonella group continued its annual
increase with 548 cases being reported. This organism is very prevalent and readily
contaminates so many foods that the most meticulous attention to proper food-
handling techniques is necessary to reduce the incidence of this type of poisoning.
* See Table VI.
J
I 14 PUBLIC HEALTH SERVICES REPORT, 1971
RHEUMATIC FEVER
The rheumatic fever prophylaxis programme showed only a very minor increase
in numbers during the year. At the end of the year, 1,286 children were receiving
free prophylactic penicillin daily in order to prevent a recurrence of their infection
and possible heart damage.
TUBERCULOSIS
In 1970, a significant decrease in the number of active tuberculosis cases
occurred. Four hundred and fifty-three cases were found representing a drop
of 13 per cent. This decrease in 1970 was not confined to British Columbia but
was found in other provinces as well. However, in 1971 there was an increase in
the number of active cases to 475 so it would appear the 1970 figure did not indicate the start of a trend but may be regarded as a continuation of the fluctuating
pattern observed for some years. In any event, tuberculosis continues to present a
large health problem and there is little room for complacency. In many ways, as
the numbers decrease, the difficulties in discovering active cases increases and results
in an increase in the cost on a per-case basis. It is necessary to continue the critical
examination of case-finding techniques and the modification of the nonproductive
methods with greater stress being placed on the more productive procedures.
Of the total of 152,803 miniature X-rays taken in the Province in 1970, the
general hospitals took 13,051, or 8.5 per cent. Of the 453 active cases found,
almost one-half were from general hospitals.
The Division of Tuberculosis Control has continued the policy of transferring
the miniature equipment to health units when they are removed from hospitals.
Contact tracing continues to be diligently carried out. The results show that 3
per cent of those contacts of an individual who has a positive smear have active
disease. On the other hand, only 0.8 per cent of the contacts of an individual with
a positive culture have active disease.
Mortality rates from tuberculosis remain low—the total for the Province in
1970 being 2.0 per 100,000.
The demand for sanatorium beds remains relatively unchanged. The proposed
change to give the north-south wing of the second floor at Willow Chest Centre to
the Vancouver General Hospital for cardiac surgical patients will require considerable redistribution of patients and, in all likelihood, the necessity of a third ward at
Pearson Hospital. It has been proposed that all the patients at Willow Chest Centre
be placed on the third floor with the remainder of the second floor being used for
ancillary services, such as recreational therapy and occupational therapy. The new
legislation for dealing with recalcitrant patients will be of assistance but there will
be continued difficulties with lesser misdemeanors not justifying the utilization of
this legislation.
The policy of out-patient treatment continues. Over the last few years, approximately 40 per cent of those diagnosed with active disease have received their
treatment wholly as out-patients. Individuals with tuberculosis are admitted only
if they cannot be treated in their home environment, have extensive or serious forms
of disease, have problems with their treatment, are not progressing favourably, or
refuse to co-operate. Native Indians continue to pose a problem because they often
live in inaccessible regions so that out-patient supervision is not possible. They have
also shown a tendency to discontinue their treatment on discharge from hospital so
that, for these reasons, they are more frequently admitted and have a more prolonged hospital stay.
The mainstay of the tuberculosis control programme is still the stationary and
travelling clinics, which continue case-finding and the following-up of known cases
COMMUNICABLE AND REPORTABLE DISEASE I 15
of tuberculosis and investigate individuals suspected of having the disease. These
clinics provide a valuable service to the community and often act as consultants in
chest disease, assisting the private physicians.
In the process of seeking cases of tuberculosis, many other chest conditions,
such as bronchogenic carcinoma, are brought to light. It is only because of these
clinics that an extensive out-patient treatment programme has been carried out
successfully. An essential portion of this programme has been the assistance of the
local public health authorities who supervise treatment at the home level.
One area of the case-finding programme now receiving considerable attention
is that of the community surveys. Consideration is being given to conducting
surveys only in communities which do not have miniature X-ray facilities and in
communities considered to be high-incidence areas. Further, consideration is being
given to the use of a second van in special locations such as the Pacific National
Exhibition, local fairs, and rodeos.
It was proposed that the school skin-testing nurse would work independently
from the community survey, covering the schools throughout the Province and
testing Grade IX students only, but local health authorities declined to take part in
such a programme. Therefore, a pilot study will be conducted on Vancouver Island
to determine the feasibility of the Division of Tuberculosis Control conducting such
a programme on its own.
VENEREAL DISEASE
Infectious syphilis continues to be under good control but gonorrhoea continues
to increase at an alarming rate.* The increase varies between 11 and 25 per cent
each year and this has occurred since 1969. The incidence of nongonococcal
urethritis parallels the incidence of gonorrhoea. Gonorrhoea is a disease of young
people, particularly transients and unemployed young people. They are difficult to
reach, and it has been necessary for field nurses to hold clinics where young people
congregate.
Infectious Syphilis
The problem in controlling this disease remains much the same as it has in
previous years. Single male homosexuals frequently travel to cities on the United
States west coast, single males visit Mexico, and transients visit from the United
States. Some of these people acquire the infection elsewhere and introduce it into
the Province. The control programme is effective and so far has been able to
contain the spread of this disease.
Latent Syphilis
Many people who have acquired an infection of syphilis have no skin manifestations to indicate the infection or they may be of a relatively minor nature and go
unheeded. In order to uncover these latent cases so that they are prevented from
going on to late manifestations—heart disease and paralysis—approximately 600
blood tests are taken each day. These blood tests are taken as part of prenatal and
physical examinations by physicians, by the Red Cross Society on all blood donated,
and in patients admitted to the veterans' hospitals and mental hospitals.
Gonorrhoea
Gonorrhoea is an infection which is usually limited to the genital tract. The
incubation period is two to nine days and the male knows he is infected from the
symptoms of a burning pain on urination and a discharge. The female, however,
in most cases, has few or no symptoms, does not know she is infected, and continues
to spread the disease.
* See Table VII.
J 16 PUBLIC HEALTH SERVICES REPORT, 1971
• The infections occur mostly in young people who have evolved a permissive
sexual attitude. This tends to occur when young people are away from home
and are not under the influence of restrictive social and parental controls.
• The present epidemic is centred in young people living away from home
and in the city of Vancouver. This group has been estimated to number
12,000 during the 1970/71 winter.
• The epidemic increases during the summer reaching a peak in September,
remaining high throughout the fall, and showing a precipitous drop at
Christmas-time. It is thought that the maintenance of the infection during
the fall of the year is caused when young people who have been travelling
return to the Province for the winter, and that the drop at Christmas-time is
caused by young people returning to their homes elsewhere in the country
at that time of the year.
Many young people have an "anti-establishment" attitude and do not wish to
attend a formal clinic. It has been necessary to obtain the services of young nurses
to work with these young people and hold clinics where they congregate. As these
young people have many other problems it is necessary to provide a comprehensive
service providing treatment where applicable and referral to other services when
indicated.
During the summer of 1971 this service was extended by health units to hostels
throughout the Province. In this way it has been possible to reach these young
people and control gonorrhoea when it has been found. Unfortunately, the disease
is still being spread faster than it is being eradicated so there is a continued increase
in the number of cases reported.
Nongonococcal Urethritis
Nongonococcal urethritis is a disease similar to gonorrhoea but with a longer
incubation period of 18 to 28 days and instead of a purulent discharge there is
a watery discharge. The incidence of the infection in males parallels that of
gonorrhoea. Current studies indicate that two organisms are involved, mycoplasma
and conjunctivitis inclusion virus. Neither of these infections responds to treatment
with penicillin but they both respond to seven days of therapy with tetracycline or
sulpha. If a steady female partner is involved it is necessary also to treat this
partner to prevent a rebound of the infection.
General
Diagnostic and treatment clinics are maintained in Vancouver, New Westminster, Victoria, Prince Rupert, Dawson Creek, Prince George, and Kamloops. Clinics
are also operated at the Vancouver City Gaol, Willingdon School for Girls, and
Oakalla Prison Farm.
In 1971, services to youth were provided by four public health nurses in the
Vancouver metropolitan area, one of which was supplied by the Provincial Government, one by the city of Vancouver, and two by the Opportunities for Youth Program of the Federal Government. These services were also extended by public
health nurses throughout the Province to local hostels.
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
Public health nurses are involved in the prevention and control of a number
of diseases.
• Tuberculosis is an important part of this programme. During the year,
7,777 visits were made to patients and their families.
COMMUNICABLE AND REPORTABLE DISEASE
J 17
• Public health nurses administered 15,552 tuberculin tests to determine
sensitivity to tuberculosis. Most tests were given to contacts of known
cases and to selected grades of school children in districts known to have
a high incidence of tuberculosis.
• Visits for the control of venereal disease increased 34 per cent over last
year for a total of 4,779 visits.
• Public health nurses supervised 1,118 children on rheumatic fever prophylaxis.
• In addition, 6,578 visits were made for epidemiological investigations and
injections for infectious hepatitis.
• Public health nurses gave 623,235 individual immunizations at special
clinics and child health conferences held in local districts. The 30-percent increase in numbers over the previous year was largely due to the
addition of rubella immunization for protection of children between the
ages of 1 and 12 years. See Table VIII for contribution of public health
nurses to immunizations.
Immunizations as done by the public health nurses provided a measure of
saving to the British Columbia Medical Plan which might otherwise be charged at
a rate of $2 per dose for an over-all estimated saving of $ 1,246,000.
Disease control—A number of public health nurses work with young people in metropolitan areas. Many health problems are brought to their attention and this picture illustrates the casual approach toward what might otherwise be a difficult problem. The young
couple in the photograph are members of the staff at the Vancouver YMCA-YWCA and
acted as models to illustrate one facet of the work of a public health nurse in the city.
2
J 18
PUBLIC HEALTH SERVICES REPORT, 1971
HEALTH AND OUR ENVIRONMENT
Work under this main heading is carried out by the Division of Environmental
Engineering, the Division of Public Health Inspection, and the Division of Occupational Health. The reports of the three divisions are given separately as follows:
ENVIRONMENTAL ENGINEERING
The work of this Division is divided about equally between approving plans
and specifications, under the Health Act, of all proposed public waterworks within
the Province, and consulting with Medical Health Officers and their staffs on
matters of small water supplies, small sewage-disposal systems, solid-waste disposal,
public swimming-pools, and subdivision developments. Records kept include water
analyses, master plans of water systems, fluoridation, public swimming-pools, and
pollution control permits.
Water Systems
A Health Department final certificate of approval must be obtained by the
owner of a public waterworks system prior to construction of the works. This year,
380 certificates were issued, an increase of 88 over last year. The review of plans
and specifications for public waterworks has promoted a good standard of design.
A waterworks design manual is near completion and will be made available to
municipalities and design engineers. The manual should help to raise the standard
of design even further. Copies of published Water Quality Standards are available
on request.
It is noted that water quality for many municipal water systems is deteriorating
with respect to aesthetic features such as colour and turbidity. Unless the water
purveyor is prepared to buy the land which effectively controls access to his watershed or gain this control in some other way, water-treatment plants will be necessary
in order for these municipalities to meet the high standards for acceptable drinking-
water supplies.
One of the major roles of the Division is to offer consultative engineering services to municipalities on subjects relating to environmental control. During 137
field visits, engineers inspected waterworks for the purpose of reviewing operation
to ensure public health safety.
Pollution Control
All pollution control permit applications are reviewed jointly by the Division
and the Medical Health Officer affected. The departmental policy requiring minimum primary-sewage treatment and the British Columbia recommended water-
quality standards act as the principal guidelines for recommendations to the Pollution Control Branch concerning these permit applications. There was a dramatic
increase in the number of permit applications referred to the Division in 1971 and
it is expected the rate of increase will continue until the backlog of registrations is
depleted.
Fluoridation
The investigation of fluoridation systems throughout the Province continued
this year and recommendations were made to the Director of Preventive Dentistry
regarding a supplementary control programme.
HEALTH AND OUR ENVIRONMENT
I 19
Engineering—Provincial Environmental Engineers review swimming-pool plans as
consultants to local medical health officers. In this photograph they inspect plans for a
swimming-pool at Kitimat, which was completed in 1971.
SWIMMING-POOLS
The second edition of a swimming-pool manual was published. While the
first edition (1969) dealt with the operation of larger municipal pools, the second
edition focused on the smaller motel and apartment pools. The manual was given
to an estimated 450 persons who attended a one-day short course offered at various
centres throughout the Province. The course was presented by the engineers in
co-operation with a number of health units.
Other Projects
Projects which were initiated in 1970 continued during 1971, and other activities are summarized below.
• Several units of a pre-fabricated sewage-treatment plant designed for a
single home were tested in two health units. These plants performed very
well and may prove to be satisfactory for certain residential lots unable to
accommodate the conventional septic tank system.
• Another interesting project this year involved a mysterious chlorophenolic
taste and odour in a waterworks system. After extensive sampling and
testing, the cause was found to be the inside coating of a section of new
pipe used in the distribution system. Half a mile of large-diameter pipe was
replaced and the problem disappeared.
J 20
PUBLIC HEALTH SERVICES REPORT, 1971
• Consultative services to the Medical Health Officers continued to be an
important function of the Division. Engineers made 190 official visits to
health unit offices. Services offered are largely dependent upon knowledge
acquired by the staff at short courses and conferences which they are able
to attend.
• Conferences attended this year included Environmental Management, Vancouver; Noise Abatement in the Seventies, University of British Columbia;
Noise and the Environment, Vancouver; Public Works Association of British
Columbia, Prince George. A short course on backflow prevention held in
Los Angeles, California, was exceptionally worthwhile and a programme of
education and promotion in this important public health measure is planned
for the next few years. Another short course on Water Quality Studies given
in Corvallis, Oregon, provided very much needed information in this changing field of sanitary engineering.
Public Education
The members of the Division accepted a number of requests to speak to service
clubs, church groups, special interest groups associated with the environment, technical and professional groups, and school children.
Technical papers were presented to the B.C. Water and Waste School at the
University of British Columbia, the Water and Waste Conference in Vancouver, the
Provincial Aquatics Conference in Vancouver, and a University of British Columbia
Public health inspection—-The tasks of public health inspectors in the Province are
many and varied. In this photograph the Provincial Director of the Division of Public
Health Inspection and a public health inspector are seen taking part in a Victoria television
programme. The subject under discussion was cooking and holding temperatures for
turkeys.
HEALTH AND OUR ENVIRONMENT J 21
engineering extension course—Legal Aspects of Water Resource Management—in
Vernon.
A brief was presented to the Pollution Control Board hearing in Victoria.
PUBLIC HEALTH INSPECTION
The Division of Public Health Inspection has been active in
• evaluating the programmes of public health inspectors by gathering statistical data and carrying out a time study;*
• revising the policy and procedure manual for public health inspectors;
• preparing pamphlets on the services provided by public health inspectors;
• reviewing plans of private water supplies and septic tanks;
• promoting educational television and radio programmes;
• writing food premises regulations and amendments to mobile-home parks,
camp-sites, and sewage-disposal regulations.
Surveys
A bathing beach sampling programme was undertaken from June to August
1971
to compare the total and faecal coliform counts;
to determine the optimal sampling frequency for beach waters;
• to assess the value of the fecal coliform test.
Sampling was done by four Provincial health units and the Vancouver City
Health Department. The results suggest a single standard (the faecal coliform test)
should be adopted for evaluating water quality used for primary contact recreation,
and that the standard be applied to fresh, estuarine, and marine waters.
Educational Activities
The Director of the Division of Public Health Inspection has worked closely
with the British Columbia Institute of Technology as a member of the Environmental
Technology-Public Health Advisory Committee. The Health Branch provided
field training for 10 students, and members of the Health Branch have acted as
examiners for the Board of Certification of Public Health Inspectors of the Canadian
Public Health Association.
Health inspectors have co-operated with the administrators of the Public Health
Inspectors' course not only with field training, but also by the giving of lectures.f
Activities With Other Departments
The following points illustrate the Division's activities with other Government
departments:
• Public health inspectors have worked very closely with Regional Districts,
the Department of Highways, the Department of Municipal Affairs, and
the Lands Branch in the control of subdivisions. Health Branch officials on the Interdepartmental Subdivision Committee assisted with the
preparation of subdivision regulations.
• The Division has co-operated with the Department of Agriculture and the
Vancouver Health Department to improve the quality of soft ice cream.
• Close liaison with the Federal Department of Fisheries has resulted in good
control over commercial shellfish operations.
•See Table DC.
iSee Table X.
J 22
PUBLIC HEALTH SERVICES REPORT, 1971
OCCUPATIONAL HEALTH
Radiation
The Division of Occupational Health is responsible for radiation protection
services in British Columbia.
Radiation emitting devices are no longer solely in the hands of the professional
man or scientist, but are found in homes, schools, commercial establishments, and
industry.
Man is becoming more concerned with his environment. Radiation can be a
health hazard. Can it be reduced? International recommendations, national regulations, and professional codes of ethics are requiring a reappraisal of the situation
with a view to a further reduction in the permissible limits, as more and more of the
population is being exposed to this possible hazard. This increased concern is
evidenced by the inquiries and the workload of the Radiation Protection Section.
In the case of radioisotopes, it is also of interest to note the comparison in the
size of sources being used in industry. In 1962, the largest Cesium-137 source was
750 millicuries, today there are a number of sources throughout the Province of
5,000 millicuries. This increase in size brings with it increased problems of containment and radiation protection, and during the year samples from 48 industries
were checked by the section and found to be clean.
There have been 18 inquiries or investigations during 1971 involving suspected
or actual over-exposures to radiation and damaged shipments of radioactive
Radiation—The increasing use of electronic equipment poses the possibility of radiation leaks, which might be damaging to human health, and therefore the Health Branch
has assembled sophisticated monitoring and testing equipment such as that shown in this
photograph. It is available at all times to test possible radiation leaks.
J
HEALTH AND OUR ENVIRONMENT I 23
materials. Two persons who received over-exposures to medical X-ray may experience serious health problems as a result.
With the increasing use of radioactive sources there is an increase in the likelihood of radiation-induced burns from the units involved. The radiation section
now has instruments to check these units and a Provincial survey programme will
be instituted as soon as staff can be trained.
As detailed in previous annual reports, the Tri-University Meson Facility
(TRIUMF) on the campus at the University of British Columbia and the quarter
scale working model are both progressing according to schedule. The model, known
as Central Regional Model, has been partially activated to the stage where it has
produced some radiation which caused concern by the radiation safety group, as
there was no instrumentation available to measure it.
As previously reported, progress is being made in negotiations for the approval
of a Provincial storage area for radioactive wastes from all parts of the Province.
Three American nuclear submarines have paid visits to Canadian waters,
necessitating continuous environmental monitoring during their stay, which has been
up to five days duration.
Acting as the advisers to the Atomic Energy Commission and the British Columbia Hospital Insurance Commission, the section has been called on by a number
of hospitals in the Province to give active consideration to the danger and protection
requirements for hospital radioactive installations.
Other Activities
The Director of the Occupational Health Division has been involved in numerous other activities appertaining to environmental health which include: Advisory
Committee on Agricultural Pesticides; Interdepartmental Committee on Pesticide
Use; TRIUMF Safety Advisory Committee; Health Department adviser to Pollution
Control Branch for air pollution applications; Vancouver Regional District Noise
Pollution Study and Nuclear Warships Local Authorities' Committee. The Division
also provides consultative service on environmental and industrial hygiene matters
to local health units and other departments of government.
J 24
PUBLIC HEALTH SERVICES REPORT, 1971
SPECIALIZED COMMUNITY HEALTH PROGRAMMES
The Health Branch is responsible for the maintenance of a number of specialized programmes designed to help various sections of the community. These include
people afflicted with a specific and sometimes rare disease, and elderly people and
very young children requiring special care for a variety of reasons. Motor-vehicle
and poisoning accidents are also covered by special programmes.
A summary of these is as follows:
KIDNEY FAILURE CORRECTION PROGRAMME
A kidney failure correction programme operated by the Health Branch is
designed to maintain the life of patients who have kidney dysfunction and to reduce
the cost of the care which otherwise would have to be given in hospital. There are
approximately 75 hospital beds for patients with kidney dysfunction located at
Vancouver, Victoria, Kamloops, and Trail. It is an expensive hospital service
costing $18,000 per year per bed. As 25 to 30 patients are admitted each year, it
is necessary to discharge this number of patients either to home dialysis or to have a
kidney transplant. Patients can be maintained in good health with an artificial
kidney in their own home, where the cost is less than $2,000 a year per patient. It
is an efficient method of caring for these patients.
It takes approximately two months to train a patient to operate an artificial
kidney machine. There are three centres at which patients may receive this training,
located at the Vancouver General and St. Paul's Hospitals in Vancouver and the
Royal Jubilee Hospital in Victoria. Approximately 25 patients per year receive this
training. At the present time there are 76 patients being maintained at home.
Most patients are placed on a hemodialysis programme whereby an artificial
kidney functions to wash impurities from the blood. Each patient is required usually to dialyze his blood through this machine for approximately 10 hours, three
times a week. In order to operate the necessary equipment, plumbing and electrical
changes in the house are required amounting to $7,000. The dialysis solution, supplies, and drugs cost about $2,000 a year. Most patients are maintained in good
health and are able to pursue normally productive lives engaged in their usual
occupations.
There are some patients who for one reason or another cannot be placed on
an artificial kidney. They may be placed on an alternative method known as peritoneal dialysis. Although this requires large quantities of solution at a relatively high
cost, approximating $8,000 per year, it permits the patients to be ambulatory and
gainfully employed while controlling the disease symptoms. It is a less costly
procedure than hospital dialysis. This method of dialysis was providing therapy for
11 patients as the year ended.
The hospitals which undertook the distribution of the dialysate and other supplies to each patient are finding it to be an administrative burden as the numbers
increase. Plans are being made to establish a central depot for dialysis equipment,
supplies, and drugs through the pharmacy at Willow Chest Centre. A warehouseman has been employed to assist the pharmacist and expansion of storage accommodation is to be undertaken. Technical improvements in home dialysis equipment
have occurred. A much more efficient artificial kidney is now being used that is
only half the weight of the original 70-pound earlier models. One hospital is con-
SPECIALIZED COMMUNITY HEALTH PROGRAMMES
J 25
ducting a trial of a surgical union of an artery and vein from which to draw blood so
as to reduce the complication of the blood clotting. Other changes are proposed
but have not reached the production stage.
AGAMMAGLOBULINEMIA
There are now eight people with this rare condition receiving free monthly
injections of immune serum globulin on a permanent basis. A number of applicants
were rejected this year because the Advisory Committee to the programme did not
feel that the medical indications for providing this product were sufficient to justify
a commitment to supply this expensive medication.
POISON CONTROL
Ten more hospital-based poison-control information centres were established
this year, to bring the total to 56. Well over 7,000 cases of accidental poisoning or
drug abuse were reported during the year. It was not possible to open the planned
Provincial referral centre due to lack of space at the Vancouver General Hospital,
where it is to be located. However, all the equipment is now ready and it is hoped
that space will be available in the new year.
Poison control—In this photograph a hospital nurse in Vernon consults the poison-
control file in order to give fast service on emergency calls. There are 56 such centres in
the Province.
I 26
PUBLIC HEALTH SERVICES REPORT, 1971
MOTOR-VEHICLE ACCIDENT PREVENTION
Again this year the Health Branch provided a consultative service to the Driver
Licensing Division of the Motor-vehicle Branch by giving advice on the ability of
persons with medical defects to drive safely. The revision of the booklet Guide to
Physicians in Determining Fitness to Drive a Motor-vehicle is almost complete and
it should be ready for distribution within the next few months. It is hoped that this
guide will form the basis for Canada-wide standards.
COMMUNITY CARE FACILITIES LICENSING
The administration of the Community Care Facilities Licensing Act was transferred to the Minister of Health Services and Hospital Insurance this year, and the
professional staff who carry out the licensing procedure called for under the Act
were placed in the Health Branch.
Implied in the transfer was the need to give a greater emphasis to the physical,
nutritional, and social well-being of approximately 92,000 persons, adults and children, in 1,100 licensed facilities throughout British Columbia.
A member of the Health Branch staff continued to act as Chairman of the
Interdepartmental Licensing Board set up under this Act so that board policy and
staff activities and inspections could be fully co-ordinated. As in past years, complaints about the standard of care given in licensed facilities were investigated and
Community care facilities—Fun for Fingers. Services to children in the Health Branch
Group Day Care Programme is one of the fastest growing licensing activities. Children,
such as those shown in this picture, are learning to develop social as well as tactile skills
under the capable guidance of a fully qualified pre-school supervisor.
SPECIALIZED COMMUNITY HEALTH PROGRAMMES
I 27
corrective action taken. In two instances, where deaths resulted from accidents in
licensed rest homes, the coroner's jury made strong recommendations about the
need for better supervision. The new regulations that are now being drafted will
require a higher level of supervision for elderly guests.
Toward the end of the year, four personal-care homes were being planned
under Government auspices.
Occupational health—There are 3 centres in the Province where employees of the
Provincial Government may obtain advice on health problems. In this picture a Health
Branch doctor examines a Government employee at the Victoria office.
EMPLOYEES' HEALTH SERVICE
The Provincial Government Employees' Health Service, operated by the Division of Occupational Health, has continued to give a variety of services to employee
groups in Vancouver and Victoria (see Table XII). Moreover, in the Riverview
area, due to an outbreak of salmonellosis, it was necessary to start health screening
of all new food handlers, while extensive stool sampling of the present employees
was carried out over a period of five or six months. In September, an extra nurse
was provided by the Mental Health Services to expand the over-all programmes
such as health screening, infection control, and safety instruction at Riverview,
Valleyview, and The Woodlands School.
Early medical treatment can make a positive contribution to the productivities
of employees in industry by improvement in the efficiency of patient treatment. To
this end, the Division of Occupational Health endeavours to work with the practising
physician in providing such ambulatory, diagnostic, therapeutic, and rehabilitative
services as are feasible on the job. All but a small proportion of ill or injured employees can return to work after treatment at a physician-sponsored industrial health
clinic with minimal time lost.
J 28 PUBLIC HEALTH SERVICES REPORT, 1971
It is encouraging to note that a medical clinic in the Vancouver area is interested
in developing an occupational health service for surrounding industry. The Division
advised the clinic of the importance of establishing a service which is efficient in
its handling of patients (employees) and also expeditious in its dealings with environmental problems within a plant.
The Director of the Occupational Health Division has been Chairman of the
Civil Service Commission Screening Committee, which is set up to review cases of
employees who have become incapacitated while employed in the Service. The
purpose of this committee is to re-establish the employee in a job.
In October, the Civil Service Commission announced a programme dedicated
to the recognition and treatment of alcoholism within the Government Service.
Alcoholism is regarded as an illness and the programme is based on the rehabilitation
of the problem drinker.
COMMUNITY HEALTH NURSING
COMMUN,TY HEALTH NURS.NG
I 29
til™1"8 '-mZnZSSlta ph— -S53 SI
Programmes ,„d serv,KS ^f**. >«M. centres, and inwSm
taor ex«s a focal poi„t £ S^L^^ vary. Where a •££
• The pnblie health nnrse is .hi., pr0mot,on K Provided. "Sk
protessional trainmg m public
f»MMii:g
Nursing—Public h in.
'^TableXl. nHOSpital'PreP-atorytogobghomfethe nUrSInS ^
J 30
PUBLIC HEALTH SERVICES REPORT, 1971
Public health nursing service is provided within the established policies of
the Health Branch and the health unit concerned so that similar public
health nursing services are available to all the residents of the Province.
The Public Health Nursing Division provides nursing consultant service to
assist health units evaluate their programme so that services can be carried
out as efficiently and economically as possible.
To maintain a high quality of service relevant to changing social and
economic conditions the Public Health Nursing Division plans and arranges
for professional training to enable the public health nurses to keep their
clinical expertise in public health nursing up to date.
The public health nurses made 169,450 visits to homes to provide family
service and in addition gave 206,618 individual professional services by
telephone. (See Table VIII).
HOME CARE
J 31
HOME CARE
Home care represents an important method of delivering health care in a setting other than an expensive hospital or institution, and thus it is an efficient and
economical way of caring for persons at home who need part-time nursing and
related health services. It is part of the generalized public health nursing programme given under the medical direction of a private physician.
As well as the public health nurse, various health workers are utilized for the
benefit of individual patients. These include registered nurses, physiotherapists,
orderlies, visiting homemakers, meals-on-wheels personnel, visiting volunteers, occupational and recreational workers.
• Home care is available in 113 communities to about 80 per cent of the
population in health units. During the year the Kamloops service extended
its area to include Valleyview municipality, and a new service commenced
at Fort St. John.
• There were 82,296 home visits made for general nursing service which
represents a 6-per-cent increase over the previous year. Sixty-nine per cent
of patients on service were over 65 years of age.
• There were 10,827 additional home visits made to patients receiving care
for emotional disorders. This included patients discharged from a psychiatric unit of an acute or psychiatric hospital, as well as services provided
to the retarded.
• Ninety-four per cent of the patients receiving psychiatric mental health
follow-up were under 65 years of age, with approximately 50 per cent being
adults.
• At the accepted charge to the British Columbia Medical Plan of $2 for
nursing visits by a voluntary nursing organization, an estimate of the saving
to the plan represented by home care visits carried out by public health
nurses is $186,000.
• A special home-care project was initiated in the Simon Fraser Health Unit
in co-operation with the Royal Columbian and St. Mary's Hospitals. This
project was designed to provide detailed information concerning the type
and cost of a comprehensive service required for the early discharge of
patients from acute hospitals to determine the types of patients and diagnosis
most suitable for discharge. It includes the provision for measurement of
change, by diagnosis, in the average length of hospitalization.
PUBLIC HEALTH PHYSIOTHERAPISTS
The primary responsibility of consultant public health physiotherapists, now
serving in nine health units, is the promotion of rehabilitation nursing in the home
care programme. During the year public health physiotherapists, who have also
contributed to general health service, made 1,826 home visits, assessed 787 patients,
and did 892 reassessments. (In 1970, home visits totalled 1,267, of which 521 were
individual assessments and 566 reassessments.) Liaison with institutions which
provide treatment service is necessary to ensure that rehabilitation nursing is carried
on in the home situation and 432 liaison visits were made.
J 32
PUBLIC HEALTH SERVICES REPORT, 1971
In addition, the public health physiotherapists provided instruction and education to public health nurses at 111 group sessions and in 439 individual case conferences. They also provided consultation and assessment for children in schools
and kindergartens, where teachers were concerned about the muscular co-ordination
of certain children, and thus have been most helpful in arranging needed care as
indicated.
Physiotherapy—A Provincial physiotherapist demonstrates and explains the benefits of
exercise to a senior citizen.
MENTAL HEALTH
In this programme the primary objective of the public health nurse is to prevent the development of mental illness, and to identify individuals who show early
signs of potential illness so that they may be given assistance and thus avoid early
breakdowns. In the course of their routine work, public health nurses see families
in crisis situations so that they are particularly suitable and available to provide help
when there is a high risk factor for potential breakdown. Special efforts are made
to identify potential problems in home visits, child health conferences, prenatal
classes, and schools.
• During the year public health nurses made 7,201 visits for primary prevention which represents a 22-per-cent increase over last year.
• In addition, they made 10,827 visits for secondary prevention to patients
under care for emotional disorders.
HOME CARE
I 33
YOUTH SERVICE
As it was believed that there might be a great influx of transient youth to the
Province during the summer months, which would result in increased communicable
disease, particularly venereal disease, arrangements were made for public health
nurses in health units to provide special assistance to meet the possible health needs
of transient youths. Special kits of literature and medical supplies were made
available to all offices. During the period June through August, 698 transients were
seen by public health nurses and approximately one-third of this group came to
the health unit offices, the remainder being seen at youth hostels. Individual services numbering 768 were given. Varied reasons were given by the young people
for seeking assistance:
• The majority (389) came because of minor injury, illness, skin infections,
or intestinal disorders.
• 107 were seen for suspected venereal disease.
• 89 for general health information or advice on finance.
• 51 for contraceptive advice.
• Eight because of emotional disturbance.
• Eight because of drug abuse.
It is believed that the special programme for travelling youth probably prevented more serious health problems from developing, as needed care was given or
arranged at an early stage.
ADULT AND GERIATRIC SERVICES
An important part of the work done by public health nurses is with adults for
general health supervision. During the year, there were 45,987 visits for general
health appraisal. This resulted in many persons obtaining early diagnosis, treatment, and care for medical conditions, and included general health guidance, nutrition advice, and referral to other agencies for further attention.
• Family planning counselling is included in discussions with parents at expectant parent classes, and in individual discussions at the time of home
visits or at special clinics held in some health units.
• Adults receive special attention under special programmes, as noted elsewhere, particularly in relation to communicable disease control, home care,
and maternal care.
• 56 per cent of the general health supervision visits and almost 70 per cent
of home care visits were made to patients over the age of 65 years.
SERVICE TO INDIANS
Certain Indian reserves are provided with public health nursing service from
health units through a special arrangement with the Medical Services Directorate of
the Department of National Health and Welfare. One reserve at Parsnip River was
added, so that public health nurses now serve 72 reserves with a population of
about 9,400 Indians. It is interesting to note that close to one-third of the 50,663
Indians in the Province now live off the reserves and receive the same general health
service as the non-Indian population. In addition, school health services are provided by public health nurses to all the Indian children who now attend Provincial
schools.
3
I 34
PUBLIC HEALTH SERVICES REPORT, 1971
AUXILIARY WORKERS FOR PUBLIC HEALTH NURSING
PROGRAMMES
It has been possible for public health nurses to continue to provide a good
quality of professional nursing service in spite of rising case loads by utilizing the
services of auxiliary workers who have been trained on the job to do essential
routine work. During the year, volunteers gave approximately 12,000 hours of their
time which is equivalent to more than eight full-time workers. In addition, health
unit aides extended their activities into the community setting where they have
been able to assist public health nurses in schools and clinics. Incentive programme
trainees also rendered valuable assistance (see Table XI).
MATERNAL AND CHILD HEALTH
I 35
MATERNAL AND CHILD HEALTH
Classes for expectant parents continue to be popular as indicated by an over-all
increase of 30 per cent in attendance over the previous year. Of the classes, 60 per
cent are open to both parents. Public health nurses centre their teaching around
the physical and emotional problems of pregnancy, normal development, changed
family relationships, nutrition, family planning, and include recommended relaxation exercises.
• Classes were held at 64 health centres where a total of 379 series were
presented. It is estimated that around 50 per cent of all new mothers
attend classes prior to the birth of their first baby.
• 4,659 expectant mothers took part, or 28 per cent more than last year,
while 1,967 fathers attended, which is a 28-per-cent increase over last year.
• In addition, public health nurses made 4,447 prenatal and 20,123 postnatal
visits to discuss maternal and child health.
INFANT AND PRE-SCHOOL CHILDREN
As prompt attention to potential health problems of early childhood will prevent these problems from becoming serious at a later date emphasis is placed on
early case finding and arrangements for treatment and care. Public health nurses
are involved in a number of programmes where they have the opportunity of assessing the health status of young children, in special clinics, child health conferences,
kindergartens, and play groups, as well as in the home situation. Screening programmes include testing for hearing loss, vision, retardation, deviation from normal
growth and development. A number of health units are using the standardized
Denver Developmental Screening test, to assess for motor, language, and personal
social development. More emphasis has been directed to the 3- and 4-year-old
child.
• Public health nurses made 34,006 visits to homes of infants for general
health assessment and counselling.
• 80 per cent of new-born infants received one visit from a public health
nurse during the important first six weeks of life.
• 17,211 infants attended child health conferences which had a 5-per-cent
increase over last year when public health nurses provided 18,822 individual
services and counselling sessions.
• 6,966 pre-school children attended child health conferences where there
was a 22-per-cent increase of children attending and the public health nurses
provided 88,613 individual services.
• Public health nurses made 29,746 visits to homes on behalf of pre-school
children of which 1,250 were for primary and secondary mental health
problems.
I 36
PUBLIC HEALTH SERVICES REPORT, 1971
SCHOOL HEALTH
This year a revision of the school health programme procedure manual was
prepared jointly by members of the Department of Education and the Health
Branch, and has been distributed to health units, district superintendents and school
principals. This revision clarifies the responsibilities of health and education personnel and points up areas in which close co-operation is essential.
The school child continues to receive a major part of the time and attention
of the public health nurse as well as the services of other members of the health
unit staff—the health unit director, the public health inspector, the preventive dentistry team, and in some areas the speech therapist. Through the co-operation of
the public health nurses, services are made available from the mental health team
and many local and Provincial health and welfare services.
At 5 years of age approximately 70 per cent of children in British Columbia
attend kindergarten and by 6 years of age virtually 100 per cent come under the
surveillance of school and public health personnel. One can therefore appreciate
the great potential for preventive health measures through the school health programme.*
Increasing emphasis on pre-school screening, particularly at the 4-year-old
level, has an influence on the school health programme. If a pre-school child is
found to be below the usual level of development for his age, the nurse works with
the parent and the child to introduce activities which will help him to develop
appropriate skills. Before the child enters school, either kindergarten or Grade I,
the nurse gives the school principal any information which may be significant to the
child's adjustment to school, such as health or developmental problems or cultural
deprivation. This approach is in keeping with the concept of prevention and early
remedial treatment and can have a far-reaching effect on a child's emotional health
and his ability to adjust successfully to school. The public health nurse also tries
to ensure that immunization is brought up to date before a child starts school.
Table XIV shows that a high percentage of children have basic immunization prior
to entering Grade I.
Another change has been the increasing use of auxiliary workers to assist nurses
in schools. In the school year 1970/71, auxiliary workers employed as health unit
aides and others who serve as volunteers have performed about 62,000 screening
tests for vision and hearing as well as helping at immunization clinics. This assistance has freed the public health nurse for other work such as consultation with
teachers and home visiting.
Rather than make routine inspections of large numbers of healthy children the
nurses select children who have special needs. The teacher is a valuable ally in this
selection. Her daily contact with a child familiarizes her with his usual appearance
and behaviour and she can recognize early changes. She also has the opportunity
to observe him in relation to his peers. In the past school year 15.3 per cent of
school children were selected for special attention by the public health nurse and
7.5 per cent were referred by her for further care. (See Table XV.)
During the year public health nurses provided 267,245 individual services to
pupils in schools, while 6,409 formal conferences were held with classroom teachers
to review the health status of the children.
* See Tables XIII, XIV, and XV.
SCHOOL HEALTH
I 37
In addition 60,445 unscheduled conferences were held with teachers and the
public health nurses participated in 2,126 teachers' meetings. The number of
sessions held by the public health nurses with groups of pupils more than doubled,
to 3,521 sessions. A total of 44,217 home visits were made on behalf of school
children and 16 per cent of these visits involved emotional health problems.
School health—An audiologist tests a youngster's hearing with an audiometer in the
Child Health Programme.
With an improved standard of living, extensive medical care coverage and
increased preventive health care, physical defects are causing less concern than
emotional problems. The most frequently discovered physical problems are defects
of vision and by the time students reach Grade X about one-third are wearing glasses
and would have been handicapped to some degree if the condition had not been
discovered. Another aspect of physical care is immunization, and nurses have a
responsibility for keeping protection at a high level, through offering reinforcing
immunization in Grades I, V, and X.
In the area of mental health, in recent years public health nurses have had
more preparation and in-service education on how to promote emotional health
and deal effectively with children who have emotional problems. Support and
guidance given early to the child, the family, and the teacher often result in preventing the development of a more serious problem.
I 38
PUBLIC HEALTH SERVICES REPORT, 1971
PREVENTIVE DENTISTRY
The objective of the Division of Preventive Dentistry is to endeavour by all
means available to improve the dental health status of the people of British Columbia. Ideal dental health status is the complete absence of oral diseases and dento-
facial abnormalities. As yet but few persons may anticipate a lifetime completely
free of oral disease (dental caries or periodontal disease), but a person's dental
health may be very significantly restored by regular dental treatment and maintained
by daily meticulous oral hygiene.
During 1971 results of two nation-wide dental health surveys were reported.
The first included 12 dental health indices, and each was recorded for children
between the ages of 5 and 16. Results were reported for each province and for all
Canada. The children of British Columbia ranked in the first three positions in a
majority of such age-specific indices.
The second national survey was carried out by adding a few selected dental
questions to a labour force survey routinely conducted by the Dominion Bureau of
Statistics. Results of this survey reported in British Columbia, on an average, more
persons visited a dentist than in any of the other four regions (Maritime, Quebec,
Ontario, Prairies), and this applied in all age groups, including those under 14 years
of age.
In British Columbia a dental health survey is carried out each year by Provincial authorities in one of seven regions. In 1971, close to 1,500 children aged 7-15
years in the Vancouver Island Region were dentally examined. Comparisons with
the last survey in this region in 1961 are difficult since this year four school districts
were included which were not on the previous occasion the responsibility of this
jurisdiction. Furthermore, in all these four districts there is an acute shortage of
dental manpower and these children represented approximately 18 per cent of the
total sample. In spite of this dilution some modest improvements were found in
the dental health status of the children of this region and were demonstrated to be
statistically significant. For example, the percentage of children with no untreated
carious teeth at the time of examination increased from 13.7 per cent in 1961 to
16.1 per cent in this 10-year period. Also statistically significant was a decrease
from 25.9 per cent to 22.1 per cent in the proportion of all children who had lost
one or more permanent teeth. However, there are no grounds for complacency
when we note that both in 1961 and again in 1971 there were 28 per cent of all
children in the category "Neglected treatment for dental caries," i.e., having cavities
but not one tooth restored. A great deal more needs to be done to decrease the
prevalence of dental caries, as well as periodontal disease and malocclusion. Especially is this true for low and lower-middle income families, who find great difficulty
in meeting the costs of treatment. As the result of failure to provide treatment, the
child may become a life-long dental cripple.
Active concern for these children is growing rapidly. By resolution at the
1971 Annual Meeting of the Associated Boards of Health of British Columbia, their
executive was directed to explore forthwith means by which a Dental Rehabilitation
Foundation might be established to which parents of dentally neglected children
might apply for assistance in the purchase of dental care for these children.
Under the direction of the Okanagan Regional Dental Consultant, a dentist
with graduate training in public health, dental hygienists, dental assistants, registered
nurses with training in preventive dentistry and appropriate clerical staff continue
PREVENTIVE DENTISTRY
I 39
to demonstrate how community dental health can be significantly improved with the
utilization of such auxiliary personnel. In the fall of 1971 a similar but smaller
programme commenced in the Fraser Valley, while a part-time programme operates
in the Courtenay School District.
The successful results attained by the Okanagan dental hygienist programme
have been well documented. For example, in 1965, prior to its activities in the
Kelowna school, 53 per cent of the Grade I pupils were in need of dental treatment
when examined in the schools. In 1971 only 36 per cent were in this category.
Furthermore, in 1965, 24 per cent of these children had teeth extracted prematurely
because of dental disease, but in 1971, only 11 per cent were so classified. As a
result, the expansion of the dental hygiene programme is being considered.
Some 30 communities, each without a resident dentist were visited during 1971
by young graduate dentists. To each was provided on free loan a complete set of
modern transportable dental equipment including a dental X-ray unit. In most
communities a subsidized dental-care programme for younger children was arranged,
the costs usually being shared with the board of school trustees of the local school
district. This past year, in the belief that the knowledge of the necessity for early
and regular dental care is now firmly established in most families of these communities, in a few places all treatment for all ages was rendered solely on a fee-for-
service basis. From this experience stems the opinion that this programme is entirely viable on this basis. Moneys saved by the deletion of the subsidized dental-
care programmes for younger children will be utilized to provide travel and other
allowances for more dentists to provide more treatment service in the same areas
or extend this service to other areas and (or) for the extension of truly preventive
programmes operated by dental hygienists or other dental auxiliary personnel.
To overcome difficulties in finding suitable clinic accommodation for the visiting dentist, when he provides all treatment on a fee-for-service basis, the North
Okanagan Union Board of Health has purchased a mobile trailer. The cost has
been snared between this Health Branch and the Okanagan communities that will
benefit by this service.
Three-year-old birthday card dental programmes continue to expand. During
the period September 1970 to August 1971 close to 8,000 three-year-olds thereby
visited their family dentists, an increase of 17 per cent over the previous year. These
children received, at no direct cost to their parents, a dental examination, with
X-rays if considered necessary. In addition, their teeth usually were painted with
a decay-preventing fluoride solution and the parents received counselling in respect
to oral hygiene and dietary practices for the prevention of dental decay. Currently
such programmes operate in 48 school districts and it is hoped that a further six
may be organized during the coming year. Participation in these programmes
ranged from approximately 50 per cent in programmes in newly organized areas to
well over 80 per cent where they have operated under optimum conditions over
several years.
At the close of 1971 there were 1,042 dentists licensed to practise in British
Columbia, of whom 102 newly registered this past year. Of these 16 were
graduates of the University of British Columbia. It is hoped that this school will
increase its graduating class to 31 in 1972.
The ratio of population to dentist at the beginning of 1971 was 2,309:1, which
ratio since 1958 has been steadily improving. During the past 10 years this ratio
has significantly improved in the Kootenay and Okanagan regions but remains a
matter of some concern in the northern and northwestern areas of this Province.
However, it can now be reported that 35 dentists newly registering in this Province
J 40
PUBLIC HEALTH SERVICES REPORT, 1971
this past year elected to practise outside the metropolitan areas of Greater Vancouver
and Greater Victoria. Also helping to increase available dental services in British
Columbia are 153 dental hygienists, of whom in 1965 there were but 15. In addition, by regulations proposed by the College of Dental Surgeons of British Columbia
and passed late in 1970, certified dental assistants are being trained in three vocational schools in this Province. These auxiliary personnel will be trained and
authorized to carry out in the oral cavity certain simple technical procedures which
previously required the services of a dentist or dental hygienist. At the close of
1971 there were 102 certified dental assistants registered in British Columbia.
Dental brush-in—Grade III students at West Vernon Elementary School engage in a
brush-in under the watchful eyes of a dental supervisor and her assistant. The youngsters
are using self-applied prophylactic paste. Many children throughout the Province are
checked for teeth disorders.
—Photograph courtesy oj the Vernon News Ltd.
This Division continues to sponsor scientific clinical studies for the improvement of techniques for the prevention of dental diseases and abnormalities. During
the past year two large-scale trials were initiated. Each included some 1,400 children initially in Grades IV and V, with one study being held in the Surrey School
District and the other in six northern communities. Both studies are testing mouth
rinses which in laboratory tests and animal trials showed great potential for the
prevention of dental caries.
At the suggestion of a member of this Division, the Faculty of Dentistry of
the University of British Columbia has applied for and received a research grant to
develop a fluoride paste which would have an anticariogenic (decay preventing)
PREVENTIVE DENTISTRY
I 41
potential, and could be produced in quantity for large scale "brush-ins." This is a
method of attempting to curb dental decay in children by the self-administration of
a fluoride paste by means of a tooth brush. If the Faculty of Pharmacy is successful
in its laboratory trials, a clinical trial of the effectiveness of the paste is planned.
Dr. and Mrs. David Gillett are kept extremely busy in Houston, British Columbia.
As a recent graduate from dental school, Dr. Gillett and four others are spending a year
touring various parts of the Province before settling down to regular practice. It is all
part of a programme, in co-operation with the Health Branch, for pre-school children.
J 42
PUBLIC HEALTH SERVICES REPORT, 1971
NUTRITION SERVICE
From June 28 to September 22, British Columbia participated in the first phase
of the national nutrition survey—NUTRITION CANADA. More than 17,000
British Columbians were examined by the team of investigators which toured 40
locations throughout the Province collecting data on the nutritional well-being of
the population. The second phase of the survey will take place from January to
April of 1972.
In recent years the broad base from which nutrition education was formerly
presented has had to be restricted to the nutritionally most vulnerable groups in the
community. These are pregnant women, pre-schoolers, adolescents, the aged, the
obese, those requiring special diet counselling, and those with limited incomes.
The area of concentration in nutrition education in British Columbia has been
nutritional value for the food dollar with particular emphasis on low-income families.
Food buying slides have been reorganized and updated. Their use by public
health nurses and home economics teachers under the title Of Consuming Interest
was promoted for consumer groups, prenatal classes, family planning classes, high
school home economics classes, homemaking classes for Indians, training programmes for visiting homemakers, and counselling low-income families. The slides
were used extensively over television, and consumer cards carrying the same information were available for distribution to the general public.
A series of 55 basic low-cost recipes was developed for nutrition education
using the four food groups as a guide to menu planning.
Consultative service was offered to the public in the form of curriculum guidelines for homemaker classes for those receiving social assistance and for low-income
families. Individual counselling was given through the public health nurse to many
multiproblem low-income families.
Weight-control information developed by the nutrition service was widely distributed throughout the Province for use primarily by the public health nurse and
home economics teacher. How to Be a Good Loser slides and pamphlet were used
as discussion guidelines for talks to weight-watching groups by members of the
British Columbia Dietetics Association Auxiliary. A kit of materials for working
with obese school children was used by several health units.
As a part of the health education programme for transient youth, a nutrition
pamphlet entitled Food for People on the Move was prepared for distribution from
health units, youth hostels, and kiosks, in order to provide practical nutrition information to this group in a readily acceptable form.
A programme of orientation of the public health nursing staff to the concept of
nutrition education for the pre-schooler has been undertaken using materials from
project Head Start of the United States Children's Bureau. Response has been
favourable and the use of the film Jenny Is a Good Thing and other materials in
child health conferences and pre-school discussion groups has begun in several areas.
Consultative service to members of the community working with vulnerable
groups remained a large part of the nutritionist's activities and included:
• Participation in a regional seminar for food service workers.
• Liaison with local dietitians concerning teaching aids available for childhood
diabetes and alcoholic malnutrition.
NUTRITION SERVICE
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J 44 PUBLIC HEALTH SERVICES REPORT, 1971
PUBLIC HEALTH EDUCATION
Health, both personal and community, is of major concern today. The education of people in public health matters is a most important function of all members
of the Health Branch staff who deal with people in their homes, in schools, at places
of work, and in hospitals operated by the Health Branch.
On the staff are nurses, doctors, public health inspectors, speech therapists,
dentists, occupational therapists, rehabilitation officers, clerical staff, and health
educators, all of whom spend much of their time informing the public on public
health matters and guiding them toward better health.
All staff members are involved in the assessment of the importance of health
problems and determining the method of education to be used to meet those problems. The foregoing, in a health education programme, requires an understanding
of human behaviour, human learning processes, and educational methods.
To assist the Health Branch staff who have direct contact with the public, the
Health Branch maintains a central group of specialists in health education—the
Division of Public Health Education. The Division provides an education consulting service, development and production of printed educational and audio-visual
material, audio-visual equipment, and a library service.
Examples of the activities of the Division of Health Education in 1971 were
as follows:
• Divisional staff acted in a consulting and advisory capacity to Health
Education Research Project, in School District No. 47, sponsored by the
Medical Services of the Department of National Health and Welfare.
• Lectures in health education were given to students in nursing and dentistry
at the University of British Columbia, and a photographic workshop was
conducted at the British Columbia Institute of Technology for students in
public health inspection.
• Staff members participated in the formation of the British Columbia Health
Education Council under the sponsorship of the Canadian Public Health
Association (British Columbia Branch). The purpose of the Council is to
foster communication, to identify gaps in present programmes, and to provide an opportunity for voluntary co-operation between agencies offering
similar programmes.
• Divisional staff co-ordinated the evaluation and assessment of proposed
Federal pamphlets on family planning.
• A film survey was conducted to determine the factors affecting utilization of
films in an effort to assist future planning.
• In the technical field, three super 8-mm. films covering dental health, auditory assessment, and physical appraisal of the newborn child were developed.
• Educational slides dealing with nutrition, venereal disease, and home care
were prepared for the use of staff.
Methods and techniques in the presentation of educational material to the
public are studied carefully and evaluated for use in the Health Branch. An example
is the increasing use to which television and radio are being put by staff members.
Steady progress is being made in this field, and plans for the introduction and use
of video-tape recording equipment are well advanced.
VITAL STATISTICS I 45
VITAL STATISTICS
The Division continued to carry out its statutory functions in the administration
of the Vital Statistics Act, the Marriage Act, the Change of Name Act, and the Wills
Act; and to provide centralized statistical service to the Health Branch as a whole,
and to other Government departments and voluntary health agencies.
In connection with the administration of the above-mentioned Acts, services
are provided to the public through the main office in Victoria, and about 110 district
offices and suboffices throughout the Province.
Table XVI indicates the volume of documents processed under the above-
mentioned Acts in 1970 and 1971.
Significant features of the Division's work during 1971 were:
• The total volume of registrations continued to increase, due mainly to a
substantial increase in registrations of wills notices under the Wills Act, and
a slight percentage increase in the number of death registrations.
• The moderate decline in the number of birth registrations reflected a reversal
of the upward trend of births during the preceding few years.
• Divorce registrations, which had risen sharply in the past two years following the introduction of the Federal Divorce Act in 1968, levelled off in 1971.
• By means of an amendment to the Marriage Act, the issue of marriage
licences was extended to include marriages solemnized by civil contract
which previously were authorized by a different procedure in this Province.
At the same time the prescribed waiting period following application for a
marriage licence was reduced by two days.
• The Division undertook analysis of the results of a dental survey to test the
effectiveness of a caries-inhibiting chewing gum on Trail school children.
A paper covering the findings of the survey was prepared in collaboration
with examining dentists in charge of the study, and the Director of the
Division of Preventive Dentistry.
• Field records of two studies of fluoridated mouth wash in the Fraser Valley
and northern regions of the Province were also processed.
• The Division participated in a study of the role of radiographs in the determination of dental caries, and the resulting paper has been published in the
American Journal of Public Health Dentistry.
• The Division continued to process statistical data for the Central Cytology
Laboratory. About 380,000 forms representing that many cervical smears
from screened women throughout the Province were transferred to punch
cards and mechanically tabulated.
• The Division also participated in the planning, processing, and analysis of
a special study entitled A Case Study of Pre-clinical Carcinoma of the
Cervix and the Possible Effects of Birth-control Pills and Other Factors.
A report on the study was submitted to the Food and Drug Directorate,
Department of National Health and Welfare, at whose request it was
undertaken.
• Assistance was given to a member of the British Columbia Cancer Institute
in a study on mortality from cancer of different sites of the digestive system.
• The Registry for Handicapped Children and Adults continued to maintain
a level of between 200 and 300 registrations per month. The Registry co-
J 46
PUBLIC HEALTH SERVICES REPORT, 1971
operated with the Alberta Department of Health in a special study on
reduction deformity in children born in 1970. One of the consultants to
the Registry presented a paper at the International Congress of Pasdiatricians
held in Vienna in September 1971, summarizing the results of 20 years'
experience of the Registry. The Registry staff also co-operated in several
studies which utilized statistics collected in the Registry.*
The Division continued to co-operate with the Child and Maternal Health
Division of the Department of National Health and Welfare in the maintenance of a National Registry of Congenital Anomalies.
The data derived from the Obstetrical Discharge Summary form, which is
completed by three lower mainland hospitals, were processed in the usual
manner, and assistance was given to a Vancouver physician in the preparation of a paper based on this study, and entitled The Effect of Age on the
Outcome of Pregnancy.
The results of a pre-school health screening of children in the Central Vancouver Island Health Unit were processed by the Division and tabulations
were supplied to the health unit director. The results included counts of
children found to have defective hearing or eyesight, or vascular diseases.
The Division continued to provide biostatistical services to other divisions,
other departments of Government, and voluntary agencies.
Vital statistics—Births, marriages, and deaths in British Columbia must be registered,
and the various documents finally arrive in this section of the Division of Vital Statistics in
Victoria. The picture shows two staff members working in the massive library of records.
* See "Publications," page 57.
EXTENDED CARE
J 47
EXTENDED CARE
The Pearson Hospital has two patient-care programmes, one being extended
care for those requiring continuing care, including patients with severe respiratory
disabilities from poliomyelitis, and the other for those with tuberculosis. There has
been greater emphasis on admitting a younger age group to the extended-care wards,
resulting in more activity in the physiotherapy and occupational therapy services.
Staff changes have mainly involved the retirement of several senior nursing
personnel and recruitment difficulties because of an unusual decrease in numbers of
graduate nurses seeking employment in the extended-care hospitals.
A study of the hospital's patient programme and facilities was carried out
during the early part of the year by personnel from the Hospital Insurance Service.
Their recommendations are being studied.
Constructional work included installation of improved ventilation and sound
absorption materials in the Dietary Department and the exterior painting of the
hospital.
There was an increase in the types of biochemical techniques now being done
by the laboratory at the hospital, thus providing a more comprehensive service. The
total laboratory work load increased slightly.
The activity wing services increased both in occupational therapy and physiotherapy. The latter acquired a flake-ice machine which provides a more suitable
form of ice for treating patients with muscle spasms, and the manufacture of self-
help aids by the occupational therapists increased in volume.
The Social Service Department in conjunction with the Division for Aid to
Handicapped has reactivated the rehabilitation committee for patients in Pearson
Hospital and Willow Chest Centre.
The Department of Nursing which supervises the in-service education programme has provided a high quality of leadership.
Students from the practical nurses course at the Vancouver Vocational Institute
and physiotherapy and occupational therapy students from the School of Rehabilitation Medicine at the University of British Columbia attended at the hospital for
part of their practical work. The patient tutoring service has been more active during
the past year and the patient library service improved. The library is now under the
supervision of the occupational therapy service.
The business office is proceeding with the amalgamation of the stores department of Willow Chest Centre with that of Pearson Hospital so that henceforth stores
will be located at the hospital.
Again, the Women's Auxiliary made hospital life much more pleasant and
easy. The members of this group started their programme at the Marpole infirmary
long before that institution was closed and the patients transferred to Pearson Hospital in 1956. It is indeed fortunate for both patients and staff that these dedicated
women have continued to give service at the new location.
J 48
PUBLIC HEALTH SERVICES REPORT, 1971
AID TO HANDICAPPED
During the past year, the Division has undergone some changes. It has expanded to cover more areas of the Province and has experimentally begun to offer
services to broader categories of disabled persons.
An important name change has been made from the Division of Rehabilitation
to the Division for Aid to Handicapped. This describes more accurately the function
and philosophy of the Division, which of necessity, was preoccupied with the vocational rehabilitation of the handicapped but now provides assistance to handicapped
individuals without particular reference to a vocational resettlement. However,
the Division still believes that the goal for most disabled people is gainful employment, and it is toward this end that services are directed.
Over the past 10 years, the Division has developed a method of delivering
services designed to provide maximum benefit for each handicapped person. This
method is based on a practical application of the idea that handicapped persons
require a variety of services skilfully offered in proper sequence by a number of
disciplines in a co-ordinated way. To accomplish this the Division endeavours to
make full use of the various resources available within the Province.
Initially in British Columbia, personnel resources included a well-developed
network of public health services and social services. The then National Employment Service, with offices throughout the Province, offered considerable expertise
in vocational counselling, job training, and job placement. It was obvious that the
three basic elements required were available, but more co-ordination of these was
required.
There are now 33 Aid to Handicapped Committees operating in the Province. In this
picture a group at Trail is shown in conference.
AID TO HANDICAPPED I 49
It was felt, therefore, that this Division should attempt to ensure that a coordinated approach to the problems of the handicapped was developed at the local
level using existing personnel and programme resources. To test this theory, in
1960/61 the Health Branch launched an experimental programme using the City
of Nanaimo and environs as a test location with the co-operation of the then Department of Social Welfare and the National Employment Service. A year was
spent in selecting patients, devising methods of operation, and providing services
to develop a system which could be utilized in other areas of the Province, and the
first Rehabilitation Committee in the Province was formed. The Committee consisted of the Medical Officer of Health as Chairman and medical consultant, the
Supervisor of the Social Welfare Department, and the Senior Placement Officer of
the National Employment Service. The responsibility for providing and developing
a rehabilitation programme for the individual rested jointly with all members of the
Committee.
Subsequently, similar committees were developed in Chilliwack and Prince
George.
The committees are now called Aid to Handicapped Committees and the
members are the Medical Officer of Health as medical consultant, the Supervisor
of the local office of the Department of Rehabilitation and Social Improvement, the
Senior Counsellor of the Canada Manpower Centre, and the Consultant from the
Division for Aid to Handicapped. At the end of this year 38 committees were
active, serving a total of 1,989 handicapped citizens in the Province. This exoansion
of services has been made possible with completion of recruitment to provide a full
complement of staff. Appointments of consultants for the Division for Aid to Handicapped have been made in the east and west Kootenays with headquarters in Nelson,
and in the metropolitan area of Greater Victoria. Services in the Okanagan have
been hampered for a portion of the year due to the illness and subsequent resignation
of the consultant. He has been succeeded by a well-trained consultant with considerable experience in the field.
During the year, the Division increased its financial assistance to selected
rehabilitation agencies. According to a policy established some years ago, the
funds were designated specifically to assist in the employment of professional staff.
As a result, there has been a considerable improvement in the ability of the agencies
to deliver better services to a greater number of disabled persons, services which
otherwise would have to be provided by the Division.
An increase in funds for vocational training was provided which enabled the
Division to provide such training for a greater number of handicapped and to increase
living and other allowances to meet the rising cost of living, books, materials, and
fees. Advantage was taken of almost every resource through which training for
gainful employment can be obtained. An important example of this type of activity
is the Division's assistance to 13 graduates of the Jericho Hill School for the Deaf
in their current further training at Gallaudet College, Washington, D.C.
The Division has received assistance from other departments of the Government of British Columbia, notably the Departments of Education, Labour, and
Rehabilitation and Social Improvement. Canada Manpower has also assisted the
Division, as have the many voluntary agencies in the Province.
Table XVII shows an analysis of cases closed during 1971.
J 50
PUBLIC HEALTH SERVICES REPORT, 1971
LABORATORY SERVICES
PUBLIC HEALTH LABORATORY SERVICES
After transfer of the Chemistry Service from the Health Branch to the Water
Resources Service of the Department of Lands, Forests, and Water Resources on
April 1, 1971, the Provincial Laboratories continued to provide expanding service
in the fields of bacteriology, mycology, parasitology, and virology.
In Table XVIII, the number of tests performed in the main laboratory, the
Nelson branch laboratory, and the Victoria branch laboratory in 1971 are compared with corresponding figures for 1970. The work load increased from more
than 454,000 tests in 1970, to nearly 498,000 tests in 1971. The work load showed
the following increases: Smears and cultures for Neisseria gonorrhoea, 22 per cent;
examination for intestinal parasites, 37 per cent; fluorescent microscopy examination
for diagnosis of syphilis, 167 per cent; and hasmagglutination-inhibition test for
rubella, 240 per cent. The only appreciable decrease was in the agglutination tests
for febrile illnesses, 50 per cent.
In 1970 and 1971, a comparative study of the faecal coliform and total coliform
tests was conducted on bathing beach water samples. It was recommended that the
total coliform test be replaced by the fascal coliform test as the standard for classifying the quality of beaches for recreational purposes.
Laboratory Services—The Health Branch maintains an extensive laboratory service and
in this photograph, laboratory technicians prepare cultures for identification of bacteriological diseases.
LABORATORY SERVICES
J 51
The outbreak of rubella, which began in the spring of 1970, continued into
1971. In more than 300 cases the diagnosis was proved by virus isolation, by serological identification, or by both methods.
In June 1971, in association with the Department of National Health and Welfare, the Canadian Botulism Reference Service was established in the Provincial
Laboratories to replace the service previously provided at the University of British
Columbia under the direction of Dr. C. E. Dolman.
The depot for exotic drugs continued to provide drugs and consultative services
for the diagnosis and treatment of parasitic and exotic diseases imported into British
Columbia by immigrants, and by Canadians returning from overseas.
J 52 PUBLIC HEALTH SERVICES REPORT, 1971
EMERGENCY HEALTH SERVICE
The objective of the British Columbia Emergency Health Service is the provision of mass casualty care and emergency public health service.
PRE-POSITIONING OF EMERGENCY HEALTH SUPPLIES
Pre-positioning and maintenance of emergency medical units is still an active
programme as basic industries and populations move into new areas or expand in
existing areas. The programme, still incomplete, includes methodical marking and
cataloguing of supplies and equipment in the Advanced Treatment Centres and Hospital Training Units. This work absorbs the greater portion of the annual budget.
• The following emergency health supplies were pre-positioned during 1971:
Emergency Hospital 1
Advanced Treatment Centres 5
Casualty Collecting Units 7
• 33 hospitals in the Province provide storage space for Emergency Hospitals,
Advanced Treatment Centres, and Casualty Collecting Units. There are
now 183 units in 109 storage locations in 73 municipalities.*
• It has been suggested that a small cadre of personnel be highly trained in
the setting-up and repacking of emergency health supplies, and that arrangements be made for their services to be available anywhere in the Province
on short notice. In a disaster situation they would provide the direction
and leadership for local volunteers to put an emergency medical unit into
operation.
• Following a conference with the St. John Ambulance organization concerning Casualty Collecting Units a unit has been placed in the St. John Ambulance building in Vancouver.
COMMUNITY AND HOSPITAL DISASTER PLANNING
The following are the developments in this section:
• Hospital disaster planning was discussed with a number of hospital administrators, particularly those in small hospitals. All are aware that accreditation depends upon the formulation of an acceptable hospital disaster plan.
• Due to improved communication facilities of ambulance and police services,
the Lower Mainland Medical Disaster Plan has been revised and will be
exercised in the near future.
• A Regional Disaster Medical Plan for Victoria, the second in British Columbia, was prepared and exercised in September 1971.
• Provincial Emergency Health Services supported community disaster exercises with items for casualty simulation and training supplies for use by
first aid personnel.
TRAINING
The Emergency Health Services Co-ordinator has been active in several fields:
• Five sessions on disaster nursing were conducted by the nursing schools of
the Royal Jubilee Hospital and St. Joseph's Hospital in Victoria, with the
assistance of the Co-ordinator. About 30 nurses attended each course.
* See Table XIX for total units pre-positioned.
EMERGENCY HEALTH SERVICE
I 53
Emergency Health Services—Looking over pre-packaged emergency hospital supplies
at Creston Valley Hospital is the Provincial Co-ordinator of Emergency Health Services
(left) and the Hospital Administrator. Units are located at strategic points in the Province,
and may be called into use when local authorities need help with an emergency.
-Picture courtesy oj Creston Valley Advance.
Six pharmacists attended a two-and-one-half-day course for health supplies
officers conducted by the Co-ordinator. This was the last health supplies
officers' course conducted separately for them. Pharmacists are now included in the Provincial community emergency health planning courses.
Provincial Emergency Health Services supported a course jointly conducted
by the Continuing Health Science Centre, University of British Columbia,
and the Vancouver General Hospital. The course, Primary Care for the
Emergency Patient, was well attended by ambulance personnel, industrial
first aid personnel, and hospital emergency department staff.
Provincial Emergency Health Services conducted a series of seminars in the
Okanagan Valley region. There were two full-day sessions for general
attendance and two evening sessions designed particularly for pharmacists.
From the results, it was evident that the action is at the local level, whether
for training purposes or an actual disaster, and the result in either instance
will be in direct proportion to the interest of the citizens of the community.
A successful display of Emergency Health Services materials and literature was set up at the annual meeting of the British Columbia Hospitals
Association.
J 54
PUBLIC HEALTH SERVICES REPORT, 1971
A display panel was made available by the British Columbia Hospital Insurance Service, for use by Provincial Emergency Health Services in the
health section of the Provincial building at the Pacific National Exhibition
grounds. The display shows the location of 200-bed Emergency Hospitals
in the Province.
Special displays were on view at the annual meeting of the Union of British
Columbia Municipalities, and the Abbotsford Air Show.
Casualty simulation has become an integral part of community disaster
exercises and 13 candidates attended a casualty simulation course in June.
13 candidates from hospital staffs attended a two-and-one-half-day Provincial community emergency health planning course.
PHARMACEUTICAL CONSULTANT SERVICE
I 55
PHARMACEUTICAL CONSULTANT SERVICE
The Consultant in Pharmacy provides advice to the Minister and Deputy
Minister and, upon request, to other departments of Government.
A Drug Advisory Committee commissioned by the Minister of Health Services
and Hospital Insurance and composed of representatives of the B.C. Medical Association, B.C. Pharmaceutical Association, and Faculties of Medicine and Pharmaceutical Sciences, University of British Columbia, is chaired by the Pharmaceutical
Consultant.
The Committee's terms of reference include investigation of drag prices, product selection, labelling of products, advertising of brand-name products and generic
equivalents and the pharmacist's fees for dispensing prescriptions. The Committee
is also requested to make recommendations concerning action that might be taken
to reduce the cost of drugs to the elderly, the poor, and those people requiring
expensive drugs over a long period of time.
Based on experience elsewhere, it is becoming recognized that there is an
advantage to be gained when a pharmacist maintains an individual or family
prescription drug profile record system. A report of the Commission on Pharmaceutical Services states that a more active and critical discharge of the monitoring
function represents one of the most useful ways in which pharmacists can bring
their specialized knowledge to more effective use.
The Pharmaceutical Consultant maintained close interest in developments in
pharmaceutical matters and attended a number of conferences appropriate to hospital pharmacy and Emergency Health Services.
J 56
PUBLIC HEALTH SERVICES REPORT, 1971
COUNCIL OF PRACTICAL NURSES
The Council of Practical Nurses operates by the authority of the Practical
Nurses Act and the regulations made under the Act. There are 10 members appointed by order of the Lieutenant-Governor in Council on the basis of nominations
submitted by the Minister of Health Services and Hospital Insurance, the College
of Physicians and Surgeons of British Columbia, the Registered Nurses' Association
of British Columbia, the Minister of Education, the British Columbia Hospitals'
Association, and the Licensed Practical Nurses' Association of British Columbia.
The main function of Council is the licensing of persons who are qualified.
The first applications for licences were issued in 1965 and, to the end of 1971,
approximately 4,800 licences have been issued. Table XX shows the disposition
of applications received since the inception of the programme.
During 1971, there were six regular meetings and two special meetings of the
Council as a whole. This brought to 46 the number of meetings held since the
beginning of the licensing programme.
The Chairman, with the approval of Council, appoints committees from time
to time to study and report on specific matters. During the year these committees
held numerous meetings. Of special importance was the work of the Committee on
Credentials which serves on a continuing basis. Its function is to assess the qualifications of applicants and to submit to the Council recommendations concerning
their acceptability.
Many of the applicants are graduates of training schools operated under the
authority of the Public Schools Act of British Columbia. Because of this, the
Council works in close co-operation with the Department of Education. The liaison
is provided by the member of the Council who is nominated by the Minister of
Education.
PUBLICATIONS, 1971 J 57
PUBLICATIONS, 1971
The Expanded Role of the Public Health Nurse, Canadian Journal of Public Health
62:147, March/April 1971, by Monica M. Green.
The Effects of Various Persuasive Communications in Community Dental Health,
Canadian Journal of Public Health 62:105, March/April 1971, by K. E.
Barnes, Donna Gunther, Irene Jordan, and A. S. Gray.
A Simplified Method of Determining a Population's Needs for Dental Treatment,
J. Public Health Dent. 31:84, Spring 1971, by J. M. Conchie, K. I. Scott, and
J. J. Philion.
The Role of Radiographs in Clinical Studies of Caries and Inhibitory Agents, J.
Public Health Dent. 31:158, Summer 1971, by A. S. Richardson, L. W. Hole,
and J. F. Williams.
Ion Exchange Water Softeners and Their Effect on Private Sewage Systems, Environmental Health Review 15:2, Summer 1971, by G. A. Duffield.
Tuberculosis Among Patients With Various Radiological Abnormalities Followed
by the Tuberculosis Chest Clinic Service, American Review of Respiratory
Diseases 104:4, October 1971, by S. Gryzbowski, H. Fishaut, J. Rowe, and
Ann Brown.
Prevalence of Cleft Uvula in British Columbia, The Angle Orthodontist 41:336,
October 1971, by John M. Crewe and Frank McCombie.
British Columbia Flash Floods, Emergency Measures Organization National Digest,
December 1971, by N. Schmitt, H. B. Catlin, K. W. G. Saunders, and E. J.
Bowmer.
Pesticide Residues in Mother's Milk, British Columbia Medical Journal, May 1971,
by A. A. Larsen, D. A. Clarke, A. S. Arneil, M. R. Smart, N. Schmitt, and E.
L. Devlin.
Pesticide Residues in Mother's Milk and Human Fat From Intensive Use of Soil
Insecticides, Health Services and Mental Health Administration Health Reports,
May 1971, by A. A. Larsen, J. M. Robinson, N. Schmitt, and L. W. Hole.
Lead Poisoning in Horses—Environmental Health Hazard, Archives of Environmental Health, September 1971, by N. Schmitt, G. Brown, E. L. Devlin, A.
A. Larsen, E. D. Causeland, and J. Maxwell.
Relative Frequency of the Hurlers" and Hunters' Syndrome, New England Journal
of Medicine 284:221-222, January 28, 1971, by R. B. Lowry and D. H. D.
Renwick.
J 58 PUBLIC HEALTH SERVICES REPORT, 1971
TABLES
Table I—Approximate Numbers of Health Branch Employees by Major
Categories at the End of 1971
Physicians in local health services _• 20
Physicians in institutional and other employment 18
Nurses in local health services 322
Nurses in institutions 87
Public health inspectors 61
Dentists in local health services 5
Laboratory scientists 25
Laboratory technicians 25
Public health engineers 6
Statisticians 7
Others 741
Total 1,317
Table II—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1971)
Health Branch headquarters, Legislative Buildings, Victoria 51
Health Branch office, 828 West Tenth Avenue, Vancouver 31
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings,
Victoria 6 8
Vancouver office, 828 West Tenth Avenue, Vancouver __ 20
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vancouver 10
Willow Chest Centre, 2647 Willow Street, Vancouver .... 121
Pearson Hospital, 700 West 57th Avenue, Vancouver 333
Victoria and Island Chest Clinic, 1902 Fort Street, Victoria 11
New Westminster Chest Clinic, Sixth and Carnarvon,
New Westminster 6
Travelling clinics, 2647 Willow Street, Vancouver 19
Division of Laboratories—
Headquarters and Vancouver Laboratory, 828 West
Tenth Avenue, Vancouver 80
Nelson Branch Laboratory, Kootenay Lake General Hospital 1
Victoria Branch Laboratory, Royal Jubilee Hospital1
82
88
500
1 Services are purchased from the Royal Jubilee Hospital, which uses its own staff to perform the tests.
TABLES
J 59
Table II—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1971)—Continued
Division of Venereal Disease Control—Headquarters and
Vancouver Clinic, 828 West Tenth Avenue, Vancouver....
Division for Aid to Handicapped—
Headquarters, 828 West Tenth Avenue, Vancouver 9
Nanaimo
Vernon _
Prince George
Surrey
Nelson
Local Public Health Services (Health Units)-
East Kootenay, Cranbrook
Selkirk, Nelson L=.
West Kootenay, Trail
28
14
22
North Okanagan, Vernon ... 25
South Okanagan, Kelowna
South Central, Kamloops
Upper Fraser Valley, Chilliwack
Central Fraser Valley, Mission __
Boundary, Cloverdale
38
.1 .. 30
..______ . ,___-_. 28
. 27
53
Simon Fraser, Coquitlam _ 34
Coast-Garibaldi, Powell River 17
Saanich and South Vancouver Island, 780 Vernon Avenue, Victoria 43
Central Vancouver Island, Nanaimo 54
Upper Island, Courtenay 22
Cariboo, Williams Lake 16
Skeena, Prince Rupert 28
Peace River, Dawson Creek 19
Northern Interior, Prince George 35
Total
19
14
533
1,317
There were also part-time employees in many of the places listed. The part-
time employees serving on a continuous basis totalled the equivalent of approximately 66 full-time employees.
J 60
PUBLIC HEALTH SERVICES REPORT, 1971
Table III—Comparison of Public Health Services Gross Expenditures
for the Fiscal Years 1968/69 to 1970/71
Gross Expenditure
Percentage of
Gross Expenditure
Percentage
Increase or
Decrease
(-)
1968/69
1969/70
1970/71
1968/69
1969/70
1970/71
Over
Previous
Year
Patient care ...
$3,765,566
5,467,761
2,639,181
929,735
638,210
521,397
173,225
$4,200,358
5,924,284
2,637,205
899,100
860,196
560,231
176,973
$4,335,945
6,235,726
1,774,510
1,205,622
923,546
599,684
189,188
26.6
38.7
18.7
6.6
4.5
3.7
1.2
27.5
38.8
17.3
5.9
5.6
3.7
1.2
28.4
40.9
11.6
7.9
6.1
3.9
1.2
+3.2
+5.3
Cancer, arthritis, rehabilita-
—32.71
General administrative and
consultative services.
+34.U
+7.4
Division of Vital Statistics
Division of Venereal Disease
Control
+7.0
+6.9
$14,135,075
$15,258,347
$15,264,221
100.0
100.0
100.0
+0.04
1 The sources of financial assistance for the Cancer Cytology Laboratory and the G. F. Strong Rehabilitation Centre were transferred from the Public Health Branch to the British Columbia Hospital Insurance Service,
and the cost of the Kidney Failure Correction Programme was transferred from "Cancer, arthritis, rehabilitation,
and research" to "General administrative and consultative services." These transfers resulted in the relatively
large percentage changes in these two categories.
Table IV—Training of Health Branch Staff Proceeding Toward a Diploma or
Degree in a Public Health Specialty
(Types of training, universities or other training centres attended, and numbers trained)
Completed training during 1971—
Canadian Hospitals' Association's Medical Records Clerk Course
(correspondence)
Master's Degree in Speech Pathology (Oregon)
Diploma in Public Health Nursing (University of British Columbia
Diploma in Public Health Nursing (University of Ottawa)
Diploma in Public Health (Toronto)
Diploma in Dental Public Health (Toronto)
Bachelor of Science in Nursing (McGill University)
Bachelor of Science in Nursing (University of Washington)
2
1
3
1
2
1
1
1
Total
12
Commenced training during 1971—
Bachelor of Science in Nursing (Dalhousie University)
1
Diploma in Public Health Nursing (University of British Columbia) 2
Diploma in Public Health Nursing Supervision (Dalhousie University) 1
Total _
TABLES J 61
Table V—Training of Health Branch Staff by Means of Short Courses
(Types of training, universities or other training centres, and numbers trained)
Cross Connection Control Course (University of Southern California) 1
The Prevention of Periodontal Disease and Dental Caries (University
of Washington) 1
Workshop for Public Health Nurses (The Woodlands School for Retarded, Vancouver) 8
Mercury in Man's Environment (Royal Canadian Society Special
Symposium, Ottawa) 1
Fourteenth Annual Refresher Course for Medical Health Officers
(University of Toronto) 3
Occupational Health Nurse Course (University of Toronto) 1
Canadian Communicable Disease Centre and Ontario Provincial Public Health Laboratories 1
Diagnosis and Management of Family Problems (University of British
Columbia, Vancouver) 8
New Research in Dental Caries (University of Washington) 2
Anticipatory Guidance and the Concept of Loss (University of British Columbia) 4
Care of the Dying Patient and His Family (University of British Columbia) 1
Seminar on Drugs (Washington State Society of Hospital Pharmacists, Seattle) 1
Kidneys—What Turns 'em on and off (University of Washington) 1
Infectious Diseases—Advanced Course in Pasdiatrics (University of
British Columbia) 1
One Million Children Conference (Provincial Association of Teachers of Special Education, Vernon) 1
Extended Care Nursing (University of British Columbia) 2
Institute on Rehabilitation Workshop (University of British Columbia) 5
Annual Seminar (Hospital Administrators' Association of British
Columbia) 1
Maternity Guidance (University of British Columbia) 1
Psychological Needs of the Patient (Sponsored by University of British Columbia and Registered Nurses' Association of British Columbia) 1
Theoretical and Applied Statistics (correspondence course conducted
by Institute of Statisticians, London) 1
I 62 PUBLIC HEALTH SERVICES REPORT, 1971
Table V—Training of Health Branch Staff by Means of Short Courses—Continued
Nursing Service Administration (School of Nursing, University of
British Columbia) 1
Exceptional Child—Today and Tomorrow (seminar conducted in
Prince George) 1
Nutrition in Pregnancy (University of British Columbia) 3
Visits to the Ontario Health Branch, University of Toronto, and Hospital for Sick Children 1
Supervisor's Training Course in Accident Prevention (University of
British Columbia) . 1
Noise and the Environment (University of British Columbia) 2
Water Quality Studies (U.S. Department of the Interior, Corvallis,
Oregon) 1
Population and Birth Control—Before and After the Fact (University of British Columbia) 1
Group Skills Development Workshop (University of British Columbia) , 20
Development and Control of New Drug Products Symposium (University of British Columbia) 1
Pharmacy Continuing Education (Holy Family Hospital, Vancouver) 1
Community Mental Health Workshop (Provincial Mental Health Services, Vancouver) 9
TABLES
J 63
Table VI—Reported Communicable Diseases in British Columbia, 1967—71
(Including Indians)
(Rate per 100,000 population)
1967
1968
1969
1970
1971
Reported Disease
Number
Number
Number
Number
Number
of
Rate
of
Rate
of
Rate
of
Rate
of
Rate
Cases
Cases
Cases
Cases
Cases
Amcebiasis
2
0.1
4
0.2
12
0.6
5
0.2
1
0.1
Brucellosis —
1
0.1
1
0.1
Diarrhoea of the newborn
(E. coli)
16
0.8
19
0.9
23
1.1
54
2.5
64
2.9
Diphtheria
1
0.1
8
0.4
14
0.7
9
0.4
11
0.5
Dysentery, type unspecified.
489
25.1
165
8.2
209
10.1
143
6.7
126
5.7
Food infection—
Salmonellosis
256
13.1
165
8.2
400
19.3
532
24.9
548
24.9
Unspecified —
24
1.2
311
15.5
19
0.9
6
0.3
8
0.4
Food intoxication—
Staphylococcal—
9
0.5
9
0.4
29
1.4
8
0.4
6
0.3
1
0.1
2
0.1
8
0.4
2
0.1
Hepatitis, infectious
1,664
85.4
2,032
101.3
2,139
103.3
1,910
89.4
1,954
89.0
Leprosy
1
0.1
1
0.1
Meningitis—
Bacterial .
12
0.6
17
0.8
13
0.6
14
0.6
17
0.8
Viral.
40
2.1
43
2.2
22
1.1
32
1.5
45
2.0
Pertussis
264
13.5
136
6.8
59
2.9
155
7.2
91
4.1
Rubella
(*)
(*)
(*)
(*)
(*)
(*)
(*)
(*)
(*)
1,168
53.2
Rubeola '
(*)
(*)
(*)
(*)
(*)
(*)
(*)
200
9.1
Shigellosis — —
138
7.1
276
13.8
64
3.1
166
7.8
241
11.0
Streptococcal throat infec-
2,477
127.1
1,020
50.9
1,236
59.7
644
30.1
306
13.9
3
0.2
2
0.1
1
0.1
Typhoid and paratyphoid
14
0.7
5
0.2
5
0.2
5
0.3
5
0.2
Total
5,413
278.0
4,212
209.9
4,255
205.6
3,685
172.4
4,792
218.2
Not reportable.
Table VII—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946,1951, 1956, 1961, 1964-71
Year
Infectious Syphilis
Gonorrhoea
Number
Ratei
Number
Ratei
1946 -
834
36
11
64
304
165
83.0
3.1
0.8
3.9
17.5
9.2
4,618
3,336
3,425
3,670
5,821
6,005
5,415
4,706
4,179
4,780
1 6,070
] 6,700
1
460.4
1951
286.4
1956
1961 a.
244.9
225.3
1964..
1965 ..
344.9
335.7
1966
1967
1968
71 J 3.8
72 3.7
68 j 3.4
45 2.2
76 1 3.6
802 3.Q
290.8
241.7
208.2
1969
1970
231.2
284.0
1971 ..
290.02
I
,1 Rate per 100,000 population.
! Preliminary.
J 64 PUBLIC HEALTH SERVICES REPORT, 1971
Table VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1970 to August 1971, Inclusive1
School service—•
Directly by nurse 267,245
Directly by aides 61,973
Teacher/Nurse conferences 6,409
Home visits 44,217
Group sessions with pupils 4,574
Meetings with staff 2,126
Conferences with staff 60,445
Expectant parents—
Class attendance by mothers 18,822
Class attendance by fathers 5,720
Prenatal home visits 4,447
Postnatal visits 20,123
Child health-
Infants—
Conference attendance 55,040
Home visits 34,006
Pre-school—
Conference attendance 88,613
Home visits 29,746
Home Care—
Nursing care visits 82,296
Physiotherapist assessments 1,826
Adult health supervision visits 45,987
Mental health visits 18,028
Disease control—
Tuberculosis visits 7,777
Venereal disease visits 4,779
Communicable disease visits 6,578
Immunizations—
Smallpox 97,524
Poliomyelitis 144,534
Basic series 19,880
Rubella 187,660
Measles (rubeola) 20,969
Other 152,668
Total doses 623,235
Tests—
Tuberculin 15,552
Other 2,953
Total visits to homes 169,450
Professional services by telephone 206,618
i Services provided by public health nurses under the jurisdiction of the Health Branch, but does not include
service provided by Greater Vancouver, Victoria, Esquimau, Oak Bay, and New Westminster.
TABLES
J 65
Table IX—Public Health Inspectors' Time-study
Per
1970
3.5
0.6
Hospitals and community care (includes summer camps) 0.7
Housing 1.0
1.6
0.2
0.6
0.2
0.3
6.0
7.1
0.2
0.8
0.7
0.2
2.1
0.5
0.6
4.0
Consultations with Health and allied local personnel 9.1
Meetings( staff, other) 3.2
1.0
2.0
4.2
21.3
Food premises
Industrial camps and factories.
Mobile home and camp-sites
Barber shops and beauty parlours
Offensive trade, farms
Air pollution .
Fairs, parks, restrooms (other)
Sewage
Subdivision and site inspection
Common carrier and Indian reserves
Surveys
Waste disposal
Schools
Water supplies
Swimming-pools
Water quality (samples)
Nuisances (refuse, sewage, pests, and others)
Supervision (senior public health inspectors)
Educational activities
Other activities
Travel time
Office, professional—
Letters and reports
Review of plans
Telephone consultations
Public inquiries
Other
Office, nonprofessional—
Filing and recording
7.6
2.5
5.3
6.1
4.5
1.3
Cent of Time
1971
2.8
0.6
0.7
0.8
1.6
0.2
0.2
Nil
0.5
6.2
6.8
0.2
0.8
0.5
Nil
2.3
1.5
0.3
3.4
7.1
6.3
0.6
2.4
4.4
20.7
7.0
2.7
6.0
5.5
6.2
1.7
J 66
PUBLIC HEALTH SERVICES REPORT, 1971
Table X—Statistical Summary of Public Health Inspectors' Activities, 1969-71,
for 17 Provincial Health Units
1969
1970
197U
(Estimate)
Food Premises—
Eating and drinking places.
Food processing_
Food stores
Other
Factories....
Industrial camps
Hospitals
Boarding homes
Schools
Summer camps
Other institutions
Housing
Mobile-home parks
Camp-sites
Other housing
Hairdressing places
Farms
Fairs
Parks and beaches
Swimming-pools—
Inspection
Samples
Surveys (sanitary and other).
Waste disposal
Public water supplies—■
Inspection
Sample
Private water supplies—
Inspection
Sample _ _
Pollution samples—
Bacteriological
Chemical
Field tests
Private sewage disposal
Municipal outfalls and plants
Plumbing
Subdivisions
Site inspections
Nuisances—
Sewage
Garbage and refuse _
Other (pests, etc.)
Disease investigation
Meetings
Educational activities
4,390
765
1,558
410
748
375
119
374
956
179
197
1,721
1,287
779
(2)
682
339
37
692
1,505
1,122
876
1,057
1,108
5,044
2,172
3,353
2,379
1,251
682
11,130
888
211
4,195
8,084
3,886
2,536
2,059
310
3,287
1,253
4,718
751
1,516
408
714
416
88
397
723
179
251
1,856
1,550
837
262
501
440
52
915
1,232
1,207
768
1,270
1,150
5,302
2,068
3,422
1,685
864
406
11,808
836
211
4,305
8,833
3,707
2,364
2,338
308
3,502
1,139
3,876
756
1,394
424
580
277
86
414
414
250
244
1,864
1,403
874
270
536
406
50
1,078
1,642
1,330
798
948
1,150
4,954
1,894
3,078
1,966
278
592
12,918
580
262
4,604
10,594
4,655
2,366
2,386
248
4,110
1,298
1 These are estimated figures only.
2 Not classified in 1969.
Table XI—Report of Direct Service by Auxiliary Workers to Public Health Nursing
Programme, September 1970 to August 1971
For
Infants,
Number
of
Vision
Tests
For Pre-school Children
For School Children
Adult Services
Number of Tests for
Other
Service
Number of Tests for
Other
Service
Under
65 Years
65 Years
Vision
Hearing
Vision
Hearing
and Over
Health Unit aide
Incentive trainee
Volunteers —
26
3
3,519
519
2,331
3,134
425
2,366
224
662
34,831
10,030
3,978
6,284
2,739
1,183
812
323
1,793
56
5
5
24
557
Total....
29
6,369
5,925
886
48,839
10,206
2,928
66
581
TABLES
J 67
Table XII—Summary of Service Provided in Three Areas by
Employees' Health Services Staff, 1971
Service Rendered
Provincial Mental
Hospitals
Vancouver Area
Victoria Area
Health counselling and (or) examination-
Occupational health nursei
Physiciani..
Immunizations administered (including tetanus, diphtheria,
polio, influenza, and smallpox)
Medical and surgical treatments _
762
303
1,5302
946
913
125
982
525
726
49
2,599
1,702
1 An occupational health nurse provides full-time service in each area. A physician is available on request,
in the Vancouver area, for two days a month in the Provincial Mental Hospital, and one or two days a month
in the Victoria area.
2 Includes 431 staff and 1,099 patients.
Table XIII—Enrolment in Public and Private Schools in British Columbia,
June 1971
Grade Schools
Kindergartens
Schools for
Retarded Children
Total
Greater Vancouver—
Public
144,067
7,844
43,096
1,801
316,759
9,693
7,370
(!)
2,474
310
11,212
5,685
317
122
122
689
376
151,754
Private
Greater Victoria—
Public
7,966
45,692
2,111
Remainder of Province—
Public
328,660
Private —
15,754
Totals—■
Public
Private
503,922
19,338
21,056
5,995
1,128
498
526,106
25,831
523,260
27,051
1,626
551,937
1 Figure not available.
Table XIV—Number of Pupils Receiving Basic Immunization
Prior to Entering Grade I, September 1970
Greater
Vancouver
Greater
Victoria
Remainder
of Province
Total pupils enrolled_
Smallpox-
Diphtheria, pertussis, and tetanus-
Poliomyelitis.
Measles.
11,557
8,696 (75.2%)
9,546 (82.6%)
6,215 (53.8%)
5,235 (45.3%)
3,282
2,364 (72.0%)
2,493 (76.0%)
1,745 (53.2%)
1,611 (49.1%)
26,953
19,035 (70.6%)
20,723 (76.9%)
16,054 (59.6%)
10,134 (37.6%)
_J
J 68
PUBLIC HEALTH SERVICES REPORT, 1971
Table XV—Pupils Referred for Health Service
Greater Victoria
Province i
Referred to
Public Health
Nurse
Referred by Public
Health Nurse for
Further Care
Referred to
Public Health
Nurse
Referred by Public
Health Nurse for
Further Care
2,514
780
195
605
803
2,599
1,532
363
93
341
461
1,105
20,427
6,523
1,447
5,428
4,649
13,862
12,898
2,367
628
2,507
2,049
5,166
Speech
Emotional
Other
Totals
7,496
3,895
52,336
25,615
15.7
8.1
15.2
7.5
under Vital Statistics
i Excluding Greater Vancouver and Greater Victoria.
Table XVI—Registrations Accepted Under Various Acts
Registrations accepted
Act—
Birth registrations
Death registrations
Marriage registrations
Stillbirth registrations .
Adoption orders
Divorce orders
Delayed registrations of birth
Registrations of wills notices accepted under
Wills Act
1970
36,684
17,104
20,364
419
2,939
5,266
434
17,682
Total registrations accepted 100,892
Legitimations of birth affected under Vital Statistics Act 250
Alterations of given name effected under Vital
Statistics Act 187
Changes of name under Change of Name Act 830
Materials issued—
Birth certificates 60,861
Death certificates 8,750
Marriage certificates 6,817
Baptismal certificates 12
Change of name certificates 992
Divorce certificates 234
Photographic copies 7,181
Wills notice certification 10,020
Total certificates issued 94,867
Nonrevenue searches for Government departments 12,085
Total revenue $347,694
1971
35,470
17,830
20,600
420
2,720
5,070
371
19,286
101,767
219
185
780
58,915
8,283
7,204
17
1,001
239
7,240
10,610
93,509
12,530
$385,282
TABLES
J 69
Table XVII—Case Load of the Division for Aid to Handicapped,
January 1 to December 31, 1971
Accepted cases active at January 1, 1971 972
New cases referred to Aid to Handicapped Committees 585
New cases referred from other sources 313
Cases reopened _. 119
Total referrals considered for services, January 1, 1971, to December 31, 1971 ... 1,017
Total
1,989
Analysis of Closed Cases From January 1 to December 31,1971
Employment placements made—
Canada Manpower Centres 27
Division for Aid to Handicapped Staff 8
Placements on graduation from training 160
Resumed former activities
195
6
Job placements not feasible (physical restoration only) 26
Deceased „.......________ 1
Awaiting job placement (training completed) 7
Other (unable to locate clients, moved from Province, lack of
motivation, etc.)
114
Cases assessed and found not capable of benefiting from services
Cases currently under assessment or receiving services...
349
538
1,102
Total
1,989
J 701
PUBLIC HEALTH SERVICES REPORT, 1971
Table XVIII—Statistical Report of Tests Performed in 1970 and 1971,
Main Laboratory, Nelson Branch Laboratory, and Victoria Branch Laboratory
1970
1971
Main
Nelson
Victoria
Main
Nelson
Victoria
Bacteriology Service
Enteric Section—
Cultures—
18,670
3,444
123
1,296
4,822
4,222
6,099
9,965
55,057
53
29,592
18,875
1,059
269
677
7,298
295
4,356
1,101
24
220
5,463
23
2,177
1,998
2,133
1
2,113
1,594
16,999
3,938
135
5,666
212
3,936
Enteropathogenic E. coli
1,361
53
Miscellaneous Section—
Cultures—■
105
924
826
36
335
496
942
1,105
4,534
3,443
12,840
66,663
105
29,663
19,852
932
248
420
8,490
1,516
23,848
2,015
5,127
16
2,416
18
172,055
2,053
2,951
7,347
149
6,480
8,954
2,424
1,107
348
255
22,515
3,185
4,665
3,894
34
1,087
2,394
534
821
2,535
Tuberculosis Section—
102
2,089
46
1,730
22
1,649
49
20
Parasites—•
75
2,901
118
1,683
Water Microbiology Section—
22,407
2,222
3,770
120
2,337
20
164,856
2,163
3,120
2,747
137
12,970
8,884
1,642
261
393
278
6,602
1,820
2,875
3,636
2,958
295
349
398
2,687
199
6,721
1,182
1,523
239
Serology Section—-
VDRL, blood (qualitative)
4,170
11
10,198
60
708
3
966
429
4,188
17
10,475
VDRL, blood (quantitative)
52
VDRL, CSF
693
FTA-ABS
Darkfield
6
Agglutinations—■
Widal, Brucella, Paul-Bunnell, other
ASTO
352
350
640
531
Virology Service
Virus Isolation—
Rubella
Serological Identification—■
Hasmagglutination inhibition—■
Rubella
Other viruses
Complement fixation _
Neutralization
Totals _
404,781
10,413
39,238
447,266
9,436
40,941
454,432
497,643
* Includes pinworm swabs in 1970.
TABLES J 71
Table XIX—Emergency Health Service Medical Units Pre-positioned
Throughout British Columbia
Emergency hospitals 15
Advanced treatment centres 43
Casualty collecting units 64
Hospital disaster supplies units 236
Blood donor packs 22
Table XX—Licensing of Practical Nurses
(Disposition of applications received since inception of programme in 1965
to December 31, 1971)
Received 7,365
Approved—
On the basis of formal training 4,159
On the basis of experience only—
Full licence 396
Partial licence 875
1,271
5,430
Rejected 1,035
Deferred pending further training, etc. 651
Deferred pending receipt of further information from ap-
plicants
69
Awaiting assessment at December 31, 1971
180
Total
7,365
Number of licences issued to December 31, 1971 4,808x
Number of practical nurses holding currently valid licences at December 31, 1971 3,9942
i The number of licences issued (4,808) is less than the number of applications approved (5,430) because
some persons whose applications were approved did not take the final action of paying their fees.
2 The number of currently valid licences (3,994) is less than the total number of licences issued (4,808)
because some persons who have received licences at some time had not requested the annual renewal.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1972
780-1271-9282
BC Sessional Papers
Seventy-fifth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1972
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