Lesson from Hawaii

Best health record in the world is that of the 87,000 workers on the plantations of the Hawaiian Sugar Planters' Association. Their infant-mortality rate, prime index of health status, was only 16 infant deaths per 1,000 live births last year--enough to make any health officer whistle.* When the owners began the medical program in 1929, the rate on a typical plantation was 160.6 among half a dozen nationalities: Filipinos, Japanese, a conglomerate of Hawaiians, Chinese and Caucasians, a sprinkling of Portuguese and Puerto Ricans.

Hawaiian Swede. The man back of this triumph of paternalism over disease is big, redheaded, Swedish-born Dr. Nils Paul Larsen, Medical Director of Queens Hospital in Honolulu, allergist, artist, mountain climber and deep-sea diver (until heart trouble recently put a stop to it). Now 53, he went to Hawaii in 1921 as head of the hospital, a job he kept until his retirement last year. In the '20s the high infant-mortality rate on the plantations shocked him, but he thought the plantations potentially "the finest biological test tubes in the world." He talked the Association directors into establishing a health research center on Oahu in 1929.

Today each plantation either has its own hospital or shares one with an adjoining plantation: there are 24 hospitals, with

45% more hospital beds per capita than is considered necessary in the U.S. About 42 doctors -- American, native, Chinese --care for the workers on the 38 plantations.

For all this the owners spend $17.20 per capita a year, reap the profit of their investment in better work by men & women in the fields and mills. Cooperation of the workers is close to perfect. Working for the backers of the medical system they can be told what to do. They conform. There is no slackness.

Intelligent Selfishness. Dr. Larsen has removed many frills from medical care, but has also added many preventive measures not used elsewhere :

> Patients are encouraged to quit work, even go to the hospital, for the slightest infection. Example of results : "In a study . . . in 1936 we showed that if a man was taken out of his gang and isolated when the first sign of a cold appeared, the incidence dropped from 18,800 to 4,430."

> Workers are instructed to go to the doctor instead of requesting a house call if they possibly can, thus saving the doctor's time and getting a more efficient examination. They are taught not to wait until they are too sick to be moved.

> Pregnant women are rounded up weekly in station wagons, taken to the clinic.

New mothers are taught to care for their children.

> Monthly health records have been kept since 1935; by consulting them, the staff can see dangerous conditions before they fully develop.

> Queens Hospital has been a proving ground for new treatments. Says Dr. Larsen: "The literature and the drug houses often exploit something that eventually proves to be worthless. We were able to publish the first adverse report in America on the uselessness of mercurochrome as a specific cure for streptococcus infections.

On the other hand, before the literature was definite on sulfanilamide we were able to report the results on 146 cases. . . ."

> The number of sterilizations last year was 206. These operations are done only when the doctors deem them advisable for the health of individuals or the community, require the consent of those sterilized.

Though the birth rate has declined, more children are being raised each year, owing to the lowered infant-mortality rate.

> The venereal-disease rate -- 289 new cases per 100,000 -- is high, but the rate for all Hawaii was 454 (1939). Gonorrhea has almost completely disappeared.

> Mass X-rays are used to detect tuberculosis and heart disease in the early stages. Since 1935 the tuberculosis rate has dropped from 200 new cases of tuberculosis per 100,000 to about 100. For all Hawaii the rate is 143.

Dr. Larsen thinks they have proved that "intelligent selfishness" pays. But in the plantation doctors' own periodical, Plantation Health, he expresses the fear that under postwar free trade these standards could not economically be maintained.

He has" an unusual solution: "If American agriculture could insert (at a future conference table) at least minimum requirements for a standard of health protection and security for agricultural workers, progress would be made. . . . Every commodity package sold in the open markets of the world must be labeled: 'Produced under the international health standards.' "

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