185

THE EMPLOYMENT OF EX-PATIENTS IN A SANATORIUM *

By JOSEPH LOG~'~, M.D., D.P.H. Peamount Sanatorium, Dublin.

T HE person who is known to have suffered from tuberculosis is still under certain disadvantages for the rest of his life, and only one of these disadvantages is his difficulty ill finding employment. But

if he can find employment and keep it his other difficulties tend to dis- appear. The recently set up Rehabilitation Association will no doubt some day prove a great help to all disabled people, including the tuber- culous, and various voluntary bodies are at present helping many patients to find work, but up to now the problem of finding employment for ex-tuberculous patients has had no general solution. It is my opinion that this problem can be eased by the employment of ex-patients in sanatoria, and I venture to describe our experience of such employment at Peamount in support of my opinion

155

J33

! ~ + ,.,.Jl.~ ~ p,.,+.o,+ i] ~+,+

175 182

201 213

86

/ ~ ~o%

2.53

~9

/ / -

/ / / / / / / / /

, I /

1949 1950 1951 1952 1953 1954 t9~5

( sept . )

Peamount Sanatorium has a bed complement of 530, including 84 school children and equally divided as to sex. The total staff at present employed is 233, of whom 99 (42 per cent.) are ex-patients. Table 1 shows how the total staff and the proportion of ex-patients employed have increased since 1949.

Table 2 shows that in each year since 1949 ex-patients have made up an increasing proportion of the staff newly employed.

* B a s e d o n a p a p e r r e a d t o t h e I r i s h T u b e r c u l o s i s S o c i e t y o n O c t o b e r 14 th , 1955.

lS6 I R I S H J O U R N A L OF M E D I C A L S C I E N C E

T A B L E 2. Percentage of those newly employed who were ex.patients.

1949 . . 1950 . . 1951 . . 1952 . . 1953 . . 1954 1955 (to sept. 30th)

T o t a l E x - p a t i e n t s % E x - p a t i e n t s

112 115 135 115

94 138

51

7 13 18 24 3O 52 18

6 11 13 21 29 38 35

I t will be apparen t that we go out of our way to employ ex-patients, and this is so, but it would be an over-simplification to say that we give preference to ex-patients. ( l iving preference implies competition, and there is a remarkable lack of eompeti t ion for most of the jobs we have te offer. We do, however seek out ex-patients for jobs and when neces- sary we so modify existing jobs as to make them suitable and at t ract ive to ex-patients. We also let it be known that we are p repared to employ ex-patients and welcome applicat ions f rom them.

There is, for example, no competi t ion among women for employment as domestic workers. About 40 per cent. of the women discharged front Peamount in any year either have been previously employed as domestic workers or in a similar type of employment , or seem generally suited to this type of work. Each one of these women who is well enough, and not otherwise unsuitable, is offered and encouraged to take a post on the domestic staff. But at the end of September, 1955, only 7 ex-patients were so employed.

T A B L E 3.

Total StaJJ at 30th September, 1955 showing percentage ex.patient,v in each grade.

T r a i n e d N u r s e s , P e r m a n e n t T r a i n e d N u r s e s , T e m p o r a r y S t u d e n t N u r s e s D o m e s t i c W o r k e r s , " Womgn D o m e s t i c W o r k e r s , Men O t h e r s . . . . . .

T o t a l

20 34 57 48 45 29

E x - p a t i e n t s

4 5

29 7

45 9

% F. .x-pat ients

20 15 51 15

100 24

The type of work carr ied out by ex-patients is shown in Table 3. �9 " Others " includes professional, technical and clerical workers.

There is competi t ion at present for posts as staff nurses, who are employed for one year and take the Post-Registrat ion qualification dur ing this time. This competi t ion means a certain variable delay in offering employment to an appl icant , but all suitable appl icants are taken ult imately.

I t will be seen that s tudent nurses are still employed al though the scheme for their t ra in ing has been officially dropped in local au thor i ty hospitals. The reason for main ta in ing this scheme is that it offers ex- pat ients an ent ry into nurs ing which might 'o therwise be impossible for them.

Table 4 shows the course pursued by a total of 246 student nurses employed at Peamount up to 24/9 / '55 . Of the 52 ex-patients so era-

E M P L O Y M E N T OF E X - P A T I E N T S IN A SANATORIUM

T A B L E 4.

St,t*dent Nurses, to 24/9/'55.

187

C o m m e n c e d T r a i n i n g . . . . . . Sti l l in T r a i n i n g . . . . . .

C o m p l e t e d Course . . . . . .

L e f t b e f o r e C o m p l e t i o n . . . . G e n e r a l T r a i n i n g ( E n g l a n d ) . . . . G e n e r a l T r a i n i n g ( I r e l a n d ) . . Ass i s t . N u r s e s . . . . . . M e n t a l N u r s i n g . . . . . . Ceased N u r s i n g . . . . . . M a r r i e d I l l - h e a l t h . N o t T u b e r c u l o s i s . . C o n t r a c t e d T u b e r c u l o s i s . . . . B r e a k - d o w n o f T u b e r c u l o s i s . . N o r m a l E m p l o y m e n t . . . . U n k n o w n . . . . . . . .

. ~

. ~

~ 1 4 9

� 9 1 7 6

~

. ~

. ,

T o t a l

246 56

190 48

142 32

1 7 2 42

100 9 3 2 4 1

82

142

E x - p a t i e n t s

52 29

?3 3

2O 3

1 - - 4

16 3

4 l

8

20

ployed, only 3 have as yet completed the course and obtained the certi- ficate, whereas 20 left before completion.

The fact that so many abandoned t ra in ing does not necessarily mean that their employment was a waste of time. A period of employment under conditions of constant and exper t surveillance has obvious ad- vantages to an ex-pat ient ; the work of a sanator ium nurse is relatively light and yet gives a certain degree of skill which must be of some value to a woman however occupied.

Employment of nurses is restr icted to those who cannot be shown to be excreting tubercle bacilli in their sputum�9 This is solely because lh, ing (and especially eating) a r rangements separate f rom other nurses are not available. There is no obvious objection to a nurse whose sputum contains tubercle bacilli nurs ing tuberculous patients, and if there were enough such candidates we would make ar rangements for their housing.

Table 3 shows tha t 4 ex-patients are employed in permanent nurs ing posts, tha t is as ward sisters or higher grades.

Table 5 shows tha t by f a r the largest number of expat ients were men employed as domestic workers. The employment of men for this type of work was suggested by the difficulty of gett ing maids and the know- ledge that numbers of men recently discharged were looking for work and professing themselves ready to consider anything. At present 45 men are employed in this work and a total of 71 have been given such jobs- -which were held for widely vary ing lengths of time. Table 5 shows tha t of the 36 men who ceased this work 6 have been promoted; they are now employed on the clerical or technical staff at full wages for their type of work. These are the men in whom rehabil i tat ion has been most successful. Nineteen are shown to have resumed their normal or other outside work. At least 15 of these did so p remature ly in our view, and at least two have since broken down. The work was unsuitable in nearly all cases, and many emigrated. Fou r men suffered exacerbation of disease while employed and were re-admitted.

188 I R I S H J O U R N A L O F M E D I C A L S C I E N C E

The t y p e of disease a n d d i s a b i l i t y f r o m which these men were suffer- i ng v a r i e d f r o m m i n i m a l a n d we l l -hea led to the l a te resu l t s of ex tens ive p u l m o n a r y des t ruc t ion . S e v e r a l were e x c r e t i n g tube rc l e bac i l l i in the s p u t u m , bu t s ince t h e y h a d s e p a r a t e l i v ing q u a r t e r s s h a r e d on ly b y ex- pa t i en t s , i t was no t t h o u g h t neces sa ry to exclude them f rom e m p l o y m e n t on th i s account .

TABLE 5. Me~ E r-r, atieats.

Total employed since 1/1 "49 . . . . Domestic Work . . . . Others . . . . . .

Those Employed to do Domestic Work Disease Broke Down

" Normal " .. _Worl~ " Resumed Dismissed . . . . . . Promoted . . . . . .

Still doing Domestic ~Tork

71 13

4 19 7 6

45

84

71

71

The wages p a i d to m e n domes t ic worke r s a re s 5s. 3d. a week wi th b o a r d a n d l odg ing in add i t i on . The w o r k is no t sk i l l ed no r does i t p ro- v ide o p p o r t u n i t i e s fo r a c q u i r i n g sk i l l ; a n d the l i v i n g cond i t ions a re b y no means luxur ious . Never the less , the jobs a re p o p u l a r and the re a re f a r more a p p l i c a n t s t h a n we can t ake a t p resen t . As in the case of o thers , the p e r i o d of w o r k u n d e r su rve i l l ance is of va lue in i t se l f a n d as a p r e l i m i n a r y to r e t u r n to f u l l y compe t i t i ve work. So f a r as I know, no T r a d e U n i o n has sough t to en l i s t these men.

S ince so m a n y of our ex~pat ien t employees have been r e c e n t l y dis- c b a r g e d a n d a re u n d e r the eye of doc tors a n d nurses who a re wel l a w a r e of t h e i r cond i t ion , i t is i nev i t ab l e t h a t m i n o r i l lnesses a re made more of t h a n in the case of h e a l t h i e r staff. D u r i n g 1954 t ime off work fo r m i n o r i l lness was twice as much p e r head in ex -pa t i en t s as in o the r staff. B u t s ince the t o t a l d a y s lost b y ex -pa t i en t s a v e r a g e d only two days each, th is is not cons ide r ed of s ignif icance.

TABLE 6. Ex.patients Employed.

1949 1950 1951 1952 1953 1954 1955

. ~

~

~

. .

. ~

~

. .

~

. .

~

Total Ex-Peamount Major Surgery

7 13 18 24 30 52 18

4 7

12 17 19 35 13

2 3 5 5

12 25 12

The f ac t t h a t e x - p a t i e n t s of o the r i n s t i t u t i ons a re a t t r a c t e d to pos t s on our staff is a p p a r e n t f r o m th i s t ab l e which also shows t h a t a h igh p r o p o r t i o n of those e m p l o y e d have h a d m a j o r s u r g e r y as p a r t of t h e i r t r e a t m e n t .

I t is m y exper i ence t h a t h a v i n g h a d a m a j o r o p e r a t i o n qu i te f r e q u e n t l y

E M P L O Y M E N T OF E X - P A T I E N T S IN A SANATORIUM ]89

gives the patient (and his doctor) confidence in his ability to undertake work, and that this confidence comes much earlier than in patients whose routine and antiobiotic t reatment appears vague and indefinite by contrast. However that may be, I think the most powerful incentive to go to work comes from an unhappy and inhospitable home. When suitable work is not available locally, the ex-patient is driven to emigrate. I think it is f requent ly of great help to such men to have worked for a period at Peamount before undertaking the rigours of labouring or factory work here or in Britain.

TABLE 7.

Total S~aff Ex-pat ie its % Ex-pat ionts

Ardkeen (Vv~aterford) Blanchards town (Co. Dubli'l~) Merlin P a r k (Galway) . . :Newcastle (Co. Wicklow) P e a m o u n t (Co. Dublin) . . Baguley (Manchester) . . Fors te r Green (Belfast) .. Market Dray ton (Shropshire) Poole (Yorkshire) . . . .

133 212 223 137 233 234 140 171 167

7 15 19 17 99 17 19 77 19

5.2 7-1 8.5

12.5 42.5

7.2 13.5 45.0 11.3

Table 7 shows the facts obtained from a letter addressed to the Medical Superintendent , or equivalent officer, of 12 chest hospitals thought to be a representative selection. I t appears that employment of ex-patients is generally lower in Irish local authori ty hospitals than in any others.

Discussion. I am of the opinion that employment can and should be found for a

large number of ex-patients in a sanatorimn or chest hospital. The presence of ex-patients at work and visibly supporting themselves

is of the greatest value to the patients, especially those for whom surgery has to be recommended.

I think it is good for the staff who are not ex-patients to work along- side ex-patients~-that it gives the healthy staff an insight into the diffi- culties of both the ex-patient and the patient, which may sometimes be deplorably lacking.

I am not aware of any good reason for limiting the employment of ex-patients in sanatoria. I f there is in fact a reluctance to employ them, I think such reluctance is not obviously justified on grounds of economy. There may perhaps exist a feeling that ex-patients are liable to frequent and long interrupt ions of service and that their employment would consequently prove costly and reduce efficiency. There is nothing in my experience to support such a feeling.

While I consider that any sweeping or comprehensive directions for the employment of ex-patients would be inappropriate and undesirable, ] believe that an official encouragement to hospital authorities could result in the employment of up to 500 ex-patients in sanatoria in this country. I fu r ther believe that this employment would benefit the em- ployed and the patients served by them and that it would prove an economy to the Heal th Authori ty responsible for payment of maintenance allowances.