大象传媒

This contribution has been entered on behalf of Margaret Chadd (nee Collett) by Roger Wood.

The Queen Victoria Hospital, East Grinstead, Sussex.
Presentation by Margaret Chadd (nee Collett) in 1945 to London University on her role as Lady Almoner during the war years.

For the past five years, I have had the privilege of working as the Lady Almoner at this hospital. During this time there have been many interesting wartime incidents and it has been possible to obtain the most valuable practical experience in medical social work. This hospital, in addition to serving the needs of the local people of the district, is an EMS Plastic Surgery and Jaw Injury Centre for service personnel and civilians injured in air raids. My Almoner's work included opportunities of dealing with a very wide variety of severely disabled persons and their particular medical and social problems.
Under the guidance of Mr. Archie Mclndoe, this hospital evolved a plan for the rehabilitation and resettlement of all its disabled patients. This plan is not an isolated attempt to deal with their vast problems, but it is part of a movement, which is going on throughout the country. It is supplementary to, rather than in competition with, the schemes set up by the Ministry of Labour.
The East Grinstead Plan comprises of the three R鈥檚 of hospital treatment - namely Responsibility, Rehabilitation and Resettlement. The last two are fairly obvious functions of any hospital but the conception of responsibility wedded to them extends the plan enormously. Thus the surgeon and the hospital accept the full responsibility for the patient from the moment of admission, until the time when he is, once more, a fully functioning economic unit of society. The field of responsibility is extended into taking the patient back to complete self-sufficiency in normal life, by ensuring primary treatment at the time of injury. Immediately a severely injured case is admitted to the hospital, the welfare worker seeks to minimise the effect of the injury by taking away all anxieties about outside affairs. The patient is assured that his parents or close relatives know where he is, that he is in good hands and that minor worries connected with pay, kit, simple bodily comforts are being looked after. This is where the responsibility starts. At first the severely injured patient feels isolated and alone but through this contact with the welfare worker, his first link is created between him and his surroundings, resulting in a friendly institute being forged.

"Getting to know the patient" is essential because during this process he begins to feel a bond of confidence growing up between himself and the welfare worker, and enables the latter to obtain a complete and accurate picture of the patient's background and the way that he reacts towards his injuries. The type of injury encountered at East Grinstead entails a long series of surgical operations and these often cover a period of anything up to three years or more. In order that the best surgical result can be obtained, the whole procedure must be planned with great care, and it must also be assured that the patient suffers as little social disability as possible during his long stay in hospital. While this restoration is in progress, it is possible to obtain an approximate picture of the patient's permanent disability and it is the task of the welfare worker to condition him to accept the limitations imposed by his physical disabilities. This is a long and tedious process and could not be carried out under the normal routine of institutional discipline. The patient is encouraged to feel that he belongs to the hospital and must behave himself accordingly, rather to a code of honour, than by a set of rigid rules. He is then made to feel an important person in his own right within the hospital and bears the responsibility for its well-being. Any rules that exist are surgical rather and social.

After the patient鈥檚 probable type of permanent disability has been determined within broad limits by surgeon and welfare workers, the process of suggesting ideas for resettlement begins. Opening for careers suitable for the type of disability are discussed and the choice guided into the appropriate channels. This involves the building up of knowledge of his social background and we found that this could best be obtained by social contact rather than by a more formal investigation. It is, for example, of vital importance to determine the income level at which resettlement is to be attempted. Since however badly injured and disfigured the patient might be, if he comes from a family used to living on 拢1,000 a year, he will not accept a job as a lift attendant, even though this might be the only opening for him.
The essence of the East Grinstead plan is in its teamwork. When the patient's resettlement has been considered, his physical rehabilitation takes on a new meaning. He is encouraged to improve his functional ability for a specific future job. This might include the necessity for him to be instructed to move his fingers 500 times a day, which is a boring, practice, if the end view is just to be able to move his fingers. However if he can be encouraged to move them with a view to operating a machine tool, then this gives some point and interest to the exercise and acts as a spur to do better.
The actual job of resettlement is a compromise between the type of employment required and the district where the patient wishes to live. Frequently a patient from a rural area wishes to return there and to be employed as an engineer and he could be suitable for that type of work but with no vacancies. The method adopted at East Grinstead for solving this difficulty and proceeding with Resettlement is by mean of a monthly conference with the patient and the Disablement and Resettlement Officer of the Ministry of Labour. This officer needs to be introduced as early as possible. The welfare worker already knows the background of the patient and the Hospital Education Officer has an understanding of his capabilities, so the D.R.O can be briefed before he interviews the patient. In many cases the D.R.O can suggest a solution to a difficult problem by his extensive acquaintance with the requirement of Industry, or he may get in touch with the D.R.O in the district, where the patient wishes to live. In our relations with the Ministry of Labour, the weakness of their scheme that tries to substitute the use of standardised form for personal contact becomes evident and we find that the Ministry of Labour starts off with the usual disadvantages, inherent in any scheme, where the contact is only on paper.

When the vital decision of "What to Do and Where to Do It" is finally taken, resettlement should continue smoothly. The Education Officer within the hospital encourages courses and the patient and the welfare worker discuss the conditions of employment. When possible, the patient spends his inter- operational periods in his chosen career or job. It is when he is finally discharged from hospital that the plan is put to its test. The patient begins work in the job he has already tried out and will be under conditions about which he does know something. But then the impact of ordinary domestic life may impose difficulties which can only be solved by someone on the spot or who knows the patient intimately. The patient is therefore encouraged to keep in close contact with the hospital, so that if and when the need arises, the attention of some person or organisation can be focussed on him and his problem. The Guinea Pig Club, which was founded and developed intensively at East Grinstead, provides just one such means of maintaining contact. The members of this club have all been patients at the hospital and return annually on one special date for medical examination, resettlement check up and a social gathering. Such forms of follow up are important, because any financial or other assistance can be and should be obtained by reference to the hospital authorities or Welfare Committee, who in the final analysis still retain responsibility for the patient.

This plan, I hope, is only one of many in operation within most of any long term hospitals but much of the detail can only be filled in by walking around the wards, seeing the plan at work, sensing the atmosphere of hope and confidence which surrounds Mr.Mclndoe's work and seeing things as they really are for the patient.. The Plan is by no means final but it has worked so far. We have experienced no suicides or deaths because of the input of sensible and practical support throughout the long periods of hospitalisation following many sessions of surgery. The patients are vital, ordinary people who have suffered extreme burns; facial and hand disfigurement and who have had new skin grafted onto their wounds. Any plan, which deals with them, must also be alive and able to have new ideas grafted on to it if it is to succeed.
It may be of interest to know that the hospital consists of over 200 beds and that the usual average number of outpatients a week is about 250. All the plastic surgery patients are transferred originally from hospitals in other areas, thus it has been possible to maintain close co-operation with Almoners and Welfare workers in many districts all over England.
Perhaps the most memorable incident occurred on the 9th July 1943 at 5.30 p.m. when the local cinema received a direct hit during an air raid. Within the course of an hour we had admitted over 100 casualties and identified many more bodies. In addition to this we dealt with the welfare and urgent requirements of the casualties. My task as Almoner was to notify all their relatives and inform others of the deaths. It was through this contact that I was able to establish a very close relationship and contact with the people of East Grinstead -one that may continue for a long time. We were able to transfer, quite promptly, a number of the injured to other hospitals during the following 48 hours. Many of us found ourselves on duty for over 2 days because of the crisis in a relatively small hospital and in order to ensure that personal contact and the necessary paper work could be maintained.

Subsequent to this event and the growth of the hospital, it became more and more difficult for me to visit the homes of local patients and so I started a follow up scheme and enlisted the support and help of a local B.R.C.S officer. She worked with me and was introduced to the patient before he was discharged and helped with any arrangement for his return home. On a patient's discharge she made a daily visit for the first three days and then, once a week proved to be sufficient, to confirm that all was going well with any convalescent instructions being carried out, then this was followed by a weekly report for our records with visiting continuing until that patient was fully recovered.
The co-operation and support that I received from the Voluntary and Statutory Services and Agencies helped me tremendously during all my time at the Queen Victoria Hospital East Grinstead and most particularly must I praise the work of the local W.V.S, who provided clothing for the air raid casualties, who often had no garments at all on admission. They also helped with transport and many other various requests. The Assistance Board rose most nobly to any emergency connected with injury allowances, coupons and claim forms and the Citizen's Advice Bureau helped to obtain, often at very short notice, accommodation for the relatives of patients who were on the danger list. All these people and many others too, I would thank for making my task so much more congenial and easier than it might otherwise have been. I am leaving the hospital to return to University to complete my professional training. It may be that I will accept the offer to return to the hospital afterwards but who knows what the future may hold. I know that Mr.Mclndoe's Plan for Rehabilitation and Resettlement enabled nearly all our patients to find fulfilment in their lives in spite of their horrendous war injuries.
Margaret Collett

漏 Copyright of content contributed to this Archive rests with the author. Find out how you can use this.