CIVIL AFFAIRS HANDBOOK
Spontoon Island Independencies
(Formerly OPNAV 40N-10)
[Seal of the Navy Department
United States of America]
OFFICE OF THE CHIEF OF NAVAL OPERATIONS
16 FEBRUARY 1936
25. Government Health Services - Spontoon Island
The Health Services of the Spontoon Islands are mostly organized and supervised by a political branch of their national government, and financed and administered as a socialist-style state-subsidized & state-administered non-profit business organization, with some elements of co-operative organization among its general employees and professionals.
For the relatively small population of the Spontoon Island Atoll, there is a large investment in hospital and clinic facilities, and a high proportion of medical workers and professionals compared to most small nations (and large cities) in other parts of the world. Since 1925 there has been a gradual acceleration of facilities and services provided. This may be explained by the involvement of the Atoll in the Gunboat War and with the experiences of Spontoon Island citizen-soldiers in mercenary units containing during the Great War, and civilian experiences in some of the influenza epidemics after the Great War. A strong interest in Civil Defense is now part of the culture. The Spontoon Island government appears to consider that providing local & regional healthcare are sound investments. Providing generous healthcare is seen to encourage trade, tourism, and develops the friendship of the many 'independent' islands in the Spontoon Archipelago, where Spontoon Island is the central economic & transportation hub, and main contact with the outside world.
Preface – On the Spontoon Island names for
Civil Administration organizations.
(As covered in other Civil Affairs publications:
For most purposes, the Spontoon Island terms “Committee” and “Ministry” are interchangeable within the administration of the Spontoon Island government. The Public Health Ministry is essentially identical to the Public Health Committee. The Chair of the Public Health Committee is the same person as the Minister of the Ministry of Public Health. The choice of the label used can indicate differing cultural and political backgrounds, with those of a European or British inclination often using the term 'Ministry'. and those of a Pacific Island cultural or socialist background using 'Committee'. The term 'sub-committee' in local culture also refers to the paid (or volunteer) semi-autonomous co-operative working-groups that usually exist within most local civil and business organizations: Examples: 'Reception & Triage Sub-committee', 'Restaurant Inspection Sub-committee', 'Facility Maintenance & Repair Sub-committee'. One will discover that most Vice-Ministers (with a dedicated staff) are actually also the monitors of named 'committees' & 'sub-committees', that may actually be semi-autonomous working organizations.)
(The use of the term 'Ministry' may reflect a view of an administrative staff existing as a result of frequent voters' decisions to change policies, & the pragmatic politics of political organizations. The term 'Committee' may be emphasizing a view of administrative workers as working as a part of a less-political 'civil service' (as the term is used in the USA). It is reasonable to expect that no matter what the label used, the Spontoon Island administrators would be aware of & react to both influences.)
(For the sake of emphasizing the possible uniqueness of the local political & civil service structure, the editor chooses to use the term 'Committee' in this background essay.)
251. Public Health Service Organization
There is a Public Health Committee (“HealthCom”) that is part of the government of the Spontoon Island Althing. This political committee (“com”) confers & interlocks with the governing organizations of the Spontoon 'Kami-Priestesses', the Shamans, and the Civil Defense Coms. The Civil Defence Com is a communications link with the Spontoon Island Militias, including their Naval Militia. There is also active co-operation with their ally, the Rain Island Naval Syndicate, concerning medical offices and wards at the Moon Island naval base, and the medical detachments of the various RINS ships that may be temporarily stationed at the Moon Island base, or patrolling in the Spontoon Archipelago (that region of various islands in the North Pacific Ocean designated the Spontoon Island Independencies).
The Spontoon Althing Public Health Committee (“HealthCom”) budgets & distributes its share of Spontoon Althing revenues. HealthCom appoints a salaried Medical Commissioner (usually a medical doctor with administration skills), and the Medical Commissioner has a small staff, with headquarters at the Meeting Island Hospital. There is an Assistant Commissioner, who has a small office in the Casino Island Hospital.
The Althing considers the Public Health to be protected best by concern for the health of the greater Spontoon Archipelago. First aid training is considered part of the regional civil defense. The Spontoon HealthCom trains & assists local groups or individuals at the village level on most all of the Archipelago islands. (Note: Most of the Archipelago islands are claimed by the Althing to be autonomous and self-governing. (“The Spontoon Island Independencies”) To the extent that this is true, there are indeed some islands that do not want this involvement with the Althing government -- even for assistance in public health care. (See the detailed charts in the Archipelago Appendix.) Throughout the Archipelago islands in the Nimitz Sea region, the Althing (through the HealthCom) assists in the establishment of local island clinics, traveling doctors & nurses, and helps co-ordinate medical referrals from around the region to the larger Spontoon Atoll hospitals. Patients needing fast medical care may be flown to the Spontoon Atoll by Naval Syndicate sea-rescue aircraft, or charter ambulance aircraft, or ad hoc charity-rescue seaplanes.
Casino Island Hospital
The larger public HealthCom hospital is on Casino Island. It is located there because of the concentration of population, tranportation links, and access to communication lines. It serves all the communities in the region: Spontoonie, Euro residents, patients referred from the Archipelago, visitors, transient workers, sailors, & tourists.
The hospital's head administrator is traditionally a Euro. The administrator in 1935 is Dr. "X" (sic), who has a very good working relationship with the Euro Community and the Althing.
Doctors, nurses, & staff can be Spontoonie, Euro resident, or Euro on contract. Currently, most doctors at the Casino Island Hospital are of Euro culture, but a significant minority of the doctors are locals who have returned after medical school training in other Pacific nations.
Hospital Services: There is an Emergency Room, open wards, a few private rooms, exam rooms, x-ray, labs, isolation ward, general nursing wards, surgery, internal medicine clinic, sexual clinic, maternity clinic, dental clinic, Eye, ear, nose & throat clinic, nursing & orderly staff, pharmacy, kitchen, laundry, records, administrative offices.
Meeting Island Hospital ("Island Hospital")
A smaller general hospital is on Meeting Island. It is associated with a campus of free-standing buildings: Clinics and dorms more oriented to long-term & hospice care.
The head administrator at this hospital has usually been of Spontoonie culture. There is more Spontoonie medical staff at this hospital, with a significant minority of Euros.
There is a small Emergency Room, isolation wards, a Tropical Diseases Clinic, a Maternity ward, a Psychiatric Building (with clinic & rooms & wards for long-term care), a rehab clinic, orthopedic clinic, dental clinic, Hospice ward, labs (including Medical Examiner's facilities), kitchen, laundry, nursing & orderly staff, records, and administrative offices.
Though it is not obvious to an outsider, the Meeting Island hospital has a very strong relationship with the Priestesses, Shamans, and Spontoonie midwives, and some of these individuals are considered part of the hospital staff. The Spontoonie Priestesses are said to have considerable influence on treatment policies here. (See Notes.)
Moon Island Medical Facility,
Rain Island Naval Syndicate (RINS) Base
There is a medical ward with Emergency Room with a Doctor & assistant on call 24 hours at the Moon Island military base. RINS navy doctors & orderlies on ships are available when the ships are in port. It is understood that other RINS nursing support may be rotated through as a duty assignment. While intended for Naval Syndicate members & dependents, the medical staff will see anyone in case of emergency, and the ward acts as a screening point for the near area of the Spontoon Lagoon, including civilians on Moon Island & Eastern Island. There is a co-operative arrangement for treating RINS patients at the Spontoon HealthCom hospitals. (Note: RINS press releases report an equipped medical ward within the naval base “military bunkers”.
Casino Island Clinics
There is a prophylactic clinic near Ferry Square. Staffed by enthuesiastic volunteers & well equiped. This is also one of several neighborhood spaces that are used for a rotating screening & preventive medicine neighborhood clinic for the Casino Island Hospital.
Main Island Clinics
There is a screening & preventive medicine clinic with a duty nurse at the main village on the central south shore, next to the Althing dock. The clinic has telephone communication with the various hospital services. This central clinic has telephone, local telegraph, & local radio contact with this island's many village clinics.
There is a screening clinic at the central North Shore village, near the central fishing dock. The nurse on duty lives upstairs. Telephone & Radio are available.
There is a dental clinic truck that travels a circuit of Main Island, and a dental clinic boat that makes scheduled stops at wharves on the various islands of the Lagoon.
South Island Clinic
During tourist season there is a screening clinic on the south-central side of Resort Bay. There is a nurse subsidized by the Tourist Information Board. Telephone & radio.
The larger hotels & resorts may have a private nurse or doctor on duty at the hotel, or on call from clinics. Most hospitality facilities have a co-operative arrangement with the large HealthCom hospitals.
Eastern Island Clinic
There is a screening clinic next to the watertaxi docks near the west end of the runway. The attending nurse lives in an efficiency apartment above the bar next door. Telephone & Aldis lamp (An aimed directional light with trigger for flashing the light to send code) to send & recieve code signals to Moon Island seaplane control towers & Eastern Island air control tower – all within view of the clinic.)
Village Clinics (multiple locations)
All the villages (& urban neighborhoods), as part of the Civil Defense Committees, have a designated clinic area, with stored basic first aid supplies & health records, in or near the village's Althing building (which will have a radio, telephone, or at least a telegraph connected with the local regional telegraph network). In some villages this clinic is a separate small building, or it may be as small as a locked storage closet that is part of a village voting-assembly hall. When a touring nurse or doctor comes by to a village, this is also usually their clinic area.
The village Spontoonies are generally motivated enough to be prepared in emergency health care, but not everyone will have the same level of interest or ability in first-aid skills. This is like volunteer firefighting, though: Preparing for the job is considered a good excuse to socialize. Out of a village of 100, maybe 5 will have the inclination to learn first aid & be well-trained, with about 5 friendly helpers -- and that is considered to be enough for most emergencies. If a medical event happens, the local first-aid providers are to give a doctor or a screening clinic a call, and they are to prepare to transport the patient, if that is needed.
Public & Private School Health Services (Education)
The larger consolidated (regional) secondary education schools usually have their own small nursing staff, with nursing rooms, but there is also a generous co-op agreement for health care shared from HealthCom. Public Health instruction and First Aid courses seem to be a mandatory subject at all the schools, but also the continuing assistance of neighborhood volunteer helpers are recruited from the motivated or and/or skilled students.
252. Private Clinics & Doctors in private practice.
On the Spontoon Island Atoll, most of the several private doctors & clinics are on Casino Island and Eastern Island, with a few on South Island during the tourist season. Some of these physicians are on-call to (or with offices at) the Casino and resort hotels. Most are quite skilled specialists and work as regional professionals for the wealthy; and also for those travelers who are uncomfortable with the customs and manners of a co-op socialist version of health services. (Note: Sources indicate that private medical practices are kept well-monitored by HealthCom and the Constabulary – as, since being high-income and seasonal (or transient) businesses, there were some cases of fraud and malpractice in the early 1930s.)
253. Medical Examiner & Coroner
These duties serve HealthCom, the Spontoon Constabulary, and the JudicialCom. Office, dedicated Lab space, & storage space are available at Meeting Island Hospital.
In 1935, these two offices are held by a respected private medical doctor, (Dr. James Meffit, MD), who has a small private practice & clinic on Meeting Island, in the neighborhood known as Embassy Row. Most all of the administrative & lab duties for his offices can be done at his clinic, where has added a small well-equipped annex. There is storage space, and a small modern medical lab that can do autopsies & most all modern forensic tests. The doctor is well regarded by the local Constabulary, and reported to have been of major assistance in some RINS Navy investigations.
The doctor's duties include administrative committee service and consultation in the HealthCom systems of food-service & hospitality-service licensing & inspections. ("Health Officers")
The Spontoon Island Althing's Health Committee operation of public health services seems to be delivering acceptable services to the community of Spontoon Island. The development of a depth of community involvement is to be respected. The co-operative non-profit system is similar to many of the non-profit community hospitals and local government hospitals in the USA, as well as the various armed services medical facilities and the Veterans' Hospitals that we know in America. While there have not been many major tests of the civil defense abilities of this system, it has served well in several influenza epidemics, and outbreaks of other contagious diseases, including some incidents on the diverse Archipelago islands. The public health appears to have been well cared for, including specialized over-watch inspection services for the housing & food-distribution sectors. Visitors & tourists seem to be well protected. For the citizens of the Spontoon Islands, there is wide-spread availability of basic neighborhood health clinics for first-aid and preventive medicine.
Notes: On controversial subjects
in Spontoon Island Health Services
The treatment for some long-term conditions and addictions (and the accepted legal use of some recreational drugs) is considered unusual and controversial to many outside observers, but seems to be accepted by most of the local population, government & medical community, and has not even been a minor internal political issue.
The recent alleged discovery of some involvement of the local Spontoon Island priestesses and shamans as advisors in parts of community health care (especially the occasional treatment of some psychiatric conditions) is also controversial to some foreign medical practitioners (including those from the USA), as not fitting-in well with 20th century understanding of best-practices in modern medical science.
However, that being said, it would be advisable to be cautious about making any commentary or judgement on these stories (or practices) at this time. While scientific research may have the possibility of being sensationalized, recent articles published in reputable & reliable medical journals have informed us that since 1919 it has been discovered (and scientifically verified in Great Britain, Germany, Italy, and at Arkham University, Rhode Island) that some individuals can contact and communicate with faith-based entities and powers for assistance in some psychiatric diagnosis and assistance with some other objective results of patient healing and recovery.
One trustworthy local source tells us that the Spontoon Island priestesses,“may have been doing their own Athena-blessed 'medical research' using these contacts with their so-called 'Kami' for at least the last 50 years. Or perhaps much longer than that.” Another source high in US Navy Naval Operations, Pacific has informed us that similar successful contacts for faith-healing and secular-confirmed assistance have been demonstrated to be happening within a small scattered number of the faithful of most of the faith-based communities. That includes in most of our world cultures. He says this is not well known and not much believed, as our secular-centered societies (especially since the start of industrial development) are perfectly happy to organize major parts of their lives within their mass-cultures around the advantages of technological and scientific advances in surgery and laboratory developed medicines. Also, our informant says that this 'magic' and 'communication' also does not usually work the way many people have believed it would, and is perhaps often beyond the comprehension of bureaucratic-structured religions, and the scientific and secular standards of the established medical research community.
Notes: Emergency medical services for US Navy vessels,
and for other naval accidents and disasters at sea.
Subject to timely bulletins from U.S. Naval Operations or the State Department Consular Service, USN ship Captains and officers may use their judgement in contacting the Spontoon Island authorities by radio for emergency medial assistance and hospital services 24 hours a day.
We understand that clear-signal advance communication from aircraft to Spontoon Island air traffic command will ensure emergency landing clearance on either the land airstrip on Eastern Island, or in the seaplane lanes in the Spontoon Lagoon. (Circumstance permitting, seaplane pilots may be guided by crash boats to beaches or piers nearest the hospitals.) Many emergency small craft will be available for the transfer of casualties at short notice.
There are also emergency air/sea rescue craft on duty 24 hours a day, that will go to rescue locations near the Archipelago region. With 3 hours notice, it has been affirmed that up to 15 additional volunteer seaplanes with emergency stretcher-spaces may be ready to go to a rendezvous location, some aircraft with medically-trained crew.
Naval Operations has reason to believe that these offered emergency services are reliable and discreet. The editors of this handbook are authorized to share, that if any reader happened to wonder why there were any survivors (at all) of the disaster of the Vostokii Imperial Navy Fleet-oiler Beliu Rassvet in 1933... you may now make a guess. A discreet guess.
(Excerpts compiled & edited by Ken Fletcher, 2006 & 2017, with the assistance of Spontoon Island contributors, including E.O. Costello. Presented the form of a supposed US Navy Civil Affairs Handbook of 1936, set in the alternate world of Spontoon Island.)