The Department of Women’s and Children’s Health was formed in 1999 by combining the previous Department of Paediatrics and Child Health with the Department of Obstetrics and Gynaecology. The amalgamation aimed to strengthen the research interests of the two departments and streamline the medical teaching programme.
The previous departments are now the Section of Paediatrics and Child Health, and the Section of Obstetrics and Gynaecology; both within the Department of Women’s and Children’s Health. In their previous incarnations as stand-alone departments, both of these sections have long histories with important contributions to the advancement of women’s and children’s health in New Zealand.
Since amalgamation, the Department has steadily grown. Its success and reputation has mostly arisen from research that has attracted a national and international reputation for excellence.
Medical teaching of childhood diseases and action to improve child health goes back to the founding of the medical school
The first academic position specifically dedicated to child health was held by Dr Isaiah de Zouche, a graduate of Queens University (Ireland) and MRCS (London), who was appointed as Honorary Lecturer in Diseases of Children in 1888; eleven years after the Medical School was established under Professor John Halliday Scott. Dr Frederic Truby King was also made an Honorary Lecturer in Mental Diseases around the same time, who went on to found the Royal New Zealand Plunket Society.
It was first suggested that a Chair of Paediatrics at Otago should be established as early as 1940, but the war meant these plans were never followed through. The project was revived in 1964 and finally James Michael Watt was appointed as New Zealand’s first Professor of Paediatrics and Child Health in 1967. It was during this time that postgraduate teaching began to flourish in Dunedin and a number of his former residents proceeded to prominent paediatric positions both within New Zealand and overseas. Professor Watt had a special interest in inborn errors of metabolism, and collaborated with Professor Arthur M O Veale (a geneticist) in establishing the Guthrie Card testing regime for all newborn infants in New Zealand, following a visit by the developer of the test, Dr Robert Guthrie, in 1968–1969.
Another notable milestone in paediatric care in New Zealand came from Dr Helen Deem, who was appointed as an Assistant Lecturer in 1947; she was responsible for introducing growth charts into the surveillance of well being of infants and young children.
In 1967 Dr Patricia Buckfield, an Otago graduate, was appointed as Lecturer following a period of postgraduate training at the Institute of Child Health at Hammersmith Hospital, London. Dr Buckfield had a particular interest in neonatology and had gathered data on every baby born at Dunedin’s Queen Mary obstetric hospital between 1967 and 1973; 12,000 in all. From her research came the creation of the Dunedin Multidisciplinary Health and Development Unit under the direction of Dr Phil A Silva. This Unit evolved from an initial study of 1,037 infants born in the Dunedin area between 1 April 1972 and 30 March 1973. The research from this study has achieved international acclaim for its contributions to understanding human health and development from infancy to adult life, and has resulted in the publication of several hundred scientific papers.
In 1981, a Diploma of Child Health (Otago) was established with support from clinical schools in Wellington and Christchurch. Initially, this diploma was intended to raise the standard of paediatrics amongst those intending to enter general practice, but it rapidly became a preliminary stepping-stone for those proceeding to FRACP (Fellow of the Royal Australasian College of Physicians) and specialist practice.
The Department of Obstetrics and Gynaecology: A New Zealand first to improve women’s health and reduce maternal mortality
Prior to the 1930s, there was no direct path to obstetrical and gynaecological specialisation for medical practitioners in New Zealand. General practitioners or midwives did most of the obstetric work, and women ordinarily delivered in maternity hospitals or at home with midwives. Any complications were dealt with surgically, usually by the general surgeon on duty.
Dr Emily Seideberg, New Zealand’s first female medical graduate, was responsible for opening New Zealand’s first antenatal clinic in 1918. At the time she was Superintendent at St. Helen’s Maternity Hospital, Dunedin, and played an active role in the training of midwives and medical students, working closely with the Plunket Society.
A number of national events set the scene for the development of a Chair of Obstetrics and Gynaecology at the University of Otago. In the 1920s, maternal mortality in New Zealand was high. Following five maternal deaths from puerperal sepsis at Calvin Private Hospital in Auckland a public outcry ensued. In 1924, a campaign for safe maternity care was set up at the Annual General Meeting of the Plunket Society. A new Health Act was passed under Director General Dr Thomas Harcourt Valintine, whereby maternal and child health was to become a primary concern. As a result, a Maternal Mortality Committee was established and one of their recommendations was the improvement of obstetrical training to medical students. The establishment of a Chair of Obstetrics and Gynaecology at Otago was strongly recommended.
Also around this time the idea of an association of doctors practicing obstetrics was proposed. In February 1927, the inaugural meeting of the New Zealand Obstetrics and Gynaecological Society was held in Dunedin, with 180 doctors as foundation members. The Obstetrics and Gynaecology Society, headed by Dr William Irving of Christchurch, undertook to raise funds for the establishment of a full-time Chair at Otago and succeeded in collecting over £31,000.
The Chair of Obstetrics and Gynaecology at Otago was finally realised in 1932, when Sir J Bernard Dawson began his duties as Professor in Obstetrics and Gynaecology. He immediately commenced improving the standard of teaching, including personally supervising most of the deliveries conducted by the students. After negotiations between the hospital and Minister of Health, funding was obtained in 1934 for a 26-bed Queen Mary Maternity Hospital, formally opened in November 1937.
Through to the 1950s, Dunedin was the only medical centre in New Zealand with a separate Department of Obstetrics and Gynaecology. A scheme of obstetric tutors was introduced around this time, with a number of leading general practitioners and midwives accepting having a student present to assist them during normal deliveries. The scheme was an immediate success. In other medical centres in Wellington and Auckland, obstetrics and gynaecology continued to be part of the rest of the general surgical and medical training. Sir Dawson lobbied hard for the establishment of proper Obstetrics and Gynaecological units in the major hospitals in New Zealand, staffed with appropriate specialists and with training positions for postgraduate residents. He was also instrumental in establishing the National Women’s Hospital and the Chair of Obstetrics and Gynaecology at Auckland University College.
In 1951, Dr Lawrence Wright succeeded Sir Dawson as Chair of the Department of Obstetrics and Gynaecology. For the next 40 years, 1951–1992, the Professor was in sole charge of the Otago Hospital Board’s Maternity Hospital and responsible for the training of medical students, who were required by the medical council to have personally delivered 20 babies. A new Queen Mary ward opened in 1960 and it was run almost single-handedly by Dr Wright.
In the 1960s, the Diploma in Obstetrics was introduced to simulate the equivalent diploma of the Royal College of Obstetricians and Gynaecologists in London. Six months had to be spent at an approved obstetrical appointment and finished with a theoretical and practical clinical examination. This innovation proved to be very popular and there was never a shortage of candidates wishing to undertake the Diploma.
With the integration of readily available consultants into standard obstetric care, the possibility of caesarean section when necessary, and the use of ergometrine to aid in delivery of the placenta, maternal mortality continued to fall dramatically during Lawrence Wright’s tenure. Moreover, the Department retained a commitment to cervical cancer screening and continued its roll-out of cervical smear testing, despite pressure to suspend the service in other parts of the country.
Other consultants and academic staff during Professor Wright’s tenure included Associate Professor Earle Wilson (1971–1979), who fostered a strong research emphasis in the Department, with interests in the biology of the endometrium, contraception, and fertility. Professor Wilson left in 1979 to head the World Health Organization Task Force on Reproductive Health. In addition, Dr Tom Fiddes (1974–1999), introduced and developed obstetric ultrasound at Queen Mary Hospital.
The Department continued to expand its research throughout the 1980s and 1990s, with ongoing research covering reproductive endocrinology, infertility, biology of the endometrium, and urogynaecology. The merger into the current Department of Women’s and Children’s Health in 1999 has only strengthened the overlap in clinical interests and research expertise shared between these former departments.
New areas of medical research are being explored, and the next generation of staff continue the proud history of these departments.