The smell of porridge.

Keith Howard has written a chapter for the update of the late Dr Bert Evans’ book on the history of paediatrics in the Hunter. He has kindly given permission for the following extracts that focus particularly on the children’s ward at The Maitland Hospital to be shared here. Keith Howard writes:

I arrived as the first paediatrician in Maitland at the beginning of 1979 with an appointment as Honorary Medical Officer at The Maitland Hospital.

A policy of open visiting for parents of children on the ward was already in place.

A pervading memory of the early years is the smell of a saucepan of porridge which was put on to cook every night in the ward kitchen in readiness for the patients' breakfast.

Nursing staff

Elizabeth Hanks was the sister in charge of the children's ward when I arrived. On my first day on the ward I was also greeted by a deputation of early childhood nurses, whose ranks Elizabeth Hanks soon joined. A request was made for regular educational meetings, an arrangement which lasted over 30 years.

Elizabeth Hanks was replaced by Dawn Weighman for a year, then more permanently by Janet Ausling, initially in a job-sharing role with Val Simm.

Leanne Crittenden joined Janet Ausling as joint Nurse Unit Managers of the Children's Ward in 1995. Leanne moved on and, following Janet's death, the role was taken on by Debbie Kerz, then Debbie Telitski and subsequently Jade Starky, who had been working at John Hunter Children's Hospital (JHCH). In 2014 Jade returned to JHCH and was replaced by Jess Crombie.

The ward was fortunate also in having a play therapist, a role filled initially by Megan Gorringe and now for many years by Bernice Kavanagh.

**Composite portrait of children’s ward staff.**
(Maitland Hospital Collection 419)
Keith Howard explains:
The photos were assembled about 20 years ago and are of staff from the Children’s Ward and some partners. Some of the pictures were already 20 years old by then. They were put together by a long-standing and valued member of staff.
It was a very collegiate unit, with many staff working there for several decades. We would go out for dinner together a couple of times a year, as evidenced by a number of the photos.
Most recently, the collage hung in the office of the NSW Children’s Healthcare Network. That institution won’t be part of either the old or the new hospital.

Medical staff and services

Peter Donald arrived as the next paediatrician in Maitland in early 1981. Around that time we were offered appointments as Visiting Medical Officers. Having two paediatricians in town allowed us to establish outreach clinics: Peter in Muswellbrook and me in Singleton. Peter soon also arranged for Richard Hawker to provide regular paediatric cardiology clinics in Maitland from his base at Royal Alexandra Hospital for Children, Camperdown, a service that continued for more than 30 years.

1981 was also the year that the first group of students at the new Medical School in Newcastle started the paediatric component of their training and we were pleased to welcome them into the hospital and our rooms from the outset.

In 1983 the Children's Ward was renovated and extended to include an area of six beds for children with infectious diseases and three rooms for parents of families living out of town. This brought the ward capacity close to 20 beds. Sadly there was no way of preserving murals painted by Pixie O'Harris in the 1950s but Don Brook and Dick Breiner, the hospital painters, more than made up for this with a happy combination of Don's cartoon style and Dick's realistic pictures of Australian wildlife.

**Dick Breiner wall painting** (detail)

View *Give a cheerful atmosphere* for more details.

By 1991 there was sufficient work to warrant the appointment of a third paediatrician. With the active support of the CEO of Lower Hunter at that time, Ken Miller, we welcomed Geoff Hardacre from Newcastle. By this time, and before the arrival in Newcastle of a specialist paediatric oncologist, our service had developed to include local care of children with malignant disease, under the very supportive supervision of the Paediatric Oncology team at Prince of Wales Children's Hospital in Sydney. Many of these children lived some distance from Maitland, including Muswellbrook and Laguna, and over the years we were able to spare some thirty families the added inconvenience of frequent journeys to Randwick or Newcastle.

In 1993 Geoff Hardacre moved to Dubbo. He was replaced by Libby Pickford, who established further outreach clinics in Nelson Bay and Raymond Terrace.

The face of paediatrics was changing. The disappearance of mist tents from the everyday landscape of the ward was unlamented as we learned that steroids were a more effective treatment for viral croup than steam. Haemophilus immunisation effectively eradicated the commonest cause of bacterial meningitis, and there was a growing awareness of Attention Deficit Hyperactivity Disorder (ADHD). Peter Donald and I had both taken six-month sabbaticals at different times during 1992. Before I left I had accumulated a small handful of patients identified as having ADHD. By my return I was receiving up to five referrals a day asking no longer ‘what is the diagnosis underlying my child's symptoms and your recommended management?’ but the less open-ended question ‘does my child have ADHD and would stimulants help?’ Both Peter and Libby developed great interest and expertise in behavioural paediatrics.

After five years Libby returned to Sydney to establish her own practice and proved a hard act to follow. We were unable to recruit a replacement and for a couple of years Peter and I worked a one in two on call roster again, eventually with the very welcome locum support on some weekends from Daniel Lin. The hospital's junior medical staff had increased from four during the 1980s but the paediatric department still only had a share of one resident by the late 1990s and did not have a registrar position until 1999. Mark Lee, as the first in this role, ensured that the transition was not only highly beneficial but also welcomed by all concerned.

In 1996 the children's ward moved from what has since been used as the physiotherapy unit into the new wing of a major re-development of the hospital. This entailed a considerable loss of space and bed numbers, partly justifiable because of welcome reductions in average length of stay. We were able to negotiate the exchange of some administrative space for an additional four bed room, specifically for adolescents. This brought the bed number up to 16, including two single rooms with en-suite bathrooms and provision for reverse barrier nursing of children at increased risk of severe infection. One of these rooms was later modified by the Nicholas Butters Trust to provide palliative care when necessary.

In 1999 we returned to full strength with the arrival of Andrew Gardiner, an experienced paediatrician from Tamworth. In 2001 we all accepted an offer to switch from Visiting Medical Officer to Staff Specialist status. This change included providing outpatient services from hospital clinics and allowed us to expand our outreach clinic service to include Cessnock and occasionally Dungog. At Maitland the outpatient clinic was initially shared with adult clinics but we rapidly outgrew the available space and the then CEO of the hospital, Geoff Rainer, provided the insight and the opportunity to convert the old, Nightingale-style A ward into a clinic exclusively for children and young people. With four consulting rooms, plus one for the use of registrars, and adjacent office space for paediatricians and secretarial staff, this worked very well.

Becoming staff specialists also provided scope to provide a true Paediatrics and Child Health service, in collaboration with many other child care professionals, including Early Childhood Nurses, Early Intervention, Education, Child Protection and Child Psychiatry agencies.

In the early 2000s we were able to increase our establishment of paediatricians to 4, later 4.2 full time equivalents. Anne McGeechan joined us from Salisbury, followed over the next 10 years by Fergus Elder, Karen O'Brien, Marea Murray and Nadine Ogle. By 2012 over 11,000 children were seen annually in Maitland Emergency Department with 12% admissions. There were 1750 births at the hospital, with Level 2 Nursery support provided, when necessary, for an additional 500 births between Muswellbrook, Scone and Singleton Hospitals. 4000 children were seen as out-patients. Maitland was comfortably the busiest Regional Referral Hospital in NSW in terms of births, paediatric emergency presentations and admissions to children's ward.

We achieved full time registrar cover in 2014.

Peter Donald retired in 2013 and was replaced by David Rogers, who took over the vacant Director role. I retired from clinical work at the hospital in 2014.

Editor’s note:

In 2017 Keith Howard’s work was recognised by the Humpty Dumpy Foundation with the following mention in NSW Parliament by Jenny Aitchison, Member for Maitland:

A new timeline.

Nurses’ reunions.