長崎県巡回療育相談の変遷—離島を多く抱える地域での療育

History of Medical Education Consultation for Children with Physical Disability in Nagasaki Prefecture

要旨

目的：1954年，長崎県の県央地区に肢体不自由児施設，整肢療育園が開設され，翌年から施設職員が県下各地域に出向き，地域の療育関係者の相談に応じる巡回療育相談が開始された．開始から62年継続している本事業に関して，現在までの変遷を調査した．

方法：巡回療育相談に出向いた地域数およびその回数，相談件数を調査した．現存する資料を調べ，過去の巡回療育相談と現在のそれとを比較した．考察に必要な歴史的背景に関しては共同著者を中心に，また各地域での本事業の受け止め方に関しては，巡回療育相談に出向いた際，現地保健師から直接聞き取りを行った．

結果と考察：調査可能であった期間は36年で全期間の58％であった．1980年代は15カ所であった訪問地域数は，離島を中心とした5カ所に減少していた．相談件数は最も多かった1985年と比較して1/5程度となっていた．地域に出向いた回数に大きな変化はなかった．

Objective：The Nagasaki Prefectural Centre of Medicine and Welfare for Children was established in 1954 as a center for children with physical disabilities in Nagasaki prefecture. Medical education consultation in the local area of Nagasaki prefecture was started in the following year.

Methods：We examined the number of patients and the area selected for this project over the recent 36 years. Documents from the center's library were examined, and orthopedic physicians who had previously participated in the project were interviewed.

Results：The number of patients and visiting areas in the project continuously decreased. This patient tendency was caused by the declining birth rate in Japan and the satisfaction from human services in local areas. The decrease in the number of local areas visited was affected by the financial administration of our center and the development of a traffic network in the mainland of Nagasaki prefecture. Health visitors now working in the island continue to require visits to pediatric specialists from the mainland twice a year. The number of visits to four selected isolated islands has been maintained till date.

Conclusion：Medical support from the mainland is necessary for isolated islands because of the absence of physicians, especially those for children with physical disabilities, and visiting the hospital in the mainland by airplane is difficult for these children.