When Mrs. Sheila Manderson came home to Bermuda to become executive director of the Bermuda Hospitals Board eight months ago, she scored a number of firsts.

She was the first Bermudian, the first black person, the first woman and the first trained nurse to fill the position of top administrator of King Edward VII Memorial Hospital and St. Brendan's Hospital.

But Mrs. Manderson, 52, has been blazing trails since she first entered the medical field.

At Kaiser Permanente Hospital near San Francisco, she served as assistant administrator for hospital operations/director of nursing, director of education and training, nursing in-service coordinator, and as nursing supervisor dating back to 1974. Prior to that she worked as a staff nurse in a 15-bed ICU/CCU unit in San Francisco for six years.

Her most recent position was medical centre administrator at the hospital in Richmond, California.

At Kaiser Permanente, Mrs. Manderson directed and integrated all administrative and operational activities at the acute care hospital for six years. She also oversaw ambulatory care multi-specialty clinics with 65 physician providers serving 65,000 members.

Kaiser Permanente, with Mrs. Manderson as its top administrator, underwent a $64 million construction project which included a new hospital, medical office building and a 600-car parking garage.

Then she heard about the job in Bermuda.

"A friend said the executive director's position would be vacant,'' she said.

"I talked with Hume Martin about the position and was asked to submit a resume.'' Mr. Martin, the former executive director, has returned to Canada.

Now she is comfortably ensconced at the top of the two hospitals, which facilities have 510 beds and employ 1,200 people.

Calling her work "tremendously challenging'', Mrs. Manderson said that although she misses California, "it is nice to be back in Bermuda''.

One of the biggest changes for Mrs. Manderson is the difficulty in networking and communicating with other top hospital administrators as KEMH is the only medical hospital on the Island.

She also said people must recognise hospitals have a business focus as well as a focus on quality health care.

"Some people do not recognise that health care is big business and it's complicated. A large percentage of the Gross Domestic Product goes to health care. Hospitals have to be run like a business. There is a tremendous focus on cost of care. People expect us to run the hospitals in a cost-effective way and they also expect quality care and quality service,'' she said.

Mrs. Manderson said that in the last year the cost of running the Bermuda hospitals increased about five percent to $66 million.

In the US, the percentage last year for the first time in many years dropped below ten percent. But the reason for the decline was directly linked to large cutbacks in the levels of US health care, she said.

Forty percent of the Bermuda Hospital Boards' operations are Government funded.

The cost of operating St. Brendan's is 98 percent Government sponsored. This year Government froze its subsidy to the hospital, said Mrs. Manderson.

She estimated the cost of updating equipment at $1-$1.5 million yearly to keep pace.

"Technology is a major challenge as well as it is always changing. We have the very latest in CATscan equipment, excellent physicians and intensive care.

Our intensive care is rated as good as or better than several hospitals.

Bermudians have a lot to be proud of when it comes to their hospitals.'' The Bermuda Hospitals Board next year will undergo a Canadian Council of Health Services Accreditation review. The Bermuda board is the only non-Canadian member of that organisation. The review takes place every three years.

Another concern that must be planned for is Bermuda's aging population. We must find alternative methods of caring for the elderly. The hospitals must be cognisant of bed utilisation, according to Mrs. Manderson.

"It is important to utilise hospital beds in a cost effective way,'' she said. "We currently have an adequate number of beds.'' But there have been occasions when all the beds have been full and a six-bed temporary room has been activated, she added.

There are also occasions where patients could be sent home if they were alternatives.

"We have an elder care task force. We are looking at several avenues,'' she said.

These are issues that must be addressed when Bermuda's hospitals look at cost effectiveness, said Mrs. Manderson.

But the most cost-effective way to operate a hospital, she said, is for people to keep healthy through proper lifestyles.

Mrs. Manderson, who jogs every morning, said exercise and diet are the best medicine.

"I think there is a greater awareness of what's healthy today.'' "I play some tennis and some golf and am interested in gardening but there is a tremendous amount of work being the executive director so finding time for these pursuits has not been easy,'' she said.

Mrs. Manderson and her husband, Mr. Neville Manderson, have one son, Brian, who continues to live in California.

Mr. Manderson, who worked in administration at the University of California at Berkeley, is retired.

Mrs. Sheila Manderson