In 1918, large areas of India and Europe were afflicted with a devastating influenza epidemic, which also took its toll of victims in Africa. The Franciscan Sisters in the hospital on Mission Hill exerted themselves to the utmost in their nursing services. The report the Administration of 1918, lists 79 casualties of white and 568 of black people in Windhoek.

In 1922, the Maria Hilf Hospital, as later dubbed by the Franciscan Sisters, listed 60 beds and one can guess that 30 were allocated to the isolation ward.

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May 1923 brought about a change of Sister personnel, with the arrival of eight sisters from Germany. Three of the sisters being nursing staff, one supervised the operating room, one worked in the kitchen, two were engaged with laundry and sewing, and the last one served to manage and administer the hospital. With the financial constraints of the country, only 12 patients were registered in the hospital, even though 60 beds were registered to the hospital. One can guess that 30 beds were part of the general ward, and the other 30 allocated to the isolation ward. In the same year, the missionary Benedictine Sisters of Tutzing renamed the hospital as the hospital of our Lady of Perpetual Help, or simply, ‘Maria Hilf Krankenhaus.’

April 1924 saw electricity being installed, and a farmer rendered repair assistance to the wards, in lieu of payment for his medical care. The number in the statistics far surpassed those of previous years. During most of the operations, there was only one doctor present, with three to four Sisters handling the anesthesia and assisting him.

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February 1925 was the first major change that was undertaken in the construction of the hospital. A new wing was being added with five new patient wards, one bath and two very modern operating rooms. The re-modeling also included the addition of a small chapel. Funds were raised by planning and having a two day bazaar. Which brought in an amount of 700 pounds sterling, and the first patient entered the new wing of June 8th of that year. Also with the ‘wonder doctor’, Dr. Friedrich, who was a famous surgeon, the hospital was well occupied. From October 1925 to 1927, many patients were admitted with scarlet fever and typhoid.

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In 1928, after inspection, certain changes had to be made due to British Law requirements, and these minor changes were made at the cost of the city administration. In the same year, the South African Parliament passed the “Medical, Dental and Pharmacy Act no 13” which was to also take effect in South West Africa after 1929. Amongst other requirements, it allowed only nurses and midwives who were registered in the Union of SA to work in approved hospitals. It meant only nurses with training and examinations done in England and SA. None of the German nurses were thus qualified at the time.
They could however apply for registration, but this was only granted till 31st December 1938, and it was presumed that it was only granted due to the shortage of nursing Sisters. The outbreak of World War 2, brought a temporary end to this problem. After the war, the problem was solved by allowing applicants with 2 years successful training in Germany, to take a 3rd year in SA, to register and be recognized as a qualified nurse in Namibia. In 1992 The University of Namibia provided refresher and updated courses for assistant nurses to qualify them as “professional nurses”.