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PUBLIC RECORD OFFICE
T།། །། །
Reference:
885/26
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
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16 February, 1920.]
COLONIAL MEDICAL SERVICES COMMITTEE,
DR. H. H. STEWART,
think. The functions of the West African Medical Staff I need not enter inta; I think probably by this time you will be fully conversant with the general functions of the staff.
3263. I did not want you to enter into that at all, but you said there were professional reasons for dis content; I wanted to know what they were?—The first question, if I may take you back, refers to a medical officer who joins the Service; he joins the Service; he has a course of Tropical Medicine at the London or Liverpool Tropical School; he goes out to West Africa, then he arrives in the colony, and, as a rule, the majority. I think I may certainly say the majority in the past, of newly appointed medical officers have proceeded direct to their stations to relieve sometimes another medical officer, or, in my own caso, to take over a station in which there was no medical officer. The medical officer may be and very often is, in the case of a place such as Lagos or Calabar, only one night or half a day at the headquarters of the pro- vince; the Provincial Modical Officer may see him or may not; he probably does not. The Principal Medical Officer probably never sees him, perhaps he may not see him for a year or two years, and be arrives at his station in the bush perhaps utterly ignorant of all departmental routine. He feels abso- lutely helpless and his colleague may or may not help him or be in a position to point out certain important things. Very often it results in the fact that the medical officer on his first appointment finds himself absolutely in the hands of his native staff for the purposes of routine work, office work and work in connection with the Sanitary and other Departments. The officer himself feels absolutely helpless we all know the exact relation of the Administrative Political Officer to the medical officer-and it may, and very often does, happen that the Administrative Officer in certain matters of sanitation takes advantage of the ignorance of the newly joined medical officer by doing certain things that a more experienced medical officer would not permit. Do you wish me to propose s remedy for that? That is how the first seed of dis- content is planted.
3284. There are over 7,000,000 people in Southern Nigeria, are there not P-Over 7,000,000, yes.
3265. The way of getting to a great many stations is walking? I can hardly imagine any to-day that you cannot get to by motor bicycle or launch. I have been in or passed through every station in Southern Nigeria, with the exception of Port Harcourt and Opobo.
3266. You think communications are good?-Very much better, infinitely better than when I first went there, and my experience is not very great.
3267. Well, I suppose the remedy you would pro- pose is that a new officer should get so many months nt headquarters before he is sent up country?—Well, kept a certain time at headquarters. I may say, in my own case, that that happened to me, and I must say that the benefit I received was absolutely in. estimatable.
3268. How long were you kept?-I was kept for a fortnight. It simply happened that at Calabar the steamer broke down and another steamer was not available and I was not able to go up and I was kept a fortnight waiting to go to Bende. I got a full insight into departmental matters. I knew what a Store Transfer Issue Voucher was when it was presented to me at the station, and that is a thing that other medical officers did not know when they first came. They felt themselves absolutely helpless. 3269. I do not think anybody would dispute the advantage of keeping a newly arrived medical officer at a large station for some weeks or longer, but the reason why it has not been done must be obvious to you that to do that would have necessitated leaving the station where he was probably going without a medical officer for that time?-Not in the case of a new medical officer,
3270. It would necessitate getting so many more medical officers-Would it not mean sending them out before their time,
[Continued.
3271. It would mean having more medical officers in the colony P-Exactly; that is only a question of expenditure.
9272. That is all. Well, will you go on to andther point; I think we understand? When the medical officer gets to his station, then arises the question of inspections by the Provincial Medical Officer under whom he is working. In the past there has not been an adequate inspection. I know that from 1913 to 1916 of course, I realise the war again-I was never inspected until I went to Lagos by a Provincial Medical Officer or a Senior Medical Officer, and that is borne out by many of my colleagues who have made a similar remark to me.
3273. You went out in 1913P-Yes, Sir. 3274. Where did you go to?-Bonde.
3275. And you were there a year?-No, Bende was closed down then and I travelled round and practic- ally went from station to station; but in core of the stations in which I had been had there been an in- spection by a Provincial Medios1 Officer within a year.
3276. Within a year P-Yes, Sir.
3277. You were speaking of the deficiencies of the Service form a professional point of view, saying that out stations were not visited regularly by the Pro- vincial Medical Officers?--Yea.
3278. Is there any other heading under which you think matters might be altered? On the question of dealing with inspection, of course, owing to the war shortage, there was great deal of difficulty, but before the war there was difficulty, and Medical Officers themselves realise there is not a sufficiency of inspections, and one way in which this reacts on the Medical Officer himself is that it is very difficult when eventually an inspection does take place for the in- specting Officer, if he finds a station in a bad condi. tion, to allocate blame exactly, because it may be either due to the Officer who is at present in the station when he visite it or it may be due to his pre- decessor, and it is an extremely difficult matter for him, and only frequent inspections can rectify that. And in addition to that, one gradually gets the in- pression that an Officer is judged solely on his clorical work, that is to say, his ordinary routine office work, and as long as you add up your figures correctly, and send correct returns to Headquarters, the actual pro- fessional medical work that you do is not of very much value to you in later years. The many Modical Officers who have spoken to me have all said that; and I know in the first years of my service that was to a great extent my own impression on the question of inspection. I would have welcomed, and would have liked, to have been inspected by a Provincial Medical Officer to show him what I was doing.
I
3279. Any other point from the professional point of view? The question of an Officer's work. The question which has been raised very often concerns the Reports of an Officer's work-the confidential re. porta. I think I am correct in saying that, in the Army, if an officer's confidential report is adverse, he in allowed to be shown it, and hitherto, would be far as I know, and as far as my colleagues can inform me. that has not been done in the caso of the Officers serv ing in the West African Medical Staff. I think the ordinary failings of a Medical Officer-we all have failings are too seldom pointed out to him, and there is too often a failure to give helpful criticism. know the reason for the procedure. It possibly does great credit to the Administrative Medical Officer's heart, but not, perhaps, so much credit to his head. He does not like to speak adversely about professional men under him, and I think it would be a great advantage if we could always have an adverse report shown to an Officer. I am sure he would benefit by it and effect improvements if he knew. Another question arises in this way: The report might not bo absolutely adverse, but it might be a weak report, and the question is whether it might not be possible to arrange for the officer in every case to br interviewed by the Principal Medical Officer, an:1 have the points of difficulty discussed at full length
16 February, 1920.]
MINUTES OF EVIDENCE.
DR. H. H. STEWART.
Wo
with the Officer in question. Those views have been put repeatedly before me, and it is a question which we have repeatedly discussed among ourselves. would all like to know exactly how we stand in regard to our professional conduct in the oyes of the Autho ritics, and at prosent we know nothing at all. You may be very satisfactory, or you may be very bad, or you may have failings about which you do not know anything, but at the present moment we do not know where we stand. Now, I go on to deal with another point, and that is the question of the Medical Officer's work, the question of his position in the Government Service in regard to the professional sup- plies by the Government. In the past, the stations have been clarified into various heads rather depen dent on the political provinces under which they fall, and I think the feeling now among the Staff in that it would be probably better to classify, in view of modern developments in medicine, the stations under three groups, under (1) the one where team work is possible and essential, under (2) where team work is only possible, and under (8) where it is not possible. Team work is the most recent, the most modern de velopment of medicine.
3280. Does team work mean two or more Medical Officers working together?-Collaborating; together, each bringing his own speciality to bear on the par- ticular problems which are presented professionally to him. In an isolated station, of course, it is abbo- lutely impossible to do so.
t
9281. When you say that, you are talking about the medical supplies furnished to out stations?--You, with a view to furnishing supplies commensurate with the work which they have to do.
3282, Research work?—No, ordinary clinical work in their ordinary professional capacity in curing and dealing with the diseases which arise among the natives.
3288. The instruments supplied and the medicines supplied to each station are fixed, are they not? They are determined by the Principal Medical Officer P-They are determined to a certain extent by the Principal Medical Officer. I think reatly they are determined by the amount of money allocated; I think we might really say the amount which the administration allocates to the Medical estimates.
3284. I thought they were fixed from year to year; just the same from year to year? I bave the osti- mates here; the amounts of the estimates are fixed, I think, in relation to
3295. I do not mean that; I mean in the quantity of medicines, and the kind of medicines, and so on, they are not fixed?-No, toose are indented for under the present system by the individual Medical Officer on the Store, on the Central Store. Take the Cross River-- 3286. Yes, but is há not told to keep up his stock to a certain standard? No, there is no standard. There was brought out a standard of surgical equipment which was never applied.
I think at one time the stock at each station was fixed and it was found necessary to do it because each new Medical Officer ordered a new specific medicine. I think, for instance, at one station, we found ten different kinds of meat extract. One wanted Liebig, another wanted another kind, and so on.
3287, Sir James Fowler: What you are speaking of is the equipment necessary for accurate diagnosis?- Exactly.
3288. It has nothing to do with drugs, or anything of that sort; it is the equipment necessary for accurate diagnosis?-Yos,
3289. Chairman: Is there not a standard for each station, or class of station P-No, sir; there is no standard whatever either in drugs or equipment of the hospital. There are no standards at present in Nigeria, there are no standards at all for any class of station. There was certainly brought out just before the War a standard classified equipment for surgical instruments. That has never matured.
3290. That was brought out before 1912.-I went through and chocked those. With the usual equip- ment of what I call a class (3) station, a bush station,
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105
[Continued.
it is quite impossible to do any surgical work without either supplementing it enormously by your OWIL resources or else endeavouring to obtain from head- quarters extra instruments, and the fact is that at s Headquarters Station, Central Stores, there has not been in the past sufficient equipment to meet exceptional demands. A Medical Officer may go up to a station and he may be a very ardent surgeon, and he may wish to do surgery; in the past there has never been at the Store a sufficient number of instruments kept to supply any emergency as it has arisen.
3291. I think we quite understand what you are asking for; I do not think you need elaborate the point further?--You do not want the point elaborated.
3292. You may go on to another point?-Another important point is the question of supplying books to them.
3299. Medical books P-Yes, it is very difficult for n Medical Officer in the out-stations to carry books without making serious inroads on his very scanty allowance of loads; everything has to be carried; 561b. or 80lb. And if some not too elaborate Medical Library at Provincial Headquarters were instituted it would be of the very greatest aid to an Officer who desired to supplement his own few books which he carried.
3294. You only ask for that at the Provinical Head- quarters? Yes, sir, I do not think there would be any reason otherwise; to have at each Headquarters a Library and a well-stocked Library of books of reference. If you were making any particular investi- gation, you could call upon that Library to supply you. From my own practical experience I found that of the very greatest value at Lagos; it was the first station where I was able to get any assistance in Medicine and Surgery in my daily work. I do not know whether you wish me to speak about the team work?
3295. No, I do not think so?-Then I would like to deal with the question of specialised work, because that is very essential now in the light of team work. It is quite impossible, of course, as a rule for a Medical Officer 11 au out-station to absolutely specialiso, because he is more or less out of contact and has numerous duties to perform, but I think men in the Service ought to be encouraged to specialise. They would he looked upon as specialists, and would be able, say, at the end of five years, by studying at home in England, to qualify for the specialist title.
3296. You would have Specialist appointments in the Service?—Yes; Specialist appointments in the Service. 3297. And would keep a man during the whole of his service at that particular work?—Yes.
3298. With an increasing salary?-Yes; with an increasing salary.
3299. As his service lengthened? As his service lengthened.
3300. Would you give him as good a prospect as a man who did not go into a Specialist Branch? Well, that brings out the relation of the Specialist to what I might call the Administrative Medical Officer-the Principal Medical Officer and the Deputy Principal Medical Officer.
If you did not hold out to the Specialist as good prospects from the financial point of view as to the higher ranks, he might be tempted to turn out to the Administrative side and then it would be a great economic loss to the Government because they would lose the valuable services of, say, a surgeon, and not only a surgeon, but also a surgeon who had many years' experience in Surgery in the Tropics. And, therefore, I think if any Specialist appointments were made they should be made so attractive that there would be no temptation for an Officer to leave his specialism in order to better himself in the higher ranks of the Service.
3301. Only
a large and rich Colony could afford to have many of those appointments. What would you specially concentrate on; Surgery for one?-I should certainly say Surgery, and one of the most important things, I think, without any doubt, is Clinical Patho- logy Clinical Pathologist. I do not mean from the point of view of research work, but the ordinary
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