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16 February, 1920.]
COLONIAL MEDICAL SERVICES COMMITTEE.
DR. II. H. STEWART.
routine Clinical Pathology. We have no Clinical Pathologist just at present in Nigeria,
3302. That is for d'agnosis?—As an aid to diagnosis. We have no Clinical Pathologist, and two or three are very badly required. There are other branches which at any time we might add as the case demands, but the one we want particularly just now is a Clinical Pathologist or Pathologists.
3303. Does that contemplate the Professional points? No, sir. The unit of administration at pre- sent in the Political District. Medical Officers aro District Medical Officers, and this does not always, in fact very seldom, tally as regards the Medical requirements. A Medical Officer generally is very often stationed at a place where he is really out of touch with the native population.
He does not get tha necessary practice because probably, for certain reasons, he is very often put at the Provincial or the District Officer's Headquarters.
3304. But surely the Political Officer's station is in touch with them. His district is at the best centre. Surely the station is selected as the best centre of the Native population? The Political and Medical point of view, I think, are two quite different matters. From the point of view of living near them, quite near your patients and studying disease, it is neces anry for a Medical Officer to go to the place and see things and live on the spot with disease, which is not at all desirable or possible for a Political Officer.
3305. Do you not see disadvantages in two Euro- peans in a district living, say, ten miles apart, with half a million Natives to look after?-I see some ad- vantages; there may be disadvantages.
9906. From their own standpoint, I should think to be ten miles away from the only European in your district wou'd be rather a curious arrangement? Yes, from certain points of view. I am only tak ng purely the Professional outlook. I am particularly referring to the fact that, in questions of this nature, the ques tion of team work and two or three Medical Officers combining, in the future, we would have to regard our stations, where we placed these Medical Officers, more from the point of view of the population which they were go ng directly to serve than as we have done in the past. the purely political aspect.
3907. For team work, if you had a District Medical Officer here (indicating) and another one here, you would move them both and put them there?-Exact- ly, they would do much more valuable work.
3308. They may be a very long way away from this side of the district, and this side?--I grant you, but if wa are not to increase the staff, it is cseless to talk about team work at all. I am only wasting the Com- mitteo's time if there is no idea to increase the staff, if we are merely to go on as we have been doing, hav ing one Medical Officer in charge of three districts,
a total length of 150 miles in a direct line.
3309. That was during the war?- Or presibly in peace time, too.
8910. 150 miles? Yes.
3311. Where? From Obudu to Abakaliki.
3312. There is a Medical Oficer at ca.h of those places? There was not during the war.
3313. Not during the war, no; I do not think you neo: dilate on conditions which have been created by the war? No; but the Important thing is that they should not remain.
3314. Oh! they will not; I think you may be quite sure of that. On the question of study leave at the oad of five years, there is a course prescribed for higher salaries, and after that there is nothing else I think the majority of Med'eal men realise out there, that it would be for their own benefit if there were another course at the end of, say, twelve years, he cause, medicine making the strides it dos. it is ex- tremoly difficult to cope with and keep up-to dat in all departments of Medicine, and also the S n'or ranks shou'd be granted facilitica to study hospital administration. I do not mean in thes erses a com- pulsory course extinding for two or three months— but facilities for keeping abreast of modern work by visiting hospitals, and Principal Medical Officers es- pecially, because it would tend to make them mo sympathetically inclined towardfs modern progress and
[Continued.
88
A
modern Medicine, if something of that sort could ha done. I do not mesa that Principal
Medical Officers should have to study medical student for any certificate, but that facili- ties should be granted, and that it should be an unwritten law that from time to time they shoul make themselves acquainted with modern methods. and that is one of the points which has been brought up by many Medical Officere. I think I dealt with Specialists, but a Specialist should be dobarred from higher administration; it should not be considered he was in any way competing or could in any way become a Principal Medical Officer or Director. In Specialists, I think we ought to include Sanitary Officers in the Sanitary Departments who are dis- tinctly Specialist Officera in their own line. I know that in the past there have been cases where the promotion of sanitary officers to administrative posts has worked very well, The other day, however, there was a case where a Senior Sanitary Officer was promoted to the equivalent rank of & Deputy Principal Medical Officer, which, I may say, did not plenso a large number of medical officers. It caused a lot of discussion, and there was economic loss to the Government in taking a highly trained sunitary officer and putting him into merely ordinary administrative routine work. If this were done frequently, medical officers would feel that they should go into the Sanitary Department or Specialist Department, not because they liked the subject of itself, but because they wished to make it a short cut to prousation, and thereby the specialisation would undoubtedly suffer if an officer regarded a annitary officership or post as merely a short cut to promotion. That is one of the things we feel, that it should not be regarded as a short cut to promotion. I do not know whether you are considering the ques tion of the Sanitary Department; I do not know whether I am correct in bringing this before you, but there is a cause of dissatisfaction among the sanitary officers themselves, that is the title "Sani- tary." It is only a trivial point; they do not like the title "Sanitary." They would prefer a title more indicative of their function. Three senior banitary officers, the Gold Coast, Southern Nigeria and Sierra Leone have written to me and spoken to me, and asked me if I would express the view that it is a misleading title.
3315. What title would you suggest? Well, they would suggest that Health Officer is really the correct title.
316. It might lead to confusion; Health Officer is generally the name attached to the Health Officer at Port? That is Port Medical Officer of Health, but the sanitary officer is really purely and simply a Health Officer; it is preventive medicine.
3317. Publ'e Health Department? Some title which would indicate the work they are doing. Then, there is the question of promotions. The general feeling among the staff is that, as a rule, the Principal Medical Officers are not consulted, nor are their recommendations asked for with regard to pro- motions. I do not mean their recommendations as regards the General Confidential Reports, but ra specific requests are made and no special lists are drawn out for promotions.
3318. How do you know that? I say, Sir, it is this general opinion among the staff.
919. Is it not the custom of the Principal Medical Officer to make recommendations to the Governor and the G wernor to make recommendations to the Sentry of State? In a recent instance the Prin- cipal Medical Officer expressed surprise that a certain officer had been promoted in his Colony.
9320. To another Colony?- In his own Colony, which would certainly show that he had not, in that instance, bien consulted.
$321. Promoted in his own Colony; to another post in the same Colony-To another grade in the same Colony. That is the feeling of the staff that the Principal Medical Officers are not consulted. An obvious thing is that Medical Officers feel that. however intimate a knowledge the Principal Medical Officer has of their abil'tics, it does not stand them in very great stead when the question of promotion enines up, and they think the Principal Medical Officers might be asked to forward special lists to the Colonial Office whenever a vacancy occurs.
16 February, 1920.]
MINUTES OF EVIDENCE.
DR. H. H. STEWART.
3322. Direct, or through the Governor? Oh ! through the usual channels, Sir. Whether it were considered by a Committee or not, would not very much matter, but it would establish a feeling of confidence among the medical officers if that were lone, and that feeling of confidence, I say, at present is lacking. We feel that the Principal Medical Officers are not consulted with regard to furnishing lists of men for promotion, special or otherwise. Then there is the question of non-promotion. If uncers are unsuited for promotion, for any reason, they should automatically retire on reaching either an age limit to be laid down, or after 18 years' service. I know that that is done in the case of the Army and the Navy; it automatically operate. I believe if an officer does not reach a certain rank by a certain age he automatically retires at a pre- flotermined age. It would relieve a great deal of congestion, and I think it would make officers much keener. I would like to speak of the dissatisfaction of the Medical Department in its relation to the Administrative, to the Local Government. There is a feeling among the staff that the Medical Depart ment is, by the Local Governments, more or less taken for granted. There is no great interest taken in medical work. It would only be wasting your time if I were to explain to you what medical work has done in the past in developing these Colonies, but may I, just as an illustration, show you exactly what I mean and what a bad impression is created in the minds of the medical men. I have here the Report of Sir Frederick Lugard on the Adminis. tration of Southern Nigeria and Northern, 1912-19, and in it we find 7 pages on native labour, 7 pages on education, on construction generally, on develop- ment of the Colony, a lot of everything except Tropical Medicine in the Medical Department of his Colony. The only reference we find is a short paragraph in 36 which records the appointment of a Director of Medical and Sanitary Services. That is the only thing. I do not think it is necessary for me to emphasise in a report of seven years' work of this nature the unfortunate impression which it makes on the medical services of the Colony.
3323. Sir James Fowler: Is that an annual report? No, Sir, this is a special report on the amalgama- tion of the administrations. I wish, particularly, to bring that forward because I think it shows the great misapprehension which exists. I have marked the paragraph. The Medical Department has, I know, been looked upon as a non-revenue earning depart- ment, as purely a spending department, but that is not true in any manner whatsoever. I have hero a table of estimates for the past seven years, and from it we see that there has been latterly, 1919, no provision commensurate with the extension which we hope will take place in medical equipment and provision gener- ally for treating the natives. To take an instance, the pre-war expenditure on surgical instruments in 1914 was £1,788; in 1919 the provision made was £2,100. If you only take it on the basis of the present value and purchasing power of the sovereign it should be £3,560. It is the same all the way through,
3324. Chairman: Would not one reason for that be the depletion of the medical staff owing to the war; there are fewer medical officers: you would be unable to use so many instruments? No, Sir; the real reason, I know from my own experience at Lagos and the experience of others, is that we have not got the equipment and the money is not forthcoming by the Government. We could spend three times £3,560 in equipping hospitals as they might be equipped; in equipping technique for modern diagnostic methods. The fact I am particularly drawing attention to is that, in 1919 we had opportunities for getting, and did to a limited extent purchase, the surplus material from the War Office. The nation had a great deal left; we could have got about £4,000 worth more if the money had been forthcoming.
3325. Mr. Fiddian: There are the estimates ?-. Drawn up after the Armistice.
3328. Very shortly after? They were drawn up about December, because I saw them in their final Alape in December.
3327. Dr. Hood: There was £10,000 worth of stuff bought from surplus Government stores in East
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[Continued.
Africa? Yes; I had the opportunity of seeing that; most of it was in a condition quite unsuitable for issue; there were no instruments, in that sense, at all. 3328. I disagree with you there; there were some beautiful instruments P-I did not see any.
3329. The head of the Medical Department would send in these estimates not later than September, 1918, would he not ?-Oh, no; they are not made up; I know in Lagos they are not made up.
3330. When does the financial year end, in March or December ?-December 21st.
3331. Chairman: The Head of the Medical Depart- ment must send them in by September.
3332. Dr. Hood: They generally go in in June; they are generally discussed and fixed up by October? -When I left in November we were still making up the indents for Lagos Hospital for medical apparatus. 3333. Chairman: You order the indents for the next year? For 1920, in December.
3334. The amount that was to be spent by the Colony in 1920 would be fixed not later than Septem- ber or October, 1919P-Yes; the total amount to be spent by the Colony in the next year.
3335. The procedure is for each District Medical Officer to send in his estimates to the Principal Medical Officer ? Yes.
3336. The Principal Medical Officer revises them, adds together and sends them on to the Government? -Yes.
3937. The Governor settles the total amount to be spent. Then it comes home to the Secretary of State; then it comes back from the Secretary of Stato either as sent home or revised; then, when you have the Secretary of State's approval, you can indent on the supplies from home?-Exactly, and those indents were sent to the Principal Medical Officer in Decem ber or the end of November.
3328. Quite ao, but they were based on what had been done months before?--Yes, and after the war was over no special warrant was given to increase. It is a very easy matter by a special warrant.
Dr. Hood: All the estimates for drugs and food and instruments were exceeded; a special warrant was issued to cover that
3999. Chairman: Will you go on to your next point? On the question of native nurses and dis- pensers, the class of nurse and the pay which is given them I do not think are very satisfactory. I think we ought to have a better class of men and there is a feeling, of course, I know it is an extremely difficult matter, that we ought not to have a nurse at £90 and make him pensionable; it is an extremely difficult problem. The native nurse is. like ourselves, safeguarded by all the Colonial Regulations, and exactly the same Regulations apply to him. If you want to get rid of him for inefficiency, it is practically an impossibility to get rid of a nurse. I suppose it is an inherent drawback. No large General Hospital at home would tolerate the same condition of service which we have to put up with from these nurses. We get a
nurse on the permanent staff, and no matter how inefficient he is, it is practically im possible to get rid of him under the existing cir-
cumstances,
3340. Do you know how it works in the Royal Army Medical Corps? I am not aware how that difficulty is got over, but, of course, there they are subject to discipline, and in the Royal Army Medical Corps you are dealing with Europeans and not antives, which I think makes a great deal of difference,
3341. You have inefficient men there a well as elsewhere? The facilities for training nurses and dispensers have not been at all good in the past. The training of Government dispensers is practically left in the hands of the Chief Dispenser, a native whose technique and general knowledge is not, think, certainly in the case of Nigeria, up to the modern standard.
3342. Would you have local schools for training dispensers? Yes, I think there should be Govern- mont schools, with a European instructor, for train- ing dispensers.
3343. Would you train for a subordinate medical service; what they call apothecaries and assistant surgeons? On the lines of the Indian Medical Staff? 3344. Yes!--Well, that question has also been con- sidered. The supply of native medical men just now
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