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PUBLIC RECORD OFFICE

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། ། ། ། ། ། wwhfC.O.882/12

PUBLIC RECORD OFFICE, LONDON

| ALLY WITHOUT PERMISSION OF THE

BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH—NOT TO

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Rs.90,000 is spent on local sanitary services in the rural area. There is a skeleton system of quarantine costing Rs.8,248. The Bacteriological Laboratory and specialist posts at present cost Rs.61,415.

The main divisions of expenditure are:-

Direction and stores, costing in round figures, Rs.125,000; Health Services, costing Rs.250,000; and the Hospitals which cost a little more than one million rupees.

2. This heavy expenditure on services so essential as medical relief and sanitary control cannot be questioned in principle, but must demand careful examination in detail. It has already been given close attention by the Governor and the Legislature.

We need not recapitulate the history of the local Medical Com- mission of 1929, or summarize the proposals and counter-proposals which have been produced since that Commission sat, as the com- plete papers have been submitted by the Colonial Government in their despatches Nos. 283 of 25th July* and 297 of 31st July, 1931.† While referring when necessary to the earlier proposals we regard 'these despatches as having already to a large extent determined the questions at issue in the Medical Department, and in the views which we express we are to a very large extent in agreement with them.

3. Three hospitals, the Civil Hospital of Port Louis, the Victoria Hospital near Quatre Bornes, and the Mental Hospital at Beau Bassin are responsible for the greater part of the annual allotment of one million rupees to the hospital branch. In regard to them no major issue can arise; neither their sites nor their buildings are ideal for central hospitals but no change is possible; their superior staff of one superintendent in each case, and two resident doctors for Port Louis and Victoria and one for the Mental Hospital cannot be regarded as excessive, and we certainly concur in the decision of the Government not to entertain the suggestion that no Medical Officer is required for the 600 patients in the Mental Hospital in addition to the Superintendent. The cost of the three hospitals in provisions, fuel, lighting, clothing, bedding, uniforms, and washing is undoubtedly a large item in the budget, but cannot be curtailed, as has been suggested, by a lump deduction based on no data; the only possible check is the test by daily average, and this test is now being made; figures are available for the last quarter and show that the average cost of a patient at the Mental Hospital is 98 cents, at the Victoria Hospital Rs. 1.22 and at the Civil Hospital 88 cents; these figures can more justly be described as surprisingly low than unreasonably high. The estimates can be more carefully watched in future if, as we now recommend, the * C. 84617/31 (No. 1]: ot printed. + C. 84817/31 [No. 2]: not printed.

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items of expenditure both for personal emoluments and for other charges, are shown in the budget in separate groups for the Civil and Victoria Hospitals, respectively, exactly as is already done in the case of the Mental Hospital. We take the opportunity of noting that when the Medical Department pays the Poor Law Department for hospital washing, clothing, and bedding, or the Prison Department for bread, furniture, or other equipment it is quite improper to record these payments as being part of the general revenues of the Colony (Revenue Head IV, items 27, 29, 32, and 33). There is an adjustment between departments, but there is no revenue.

cretion.

We have some evidence that attention is being given to economies in drugs and instruments, though we are not satisfied that the storekeepers' departments are controlled as closely as they should be. But in considering the large allotment of Rs.90,000 for drugs and instruments, we have to remember the isolation of Mauritius and the difficulty of obtaining any new supplies in an emergency. 4. The provision for nurses, servants, and extra staff raises more difficult questions. The Chairman of the 1929 Commission, using a numerical standard, proposed that the number of servants at the Mental Hospital should be 109 instead of 107, 52 at Port Louis instead of 58, and 43 at Victoria instead of 31. This small variation obtained by the application of an arbitrary standard gives us no ground for suggesting that there should be any change, but on such a question, which with the time at our disposal we cannot closely examine, the decision should be left to the Director's dis- We would, however, recommend that the suggestion made in 1929, which the Director was at first disposed to accept, that all servants should be brought on to an incremental scale, the minimum being the present lowest pay and the maximum the present highest pay, should not be adopted. It is quite unusual to put employees of this type on incremental pay-the most obvious example is that of police constables-and the suggestion involves a large increase of cost with no sufficient justification. The Director has already modified his scheme on this point, and agrees with us, 5. There can be no doubt that the nursing staff both in the larger hospitals and in the country hospitals is far smaller than is desirable in the interests of the patients, even taking into con- sideration the fact that owing to social conditions in Mauritius some of what are the normal duties of nurses are placed upon the servants. No authority has recommended any increase in the number of nurses and male attendants at the Mental Hospital, but for the Civil and Victoria Hospitals the Commission recommended 16 nurses and 17 probationers, and 20 male attendants, and the Director states as his minimum requirements 83 nurses and attendants for the two hospitals and 47 for the other institutions. The total number at present employed is only 50 for all other