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PUBLIC PECORD

OFFICE

Reference -

TILLC.O.882/12

PUBLIC RECORD OFFICE, LONDON

| COPYRIGHT PHOTOGRAPH-NOT TO ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

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Post-mortem and Court work is a normal duty of a local doctor, and there should be nothing in this work which is professionally beyond his competence, except extraordinary cases on which a second opinion can be obtained. It would be a waste of time and travelling money to give this work to one doctor only.

13. The staff therefore which remains for Health work out- side the urban area consists of a Medical Officer of Health for the Plaines Wilhems area, a Sanitary Warden who is supposed to exercise sanitary functions in the Southern Districts, and a Hookworm Specialist whose area of work is the whole island, though he can only deal with a portion of it at any one period. We have also to consider, in view of the Director's scheme, the Government Medical Officer of Plaines Wilhems, who has no hospital but visits the local dispensaries, and has the prison and police work from which we now propose to relieve him, and six Government Medical Officers in charge of country hospitals. We further note as a possible resource the fact that there are two unfilled posts on Rs.7,000-10,000.

Of the value of the Government Medical Officers for ordinary Health work the Director has written in some eminently prac tical paragraphs :—

Unless the rural dweller is given the instruction which will enable him to co-operate with the Health Authority little progress can be made, whatever the Health Authority may attempt. Who is the best person to impart this instruc- tion to him? It must be someone in whom he has trust and preferably to whom he is bound by some tie of grati- tude. It appears that the person most likely to have these qualities is the doctor who attends him when he is ill. The physician is the person best qualified to im- part the necessary instruction, for he not only has the con- fidence of the convalescent patient and his friends, but he has also the opportunity to instruct the patient in the art of keeping well at the time when the patient is in his most receptive mood."

Dr. Kirk's case for using the Medical Officers on sanitary work in their districts has been reinforced by the following observations which we would like to quote from the Government's despatch of 25th July, 1931.*

"The public health work to be carried out in rural areas needs no very special experience or skill on the part of the Medical Officers

what is wanted is the constant presence and supervision of an officer associated in the minds of the people with their cur in times of illness, one, there- fore, whose aid is to be sought in times of trouble and not one who is to be avoided as far as possible whenever he appears. In the more populous urban areas it would not

* C. 84617/31 [No, 1]: not printed.

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be possible for one officer to carry out both medical and sani- tary work, but in rural areas it would have many advantages." We agree in these statements of the human aspect of Health work; we would also point out that these Government Medical Officers are the officers in direct charge of poor relief, they have a personal responsibility for knowing the distressed poor of their districts, they must be in direct contact with them, and should know the circumstances in which they live; it is but a short step from this position to that of personal responsibility for the health conditions of their districts.

!

We strongly support the view that the Government Medical Officers should be employed on Health work, but we have from the first added the proviso that the areas under their administra- tion must not be too large. A doctor who is in charge of a hospital cannot be expected to do effective Health work over a wide area.

14. Stated in its simplest form the problem of Health adminis- tration outside Port Louis is that of using to the best advantage the services of ten Medical Officers, represented by the posts of the Health Officer and Government Medical Officer of Plaines Willems, the Hookworm Officer, the Sanitary Warden, and six Government Medical Officers in charge of hospitals, subject to our proviso that circles must be small and subject also to the principle put forward by Dr. Kirk that malaria and hookworm cannot be adequately controlled through the Health Officers alone, and that the measures for their relief ought to be entrusted to a special officer and his assistant.

It is now time for us to invite attention to the map" which we have prepared. We cannot but think that it would have been advantageous, in the somewhat controversial discussion of this case before the Government, if more reference had been made to the geographical facts which indicate a very simple problem. The map illustrates roughly the areas (shaded) which are covered with woods and heaths, and which contain practically no houses. If we exclude these areas and that of Port Louis and the suburbs which should certainly be controlled by the Health Officer of the town, there remain some 500 square miles which our ten officers must control; the proviso which we lay down that the area of Health administration must be small is not therefore likely to be a practical obstacle.

Dr. Kirk has informed us, however, that no change is needed in the present Health administration of the suburban or township area of Plaines Wilhems or of the sparsely-populated Black River district. He has also stated that the Health Officer can easily visit the few dispensaries in this area-the number of dispensaries in Black River will probably be reduced-and that the post of Government Medical Officer, Plaines Wilhems, is not required. It is in Plaines Wilhems that most of the better classes live, and there are doctors and chemists apart from the Government hospital and dispensaries. We agree that if the post of Government Not reproduced.