40
With regard to propaganda, efforts have been spasmodic and scattered.
With regard to cooperation, very little has been achieved, each body working in isolation and knowing nothing of what the others are aiming at or what they have accomplished. A certain amount has been done by the B.M.A. and the C.M.A, but nothing compared to what is possible in this line.
With regard to cure, effort is divided among the Government Medical Depart- ment, the University, the Chinese Hospitals and Dispensaries, the Missionary Hospi- tals and Institutions and the Private Practitioners. Taking into consideration all the beds in the above institutions there is only one bed per 1,000 population, a very There is nothing in the way of an infirmary for chronic cases, no sanitorium and no leper settlement, and the total accommodation for infectious cases is 86 beds, of which 26 are maintained by Government and 60 by the Tung Wah.
The Hong Kong Public Health Organisation is not unlike a fretwork picture puzzle with some of the parts missing. Most of the pieces are somewhere but there is no key and only after very careful study spread over a considerable period does one find the pieces. And when one has found them there is difficulty in putting each in its proper place in the picture for there is no one authority for either coordina- tion or cooperation.
There is far too much division of authority with its consequent overlapping and confusion as to where the responsibility of one begins and the other ends.
The position as it is today is understood by no one and least of all by the Sanitary experts who from time to time visit this port. British, Dutch, Japanese, French and Americans have all condemned our system as one impossible for effi- ciency. It is in many respects that of England in the early Victorian era.
41
CHAPTER V.
THE SYSTEM OF MODERN PUBLIC HEALTH
ORGANISATION.
The care of the Public Health was in the beginning purely a matter of cure of disease or to be nearer the truth the care of the sick.
As knowledge of the causes of disease developed the importance of prevention through attention to the environment became evident-Later as researches in physi- ology, pathology, and bacteriology brought to light the fact that the real cure of disease is effected by the reaction of the cells of the body and that the power of reac- tion depends greatly on the tone and training of the tissues the pendulum swung to- wards the promotion of physical fitness through attention to the individual-Lastly the discovery of insect carriers made the study of their life history essential.
Until quite recently the term Public Health or preventive medicine or state medicine was confined to attention to the environment (including housing, water supply and food supply) and to isolation of cases of infectious disease-The term curative medicine or clinical medicine was applied to the diagnosis and relief of per- sons actually sick from non-epidemic infectious diseases.
Preventive medicine and curative medicine were supposed to be more or less distinct entities. It is becomming more and more evident that cure is part of preven- tion and that Public Health includes both the cure and the prevention of disease.
It is universally admitted that the organisation and control of hospitals. Junatic asylums, and bacteriological laboratories should be in the hands of medical men—– but the opinion that anyone of sense is capable of successfully organising and direct- ing a sanitary service is as common as it is erroneous If the term sanitation be limited to street cleansing, scavenging, and conservanev. any capable man is com- petent to deal with it, but if it be extended to cover the whole field of preventive medicine--including town improvement. housing, water, sewerage, control of food and drugs, school hygiene, maternity and child welfare, factories and workshops, dangerous trades, tuberculosis, malaria. infectious disease and vaccination, it is quite a different matter, and no layman has either the training or knowledge necessary for dealing with it.
In Public Health Organisation as in most other organisations when the issue is involved by a number of departments each working more or less independently but each a part of a whole-there must be delegation of authority-There must be a place for everything and a place for everybody--and it must be laid down clearly and concisely what everything is for and what everyone is responsible for and in order that there may be complete efficiency in the machine there must be heads of departments who are capable of understanding and driving that portion of the ma- chine which is put under their control-and what is most important they must be given the power necessary to do that driving.
Individuals must be grouped into classes, classes into sub-classes and sub- classes into groups, every class, sub-class and group being a harmonious entity in one whole. Where technical knowledge is concerned the head of the class must be one skilled in that particular knowledge and the same remark applies to the sub-classes and groups.
The head of the whole must be one who has practical knowledge of the whole subject and provided he has the necessary organising ability, the more he knows of the details the better will he be able to control the machine and to rectify faults. In any emergency he must be competent to take direct control of any department or group of departments and rearrange the machinery to suit the case.
61
No comments yet.
Private notes are available after approval.