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CHAPTER VI.
RECOMMENDATION FOR AN UP-TO-DATE, PUBLIC HEALTHI
ORGANISATION IN HONG KONG.
In judging the needs of a Colony in the matter of a Public Health Service one should look upon such a services as an insurance against sickness and death. Provided Hong Kong is willing to adopt a modern scheme she can have just as much insurance as she is willing to pay for. But she cannot attain the rank achieved by Panama or such cities as Shanghai and Toronto unless she changes her system and provides a staff adequate in numbers and qualifications.
All leading modern authorities are agreed that the fundamentals of Public Health Organisation should be the same all the world over viz.: a division of effort so that there may be one branch for investigation, one for prevention and one for cure, each under its own head and the whole under one co-ordinator, a fully quali- fied Medical man who has had experience with all three branches.
Systems in accordance with the above have been established in Canada, Now Zealand, Australia, Konya, West Africa, the Federated Malay States, the Dutch Indies, the French Colonies, the Philippines, Macao, Shanghai International Settle- ment, and Panama, where they have proved successful. The health system of Can- ton is modelled on these lines and so are those of Nanking, Peking and Greater Shang- hai.
The
It of course stands to reason that the best scheme of organisation will cer- tainly fail if the staff provided be insufficient in quantity or in quality. For some time the Colony has not had a satisfactory Medical Service and one of the principal reasons has been the dearth of suitable recruits. The Federated Malay States was once in the same plight and it remained so until the conditions were bettered same applies to Kenya. Good men will not accept service in Hong Kong when the conditions offered in Malaya, in Kenya and in the West African Colonies are more attractive. Until the status, the authority, the pay. the allowances, the liberty as regards private practice, the leave, the organisation and the chances of promotion are brought up to the level of those colonies Hong Kong cannot expect to compete with them in the matter of attracting recruits and the chances of building up and maintaining a modern public health system are practically nil.
Hong Kong can have a satisfactory senior European service at the market price, she can have a Chinese service also at the market price, but a satisfactory mixed Senior Services is impossible. The Indian Medical Service for commissions in which there was once such competition now attracts few recruits of pure Eur- opean descent and the same would happen here.
ease
But Hong Kong can never hope to recruit satisfactory Medical Officers of Health while the chief administrative post for sanitation and the prevention of dis- reserved for a Cadet. Neither can she hope to recruit suitable Officers for the Medical side when there are no senior billets in surgery, medicine and mid- wifery and what prize posts there are are reserved for University Professors who are not members of the Government Service. It must be evident that no one of any ambition would join if he were aware of the limitations imposed on the service.
Provided there be the right staff, the right conditions, and the right laws, the sanitation of the Colony can be dealt with in much the same way as has proved successful in other cities where Chinese are gathered together. In spite of all that has been said to the contrary there is no difficulty in getting the Chinese to comply with reasonable and just laws of health if the matter he explained in a way they can understand and experience in many places has proved that it is not necessary for the sanitarian himself to be a Chinese scholar in order to get such an understand- ing. A knowledge of Chinese is of course a help, but a training in Sanitary Science is essential.
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Experience in the Dutch East Indies, in Malaya, in French Indo China, in Macao and the philippines has shown that the Chinese have no objection to reason- able laws when they understand them even though these laws be administered by a non-Chinese speaking foreigner. Chinese of standing in Hong Kong admit freely that it is the fear of squeeze and disturbance of family life which makes the coolie class dubious concerning health laws and if their minds can be put at ease on these points there will be little difficulty.
For over fifty years Hong Kong has been legislating for improving its sanitary condition in the hope that such would bring it up to the standard of other first class cities in the civilised world. It is clear that it is still a long way from the desired goal.
Twenty-two years ago the Government saw the key to success in the appoint- ment of a cadet to organise and direct the measures for sanitation and control of infectious disease. In deciding on the policy of placing a layman in charge of a highly technical science it progressed in the opposite direction to that deemed pru- dent by the rest of the world. Twenty-two years has the system been tried and the sanitation to-day is the result.
In an endeavour to explain the want of success the blame has been placed on the Chinese. It is said this and that cannot be done in the manner it is done else- where because Hong Kong is China and no one who has not spent years in studying the Chinese language is competent to understand the situation. If that be the case Hong Kong must continue to have her sanitary destiny decided by English laymen who are Chinese scholars and remain where she is in the matter of public Health
But the Shanghai International Settlement with an area of 8 square miles and population of a million of which nine tenths are Chinese, is in far closer proximity to Chinese territory than is Hong Kong and in a far more difficult position with re- gard to the making of laws and facilities for carrying out health regulations.
In the words of Dr. Noel Davis, the Commissioner of Public Health of Shang- hai "For the last thirty years attempts have been made to institute a code of com- prebensive legislation on Public Health but without success on account of the diffi- culties arising out of the complex political situation" "The Public Health laws are inadequate and out of date"." "The maintenance of Public Health in the Interna- tional Settlement depends largely on mutual arrangements between the Health De- partment and the Medical Practitioners and on the education and co-operation of the people".
In spite of all the difficulties of the situation the Commissioners of Public Health, British Medical men with no pretense of being Chinese scholars, have built up during the last 33 years a Public Health Organisation which has gained universal approbation for its efficiency.
For 33 years this department has carried on on up-to-date principles and far from receiving opposition from the Chinese it has through education and example gained their co-operation.
Dr. Rajchman, Director of the Health Section of the League of Nations, said in his recent report "The Health Commissioner and his predecessors have built up a department in all respects equal to the health department of an average provincial town in England". "The sanitary work of the health department has been partien- larly noteworthy in respect of markets, which it has constructed and organised. slaughter-houses and dairies".
Surely what Shanghai has accomplished Hong Kong can accomplish if there be the will
Proof that this system is applicable to China is the fact that the Chinese Government have already adopted it with success in Greater Shanghai, Nanking. Pek- ing, and Canton, where there are as Public Health Commissioners Chinese Medical men who have been trained in scientific medicine. The Minister of Health and the Vice-Minister are both graduates in Western Medicine.
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