4.5 p.m.
The subject which I wish to bring to the notice of the House on this Adjournment is that of tuberculosis in our African territories, and I want to urge upon the Under-Secretary of State for the Colonies that the problem can be dealt with without the expenditure of a large sum of money, in spite of the difficulties that we have in obtaining sufficient staff and suitable equipment.
I would invite hon. Members to look at the Report entitled "The Colonial Territories" issued a few days ago. The principles I have in mind, and which I want to have accepted, are clearly laid down in that report. On page 91, under the heading "Medical and Health Services" it is clearly stated that there is now recognition of the importance of the preventive approach to medical problems. Over the page, in paragraph 456, there is a description of a conference held last year in London where a paper was read setting forth views as to the most effective methods of raising health standards in Africa. It is clear that the emphasis was laid on the importance of preventive and social measures in a balanced medical policy and, what is perhaps more important, upon the important part which locally-recruited staff and the population itself must play in making such measures fully effective. I think that it is accepted by everyone who has studied the subject that the medical and the ancillary medical staff throughout the Colonies have played a magnificent and vital part in assisting the Colonial Office throughout the world. On the other hand, it is fair to say that the problem I am now discussing is so vast that there has been a temptation to neglect it. It is true that one will be told that surveys are being made as, for example, on the Gold Coast, and that a tuberculosis officer is to go to Nigeria. Surveys of this type in territories where we know full well that tuberculosis is a major killing disease, tend to be a waste of time. It is far better to institute the work immediately. In the process of doing the work itself we are bound to gain as much information as we can get by a series of tuberculin tests or any other kind of survey. The Colonial Office medical services have shown in other parts of the world outside Africa that much can be done quickly and well. Areas are either fully or partly under control in Cyprus, Aden, British Guiana, Trinidad, Jamaica, Fiji and Singapore. I know from a recent report from the medical officer in charge of Singapore, and the report of the General Hospital, there has been over the past nine years an increase in the number of beds available for the treatment of tuberculosis from 72 to 326. That is only the first stage, for it is proposed to fit out and supply a further 500 beds immediately at Tan Tock Seng Hospital in Singapore. The Secretary of State told me the other day in answer to a Question that in Aden the number of beds now available is 100. I understand that four or five years ago there were 10 or 15. Those beds have been prepared very quickly at a cost of only £90 each. There is nothing to prevent our doing in Africa what is now being done so well in other territories. If staffs are sent out to Africa who are trained in and used to British standards and conditions, it is not surprising that they feel overwhelmed by the size of the problem which they meet and the difficulties with which they are faced. There is sometimes a tendency for the almost impossible environmental conditions in Africa to be used as an excuse for saying that nothing can be done in the way of combating tuberculosis unless and until the other environmental problems are solved. I am referring to the housing situation and the extent of malnutrition. My point today—I hope the Under-Secretary will agree with me—is that on no account can we allow it to be said that a vigorous anti-tuberculosis campaign should not be instituted at once irrespective of what may be going on in other directions. The Africans cannot really wait, for they are the most susceptible of all peoples to tuberculosis infection, and, once infected, they have the least chance of recovery unless every care is taken. The difficulties in getting statistical information are very great, and what information one can get is poor and incomplete. Where such information is available, it tends to support the view that surveys are incomplete, that most of the cases which are notified are notified at hospitals, that there is no follow-up afterwards, and that the great majority of cases go back to the towns and villages to die and, in so doing, infect other groups of people over and over again. That makes it all the more important that we should at once institute a very widely spread network of therapeutic measures throughout Africa. If I suggested a remedy, it would be that from every point of view the answer to the problem is to train African medical men in Africa itself. Through its medical section, the Colonial Office has the personnel available to do it. A number of people in the service have had experience of tuberculosis in the tropics, and only such a man could possibly be a director of a training school for teaching the therapeutic measures to be used in Africa. European tuberculosis officers sent out from Britain do not go in order to live there for the rest of their lives—they are birds of passage—and it ought to be accepted that nothing could be wiser than employing men and women who will spend all their lives in the same territory. I ask the Under-Secretary to accept the principle that it is time that we instituted a teaching centre in either East Africa or West Africa to combat tuberculosis and that at that centre African medical men and women from all the African Colonies should be trained, probably by means of an intensive six months' course, under a director with experience of T.B. in the tropics. The kind of unit I have in mind would be based upon a large town having a circle of villages within reasonable distance of it. It would be a type of demonstration area. In view of our experience and of the trends here in Britain, where we are departing from the procedure of having bigger and better sanatoria with more and more chromium plating, the main thing to remember is that we do not have to wait to build an expensive sanatorium before starting work. The evidence from Aden alone is sufficient to show that by improvisation one can rapidly use huts and temporary equipment in order to start work. I think, too, that we should not consider the more advanced surgical technique, such as thoracoplasty, as being an absolute essential. If there be any real meaning in the views given in the report from which I have read, it is prevention we must think of in the first place, and in the second and in the third too. Not that treatment of every kind should not be given but, until a few years ago, we were content and did well in this country with the time-honoured method of treating tuberculosis by means of rest, good food, pneumothorax and the proper use of antibiotics which we now have available. The Under-Secretary may ask where will the money come from to do this? I assert that it may not need a great deal of money, and I think my hon. Friend would agree with me. However, he has the Colonial Development and Welfare Fund to draw upon, and this should be used. No legislation is required. Already during these past few years it is fair to say that the Colonial Office has increased its reputation beyond all recognition. I think it is recognised all over the world, except in quarters not very friendly to us, that with all sincerity we intend to care for our people in the Colonial territories of the world wherever their care falls upon our shoulders. We are most anxious that they should be able to rely upon themselves. It is part of their general education for life, and I ask that we should train Africans in Africa at once in a great centre of the type I have envisaged, so that within three years we can turn out a steady flow of fully trained people. This would indeed enhance our reputation and be a beginning in solving this dreadful problem.4.18 p.m.
I am grateful to the hon. Member for Hanley (Dr. Stross) for raising this subject because it is a most important one, and I am grateful to him also for his interest in this matter, an interest which is enhanced by his professional standing and knowledge. I can assure my hon. Friend that we shall take carefully into account the speech he has made, and we shall try to carry out so far as is practicable some of the suggestions he has put to us. I know that he will not expect me today, in 11 minutes, to try to deal exhaustively with the important speech he has made.
My right hon. Friend the Secretary of State, I myself and the officials both in the Colonial Office and in Africa, have this matter much in mind, and we sympathise with the point of view which the hon. Gentleman has put. In my own case I remember only too clearly 20 years ago speaking to a man who was coughing out his life with tuberculosis in a street in a British Colony where the air was so thick with copra dust that it did not seem to me to be the right sort of atmosphere for anybody, let alone a man suffering from tuberculosis. At that time it appeared that our precautions with regard to tuberculosis were rudimentary. As my hon. Friend said, we have made strides since that time. He has mentioned Singapore and various other places where considerable work has been done. Only this morning I was reading an account of the change in Cyprus, where the death rate is one of the lowest in the world, in fact I think it is lower than in this country. In Aden much good work has been done and in Singapore the tuberculosis service is developing. But these are comparatively small territories and when we consider the vast territories in Africa, differing enormously from one another with scattered populations, poor communications, and low productivity, my hon. Friend will see that the problem, at all events in extent, is far greater than in the comparatively small territories he has mentioned. The problem we have to face is one of control of tuberculosis which, fundamentally, is the same everywhere. It is based on established scientific knowledge but circumstances must vary in individual territories with different cultures, different types of social life, varying economic resources and the like. Our approach therefore must vary, and generalisations are dangerous. We have spent a good deal in money and resources in combating the great killing diseases in the last few years. For example, we have had an all out attack on malaria, and entirely cleared Cyprus of malaria. I wish those Cypriot patriots who are continually inveighing against the British would occasionally give us some credit for some of the things we do. Yellow Fever is nowhere near the peril it was owing to the preventive measures taken and we have attacked sleeping sickness. To some extent the funds and resources available for anti-tuberculosis measures have been made smaller than they might have been, owing to these all out attacks and I think my hon. Friend will agree that that was the proper course to take in the circumstances which presented themselves in these postwar years. There are three main heads to the problem, the statistical—verification of age, sex, racial and geographical distribution—therapeutic and preventive. To deal with this statistical head first, my hon. Friend has said that he thinks surveys are a waste of time in the circumstances. A very elaborate survey might be a waste of time, but there are some surveys, I am informed by the experts in the Colonial Office, which are necessary. Some information is definitely desired and required. Before the campaign can be started, research must be put in hand into the type of disease and into the resistance of the population. I agree with my hon. Friend that, generally speaking, the African is particularly susceptible to tuberculosis infection. It is especially so, of course, in the urban areas. As to the therapeutic side of the question, all methods of treatment known to science are applicable and we shall apply them to the limit of our resources. We believe that the greatest possible contribution to this problem would be in increasing the standard of living—better hygiene, better housing, better nutrition and more education. All this is being put in hand, but the leeway to be made up is very great indeed. Our policy is that we should do everything possible within our resources to make an all out attack on this disease, especially since we have had considerable success in dealing with the killing diseases. We are under difficulties and it is no use my trying to disguise them. First, we cannot recruit members for the specialist staff in the United Kingdom because they are not to be had. We find the greatest difficulty in obtaining from the United Kingdom the trained officers, research workers and the like who have a great knowledge of T.B. But as and when they become available we shall try to secure the services of specialist staff for the Colonial territories. To a large extent, therefore, we have been forced to do what my hon. Friend has suggested we should do, namely to depend upon the Colonial medical service itself and to develop the knowledge and skill of certain members of the service so that they become specialists in the treatment of this disease. That applies to African as well as European doctors. They are brought to this country and put through a specialist course here.It is on this point that we are a little at variance. The view which I take is that to bring them over and to teach them here gives them an education and environment which is essentially false for them when they go back. Because that is so, my plea is that they should be taught in Africa by the best people we can get.
I was not alluding to the vast number of people who will be taught in Africa—the various medical assistants, nurses, and so forth, who have to be taught. I was alluding to the people who will be the specialists in this disease in Africa. I am here in some difficulty. I am not a medical man and I bow to the knowledge of my hon. Friend in that respect, but it has up to now been the opinion of the medical advisers of the Secretary of State that these key men, if I might call them such, should have their training reinforced, so to speak, in this country. I will put my hon. Friend's point to them and see whether they are likely to change their minds.
I do not think I can do more at the moment than assure my hon. Friend that we are not at all satisfied with the present position. We blame no one, we know all the difficulties. Owing to the various reasons which I have given the situation is what it is. In this field as in many others we are not satisfied. Therefore, our feeling in this matter is that we must do everything we possible can to improve the position. In doing that we shall take into account all the relevant circumstances—the speech made by my hon. Friend, the interest which this Debate will undoubtedly arouse in the professional papers, and so on. We shall be only too anxious to put into effect at the earliest possible moment the campaign against tuberculosis, which I hope will have the same success as the campaigns against the killing diseases have already had.Question put, and agreed to.
Adjourned accordingly at Twenty-nine Minutes past Four o'Clock.