Mr. Speaker, I move—

That the Bill be now read a Third Time.

The Minister has said that the only criticism that has come from us on this side has been that this legislation is not far-reaching enough and that it contains inadequacies. Generally speaking that is correct. However, what he omitted to say was that we regretted that this legislation had not been introduced much sooner. He also said that at the time of the Wafra incident he was criticized for having said that we do not possess the necessary means to prevent pollution, but then went on to admit that that was indeed the case. At the time of the Wafra incident we asked him and we ask him now once more, what he is going to do to provide enough deep-sea tugs for all our harbours in order to enable us to prevent a recurrence of a Wafra incident? Furthermore, what is he going to do to provide an adequate patrol boat service? Is he going to leave this aspect of the matter to other Ministers, to the Minister of Defence and the Minister of Transport for instance? Or is he himself going to set up the necessary machinery? I want to tell him that his attitude to this matter is completely negative in the light of the fact that this Bill only concerns pollution that has already taken place, whereas we on this side of the House want to see measures to prevent the stranding of a tanker, and some of the measures we have suggested will do just that. Under this Bill machinery is being set up to clear up the mess after pollution has taken place.

The Minister also referred to a brochure issued by the Department of Industries, a brochure on oil pollution of our beaches and setting up a code of action. He also referred to the establishment of action committees, the operation of control centres the establishment of technical committees to collaborate with oil companies in research into oil pollution and certain other emergency procedures. But none of these measures are new. As a matter of fact, we heard this too at the time of the Wafra incident, and we have heard it in reply to questions which we have put. What we want from the hon. the Minister is the assurance that this machinery is in operation and is effective, that it is something more than just a paper plan.

The Minister also said that the S.A. Police and the Railway Police would inspect ships to see whether or not pollution is occurring, but where are they going to do this? Are they going to do this in our harbours? The Minister must know that we do not have enough patrol launches, both police patrol launches and others, to carry out such inspection within our territorial waters or within the fishing zone. Does he know how many launches the various Government departments have available? He maintains that the hon. member for Von Brandis has been unrealistic in saying that this legislation was not worth the paper it was written on unless the necessary provision was made for patrol services. But almost with pride in his voice the Minister said: “I do not have the necessary patrol services.” He said it was presumptuous, indeed ludicrous, to suggest that South Africa with a very long coast line, should have such a patrol service because to have one would cost millions and millions of rand and millions more to maintain.

His reaction was: “Ons kan nie vlieg voordat ons kan loop nie. Daarom is dit nie praktiese politiek om voorstelle soos die van die agb. lid vir Von Brandis te maak nie.” He also poured scorn on a suggestion I made that during the Committee Stage it might be possible to introduce, if necessary, a provision to cover a situation where a sinking tanker is taken in tow under a salvage operation. He said to me that mine was a ludicrous suggestion. However, I have looked at this Bill once again more carefully, and what did I find? Quite contrary to my proposition being ludicrous, I found that this particular situation was actually covered in his own Bill, under the definition of “master”. In terms of that definition a “master” seems to include a master of a salvage vessel in control of a tanker whose commander or master had to leave the ship.

The Minister also said that I should never have dared to speak about international conventions. He regarded this as another case of fools rushing in where angels fear to tread. But has he not then read his own ad hoc committee's report, Prof. Mallery’s report? Because this says that South Africa must become a signatory to international conventions concerning oil pollution. The Minister says that because we are not a signatory to any convention it will not help us to provide in this legislation that the boundaries of the prohibited zones should be either 20, 50 or 100 miles from our coast. But when did anyone on this side of the House say that such a provision ought to be in this legislation? What I did say was that over the years I for one pleaded in this House for the Government to extend our territorial waters and our fishery zones and to incorporate within them the continental shelf of our coast.

If the Government had done as I suggested, then these areas would have been included under the definition of a “prohibited zone”. And they would have been far greater than 12 miles. The Minister says that greater claims to sovereignty of one kind or another to the sea would not he internationally recognized, but he says that the present six plus six miles is recognized. Does he not know that in practice most states today claim a 12-mile territorial sea and that this matter was considered at the last International Sea Conference and was lost by only one vote? Since then it has become perfectly obvious in the international sphere that most countries accept a 12-mile limit. And is he not aware of the fact that many countries with rich fishing grounds have expanded their claims to include large areas of the sea for fishing conservation purposes? I refer to the Argentine, Chile, Peru and Equator. All these countries have sufficient national pride to take steps to protect their vital interests, but this Government, which is the Government of the eighth largest fishing nation, is a petrified model of inactivity.

*The Minister singled me out for a vicious, personal attack, something he must obviously have been repressing for weeks, because it had no relation at all to the content of my Second Reading speech. The Minister was simply looking for an opportunity to attack me. In my modest opinion I think this was an error of judgment, because this Bill is concerned with a matter of national interest and not with personalities, and the Opposition offered its support for this measure. This is not the Minister’s first distasteful error of judgment. The case of the Japanese jockey is still fresh in our memories, and we also remember his offensive remarks relating to Jews in South Africa.

Order! The hon. member must come back to the Bill.

Sir, the hon. the Minister attacked me personally by using these words.

That has nothing to do with the matter.

I want to quote the Minister. I want to quote from what the Minister said of me. He said:

Sir, this is very strong language, and I want to challenge the Minister this afternoon to point out any significant misrepresentation in any of the three speeches I made this session on the fishing industry in South Africa. Let him rise on his Vote and tell me personally, not through the mouth of the Deputy Minister, where I went wrong. I am challenging him, this sanctimonious so-called “Cape liberal Nat.” with a petty-minded outlook on life and a sense of inferiority. I am challenging him today to promise that he will do so on his Vote. This morning I sent him the Hansards of my three speeches. He will have an opportunity of studying those speeches and may react to them later on. If he does not, he will be known as a man who not only commits errors of judgment, but who has neither the decency nor the chivalry to correct his faulty statements.

Mr. Speaker, I have so much contempt for the conduct of that hon. member in debates such as this one that I would not even have replied to him had he not made misrepresentations. I shall reply only to his misrepresentations now. He said that I had said we could not deal with pollution on our coasts. This is untrue; it is wrong. On the occasion of the discussion of the Second Reading yesterday, I said I agreed with the statement of the hon. member for South Coast that we would never be able to eliminate the pollution of the sea altogether, and I explained that we would have to expect the stranding of tankers to occur from time to time. If a tanker is stranded and man, with the means he has at his disposal, is unable to pull it from the rocks, one must expect pollution to occur. But our task is to restrict pollution to a minimum, and that is what we are trying to do in terms of this legislation. Sir, we discussed this matter in the Second Reading debate. This legislation empowers us to take certain steps. We have already discussed the question of territorial waters; I have already explained the position. There is no point in bringing in areas under this legislation when we cannot enforce our powers, because the world does not accept them. I have already explained this; it was dealt with in the Second Reading debate, and I do not think the hon. member is worthy of a further reply from me.

Arrogance!

Order!

Motion put and agreed to.

Bill read a Third Time.

ATOMIC ENERGY AMENDMENT BILL

Bill read a Third Time.

ELECTORAL LAWS AMENDMENT BILL(Committee Stage)

Clause 1:

During the Second Reading debate I put certain questions to the hon. the Minister which he was unable to answer yesterday in his reply to the Second Reading debate. I feel that I must put these questions to the hon. the Minister and see whether he is able today to give the information which he was unable to give yesterday during the Second Reading. I dealt with certain aspects which come under clause I. The first point which I raised yesterday, and to which the hon. the Minister could not reply, was when this re-registration which is now to take place in 1972, is likely to take place. I pointed out to the hon. the Minister that there are certain projected municipal elections in particular which are to take place in September of next year. Those elections, if certain legislation is passed in the Cape provincial councils, will be held on the Parliamentary voters’ roll. In the other provinces—this applies in the Transvaal in any case—these elections must be held on the Parliamentary roll. I think it is as well that the public should know that even with the passing of this measure it would appear to be unlikely that a new roll will be available for the 1972 elections: in other words, the present rolls would have to be used for municipal election purposes. Secondly, Sir, I asked the hon. the Minister to give us some indication of the start and completion of this projected re-registration. The date has been brought forward for the reason which he indicated, and that is to allow additional time because of staff difficulties and also because of computerization. Here again I think we would like to know from the hon. the Minister what the timetable is. When is it anticipated that this computerization of the roll will be completed? When will the information be available to the public and to political parties for election purposes? Otherwise the position is going to be that the department will have to run the two systems simultaneously, that is, to establish a manual roll under the old system and to do the computerization at the same time.

A further question which I asked yesterday with regard to computerization was when it was anticipated that the service which is to be offered for a fee, as he indicated, to political parties, that is to say, the service of printing rolls by computer or printing individual voters' cards also by computer, will be available to those interested. Sir, I also requested the hon. the Minister to indicate whether there was to be any change in the forms to be used by enumerators, in other words, whether there would be a simplified form where it is a case of re-registration of an existing voter, as against the full form, the R.V.I, which is used for a new registration. The completion of R.V.Is in every case can be a time-consuming operation, and I asked the hon. the Minister whether it was his intention to try to save time by having existing registered voters complete a shorter form of card. I shall be grateful if the hon. the Minister would indicate to us his views on these points, which are material in so far as this clause we are now considering is concerned.

Mr. Chairman, I have gone into most of these points and I am not quite sure whether I am at one with the hon. member when he says that they all fall under this particular point. Personally, I would prefer to reply to them during the Third Reading debate, as they can then be replied to as matters of principle. Firstly, the hon. member wanted to know whether these rolls would be available next year for the municipal elections. He will realize that this is not possible. We have not decided on a particular starting date yet, but we may decide to introduce the new registration system some time in the second half of next year, in September, even later or earlier. It will therefore not be possible to have these rolls ready for use by the municipalities.

The hon. member will also appreciate that arrangements regarding a timetable are still rather fluid at this stage. It is very difficult to work out a timetable and to give the hon. member an assurance that certain facts and information will be available on certain dates. This is something which will naturally depend on the manpower which is available and on the speed with which this work can be done. I am afraid I cannot go any further than that. Neither can I for example give the hon. member any assurance regarding the question of payment for the printing of forms by computers. The hon. member feels that this question falls under the proposed new subsection (2). This is a matter which has to be investigated further. After all, we are dealing only with broad principles at this stage. The new registration scheme is quite different to that which is in use at the moment and our actions will thus depend upon the result of our investigations. I can, however, give tile hon. member the assurance that whenever information becomes available—information which can be given to the public—we shall do so.

Mr. Chairman, I am amazed at the reply of the hon. the Minister. During the Second Reading debate the hon. member for Green Point raised various matters pertaining to this measure. When the hon. the Minister rose to reply, he said: “I cannot reply now. I shall reply during the Committee Stage.” We are now in the Committee Stage of what is a one-clause Bill. The total content of this Bill is to be found in one clause, and the hon. the Minister stands up and says: “I cannot reply now. I shall rather deal with the matter at the Third Reading.” When we reach the Third Reading, what is the hon. the Minister going to say? Will he say: ‘‘I cannot answer now. I shall deal with the matter in the Other Place.” Sir, we have before us a Bill which asks us to change the date of the general registration from 1973 to 1972.

That is a basic factor.

That is what this House is being asked to do. Therefore we are asking the hon. the Minister: What is your timetable? How do you intend to complete this task by 1972? Sir, these questions are germane to the content of this clause. Then the hon. the Minister says: “I have no timetable; I do not know what I am going to do.” Then we come to the question of cards and the Minister says: “I do not know what we are going to do.” The hon. member for Green Point raised the question of simplified general registration cards to be used for re-registration. The hon. the Minister does not know what he is going to answer on that. What is tile matter of principle that the hon. the Minister will deal with during the Third Reading debate? This is not a long Bill where overlapping clauses have to be discussed. It is a simple one-clause Bill purporting to set out the programme for a general registration motivated by the need to have clean rolls. But what is the use of our passing this Bill if this Bill is to be administered by an hon. Minister who does not know what he will do with it, an hon. Minister who has no programme, who has no plan, who some time will come to us and say that he will now have a general registration? The programme for the general registration is germane to this change of date, because it ties in with all the other factors involved. It ties in with the delimitation which is to follow. It ties in with the supplementary registrations, with how soon the parties will receive the information so that they too can plan their campaign. I am sure that if that hon. Minister’s party had a public relations officer …

Oh, shut up!

Mr. Chairman, I seem to have touched on rather a raw spot. Let me put it this way: If the hon. the Minister were properly advised by his own party, they too would agree that it is desirable to know what programme will be followed. This involves fundamental changes in party planning. Party organizations which work on voters rolls now have to rethink to working on cards. Party organizations which today work on cards, have to rethink and replan in order to fit in with the printed cards which we will get from the department. When a party is planning, it orders its supply of, for instance, voters cards for a year ahead. It will order 100 000 or 200 000 or whatever number it needs.

You do not have so many voters.

That hon. member does not need them, because in his constituency he will not have enough Nationalists to use those cards. But we on this side of the House, need cards. We want to know and we are entitled to ask the hon. the Minister. After all, he is presumed to be in charge of this measure. He is presumed to know that he is asking for a measure which he will administer. I ask the hon. the Minister to get up and show that he understands what this Bill is about and to give the replies to the questions of the hon. member for Green Point.

Mr. Chairman, with respect to the hon. member for Durban Point, if he had listened to my Second Reading speech, he will remember …

I did.

Did you? Then the hon. member will remember that I said that there are only three principles in the whole measure.

Yes, but we are dealing with the details.

Wait a minute. I am replying to the hon. member’s argument. The hon. member mentioned only one of these three principles and did not refer to the other two. What, in fact, did I say to the hon. members? I said that this measure contained three principles and that I discussed these principles with the head of the hon. member’s party. The party agreed to these in toto. Now the hon. member tries to force me into accepting a time table.

We are asking you; that’s all.

I told the hon. member yesterday that at a suitable time I will give him the replies. In fact, I said that I would give it to all three parties as soon as they are available. In respect of this particular matter, the card is very important. This should take about 18 months.

That is the answer.

Now the hon. member can work it out himself. I have also said this afternoon that the registration will probably be started towards the second half of next year, in August or September. Let that hon. member work it out for himself. It all depends on the machinery and on the people we get to do the initial work. It is not possible to tell hon. members in detail whether it will be available on this, that or the other date. The hon. member infers that I do not know what is contained in this Bill. On the contrary, I have spent a great deal of time on this Bill already. But we are only dealing in principle with what is before us. Three matters of principle are mentioned in this Bill. The hon. member did not speak about them yesterday although he was listening to me all afternoon.

I did not need to either.

I explained what the principles were, and I suggested that if the hon. members had anything else they wished to mention they should come and tell me. I said that I was throwing the door open to the parties and that if they wanted to let me know how they felt about it or what they thought about it, they could do so. In fact, they can do so by all means; I am not trying to withhold anything from hon. members. Why should I? One of the hon. members opposite is laughing but this is no laughing matter. In this respect I told the leader of the party, and he called the members together. I told him exactly what this was about; in fact, I gave him the whole script and he read it. He told me that he would tell hon. members what it was all about. Now hon. members want to put questions to me in regard to details which are not available, the time-table and that sort of thing. If the hon. member wants to come back to me in three months’ time I will tell him that we have progressed so far that I am able to tell the hon. members a little more, that in another three months’ time or six months’ time we shall be able to do this, that or the other. We are changing over to a different kind of system. If the hon. member had listened to what I said yesterday, he would have remembered that I said it would take a long time to switch over from the present procedure which is a very unsatisfactory one, to a new one. I told him that the switch-over in itself would be quite a major operation. Matters of this kind are not worked out in detail in the early stages. For that reason I said that I could not commit myself to a specific date. How can I commit myself to saying, for instance, that the 8th of September, 1972, will be the date instead of a date in 1973? All we are doing, is simply to put the matter of an earlier start before the House. I also indicated—in fact I interrupted myself—that I could give the assurance that the question of the non-White registration which is to take place towards the middle and end of 1973, had made this necessary.The hon. member should have listened to what I said, because that was the real reason for starting earlier. All I am asking this House to do in this Bill is to move the date of registration back a year. The hon. members agreed to that. We are in fact, agreeing in principle to three separate matters. Firstly there is to be the de novo system; secondly, we are bringing back the matter of registration for a year and thirdly, we are giving certain rights to magistrates. We are now giving magistrates the right they did not have in the past, which is to register certain votes. Surely, the hon. member should tell me now with what aspect he is not satisfied.

Mr. Chairman, the hon. the Minister referred to discussions which took place before this measure was introduced. I think we must get the record straight. The hon. the Minister, in accordance with normal custom, when we deal with matters in regard to electoral laws, passed a memorandum to the general secretary of our party. The memorandum dealt with what the intention was and it mentioned the three principles concerned. We indicated to the hon. the Minister that those three principles were acceptable and we accepted them during the Second Reading. That is clear. In the committee stage we want to deal with the details. The hon. the Minister knows that his department is spending thousands of rand per month in hiring computers. Does he not know yet what programming can be done in what period of time with the assistance of these computers which are costing the State a mint of money? The hon. the Minister said during the Second Reading that he was asking for this date to come forward because the Department wanted more time for the purpose of enumeration because of the shortage of staff. Surely he did an investigation. The department must surely have made an investigation. He is asking us to bring the date forward so that registration will be completed by a certain time. Are we to accept that his department is doing this work on a hit-and-miss, take-as-long-as- you - like, see - how - quickly - we - can - do - it, basis? Is that how the electoral machinery is to be run in this country? I think the hon. the Minister is not being fair to us on this side of the House and to the country. I also do not think that he is being fair to his department and to his officials, by giving the impression that those men and that department do not know how long this job is likely to take.

We do know.

Let us then know how long the programming is going to take. I want to suggest that if the hon. the Minister cannot tell us the hon. member for Westdene, the information officer, may be able to tell us.

Mr. Chairman, the hon. member for Green Point has raised no new points. Naturally we have a schedule and have worked out how long it will take to complete the work.

Then tell us.

There is nothing secret about it, but it is not before the House at the moment. Why must the department commit itself to some date or another? All we are asking hon. members opposite in good faith is to give us the opportunity to bring back the date of the general registration with one year. That is all we are doing. If we do it with the ability and the machinery available hon. members have no cause for worry. From time to time we will tell hon. members what progress has been made. I said this yesterday.

Will it take 18 months or two years?

If hon. members are interested and if they think it will help them, I can tell them that we may use the R.V.I system. The hon. member for Green Point might know what the R.V.I form is.

We know.

What?

Can the hon. the Minister tell us what this form is?

I have said what I have to say about the matter and if hon. members want to take the matter further they can do so with pleasure during the Third Reading debate. What is the hon. member laughing about? There are thousands of people working in this department and many of them are busy with this work. They must determine what can be done within the broad framework which has been laid down. If the work can be completed within the time laid down, we will surely let hon. members know from time to time what is going on. Why should we not do this?

But you said you already had a schedule?

We have a preliminary schedule which has been laid before me. If I remember correctly this is the way in which all managers of departments work. Surely this draft schedule is not given to everyone in the department. I have the draft schedule with the possible dates by which the work may be completed. We may for instance start with the work in August or on the 7th September, 1972.

Starting with the registration?

Yes, this is the only way in which the work can be done. We hope to have the manpower available during say the first part of September. But surely it will be foolish for me to commit myself at this stage to announce a detailed programme. That is why I gave a rather vague answer. As hon. members have kindly approved of the principles of this measure when it was laid before their party chief, we will go ahead as planned. As far as I know there has been no objection to the subject matter of this Bill. If hon. members have objections they can discuss it with me privately, if they wish to do so. I cannot see why the department should commit itself in regard to the details of the matter in any way. If the hon. member for Durban Point had been on this side of the House and in charge of, inter alia, the general registration of voters I would have liked to see him handle this particular matter in all its details when the Vote is introduced for the first time.

The date is important—especially since the hon. the Minister said that it had to be advanced in order to facilitate computerization—as well as the delimitation which has to follow on that. The delimitation must follow the general registration as soon as possible. That is where a further question arises, namely When will it be possible to prepare the supplementary voters’ list? Is the delimitation going to take place on the basis of the supplementary voters’ list plus the general registration? If one wants computerization and the delimitation to take place simultaneously, one may land in difficulties, as the voters’ lists based on the general registration will be available at such a late stage that it will not be possible for the political parties to get voters on the supplementary voters’ list. That is why the hon. the Minister ought to give us an idea as to whether the delimitation will be based on the first or the second supplementary voters’ list.

I shall help the hon. member further by telling him that he will probably have time to have two supplementary registrations.

Mr. Chairman, the hon. the Minister has given us a date, which is all we asked for in the first place. Once he has given us the starting date, which is September, he will find, if he refers to the law, that the next stages are laid down. It lays down how long for each stage. We can now calculate and work that out.

Now I want to come to another matter of detail to which the hon. the Minister referred. This Bill provides for a new type of general registration, ab initio, with everybody coming off the roll.

De novo.

De novo, all right, I accept that. It will be de novo, a complete fresh roll, everybody filling in a new card. We have asked for a simplified card for those who are registered voters and can show it. That is what the hon. member for Green Point suggested, namely a simplified card, so that a South African citizen who is a voter and has voted all his or her life, does not have to sit there and fill in some 20-odd questions, for example “when did you enter the country?" and so on. This is the form R.V.I. which I assume is what the hon. the Minister referred to as an “R.V.I”. It is the first form in the electoral series. We have asked for a simplified form of re-registration for an existing voter; because in practice tens of thousands of South Africans who are South Africans by normal naturalization before 1948 have now to fill in that card and trace back particulars which in many cases go right back to the turn of the century, and sometimes before.

Oh no, that is nonsense.

Of course it is not wrong. The hon. member for Pretoria District should not become excited. Every South African who entered South Africa before 1948 has to state on that form the date and details of entry into Smith Africa. I have had dozens of cases where one asks “When did you enter South Africa?”, and the answer is “Oh, about 1906”. “How old were you?”—“I was four years old.”

That is nothing.

What is nothing? in every registration, hundreds of people receive notification: “Your form is disallowed because of lack of proof of South African citizenship,” With every election there are hundreds of them. Every one of them means that an official in the electoral office has to query it, fill in a form notifying rejection, address an envelope and post it to the voter. The voter then has to give the answer and post it back. It is a whole series of operations which we believe are avoidable. They are avoidable by the simple formula of having a card stating the name and the address, when previously registered and the voter’s number. This will save all this filling in of a long complicated rigmarole and the queries which arise from it. Sir, this is just plain, practical commonsense, Now we have asked the hon. the Minister about this. We asked him in the Second Reading and we ask him again now. I ask him whether he can reply to this suggestion made by this side of the House. That is one of the practical issues. In principle there is no disagreement. The Minister seemed surprised that there was not a long Second Reading debate, but it was because the Second Reading dealt with the principle which we accepted. But when it comes to the details, we are trying to make constructive proposals. That is why we raise it now at the proper time, in the proper place and in the proper context, with the object of trying to provide better legislation and better administration thereof.

If the hon. member for Durban Point were to read my Hansard of yesterday, he would see that I indicated, when answering the hon. member for Green Point, that I could not reply in detail. But what I did say to him was this. He raised the matter of simplifying the form. He raised two possibilities, the one of people born before 1948 and the other was the question of naturalization. I said to him in reply that I would go into this and see whether I could do so—with the greatest of pleasure—and I repeat this. I said this yesterday, and all the hon. member has done now is to repeat what the hon. member for Green Point said yesterday, on which I gave a reply when I said I would go into this matter.

You said you would answer in the Committee Stage.

That is how you look at it, because you want to infer that I do not know what is going on and that I do not have sufficient information.

I have grave doubts.

I want to suggest that the hon. member be a little more careful in what he says. I gave the reply yesterday. I said that as far as the other matters were concerned, I would go into that. That is the same reply that I gave to the hon. member for Pinelands. I said I would go into those things; I am glad hon. members agree in principle, but they must give us time to sort these filings out; we cannot say offhand whether we will agree to simplifying this particular form. In fact, I said to the hon. member for Green Point that we might be able to leave these new forms, if they become simplified, at places where they are easily available to newcomers or people from overseas. Is the hon. member still listening?

Yes.

I suggested it then, and I am repeating it now, but the hon. member is putting the same questions. My reply in any event remains the same. We will go into this question of the simplified form and I give the assurance that if possible we shall leave them at places where they are easily available.

I should like to know from the hon. the Minister whether he is in a position to furnish us with details and an explanation of what connection there is going to be between the R.V.I, the voters’ list and that computer. The Minister’s predecessor told us that in preparing the new population register, they would feed all the particulars into that computer, and all that would be necessary then, would be to have the voters’ lists printed by that machine. But two sets of information are now going to be required from the voters: firstly, all the particulars on the R.V.I, and, secondly, all the particulars—a duplication thereof—on the population register? Why is not possible to do only one of them, as they planned to do originally? Let them then print the voters’ lists from that population register. To me it definitely seems unnecessary to ask for the same information on two occasions. The hon. the Minister must furnish us with an explanation, for the whole question of manpower is also involved here. It is going to take hundreds or even thousands or people to prepare these voters’ lists, and then again it is going to take hundreds of thousands of people to prepare the population register. Why should this work be duplicated?

I want to reply briefly to the hon. member. The idea is to have two systems initially, i.e. the existing one and the new one, but the two can function side by side. I think this is common logic. After all, if it is our intention to incorporate it in the population register, then it is not wise to abolish the old system immediately and to adopt the attitude that one can introduce one’s new system on a specific day; in order to do the sensible thing, in order to bridge the gap, one is going to have the two systems functioning side by side for a while. As soon as the full particulars have been incorporated in the population register and are available, one may abolish the old system. But that is a matter of detail. I do not think that it will help us to take a decision in that connection this afternoon.

The hon. the Minister implied that I had not listened to his reply yesterday. I think it is only fair that, for the sake of the record, I should quote from the hon. the Minister’s Hansard. I quote—

Then in reference to the cards, the hon. the Minister’s reply was—

Sir, no answer at all to the suggestion of simplified forms; nothing like what the hon. the Minister now says he said. How can the Minister come along in the Committee Stage and say that he said things in reply to the Second Reading which in fact he did not say? Here is his Hansard—the whole three pages. I have read through his Hansard to see whether I have made a mistake. I find that I am absolutely correct and that the hon. the Minister is absolutely wrong. He did not deal with the forms other than to say that forms would be available. He did specifically say that he would go into the matter in his office and that he would deal with these matters in the Committee Stage. That is exactly what we have said and I submit, Sir, that we are within our rights. It is the accepted duty of Parliament to examine any legislation which it is asked to pass. Whether we agree with it or not, is not the point. If we agree with it, there is all the more reason why we as Parliament have the responsibility to examine that legislation and to raise matters of detail in the Committee Stage. That is what we have done; that is our responsibility as members of this House; and that is the responsibility of Parliament. I want to put that on record beyond any shadow of doubt.

Clause put and agreed to.

House Resumed:

Bill reported without amendment

I wish to refer once again to a subject I raised under this Vote last year. Under Head P of this year’s Estimates provision is made for a contribution to the National Cancer Association of South Africa of R200. I have to express my disappointment, Mr. Chairman, at seeing that this amount has remained static for almost seven years. The income which the Government derives from excise duty on cigarette tobacco was estimated last year to be R91 500 000. In this year’s Estimates this figure has increased to R96 000 000—an increase of R4 500 000. Yet the amount allocated to the National Cancer Association, an organization which is doing such wonderful work, is remaining static. I believe there are very few hon. members in this House who have not been made aware of the ravages of cancer and of the distress it can cause.

I want to refer with gratification to Head Q, from which it can be seen that there has been an increase in the contribution to the S.A. Medical Research Council to an amount of almost R250 000. This is pleasing indeed. I can only assume that a certain portion of this amount will be directed to cancer research. I think we can accept that the main cause of lung cancer has been proved beyond doubt, that the issue is no longer in doubt. As a matter of fact, any further research in this connection will only serve to confirm what has already been discovered. Instead efforts should be directed urgently more towards prevention and cure. The hon. the Minister told us last year that at that stage the Government had come to the decision not to bring to the attention of the public the possible detrimental effects of cigarette smoking. Subsequently the hon. the Minister in a letter to me indicated that the Government did not contemplate any official measures against cigarette smoking, not at that juncture. He said his department was aware of the effects of the smoking habit and that the department would continue to bring that to the attention of the public. He also said, and I believe he is perfectly right, that the public must be motivated to change their attitude towards health matters.

Certain matters in regard to health education, he said, were matters of priority. In this connection he referred specifically to problems arising from the abuse of drugs, alcohol and cigarette smoking. The hon. the Minister also advised me that he had appointed a Director of Health Education. I found it gratifying to see in the Estimates, under Head E, that the health publicity and educating work has been allocated an increased amount of R121 000— four times the amount previously allocated. This is indeed gratifying. However, since last year, when the hon. the Minister made this announcement, there have been certain very interesting developments. Firstly, we have had a very positive announcement from President Nixon of the United States in regard to cancer, while on the home front we have had the National Cancer Association instituting a campaign.

The Chamber of Mines has stated its position quite unequivocally. The Chamber of Mines has, I believe, under its control almost half a million people. Not only did it make its position clear, but it is already implementing a plan in connection with the advertisement of cigarette products. The Dental Association of South Africa has also passed a very definite resolution and even more recently a strong and unequivocal resolution was passed by the Federal Council of the S.A. Medical Association. All these are strong opinions, all by responsible people. I should now like to ask the hon. the Minister whether his department, or the Director of Health Education, would give these other bodies support and guidance and whether there is liaison between them and the department. Furthermore, will the department act as a co-ordinating body to see that the best efforts produce good results?

Now I want to come briefly to the question of district surgeons. The hon. member for Newcastle last night referred to some of the difficulties under which district surgeons work. Indeed, we know that as far as part-time district surgeons are concerned there has been a chronic shortage of these people. According to the Estimates the present establishment is 403 and, as far as I know, there has been an increase only of ten during the last eight years. I am talking of part-time district surgeons. Of these 403, 356 receive a drug allowance. Consequently I assume that part of their activities is the provision of drugs and the dispensing and issue of medicine, Is there any reason why greater use should not be made, where such facilities exist, of the services of chemists and druggists in connection with the supply of medicines, medicines ordered by district surgeons? We know that a Government dispensing contract is in existence, so that there can be no administrative or mechanical difficulties when a part-time district surgeon chooses to issue a prescription.

I know the hon. the Minister can come back and tell me that there are many part-time district surgeons operating in areas far from established pharmaceutical services. That is true, but from an analysis I made from advertisements appearing with monotonous regularity in the Government Gazette for the services of part-time district surgeons, with an indication of where a drug allowance is available, it is obvious that in about a quarter of those areas there are in fact established pharmaceutical services. With the advent of the legislation for the tighter control of drugs, I believe there are going to be greater administrative responsibilities. It is apparent from what the hon. member for Newcastle said last night that both part-time and full-time district surgeons are already overworked. If this responsibility could be passed to another responsible profession for them to undertake the administrative problems arising out of that legislation, this would serve at least to relieve the burden on part-time district surgeons. I therefore commend this suggestion to the hon. the Minister and will be interested to learn whether there will be any difficulties of which I am not aware at this stage, difficulties which would preclude a greater use of pharmaceutical services.

In the few minutes left to me I wish to deal with the provision of facilities for drug addicts and alcoholics. Earlier this Session I asked the Minister a question in regard to the amount spent by his department in connection with drug addiction and I was told that persons addicted to drugs were treated in the departmental psychiatric hospitals and out-patients departments. I understand that specific figures could not be available under those circumstances. We know in legislation that has gone through this House recently, the responsibility for providing rehabilitation centres, devolves mainly on the hon. the Minister of Social Welfare and Pensions. The Act makes specific financial provision for that. But in the meantime, there must be a lime lag before the hon. the Minister of Social Welfare and Pensions can pro-vide these very urgently needed facilities for all races.

I wonder whether the hon. the Minister could give us some indication that he is satisfied that at least the institutions under the control of his department, are geared to take the necessary steps to deal with these cases. My information is that there are areas in the country where the facilities are extremely limited. I have had my attention drawn to the area of the Eastern Cape particularly where it is claimed that people who require treatment for alcoholism and for drug abuse usually have to be sent away if they wish to receive the specialized treatment that their case merits. In many cases they have to be sent as far as the Transvaal or to Natal. The hon. the Minister is aware of the increasing importance and urgency of this problem. I hope that he will be able to assure this Committee that adequate steps will be taken by his department to supply the services until the Department of Social Welfare and Pensions is better equipped to take over from his department. [Time expired.]

Mr. Chairman, I do not want to reply to what the hon. member, who has just resumed his seat, said. However, I want to make a few remarks as a result of the announcement the hon. the Minister made yester-day evening about the colouring of margarine. In this connection I want to say that if the object of the colouring of margarine is its enrichment, I could find this acceptable, but if the object is to create a situation in which the consumer cannot distinguish between natural butter and coloured margarine, I must express my doubts about the matter. I hope that pro-vision will be made for this in the legislation.

But I do not actually want to speak about that. I want to say a few words about something that took place in the Medical Association of South Africa to-wards the end of last year. Shortly after the last world war a British Commonwealth Medical Conference was inaugurated, of which South Africa was a member. After several meetings had been held in several countries, it was decided, in 1962, to convert this British Commonwealth Medical Conference into the British Commonwealth Medical Association. South Africa’s Medical Association was also a member of this British Commonwealth Medical Association in 1962, even after the Republic had left the Commonwealth. Thus they remained a member of this British Commonwealth Medical Association until the end of 1970, Then, at a meeting that was held in Singapore, it was proposed that the membership of the Medical Association of South Africa be terminated, together with that of Rhodesia. The reasons advanced for this can actually be summed up if one realizes that the voting there took place in accordance with the usual pattern we have by now become accustomed to, i.e. 13 votes against, with four abstentions. I think that this should serve us as a warning to people who have all kinds of illusions about how they could simply change South Africa’s policy a little and thereby make it acceptable to the world. The fact is that in the Medical Association of South Africa, as in the South African Medical and Dental Council, there are no race differences. In fact, it is not even possible to say how many non-White doctors there are in South Africa today, because these people are regstered with this council on exactly the same register as every other doctor in the country. This meeting proposed that the Medical Association should allow a non-White to become a member of the Federal Council of the Medical Association, or of the Medical and Dental Council as well. Regarded from a philanthropic point of view, very serious objections could be lodged, because this would simply mean that the election of such a council is only being done on a racial basis. It would then be a repetition of what happened when the Cricket Board of Control wanted to prescribe to us what the composition of the cricket team to Australia should be. We would have been is the same position, because if the constitution provides that such a person should have a seat there, he could only do so on a racial basis and no other. Within that association there is at present no objection to a non-White being a member of the federal council of the association. I must then concede that I do not think the chances of that are very good.

They are not very good, statistically speaking. For all that, the Medical Association of South Africa's membership of the Commonwealth Medical Association was terminated on a racial basis. I find this regrettable, particularly since the object of this Commonwealth Medical Association was, and I quote:

1. (1) To promote within the Commonwealth the interests of the medical and the allied sciences and to maintain the honour and the traditions of the profession.
2. (2) To effect the closest possible links between its members.
3. (3) To disseminate news and information of interest.

I find it regrettable that this had to happen. Although it has now happened, I think that it befits us now to make an appeal to the Medical Association of South Africa and the South African medical profession. We must appeal to them not to thereby regard their task as having been completed. In fact, I think that the medical profession is doing a particularly praiseworthy job in Africa. One only has to think of the numerous and at this stage it already amounts to thousands—operations that have been completed with the utmost success in areas outside South Africa. This was done free of charge on the part of the doctors, in terms of a plan that is being encouraged by Dr. Anton Rupert. I think we can be proud of the fact.

I want to advocate here that, as far as the Medical Research Council is concerned, the Government should also make special provision for funds. I want to advocate that the Medical Research Council should also turn its gaze outwards to Africa. Just as the Onderstepoort Veterinary Institute has ventured into Africa, I want to advocate that the Medical Research Council should also extend its hand to Africa. The Medical Association of South Africa and the Medical Research Council of South Africa should continually be proffering aid to Africa. We have already done a great deal in that connection, but I think that we can still do a great deal more. I am thinking of what we did with malaria. However, I am also thinking of what lies ahead for us as far as the combating of bilharzia is conversed. I am also thinking of what is in for us, when it comes to research, in the field of dystrophy. I am also thinking of what lies ahead in the field of cancer research. That South Africa is one of the for most countries in the world in the medical field, I do not need to state here today. I could mention numerous examples of South Africa’s position of leadership in the field of medicine. South Africa’s leadership in this field in Africa is beyond doubt. I believe and hope that the hon. the Minister, the Department of Health and the Medical Research Council will, also direct their steps outwards in this respect and continually extend their helping hand to the countries of Africa in order to help Africa’s less privileged people, people who have been hit even harder by this expulsion.

Mr. Chairman, I want to raise with the hon. the Minister a subject I brought up right at the beginning of this session. It is a subject which I have discussed under other Votes like the Vote of the hon. the Minister of Bantu Administration and Development. This is the question of the widespread malnutrition which presently exists in South Africa. I want to say at once that the Minister's reply to a question which I put on the 5th of February was a very full and detailed one. In it he, inter alia, told me that many steps were being taken to combat malnutrition, and notably kwashiorkor and pellagra, which are the two most widely-known diseases existing amongst Africans, children and adults, in this country. He also said that long-term planning was necessary and I agree entirely with what he said Long-term planning is necessary in order to raise the standards of living of the population so that we will have a reduction in the large families of the very poor. Long-term planning is required as regards family planning itself. Long-term planning is also necessary for education as far as nutrition is concerned, and so on. The overwhelming problem is, however, to combat poverty and in regard to this enormous changes will have to take place in South Africa. There must be an increase in the productivity of the poor, the training and educating of such people and also the removal of restrictions on their productivity. These are matters which fall outside the hon. the Minister’s authority, as indeed do other important matters such as the halting of removal schemes into poverty-stricken Bantu areas where there are no means of employment and where malnutrition is particularly rife. These are all matters which the hon. the Minister will have to discuss with his colleagues in an effort to get some co-operation from them as far as long-term planning is concerned. There arc, however, short-term methods for which the hon. the Minister is responsible and I would like to discuss those very briefly in the short time at my disposal.

First of all it is absolutely true that there has been an improvement over the last year or so. I wish again to give credit to the Department of Health for the efforts which have been made to improve nutrition through the nutritional experts, people like Dr. Erasmus, Dr. Wittman, Dr. Dreyer and others. I know they have been doing a fine job and the mission hospitals, particularly, give them credit in their annual reports for the work which they have done. The hon. the Minister has mentioned that an amount of R150 000 has now been made available for the distribution of skimmed milk powder which is of course a very successful means of attempting to combat kwashiorkor. I want to put it to the hon the Minister that that is not nearly enough. He will have to use his influence with the hon. the Minister of Finance to get a greater allocation of funds, because at present apparently only 19 of the mission hospitals are engaged in the subsidized milk scheme. I do not know how many State hospitals in the Bantu areas are covered by this scheme and I do not think by any means that all the local authorizes are yet participating. This is a very important short-term measure of combating malnutrition. As we know, it costs about R17-17 to cure a case of kwashiorkor. I think it was Dr. Gardner of the Kwashiorkor Home at St. Michael’s Mission who estimated that it costs R17-17 to cure a case of kwashiorkor. That is once the case actually has got kwashiorkor. Preventive measures using the dried milk powder, of course, are much cheaper. But there are still hundreds of cases in South Africa. At all these mission hospitals hundreds of cases are being seen, and it is essential therefore that this scheme be broadened considerably so that South Africa can obtain the benefit of a healthy population. I do not need to tell the hon. the Minister, who is a doctor, that kwashiorkor leaves lasting results. It results in a retarded population. As far as the distribution of skimmed milk powder is concerned, I am sure that will go ahead. There are other methods. I was glad to see that suitable publicity was given to the P.V.M., the new powder which has been developed after seven years of intensive research by the Nutritional Institute. Publicity was given to this in the January issue of baNtu. I think it is a matter of 1 oz a day, which will provide sufficient protein, vitamins and minerals for a child under six, and 2 oz a day for a child of six and up. The cost, I think, is very low. It is about 2½ cents per oz. This, too, would be a tremendously important scheme if the hon. the Minister would undertake it and subsidize it—and I think it should be subsidized—and distribute this very valuable food substance to the very poor people in South Africa. I must say that it is not only among Africans that one finds these deficiencies, but also among Coloured children and Indian children and among White children as well. [Interjections.] Yes, it is not only among the poor, but that is a matter of education, which is a different matter.

There is another scheme which is presently being investigated and the hon. the Minister mentioned it to me in his reply. That is the fortification of maize. I always thought it was possible to fortify maize by adding skimmed milk powder, but apparently it is not so easy. But what has, of course, been demonstrated by the National Nutritional Research Institute is that it is possible to fortify maize with vitamins, particularly with riboflavin and nicotinamide. Apparently this is enormously important in combating pellagra, which of course is largely an adult disease but also affects children as a nutritional disease. I was wondering whether the hon. the Minister could give us any information about assisting in the subsidization of a scheme to fortify maize, which is the staple diet of the very poor in this country. Apparently it is not very difficult as far as the technological side is concerned, and the millers do not appear to be too hostile to the scheme. I am very much hoping that the hon. the Minister this afternoon will give us some information about how far that scheme has progressed and also as far as the distribution of P.V.M. is concerned.

I also want to ask the hon. the Minister whether he intends to make kwashiorkor a notifiable disease again. It was made notifiable in 1962. I admit that the figures and statistics obtained thereby were not entirely reliable, mostly because doctors failed to notify the cases and many of the district surgeons were too busy to do so, but, also in any case doctors only see the very worst cases, which are the cases which arrive at the clinics or the hospitals in an advanced stage of malnutrition. So it does not, give us the whole picture. But it would, if-made notifiable, at least give us a guide? as to how great the problem is in South Africa. As we go ahead with these schemes of skimmed milk powder distribution,. P.V.M. and the fortification of maize, I think it would be very valuable if kwashiorkor, which was removed from the notifiable diseases list in, I think, 1968, was once again made a notifiable disease by the hon. the Minister. I look forward to getting a favourable reply from the hon. the Minister.

This is indeed a unique day when the hon. member for Houghton gets up and gives the hon. the Minister credit for what he has done in regard to malnutrition.

I always give credit where it is deserved.

It is indeed a noteworthy occasion and we appreciate it.

The hon. member for Rosettenville last night accused the Government that for 23 years this Government has seen a gradual deterioration in the general health services of our country and that they have failed year after year to show any sign of planning for the future. This statement is hardly borne out by the facts of the matter, and furthermore, the hon. member did not go to the trouble of substantiating this statement with specific examples. He did quote the case of one hospital in Natal but his allegation was adequately dealt with by the hon. member for Newcastle. Sir, what is the real position? Since 1948 this Government has established no fewer than three training hospitals for doctors—one at Stellenbosch, one at Bloemfontein and one at Durban for non-Whites. A Medical Research Council has been established by this Government in recent years.

*Sir, legislation has been introduced to make it easier for doctors to enter and to practise in this country in cases where there are no reciprocal arrangements between the countries concerned and ours. From 50 to 60 doctors enter the country each year, with or without restrictions as regards practising their profession. Recently the Department of Health was re-organized drastically with a view to rendering a more efficient service, and functionally the department has derived considerable benefit from this. The Monnig Committee was appointed to go into the establishment of more medical schools in the Republic, and it recommended that a medical school be established at Bloemfontein forthwith. The school has been established. Furthermore, it recommended in principle that a medical school be established at R.A.U. and in Natal, and that a Bantu Medical School be established as well. I just want to mention to the hon. member that even now two of the Bantu universities are investigating the establishment of medical faculties at their universities.

But, Sir, we must not make the basic mistake of thinking that the establishment of medical schools for the training of doctors will cause all our problems to disappear like mist before the morning-sun. We must, in the first place, understand that medical schools are expensive undertakings and that we have to take our financial position into account when we talk about the establishment of medical schools. There are however, other factors as well on which the success of a medical school is dependent and to which its success is very closely linked. In the first place, we have to have regard to the fact that suitable human material to be trained in some science or another is not always readily available. There is intense competition between the various scientific disciplines for people to be trained within those specific disciplines. Sir, the availability or otherwise of clinical material and suitable facilities for establishing such a medical school are things which have to be taken into account. In addition regard also has to be had to the availability of lecturers and qualified staff to staff such a medical school. The shortage of staff in the field of medicine cannot he seen as an isolated phenomenon. The situation cannot be viewed in a vacuum, because it is tied up with the manpower position in the country as a whole. It must be judged against the background of the general manpower shortage which is prevailing in this country at present and which is being experienced in every facet of the technological or scientific field.

Sir, with reference to this, I nevertheless want to pose the question whether there is not perhaps a poor distribution of doctors in our country as far as the question of locality is concerned. I do not want to make the statement that there is, in fact, a maldistribution; I am posing the question in order to stimulate an inquiry into this situation- Because in the rural areas, with which I am closely associated, and particularly in the central part of the Karoo, we are finding to an increasing extent that the smaller towns have to do without the services of doctors and particularly of district surgeons. I know of one district surgeon in a district in the central Karoo, who is holding the appointment of district surgeon for no fewer than four districts at present. We cannot say this is simply the result of a shortage of doctors, because there are many factors which determine why a doctor wants to practise in one specific place and not in another. But the Government, least of all, can be held responsible for this situation, because it cannot take a doctor by the scruff of the neck and tell him, “You are going to practise at Hanover, Williston or Hofmeyr.” This is a voluntary service which is rendered, and the Government, least of all, can be held responsible for it. But, Sir, there are also other factors which are responsible for this situation. We are living in the age of specialization. The younger doctors are no longer interested in a general practice, which is exacting, particularly in the rural areas. It makes very high physical and mental demands on the doctor, and our young people are simply not interested in this kind of work anymore. But there is a further factor which has to be taken into account, i.e. the cultural attractions of our larger towns and centres, in which there definitely is no shortage of doctors. After seven years of training and study, young doctors who want to start a family, want to have schools for those children; they want to enjoy sufficient and adequate recreational facilities. For that reason they move to the cities and larger centres, in order to satisfy their cultural needs as well.

A further consideration is the economic factor. It is a known fact that, because of the slump in the rural economy, the means of payment in the rural areas are not as plentiful as they used to be. After seven years of study, and in most cases, after they have incurred study debts amounting to large amounts, these young doctors feel that they would rather settle at places where they are able to pay off those study debts in a short time and where they will be able to make themselves financially independent.

A further factor is that the task of a district surgeon is performed under very difficult circumstances, as my hon. colleague from Newcastle rightly pointed out yesterday evening. It is a day and night job, and one which is far more prosaic than the romance surrounding the work of the surgeon and the specialist in internal diseases. But this is the problem with which we have to contend. Hon. members can see that these factors with which we are faced, are formidable ones which most certainly do not lend themselves readily to obvious solutions. I am of the opinion, however, that the department should rightly give attention to the possibility of appointing district nurses and providing them with vehicles at these places in which district surgeons are not available, nurses who will be able to do a major part of the work which district surgeons are expected to do. Those district nurses may then be placed under the control of a nearby district surgeon and hospital. But a prerequisite will be that these district nurses will have to be provided with vehicles of the combi type, so that they may transport patients, in cases when it is necessary to do so, to the nearest hospital or district surgeon and back. But this situation is also the responsibility of the doctors, and specifically of the Medical Association, which is the mouthpiece of the doctors. It would appear to me as though a fruitful discussion on meeting this problem may take place between the department, the Medical Association and the Health Advisory Council which is to be established. We cannot allow health services in the rural areas to collapse.

Mr. Chairman, as a layman I do not want to interfere with the medical trade union, but I must respond to the proud observation by the hon. member for Cradock, where he threw out his chest and said: “See what we have done! In 23 years we have built two medical schools for Whites.”

How many had you expected—20?

We have a country with a population that has increased to more than 20 million.

Since when?

From now until the end of the century it will eventually mean an increase of a million South Africans a year. The hon. the Minister’s own department has a shortage of 153 medical officers. Boys and girls who want to become doctors cannot gain admission to the present medical schools. I leave it at that for the people to decide whether this Government has really acted as it should have in connection with this problem.

May I put a question to the hon. member?

No, I have only 10 minutes. I want to return to the question of administration.

†I want to put it to the hon. the Minister that perhaps he himself is responsible for some of his own problems of shortage of staff, as a result of the way in which some members of the department have been handled, and the adverse effect this has had on the morale of his department as a whole.

Adverse?

Yes, the adverse effect. I want to start by pointing out that, as part of his new re-organization, including a new secretary of the department, transfers in the department in 1968 numbered two, in 1969 five and in 1970 thirteen. Thirteen senior medical officers were transferred in one year. This happened all over the country and I want to deal with this. The first thing that happened was that there was a re-organization of the head office of the department with the appointment of six directors and deputy directors. Posts were upgraded and everybody had to re-apply for those posts. It is with one of these re-applications that I want to deal, and I hope the hon. the Minister will listen to this. This is the case of a regional director who was transferred from his region— to become an assistant-regional director. Admittedly be did not lose financially through it but he came down from director to assistant-regional director.

You want the reason?

I want to suggest that this man was replaced by an outside person who was an ordinary general practitioner, a man from outside the department. Now, what sort of morale can one have in a department when a regional director is transferred and down-graded and an outsider is brought in to replace him? I am not questioning the ability of the new incumbent. He may be the most able person. The Minister can perhaps tell us because I understand he knows him well, that they were students together. As to this man’s ability, I am therefore not qualified to speak to the same extent as the Minister is. Obviously the Minister knows this man because he nods his head. But I want to ask whether this person who was brought in to replace a permanent officer of the department as regional director, in fact had a diploma in public health when he was appointed. I should also like to know what experience this person has had in public health, whether he was qualified or had any experience in industrial health or in preventive medicine, or whether he was qualified in fact only as a general practitioner? I ask this in view of the fact that he was appointed to take charge of a department of public health. I do not want to mention names, but I am nevertheless anxious to hear the hon. the Minister's explanation.

I do not know whom you are talking about; I do not want you to tell the House because I do not like to deal with individual cases across the floor of the House.

I thought you nodded your head, indicating that you knew who this person was. I deliberately refrained from mentioning this person’s name. However, these are the facts. Let us take the division of industrial health. There three posts are in question. To fill one of these somebody was imported into the department; another one was filled by a person who was not qualified in industrial health, and this was done while there were doctors available who were specializing in industrial health. They, however, were not appointed; others were brought in from outside. I am relating these facts as a background against which one must judge the degree of morale, loyalty and efficiency in the department.

Let me deal with another case, the case of an assistant-regional director who has had 22 years’ service with the department. In this reshuffle he was transferred as a district surgeon. He was a specialist in preventive medicine and he was on the register of specialists. Because he had been in public health for 22 years he wrote to the director stating that he did not consider that he was a suitable person to handle patients due to his lack of clinical experience. He felt it would be unethical of him as a specialist to do general practitioner’s work without previous practical experience. He received a reply which I cannot read in full—I do not have the time. But I want to quote one paragraph of it—

You are a real old gossip-monger.

So, what happens? A specialist is being told that it is not intended to use him as a specialist and that he should take his name off the roll of specialists.

Order! The hon. the Minister must withdraw that expression.

I do so, Mr. Chairman.

He then accepted the post on condition that he did not have to treat people. But he received another letter telling him that in view of his letter he had to admit that he was “onbevoeg” to carry out his duties.

Completely.

The word used is the word “onbevoeg”.

I am telling you now: I do not care what is in the letter. I think it is a shame that you bring personal things of people here instead of coming to my office about it. I cannot give you a reply because if I mention names everybody will know who it is.

I am mentioning no names; I am only giving an example of what I regard as a waste of manpower.

One of them is a complete drunkard and now the hon. member comes along here and seems to expect names to be mentioned.

In connection with this case I have here a file of highly spoken references, references going right through from 1963 to 1370. The point I want to make is that if a person is no good, then deal with him. For instance, sack him or discipline him; do what you have to do with him. Do not, however, appoint him to another position and pay him, as has happened in this case, with public funds for ten months, whilst for ethical reasons he was unable to carry out the duties he was supposed to carry out. Eventually this person applied and received his discharge with full benefits. However, a year had been wasted and public money had been spent. If this is what is happening in the department, if this is what is happening with individuals in the department, is it any wonder then that there are rumblings and grumblings and that there is a shortage of 153 people in the department? I can go on and quote other cases. There are at least two other regional directors who were also transferred and who were superseded by persons junior to them in service.

This is not the Army; it is the Health Department.

See, Mr. Chairman, how sensitive hon. members are. Here I come with facts and hon. members react like this. All they want is a rubber stamp Parliament to say “ja en dankie baas’’ to the Minister. But as soon as anyone dares criticize or raises things which … [Time expired.]

You have not got the guts to criticize.

I had intended replying at the end of the debate to the matters which have been raised here. But I am entering this debate now in order to deal with this pollution which has now entered this debate on Health. I am referring to the conduct of the hon. member for Durban Point. Mr. Chairman, we have re-organized the Department of Health in order to provide South Africa with a more effective service. I may say in all humility that we have succeeded in re-organizing the department to the satisfaction of an overwhelming number of medical men, nurses and all others concerned in health services in the whole of South Africa. Go and ask them. Go and ask doctors who belong to the United Party as well, because this matter has nothing whatsoever to do with politics. Indeed, matters affecting transfers have been dealt with in the re organization in order to bring about greater efficiency. In a department which had not been re-organized for years, one would naturally have people who were misplaced and who could not render efficient service in the positions they were occupying. In the second place, there were persons who had other problems, problems such as those the hon. member for Durban Point perhaps has as well. These are problems I do not want to mention in this House. These are problems in respect of which the Department of Health, in particular, should assist such an official for the sake of his wife and children. Now, the hon. member said we transferred such an official to another position for ten months and that he was being paid with public funds. The hon. member wanted to know why he was not discharged if he was not competent. We do not do such things. We do our utmost, and I am not ashamed to say, with public funds, to help such persons. It is not only we who do this. There are other organizations as well. Take, for example, an organization like lscor, as well as many other organizations. There are many people who, in reality, are not pulling their full weight, but who are being assisted to the utmost. My department will continue doing so. In fact, my department has been instructed to act in this way.

But the hon. member has behaved in a scandalous way. The vast majority of officials are good officials. It is the individual who creates problems for one in a large department. The hon. member knows just as well as I do that I cannot even by approximation refer to where the official is stationed and to what post he occupied In that case it would be possible to deduce his identity immediately. I shall not do that either. I shall not drag the name of the poorest official or even the name of one who has transgressed, across the floor of this House, not for the sake of the hon. member for Durban Point or anybody else. For that reason I am not going into details. But surely, if the hon. member wanted information, he could have come to my office. The hon. member may still come.

But I have it here in black and white.

Yes, in black and white. Bring it to my office in black and white. If the hon. member wants to, he can bring it in red and blue as well. The hon. member may come to my office and question me about every official. I shall recognize the right of the hon. member as a member of this House of Assembly and furnish him with as much as possible of the information I am allowed to divulge, even from the files concerned. This is an invitation. If the hon. member is not satisfied after that, he may come to this House. But now the other method is being employed in order to try to create an impression here. And what is that impression? Did hon. members hear what the hon. member said? The hon. member said that the one person who had been promoted or appointed, had been at university with me. What is the implication of that?

I said you knew his capabilities.

What is the implication? That there was favouritism? I do not know to whom the hon. member was referring. I know of a person I have transferred without promotion, too, and who was also at university with me. It is a person I have known since the days of our childhood, and he is a member of the National Party and not of the United Party.

It does not matter.

It does not matter, but I just want to say that I reject the accusation or the insinuation made by the hon. member with the contempt it deserves.

The hon. member spoke of industrial health and three persons allegedly involved in this. I am not going to discuss that with him either. But despite this unforgivable and distasteful step taken by the hon. member today, my door will remain open to him to come and discuss these matters with me one by one. If the hon. member is still not satisfied after that, he may raise the matters next year in this House.

May I put a question to the hon. the Minister?

No, I am not going to reply to any questions. I am finished with you.

Mr. Chairman, I think the hon. member for Durban Point hit the nail on the head when he said that he was speaking as a layman. As a layman, even I realize what a layman’s knowledge the hon. member has in connection with the establishment of medical faculties. I should like to express a few ideas about a matter which has already frequently been raised in this House and to which the hon. member for Berea also referred, incidentally, i.e. the combating of cancer. It is generally known that apart from heart diseases, cancer is the biggest cause of death among people in developed countries. World experts in the field of cancer claim that one person out of every thousands of the population annually runs the risk of dying from cancer. The seriousness with which the problem of cancer is treated in our country, is reflected in the fact that in 1951—this date is particularly important—a nation-wide congress was held under the chairmanship of the then Minister of Health, the late Dr. Karel Bremer, in order to discuss cancer. At this congress it was decided to collect funds on a large scale in order to set the combating of cancer in motion. And this was done. In 1955 the National Cancer Association of South Africa could organize its activities to supply extensive guidance to all population groups in all four provinces of South Africa.

In addition, this matter occupied the serious attention of doctors during medical congresses, and it occupied the serious attention of Government bodies. Positive action was also taken in the establishment of the necessary facilities for the treatment of cancer. These facilities are today spread throughout the country. Highly specialized manpower and sophisticated equipment has been gathered at strategic centres.

I do not want to elaborate on all the facilities for treatment available in our country today. However, what is of great importance is that the equipment involved in the majority of cases is very expensive and complicated. I just want to mention two examples in order to come to my next statement. The first is the exceptionally expensive equipment which is necessary, for example, to make an effective diagnosis with radio isotopes.

I should like to say more, however, about the second example. A well-known and efficient weapon against cancer is the use of radioactive materials and radiation. The development of increasingly more powerful rays has brought the stronger X-ray therapy apparatus into our country since 1930. Over the past decade phenomenal progress has taken place in the development of even more powerful and better quality radiation as it is now available in high voltage therapy apparatus. But the decision to start a high voltage therapy unit cannot be taken lightly. It requires great capital expenditure on buildings and equipment. In conjunction it also requires the appointment of highly trained and specialized staff that is difficult to obtain. The kind of high voltage therapy apparatus which has been installed in Bloemfontein, for example, i.e. a linear accelerator, is for the moment the only linear accelerator for clinical use on the continent of Africa. Wherever it has been used throughout the world, this apparatus has become an efficient weapon in the fight against cancer. With this apparatus it has become possible to use more powerful radiation which is well defined, the depth of which can be controlled, and which can maintain a high level of performance. There is also the added advantage that now an electron beam has also been made available to doctors, a beam which is particularly efficient in treating superficial cancers without damaging the deeper tissue.

I want to emphasize that the linear accelerator is not the alpha and the omega of cancer treatment. But it can, in many more cases, help to extend the lifespan of the cancer sufferer, which is extremely important to the breadwinner and the mother of a family. It can also help to alleviate the suffering and enable a person to live a productive life in the additional time by which his lifespan is extended.

But to achieve success with the various methods of treatment, it is necessary that research be done intensively and unremittingly. For the medical scientist. South Africa has the advantage of affording him a multi-racial population for research. It is a well-known fact that certain kinds of disease occur more frequently in certain races. Since cancer consists of quite a number of different kinds of disease, there are also quite a number of causal factors in these illnesses. A great deal of research is being done at present to identify the causes. Research has already proved that if the exact cause of cancer can be identified, the disease can be prevented instead of placing the emphasis on its treatment. The National Cancer Association of South Africa gives ample financial support to cancer research. Certain projects are also directly financed by the Medical Research Council. Indirect support is also given by the Medical Research Council in the purchase of clinical equipment that can be used, directly and indirectly, for research purposes.

That is why I want to associate myself with the appeal the hon. the Minister made yesterday with respect to a good balance being maintained in donations for medical research, because it is not only the task of the authorities to provide the facilities. It is also the community’s task to make a contribution in this regard. In cancer research, for example, it would appear that the Republic can make more funds available for epidemiological research, because in South Africa we are rich in the material for this. With epidemiological research we can probably make a unique contribution to the benefit of humanity as a whole. In all cases of cancer, an early cure is the best. An early cure depends on early identification. In fairly recent surveys that were conducted, it was indicated that 46 per cent of all breast cancers in women were completely cured after treatment. If the same number of cases were referred earlier to a doctor, however, and efficient treatment is applied from an early stage, the percentage could be increased from 46 to 81. In the case of mouth cancer about 36 per cent of the cases reported to doctors are cured. However, if there had been earlier reports of these cases, this 36 per cent could have been increased to 65 per cent. [Time expired.]

The hon. member who has just resumed his seat was obviously speaking on a matter which is of great personal concern to him, as it is to the whole of the country. He confined himself to one aspect of research, cancer research. That brings me to an aspect which I wish to discuss with the hon. the Minister this afternoon, and that is the greater involvement of the public with the medical services of our country. I believe that the White Paper on the Schumann Commission's recommendations will prove to be a cause for concern and disappointment to many people in this country. I hope that before the steps indicated by the Government, which it is likely to take in terms of that White Paper, are commenced, the hon. the Minister will perhaps give further thought to some aspects of the matter. I speak as a layman, but I speak as one who has been involved in the administration of some aspects of health services and who still has the privilege of serving on a hospital board. As a layman, looking at this in the light of the contribution which one can make as a general member of the public towards health services, one finds firstly in regard to the recommendations in the White Paper as opposed to the recommendations of the Schumann Commission, that there is a tendency towards action which will curtail public involvement in health services, in institutions and in health research. I will go into a little more detail in this regard in a few minutes. Secondly, I do believe that the recommendations in the White Paper as against the recommendations of the Schumann Commission will not achieve the desired result of facing up to the fact that the existing division of health functions between the various authorities is unsatisfactory and should be rationalized both in the interests of the sick and the economic administration of our health services.

Sir, I want to say before going further that I accept and personally support the commission’s recommendation, which was also accepted by the Government, according to the White Paper, in regard to the establishment of a national health advisory council with the function, as stated in the commission’s report, of formulating a national health policy and co-ordinating the services in the hands of the provinces and other authorities. I also believe that it is correct to have regional health authorities, but unfortunately I find, in looking at The manner in which the Government proposes to implement these recommendations, that the National Council and the regional authorities are to be constituted in such a way and to be given such powers that they negative the whole purpose for which they were recommended by the commission.

Sir, I believe that public involvement is essential. Let me deal with the aspect of regional authorities. The Schumann Commission recommended that those regional authorities should comprise representatives of the local authorities and welfare organizations within a region; in other words, that you bring regional persons interested in the welfare of the community together into this regional authority, under the control of a provincial regional director. Sir, the Minister's attitude, it would appear from the White Paper, is to depart entirely from that principle. The Minister’s concept, according to the White Paper, is that a regional authority will be just another department of State. I must say that I find that statement in the White Paper very hard to accept as reasonable or justified when the explanation in the White Paper for doing this and for the elimination of local representation on the regional authority is that local residents have an effective voice through local authorities in the health services which are provided to them. I want to say to the hon. the Minister that I think that that is too far removed. The hon. the Minister yesterday indicated an enthusiasm to acquire certain capital funds which are available for research and which have been collected in the Peninsula and elsewhere in South Africa. Let me say to him, Sir, that one of the most encouraging features of raising money for the Chris Barnard Fund has been the public feeling of involvement and participation, and the fact that members of the public know that every donation which is made, is retained intact and that only the interest is used for research purposes. In other words, they remain involved. I believe that if the Minister were to proceed to form regional authorities on the basis that is suggested in this White Paper he will be damaging that interest which the public takes.

Sir, the hon. member for Bloemfontein West has talked about cancer. The hon. the Minister knows the predicament in which the cancer patient finds himself when he attends an out-patients’ department. He cannot be hospitalized; he is receiving outpatient treatment for cancer, which causes a visible disfigurement. The hospitals cannot build homes for these people and they cannot provide temporary homes and housing for them while they are visiting the hospital. The province cannot build them and the State does not build them. When the public feel that they are involved in an institution they will come forward to see 7673 that that type of person is properly housed when they are attending a main hospital centre. I do hope that the hon. the Minister will look again at that aspect; that he will not override the recommendations of the Schumann Commission in the constitution of those authorities.

The second point I referred to was the question of the division of responsibility. The partial acceptance and the partial rejection of the recommendations is not really going to improve the position. Let me give hon. members an example. Too many patients and people who are ill feel today that they are shunted around from one authority to another. For instance, if a needy patient undergoes surgery; let us say an amputation, and he needs an artificial limb, the responsibility of the hospital doing the curative work ceases when the amputation has been completed, It is the Department of Social Welfare, in other words, the State’s rehabilitative responsibility to provide the artificial limb. In the case of kwashiorkor, as was brought out by Dr. Clark in his evidence before the Schumann Commission, the authority responsible for curative medicine is unable to hand out the skimmed milk which can prevent or at least check the incidence of this disease. Unfortunately, as I see the recommendations of this White Paper, these problems are not going to be eliminated. Let me refer the hon. the Minister to one aspect. That is in regard to the question of mental hospitals. We have the position that a psychiatrist will be employed by the Central Government and be seconded to provincial hospitals to do psychiatric work in acute cases.

Eventually.

That is what the case is going to be. Where is the treatment to be done? Here we are to retain a division in the curative provincial hospitals for psychiatric treatment and at the same time we are to retain mental hospitals under the Slate. Unfortunately my time is limited and I cannot elaborate further. I want to make an appeal to the hon. the Minister to look again at the recommendations. The hon. the Minister should not let this opportunity of retaining the involvement of the public in their local medical services pass. Everyone who has any connection with any hospital in any part of this country knows of what tremendous value it is to that hospital. [Time expired.]

Mr. Chairman, in part I should like to associate myself with what the hon. member for Green Point said, I would also welcome it if the sympathetic attitude, which has always existed on the part of the public for the furnishing of health services, could be perpetuated and extended. It is only true that many of the health services in the past were done, not only by people who served on hospital boards, but also by voluntary bodies such as the Council for the Care of Epileptics, the Cripple Care Association and other associations organized on similar lines. I agree wholeheartedly with the hon. member for Green Point that it would be a sad day if this sympathetic attitude to the work of the Department of Health were to be adversely affected in any way. However, I want to disagree with the hon. member in his view of it as an inevitable consequence of the recommendations in the White Paper. I specifically read it as being the opposite. As I read it, the possibility exists here that there can be development, on the basis of the experience we gained in the past and the reports that have been handed in, in establishing a complete review of the 1919 Public Health Act This, can be done with due allowance for the role of the public, as the hon. member stated very strongly, and then a scheme could be worked out for the implementation of the objects set out in both the White Paper and in the Schumann Commission’s, report. I want to endorse what the hon. member said by asking the Minister to involve the public as well, as far as this is at all possible in practice, in determining the task of this National Health Advisory Council that is to be established, so that they will retain their interest in this matter. I think it is possible to do so. We have had experience of a body which, unfortunately, perhaps had inherent weaknesses and therefore could not be a success, i.e. the Central Health Services and Hospitals Co-ordinating Council. According to the report of the commission, this council only convened a few times, and therefore had no hope of success. I trust that this new Health Advisory Council will serve its purpose, as set out in the White Paper.

I hope that in the first place there will be a formulation of a uniform national health policy. In recent years, progress has been made in this direction, but I think the time has come for us to give final shape to the most efficient form of control. In his Budget speech the hon. the Minister of Finance announced that the recommendations of the Borckenhagen Committee, in connection with the financial responsibilities of the Government for health services for communicable diseases, are being accepted, and that about R1½ million extra will be voted to local authorities in order to provide these services. I am glad of this and I want to lodge a plea to the effect that this should not merely remain a static figure, but should be increased with the growing needs, if its success is evident, so that the local authorities can also, as in the past, feel that they form part of this large structure of providing health services.

The only comment I want to make on the Schumann Commission and Borckenhagen Committee’s reports, and the White Papers about them, is that I hope that this is not the final word in connection with the regulation of health services as far as this affects the general public. I do not think it was the object of the reports of these commissions to treat fully such intimate circumstances in which people find themselves. This cannot possibly be dealt with properly in such reports. There are, of course, certain things, affecting-the patient, to which attention can be given now that it is proposed soon to have the Public Health Act of 1919 re-written. I am thinking, for examples, of cases where patients of one Government body are sent to another. The hon. member for Green Point also spoke about this, and I hope that this kind of overlapping will be eliminated. I also trust that the personal relationships between patients and doctors will not be damaged, not even in the case of the most indigent persons in this country. I hope that proper health services will not be regarded as alms that are being given to people, but as a necessary service, which is a country’s responsibility to its population as a whole. I should like to leave this point in order to touch upon a second matter which I want, in all humility, to bring to the hon. the Minister’s attention.

The matter I want to raise concerns the high cost of medicine. I do not want to go into the history of the Snyman Commission’s report and the other interim reports submitted, although I think it necessary to refresh our memories. In this commission’s report certain matters are touched upon concerning the high costs of medicines, which is now particularly relevant in connection with our new monetary and fiscal policy. I want to quote from the English version of the report, page 111. It is stated, inter alia—

I should like to focus the hon. the Minister’s attention on this, particularly on the possibility of instituting an investigation into whether these raw materials cannot be found in South Africa. It would be tragic if, in an emergency, when we perhaps cannot import these materials from overseas, diverse channels are to be depended upon to try and obtain them in a roundabout way, for example if the evil day ever dawned—may we be spared that—that boycotts threaten our country. I do not know if there is any improvement in that connection, but I know that our older and indigent people are complaining—and I know that they have reason to complain—about the tremendous increase in the costs of medicine. I think that a little inquiry could profitably be made here.

I conclude by mentioning, in passing, a third small matter. I ask the hon. the Minister’s pardon for this fragmentariness, but one only has one opportunity a year to do this in open debate. The matter concerns the work that is being done by district surgeons in connection with third party insurance claims. I do not know whether it is unfair to level an accusation at the companies undertaking third party insurance, but the position is merely such that, when third party claims are instituted, it is expected that a form should be filled in, the “M.V.A.13—Claim for Compensation in terms of section 11 of Act No. 29 of 1942”. This form must be filled in by doctors in the midst of their pressure of business. They receive no compensation for it. It now appears that district surgeons, in particular, are extremely hesitant when it comes to undertaking the work. One cannot blame them for it. I want to ask the Minister whether it is not possible to reach an agreement with third party insurers that they pay for these services that must be furnished, [Time expired]

Mr. Chairman, I agree with much of what the hon. member for Witbank has said, especially about the cost of drugs. I want to add something to what he has said, I have a cutting here which is quite sensational in its contents. It says here—

It goes on to say that—

Will you pass it on to Wood?

Yes.—

The company says it expects that the pre-tax profit for the full year will not be less than R3 ¾ million.

That was taken by one company from the people who need medicines, and they say that things are getting better all the time!

Last night I spoke about the shortages of medical personnel. I want to come back to it for a moment or two, because it fits in with what the hon. member for Cradock said about medical schools. They tie up with one another. We have two problems. Firstly, there is the inability of the medical schools to accept the students who apply for admission, because of the lack of physical space. The other problem is the lack of young women coming forward into the nursing profession. There are not nearly enough nurses in the hospitals at the moment. My figures may not be right, because I cannot believe that there is such a big discrepancy in the need for nurses, but they reveal that there are 366 nurses short in the General Hospital in Johannesburg. In the H F. Verwoerd Hospital there are 315 nurses short. These are the figures although I do not vouch for them.

In any event, there is a shortage.

Yes. What is important, over and above the nurse shortage, is the empty beds in these hospitals. At the South Rand Hospital 170 beds are vacant, at the Johannesburg General Hospital 86 while in the J. G. Strijdom Hospital 100 beds have been closed. This is because of the nine wards available out of the 27 in the hospital only five can be used. In the Hendrik Verwoerd Hospital 62 beds are unused and 29 in the Krugersdorp Hospital. I want to tie this up with what the hon. member for Cradock said. The position is becoming so critical today, as far as beds are concerned in general hospitals which are also teaching hospitals, that it is quite possible that soon there will not be enough patients for clinical study. This is a matter which needs immediate attention because the shortage of doctors, the shortage of nurses and the empty beds all mean that our people are not getting satisfactory service. Nurses and doctors have to work overtime and let me say to the hon. the Minister in this connection that where doctors and nurses have to work overtime, they ought to be paid for that overtime. I said in this House before but I must repeat it once more, that the demand on medical aid schemes is increasing all the time. People cannot get beds in general hospitals and have to go to nursing homes. These nursing homes are taking nurses away from the general hospitals. I want to pause here for a moment and ask the hon. the Minister whether he has had discussions with the Nursing Homes Association and if so whether he would inform the House how far he has got. We have to do something to restrict this flow of nurses to nursing homes.

Talking about paying nurses for overtime work, I want to ask the Minister to take a lead now to see that the salary gap of medical practitioners working for the State is closed. It is quite unfair that doctors who do the same work and have the same qualifications and the same responsibilities should have such a large differentiation in their pay-packets. A White intern starts with R4 050 per annum, in comparison with R2 520 in the case of a Bantu— a tremendous gap, A Coloured intern gets R2 880. As we go up the scale so the gap becomes larger. A White professor has a fixed scale of RI2 000 per annum, in comparison with R7 800 for a Coloured professor and R7 200 for a Bantu professor. Now, R7 200 is a good salary but there is a discrepancy of almost R5 000 per annum between his salary and that of a White professor, and this between professional people doing the same work, having the same qualifications and carrying the same responsibilities. We cannot go on like this.

In the time still at my disposal I want to say that I am very disappointed with the efforts of the department in combating venereal disease. Last year and the year before I asked the hon. the Minister to set afoot an intensive campaign for the combating of venereal disease. I am unable to find any notices about this disease in those places where one would expect to find them, notices telling persons where they can go for treatment if they have venereal disease; where clinics have been established and what the dangers of this disease are. Those things were, as the Minister knows, publicized 20 years ago. However, all the notices have disappeared. One does not find a notice like that in a public convenience any more, neither in the brochures distributed by the department. It is true that local authorities are responsible for it, but the Minister should give a directive and insist that they do this. What is more, we have to find the staff to do this. I do not know what the hon. the Minister is going to do in this connection and I do not envy him his position. However, he is the head of the department and has therefore to find the ways and means.

Except that I am not responsible for public conveniences.

Yes, but you are responsible for these notices in those conveniences. However, there is another very important matter I should like to bring to the notice of the Minister, i.e. the question of inoculation against German and ordinary measles. I raised this matter already under the Vote Social Welfare when I pointed out that we would save much suffering and millions of rand if we inoculated young girls, teenagers, against German measles. The Minister knows, as well as all of us in this House, that many cases of retardation, deformity, blindness, and deafness are caused through the mother contracting German measles while pregnant. Consequently, I would urge the hon. the Minister to introduce free vaccination for every teenager girl whether at school or at college.

Not compulsory, I take it?

I do not think we ought to make it compulsory. It is infectious, although not so dangerous for the person who contracts it. If we make it compulsory lots of girls will refuse to have it. [Time expired.]

In the course of his speech, the hon. member for Rosettenville spoke, inter alia, about the shortage of nurses. I do not dispute the fact that there are empty beds in some hospitals. However, I shall indicate in a moment why this is the case. For the record, I think it is necessary for me to indicate how fortunate South Africa really is in regard to nursing services. In regard to Whites, the position that we have one nurse for every 166 Whites is an outstanding record of which we may rightly be proud.

Do not be ridiculous.

In America there is one nurse for every 550 people. However, there are reasons why there are empty beds, especially in provincial hospitals. One reason is that private nursing homes in this country—and this is a matter I should like to take up with the hon. the Minister—are luring nurses away from the provincial service by means of very high salaries. I want to Say at once that I am not opposed to there being private nursing homes. I think they are definitely rendering a service. Neither do I want to say that they are not entitled to a good return on their capital investment. However. I think it is morally wrong that people should enrich themselves at the cost of the sick This is what we have against them. I think the prices the public have to pay in these private nursing homes are disproportionate to the service actually rendered there. The big problem is really that these nursing homes do not train nurses. They are simply committing labour piracy against the provincial institutions. This is an important matter, because those provincial institutions render a service to the less well-to-do people of the Republic of South Africa.

The less well-to-do people are being deprived of an essential service as a result of the actions of these private nursing homes. I therefore want to ask the hon. the Minister this afternoon whether the lime has not arrived for serious attention to be given to these private nursing homes. Has the time not arrived for consideration to be given to measures which will prevent nursing homes from luring away essential nurses from those institutions which have trained them, on the scale on which it is taking place at present? There are ways in which this can be done. One of the methods which may be used is forcing these private nursing homes to provide training as well. I think it is perfectly fair to say it is wrong that they should receive the benefit of the trained nurses. Perhaps consideration can also be given to pegging the fees which patients are charged by these nursing homes. If this could be done effectively, I think the tendency of offering very high salaries to nurses in order to lure them away from the provincial institutions, will definitely come to an end. I want to submit a very earnest plea to the hon. the Minister in regard to this matter, so that he may give serious consideration to it.

There is another matter in connection with nurses to which I should like to draw the attention of the hon. the Minister. In South Africa the ratio is that we have one White nurse for every 166 Whites. I repeat that this is an excellent ratio. At the moment there are, in round figures, 9 000 nurses on the register of the Nursing Council who are no longer practising. I think this is an unnecessary waste of good womanpower, if one may term it thus. I wonder whether ways and means cannot be found of attracting these people, who are well-equipped for their task and still reveal so much interest that they retain their registration, back to their profession to a greater extent, so that they may Tender service to their profession, even if it is on a temporary basis.

In conclusion I should like to refer—I think it is appropriate for me to do so— to the first report of the South African Medical Research Council. I think it is appropriate for us to congratulate them on this occasion on the success which has been achieved in a very short time, as borne out in this report, and to wish them strength in pursuing the objects laid down for them in the Act. I think they are following a very good course and that we can expect a great deal to be heard from them in future.

Now I should like to submit a plea that steps should perhaps be taken to incorporate the public to a greater extent in these research projects on which the Medical Research Council is engaged; not only to incorporate them physically, where it is practicable, but that steps should also be taken to encourage institutions to make positive financial contributions in order to help ensure that the work started here will be completed at an accelerated rate, if possible. I think that if this is done, the country will reap the benefit of such action.

The hon. member for Springs dealt with the question of nurses and the ideal number of nurses there should be in the country. This is, of course, a matter which hon. members on this side of the House have raised on a number of occasions, and is one of the reasons why hon. members on this side of the House welcomed the statement that was made by the hon. the Minister on 2nd April, 1971, when he said in a Press statement that facilities and the position as far as nurses were concerned in the private nursing homes should be investigated and the matter should be discussed at a meeting of the Administrators. He also said there should be a comprehensive investigation in connection with tariffs, registration and control of private nursing homes. We on this side of the House welcomed this statement. We believe that the time is well overdue for this matter to receive attention.

There is another matter I should like to mention. That is the Minister’s statement announcing the availability of yellow margarine. I mention this because the hon. the Minister on Wednesday evening, when the Vote came under discussion, announced that his colleague, the hon. the Minister to Agriculture, would be introducing legislation amending the existing legislation which prohibits the manufacture of yellow margarine. This came as a great surprise to many of us on this side of the House, in view of the fact that a question was put to the Minister of Agriculture only the previous day. On the previous day I asked the Minister of Agriculture whether he had given further consideration to permitting the manufacture of yellow margarine and, if so, what steps were contemplated. That was on Tuesday, and the Minister of Agriculture replied that the matter was considered from time to time, but he failed to answer the question as to what steps were contemplated. But the very next day, within 24 hours, the Government announced that they would introduce amending legislation to permit the manufacture of yellow margarine. In asking such a question in the House, one expects to receive an answer giving some indication as to what steps are contemplated. It would appear that in the short space from Tuesday, at approximately 2.15 p.m., until Wednesday at approximately 10.15 am., the decision had been arrived at that steps were being contemplated and we were then told what steps would be taken.

In regard to representations, the Minister replied that he had not recently received any representations, but he failed to mention that on a number of occasions representations had been made by a number of organizations like the National Council for Women, which I know made representations many times. Housewives generally, of course, will welcome this news, and we hope that it will not be long before it will be implemented and that they will be able to purchase yellow margarine, particularly in view of the acute shortage of butter at present.

The other matter which has been discussed very fully during the debate on this Vote was the shortage of nurses and doctors and, indeed, of medical personnel generally. Here I would like to bring to the attention of the hon. the Minister the complete lack of facilities there are in so far as many potential young doctors are concerned in the province of Natal. The whole question of providing facilities for the training of doctors has been sadly neglected. There is no doubt that a vast potential has been lost to this country, and I believe this is a great tragedy. The Minister himself admits that there is a shortage of doctors and, indeed, not long ago a statement was issued whereby an announcement was issued by the Public Service Commission making available bursaries for medical students who previously were entitled to apply for such bursaries after the third year, to apply after the second year so as to augment the ranks of medical officers in tuberculosis, leper, mental and pneumoconiosis hospitals, as well as the number of district surgeons. The situation in the province of Natal today is that there are many hundreds of persons who apply for admission as students to either the Witwatersrand University Medical School or to the University of Cape Town, I understand that this year, although I have not been able to obtain the figures officially due to the fact that the census is only taken on the 1st June, there were some 900 applicants for admission as first-year medical students at the University of Cape Town, of whom only 200 were accepted. A similar position existed in the Transvaal at the Witwatersrand Medical School. Many people from Natal who endeavour to gain admission to the Medical School for the purpose of studying to become doctors find that their whole future is thwarted by the fact that they are unable to gain admission to a medical school where they can receive instruction through the medium of English. Sir, I believe, that this is a tremendous wastage of manpower, and it seems a great pity that the Government has not been able to expedite the provision of the necessary facilities at these Medical Schools so that they will have a greater intake of students. This, of course, is affecting not only the Government’s own hospitals, for which this hon. Minister is responsible, but the provincial hospitals as well. Almost every day one reads in the Press of the tremendous shortage of medical personnel at the various hospitals. As recently as the 20th May, 1971, there was a report dealing with the position at the Umgeni Water Falls Institution, which is a mental hospital for which the hon. the Minister is responsible. It appears that there are only seven sisters at that hospital which has 450 beds. Consequently a large number of non-White nurse-aids have to be employed to assist with the very essential work that is being done at this institution at Howick. Sir, there are many other hospitals which are facing a crisis as far as their medical services are concerned. I think this is the result of neglect in past years in providing sufficient training facilities at the medical schools, particularly at the two English-medium medical schools at the University of Cape Town and the Witwatersrand University. This situation can only deteriorate unless action is taken expeditiously. We know that the Minister of National Education is the person who is mainly responsible for this aspect, but it is the hon. the Minister of Health whose responsibility it is to see that there are adequate health services in the country as a whole. We know that when the hon. the Minister was also Minister of Planning. he appointed the Monnig Committee of Inquiry to investigate facilities at medical schools. Sir, the present shortage is undoubtedly reaching crisis proportions, and it appears that many hospitals are faced with severe difficulties. As far as non-European hospitals are concerned, the hon. member for Newcastle referred to the position in Natal, but he failed to inform the Committee that one of the greatest difficulties is that many of these Bantu hospitals situated in White areas, have been unable to cope with the demands made upon them and have been unable to extend their facilities due to the policy of this Government. The Government insists that these new hospitals should be built in the Bantu homelands. Consequently we have the situation at King Edward VIII hospital, that they sometimes have as many as 2 000 out-patients to attend to during the course of the day in addition to the 2 000 in-patients, with the result that the staff is having to work at tremendous pressure. The situation has reached a crisis point on many occasions, particularly when there was this dispute with regard to doctors’ salaries. They are unable to proceed with extensions to this hospital so as to be able to cope with the increased number of patients, due to the fact that the Government has said that a hospital is to be built at Umlazi. Sir, by the time that hospital at Umlazi is ready for occupation, at least five years will have elapsed. We are faced with a crisis in many of the Bantu hospitals which are situated in White areas and which are unable to carry out extensions which are absolutely essential if these hospitals are not to reach the point of breakdown.

There is another aspect which I should like to raise with the hon. the Minister in the few minutes left at my disposal, namely the position of dental mechanicians. The hon. the Minister is fully aware of the dispute that has arisen between the Dental Association and the South African Council of Dental Mechanicians. This is an occupation that plays a very important part in the dental service to the community. It is a supplementary service to dentistry in that these people are prevented under the Dental Mechanicians Act of 1945 from dealing with the public directly. Consequently, they are fully in the hands of the dental profession as a recent court case indicated. The protection which they thought they had in terms of the 1945 Act, in fact does not exist. Today these people are receiving an amount of only R14-95 from a dentist for the manufacture of lower and upper dentures, whereas the dentists ask R74 in medical aid cases. [Time expired.]

Mr. Chairman, the hon. member for Turffontein as well as a few other speakers who participated in this debate, referred to the training of doctors. It would appear that they want to hold the Government responsible for there not being sufficient facilities for the training of doctors. I just want to point out that the Government has in fact established adequate hospital facilities. It is as a result of a shortage of clinical material that the teaching hospitals cannot train any more doctors. One finds the clinical material in the provincial hospitals. But now we find that many wards in the provincial hospitals have been closed and that there are hundreds of empty beds as a result of a shortage of nursing staff. I want to support the hon. member for Springs in his appeal that the hon. the Minister should take positive action against the private hospitals which are luring the trained nursing staff away from the provincial hospitals and in this way preventing the public of South Africa from receiving good medical attention at reasonable charges. Patients in private hospitals are charged at least twice as much as those in provincial hospitals.

In addition, I want to ask the hon. the Minister whether it would not perhaps be possible for more clinical material to be made available to these teaching universities by persuading some of the patients belonging to medical aid schemes to make themselves available as clinical material for the training of students. I do not know how it would be possible to do this, because they are regarded as private patients, hut perhaps in consultation with these institutions one would be able to obtain the right to use such patients for the training of doctors.

Furthermore, I just want to refer to another matter which has already been touched upon here a few times. This is the announcement made by the hon. the Minister yesterday evening, namely that the Government had decided to allow margarine to be marketed in a yellow form. It has been erroneously stated that yellow margarine can be manufactured. The position is that margarine is in fact yellow in its natural form and that it has to be bleached in terms of the Act. It will now he possible to make margarine available to the public in its more natural form.

Does it not need any colouring?

No, it does not need much colouring, because in its natural form it is considerably yellower. In the form in which it is marketed today, it has been bleached. I do not think it is necessary for me to make representations on behalf of the dairy farmers or the oilseed farmers. This is a matter which quite possibly has already been considered by the Government and by the Minister of Agriculture. I have always regarded it as unfair that we should import butter to the value of almost R5 million annually, while the oilseed farmers have to send one mission after another overseas in order to find markets for their products. Now margarine will perhaps become more popular, which may result in less butter having to be imported. I welcome this decision from the health and medical point of view, because we know that vegetable oil such as margarine does not produce the same cholesterol content in the human body that animal fats do. The Government is therefore making a welcome concession to heart patients.

I also want to refer briefly to the report of the Borckenhagen Commission. It recommended that a national health advisory council be established. I only hope that this will not be limited to a national health advisory council, because I feel there should be better co-ordination of medical services in the country. This is absolutely essential. If this were to happen, we would not have the same difficulties as we are experiencing today. For example, we know that the Minister and his Health Department have now introduced the hospital-centric system of medical services in the homelands. The position there is much better than here in the Republic. There the hospital services are rendered from a hospital where one authority is responsible for rendering clinical services, home visits and immunization. In the Republic immunization, for example, is done by a local authority as well as by the district surgeon. It is quite unnecessary that immunization should be done at two places.

I again want to refer to our friend the dairy farmer. If he supplies milk to three towns, he must apply to the health officers of the three towns for a certificate allowing him to supply milk in each of the different towns. This cumbersome procedure can be eliminated. We know that the hon. the Minister is experiencing difficulty in obtaining district surgeons. Why cannot the same authority of one town or of a few towns surrounding it control all the services, the hospitalization of the patient and the outside treatment of the patient in the clime or at his home? I do not think our country can afford this overlapping of health services in respect of the care of our patients any longer. I think that if we could combine these, it would be to the benefit of not only the patients, but also the Government and everyone concerned in the matter.

Mr. Chairman, I want to begin with what the hon. member for Springs said. I shall reply to the last matter he raised in the course of my reply to other speakers because it is a very important matter. The hon. member also spoke about margarine. If my information is correct, it is cream-coloured. All that will happen now is that the prohibition on the manufacture, marketing and import of coloured margarine will now be lifted.

The hon. members for Geduld, Umbilo, Rosettenville and Springs, raised the matter of the shortage of nurses. There is no doubt that there is a shortage. There are empty beds in provincial hospitals as a result of this shortage. However, this does not only apply to provincial hospitals. My information is that in private hospitals, as in those on the Witwatersrand, up to 25 per cent of the beds are empty as a result of this shortage of nurses.

Is it not perhaps that the people are so healthy?

No, but perhaps too many hospital beds are being made available in South Africa without making certain that the necessary staff is available to cope with all the patients. But I have had talks with the Private Hospitals Association, and also with the four Administrators. I am in the difficult position that I cannot at the moment make a report to this House on that matter because all four Administrators undertook to discuss this and other matters at length with their executive committees, and then report to me. We shall then see whether we cannot find a solution to this problem, or at least take some action. These talks took place about three weeks ago.

The hon. members for Geduld, Umbilo, Rosettenville and Springs also raised the question of the shortage of clinical material in our training hospitals. I can inform hon. members that this fact is a cause of great concern to our medical schools and the Department, because the number of medical fund patients in hospitals has increased so tremendously. A medical fund patient is of course a private patient and is usually not available as clinical material for the training of students. But I can give hon. members the assurance that we, together with the authorities in question, are considering this matter. Attention is being given to this matter, particularly in the case of the new medical school at Bloemfontein, to see whether we cannot possibly make more patients available. This is quite a major problem at the University of Stellenbosch as well.

The hon. member for Umbilo also expressed his amazement at having received a reply on Thursday in regard to margarine which indicated that this matter was receiving attention from time to time, and so on. The simple reply is that the decision that margarine in the yellow form may in fact be marketed, was taken after he had received his reply, in other words, yesterday morning.

The hon. member also said that we were losing many potential young doctors. There is no doubt that this is true, but it applies to both Afrikaans and English-speaking students. There are large numbers of Afrikaans and English-speaking students who would like to receive medical training, but who are simply unable to obtain admission to a medical school. But I do not think we should use words like “neglect” and “crisis" so easily. It is just not possible for a country like South Africa, under the good Government it now has or under a poor one it used to have, to insure the expenses of training all those people. We must accept that. This is an old figure, but I want to mention that it costs more than RI2 000 to train one medical student. Since then this amount has probably doubted. In other words, it is a question of finances on the one hand and on the other hand a question of the availability of clinical material. In the third place, and this is very important, there is still the question of the availability of lecturers of whom there is a dire shortage in South Africa.

If you pay them better, you will get them.

I am not aware of any people in South Africa who would like to give training and who do not do so because of the salary being offered. If the hon. member would help me to persuade the Minister of Finance to impose heavier taxes, we could perhaps do that.

The hon. member for Springs raised the question of private nursing homes. I can give him the assurance that we are looking into this matter, in conjunction with the Administrators. What the solution is I do not know, but it seems to me that the private nursing homes will have to play a part in the training of nurses. To me it appears to be quite wrong that if there are empty beds in general hospitals, up to 25 per cent of the total number in some cases, as the Association told me … [Interjections.] They said they are phoning doctors in Johannesburg to send their patients there, because 25 per cent of their beds are empty. I have to believe that.

That is because they keep them for surgical cases.

Anyway, the point is, that if there are empty beds. I cannot see why new buildings should go up for the purpose of hospitalization.

They keep them for surgical patients.

Well, that may be so.

*As I have said, I do not know what the solution is, but this matter is at present receiving consideration.

The hon. member for Rosettenville raised the question of German measles. We shall give this matter very serious consideration. I do not think we can make it compulsory, but it is true that with information services it could probably be brought to the attention of the public to a very large extent. The same applies to venereal diseases. I do not go to these places often, but I have been informed that there are in fact notices in the public cloakrooms, in Cape Town at any rate. Someone has just sent me a note—I think the hon. member should walk down here to the Parade. A very satisfactory notice has been put up in the cloakroom there. Now, I cannot accept that the Cape Town City Council would put up a notice in one cloakroom only.

The hon. member for Rosettenville also asked questions in regard to overtime and extra sessions for nurses, as well as the difference in the salaries of White and non-White nurses and doctors. I expect my colleague, the Minister of the Interior, who is responsible for this, to make an announcement in regard to nurses and the specific payment for overtime or extra sessions within the foreseeable future. As far as I know, he has not yet made the announcement. I do not want to go into the history of the difference in the salaries of Whites and non-Whites, but the entire matter does not only relate to doctors and nurses. It involves teachers and all the professional groups as well. This entire matter has been referred to the Public Service Commission. It must return to the Cabinet so that we can see what to do about this matter. Let me make it very clear now that the point of departure is that the gap should become narrower, and not wider. To rectify this immediately, is simply not practical. If I were to tell hon. members that this would be done, I would be wrong. I can say this on behalf of the Government—I think it has been said before by the Minister or the Deputy Minister of Coloured Affairs— the point of departure is that the gap should become narrower and not wider.

The hon. member for Witbank referred to the high cost of medicine and said that our elderly people in particular were having a hard time of it. That is so, but our indigent elderly people can of course get their medicine free of charge. This is general knowledge—I am simply saying it again. The hon. member for Rosettenville also read out some information here to show how profitable it is to be in the pharmaceutical wholesale trade. I do not know whether that is true.

The hon. member for Witbank raised a very important point, to which we shall certainly have to give attention. He asked whether we could not manufacture the raw materials in South Africa, or at least make sure that we will have them in a time of emergency. In this connection I should just like to point out how dependent we are, which is one of the reasons why the price of medicine has increased so tremendously. I have here in my hand the cost of raw materials which are being imported. Hon. members will appreciate that neither the Government nor the pharmacists have any control over the cost of raw material being imported. One is absolutely dependent on the overseas price, and one must have these materials in order to manufacture medicines properly. During the last six months, from December, 1969, to July, 1970, the prices of certain commodities increased as follows:

This is how the overseas prices have increased over a period of six months. I am just mentioning this to indicate what the position is. Buchu leaves, which all of us know, increased from R4-78 to R5-73, while cardamons increased from R8-26 to R13-33. Here are further examples of price increases:

hon. members will know that any stomach medicine which does not contain a little peppermint, does not mean a thing. Actually, I must not say that it does not mean a thing, but it is of course better if it does contain peppermint. These are astonishing figures, and I have just mentioned them now to indicate how important a point the hon. member for Witbank raised when he spoke about raw materials used for the manufacture of medicines.

The hon. member for Witbank also expressed the hope that the indications in the White Papers on the Borckenhagen and Schumann reports would not be the last word in regard to the medical profession. It will most certainly not be the last word, because we are dealing here with a living organism, It just want to indicate to hon. members how the entire matter has, in my opinion, undergone a change for the better. At present approximately 60 per cent of all White South Africans are making use of medical insurance. Approximately 20 per cent of the Whites are indigent, whom we must look after in any case. Then there are 5 per cent that belong to the top group, and who are therefore of no significance here, because they look after themselves. This is therefore a grand total of 85 per cent. Only 15 per cent of our White population is not therefore covered by some or other form of medical insurance. I think that we should make it clear to that 15 per cent how essential it is for them to obtain medical insurance, for that is what is best for the whole family.

There is a further point I want to mention, arising from the hon. member’s request. Hon. members will appreciate that as soon as the percentage of persons who are covered by medical funds begin to increase, the 20 per cent for whom the State is responsible will begin to diminish for they are of course covered until the day they die. This is also in the interests of doctors, and for their sake I emphasize the fact that the percentage of patients who enjoy medical cover will be higher in future than in the past. Thus I consider it to be my duty to make another serious appeal to all doctors and dentists today who have contracted out. Unless their practice is of such a nature that they cannot do so, they must return and contract back again, because it is in their own interests as well as in the interests of the public of South Africa.

Sir, may I ask the hon. the Minister a question? There are some of these medical aid associations which have not yet adjusted their tariffs to those of the Central Council, and who are not yet doing their duty. Could the Minister not also make a similar appeal to them?

Such an appeal has already been made. I endorse the hon. member’s point. But I want to add that it is in the hands of the doctor and the patient. If there are such cases they must bring them to the attention of the Central Council for Medical Schemes immediately, because that Council has full power to take action in that regard.

The hon. member, as well as the hon. member for Green Point, mentioned compensation to local authorities. The fact of the matter is of course that provision for that, and for other things I do not want to go into now, is also being made in the White Paper, but I may just say that in the General Law Amendment Act which is being dealt with by my colleague, the hon. the Minister of Justice, there will also be a clause to make it possible for the full amount to be paid to local authorities.

The hon. member then raised the question of the revision of the Public Health Act of 1919. Not only is it being revised, but it is being consolidated as well, and of course the matters arising out of the White Paper will be incorporated therein. My Department undertook to have the consolidated and revised law ready for the 1972 session. However, I want to say to the House, and this is something I also said to my Department, that I would welcome it if it could be ready, but I do not want to give an undertaking to that effect, because to me it seems like a major task, particularly the translation from the High Dutch, which will be very difficult to have ready for the 1972 session. But this is the goal the Department has set itself.

The hon. member referred to the consolidation of the good relationships with and the work of the public, and this linked up with what the hon. member for Green Point said, I know that both of them speak with authority on this matter because they were for years personally and intimately involved in it. Now I want to say this. It is also the point of departure of the Department and myself, and I attach a different interpretation to the White Paper than the hon. member for Green Point, that we should not exclude the public to an increasing extent from welfare work, but should utilize them to an ever increasing extent. I also think it is fitting that we express a word of thanks here for the extremely good work, work which could not possibly have been done by the Government and provincial bodies, and which is being done by voluntary workers throughout South Africa. I may just say that the greater participation on the part of the public is being emphasized in the policy we are applying in the homelands. In the take-over of the financial responsibility by Bantu Administration, and the administrative responsibility by the Department of Health we did not exclude the church societies and the mission societies, and I want to give them the assurance again today that we welcome their participation. The only condition is that there must be absolute supervision and control. We are talking about mission hospitals in the homelands. There are 146 of them, but I do not know how many hon. members know that the name “mission hospitals”, in view of the expenditure, the cost borne, is a complete misnomer. The valued administration, which has to be continued, is in fact the task of the mission society, but the costs attached to that hospital are borne in full by the State. There is no contribution whatsoever by the mission society, and in the few cases where there is a contribution, it is of a minimal nature. I think we must take absolute cognizance of the fact that the continued functioning of all mission hospitals in South Africa is made financially possible, in full, by the Government, and it is that financial control which my Department and I are now exercising.

The hon. member for Green Point said that he agreed with many matters stated in the White Paper, and he must surely agree with the National Health Advisory Board.

The powers …?

Yes, the powers are his problem. Now I want to ask the hon. member as a person who takes a great interest in these matters, whether he would do me the favour of thinking about these matters again, because we will have to discuss them. We shall introduce legislation and perhaps we shall come to view these matters in a different light. As the hon. member correctly said, establishing a national health policy is not worth the paper it is written on if one does not have an authority at one point to ensure that that policy is carried out. It will not be vested with the power of the Medes and the Persians. According to the proposals it will be an advisory board only, but the authority to implement it will ultimately be vested in the Minister of Health. The method of implementing this will of course be by having full consultation with the various Administrators. But if there is no body of authority, and this I want to say to the hon. member in a very friendly spirit, we are back in 1946 and we are once again starting something which simply will not work. I also agree with the hon. member that one of the perturbing aspects is that patients are sent from Pontius to Pilate, Our entire point of departure in the White Paper—and if the hon. member can help me with this, I would welcome it—is in fact to simplify this matter as much as possible and to solve this problem.

The hon. member for Bloemfontein East raised the very important matter of cancer here. The hon. member spoke with authority and knowledge because he was for many years a member of the Central Health Services and Hospitals Co-ordinating Council. He was for a long time a member of the Executive Committee to which hospital services in the Orange Free State had been entrusted, and what he said here was absolutely true. He also referred her to the linear accelerator in Bloemfontein, and the tremendous costs attached to this apparatus required for the treatment of cancer. I just want to add to what he said that we will have to centralize as far as these matters are concerned. I see it as one of the major functions of this National Health Advisory Council to consult in regard to these matters and to make the necessary recommendation to the Administrators and to me. We cannot, in view of the fact that costs have soared, create every facility everywhere and at every medical school.

The hon. member mentioned another point which I should just like to endorse, and once again I hope that this will be publicized for our newspapers. Cancer is today one of the most dreaded diseases, but it is no longer the dreaded disease it used to be, because the success achieved with treatment, provided the case is discovered at an early stage, is absolutely astounding. It is not Simply a question of a cure; it is either a full cure, or a prolonging, sometimes by many years, of the patient’s span of life or, in the last instance, a great alleviation of the suffering. But the gist of the whole matter, as the hon. member rightly said, is the early discovery of such a case. He also spoke about epidemiological research. This could be done and would receive great support if we could have a national cancer register. This is one of the matters to which my Department is giving its attention.

The hon. member for Cradock also discussed the availability of doctors here. At the medical congress which has just been held I brought this matter very clearly to the attention of my colleagues. In fact, I did not only do so in my opening speech. I also did so in talks we held over a period of several days. I may just say in passing that it was probably one of the most successful medical congresses we have ever held in South Africa. The whole analysis by the hon. member of the situation in regard to the availability of doctors and the distribution of our doctors was such a correct diagnosis that there is nothing I want to add to it. That is actually what I conveyed at the medical congress.

He also discussed the matter of district sisters here and placed emphasis on the transport which should be available for them. It is true; we are already utilizing district nurses in a supplementary capacity to our district surgeons. The problem of course is not as simple as that. If we have a hospital-centric service, as we have in the Bantu homelands, then this entire situation is so much easier to solve and handle. This matter which the hon. member raised is one of the matters which the Health Advisory Council will in fact have to give thorough consideration to, because it applies to the entire country.

The hon. member for Houghton was careful in her speech. She spoke mainly about malnutrition here, and I am grateful to her for specifically speaking of malnutrition and not of starvation, because it is an unpardonable thing to speak of starvation, not that it does not happen in isolated cases. But reports such as the one which appeared in the Star, a South African newspaper, i.e. Dark shadow of starvation, plays into peoples’ hands and leads to the kind of film which is being exhibited in the United Kingdom, the title of which was Death Sentence for Africans. I repeat, I am grateful to the hon. member for choosing her words carefully in discussing this subject. I want to advise her to visit the Bantu homelands herself in order to see under what circumstances those hospitals are operating. Let me say at once that it is not just a question of more money. It does not merely involve income, although poverty is a factor. I think I have every right to say that as far as South Africa’s non-White populations as well as the White population are concerned, although one of the causes of malnutrition is in fact poverty, it is by no means a cause to the same extent as it is in any other comparable country in Africa, In the second place I want to say that I doubt very much whether poverty is a very great factor. I am saying this from my own experience, and I now want to mention a few examples. I visited the homelands myself. The hospital at Kuruman was, for example, in the news recently, but One must just go and speak to the matron there. The matron is an Englishwoman with a great deal of experience and with good training. As far as the administrative side is concerned, she is one of the best matrons I have ever come across in my life. The hospital there is situated very close to the town, but an interesting fact she told me was that their cases of malnutrition did not come from remote areas. Those cases, in fact, occurred in the town, which is very close to the hospital. They have all the facilities there. The school, for example, is within a stone’s throw from the hospital, and 700 children are attending school there. I must therefore conclude that it is not poverty which plays a great role there, but ignorance.

Why not?

Because, if a child shows the slightest sign of malnutrition, he can simply be taken across the street to the hospital. In addition, powdered milk is available at that hospital. The people can get as much as they want. I shall come to the figures later on.

The second example I want to mention to the hon. member, is something I saw in the Northern Transvaal. This was at a settlement where vegetables are being cultivated. The father of the family in question is in fact a head teacher and the mother also teaches, and still their youngster was suffering from malnutrition, or kwashiorkor. I am not saying that this is so in all cases. The third point I want to mention, is that the customs of our Bantu and their taboos play a greater role than we realize. One of the greatest problems is that the Bantu women do not discuss this with one another. There is no communication. Should they refer to a baby or to any other circumstances, it is in the most cases regarded as an unfriendly action. This is the problem my Department is experiencing. This is also the problem the mission hospitals are complaining about. To disseminate knowledge in regard to these matters is an almost impossible task. Those people spend a great deal of time at watering places where they go to fetch water, but they really do not want to discuss these things amongst themselves. It is simply not done. It is in fact precisely the opposite to the situation in Houghton. I must also say that there is unfortunately still a degree of unwillingness among non-Whites, as well as among other authorities, to participate fully in this regard. I have already on a previous occasion told the hon. member what we are doing, and I do not want to discuss it again here, but I would just like to mention the figures in this connection. In regard to powdered milk, R90 000 was available last year in the White areas. I am speaking in round figures now. Expenditure to the amount of R83 000 was approved, and the expenditure incurred only amounted to R56 000, In the Bantu areas R60000 was made available; expenditure amounting to R28 000 was approved and only R7 000 was expended.

Why?

Because these people do not want to participate in this. This hospital at Kuruman placed the smallest order for powdered milk of all the hospitals in the Republic, but then they are in the news. In 1970 mission hospitals participated in this scheme for only three months The fact of the matter is that for the 1971-'72 financial year R200 000 was appropriated for the Bantu areas. To date only 17 hospitals have applied for participation in this scheme, and specifically in respect of an amount of R27 185.

I think you must help them to know that this is available …

We are doing this, Sir. All I want to say is that the hon. member should not lay this complaint at the door of the Government, or anyone else for that matter. These are people who have not yet been educated to participate in these matters. In any case I also want to tell the hon. member that these cases of malnutrition have more to do with, droughts and seasonal circumstances than we realize. I drove through the Northern Transvaal and touched on at 18 hospitals. I saw three acute cases of kwashiorkor in all those hospitals. That is why I can say to the hon. member that as far as this matter is concerned, she should acquaint herself with the facts.

What about P.V.M.?

Oh yes, we have already held talks with the miller. We now have a committee which is investigating the financial implications of converting the mills.

It will be 2,5 cents per 180 lb. bag.

No, but we do not know what the altering of the plant will cost.

This is in the medical journal.

Yes, I know, but that is for enrichment.

No, including the change of the plant.

I know it is in there but that is not the final answer. That is the medical journal. We had this meeting in Pretoria either last week or last month. What is very important is that this subcommittee are now going into the question of control measures.

*Then there is the question of the compulsory notification of kwashiorkor. We as a department are not inclined to do this because there are various other methods of obtaining information in this regard in the course of time. For example records must be held of all powdered milk schemes. When it is compulsory, one has all kinds of problems because there are so many cases where the diagnosis leaves much to be desired.

To the hon. member for Fauresmith I want to say that yellow margarine will be subject to a permit system. There will in fact be certain conditions, but I would not like to anticipate this. It is a matter which should be dealt with by my colleague, the Minister of Agriculture.

The hon. member also raised the question of the British Commonwealth Medical Association. The hon. member stated the matter very correctly. All that I want to say in this connection, is that South Africa is not isolated in the medical sphere. If these people act in this way they are losing, in view of the achievements of South African doctors, just as much or perhaps even more than South Africa might be losing.

As far as our task in South Africa is concerned, I want to assure the hon. member that in regard to the outward policy and the things the hon. the Minister of Foreign Affairs and the hon. the Prime Minister have said, the service department which is always involved in this contact which is made during visits, is the Department of Health. This is involves the supply and the provision of immunization substances and all kinds of other things which are necessary for the national health of our neighbours and those further away. But I think I must leave these matters in the hands of the hon. the Minister of Foreign Affairs, and he can from time to time furnish the information if it is in the interests of one of those States or in our own.

The hon. member for Berea spoke about alcoholism and dependence-producing substances. I just want to inform the hon. member that detoxification is of course a matter which, in its antiquated form, falls under the Department of Health. We are doing it at our various institutions. If we have to expand facilities there, we shall do so. To date I have not found it necessary to do so. If it is not all that readily available in specific vicinities, then it is the task of the Minister of Social Welfare. To date alcoholism and the treatment thereof has been the responsibility of the Department of Social Welfare and Pensions. What I do in fact want to say is that as soon as the person has been detoxified, the social rehabilitation is the responsibility of that Department and we have completed our task.

The hon. member also referred to the greater utilization of pharmacists in regard to our district surgeon services, Many of the allowances which are being paid to doctors are in any case being used by them for prescriptions which are sent to pharmacists. But we must have one responsible body. We cannot divide that responsibility. It must be an arrangement between the district surgeons and the pharmacists themselves.

The hon. member also put a question to me in regard to smoke. The policy of the Government is still precisely the same. I indicated the reasons for that last year. However, I welcome what the mining houses are doing, what our own Department is doing and what other bodies are doing to bring the deleterious consequences of smoke to the attention of the public.

The hon. member for Newcastle also put a question to me in regard to district surgeon services, I just want to say that we have reached an agreement with the Medical Association to the effect that the Department and the Association will together take the entire matter of district surgeon services under consideration, including the matter of transport. In any case, there are now negotiations through the Public Service Commission to increase the 10 cents per mile to 10 cents per kilometre. But this entire matter depends on the negotiations we are conducting with the Medical Association in this connection. I also agree with the hon. member that the exacting work which these people are doing certainly entitles them to a decent remuneration.

The hon. member for Rosettenville discussed the Empangeni Hospital. I am not going to reply to that hon. member because he launched a destructive attack on that hospital. His attack was very effective. But that hospital belongs lock, stock and barrel to the provincial administration of Natal.

[Inaudible.]

No, the hon. member has got it all wrong. There are two hospitals. We are responsible for Ngwelezana. But the provincial administration of Natal is responsible for the Empangeni Hospital. This Mr. Waterson, to whom reference was made, is a Natal M.E.C. I shall not negotiate with him because he is unreliable and incompetent. He has never been in Cape Town. I am saying this now with all the seriousness and responsibility at my disposal. He makes statements in newspapers which are unsubstantiated. I now want to give hon. members the facts. He speaks of six doctors there. The fact of the matter is that at Ngwelezana and Empangeni there are altogether eleven full-time medical practitioners and three part-time practitioners. I should like to quote the following information in regard to these hospitals:

What did in fact happen, is that the Department of Health came to their assistance and are provisionally helping them with the problems they are experiencing. We have now converted a tuberculosis hospital to take in other cases as well and have in this way been of assistance to them. But my United Party friends in Natal tell me that this Mr. Waterson is trying to become the leader of the United Party in the Natal Provincial Council. Now he wants to use health matters to succeed in achieving his aims. He supplies incorrect and misleading information and says certain things which are simply devoid of any truth.

That is a shocking thing to say.

I am saying it. It is not shocking. He has said things that are not true.

He is concerned with the lack of facilities due to the fact that the Central Government is not providing facilities in the homelands.

We took over on the 1st April. In January already we gave all the particulars in regard to what was needed, to the Department of Bantu Administration and Development. We have already been given the permission to instal X-ray equipment and to start with other facilities such as theatres and so forth. The fact of the matter is that this has always been the responsibility of the Natal Provincial Administration at Empangeni. The facts that this member of the Executive Committee gave to the newspapers are just not true. As I have been doing for quite some time, I am prepared to deal with the Administrator and my personnel have been to see the Administrator. They are in constant contact. I am prepared to deal with the Administrator and my department is prepared to deal with him and with the officials in Natal. But I cannot deal with a gentleman like this who has given all this information to the newspapers knowing full well that that information is not true. I leave it at that and I thank hon. members for the fruitful discussions we have had in the discussion of my vote.

Votes put and agreed to.

Chairman directed to report progress.