Mr. Chairman, I should like to ask for the privilege of the half-hour.

Mr. Chairman, nobody who has come into contact and has had dealings with the hon. the Minister of Health will not agree that he is a nice person and that he is a person who generally will lean over backwards in an attempt to meet people’s representations and to help people. Those are very fine qualities in a Minister. However, I should like to put it to the hon. the Minister that the responsibilities he has to the people of South Africa are of such a nature that circumstances demand that he should be far more forceful than he has been in the past in insisting and demanding that action is taken with regard to health services in our country.

We are today going to bring to the attention of the hon. the Minister as pertinently as we can certain things which we see as evils and which are undermining the health of our people, which are causing destruction in the society of South Africa and which are preventing the extension of effective, really meaningful and successful health services to the people of this country. We are going to talk about a number of evils, but in particular about five evils that we perceive as playing a major role in the undermining and the devastation of the health of our people. Later on today the hon. member for Pinelands will be referring to and speaking about the devastation caused to the health of people by the problem of alcohol in this country. This afternoon the hon. member for Hillbrow will be talking of the dangers of and the harm caused by the problem of smoking.

I should like to deal with three evils, if time permits. I know that at least one of them will immediately evoke a very sharp reaction from the other side. I am referring to the evil of apartheid in South Africa’s health services and the harm and the damage which has been caused to our health services by the ideology of apartheid. [Interjections.] Together with this, I should like to speak about the harm caused by the fragmented structure of health services in South Africa. These two things overlap because very often the fragmented nature of health services has no logical basis but is purely founded on the need to accommodate the ideological prejudices of the Government in the provision of health services. These two things will often be seen to be overlapping; the one leads to the other. I should also like to refer to the evil of malnutrition and the harm that is being done to the health of our population by malnutrition.

Mr. Chairman, the health of our nation is one of the most important primary responsibilities of the Government. I should like to state that as an absolute fact, and I do not think anybody will disagree with that. “Nation” in this context is not any one particular group, but means nothing less than all the members of the South African society, irrespective of race (I want to emphasize that), all having an equal right to good health and all having an equal claim to the health services that are or should be rendered in this country by the Government. “Government” in this context, the other side of the coin, involves all levels and all agencies of government, all sharing this vital responsibility, and not just one aspect or one level of government. Politics, and in particular the Government’s peculiar obsession to structure all South Africa’s systems and services primarily on racial differences, must in the future not be permitted to undermine the health of our nation in the way which it has undermined health services and the health of the nation in the past. I want to make this appeal to the hon. the Minister—and this is what I mean by forceful action on the part of the Minister— that he must be heard to speak out against apartheid where apartheid undermines the health services for which he is responsible. The hon. the Minister may say that he speaks out in the Cabinet, and possibly also within the Nationalist caucus. Mr. Chairman, that is not good enough. The hon. the Minister has a primary responsibility to the people of South Africa to speak out in this Parliament. I should like to hear him speak out in this Parliament against the evils that we are going to talk about today and with regard to which, I believe, this debate should take place. I want the hon. the Minister to say that he will remove the ideological architects from the drawing boards where the future of the nation is being planned.

In this debate we are talking about the future of the nation in terms of its health and health services. I believe the hon. the Minister must in terms of his own principles and his own beliefs accept that apartheid cannot be part of the health or the health services of a nation and that if one allows racial segregation to be part and parcel of the health services of a nation, one is as an unavoidable, inevitable consequence undermining that health and those health services. The health of our nation has really suffered as a result of apartheid. It is debilitated by the fever of racial prejudice— racial prejudice is, after all, an emotion, a fever. It is septic with the infection of apartheid. It has mentally incapacitated our people by racial fears for many of which there is no real rational reason.

Let me mention a few examples of where this has been the practical consequence of the ideology of this Government. Let us look at the whole structure of segregated health services which has been created in this country, resulting in duplication, triplication and even quadruplication of health services throughout the country and the consequences which arise from this, apart from the tremendously increased costs of providing segregated health services. I am sure that the consequences of this for the people of the country have been brought to the attention of the hon. the Minister on numerous occasions. I am sure that the hon. the Minister knows, because I know of many fatalities that have been the direct consequence of segregated health services. These are consequences that result from the fact that if you have segregated hospitals or segregated health services, you of necessity increase the distance between the patient or the victim of assault or an accident and the centre where health services, emergency services can be rendered to such patient or victim. Because a segregated health service increases vastly the average distance between the place where a patient or a victim is and the place where he receives attention, you have inevitable delays. Valuable minutes are wasted and lives are lost. Many lives have been lost as a result of that.

I should like to mention a few examples that I am aware of. I remember some years ago a young man being injured in the Johannesburg area, and that the first ambulance that arrived was an ambulance for Black people. That ambulance refused to remove that victim to hospital.

That is an old story. You told it in the Provincial Council as well.

Mr. Chairman, it is an old but pertinent story. It illustrates the consequences of the policy of apartheid.

†That young man died as a result of the fact that the Black ambulance refused to remove him to a hospital and the White ambulance only arrived some time later. That person lost his life as a result of that, or possibly as a result of that. I know of cases where people who had been severely injured on roads near to, for instance, Baragwanath Hospital, and if they had been taken to Baragwanath Hospital their lives could have been saved, but because they had to be taken many miles to the nearest White hospital those lives were lost.

Mention the cases.

Mr. Chairman, there are dozens of examples. They have been recorded and have been brought to the attention of the Government.

Dozens?

Probably more. There are dozens of examples throughout South Africa where valuable minutes have been lost because of segregated health services, resulting in the loss of lives.

I know of another case where somebody from my constituency had to take a very ill Black person to a hospital. He was not an accident victim, but was very ill. The nearest hospital happened to be the J. G. Strydom Hospital. When they arrived there they were referred to the Thembisa Hospital, which is 25 miles away from the J. G. Strydom Hospital. When they arrived at Thembisa Hospital the person had unfortunately passed away. The point I am trying to make is that these things happen, that there are serious consequences resulting from segregated health services. I believe that the Government and the hon. the Minister should take action to prevent these consequences.

The other evil I want to talk about is the fragmentation of health services and the control of health services resulting in lack of co-ordination and inefficiency. One of the main causes of this is the existence of the provincial health departments and the provincial health services. We have four different hospital services. We have an unnecessary interspersion of control and service between the Government and local authorities. Now we are once again moving to a new constitutional dispensation. I believe there is now an opportunity for and a responsibility resting on the hon. the Minister and the Government to avoid the same problems arising again. It appears that the new constitutional dispensation is once again primarily based on racial and ideological considerations. Once again there is a relegation of the real needs of the people of South Africa to a status inferior to that of the requirements of the ideology of the Government. I am afraid we are once again poised to make the same mistakes leading to the same unfortunate consequences. It cannot be allowed to happen. It is our responsibility to warn against it and protest against it and to appeal to the hon. the Minister, if he perceives his responsibilities in this respect clearly, to act before it is too late and to see to it that the health services and the structure of health services of South Africa in the future will not be based on apartheid or ideology. I should like to quote a few authorities on this.

Prof. Marie Uys in Health News, the Department of Health’s newspaper, said that lack of co-ordination among health authorities was responsible for large voids in community health services. She said that health services are fragmented by legislation, which places each type of service in its own sphere with its own responsibilities, facilities and financial supply. One of the consequences is that many bottle-necks arise in municipal health services. When after-care health services are undertaken by hospital staff and district nurses of the Department of Health visit people in need of care, overlapping may occur, with municipal health authorities already having visited those people. As a result of this, you have overlapping you have conflict, you have wastage of resources and services. There is a loss of continuity in treatment, which is caused by the reference of patients from one authority to another. There is no single co-ordinating authority assessing the need for health services, evaluating that need and deciding on the provision of those health services. It is very often a matter of a patient going from one authority to another in an attempt to get a balanced health service. Prof. Uys further said that there was a lack of co-operation due to ignorance about the functions of the responsible authorities in respect of certain diseases. Once again, because of the fragmentation of the services, because of the interspersion of control, that void is evident. She further said that as funds for curative and preventive services are handed out on an unequal basis—this is absolutely true—far too much money is spent on curative services and far too little on preventive health services. Funds are handed out on an unequal basis in the central Government budget, and the municipal health services are so often the Cinderella as far as the provision of health services in this country is concerned. Dr. Raath of the Department of Health said that at present the emphasis of the system of health care is on curative services. He mentioned that approximately R60 was budgeted per patient per day in teaching hospitals. He said that far too little attention was being paid and far too little money was being invested in the promotion of preventive health services. With regard to the problems experienced by local government, Mr. J. D. K. Saayman, of the United Municipal Executive, had the following to say—

Mr. Chairman, I want to point out that there is widespread concern, widespread unhappiness about the vagueness of Government planning and directives, about the fragmentation that exists and about the lack of co-ordination. Only this hon. Minister can put it right, because he stands at the head of the health services. It is no good attempting to put it right over a long period of time after having had a large number of different symposia, conferences and meetings. The hon. the Minister must take action. He must take action now and see to it that these problems are avoided. I think the hon. the Minister must tell us in this debate what the future of the provincial health services is in terms of the new constitutional proposals. Will these services continue? Will they disappear? What will take their place? Will the hon. the Minister make a point of insisting that the provision for health services in the new constitutional proposals for once in the history of this country will not be based on ideological and apartheid considerations, but that it will be based fairly and squarely and truly on the health needs of the nation and all peoples that go to make up that nation?

The hon. member for Bryanston introduced this debate on the Health Vote today by referring to certain matters which are considered to be evil in the health services of South Africa. He actually considered a number of matters which I think the hon. the Minister will deal with later on in this debate. We have maintained a tradition over many years in discussing the Health Vote in Parliament. It is a tradition where this debate was elevated above the level of common politics. This was done to the benefit of health services in South Africa. We managed to place the emphasis on the positive aspects. Mr. Chairman, I think it is a sad day today that this tradition was broken by the Official Opposition. It is indeed a sad day. The opposition has descended to this low level of playing politics with such an important matter. I have no fear of contradiction when I say that South Africa provides of the best health services in the world irrespective of race, colour or creed.

*Mr. Chairman, it is true that an effective health service in any country of the world ought to enjoy the highest priority on the part of any civilized government. We are one of the few fortunate countries in the world that can boast of a health service for its people regardless of race or colour. I do not think this can be matched by many countries. Notwithstanding what the hon. member for Bryanston has said here today, during the past few years in particular, by re-organizing the department and by means of new legislation and a comprehensive health service that is still in the process of implementation, the hon. the Minister and his department have succeeded to a great extent in realizing this ideal.

In my view, three factors are the key to such an ideal. In the first place, one must have a good system. In the second place, there must be adequate facilities and also enough expert staff to implement the system and to render the service. As far as the latter is concerned, we in South Africa have gained the highest reputation. However, I want to single out the professional people in particular because, as a doctor, I should like to examine this problem. The doctor plays the most important role in the effective functioning of the health team, as was mentioned recently by Prof. Snyman when he spoke on the emphasis in the training of our modem doctors. Despite the good reputation it has and the quality of the service this sector has rendered with great distinction, there are a few disconcerting facts I want to speak about today. This has nothing to do with politics.

First and foremost, there is the large number of doctors who have left South Africa during recent years. Approximately 34,7% of the doctors who qualified in South Africa between the years 1960 and 1977 are no longer in the country. These are the figures that appeared in The Citizen of 19 January this year. It costs the taxpayer approximately R30 000 to enable a single medical student to complete his studies, and these costs are still rising. The question arises whether we can afford to let this state of affairs continue indefinitely? I say we shall have to do something about the problem. It cannot simply be left as it is.

However, before we express unqualified disapproval of these people who leave the country, it is necessary for us to take a thorough look at the reasons why these people leave the country. We must take into account that there has always been a considerable emigration of professional people from South Africa but that this has been counteracted in the same way by immigration, by way of the return of people who were abroad purely for the sake of gaining experience and also the immigration of foreign doctors who have come to settle here either permanently or for the purpose of gaining experience. The latter group seems to have increased in the most recent past. My experience is that a considerable number of these people have very limited practical experience and often create problems. This also creates language problems.

However, I contend that a large number of our own doctors who go abroad go there for financial reasons. This applies in particular to people who go to the United States and to Canada. Salaries and remuneration are considerably higher in those countries and the marginal rate of tax is also very low. This brings us to two shortcomings in the South African set-up that will have to receive attention.

The first of these is the fact that more and more doctors in South Africa who reach a level of income which borders on or exceeds the marginal rate, are curtailing their professional activities. This is a serious wastage of professional manpower, mainly as a result of the lack of incentive or motivation.

Furthermore, at certain provincial hospitals there is a very unfortunate position in respect of salary scales. It is not simply a question of the salaries being inadequate; I regard it as a source of serious frustration that the fixed salary of a senior medical officer is only R55 a month lower than that of a senior specialist and only R110 a month lower than that of a principal senior specialist. This is a doctor without any post-graduate qualifications. This state of affairs holds no incentive for a highly qualified doctor to remain in South Africa. These people earn 10 times more in other countries such as America. I am speaking specifically here of the highly qualified specialist. I am not advocating higher salaries but qualifications and expertise simply must enjoy a higher priority if we want to retain these people in South Africa.

I think it was welcomed, with this budget, that the marginal rate was adjusted, and this is, of course, highly appreciated by the medical profession. However, financial encouragement alone is not sufficient. We can no longer afford to have large numbers of doctors leaving the country after they have been trained here. In the first place, I want to associate myself with the principal and vice-chancellor of the University of the Witwatersrand, Prof. D. J. Du Plessis, who recently made an earnest appeal when he told students—

Furthermore, it has become essential for us to obtain undertakings from students that they will work in South Africa for a minimum period after they have qualified. We shall even have to consider placing restrictions on doctors who leave the country without sufficient reason, perhaps in respect of conditions that can be stipulated on their return. It is a fact that too many of our own doctors are leaving the country and that we admit foreign doctors here all too readily. We need to have a new approach in regard to the entire medical profession as far as this is concerned because I think that at the moment we have a situation where we already have an artificial shortage of doctors and this costs the State a lot of money.

The hon. member for Newcastle will forgive me if I do not follow him as will the hon. member for Bryanston, beyond to say that I agree that it is a pity that he spent so much of his time launching a political tirade because he indicated in his opening remarks that the Progressive Reform Party intended dealing with certain subjects. It is their bad luck that one of the subjects I intend dealing with is one of the subjects they gave notice of. Perhaps if he had used his time more effectively in dealing with that subject they would not have been pipped at the post.

I wish to deal firstly with the problem of cancer and some of the aspects surrounding its treatment because it is a very serious problem in this country and the number two killer of Whites in South Africa today. It is second only to the number of deaths caused by circulatory diseases and way ahead of the deaths caused by motor accidents, which are commonly held to be very high.

Lung cancer kills roughly one in five of the people who die in South Africa from cancer and this in itself is an extremely high figure. One might ask what we are doing to stop the death march of lung cancer in this country? One would imagine that with over 1 000 deaths in 19755-’76 and approximately 1 100 deaths in 1976 everything possible is being done to discourage smoking in this country, but we find that there is a vast industry in South Africa which is geared to the glamourizing of smoking as such. We have very sophisticated advertising telling us how satisfying, how relaxing and how exciting it is to smoke. So enticing is the advertising that large numbers of young people think that it is the in thing to puff along too. We cannot expect young people to be aware of the dangers and the implications of smoking on their later lives. Every accredited research project shows us that smokers are more liable to respiratory problems, including lung cancer as well as a lot of other medical problems, but particularly in this respect lung cancer. I believe that what is needed is a comprehensive educational programme aimed largely at young people to make them aware of the dangers and the implications and to show them that it is not necessary that they grow up in life being smokers. Impressionable school children can be very receptive to well presented facts discouraging them from smoking and pointing out the effects on their health in later life. I believe therefore that education particularly in the schools, should be extended in this regard.

When one thinks of education one thinks of what has been done in other countries and one looks particularly to the United Kingdom and perhaps to America as well where they have made a start on actively discouraging all people from the habit of smoking. One thinks of the compulsory health warnings which are carried on the packs of cigarette and tobacco products and the same health warnings which are carried on the advertisements of these products in whichever media they are advertised. I believe that this is a very good point at which to start.

I would like to ask the hon. the Minister today to grasp the nettle firmly and to initiate a similar programme in this country. I want to make a strong plea to the hon. the Minister to do this because I believe that he knows that is the right thing to do and I believe that we, whatever reservations we might have, also know that this is the right thing to do and I believe that it is something that should be done quickly. A health warning should appear on every packet of cigarettes, tobacco or cigars and a health warning should be on every advertisement in any media.

I know that there are strong vested interests which would find a move like this unpopular because there is a large industry geared to encourage people to use increasing quantities of smoking requisites. Any moves to discourage sales of tobacco products will obviously be very unpopular with these people. But I would like to point out that the Government does not hesitate to take strong and unpopular action with other measures where it considers these measures to be in the interest of South Africa. I believe that a measure like this which could well reduce the number of deaths from lung cancer is very definitely in the interest of South Africa and I believe that the Government has the power to do it and I think we could ask the hon. the Minister to give it his urgent attention today. Before we hear any arguments that a move like this would lead to declining cigarette sales and a loss of excise and tax which we cannot afford to lose in our present circumstances, let me say that we are losing hundreds of lives from lung cancer which we can afford to lose even less.

I do not believe that our efforts should stop at insistence on a health warning. I believe that we should also consider the implications of the advertising of cigarettes and tobacco because this is a very important aspect as well. There are many people who believe that the ideal solution would be to have less advertising. In this way of course tobacco would lose its glamour image and perhaps many people who take to a lifetime of smoking would not start. I realize of course that this ideal will be difficult to achieve.

I would like to refer to a couple of facts and I would like to refer to the stand of the Reader’s Digest on this matter. They have voluntarily declined to accept advertisements for cigarette and tobacco products. They have set a very courageous lead here. Indeed their publications and their feature articles which constantly stress the dangers of smoking are a very valuable part of the educational programme and I believe we need to bring the risks to the public eye time and time again. SATV has given a similar lead by refusing to carry advertisements on cigarette products. Perhaps the SABC will follow suit. It would in fact be ideal if all other media in this country were to consider voluntary discipline in the matter of acceptance of advertisements for cigarette products. Perhaps other media are considering this step and what we should be doing is to encourage them to do so.

I think we should also consider a suggestion that the emphasis of advertising of cigarettes tend away from the glamourizing aspects which they do. By this I mean that the advertisement should refrain from creating any impression that in order to lead a successful and happy life it is necessary to smoke. It could also perhaps be seen to that prominent personalities are not featured in the adverts creating the impression that their prominence is due to the fact that they smoke a certain brand.

The sobering thought when one looks at the statistics and extrapolate them even conservatively are that in the 10 years from 1976 to 1985 it is likely that we are going to have more than 15 000 deaths from lung cancer in South Africa. This to me is a frightening figure. I want to ask the hon. the Minister if we can afford not to tackle this problem with every means at our disposal?

I would also like to deal briefly with another health problem in certain areas of this country and that is the problem of bilharzia. This seems to be a growing problem in certain areas where the problem is endemic. Something between 80% and 90% of young rural Blacks under the age of 25 suffer from this and are carriers. The problem seems to be the concentrations of these young people due to the natural concentration of their population and the fact that the younger people are those who are more keen on swimming. As we know the eggs are passed into the water and this is the very important part in the life cycle.

I have the Department’s booklet, and I believe that this is a good start. More education is always a good thing. I refer to the annual report of the Department of Health. In the section which provides for services for diagnosis and control bilharzia has certainly accorded importance. It is the fifth in order of the amount of units, namely 127 251, budgeted for. It is fifth in line behind venereal disease, tuberculosis, cervical smears for cancer and bacillary dysentery.

The hon. member for Berea made an interesting speech on lung cancer. I do not think he had any problem in convincing the hon. the Minister or myself because we Van der Merwes do not smoke. We agree with him. But about his method one can have a long debate because it worries all of us.

I just want to refer briefly to what the hon. member for Bryanston said, and I shall try to do this calmly. I do not think any person with even the slightest knowledge of health matters and of the medical profession would have made the type of speech he made here this morning. I think it is an absolute tragedy, and I feel I can say in regard to him: “Father, forgive him, because he knows not what he is doing.” I want to refer to something he mentioned so that everyone can understand what it is all about in the international field today. I want today to deal with an international onslaught against the medical profession in South Africa. I stand here with a letter in my hand written by Amnesty International to Dr. Lang. Dr. Lang, as you know, is one of the doctors who was involved in the Biko case. The letter reads as follows—

I shall come back to that again. I quote further—

You see, this is an absolute threat against the medical profession in South Africa. Now I must also quote here from a letter from which the hon. the Minister of Justice quoted the other day in the course of the Justice debate and which was addressed to Dr. Isadore Gordon, one of the most eminent pathologists in South Africa. This letter concerns the same matter; it concerns the same people, but this letter was signed by different people. I just want to tell you that Dr. Gordon was one of the assessors at the Biko inquiry. I quote—

Then a few names are mentioned. The letter states further—

It must be noted that Dr. Gordon is a pathologist who has not seen a patient during the past 35 years. He is a man who is, or was, a pathologist at a university in Durban—I think he has now retired. One of these people died in Cape Town, another one in Johannesburg and the third one at some other place. This is the sort of attack that is being made on our doctors. I think it would be as well for us to look at the instructions of the Department of Health to its doctors. I have with me here The Medical Practitioner in the Health Service. Basically, the medical profession, and also the doctors in the service of the Department of Health, are governed by codes of ethics, the best known of which is the ancient Oath of Hippocrates. The Oath of Hippocrates reads, inter alia—

and it goes on in that vein. It has been converted in its modern form into the oath taken by doctors these days which, to the best of my knowledge, they adhere to. Admittedly there are black sheep in every field. The current oath is known as the Declaration of Geneva. I want to quote a few extracts from the code the doctors adhere to—

I repeat “… from the time of conception”—

These are the instructions to the doctors in the Department of Health. These are the instructions every doctor in this country is supposed to adhere to. There is also a further one, the International Code of Medical Ethics. I want to quote just a few extracts from this ethical code because I think it is necessary in these circumstances. It reads—

Order! The hon. member’s time has expired.

Mr. Chairman, I rise merely to say that the hon. member may proceed.

The hon. member may proceed.

I thank the hon. member. I referred to the Tokyo Declaration just now. The Tokoyo Declaration is a declaration that was issued by the World Medical Association and the World Health Organization after the last World War in consequence of the cruel treatment meted out to patients in certain camps during the war. It deals mainly with the maltreatment of patients. The Medical Association of South Africa and the Department of Health of South Africa are signatories to this document. I want to quote a few extracts from that declaration—

I can go on in this way because there are many of these things. This is the code, the instruction given to all physicians. There is also a specific instruction to every district surgeon, namely that after he has examined a patient and he is not certain of his diagnosis, he must obtain a second opinion. Now you can tell me: That is all very well, that is what is being done. But what is the result? How do we know that this is in fact being done? Now I must also tell you that the Medical and Dental Council keeps a watchful eye on this entire procedure. This independent and autonomous council, which is actually not under the control of the Department of Health, and which is not involved in the administration of justice, keeps a watchful eye on the conduct of doctors. In every court case where evidence is given about doctors or by doctors, and in any other case where the judge or the magistrate thinks it is necessary, all the evidence given by the doctors is submitted to the Medical Council. In accordance with this procedure, of his own violation the magistrate in the Biko case submitted the evidence given by the doctors, to the Council.

What was also done—and anyone is free to make this request—was that somebody requested a further investigation. The ombudsman of the Anglican Church, Mr. Roelofse, said he was not satisfied with the evidence given in that case. His objection was submitted to the Medical Council and a further investigation was asked for. Dr. Snyman, Chairman of the Medical Council, announced that the three doctors involved in the case had been asked for an explanation. Once the Council has received these it will take action if it appears that the professional code has not been properly complied with. I am now referring to these four codes, the most important points of which I quoted here. That, Mr. Chairman, is the nature of the control, the conduct, the way in which this profession acts in this country, and I am honoured to be a member of it. I say again that I do not think there is one of us who does not act in that way. When I say not one, I do not want to generalize because I know that there are always exceptions. If the telephone rings at any time of the night the doctor gets up. He does not ask who it is or what the problem is but the work is done as it should be done. If the doctors in this country remain independent, as they are now, if they and the officials of the court—here I am really referring to the people in legal practice, the advocates, the judges remain independent— then I cannot but agree with Mr. Justice Jan Snyman who said at a symposium here in Cape Town the other day—

As far as the latter are concerned, he spoke of both legal practitioners and medical practitioners. He went on to say—

Mr. Chairman, I have confidence in the profession. I have confidence in my colleagues and I reject this onslaught from outside on the integrity of the medical profession in South Africa with the contempt it deserves. I believe that our training in South Africa—as we have proved over the years—the integrity of our teachers and the inviolability of our code of ethics is second to none in the whole world. We shall perform our task regardless of opposition. We shall perform it the way it must be performed, and it is not difficult to do so; on the contrary, it is easy to do so. There is nobody in South Africa who expects any doctor to act dishonestly, and if a doctor is inveigled into doing so he will have to bear the consequences.

The hon. member who has just sat down has devoted his time to the defence of the medical profession, and I want to say that there is perhaps no other profession in South Africa which enjoys greater respect in this country and also—this I assume is true—all over the world. The hon. member himself makes the point that in every profession there are the Black sheep and it is true, unfortunately. Therefore one is glad and grateful to bear in mind that there is a Medical Council which acts as a watchdog over the profession, and I identify myself with the comments he has made about the good work that the Medical Council is doing in this regard and, indeed, is doing particularly in regard to the recent Biko case, as the hon. member himself has indicated. I just want to say a brief word about Dr. Gordon, whom I know personally and professionally, and I think that it is a matter of great regret that the outside organization, Amnesty International, has seen fit to write to him in the terms which they have, and on a completely fabricated charge. As I say, I know the man, both professionally and personally, and I think it is a matter of deep regret.

Just one other comment before I move on to the topic which I want to speak on. There has been a considerable reaction from the other side to the speech made by my colleague in his introduction to this debate. I want to make it quite clear that whenever the Government, whether it be in matters of social welfare or whether it be in matters of health, chooses to place an ideology in the forefront, we cannot and dare not remain silent. That is part of our responsibility, and I believe that it is absolutely right in any debate which conflicts with the basic approach; for example, two Ministers are now on record in recent days saying that we have a policy of merit in South Africa, a word which we have been using for a very, very long time. If that is so, then when we approach the matters of health, of social welfare, surely our approach should be in accordance with need rather than anything else.

The hon. member for Durban Berea referred to a very serious problem, and that is the extent of the effects of smoking and its direct relation in many areas of the world to lung cancer. I think that that is a very important point to have made, and I want to approach a related problem, and that is the problem of alcoholism. The alcoholism in South Africa leaves no one untouched. It affects all race groups. I understand, if my figures are right, that there are more than 60 000 White alcoholics in South Africa, and 143 800 abusers of alcohol. In 1970 consumption of liquor was 11,04 litres for every White person living in South Africa.

When one bears in mind that the comparative figure for West Germany was 10, and that for the United States, 10,4, one realizes that we have an unenviable record in this regard. In 1973-’74 prosecutions for drunkenness had risen to 181 313. The significance of this figure for this Committee is that over a period of seven years—which is a very short period—the increase of prosecutions for drunkenness in South Africa was 98%. This suggests that there is a problem which is being aggravated and which is increasing every year.

When we look at recent statements about alcoholism amongst our Black population, we find that this problem is just as serious. How serious this problem is, is only now becoming clear. Only the other day, Bishop Tutu, addressing a large gathering in Soweto, made the point that if the Blacks are going to work towards their own liberation, they must fight those things which prevent them from advancing. One of the things he referred to in this regard, was drunkenness in the townships, the workplace and the home. This is a serious problem which touches every person and every population group in South Africa.

As far as the incidence of road accidents is concerned—unfortunately I do not have the time to quote all the facts and figures—I am sure that the hon. Minister is as aware as I am, if not more so, of the new awareness shown by officials and illustrated by reports in medical journals, of the number of offences, accidents and deaths where alcohol played a very dominant role. This is equally true of pedestrians. The number of pedestrians who were involved in accidents and who had consumed too much alcohol, is a matter of record.

Alcohol also plays a part in the incidence of crime. I have been reading the records of magistrate’s courts as well as of cases that came before the bench and it is remarkable and frightening how many cases have a direct relation to a person who was under the influence of alcohol. It is almost as if this is being used as an excuse. It almost seems that one can murder, rape, kill and steal because one had too much to drink. This kind of abuse is now becoming commonplace and I believe that we should take urgent action.

When one looks at alcoholism and the way it affects industry and when one realizes that between 6% and 8% of all employees are alcoholics, we realize that it is a very frightening figure. This is something to which we are simply not giving enough attention in our country. When one looks at the figures for the different diseases we find that alcoholism is the third biggest hazard to health in South Africa. There have already been references to the first two. I have been told by the man who runs the Johannesburg Hospital, that one in three of all Black patients admitted to that hospital suffers from alcohol-related diseases. When one realizes that the figure is one in three, one can begin to realize the enormity of the problem. The total liquor bill in this country is R1 382 million, which is R32 million more than the national defence budget. When one begins to see it in those terms, I think that one begins to realize that the time for action is overdue. Some people have estimated the cost to industry and commerce to be R150 million during each year. This is estimated in terms of absenteeism and bad decisions.

What must we do about this? When one looks at the attractive report of the Department of Health, and the reference therein to alcoholism and alcoholism prevention, one finds only one single reference. This is a very brief paragraph which reads—

More serious, Sir, if one looks at page 43 of the report under the headings: “Publicity services” and “Publications” one finds no reference to this problem in terms of radio talks, television, audio visual services and health forums. There is no mention of this problem whatsoever.

I know that the response would be that this should fall under the Department of Social Welfare and Pensions, but I do not believe that that is so. I believe that because it affects the health of this nation, and because it is such a serious health hazard, the hon. the Minister of Health and his Department must take a more dominant and aggressive role and make use of radio, television and education in school so as to wean people away from the idea that to be a man, one must drink alcohol, with all its attendant abuses. I appeal to the hon. Minister to do everything he can to prevent that. [Time expired.]

Mr. Chairman, at the beginning of his speech the hon. member for Pinelands tried to excuse the behaviour of the hon. member for Bryanston. In almost the exactly the same way as the hon. member for Fauresmith indicated to us, the hon. member for Bryanston launched an attack from the Opposition benches on the medical services in South Africa. I think this should be rejected by every right-thinking person in South Africa and that no excuse can be made for it.

Mr. Chairman, since the earliest times when man was placed on earth in order to inhabit and cultivate it there has been a conflict situation. There has been a clash of interests between man and his environment. For many centuries the wide open spaces on earth and the blue expanses of the heavens were large enough to absorb and process the damage and pollution caused by man in nature’s way. However, we had reached the end of this road by the mid-fifties of this century. Then the more visible pollution problem, viz. air pollution, appeared as a real problem. Most of the industrialized countries were obliged to take steps to combat this serious threat to health. We find some of the earliest warnings to man in the Bible, viz. in Jeremiah 2, verse 7, when the people of Israel were warned by the prophet as follows—

I feel that this does not only concern spiritual matters but all of creation about us too. When we look at the excellent report of the Department of Health, we note that an entire chapter is devoted to health protection which includes all the components of environmental pollution. It also points out the effective role which the Department of Health is playing in the protection of the Republic of South Africa. We have subdivisions like air pollution control, water and surface pollution control, water research services, radiation control, control of hazardous substances, foodstuffs, cosmetics and disinfectants, medicines control, public environmental services and industrial health.

In the limited time at my disposal I should like to bring a few aspects of the problem of air pollution to the attention of this Committee. Air pollution affects the health of our elderly people and our children in particular. In adults, the pattern is usually that the lungs are first damaged by cigarette smoke and other lung diseases before air pollution can really do its damage. The most important sources of air pollution are usually smelting works, railway works, coal fires, the smoke from Black residential areas and the exhaust fumes of a high concentration of cars and lorries. On a flight over Pretoria in the winter months one cannot but be shocked that one can see only the tips of the highest buildings in Pretoria protruding above the layer of smog. If the Department of Health does not take active steps to prevent and stop this, the inhabitants of that fine city will ultimately suffocate in the smoke and gas.

The first really dangerous air pollution noted in the world was noted in 1948 at Donara in Pennsylvania in the United States of America. On that occasion a dangerous concentration of exhaust gases and smog built up and 20 inhabitants died whilst 5 000 became ill. In 1952 an unprecedented smog cloud descended upon England and in one week 4 000 people died whilst approximately 8 000 people died in the following three months. This led to the so-called “Clear Act” of 1956. Our own Air Pollution Prevention Act dates from 1965. In 1967 America adopted its “Air Quality Act” and on that occasion President Lyndon Johnson said the following—

Mr. Chairman, the same gloomy situation faces South Africa but fortunately, today we have a Department of Health which is already taking positive steps in this regard. There are approximately 137 local authorities that have already issued smoke control directives whilst 67 local authorities are also controlling light industries in their areas of jurisdiction. The degree of air pollution in the urban areas of South Africa, however, remains a source of concern, especially as regards our young people and children. In an interesting address that was delivered in 1976 during an international conference on air pollution in South Africa it was pointed out that a comparable study over a period of five years had indicated that there was a considerable difference as regards chronic diseases among people in the rural areas where there is relatively pure air in comparison with the position in the cities and industrial areas where air pollution occurs. For instance, it was found that the incidence of chronic bronchitis among children was 25 times higher in the air polluted areas. The incidence of chronic bronchitis among adults was 19 times higher, high blood pressure 4,4 times higher, coronary heart diseases four times higher, stomach and duodenal ulcers 2½ times higher and enlarged tonsils among children 11,4 times higher. These are scientifically established facts.

When we consider that cigarette smoke increases the degree of air pollution fourteen fold in the case of an addict—and I am not exaggerating—we can form some idea of the detrimental effect of smoking, especially against the background of our already polluted atmosphere. It has already been proved that there are 16 cancer forming substances in cigarette smoke, according to figures released by the South African National Cancer Association, and it has also been proved that one out of every eight persons who smoke will contract lung cancer with its horrible consequences and die of it. I think that anyone who has observed the terrible death of such a person will realize the horror of it. I want to say that the chances of the person who is addicted to smoking of contracting cancer are 30 to 35 times greater than those of the non-smoker. I am not telling you this in order to scare you but these are scientifically proven facts. We cannot do enough to bring the detrimental influence of this habit to the attention particularly of our young children who are growing up and living in a polluted atmosphere to which we may possibly not have been exposed and to which the older generation may have been exposed even less. I want therefore to ask the hon. the Minister that the Department of Health sit in motion an even more intensive campaign as regards this problem, at our schools in particular. We owe this to our most precious possessions, our children. I want to agree with the hon. member for Berea that the misleading advertisements that link smoking with masculinity, success stories and sporting personalities, should have no place in this country.

Another form of air pollution that is going to assume dangerous proportions in the future is the exhaust fumes of the internal combustion engine. I want to ask the Department of Health to keep an eagle eye on the situation and take the necessary steps in good time. The increase in the local content of our cars is important, but the enormous quantity of invisible carbon monoxide that is expelled into our country’s clean air is more important than the local content for the survival of man at this Southern tip of Africa. We must try to keep the blue of our heavens as blue and clean as possible and the woods and mountains of our beautiful country as undefiled as possible. We owe it to those who are going to live in our beautiful country after us. We must not spare any effort or expense in striving towards this goal with motivation and enthusiasm. [Time expired.]

I do not intend to reply to the hon. member who has just spoken, apart from saying that I certainly share his concern as far as air pollution is concerned. It is a very serious problem in our cities, and those of us who represent constituencies that lie in built-up and industrial areas realize that although there is legislation to cope with this problem, it does not appear to be effective, as the problem still persists. For instance, there is a power station in my constituency which emits a tremendous amount of smoke and causes an enormous amount of air pollution. For a period of about 25 years the residents of that area, and indeed of Durban, have endeavoured to get Escom to close down that power station. I do realize that provision must be made for electricity, and that it would probably have to be phased out. Air pollution is a cause of concern in built-up areas where there are large numbers of heavy vehicles. Many of these heavy vehicles seem to go unhindered through our cities and residential areas, emitting a vast quantity of poisonous smoke. We do share his concern in this regard.

The matter I would like to raise with the hon. the Minister on the occasion of this Vote is in line with the points made by the hon. member for Newcastle. He indicated that the trained medical practitioner is the very basis of the provision of an adequate medical service in South Africa. From the facts and figures that have become available, we can see that there is indeed a shortage of doctors. Various estimates are available, and some of them estimate that there is a shortage of about 2 000 medical practitioners in South Africa at present. In addition to that, a large number of dentists are also required. In the very fine publication, The Health of the People, which was recently made available to members, figures were given as to the number of doctors in South Africa. It is interesting to see that there are 14 552 registered medical practitioners of all race groups in South Africa, which means approximately one doctor for every 1 806 members of the population. There are also 2 088 dentists in South Africa. These figures indicate the number of trained medical practitioners that we have, and other estimates have shown, as far as the ratio in connection with the various race groups is concerned, that there is an ever-growing shortage of Black doctors because the Black population is increasing at a considerable rate, while the number of medical graduates amongst the Black community is not anywhere near keeping pace. According to a survey which was undertaken by the University of Natal, we find that there is one doctor per 400 of population in the White group, one to 900 in the Indian group, but one to 40 000 in the Black group. This means that there is a tremendous work-load being carried by our medical practitioners. We know from the Department’s report that there is a shortage of district surgeons, and that only approximately half the number of district surgeons’ posts are filled by full-time staff. The other posts are filled by part-time staff. I hope at a later stage to deal with this problem of district surgeons.

The matter of the shortage of doctors is one that is a cause for grave concern. As mentioned by the hon. member for Newcastle, this matter can be further aggravated by the fact that, unfortunately, doctors and specialists whom we cannot afford to lose, are emigrating and leaving South Africa. This is a great tragedy as far as the health services are concerned, and it is a great pity that after the vast cost involved to the State in having a doctor qualify, these people then leave and so their talents are lost to South Africa. This is so particularly in regard to specialists. If a person is referred to a specialist, he invariably has to wait several weeks before he can even obtain an appointment. This is a difficult problem, and one does not quite know how it can be met, apart from improving services and the conditions of particularly those doctors who work in some of our hospitals where there is perhaps disparity in pay and where some Black, Coloured or Indian doctors may be tempted to go overseas because of the monetary benefits they could achieve over there as opposed to in their own country. Another aspect that has to be taken very seriously is the question of our medical schools and the training and the qualification of our doctors. I fully appreciate that the medical schools and the faculties of medicine fall under the jurisdiction of the Minister of National Education, but I do feel that the hon. the Minister of Health, who is responsible for the health of our people, should bring pressure to bear on his colleague to ensure that greater facilities are made available for the training of doctors. It would appear that there are a number of potential doctors who are being lost to South Africa, apart from qualified doctors and qualified specialists. The matter has been raised from time to time in the House of Assembly, which indicates the lack of adequate facilities for the intake of our students and undergraduates. I hope that when the Government comes to a decision, which would probably be a Cabinet decision, about the extension of the training facilities at our various medical faculties, that this matter will be given top priority. As a result of legislation that has been passed, the Medical University of Southern Africa at Ga-Rankuwa is being established. We know that this can only accommodate a limited number of students, and I believe that they can take up to 200 students as an intake in their second year.

This has altered the position slightly as far as the training of Black doctors is concerned. We have a medical school at the University of Natal that was established in 1951, which is some 27 years ago, and their first doctors graduated in 1957, when there were 12 graduates. It has produced a number of doctors, but this is still far short of what is required in South Africa. From the last figures which I have received, there are 612 doctors who have been capped, and of these 216 were Blacks, 350 were Indians and 46 were Coloureds. We now have the situation where there is a university possessing a medical faculty; it is a White university, and their medical school is in my constituency, which is in a White residential area, and yet they are not permitted to admit White undergraduates for the study of medicine. This seems to be quite absurd. I am sure that the hon. member for Newcastle will be interested, as he also represents a Natal seat, that we have a situation where the province of Natal is the only province where there is no medical school at a university where White students can be admitted to train and qualify as doctors. The parents of many of these young potential doctors are unable to afford to have their children attend universities outside of the province of Natal because of the additional costs that would be involved. They are also virtually discouraged from attending the other medical schools, because in many cases they find that they are unable to gain admission. The applicants for admission, to particularly the University of Cape Town and the University of the Witwatersrand, far exceed the number of students that they can take at those universities. We consequently have a shortage of doctors, while doctors and specialists are emigrating from South Africa and yet we are denying a large number of young people the opportunity to train as doctors because, as I have mentioned, there are a large number of these people who would be able to attend the University of Natal should they be allowed to study medicine at that university. I hope that the hon. the Minister will give serious consideration to this, because surely, taking the population growth into consideration, the shortage of doctors can only be aggravated by the present situation. It should be ensured that universities are permitted to accept students of all race groups. It should be left to the universities to decide which students they should admit. I believe that the Government can take a great step forward in this regard, particularly where we have a university such as the University of Natal, where these people from all race groups could attend that medical school. It is a medical school which has a very fine record. I do not wish to bore the Committee by quoting their various achievements in the field of research, but there are large numbers of research projects that have been undertaken at that hospital.

Order! The hon. member’s time has expired.

Mr. Chairman, I rise merely to afford the hon. member the opportunity to complete his speech.

I thank the hon. member. Mr. Chairman, these people are able to qualify at other universities, whereas in the province of Natal they do not have this facility. The medical school is attached to the King Edward VIII Hospital. This hospital, although it is old and may not be ideally suitable as a training hospital, does have tremendous clinical material available to the extent that there are many people who come to South Africa and accept posts at King Edward VIII Hospital so that they can receive the training to become specialists. The ironical situation arises where people come from outside South Africa and can be admitted to the medical school for postgraduate studies. They use all the material that is available at the King Edward VIII Hospital, particularly in the maternity and obstetric sections, where they gain tremendous knowledge and they have the opportunity of studying a wide variety of clinical material. They then return to their country of origin as specialists, having used the facilities and having gained tremendous knowledge here at our own King Edward VIII Hospital. They do allow persons to study there for post-graduate purposes, whether it be a White person or a person emanating from outside this country, but our own White South African youths in the province of Natal can unfortunately not register as medical students at that university. It is to be hoped that the hon. the Minister will take up this matter to ensure that, when the time does come when White students can be admitted, dentistry will also be able to be studied at that medical school.

It has been suggested that a medical school should be established at the University of Durban-Westville, for Indian students. This I think would be a tremendous waste of money, as we already have in existence a medical school at the University of Natal, which could easily cope with the situation, particularly if the majority of the Black students are to be educated at Ga-Rankuwa, the Medical University of Southern Africa. This would mean that the additional vast expenditure of establishing a medical school at Durban-Westville could be obviated by extending the facilities at the present medical school in Durban to be able to cater for those people who wish to study medicine. This, I believe, is an important factor in dealing with our medical services to ensure that we have medical graduates joining the medical profession to play their part in providing medical care for the inhabitants of South Africa.

I want to compliment the Department of Health on a very comprehensive report. This report contains a vast amount of information which is of great benefit to us as members of this Committee who have to consider this Health Vote. The question of the position of district surgeons does give cause for some concern, in that although many of them are part-time district surgeons, an additional work-load is being created for district surgeons, particularly in view of persons such as old age and social pensioners and other people who require the assistance of a district surgeon. We know that there has been an extension of facilities whereby district surgeons visiting old-age homes can assist these people. It is hoped that a Chair of Geriatrics will be established at the University of Cape Town, which will go a long way towards providing medical attention for these people. The field of the district surgeon is a wide one and I hope that as far as the service to the older persons and to geriatric cases is concerned, it can still be extended further. There is obviously, though, a difficulty in a district surgeon visiting a person who is not in an old age home but who is living alone.

As far as the provision of facilities such as hearing aids and spectacles is concerned, it would appear that in recent times the Department of Health has adopted a far stricter line in regard to a person requiring a hearing aid or a pair of spectacles. I have had many cases where people who have failing eyesight, or failing hearing, have found it extremely difficult to obtain those hearing aids and spectacles from the Department of Health after having been referred to them by the Department of Social Welfare and Pensions.

I would also like to deal with the aspect of the task of the district surgeon, and in particular with the work which they have to undertake for the Department of Social Welfare and Pensions. On the application for any disability pension, whether it be a military disability pension or an ordinary disability pension, it is necessary for the person to be examined by a district surgeon. In recent times it has been found that there have been several cases where the decision of the district surgeon, unfortunately, does not appear to have been a correct decision. I have a number of cases as far as Indians in the Pietermaritzburg area are concerned, who were referred to a district surgeon for examination and were found and considered to be fit for employment, and then within a few weeks of having been examined and being turned down for a disability pension, have died as a result of their disabilities. I have a number of cases which I can make available to the hon. the Minister and with which I do not want to bore the Committee. I have brought them to the attention of the hon. the Minister for Indian Affairs, and he indicated that the matter would be taken up with the district surgeon in Pietermaritzburg and that these reports would also be referred to the district surgeon in Durban for his attention. I have had an instance where a sickly woman was told by the district surgeon that she did not qualify for a disability pension and that she would have to seek employment, and she died within four weeks of having been told to look for a job. There are people who claim that they were not examined by the district surgeon, but that he merely asked them whether they had been in employment, and when they answered in the affirmative he suggested that they should find further employment and did not examine the applicants for disability pensions. This has been alleged by a number of people and is not just a few isolated cases. The person who approached me in this regard said that there were over 100 cases of people who felt that they had been unjustly treated by the district surgeon and had not received an adequate and professional examination from a district surgeon.

Are you referring to a particular district surgeon?

No, I am referring to a district surgeon who is also a district surgeon in Newcastle. A person was examined by a district surgeon in Newcastle, and I hope that the hon. member is not the part-time district surgeon in Newcastle! This person, suffering from severe asthma, applied for a disability pension, the application was rejected, and the same person died three weeks later of bronchial asthma. These cases do occur, and I hope that the hon. the Minister of Health can investigate some of these accusations which have been made. I am merely bringing them to the attention of the hon. the Minister and of the Committee. We, however, have other, problems dealing with disability pensions, where district surgeons are required to examine people. Here I refer to the position of Blacks, because many Blacks are unable to produce a birth certificate or to give any proof of their age. I recently had a case where a person applied for an old age pension for a domestic servant whom they thought was now reaching the retirement age. She was referred to a district surgeon, who examined her and estimated her age to be 52 years. She could therefore not be considered for an old age pension, as she was not considered to be 60 years of age. She did, however, have a marriage certificate which gave her age as approximately 20 years of age when she was married on 23 January 1934. As far as the estimate of her age was concerned, this would have meant that she was married at the age of nine years, and she claims to be 62 years of age. The question of attempting to judge the age of an African person is perhaps extremely difficult, but it would appear that a person is precluded from obtaining a benefit to which he would normally be entitled, as a result of an examination which puts him many years younger than his real age. There are other cases as well dealing with the estimation of the age of people, particularly by district surgeons in various rural areas amongst Black persons applying for old age pensions. These, I believe, do give us cause for concern. [Time expired.]

Mr. Chairman, I really admire the ability of the hon. member for Umbilo to deal with pensions during the discussion of any Vote, and I have appreciation for the special knowledge which he has as far as pensions are concerned.

Today is the very first time that I have the privilege of speaking in this illustrious place. It is also the first time in my career that I am participating in the discussion of the Health Vote, and you may deduce from that that I have come here to speak for my health. That is not quite correct because I want to avail myself of this particular opportunity today to pay tribute to the South African Medical Research Council under the dynamic leadership of its president. Prof. Andries Brink, and its Vice-President, Dr. Jan Lochner. About eight years ago the head office of the Medical Research Council was established in Parowvallei, the main town in my constituency. As such, it is the only scientific research council that has its head office situated outside the Transvaal. It is clear that the Cabinet took a wise decision in establishing the head office at this specific place from the fact that the head office and four of its seven institutes are situated next to an academic and training facility, as well as being close to three universities, two faculties of medicine and two faculties of dentistry. We can rightly say today that the South African Medical Research Council is being instrumental in opening doors of international access to the medical researchers of our country in a special way. That is why I want to emphasize the council’s function as a builder of bridges in the international sphere in particular rather than to speak about the excellent achievements gained in the research sphere in South Africa. The fact that this international access still exists and is still possible, is proved by the fact that the Medical Research Council is still representing South Africa without any problems as a full-fledged member on that international umbrella organization, the Council for International Organizations of Medical Sciences. This body was established a while ago under the auspices of UNESCO and the World Health Organization. Our country’s medical researchers have unrestricted access to colleagues and their facilities throughout the world. Similarly, foreign researchers have the same access to our medical researchers and their facilities. This takes place on a large, regular scale and I think that hon. members are probably aware of these details because a considerable amount of information has been made available to them from time to time.

I understand from a survey which was made by the research workers of the Medical Research Council that 221 scientific articles of theirs appeared in international magazines last year. These articles resulted in a flood of 11 076 requests from all over the world to reprint the articles. I believe too that this reaction is nothing out of the ordinary because it has been taking place regularly over the past number of years. What is important to me, however, is the following two matters which I should like to emphasize. The first is that these requests are made in spite of the modem tendency on the part of scientists to make photostatic copies of articles instead of requesting reprints from the original authors or obtaining them from international data bases. In the second place, what I find very important is that some of these requests come from research workers in countries like Russia, Czechoslovakia, Hungary, Poland, Yugoslavia, East Germany, Bulgaria, Rumania, Communist China, Turkey and a large number of others, as well as from Africa States like Nigeria, Kenya, the Camerouns, Senegal and Tunisia, to mention only a few. Since the Medical Research Council and the medical research workers of our country are affording our country an excellent opportunity to gain respect and better understanding abroad, we must go out of our way to make it easier for our scientists to liaise internationally in order to maintain international access. Their problem is not international isolation or time; it is merely a problem of finance for their travels abroad. It is during this kind of visit when liaison takes place on an official, non-official and personal level that our research as well as the quality of our research workers and the medical services rendered to all our population groups are brought to the attention of the scientists of the world. Those scientists are usually not bound by the political statements and conditions of specific governments and they can therefore exchange opinions freely with our people and gather information. I am informed that some of our best friends have been recruited in this manner, and I should like to place “recruited” in quotation marks. They will continue to promote South Africa’s cause in meaningful circles provided that they are given all the facts in order by so doing to build up a balanced outlook.

Business suspended at 12h45 and resumed at 14h15.

Afternoon Sitting

Mr. Chairman, when the debate was interrupted by the suspension I was saying that we recruited foreign friends in an official and non-official way by means of communication among scientists. I tried to indicate that these friends of South Africa will continue to promote our cause in important circles provided they receive all the facts in order to build up a balanced viewpoint.

The key to good communication in this sphere, in my opinion, lies in the use of the scientists themselves who can exchange information in an atmosphere of mutual confidence. They can communicate in a calculated, factual manner in scientific language which is universal and which does not contain the disadvantages of official propaganda.

That is why I should like to ask the hon. the Minister seriously today—I know he is sympathetic and I know he is understanding in this regard—to grant the Medical Research Council more funds, not only for the expansion of the research programme but also to enable our research workers to communicate internationally not simply in the interests of research but in the interests of South Africa as well.

Over the past while contact has been built up with influential medical practitioners in Israel, Sweden, the Netherlands, Switzerland, the USA, Canada and many more, and that is why I want to ask today that we provide the MRC with the necessary means not only to maintain this liaison but also to extend it in the interests of South Africa.

Mr. Chairman, I hope the hon. member for Tygervallei will forgive me for not referring to his speech, but I have other matters entirely to deal with in the very short time at my disposal.

I am sorry the hon. member for Fauresmith is not here, Sir, because I should have liked to reply to him. I understand he is in the House, but I would like to place on record, Sir, that I appreciated his spirited defence of the medical profession. As the wife of a doctor who was the senior physician for a long period at the Johannesburg General Hospital until his retirement a few years ago, I am very well aware of the demands made on members of that profession. But, Sir, I must say that for the hon. member to use the normal behaviour of the profession to excuse in any qay the behaviour of the district surgeons who attended to Biko, to my mind is somewhat ridiculous. I would advise the hon. member for Fauresmith to read the evidence, as I have done, very carefully, and I think, Sir, he will be less than proud of the manner in which those men conducted themselves during the time that that man was in custody. I do not blame them entirely for what happened, I might add, because I believe they were seriously misled by the police in whose charge that man died.

It has been referred to the Medical Council …

Yes, it has been referred to the Medical Council, but nevertheless, Sir, he seemed to express doubt that anything could ever be done by members of the medical profession which was not absolutely above board. I am afraid, therefore, that he could not have studied the evidence in that case very thoroughly, and I am quite sure when he does, and if he does it objectively, he will find much that he would deplore in the behaviour of those members of the profession.

Now, Sir, I want to say something about the emigration of doctors, which was referred to by the hon. member for Newcastle. This is a very serious matter indeed, and I do not know what the hon. Minister can do about it. I do not think that this idea of compelling people to spend some years in the country after they have qualified is the answer, because one might find that they will not start in the profession at all. Also, this should apply to engineers, architects and other professional men who leave the country, having been educated at considerable cost by the State. But I do sympathize with his concern about this because I think the matter is reaching alarming proportions.

It is very difficult to get any reliable statistics about this, but I am informed by members of the profession that one of the yardsticks used is the number of resignations from, say, the Medical Defence Union, which is the malpractice fund used by doctors. I gather that something like 250 doctors resigned from that fund last year, which is about double the number that resigned the year before, and double again the number that resigned the previous year. That brings us to a total of 430 over the last three years, and I am not including this year’s figures. I am told by people at hospitals like Groote Schuur that the situation is really very serious indeed, that last year something like 20 consultants left Groote Schuur Hospital and that a number of senior men are expected to emigrate this year. I know for instance that the associate professor from the Intensive Care Unit, the associate professor of Endocrinology and the associate professor in the Cardiology department and in the department of internal medicine are all about to emigrate to other countries.

Now, why is this happening, Sir? How they will ever staff the enormous new Johannesburg General Hospital is beyond me if this rate of emigration continues. It is not only the number of people who are going that is so upsetting, it is the quality of the people who are going. These are our real experts, our well-trained men with high post-graduate qualifications and years of experience behind them.

What is the reason for this, Sir? One can say glibly it is the political climate, and that does play a part. I will say that at once. Doctors are no different from anybody else, they are worried about the political security of the country, and clearly this is uppermost in people’s minds. But that is not the only reason by any means. There are other reasons. Conditions of service, I believe, are very important; the salaries of the full-time people, as the hon. member for Newcastle mentioned, do not compare with the salaries in other professions.

There is also the fact that the full-time medical profession falls under the Public Service Commission, and I am wondering whether the hon. the Minister will not make an effort to try to remove the medical profession from the aegis of the Public Service Commission, because then all sorts of changes can come about. One fact for instance, which I know has motivated some of these men in leaving is the fact that the undertaking to close the salary gap between White doctors and Black doctors has not in practice taken place. Indeed, with the increase given this year, I understand the gap has actually widened, to such an extent that something like 72 of the doctors on the full-time staff at Groote Schuur signed an undertaking that they would voluntarily give up their increase in salaries if the salaries of their Black colleagues could be increased instead. I do not believe they have ever had any reply to that memorandum which they sent out, and this worries them very much.

I have not seen it.

Well, if the hon. Minister of Health has not got it he should find out about it, either from Dr. Mulder, who was then, I think, in charge of the Public Service Commission as Minister of the Interior, or from Dr. Munnik as the Administrator of the Province. It is a very bad thing that the hon. the Minister has not been informed of the seriousness with which these full-time men regard this question. That is why I ask him particularly to try to get the medical profession removed from the aegis of the Public Service Commission. That was the other important point I wished to raise, the closing of the gap. They feel they have lost a nine-year campaign over this matter and they feel very strongly about it indeed.

In the few minutes left to me I should like to say something on the subject of abortion. I see that the report of the Department of Health gives some very interesting figures regarding the legal abortions which have been performed. I have not analysed them properly, Sir, but I see that the first section, which is “pregnancy endangering the life of the woman concerned” appears to be the major factor in granting legal abortions. What worries me very much indeed, Sir, is that we do not as yet have the figures for illegal abortions. The hon. the Minister promulgated the regulations requiring superintendents of hospitals to keep statistics in this regard and I think this was implemented from 1 March of this year, so it is too soon to have figures yet. But this time next year we will have figures and I personally have no doubt that we are going to find an alarming rise in the number of septic abortions that are reported at hospitals. It was only a couple of years ago that Dr. Bloch, who was deputy-director of the Department of Gynaecology at Wits., reported to the Cillie Commission that there were 20 septic ' abortions per day at Baragwanath hospital. That is an enormous number, Sir. I think the hon. the Minister may have to revise the whole situation when we get some official statistics as far as this is concerned. It is no good forbidding things that people are notwithstanding going to do illegally; one has to help them to see what can be done about it. When people with large families do not want any more children, it is no good digging in one’s heels in and saying one will not permit abortions. They take place anyway. They take place either illegally, self-inflicted, so to speak, or through these back-street abortionists and a very high mortality rate results from this. Dr. Bloch also mentioned in his report to the Cillie Commission that the number of battered and unwanted children was increasing at an alarming rate. These are matters which I want to commend to the hon. the Minister’s just passing laws and thinking that that is the answer to these serious social problems just simply does not work.

There is another point I want to make about the emigration of doctors, Sir, if I have the time. Another reason why doctors are leaving because of the conditions of service is that no sabbaticals are granted to them. They feel very strongly about this. They feel the need to attend medical congresses abroad so that they can catch up on the advancement in medical science, the latest experiments, etc. that have taken place there. They find that they are penalized financially when they do go abroad. They either lose their entire annual leave if they happen to be full-time doctors attached to a hospital or they are not given the necessary financial recompense for the expenses involved in travelling abroad to attend medical congresses.

Sir, we cannot go on treating our doctors in this way. We are losing them, we cannot afford to lose them, and I believe a serious situation has developed throughout the country in all the specialist departments of medicine throughout South Africa. [Time expired.]

Mr. Chairman, I have listened carefully to the various members who participated in the debate. I think the debate has been particularly interesting up to now and the contributions have evidenced a thorough study and an uncommon involvement on the part of the members in our health problems— except, perhaps, for one single discordant note we heard in the beginning and which gradually weakened. I must make some reference to that.

†Although as a rule I do not question the bona fides of the hon. member for Bryanston I think he did himself a disservice today. He started off by praising me and then also condemned me in the same breath. He began by enumerating the five evils that are detrimentally affecting our health and he again saddled up that old horse of 1948, apartheid. I am not impressed either by his praise or in this specific instance his ideas about the old apartheid. In health we treat matters without beating about the bush. This hon. member mentioned five factors detrimentally affecting the efficient working, so to speak, of our Department of Health or the health of the people of South Africa. He mentioned apartheid, malnutrition, the fragmentation of health services, smoking and alcohol. The last four are matters of common concern and I appreciate it when members do refer to these matters. Actually I welcome a debate on these subjects. However, as far as the first mentioned matter is concerned, he is a stranger in Jerusalem. I think his attack was unfair, I think his attack was unjustified and I think his attack was misdirected. He attacked the Department of Health and intimated that we were still clinging to concepts that were older than a quarter of a century as far as our treatment of different patients is concerned.

*I must tell the hon. member that we have no place for party politics in health matters. If anybody wants to apply the Hertzogite concept of apartheid of 1948 while I am Minister of Health, then I want to tell him to his face that that is a model that is altogether out of date. That model does not work anymore; it is out of circulation as far as the philosophy of discrimination per se is concerned—in other words, separateness purely for the sake of the idea of the necessity of separateness and for no other consideration. The Department of Health does not deny that differences exist among human groups and cultures, and so forth. But in the department’s planning over the past five years, in its planning and in its publications, we have been far removed from that whole notion of apartheid. I have here a publication I send all over the world. I have never had a single word of criticism from any country about the handling of health matters in South Africa. I think the hon. member is aware of the fact that in our legislation in the debates on which he has participated, we have never placed reliance on the idea that one has to classify an individual in regard to one’s treatment of him, in regard to one’s relations with him, as an individual, as a patient, as a person in need of assistance, as an individual who is suffering, and that we draw a distinction between one person and another.

†His refusal to acknowledge what has happened in the past in legislation, in our actions, in our publications and in all other matters where we are active in the health field, is really deplorable. We as a Nationalist Government acknowledge these differences, as I have said, differences in culture, in customs, in affinities, but the hon. member has a deplorable lack of insight into those things. I sincerely trust that this will be the last time that he will introduce a note of that kind in a debate of this nature. We treat differences between peoples and groups humanely and with a comprehension of the delicate nature of these specific human beings, their attitudes, their dignity. I have not had any criticism levelled at me or at my department that we discriminate. I am not talking about a certain amount of differentiation which is based on historical, cultural and other differences. I think the hon. member should acquaint himself with the true position. He said I should be more forceful in speaking out publicly against apartheid. I think he has got it all wrong, Sir. I suspect that he wants me to use a political platform to attack his antiquated version of apartheid and at the same time aid our internal and external enemies. That I am not going to do; I am sorry.

*Of course, not everything the hon. member said was of a negative nature. He raised certain matters here which we shall attend to. However, his information is not always correct. He must know, after all, that we are now discussing the trend and the action that has been taken during recent years. Must he complain, now, that mistakes occurred, as in the case of a person who, according to him, died in an ambulance as a result of apartheid? I say that person died as a result of an official’s inability to decide for himself.

Inability to give an instruction.

Yes, to give an instruction. The policy of the Government, which was set out by the previous Minister of Health as far back as 1969, is that when a person is seriously ill he must be picked up by an ambulance.

How does the ambulance driver know whether a person is seriously ill or not?

That is a general statement and you are talking of a person who has been seriously injured. Ambulance drivers, except novices who should not be performing service in an ambulance in any case have, as a rule, an elementary knowledge of when a person has been seriously injured. The ambulance driver should know. What you want is total mixing in all respects. I have told you that we have to take cognizance of the differences in the customs and cultures etc., of people, without enforcing these things unjustly. That is altogether a different matter.

The hon. member also spoke of the fragmentation of health services. I must tell him once again that in this respect, too, he is a stranger in Jerusalem. Why does he attack us on a matter in connection with which he knows as well as I do that last year, after 58 years, we succeeded in integrating our health services, and that we immediately started implementing them?

†The provinces and myself, for the first time this year got together on an integrated basis in order to implement this integrated hierarchical service that was fragmented for 58 years. While we are busy with this, he starts criticizing us on the strength of things which happened over the years before 1977.

*I think the hon. member should have displayed a greater willingness to give people their due. However, I trust that he will not sound that note again when we discuss health matters.

The hon. member for Newcastle made a very interesting speech. He spoke of the necessity for a good service. One can achieve that by means of a good system and also by means of a good professional corps. He spoke of the emigration of doctors. This is not a matter we can thrash out in detail here today. There are many reasons why doctors leave. I accept that not all of them are equally devoted to South Africa. I accept that there are people who leave the country for financial reasons. I accept that there are people who leave for political reasons. I accept that there are people who leave because they do not like the country or because they feel that, as a temporary measure, they want to avail themselves of better study opportunities in a foreign country or in one of the Western countries. There are quite a number of reasons. I concede—and here I am replying at the same time to the hon. member for Houghton—that in certain cases there are perhaps not adequate academic facilities available to them. But then I want to point out that last year the State made a contribution in 510 cases so that some of our academic people could go overseas to become better qualified there. As far as salaries are concerned, the hon. member for Newcastle spoke, on the one hand, of the large number of private practitioners who have reached the marginal notch. I believe the complaint there is that the tax is too high. Is it not strange that on the one hand a person complains about the tax being too high and, on the other hand, that he does not earn enough? Sometimes, that is an anomaly to me.

I think our doctors should give this careful thought because there are also those among them who have told me that it is only necessary for them to work for three days and who have asked why they should have to work for the remaining two days because it is only to the benefit of the State. I want to tell my colleagues again now—and some of them have already taken me to task in this regard— that when one is devoted to this country with its particular national structure then the doctor who regards himself as being devoted to this country should be willing to render his services in such a way that the people who do not have sufficient doctors can also sometimes avail themselves of those services, even though they cannot remunerate him as well as they would like to.

There is the immense fear of socialization, which is nothing but a spectre that has been conjured up. However, if there is one way in which we shall incur socialization that will lead to equalization and uniformity and to a negation of the striving of the human being to do the best for himself in relation to his abilities, it is to look only after one’s own interests. That happens when one does not take account of the structure, the composition of the people of one’s country and of the extent to which the services of us Whites, who have a sufficient number of doctors, are required elsewhere. The Whites have one doctor for every 400 people, the Coloureds one for every 6 500 and the Indians one for every 8 900. Our Black people have one Black doctor for every 44 000 people. In other words, this is a unique task. I admit that from a financial point of view, and by way of comparison, the position of the doctor in the full-time service of the State is not rosy. I admit that they have my full support and that in this regard we must constantly strive to give the doctor his due as far as remuneration is concerned so that he can compare favourably with the man abroad. However, in that respect I want to tell him that I agree with him and I want to point out that we are attending to this matter and that we have it constantly in mind. In this regard I want to come back to what the hon. member for Houghton said in connection with equal salaries. I am not afraid to tell you here today that if I could obtain the money tomorrow I should equalize all the salaries of qualified doctors on the very same day. As far as I am concerned there can be no such thing as people receiving different salaries on account of the fact that they are of different nationality or race. A person’s productivity, his capacity, his ability, his background and training are the things that should count. Whether that is possible depends upon other factors. What is more, it is not merely a question of equalizing salaries per se and thus putting everything in order. The rest of the world finds that although there is legislation for the recognition of the rights of people, salaries are simply not equal. However, I accept the argument that a man who is qualified at that level and who performs his duty and who does it for the State, should receive the same salary. On the other hand I want to say—and in this respect I believe that the hon. member for Houghton did not do her homework properly—that the two universities the students of which do not leave South Africa or at which the percentage of students leaving South Africa is negligible, are one Black medical faculty and one or two White universities. These are the medical graduates of the University of Durban-Westville and the University of Stellenbosch. There are others too—some with a high percentage and some with a low percentage. It is not necessary for me to mention their names here. I am only very pleased that the universities themselves are now giving attention to this matter and that they are concerned about it. It is the subject of an investigation at present and I already have certain facts in that regard at my disposal. It is true that the emigration of doctors has increased but we find that the rate has now levelled off, that it is now more steady, and we expect the position to improve in future.

†Mr. Chairman, the hon. member for Berea mentioned a few very interesting subjects and among others spoke about the deleterious effects of smoking. He wanted to know what we could perhaps do in regard to an antismoking campaign. The hon. member for Pinelands, on the other hand, was concerned about the problem of alcoholism. As far as the warning on cigarette packs is concerned, we are at the moment conferring with various interested groups to see whether it is feasible to publish these warnings on cigarette packs. We are giving attention to this matter because I have been inundated by letters during the past year in regard to this. I think that one should pay heed to public opinion as far as this is concerned. I do not suggest that we should become hysterical about it, but at the same time I must tell the hon. member that the Department has published a very extensive statement—I could even call it an article—on our attitude towards the smoking habit. I will not go into detail about this statement as it is freely available and I think the hon. member should avail himself the opportunity to get a copy and study it. We are not being coercive at the moment, but the time might come when we will have to introduce legislation. At the same time the Government cannot simply start using the hatchet. We have to consider certain things. But basically I agree with the hon. member that this is a very important matter, something to which we should continually apply our minds. I hope that during this year we will find some way of taking action in regard to the smoking of cigarettes. Some hon. members also mentioned the deleterious effects of cigar and pipe smoking, but I do not think that any important statistical evidence has been produced to prove that pipe and cigar smoking is without any doubt as bad for one’s health as cigarette smoking is. One should therefore perhaps use a little discretion in that regard. It is not necessary to be opposed to the tobacco industry as such.

The hon. member also spoke about bilharzia. In this regard we are not only continually doing basic research but also applied research, and this is a team effort between the Medical Research Council, the Department of Health, the South African Institute of Medical Research and the Department of Water Affairs. Our field unit in the Northern Transvaal is at the moment engaged in a field study, and we have involved the school-children of this area in this project.

*The hon. member for Fauresmith spoke with particular appreciation of the medical profession besides the remarks he addressed to the hon. member for Bryanston. Of course, I fully endorse what he said. I do not think it can have any great use to conduct a debate here about the conduct of the district surgeons in the Biko case. Let me repeat this once again although the Press has already dragged it out of me. A doctor cannot claim privileged treatment if it is proved that he was negligent or that he did not act in the highest traditions of medical science. In this case it is not a question of protecting people; it is a question of following the correct procedure. If one of one’s employees has completed his task but one is of the opinion that he has not done it properly, one investigates the matter to the best of one’s ability. One realizes that it is one’s task to institute inquiries at a certain level. In that regard the department carried out its task. The department ordered an investigation and came to the conclusion that, taking everything into account, there was no justification for departmental action against those district surgeons. But if doubt or suspicion should arise that there has been unethical or incompetent conduct, it is a matter that can be referred to our statutory council. This matter is at present receiving the attention of the statutory council and hon. members can accept the fact that this council will carry out its duty in this regard irrespective of the persons involved.

†The hon. member for Pinelands spoke about the scourge of alcoholism. I think this is a most difficult matter for me to attempt to reply to. It is a very disturbing phenomenon that has been in existence from time immemorial. But in the present time of stresses and strains it is of course a cause for great concern. It was particularly interesting to listen to the figures he gave in regard to the effect of alcoholism on our economy, and I fully agree with him. I do not have any knowledge of those figures but they are undoubtedly astronomical, i.e. R150 million. We are just as concerned as the hon. member is. Unfortunately, at the moment this matter falls under the Department of Social Welfare and Pensions. I know the hon. member disagrees with that, but at the moment it is a fact. But we do not dissociate ourselves from the problem because there is a health aspect involved. We are involved in the curative action and in this regard we should do our duty. I might mention, however, that my department is giving attention to the abuse of methylated spirits and together with the Department of Customs and Excise we are going into this matter. This is a very serious problem because it is one of the cheapest ways of getting drunk, i.e. by drinking methylated spirits, especially among our Coloured people. The problem is enormous. I think we might be able, with the right amount of co-operative effort, to make progress in time to come.

Mr. Chairman, may I put a question? Unfortunately I did not have enough time to complete my speech, so may I ask the hon. the Minister whether he and his department, together with the Department of Social Welfare and Pensions, will not give some consideration to mounting a campaign at every level—school level, television level, radio level, audio-visual level—to combat this particular scourge, because I think I have indicated just how serious it is.

I think that is a very laudable idea, Sir, although I do not think that the hon. member expects me to make any firm promises in this regard immediately. However, I am sympathetic towards the idea, and, of course, the other department has to be consulted in this instance.

*The hon. member for Pietersburg made a very interesting speech. He spoke mainly about environmental and air pollution and so forth. I welcome the philosophical yet realistic way in which he approached our changing world and the trauma that has arisen in it. He referred to what we might call our human destructiveness and the price we have to pay for development—industries and so forth. I may discuss that aspect later this afternoon. I shall bring it into relation with the increase in the population or the population explosion.

†Mr. Chairman, the hon. member for Umbilo spoke about the shortage of doctors. I am also just as concerned in that regard.

For the information of the hon. member for Pinelands, I am just now reminded of the fact that alcoholism forms part of our health year programme for next year. In my reply to him, I did not think about that aspect. This will be included in a very comprehensive programme.

Do you mean in combating this problem?

Yes, not abolishing alcohol because we cannot do without it completely.

I should like to tell the hon. member for Umbilo that we are in constant consultation with the Department of National Education. The recent relaxation in regard to the admission of Black students to the so-called closed universities, is an outcome of the consultations we have had. We are continually giving attention to this matter and we have also done so in the case of Medunsa. We are also planning to increase the number of medical/scientific staff and eventually doctors at the University of Natal. Where the hon. member has asked that Black or White medical students should be allowed to study at the University of Durban-Westville, I would like to tell him that in this case there is another side of the coin.

I was not referring to Durban-Westville but to Natal University.

At Natal University. In any event, very high costs are involved in providing the necessary facilities. Therefore we cannot establish a separate university with separate facilities.

We do not have a dearth of White doctors with the result that there has been less demand for facilities for Black medical students. At the moment we are concerned that these people should get all the necessary facilities. We must seek to attract these people from their population groups. Without imposing any restrictions and depending on what the university council decides, post-graduate students could be admitted to a non-White universities or faculties and I have no objection to that.

I wat the White undergraduate students …

Yes, I know, but I have told the hon. member that we do not have the money available at present. We have to see to it that everything is done in proportion. We do not have the finances to create another White medical faculty.

There is no need for it; it is already there.

Yes, a faculty exists. I said at the outset that it already exists but that it caters for undergraduate Black students. The facilities are only for Black students. They do not even have sufficient facilities for those students. Now the hon. member wants White undergraduates to be admitted these who would eventually encroach upon the Black students’ facilities. That is the point I am trying to make.

But you established the Medical University of South Africa at Ga Rankuwa for Blacks which has an intake of 200 Black students.

Yes, that is the case but those facilities will only be available over a period of time. If we really wish to cater for the needs of these people at the moment we do not need only one university but three Black universities. This is basically a question of a relative approach to this matter. The hon. member will appreciate that I do not want White students to encroach upon the facilities of the Black students at the University of Durban-Westville.

I am not concerned about Durban-Westville; I am talking about the university of Natal.

Perhaps I should not have mentioned Durban-Westville. I can only add that the University of Natal has a faculty that caters for Blacks. Those facilities are barely adequate. Let us leave the matter at that.

The hon. member also mentioned immigration and I have already given him my reply. He also spoke about district surgeons. I would like to ask him to bring such cases to my attention. He need not even do so through the Department of Social Welfare and Pensions because these people are actually appointed by my Department. I would of course consult the Department of Social j Welfare and Pensions but the hon. member can approach me directly. I do not think we can in any profitable way discuss this matter here today.

I have discussed the training of medical practitioners. In regard to the future role of district surgeons I might add that we are reconsidering that aspect at the moment. A great many of the duties of district surgeons can be executed more effectively under provincial councils. It is possible that the medical legal work can be done more effectively this way than under the Department of Health. However, we are still considering that matter. We do not only have full-time district surgeons; we also have a great many part-time district surgeons. I know the service is not what it should be and we are trying to find out whether we cannot aid these district surgeons by means of nursing services. In such cases a nurse can do a lot of work which the doctors would otherwise have to do. To a certain extent we are now trying to alleviate that problem.

*The hon. member for Tygervallei spoke about the Medical Research Council. I fully endorse what the hon. member said about this council. The principal objective of this council is to promote the health of all the people in this country, and it makes an immense contribution in that field. The council as such does not always receive the necessary attention in Parliament because, in general, people are reluctant to speak about scientific matters. The hon. member did not attempt to be technical but he did speak with appreciation of the work done by the council. I fully agree with him. Even if one does become technical one can speak with great praise of this council.

It has been in existence now for eight years and during this period it has brought a good cadre of able researchers in the medical world to the fore. These researchers perform specific tasks and, as a result, they have gained worldwide recognition for the council. The hon. member also referred to the fact that the council is acting in a very good liaison capacity in its relations with foreign medical scientists. Last year an agreement was entered into with the NCRD (National Council of Research and Development) of Israel. That is actually the supreme body in the field of the natural and medical sciences in Israel. It was agreed that there could be an exchange of scientists for research purposes, that they would assist one another mutually—by way of lectures or in other ways—and that they would arrange consultations and conferences regularly. As we are all aware, the Medical Research Council has its seat in Tygervallei and consists of quite a number of institutes and units that undertake specific research. The council has gained quite a number of outstanding achievements. I can think of 10 great achievements on its part during the past year. There was particular research into ischaemic heart diseases among men in the age group 30 to 45 which occur in 23 out of every thousand in South Africa whereas in America at the moment the figure is only 9½%. That is the most affluent country in the world. These are environmental diseases and they arise from our living habits. However, I do not want to become technical.

I just want to mention the chromosome which determines the characteristics of man. There has been chromosome research in which the qualities or even the risks of illness to which a child would be prone can be determined before birth. There is research in which the qualities of the cell are ascertained. Certain skin diseases are being investigated. There is also research in the industrial field, for example, where steelworkers experience problems in their work environment. Then there is also electromicroscopy whereby objects can be enlarged enormously and studied. In our homelands, in particular, and among our Black people, tuberculosis research has brought many interesting aspects to the fore. Research is being conducted in regard to diseases related to feeding and the enrichment of foodstuffs as well while cancer research has also not lagged behind. In many fields, there is the closest international cooperation.

The hon. member made a plea for more funds for research, particularly for funds to promote international research and liaison. I am very sympathetically disposed towards this request but the hon. member must realize that these days we all make demands of the hon. the Minister of Finance. However, if a case can be made out—which can be done in the usual formal manner—the hon. member will not find me unsympathetic.

†The hon. member for Houghton raised a few matters, but I think I have replied to all of them. I have replied to her remarks about Biko, as well as in regard to the emigration of doctors. I have also replied to her questions about the inequality of remuneration.

Mr. Chairman, may I please put a question to the hon. the Minister? Can the Minister give us an indication as to whether the possibility exists that the department will look into the difference in salaries between senior medical officers and senior specialists with a view to improving the position?

I think I have already said that at the moment these matters are being investigated in co-operation with the Public Service Commission and, even since the salary adjustments, there has been the feeling among senior officials that, relatively speaking, the senior officer or the person with more experience is not all that better off as he ought to be if his capability and experience are taken into account. The hon. member may rest assured that we are giving the requisite attention to this matter. I want at this stage, to content myself with these few remarks.

Mr. Chairman may I ask the hon. the Minister a question? In regard to medical undergraduate students, the Medical University of South Africa at Ga Rankuwa is to admit Black medical students and the instruction to the University of Natal has been that as from next year they will not be permitted to admit Black undergraduates. If the Government’s policy is to prohibit further Black undergraduates from registering at the University of Natal, there will then be space available at this university. The Government wishes Black students to go to the University at Ga Rankuwa. Is the hon. the Minister taking steps to ensure that the University of Natal will be permitted to continue to admit Black undergraduates?

Mr. Chairman, may I ask the hon. the Minister a further question? I wish to ask the question on behalf of the hon. member for Houghton, who is taking part in another debate and who has asked to be excused. I wish to raise two matters, viz. the movement away from the public service in respect of doctors’ remuneration and whether the hon. the Minister would support that, and secondly, whether the hon. the Minister will give the Committee some figures in regard to illegal abortions.

Mr. Chairman, I should also like to ask the hon. the Minister a question. I want to do so in pursuance of the reply he furnished to statements I had made in my speech. Suppose a White person is injured or becomes seriously ill in the vicinity of the Baragwanath Hospital, may such a White person be taken to the Baragwanath Hospital for treatment? If, for instance, a Black man is seriously injured or becomes ill in the vicinity of the J. G. Strijdom Hospital, may he go or be taken to that hospital for treatment? If a patient or injured person is conveyed to the hospital by ambulance, is the position really as the hon. the Minister indicated, namely that the responsibility rests on the driver of that ambulance to judge whether the injury or illness is of such a nature that such a patient may be taken to the nearest hospital and be conveyed in that ambulance?

Mr. Chairman, as far as the phasing out of Black students at the University of Natal is concerned, the hon. member can only get a final reply or statement from the responsible Minister.

I thought he sent a directive to the University informing them that as from next year they would not be able to register Black students.

Which Minister did that?

The Minister of Plural Relations and Development.

I am talking about the Minister of National Education.

What about the medical university at Ga Rankuwa?

There is no problem about that, because it falls under the Minister of Education and Training. The admission of Black students to the University of Natal is the responsibility of the Minister of National Education and he is the only person who can make a statement about this. I think the hon. member will get a satisfactory reply from him, and he may even be not too disappointed.

The hon. member for Pinelands asked about the movement away from the public service. I do not wish to be drawn into a discussion of this kind. I am in favour of coordination, but if there is a case to be made out for a specific type of scientist or group of scientists to be treated in a special way as far as certain aspects of their conditions of service are concerned I would not go against it. I am all in favour of a practical approach. However, a movement away from the public service, as the hon. member calls it, is a rather vague concept and I do not think I should say anything further about it. As far as illegal abortions are concerned, this is a matter for the police and we are not able to impose any conditions on the police as far as this matter is concerned. I would be glad if we could have statistics in this regard. As the hon. member is aware, we have made some progress in this regard as a result of the regulations we promulgated regarding the remnants of abortions removed in hospitals. In such cases we have to be provided with statistics.

As regards the Baragwanath and J. G. Strijdom hospitals, if a very serious case of injury or disease affecting a person of whatever colour occurs in the vicinity of these hospitals, I cannot see any reason why such a person cannot be taken to either of these hospitals. If the person who comes across such an injured or ill person feels that the case is serious enough, he should be able to take him to the nearest hospital. However, he must not simply take that ill or injured person to the nearest hospital just because that person happens to be ill or injured. He must be convinced that it is a serious case because for various reasons we have separate hospitals. I see no reason why such a person cannot be admitted to either of these hospitals, at least to the out-patients department, so that doctors can determine his condition and give him temporary relief or assistance. However, there are quite a few reservations in this regard. If people abuse this magnanimous approach to this problem, it will lead to trouble. Sometimes the patients themselves object or the people who work in the hospital. In spite of that, however, I feel that if the case is serious enough I can see no reason why such a person cannot be given preliminary attention at any hospital.

As far as the ambulance driver is concerned, it is not a question of his responsibility but of his decision. If he makes a bona fide decision and is proved to be wrong, as far as I am concerned this is not a problem. Should he decide that the injured man is in danger of losing his life, and that he is very ill and he suspects he might die within a few minutes, and he is taken in there, I think that is wrong and not fair to subject this person to some sort of inquisition, because of a wrong decision.

Mr. Chairman, unlike the hon. member for Bryanston, I have the highest appreciation for the hon. the Minister for the good work which he is doing, for the good work which is being done by his department, as well as by the health services in South Africa in general. We have every confidence in the Department of Health.

It is said that everyone has certain basic rights. He has the right to live, the right to have the roof over his head, the right to work, and so one could go on. But, Sir, every person also has certain basic responsibilities, and a balance has to be struck between responsibility and rights, otherwise the whole thing goes awry. I want to say that the person who has the ability to fend for himself does not have the right to become a burden to the community or to the State. I want to confine myself more specifically to responsible parenthood, to the question of family planning and the question of judicious population growth.

I think the first place where one should seek the cause of the problem is in the ignorance which prevails concerning the question of population and family building. Education and information and assistance, if necessary, are a preventive service, a service which has to be performed. Uncontrolled growth gives rise to a vicious circle, and owing to a lack of time I cannot go into all the details now. I want to mention only a few.

Hon. members mentioned certain evils, dangers, certain bad habits and certain threats here. I want to tell you, Sir, that the biggest and most serious canker in national life and the life of people in general throughout the world, is definitely uncontrolled population growth. This poses the greater threat to man, to a nation, to a community, than any other danger like smoking, alcohol, the abuse of liquor, etc. I do not mean at all that one should not warn against these habits, but I should like to emphasize the seriousness of uncontrolled growth, and this is what it is all about.

I am not referring now to other countries where the same phenomenon occurs. In the first 50 years since 1900 the population in South Africa grew from 5 million to 12 million, an increase of 7 million. From 1950 to 1975 it grew by 13 million; this was in the space of a mere five years. But from 1975 to the year 2000 the projection is that the population will grow to 50 million. In the year 2020, according to projections, there will be an increase to 81 million. South Africa cannot afford this. For instance, in this regard we think of agriculture and the people that have to be fed. In 1970 there were 22 million people, and according to projections there will be 50,2 million people by the year 2000. In the year 2020 there will be 81,34 million people. Let us consider unemployment. It is said that every person has the right to work, but there has to be responsibility. At the moment provision has to be made for an average of 1 000 employment opportunities per day for young people entering the labour market. By the year 2000 we will have to provide, on an average, 1 500 employment opportunities per day in order to meet the needs of accommodating everybody. In the year 2020 more than 2 000 employment opportunities per day will have to be provided.

I have merely mentioned these few statistics, Mr. Chairman, in order to emphasize the seriousness of the matter. I now want to come to the department’s report, and I want to congratulate the department, as well as the Secretary for Health, on this very fine report. This report bears testimony to dedication, knowledge ability and earnestness. I want to refer to chapter 7, the national family-planning programme. I see there that very good progress has been made as regards family planning, but I want to add that in my opinion not enough has yet been done. As I have said, population growth is basic to survival and all the evils resulting from it Progress has been made in this regard, and the data are as follows: In 1970 Whites increased by 24,9 per 1 000, and in 1975 it was 18,9. This is a decrease. The figure for Coloureds in 1970 is 46,6, and in 1975 it was 28,5; Indians: 29,7 in 1970, and 27,9 in 1975. As regards the Bantu, the estimated figures are is 45 in 1970 and only 38 in 1975.

Progress has therefore been made. For this financial year R1,8 million more has been voted than last year, for which one should be grateful. One should also note with gratitude, since community involvement is so necessary, what the public press did, according to the report. There are, however, a few exceptions.

Furthermore, we should note with appreciation what is being done by the family-planning association of South Africa. These people are efficient. Their task is to provide information, to provide education, as well as after care and follow-up work. Then they also do collection work. Now the hon. member for Bryanston can listen. The familyplanning association makes no exception in respect of race or colour or nation. Everyone is involved and no one is coerced; it is a voluntary affair and is done by choice, one’s absolute own and free choice. Nobody is forced, and the membership of this association is not based on race or colour or whatever the case may be. It is for people as such.

This is not a political body. These people are not members of a particular religious persuasion. These people do not have certain convictions which are different from those of other people, and that is why they are not prejudiced, that is why these people do very good work. These people do not encourage licentiousness; they rather promote the morals of our people. Now I want to ask that the clinics be fully equipped with all types of contraceptives, because if a certain contraceptive does not agree with a person and he is unable to obtain another one, it results in his staying away. And once someone stays away, it is very difficult to educate him into returning. Some people are bent on having everything within convenient reach, and that is why I should like to thank the hon. the Minister very much for the mobile units.

I want to hazard a proposal, Sir. I should like to suggest that better community involvement be brought about. This is an urgent necessity in this case. I am asking for serious attention to be given to community facilities in every community so that every community may serve itself within a small area. [Time expired.]

Mr. Chairman, I should like to congratulate the hon. member for Hercules on his interesting speech, and in certain respects I shall be able to continue his line of thought in the course of my speech.

I should like to avail myself of this opportunity to highlight the task of the health information officer, to express appreciation for it and to plead for greater involvement. Unlike the hon. member for Bryanston, I have the greatest regard for our medical and health services. Our medical and health services can compare with the best in the world and we can take credit for some of the greatest medical achievements in the world. In the field of research, too, we enjoy a very high reputation and there are very few countries that surpass us. The hon. the Minister has already referred to this and I shall not enlarge on it any further.

I think, too, of the many achievements of our scientists. Just think of the one of Dr. Gear, who received the Manson medal for tropical medicine. He is really an expert in that sphere. There is Dr. Alexander, for example, who made a famous break-through in the field of cancer research, etc. Add to this the excellent work which is being done by the researchers at our various universities, then I have reason to say that we are second to none. In the second place, I want to draw attention to the training facilities which exist for the training of our medical practitioners at our five universities. In the third place, we have our well-planned and equipped hospitals and other institutions, through which we are able to provide medical services of a high quality to our whole population.

The principal aspect I want to refer to is the problem of conveying to the man in the street, to the public, the results of our research and the knowledge available to us. Preventive guidance is therefore the specific subject on which I want to lay special emphasis today. We always say that prevention is better than cure. Preventive medicine is of the greatest importance today, and therefore I want to draw attention to this subject and to the preventive guidance service. Preventive guidance is the direction which is receiving great attention at the moment. Compared to curative services, guidance is really a newcomer to the scene. Through guidance services an attempt is made, as far as possible, to bring about a change in our services, i.e. the department endeavours to prevent people from being admitted to hospital and treated there, which is a very expensive process. In this process of guidance, there is very close liaison with all our various communication media such as the Press, the SABS with its television and radio programmes. Informative publications play an important part in the process of instruction. A number of excellent brochures have already appeared in the professional series of the National Health Guidance Programme. The emphasis falls on the need for greater participation by the health professions in community-orientated health care. I shall mention just a few of the large number of publications which have appeared. There is the well-known My heart and I, as well as the Bilharzia in South Africa, Successful Family Planning, Emergency Feeding, and family planning pamphlets which are published in Bantu languages. The department also makes use of the other news media. For the radio, a series of 20 recordings were made for Monitor. Morning talks have been presented about My heart and I, which I have already mentioned, My Blood pressure and I, and several others. Interesting television programmes on family planning, on psychiatry, on coronary vascular diseases have already been presented. They have all been most interesting and have had a wide impact. In 1977, the principal aim was to emphasize the importance of coronary vascular diseases in various ways. Another method which was used was the various health forums which were held in this connection. Over and above the National Film Board, which has produced several very important and suitable guidance films, there is the departmental news magazine, which plays a very important part and which is distributed all over the country.

According to Dr. Howard Botha, the health guidance department is one of the bodies which is doing very important work for our country today. It is of the greatest importance that there should be close liaison between the Department of Health and voluntary organizations. He emphasizes greater community involvement on the part of health services. He says that the emphasis is shifting more and more in South Africa from the curative to the preventive health services and the earlier discovery of the disease. Expensive hospitalization is a practice which has to be avoided as far as possible. If the public can therefore be taught to make proper use of the available services, it can be successful.

I therefore want to plead here that the guidance which is still being offered in a fragmentary way today should be better coordinated to eliminate duplication. I am thinking here, for example, of the activities of the Cancer Association, of Santa, and of many other private bodies which are all active in the field of guidance. I believe that our country cannot afford these fragmented services. We do not have the funds or the manpower and they must be closely coordinated. In addition, the continued involvement and the active participation of the population are preconditions for success in the field of health services. The announcement that 1979 would be known as a health year ought to bring about the community involvement which is advocated. Here I find myself in very good company, Sir, because I know that Dr. De Beer himself made a very serious plea for this in the health newsletter of 1 November 1977. I therefore ask the department to consider it its task to co-ordinate and to provide guidance to all the bodies on every one of these aspects, so that there will not be any duplication.

Health guidance is not only the task of the department. I want to make a serious appeal for the co-operation of the public as a whole. I ask myself: Who is best able to provide guidance and information in respect of family planning? Is this not the unique opportunity of every housewife? She has a special opportunity to impart information, not only among the members of her family, but among her servants as well. I believe that successful family guidance can begin in the kitchen. We as employers, too, can do a great deal to promote family planning and to co-operate with the people who provide guidance. It has been proved over and over again that men’s resistance to modem family planning is only caused by ignorance about contraception. If the ignorance is removed, the co-operation is spontaneous and automatic. I find it a pity that these excellent and valuable brochures, which deal with vital subjects, do not always reach the general public. I am referring to the brochures dealing with the dangers of the smoking habit, or the dangers of vascular diseases, and so forth. It is true that one has to fall ill in order to appreciate one’s health. I may as well tell this committee: It is 12 years ago today that I stopped smoking. If I had not done it then, I would very definitely not have been here today. Therefore I believe that we all have a duty to spread knowledge, to enable everyone to share in the benefits of that knowledge. I believe that these appropriate brochures should also be provided at our schools and at our educational institutions. I believe that they should be made more freely available, in places such as the waiting-rooms of doctors and dentists. There one often has to page through magazines which are 50 years old. These brochures would be very welcome there. You should be told that you can take the brochures home, for that is where we want them to be. Therefore my plea is that we should greatly expand the services already provided in this respect. [Time expired.]

Mr. Chairman, it is always a pleasure to hear someone asking for prevention rather than cure and I should like to support the hon. member who has just resumed his seat and thank him also for his indirect support for a plea that I made earlier today. I should also like to refer to the support of the hon. member for Pietersburg, the hon. member for Pinelands and in fact, the support of the hon. the Minister. It looks as though we have what one might call a certain degree of unanimity on the idea that smoking should be discouraged wherever possible.

I should like to make one last point in this regard and that is that the excise duties which we earn in this country annually amount to some R238 million and the amount which we give to the National Cancer Association under this Vote is R200. I think that this disparity indicates that we should have another look at our priorities and get them in better order than they are at present. However, I shall leave it at that.

Mr. Chairman, as public representatives we are often approached by people who have been the victims of various misfortunes, often illnesses, sometimes rare and unusual illnesses, and they bring their problems to us. While I agree that the health services of a country should be aimed at the majority of the problems we see, I feel that it is our duty as public representatives to bring these lesser-known illnesses out into the open and into the glare of publicity and discuss them in public debate from time to time because by so doing, they hold the attention of people which makes it more likely that something will get done.

I should like to deal briefly today with three problems, one which affects mainly older people and the other two which affect children, infants.

If one mentions the word Parkinsonism today, especially to older folk, one tends to get a rather horrified reaction from them because they have visions of the shakes, the shuffling walk, and the mask-like vision, and it generally conjures up pictures that are less than wholesome. This is a very real problem among older people. It is debilitating, it is demoralizing and it is also very depressing. Fortunately, there are treatments for this problem, the older treatments, of course, by means of the anti-colonergic drugs which reduce the tremor and improve the mood. Latterly there were the dopa drugs, the laradopa in particular which acted through the neuro-transmissions to improve the condition as well. Unfortunately, of course, in regard to the first group of drugs, the anti-colonergics, they were only successful in a certain percentage of patients, some 70%, and were not generally successful in the more severe cases. The dopa products of course were effective in the more severe cases but both groups of drugs together were found to be very much more effective and to give fewer side effects. One problem was found to be side effects and another problem, particularly with the more modem dopa drugs, is the problem of cost. One realizes that as most of the people suffering from Parkinson’s disease are older folk, many of them pensioners, the question of cost becomes a very real problem to them.

A third problem one might add, is the problem that the onset of symptoms in various older folk can sometimes be slow. These symptoms are sometimes referred to as a pre-Parkinsonism syndrome, and they are not always detected. Patients are not always put on to treatment as soon as they might be which would delay the onset of the problem. I think one could well ask the hon. the Minister and his Department to look at these problems and see whether they can come forward with some ideas about better public education and, in fact, in some instances, better education for the medical profession, some of whom might miss the early symptoms of pre-Parkinsonism.

Then I should like to deal briefly with two problems which fall under the heading of genetic problems. I am glad that mention was made of the research on genetic counselling earlier this afternoon.

The first problem I should like to deal with briefly is that of cystic fibrosis. I have gone through the booklet of the Department of Health and it is a mine of information. I believe a very good job has been done in compiling this booklet. If I could be so bold as to make one suggestion I should like to ask the hon. the Minister whether perhaps in the presentation of future booklets the question of the dietary supplementation of patients suffering from cystic fibrosis could not be dealt with in more detail. We are aware that the food known as Alien’s food can be of great help to young sufferers from this disease. When one considers that the basic components of Allen’s food are very simple, mainly falling under the categories of a pre-digested protein, a carbohydrate similar to glucose, the medium chain triglyceride oils, vitamins, minerals and, finally, the essential fatty acids, none of which need necessarily be very expensive, I wonder whether some research could not be done to produce a food like this in this country. My information is that this type of food, Allen’s food, is imported, and the cost for a youngster of five or six years can be in the region of R200 per month, which is very excessive for a family of limited income. I shall leave that thought with the hon. the Minister.

Finally, I should like to discuss a very rare problem: There are not many votes in it and it is not a publicity-catcher but I think, again, these things should be discussed from time to time, viz. the problem of Hurler’s syndrome. There are only nine sufferers in the country so it is not exactly the sort of thing that everybody is aware of. I am told that there are numbers of medical people who have not heard of or come across this syndrome at all. When one understands that only one in a 100 000 live births results in this syndrome one realizes why it is not seen every day. But to the parents of children who are sufferers, this is a very real problem. It is also a genetic problem. Unlike the cystic fibrosis I understand it can be detected before birth, during pregnancy, by the process of amniocentesis which, if done privately, is a rather expensive procedure but which can be done through provincial hospitals. I understand too that research overseas, particularly in the United States, has been proceeding apace. In fact, they have more doctors qualified to treat this disease there apparently than patients with this sickness. I do hope that we will be kept informed with any discoveries in regard to treatment which they may come up with. I understand that a break-through was made recently using concentrated cells from urine, but that this in fact, when injected, only gave temporarily relief. However, I understand from information I have that it is felt that they are on the verge of a break-through in treatment and I would urge the hon. the Minister to give consideration to making any treatment that becomes available, available to children in this country because this is a very real problem as far as the affected families are concerned.

On this line I think one should also plead for more genetic clinics. I am aware that there is a full-time clinic in Johannesburg and I am told that there is one at Groote Schuur. However, in a city the size of Durban, there is only a part-time clinic and it seems to me that what we could ask for is more attention to be given to genetic clinics where genetic counselling can be undertaken because there is a very real stigma attached to problems of this nature that are hereditary. People must be educated that this is nothing to be ashamed of and that by bringing this out into the open and discussing it, people with like problems can come together and form associations such as the one we have at present, the South African Inherited Diseases Association, where these problems can be discussed and parents can get together and deal with the problem on a collective basis.

Finally, before I sit down, I should like to say from the New Republic Party that we should like to express our thanks to the members of the Department who back this hon. Minister. We have at all times received nothing but courtesy and co-operation from them and we value this.

Mr. Chairman, in entering this debate today I am grateful for the opportunity to pay tribute to the institutions in our country in which people are cared for. I want to concentrate on the centres for mentally retarded persons, and I do this because my wife and I, as parents who are personally involved, have been associated with one of these institutions, namely Witrand. I shall say more about this in the course of my speech.

At the moment, the department has five rehabilitation and care centres under its control, four for Whites and one for Coloureds. The four for Whites are situated in Alexandra at Maitland, Witrand at Potchefstroom, Cullinan, north-east of Pretoria, and Umgeni Waterfalls at Howick. The A. J. Stills institution at Westlake is for Coloureds. I want to thank the hon. the Minister and his department for what is being planned for the next few years, because the waiting lists in respect of these patients are alarmingly long. Let us just look at a few figures. At the Alexandra institution there is a waiting list of 404, while there are 900 on the list at Witrand, 300 at Umgeni and 856 at the A. J. Stals institution. In respect of the Whites, additional accommodation is being envisaged for 1 200 mentally retarded persons, in Oranje Hospital in Bloemfontein, at Cullinan and in the Rietfontein Hospital in Edenvale. In respect of Coloured people, additional accommodation will be provided for 1 040, including accommodation for 800 at Mitchell’s Plain. For the Indians, accommodation is being planned for 360 patients, and for the Black people, for 960.

However, what is giving cause for grave concern, Mr. Chairman, is the staff position at these centres. The present staff are actually fighting with their backs to the wall, and I just want to furnish a few statistics. In the centres for mentally retarded persons, there are only 55,19 nursing staff members for every thousand patients, as against 103,81 in psychiatric hospitals. The number in respect of nursing assistants is 155,19, while it is 1,73 for medical practitioners, 0,21 for physiotherapists and 0,86 for occupational therapists.

The department finds it difficult to recruit trained nurses for these centres. It is likely that the reason for this state of affairs lies in certain factors of which the following are probably the most important. In the first place, the treatment of the patients is naturally a continuous process and certainly does not have a stimulating effect on the nursing staff. Secondly, these institutions do not form a part of the medical and nursing training schools, as does a psychiatric hospital, where basic training is offered to nurses, doctors and other students.

I want to pay a special tribute today to the nursing staff and their assistants who continue to perform this labour of love, because, Mr. Chairman, it is indeed a labour of love. And in saying this, I am not just speechifying, but I am speaking on behalf of my wife and myself, who have been very closely associated as parents with one of these centres, namely Witrand, where our eldest son has been cared for in recent years. I am also speaking on behalf of other parents. There we made the acquaintance of a small group of people, dedicated people who obey the commandment to love one’s neighbour. When one thinks of the nursing staff at these centres, Mr. Chairman, one for every 20 patients, and when one realizes that for the most part, they are simply looking after their patients, one is tremendously grateful for the fact that there are still persons, men and women, who are prepared to make themselves available for this work.

I should like to pay tribute today to the staff of these institutions all over our country and in these five centres, with a special and sincere word of thanks to the staff of Witrand.

Mentally-retarded children are not so rare as seems to be generally believed. There are various degrees of mental retardation. Persons suffering from mental retardation in light and moderate degrees derive great benefit from the special training in special schools established in these centres by the Department of National Education. They are enabled to make a contribution to the economy of the country. In this way, for example, 62 men and 23 women are living at Witrand and functioning on the open labour market at the moment. The department itself also finds employment for these patients as labourers and assistants and I can assure you, Sir, that they enjoy their work. They are also able to help look after the younger patients. We have personally seen the compassion and love with which they look after the children who have been entrusted to them, especially the patients who are mentally retarded to an extreme degree, i.e. those with an I.Q. of below 20.

Now I suppose one could argue about the question of whether these mentally retarded children should be placed in a centre or brought up at home within a family context. Mr. Chairman, just as there are many advantages attached to the preservation of the family unit, it certainly has many advantages for the patient to be placed in a centre. Sooner or later, the parents concerned must make a choice in this connection. Let me tell you at once, Sir, this is certainly not an easy choice. Every couple will have to be guided by the specific circumstances.

In this connection I should therefore like to make a request to the hon. the Minister, i.e. to provide a specialized guidance service to advise the parents concerned in this connection and to provide them with the necessary guidance. I am aware of the fact that the Director of Personal Health Services could give assistance in this connection, but I think the time has come for the parent to be more fully informed about the whole set-up and the problems of mental retardation, so that such parents may know where they may turn to for such assistance. The parents must realize that such a child is not an outcast. It is not a child to be hidden away. For the sake of the parents themselves, for the sake of the family and also for the sake of the other children in the family concerned, such a child must be regarded as a part of the family, even when such a child is admitted to a centre.

Mr. Chairman, there are two psychiatric hospitals in the constituency of Albany, and I wonder if there is any other constituency which contains two such hospitals. A mischievous member might say that it indicates that there may be something wrong with the people of Albany, but I may point out that the previous elections proved the contrary. The first of these hospitals is the Kowie Hospital at Port Alfred, which has actually been specially equipped for chronic non-White patients. However, I want to allege today that that hospital no longer fits into the pattern of life at Port Alfred. Several arguments could be advanced which I am not going to mention now, but I may just point out that, amongst other things, it no longer fits into the pattern of treatment now applied by the department, i.e. that the community should be involved. There is not a large enough non-White community to be involved with these patients. I therefore want to suggest that the hon. the Minister and the department should seriously consider making a change in respect of this hospital. I advocate that the hospital should indeed be retained, but I may mention three possible suggestions in this connection which may be considered jointly or separately. In the first place, this hospital could be equipped for White mentally deficient patients. Secondly, it could be used as a kind of White holiday hospital. There must be many chronic patients in the cities who live far from the sea and they could be taken to the Kowie hospital from time to time. The third possibility is that it could be integrated into a provincial hospital, in which case negotiations would have to be conducted with the provincial authorities. There is in fact a need for a provincial hospital at Port Alfred. I believe the policy is that mental health and ordinary health should now be associated in many respects.

The larger hospital which is better known to me is the Fortt England at Grahamstown. I wish to express my personal thanks as well as those of our community for the extensions to this hospital. In 1975, the hospital celebrated its 100th anniversary with a very pleasant function. There were great festivities and the public participated on a large scale. Although some of these buildings are old, they are still in a good condition. In the last three years, more has been spent on the buildings than in the previous 10 years. This indicates that the department is prepared to look after this hospital as well as possible. At the moment, a large building is being completed, and I understand that further buildings are being planned. I trust that the plans will be carried out. In particular, I should like to express my thanks for the services rendered at this hospital. It has also been equipped as a hospital where staff can be trained. Fairly recently, provision has also been made for clinical psychologists to be trained there. While I am expressing my thanks here, Mr. Chairman, you must allow me a slight digression. However, I shall keep to the point. I should like to point out that Grahamstown, like many other rural towns, is finding it very difficult to expand and prosper. The Government is trying to help, and for that reason it has provided for the development of border industries in Grahamstown. Because of the expansion and attraction of Port Elizabeth and the Berlin-East London complex as well as the Ciskei and the Transkei on the other side, I do not think there is going to be much expansion in this connection at Grahamstown, although suitable facilities are in fact available there. That is why I am so grateful for the fact that the State, and especially the Department of Health, has provided services there. I therefore want to plead with the hon. the Minister—it is a pity that there are no other Ministers involved to hear my plea—that the State should do everything in its power to provide services at Grahamstown which will cause people to settle there. Perhaps the hon. the Minister could take cognizance more specifically in his other capacity of what I have said here.

If I may make any further suggestions in connection with the Fort England hospital, they would be the following. As I understand the position, there are no hospital facilities specifically set aside for Coloured people in the entire Eastern Cape. I do not think that Coloured people should share the same wards with Bantu people. It may be quite possible to provide for separate wards for Coloured people at Fort England. There are enough Coloured members of the public to obtain the necessary co-operation. It could also be a hospital where Coloured people could be trained together with the existing training facilities. This could also create job opportunities for the Coloured population of Grahamstown, which is not inconsiderable.

Sir, I am closely involved with the Fort England hospital. In this way I have gained some experience and knowledge in connection with our country’s policy and procedures in respect of mental health. In my own experience and according to what I have discovered, I may confidently say that we are second to no other country in the world in this respect. People who attack our country in this connection from time to time are completely mistaken. There is no justification for the attacks which are made on our country. The validity of what I have just said is also proved by the fact that the International Red Cross sent a committee to South Africa at the end of 1976, which freely visited our hospitals. According to the report they published, it appears that there is nothing wrong with our services. I can also confirm that the new approach in respect of the mentally ill and their treatment in the psychiatric hospitals is a great success. One could give this new approach a name and call it the “outgoing” or “open” policy. It briefly means that the community is involved to the maximum extent in the activities of the hospital, staff and patients. Indeed, a patient also receives the best treatment if he can be supported by the community. On the other hand, the hospitals are thrown open and the public is regularly invited to visit the hospitals. There are open days on which this can be done. What is also important is that the condition of the patients who are in hospital at the moment is diagnosed as soon as possible in order to treat them and send them back to the community, where they can make greater use of out-patient services. Available figures also show that a much larger number of patients are being admitted to hospital for shorter periods, so that the numbers in hospitals are actually declining. The out-patient visits are showing a great increase, however. The ideal is really to return the patient to the community as soon as possible.

I also want to take this opportunity of appealing to the public of our country to cooperate with this open policy. This can be done in three basic ways. Firstly, they can take an interest in the activities of the hospital and they can visit hospitals in their own vicinity on open days or on other occasions which are arranged. Secondly, they can join the friends of the hospital association, which I believe exists at all hospitals. In this connection I want to say in passing that the friends of Fort England hospital are doing very good work and that the community takes great pride in that work.

Sir, I want to dwell for a moment on the most important point, namely that the communities should accept patients who have been in hospital and who have been discharged as normal people. They must be given the opportunity to rehabilitate themselves completely. No matter what rehabilitation work is done in a hospital, it can only be carried to a successful conclusion if the community contributes to and continues the rehabilitation work. In this connection I want to make a special appeal to commerce and industry. It is known, after all, that the best treatment one could have is to be able to do some kind of work. If the people cannot find work after being discharged from the hospitals, nothing will come of all the good work which is done in the hospitals. If time allows me, I shall come back to this and refer to a very interesting article in this connection.

First, however, I want to express a special word of thanks to the staff working at this type of hospital. In the discussion on another Vote the other day, mention was made of the good work done by the Police and the fact that they should receive special recognition and that their salaries should be calculated on a different basis. I want to say with great conviction that anything which was said in connection with the police is equally applicable to nursing staff in general, and to the staff of this kind of hospital in particular.

Mr. Chairman, I have no quarrel with what the hon. member for Albany has said. I do however wish to comment on what the hon. the Minister has said in reply to the hon. member for Bryanston when he raised the question of apartheid. What we should do to the hon. member for Bryanston, is to admire him for his courage in raising the matter. I am delighted that the hon. the Minister has in fact replied by saying that the apartheid of 1948 belongs to a forgotten era of the past. We can all agree that from here onwards we will all go forward together on one basic premise, no matter what our ideological differences are, namely that henceforth we should judge a man not by the colour of his skin, but on merit.

Let me turn to the subject matter of my address here today, viz. the question of smoking. I wish to commence by referring to the figures of the CSIR, which show that in South Africa today 58% of White males and 31% of White women smoke. As far as the Black population is concerned, 70% of the men and 20% of the women smoke, and as for Indians, 57% of the men and 2% of the women smoke. The daily consumption by White males is 20 cigarettes, 18 by the Indians and approximately 10 per day by the Black man. But on the credit side we find that approximately 20% of smokers today are giving up smoking.

The battlelines have now been drawn between vested interests on the one hand and the health of the nation on the other. Here we are up against a multi-million rand tobacco enterprise and the turnover of which amounts to between R400 million and R500 million per year. The State enjoys annual revenue from customs and excise duties on tobacco, cigarettes, cigars etc. to an amount of R249 800 000. I have also calculated what the 4% sales duty will represent for the year commencing 3 July, on the basis that two billion cigarettes are smoked in South Africa every day at a cost of 2c each. Together with cigars, this will bring in another R20 million in revenue. South African smokers, therefore, have a vested interest in the State of R270 million. South Africans smoke R20 million worth of cigarettes per year, and this is one of the highest per capita consumption rates in the world. We know that some 12 000 people who are heavy smokers die of cancer every year. The death rate from lung cancer amongst Coloured males, rises by about 1 000% among smokers than as against non-smokers. Heart and blood vessel diseases are the main causes of death in this country and in this sphere South African Whites can claim the highest death rate in the world. The mortality rate from coronary heart diseases among smokers is three and a half times higher than it is for non-smokers. Death from emphysema is 500% higher among smokers than among non-smokers. As far as lung cancer is concerned it kills 30 000 people every year.

In the United Kingdom alone cancer of the larynx and oesophagus accounts for a high percentage, while chronic bronchitis, a disease which kills more than 32 000 people annually, is caused mainly by cigarette smoking. We are told that each cigarette shortens our lives by 5½ minutes. According to the Food and Drug Administration of the United States of America, ladies who take oral contraceptives should not smoke. In fact, it goes further and says that this even causes wrinkles. Evidence shows that the number of adult smokers in a country is almost identical to the percentage of smokers in the 20-year-old group. I shall return to this point in a moment, in more detail.

The Expert Committee on Smoking and its Effects on Health of the World Health Organization, which met in Geneva in 1974, stated that strong political decisions at government level are necessary in any campaign to control excessive smoking if it is to have any chance of succeeding. The committee further affirmed that legislation should be an integral part of the anti-smoking campaign. Dealing with the question of legislation, it was also stressed by the committee in Europe in 1972 that compulsory notices, advertising, etc., should be scrutinized and that there should be a ban on the manufacture and sale of cigarettes containing more than one milligram of nicotine and more than 15 milligrams of tar.

However, there are certain obstacles in the way of legislation. I have already referred to the revenue derived by the State. The Federal Republic of Germany’s revenue from this source is DM8 900 million. It has been calculated that in 1973 the 20 000 lung cancer cases and the 30 000 deaths from cardio-vascular diseases cost that country between DM3 000 million and DM4 000 million. If we have to make a choice in this matter, I want to submit with great respect that we in fact have no choice whatsoever.

In regard to the advertising of cigarettes, I want to ask the hon. the Minister to consider steps to effect an agreement among all advertisers in South Africa, just as there is an agreement among advertisers in Austria, Belgium, Denmark, Finland, Sweden and the United Kingdom, to the effect that smoking advertisements will not portray the virility of the individual, the heroes of the youth or public figures, or over-stress the pleasures of smoking.

As far as the youth is concerned, I have a lot of statistics but I do not have the time to quote them here. I could give them to the hon. the Minister. In Belgium 65% of people under the age of 20 smoke, in the Netherlands 40%-45%, in Poland 75% and in Sweden 44%. In the United Kingdom the responsible Minister said in Parliament that of the 19 million smokers, 15% of the young people who did not smoke took to smoking in later years. In Canada they have the Tobacco Restraint Act which prohibits the sale of cigarettes to people under the age of 16. Japan has had a law since 1910 prohibiting the sale of cigarettes to citizens under 20 years of age. France has introduced a new law recently prohibiting advertising in places where there are children and magazines which children read. In the State of Kentucky, if one smokes on premises where there are children, one can be fined up to $5. There is a ban on advertising in many countries such as Peru and Italy in cinemas and in public places. I wish to urge the hon. the Minister today to consider imposing a ban on the advertising of cigarettes in all cinemas and newspapers, on the radio and television and at sports grounds and other places of entertainment.

As far as warning notices are concerned, we know that in the United Kingdom, through the District Surgeon over there, the slogan “Smoking is dangerous” appears on every packet of cigarettes. Egypt has quite a novel slogan which states: “Smoking is the responsibility of every smoker. The Ministry of Health cautions you on the dangers of smoking.” Sweden has decided to use 16 different slogans, because they argue that if only one slogan is used people get accustomed to it and then take no further notice of it. I could make all 16 of these slogans available to the hon. the Minister so that he can consider what slogan we should use. The hon. the Minister should also take a leaf out the book of his famous counterpart in France, the famous madame Simone Veil, who is the Minister of Health in France. She has taken vigorous measures in regard to smoking.

And she herself smokes about 30 cigarettes a day, I am told.

Then she is very naughty! The slogan over there is “Abuse is dangerous”. In addition, manufacturers have to state the nicotine content and the tar content of the cigarettes on every packet. I feel that we should introduce one of the 16 slogans they use in Sweden.

I wish to thank the S.A. Airways for doing what they have done. Of 56 airlines, 75% provide non-smoking areas in their aircraft. I call upon the hon. the Minister to provide money for research to investigate factors influencing smoking and to determine more effective methods of teaching and reducing the tar and nicotine content of cigarettes. We need funds for this research and we must plan for it. The time for action has come. I call on the hon. the Minister to take action and I also call upon his Cabinet colleagues to impose a 1% tax on the sale of all cigarettes, to provide the money for research. A sum of money should also be set aside by the Workmen’s Compensation Commissioner because of the enormous amount of manhours which are lost due to illnesses as a result of excessive cigarette smoking. In the United Kingdom 50 million workdays, involving 71% hospitalization, are lost annually.

I also wish to ask the hon. the Minister to form a national clearing house on smoking and health for the purpose of a national programme of public education and information regarding the dangers of smoking. There should also be state and local authority programmes and school education programmes. The target area should be teachers, students and schoolchildren. Finally, I ask the hon. the Minister to call upon all doctors in South Africa to set an example in this regard. I also call upon all Cabinet Ministers, senators, all members of Parliament and Government officials to set an example to South Africa and to refrain from smoking.

Mr. Chairman, I want to react briefly on what the hon. member for Hillbrow has just said in connection with the abuses of cigarette smoking. I represent a constituency where farmers are making their living chiefly from the cultivation of tobacco. A few days ago I made the remark in the House of Assembly— and this also goes for the hon. member for Egypt, if he would care to listen—that any abuse, whether of alcohol, tobacco or food, is detrimental to the body and, according to the Bible, a sin as well. But if these things are taken in moderation, we find no negative problems. I just want Brits to take note of this.

I should very much like to associate myself with the hon. member for Pietermaritzburg where, in the short time available to him, he spoke on air pollution in a very capable manner. Sir, I, too, want to talk about pollution this afternoon, but another aspect of pollution which I could perhaps describe as psychic or social pollution. There is a certain tendency in society today that has become very evident since the last World War, viz. certain neuroticizing factors in society which leave a definite mark on society and the people comprising society.

In September this year a congress on social psychiatry will be held in Lisbon. This is a branch of science which has evolved over the last thirty years. This will be their seventh international congress in a series of congresses held every two or three years. The theme of their discussions will be the tremendous pressure on present-day society.

I want to be very brief, and for that reason I shall put my point as follows. Since World War II, most handbooks being used at our universities and elsewhere—regardless of whether it is in the field of natural science or the humanities or social sciences—are considered to be out of date, because we entered a totally new milieu with its own distinctive problems after World War IT. Perhaps I could illustrate this to you by giving you an example. Allow me to mention a single aspect as to the way man has changed as a result of the factors influencing him. If one were to have taken a look at man in 1850, for example—i.e. 120 to 130 years ago—one would have noticed that physical maturity accompanied social or psychic maturity. In other words, these two entities ran parallel to each other. I want to mention the following by way of an example: In those days a young man of 15 and a young girl of 15 could easily get married because both were physically, sexually, and also psychically and socially mature enough to do so. Since the turn of this century, and particularly after the ’twenties, this situation has changed completely.

Just consider the position at present. It is unthinkable that a child of 15 years, whether a boy or a girl, would be regarded as being mature enough physically as well as psychically and socially to get married, let alone to become parents. They cannot accept or shoulder the responsibility. What I imply here is that the various phases of life in which every person finds himself in the course of time have slowly but surely been extended, particularly since the turn of the century and culminating after World War II. In 1900 it was nothing unusual for a girl to menstruate at the age of 13. Today it is not strange for a girl to begin menstruating at the age of 16 or 17. At that time it was not unusual for a woman to reach menopause at the age of 40. Today we find that that age has moved on to 50 years.

I mention these facts to you today, Sir, as they have emerged from the latest developments as embodied in the human sciences and the natural sciences, to prove to you that we are dealing with people who are living in a certain milieu, where that milieu has a particular influence on them, and that that influence can in fact be measured and can clearly be calculated.

Having furnished these examples, I want to come back to my subject, by quoting people such as Roehmke and Peter Hayes. The hon. member for Albany spoke about the open community and the treatment of the psychiatric patient of today. Peter Hayes is the person who put forward this concept in his book New Horizons in Psychiatry. He also tied this concept in with social psychiatry, in the sense that a hand was extended across the bounds of subject disciplines from the human sciences to the natural sciences and vice versa, because they needed each other in the approach to and treatment of man.

Therefore, when I talk of social or spiritual pollution, or, to phrase it differently, the neuroticizing factors of our time, I believe I owe you, first of all, a brief explanation of what a neurosis is. In short, such a person experiences disturbances in making contact with himself, with his fellowman and with the things with which he is occupied. In other words, it is someone who is obsesses with something and is caught up in a pattern from which he cannot escape. There is no time to go into the various causes, but I want to touch on one cause, and that is my topic today.

These neuroticizing factors of society are very important, and the whole of the social psychiatry discipline and medical science have been making the calling upon us appeal at congresses that we look into these things and that our universities pay attention to them as well. In this respect I am also asking for the valued attention of our hon. Minister. He should use his influence so as to ensure that not only part of man is cared for, but also the society in which he lives. One cannot understand man if one does not understand and takes note of the society in which he lives. In the first place, I maintain that the unfetteredness of society plays a tremendously important role. Man is, as it were, being fragmented because his interests are so diverse, without their actually having any connection with one another. In this case we can in fact talk of a plural “self” which comes into being because of the dividing lines between those things occupying his mind becoming blurred, and it could happen that the screws of such a person could become loose literally and figuratively.

In the second place there is—and this affects many of us because we live in this society, this milieu—the modem mobility of man. Today we are here, tomorrow in Europe, the day after tomorrow back again, today in this milieu, tomorrow in that milieu, and then the day after tomorrow in another again. As a result the fast-moving world citizen has only fleeting and superficial contact with his fellowman. This leads to loneliness, to isolation and eventually to desolation, which is a characteristic of a neurotic.

In the third place I want to link up to this the disappearance of the small group of people that is absorbed by larger groups of people. Individuality no longer exists. One becomes part of the larger entity, and within this cadre, Sir, very definitely also falls the weakening of entity, family ties through the secularization of marriage, through the heterogeneity of family life, and through the loss of function of the family. Other hon. members have already referred to this in a different context.

Furthermore—I believe that this is very important, Mr. Chairman—in this age of materialism in which we live, which is being encountered outside the home and in which each member of the family strikes out in his own direction and, in other words, is weakening the family ties indirectly, we find that our securities are disappearing, and here we arrive once again at this so-called type of pollution which I referred to earlier on. This goes hand in hand with the undermining of authority and the undermining of respect for persons in authority and for public institutions.

I believe hon. members of the Opposition should pay particular attention to this. Authority and a respect for talent, for ability, for competence, lends structure to all relations, also those within the PFP. If this structure is lost as a result of the undermining of authority, the individual becomes insecure, and insecurity, together with social isolation, is a characteristic of a neurosis. This brings me to my second last point. [Time expired.]

Mr. Chairman, last year Parliament passed the Health Act, Act No. 63 of 1977. The purpose of the Act, as defined in the long title, was to provide for measures for the promotion of the health of the inhabitants of the Republic; to that end to provide for the rendering of health services and to define the duties, powers and responsibilities of the several authorities which render health services in the Republic. In the provisions of the Act the responsibilities and duties of the provincial authorities are also defined, which in the main amounts to the provinces being responsible, inter alia, for hospital facilities and hospital services, for ambulance services and for providing facilities for the treatment of out-patients, in hospitals or in other places where patients are treated for a period of less than 24 hours. It is the first time that the provinces are being included in legislation of this nature and that the activities and powers of the provinces are being spelt out. The Secretary for Health wrote the following in his annual report—

I should like to emphasize this—

Mr. Chairman, in discussing the matter which I should like to discuss now, I can testify that in my constituency there is the most cordial co-operation between the Department of Health and the provincial Department of Hospital Services and everyone concerned. I should like to discuss the district surgeon services in my constituency. During the second half of the year the district surgeon of Middelburg resigned, offering the alternative that he would stay on provided that the remuneration for the post be increased considerably. That would naturally have had terrible financial consequences throughout the country. Extensive negotiations were conducted with that particular district surgeon, as well as with other doctors, and eventually it was decided to approach the Department of Hospital Services. I should like to mention this for the record, because many people assumed that the department simply took away the services of the district surgeon from the private doctors. Because the lengthy negotiations did not succeed, an agreement with the province was reached at short notice for the latter to provide the services. Sir, this was a drastic change which affects mainly the social pensioner, in other words old people, and officials of the South African Police and the Department of Prisons.

I believe hon. members are aware of the fact that that is one of the conditions of service for the officials of the two departments concerned. Sir, this change is drastic because hospital services are providing this service exclusively on an outpatient basis. This means that the district surgeon’s patients no longer have their family doctor at their disposal. In other words, the intimate relationship between patient and doctor no longer exists, which creates a very great problem particularly for women, because they cannot so readily discuss those sensitive problems of theirs with various doctors as they could previously do with their family doctor. Police and Prison Service Officials in particular were hit very hard. Those people feel very unhappy about this. The aged also feel unhappy about it and a second radically important problem, which affected the elderly in particular, was the house calls to patients which could no longer take place. Patients have to see their doctors on an out-patient basis now and have to go to hospital when they are sick. In cases where doctors did house calls where patients were not mobile, the patients have to be transported by ambulance now, after a nurse or perhaps somebody else has certified that sending out an ambulance is justified. Some of those people find it very hard to move around and to get to hospital. For instance we have a patient who has been bedridden for 12 years. Every time when it is essential for him to see a doctor, he has to go through this cumbrous procedure before reaching the hospital. Sometimes it is also very difficult to transport that patient.

Another problem is the prescribing of medicine. On the out-patient basis all medicines are issued from the hospital dispensaries. In terms of an economizing policy hospitals are keeping limited stocks of medicine on their code lists. It happens that there are patients who are used to a specific medicine which does not appear on the code list. It also happens that a patient reacts better to one preparation than to another. The limited code list of medicines of the hospital really causes many problems. Considerable protest is coming from private pharmacists because they allegedly experience a loss of R16 000 in turnover per month and are in some cases stuck with stocks which they cannot sell because the medicine they had in stock was only prescribed to the elderly, which they kept in stock as a result of the prescription pattern of the district surgeons which is no longer being followed now. This problem has to a large extent been solved because there has been a concession with regard to prescriptions for Police and Prison Service officials. Those people can in fact take some of their prescriptions to a private pharmacist now.

I want to point out a further problem which is that of accommodation. Because of the increasing number of patients going to the out-patients’ section now, there is an inflow and people can only be accommodated with great difficulty, sometimes very uncomfortably in corridors where they are lying in a draught and where people come and go.

It also happens that the pharmacists cannot keep up with the dispensing of prescriptions and that patients have to come back for their medicine. Because our hospital is the first to render this service, it is obvious that the bottlenecks will have to be pointed out and solutions found for those problems. There is a very good spirit of co-operation, as I have said, and in this regard I want to refer specifically to the Superintendent of the hospital, Dr. Cilliers. He has a very great understanding of the problems, but for the sake of public convenience we must assist him in finding solutions. The Department of Health is doing everything in its power to assist in the smooth functioning of this service, particularly in providing medical officials. Since we are dealing here with a service which has not yet been tested elsewhere, I want to ask the hon. the Minister whether an in-depth study of this service could be made as regards the confidential relationship between the doctor and the patient, for example by appointing doctors for this service only. In that way one would to a large extent bring back the district surgeon service to its traditional practice, for example the doctor-patient relationship, the possibility of house calls, where possible, and for a basis on which medicine can be made available, a more comprehensive code list perhaps or a concession that some of the prescriptions could be provided by private pharmacists. [Time expired.]

Mr. Chairman, we have been listening to very interesting speeches and debating in this Committee today. I believe one fact has emerged very clearly, and that is that a healthy population is the greatest asset which a country can ever have. Without a healthy population no country can survive. Mr. Chairman, South Africa’s health services are the most comprehensive on the whole continent of Africa, which is in my opinion a fact of which we should be very proud. In addition these services are available to everyone in South Africa, irrespective of race or colour. These services are even made available to foreigners. There was a dissonant note in this debate this morning arising out of a certain measure of “apartheid” in respect of medical services. I want to state unequivocally today that medical services know no discrimination. Several examples have been furnished. I believe I can also illustrate my claim that medical services know no discrimination, with an example. A week or two ago, I had the opportunity of visiting a local White hospital and the hon. member for Bryanston is very welcome to visit this hospital, because a constituent of mine came here to undergo a cardiac operation. I should like to tell you who were lying in that intensive care unit when we arrived there that evening to visit this patient. Firstly, there was an Italian girl, secondly, a Black teenage girl, thirdly, a Black girl from Malawi, and fourthly, my White constituent. The fifth patient was a little Coloured girl of two years old. Sir, we have no knowledge of any discrimination in the hospital services of South Africa.

The hon. member for Umbilo referred to the number of registered doctors and the number of nurses that we have. I feel we should go further, however. A figure of which we can be particularly proud, is the 142 470 hospital beds available in South Africa. Over the past few years the emphasis has shifted from the cure to the prevention of diseases. In this regard the department and its officials have played a particularly great role.

A comprehensive health education programme has also been launched in South Africa to impress the idea upon everybody that a healthy body means a healthy person. I think it was Benjamin Disraeli who said: “The health of the people is really the foundation upon which all their happiness and all their powers as a State depend.” Brief reference has also been made by the hon. the Minister and also by the hon. member for Umbilo to a very interesting book which was published recently. I should like to refer to this particular book today, viz. The Health of the People. A total of 20 000 copies of this book were printed in English, 5 000 in Spanish, 5 000 in German, and 5 000 in French. This department supplied the text and the photographs.

I want to congratulate all people concerned on an absolutely first-rate book. It was not intended as public propaganda. The intention was merely to tell the outside world of South Africa’s work in the field of the medical sciences. These are not mere words. The department can testify to the many letters which they received from people who are astounded by the medical services which South Africa can offer the world. I want to read you a few extracts from this book.

Where did you get the book?

I borrowed it from a colleague. Have you not received it yet?

No.

I believe you must apply for one. It sells for R2,95 abroad.

I believe the hon. the Minister was correct when he wrote the preface to this book and said the following—

He goes on—

Sir, one cannot read the whole book to you today. But what is of particular interest, is that apart from what South Africa is offering the world in the sphere of medical science, it also refers to a specific area which is of importance to us. That is the international communication to be found in the medical sphere. I want to read you some more—

Furthermore, it is stated—

Elsewhere it is stated—

Sir, for anyone who does not realize what medical services entail, this shows how wide the scope of this department is. If one takes a look at psychiatric services, for example, the prevention of diseases, industrial diseases, health education, family planning, environmental health services, atmospheric pollution—some aspects of the latter cropped up in the debate today—it shows one how demanding the task of this department is.

This department, as I have said, has a demanding task in South Africa as the result of our population structure. However, the department sees this task as a challenge to do the best for everybody’s health in South Africa at all times.

Mr. Chairman, we can be proud of the fact that expenditure on health services has increased by 234% over the past six years. The purpose and function of this department is to promote the health of all people in South Africa, both in general and individually. A service structure has been established of which everybody can be proud. The department still has a great role to play in future, not only in South Africa, but particularly with regard to the relations with Africa and the outside world. South Africa’s medical services and this Department of Health, need not take second place to the services of any country and need not be ashamed at all of what South Africa can offer the world.

Mr. Chairman, I want to express my sincere thanks to hon. members for their contributions, during this last part of the debate as well. The hon. member for Hercules, who spoke after the hon. member for Houghton, concentrated specifically on family planning. I am very glad that he approached this in the right manner. One looks at responsible parenthood in the light of the economic life and the spiritual and social life of families, because one really wants them to be able to attain the highest degree of physical, social and spiritual well-being as a family. In that process, we sometimes have to intervene and do things because in the course of his development, man sometimes does things which are natural to him or which form part of his make-up, things which can eventually destroy him.

At 16h43, proceedings suspended until 16h58 to enable members to attend a division.

Mr. Chairman, before I proceed, I first want to make a statement which may be of importance to you. I want to draw hon. members’ attention to the fact that we have had a sudden rise in the incidence of malaria over the past few weeks. This has occurred especially in the northern and north eastern regions of our country. It applies in particular to the northern parts of Natal and the Transvaal. One is especially struck by the fact that it is now occurring in areas which used to be free of malaria. A further factor is the movement of people across our borders from countries where the necessary measures have not been applied stringently enough. We have experienced this in the past as well. The department has requested urgent additional funds to combat this threat and an amount of almost R300 000 is involved. I am just disclosing this by way of general information.

Mr. Chairman, may I ask the hon. the Minister a question? In reply to a question earlier this year the hon. the Minister indicated that more staff were being made available for mosquito spraying. Is the amount that he has just mentioned, part of the same approach to the problem?

Yes, it is part of the whole comprehensive project.

Sir, I began by replying to the hon. member for Hercules. He gave a very fine exposition and dealt with the question of family planning in a delicate and serious way. In doing so, he showed his understanding of what it actually entails. At the beginning of his speech in particular he painted a rather sombre picture. Once again we are faced with the idea of the population explosion and the attendant dangers for the world. This is a sensitive matter. It must be approached in a judicious and balanced way. If we handle the matter tactfully, we shall find acceptance for this concept. There is a gratifying increase, not only in the acceptance of family planning, but also in the active attendance by women of all races and population groups. In recent times, men are also more inclined to find out what family planning means. At the same time, they are more willing to undergo sterilization, which is a very simple operation. Family planning has expanded tremendously. Our number of service points has increased enormously in recent times. They now number almost 3 000. Our target was 3 000 in 1980. Because 48% of the 50% of women at risk whom we wanted to reach by 1980 had already been reached in 1977, we set new targets for 1983. Our target for the number of clinics was 3 000, and already there are 2 675. Our target for 1980 in respect of the number of women at risk is 1,1 million. Last year we had already reached 954 000. When I mention just these few figures, hon. members can see how much progress has been made.

It is true that the idea has not yet found wide enough acceptance among all the population groups. In the case of Whites, family planning takes place without any control by my department. In the case of Coloured people, Indians and Bantu, family planning has been making very rapid progress lately. We believe that next year, during the health year, we shall have to give attention to this matter and to involve the community. As far as finance is concerned, we shall also try to have an open hand.

Before I come to the end of my speech, I shall refer to the whole question of man and his environment and the crises which confront us. I hope time will allow me to do this. We originally estimated that by the year 2010, we would have been able to prevent 13 million births by means of this programme. This will be the position if the project goes according to plan, and depending on the cost per birth, it could save the State an amount of R90 000 million. I think the hon. member will also find it interesting to see in the budget figure that the money appropriated for family planning has increased from R463 000 to R7 973 000, or by almost R8 million, within a matter of seven years. We intend to vote more than R40 million for family planning over a period of 50 years. We have had certain surveys done about this interesting matter which one could discuss at great length. Since the year this programme was introduced, i.e. in 1974, we have found that Black people accept family planning. I think that the approach has been important in this case. The aspects of involvement, guidance and so forth are very important, and the hon. member may rest assured that this is a matter which we are not going to neglect.

The hon. member for Kempton Park gave a fine exposition of the department’s task, especially with regard to guidance services, something which he advocated. In the department’s programmes under the target budget he will see that the main divisions are Administration, Infectious Communicable and Preventable Diseases, Mental Health, Medical Care, Health Protection and Associated and Supporting Services. Under virtually every one of these programmes, provision is made for guidance services. A considerable amount of money is being spent on guidance, because we have to involve the community and to make it realize how important health services are to a nation. I am glad that the hon. member noticed the shift in emphasis in respect of guidance services which we have brought about in the last year or so. In this case we are trying, of course, to encourage voluntary contributions and public involvement as far as possible.

†The hon. member for Berea spoke about three very interesting problems—call them diseases or disease tendencies if you like. He spoke about genetic diseases and about Parkinson’s disease, which is a terrible disease affecting in the main older people. He also spoke about cystic fibrosis. However, the hon. member resorted to a certain amount of advertising by speaking about Allen’s food. Although I may agree with him that this is a very good and balanced way of adding to the necessary medication for cystic fibrosis, I think one should never mention any trade names. One does not do that in debates in this hon. House. In any event, I do not think it was meant in that way. Hurler’s syndrome is a very rare and interesting disease. However, I cannot comment on the hon. member’s remarks in a knowledgeable way. As far as amniocentesis and chromosome research are concerned, the department is conducting research in this field. The Medical Research Council is also doing a lot of work in this regard in an attempt to determine certain characteristics of unborn babies. They are trying to determine the nature of the chromosomes in the amniotic fluid.

*The hon. member for Gezina made a fine contribution. He paid striking tribute to an institution which has meant a great deal to him. I was moved by his plea and I can tell him that we are working on the things he suggested to us. He spoke of guidance brochures for parents. It is one of the most frustrating and heart-rending things to see the difficulties parents sometimes have with a child because of a lack of understanding. Others who have the understanding have to be helped to convey it. Guidance in this connection is extremely important.

The hon. member for Albany discussed a few more local matters and made interesting suggestions about what we could do in connection with the hospital at Port Alfred. He also spoke about Fort England at Grahamstown. I have taken cognizance of all his proposals and I think he should convey them to the department and we can discuss them. But I want to tell him that as far as staff is concerned, we are having great difficulties, and we shall always have difficulties, in the areas where the facilities are not very good. There we shall always have problems as far as the highly specialized staff is concerned. We do what we can. You will see from the report that we are trying to interest people by means of administrative and other services. We have also introduced hospital days. We recently appointed an extra lady and she deals with women’s associations in an attempt to involve people. I have also appointed members of Parliament to hospital boards to involve you as well, and in this way we are trying to acquaint the public with this particular aspect of our services. We try to emphasize it and we try to increase our involvement there.

†The hon. member for Hillbrow spoke about smoking. I think he said a mouthful in a short time. He quoted some very, very interesting figures and I listened with a great deal of interest to what he had to say. I do not think I should comment on everything that he said. Perhaps I should sound a note of warning. In one’s attitude to smoking, or in one’s anti-smoking campaign, one should not let that attitude eventually border on hysteria. I am not saying that the hon. member has in any way displayed that sort of attitude here. He stuck to facts and he gave us a lot of interesting information, but I detected a slight note of hysterical zeal. I must say, of course, that I do like people who go about things in a zealous way, but nevertheless we must be careful. We must try to maintain a balance.

It is not merely a question of tobacco or the use of tobacco, as I said earlier. One can use tobacco in a moderate way. What is wrong with that? What is wrong with a cigar, or perhaps a pipe? Or perhaps two cigarettes a day? It has not been proved conclusively that that is so very wrong, although human frailty enters the picture here, because it is so very seldom that people only smoke two a day. I smoke about two or three a year, and, I have been told that I am fortunate in that I have not started smoking again. But I have not started smoking again because I have to uphold the Van der Merwe name.

The hon. member said something interesting about ladies who do not smoke. No, let me correct that; he said this: He said ladies who take contraceptives do not smoke. Is that so?

Ladies on the pill should not smoke.

Oh, they should not smoke; I thought you said they do not smoke because, if they do not smoke, what vice do they actually have? Is there anything that they do that is nice? It was just that I found it surprising that they do not smoke; they use contraceptives but they do not smoke. Don’t they drink, don’t they do anything else, as one sometimes does?

Regarding the ban on advertising and all the other restrictions he proposed I want to say that we are examining this whole problem this year and we are going to apply our minds to it. We will look into the banning of cigarette advertisements and all the other things he mentioned. We will look into that, but I may not agree with him as far as each and every one of these is concerned. It was interesting to hear him mention madame Simone Veil as a person who is really to be emulated in what she has done. I was told some years ago that she had reduced her smoking from 60 a day to 30 a day. That was the sacrifice she made, I am told. If she is smoking 30, of course, she could have stopped smoking!

May I ask the hon. the Minister a question? I do realize he cannot reply to everything, but one thing is very important, and that is the money needed for research. Is the hon. the Minister prepared to look into the question of 1% surcharge on the tax and money from the Workmen’s Compensation Commissioner?

I cannot commit myself. However, I can commit myself as far as the possibility of research is concerned. We can have a look into that matter but not specifically into the way in which we can get that money.

*The hon. member for Brits continued the line of thought of the hon. member for Pietersburg and he made a very interesting speech. I would be boring hon. members if I were to try to be clever in this connection. The hon. member is well versed in his subject. He outlined the psychic changes in man and his reactions to his environment very effectively. He referred to the neuroses people have been suffering from lately. He also referred to the disappearance of the small group and its absorption into the larger group. I listened to his speech with great interest. I think that philosophical discourses are always appropriate, even in this Committee, and I listen to them with great pleasure. It makes one feel sometimes that one is learning more than just the basic things.

The hon. member for Middelburg discussed the problems he had experienced with district surgeon services. That is so; problems do a raise. However, we could not have those services provided at the ordinary tariff. The doctors wanted the same tariffs as private practitioners. The department did not have enough money to pay them. Therefore we had to find an alternative. We originally intended to approach the Transvaal provincial administration or any other administration and to take over the district surgeon service. We wanted to do it in such a way that some of the services would be made available to patients by the hospitals.

The hon. member referred to the question of confidentiality, which is also very important. It is a great pity if doctors charge impossibly high fees. However, the department cannot always keep up. I recall that our account for the services of district surgeons at Kestel, a small town in the Free State, amounted to R70 000 a year or two ago. This happened at a time when R10 000 was still a lot of money. However, we are aware of the problem. A committee is already going into these aspects. The report will be referred to the Health Matters Advisory Committee, on which officials of the Central Government and the provinces sit, and if necessary, to the National Health Policy Council as well. That is my reply to the hon. member for Middelburg.

I also want to express my sincere thanks to the hon. member for Overvaal. He gave a very good survey and a balanced view of the department’s task. He spoke with appreciation of what had been accomplished. I quite agree with him. The book we have published throws a special light on the philosophy. The tasks performed by the Health Department of the Republic are very well portrayed. This book is distributed all over the world, in Europe and in America. We are receiving many letters at the moment, not letters of criticism, but letters in which mention is made of the gratifying expansion in our health services and of the special approach of our department to the health of the individual as a component of the total population.

†In the few minutes left, I would like to refer to a short article which I have read some time ago. In order to save time, I will have to refer to my notes more often than usual. I know it is not allowed to read a speech but in this instance I shall have to do so at times. The hon. member for Hercules mentioned a few figures in regard to the increase in the population of South Africa which portends ill for the future. However, it is interesting to note that up to 1830, two million years were required to add one billion people to the world’s population. The second billion took a hundred years up to 1930. The third billion took 30 years, up to 1960; the fourth billion took 15 years, up to 1975, the fifth billion 11 years, up to 1986, and the sixth billion only 9 years, up to 1995. As we all know, the earth’s primary biological systems, the organic fisheries, the grasslands, the crop lands, the forests are being stretched to their limits these days, because of the increase in population. Then we have these stresses, as some of the hon. members have pointed out. However, if one looks at these facts the outlook is not really so dismal as long as we continue to perform our tasks taking into account what science has taught us.

Population growth fans inflation by creating resource scarcities. It raises unemployment by increasing the number of job seekers faster than jobs are created. Where it outstrips economic growth it pushes down standards of living. Thus in poor countries where population growth rates are high more of the available capital must be spent on food and shelter leaving less for health care, education and culture. Lately we have had more reassuring news as far as population growth is concerned. We must look at the trends up till 1970, when there was a sort of exponential increase in the growth of the world’s population. However, somewhere around 1970 the rate of world population growth reached an all-time height and then began to subside. At that point the longstanding trend of accelerating population growth reversed itself. In 1970 the world population grew by an estimated 1,9%. The most recent data shows a marked decline to 1,64% in 1975. In most parts of the world the decline reflects falling birthrates and a global trend towards small families but in a number of low-income, food deficit countries rising death rates also are an important factor.

As far as the growth in world population is concerned the excess in births over deaths fell from an estimated 69 million in 1970 to 64 million in 1975, despite a substantial increase during those years in the number of young people of reproductive age. I am telling you this because I want to bring home to you the importance of our family planning programme.

*I think we have so many strangers in Jerusalem, because I have read an article in one of our Afrikaans newspapers which really shows the author to be a stranger in Jerusalem. A columnist actually says the following—

The person does not know what is going on. He supplements his remarks with a little sermon to the effect that we should embark upon family planning without delay, something we have been engaged in for almost five years. He would have found this out if he had only taken the elementary trouble of ascertaining what was going on. I do not think a member of the press is a credit to his profession when he shows such ignorance.

†More than anything else this progress reflects a widening availability of family planning services and a growing desire to use them.

I want to repeat that. The early 1970s saw a shift towards greater reliance on male and female sterilization. Voluntary sterilization now ranks first among contraceptive methods in the world. Between 1970 and 1975 the population’s growth rate fell by almost one-half in Western Europe and one-third in North America and East Asia. Western Europe with 343 million people cut its annual population growth from 0,6% in 1970 to 0,32% in 1975, a reduction without precedent for such a large geographic area. North America’s growth rate of 0,6% in 1976 compares with the rate of 0,9% in 1970. The estimated reduction in the Chinese crude birth rate from 32 per 1 000 of total population to 19 or 2,6 points per year is the most rapid ever recorded over a five year span. This pronounced East Asian fall-off should come as no surprise since virtually every country in the region has a dynamic and highly successful national family-planning programme—I repeat, a highly successful national family-planning programme. This is not a drastic way of restricting population growth, but a family planning programme.

Only a few Latin American countries have successfully reduced fertility rates, for example, Costa Rica, Panama and Colombia. The Latin American countries still have a very high growth rate. Interesting and well advanced is the attitude of six countries of Europe. East Germany, West Germany, Luxembourg, Austria, Belgium and the United Kingdom had stable or declining populations in 1976.

There is also the phenomenon of rising death rates. In the 1970s we have witnessed sporadic rises in death rates in many developing countries. World grain reserves were quickly depleted between 1972 and 1974, and food prices climbed accordingly, often leading to a rise in nutritional stress. Then there are also ecological stresses, pollution and capital scarcity.

We have the problem of over-fishing. Recently the human appetite for marine protein has grown stronger than the ocean’s ability to provide such protein on a sustained basis, exceeding the regenerative capacity of fisheries.

All biological systems are affected by pollution. At least one industrial country, the United Kingdom, has managed to visibly improve its environment. London now has far cleaner air than at any time in recent history, and in 1975 had 8% more sunshine than in 1955.

Environmentally induced illnesses, those caused directly or indirectly by human alterations of the environment, rank high among the world-wide causes of human suffering, among these schistosomiasis, cancer and heart disease. Still other environmentally induced illnesses originate in modem materialistic lifestyles typified by under-exercising and over-eating. Humans are now altering the environment with only the vaguest understanding of the consequences of their actions. Each year the world’s farmers and fishermen already straining to feed some 4 billion people must attempt to feed 64 million more people. Each day 178 000 new faces appear at breakfast tables.

And now we have the problem of inflation. Even things normally taken for granted like land, living space, fresh water and clean air become costly as we have increasing inflation. There is also a scarcity of capital. We therefore have this choice. We must limit our births, or we must continue pressing against the earth’s biological limits until regulation becomes mandatory.

*Mr. Chairman, I decided to furnish these particulars because I believe that family planning is actually one of the tasks of the department through which we can to a large extent prevent our country from being overcome by many of the other crisis before the end of the century.

Vote agreed to.

The Committee rose at 17h29.