Chapter IX.

PEOFESSIONAL TRAINING.
In my remarks on Achimota College I pointed out that the nature of the higher education given would be such as to fit the student to take up those further special courses which are necessary for entering a pro- fession, and would also include provision for the latter during the last year or two of the student's residence. It is too early for me to state here the exact nature of the curriculum at our new college ; that will be drawn up by the Headmaster, as narrated in Chapter V, after he has acquainted himself with our present standard of education, for, although the nature of the education at Achimota will be the highest obtainable, it may he necessary, to begin with, to make some allowance for the quality of our elementary schools. The education will be of a secondary nature, rising steadily as second- ary schools in the Gold Coast begin to supply entrants possessing a better education.
Whatever system is adopted, provision will be made during the last year or two of the student's residence for the special studies necessary for entering the pro- fession for which he is destined. It is too early to state definitely that all the studies necessary for every pro- fession will be included in the immediate future, some further training in Europe after leaving college may be required for a few years. But gradually we should arrive at the moment when everything that is taught at an English college can be adopted at Achimota.
I do not propose to go fully into this quescion now. It is sufficient to say that our aim at Achimota will be,
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if a student's furtlier training in Europe is necessary, to cut down the time during wliicli lie is away from his country to the lowest possible period ; but when further training can be got in the Gold Coast, to co-operate, as regards the engineer, with the Public Works and Rail- way Departments and such large private firms as exist ; as regards the barrister and solicitor, with the local Bar; and so on and so forth.
Perhaps I can best illustrate this by quoting from my last Annual Message to the Legislative Council the following description of the Gold Coast Hospital and its function as the centre of a complete training system for African physicians, surgeons, officers of health, nurses and midwives, dispensers and sanitary inspectors.
Owing to the position which it occupies in the Public Health programme, undoubtedly the most important event in the Gold Coast in 192^3 was the opening of the Gold Coast Hospital for Africans at Korle Bu on the 9th October, 1923. The first block of wards, with accommodation for 96 patients, on the 26th October, and the second block, for 112 patients, on the 28th of December. The entire hospital, with its complete staS of doctors and European and African nurses, was in full working order on the 1st January, 1924. Its success was instantaneous, and since the first day it has been full to overflowing.
As the hospital is destined to exercise a powerful influence in the medical and sanitary development of the Gold Coast, a few words as to its inception and construc- tion will not be out of place. The necessity for a new Native Hospital was apparent before the war, but it was not until the end of 1919 that Government was in a sufficiently favourable financial condition to under-
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take the work. Since then it has consistently main- tained its position at the head of the building programme ; every possible step was taken during 1920 to ascertain and include in the design the latest develop- ments of medical and surgical architecture. The hospital practically took three years to build, as, although I laid the foundation stone in January, 1921, work had begun some months earlier.
The following is a brief description of the various buildings.
The Out-Patients' Block is a handsome double- storied building with a large dispensary at the back. On the ground floor are commodious waiting-rooms, separate consulting-rooms for male and female patients, and a minor operating theatre. An electric lift is provided for patients attending the dental surgery, the opthalmic rooms, and the X-Ray rooms on the first floor. A colonnade over 400 feet in length runs from the Out-Patients' Block to the Administration Block, half-way along which is the Ablution Block with cloth- ing store, bathrooms and changing-rooms for male and female patients who are admitted to the hospital.
The Administration Block is a handsome two-storied building with record offices and staff-rooms on the ground floor, and a telephone exchange connected to every room in the hospital. On the first floor are lecture rooms and laboratories for the instruction of dispensers, sanitary inspectors, etc.
The tAvo large Ward Blocks lie one behind the other in the rear of the Administration Block, all being joined together by a handsome double-storied colonnade. Each block has four large wards, two in each floor; and at
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the end of each ward is a wide shady verandah for convalescent patients and open-air treatment. In addition to the large wards, each block contains four small wards with accommodation for one or two patients.
Between the two large Ward Blocks lie two Operating Theatres and all the necesary rooms for sterilising, anaesthetics, etc.
Up-to-date kitchens, laundries, disinfector-house, medical store-rooms and mortuaries, together with lodges, engine-rooms and workshops, complete the working part of the hospital, which is lighted by electricity and supplied throughout with hot water. Both hand and electric lifts and the layout of the buildings reduces to a minimum the actual amount of labour required.
Outside the railings of the hospital lie a thoroughly up-to-date Pathological I^aboratory and quarters for fifteen or sixteen officials, besides about sixty members of the subordinate staff. The whole hospital lies on Government land of some 250 acres in area, so that ample provision is made for any extensions that are ever likely to be required.
Apart from its initial cost of over £220,000, the maintenance of the new hospital will add considerably to Government's recurrent expenditure. The actual annual cost is not yet known, but the administration and accounts have been separated from those of the Medical Department and careful records will be kept of all expenses during the first twelve months of its existence as a guide for the future. If our plans for the future extension and development of this hospital — as the centre of medical healing and instruction in the manner in which I shall presently describe — mature,
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tlie problem of meeting expenses will require very care- ful consideration, and it is highly probable that we shall need an endowment fund. For that reason, and also owing to the fact that the Director of Medical and Sani- tary Services is already overburdened with an immense amount of what I may describe as routine work, I have considered it advisable to place the control of the hospital under a separate board, of which the chief members are : the Governor as President, the Colonial Secretary, the Treasurer, and the Director of Medical and Sanitary Services. To this board the Resident Medical Officer will be directly responsible for the economical and efficient running of the hospital. In addition to the Board of Control, a Board of Visitors under the chairmanship of the Director of Medical and Sanitary Services has been appointed, the members of which are the Honourable F. E. Tallant (Banks), Mr. Pitcher (Merchants), the Reverend A. W. Wilkie (Missions), and Dr. Nanka-Bruce and Mr. Van Hien, representing the Africans.
A complete scheme for the progressive expansion of the Gold Coast Hospital is at present being carefully drawn up. The next new buildings to be erected will be a Maternity Block, with a residential school attached for the instruction of mid wives, an isolation ward, and a venereal clinic ; to be followed in due course by the necessary residential quarters, lecture-rooms and labora- tories for the instruction of medical students.
The whole scheme of extension and development is based on the necessity for forming a large staff of African Medical Officers, educated and trained locally to the utmost extent possible, to carry out the very heavy and pressing campaign against disease and
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insanitary conditions in this country. I "will premise my brief account of Government's proposals by stating that they will be dependent on satisfactory arrangements being made with regard to the recognition of classes, examinations, and degrees with the General Medical Council and the Universities of the United Kingdom.
To begin with, we recognise that the training of the young African for the medical profession must, to meet with complete success, be undertaken locally. Although it has been very truly said that all judgments about the attributes of a nation or of a class are bound to be imperfect and must necessarily do injustice to exceptional individuals, nevertheless I must point out that experi- ence has shown that the present system of training Africans as medical men in Europe has not met with general success, at any rate not with that success that is necessary if Government is to create the large African medical staff that it requires. Failure has undoubtedly been due to the lack of facilities that have hitherto existed for adequate secondary education and character- training in the Gold Coast. To remedy this, we pro- pose to include special instruction in connection with medicine at Achimota College, and to follow this up by providing a proper medical school at the Gold Coast Hospital.
With regard to Achimota, students at the college who are destined for the medical profession will receive special instruction during the last years of their resi- dence in chemistry, physics, and biology under duly qualified professors. The necessary lecture-rooms and laboratories with modern equipment for these subjects will be provided, and the future medical students will live with the others in the college " Houses " under the care of the house-masters.
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After successfully passing the necessary examinations the student will proceed to the medical school at the Gold Coast Hospital. There he will be a boarder under the discipline of a house-master, who will himself be a qualified medical man and teacher, and will help the students in their studies and act as tutor. Here for two years the student will devote himself to anatomy, physi- ology, pharmacology, and therapeutics under properly qualified professors. Lecture-rooms and laboratories will be provided and equipped on the most modern methods.
On completion of the two years' course at the Medical School the students will, for the first few years, probably have to go to England to pass their second professional examination. I am, however, hopeful that this dis- advantage may be done away with, as I show below. This second examination is the hardest in the medical curriculum, and unless a student is judged by the local professional staff to be capable of passing this examina- tion, he will not be sent to England with their recom- mendation.
After passing his second examination in England, the student will proceed to any university with which satisfactory arrangements have been made by the Gold Coast Government for co-operating in our scheme of medical training. Efforts will be made to arrange with the university to which they go that they should live in a hostel under supervision.
One of the chief difficulties encountered in the medical training of African students in English hospitals is the facility for doing clinical work. To remedy this will be the first aim of our local medical school. With the great extension of the Gold Coast Hospital that will have taken place by then with the infant welfare centres,
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contagious diseases hospital and the asylum there will be ample opportunity for clinical work. Pathology can be taught at the Medical Research Institute, and duly qualified professors will be required for medical train- ing, pathology, medicine, surgery and midwifery, with all their various branches.
Provided that the necessary arrangements with and approval of the General Medical Council and home universities can be satisfactorily settled, I foresee no insuperable difficulties to the ultimate formation in the Gold Coast of a complete school of medicine. The date for this is still several years off. For some time we must still continue to rely on the institutions in the United Kingdom for the completion of medical training. We shall, however, have achieved two most important objects, namely, that the period of residence in Europe will be greatly shortened owing to the preliminary train- ing which the medical student will have received in the Gold Coast ; and when he does go to Europe he will have received the great benefit of that character-training which will be a conspicuous feature in the life at our future secondary schools and at Achimota.
I am greatly indebted to Drs. A. J. E,. O'Brien, M.C., and J. M. O'Brien, for the very careful thought which they have given to the future of Africans in the medical and surgical professions, and not least for the consideration which they have shown to a layman in his crude views on the necessity of a programme for the systematic extension of healing and sanitation through- out this country. The great infant mortality, the existence of endemic disease, and the periodical outbreaks of epidemics, all demands a careful programme for the future, a programme that requires the first attention
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of any Government from the financial and political points of view; and, from the medical staff, the deepest con- sideration accompanied by that self-sacrificing devotion to the welfare of the native races which has been the characteristic of so many Medical Officers and should be that of all in the West African Medical Service.
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