Prescriptions for Third World Health

...Brave new words...

...In India, over 60,000 pharmaceutical concoctions are on the market— most at prices only the rich can easily afford...

...Another of Dr...

...As a point of comparison, the world's military outlays total approximately $500 billion, or $150 for every Third World inhabitant...

...Darryl D'Monte often writes for the NL on Indian and Third World affairs...

...At present, access to a safe supply of water is a relative luxury in much of the world...

...Yet despite the bluster of the "Health for All" slogan, one cannot help being impressed by the strategy behind it...

...These statistics are a grim index of underdevelopment, and a shocking reflection of the medical system's failure to protect human existence in its vulnerable beginning stage...

...In India in the early '70s, for example, then Prime Minister Indira Gandhi toyed with the idea of drafting the services of practitioners of Indian folk medicine, but her primary interest was in having them promote family planning...

...Many health groups have trained the village midwives to follow more scientific methods when they assist at adelivery, and supply them with kits containing sterile materials at a modest cost...

...One of these involves, quite simply, increasing the availability of clean water...

...The WHO, striving to correct this way of thinking, has defined good health as "a state of complete physical, mental and social well-being...

...Where one does see signs of the barefoot principle at work here is in the cooperation between village midwives, or dais, and nongovernmental voluntary health groups...

...Mahler says...

...In the majority of developing countries, only a small minority is served by piped water, even in urban areas...

...At the most basic level, the WHO is trying to convince those living in developing countries that their health is to a large degree in their own hands—and not dependent on some elusive whitecoated doctor, or on the powders and liquids peddled by the international drug industry...

...Moreover, the simple home remedy of a little sugar and salt in a glassful of water will remove the threat of dehydration posed by infant diarrhea —a major killer in the Third World, where medicine is not always available when an emergency occurs...

...The short-lived Janata Party government (1977-79) did train some 15,000 community health workers at 700 centers throughout the country, and their ranks were supposed to swell to 500,000 by 1981...

...Unfortunately, this project was abandoned in the subsequent political turmoil, and the government's stirring motto, "People's health in people's hands," vanished into thin air...

...Scarce household money spent on such useless commercial preparations could be much more prudently used by prospective mothers to assure themselves healthier diets...

...Innovations such as the provision of clean water and the marshaling of community health resources to extend preventive techniques can in a vast number of cases make a difference between life and death...

...Mahler's parting prescriptions for improving the world's health would make greater use of "barefoot doctors"—traditional quasi-medical personnel with roots in their communities—to deliver health care...

...At the same time, the retiring WHO head emphasizes that a small number of basic drugs, possibly as few as 200, would be adequate for primary health care...

...The magnitude of the suffering in the Third World caused by diseases attributable to contaminated water can perhaps be most vividly expressed by putting the problem in terms of First and Second World equivalents: Imagine, forinstance, a partof the globe where those urinating blood as a result of bilharziasis equal virtually the entire population of the United States, those in the grip of gastroenteritis add up to all the residents of Western Europe, and those afflicted with swollen legs due to elephantiasis could replace every citizen of the Soviet Union...

...That means an unnecessary trip to the doctor—either a full-fledged medical graduate who visits the village from time to time or perhaps a less well-trained practitioner who has set up shop locally...

...Such is the mystique of modern medicine in the Third World that people there tend not to realize how much they can accomplish on their own initiative, without the help of professionals...

...Indeed, Christiaan Barnard— arguably the world's most famous doctor —was not expressing a terribly heterodox attitude when he said just prior to the Alma-Ata conference, "malnutrition is not a medical problem...

...Actually, the 62year-old Danish physician would spend his money in a rather old-fashioned, unspectacular way—not on exotic medicines or futuristic technologies, but on primary health care...

...Although many developing nations pay lip service to this concept, few other than China have done much to put it into effect...

...Take the case of infant mortality...

...In the fourth century B.C., Hippocrates wrote that "to investigate medicine properly, one must take into account the seasons, the winds, water, orientation of the city, topography, and the customs and occupations of the people under observation...

...Pulses, leafy vegetables and other foodstuffs that furnish nutrients essential to the developing fetus are affordable even by rural families on tight budgets...

...Mahler discussed some of the measures outside the usual purview of the medical establishment that have enormous potential to raise the standards of health in poor countries...

...Oddly, the Heritage Institute, an ultraconservative Washington think tank, smells something subversive in this effort...

...Declaring that he is about to become a "development terrorist," he told a recent interviewer: "Drop me in Africa or Asia or Latin America, give me $20 for each member of the population I'm going to serve, and I'll show you we can produce a miracle...

...That precaution requires fuel, however...

...That is not to suggest medicines have no role to play in raising Third World health standards, Dr...

...What makes India's infant mortality rate all the more distressing is the extent to which it is due to simple ignorance...

...Providing clean water wherever it is not now available would, by the WHO'S estimates, cost as little as $15 billion annually—or a paltry $5 for every man, woman and child...

...As this writer can attest from his observations at rural health projects throughout India, families here find it difficult to discard the belief that the "weakness" besetting a woman during pregnancy must be "cured" before she gives birth or else it will be transferred to the offspring...

...That, in fact, is the approach the WHO has been energetically promoting as part of its ongoing "Health for All by the Year 2000" program, conceived a decade ago at a conference in the Soviet city of Alma-Ata...

...Haledan T. Mahler, who in July will be stepping down as Director General of the World Health Organization (WHO) after 15 long years in that position, can at times sound like the arrogant Western expert armed with all the answers to the Third World's problems...

...Indian municipal authorities suggest that drinking water be boiled in the summer months to prevent typhoid, cholera and other diseases...

...It is not necessary, "alternative technologists" have been pointing out, to reproduce the conventional water supply and purification systems that have become standard in the West...

...in a city like Bombay, over half the population lives in slums and cannot afford the "luxury...

...Several cheaper substitutes are available that could be built and operated with local labor and materials in the less advanced countries...

...Modern physicians, who still take Hippocrates' oath upon completing their medical school training, have too often lost sight of this...

...In India, one in every three babies is stillborn, and some 65 out of every 1,000 who survive birth die in the crucial first week of life...

...The father of medicine was thus well aware that health is holistic in character...

...The dais, though entirely illiterate, have extensive rapport with the people in their communities—unlike visiting doctors and paramedics—and can perform such simple yet significant tasks as monitoring the weight of babies...

...Of course, there is not much chance that the WHO will succeed in totally eradicating diseases as prevalent as malaria and bilharziasis in the mere dozen years remaining before the deadline it has given itself...

...See my "Undermining the WHO," NL, July 14-28, 1986...

...Invariably these well-meaning individuals prescribe one or more of the "tonics" produced by pharmaceutical firms in bewildering variety to ameliorate every "ailment" under the sun— including pregnancy...

...In a farewell interview, Dr...