STATE OF THE WORLD
Fisher, Markoosha & Hepner, Arthur W.
STATE OF THE WORLD Reports from Naples and Mexico City Darkness in Naples By Markoosha Fischer Naples THE BAY of Naples possesses an enchanting beauty which has been justly praised for...
...They live in densely packed filthy houses with little daylight or electric light, and don't get enough to eat...
...Is it too much to hope that some day humanity will be stirred out of the shallow, unimaginative state of mind it is in now and will learn to share and to enjoy the indescribable beauty and immeasurable wealth of this earth...
...Certainly nothing is taught about the strictly prohibited facts of birth control...
...Now the doctor, dentist, nurse, pharmacist, and clerk must punch the clock at the start and finish of the work shift...
...They are above begging—begging is too honest a profession for them, too tame and commonplace...
...Part of the dream of my youth was that after frontiers and tariffs and the barriers between nations were abolished, each country would contribute to the rest of the world whatever the country possessed— technology, silk, food, steel, landscape, minerals, scientists, winter sports, museums—and in return receive from other countries what it did not possess...
...and accidents and injuries sustained on the job...
...For every case of political favoritism which gives one doctor a better deal over a rival, there are hundreds where patients have gotten much better medical attention than under private practice...
...There are at present 36 clinics in the five areas...
...The Italians are friendly and gay...
...He took me to the houses of Pompeii's poorest inhabitants and said with great bitterness: "We think we live in an enlightened age, and have made great progress...
...Mexico's program got the green light from the Avila Comacho Administration in January, 1943, but a year elapsed before the idea was transformed into a plan of actios...
...She is the author of "My Lives in Russia" and "The Nazarovs...
...The Naples slums are an inseparable part of Naples...
...The employer's share is 8.84 centavos and the employe's and state's each 3.5...
...They fill the streets with noisy shouting...
...They roam the streets in bands, small boys and girls, ragged, diseased, filthy...
...In the five areas where the program functions, the basic unit is the neighborhood clinic...
...I mentioned the slums to the guide who was showing me Pompeii...
...Expensive as this seems, the cost of medical care to the worker and his family is much less than it was under the old system of get sick and pay the doctor yourself...
...A friend of mine, a specialist, has a three-hour work schedule but finds, he says, he needs four hours to complete it effectively...
...The easy, almost carefree life of the country has its charms in many respects, but it can be exasperating when one needs immediate diagnosis and treatment...
...If you canvas a random sample of the younger doctors, you'll find this to be the dominant attitude...
...In the 5]/2 years of operation, interest in the program has increased fourfold among patients...
...They seem to enjoy the begging (with some stealing as a sideline) and the excitement of street life...
...Some are obviously lost to society...
...Everywhere in Naples one sees the young milling around, doing nothing...
...There is no work for them...
...The same goes for other European travelers in a position to travel...
...We have not made very much use of this knowledge to improve the lot of mankind...
...The coverage is truly complete, taking in ambulance service, medicines, dental work, laboratory tests, and even emergency house calls...
...The total cost is a small percentage of the annual wage bill...
...So do those whose hollow cheeks and sunken eyes show unmistakable signs of a deep-down hunger...
...Red tape sets in...
...ARTHUR HEPNER, presently a film writer in Mexico, was formerly London correspondent for the Columbia Broadcasting System and a member of the staff of the St Louis Post-Dispatch...
...They go to bed when their elders go, which is more often than not long past midnight...
...Doctors admit that medical practice in Mexico has improved as a result...
...Still, the number of employers who have put it on the line has almost doubled since the inception of the program...
...They did not impress me as lazy men who prefer to beg or sit idly in the sun instead of working...
...Unless an aroused social consciousness and conscience coupled with a daring imagination finds means to open their gates to the numberless people who so desperately need them, they will die, and humanity will be much poorer for their death...
...Can we reverse the cess before it is too late...
...Even the hardboiled industrialists have begun to realize the advantages...
...As a result employers could, if they wished, procrastinate indefinitely before signing up...
...To a superficial traveler, the inhabitants of the Naples slums may seem carefree and gay...
...Last year, Seguro Social took in 124,213,370 pesos ($25,000,000 approximately at the old rate of 4.85...
...For the first two, the employer contributes 50% of the cost while the worker and the state each subscribe 25...
...This leads to the primary criticism of the program, lack of professional personnel...
...Lesson for America By Arthur W. Hepner Mexico Ci'fj, AFTER 5lA years, the evidence is piling up that Mexico is pleased with its program of social medicine for workers in the big industrial centers...
...I wonder whether this is so...
...But now they are not supposed to be nationalists...
...Not much attention is paid to punctuality and this lack of concern often creates ill-feeling in a patient waiting to see the doctor...
...Of late, though, the resistance against participating zestfully is the thing which has been toppling, and doctors, workers, and their bosses all accept social security as something here to stay...
...Still remembered, too, are appeals to patriotism and nationalism...
...Now the number of workers and family members enrolled exceeds a million, and the doctors on the Seguro Social payrolls hardly find time for a smoke between patients...
...STATE OF THE WORLD Reports from Naples and Mexico City Darkness in Naples By Markoosha Fischer Naples THE BAY of Naples possesses an enchanting beauty which has been justly praised for centuries on canvas and in song and verse...
...In 1944, the country pioneered through a wilderness of medical administrative problems and in a relatively short time not only cleared away the trees but burned the stumps and erected a thriving civilization...
...My specialist friend says he accords his Seguro Social patients the same quality of care and develops the same doctor-patient relationship as in his private practice...
...Here general practitioners see the patients, make examinations and diagnoses...
...Nationalism, they are told, is not good for them now that they are free of Fascism...
...These colorful slums, filled with turbulent life which spills out of the wretched dwellings into the streets, may delight the tourist, but they hardly delight the people who live there...
...They prescribe medicines, hospitalization, - or specialists as indicated, and these extras, like the preliminary examination, are provided without cost...
...Many fathers of those children who do have parents (mothers have little to say) are not always convinced that schools are the best preparation for their offspring's future...
...Neither private nor public funds are being invested in such a hopeless venture...
...The Church and the Communists are eager to provide the answers, and they are the only forces which seek to arouse hope, stimulate faith, and excite them as Fascism did...
...And this sets up all sorts of subsidiary criticisms...
...And for the more complicated cases, the Institute has access to 21 hospitals and an equal number of specialized sanatoriums...
...They all sleep in one room, and it is useless for anyone to try to sleep before the big noisy family does...
...III I had a feeling of despair over the inability of mankind to distribute fairly and intelligently the wealth at its disposal when I compared the slums of Naples with the huge empty hotels in Merano, the lovely Tyrolian town in Italy's North...
...Notwithstanding the songs and the laughter one hears, the people in the slums lead a poverty-stricken existence...
...There are three categories: general health and maternity care...
...There are four hospitals available for maternity cases...
...They don't mind it...
...The faults with the program lie in the direction of administration and Mexican habits...
...But we have made tremendous use of our scientific modern knowledge of destroying human life...
...Is the dream of my youth forever to remain a fantasy...
...Doctors contend this MARKOOSHA FISCHER, author and lecturer, has been living in Italy for 10 months, working on a new book, following a long stint as special representative of the International Rescue and Relief Committee in Germany...
...they don't know any better...
...Under Seguro' Social, all workers in factories, plants, offices, and stores in Mexico City and four other industrial areas are entitled to full medical and hospital care, indemnification in case of accident, invalidity, injury or chronic illness and death benefits...
...He refuses work when he can get it and prefers to bask in the sun and look at the sea or beg and send his children to beg . . . The Neapolitans have always lived this way...
...Whatever its shortcomings, and they vary from day to day, Seguro Social in Mexico demonstrates that tripartite insurance to uplift the health of the people is no Communistic monster...
...Moreover, there is now a boon to the economy in the indemnifications paid to the disabled and in the benefits paid to widows and orphans...
...I was told that this was not only a result of undernourishment...
...It paid out for administration, benefits and services 91,775,300 pesos ($14,500,000 approximately...
...This takes a heavy load off other state agencies and cuts down the number who would otherwise seek assistance or go onto the streets as beggars...
...On the other hand, they also admit that no patient has suffered from lack of consideration because of Seguro Social and its time-clock operation...
...It is ribly late—later than many of have suspected...
...Meanwhile, Seguro Social is a lesson in content and form—both for its do's and don'ts—for the United States...
...So much so that the Mexican Social Security Institute now talks of pushing the plan out to farms and fields...
...Naples is an inseparable part of the bay and of its beauty...
...He is paid only for three hours of work at a rate of 572 pesos monthly...
...old age, death, and disability benefits...
...In plain words, the five big industrial centers of Mexico have "socialized medicine...
...Most of the medical personnel find it difficult to carry their respective loads in the time allotted...
...Is there any hope for a world which, with plenty of empty Meranos at its disposal, permits hundreds of millions of its people to lead a substandard existence, crowded, filthy, without sun and air, breeding disease, crime, immorality, backwardness, fanaticism...
...they know how to live and how to enjoy life...
...Must we give up hope that the human race will, within a foreseeable time, develop the necessary vision, courage, and wisdom to start living a dignified life worthy of man...
...The children of Naples are a baffling problem...
...It is felt that this goads employers into minimizing hazards and improving the working environment...
...But in the past there were usually three, never less than two, rooms for • family...
...And for every case of maladministration, there are hundreds of new infants born under sanitary conditions...
...and their financial loss is their professional gain...
...Americans have not yet discovered Europe's less famous resort area...
...The Italians have great abilities and great personal qualities...
...We have in our possession a great deal of knowledge about how to improve human health, how to prolong human life, how to harness nature to our needs, how to produce, how to measure the influences of heredity and environment on human behavior, and so much more...
...In every phase of medical activity, the officials of Seguro Social can point proudly to brightly-colored charts showing the increased use of their facilities...
...They are hard workers, excellent artisans...
...The amount of money which the few English visitors have at their disposal is too trifling to make any difference in the town's budget...
...they are happier this way...
...They are disillusioned...
...III Employers find that a healthier working force and reduced abstentee-ism offsets the cost...
...The exhilaration of Mussolini's youth organizations and parades is still fresh in their memory...
...But they are pale and have deep dark rings under their eyes...
...There is a shortage of both doctors and nurses...
...delays are frequent...
...Unless fundamental changes take place soon—great industrial development or effective land reform on a large scale—there is little they can look forward to except possibly emigration...
...And, besides, there just is not enough work in Italy for everybody...
...They now see many more and more varied cases than under private practice...
...The children look and live like little animals...
...The time unfortunately is not near when some provision will be made for the adult unemployed, but there is hope that the companion agency of public health will increase its medical standards to match those of Seguro Social, thus giving Mexico two government agencies capable of attending to all the health problems of the Mexican people...
...When the arithmetic is worked out, a fund equalling almost 16 cen-tavos out of every peso paid as salary or wages is set aside to defray the Seguro Social operating cost...
...For the third, the employer pays the full bill...
...The Germans, Austrians, and Eastern Europeans from behind the Communist curtain don't exist as tourists...
...The prevailing schedule is for a general practitioner to work four hours daily for a monthly fee of 434 pesos...
...A big chunk went to the salaried physicians, dentists, and nurses...
...But the many hotels and boarding houses are either boarded up and decaying rapidly beyond repair, or they drag out a miserable existence, their furniture shabby and plumbing outdated...
...It points to a format for bringing effective medical care to a wider segment of the population, and it shows doctors that there is no vicious ogre hiding beneath the facade of "social medicine...
...This "cradle to grave" coverage is a luxury available not alone to the workers but to wives and "companions" and children under 16, or 25 in the case of those physically handicapped or continuing with their education...
...Mexico's program shows that the job can be done competently and efficiently, even if some of the evils of government intervention now and then crop up...
...Their houses as well as their bodies are unprotected against the occasional blasts of cold and rain...
...Besides, if they beg, they bring home much needed money...
...Moreover, the initiation of team medicine, implicit in the structure of the clinic system, has given the doctors added opportunities to work collaboratively and even to take on study projects...
...But the eyes of the women—tragic, resigned eyes—belie first impressions...
...So the doctors actually give more than they get...
...As a result, the children are not always encouraged at home to attend school regularly...
...although the program is obligatory, enforcement is like everything else in Mexico.—tomorrow is as good as today...
...our poor in Naples today are glad to have one room for a family...
...The world has been acquainted for centuries with the country's beauty and blessed climate...
...The old customers are no more...
...But more often I heard others, better off, dismiss this abject misery of Italy's South with an indifferent shrug and words like these: "You don't have to be sorry for them...
...To care for the 1,040,499 eligible for service, there are but 1,746 physicians, surgeons, and dentists on the payroll...
...The town's shopkeepers, artisans, hotel workers, clerks, cooks, waiters, porters, and chambermaids, whose livelihood for generations depended on tourism, carry on a desperate struggle for survival...
...They are the children who have no families and are on their own...
...If they end in prison or on the gallows, the fault will certainly not be theirs...
...They have much to contribute to the world—yet those who want to live above the level of desperate poverty must leave their beautiful country in search of their daily bread...
...Workers and their families, of course, get the gravy at a minimum cost to themselves...
...prevents them from developing the proper frame of mind in which to see patients...
...The ranks of unemployed grow—and so does the number of Communist posters and the attendance at Communist meetings...
...Time clocks were virtually unknown in Mexico until Seguro Social started...
...Doctors and dentists work for the Institute a few hours a day, leaving them time also for private practice...
...Then, too, many doctors complain of the time-clock innovation...
...Patients don't get prompt service all the time...
...Once a prosperous, popular health resort to which Europe's rich flocked to restore their health and strength, it is now dying a slow, sad death...
...Nothing can take away the charm of Merano's mountains, of the streams, of the luxuriant vegetation, of the acres of vineyards, of the invigorating air and warm sun...
...Much of the outlay was for new buildings and equipment, for Seguro Social is adding to its facilities all the time...
...Generation after generation grows up living in the same overcrowded quarters which become more insanitary and unhealthy every year...
...Little work is being done to enlighten the adults about hygiene, sanitation, and the needs of growing children...
...II The program is financed largely on a tripartite basis, with the employer carrying the brunt of the load...
...They have always possessed artistic skill and good taste, and they have retained them...
...What is good for them...
...The salaries are perhaps low by American standards, but they are equitable in terms of the Mexican economy...
...Merano with its closed hotels, its empty tree-lined boulevards and empty parks, and the many other Meranos are being choked to death for lack of visitors...
...I have seen many sad, worried faces, many emaciated men pitifully trying to earn a couple of pennies...
...Doctors saw a little over a million cases in the first year and more than 4J4 million during 1948, the last year for which complete information has been compiled...
...That's because the doctor-patient ratio is on the high side...
...II Long ago, in my youth, some of us dreamt a dream of how the most beautiful areas of the world, above all Italy, would be converted into vast international vacation lands and rest homes, open to all human beings in need of them—to children born in slums, to the tired, the ill, and the aged...
...We have gone downhill...
...This new undertaking may pose a motley of unprecedented administrative and fiscal problems, but no one bothers much about them...
...In many places the program llliprofaned as Communistic and (Migion-schooled Mexicans crossed themselves pleading to be killed rath-ir than be taken to the Seguro Social hospitals or clinics...
...Just the same, nearly everyone agrees that the program is sound theoretically...
...These are supplemented by 191 first aid stations maintained by Seguro Social in industrial plants and factories...
...There are those who say that this new medical order has its cracks in the concrete and its shaky buildings...
...Nurses work full time...
...A Neapolitan is lazy by nature and this is why he is poor . . . He won't work more than required to earn his food for the day...
...The residue was dumped into a reserve fund to care for pensions which begin in 1962...
...Early suspicion and opposition were strong...
Vol. 14 • March 1950 • No. 3
