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Medical missionaries, historically the pioneers in introducing Western medicine into many tropical countries, are today responsible for a significant proportion of health care in several of those countries. Illustrating his theme with references to personal experiences in the former Belgian Congo, the author enlarges on the organization of a church-related comprehensive health care programme based on a chain of rural health centres and satellite dispensaries that brought curative and preventive medicine to the whole population within the area covered. Trypanosomiasis was eradicated, yaws and tuberculosis controlled, cerebral malaria eliminated, worm-loads reduced and nutrition improved. Leprosy was treated within the integrated service as soon as the sulphones became available. Medical auxiliaries and nurse-midwives were trained practically to tackle the local problems. Students from many missions over a wide area went into government, mission and company employ after training. Research concentrated mainly on the solution of pressing local problems, such as onchocerciasis and leprosy, but incidentally investigated interesting clinical phenomena.
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PMID:The contribution of medical missionaries to tropical medicine. Service-training-research. 40 Feb 1

Adding family planning and population programs to the list of tropical medicine components expands the definition of what might be called appropriate medicine for the developing countries. This comprehensive definition covers the topics of prime importance to the health and ultimate development of preindustrial societies. These topics are given low priority in all medical education. Nutrition has been left to the schools of public health. Schools of agriculture are interested in the quality and quantity of food production but not in the social and economic complexities of relating food production to the nutritional status of the population to be served. the variables are interdependent. In the world more than 3 billion people live on the margin of existence. High mortality contributes to high fertility rates because living children are the only available form of social security. Food production cannot keep pace. Malnutrition is a factor in at least 1/2 of the 45 million global deaths in those less than 5 years of age. In the Far East and Africa 25-30% of the population are undernourished. During the next 15 years the world may add 1 billion people to its present 4 billion and there may be 8 billion shortly after the year 2000. Of these 6.6 billion would be in developing countries. In Africa, South America, and the Middle East, surveys have shown that 96% of 1000 women in the third trimester of pregnancy and 75% of school children in South India were anemic. At least a 4% annual increase in food production is needed between now and the year 2000 to meet the needs of present malnutrition and projected population growth. The prospects of achieving this are not good. Also, of regional importance are vector borne and macroparasitic diseases and trachoma and yaws. Of universal importance are fecally related diseases and air-borne diseases. Malaria still persists in many areas with an estimated 1 million deaths annually. Recently the World Bank has paid increasing attention to provisions for health. In 1976 about 357 million dollrs is proposed for loans and credits for health-related projcts. Intra- and transnational migration of human populations is steadily increasing and has and will continue to spread disease. The potential for mass epidemics remains. Our global responsibility for training of public health workers from and for developing countries remains. Food, population, and health are the major independent variables in the global equation for the quality of life. The control of transmissible disease remains a vital undertaking for the American health establishment. We live in an increasing interdependent world. Many people and nations look to the U.S. to sustain its leadership in biomedical research and medical and public health education. An interdependent world cannot afford the stresses of ill health, poverty, and explosive population growth. We need resurgence of interest in public health, tropical medicine, and a change in individual and national life styles.
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PMID:Editorial: American medicine and world health 1976. 125 95

World Health Organization's goal Health for All is the starting point for a most ambitious health policy ever. The paper analyzes the role of epidemiology in the Organization's work, particularly in the Health for All development. During WHO's early years, epidemiology helped to design and carry out major public health campaigns against such scourges of the humanity as yaws, tuberculosis, malaria and small pox. When the Organization during the 1960s began to emphasize the need to develop the infrastructure of health care, health services research partly replaced epidemiology as WHO's main scientific allay. After the Health for All policy was launched in 1987, epidemiology has again played a major role in establishing the scientific background of the policy. The European experiences show how the epidemiologists can help WHO to identify the most important health problems and set achievable and measurable targets for them. The paper concludes that epidemiology serves to identify problems, show ways to solve them, monitor the changes in the situation and evaluate the achievements.
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PMID:Epidemiology and Health for All. The role of epidemiology in a health policy. 160 35

To mark the 40th anniversary year of WHO, this article presents major events from WHO's life story, including episodes from its foundation in the aftermath of a world war, through the high hopes of the mass campaigns and the brilliant victory over smallpox, to the present great endeavour to achieve health for all. Between the world wars, international health work had been carried out by 3 separate organizations. Urgently needed was a new, truly global health organization to replace them. During the late 1950s, WHO was assisting yaws campaigns in 28 countries with a combined population of over 150 million. By 1960, in 64 countries or territories, 265 million children and adolescents had been tested with tuberculin and 106 million vaccinated with BCG. The technique of residual spraying with DDT held out the promise of conquering malaria by preventing the transmission of the malaria parasite. Within 12 years of its launch, the global malaria program had brought protection against the scourge of malaria to almost 1 billion people--more than 1/4 of the world's population. Smallpox victims were estimated at 10-15 million each year, of whom 1.5-2.0 million died. Through quiet advocacy backed up by solid research, WHO had helped to give family planning the international respectability it had so much needed. WHO increasingly urged governments to integrate disease control campaigns with the general health services and helped them to do so.
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PMID:WHO--the days of the mass campaigns. 307 20

Serological tests for treponemal disease were undertaken among the inhabitants of 10 census units in the Eastern Highlands of New Guinea. Many sera gave reactive results to some or all of the tests performed. To exclude biological false positive reactions the Treponema pallidum immobilization (TPI) test was carried out on each serum, the results being taken to indicate the presence or absence of treponemal disease in the individual. Clinically, leprosy and malaria were rare and no cases of active yaws were seen. Some middle-aged people showed clinical evidence of old yaws infections. The prevalence of treponemal disease in the census units varied from 3.9% to 79.2%, males having a higher prevalence than females. The children under 15 years showed no serological evidence of treponemal disease in all but 3 units, in which the prevalence ranged from 14.3% to 40%. It is concluded that the treponemal disease involved was yaws. Special interest lies in the non-infected children and adults who have no relative cross-immunity from yaws in a country which is rapidly developing.
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PMID:Treponematosis in the eastern highlands of New Guinea. 530 97

Paralysis from poliomyelitis may follow injections yet injections are extremely popular in the Third World. Some injections are given by hospital doctors and nurses but the majority are given by traditional healers, pharmacists and paramedical workers who have acquired syringes. Many injections may be given to a sick child. I suggest that the early use of vaccines did not persuade people of the mystic of injections and that the mystic predated the use of penicillin. The earliest mystical result would have been the injection of quinine for malaria and antrypal for sleeping sickness. The words brilliant, spectacular and dramatic were first used to describe the mass campaigns against yaws and kala-azar in the 1920s and 1930s. A single injection healed the ugly lesions in a week: cause and effect were visible. In the 1950s penicillin was used in mass eradication campaigns. The countries where injections are so popular correspond roughly with the areas of mass eradication programmes. Many or perhaps most of the injections are not sterile and present a great risk of attendant paralysis. Proof that injections are causal may be impossible. Meanwhile we need to know why injections are so popular and how they can be less so.
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PMID:The popularity of injections in the Third World: origins and consequences for poliomyelitis. 651 26

Worldwide attempts to eradicate yaws, malaria, and smallpox have all been effective to varying extents, and all have taught some valuable lessons that should be taken into account as a new global crusade is mounted against tropical diseases. But it should not be forgotten that infectious disease remains a major public health problem in the U.S., and new diseases are arising to replace those already vanquished.
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PMID:Health crusades and tropical diseases. 739 67

The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.
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PMID:The European-American exchange. 752 30

The fifteenth-century encounter between previously separate disease environments was not simply an encounter between Europe and the Americas. It was preceded by an encounter between Europe and tropical Africa and followed by a still-more-intense transmission of diseases across the tropical Atlantic, mainly from Africa to the Americas. This transmission principally involved smallpox, yaws, yellow fever, and falciparum malaria. Many other vector-borne diseases failed to make the transfer for lack of suitable vectors in the Americas. The African diseases contributed even more than those from Europe to the depopulation of the humid tropics in the Americas. They also set up conditions that made residence in the tropical Americas dangerous for newly arrived people from Europe.
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PMID:Disease exchange across the tropical Atlantic. 752 31

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yaws); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.
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PMID:Forty years. An introduction to the development of a Caribbean public health. 1036 15


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