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AT MICROFICHE REFERENCE LIBRARY A project of Volunteers in Asia Medical Care in Developins Countries Edited by: Maurice King Published by: Oxford University Press/East & Central Africa P.O. Box 72532 Nairobi, Kenya Paper copies are $13.95. Available from: Oxford University Press 16-00 Pollitt Drive Fair Lawn, NJ 07410 USA Reproduced by permission of the Oxford University Press, East and Central Africa. Reproduction of this microfiche document in any form is subject to the same restrictions as those of the original document. IJdEDIC,LhL CARE IN DEVELOPING COUNTRIES A Primer on the Medicine of Poverty and A Symposium from Makerere Edited and Illustrated by MAURICE KING, M.A. Cantab., M.R.C.P. Lo& Based on a conference assisted by WHO/ UNICEF, and an experimental edition assisted by UNICEF Published with a grant from the Ford Foundation, through the ‘East African Teaching Materials Fund’ Nairobi OXFORD UNIVERSITY PRESS Lusaka Addis Ababa London ,, ‘j Oxford University Press, Eiy House, London W. I QLASOOW NEW YORK TQRONTO MELBOUHNE WBLLINOTON CAPi TOWN IlJADAN NAIROBI DAR Ii9 SALAAM LU8AKA ADDl# AOADA DELHI BOMBAY CALCUTSA MADRAS KARACHI LAHORS DACCA KLlAW LUMPUR HONO KONG SlNQAPORE TOKYO Oxford University Press, P.O. Box 72,532, Nairobi 8 Oxford University Press, 1966 ISBN 0 19 644018 1 Reprinted wirh minor revisiow, 1367 (twice) Reprinted 1968 (twice], 1969, X970 (twice), 1972, 1973 Cover artwork prepared by HILLARY CORREIA Made and Printed in East Africa To the reader and to our students, and through them to the common man and his family in developing countries ‘everywhere. FOREWORD No conscientious doctor in AhZca can afford to isolate himself from the special needs and circumstances c;f community medicine any more than he can afford to isolate himself from Africa as a whole. These needs and circumstances are very real and very compulsive in determining the general pattern of medical care and enforcing a logical solution to the problems of under-doctored countries, which are lentirely different from those of the highly-doctored ones. The neelr(; and conditions of the patient, and the diseases from which he suffers are different, and the types of subject on which he needs education and advice differ quite radically, though perhaps not in principle, from those which are put before practitioners in other countries. Moreover, the responsibility of the doctor is inevitably diEerent. Whereas in the highly-doctored countries it is possible, and often reasonable, for him to accept responsibility for a limited group of people knowing well that others can seek and obtain equivalent advice and care elsewhere, in the under-doctored countries he must often accept responsibility for large numbers of people, often quite beyond the possibility of his own personal management, acknowledging that if he declines this responsibility he deprives them of all sources of medical help. He thus finds himself necessarily as the central unit of a group of people of varied training and origin whom he must himself manage, supervise and often train in order to meet his responsibiiities. Although these points are put as if they should be axiomatic, they have not always been recognized. Too much of tropical medical practice consists of a limited effort to repeat the activities which are appropriate to highly-doctored areas, to the advantage of a few but to the great deprivation of the majority, and, though there have been brilliant exceptions, many of the available textbooks have dealt with medicine exclusively from the point of view of the highly-developed areas. Admittedly the scientific basis of medicine must be the same in both, and the developing countries, whether tropical or not, deserve the same high standard of technical education for their doctors in this scientific basis, but the vocational aspect of medicine differs radically and different teachings and practices are more than justified, indeed they are essential. This book is a leader amongst the brilliant exceptions in the teaching of the vocational aspect of medicine. The twelve axioms with which it starts epitomize the attitudes which run throughout the book and deserve very careful study in their fully amplified form. T’he authors regard the doctor as the essential unit in an organization, not as an isolated individual. Moreover, they develop that organization on the soundest of principles, ensuring accessibility to the public by due attention to distance, as well as to population/staff ratios within the organization. The doctor needs urgently to retain his technical skill; yreover he needs to acquire new skills in some aspects of technology