Medical problems of the developing countries

Science. 1966 Jul 15;153(3733):271-5. doi: 10.1126/science.153.3733.271.


There can be no immediate solution to the medical problems of the developing countries. Priorities are demanded, and it must be acknowledged that in allocation of medical priorities certain compromises are required. It can be hoped that the least detrimental compromises will be selected. Careful planning of health services and also of training programs for various medical personnel must not rely on what exists in developed countries, because those facilities and programs may be completely inappropriate to other situation. At the same time as inroads are made into the preventable conditions which now claim thousands of young lives, programs of birth control and improvement of agricultural methods must be emphasized. The reduced morbidity and mortality which results from immunization against childhood infectious diseases, smallpox, and tuberculosis must be borne in mind in overall planning for schools and general health services. Inexpensive and practical programs that could be managed by medical personnel who are not highly trained should be considered. As the benefits of technical development gradually reach the urbanizing population living under poor social and hygienic conditions, changes in the disease picture must be anticipated. Those involved with planning and training must understand various cultural influences so that the transition period can be made as painless as possible. Certain seemingly attractive Western procedures should be guarded against if they are not practical. For instance, a common tendency is to build large modern hospitals throughout the land with disregard for the fact that these hospitals cannot possibly be staffed, equipped, or maintained because of shortages of trained people and available funds (14). This has been called an "edifice complex" and is unfortunately found in many developing regions, stimulated often by ill-considered advice from overseas experts. At the same time as medical services are being improved, it is extremely important to document the improvements by means of carefully recorded statistics. Guidance in necessary methods for documentation should be sought early in the development of medical care (15). Obviously it is vital to determine what and where the major medical problems are so that programs designed to attack them. Once the problems are sorted out, available resources can be allocated and preventive measures and health education can be aimed at specific aspects of public health. Many general statements have been made to describe the medical problems in the developing countries of the world. There is a need to particularize the problems and approach the specific manifestations of disease with knowledge of local conditions and resources. Accepted textbook solutions no longer apply in the field, and the ultimate solution may be along lines which are completely unique and nontraditional. To break the usual rules may be the only practical means to solve the problem at hand, and modified common sense must often replace modern technology. The practical variations on the general theme described here make medical work in developing countries interesting, exciting, and rewarding.