Howe Ceouattries Are Meeting Problems / 91
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education, and great forward strides in understanding these diseases, the major causes of mortality and morbidity have been
lightly influenced. This is not a criticism of the health profession of
Colombia; far from it, it is intended to showthat despite vigorous
and imaginative leadership, these problems remain. Solutions to
‘health problems do not follow automatically from establishing
medical centers, producing more health personnel, and enlarging
* health services. There are certain critical connections between med“ical technology and the public, and if these connections are not
_ firm and etfective, the benefits of that technology do not reach the
public.
In Cali there is strong appreciation for the complexities of fitting
health resources to health problems and of the importance of thinking in terms of cost and effect. For example, concern fer the critical
role of nursing in health care has led to newapproaches to educating, auxiliaries in a university setting; to the development of a master’s degree program to strengthen nursing leadership: and to an
effort to develop an intermediate-level nursing category to provide
closer supervision for auxiliary nurses.
More recently the institution has been working with other national groups in studying health care systems. using the techniques
of operations research with the objectives of designing new syvstems that are more effective within the constraints of available
resources.
We are confronted, however, with a sobering concept. It is the
lag between the time an idea or an institution is born and the time
that a substantial difference appears in the population being served.
We will do well to ask what are the ways in which that lag might
be reduced.
Summary
We see the passing scenes: patients come from far away and
stand in long lines; auxiliaries work alone doing what would be
done by a team in other places: physicians and nurses stretch resources beyond thinness to serve vast numbers of people; ministry
officials make decisions on human lives unguided by analytical
data or administrative assistance. And outside these scenes are
others—of traditional means of dealing with sickness. Andall are
entwined in the slow march of development along with education,
transistor radios, roads, rains, crops, and political decisions—factors that affect health in ways we do not know.
It is difficult to find a meaningful order among such disparate
patterns, but there are the common elements of man and disease
interacting and other men trying to help. By focusing on health
needs and efforts to meet them, a framework can be built for evalu-
ating and looking for relationships among what might otherwise
seem to be scattered and unconnected events.
We might think of it in this way: between our biomedical knowledge and the people who stand to benefit from it is a long chain—
of people, concepts, instrumentation, techniques, money, and miles.
If critical links are missing from the chain, the people in need will
not benefit.
It needs to be said that critical links are missing. Large numbers
of the world’s people, probably more than half, have no access to
medical care at all. Fer those who can reach the medical care system,
the contact may have no significant influence on their lives and
healt!—-the malnourished child with diarrhea cries with an infected
ear; the physicien prescribes penicillin and ear drops; the child
returns to the same crippling setting from which he came.
Looking along the chain, some missing links are obvious—sheer
lack of resources: lack of capability for effective planning; failure
to use auxiliary midwives in one country and medical assistants in
another; lack of cooperation between university and government.
Other weaknesses in the chain may be more subtle—‘‘curative”
medicine that is not curative at all but is only treatment of symptoms: health personnel whose work has little effect on the health
of persens and communities: programs that seem sensible but are
not the best use of scarce resources.
To what extent are these problems the unavoidable consequences
of underdevelopment? To be sure, we are dealing with the problems
of slow modernization—lack of money, lack of an infrastructure,
low educational levels, administrative inexperience. In addition,
however, there are major faults underlving the systems of health
care and education of health personnel that have nothing to do
with the development process except perhaps to augment its weaknesses.
The systems for health care and education of health personnel,
with few exceptions, were not designed to meet the needs of these