From: Student Pugwash USA <uspugwash@igc.apc.org>
Newsgroups: alt.org.pugwash
Date: 14 Dec 92 11:48 PST
Subject: Re: *Tough Questions: Fall 92 News
Nf-ID: #R:cdp:1758700030:cdp:1758700036:000:4934
Nf-From: cdp.UUCP!uspugwash    Dec 14 11:48:00 1992


Tough Questions - Conference Issue 1992

HEALTH CARE : LOOK, LISTEN, AND LEARN
By Liesl Cooper, Lyta Hamm and Troy Jacobs

     The Health Care in Developing Countries working group was 
comprised of participants from seven countries, with many varied 
perspectives and experiences represented. Because health care in 
developing countries is largely dependent on foreign aid, the 
relationship between donor and recipient was a recurring theme.  We 
paid particular attention to programs which failed to be effective 
because they did not, or were not able to, address the self-
identified problems of the community affected.  Without a sincere 
and sustained dialogue between donor and recipient, it seems 
impossible to plan and implement sustainable health care initiatives.

     In order to illustrate this, we would like to invite you to tune 
in to the Health Channel.  Here on the RLook, Listen, and Learn ShowS
 your window into the world of health and development -  we have Dr. 
North representing global aid in  the Developed World, and Ms. South 
representing the Developing World:

Dr. North:  A team of development professionals from the 
Industrialized Nations and I viewed a colleagueUs slide presentation 
a while ago, and we were deeply concerned about rural 
underdevelopment. We saw pictures of malnourished children, dirty  
living conditions, no indoor plumbing or toilets, and rampant diseases. 
We decided that the best intervention was to send a team to build a 
modern clinic in your village.  As you know, the clinic has not been 
wholly successful.  What went wrong?

Ms. South:  For the first few weeks, people from my village did not 
go to the clinic, for they thought that people went there to die. The 
translators came to tell the people that it was better than our old 
ways and villagers eventually went, hoping to get better, but then 
funding for the project ceased and the doctors left the clinic.  
Nothing has changed, really.  We still have malnutrition, poor water 
and disease.

Dr. North:  The clinic is a state-of-the-art facility, and we sent 
a well-qualified staff to run it and train others.  Granted, many of 
the diseases are recurring and our follow-up procedures could have 
been better, but what more could we have done? Tell me, Ms. South, 
how can we better assist you?

Ms. South:  In the work of a non-governmental organization in my 
village, weUve seen that, above all, community participation builds 
health.  One must respect good and bad traditions, and reason with 
people.  In this way, people feel like they own the project, and 
eventually improvements occur.  Furthermore, one must listen to the 
needs of the people and promote development in a broad sense.  We 
often promote agriculture, breast feeding, and the equal status of 
women in the name of comprehensive community health and empowerment.

Dr. North:  Your approach sounds workable in a small area, but what 
about an entire country or world?

Ms. South:  This is the true challenge we face.  I am convinced, 
however, that the change must be instituted by the communities 
themselves in order  to be effective and permanent.

     Bearing in mind this kind of bottom-up approach, we explored 
many structural issues during the course of the week.  These 
included increasing the status of women and the availability of 
family planning services in order to increase the health status of 
a society.  Other needs discussed were improved sanitation, food 
supply, transportation,  rural health services, occupational safety 
and the reduction of pollution hazards.  In addition, we discussed 
the need for governmental 'political will' to make health a priority 
and the need for political stability.  Many hard-won health gains 
have been eliminated by political instability and war.

     However, we must not forget that, in reality, this sort of 
mutually respectful dialogue between  North and South rarely occurs. 
The largest barriers to improved health care are the same barriers 
which inhibit success in nearly all aspects of society and science. 
These barriers are not due to a lack of technology, research or 
ideas, nor even to a lack of resources.  Rather, they are due to 
the way in which we interact, as individuals, as communities, as 
organizations, and as nations.  Our critical examination of health 
care issues in developing countries led us to conclude that this was 
the point of failure in societyUs efforts.  Overcoming this is the 
challenge for a sustainable world today.

     The type of koinonia, or commonality of community, that has been 
identified as occurring in the 1992 Student Pugwash USA International 
Conference as a whole occurred in our working group as well.  We 
challenge you to Look, Listen, and Learn: Look for  underlying 
problems and long-term solutions, Listen actively and respect other 
people's points of view, and Learn to think in a new way.