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A n a i s d o I HM T
Also:
•
A large body of adequately trained auxiliary personnel is im-
portant to ensure that the connecting link between the rural in-
habitant and the medical men may be as efficient as possible.
•
It is essential to the proper functioning of a health service
that the emoluments offered be fully adequate so that the right
type of man with proper training may be attracted and retained,
and enabled to devote his full time to the service.
The Commission dealing with rural reconstruction called for the
planning and execution of Government services to be coordi-
nated so as to be integrated, comprehensive and effective. Each
village or group of villages should have an organization of its own
– namely, a committee for conducting its affairs and promoting
its welfare in all directions.These committees in turn should be
advised by a committee of management consisting of Govern-
ment experts, representatives of villages and other non-officials.
The village committees may be entrusted with duties relating to
water supply; sanitation, house improvement and village-plan-
ning; construction and maintenance of village roads and water-
ways; social and recreational activities including playgrounds;
and education of adults, both men and women.
Also, in a much quoted conclusion, given its political implica-
tions, the Conference judged that “without land reform… ru-
ral reconstruction will not rest on a permanent basis; serious
consideration of this problem and the study of methods best
adapted to local conditions is urgently recommended to Gov-
ernments” [6:26].
While the Conference did not identify any country as having sat-
isfied these recommendations, even in part, several of the back-
ground papers as well as on-going programs illustrated certain
positive experiences.These included the training of‘native medi-
cal practitioners’ (NMPs), who have “undoubtedly played the
largest part in arousing the confidence of the native in western
methods of treating disease…” [7:9]. China’s rural health pro-
gram inTinghsien county led by CC Chen, which is considered
to be the precursor of the bare-foot doctor that gained global
prominence in the 1970s, in which lay workers, selected by vil-
lage leaders and drawn from the farming population, carried out
essential health promotion activities [8] and the program of Dr
John L Hydrick, an Rockefeller Foundation staff member sta-
tioned in nearby Bandoeng, which “aimed to communicate the
usefulness of hygiene measures to the population by simple and
practical demonstration, films and public lectures, home visits,
etc.” [9: 67].
Hydrick’s 60-page book, from which this last quote was taken,
is essentially a ‘do-it-yourself’ manual, largely dedicated to en-
vironmental sanitation: latrine building, boiling of water, mak-
ing houses safe, bringing clean water into the schools, protect-
ing food from flies, et al. Health education was a central theme
in Hydrick’s program. Educational methods and materials used
elsewhere were altered tomake them suitable for use under local
conditions. Campaigns were begun “on a small scale in order to
keep the cost of work and the cost of necessary changes within
reasonable limits”;work was extended “slowly and only as results
justified extension” [9:3].
The detailed activities of each of the field stations that Hydrick
established were carried out by hygiene mantris, midwives, and
other members of the subordinate personnel. Mantris were
health workers who initially were concerned with educating the
public about hookworm before moving on to other problems.
They were all males (at first), were literate, spoke well and in-
spired confidence.Midwives entered the program at a later date.
Hydrick arranged for their training to be conducted by experi-
enced midwives
The diseases that were most widespread where Hydrick worked
were “those that belong to the great group of intestinal diseases
or filth borne diseases. In the ordinary living habits of the people
of the rural areas, the pollution of surface soil and streams is far
more common than the use of latrines. Of all the diseases which
are spread by soil and water pollution, the worm diseases are not
only the easiest to explain and demonstrate, but are also the most
widespread over the East Indian Islands” [9: 4].Activities carried
out concerning the prevention of soil and water pollution “were
so organized that they could be used as a basis for building up
small health services” [9:24].
The Bandoeng Conference represented the last major initiative
on the part of the LNHO concerning rural health.
Post-war carryover
The threat of war dramatically reduced the activities of the
LNHO; it did not surviveWorldWar II. Country programs were
equally affected.None of the programs cited above (China, Indo-
nesia and Suva) survived the war.What remained was in the form
of written accounts and personal awareness.
Hydrick’s book was favorably reviewed in theAJPH:This book is
much more than a delightful report of outstanding public health
work; it is a philosophy of public health expressed in terms of
successful experience [10:885]. Dorolle, who becameWHO’s
Deputy Director General in 1950, translated it into French in
1938 and also arranged for its translation into Spanish in 1944.
In his extensive introductory commentary to the French version,
Dorolle expressed his admiration for Hydrick’s book in multiple
ways: its simplicity, the progressive manner in which Hydrick
carried out his work, his experimental and realistic spirit, his me-
ticulous care to detail, his concern for educating health workers,
to name just a few.There was much to be learned in Hydrick’s
school and much to be gained by following certain of his princi-
ples concluded Dorolle.
John B Grant, a Rockefeller Foundation staff member, who
helped shape the pre-WWII program in China, played an im-
portant role in promoting similar ideas after the war, as discussed
below. China’s experience, as well as that of Hydrick’s, was wit-
nessed firsthand by Harry Gear,“who was largely responsible for
the establishment of the health centre at Pholela [South Africa]
and selecting Sidney Kark as its Director” [11]. Gear played an