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important part in WHO’s early history, first as South Africa’s
representative inWHO’s Executive Board, and then as a senior
staff member.
New experiences
Grant visited Kark’s program in 1947, which had been initi-
ated several years earlier. He found it to be “one of the most
forward looking and comprehensive health plans of any coun-
try” [12: 181]. Its essential features included “care of the sick and
prevention of illness by the doctor and nurse, associated with a
programme of health education carried out by specially trained
‘health assistants’ acting under the direction of the doctor”.The
result was “a very closely integrated curative, preventive and pro-
motive health service in which there is an ever-increasing appre-
ciation of the community’s health needs and an understanding of
the various families served” [13: 101]. Each health center served
a defined area within which staff conducted home visits. Center
staff helped local people with simple environmental sanitation
and stimulated the establishment of school feeding schemers,
nursery schools, recreation clubs, gardening clubs and discussion
groups.
Another early post-WWII experience is that of Ethiopia. Ironi-
cally, it was due to Ethiopia having been attacked by Italy that led
to United Nations Relief and Rehabilitation Agency (UNRRA)
heavily supporting health work there. UNRRA first assisted in “a
rapid training course for sanitary inspectors, dressers, and health
visitors” [14: 577]. This was followed by a joint US/WHO pro-
gram consisting of three successive stages, the first covering very
simple training for nursing and sanitary aides, the second for
nurses and medical assistants, and the third, covering university
training.Attention was first on the airborne diseases, principally
malaria and dysentery, followed by waterborne diseases. Clinics
and health centers were set up “as fast as you could train Ethio-
pians to run them” [15: 66]. It very quickly developed into “one
of the finest health programs in the whole ofAfrica” [15: 65].
WHO’s chaotic beginning
It was Brock Chisholm, WHO’s first Director General, who
used the term “chaotic” when referring to the first years during
which the InterimCommission (IC) worked to develop the early
program ofWHO [16:11].While he did not specify his reasons
for describing it as such, a brief account of some of the discus-
sions that took place concerning the selection of priority sub-
jects is suggestive of chaos. Also, it must be taken into account
that Chisholm associated himself with those visionaries who
were proponents of social medicine and who believed that “any
improvement in the public health would require social and eco-
nomic measures as well as strictly medical ones” [1:3]. In other
words, he looked to the IC andWHO’s governing bodies to de-
velop programs that promoted similar ideas; that they weakly did
so, might also have led him to judge their work as chaotic.
Rural hygiene appeared in several contexts in the‘chaotic’ period
of the IC, sometimes on its own, other times in the guise of rural
health and/or tropical hygiene/health. In a draft list of activi-
ties thatWHO was currently engaged in, written in December
1947, i.e. just before the last session of the Interim Commission
that had been established in 1946 to guide the development of
WHO’s program, rural health was listed under the section ‘so-
cial medicine’ along with housing, town planning and sanitation,
tropical hygiene, industrial hygiene, sanitary engineering, hospi-
tals and clinics, nutrition,medical care, natural resources, school
hygiene, and recreation [17]!
When presenting this list to the 5
th
session of the IC, Chisholm
suggested that for the purpose of the 1
st
WHA,which was sched-
uled to take place in 1948, these items could be grouped under
five headings: (a) an action program that included specific activi-
ties; (b) study and analysis of a problem with a view of develop-
ing recommendations for future years’ activities; (c) central staff
assigned of a minimum of one medical officer, one research as-
sistant and one stenographer; (d) a central staff of a minimum
of one medical officer and one stenographer; and (e) no action
to be taken during the first year.The first category implied “the
provision of field services, an expert committee, demonstra-
tion teams, central staff and any other specific activities recom-
mended”, while the second category implied the provision of “an
expert committee and central staff ” [18:37].
Despite the fact that the budget had not yet been discussed,the IC
accepted Chisholm’s challenge to place the items under discus-
sion in one of these headings. Henry van Zile Hyde, who earlier
had been Chief, Health Division, UNRRA, and later Director of
the Point IV Health Program within the US State Department,
and was then Chief, Division of International Health, USPHS,
took the
lead.Heplacedmalaria,TB,MCH and venereal diseases
in category (a), while indicating that the specific activities would
include field missions, fellowships, and visiting lectureships and
tours.Hethen indicated that public health administration “should
be placed in category (a)”, given that “one of the main objects
of theWHO was to help to develop efficient national and local
health administrations in all countries” [18:38].To this he would
attach tropical hygiene, rural hygiene, industrial hygiene, sani-
tary engineering, hospitals and clinics andmedical care, as well as
public health nursing.
While the Commission went along with almost all of his sug-
gestions, public health administration was placed in category
(c), along with most of the other items with which Hyde had
grouped it, with no discussion!Tropical and rural hygiene were
placed in category (b), along with nutrition, since it was indi-
cated that joint committees with the FAO on both subjects had
already been agreed to.
The only solid priorities decided upon were those of malaria,
MCH,TB and venereal diseases, which had already been agreed
upon earlier. In the IC’s final report to theWHA, it was noted
that “the fundamental importance of rural hygiene in the health
of the populations of vast areas of the world is generally recog-
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