130 / 210
130
higher administrative level of government. Other technical
services, such as laboratories, health education, and investiga-
tions, should be correlated with the needs of the rural sanitation
program” [24: 13].
The committee emphasized “the essential value of sanitation per-
sonnel who can enter into people’s homes”. Health aids should
be able to do so. Employing women at this level was judged to be
of “considerable value” as “many countries” had been successful in
using “trained women in both domestic and community sanita-
tion programs” [24: 16].
Given the global importance assigned to malaria at the time, it
is of note that the Committee, chaired by George Macdonald, a
leading figure in the global malaria eradication campaign, recom-
mended that “in every area in which vector control is a primary
need, suitable measures should be taken, but as an integral part
of the general programme of environmental sanitation. It is em-
phasized that this activity should not take such precedence in the
programme as to exclude action in the safe disposal of excreta
and in the provision of safe water-supplies” [24: 14].
Taken as a whole, this report is the closest in spirit and in content
to the Bandoeng report of all WHO papers produced around
that time.
Promising initiatives
President Truman’s Point IV program, initiated in 1949,
opened the door to America providing technical assistance
to underdeveloped areas. Stanley Andrews was asked to take
charge of this program, which he did until Eisenhower’s elec-
tion in November 1952. His oral history account of his term
as director provides ample evidence of how difficult it was to
overcome Congressional opposition (mostly on the part of the
Republicans) and bureaucratic opposition (mostly in the form
of different agencies within the Administration competing
with each other or simply reluctant to take technical assistance
seriously). Nevertheless, he tells of how Hyde “did a marve-
lous job “of mapping out a world health program” and where
Point IV fit into it (15, p120).What is clear from this testi-
mony is that there were elements in the Administration that
were favorable to the kinds of programs that Hyde approved
of, which included rural hygiene. It was one of these elements
that led to Grant being engaged in 1950 to develop “an emer-
gency program… of assistance to southeast Asia” [25].
Grant undertook a tour to explore possibilities for inter-agency
cooperation (America’s Economic Cooperation Administration
(ECA),WHO and UNICEF). Hopes were high as the ECA had
“secured the release of $63,000,000 of China Area ECA funds
for allocation to southeast Asia” for which 6 million were avail-
able for public health in the coming 15 months [26].
Grant proposed two “immediate measures” – every country be-
coming self-contained in the production of vaccines and sera for
the common immunisable diseases, and measures directed to-
wards the building up of the services required for nation-wide
prevention of uncontrolled major preventable diseases. Con-
cerning the latter point, he stressed two steps: the institution and
extension of environmental sanitation services,particularly rural,
and the institution and extension of the personal health services,
both of which were “now practically non-existent” [26].
He identified a number of elements to be covered by environ-
mental services: insect control through residual DDT spraying,
and provision of potable water supplies and adequate night soil
disposal in the
villages.Inas much as labor is amajor factor of cost
in undertaking these measures “it is important that the principle
of‘village self-help’ be instituted.This would entail the establish-
ment of village health committees who would be responsible for
procuring the non-technical labor when the insect control and
sanitation teams reach each village” [26].
Chisholm engaged Cora Du Bois, an American cultural anthro-
pologist, to explore “the possible value of anthropology in pub-
lic health” [27]. Grant paid careful attention to her work, using
each of his visits to Geneva to find out how she was progressing.
They seemed only to have met once when they both participated
in a meeting held in the UNICEF office in Bangkok in August
1950 to discuss the implications of a‘tentative budget’ by the US
ECA forThailand of an amount of nearly 3 million US$. A few
days later another meeting was organized specifically to discuss
with “Dr Cora Du Bois … some of the basic questions regarding
operational planning” that had arisen from the previous opera-
tional discussions” [2]8. Mr Keeney, UNICEF officer in charge
of the Bangkok office, indicated that there was no disagreement
as to the principle that Du Bois was advocating, but he pointed
out that UNICEF “was not a very powerful force in the situa-
tion because the‘big money’ does not come fromus”.He further
pointed out that “UNICEF has to wait till it is invited to join in
wider conferences, such as with ECA or else make arrangements
to be invited” [28].
Milton Roemer was hired in 1950 to visit two countries, Ceylon
and El Salvador, to spell out what shape a demonstration project
might take in each of those countries. Before taking up this as-
signment, Roemer was a member of the commissioned corps of
the US Public Health Service. He was also co-author of a book
on rural health and a student of rural health programs in differ-
ent nations. Perhaps in anticipation of his eventually working for
WHO, he had already indicated in 1947 thatWHO would “de-
vote much of its efforts to the advancement of rural public health
services throughout the world [29: 63-64].
Both reports prepared by Roemer concerning demonstration ar-
eas are substantial documents; that of El Salvador was 233 pages
long! Roemer identified the important objectives of such an area
in the following terms: 1. to demonstrate a unit of well-balanced
health services (including medical and dental care) within the
economic resources of a community; 2. to demonstrate the
modern methods and techniques in medical science as applied
to a community for the prevention of diseases and promotion
of health of the people; and 3. to demonstrate that health is the
determining factor in an organized effort in social and economic
development of an area. By organizing the simultaneous multiple
Políticas e redes internacionais de saúde pública no século XX