The Rural Health Unit in the Philippines
MALCOLM J. FORD, M.D., M.P.H., and AMADEO H. CRUZ, M.D., C.P.H.
JN the couniitries of the Elast, ml-ore aiid m lore
iinterest is being(, focused oni rurial areas b-
cau11se of the rise in population, the importallce
of food piroducctioni, anid the progress of lancd
health services to rurlal inhabitants is of mlajor
sionificance aild, ill the Philippines, the gov-
erlment's lhealtlhp)iogramiilhas recently been
mniciplality ill the Repuiblic.
serv-ices to every
l'iublic lhealtlh in the 1Philippines appears to
have beeni fostered by the Franciscani friars.
In 1577, Friallr Cleiiienlte of the Order of Friars
luilova set uip a miiedical dispensary for the
in(ligenit of Manila in the l'osteria of the Fraln-
ciscan convent ini the Intramutiros, or old walle(d
city of AlsInila.
This eventually becamiie the
Sain Juian de Dios lHospital, whiclh operated at
its origyinal site for 368 years, up to the Second
AW'orld War. Followiing the creation of this in-
stitntiOll, otlher lhospitals were built in miianyv
otlher parts of the Plilippinies.
In 1690, dntring the Spanisl occuplation,the
Doml-inican Padre Juani de Pergero was instru-
menital in installinig a water system for the towin
of Sani Juan
Charles IV of Spaini senit his personal physi-
ciall, Dr. Francisco Javier de Balmnis, to MIexico,
Cenitral anid Soutlh Amiierica, aand the Plhilip-
piies, whlere lhe ariived in 1805 to introduce
At the time of this study, Dr. Ford was rural health
adviser to the United States Operations Mission
to the Philippines.
He is now chief, Special Health
Cruz serves as project director of the rural health
7, Public Health Service.
the Clentral Botard of VIaccinationI waC.S estab-
It wvas the earliest officical public lhealltl
organizationl in the Philippinies.
Spanislh Goverinment appoinited medicos titua-
1are.s,wh-lio were esseintially the provincial lhealth
officers of that day, anid, by the encd of the
Spaniislh regime, there was ani official of this type
in ev-erv province but oine.
lale,8 were Spanish.
A fumrther step in the developmienit ofp)ublic
lhealtlh was the creation- of the Superior lBoaird
of Healtlh anid Clhairity in 1888, and(l onie of the
last aclhievemnenits in lhealtlh uinder the Spaniislh
occulpationi was the taddition of a 2-year couirse
ill somle funidaiimenital medical and dential siub-
jects to the curriculllum, of the UIiiversity of
Sanito Tomiias inl 1898. Giraduates of this couirse,
chwjatnos in,inistrantes, served as male nurses
an-d sanitary inspectors.
miniisteredl to the sick in the absence of a plhysi-
Al'itlh tIme AmlleriCillOcctil)pationcanie a chanige
Plhilippine Comlimission in 1901 set uip a Bo.ard
of Health of the Philippine Islanids; aind( in the
saime year, Acts 307 tlhroug,lh 309 provided for
proviiicial anidml unllicipalboards oflhealth,witl
botlh Filipinio and ANmerican members.
Ill 1906, tlhe provincial boards of lhealtlh were
replaced by district lhealtlh officers witlh juris-
were usually coextensive witlh a province but
soin.etimles encomil)assed imiore tlhan one prv-
ince or parts of provinices.
in piblic healtlh took place in 1912 witlh the
"Fajardo Akct," wlhlich created saniitary divi-
sions, essentially geograplhic (livisions of munici -
palities within the provinces.
1 to 4 muinicipalities;
"presidenit," whlo hIad to be a duly qualifiedt
In 1876, the
AMost 7;1,nedwiPos tit-
In remuote areas, they-
eaclh was assigned
Vol. 72, No. 8, August 1957
plhysician, for supervision
Usually a sanitary inspector and occasionally
a nurse were also assigned to the sanitary
Dr. Jose Fabella, the
broughlt about the establislhment of puericul-
ture centers in 1925 for nmiaternial anid child
health car'e in local areas. They were supported
by voluintariy contributionis m-iatched by
tional funds received from the Nationial Sweep-
These puericulture centers wvere
staffed for the nmost. part by a niurse or midwife
and a woman attendanit, assisted by a l)art-time
pliysiciani. Trhe programli was largely confiined
to prenatal services concenitrCatiing oIn the de-
These ceniteirs still suffer from
inisuifficient loc-alsup,portand lack of year-round
tnder Dr. Fabella, mulnicipal miiaterniity ancd
clharity cliniics were also set up) in 1939.
operated in muniicipalities anid mutnicipal dis-
tr'icts of less tlhani 8,000 in population aind were
directe(l by eitlher a plhysician, llurse, or mid-
Salaries included a basic compensation
n(l danaccadditionial amiiouniit for (leliveries per-
sonally attenided, up to a s,pecified maximum.
Compenisation of personnel assignied to certain
lhardslhip aireas was dooubled if they were iion-
riesidents of these areas at the timie of appoinit-
In some instances, treatment of the inI-
dligenit sick in these cliniics duplicated the work
of the sanitary divisions.
the Philippine Department
Health reorganiized into butrieaus: the bureau of
lhospitals; the bureau of quaraintine; and the
bureau of health, for supervising prevenitive
health services throughout the counitry.
reorganization placed administration of city
lhealth departments at the bureau level and
p)lacedmuany specialty programs, suclh as tu-
berculosis control, liealtlh education, and nu-
trition in the division of laboratories.
municip)almaterniity anid clharity clinics were
now unider the bureau of lhospitals, and the
saniitary divisions, unider the bureau of lhealth.
At the mid-centuiry mark, many separate
local lhealth programs lhad accumulated.
president of the sanitary division was clharged
witlh duties in l)reventive medicine in addition
of health work.
first Secretary of
to medical care.
than 1 or 2 sanitary inspectors to assist him.
He was required by the act creating his office
to "provide hiimself with the necessary ap,pli-
ances and also the instrumnents for all einer-
gency cases, nmedical, surgical, and obstetricall."
He lhad an advisory relation only to the ptueri-
culture centers. There were about 400 sanitary
divisionis servinig about 1,200 muniicipalities.
The activities of all local lhealtlh Iuniits were
conifined almiiost entirely to the poblacimo
town' ceniter, leaving the outlyinig barrioiu
ruial areas relatively uniserved.
The specialty programs concenitrated oni iso-
lated plhases of the lhealtli problem, suclh as
A program-i of inmmuniza-
tioln, principally foIr sallpox, was carried out
by vacciniatingc parties, wlhiclh were mnade up
of nioniprofessionial workers whlo covered speci-
Their sclhedule called for a visit to
eaclh provinice onice in 5 years.
)eI'ViSill(r tllis gr'oupt) of activities in the pro-
vince was the district lhealtlh officer', whlose ac-
tual authlority apparently extenided onily to the
presideintsof the sanitary divisionis.
lhad general supervision of the lhealtlh of the
people of the province.
tary inspectors, nurses, anid clerks he had to
assist himii depenided on the size anid popula-
Frequently, he had no more
The number of sani-
Nurse at the El Salvador Rural Health Unit, Misa-
mis Occidental, gives prescribed medication to
Public Health Reports
The largest number of rural health unit personnel were trained at the Quezon City Rural Health
and Demonstration Center, a part of the rural health program
center's project director illustrates its scope and functions.
in the Philippines.
tion of the province.
gramizationis were inactive, his ownl local activi-
ties offered the sole mnedical services to the coni-
He apparenitly lhad no official con-
trol over the pueiriculture ceniters and essen-
tially nonie over the var'ious specialized pro-
In 1954, the bureaui of health lhad 402 physi-
cianls, 152 nlurses, 15 midwives, an(1 1,478 sani-
tary inspectors in the rural areas.
450 charity clinics operated by the bureau of
hospitals anid 500 active puericulture centers,
theIe were an additional 880 physicianis, 1,185
nurses, and 295 miidwives employed at least part
time in the rutral areas.
Ofteni, whlere other or-
Professional Health Workers
The duties of the sanitary inspector cover a
wi'der field of activity thain they do in the
Inited States. In the Philippinies, the sanitary
inspector is an all-rounid healtlh worker.
gives first aid and inmmnunizations, makes sanli-
tary surveys, diagnoses anld treats disease, and
fills out birth, death, anid morbidity certificates.
There is one stationed in more than 90 percent
of the country's municipalities. In many areas,
he is the first and only official health worker and
sometimes the only government, worker of any
school graduation, and, before 1954, traininlg
was by the apprentice method. He still favors
the khaki uniform with appropriate inisignia
and assumes the "parade rest" posture wlhen in
the presen-ce of lhealth officers, suggesting the
quasi-military background of hiis specialty.
Midwifery is fairly well advanced in the
Plhilippines, tlhough tlhere are many opportuni-
ties for improvement..
license from the Board of AMedical Examiners,
applicaiit must halve completed an
months' course in a school approved by the
c'overnmeiit and have actually performed
specified numbei of deliveries unider supervi-
In order to receive a
Vol. 72, No. 8, August 1957
Schlools of nursinig also leave somnethinig to
be desired but are generally very acceptable.
A bachelor's degree in public lhealtlh niursing
is offered by the UIniversity of the Plilippinies,
and nuirses were recenitly admiitted to the In-
stitute of 1Hygiene, the governiment uiniversity's
postgraduate school of public lhealth.
Plhysicians anid engineers receive good spe-
cialty trainiing in public, healtlh in the iinstitute,
wliclh grcanits the certificate of public healtl
adl, piovided a specified (rilade is mniainitained
anid a thesis appioved, the degree of imiaster of
ptublic health. Approximately 50 stutdenits are
graduated each year, abouit 40 of wlhom are
visiting teaclhers are l)rovidlel by Johns Hlop-
Rockefeller F'onii(lationi ani(l by the 1T. S. In-
terniiational CoopeiratioIn Administration.
is well triainied, an(l
According to ani official estim-cate, the popula-
tiOln of the Plhilippinies in 1956 was 22,265,330.
Of the three genier-al areas in the Republic,
LuJIzoni Islanid is the mnost (lensely populated.
-isa}'yani group of miianiy smiialler islainds, and
last is Mindanao Islanid.
daniao Islands, with the inost acreage of essen-
tially iuinhalibited land, are the m-iaini areas in-
v-olvled in the resettlemlienit (area program of the
'I'lhe Filipino is predoininately a rurial citizeni.
At lealst 70 l)ercent of the people live in rural
aireas aind engage in predomini ately agricultural
The .53 proviinces are subhdiI ided
inito nmunicil)alities, the basic governmlilenit unllits,
an(l the seat of muinicipal governimeint is in the
p)oblacion,situated whlere the population
denisest.Elected officials of the iuniiicipality
police, and jtustice of the peace.
the poblacson is also the site of ani anicienlt
clhurlch constructed durinig the Spaniislh regime.
Scattered tlhrouglhouit the remainider of the
muinicipality are more or less clearly definied
subdivisions kniowni as barriios.
erned by a teniente or commliulinity leader, who
is elected in some cases buit wlho usuially serves
witlhouit pay, anid a bairrio counicil.
ill population density
is the central or
Palawani anid Mmin-
a nmayor, couniicil
These are gov-
smilaller divisionl is the sitio, lhardly miiore than
a collection of lhouses.
tirates the poptulationi levels of the muniici-
palities accordinig to tlhe cenisuis of 1948:
IUnder 5,000 _-- _----
40,000 and over
Anotlher geographic division is the muniicipal
district, wlichl is administered entirely by ap-
poiinte(d officials anid lhas less auitonlomy,v tlhani a
A l)eculiarity of the couniitry is the large ex-
pauseof some of its 27 cities.
lhave large areas that are defiinitely riural.
is said to be larger in are-a tlhani ani
in the world, and aniother lhaspartswlichli,
recently, were un-explored.
The followiingc illus-
,'r of miunicipalitic.'9
Some of these
The cities have
Medical and Auxiliary Personnel
The (listribtitioin of miledical aind( auxiliary
1955, physicians in AManila anid otlher urbani
areas nutimbered 4,996 ouit of an estimatedPopn-
lation of 6 million, wlhile the estimated rural
populationof 15 millioni lhad onlv 3,331.
number of miedical school gcradtiates examinied
anniiually by tIme Board of MAledical Examiniers
more tlhain qutadrupled (249L to 1,050) between
1949 and 1954.
In 1954 theIe were 3,030 gcraduate nurses
active it the country, a ratio of 1: 5,400 of popui-
The ratio ranged fromii 1: 940 in Manila
to 1: 2(1,972 in onie of the pirovinices.
provinmceshad less tlhain 1 nurlise for eaclh 10,000
During the 3-year period 19.50-34 a
total of 2,533 nurses were licensed by the Na-
tional B3oarld of Nurse Examiinlers. There were
2,167 inactiv-e inurses in April 1954.
same mnonth, there were 1,173 registered imlid-
wives, 287 of wlhom were in Ainila.
Aks with most iiatioiis of AItllayaii ancestry,
pulnionary tuberculosis is an importanit prob-
lelll ill tlle Plhilipplines. Tbe tropicIal climal l-e
Public Health Reports
ICA nursing consultant and her counterpart, a Filipino rural health nurse, make a home visit to a
rural home in Tala, Rizal.
colltributte(l miuheli to tile role of ml-daria asaI
lea(lin'e, cauise of m11or1bidity Iand(l mortality, btit
fortuna-Itely tlis disease is rapidly- dis(appearning
as the restult of a stuccessful residual spray pro-
3Because of poor sanitation, the eniteirit-
ides anid schistosoini-asis colntiinuie to be preva-
ilpl)ortantenilemeiic ar-ea in the world for 8S(/hlb-
to(.wiut jaOl o10i(-m;
clildreni, yaws, dermlaltophytoses, scalbies, anid
"tropical ulcer" are coi:mmiioni.
of livinig have conitribuited to the reported high
illcidlence of nuiitiitionial deficiencies.
Campaigns aglainst hliglllv epi(lemric diseases,
Smlall outbr-eaks have occuirred, b it
110 simolificant ilncidence lhas beei rel)ortedl for
Tlhe last recorded case of sniall-
pox was in 1949, and ofclholera, in 1935.
Aplropos of this is the qutality of mortality
Also, the effect of
hal)its and relatively low standards
as Cholera an(d SmallI)ox, lave beeni suc-
amnd morbidity re)ortilg whliclh leaves muntichl to
Rlel)orts fromi rurllal arieals lha-ve beeni
in a hig( lipercentange of cacses, froimi niouniiedical
lersonllel or fronii plyN,sicianlis wh1o hlave never
seeni the calses.
Higlh inifalnit mort(ality, plresulablyrelated to
poor ol)stetrlical (clrle, 1)01oo sanitfation ai(l nim-
tritioll, is aiotherlul)pliclhealtlh problem.
1953 m-iore than onie-fourtlh (29.9 lelcenlt) of
tile (leatlis in tile Philippines occutrred l)elow
g(re 1, anidmllore tllall olle-lmalf (53.5p)ercellt)
Afost, deliver ies are l)elfor'mne(l
by the traditional lbirtll atteni(lanit
l)orts oftIle pelrcen1tacgeofdeliveries by hilot7s
p)roportionof (leliveries by liceilse(l miidwives
aiid iiiiises are albolut 10 pel)celit, andl b)y l)hysi-
Hospitals usually take catre
of only abnorimal (leliv-eries, mlost wollnell pie-
feiiiiing to be (leliv-ered lat lhomile.
or- bl0t, an
Estimlates of the
Vol. 72, No. 8, August 1957
Following the establishment of the first mis-
sion of the U. S. Mutual Security Agency to
the Philippines in 1951, the Departinent of
Health made numerous studies of the health
situation in cooper-ation with the Healtlh Di-
vision of the mission.
In 1952 the rural lhealtl
unit project was formed.
centrated on a demonstration of integrated
at the municipal level and
provided a team ofprofessional health work-
ers for the demonstration.
communities witlhout puericulture centers or
clharity clinics were clhosen as sites for the
sional lhealth workers, each consisting of a
plhysician, public healthl nurse, micdwife, and a
saniitary inspector, were employed by the De-
partnment of Healtlh
Plhilippine Council for IUnited States Aid, and
assigned to 81 nmunicipalities.
tual Security Agency contributed equipment
and supplies to the project.
a jeep, refrigerator, instrument sterilizer, mi-
crosope, examining tables, various medical in-
strumenits, aiid a supply of medicine calculated
to last a year.
These Iunlits were put inlto the
field in 19953.
In the subsequent year, addi-
tional uuits were set up in 5)2 sainitai'y district
By the end of fiscal year 1954-55, a total of
244 units lhad been built up to a basic staff of
4 anid given necessary equipment.
rently witlh the inception of tlhis project, a
training program was set up for the orienita-
tion of incomiing personnel.
were founded in four major cities of the Philip-
Also, the Rural Healtlh Demonstration
and Training Ceniter in Quezon City was util-
ized.The orientationi course, lasting about 6
weeks, consisted of a general review of public
health pro(grams, the organization of the de-
partmenit of lhealth, and various adminiistra-
tive procedures in the colduct of local lhealtl
The barrio medical kit was an early feature
of this rural health program.
to furnish prompt medical caie to the isolated
barrio during the interim when more compre-
hensive phases of the rural healtlh program
This project con-
In most instances,
funcds from the
The IT. S. AMu-
Eaclh Unlit received
Its purpose is
are being organized.
large plyw-ood case containing a supply of rela-
tively simple drugs and remedies whiclh could
be used with a mninimum of medical super-
Accompaniying it is a manual covering
basic sanitation, nutrition, health education,
first aid, and emergency treatment of common
conditions found in rural areas.
preferably placed in a newl hut or a house speci-
ally constructed of local materials, but some-
times the residence of a prominent citizen is
The kit is administered by a barrio health
committee of from 3 to 5 members, usually in-
clhiding a teacher and a sanitary inspector, if
one is stationeld in the area.
signed to the municipal healtlh officer. UJsually,
the provincial healtlh officer is also particularly
interested in the project anid assists in its or-
ganization and supervision.
Local health services have been assisted by
the UInited Nations Children's Fund, mainly
in the form of support of special programs,
including maternal and child hygienie, yaws
control, and BCG vaccination.
Essentially, the kit is a
The kit is
Supervision is as-
The Rural Health Act of 1954
In .July 19.54, the Coongress of the Plhilip-
pines passed the Rural Health Act, callingfor
the establishment of a rural healtlh utinit in every
miiutticipality and municipal
among them the appointment of municipal
health officers, the clhanging of the name of
the district lhealtlh officer to provincial lhealtlh
officer, the establishmlent of dental services in
eaclh congressional district, anid the general in-
crease in salaries of local lhealtlh personniel.
also appropriated for this program 4 million
pesos ($2 millioni, at the official rate) plus 1
million pesos annually for 4 years.
date for full application of the act is July 1958.
The act called for two categories of units, a
senior uinit of a plhysician, public healtlh nurse,
midwife, anid sanitary inspector; and a juniior
un-it witlh a combinatioin of a plhysician or a
nurse plus a midwife or a sanitary inspector.
Every muniicipality or combination of muni-
cipal districts witlh a population of more tlha
district of the
It also made several administra-
in the rural health program,
Public Health Reports
Status of rural health units relative to staffing projected under the Rural Health Act
at end of
Raised to Incomplete
1 To be raised to complete staff of four members before end of fiscal year.
.5,000 was to receive a senior unit.
more than 35,000 were given a junior unit in
An additional provision established a public
hlealth dentist in each congressional district,
those with more than 150,000 population re-
ceiving an additional dentist.
timated to provide 162 dentists for tlhe 102 con-
Dental positions already
in the public health programs were included
in this total figure.
This program has been
developing slowly, and funds for travel and
for equipment have been increased to accelerate
The Rural Health Act also set up the fol-
lowiing new scale of salaries for local health
This was es-
Municipal health officer______________
Public health dentist_________________
Public health nurse__________________
Provincial sanitary inspector_________
These salaries may be compared with the
wages of private corporation employees com-
piled in a survey made for the Wage and Posi-
tion Classification Office of the Philippine Gov-
ernment in 1954. These salaries apply to urban
1*3, 000-4, 200
2, 400-2, 380
1, 440-1, 560
T2, 092-5, 550
1, 266-1, 785)
Hospital attendant- _-__________-_1, 075-1, 238
To fulfill the project in an orderly manner,
a plan of operation was drawn up in 1954 in
which the rural health units gradually pro-
gress towards the complete staffing called for in
the act (see table).
As of July 1, 1956, the project was proceeding
well, even a little ahead of schedule.
lowing is an analysis of the staffing of rural
healtlh units on that day in 1,317 municipalities
and municipal districts, in reference to the
Number with all four categories filled_--------
Percent with all four categories filled_-------
Number with three or more categories filled____
Percent with three or more categories filled____
Number with health personnel of any category__ 1, 231
Percent with health personnel of any category__
Number of physicians on duty_---------------
Number of nurses on duty_-------------------
Number of midwives on duty_-----------------
Number of sanitary inspectors on duty_-------
Usefulness of Equipment
At the end of 1953, the 81 demonstration
units were polled on their use of the various
items of equipment. Among the items listed as
most useful were the jeep, the outboard motor,
the sphygmomanometer, stethoscope, micro-
scope, examining table and chairs, and refrig-
The following are the results of the
poll, in general, and some observations made
by unit personnel and consultants.
The most useful piece of equipment, accord-
ing to 66 of the 81 units, was the jeep.
any reasonable semblance of road existed, it
increased the effective range of health unit per-
sonnel in their assigned areas.
sections, automotive transportation, public or
private, was still scarce.
not only to transport unit personnel to the peo-
In most rural
The jeep was used
Vol. 72, No. 8, August 1957
ple butt 'also tocarry patientsto the lhospital.
It mobilize(d the unit.
few facilities for repair an(l miiainitenantllce
mllost irural areas.
Also, sinice atutomobiles were
relatively scarce in miost of these areas, even
amiiong gov-erninenit officials, the jeep was suib-
ject to unautlhorized uise.
tively few Filipinos lha(l been trainied to drive
or piroperly ma aintaiii automotive equiipineiut.
Solutions were beinig founiid to IIlost of thepLiob-
blenms, lhoweve-r, tlhrouiglh revisioni ofaniItquated
ruiles an(l regulationis, tralilnig of peIrsonnllel,
and the im-aximum- use of district enogineersta-
tioiis or vocational trainiiig schlools.
Particularly useful in the Plhilippinies for
servinig the more tlhani 600 inhlabited islands
lanids are settled onily along their coasts and
since few or no roads exist inlanid, transporta-
tion imiust be by water, either oin rivers or the
Frequently, one municipality
chlides severial small islanids to wthiclh no piiblic
transportation is available.
to propel the traditionial banca type of boat
wlichl couild be mnaneuvered close to slhoie annd
whliclh, wlhen equipped with outrigginig anid a
25 hp. motor,
stretches of open water.
of suipply ancd mninitenance applie(d lhere but
were niot so large.
The origin-al 81 demonistrationi uinits reported
thle sphygmomanometer and stethoscope to be
the seconcd most useful items. They were used
extensively by plhysiciani, nurse, and midwife
in maternial and child lhygiene work.
these mercury type sphygmomanometers that
were supplied apparently were ini good con(li-
tion after 3 years.
The original justification for the typewriter
was for typing of records, reports, anid corre-
spol(lenice. Correspondence wasmiinimal, how--
ever, and maniy records were
There was considerable doubt that the useful-
ness of this item for persons n-ot particularly
trainied in its use justified its relatively high
The use of the microscope was mainly coni-
finied to the exam-linationi of urinie (a small hand
centrifuge was also supplied) anid of feces for
Blood smears for malaria were
Tllele wer-e, lhowever,
In additioni, rela-
U-7sually, the smlall is-
MIotors were uised
Thle same problems
exam1ined occasionally anid blood couInts infre-
The genieral opiniioni was that
Microscol)e shouldl be issued onily to physicians
woll) could be expected to use
rYrowth onl the lenis 'and some rust or
corrosion weire tioted but less tlhani expecte(d in
the tropical climate.
Few- facilities existed in
the PhilippMies for repair a-uid ndaiiitenanice of
Foir eieigenecy anid minii'or surgery, the origi-
inal lnlits w-ere suipplied witlh 12 niosquito for-
Ceps,24 lhemlostats, 4 tissue forceps, 4 dressing
forceps, 2 sponige forceps, 2 nieedle holders, 6
Also inielucde(d were an etlher mask, an etlher
dropper, an(Id rtibblr gloves.
after 2 years of operationi v-ery few units lhad
use(l more thlian 1 oIr 2 of the instruments.
mayunl'Illits lmlost of the forceps were never re-
noved fiom the originial package.
iask anld diropper were not knoown to have been
uise(d inaniy uniiit, anid the rubber gloves in many
inistaiices lhad deteriiorated.
were (loingr little miore tlhanirepairof superficial
lacerationis or other very nminor surgery; the
nee(ls, except for obstetrical foiceps wlichl were
by miianyv units.
(lelntly preferred to tIranispor't seriously injured
or ill patients to the lhospital thani to operate
undler unfavor-able coniditions, especially if tlhey
didl not hlave special training or experience in
Also, the lhospital system
ill the Philippinies was fairly well developed,
tlhere beinig at least onie governilmenit hospital ini
The uise of the refrigerator in rural lhealth
iuniits lhas beeni miainly for storage of biologics,
alitfibiotics, aind( perislhable drugs.
an(l urinie specimenis, water samlples, or otlher
milater'ials for examiniation were store(l in r e-
systeml- of reegional laboratories lhad niot been
suifficienitly developed to lhanidle suchl work fromn
the (aver(agre lhealtlh unit.
7 cubic feet were placed iniiitits, bult they were
miuchl too large for the aN-erage 4- to 5-worker
Unlit in the presenit stage of developmient.
smaiill 11/2 cubic foot refrigerators are being
Problems of operation also plagued
It was found that
Rural health units
Rural physicians evi-
Refrigerators up to
Public Health Reports
the uise of tlis itemii.
no electiic currenit or lhad it only for varying,
periodsof 6 to 12 hours a day.
full capacity of the fr-eezing Unit were used to
freeze ice during the timne the unit was in opera-
fion,v the box would be cool (luiringt the iionoper-
Aniotlher apparently successful
Kerosenie was usually available in the rural
areas, anid, when properly operated, this type
seemiied to function well
tables anid chlairs wiere uindouibtedly in use, as
was otlher furniture supplied by the Philippine
Department of Health.
that these items could be constructed locally
from native materials, it was decided to foster
this approaclh to stimulate initerest in the health
uniit and its work. Such tables ancd chairs were
frequently doniated by individuials, with credit
plaiinly lettered oni the piece.
and bills of materials were supplied to local
The items will therefore prob-
a-bly not be supplied to the Philippine rural
health program by interncationial
agencies in the future.
alcolhol sterilizers were sup-
M.1any smiiall townis hIad
conistrltcte(I metal exa.miniing
After much evidence
plied, as well. asplansfor use on primils stoves.
The same (lifficiilty was found with the electric
witlh other electric applianices.
Sterilizing inistrumiiieints was possible at niight
wh-leni cIuirrlenit was available bult the uniit per-
sonniiel were not anixious to do the job then; they
prefeiredto findotlher metlhodsthat could be
used (luriig the day. The large alcohol steri-
lizer nieeded a large amouint of fuel to bring(, the
necess,ary tanoiont of water to a boil.
it was use(l onily to sterilize the larger inlstii'-
ments suc(li as obstetrical forceps.
alcolhol syrinlge anlI
nieedle sterilizer was iuseful
iii smlliler clinliCs.
T1le bac-kground anId salienit poinits in the
evolution andp)rogressof local health services
in the Republic of the Philippinies lhave been
presenited witlh the expectationi that the prob-
lemns in that country are parallel with those
in otlher countries in thle area.
will arise in the futute for exclhanige of infor-
milatioln Onl the applicationi of the Plhilippinie
One tling is certain: The rural peo-
plein thePhilippines want these services, anid
the demand(I is large aind steadily auguieiting.
Tenth World Health Assembly
Surtgeon Genieral I3urney lheaded the United States delegation at
the Tenitlh World Health Assembly in Genieva, Alay 7-24, 1957.
liglhts of the assembly weere adoption of thle 1958 budget of $13,500,000
recommenided by the executive boar d aii(
invitationi to lhold the elevenitlh
asseml-bly in the U,nited States.
J.S.S.R., Albania, Bulgaria, annd PolanIdrIesuiied active membership.
In adlditioll to calling for more voluntary conitributions to the spe-
cial malaria. eradicatioin funld, the assembly approved a continuing
in peaceful uses of atomic eniergy.
plhysicists anid plhysicianis in public healthl
alsl)ects of atomic energy, sclheduiliing
(lisl)osal of radioactive wi,astes.
Dr. Al-Wahbi of Iraq, presideint of the assembly, awvarded the
Founlidatioin Medal and Prize to D%. Paul F. Russell of the
PRockefeller Foundationi for outstandinig achievements in thle cointrol
The Leon Bernlard Foundation Pr'ize was awar'ded to
P'rofessor Kacpirzak of Poland for lhis wvork in social medicille.
un1aninous acceptance of the
an expert committee meeting
hlealtlh tiraininig in atomliic eniergy and stuidy of
Vol. 72, No. 8, August 1957
rolled up his pants legs to the hip, jumped out in the
falling snow and icy water, and began digging furi-
ously, singing gaily the whole time.
a half later with the help of a cable to another car
we wound ourselves up out of the sea of mud.
the meantime my efforts to help had amounted to my
stepping off into space of the black night for a
An hour and
These paragraphs, based on overseas reports from
public health personnel with missions and field
parties of the International Cooperation Adminis-
tration, give a glimpse into health work abroad.
Most of the original material appears in an adminis-
trative publication distributted by the Public Health
Division of the ICA.
Plaque for Sulimaniyah
The new health center of Sulimaniyah in Iraq
received a silver plaque in honor of its part in the
agriculture and industry exhibition held for the
first time in that place.
village were received at the center with complete ex-
planations of the uses of this facility.
has been isolated from external influences.
economy is rural, the faith Islamic (Sunni sect), the
language Kurdish (many dialects).
also speak some Turkish, Farsi, or Arabic.
who have been to school read, write, and speak
Arabic and Kurdish and frequently have some under-
standing of English.
-M. ELIZABETH DARDEN, public health nurse ad-
viser, formerly with United States Operations
Visitors from town and
Smallpox Detection the Hard Way
On the afternoon of December 13 we received a
report of smallpox in the village of Pishvah 45 miles
southeast of Teheran in the Varamin area of Iran.
Dr. Cyrus Arasteh and I readied an investigation
team and vehicle and departed that night, in a mix-
ture of snow and drizzle.
river where we charged with our 4-wheel drive
around a bus and a large truck that were stuck side
by side blocking the "road."
the hubs and slammed against a high bank.
hardy Iranian driver, Akbar, took off his shoes,
We came to a flooded
But we mired in over
A tiny Iranian gets immunized against smallpox in
Iran's national campaign against the disease by one
of the vaccinators trained by the International Co-
operation Administration for the program.
6-foot fall into a ravine where I ended up with
muddy water over my head.
to my knee and was litter bound for the rest of the
During our investigation three cases of
smallpox were found in a family that had recently
arrived from Tabriz.
Nine thousand persons in the
area were vaccinated, and it was reported that no
more smallpox occurred.
-FRANZ ROSA, M.D., public health physician, United
States Operations Mission, Iran.
I had some damage
In a village near Shiraz, Iran, the year-long efforts
of a sanitary aide with the Public Health Cooperative
Organization to build a sanitary program reaped an
unexpected benefit. One of the villagers, who owned
a small amount of property, became so impressed
with what he had learned about sanitation and hy-
giene that he endowed the rent from one of his shops
to the village council for sanitation in the village.
-ALBERT P. KNIGHT, M.D., chief, Health Division,
United States Operations Mission, Iran
Public Health Reports