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WOILD HIALTH OIGANI%ATION REGIONAl. OFFICE FOR THI W£ST£RN PACIFIC:
ORGANISATION MOIIDIALI DE LA SAM1I BUREAU REGIONAl..
PACIFIQUE OCCI.,....TAL.
au
WHO/CST/18 27 January 1958 ORIGINAL: ENGLISH
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REPORT OF THE WORLD HEALTH O~NIZATION PUBLIC HEALTH CONFERENCE AND STUDY TOUR Japan and Taiwan, China 13-30 September, 1957
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TABIE OF C(}JTEN1S
1.
INTRODUCTION •••.•.•.•.•.•••••••••••••••••••••••••••••••.•••• DIARY
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RAPPORTEURS' REPCR1S
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3.1 3.2 4.
Report on Proceedings in Japan ••.•••.••....••.•••••.• Report an Procoedings in Taiwan, China ••••••••••••••• ...
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CCNSULTIINT'S REPCRT
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LIST OF PARTICIPANTS APPENDICES Appendix 1
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Technical Papers, WHO/CST/I-I? a. b. c. d. Health Planning by O. R. McCoy (WHO/CST/I) Health Planning (WHO/CST/2) Health Planning and Community Organization by R. Firth (WHO/CST!;) Methods for the Preparation of National Public Health Plans by G. Arbma (WHO/CST/4) Discussion Sub-headings and Selected Reference Material (WHO/CST/5) Community Developroont by J.B. Grant (WHO/CST/6) COllllTlU!lity Development Defined by L.M. Miniclier (WHO/CST/?) Cultural Factors in Rural • Community Development by I.T. Sanders (WHO/CST/?) Community Development Programs and Methods by C.C. Taylor (WHO/CST/?) Community Development and Related Services (WHO/CST/B) Social Progress through COlllllunity Development (WHO/CST/9)
e. f. g.
h. i.
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TABlE OF COO Tlill 'IS
j. k. 1. m. n. o. p. q. Appendix 2
Environmental Sanitation Projects :in Japan and Taiwan (WHO/CST/lO) Malaria Eradication, Taman (WHO/CST/ll) The Matemal and Child Health Project, Taiwan (WHO/CST/l2) Care of Premature Infants, Japan (\o4IO/05T/13) Rehabilitation of Crippled Children, Japan (WHO/CST/14) Trachoma, Taiwan (WHO/CST/15) Tuberculosis, Taiwan (WHO/05T/16/ Venereal-{)isease Control Project (WHO/CST/17 _
Specimen Questionnaire Forms Appendix J Copies of the Regional Diroctor1s Letter of Thanks tOI /
a. b. c. Appendix 4
the Government of Japan the Government of the Republic of China the Rockefeller Foundation
Material received from the Japane se Govemmen t as folla.rsl A Brief Report on Public Health Administration in Japan. Background Information on Health Situation in Japan. Composting of Organic Wastes, Kobe City. The National Institute of Health. Background Information Regarding Nurs:ing in Japan. Services for Crippled Children in Japan, JuJ;y" 1954. A Guide to Seishi-Ryogoen Hospital School and Hopo for Crippled Children.
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TABlE OF Crn'lEN'lS
The National Rehabilitation Center for the Physically Handicapped. The Treatment Results during the Last Three Years at the National Rehabilitation Center for the Physically Handicapped in Tokyo. Outline of Organization and Business in Division of Health and Welfare Statistics Ministry of Health and Welfare. The Forms of the Schedules for Vital Statistics and Public Health stur;y. The Central Nllternity Hospital of tre Japanese Red Cross •
. Appendix 5 Material received frClll the Government of the Republic of China as followsl Health Situation of Republic of China, Part I. General Infol'llBtion, National Ta:ilian Universi i<v College of Medicine. National Taiwan University Hospital,·Service, Education, Research, Public Health. History and Deve10pnent of tho Basic Nursing Program at National Taiwan University. lhstiw.te of Public Health, College of }Iedicine, National Taiwan University. Taiwan Sorum Vaccine Laboratory Annual Report for Laboratory Studies on Influenza-Epidemic in Ta:iwan Durin g April,,"*ay 19'J7. 1956 Annual Report of the Taiwan Instiruto of Environmental Sanitation. lh traduction to She-Tze EnvirOlllllental Sanitation Improvement Demonstration Area. National Defense Medical Center.
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1956.
TABIE OF CON'lEN'lS Tuberculosis Program in Taiwan. Work Report, Taiwan Tuberculosis Associa tion. School Health Program in Taiwan, China. Venereal-Diseases Control, Taiwan. Taiwan1s Standardized Venereal Disease Laboratory Service by the Reference Laboratory, Taiwan VD Control Center, Shih-Lin, Taiwan. Informatien en Hsi-chih cren. Brief Report on the Health Situation of Taoyuan County. Public Health Nursin£ Training Program. High Lights of Land Reform in Taiwan. £nti-Malaria Campaign in Taiwan, Republic of China. General Information on the Spraying Program in Kan-ting Township. Brief Report by Ping-Tung Prefectural Health Center. Ping-Tung Municipal Refuse composting Exvorimental Staticn (Published by the Taiwan Institute of Environmental Sanitation) • Pine-Tung Composting Experimental Station Progress Report No.1. utilizatien of Ore;anic Waste in Taiwan (D. F. Yung). Sampling and Anaqsis of Nightsoil and Study of Effect an its Detention in Taipei City. Water Suppq and Water I;(uality of Taiwan (D. F. Yung)
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Appendix 6 Information Circular
WHO/CST/IS page 1
I.
lNTRODUCTION
During its fourth session, the WHO Regional Committee for the Western pacific adopted the following resolutionl "The Regional CO!lllli ttee, "REALlZlliG the :importance of and benefits to be derived from group conferences and study tours in the countries included in the Western Pacific Region,
"REQUES'IS, the Regional Director to give consideration, where funds are available, to the provision of study tours in the countries of the Western pacific Region."l A project called "Conference and Study Tour" appeared in the "Proposed Programme and Budget Est:imates for the Financial Year, 1 January - 31 December 1957:- and too project justification was as followsl "The standard of public-health administration, on which the success of public-health work largely depends, differs widely in the different countriGS of the Region and this affects n eighbolU"ing territories as well as the countries themselves. It is proposed to organize a conference and group study tour for experienced pUblichealth administrators from comtries in the Region, preferably heads of administrations who will continue to serve their countries for a reascnable t:ime. '!he conference will enable the participants to exchange experience and outstanding public-health administrators will be brought in as consultants to speak on their specialties. The group study tour will cover a number of selected countries so that the participants can study one another's problems. It is believed thet a common viewpoint and the better understanding of the various aspects of the problems can be obtained." Consultations took place between the WHO Regional Office for the Wostern Pacific and Hoadquarters concerning the countries to be visited, thG topic(s) to be discculsag, consultant(s), etc. Mueh was learned frem the experience gained by . the Regional Of£ice for the Eastern Mediterranean which sponsored a publichealth administration seminar in Egypt and Sudan, 15 November - 3 December 1955 the t was highly successful. The wri tor was de signa tod as the "operational officer" in the Rogicnal Office to be responsible for the planning and preparaticns. He was advised by a committee of several other technical and
laesolution WP/RC4.R.14 ~cproduced in Off. Rec. Wld Hlth Org. 66
WllO/CST/18 page 2 administrative officers in the Regional Office. "Comprehensive Health Planning ll was flhosen as the ccnference topic arrl the Governments of Japan and the Republic of China gracious1y agreed to act as host countries. National preparatory canmittees were established and local funds made available. ilie Rockefeller Foundation kind1y sent Dr. John B. Grant to serve as consultant, generously agreeing to be responsible for the consultant's salary, fares and expenses. The writer, together with an interpreter-translator and a secretary, had the privilege and pleasure of accompanying and servicing the conference and stuqy ·tour group during the trip to Japan and Taiwan. Documents were assembled in the Regional Office, some being obtained from the United Nations and the United states International Co-operation Administration (IC19, others were special1y written. All were summarized am translated so that they were available in both English and French. Unfortunate1y, owing to circumstances beyond his control, the consultant was not able to visit Japan and Taiwan in advance to see what was to be sham to the group and to meet the group in Hongkong for some prel;iJninary briefing. The Public Health Conference and study Tour of Japan and Taman, which lasted fram 13-30 September, started immediately after the successful conclusion of tho lIEeting of the Regional Cormnittee in Hoogkoog. Invitations were extended for a senior health officer fran each of the Member states represented on the Regional Committee and their territories to participate. Twelve representatives fran eleven delegations to. the Regional Committee constituted the group. (he of them had t;iJne on1y to visit Japan, another participant joined the group in Tokyo and one joined in Taipei. Among the participants were, one director of natibnal health services, one deputy director-general, two assistant directors-general, one inspector-general of national health services, two chiefs of bure au of health at the national level, one provincial health commissiooer, one director of territorial health services, one assistant director of territorial health services. One of the participants was the Japanese Ministry of Health and Welfare liaison officer for WHO fellows studying in Japan. A large proportion of WHO fellows going to Japan are Chinese nationals. We believe that he has an even better .understanding of WHO fellows, their problems and needs after having visited Taiwan. The United states participant was the new1y appointe9 Chief' of Health and Sani tatioo of the lCA Mission in Taipe i. We believe that it profited h;iJn, rCA, Taiwan and WHO to SOe local ccnditions am health services as a membor and one of the rapporteurs of the group. The Regional Director met with the group before it left Hongkong. During this meeting, the group leader, co-leaders and rapporteurs were elected. These officers constituted an unofficial "ste·oring cCllllllittee'!. The host gCIITernnents provided full do ctmlentation which was distributed en the spot. They also provided the services of administrative assistants and typists and office equipnent and supplie s, and were respoosible for the preparations in their own countries. Immigration and customs fbrmal1ties were thus reduced to the absolute min;iJnum. One host govemmen't provide" transportation in tho citi~s visite<il, the other provided all transFl0rtation Within its territory. The or[anization was extreme1y efficient, the schedule was closely adhered to and t;iJning was perfect. The host governments were also very generous with hospitah ty and no effort was spared to make everyth~
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WHO/CST/18 page 3
convenient, canfortable and enjoyable for the participants am WHO staff. It is ;impossible to include and thank everyone but special mention of the following must be made I lh Japanl
Dr. T. Soda Dr. M. Hashimoto Mr. A. Saita Mr. K. Watanabe
ill Taiwana
Dr. Dr. Dr. Dr. Mr. Mr.
J. C. Y. S. C. T.
Heng Liu H. Mong T. Kuo Chiang C. Chen S. Koo
and of course :in addition, Drs. Yamaguchi, Seijo, Wu and Yen, participants from the host countries. The group visited over twenty-seven institutions, programmes am projects embracing research laboratories, medical schools, institutes of public health, nursing education projects, vital and health statistical services, environmental sanitation projects, hospitals, health centres and stations, maternal and child hcalth services, crippled children services and programmes for centrol of commmicable diseases, such as malaria, tuberculosis, leprosy, venereal diseases and trachana. (During the visit to the Tqkatsu Health Centre :in Tokyo and its tuberculosis survey and BCG vacc:ination work, the group was joined by Dr. pauline Stitt, Assistant Professor of lIaternal and Child Health, Harvard School of public Health mo happened to be in Tokyo while on a WHO fellowship. WHO is giv:ing fellowships to several teachers :in the United States of America schools of public health to acqua:int them with comitions in comtries from which they frequently receive WHO fellows). During seven conference sessiOns, the group considered the subje ct of "Comprehensive Health Planning" which included commmity developnent. Notes were taken and reports written by the rapporteurs. While preparing to receive the group, the workers in the institutions and on programmes and projects to be visited had an opportunity to re-evaluate their work. We believe that this was highly profitablCl as the presence of the group stimulated interest in health in official circles and among the general population. The participants had an opportuni4Y to see projects assisted Qr WHO , UNICEF an~/or bilateral agencies and were impressed to sec }]a how effectively Of • the international dollar was be:ing spent. They were able to exc nge news and experiencos with health workClrs :in tho ho~t com tries. The ~iscus sions were serious and at the high level, but the fWllospherc was very lIlfonnal and most friend~. The consultant had over thirty years first-hand knowledge of and experience • The host governments benefited from tre advice wh ich he laJ.wan. in Japan and m gave upon their request.
\vHO/CST/l8 page 4 Since the participants were senior health officials and before they started they already would have been away from their posts for almost a week attending the Regional Committee Neeting, the length of time planned for the Conference and Study Tour was fifteen working days. However, the consensus of opinion of the participant was that the allocated time, especially that for discussions, was not adequate. An evaluation questionnaire was specially prepared. Depending on the answers given, it was possible to grade the project as "very successful", "successful", "fair" and "failure". 64% of the answers indicated that the participants considered the pro ject "very successful", 33~ 11 successful", ~ "fair", and 37' "failure". Several participants suggested that such a project should be implemented every two or three years. In terms of lVHO money, this was an unexpensive proj ect. No special trip to the host countries was made during the planning period, all consultations being conducted bw correspondence. The participants already had their return air passages between their home countries and Hongkong paid by their governments, in order to attend the Regional Committee Heeting. WHO paid the required extra amounts to have their tickets re-routed to cover the stuqy tour itinerary. They travelled by tourist class and were paid standard WHO fellowship stipends. WHO sent only a public-health administrator, an interpreter-translator and a secretary to accompany the consuJ-tant and the group.
Concerning the documents forming the appendices to the report, those referred to as fonning Appendices 1, 4 and 5 were furnished the pt.rticipants and the consultant in Hongkong, Japan and Taiwan. If additional copies of documents WHO/CST!7, WHO/CST/8 and WHO/CST/9 forming "ppendix 1 are required, these may be obtained upon request from the United States International Co-operation Administration and the United Nations. Documents forming l,ppendix 4 will not be sent with copies of the report to the Japanese Government. Unfortunately, extra copies are not available for general distribution together with the report. Documents forming Appendix 5 will not be sent with copies of the report to the Chinese Government. Some documents in Appendix 5 are still being printed and will be distributed as soon as these are available. It is regretted that there is no French version of the documents forming Appendices 4 and 5, which were distributed on the spot tv the host governments. To translate them all would take several months and hold up, the early despatch of the report. The English version of this introduction and the rapporteurs' and consultant·s contributions were cleared with the participants and Hith the consultant. They were written by different individuals and it is hoped that variations in the presentation will nake the whole report more interesting. The French version will be a translation of the English test.
Chang-Yui SHU Regional Public-Health Administrator WHO-lYffiO 27 January .1.958
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page 5 2. D I A R Y
Japan
12 September 1957 (Thursday) 13 September 1957 (Friday)
11:00 p.m. - arrived in Tokyo by plane. Morning Courtesy call on Minister and Vice-l·linister of Health and Welfare by Dr. Bierdrager (group loader), Drs. Wu and Yamaguchi (co-leaders), Drs. Downes, Nguyen, Turbott and Yen (rapporteurs). Afternoon to Futago-Shinchi to observe TB mass survey and BCG vaccination work. *Visit to Takatsu Health Centre. Departed for Kobe by night express train. ;~Visit
14 3eptember 1957 (Saturday)
110rning Arrived in Kobe. Visit to City Hall - welcomed by the Mayor. Discussions on composting project. Visit to the composting plant. Luncheon given by the Mayor of Kobe. Afternoon
,. 15 September 1957 (Sunday)
Sight-seeing tour in Kobe, Mt. Rokko. Departed for Kyoto by bus. Morning Free. Afternoon Sight-seeing tour in Kyoto. Dinner given by the Mayor. Departed for Tokyo by night express train.
... * Professor P. Stitt, WHO fellow, was also present.
WHO/CST/IS page 6
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16 September 1957 (~!onday)
Morning Arrived in ·~:-.I;~yo.
ConferencJ Afternoon
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the Institute of Public Health.
Visit to the National Institute of Health, including WHO-designated centres. Visit to the Institute of Public Health, including the WHO-assisted nursing education project. Cocktails given by the Governor of Tokyo 11etropolis at "Chinzan-so".
17 September 1957 (Tuesday)
Morning Visit to the Crippled Children's Centre and dis cuss ions. Afternoon Visit to the National Rehabilitation Centre for Adult Handicapped and discussions. Conference at the Institute of Public Health. Cocktails given by the Minister of Health and Welfare at Happoen.
IS September 1957 (l-lednesday)
Morning Visit to the Health and Welfare Statistics Division and discussions. Afternoon Visit to the Premature Infant Centre of Japan Red Cross ~mternity Hospital and discussions. Individual visits by members of the group.
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19 September 1957 (Thursday)
Morning Conference at the Institute of Public Health. Luncheon given by the Japmese Public Health Association. Afternoon Free.
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·. 1!H0/CST/IS pr·Lc 7
20 September 1957 (Friday)
Morning Departed for Taipei by plane. Opening ceremony at Yang Ming Shan under the chairmanship of Dr. J. Heng Liu, Chairman of Host Country Preparatory Committee. Welcomed by the Vice-llinister of Interior. ~jessage of ,Ielcome from the Provincial Governor read by Dr. C. H. Yen. Conference. Afternoon Free. Dinner given by the Ninister of Interior at the Grand Hotel.
21 September 1957 (Saturday)
Morning Vis it to the National Taiwan University Medical College, including the nursing education project and the Institute of Public Health, and the Taita Hospital. Afternoon Visit to Shih-Lin Serum and Vaccine Laboratory. Visit to Shih-Lin environmental sanitation demonstration area.
22 September 1957 (Sunday) 23 September 1957 (Monday)
Sight-seeing at Tze-Nan Temple and Green Lake. Dinner given by Dr. Wu Ching at the National Atomic Medical Institute. Norning Visit to the National Defense Medical Centre. Afternoon Visit to the Provincial Taipei Tuberculosis Control Centre and the tuberculosis control project. Visit to Sungshan Tuberculosis Sanatorium. Cocktail party ~iven by captain R.A. Phillips, Command ing Officer, llANRU-2. Dinner given jointly by the National Taiwan University Medical College and the National Defense Hedical Centre at the Pao Lui Ting, City Hall.
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WHO/CST/18 page 8
24 September 1957 ( Tuesday)
Morning Visit to a primary school for school h8alth project Taipei. Courtesy call on His Excellency President Chiang Kai-shek. Visit to another primary school - trachoma control. Afternoon Visit to Hsi-chih venereal disease control demonstration area and VD control project.
25 September 1957 (fJednesday )
Morning Visit to the Taoyuan Health Centre, Public-Health Nurses' Training Centre and Land Reform Office. Afternoon Conference at the Yang Ming Shan Conference Room. Left Taipei in the evening by train for Kaohsiung.
26 September 1957 ( Thursd.ay )
Morning Arrived at Kaohsiung Visit to the Taiwan Anti-malaria Research Institute at Chao-chow. Also observation of ~lOrk of a spraying team. Luncheon given by the Anti-malaria Research Institute. Afternoon Visit to Chao-chow Tsen Health Station. Discussions at the Government Hall, Ping-tung. Visit to Ping-tung Health Station. Visit to Ping-tung composting project. Visit to Takau Medical College.
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27 September 1957 (Friday)
Horning Departed by bus for Tainan. Visit to the Tainan Tuberculosis Control Centre and the Tainan City Health Centre. Visit to the Tainan l1useum. Arrived in Chiayi - luncheon given by the Mayor. Departed for Taichung. Visit to the MCR Centre. Several health stations also seen on the 1'lay. Departed for Sun Hoon Lake.
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28 September 1957 (Saturday)
Morning Conference at the Evergreen Hotel, Sun Moon lake. Afternoon Sight-seeine on Sun Noon Lake • . Dinner given by the COIllll1is sioner of the Taiwan Provincial HGalth Administration.
29 September 1957 (Sunday)
Morning Departed from Sun Moon Lake. Visit to the National J-Iuseum at Pei-ko. Luncheon given by the Governor of Taiwan at the Chang Hwa Bank Hall, Taichung. Afternoon Left Taichung by train for Taipei.
30 September 1957 (Monday)
Morning Final conference at the Yang Ming Shan Conference Room. Courtesy call on Madame Chiang Kai-shek. A:!'ternoon Visit to the Children's Home on invitation by }!adame Chiang.
1 October 1957
( TUesday) 2 October 1957 (ivednesday)
Participants and staff left for Manila and points beyond. Participants departed for Tokyo. Participants departed for Hong Kong and points beyond.
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,. 1'HO/CST/18 paee 10 3. RAPPORTEURS I REPORTS
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Report on Proceedings in Japan, 13-19 September 1957 Friday morning, 13 September Courtesy Calls
Ch the morning of Friday, 13 September, a courte sy call was made to the Ministry of Health and Welfare by Dr. J. Bierdrager (group leader), Dr. C. Wu and Dr. M. Yamaguchi (co-leaders), and Dr. H. E. Downes, Dr. Ngu.ven Tang Nguyen, Dr. H. B. Turbett and Dr. C. H. Yen (rapporteurs). They were introduced by Mr. A. Saita, Chief Liaison Officer to the Minister of Health and Welfare, His Excellency Mr. K. Horiki, am the ViceMinister, Nr. S. Tanabe. The Minister, during tea, referred to the imprO'lement in nutri tion and stature of his people, associated with increased protein intake and mentioned the physicaJ. education of the young women in Japan. He stated that efforts were being made to complete the rehabili tat ion of hi s oountry an:! to cont inue the work against tuberculosis. Dr. Bierdrager, on behalf of the study group, thanked His Excellency for the efficient manner in" which the study tour had been arranged in Japan. Friday afternoon, 13 September Visit to Futago-6hinchi (to see TB mass examination) and Takatsu Health Centre Ch the afternoon of Friday, 13 September, the group proceeded by bus for the Kawasaki area, which is between Tokyo and Yokohama, and has a high incidence of tuberculosis. Here, at the villago of Futago-Shinchi, Dr. Kamiyama, Director, who is attached to the Takatsu Health Centre, demonstrated tuberculosis mass examination work. Examinations are made of preschool children under the age of six, and adults; school children being the responsibili ty of the Ministry of Education. Tuberculin tests, using 0.1 cc. of 2000 x old tuberculin intradermally, is used initially, at too rate of 500 per day. The results are read in 48 hours, and the positive cases with redness of over 10 rom. subjected to mass miniature radio-photography in a mobile van. Those with a negative reaction (redness 0-4 rom.) or of doubtful reaction (redness 5-9 mm.) are treated with BCG vaccination, using 0.05 mg. of dried BCG vaccine in 0.1 cc. :intradermally. It was ascertained that 8O,l: of children under six gave a positive reaction to the tuberculin test. Doubtful miniature film results in 10% of persons subjected to X-ray by full size film.
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WHO/CST/18 page 11 7he mobile unit had canpletod 33 000 eXBJllinations in 1956. Over the whole of Japan, it was ascertained that the 783 health centres averaged 20 ()(X) examinations per annum.
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After tho tuberculosis mass examinatien demonstratJ.on, the stuqy group was later taken to the Takatsu Health Centre, where Dr. Seijo, who is in charge of the health centre organization, Dr. Kamiyama, in charge of Takatsu, and Dr. Tsuda, in charge of tuberculosis centrol, described the health centre work in Japan and their efforts against tuberculosis and other communicable diseases. Subsequently, they were subjected to lively questJ.oning :In a poriod of detailed discussion, which was most informative. The administrative divisions of health in Japan were first explained. Public-health centrol is directed by the Ministr,y of Health and Welfare, school health by the Ministry of Educat:1.on, and :Industrial health by the Ministry of Labour. The country is divided :Into 46 prefectures, each of whi.ch has a prefectural health centre. There are 30 large cities Which are responsible for the mmicipal health services, Which control such activities as waste disposal, communicable diseases. The growth of the health centres was described, first ccmnencing in 1935, increasing to 717 by 1944 when tuberculosis arx;! maternal and child heal th were the on~ tasks. The number of centres has now increased to 783 with added responsibilities. The three types of health centres in Japan were described. The largest, Type A, of which ~here are 208, has four divisions, occupies 10 aoo sq. ft. and has a staff of 57. 'JYpc B health centre, of which there are 75, occupies 8100 has three divisiens, and a staff of 47. Type C health centre, nlIllbering 5(X) occupios 5400 has three divisions.
sq. ft.,
sq. ft. and also
~pes B and C have as their three divisions, first, sant tation which includes insect and rodent control, disinfection service, food inspection and control; second, prevention of diseases division which includes tuberculosis c~trol, laboratory services, mental health and dispensaries; and third, the divisien of health promotion, which includes health educatica, public-health nursing, nutriti~, birth control guidance and maternal and child health. Type A health centres have an additional div:1Bion providing for extension services in public health.
Dr. Komiyama described the work of the Takatsu centre. l\mOng other things, he mentioned that 80-9<$ of the children are :immuniZed agains'!; diphtheria, the typhoid group. whooping cough and smallpox; 75% of mothers attend pre~ata1 clinics, and 80,1; of infants are brou~t to the centres, a1 though the infantile mortal1 ty fi gure is 40.
WHO/CST/IS page 12 Regard:ing tubcrcuJ.osis, it is a notifiable di sease, and 18% of patients are :in a sanatorium. The ambuJ.ant therapy of trn remainder was described. The involved procedure for f:inancial support of the families of tuberculosis sufforers was described also. Among the highlights of the discussion period were questions concerning the relationship of the private practitioner to the health centre staff; the school health service which employs a private practitioner for each 1000 pupils on one day per manth; and general health insurance, which covers &::If, of the populatian. It was noted that old tubercuJ.in is used exclusively for tubercul:in tests, PPD not being used in any centre. Similarly, dried BCG is exclusively used in Japan. Nany questions confirmed the fact that 80% of the children in the group up to 6 years of ago was positive to the tuberculin test; and that this rate had existed on first test of children over the plst three to four years, since tuberculosis control was well organized in the area. Dr. Bierdrager thanked the Japanese health officials for the demonstration and discussion at the conclusion of the visit, and evaluation forms were completed and collected. Dr. H.E. Downes (Rapporteur) Saturday, 14 September Visit to Composting Plant, Kobe The study group arrived a1 Sm-mo;:Jiy" Station and, after a wash-up and breakfast at the International Hotel, were received by the Mayor, Hr. C. Haraguchi, :in the Cit,y Hall. Thereafter, a group discussion was held under trn chairmanship of Dr. Soda. Mr. T. Hara, Director of the Sanitary Bureau, Cit,y Hall, expla:ined that in Kobe Cit,y there had been two years of experimentation with canposting procedures, under the guidance of Mr. P. Bierstein of WHO. He was quite convinced they would achieve success :in the near future, and their experience would be of value to other countries in the Region. Mr. Y. Kaibuchi, Director of the Sewage Department, Kobe City, and acting supervisor of the composting project, gave details of difficuJ.ties that had arisen in operation. On a model he had alreaqy explained the method of operation. In his op:inion. the grinder was the key to satisfactory action.
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The group was now invited to ask questions. Did the heat achieved kill bacteria and viruses? It was explained that if too much heat was evolved the end material was not so valuable as manure. As many mesophilic organisms as possible should be reta:inod because it was desired to hOld as much nitrogen as possible. If these were all killed
WHO/CST/IS page 13 the thermophilic organisms left were not so good in achieving a valuable agricultural end-product. Temperatures as high as 700 C had been reached, although the general rise was around 600 c by the end of the first or in the second day, slowl;y falling through the third and fourth days. The 600 C would be retained for at least two hours, enough to render the material safe from bacterial pathogens and ova, but not sufficient to deal with viruses such as poliomyelitis. One good point is that this temperature is achieved all the year round. 'Had the end result been tested for bacterial content? This had not been done yet, because the plAnt was still exper£iiental. When the proto typo was finall;y satisfactory, tho bacterial checks would be undertaken seriousl;y. At the moment it was known there were b. coli in the final material but it was thought that these would prove to be of the acrogenes soil types when these were typed later on. How did the selling rice co are wi til artificial manures? The end result was sold for the equivalent of US 2. 2 per ten. They were not using nightsoil at the moment and the product was low in nitrogen compared with artificial manure. However, this should be offset by the fact that the organic material was valuable to farmers, replacing organic loss, acting as a soil conditioner improving the water-holding capacity, increaSing plant resistance to disease and replacing sane trace minerals such as boron. '!be test should not be a chemical anal;ysis one, but the real one of an increased crop yield. Of course, the farmer had still to be convinced it was bettor than nightsoil. It was expected Was this camposting procedure profitable to Kobe City? to break even. The real evaluation should be that such attempts to utili ze an:! conserve natural resources should cost a city no more than other methods of refuse disposal. When nightsoil was added how much did this co e with ni htsoil disposal? No" muc. The pan" cannot hand e t n tso in more than one persen to eight persons' refuse ratio. It was hoped eventually to have a one to one ratio, but some means of handling the liquid in n:i€htsoil had to be evolved. More than a one to eight ratio made the material too wet to convert satisfactorily. Will one plant handle a city1s wastes? The optimum size of plant is still to be detemined. For a large city many factors, such as transport costa, well necessitate several locations. The study group asked questions about operating methods but, althrugh these wero answered, they were solved bost b,y visiting the prototype plant, which the group now did. The raw refuse is fed into a conveyor belt. As it passes along, workers sort out non-compostablc material for salvage or incineration. About a third of the total is removed in this way. The remainder enters the grinder which expedites decanposi tion by broaking up the material finely 11n:! so exposing more surface to aeration. Forced aeration helps supply oxygen for fermentation. The ground-up material goes next to storage bins, where nightsoll is added i f desired. (Not being done a.t the moment). Next it arrives at a
WHO/CST/18 page 14 pr:imary digestor with three horizontal. decks, each divided into two cCJllpartments. k['itators on a krchimedes principle agitate and push the material through these chambers, taking two days for the process. Air is forced through these chambers continuously, and it is here that the 60 0 c or more is roached. From the primary digestor the material goes to curing bins, where forced air allows further oxidation and also controls the moisture of the final product. The cur:ing or secondary digestor stage lasts two days - a total of four days before the product is ready for sale. The study group had a valuable morning. The afternoon was spent in sightseeing and travelling by bus from Kobe to Kyoto. Dr. H.B. Turbott (Rapporteur)
Monday morning, 16 September Public-Heal th Ccnference at the Institute of Public Health Dr. Bierdrager introduced Dr. J. B. Grant to the group. Dr. Grant elaborated the followingl A. Concerning the items to be covered by this study tour, he outlined the scope of the discussions and studies as followsl 1. 2. 3. Organization and development of public-health services. Staffing and facilities for health services. Meaning of community development to health services.
B. Concerning the points of interest as contained in the "Brief Report on Public Health Administration in Japan, 1957", tho following questions were raisedl 1. What is the meaning of planning section? Dr. Yamaguchi replied that at one tilOO it dealt with mental hygiene. NowJ it is the General Affairs Section which co-ordinates the work of various sections within the Bureau. It also handles the family planning and prefecture laboratories. The real overall planning within the M:inistry is by the Office of Prograllllle Evaluation of the Minister's Secretariat. There is an annual report made by this office. 2. What is the flow between the central and local health services? Dr. Yamaguchi explained that the relationships of these can be surrrnariZed as follows I
WHO/CST/18 page 15
No. of units
'-
National Gov·'mment Ministry of Health and
Wffar Prefectures Government
1
46
Health Districts
1
!
City
/li"~i~' (Population varies from 2000 to 20 000 in villages, towns and cities)
3800
Community organization (average population, 500)
3. Are medical and hoalth services canbined? Dr. Yamaguchi said that the health centres are doing chiefly preventive sorvices, except in cases of tuberculosi s and venereal disease where medi cal care is also given. Hospital care comes under a separate bureau called the Medical Affairs Bureau. 4. How many welfare centres are there? Dr. Yamaguchi replied that there are about l021'welfare centres throughout the country. About 300 of these are in cities and the rest are in the level of prefectures. Thare is a close co-operaticn between the health centre and the welfare centre, the latter being the one assisting the indigent group. The areas cOlTered by heal til centres and welfare centres may or may not correspond. Dr. Downes pointed out: page 5, the areas of the building of health cen tres in sq. ft. should be multiplied by 6. 1. ()1
2. As there are 783 health centres, it is presumed that a prefecture may have many health centres.
3. Is the prefectural government responsible for asking the National Government to assist in case a hospital is to be set up?
WHOjCSTj18 page 16
Dr. Yamaguchi answered Dr. Downes I questions as follows I 1. 2. To multiply the areas in sq. ft. blf 6 is correct. Yes, and tlEy are directly under the .prefectural gOlTe rome nt.
3. Depending on whether it is a national or prefectural hospital. If it is the latter, then the responsibility rests in the prefectural
government. Dr. Bierdrager asked what cruncils assist in the admission of indigent patients to these hospitals. Dr. Yamaguchi replied that the committees on admission of patients are governed blf the "Daily Life Security Lawll and tIE "Tuberculosis Control
Law" • Dr. Nolasco enquired i f there is any prov~s~on for those who cannot pay, and was informed that these are covered in the provisims of tIE Daily Life Security Law. Dr. Yun wanted to know how the voluntary organizations are co-ordinated, and Dr. Yamaguchi answered that that is a problem Which is being tackled at present and efforts are being made to :integrate the work of these organizations.
Mr. Saita elaborated that there are many public assi stance laws, so there are separate committees which screen groups of people who are seeking medical assistance. Those not covered blf these specific laws m~ receive aid from the public assistance programne. The cost of tuberculosis assistance is so high that the Government is considering the establishment of a new law for tuberculosis assistance separately. Dr. Yen asked whether the indigent groups that do not belong to the various social insurance systems are given assi stance under the public social assistance programme.
Mr. Saita stated that this was practically done, but there is room far improvement. Dr. Downes enquired if tIE tuberculosis, venereal-disease and mental hospitals are be:ing run blf the national or the local government, and was informed that these hospitals, except those for venereal disease which are run blf the prefoctural government, are under various levels of government. The question was asked as to the functions of tho Life Improvement Section and it was explained that this section takes care of the problems of social and welfare rather than those of health. Dr. Teng asked i f this section deals with. hous:ing matters and was given a negative answer.
WHO/CST/IS page 17 A query was raised as to the functions of the Institute of Population. It was stated that it takes care of family planning programnes. A written report on this will be supplied later. The chief causes of death in Japan (1956) were given in the followmg ordera 1. 2. 3. 4. vascular lesion affecting tho central nervcus system; malignant neoplasm; senility; heart disease.
The Government has established heart disease and cancer consultation centres but it was hoped that these will be carried out at local health unit level. Dr. Turbott asked how tho problem in relation to tIE care of tile aged, including that of job placement, was being met.
The old custom of each family taking care of the old is breaking down and a study is being made of the establishment of a pension law. There are institutions for the aged rut these are not sufficient".
Mr. Saita said that it is an increasing problem.
a:
- Dr. Downes stated that in his country an allowance of 3000-3500 yen weel is provided for wanon over 60 years old and men over 65 years. This takes up about 1.0% of the national budget. "
Dr. Bierdrager" indicated that what is done in Australia is also being followed in Netherlands. The functions of the Institute of Nutrition were outlined as followsl 1.
2. 3. 4.
Conduct national surveys, with reference to specific diseases; Train personnel; Educate the public; Advise the Ministry of Agriculture and Food.
Dr. Wu asked i f a survey on school children has been conducted. Dr. YamagUchi said that palOe Z7 of the "Brief Report on Public Health Administration (Japan, 1957)" illustrates the work done. The recent survey has shown an increase in the stature of school boys which is perhaps due to the school lunch programme. Dr. Yun enquired whether or not there is any regulation covermg the polishing of rice to save vitamin B. A negative reply was given, but it was explained that action was being encouraged. Dr. C.H. Yen (Rapporteur)
."
WHO/CST/18 page 18 Monday afternoon, 16 September Visit to the National Institute of Health Dr. S. Kojima, Director of the National Institute of Health, gave a report on the organization and functions of the Institute and the brief report is given in the mimeographed sheet presented. Dr. Nakamura said he welcollEd the visit of the WHO study group and would like to have questions discussed freels". Dr. Kitaoka explained the poliomyelitis centre which was designated qy WHO, and is also a leptrospiral centre. He said that from a recent specimen from Taipei the poliomyelitis virus was found to be ~pe I and the sera of the individuals were also found to be anti-Type I virus. Dr. Grant asked about the Atomic Bomb Casualty Commission and Dr. Kojima replied that the after-effects of the atomic radiation in the Hiroshima casualties were being surveyed in co-operation wi th the American Atomic Commission. Dr. Yen raised the question of how O.T. and dried BGG vaccme are used in Japan and why P.P.D. ani liquid BGG are not used instead. The answer was that O.T. deteriorates less quickls" than P.P.D. when diluted. Dried BCG vaccine potency also lasts longer (as long as 7 years). Dr. Yen said that in the dried vaccine it was difficult to obtain a uniform emulsion when fluid is added before :inoculaticn. From experi alce he has found that there are more severe local reactions than with the liquid BCG. P.P.D. would be kept in dried form and diluted before use. Regarding the subject of radiation, Dr. Turbott enquired about till study being made on protection against radiation and was informed that the stuqy was being undertaken to determine the wpe of building and mode of living which can be considered protective. Dr. Yen asked what type of influenza has been found during -the last epidemic and what are the future plans regarding vaccination, if arv. It was stated that it was sub-type A. Dr. Yen then asked what was the predom;!nating bacteriophagic type of Eberthelda typhosus in Japan and was advised that fuis information would be supplied later.
,-
Dr. Sany queried the effect of radiaticn in the fonnaticn of the fetus and on other diseases. It was explained that fuere was no conclusive eVIDence to show definite hereditary effects. Dr.. Wu stressed fuc importance of setting up an international standard for protection against radiation.
·<
WHOjCSTj18 page 19
..
Dr. Yun asked about the elql6riences w the use of Japanese Type B encephali tis vaccine. The repl;y- was that an animal test was carried out for potency test. Some 500 000 children were vaccinatell in Tokyo. The incidence was on:i;Y 1/4, compared Wi th the unvaccinated ones. It was also found that brain vaccine is better than chicken embryo vaccine • Dr. Turbott enquired about the standard for the biological prepara-
'
tion. It was explained that the standardizatiw of antigenicity, potency, safety, chemical, physiological and physical properties was carried out based w the recQlUllendations of the NllI (USA), the Serum Institute :In Copenhagen and WHO expert committee's reports. The total nlnber of :Institute staff is 4ll. of which 256 are technical officers and 103 technical assistants. There are 40 scientists and 16 tecmicians in the Inst,itute. annual blXiget is 232 million yen. The
r
Dr. C.H. Yen (Rapporteur) Monday afternoon, 16 September Conference at the Institute of Public Health Dr. Saito, Director of the Institute of Public Health, explained that the Insti tute is under the Ministry of Health and We liara • The functions and activities were outlined and a booklet in this connectiw was furnished to the group. Dr. Sany asked what language was required for foreign students ani whether or not there was any limitation made on the ntl1lber of these stUdents. The Japanese language, it was explained, was used onq and the number of foreign students was indefinite. There is no undergraduate training and the total number of students in the Institute is about 200 in all years. The budget is ¥92 million. Occasional regional conferences are held to enable the field nursing leaders and the Insti tuts nursing leader to sort CAl t possible differences and to provide in-service techniques, etc.
Dr. C.H. Yen ,Tuesd~
(Rapporteur) morning, 17 September
Visit to the Crippled Children's Centre Dr. Koike, Deputy Director, gave a brief account of the historical developnent and organization of the Centre (see documents "A Guide to SelsniRyogoen Hospital SchOol and Home for Crippled Children" and "What Japan is doing
WHO/CST/18 page 20
for Crippled Children"). He then explained the distri 1::ution of the varioUs services and wards as mentioned in these documents. Dr. Shu stated that WHO had provided fellowships and sent consultants to the Centre and one of the conSultants will return next month. Furthermore, UNICEF will grant equipnent and supplies in the amount of US $200 000 for 22 prefectural centres throughout Japan. Centre. Dr. Yen asked wl1at was the average duration of hospi tallzation in the lhis duration varied from one to 1-1/2 years.
A question was raised regard:ing the discharge of cured children and it was pointed out that sometimes difficulties arose because of the extreme poverty of families. The cost of hospitalization vari ad fran ¥20 000 to VO 000 per month per person. Dr. Yun enquired where the funds for the Centre came from and was informed that these came partJ;y from the families of patients, fran the Japanese Socie'tiY for Crippled Children, and partJ;y from the State which covered the losses of the Centre.
Dr. Nguyen asked how much the annual deficit amounted to. In his repJ;y the Deputy Director stated that tltLs amounted to 5 million yen, as compared to 50 million yen annual expenses. Dr. Yen enquired as to how fue patients were transported from their homes to the Centre and it was pointed out fuat the prefecture gathered fu(J1l and sent them to the Cmtre often by train. r
Dr. Sany raised the point concerning the schedule of work of the nurses and it was mentioned that the nurses worked in three 8-hour shifts. Dr. Teng wanted to know something about the specialist in orthopaedic appliances. The Deputy Director stated that the Centre had a specialist who came <nd visited tlJa Centre once a year. ~.s soon as the· workshop was opEl1ed, a specialist would be perm<nentJ;y assigned to the Centre. Dr. Shu asked for some information regard:ing the nursing staff, fue physi ethc rapist <nd occupational therapist. It was explained that the Centre employed masseurs who had been trained and other physiotherapists were being utilized but there were no specialized schools as yet in Japan. Replying to Dr. Turbott's query concerning speech therapy, the Depu'tiY Director said that at prescnt Dr. TaguclIi was working in the Centre and a specialist, who was not a medical officer, had gone to tte United States. Dr. Shu wished to know whether there was any co-ordination between the Crippled Children's Centre and the National Rehabilitation Centre for Adult Han:licapped. The Deputy Director stated that the Crippled Children's Centre had mainJ;y curative duties, whereas the main aim of the National Rehabilitation Centre for Adult Handicapped was rehabili tation. There were
WO/CST/18 page 21 other bodies dealing with these cases, such as the Hospital for Injured Peoplfl, the Hospital for Occupational Accidcnts, etc. Dr. Turbott asked whether thero was any occupational health progral1J!lG. Dr. Yamaguchi replied that the M:inistry of Labour was deal:ing with this problEJn and that the M:inistry of Health co-operated with the former in this respect. Dr. Bierdrager enquired about plans for the build:ing of Similar centres and Dr. Yamaguchi stated that the Government's participation in too oonstructim of prefectural cm-tres was 50%. At present there were 22 such centres and there were still 24 outstanding. The Centre was sufficient to meet the needs of the CiW of Tokyo. Dr. Nolasco wanted to know how much was the average cost of prosthetic braces and was told that this ~ounted to ¥OlO 000. Dr. Sany asked what was the percentage of cerebral relsy ~mg the abnormal children in Japan. The Dej:Uty Director said that this was 1% for a total of 400 000· crippled children. Dr. Wu enquired if the cases of rone and joint tuberculosis wi th pulmonary tuberculosis, were also accepted at the Centre. It was stated that the Centre accepted only mixed cases when the pulmonary tuberculosis was very mild.
Dr. Downes wished to be informed where thol cases of cerebral palsy were being treated. It was expla:ined that the Centre received only curable cases and other centres dealt specifically with children suffer:ing from cerebral palsy. Dr. Turbott asked what was the average duration of stay of children suffering from cerebral palsy and was told that the duration varied between two and three years. Dr. Turbott then stressed the difficulW of selecting the cases to be treated. In New Zealand the method aoopted was that treaimmt was conducted at tho homes where the mothers took better care of their children than was the case at the hospital. A nurse visited the families periodically. At present 3o,t of all these cases were treated in this manner. Dr. D<Mnes asked whether studies had been made m the poss1blfl influence of bovine tuberculosis on the high tuberculosis rate. In his reply, Dr. Soda said that at present they did not have any problem, since all milk consumed was be:ing boiled. Dr. Sany raised the question concerning the mmgoloid cases. Deputy Director stated that they were not treated in the Centre. hip.
The
A query was raised concerning the diagnosis of congenital di slocated The reply was that the diagnosis was made clinically and wi th X-rays.
The diffe:rent sections of the Centre were then visited. The Secticn of Occupational Treatment had :installaticns and toys in order to give movement to certain specific groups of muscles - fingers, hands, legs, neck, etc.
WHO/CST/18 page 22 Some of these installations and toys were specially made in Japan on the request of the Centre. The rehabilitation treatment of poliomyelitis was started in the Orthopaedic Section two weeks after the acute period. Other sections Visited were those of speech therapy, physiotherapy, pre-occupational training where work on metal, printing, designing, sewing was seen, and teaching was performed in small wards in groups for the patients. During the discussions that followed, Dr. Nguyen asked whether there was ar:w protection device for the circular saw. In his rep~ Dr. Yamaguchi. said that this installation was set up in April 1957 and that close attmticn was paid parti rularly to clumsy children so that they would not come near thi s machine. Dr. Sany also raised the que stion concerning hydrotherapy am was infonned that there was an outdoor swimming pool, in addition to hot bafus.
..
Dr. Nguyen Tang Nguyen ( Rapporteu r) Tuesday afternoon, 17 September Visit to the National Rehabilitation Centre for Adult Handicapped Documents distributedl (1) "The National Rehabilitation Centre for the physical~ handicapped" (2) "The treatment at the National Rehabilitation Centre" In bis introduction, Dr. Takase said the Centre receives patients above 18 years of age who are being sent by the local social centres, where the patients have been previously screened. The Centre provides medical care, physical rehabilitation and vocational training. The treatment is given on individual basis. Each patient undergoes prel:iminary tests, both physical and psychological am, with the patimt I s agreement, the treatment is determined and special operations performed according to the possible future profession of the handicapped. At present, there are 20 patients for special operaticns and 8 various vocational courses are being given.
•
During treatment, the patient also attends lectures to facilitate their social adaptability and are counselled by the psychologist of tho centre. . One of the main problem; is to find jobs for handicapped who have been trained. Dr. H~eda, surgeon of the Centre explained that the Centre receives serious cases only, others are being treated in the 38 regicnal centres. At present, there are 30 orthopaedic cases in the Centre. Physical therapy is being used, but at present there are no trained therapists. Tbare are 2 trained physcial instructors, 2 massour-assistant phYsical therapists, 2 therapists
,
·>
WHO/CST/18 page 23 for vocational rehabilitation, one prosthetics service which is not ful4' up-todate. A centre has been training 46 specialists in the manufacturing of orthopaedic appliances. Dr. Yen suggested a visit to the Centre prior to the discussion. proposal was adopted. Visitl 1) The
Wards for operated patients. Rooms for physical tests) vocational training, wood-block; wood-work; sewing, knitting and embroiderys'writing, typewriting; repair of shoes, electro-radio & T.V., prostretics workshop.
2)
Discussionl Dr. Grantl Question concerning the placement of physically handicapped. He mentioned the law in England according to which a certain percentage of the jobs has to be reserved for handicapped. No such law exists at present in Japan. However, appeals are made to the employers, making use of all means of propaganda. The local placement bureaux try to overcome the difficulties. What is the annual budget? 40 million yen.
Replyl
Dr. Grant I Replyl Dr. Nguyenl Reply:
How many handicapped leave the Centre each year?
,.
Dr. Turbott:
What is the average duration of rehabilitation?
• 15 months. Is there alW system provided - as in Switzerland according to which the rehabilitated work for a period of time in industry without pay in order to enable a gradual integration? This system is only used for a limited number of cases. What are the criteria used for too selection of patients? Document giving fUll data will be circulated. Dr. Nguyen. Tang Nguyen (Rapporteur)
Dr. SanYI
Reply: Dr. Yenl
WHO/CST/18 page 24
Tuesday afternoon, 17 September Conference at the msti tute of Public Health Chairman I Dr. J. Bierdrager.
Description of the discussion on the mental health si illation in Japan,· Dr. Yamaguchi, With regard to health planning (page 28 of report), the system is not sufficiently developed and WHO has granted its assistance. With regard to prevention, a new law has been implemented (see page 28 of report) but Japan is still lacking specialists and beds. Question concerning the number of beds for mental patients. A survey· made shows that there are 1300 000 mental cases in Japan. 430 000 of them need treaiment. There are 60 000 beds. The ratio is 6 : 10 000 and th3 goal is 15 • 10 000. At pre sen t, the ratio is of 1.2 I 1000 and that in till U. S. a ratio of 5 • 1000 had been recommended. However, in 10 or 20 years, one might have to face a similar situation we are facing at present in the tuberculosis beds. the development of ambulatory treatment, the child guidance centres will enable pre-clinical diagnosis which will reduce the number of clinical cases. This was WHO's point of view as expressed in the technical report series of the Expert Committee on Nental Health. The general plan provides for an increase of beds, but no provisions are being made for mental clinics. Example of mental hospital of Dr. Rees in East Croydon (London) • The National Insti tu te of Mental Health is at present undertaking a study, with WHO, in order to solve this problem. What are the qualifications required for psychiatric social workers? In the United States, special undergraduate courses and two years graduate studies are required. Can treaUnEtlt of mental cases be provided for in small wards of general hospitals? Yes.
.,
Dr. Grant. Dr. Yamaguchi I
Dr. Grants
Dr. Yamaguchi:
Dr. Grant, Dr. Yarmguchi:
Dr. Tengl Dr. Grant: Dr. Sodal
...
Dr. Grant:
WHO/CST/IS page 25
Dr. Grantl
Mentions again example of Dr. Rees in East Croyd<XI who had 1200 beds in his hospi tal. but 400 were now empty. The hospital serves a population of 180 000. The patients administer the hospital themselves. The problem of health personnel in Japan. This is a delicate problem. At present, the enrolment in medical schools is of 3000 students per year. The same nUlllber of graduates per ann1.ll1. The increase of the populatim is of one million and therefore, the ratio of physicians to population is satisfactory. However, more dentists should be trained. For the nurses, the problem is more difficult, since there is an annual increase of 10% of hospital beds. The present figure of 13 000 new nurses per year is insufficient. Japan therefore called upon WHO which sent Miss Lyman to assist :in the tra:ining of teaching staff. Is there aqy difficulty in send:ing the medical and nursing personnel to remote areas? Yes. For the physicians, the difficulty is not on:q geqgraphical, but also for the distribution according to various specializations. It is being tried to set up clinics in villages without medical assistance, these cl:inics to be placed lIDder supervisicn. At pre sen t, there are 150 villages Without medical assistance. In New Zealand there were 30 villages without medical assistance and it was difficult to obtain physicians. The Government built houses for the physician in each of tiDee "special areas", put a car at the disposal of each M. 0., drugs and granted the right to practice private midwifer,y. The salary was of IilZ. 2500 per annum. This yielded very good results.
Dr. Yamaguchi I Dr. Soda I
Dr. YUIll Dr. Yanilguchi I Dr. Sodal
Dr. Turbottl
Dr. YUIll Dr. Sodal
What is the status of the midWives? After tho war, Japan adapted a new training system for midwives. All midwives are trained nurses who, after their studies, attend a six-month specialized training. ihe existence of pre-war trained midwives enables to remedy the shortage of midwives. What is the percentage of deliveries performed qy physician?
Dr. Downesl Replyl
15 000.
WHO/CST/18 page 26 Wonders whether Japanese intended to continue the present system. He thinks that this system has several drawbacks in the sense that the nurses will all want to become midwives, this profession enjoying a better reputation. This problem is important, but the tendency is to maintain the present system. In reply to a question raised by Dr. Grant said t/)9.t tre
Dr. Sanys
Dr. Sodas Dr. Yamaguchis
,
statistical data on morbidity were being used for health planning purposes. Dr. Grant asked whether there was a planning bureau making recommendations for the number of hospital beds. Dr. Yamaguchi said that in 1951, the ntmlber of tuberculosis beds was 19 000 but that thanks to statistical data gathered, it had been increased to 260 000. Replying to a question raised by Dr. Ym, Dr. Soda said that t/)9. average ·inCOIllJ for physicians varied between 40 - 60 000 yen per month. Dr. Nguyen Tang Nguyen (Rapporteur) Wednesday morning, 18 September Visit to the Health and Welfare Statistics Division The study group travelled by bus to this Division which is housed in a separate though crowded building in northeast Tokyo. At the opening of the session, a welcome was extended to the group by the Director of the Division, Dr. Kato. He stated that the Division had made great progress since 1947. He hoped for integration with too statistical services of the rest of the world, and particularly with the countries of the Western Pacific Region. He introduced the Chief of the Section of Analysis and Records, Mr. Hishinuma. Mr. Hishintmla then addressed the smctr group, emphasizing certain points in the doctmlent circulated - "Outline of Organization and Business :in Division of Health and \-1elfare Statistics, Ministry of Health am. Welfare, Japanese Government", issued in August 191/.
He first dealt with the history and organization of the Division, which was established in 1947 and expanded in 1949. There are three sections of the DiviSion, dealing withl
(1) (2)
(3)
general affairs and field staff; analysis and records; tabulation. (See Chart I)
WHO/cs'l{' 18 page 27
As at 1 April 19'J7, the staff numbered 718, and for 1956 expen diture was 356 million yen, 0.4% of the total budget of the Ministry of Health and Wellare.
--
A Health and Welfare Statistics Council is also Establishment Law of the Ministry of Health and Wellare It consists of personnel appointed by the Ninister from and outside export members. The Council has six pamls (1) (2) (3) (4) (5) (6) vital statistics; medical affairs statistics; public-health statistics;
set up by the to advise the Minister. goverruoont agencies as follows I
statistical classification of diseases, injuries and causes of death; social wellare statistics; sampling techniques.
On the local level, statistical work is carried out b.Y prefectural governments and deSignated cities, utiliz:ing the services of both health and welfare centre personnel. Local governments are strengthened b.Y the placement of 322 statistical members with local health administrations, and 51 with local welfare adm:inistrations. (See Chart II) Mr. Hishinuma then talked of pro cedures involved, inc 1uding cO-Ordination with other sections of the Ministry.
r
Specifical1;y, the preparation of life tables, the application of the "Statistical Classification of Diseases, Injuries and Causes of Death" and the co-ordination of statistical surve,ys and reports are the most important aspects of the work of the Division. An outl:ine was then given to the group of the technique of collection of periodical statistics by enumerators and others, with particular reference to vital statistiCS, the national health survey, patient survey (of hospitals and clinics), and sampl:ing surve,ys (of about 190 000 households per annum). As far as health statistics are concerned, a weekly report of communicable diseases and a morbidity report are prepared on the notifications made b.Y p~sicians. Statistics are also prepared on the occurrence of food poisoning, on detailed particulars of all hospitals, on the number of eugenic operations and the artificial interruption of pregnancy.
,
The rema:inder of management reports concern mainly health centres, public health concerning public sanitation, medical affairs, pharmaceuticals supp1;y), medical institutions, and on medical personnel (a census of p~sicians, dentists and pharmacists).
WHO/<ST/18 page 28
Regarding social welfare, reports are obtained concerning their welfare programmes. The secend subject of social welfare statistics concerns the movement of recipients for assistance under the Daily Life Securi~ Law. The third is the social medical care survey. care under a number of social securi~ schemes. This refers to medical
Mr. Murai of the Tabulations Section also addressed the rooeting. He said that tabulations were either effected manua1Jy or by machine. OfJ20 machines, 30 were most important. In passing, the abacus was found to be just as speedy in additions and subtractions.
A visit was made to all the sections of the Division of Statistics; and the meeting reassembled for discussion. Dr. Yun questioned the sampling techniques, 1/10 of hospitals and of clinics. The convenience of such sampling was shown.
1/100
Dr. Sany asked whether the results achieved were reflected in malth policy. Samples were given, such as the increase in expectation of life aOO the subsequent reduction in the birth rate. It has been found that 4% of the national income is devoted to medical care - 271 500 million yen. Dr. Wu asked if the cancer death rate was increasing due to better diagnosis. This was answered in the af'finna tive. Dr. Phetsiriseng asked for details was informed that twice a year a course of together with a short course of three days governments." For the head of a Statistics is necessary. in training of statisticians. He two months is he:Jrl in Japanese, for persons from prefectural Section a full university training
Dr. Yen asked the percentage of death certificates not furniShed by medical practitioners. Tho reply was that a physician's certificate is always necessary.
L
WHO/CST/IS page 29
CHART I Ministry of Health and Welfare Minister's Secretariat Health ani Welfare ___ _ Division or Health and Welfare Statistics Council
I
.'
General Afrairs and field staff
f
Anaqsis and Records
I
CHART II
Division of Health & Welfare rtatistics
Prefectural Government Health Department Welfare Department
1 ___ DeSignated cities
Health centres
Welfare centres
Cities, towns villages
l
Dr. H.E. Downes (Rapporteur)
WHO/CST/IS page 30 Wednesday afternoon, IS September Visit to the Central Maternity Hospital, Japanese Red Cross In the afternoon of Wednesday, IS September, Dr. Mitani, Vice-Director, met the group at the Central Natemity Hospital of the Japanese Red Cross.
Dr. Goto addressed the gathering. The premature infant unit was established after tre war and 3500 infants had been attended to, 500 last year. There were 32 infants in the unit at the time of the visit. Mr. Saita stated that WHO had assisted by provid:ing one short-term
consultant and three fellowships to Australia, New Zealand and tre United States of America. Several incubators were donated by WHO; but now they are made locally. The premature ward was visited. intermittent breast-pump demonstrated. The milk bank was seen and an
In the premature ward, ten babies were in incubators, the smallest 900 grammes. In addition, there were three incubators temporarily out of use.
Normally, mothers are kept seven days after childbirth, if the babies are not premature. In the hospital for unwanted babies, there were 5S normal children under two years of age and another ward with 24 deformed unwanted children.
In the discussion, Dr. Sany asked how prematures are fed. The reply was that the mother I s milk was used, and if insufficient, milk fran the milk bank was given. For the first five days,only saline and glucose were given to infants under 1 kg. Dr. Bierdrager asked what were the criteria of prematurity. international ene is used - 1000-2500 grammes. Dr. Yen asked the weight of Japanese babies. gms. for females, and 3000 gms. for males. The
'!he weights were 2900
Dr. Turbott was informed that milk from the milk bank was pasteurized. Dr. Bierdrager asked if the birth weight of babies had increased with the nutrition of the people, and was answered in the affirmative.
Dr. H.E. Downes (Rapporteur)
WHO/CST/18 page 31 Thursday morn:ing, 19 September F:inal Conference at the Institute of Public Health (h the last morning of the stay :in Japan, the Study Group IlJi)t :in conference at the Institute of Public Health. Rema:ining questions concern:ing the provision of health facilities in Japan were dealt with.
The first concerned the relationship between too Social Welfare and the Social Insurance Bureaus. Dr. Yamaguchi expla:ined that the five sectials of the Social Affairs (Welfare) Bureau were concerned with the welfare of the poor. The b.idget of. about ¥40 billion provided daily living subsidies and medical care costs, and was derived from tax monies. The Social Insurance Bureau dealt with eleven varieties of social :insurance progrBmlOO s, the two chief ones being heal til :insurance of labour (industrial medical care) and the general natialal health insurance (medical. care of the people). All of these schemes are contributory :in nature. TWo-thirds of the population are covered by these schemes. The third of the population not covered is able to get medical care under the Social Affairs (Welfare) Bureau. The same standard of medical care is given under either Bureau.· The goal is to get every person :in Japan into some contributory schame by 1960. There will, however, aways be a section too poor to jo:in, for these the Social Affairs Bureau will continue to provide services. To what extent do these insurance schemes operate tmir own medical care? All have their o~ medical care schemes, operating hospitals and clinics. Why were so many semmes needed? This had developed because of legal :interpre tations that enactments left certain callings uncared, and was really a matter of administration.
Dr. Grant, as consultant, discussed the dangers of such multiplication of services. The progress in Japan over the last 20 years in peripheral health developnen t had been phenomenal. Then tmre were no health centres or welfare units. Now, health centres, private hospitals, public hospitals with outly:ing clinics, welfare units were multiply:ing :in unco-ordinated fashion. He suggested the time had arrived for stock-tak:ing of this situation, .and concerted attempt be made to achieve integration under one co-ordinating authority, tying the whole in with the medical school and hospital s,ystem. Dr. Yamaguchi replied that there was consciousness of this defect. Integration had been achieved in the chain of mtianal, pre fectural ani health cl:inic laboratories. Mr. Saita assured the group that Japan was awake to the problem. Amalgamation of departments had been suggested as a solution, but the Health Department had resisted thiS, want:ing to keep for prevmtive medicine its :individuality, and avoid priority planning for curative services which would result from any such ama~amation. It was proving diffi rult to persuade practitioners of curative medicine to agree to integrated planning of medical services. Some members of the group thought it was impossible to stress both preventive and curative services at too one time. Most countries gave priority planning to curative services, and when these were established, turned
WHO/CST/18 page 32 their energies to preventive measures. Whero health authori ties had a chance to plan from the beginning, it was agreed that curative services must be planned first, but in this very initial planning integration of preventive services for the community should be woven. For example, the obstetrician and paediatrician should deal not onJ.;y wi th hospital services but should also be active in antenatal am well-baby care services tied in with the hOllli tal. This was better than planning separate schemes. The next and last question for discussion was famiJ.;y planning as carried out in Japan. Voluntary agencies had pioneered birth control, am the Government did not enter this field till 1951. This was done for two reascns, firstJ.;y, asa solution of the overpopulation problem, and secondly, because tre practice of abortion was ever increasing and becoming a danger, leaving some ill effects in monthers. FamiJ.;y planning was made a national priority objective, mainJ.;y as a counter to this artificial abortion danger. It has been extremeJ.;y successful in meeting both objectives. An informaticn paper was provided for the study group members, detailing the sue cess of the famiJ.;y planning scheme. Field instructors are the midwives, although occasionalJ.;y a few public-health nurses are involved. They have an in-service training of three weeks, gain certificates, and thereafter give individual instruction to individuals. Two films made in Japan were shown, one, a health education film on tuberculosis prevention work, and the other, on hypertension for medical student instruction • Ckl behalf of tre group, Dr. Yen proposed a vote of thanks to the Japanese Government and the Ministry of Health and Welfare for the profitable and happy time the group had had in Japan.
Dr. H.B. Turbott (Rapporteur) 3.2 Report on Proceedings in Taiwan, China, 20-30 September 1957 yang Ming Shan, 'Friday morning, 20 September Opening Ceremony Dr. J. Heng Liu opened the conference and welcomed the Vice-Minister, Mr. Tang, of the Ministry of Interior. He mentioned that a Iocal canmittee had arranged the Taiwan programme. The Vice-Minister made the principal speech of welcome. He referred to the common ideals of WHO and the Chinese Government, namely, physieal and mental health and happiness. He referred also to the main political objectives, resisting communist aggressicn and return to the Mainland. He thanked WHO for assistance in controlling communicable diseases, such as malaria, venereal diseases, tuberculosis, trachoma, and for help in the maternal anG child health project, in serum and vaccine production, and in improvements in environmental sanitation.
WHO/CST/18 page 32a Dr. J. Heng.Liu stated that the Provincial Governor, Mr. Chow, intended to be present to welcome visitors but was detained in Taichung. Dr. C. H. Yen read hi s speech of welcome and stated that WHO was one of the most important in ternational bodies in the world. In China, cholera, plague and smallpox had been Wiped out and malaria was reduced. He felt that much had to be done, and hopod that the conference and study group would help his country in their deliberations. Before concluding the meeting, Dr. Liu intrOduced tho M~or of Yang Ming Shan, Mr. C. Y. Chow, who was formerly a sanitary engineer. He regretted that Dr. I. C. Fang was not present and introduced his representativo, Dr. C. Y. Shu, and the consultant, Dr. John B. Grant of the Rockefeller Foundation at present stationed at the Department or Preventive Medicine at the Puerto Rico University. The meeting closed after sane announcements by Dr. Shu. Dr. H.E. Downes (Rapporteur ) Saturday morning, 21 September Visit to National Taiwan Universi Medical College Nursing Education Projec , Institute of Public Health, and National Taiwan Universi~ Hospital, T a i p e i The morning meeting was convened by Dr. Bierdrager at the National Taiwan Universi W Medical School who· presented Dean Wei who gave an ou tline of medical education in Taiwan tod~. He then presented Dr. Chen, Director of the Institute of Public Health (!PH) who outlined the history, function and progress of this Institute. In the discussion which ensued, the follOWing questions were raised and answeredl Dr. Downesl Wiw, With the limited teaching staff, is time utilized teaching public health and preventive medicine to phannacy and dental students? Dr. Chen: (1) The first responsibility is not in !PH but in the Department of Preventive Medicine in tro undergraduate years; and (2) in Taiwan it is felt that tro pharmacist, especial~, is a key factor as a health educator and he is encouraged in this. Dr. Downesl Accepts and asksl population in Taiwan. The relatimship
or
practi timers to
Dr. Yem 1 private practitioner to 2500 population, or 1 to 2000 if army and institutional doctors included. Qoostims were askedl (1) whether Dr. Chen is responsible for both the Department of Preventive Medicine (undergraduate) as well as tre lhstitute of Public Health (graduate), and (2) how are tho faculty used in both.
WHO/CST/IS page 32b Dr. Chem in IPH. Dr. Grant congratulates Dr. Chen on t~ organizational progress made and asks, (1) what is the relationship of the practicd field to !PH, and (2) how much is the budget for the IPH, the Medical School, and is the hospital budget combined or included? Dr. Chen I (1) There has been no fixed train:ing centre in the past for the two-month course, 27 hours being allocated for visits to different health facilities and projects. Dr. Brown, recent China Medical Board consultant here has stressed tha neod for a fixed training (field) centre here and plans are to develOp this, (2) There is no special budget in the University for IPH, funds coming fran PHA and JCRR. A total of NT ~400 000 is provided for five classes of two months duration (150 trainees), or NT WOO) per trainee. Dr. Grant: Will the Dean explain the medical school budget?
(1) Yes, and (2)
Facul~
from the Medical School also used
Dean Wei: The Medical School budget is part of the Uni versi ~ budget which cames from the Hinistry of Education. They also have grants from ICA and the China Medical Board. Some income from the hospital is available to help run the school. The hospital income averages NT $1.7 million per month. Dr. Grant I Nedical School in Japan is supported largely by the hospital. Is this possible here? Dean Wei: The Medical School gets sane salary subsidy, about 10% of the hospital income, or NT $15 000 per month, for research and teaching. Dr. Yunl Asks for more information regarding the Medical Technicians School. (1) What are they teaching? and (2) Are the graduates licensed afterwards? Dean Wei: (1) Those accepted must be senior high school graduates, qualify by a special examination, and take a four-year course. The first two years are given at the College of Science, (2) A license is to be requested for graduates. Dr. SanYI States he has read tha report on the health situation in China, which discusses herb doctors, assistant pharmacists and laboratory technicians, and asks (1) How is the senior laboratory staff trained; arrl (2) with reference to the training of nurses and midwives, what is the ratio between the theoretical and practical tra:in:ing? Dean Uei: (1) The train:ing of laboratory technicians was the first step. There is not yet local train:ing for senior laboratory persmnel. There is no training course for assistant pharmacists now - those presen tly practising were trained during the Japanese occupation. (Dr. Yen) Re harb doctors, this was practised on the Mainland for thousands of years, where schools existed. There are no schools for them here nor will government schools be established, but they are allowed to practis8. Assistant pharmacists are really apprentices who work under qualified supervision, and as such, have job status in government institutions. (2) Answer postponed until nursing education discussed, .
WHO/CST/18 page 33 Question was asked whether Dean Wei will report on tile demand for medical education in Taiwan, with reference also to overseas returnees? (Also et.atos that "assistant pharmacists" are sometimes called "dispensers"). _Dean Wei' The Medical School. along with some 37 colleges and universities, give jomt entranco examinations to sonior hi/ltl school graduates, this year to sane 18 000 applicants. This gives the applicants some 40 or more choices and most of them give NTU Nedical School as first choice. Since 60 are accepted annually, the Medical School can select the best, but 30 to 40 overseas students are accepted annually, usua~ from Hone Kong. Nacau, the Philippines, Vietnam, etc. Question was asked as to too total number of practitioners. Dr. Yenl States that this is given in the distributed report and hEl thinks it is around 3400. Dr. Turbett, go hane? Dean Weil (1) As yet there have been none graduated, Out they are expected eventually to go home. Dr. TUrbott, How many medical schools are there in Taiwan? (1) Do overseas students stay here to practise or do they
Dean Wei: Two besides NW, there being NDK: and a private school which has been established for 3 years in Kaohsiung. Supplementary information was given that NDMC graduates, after satisfying their military requirements, can go into private practice. Dr. Turbott, train outiiijers? When Taiwan has shortage of doctors, can tiley afford to
• Dean Weil Realizes they need more doctors. While Taiwan has cnly 3 medical schools, there are 44 in Japan and 80 in the United States, or about 1 for each 2 million population. On this basis Taiwan needs 2 more, but recruiting of faculty, espocially for preclinical subjects is difficult. Dr. Sany, (1) Is research being done to try to adapt herb medicine to modem medicine. and (2) Is it possible to tram in the specialties wi th the present shortage of staff? Dean Wei: (1) The Department of Pharmacology has done sane research on indigenous herbs and the Ministry of Education has recentJ.y set up a Research Institute for Chinese Medicine, approved Qy the Legislative Yuan, but as yet not in operation. (2) In the clinical field, specialists, assistant to senior staff members can be trained in th; hospital and many also go to the United States for advanced study under the auspices of the International Co-operation Administration (ICA), World Health Organization (WHO), China Medical Board (CHB), American Bureau for Medical Aid to China (ABMAC). etc. For training in the preclinical and non-clinical
WHO!CST!18 page 34 specialties the Institute of Pathology, the Institute of Physiology, and the Insti tute of Public Health exist, although the latter has not as yet started a.year long course for a degree. The Institute of Physiology is divided into three branches, viz. pure physiology, chemistry, and pharmacology. Dr. Grant: What proportion of physicians work i.n govemment centres and stations and what does the government do to train them, and why is public health not included in the seventh (i.nterneship) year? Dr. Yens Does not have the exact figure rut it is about three i.n private practice to one in government service, the latter being divided i.nto (a) ministry service, (b) teaching, Laboratories, institutes, etc., and (c) local health services, there being about 500 in tho latter category. Dean Wei: In the past internes were aSsigned for one month to the Taipei Health centre and the Tuberculosis Centre but this was discontinued becausa of too difficulty in proViding faculty supervision and of fitt:ing this one month into the rotation scheme. Next year junior year stUdents will be assigled, during their vacation period, for four weeks' work i.n public health. Dr. Chen I The emphasis should be on preventive medicine rather than public health. Therefore, the four weeks are to be divided into two weeks' traini.ng in the hospital on preventive medicine, emphasizing the medico-social aspect and the famil;y study in the hospital and the home, and two weeks at the Provincial Public Health Centre working with the public-health team of a doctor,
nurse, sanitarians, etc. The second part of the morning session was devoted to the history an d developnent of the basic nursing programme at the National Ta:iMan Universiw (NTU), this bei.ng the first civilian collegiate pror,ramme of nursi.ng in Taiwan although the National Defense Hcdical Centro School of Nursi.ng was approved by the Ministry of Education to {"rant a degreo of nursing in 1954. Niss Yu, tho Directress of tre School mad" tho presentation, outlinine the en trance requirements, the curriculum anG the objectives of the School. Questions followed I Dr. SanYI Repeats his question with reference to the proportion of theoretical as to practical training. Miss Yu and Dr. Yen: Because more hours are required for a practical credit than for didactic creGit, the preponderance of training is on the practical side as far as hours go. Dr. Cherry: Dr. Yen referred to "assistant nurses" when he referred to "assistant phamacists", sta tmg that the latter were required to woIk under the supervision of a qualified phannacist. Wants to know if "assistant nurses" are required to work under qualified nursing supervision. Dr. Yenl An effort is made to do this but in some centres and stations qualified nursing personnel are not available. But in these cases they do work under medical supervision.
WHO/CST/IS page 35
Before the session closed, Dr. Shu, WHO Rev.onal Office Manila pointed out the conBUltin~ assist~ce made available through the'WHO nur~ing team, as well as the seI'V'l.ces of M~ss Brackett, NurSing Consultant from the ICA office in Taipei. The study group was then conducted by Dean Wei and Dr. Chen through the.N'l'U Medi.:al C~llege and IPH and by Dr. Kao, Superintendent of Taita Hospital aBs~sted by "he D~rectress of the Nurs:ing School, the WHO Nursing Consultant and team and the Head Nurse of Taita, through the Taita Hospi tal.
Dr. R.L. Chew (Rapporteur Saturday afternoon, 21 September Visit to Shih-lin Serum and Vaccine Laboratory and Shih-lin Environmental Sanitation Demonstration Area, Taipei In the afternoon the group proceeded by bus and car to too Taiwan SerUlll and Vaccine Laboratory at Shih-lin. Here Dr. Wu, Director of the National Department of Health, Ministry of the Interior, presided and introduced as the first speaker Dr. L. C. Yen, Director of the Laboratory Who proceeded to outline 'the history, organizaticn, technical divisions and products of the Laboratory. TO carry 00 t research work and manufacture, the latter consists of the followingl (a) Section of Diagnostic Studies and General Supply; (b) Section of Bacterial VaccinesJ (c) Section of Toxins and Antitoxins) (d) Section of Viral and Rickettsial Vaccines; (0) Section of Biologics Assay, and (f) the BOG laboratory. A copy of the 1956 annual report was provided each member, after which questions were invited. Dr. Bierdrager: Who uses most of the seemingly large allDunt of plague vaccine, the military? Dr. L.C. Yen: Dr. yamaguchi I there private firms? J.jmited capacity, mak:lng the Dr. L.e. yen: Only one private ~~.of diphtheria antitoxin, typhoid, followingt smallpox, vaccine. tetanus ant~ and anti-rabies. ~ ~ed ermits for such manufacture A question was asked as "0 Who gMr~ ~ ~ryp of Interior which did so, l' d the'" it was the m~s 0 t "~f ~h l1inis~ry of Interior the produc s and Dr. L.e. yen rep ~e and ""'"'lained that at the reques" 0 "e ~h Of "'he (lOVeroment, were assayed. -"" uf ~ I' as well as ° ose 0 " of the private man aCuure , h'l' d strains were made Regarding stra:lns, it was stated that lyop ~ ~ze and that there was some challene e work done. . The civilian population. ire all necessary vaccines produced here or are
~
00=,
WHO/CST/l8
page 36
A question was raised as to whether a street virus or strain from the United states or Japan was used, and thE) rep~ was that a street virus from the United States was utilized. It was also explained that street virus had been isolated here but not used. Dr. Yung, Director of the Insti illte of Environmental Sanitation (:IES), was then introduced and he outlined the hi story and functions of the Institute, the latter being research into and co-ordination of sanitation measures, training of personnel and in effect serving as the Division of Environmental Sanitation of the Provincial Health Administration. The Institute has been aided by WHO and lCA. Dr. Tom and Mr. Smythe were introduced as visiting coosultants from WHO. Dr. Yung provided the group with reprints, a copy of tIE 1956 annual report and material describinE the She-Tze Environmental Sanitation Improvement ,Demonstration Area, which the group was to visit later. Discussions and questions .followed. Dr. Nolasco. Dr. Yung: How are wells classified, by what criteria? r
...
Dug and deep.
None are artesian.
A question was asked as to whether or not periodic oxam:inations were made of water and Dr. Yung replied that this was done once or twice a month. Atten tion was drawn to the sulphur cm tont of the water in the hotel and a query was raised as to whether cremiioal analyses were available, md if the elern<lnts were of a curative nature, what these were and what th~'Y would cure, also had thOught been given to the dcvelopnent of spas. Dr •. L.e ~ . Yen. There have been many claims for efficacy of hot springs but no COnf~~u~on of any curative properties from chemical content. Largely used for vacau~on and physiotherapy purposes • . Dr. Grant: (referring to sanitation demonstration area) (a) Upon ~he was h lLh d L· " of the ro·e L • . ea u e uca,,~on a precedent to the initiation to supp~rt J a::~' fu~~h hadL~ v~llage-formed council or cO/lllllittee been established of the country woui/~e;m~tW:k, and (~) arc ~h~ ~sts such that the economy e expans10n of uhis "ypc of work on a nationWide basis? select~on of the village
.L L. on san~"aGJ.on preceded feasible for commun<L<es "" L "he Nayor, was fonned. (b) Economical'" ·t ~,,~ • u. wa"or supplio f . "" ~ nrust. (i) have an availabl' s, or a nllnge to 00 selected of Lh L C source of water· (ii) ~h . N""2, " e per cap~ta costs u ~ wa"er supply should no"" b contr~bute 50%. " e OVer ,.., 00, and (iii) the ccmnuni ty must and a salutation CO/lllllittee, headed by L' S
D~. Yung:
(a) Health education
weekly film
D Replying to a ques L . voluntary. u1m, r. Yung said that labour
was mostly
~ Dr. Downes. Noting that six 1n"eatinal parasites has there been ~ut of seven of the inhabit an ts had improve environmental sanitation? therapy in parallel with the efforts to
WHO/CST/l8 page 37 Dr. Yung; No.
Dr. Cherry; (a) After demonstration facilities had been :installed, did this work st:iJnulate others to request the same and i f so, row were th~ helped? (b) As a result of the work done in this area, has there been any reducti.on in the death rate from diarrhea and enteritis in children under the age of two in this area?
Dr. Yung; (a) Others want help but this 1s a very poor area. We have helped them with dra:inage, etc. (b) The t:iJne has been too short to arrive at any conclusions regarding the effect on these death rates. Dr. Yamaguchi; Is there any statistical :information regarding typhoid fever, dysenteries, etc., in this area? Dr. Yung; No. Is paraSitic infestation clinically apparent? There
Dr. Bierdrager;
Dr. Yung; Most do not take the advice to go the health station. is no data for an answer.
Dr. L.C. Yen; There is not too much clinically apparent parasi tiflll except where the burden is heavy. On the basis of some nutrition survey work done in Talwan it was felt that parasitism possibly accounted for about 10;ll of under-nutrition in children. Dr. Turbott. Did the people provide only labour, and i f so, is this the plan for the nation? Dr. Yung: Illly labour for the pig pen ;improvement and tIE drainage work) for the wells, funds were also required. Dr. L.C. Yenl Under the present ratio, the budget·will provide 6CJ%" but this ratio may have to change under certain conditions. Dr, Turbottl Regard:ing the simple sand filter described, how long will it last and are they taught haw to renew it? Dr. Yung! When the filtrat.ion flow rate decreases appreciably, they wash the fine top sand. Replying to the qll£Jstion as to how ine demonstration area was utilized and how it was related to !PH, Dr. Yung stated inat sanitarians were trained in IES and they saw this area. Train:in g in IPH was different in that it was designed more for doctors. Brief two weeks' field train:ing courses were given as refresher courses for sanitarians. Those accepted for the WO 1lIJIlths I couree must be senior high school graduates. Dr. Yung hoped eventually to see a sanitary engineer in each health centre.
WHO/CST/18 page 38
In closine, Dr. Shu (WHO) nnde mention of too part played by WHO sanitary engineers, Dr. Tom and r11'. Smy'"vhe, and the lCA sanitary engineers, Hr. SWisher and Mr. Connolly, in these projects of water supply and excreta disposal in Taiwan. At the close of the discussion, till group was shown through the Serum and Vaccine Laboratory by Dr. L.C. Yen and his staff, after which it proceeded by car to the Environmental Sanitation ImprovemEnt Demonstration Area en the small island of She-Hze, situated between the confluence of the Tansui and Keelung Rivers. The island is 7.1 kilometres long, 1.7 kilolll6tres in width at its greatest width and 400 metres wide at its least. The total area is about 700 hectares, with about 2000 houses and a population of 12 500. The most populous part had been selected for the aroa because of its lack of potable water, its poverty and its extreme1;y poor sanitation. Till group was shown drainaee worll:, wells, with locally manufactured pumps (one with a wincinill at a school), public, private and school latrines, school hand-washing facilities, an iron removal unit, Slllall filters, pig pen improvcm€ll ts and household improvements, such as additicnal window space, white-washing of inner walls and in some instances, concrete flooring to replace dirt floors.
'"
Dr. R. L. Cherry (Rapporteur) Monday morning, 23 September Visit to the National Defense Medical Centre, Taipei
en }fonday morning, 23 September, the Study Group visited the National Defense Medical Centre, which trains service medical and para-medical personnel, in contrast "to the two civilian medical schools of Taiwan. General C. T. Loo, who is in command of the Centre welcomed the group. The Vice-Director, General T. M. Pmg, gave the group an outline of the history of the Centre and its responsibilities. It commenced in Shanghai in 1947 and was evacuated to Taiwan in 1949. In the period 1950-1952, classrooms were built and a library established. From 1951-1955 the laboratory side was built up, and since 1955 clinical work has been put on a sound foundation with the establishment of hospital services and field establishments for clinical facilities. The Centre has its CMIl teaching hospi tal of 300 beds, and has another in the hills of 750 beds. A veterans' hospital of 700 beds is contamplated.
Not on1;y does the Centre train doctors (688 in 10 years) but dentists (78 in 10 years), pharmacists (127 in 10 years), nurses, laboratory technicians, sani taIjT inspectors, hospital administrators and equipnent officers. General C. C. Ha, Dean of th: Centre, described to the group the length of the courses (6-1/2 years for medicine and dentistry; 4-1/2 years for most other courses), the dormitory facilities, the level of education en
WHO/CST/18 page 39 entry, and the nlmlber of patients. In additicn, a four-year course is designed for those officers who had acted as medical staft with insufficient medical education. A licentiate is granted them after the course.
--
An inspectioo of the Cen tre was made, and details of compulsory military training elicited.
Dr. H.E. Downes (Rapporteur) Monday afternoon, 23 September Visit to the Taiwan PrOVincial Taipei lUberculosis Control Centre, the Tuberculosis Control Project, and the Sung shan Tuberculosis Sanatorium, Taipei On the afternocn of Monday, 23 September, tbe tuberculosis centre was
visited. Dr. J. C. Tao welcomed the visitors and gave a history of the antituberculosis work. Jh·l95l, 2-1/2 million children were tuberculin-tested, using Copenhagen P.P.D. vaccine; 300 000 under 6 were tested. Fifteen per cent of" five-year olds, 2at of ten-year olds, 50% of fifteen-year olds were tuberculin positive. Jhfection was worse in urban than in rural areas. The death rate was 285 per 100 000 in 1947, and now it is 62 per 100 000. Deaths occur mainly in the over-25-years age group. Apart from the tuberculin testing and BCG vaccination of non-reactors among school children, there has been operatine concurrently a mass X-ray drive, using 70 11Jll. films. OVer one million have been examined, at the rate of 3-400 000 per year. Two per cent have evidence of past TB, and of these 20-25% are bacteriologically tuberculous. . All 22 health cmtres have BeG vaccinaticn teams and a BCG vaccine production laboratory was established in 1952. Of tm hospitals, five large hospitals have TB wards. OVer 5 milUcn children under 20 have been tuberculin tested, and 3 million non-reactors vaccinated. The number of radiological units operatine is 7 mobile and 4 staticnary. Concerning treatment, this is mainly ambulatory, but surgical beds are available at the Sungshan Tuberculosis Hospital.
WHO/CST/18 page 40
Dr. H. T. Lin then addressed the stuqy group conceming t1le BeG progral!l1E, whi ch camnenced in 1949 and has since extended over the whole island. In all, 25 teams have operated, each consiating of a physician, two nurses, a clerk and a driver. Local BeG vaccine has been used since 1953. Each team has a target of 4000 per IllOnth. The teams have concentrated on the group under 25 years of age. Dr. P. Y. Hu also addressed t1le group and described the work of the main TB clinic. All cases referred to the clinic are investigated, and treatment is mainl.y ambulant. Last year 4500 sputa were examined, of which 30): were tuberculous. Seventy per cent of the people who are asked to return for followup actually do so. Public-health nurses follow up those who do not return, and attend to over 200 families as well as undertaking TB clinic work. Dr. C. C. Chang addressed the stuqy group concerning mass X-ray examinations, whi ch commenced in 1948. UNICEF contributed a mobile unit in 1952. The number of units has increased to 7 mobile and 4 stationary units. In reply to a question by Dr. Downe s, Dr. Chang said that the next plans are for the older age groups and to extend treatment facilities. Isoniazid is used exclusively at the present time.
"
Dubious x-rays of minimum lesions are followed up at 3-6 month intervals. In the discussion Which followed, Dr. Yamaguchi questioned the administrative control of BCG teams, and it was fomd that t1ley are controlled by the health centre, but technically are responsible to the Taipei Tuberculosis Centre.
Dr. Turbott compared the control with that in New Zealand, where tuberculosis was not under a separate administration. Dr. Penington, WHO consultant, advised how the private practitioner services were used in Taiwan. It was found, in reply to a question as to whet1ler there was legal control of infected cases at work, such as waitresses, school teachers and barbers, that there was no such control. A visit was then made at 4115 p.m. to Sung shan TUberculosis Hospital, which is controlled by the Taipei TUberculosis Centre. It has llO beds, 90 of which are for surgical cases, the remaining beds being utilized for TB meningi tis and miliary TB.
Dr. HoE. Downes (Rapporteur)
WHO/CST/1S page 41
Tuesday morning, 24 September Visit to the School Health Project (including School Trachoma Control), 'Taipei At 8130 a.m. the study group visited the Taipei Provincial Primary School, run by the Normal School giving practice to student teachers. In the classrooms health lessms were being conducted by teachers, and several of these were observed. The lessons seemed to be taught capabJ;y, the teachers using a varie~ of aids such as exhibits, films, practical demonstrations, and puppet shows. The school doctor was busy testing entrant children for trachoma. In the medical roam of the school the public-health nurse demonstrated the medical record card, which was a dual purpose card being also the school progress card. School milk was being served in some of the classrooms. At 10100 a.m. the study group visited the Presidential Building, and were received by, and individualJ;y introduced to the President, Generalissimo Chiang Kai Shako At 10130 a.m. another large primary school was visited. Here again, the school doctor was examining new entrants for trachoma. A demonstration of health education against trachana was given'in the form of a dellghtfulJ;y acted play performed by a group of young children. The study group then went into conference on tre School Health and Trachoma programmes. For tre 110 000 school children in Taipei, Dr. Wang, Director of the programme, explained there were 46 schools, each of which had a school doctor ei thsr pal"'" .... time from private practice or fran a city real th station, and a full-time public-health nurse. They carried out the usual supervision of the health of the children;, and the doctors had had special :In-service train:lng in trachol1E. diagnosis. For each school a health educator was supplied, in addition to tre school doctor and public-health nurse. Health education had a regular weekly period of half an hour, and was reinforced by daiJ;y morning inspections, and by integrating health tremes into other subjects. Physical examinatioos were made of new entrants. Miniature chest X-rays were made of all 3rd and 5th grade students. School treatments were given for pediculosis, scabies, ringworm, and trachoma and conjunctivitis. Weights were taken monthJ;y and height recorded every six months. Each new student was vaccinated against amallpox, and thereafter re-vacc:lnated at two year intervals. BOG vaccinations were carried out :In the schools. The trachoma control project covering all school children was a vigorous ene, diagnosis being made by ~e health station and school doctors, and treatment with 1% aureomwcin or terramwcin ointment being carried out by the teachers. This was the largest self-help programme against this disease in the world. WHO suppliod consultant help periodicallY, and UNICEF supplied the drugs needed. Treatments were given twice da1q fDr two months. Post control surveys were made at six months and again at twelve men ths. Those not cured were given another course of treatment.
!.k
WHO/CST/IS page 42
In the discussion which followed the policy statements, it was eXplained that UNICEF suppl;i.ed too dried sldlll milk for the school milk programme. l~ of the children of Taiwan received this milk, 40 gm. per child per day, diluted eight times with water. Was there agreement between consultants and local personnel on trachoma diagnosis and cure standards? This was reported as being very close, the WHO criteria being used. In-service training courses for doctors concerned with the programme had effected an even standard of diagnosis and determination of cure. What was the relapse rate? Counting re-infections and relapses together this ran at between 7 and 10% of the treated cases. What was done for the cases failing to attain cure? Such resistant cases were given a course of sulphadiazine, 40 mg. per kilo of body weight per day for 20 days. Dr. H.B. Turbott (Rapporteur) Tuesday afternoon, 24 September Visit to the Hsi-chih Venereal-Disease Control Demonstration Area aDd Venereal-Disease Control Project, T a i p c i At 2,00 p.m. the group vi sited Hsi-chih Chen Vmereal-Disease Control Demonstration Area and the Venereal-Disease Control Project. Dr. Chang explained that the project began in 1953, as a centrol service for all pregnant wanen and children, and ending up as a comprehensive venereal-disease control programme for Taiwan. WHO provided technical assistance, fellowships and some supplies, and the UNICEF, the Joint Commission on Rural Reconstruction (JCRR), and the lCA, have given material and financial assistance. The organization comprises a venereal-disease control centre, with a WHO consultant advisor, and a national venereal-disease control team of medical officers, serologist, publ;i.c-hcalth nurses, a OOalth educator, and office staff, whose function comprises national planning, training personnel and arranging venereal-disease demonstration clinics. The venereal-disease demonstration clinic provides medical services for venereal-disease and trains local personnel, investigates and follows up cases and undertakes venere~ disease health education. A reference laboratory has been established to standardize serology for syphilis work, and to train laboratory tochnicians. Twenty local laboratories scattered over the island act as agents of the central laboratory. At tho local level, health centres and hospital participate in the case finding and control work. As a routine blood specimens are examined from all out-patient depa~wnent patients of child bearing ages, all antenatal clinic patients, all hospital in-patients, all physical examinations and from cord blood at delivery of babies. Mass surveys of special groups are IIIlde fran time to time. It is hopad to have the above policy of examinations completed by 1960. Health education against venereal-disease is tote prosecuted vigorously. The Hsi-chih Chen Health Station acts as a venereal-disease demonstration clinic, integrating practising physicians with venereal-disease control work.
...
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WHO/CST/18 page 43
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The stuqy group had a round-the-table di scussion in which many que stions were asked and answered. The follow:ing were the mam facts elicited. Prostitution is allowed Officially at the local level (not nationally). There is a weekly check by health stations for gonorrhoea and chancroid and a monthly serolOgical. test for syphilis, Such studies as have been made indicate a lower level of infection in these controlled houses than in uncontrolled prostitution. If cases of primar,r chancre were adequately treated with PAM, spirochaetes disappeared after four hours. It was estimated that for ever,r case of syphilis found there would be five gonorrhoea cases in the group being investigated. There were at present no specific venereal-disease regulations, but these were under preparation. In these it is proposed to take power to msist on pre-marital and pre-natal exammations, to control cases and contacts, to make notification by doctors compulsory, and to make i t obligatory for them to do health education on venereal-disease with their patients with active disease.
A
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Dr. C. S. Chang, Director of the Health Station, gave assurance that the co-operation of local doctors was bemg given. In the town of 2:7 000 people there were eight private doctors. All take part m venereal-disease control work. If they have female patiwts of child bearing ages· they endeavour to take blood samples and they average 200 such spec:illlens monthly. The specimens are delivered to the Heal.th Station and are sent thence to the Taipei SerUlll and Vaccme Laboratory, where the test is carried out without charge. Should this be positive, the doctor is sent the requisite supply of PAM free of charge. He receives no payment for the injection work from too Health Station, but is entitled to his professional fee from the patient. It is considered the Health Statim, acting as a venereal-disease demonstration clmic, as bemg successful in eliciting private practitioners' co-operation in venereal-disease control work. Dr. H.B. Turbott (Rapp.orteur) Wednesday mornmg, 25 September Visit to the Taoyuan Health Centre and Public-Health Nurses' Training Centre, Taoyuan At shortly before 10:00 a.m., the group arrived at too Taoyuan Health Centre am Public-Health Nurses' Traming Centre. Dr. Wu presided. Here, we were briefed on the acti,ri +·10s 0f the Centre by Dr. Hsia, the Director, who also explained that the Centre was canposed of four divisic:ns and a laboratory. Cbe division is in charge of health prClllotion, one in charge of communicable disease control and sanitatic:n, one in charge of drug control and medical personnel control and one in charge of general. business management. This is both a traming and service centre and it is charged with supervision of the work of 13 health stations in towns and villages. The operating expenses of the Centre come from the county or hsien government and of the stations from the towns (chena) and villages.
WHO/CST/18 page 44
Discussions and questions were deferred until after the presmtation of the public-health nursing training programme qy Miss Hsu Ai-chu of the National Institute of Health. She gave the history of the developnent of the Centre with the assistance of JCRR funds, under tho sponsorship of the Provincial Health Acininistration, with the nurses of the National Institute of Health serving as teaching staff. This centre Gave a four-week in-service training for 510 nurses and midwives then employed in health centres and stations throughout the island. Now there are two additional types of training, under-graduate and postgraduate. All students in nursing schools in Taiwan get 80 hours of public-health nursing with field experience and it is here that this is taken. 1, total of 424 nursing students have had this before graduation. In the postgraduate course, supported qy National Institute of Health funds, qualified nurses are selected for training to prepare them as fietl supervisors or assistant teachers in nursing schools. The first six months is theory and practice and the second six months consists really of an interneship in their assigned posit1ons in centres or institutions. Here they receive periodic supervision qy staff of the National Institute of Health (NIH). Upon tho passing of a final examination they receive a certificate in public-health nursing. Fifteen students were accepted in February 1957 and a second class of ten has just started. The group was supplied with outlines of the curricula for both the undergraduate and the graduate courses. In closing Miss Hsu presented MissChu from the NIH who has immediate charge of the progra~. ~uestions
and discussion. followed:
Dr. Grant I (1) How are hoalth centres supervised and what is the relation of this centre to the 13 stations? (2) It is stated that 13 stations have out-patient departments. How is medical care given? What is the volume of attendance? Is there a hospital? How arc people hospitalized? Dr. Haial (1) The health centre is a county health department and as such is mder the county administration, but receives technical supervision from the Provincial Health Administration. The appointment of a director is with the concurrence of tm Provincial Health Administration. The stations are directly supervised qy the malth centre and all salaries are fr(]!l tm comty. (2) There is no hospital, patients requiring hospitalization beinG sent to Taipei. From 30 to 80, or an average of 40 to 50 patients are seen daily at each health station. Dr. Grant: malth? Dr. HSlas This varies, the tuberculosis team, for example, gave technical supervision. How often and to what extent other activities were given supervision' as indefinite? Dr. Yem Gave figures for OPD attendance in 1953 as 71 699, in 195<1, 70 945 and in 1955, 52 189. Dr. Cherry: What are the advantages or disadvantages, as the case may be, that arise from the fact that centres and stations receive 100% of their support fram local sources and none from provincial level?
(1)
In what activities were health stations supervised last
WHO/CST/IS page 45
Dr. Hsia: No major difficulties arise rut village officials sometimes cause connicts and it is the duty of the health centre director to solve sooh problems.
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Dr. Yen says health centres do receive aid fran the Provincial Health Administration on specific programmes, such as the rabies project, trachoma, venereal-disease, etc. and that the centres, in turn,' help the stations.
Dr. Grant I Were these 72 000 people indi€ent, and if so, how is :lndigenqr determined? Is service limited to indigents? Dr. Yem Service not limited to indigents. If the patient is unable . to pay for services, he brings a statement from the local welfare representative.
Dr. Yunl and villages. Dr. Yem roughly 5 to lO%~
Asks for breakdown on budget as to percentage from county
2.3% of the county buiget goes for health and in the villages In this county it averages 2.2% of the village budget.
Dr. SanYI Since midwives and public-health nurses work in health centres, would it not be more appropriate to use public-health nurse/midwife/ social workers? Miss Hsu: The present policy is to favour nurse/midwives, rut since there are not enough they use both. Public-health nurses get social welfare work. She then explained -the train:ing facilities for nurses and midwives, and Dr. Yen expanded on this. (Miss Hsu showed some of the health education materials). Dr. Yunl possible? Miss Hsul Yes, where they have taken the additional year1s training. After increased training for nurses, are salary increases
Dr. Wu then announced that ten minutes would be the time for seeing through the centre. liter this the group had been invited by Dr. Hsu of JCRR to visit the office and exhibit of the Land Reform Programme which was nearby. Dr. R.L. Che (Rapporteur Wednesday morning, 25 September Visit to the Land Reform Office in Taoyuan The group visited the Taoyuan Land Reform Office at the suggestion of Dr. S. C. Hsu of JCRR.
r
WHO/a3T/18 page 46
Mr. Chen, senior specialist of the JCRR, explained to the group as follows: 53% of the population in Taiwan are farmers. Previousl;y, 4C/;t of tIE fanners were tenant fanners. Through land refonn this percentage had now been reduced to 1%. Land refonn was one of the acccrnplishments of tl1e rural reconstruction programme which was brought about peacefully (without confiscation and bloodshed) by the following three steps. ;r<-
(IT Reduction of land rental to 37.-5% of the vahle of the main crop yield to be assessed according to 26 quality gradings of the farm. land. On an average, rent was thus reduced by some 30%. (2) Provisicn of more farm land by selling public land to tenant farmers. Land to the tiller movement. The Government limited three hectares of paddy fields or six hectares of dry land to each owner and his family and bought whatever that was surplUS, paying a price fixed at 2-1/2 timas the value of the main crop yield, 7C/;t in government land produce bonds and 30% in shares of governmm t enterprises. Under this programne, 7r::!f, of the total tenant land was transferred from the hands of the landlords to those of the tenant farmers.
(3)
According to Mr. Chen, the land refonn helped to wild the political and military power of the Governmen t. The group then viewed the exhibits at the Land Reform Office.
Wednesday afternoon, 25 September Second Meeting of the study Grwp at Yang Ming Shan Conference Room The second conference at Yang Ming Shan convened at 3:00 p.m. and was presided over by Dr. Bierdrager. Dr. Yen referred to the report "Health Situation of the Republic of China" sul:mitted to WHO as Part I of tl1e report on the world health situation, and copies were distributed to the group members. He referred briefl;y to the Naticnal Departmen t of Health in the Ministry of the Interior and pointed out on page 5 the important components being (1) the NIH, (2) the Narcotic Controi Bureau, (3) the Medical Suppl;y Bureau, and (4) the laboratories for food and drug control. He dealt with the Provincial Health Administration. Under its progra.nma, tl1ere are 18 provincial hospitals (see page 8 of first document in Appendix 5). In each of 22 counties and cities and in Yang Ming Shan there are health centres (health departments). Magistrates are elected by the people for three years. Under him is the director of the health centre. The comtry
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WHO/CST/18 page 47 or city mayor may not have a general rospital ~d the same applies to the tuberculosis centres, communicable disease hospitals, etc. Large cities are equivalent administrativ~1y to counties l and composed of districts. He outlined the four levels of realth and medical care on tre islald, pointiIl£ out that as trey were in an emergenc.y period, what had formerly been a Minis"'"..ry of Healtb on the mainland was now a Department of Health in tlte Ministry of the Interior. He then referred to item 4.2 on page 12, point:ing out that expenditures for health were a li tUe less than NT$15 per capita per year. In the budget table referred to he pointed out that tIE figures under hospital care did not really represent budgeted funds but were expendable hospital income. 4.8% of the provincial budget goes for healtb services and 3% of the local budget. Health centres and stations give both preventive and curative services by the sama staff and he outlined the developnent of these with JCRR 1 S assistance and lecal contributions. There are first-aid medical care facilities, patients being referred to provincial hospitals, if more care is required. He explained w\w statims were under health centres and outlined the in-service training given at IPH. Stations are of three classesl A (it has as many as 11 on the staff), B (6 to 9 on the staff), and C (5 on the staff). All have a doctor, nurse (public-health nurse or midwife) and clerk. He referred to the 30 abor:4.;ine villages and the 30 health stations and 120 sub-stations, the latter without doctors l:ut wi th health workers. There are also some 411 health posts, visited once a week by a doctor or a nurse, and 12 additional recently organized health stations for salt-worker villages. Discussion and questions were invited. Dr. Grantl (1) page 5 - How far have the three functions mentioned under the National Atomic Modical Institute been :implemented? (2) page 8 Is there a hospital section in the Provincial Health Adninistratim? (a) Is there any hospital planning arrl construction? (b) Are trere allY standards of accreditation? (c) Are qualifications laid down for re alth statim doctors? (3) page 16 - Are essential statistics obta:inable in tre centres and do they compile monthly and annual reports, and are copies of the statistics reports kept in the centres? (4)· page 21 - How are the welfare agenda s related? (5) page 25 - Item 15.5 - To what extent is the mental health programme a reality or a contemplated programme, and does Taiwan have a lang-term mental health policy? (6) page 30 - Communicable disease control - How efficient, sfIiJ percentage, wise, is reporting? (7) pago 37 - Item D - Amplify the future planning under this item. (8) Describe the taxing system. (9) To what extent is the prograrnroo of the Provincial Health Administration co-ordinated with or aware of s:imilar activities of other agencies in government, such as agriculture, education, etc., at all l.eve ls? Dr. WU stated that he has prepared a briefly written report on the lhstitute (National Atomic Medical Instimte) which he is giving Dr. Grant •. Atomic medical work is being carried en in two placeSJ Naticnal Atomic Medical Institut, (NAMI), ~da cobalt 60 unit in the NTU Medical SchOOl. NAMI is being organized; has a large building with six doctors on the staff. (be has been trained for two years in the Uni versi ty of Pennsylvania. The NAMI has a budget of around NT$SO million for buildings an:! equir:ment. It
A
1/HO/CC;T/18 peco 48 has a few diagnostic X-ray machin~ s. Dr. WU cons·.: "lors cancer as the most important world health problem, end expla:ins the increase in cancer as partl¥ due to better diagnosis. He expla:ined hopes for the expansion of NAMl and hopes for further support from his Government and from lCA. He plans practical and research work. The scope of the work includes research, survey, and clinical ~lOrk. He says that the work will actively canmence at the beginning of next year and this will bo important for radiological defense. NTU has a laboratory and will have cobalt machines. Dr. Grant: Does NW have adequatol¥ trained people?
Dr. WUI No. One man span t several weeks in the United states and another is now in Europe for a month after which he ·will visit the United states. Inasmuch as Dr. Grant had to leave to deliver a lecture at NW, it was agreed to defer answers to the rest of his questions till a later session.
Dr. Downes: Page 8 - Are the envirormental sanitation services shown in the second section of the Provincial Health Administration under a doctor or a sanitary encineer? What is the relationship of this service to the Insti tute of Environmental Sani tation? Dr. Yen: The service in section two is the administrative part and the IES is operational and does field work and trainillf. Dr. Downesl What are the qualifications of the head of each and what is the extent of collaboration? Dr. Yen: Section two is headed by a public-health doctor and the lES
by a sanitary engineer and they work closel¥ together.
Dr. Nolasco: What are the criteria for A, B and C centres other than the number of personnel? Dr. Yenl Area and problems are taken into consideration. Naturally, if they need and can afford additional personnel, they are encouraged to employ. A question was asked as to the annual per capita expenditures for public health <nd Dr. Yen replied that it was NT.015. Dr. Yun referred to page 8 and asked for a clarification of functions under the seven th secti on • Dr. Yen explained that this was a new section. The Government is retiring some 80 000 soldiers, of wham 20% are in need of medical and hospital care. The decision was to utilize civilian medical care facilities, placing this under the Provincial Health Administration, rather than set up a veterans I admini strati on •
~li;O/CST/le p2r;c 49
Dr. SanYI (1) Is there scme kind of code for behaviour of practitioners of medic:ine and if 50, is a copy available? (2) Is there an institute of forensic medi eme eo that doctors are available for medico-legal worl<:? (J) Is there a general association of medical practi tioners? .Dr. Yenl (1) There is no written code but behaviour of doctors and matters involving ethics are handled by medical societies, national or prov:incial. (2) There is no institute of forensic medicine but a departlJEnt of forensic medic:ine exists in NTU Medical School. (J) TOOre is both a national and a prov:incial association of medical practitioners·. Dr. Sasp Dr. Yenl Is participation in the associations compulsory? No.
Dr. Nguyen I Page Jl - (1) A decreaso is noted in all diseases, except diphtheria. Wlv is this so? (2) Are inoculations compulsory? Dr. Yen: (1) They are near:ing the end of tIE second year of a campaign against diphtheria and perhaps diagnosis and report:inG are better •. (2) Inoculations are not compulsory. Dr. Phetsirisengl As far as environmental sanitation is concerned. cb you have water-borne sewerage systems? Dr. Yenl None as yet, but this is planned for Taipei.
In order that th:l Be able to might hear Dr. Grant le cture at NTU, the meet:ing adjourned some JO m:inutes earlier than usual. Dr. R.L. Cherry (Rapporteur) Thursda;y morning, 26 September Visit to the Taiwan Anti-Malaria Research Institute Chao-chow, P:ing-Tung Address:ing the study group, Dr. CheJ;l., the Director of tID Institute, expla:ined that the Institute was created in 1945 by the Rockefeller Foundation and was handed over to ihe' Government two years later. The DDT campai~ started :in 1952 wi ttl the assistance of leA and WID. Before the war, over one million persClls' suffered from malaria in Taiwan and 25 000 deaths were recorded per year. In 1952 tIE DDT campaign covered 150 000 inhabitants, in 195J, 1500 000 and in 1954,5 500 000. Apart from highly malarious areas, the province is being treated wiih DDT annuall¥ and tIE spleen rate fell from 0.6% to 0.0%. In 1955 it was decided to start tID malaria eradication campaign and it is hoped that eradication will be achieved by 1960.
WHO/CST/IS page 50
Dr. Phetsiriscng mentioned the problem of the treatment of germ carriers. In Taiwan only inhabitants of highly endemic areas receive treatment as supplement to the DDT campaign. Dr. Domes wanted to know whether t .• minimus was the major vector am whether A. sinensis was also to be found. Dr. Yamaguchi asked whether thore was p.ny resistance to DDT. none had been observed. So far,
Dr. Sany raised the point concerning the existence of highly endemic areas. In his reply, Dr. Chen said that certain local conditions, such as the presence of new groups of population in certain areas rendered the DDT campai gl sanetimes ineffectivo. Dr. Shu mentioned the contribution of Chinese malaria workers to Wl.O and other countries. Apart from malariological studies, filariasis was also being studied in this Insti1llte. In this respect. the treatmmt with hetrazan has given satisfactory results in 80% of all cases. Dr. Yen then spoke of the cost of the operation which alOOunted to NT\)30 000 000 for 7 million inhabitants. Forty-two per cent of the total cost was borne by foreign aid, 34% of the rest by local governments and 9f, by the Provincial Government. The entomological and parasitological laboratories of the Institute were visited and the group was shown the DDT spraying equipnent and very good statistical tables. The group also observed the work of DDT sprayin[ teams in Kan-ting (Ping-tung) • Dr. Nguyen Tang Nguyen (Rapporteur) Thursday afternoon, 26 September Discussions at the Ping-Tung Prefectural Government Hall and Visits to the Ping-Tung Health Station. the Composting Project and the Kaohsiung Medical College The study group proceeded to the Government Hall at Ping-tung and was welcaned by the Magistrate. A discussion was held on the report of the prefectural health centre. Dr. Sany wanted some infomation on the statistics of infan t mortality and asked far details concerning the measures taken in order to control the main causes of death (gastro-entcritis and broncho-pncumonia). In his rep~ Dr. Yen said that health education was carried out in the homes and preventive measures were advocated in ordor to avoid those diseases which ha:vo gradually diminished during the last few years.
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WHO/aIT/18 page 51 As regards smallpox :iJrmunizations, the campaign was going on despite the fact that the disease had disappeared a 10Il€ time ago. This was to avoid epidemics which could pcssib~ be :impcrtod from outside. This poliq was also adopted in New Zealand. Tetanus vaccination was discontinued after 1952 after the introduction of the triple DPT vaccination. The Chao-chow health station (Type C), with its small laboraiory and two coosultation roems, was visited. The group then vi si. ted the eXIEr:iJnental compostin€: plant at Ping-tung where discussioos were held. This was a composting plant where the composting process took 20 da;ys. Workers placed the refuse on a conveyor belt and the refuse was ground. After the grinding, it was placed in fermentation aroas where blowers had been installed. Dr. Yung explained too developnent of the station and the difficulties met at the beginning. part of the installation cost was borne by JCRR and assistance was received frem lCA and WHO. The sale of paper at NT 40p per kilo consti illted a partial income of the station. Furthermore, the compcst was sold at NT$28 per ton, which brought a supplemEntary :income of NT$l50 000 a year. A question was raised regarding the quality of the compost. Apparen ~ the quali~ was very good and hig~ appreciated b,y the farmers who were eager to use the partial~ completed cempost for sandy soil. Furthennore, too nitrogen content of the cempost could be increased b,y the adcli tim of ni3htsoil and the temperature maintained at 700C and the humidity at 60)1:. Air msufflated two or three days, gives a better ·cempost. The temperature of 5~70oC was sufficient to kill all the paraSites, includ:ing ascaris.
Dr. Bierdrager asked what was done with the bagasse and Dr. Yung replied that compostmg was done by having layers of bagasse and pig manure. .~
. Ci~.
Dr. Wu asked wJw no cemposting project was being planned for Taipei
lh his rep~ Dr. Yung said that plans had been establi~ed and all that was needed was the agreement of the municipal authori ties of the city. Furthemore, a larger plant was necessary since the municipal refuse was quite bulky.
Dr. Nguyen asked whether rain did not wash away some of the important matter :in heaps of refuse and :impaired the process of femen tation. Dr. YUIlb replied that rain water was collected and poured over the heap s of refuse after the rain had stopped. Therefore, ra:in did not influence the quick process of aerobic fermentation. Dr. Phetsiriseng asked what was the quantity of compost necessary to fertilize a field of 40 metres b,y 40 metres.
WHO/CST/IS page 52 Dr. Yung said that there was a table mdicatmg the various quanti ties of artificial fertilizers required and e:ivmg a comparison with the compost necessary. Dr. Downes then asked whether all gonns woro killed at the temperature of 700 C and the answer was affirmative. II
The group thon visitod the Takau private medical school.
Dr. Nguyen Tang Nguyen (Rapporteur) Fridaymorning, 27 Soptember Visit to tho Tainan Tuberculosis Control Contre and the Taman City Hearth Centro
en Friday, Z7 September, the study group travelled no rth on the isl?nd and made its first stop at Taman, where the Tuberculosis Control Centre and the Health Centre were visited. At the latter, only public-health laboratory work is undertaken, and out-patients are sent to the hospi tal. Dr. H.E. Downos (Rapporteur) Friday afternoon, Z7 September Visit to thG Natvrnal an,: Chile: H~alth
I
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Centre, Taichung
At 3:45 p.m. on arrival at Taichung, the group met at the provmcial hospital where the Maternal and Child Health Centre is located. The group was addressed Qy Dr. Peng, leader of tho Maternal and Child Health project at Taichung. He referred to the tram:ing courses for doctors and midtnves from the hoalth stations and also for private midwives (of whom 1400 are practising in Taiwan). In-service traming is also given Qy a visitmC supervisory midwife. Dr. Yen explamed that the project is under an advisory board responsibJe to the Provincial Governmen t.
The hospital under Dr. L:ing makes 30 beds avai:Lable for demonstration in midwifery and also m paediatrics, and 10 health stations provide tIE fielO
work.
WHO/CST/18 page 53
A reply was given to Dr. Cherry conceming the adm:inistrative organization of maternal and child health in the island. Dr. Sany was informed of the maternal and infant mortality. The former was 1.?9/J.J:JOO in Taichung County in 1953, and the infant mortality for the whole island in 1955 was .3.3.89/1000. The causos of infantile mortality in order were gastro-ent er1tis, bronchitis and broncho"';Jlleumonia, congenital weakness, and lobar Jlleumonia. Dr. Grant spoke of tho desirability of all public-health activities being taught at one centro. In answer to a query by Dr. Sany, it was replied that /OOst babies are breast-fed.
Dr. Nolasco commented on too non-professional attendance at delivezy and it was disclosed that 13% of mofuers in the local distri ct was atten:1ed by such persons. The co-operation of mid,rives with local health stations is he:ing pursued, partly by giving these people a refresher course. Dr. Downes asked a question conceming abnormalities of obstetrics. When necessary, these are sent to the hospital. Dr. HoE. Downes (Rapporteur) Saturday morn:ng, 28 September Group Discussions at the Evergreen Hotel, Sun Moon Lake The frtudy group met in conference in the mom:ing and continued discussion of the ooalth situation of tb.e Republic of Ch:ina, as suggested by the series of questions posed by Dr. Grant.
(1) Is there a hospital division in the Provincial Health Adm:inistra(2) Within this divisiro 1:: tnere a hospital planning section? ~e s ecial qualifications-required l'or appoini:.ment to medical sts at heal h stations? tion? Dr. Yen replied that the prov:incial Health Adm:inistration had a Hospital Section which was purely administrative in function. Hospital planning and construction was dealt with by a committee of 18 hospital administrators. The Standing Committee of this body invited experts to. assist, but the Committee's jurisdiction was limited to prov:incial h:>spital planning. It did not appear from the discussion on this question that an overall survey of hospital needs in the various categories had been made. As regards qualific,ations required for medical officers appointed to baalth
WHO/CST/18 page 54 stations, the situation was governed by the inability to get enough doctors to enter such service. If licensed by the Hinister of Interior to practise medicine, a doctor was acceptable, but appointees were given two months' training in public health at the Institute of Public Health. Several points raised in the discussion w"rel Was there any s?,ciaJ. accrediting and licensing of specialists? At the'molOOnt, there is none. Pronded a doctor :LS licensed to practise and is a manber of the China MedicaJ. Association, he may set up as a specialist. A special board is reing organized to deal with this situation, but it is not operating yet. It was sugcested by one study group member tmt the provision of hospital beds was not as urgent a problem for Taiwan, with one bed to approximately 2000 population, as the training of more doctors. One of the three medicaJ. schools was a private one. This was bad in principle, and he suggested the Government might well consider strengthening and taking this institution over. Another member considered nursing training at the central level should be discontinued and nurses and laboratory technicians trained more in hospitals, thus saving lIDiversity ?,rsonnel a!Xl enabling more training of doctors. It was pointed out that before there could be more local level training, more instructors were necded, and this was the function of the collegiate training of nurses. As nurse instructors became available, more hospitals would be used in local training of nurses. Do stati stical reports of the health stations go to the Provincial Health Administration regularly and are these accurate? These reports are received regularly at the provincial headquarters, some monthly, Bome amually. They are accurate. One study group member considered their accuracy was doubtful, as there was little employment of autopsy in checking causes of death. In his experience, without autopsy guidance there would be an error in diagnosis of the order of 20%. What co-ordination was there between the Provincial Health Administration and the Welfare Administration? The Provincial Government has 14 divisions and includes social welfare. The tie-up with the health administration is satisfactory. For example, the Provincial Hoalth AOninistratioo is represented on the committee dealing with social insurance, and thus reduplication of medical services is avoided, and the out-patient department services used for insurance purposes. Whereas the Welfare Department budgets for old people's homes, the Health Department assumes responsibility for the medical services of these. The Department of Reconstructioo supervises industry, including its hazards, but both Health anc' Welfare Departments have personnel seconded to this department to obta:in co-ordination and avoid overlapping in supply of services. There were extremely few hespital beds in China for mental disease. Instead of building more and more beds, had China !lIly policy of developnent of community centre clinics and canrntmity machinery to detect mental disease early 2.nd deal with it before the need for a hospital bed develo?,d? At the moment, no. But it was hoped to train personnel in the future and to utilize the provincial hospitals as centres for clinics. '
·. WHO/CST/18 page 55 How efficient was the reporting of cOllll1lunicable disease? The government :Institutions Were efficient, but private practitioners inefficiEHlt. The GoverI1llent had offered to let doctors use the government laboratorie s to increase tIE accuracy of diagnosis. On~examinations for tuberculosis and venereal disease were free. The response was few, so far. One member noted sample surveys had shom 62% of goitre. Why did the Government not iodise salt for the nation as salt production was a naticnal monopol)y'! In Taiwan goitre was endemic in certain mountainous areas on~. The Government did not consider island-wide iodisation necessary, as the plain regions used fish, and fish and seaweed soups, large~ in the diet. Halever, for the endemic areas, the Government had set up a plant and was iodising salt for supp~ to such rOGions. How did the taxinG system enable the local people to participate in health activities. The provincial taxing system was explained in detail. In effect, villaces collected all forms of taxation, an:! in the bldgeting at provincial level a proportion was returned through county budgeting approved at provincial level. The difficulty was always to obtain a due budgeting proportion for health, and here the health eentre directors had to be active, in the first place to get a proper allocation for health and secondly, to see that later no diversion of health funds to other purposes occurred. In addition to this provincial taxation, a proportion of whim came back for health purposes, the village office provides 100;1: of the operational coat of the health station and usually raised ':IJ% of its construction cost. They did this for other purposes, too, such as education. The Provincial Health Administration had the ri!tJ.t of oversight of the village proposals am of their planning thereon. The study group members from Japan and Australia !IIl.de comparative statements as to their central €pvernments I methods of bliigeting for health needs. How effective was co-ordination With other government de tments? At the provincial level, very €p od, indee. There was fee J. ve lia sen with Welfare, Reconstruction, Education, Agriculture, Police, and other departmEnts. At the local level, the liaison was not as gcod as desired. A start had been made through 4-H clubs wortdng closely with health centres in carrying out extension work in the field. Extension work in liaisen with other government field workers needed developnent. Was the Fami~ Planning Association of China aChieving rosults as good as in Japan? EAperier.c~ in this regard was brief. China cl1d not believe :in sterilization or abortion and had no laws legalizing those, except en the strictest medical grounds. It had not been made official for health stations to teach birth control, but they worked in with the Fami~ Planning ASSOCiation, maternal and chUd health staff doing tho instrucr..orial work for the Association. Midwives were given training at the health centres in contraceptive methods. The study group spent part o£ the afternoon sight-seeing on Sun Moon Lake and in the evening were entertaine9 at dinner b,y the Taiwan Provincial Health Administration. Dr. H.B. Turbott (Rapporteur)
~rrIO/CST/18
P"CC 56
Monday moming, 30 Septanber Final Moetine, Yang Ming Shan Conference Room The final session of the group met on Monday, 30 September at 9100 a.m.
I. The group leader and chairman of this session, Dr. Bierdrager, referred to an informal meeting of the leaders and rapporteurs the previous even:ing and reported on its findingsl 1. 2. The host comtries and the Secretariat had efficiently performed the ir f1.1'l ctions. The pros ru~d cons of having a bilingual group were discussed. The conSensus was that in spite of difficulties of interpretation it was desirable to have a bil:ingual group. The periods for discussion were limited, and time should be available for participants fram other than host countries to comment voluntarily on and to make a comparison of procedures :in their own comtries. No f:inal resolutions and recommendations should be made, but that the final m:inutes, together with the earlier ones, should be circulated to all participants for comment prior to final consolidation by the Secretariat. Tho consultant's report should also be circulated in draft form for comment and finalization by Dr. Grant. This was fomd acceptable by the group.
3.
4.
II. vies.
Tho chairman then said that evaluation should take the form of sectional
1. Education 1.1 Medical Education Dr. Downes sugr<Jsted that Japan I s mdergradua te and pJ.blic-heal th education were good and that Taiwan needed more medical graduates possibly by support of the privately sponsored mivorsi ty in south Taiwan. Dr. Grant stated that tho social and environmental aspects of medicine, as suggested in WHO's technical report series, needed strengthen:ing in both countries. Dr. Sany suggested that a corps of speciali sts in Taiwan should be formed. Dr. Downes and Dr. Turbott said that public-health per son 00 1 both :in Japan and Taiwan should be of good calibre by making remuneratim on
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par at least with private practitioners.
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57
Dr. Grant and Dr. Turbott suggested that public-health medical staff should be encouraged to obtain additional qualificaticns, as is the case in the Philippines. It was agreed that full-time public-health work was necessary. 1.2 Nursing Education Dr. Turbott commented that in both countries the planning is sound. Dr. Downes added that realistical~ an adequate number of well-tra:lned nurses wore essentia1. lil answer to a query by Dr. SaI\Y, Dr. Yen said that graduate nurses
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would have appropriate remuneration, and Dr. Yamaguchi :Indicated that rublichealth nurses in Japan received similar higher salaries. 2. Malaria
Dr. Downes stated that the anti-illalarial efforts were excellmt, and the members of the group agreed. Dr. Cherry spoke of the Institute being admirab~ suited tor regional training purposes in this part of the world and referred to the other centres in Thailand and the Philippines.
3. Trachoma Control ,~ 4. No comments were made. TUberculosis Control
Dr. Downes referred to the valuable work beinr dene in both countries in this problem of first importance. Techniques differed (Old tuberculin in Japan as compared to PH> in Taiwan, and Japan used freeze-dried BCG, but valuable work was being dane). Decades of further work were necessary. historica~,
Dr. Yun referred to housing and economic conditions ard. addod that, this was clear~ associated.
5. Environmont[l.l r.n.n1tc.tir;':! Regarding compo sting plants, Dr. Sany commented that the Taiwan plant was much Simpler than that at Kobe, Japan, and asked conceming water supp~. Dr. Yen replied that the camposting plant in Taiwan was designed to serve rural small town refuse disposal. Regarding water supply, 27.3% of the population was covered. Dr. Yamaguchi said that both the Kobe and Taiwan plants wore on the experimental stage and the former was designed to solve the problem of large c1 ties.
WHC/CST/18 page 58
Dr. Downes referred to the compostmg plants as meeting only a snall part of environmental sanitation and commended the holding of nightsoil to eliminate bowel infestations and infections. Dr. Cherry stressed the need of more education of the public-health nurse m the basic principles of errvironmen tal sanitation for the purpose of carrying this message to homes and of improving home sanitation in the villages. Dr. Sany referred to the water problem, worse in rural ar€as, garbage and nightsoil disposal in urban areas. Dr. Turbott replied that the ccmpostmg had no effect to date on nightsoil disposal. Dr. Sany agreed that composting did not solve the nightsoil problem. Dr. Yamaguchi referred to the economic problem of nightsoil disposal by a sewage system, and where this is not available, they are setting up concrete digestion tanks system (30 days). These will not be wasted as they will be used as a final recipient of effluent from a sewage systan. Dr. Cherry emphasized the need for improvemerrt. in home handling of excreta in poor homes in the villages and said that it was necessary to devise a cheap covered container for the local holding of nightsoil, and this had,the approval of Dr. Yen. 6. Venereal-Disease Control No comments were made. A'
7.
Maternal and Child Health
Dr. Sany said that at Taichung he had questioned the extEnt of breestfeedmg, and asked what was bemg done about the two chief causes of mfant death - pulmonary infections and enteritis. To the first query, Dr. Yen said that i t was traditionally usual to breast-feed, but because of lack of breast milk supplemental feeding was necessary. Health education was being used in an attompt to reduce the two chief causes of infant mortality. Dr. Cherry comrncnded the very effective work being carried out by the Maternal and Child Health Insti -rute, particularly the training given to nurses in basic home sanitation. He hoped that the Institute of Environmental Sanitation would co-operate wi th the former. III. The chainnan invited Dr. J. B. Grant to speak on co-ordination and integration of health services. Dr. Grant recalled that he attended s-ruqy tours in Europe in 1949 and 1950. He said that WHO had now published 130 technical reports and believed that study groups should see how far host countries meet WHO's recommendations although these are compromises.
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WHO/CST/18 page 59 He referred to docunent WHO/CST/5 regarding planning, training and co-ordination at different levels. Both the United Nations and lCA now have sections on community development to co-ordinate health, education and agriculture, and other welfare a[;1Jncies. He spoke of Technical Report Series 122 regarding the oospital as tIE focal centre of regional health activities. Regarding the levels of publichealth aaninistration, there should be manuals concernine procedures at national, provincial and local levels.
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Regarding integratim, he was pleased that Dr. Yen had refused permissim for insurance groups to set up their own hospitals. Dr. Grant believed that there should be co-ordination of health activities of the m:inistires, and emphasized- the necessity of proper channels and control from the periphery to the centre. Concerning public participation,\<l!O believes :in self-help and applied crucial tests as to the extent of this. As an example, DDT spraying teams on a voluntary rather than a paid basis would save public funds.
Dr. Grant referred to regionalizatien, meaning co-ordination and :integration in Puerto Rico, where $32 miilien are spent annua~ for all health care services on a populatiCl'l of 800,000. Co-ordination increases efficiency, The private practitioner should be used more :in public-health work and group practice is :increas:ing in England. He described the varieties of duties :in the state medical officers :in Puerto Rico. Central purchasing and servic:ing promote efficiency. Medical educatiCl'l should be oriented toward such :integration. Students have a stipend and serve health centres for a similar number of years. Each regicnal office costs $400 000 per annum am is good value. Dr. Grant tlEn referred to Taiwan, and commended the wonderful improveIWllt in the past ten years, health stations havine increased from 15 to 368. He said -that tlEre was a necessity for more per sonne 1 and greater co-ord:ination. The budget for the Institute of Public Health was ridiculously low. He sugeested the need for a reappraisal survey of the needs of Taiwan. Dr. Turbett regretted that there was no tizoo to c.iscuss Dr. Grant's remarks on co-ord:ination and integration. However, re ar:reed on :integratial.
Dr. HoE. Downes (Rapporteur) Dr. Downes prefers co-ord:ination and integratien as terms but disagrees regarding regionalization in Puerto Rico and elsewhere. Feels that tuberculosis and venereal disease, for example, are being integrated. Asks Dr. Grant to p:inpo:int lack of co-ord:ination am integration. Refers to the
WHO/CST/18 page 60
decree of nationalization of medical pcrsoonal. says -that Dr. Grant states tln t one of three doctors in Puerto Rico is a goverl1!1lent employee and is trying to attract more by subsidizing students r edu caticn. Is this good? Disagrees with Dr. Turbott on the necessity for integration at all times and cites the example of Australia in effecting almost 100% Salk vaccination under the age of 14, done by private practitiOilers. says Dr. Grant's programme :Wads to the nationalization of medicine, therefore, he disagrees. Regarding co-ordination and inte[ration, these are not really a Taiwan prob:Wm but lack of co-ordination in international aid and cites the Co-orGination Committee in the Philippines. Dr. Grant replies in the reverse ordor and states that the co-ordination committee was set up in Taiwan before the Philipp:ines. Regarding regionalization, he refers to the Hill-Burton Act am its second purpose regionalizaticn. (Dr. Downes has saie that the United states would never accept regionalization.) states are required to set up co-ordination committees. Construction proceeded but regionalization l<'.f.;ged and supplementary legislation am funds were passed by Con£ress to allow study and implementaticn of regionalizaticn; and puerto Rico was the first state to institute a comprehensive scheme of co-ordination and integration. says here lack of :integration between public health and medical care exists. Most Puerto Riean cbctors leave the health service after graduation but only because of low pay. Therefore, sane geographic private practice is allowed, using government facilities. Dr. Yen feels co-ordination of health services and medical care falls in three levelsr (1) national :Wvel - Ministry of Interior has a co-ordinaticn committee of representatives of the Provincial Heelth Administration, medical schools, nursing, WHO, ill'ICEF, rCA, Military Advisozy Assistance Group (MAAG), Navy Medical Research Unit (NliMRU), etc., who meet every Saturday to prevent overlapping and reduplication of int£rnational aid, discuss special projects, etc. Minutes go to each member and WHO; (2) provincial level - county health officers meet bi-monthly with the Provincial Health Administration; hospital administrators meet every few months; (3) local J.J;vel - directors of health centres meet ro[ularly with health station chiefs. Thero is lack of co-ordination between public-health and curative facilities in local areas and points out different sources of budget. Asks Dr. Grant to whClll health officers in Puerto Rico are responsible. The three levels here present difficulti£s in co-ordination but it is being tried in one or two areas and the new policy is to try to have health centres on hospital grounds, to avoid·cuplication of OPDs, laboratories, etc. Cites Taichunc and other attempts. Feels that publichealth doctors should have clinical experience. Also, regarding integration, or lack of, answers Dr. Turbott's earlier question and says this is policy gradually beinG effected. Cites venereal-disease and tuberculosis integration and malaria prorrarnme integratim into stations. In tuberculosis, m)bile t~ams (BCG) are operated from centres. Specimens (sputum) are collected qy stations. Hore integration is planned.· Trachoma is done by centres and stations, in the schools. Refers to Dr. Cherry's statement on household sanitation and the JES must prepare data for nurse training. In all WlO programmes, integration is the ultimate aim. Dr. Grant says that Taiwan is more fortunate than Puerto Rico because it did not have the early United states influence which sernrated public health from curative. Puerto Rico had state health units, welfare units and municipal medical care, and the latter was inferior. The state now pays on&-half and the mooicipality pays one-half for hospitals, and too state appoints professional personnel. In regionalization, perscnnel are
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WHO/CST/18 page 61 responsible to the regional office and the director of th~ latter is really a deput,r secretary of health. Although welfare, medical care and public health are brought under one roof, it still lacked administrative co-ordination. Dr. Wu thanks the group on behalf of the Government of China. Feels that the tour has been interesting and educatimal and well arranged. Thinks that the conference and stuqy- tour is not onl¥ an educational exchange rut it promotes goodwill between nations. Programmes arranged from Japan were excellent, profitable and enjoyable. Hopes that all enjoyed the tillE spent in Taiwan and that conferences will give more time for discussion in the future. Appreciates Dr. Grant's great contribution and hopes that all will meet again in Manila in 1958 and in Taiwan in 195'). Thanks all. Dr. Bierdrager, as group leader, thanks all, especially the Japanese and Chinese Governments, the Minister of Health in Japan and the Minister of Interior in Taiwan. Thanks Dr. Yamaguchi, Dr. WU and Dr. Yen and all the participants. Thinks that the tour is highly appreciated by participants and hopes that the discussion will stimulate better carrying out of their jobs. Meeting adjourned. Dr. R.L. Cherry (Rapporteur )
4.
CrnSULTANT'S REPORT
The health organization of the League of Nations anployed travelling seminars with considerable success. These mayor may not have been related to the meetings of the fomer Far Eastern Association of Tropical Medicme wlDse congresses included field observations by the participants. The European Regional Office of the World Health Organization revived the mechanism with considerable benefits acknowledged totb by the participants and by the host countries. The travelling seminars permit the host countries to observe their own activities through the experience of experienced administrators from other countries. Experience to date has shown that travelling seminars are most valuable in public-health administration. The travelling seminar held by the Regional Office for
WHO/CST/IB page 62
the Eastern Mediterranean of the World Health Organization in December 19:5 SUIllI1IB.rized the main objectives as follows:- "By visiting selected countries to see their health services in action (i) to stimulate interest in public-health orGanization and administration in all the countries in the Region, rot the least in the host countries; (ii) to provide opportunities for the interchange of thought and experience across the national frcntiers; (iii) to broaden the outlook of all taking part (including leaders, participants and field workers in the
countries visited)} and (iv) to establish and foster contacts between public-health administrators in the different countries taking part in the Seminar."
An international:q emerging trend in public health is the growing consciousness of the need for evaluation. Evaluation implies yardsticks. Such yardsticks were not available :in the earl;v study tours in the European Region. Discussions consequently had to be limited to the specific brochures prepared by the host countries and to the activities which were inspected. The situation is entire:q changed :in 19;Jl. WHO, in the past eight years, has published some 130 technical reports on almost every aspect of health care services. Those relating to organization, administration and training laid down minimum principles. The consultant, when invited to participate in the study tour, suggested that pertinent Technical Report Series might be abstracted to serve as points of departure in discussing the ackninistration of the host comtries. It was hoped that specific activities could then be discussed' :in terms of the overall organizational picture of the country in question. Consequently, the Secretariat of the WHO Regional Office for the Western Pacific prepared documents 1 to 9 relating to planning, organization and administration of health services and cCIl1lllunity developnent. Document 5 abstracted the principles from Technical Report Series Nos. 22, 55 and 83, relating more specifically tOI (a) the organization and administration of health services, particularly as to the functions of different lovels, (b) prOvisions for popular participation, (c) planning and assessment, and (d) unc.ergraduate professional training. Both host countries prepared excellen t overall reports of their national health organizations ane services. It was anticipated that these would have been discussed in terms of documents Ito B before proceeding to a discussion of documents 9 to 17 relating to the specific institution anJ activities observed so that the latter could be sem :in terms of the overall trends in the national picture. WHO Technical Report 122, "The Role of Hospitals in Community Health Protection", di scusses :intecration and co-ordination under regionaliza;li!,.~, The first principle of sound ackninistration enunciated in 191B by thvii1ffi~§f1ry
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rlHO/CST/1B page 63 ._~ Reccnstruction pointed out that any functions required by a conununity should be d,;.scharged by a single administrative agenqv for tho whole comInlrlity rather than by separate agencies for special sections of the population. Failure to observe this administrative principle results inevitably ,in overlapping and -unnecessary expenditures.
Both the United Nations and lCA have established sections on community developnent and each has issued directives to regional or cOlntry offices that, in so far as pOssible, new projects in the medical field should be co-ordinated as closely as possible with other nation-building activities within a programme of comrmmity developnent. Documen ts 6 to 9 ccncem themselves with the ,question of community developnent. Unfortunately, discussion of the broad principles covered by dOClJll6nts 1 to 9 did not come up until the em of the last day's conference. This reversal of too agenda for discussion was due to time limitation occasioned by two reasons. First, it was only natural that the technical field activities should be discussed after observation. Second, the reports on public-health administration in Japan and Tawan raised questicns of organization to be answered before the group participants comprehensively discussed the organizaticn and administraticn of health services. The foregoing raises two suggestions for futuro study tours. First, early circulation of the national reports would permit questicns to be subnitted in advance of the tour and enable the host countries to provide the necessary supplementary information required. Second, descriptions of institutions and activities to be visit.ed might have an appendix abstracting any pertinent reconunendation of the specific WHO Technical Report. Series and thereby constitute a point of departure for discussion. The consultant has had a knowredge of Japan extending over 30 years. The progress made in health care services is impressive. However, observations in Kawasaki -c i -1:,- y indicated inadequate co-ordination between hospitals and outlying dispensaries with too numerous health centres now established. OperatiCll research should be an important research activity, particularly of the Institute of Public Health. The latter, haoever, to undertake such research most effectively, should be delegated with the responsibility of administering a technically selfcontained community where eKpElrimental methods and procedures could be worked out. Such an adequately controllid conununity would provide the Institutes with much more effective practice fields for training, as is the case wi til teaching hospitals, than through merely a collaborative scheme of using purely service health centres administered by non-teaching agencies. The last day's discussion in Japan raised the question of the administrative weakness, particularly in the medical care field, of overlapping national agencies, each being permitted to establish its own medical care agencies with the potential danger of unnecessary and expensive overlapping. A detailed study would be required to substantiate this statement and to make the legislators aware of fUture consequences, if present trends continue unchecked.
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WHO/CST/18 page 64 The situation in Taiwan led tm c:.sultant to submit for ·');cussion the following suggestions as to possible steps to be taken by the Government. The progress in Taiwan during the past five years has been phenomenal •. Few oountrie'l have seen as succcssful mass campaigns in malaria, tUberculosis and trachoma. The former~ unco-ordinated medical institutions are now consolidated into a modern medical school and the university hospita.l has been reorganized to provide graduate training in the clinical fields. The province has literally been blanketed with health stations even in the remotest areas. This tremendous progress has now constituted a very real crises of effective organization and of adequacy of personnel, which must be met within the next five years, if the gains are to be conserved efficiently for the future. The solut.iro of the first problem is to consolidate effective~ the several categorical health activities wi -thin a single unified organization !\1d acininistration. It must be obvious, both for permanency and economy, that Taiwan cannot afford to continue the present diversified administrat ive branches which were essential during the impact period of concentrated attack on specific problems. Local surveillance control should be integrated wi thin the health centre s and statiros. These latter in turn should be co-ordinated and integrated with the hospitals within designRted regions, Which preferab~ should stem fran a university m=dical centre. Those steps are indicated by both principles of good permanent administration, as well as by realities of finance wren the not inconsiderable bi- and multilateral support is withdrawn. The solution of the second. problem is to strengthDn, both intra- and extramurally, the Medical Centre's facilities in research and training for thD health services. The present "hard" budget 01' the lilstitute of Public Health is ridiculous. The much needed short refresher courses given during the past two years were financed qy grants-in-aid. The Institute lacks its own community resoarch and practice field. It should be comprehended that no Taita gradoote during the past ten years has entered public health. The whole future of public health in Taiwan will be endangered unless this situa ti.on is corrected in the imm=dia te future through supplementing the Institute I s personnel shortage and providing adequate community research and practice facilities. These two solutions will require some 1'ive years to acoomplish, and addiM.onal new funds over the period of an annuRl average of $250.000. However, tho foregoing is conjectural until a canprehensive rurvey is made of the present organizational status of too health care services and the research and training facilitio s required to staff them to provide tre best distribution of quality. The alternative is to permit the present expediency categorical drift to continue with the result in ten more years of an unnecessary but vested interest, bureaucratic confusion of administrative bureaux and insti 1lltes wi 1h low quality of performance because too responsible indiviruals in 1957-58 saw only the cross-section 01' 1958 without reference to 1975-2000. The foregoing is in exempli1'icatian of the consultant's recommondation that evaluatioo should constitute the specific objective of discussion in future stuqy tours and that such evaluation should utilize any available yardsticks as a point of departure for the discussions.
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5.
LlBT OF PARTICIPAN'IS
WHO/CST/18 page 65
AUSTRALIA
Dr. H.E. Downes Assistant Director-Gcneral of Health Department of Health Canberra Dr. Phav Sal\V M6decin Chef H6pital Preah Kot Nealea Phnan-Penh
Rapporteur
CAMBODIA
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CHJNA
Dr. C. Wu Director Department of Health Administration Taipei Dr. C.H. Yen Commissioner Taiwan Provincial Health Administration Taichung
Co-leader
Rapporteur
JAPAN
Dr. M. Yamaguchi Chief Public Health Bureau Ministry of Health and Welfare Tokyo Dr. N. Seijo Chief Health Centre Section Public Health Bureau Ninistry of Health and Welfare Tokyo
Co-leader
KOREA
Dr. Yu Sun Yun Assistant Directar Na tional Institute of the Prevention of Infectious Diseases Ministry of Health and Social Affairs Seoul Dr. Thongphet Phetsiriseng Directeur-Adjoint de la Sante publique Ministry of Public Hcr:lth and Social lIclfare Vientiane Dr. J. Bierdrager Director of Health Hollandia-Binnen Group Leader
LACS
NETHEIlIJlNDS
,.. WHO/CST/18 page 66 NEW ZEALk.'ID
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Dr. H. B. Turbott Deputy Director-Gcneral of Health Department of Health Dr. J. A. Nolasco Director
Rapporteur
PHllIPPINES
Bureau of Health Department of Health Manila UNl'IED KTIlGD0l1
*Dr. P.H. Teng Assistant Director of Health Services Hongkong **Dr. R.L. Cherry Chief Public Health Division US-lCA Mutual Security Mission Taipei Dr. Nguyen Tang NgWen lnspcctcur general de la Sante Mini stry of Health Saigon Rapporteur to
UNl'lED STATES
China Rapporteur
VIE'lNAM
WHO SECRETARIAT Dr. J.B • .Gre.nt Censultan"t; Dr. COY. Shu Regional Public-Health Administrator WPRO, Manila
Mr. J.P. Schellenberg Interpreter-translator WPRO, Manila
Miss P. Farro Secretary WPRO, l1anila
** Dr.
* Dr. Teng visited Japan only. Cherry visited Taiwan only.
• HHO/CST/18 APPEND lX I-a
HBALTH PIANNlNO*
Summary As health planning is a basic part of ever,y type of health work, it is of direct ooncern to ever,ycne connected with a health organizaticn regardless of indirect functicns or responsibilities. The author suggests that health planning should be approached in the following mannerl (a) what is the most desirable method to co-ordinate health
planning, (b) to what extent and in what way can economic consideraticns be integrated into health planning, (c) what elements for community co-operation must be included in health planning. These points are discussed briefly.
*Paper presented by Dr. O. R. McCoy, Rockefeller Foundation, to the Technical Discussion group during the fourth session of the WHO Regional Committee of the Western Pacific.
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HEALTH PLilNNlNG
Health plann:ing is a basic par!; of every type of heal'lh work. Therefore, it is of direct concern to everyme connected with a health organizaticn regardless of :individual fmcticns or respcnsibilit1es.
, Health planning takes place at all levels of a health organ1zaticn. At each of these levels there is competiticn far available resources -- money, facilities, manpower. For this reasm, it is essential that planning be co-ord:inated in order that a proper balance may be achieved among the various efforts devoted to health improvement. This immediately brings up the questicnl co-ordination of plann:ing be brou~t about? 1. 2. 3. How can such
Shall it be entirely within the health organization itself? Or, shall it be the responsibili~ of a commission of advisers outside the health department? Or, as mfortmate1y is sometimes true, will it be decided merely b,y a budgetary officer who holds the purse strings?
These are questims which might be taken up b,y the discussion groups. In brief - What is the II\Ost desirable method to co-ordinate health plann:ing? In considering this subject, i t must be remembered that there not only is competition for available resources at various levels wi tIrin a health organizatim, but also at the higher level of the various departments of the government. How can health planners meet the campeti tion at this level -- other demands concerned with social welfare, for education, for public works?
lh this connection, it is my op:inim that too much reliance has been placed on the hunanitarian appeal of health improvement am too little on the economic aspects. Humanitarian cmsiderat1cns may attract
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groatest attention from the public, but :in deal:ing wi th budgetary officers, firm facts and figures count most heavily. The sav:ings in the economy of the country which are broU@ht about by health improvement need to be emphasized. But, what :individual countries can supply figures as to the value of h\lllan lives that are saved -- especially those in the younger age groups where preventive medicine and public health are most effective? Also, what facts can be produced as to the extent of the reduced drain on the economy when sickness is prevented - or the increased productivity when the health and nutrition of workers are improved? These subjects also might be considered by the discussion groups. In brief, the question is - To what extent and :in what way can econanic considerations be integrated into health pLanning? I will turn now to another subject that is always a problem wherever health work is conducted -- that is, personnel. As long as health departments exist, I think they will always have a shortage of personnel. At least, I have never heard of one yet that admitted having enough trained people to do the work that needed to be done. This means that planning of projects continually must aim for a balance between material facilitios and personnel. Usually, it appears the balance is weighted too heavily on the side of material facilities. As a rule, it seems easier to find money for buildings, supplies, and equipnent than to obtain money for salaries oJ: health workers. P.lso, health officials often are reluctant to spend money· for the proper train:ing of their personnel needed for health operations. How can this situation be met in health planning? Is it a problem sufficiently distinct to warrant separate planning? Or should it be an integral part of every type of health plann:ing? The latter certainly seems the more logical; but. when han:lled in this way, the personnel aspect of health planning J:requently seems to be neglected. Most of us here have the point of view of the health ofJ:icer, and thus far, my discussion has rather followed this viewpoint. But health planning not only concerns the people who carry out health operati.ons. It is of even more importance to those for whom the work is done. It is axiomatic that public health work must have understanding and co-operc._ioo within the community, 1£ it is to be effective. Therefore, it iq appropriate now to turn to consideration of community and family factors that :influence health plann:ing. The question might be stated :in this way: What elements for community co-operation must be :included in health planning?
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\1HO/CST/18 j·.PPrNDlX l-b
HEALTH PLANNJNG*
Surrunary
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Health plann:ing :involves four factorS! (a) the problem, (b) mat is being done about it, (c) what needs to be don~ and (d) what can 'be done • Certa:in data are, however, required before any action can be taken. The next step would be the listing of priorities Which would vary according to countries. Examples are given of'how priorities are to be determined :in accordance with particular situations. Consideration is given to the structure of the health administration which should depend on the health requirements of the country concerned although there are certain responsibilities which must aJways be carried out by all health adm:inistrations. The availability of qualified personnel is an important factor in arranging the division of work am priorities :In training must be :in accordance with priorities accorded to the work to be perfbrmed. In the less developed countries the objective should be to train t~ indigenous people far all categories of health work and to ensure security of employment and satisfactory pension arrangements. Attention must then be paid to the detailed plans for each componEll t The nature of the plans prepared will depend on the type of government concerned and will vary throughout the Region. It is possible to make the most rapid progress when the people being served are keen and representatives ofcammunities should participate in the discussions at all stages of planning. of the master plan.
The relationship of health development to development in other subjects is discussed and the effect that changes :in .the economic situation may have on the plans. Every plan should be subject to constant review and evaluation but should not be modified without advice of all the people concerned. WHO could be of greater assistance to governments if more work were to be done :in the field of health planning and if each country possessed a country plan the ways in which the Organization could best assist would be more clearly revealed. *paper presented at the Technical Discussions during the fourth session of the WHO Regional Committee for the Western Pacific.
HEALTH PLANN IN 0
The object of a~ health administration is no other than the objective of the World Health Organization, namel:y, the atta:!nment by (all) people(s) of the highest. possible level of health. A health depart.ment is usually the agency set up to carry out those duties considered to be governmental responsibilities. The precise functioos of the health department va:!!y, as they should do, fran country to country, just as the historical backgrounds and the health programmes are different in all com tries.
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General A health plan is concerned with the programme not anl:y of the current year but also with the programme for the future. The preparaticn of plms can be mdertaken onl:y when all of the requisite :Information has been collected and analyzed. If such data are not available, it is necessary to·obtain them. This can usuaJ.l¥ be done best by means of health surveys. '!he documen t "Health Survey Design" is primaril:y concerned with this aspect of health planning. The types of plans which can be prepared are :Innumerable a\ld must vary according to the health requirements of the country concerned. Not onl:y do they vary with the health requiremEnts rut also with the f:lnancial and professional resources available to meet the actual needs. Detailed discussicns of health plans could be entered :Into only by using as a concrete ax:ample a single country. In this short paper it is not possible and the subject matter will, therefore, be confined to pr:lnciple s, the sui tabili ty and applicabill ty of wltich will vary from country to country. Basic Data Health planning, in simplest terms, involves four factors. We Wish to know what is the problem, what is being done about it, what needs to be done and what can be done. More specificall:y, these foUl' factors can be broken down as follows. To understand the problem, the data needed would :Include I (a) the disease picture (the reverse of the health picture) :Including, where possible, long-term trends in IOOrbidity and mortality; feb) the personnel. .•
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I I
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(b) (c) (d)
the personnel engaged in health work; the funds available for health work; the existing facilities;
in addition to more general socio-economic information. In planning what could be done in the future, additional information would be required. It should include :-
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(a) (b)
the anticipated funds available for health work for each year of the plan; and an analysis of the manpower situation.
The information required for this analysis would concern categories of people of all educational levels. Included would be those who had re~eived specialized training, those who had been partly trained and those who might become available for training. Similarly, other data particularly those concerned with the health picture should be analysed so that it would be possible to proceed to the next step. Priorities The next step in the preparation of the plan would be the listing of priorities. The particular grouping of subjects would vary considerably from country to country although less among countries possessing similar degrees of economic and social development. In some countries priority of attention might, in the first instance, need to be given to the protection of the health of the people engaged in health work. There have been instances in which due to inadequate measures being taken, health workers have become ill and the whole success of the health programme endangered. When preventable diseases, as for example, malaria, yaws and tuberculosis are very prevalent, priority of attention should be given to these diseases. Taking a long term view, it would be more economical to eradicate or at least to achieve large-scale control over the preventable diseases, thus reducing the total disease problem to more manageable proportions. This might often be difficult because of claims being made for curative services. Often, preventable diseases must be separated and accorded priorities. In such instances it is often advisable to give first attention to groups of diseases which can be prevented by single measures, as for example, by the introduction of potable water supplies or the sanitary disposal of human excreta. In certain countries a group of insect-borne diseases can be controlled by another single measure, namely, the application of insecticides. In establishing the priorities it is necessary to pay considerablc attention to the costs of the measures involved. An important point in this connection is the consideration of whether a measure would need to be repeated. The introduction of a piped water supply might be more expensive than a single Dor campaign. But if /the water system
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the water system would involve no further expense over a long period and the DDT spraying would need to be repeated at least once a year during the same period, then the water supp~ might 'cost less than the DDT campaign. In selecting priorities, consideration must be given to the number of people suffering from a particular condition. Clear~, diseases of the greatest incidences have greater claims than those of a lower incidence. Sometimes diseases of relative~ low incidence require attention because of their high fatality. Another factor which cannot and should not be ignored is the demand for certain services. A health administration should endeavour to satisfy felt needs but'not at the sacrifice of activities considered more important for technical reasons • In this connection it should be remembered that physical well being alone does not constitute health. Social progress can often be advanced in association with other governmental departments while·mental well being can often be promoted by the correct attitude and proper training of health department personnel, without actual~ giving priority to specific mental health projects. Health Administration Having listed the priorities, the next step is to consider how the work will be handled. It is convenient at this stage to consider the structure of the health administration. Experience has shown the advisability of having the responsibility for all health work vested in a single department of the national government. It is advisable for the political head of the department to possess cabinet rank or the equivalent. While the head of the department could proper~ be appointed for political reasons, it is inadvisable for other members of the health department to have their appointments dependent upon political changes. Better work would be done if personnel could have the security of tenure associated with permanent appointments. The organizational structure should always depend on the health requirements of the particular country under consideration. It should vary not on~ according to the work to be undertaken but also according to the way in which that work would be handled. For example, it would be difficult to justify a division of malaria and division of filariasis control if the same general measures were to be adapted for the control of both diseases. While the organization will always vary, there are certain responsibilities which must always be carried out qy all health departments. For example there is the responsibility either for the drafting of health laws am regulations or of aSSisting in this important work. Similarly, there is the statistical work. Sometimes vital as well as health statistics are made the responsibility of the health department but always a certain amount of statistical work must be undertaken.
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A factor determining the organization structure of a health department is the availability of qualified personnel. This is often particular~ true in !under-developed countries
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under-developed countries. There might be difficulties in recruitment or there might be difficulties in finding funds to establish certain posts. It is therefore very important to make the best use possible of existing personnel. Very often technical people spend a great deal of time doing routine administrative work which could quite well be handled by nontechnical administrators. It has been demonstrated that well trained administrators without scientific qualifications can do very useful work in health departments. Another difficulty confronting smaller administrations is to decide when the appointment of specialist phYSicians and surgeons is justified. There is no hard and fast rule for guidance in this respect but the same general principles utilized when establishing priorities are applicable. The sharing of specialists between several administrations is sometimes an answer to this difficulty. In field work the advisability is being realized more and more of using the same individuals for many types of work and of using centres and clinics for pOlyvalent activities. Such polyvalent work is not only an econo~ of manpower, but also conducive to the provision of better services. Personnel In arranging the division of work, very careful consideration must be given to the personnel who will actually carry out the work. It is useless to plan activities if insufficient people are available to do the work. Thus, if work requiring certain categories of personnel has been accorded a high priority, then priority must also be given to the training of those personnel. While partly trained personnel are needed in most countries, their services are particularly required in the less developed countries. (There is a variety of terms for such people. The words "partly trained" as used here, are meant to include all categories of health personnel and to refer to those people who have received less training than fully qualified workers in the same subject either in their own country or abroad). Sometimes people have been trained to do a single job as for example, vaccinations. Usually, however, they have been trained for more general duties and in most instances this has been found advisable. However, in designing services for the employment of such personnel, it is imperatiye to provide an adequate number of fully qualified people who can give the necessary supervision. In many countries in the early years of development, the sa~i trained people only would be indigenous. Only those possessing an intimate knowledge of the local culture are able to provide completely satisfactory health services. Therefore, the permanent employment of a large number of personnel recruited from outside the country is never completely satisfactory. The objective should be to train the indigenous people for all categories of health work. /To ensure a contented
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To ensure a contented staff there should be security of employment and satisfactory pension arrangements. Often, there is a big discrepancy between the incanes of public health officials and those of :individuals of comparable status engaged in private practice. In many countries it would seem advisable to raise the salaries of all medical people in government services and of public health Officials particular~.
Detailed Plans Having listed the priorities and the division of worl<:, it is necessary to pay attention to the detailed plans for each component of the master plan. Let us consider for example that subject which involves the largest number of health worl<:ers, namely, nursing. In less developed countries"most of the nurses are usually trained and ellI>loyed by the Health Developnent. They might be anployed not on~ in hospitals, cl:inics and other institutions, but also in home visiting and other field work. WhEil the nurses are trained and employed by a health department, the preparatilXl of nurs:ing plans is made easier. For the provision of an adequate quantity and quality of nursing services three important points might be considered. They are the recruiting of candidates for training, making the IIXlSt effective use of various kinds of nursing personnel and the provisilXl of educational facilities for all types required. There is often difficulty :in obtaining candidates for train:ing. To find the reasons a study must be made in each country. The reasons vary. In sane countries an inadequate nUlliler of girls receive sufficient school education. The reason might be unattractive conditions of work and accommodation. Again the attitude towards the nursing profession or perhaps economic factors might dissuade suitable candidates from undertaking the training. Having found the reasms for the difficulties in recruiting trainees, efforts should then be dire cted tawards overcoming them. A matter often neglected is the study of the effectiveness with which nursing resources are used. A waste of nursepower occurs if for example a nurse" is employed to do clerical and domestic work which could be done by other people. In arrangi~ nursing education programmes it is important to pay attention to the provision of attractive living and working conditicns for the students. There are three major types of education programmes. The basic programme is concerned with the training of qualified nurses for junior posi tims in hospitals, cliniCS, etc. Their training may be called the basic training programme. NUrses being trained for senior positions in hospitals and public health nursing programmes. etc., require a post basic educatim. The th:ird important type of tra1n:ing progrBllmle is for the auxiliary personnel." Such personnel can first be offered a pre-service elementary nursing training.
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IOn
the
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On the satisfactory training of nurses as well as of the other categories of health workers will the satisfactory implementation of field programmes depend. In many plans consideration of training not only for nurses but for all categories will come second only to the availability of funds as the pivotal factor in the preparation of the plln. National and Area Plans The structure of governments vary considerably throughout the Region. In certain countries, there are national governments having complete responsibility for all health services other than those undertaken by voluntary agencies, private institutions or private individuals. In other countries, there is the federal type of goverrunent with health responsibilities shared by the federal and the state governments. In many countries, municipal goverrunents undertake certain health activities. In some of the non-sell-governing terri tories, it is possible to carry out planning in the territorie~whereas in others, it is necessary to prepare plans in conjunction with the metropolitan governments. Thus, the nature of the plans prepared throughout the Region must vary according to tre type of government concerned. When realth responsibilities are shared by various units of government, it is necessary for all concerned to be associated with the plan, thus ensuring the absence of duplication, joint interest and above all, satisfactory implementatioo. Community Participation In health, as in other subjects of governmental concern, it is possible to make the most rapid progress when the people being served are keen, or even better still, anxious to receive the services. In plaming health services cognizance should be taken of this very important factor. It can be stimulated. Quite apart from the civic or general sociological aspects attention to this
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matter can be of
eno~ous
assistance to health administrations.
It is, therefore,
desirable to have representatives of community organizatioos participating in the discussions at all stages of the planning. Very often voluntary agencies are enthusiastic to carry out certain public-health activities. In preparing the plan allowance soould be made for such desires and the societies should be encouraged to do all that they are able. I t is being realized more and more that in tre development of health services it is advisable to make an integrated overall approach. It has been found advisable both to introduce government services and to ex:tend these services with all departments working togetrer. In various countries this group approach has been given various names.. Sometimes the multi-purpose approach has been along the lines of fundamental education and conununi 4Y organization and development.
Research When plans are made for large and wealthy administrations, it is oftro possible and desirable to make provisions for scientific research. Sometimes /rescarch is
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research is undertaken locally by private institutions. Whenever sound knowledge applicable to health programmes becomes available either locally or from abroad, it is essential for administrations to utilize it in making appropriate modificatioos to health programmes. During the course of a long-tenn plan too acquisition of new knowledge might necessitate radical alteratioos. Short and Long Term Plans It has"been frequently found desirable to prepare both short-term and long-term, plans. As stated above provisials must be paid for later modifications. For that reason, the preparation of a short-term as well as a long-term plan is but the placing of greater emphasis on the subject of modifications. ,
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The short-term plan provides the immediate targets and is complete with all details. The long-term plan will possess no such details and will be in more general terms but with definite objectives for each year of the period. An incidental value associated with the short-term plan is the opportunity provided for improving the techniques to be utilized in the long-term plan. Short-term pl2ns are usually concerned with ale, two or three year periods while long-term plans are concerned with periods such as five or ten years. Evaluation For the smooth development of a plan, it is imperative for it to receive initially at ieast approval in principle by the Government as a whole. For many reasons health development cannot occur without concurrent development in other sUbjects which are usually governmental responsibilities, as for example, educatioo, public works, agriculture and economic development in general. Often other government departmen ts demand increases in their budgets. The granting of these increases might upset the health plans. It is, therefore, essential to work together and co-ordinate activities with those of other departments. This would tend to obviate any sudden changes in the budget, the effect of which might be injurious to the plan. The economic situation would be important not only from the government revenue point of view but also because of the influence of economic conditions on the number of people receiving private medical care, and also the relation between economic crises and diseases. In times of economic crises there might be an increase in those diseases more directly related to poverty. Other economic factors of relevance are changes in the cost of living and of building costs. While there is a tendency for these two to increase there is also usually a gradual increase in governmental revenues. Reference has already been made to the importance of utilizing new knowledge. Such knowledge has often considerably altered the trea"lment of certain diseases. A spectacular example of this bas been the discavery of the efficacy of penicillin in the oontrol of yaws. This discovery bas oompletely altered control programmes and has, indeed, made mass programmes possible. Quite apart from the effect of programmes directed against specific diseases, the health picture itself is constantly changing. fFor these
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\ For these and many other reasons no plan can ever remain static. Every plan should be subject to constant review and evaluation. This should be done in a careful and methodical manner. Just as a plan concerns many activities, so it should be modified with the advice of all those people concerned wi th these various activities. Often it would be convenient to arrange for the evaluation to fit in with the governmental budget making timetable. In considering modifications of the plan, studies of the existing programmes must not be omitted. If these were to be assessed and evaluated, it might very well be found necessary to effect considerable changes. W1I)
llssistance J,., <
The Fourth 'lsscmbly resolution (Wtl1A.27) and the Third Session of the Regional Committee resolution (WP/RC3/RIO) are contained in reference document WP/RC4/TD 2. Several governments in the spirit of these resolutions have requested assistance in this field. Quite apart from the authority contained in these resolutions it is suggested that the Organizaticn would be of greater assistance to Members i f more work were to be done in the field of health planning. If each country possessed a health plan, then there would be more clearly revealed the ways in whi ch the Organ:ization couhl best supplcIOOnt the various activities of the governments. From an internal administrative aspect, there would also be very definite advantages in having such plans prepared. Such plans complemented by the Organization's plans would pennit the more effective and economical use of interne.tional personnel and other resources. In certain countries the Organization is not the only outside agenc,y assisting the Government. When there is ;,lore thv.n one such agency, there is even more need for a health plan and there arises also the need for good co-ordination. With proper co-ordination all such agencies can work more effectively in strengthening the national health administrations.
iIHO/CST/18 J,PP}!ND ll!; l-c
HEALTH PLANNlNG AND CO!o1!lUNITY ORGANIZA1!m*
Summary Co-operation of the people is an important element in health planning. Reasons are given as to wl\Y people do not ab;a;ys taka advantage of the health planning that is done for them. If conununi ty participation is to be enlisted then it is essential to have knowledge of the structure, the organization and of the values of the cOillllunity, of the resources available or potentially available and how these can be mobilized or utilized. Attention must also be paid to the social and cultural aspects. The need for basic information on (a) nutrition, (b) the etiology of health and disease, (c) treatment, (d) ps,rchology of the patient, (e) economic capacity of a community, (f) group structure, and (g) responsibility and leadership is stressed, and each of these points is discussed. Mention is made of the usefulness of social anthropology in a health planning organization.
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*Paper presented by Professor R. Firth, London School of Economics, London University, to the Technical Discussion group during the fourth session of the WHO Regional Committee for the Western Pacific.
.. HEALTH PLANN:rnG ~D
comrn ITI"
CEGllN lZA'lICN
I am taking as IIIiY' main theme that of community participaticn. lh doc\Illent m/4, it is stated that in health, as in other subjects of government concern, it is possible to make the most rapid progress when the people being served are keen, or even better still, are anxious to receive the services. The same point is made by the document. on health survey design. No doubt we can find excepticns to this. Great medical progress has undoubted~ been made in remedying the health of ueople who were apathetic. But I :imagine that genera~ speak:ing the idea is accepted that the co-operation of the people is an important e lelllln t in health planning. Bilt while this is so, a lot of questions are still :involved. can assume that people are always, keen to get well. If that is so, why thm do they not aJl.1ays take advantage of the health planning that is done for thEl1l? The reasons, I think, can be divided into three main categories. The first is that of stupidity, ignorance and fear what we may call a general lack of understanding of what is wanted. The second category is what is often called carelessness - meaning by this that the people are willing to co-operate and know how to do so, but in their range of preferences the necessary health measures come lower than some other ways of expending their erergy. The third category is that of resistance, meaning by this that they may know what to do but definite~ they do not want to do it. They have an attitude of objecticn for what trey consider to be good and positive reasons. If the lack of :interest in health measures is due simp~ to a lack of understanding, either with or without fear, then it may be that a fair~ Simple failure in communication is responsible. Remedies may range from more attention to the language of communicaticn, to a more outgoing attitude of personal ff,Ympathy, or to more elaborate or more specific programmes of health education. (Perhaps the use of special~ recorded talks :in the vernacular ma;y help here, or that of specially designd films).
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BIlt i f the lack of interest is due to compet:ing preferences for t:ime and attention or to definite objections to the health measures, then we have to go deeper. Cases of this are well known to everyone. It should be realized that the behaviour of people in these circtUnStances is not just random. It follows a pattern and is part of a system of behaviour which they adopt in other similar situations. Moreover, this system of behaviour has a st.ucture in which the various elements are so :inter-related that by affecting one you also influence others. It is necessary then, in attempt:ing to enlist community participation or overcome community objection:::, that there should be some knowledge of the structure e.nd of the orga.nization of the community -- the framework of the ordinary activities of tre people.
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It is also necessary to know something of their value s -- the
ideas that they have, often, with strong emotion, about the kinds of activities and things that are proper and good. Sympathy, educaticn and proof by experience can do a lot to ccnvince people who resist health measures even if the health worker is gOing on rule-of-thumb methods.' But they are not enough. They must be backed by knowJ£ dge. Much time can be saved and much more accomplished if the health worker does knOW' just what the structure and the values of the people are and how they cut across the developnent of health work or can be used to contribute to it. But the structure of the community is not always perceptible by ordinary observation. It needs s.ystematic study. It is sensible to think then that better results will be achieved if the health planner takes the possibility of such things into consideration and makes sane provision in his programme for getting information about them and co-operating with or utilizLng them. Planning is a word defined differently by different people. But, for our purposes here, it can be said to be preparatioo for the most efficient use of resources over'a given time in relation to a set of health needs or requirements. These needs or requirements are either given in the situation already or have to be assessed. And realistic planning means taking account of all factors that can be envisaged -- not in waving sane aside because they do not seem to fit into the plan. Planning then implies a knowledge of what resources are available or potenti~ available, and ideas CIl how they can be mobilized and used. But it must start from some assessment of requirements or needs. Both of these imply attention to social and cultural aspects of cODUllunity life. In the Western Pacific Region, there is great diverSity of these social and cultural aspects. Specific knowledge of them is important for two broad reasons. The first is that with the great modern use of international personnel it is advisable for them to have some knowledge of the kinds of societies in which they work -they should have a coosiderable degree of cul rural receptivity. The second reason is that, even in a single country which is of multicultural character, it may well happen that a person from one cultural group will be working among the people of another. Here, too, then there is need for this kind of special cultural know:hldge.
I suppose it is correct to sa:y that in recent years one great trend in health measures' has been a moving out more and more from the hospital to the hane. This results from many factors. But one of them is the very general recognition that with the growing cost of health services, it is expedient that the communi~ should be erilisted in its own defense. "A Home Guard for Health" might be the slogan here. It means particularly a transfer to the local field of part of the costs of health measUres, especially in labour and in that more intangible cost, responsibility. If thiB is so, the implication is that what goes on in the hame- or in the village or urban housing block or tenement house - is important for the health planner to know.
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- 3It is part of the process of "getting down to the grass roots" or in more local terms "to the rice roots", as one might say. Of course, a great deal of what goes on in the home is known -from the district health nurse, the social welfare worker, the hospital almoner, the local medical practitioner, the hospital dresser. But I put it to you that there is still a fairly big field of such domestic and local matters concerned with health about which information available to health planners in any country is still vague. For example. even in the highly developed countries we still do not know enough about CCll'llllon family patterns or about differences in nutrition and in personal hygiene among various groups of the popula ticn. What we do know is still for the most part unsystematic and impressicnistic. For the so-called "underdeveloped countries" this is still more the case. Let me briefly refer to a few aspects where information is lacking and would be very useful, (a) The first is nutrition. Here collaboration of nutrition work with social antrhopology would be very useful since the anthropologists have developed interview techniques and techniques of collecting information systematically about food habits, beliefs and taboos against the background of social and economic life. In New Guinea, for instance, some very interesting work is being done on these lines by a nutrition worker trained in social anthropology. (b) Ideas about the Recent work by socia ant opo ogists erica as shown how the ideas of people there about disease often include a division of diseases into "hot" and "cold". with cures thought to result from application of remedies of opposite type. Something analogous OCCIlI'S among MaJays. Some of the ~bolic notions involved are rather akin to those of the medieval doctrine of signatures. The suggestion is that if such ideas are known by the health planner they may be used - in therapy to get the patient on the side of the doctor, and in pt'eventive medicine to get the community in rapport with the health worker. (c) Ideas about treatment, There is frequently in the Western Pacific Region a dichotomy of another kind. Diseases are divided into two categories, those which are thought to be curable by Westem medicine and those which are thought not to be so curable. In Latin .&merica it has been said that the alleged ignorance of Western trained doctors and nurses about the latter category of diseases and local remedies has hampered people in seeking aid. en the other hand, if they feel that the doctor already knows about the treaiment they folJ.ow' in their loca,l pt'actice, then they are more readily inclined to accept his advice. Much of the local practitioner's diagnosis and treatment must, of course, be regarded as inadequate and even wrong by practitioners trained in Western science. the can expect that in the course of time, particularly as Western medicine becomes more efficacious, much of this local treatment· will disappear. On the other hand, not all of it is necessarily of this kind. As the work of Gimlette in Malaya indicates, there is often something of what may be called a primitive pharmacopeia, with certain drugs of limited efficacy. Some aspects of manipulation may also be effective. Whether this be so or not, it is a question worth considering in a given country as to whether the health plaIner might not take into consideration what is being done by local practitioners of the "medicine-man" type, and see if the ir co-operation can be enlisted in health work.
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(d) Pgrchology of the patient: Whatever be the decision about the curative role of the local practiticner fran the physical point of view, there is no doubt that psychologicalq he has the confidence of his patient. This he gets by various means, some of which like ritual dancing or mediumistic performances, certain~ not available to the health planner. But a study of his methods might give useful information as to ways in which the confidence and mora1e of the people might be secured and maintained in health work. But I want to emphasize that the information to be gained from social and cultural s"twies is by no means only negative in its application. It has ir.!portant positive aspects. (e) Economic capacity: To get the support of a canmunity for a health programme may well depend to a large degree on the capacity of the people to pay for services or to ma:intain them by their own labour. Hence, it is important for the health planner to have as adequate data as possible on the economic structure of the community, its income levels, capacities for different kinds of expenditure, available labour resources, competing claims and wants. It is not easy to get such information adequate~ even in a cash eccnomy. But, in many of the countries of the Western Pacific Region, especially in the rural areas, a great deal of the economic relaticns are in kind and not only in cash. Estimation in such conditions is extremely difficult. Here special study is required. Impressions alone are not enough. In getting the data, the services of an anthropologist wi th training in economics or an economist wi th training in anthropology could be of great use. (f) Group structure I In the effort to get community partiCipation, it may be very important to know what are the structure and functicns of the various types of groups in the community. For instance, many of the societies of the Western Pacific Region have a· structure in which there is faction and rivalxy between· the groups. Knowledge of this may help even in such small matters as selecting a site for a health centre. If the group structure is not known, the site selected may be such that the group concerned may attempt to keep other groups off or exploit the siting for its own advantage • .lgam, it may be possible to Enlist the spirit of rivall'y and competition to promote health services. One community can be encouraged to strive for a better health service than its neighbours. This can be a wasteful process but, if caref~ handled and with proper knowledge of the structure of the groups concerned, it need not, but can be of advantage. Again, such knowledge is useful in i'onning new local organizations of a voluntary or semi-official kind. Most organizations seek an anccstr,y and, if it can be shown that the new organization can find roots in a traditional one, then its basis will be more solid. But to do this adequate~ again needs a proper knowledge of what the various forces and groups in the cOllU1lunity already are. (g) Respmsibility and 1eadershipl In any health progrlDlme, one of the stumbling blocks frequently is in getting local people to take responsibility and in getting good leaders not only with initiative but also with inflUEnce enough to be able to induce the people to follow them.
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- 5Here the trouble may lie in inadequate knowledge of the basic pr:inciples on which status in the socie"t<v real1¥ depEnds. Jil some societies, for example, the real :influence lies unsuspected by the outside observer, in the hands of elders who, through leadership 'of kinship groups or the possession of ritual status or the control of economic power, dominate the community. If the health planner has a knowledge of how status is obta:ined and held in the community, then it may be much easier for him to calculate what his leadership resources m~ be, and to enlist community partiCipation as, for .example, in getting membors of a village health committee. There is another w~ in which the social anthropologist in particular can be of use, that is, :in act:ing as a social thennometer when health programmes are under way. From his :intensive observations in the community, he is usually in a position to test the reactions of the people to health measures as they are put into operation, and so provide the heaith planner with data which he can use :in any revision of his programme. From what I have said l it will be seen that material on the social and economic structure of the communi"t<v is important both in the assessment of requirements and evaluation of resources. How is provision for attaining such information to be fitted into the plan? Ckle w~ is by stimulating the interest of the health woIkers themselves in attaining such material as they can. And some tra:in:ing :in the general pr:inciples of social anthropology would increase the preciSion of many of their observations, as for example, if they collect social material as part of case histories. Another way in which more could be done is by the analysis of routine data in more systematic form -- from demographic, economic and sociological angles. But a difficulty here is frequently lack of time. The social worker or medical man rarely can spare.a great deal of time for special enquiries. Hence, help is needed from elsewhere. Some material of use to the health planner can be obta:ined from economists, social anthropolOgists and other research woIkers primarily engaged in other problems. But to be of much value, the nature of the problems and the kind of material to be collected need to be worked out in collaboration wi th the health planner before hand. Specifically oriented enquiries, either of a sociological survey typo or an analysis of special problems, are the most effective. (1 considerable amount of such work is now be:ing dene in Latin America.) Sometimes, the field anthropologist can work as a close member of a team. More often because the scope, timing and intensity of his enquiries are very different from those of the work of his fellow IOOmbers, he is best allowed to proceed on his own. But there is a great deal"t:> be said for including the social anthropologist as a definite part of the health plaming organization, not simply using his services for one or two years and then allowing him to retire from the scene. This would obviously involve proper budgetary provision for him. On the other hand, it would mean that· he becomes familiar with the problems a1 d that continuity is maintained.
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-6In conclusion, I would emphasize that the social sciences including social anthropology, in relation to health planning cannot act simply as keys in a door. The problems are complex and refractory. There are few simple solutions in overcoming resistance to and securing active co-operation in a health programme. But, if progress is slow, every advance made on a basis of systematic know:Ledge will be made on a much surer foundation.
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YiHO/C~T/18 APPflu1X lood
ME'll!ODS FOR THE PREPARATIOO OF NATI<NAL PUBLIC HEAL'll! PLl>NS"
Summary
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In the :introduction to the report thB process of plann:ing is def:ined and the advantages of a hBalth plan summarized.
A chapter is devoted to responsihility and examples given to show how this responsibility is delegated from the m:inister or the director of health downwards. A national health plan should be prepared with the participation of the largest possible number of the personnel who will be responsible for the subsequent implementation of the measures planned. In other words, planning is delegated just as responsibility and authority for execut:ing established plans ere delegated. The importance of a plann:ing board to co-ord:inate planning is stressed. The plann:ing process is discussed accord:ing to the follow:ing outl:inel (a) study and analysis to understand the problems, (b) study and analysis to determ:ine the resources, (c) def:inition of objectives, (d) formulation of programmes of activities, and (e) evaluation. National health plans are f:inally considered from the viewpo:int of :intematiooal co-operation. Mention is made of the value of an exchange among the various health plans with respect to natiooal health plans arxl the fact that the formulation of a well-def:ined health programme Qy governments would enable :international organizations to see more clearly how their :intematimal collaboratioo might be more effective.
*Paper presented Qy Dr. Guillermo Arbooa, Chief, Department of Preventive Medic:ine and Public Health, School of Medic:ine, University of Puerto Rico, to the Technical Discussion group of the Pan American Sanitar,y Bureau.
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PABB
SEAL
To c It )t ;. c a.1 Antigua Guatemala September 1956
WHO SEll.
Dis eu S S .- 0 ft. I , ........
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CD9/DT/l (Eng.) 24 July 1956 ORIGINAL: SPANISH
INTRODUCTORY ST1.TE2-II!NT ON THE TOPIC "METHODS FOR THE PREPARATION OF NATIONlJ. PUBLIC HEALTH PLANS •
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By Guillermo Arbona, M.D., M.P.H. Chief, Department of Preventive Medicine and Public Health School of Medicine University of Puerto Rico,
Reproduced in WPRO
CONTENTS ~
I.
Introduction Definition
1 1
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Advantages II. Responsibility III. The Planning Process
2 2
6 6
A. Study and analysis to understand the problems B.
Study and analysis to determine the resources Definition of objectives Formulation of programs of activities Evaluation
8 II
C. D. E.
13 13
IV. .r
International Cooperation
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B ibliogr aphy
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... CD9/TYr/1 (Eng.) Page I METHODS FOR THE PREPl.RATION OF NJ.TIONf.L PUBLIC HEALTH PLI.NS
I.
INTRODUCTION
Many authorities in administration maintain that all human activity, whether individual or collective, is preconceived, following a previously traced plan. This fact is not always evident, they point out, since the plan may sometimes exist only in an individual's subconscious mind. Planning, at times, precedes action by such a short interval that the two appear inseparable. Every health agency, on the other hand, operates on the basis of a budget of expenditures, which is in itself a plan .. We can assume, then, that every health ministry or department functions on the basis of a plan. - Definition We propose to discuss the process by which a health plan is formulated, together with the character~stics that make a plan effective. The process of planning has been described in different ways. Professor Dimock defines it thusl In its simplest form, planning is what the French call
prlv0tince, or looking ahead. It applies to individuals as we as to groups such as families, social institutions, bUSinesses, and governments. The five steps customarily involved in planning are research and analysis so as to understand the problem; the determination of objectives; the discovery of alternative solutions; deCision-making, involving the formulation of policies; and the execution of the plan which gets into such things as organization, work scheduling, and procedures.. Planning is the antithesis of improvising; planning is systematic foresight plus corrective hindsight. Entailing decision and action, planning is a dynamic concept. Planning in its simplest form also is universal because all individuals and groups make us"e of it with varying degrees of conscious design. Wherever administration is found, there also will planning be found; and the more problems there are to be solved and component factors to be coordinated, the jore attention will ordinarily be devoted to planning. ~
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11 Marshall Edward Dimock, Business
and Government, p.735.
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(Eng.)
Advantages The advantages of a health plan might well be sUIlUnarized here, not because we need to be convinced of the necessity of a plan, but rather to establish the importance of the process of planning as such. 1. The main purpose of a national health plan is to help utilize available resources as efficiently as possible for solving the health problems of the people. No country has all the resources needed to do all that could be done for the health of its population. 2. The plan serves as a guide for developing the health progt'ams of the country designed to eradicate or reduce disease and to prolong and improve the life of the people. j. long-range plan is the necessary basis for the growth of the local and national organization, by stages, and for the orderly expansion of services and facilities for the training of personnel. ~--
3. The plan is an aid in measuring results and in making required adjustments in programs when for some reason the desired goals are not being achieved.
4. The plan serves as an aid to the administrator in keeping the personnel informed of the operation, organization, and objectives of the programs, and of the contribution expected of each member of the staff. In this sense, it is also of educational value in the orientation of new personnel.
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5. The plan is likewise useful in keeping the nation's authorities and the people informed of What the health work consists of, what the technical personnel propose to do for improving it, and how the funds invested for the nation's health are being spent. 6. The plan serves to keep international agencies informed of what the country proposes to do for improving the health of its peopie, what difficulties it faces, and how the available international cooperation can be used to greatest advantage.
II.
RESPONSIBILITY
Responsibility for the nation's health services in most countries rests with the minister or secretary of health, whose responsibility to the public is through the chief executive and the legislative bodies. kccording to the best administrative practices, the minister, or the director general
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CD9/IYr/l (Eng.)
of health, is responsible for preparing the national health plan, which is subject to approval by the chief executive and the legielatute. A national health plan should be prepared with the participation of the largest possible number of the personnel who will be responsible for the subsequent implementation of the measures planned. In other words, planning is delegated, just as responsibility and authority for executing established plans are delegated. Doing What one feels it best to do is usually more gratifying than doing what someone else considers best. If a person participates in the preparation of a plan, however small his contribution, he will derive more satisfaction in carrying it out. 1. number of North American firms have achieved a marked increase in efficiency by decentralizing the planning process so as to include participation by the majority of their personnel. In an automobile factory, for example, there are different levels of planning, just as there are of administration. At the highest levels, decisions are made on the matters of greatest importance, such as model of the car to be produced, cost, type of motor. Decisions on less important matters, such as painting and wheel mounting, are left to lower levels. The crew that works on the wheels obviously has little opportunity to offer opinions on the model, production costs, or type of motor. They can, nevertheless, plan a more efficient organization of their own work and a better division of labor among themselves. Experience has shown that this system not only improves the workers I efficiency but also stimulates neW' ideas, many of which are put to advantage at the higher levels.
In the departments of health, good organization will facilitate the decentralization of planning. The various divisions and subdivisions can formulate their programs within the general standards established at the highest organizational level. ~s was stated, in the formulation of a national health plan the final responsibility rests with the minister or the director general of health. It is important to consider the manner in which they obtain staff participation. This will necessarily vary according to the organization of health activities in eacil country. In Chile the health service has two subdepartments, one to set standards and the other to execute the work. Under the Executive Subdepartment are organized the regional or zone health offices and under these, in turn, the health centers. The Executive Subdepartment delegates administrative functions to the regional offices, which in turn delegate them to the health centers. The delegation of functions includes those of administration and planning. Through the EOCecutive Subdepartment, the Standard-5etting Subdepartment receives from the field personnel information and suggestions that frequently lead to changes in the existing national standards or to the adoption of new ones. This type of organization calls not only for close collaboration between the subdepartment that sets the standards and the one that executes the work, but also for an effective delegation of both authority and responsibility to the regional offices so
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CTY}/DT/l (&g.) Page 4
that the latter may realize their responsibility for offering suggestions for action by the Standard-Setting Subdepartment. The delegation of responsibility and authority is viewed not only from the viewpoint of geographic distribution but also from that of the various services. The majority of ministries have divisions dealing with specific problems such as epidemiology, tuberculosis control, maternal and child care, and others. The experts in these divisions are responsible for advising the health minister or director on the objectives and organization of the programs in their respective fields. In formulating the various programs, the experts in these subdivisions must keep in close touch with the staff that works directly with the people, so as to draw upon the experience and receive the suggestions of the field personnel. The standards and procedures adopted by the ministry should establish this practice on a systematic basis, not leaving it to chance. When the objectives are defined, thought should be given also to the participation of the personnel of the administrative and special services. In a tuberculosis control program aid in purchasing material and equipment is essential. If the administrative staff does not understand the program's objectives or the reasons why the equipment is needed, it may not give all the desired cooperation. In the same way, operating services such as nursing, health education, social work, and the like that are expected to give assistance ought to take part in the planning of programs and the establishment of objectives. They help by indicating existing limitations, by specifying the contribution they can offer, and in many other ways. Participating in the establishment of objectives and in the general planning, in turn, helps them to better understand what is to be done and what they are expected to contribute. The most difficult task in a health department is to coordinate planning is such a way that the final plan is in keeping with the relative importance of the different health problems and at the same time is coordinated with the programs of other government departments. The coordination of planning, like the coordination of any other activity, is never an easy task, for it hinges on the human factor. We all would like others to change their plans to suit ours, but we are not always inclined to change our own to coordinate them with those of others. It has been said that programs can never be coordinated properly unless someone is assigned exclusively to promote coordination. To achieve this end, some countries have set up planning boards which have, among other duties, that of assisting the various government departments in preparing and coordinating their programs. [, good example of a national planning board is the Planning Board of India, whose activities extend to the states and regions of the country and even to the small communities. One of the Board's main functions is to integrate and coordinate the efforts of the country's agencies at the different administrative levels _.J.....
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the efforts of the country's agencies at the different administrative levels in such a way as to achieve the most efficient use of available resources.
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There is need for a similar unit in large departments of health. The Philippine Health Department is setting up within the Minister's office a planning unit whose function will be to prepare a coordinated national health plan. The unit will achieve its goal by helping the various divisions of the l1inistry plan their programs and integrate them into the national health plan. The Health Einistry of Canada has a research division whose task, among others, is to analyze and evaluate basic information, with special emphasis on technical and administrative methods, basic principles, costs, and social usefulness. This division gives advisory services to other divisions of the Ministry in preparing programs and promotes coordination among divisions. In some countries the national health service is responsible for health services at all levels of organiZation -- national, state, and local. In others, the state and even the municipality are autonomous insofar as health services are concerned •. Whatever the situation in a country, the national health plan may include plans at the national level for the adequate development of state and local health services, as well as standards, procedures, and even objectives to be carried out by the state and local services. The difference between the One situation and the other is that the national health service, in the first instance, achieves its purpose through direct action, and in the second, through promotion measures. In the first instance, the national health service organizes the health unit in the municipality, and in the second, it stimulates and aids the state or municipality in establishing the unit. 1,t the various state or municipal levels of organization, the need for planning is the same as at the central level. The national health service will naturally stimulate the state and local services to plan their programs in accordance with the standards it has set for the purpose, after consultation with them. The absence of legislation should not be an impediment to planning. Legislation making the planning of eve~y governm6n~ ~ndertaking obl~gat?ry would of course, be desirable, since 1t WGuld fac1l1tate the coord1nat1on of pr~grams among departments. The budgetary law of a country might to a certain extent constitute a good planning law, if it calls for a budgetary procedure similar to the process of planning. ~B stipulating that planning should take place usually do so without indicating the methods to be followed; these they leave to the implementing agencies, since it is much easier to modify a rule or regulation than to . amend a law. In some countries the law requires that the plans of the var10US agencies be approved by the legislative bodies. This occurs, in fact, with respect to annual plans, when an annual budget is being approved.
CD9/M/l Page 6
(Eng.}
Legislative approval is highly advantageous to long-range ~lans, since this form of approval is effective in ensuring their execut~on.
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III.
THE PLLNNING PROCESS
Dimock in the above quoted definition of the planning process, suggests a series of steps to be followed. We have modified these ~or purposes of the present discussion, according to the follow~ng outl~ne: .1)..
B.
C. D. E. •'l..
Study and analysis to understand the problems and their relative importance. Study and analysis to determine immediate and future resources I personnel, facilities, operating funds, scientific knowledge, and opinion and attitudes of the population. Definition of short-term and long-range objec~1ves. Formulation of programs of activities, organizational scheme, standards, and methods. Periodic evaluation •
Study and analysis to understand the problems
To understand the health problems of a country, one IlIUst first know about its population. The data obtained by census and through compilation and analysis of demographic material provide the necessary source of information. They give an over-all view of the country1s population, its distribution by regions, age groups, occupational groups, and of educational and economic levels. They are also the key to the population dynamics for the country as a whole and for the various regions. The importance of this type of information for planning health programs is evident. A knowledge of the country1s birth rate, for example, provides an index for determining the needs of maternity services. In planning for the future, a study of the rate of population growth in a given region is helpful in estimating the facilities the region will need in the future and making proviSion to furnish them. J. knowledge of the educational level of the population can serve as a guide for preparing educational programs. Knowing the economic level helps us estimate the financial participation the population is capable of giving.
Although population data shed light on some of the services that may be needed and to a certain extent guide us in utilizing existing resources to meet the needs, it is through an analysis of mortality and morbidity data
CD9/DT/l (Eng.) Page 7 that we learn which health problems are the most harmful to the people. The mortality data available in the .lJllerican countries have improved greatly and, in most of them, give a good idea of the relative importance of mortality in infants, children, and adults, as well as of the principal causes of eath in the various regions, for the different age groups. An essential step in every planning process is the improvement of such data for their proper use and application in establishing long-range programs. Information on morbidity, however, is generally poor. Statistics are available on some of the communicable diseases that are regularly reported by physicians, and on certain others that have been the object of special studies or surveys. Data on the morbidity of noncommunicable diseases are usually scarce and difficult to obtain. Some information on morbidity can be gathered from hospital and dispensary records and by interviews with private practitioners. The information available can be augmented through surveys. We in public health have experience in this type of work for specific communicable diseases such as tuberculosis, malaria, and intestinal parasitoses. Surveys have been made in recent years on general morbidity and on noncommunicable diseases. However, the methdology for general morbidity surveys is very deficient and as yet costly, and poses serious problems of interpretation. The knowledge of health problems is improved by studying the physical environment in which the population lives. 1.n attempt is made to discover the factors that favor the prevalence of diseases. Studies are made of water supply, waste and garbage disposal methods, housing conditions, food handling, presence of insect vectors and of animal reservoirs of infection, working conditions, and industrial health hazards. The facility of obtaining this kind of information depends on the local health organization. Health units and centers usually compile this type of information as a matter of routine. Where no local health organization exists, the gathering of information is more difficult and requires special surveys and studies, which usually cover only certain factors of particular interest to us rather than the total environment. In the study of health problems, more and more imJtance is being given to the social environment, including such factors as educational and economic levels and customs and traditions, especially as they relate to health. The cultural characteristics of a population frequently favor the development of certain diseases, a fact that apparently is especially true of mental and psychosomatic illnesses, to which ever-increasing importance is being given. The success of many health programs hinges on the attitude of the public, and there is a need for improved or new methods for gaining an understanding of the social environment. At the present time we depend largely on subjective methods, personal observations, and superficial impressions.
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CD9/rtr/l Page 8 B.
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Study and analysis to determine the resources
We take resources to mean everything in the country that can be used Resources would include, then, the medical and auxiliary medical personnel, nurses, public health workers, and others; the physical facilities, hospitals, and health centers; the funds available for their operation; the entire organization of the health department; the activities of other agencies, private or public, whose programs or interests relate to health; favorable opinion and attitudes of the public, etc. in some way for the benefit of the population's health.
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!o. inventory a country's resources for health services, one might start by taking stock of public and private organizations engaged in health programs, and of the programs themselves. This appraisal would cover the organization of the ministry of health, the health department and services under it, the personnel available, the physical facilities, and the operating funds. We use the term health ministry to cover the organizations at the state, municipal, or local levels, since in some countries state and local health services are an integral part of the ministry, while in others they function independently. Usually, some of the other public agencies, such as the social security service, the ministries of education, labor, agriculture, and others, also conduct health programs. T:-.ought must also be given to the resources of private organizations, their programs, staff, facilities, and operating funds. Agencies such as the Red Cross and societies to combat cancer or tuberculosis also operate in the majority of countries. If the national health program is to be properly planned, it is essential to know exactly what programs of health work exist in the country, since there must be coordination between the various private and public organizations for maximum effectiveness of action. In a school health program, for example, there is obvious need for proper coord-ination bet,nen the ministries of health and of education and the Junior Red Cross. i.lthough the study of health organizations in the country takes into account mainly the staff actuaily participating in the programs, it is necessary also to examine the situation as regards professional personnel at large. One should seek to know the number of physicians, nurses, laboratory technicians, engineers, social workers, and other professional personnel in the country, and to gain some information on how they are distributed geographically, how many are in government service, how many in private practice, etc. One attempts, in considering this information, to know the limitations in personnel that may affect the country's future development, and to plan how to over com-=> theso limitations. Information is likeWise sought on phYSical facilities such as hospitals and beds available in different parts of the country; their type, whether general, tuberculosis or mental, public or private; and also some data on their condition. Information on the buildings and equipment of the health centers and units is also desirable.
CD9/DT/l (Eng.) Page 9
It is very important to kna; what funds are available for operating the services. An observation made frequently in most countries, one that indicates the shortcomings in planning, is that magnificent facilities are available but ade~uate budget funds are lacking for their operation.
In measuring resources and requirements, certain fixed standards are frequently employed. Thus, in discussing the number of physicians in a country, we usually refer to the number available per inhabitants. Puerto Rico, for instance, states that it has one physician per 1,600 inhabitants. In considering how many physicians are ne"ded, the tendency is to immediately look toward the rate for countries that have the highest proportion of physicians. For example, the United states, has approximately one physician to every 750 inhabitants, and some will therefore claim that we have only half the number of physicians we require since the United States has double the proportion that we have. Yet in the United States there is already the feeling that there are not enough physicians, and someone has suggested that there should be one for every 500 inhabitants.. This method of determining needs and measuring resources frequently leads to frustration for the health worker, making him conscious, as it does, of hO;I far off is the day when all the desired personnel will be obtained.
The same occurs in trying to ~uge the hospital-bed requirements. Twenty years ago tuberculosis mortality in Puerto Rico was 330 deaths for 100,000 population. By the standard of two beds per death yearly, 10,000 beds were needed in the sanatoria; there were 1,500. It might have been said that nothing could be done to control tuberculosis. Today, tuberculosis mortality has drop~ed to 30 deaths per 100,000 inhabitants and there are more than four beds per annual death. If the plan's objectives are to be realistic and there is to be a good possibility of achieving them within the prescribed time, each country must set its own standards and consider those of other countries with caution and in the light of the conditions prevailing in those countries. What is important in the long run is to progress, through the continuous utilization of the available data in the formulation and adjustment of suitable standards in keeping with the country1s conditions and ,lith the constant advances in health practices. It is important to consider also the resources intrinsic in the population itself, in its education, culture, traditions, attitudes, and economy. The health programs most likely to succeed are those which from the outset have the support of the people. The resources and activities and the national plans in such fields as education, agriculture, public works', and others, bear a close relation to the health development of a country and hence to health programs; both in the study of the health plan and in its subsequent execution, a close relationship must be maintained with these agencies.
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In measuring resources, stock is taken of both those immediately available and those to be available in the future. In considering the present
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number of physicians in the country and the number expected in two, five, or ten years, we turn our attention to the medical school, where future physicians and occasionally some auxiliarY personnel are trained. It is important to remember that these schools, in addition to training the physicisn, can help instill in the students an appreciation of public health services. In too many countries the medical and other professional schools function apart and isolated from the health services, and students fail to receive the desired instruction in the public health problems and programs of the nation. The trend today, however, is toward closer ties between the ministries of health and the schools of medicine, with a view toward mutual aid. This subject was discussed at length at the seminars on medicine at medical schools, held in Vifia del Mar and in. Tehuacan, under the auspices of the Pan'American SanitarY Bureau. The consensus was that one should strive to achieve the type of close relationship that will enable the schools to profit from the resources of' the health services, and vice versa. What has been said about physicians and medical schools holds true for the schools of dentistrY, nursing, engineering, medical technology and others. Most countries have no schools of public health for training specialized personnel in the public health field and, hence, use the facilities of the existing schools in the Americas, through the award of fellowships. Where these schools exist, they apply what we have said about the relationship with the health services. When the available professional personnel is insufficient for the needs of the health services, the health authorities shOUld make certain that the pertinent agencies are informed of the requirements and take steps to meet them. The ministrY of health may encourage the school authorities to increase the number of graduates or to improve the training. A number of countries have done this in the past and are doing so now. In Mexico, for example, the Ministry of Public Health is helping the medical schools improve their instruotion in preventive medicine and public health by paying the salary of a full-time professor of preventive medicine. In determining physical facilities and operating funds to be available in the future, it is necessary to consider many factors, some of which are beyond the control of the public health administrators. In countries that
have national planning boards future physical resources can be estimated more easily, since these boards usually forecast the national revenue, together with the proportion thereof that will be available for meeting health needs. When there are no such boards, we must depend on past experience, on the attitudes and trends in government circles, and on the abilities of administrators. The health plan itself contains the best arguments for convincing the government authorities to provide the facilities required. We pause here to recapitulate our discussion of this first stage of the planning process: compilation and analysis of the necessarY information. At first glance this might seem like a gigantic task, one beyond the capacity of many countries. This is not the case; and even at the risk of over-optimism,
CD9/ur/l (Eng.) J'Qge II
it can be stated that all countries can accomplish this first stage of planning. There is a mass of information in all countries on health prob· lams and resources, which need only be gathered in orderly fashion and analyzed with a view to its use in formulating a health plan. When this is done, one can see what additional minimum data are needed and how they can be obtained. The first indispensable step, of course, is to give one or more experts exclusive responsibility for this task, together with the authOrity and resources they need to assemble, analyze, and complete the required information. It is my understanding that several Latin American countries are following just such a procedure this year. C.
Definition of objectives
As problems and resources are studied, Objectives are brought into focus. When i t is found, for example, that diphtheria mortality persists, one almost automatically concludes that the program Objective is to reduce and eventually eliminate this disease. Likewise, if the study of resources reveals that half· the country! s population is covered by the services of health units, it will follow that these health units swuld have diphtheria control programs. Thus, from the moment one begins thinking of objectives, one already has a good idea of the possibilities. Objectives can be claSSified as general and speCific, as short-term and long-range, as objectives relative to the health conditions of the population or to the effort that will have to be invested. A general long-range objective, as related to health conditions, '>«)uld be to reduce maternal morbidity and mortality in the country, while a specific short-term objective would be to rechce maternal mortality during the coming year by, say, 25 per cent. An objective relative to the effort required might be to provide prenatal care services to a sufficient proportion of future mothers, say, to 30 or 50 per cent, or more, depending on local resources and conditions. In attempting to determine objectives, the administrator finds that the resources available are insufficient to cope with all the existing problems; this is universally true, for in no country are resources sufficient. It is necessary to decide, then, which problems are to be approached, how intensi ve the approach will be, and which problems will be left for a later solution. These decisions are among the most important that the administratcr has tD make. Naturally, a good knowledge of the problems and resources will be helpful, but that is not enough. Gustavo Molina in his book :Principles of PUblic Health J.dministration, suggests the fo llowing , criteria fo r maldng thesedec1sJ.ons,
(a)
(b) (c) (d) (e)
Severity of the damage -- number of inhabitants affected and number of deaths or cases produced. Possibility of preventing the damage on the basis of present knowledge, and possibility of appqing this knowledge with the means available. Cost of the damage -- economic loss resulting from persistence of the prcblem, as against cost of the program to combat it. Results e:xpected from the program, in the short and long run, direct~ and indirectly. Attitude of the community -- support or resistance of the population to the measures to be taken, keeping in mind that it is a function of the health services to give guidance to the community.
In determining the objectives, it is important to remember that periodic and final evaluations of the plan Should be made. The objectives IlDlst therefore be stated in terms that will pennit later measurement of results. This is not easi~ done in some phases of health work. The objective of prOviding prenatal services for 30 per cent of all pregnant women is easy to measure. But it is quite another matter to measure how these services have helped improve the health of mothers. In other wrds, it is easy to measure the quantity of services rendered but very difficult to measure their quality and intrinsic yield. On~ through the efforts we all may contribute in this direction will we some day be able to develop the proper methodology for measuring the quality and effectiveness of health services, including the medical services. Another consideration with regard to objectives is the need for separating those that might be called objectives of organization and service from the real objectives that relate to the population's health -- not that the former are less important, but because they are means to an end rather than the end itself. It might well be the objective of a health ministry to furnish, or provide for the furnishing of, public health services for the country's entire population over a period of five years, the end objective being to improve the population's health by means of these services. The organization of such services is, therefore, a means necessary to that end. As another example, a health ministry might include in its plans the organization of a health education programme. Let us suppose that at the end of two years that service has been organized; the objective has been iUlfilled insofar as organization is concerned. The attainment of that health education service's objectives, however, can on~ be measured by ana~zing the aid it has furnished to the ministry'S programs, arrl to what extent it has succeeded in contributing toward the improvement of the population's health.
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D.
Formulation of profrarlS Gf activities
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How are the objectiv~s to be attained? There must be a program of activities and proper organization. Theoretically, the plan of activities determines the organization. In practice, however, it is difficult to first detemine the activities and then think of the organization, because quite frequently the latter already exists, and it is mor<J difficult to change an existing organization than to establish a now one. This is a problom that frequently confronts the administrator. Even 50, one should consider tho program of activitics before the organization, and then see hCM the existing organization canparcs with the one desired and to what extent it can be changed. The program of activities should indicate' till standards or noms, methods and procedures to be followed Rod used. Thus, a diphtheria prevention progrcm should indicate who will be protected, what product will be employed, what dosage will be used, and the method of application. These arc all details o! a national health plan, and it is perhaps not necessary to include them as part of the plan itselfj but they are important details in the execution of the plan and some reference should be made to them if it is decided not to include them in the plan proper. Entering into the details of executing a national health plan would in itself constitute a treanse on health administration. It is worth while recalling here what was previously st~.ted on the importance o! the hunan factor in a~ undertaking. A good plan can be no better than the personnel who caTry it out. Frequently, a good plan fails in 1.Ilskilled hands, while a poor plan ma;y succeed in able ones. A good pkm facilitates the administration of a health program. Fortunately, in the vast majoriw of cases good planning goes hand in hmd ~lith good administration. E.
Evaluation In discussing objectives, we mentioned that they should be stated in
tems that will later pennit periodic evaluation of hOI( far they arc being achieved. Some authorities in administration believo that every plan should be evaluated twice a year, others think it sufficient to evaluate the plan yearly. Evaluation of a program has one purposel to determine to what extent the established objectives arc or arc net being attained, to see what changes must be made, and to put these into effect. In the course of a program I s development, newly acquired knowledge, techniques, or procedures may also have to be incorporated.
OD9/Ii~/1' (~.) Page .14
The ministries of health prepare their budgets annual~ for approval Information on the program's development and on the results achieved usuall;y provides the best argument for favorablo consideration of bUdgetary requests. by the bodies making ihe appropriations.
or
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lNTERNATIONAL COOPERATIOO
At an internaticnal meeting such as this, it is natural to consider the national health plans from the viewpoint of international cooperation.
Countries throughout the world have given their support to close cooperaticn in matters of health. An exchange among ihe various countries with respect to national health plans would in itself be cxtrcme~ valuable. If there were written national health plans that could be cxchmged among countries, they would certainly occupy a preferential place on the library smlves of the various depar-tments. For the administrator to have at hand the health plans formulated by other countries would be of immeasurable value. The formulation of a well-defined health program would facilitate the collaboration given by the Pp..n Amcrie1lll Sanitary Bureau and the World Health Organization, and by other international agencies ?..nd foundations such as the International Cooperation Administration of the United States Government, the Rockefeller Foundation, and others. It would give these agencies an indicatien of the country's most urgont needs and of what its authorities intend to do, which would help them sec more clearly how their international collabo-ration might be made more effective. Tho international agencies can aid the countries in the preparation of their national health plans, for planning is a field pre-eminently suited to :International eollaboraticn. The aid which an international agency may give to a country :in the matter of plann.:ing will be effective in the degree to which it is directed toward hclp:ing the naticn develop the process of plann ing.
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BIBLIOGRAPHY
CD9/DT/l (Eng.) Page 15
Canada. Ministry of Public Health and WelfAre. Functions and Activities .2! the Resenrch lJi.fision of the Department 9!. Health and Welfare £! Canada. 1952. Q4imeographed). of
.2
Carrasco, Eufronio O. Planning 2E the Ministry 9!. Public Health Hlilippines. 19~. (Doctorate thesis). Business and GovernllElnt. Rev. ed. New
Dimock, Marshall Edward. York, Henry Holt, 1953.
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El Salvador. Ministerio de Salud Publica y Asistencia Social Plan Nacional de Organizacion de los Servicios Medicos de la Republica deEl Salvador:- San Salvador,"""I953. - - - -. - - -. Direccion General de Sanidad. Sanitaria.!!!! g Salvador. San Salvador, 1955.
B
~
de Demostracion
Hanlon, John J. Principles of Public Health hdministration. st. Louis, Missouri, C. V. Mosby, 1955.-(1< Spanish translation-of the first edition has been published). Hilleboe, Heman E. "Public Health in a Chan;::ing World," American. Journal of Pp.blic Health, vol. 45, no. l2, pp. 1517-1525. India. Ministzy of Public Health. Health Program. (Mimeographed) American New York,
Leavell, Hugh R. "Teamwork in the Service of Health," Journal9!. Public Health, vol. 44, no. 11, pp. 1393-1402. Marx, Fritz Morstein. Prentice Hall, 1946. Elene nts
!?!
Public Administration.
Molina, G. Gusta-,o and E. GUillermo AdriasoJa. Principios de Administraoion Sanitaria. Santia,"o de Chile, Escuela de Salubridadde la Universidad de Chile, 1955. Munoz Amato, Pedro. Introduccion ala Administracion Publica. Mexico, D. F., Fondo de Cultura Economica; ~5G.
National Conference on Evaluation in Public Health, Firat. Ann Arbo r, School of Public Health of the University of Michigan. Education Proceedings N£ 62).
PlOCeedin~S.
(dontinue
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CD9/DT/l (Ehg.) Page 16 Puerto Rico. Deparbnent of Health. i.nnua1 ~ 1955-56, and 1956-57.
Scott, J. A., D. J. B. Cooper, and S. Seuffert. The National Health Science ~, 19/h ood 1949. lorden, Eyre and Spottismode, 1950. Teacl, Ordway. ~ ~
2!
.dministration.
New York, McGraw-Hill, 1951
Unnick, L. E1enentos de Administracion. San Juan, Puerto Rico, Universidad de Puerto Rico, 1'946. (Translation from the English). Walker, H~rvey. "Las CUatro Etapas Prililordiales del Proceso Presupuesto Ofidal." Servicios Publicos, Ne~l York, July 1955, vol. 2, no. 4, pp. 19. 26-28J vol. 2. no. 5, pp. 18, 44-46. World Health Organization. Proposed .t'rorarnme ~ Budget Estil;e.tes for the l"inanciru. Year 1 January-l! uecember 19 7. Geneva, December 1955. (efficial aecords 'F!D.""6'b). - - -. Expert Committee on Public Health .drninistration. First ;por$' 1952. Second Roport, 1954. Geneva. ('fechnica1 Reports Serles os. 5 and 83).
Conununications to the Pan American Sanitary Bureau from Dr. f.ntonio Brown, Bolivia; Dr. Bichat Rodrigues, Brazil; Dr. Juan •• llwood Paredes, El Salvador; Dr. Lucien Pi8rre-No~~, Haiti.
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l.Pmm:r:;;: l-e DISCUSSla-I SUB--HEIilllNOS AND SELEC'lED REFERENCE l4\'lERIAL ORGANIZA'ITrn l>ND tillMlNIS'ffiiLTION OF HEhLTH SERVICES J\,
lillO/CST/IS
I.
Functions at Different Levels I 1. The authority and functions at the national, provine ial and local levels should be clearly defined by regulatims and procedure
manuals. 2. Medica:;' care and health services should be fully integrated. There should be a mechanism where~ the health functions of other ministries are co-ordinated at each level of government and in cammon programmes at the local level. £here should be a mechanism whereby health care services are co-ordinated between the several levels of administration to ensure a two-way flow between the base and the periphery and vice-versa.
3,
4.
The following is quoted fram the World Health Organization Technical Report Series No. 55, Expert Committee m Public-Health Administration, First Report: "In relation to the organization of health services, the follOWing conditions exist: a. The authorities and functions of national, provincial, and local health administrations in many countries have not been clearl;v defined. b. The integration of medical care into the health services has not yet been well established in most countries. c. Public-health functims are also being carried out by other ministries - dealing with education, labour, agriculture, social affairs, etc. - and there is lack 'of co-ordination of the health services provided by these various ministries. d. Jh general there is a lack of system in organizing medical and health services. The basic structure under the local health administrations for extending the needed service to the people is often ladcing also. However, experiments are being carried out in several countries, both in the eastern and western hemispheres, in which detailed structures of local health services are being set up for units of the population to provide the necessary services to the people on a decentralized basis. TIms, in addition to the national (or federal) and prOVincial (or State) health administrations, there is a series of units of health services, such as health centres, health stations and dispensaries, extending from the cities to the villages in the local areas.
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"There are certa:in health services, however, which by the nature of their organization demand administration at a regional or national level. This may be due - as :in corta:in projeets in environmental sanitation - to the high degree of technical specialization required for the work, or to the need for a wide area of supervision i f good results are to be secured. It may also be necessary to bring together for a health purpose, such as protection of water-courses, a large number of health units which should be :integrated under one co-ord:inated system of health service. In each case it is essential that the local bodies receive full information, so as to enable them to undertake and follow up the programmes with keen interest. The committee urges the importance of a decentralized administration geared effectiv~y t~ the policy of the central authority and tho active participation of the local poople. "Among the services which e.ll national health administrations can and should provide for local health departments are: plann:ing of health programmes includ:ing medical legislation on a national scale, leadership, and technical assistance :in specialized branches of work. "Broadly speak:ing, then, the chief functions of local health adm:inistrations are operational but with a power of discretion within the generous limits set by the contral authorities whose main functions are pOlicy-making, giv:ing of advice on request, and enforcing medical legislation and other standards of efficiency." The follolling is quoted from Technict.l Report Series No. 8J, Expert COlnmittee on Public-Health JI.dministration, Second RepOrt: "Health Services Rendered at the Intermediate and Nation,,-l Levels. The functions of :intermediate and higher authorities in health in relation to rural health services were summarized as follows: a. To study the health needs of the mtire area, to evaluate existing programmes, to plan ways of meeting the needs and of improving the programmes, and to educate the people to an understanding of health needs and the means of providing for them. To promote local health services by: i.providing advisory service and technice~ assistance including the services of sanitary engineers, health educators, nutritionists, cultural <nthropologists,letci lThc function of a cultural anthropologist is to aid technical experts in a health team to carry out more effectiveJ.;y- their aims and obj ectives by bring:ing to their attention or help:ing them to understand those aspects of the local cultural patterns, e.g., customs, tradition, social psychology, etc., which may have a bearing - either adverse or favourable - on whatever they are trying to do.
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- 3ii. providing financial aid; iii. delegating responsibility for direct services to local units; iv. carrying on relationships with local citizens and groups through the local health mit; v. promoting and assisting in the development of new and expanded programmes} vi. establishing standards for sound operation of local health units and assisting the local units to meet the standards (personnel practices and fiscal procedures included)} vii. recruiting and providing training opportunities for health personnel in local areas; viii. acting, in the case of intermediate health authorities, as intermediary to the national health authorities for the promotion and development of local health units, rather than providing service to local citizens directly. c. To provide certain central services to supplement the worlt of local health departments, wren the higher authority can do a more efficient jOb, or when it is legal~ required to do so. Among these may be in cluded I
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i. statistical registration and{or ana~sis; ii. production and{or distribution of biological and pharmaceutical products and materials for health education; iii. central laboratory services for certain complex procedures and for the examination of specimens transmitted from local health units and smaller departmentsJ iv .. superVision of the design, constructicn, and operaticn of waterworks and sewage-treatment plants; v. control 9f stream polluticnJ vi. organization of measures for promoting and maintaining industrial health, in co-operaticn with other governmental authorities; vii. licensing of hospitals, nursing homes, laboratories, and other institutions; viii. mental health and other specialized clinical services such as tuberculosis and venereal disease; . ix. the supervision of nutrition as a means of promoting health and preventing disease (this will include the provision of advisory and consultative services as well as research facilities) ; x. vector control; xi. veterinary services; xii. measures for adequate pro~s~on, distribution, and protection of food (this will have to be carried out in collaboration with other naticnal authorities).
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- 4 d. To organize and supervise hospitals and institutional services so that they are to the community, and to authorize such accommodatien as may be provided at the local health unit. other accessible hospital level of the f~
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To provide and mainta:in well-organized am mObile field units for:
i. the mass survey md treatment of endemic community diseases, :including the promotion of health educatienal programmes en an organized basis; ii. rapid mobilization to deal With epidemics and disasters aris:ing anywhere :in the territory. f. To promote and organize research, either directly or by means of f:inanc:l.al assistance to academic and other approved bodies. To make or propose regulaticns concerning health conditicns with:in the cOlmtry whim would serve as m:inimum standards throughout its area. To establish standards of professional tra:ining, and to promote :institutions for professional and subprofessional education. To co-ordinate and integrate all public-health activities of the governmental and other agencies operat:ing at the higher level,. so that· they become accessible to the commmity as a whole. To promote and establish international health relations.
g.
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"MaI:W of the services listed above can be referred with fair acc1lI'acy to the naticnal, :intermediate, or local levels, as the case may be."
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********** "Basic Services Offered at a Local Health Unit. The canmittee exam:ined :in considerable detail the services which it regarded as basic for local health units I i. ii. iii. iv. v. vi. vii. Maternal end child healt~. C~~unicablc-diBcaae control. Environmental sanitation. The ma:intenance of records for statistical purposes. Heal th educatien. Public-health n1lI's:ing. Medical care."
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"The Plannin ated L;>cal Health Pro ammes. The final subject for ccnsideratim e committee was the planning of integrated local health programmes. preparation of health programmes is no mechanical job: it is even more an art than a science. Like medical diagnosis, satisfactory planning depends an the psychology of those who carry it out, their general ani technical knowledge, and their perscnal study of the case with the aid of the laboratory. Here, as in medicine, prel:iJninary investigaticn of the local conditions directly or indirectly relating to health is essential to the planning of a sotnd health programme, just as is the personal and family history of , the patient for the accurate diagnosis of the case.
The
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"What is to be done first? What is feasible wi thin tIE framework of social and cultural backgrounds and the resources that the community possesses, and in the light of other demands upon these resources? How is it possible to present clearly to the local inhabitants, as well as to the experts, the objectives which can be reached in a measurable t:iJne? What are the needs felt b.r the population regarding health? Can the populatim be made cmscious of the needs to be fulfilled? Could the same results be conceivably secured through purely social or economic measures? Will the local community eventually be able to maintain from their own resources the persmnel, money, and materials required by the service? If there are existing services in the C:OlllTlunity, hOW' could they be integrated in such a way as to form a corporate whole? These and other questions of the kind' clamour for an answer before an ambitious scheme can be embarked upm. "Survey as the Basis of Plan¢ng. The initiatim of a local health programme mBy come from either a higher or a local authorit,y. As a rule, and especially in countries where local admjnistrative organizations are not well developed, the national or State lEalth authorities are requested to organize health services in local areas, or take the initiative themselves. "In such a case it is essential to appoint a trained publichealth officer to make a prel1lllinary survey of the area in which a local health unit is to be started. In order to secure accurate data or information representative of the locality, the health officer will have to find out the local leaders whose opinions are respected by the people and call on than personally to explain the purpose of his survey. He will have to convince these leaders that, if accurate informatim concerning the health problems and needs of the area is known, he will help them to pl<t1 for their area an effective health programme which is essential for the social and ecmomic development of' the locality. In addition to the local leaders, this health officer will have to make as ma~ contacts as possible with other citizens, including school-teachers ani physicians, and with religious bodies or social or ecmomic organizatims, to make than mderstand clearly what he is trying to do in the area.
"After getting h:iJnself well acquainted with the people in the area, he may tren suggest the organization of a local advisory committee,. The lOOIIlbership of such a committee will have to be representative of the entire area, without too much emphasis on educaticnal
- 6 standing. Any member of the community who understands the needs of the inhabitants and represents their views faithfully should be eligible for membership of the committee. "After the advisory committee has been forned, the health officer will inform the committee of the plan of organizing a local health unit in the area, and also explain what information is required as the basis of planning such an integrated health programma. "The preliminary contacts he has made with the public in the area will enable him to understand in a general way the life of the canmunity, as well as how ~d where the required information could be obtained. He may perhaps by this time already know something about the lOcal administrative body responsible for the welfare of the area concerned, ~d what kind of information it has available. He may already know the important social or economic structures of the locality, as well as the general envirorunental setting of the area, With the help of the advisory committee, he may wish to collect information in the following categoriesl (a) Social, economic, and cultural background (e.g., ethnological, cultural patterns, family system, religions err other religious beliefs, concepts of disease, personal habits, social customs, food production, dietary habits, handicraft or cottage industries, co~operative and other ecooomic systems, transportation, number of schools and students, illiteracy). (b) Demographic data (e.g., number of villages and towns ~d population in each, estimated number of infants and schoolchildren, birthrate, death-rate, infant mortality, chief causes of mortality and morbidity, etc. Some of these data may not be available or may be inaccurate, but attempts should be made to collect such infonnation by tak:!ng random samples in a limited number of villages in the area). (c) Environmental sanitation (e.g., housing conditions, watersupply, disposal of human and animal excreta and community waste, food sanitation, existence and breeding of disease vectors, animal diseases) , (d) Health protection facilities (e.g., number of physicians, nurses, and other health personnel; cliniCS, health units or centres, hospitals and available beds) sanatoria) health insurance; VOluntary or social welfare bodies providing medical or health services to the area; community support and participation in .health work through selfhelp)· available funds or other form of f:inancial resources for health work) • "The above categories of information are by no means exhaustive, nor is it intended that the health officer should obta:!n all such information during his preliminary survey of the area. In cortain areas some of tho information listed above can be obtained on1;y through a long period of effort Oy a team of health workers in the area. For intelligent planning of an effective local health programne detailed and accurate information of the kind listed above is essential. The members of the advisory committee should be consulted as
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frequently as is necessary to assist in the collection or ccnfinnation of the data. "With whatever information can be obtained during this preJJminary survey, the health officer should caref~ analyse and study the data, i f necessary with the help of a statistician or other specialist fram health administrations at the higher level. He wiUdraw conclusions from the result of the survey and report to the advisory committee. In this report he should bring out the most important features disclosed by his survey and the essential steps he advises in planning a health programme. The programme will have to be planned' on a lcng-tenn basis, in order to smw that the solution of these health problems depends upon a continuous effort an the part of the community through the organization of local health units. "In this connexi<:n it is also important that the health officer should make his report in Simple and plain language, so that it may be understood by the general public in the area. School-teachers may be requested to explain the report to their pupils, who will then transmit this information to their parents~ Opportunities may be offered to the local inhabitants to take part in discussions about the report and the steps in the planning of the health programme. The health officer should point out to the advisory committee, as well as to the people, that the responsibility of planning and organizing a local health unit rests with them, am that the technical staff are there only to assist in carrying out the health services of the unit. The people in the area should feel they are masters of the plan and they should make the decisions. \
lPast experience has shown that, at the initial period of the developnent of a local health service, financial subsiqy from health authorities at a higher level is essential. The health officer will therefore have to report the result of his survey and planning work to that authority for co-ordination and approval • . "OrganizatLon of the Planning Work. Health planning work is usually carned out l'Ugovernmenta health authorities when broad aspects are under consideration. Tne naticnal health authority is, in general, responsible for both health planning and co-ordination for the entire country. In the planning of a local health service, however, both the intermediate authorities and the local. bodies themselves are partners in too responsibility. Emphasis should be laid on the need for stimulating local interest in planning. If the public were infonned well in advance of any proposed health programmes, and induced to participate in the planning as it has been described in the previous section, they would cane more readily into the service when the plans had been implemented and feel that it was the fruit of their own effort. "Local health planning committees might be organized to include the responsible health officers, representatives from local administrative bodies, and reprosentatives from the local medical and nursing professions. In addition, in order to stimu1P.te the jnterest of the people themselves, representatives of the general public and of voluntary organizations should be encouraged to take part. The advisory committee referred to in the previous section. ",:Ul.d be . easi1:y tl'3Il.sformed :into the local health plaming COllllltl. t vee. Planning
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committees of this kind have been found useful not ~ in assisting the health authorities to collect information b.Y survey methods but also in keeping the public well infonned about the nature and e~tent of the health services to be provided under the programme. Two questions have been prepared to test the effectiveness of local planning and operation I 1.
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Do the people on the spot have the pOWer of decision or are they merely errand boys for a central authority? Do the oi tizens :in their private azJ.d p-'lblic capacity active1;\' participate in the enterprise?
2.
"It was pointed out that, in local health schemes, one must try to achieve a certa:in balance in social progress, in case one set of plans should get too far ahead of the others. There must be a m:inimum level at all stages, for example, :in education and :in agriculture as well as in health - a level belOW which no plan should be allowed to fall. A health service may have to mark time, as it were. :in order to maintain co-operation with other services. "The different forms of democratic government and their effect in implement:ing programmes were discussed. In general it was felt that there would be a great advantage in establishing a special committee :in the central departments to deal with all the problems of a rural area, and so achieve balanced progress. In certain countries. national planning boa.rds at the cabinet level have been established to achieve the co-ordination of the planning work in various fields. ~I
"In planning at the local level by moans of voluntary committees,
it would of course be impossible to secure effective co-operation without complote co-ordination and jo:int consideration with the larger programmes at intermediate and national levels. Joint planning was a two-wny process. The most effective work at the local 1evel would be to:
(i) (if)
gather the factual data which would establish the existing health needsJ bring together lny and profcssional groups for the jo:int study and solution of the prob1em. and for the correlation of all programmes and services (preventive, therapeutic, environmental. etc.) affecting health; combine the broad activities of public interpretation and health education with constant efforts to :increase the people IS participation :in. and reSponsibility for. planning; and develop methods for effective implementation of the plans."
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.z B. Popular Participation
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Consumer participation and responsibility should be provided at each level of health service organization. The follo;;ing is quoted from TecrmiCP.l Report SeriEs No~
55:
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"Provisions for Popular Participation in Health Work. The extent to which the problems of health administration can be solved is determined in the last resort by the finances available for health services. But material resources are by no means the sole factor to be considered. It is necessary to study the broader issues of how to organiZe people for health, for health administrators must make the fullest possible use of the goodwill and enthusiasm that exist in all camnunities. It is also necessary to consider health administration in its relations to human society - the welfare and socurity of people living in communities. Thought must be given to the effective use of peoplels time as well as money, and to seeing that staff members are proper~ educated for, and well fitted into the range of functions whiCh thly are called on to perform. Again, an essential function of health administration is to encourage self-help among the people and to bring the service within. the limits of local interest. The crucial tests are: (1) Do the men and women on the local staffs have the power of decision? and (2) Do the people in their private and group capacities, actively participate in the enterprise?
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IIHealth is a very personal thing and the people must be interested in the need for a local health administration - an administratioo cootaining both experts and citizens at large. It is also in this way that a health education programme can be made stimulating and effective. liThe developnent and operation of a health programme, rega:roless of its scope and content, will involve attention to more than legislation or finances, important as are these factors of essential support. Skilled personnel and the backing of an inforrood pUblic are fundamental, whether the funds cane from the tax revenue or fran voluntary sources. Health. is Inot something which can be imposed by a fiat from on high. Its attainment depends on the interest and willingness of individuals and groups to assume responsibility for the solution of their own problems on a well-informed basis. People are more prone to apply acceptable health practices in their daily lives if they have had a part in determining ...... (the programme) in partnership with the profeSsional health workers. ll
lwins1ow, C.-E,A. (1951) The cost of sickness and the price of health, Geneva, p. S7 (World Health Organization: Monograph Series, No.7).
10 Examples of demonstration projects showing improvements in health and living conditions, such as housing, water-supply, excreta disposal, and other measures, have also been proved to be of great value in serv:ing as practical means of health education. IThis spirit of co-operation amcng health specialists and the people themselves, at all stages of the development of a health programme, is destined to have far-reach:!ng educational influen ce. At the same time i t will serve to generate widespread publ~" goodwill and support for the total health programme. 1,,1 The following is quoted from Technical Report Series No.
83:
"During the initial period of the developnent, local support may be limited to the contribution of free labour in the fom of I selfhelp I or active participaticn in certain health activities. In all circumstances the local population can take part in the work by giving support to the programme through organized community effort. In the field of envirorunental sanitation, especia1~, organized self-help groups might achieve results without arw mmey, but with local material and labour. Transportation could be arranged in co-operation with local activity.n2 *i~********
"The Position of Voluntary and Offi cial Services. Looking back over the years, the committee observed that many of the services now recognized as public necessities began as voluntary movements. The supreme value of voluntary effort was to take up,matters that were still experimental, such as maternal and child health, child guidance, community care of mental defectives, etc. If they became established and recognized as essential services, then the official authorities should be ready to take them over as a go:ing concern. At this stage, the voluntary body should be Inlling to be integrated into the official service or to close its activities and hand over its work to the greater resources of the State. "On the other hand, there were still certa:in facilities which ought to rema:in within the voluntary sphere, although widely recognized as essential. In many areas loans of eqUipment to the sick, the provision of bloodbanks, and many other personal services were still provided on a volun tary basis, and the more established health services, such as maternal and child health and the tran sport of too Sick, were rapi~ being taken over by official agencies."
lwinslow, C.-E.A. (1951) The cost of sickness and the price of health, Geneva, p. 57 (World Health Organization, Monograph Series, No.7). 2The results of organized community effort and self-help are very well illustrated in Udi, a village in eastern Nigeria, where the local people erected a maternal and child welfare centre at very little cost by providing free local communal labour as part of a scheme for general village betterment. A film, "Daybreak :in Udi", has been prepared to describe this effort.
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****if**** uOrganized Community Effort. The success of planning and implement-
ing local health programmes depends on the organized comnll.l1ity effort. Isolated local health units have been known to exist for a great many years in certain localities of the world, with no effort on the part of the people in these localities to utilize the services ful1~ or to extend them to cover a wider area. These units were considered as something established by the 'outsiders' and tre people did not usuall¥ take much interest in the work, except for ;i.mmed:ia to needs •. Thus, such units do not take root in the canmunity, and will never grow. liTo initiate plann:ing work for health services with the active participation of the local inhabitants, as described in the previous paragraphs, is a very good means of arousing the interest of the public :in the health work of their own community. This mterest must be kept up by a systematic organization of the effort of tm local inhabitants for the protection of their own health. "As a first step, the objective to be achieved by the canmmity effort should be clear-cut, simple, and attainable. One cannot organize effective~ in vacuo. Examples of such an objective may be tre dra:i.nage of a mosquito-breedmg area, the building of a simple water-supp~, the organization of· a smallpox-vaccination campaign, or the clean:ing of f1;rbreedmg places. Whatever the objective selected for directing the cOIIIIIQ:lity effort, it must be fully recognized by the community as being something for the good of everybody in the area. Sometimes the people ma;y not see the value of the objective, and it may be necessary to plan a series of stages of heal th education in order to cultivate the public consciousness of the need. For example, to build up a sense of urgency about clearing a mosquito-breeding area, it is necessary to show the prevalence of malaria in the community and to demonstrate the transmission of malaria parasites by mosquitas which are bred in tre swamps. "The actual work to be performed by the public must be simple and easi~ done and· should be organized in such a way that, whEll each individual takes a part as directed, the sum of the total effort of the community will bring about the canplete expected result. And, finally, the result of the effort must be successful in reducing the incidence of malaria in the area, if dra:inage is taken as the objective. When such a result is achieved the public must be given fUll credit for the achievement. In this way the c<nfidence of the public is gradually buH t up through their own organized effort for the improvement of health conditions in the area. 'After the result has been demonstrated, it may be appropriate to start a more permanent organization which would enable the public to participate in a general way in the health work of the area. This may take the fom of eithElI' a voluntary committee or a local heal:'"ob board, which would have executive and legal responsibilities entrusted to it by the inhabitants. So!!iEltimes both fonns of organization may exist in an area. liThe organization of local health committees usual1¥ depends on the extent of the development of local health services in the area. If local health services are decentralized to the village level, tm
1
health workers may stimulate the interest of the Villagers to set up
-12a village health comntittee. If there is an existing eff:icient voluntary body which could undertake the health function, no new organization may be necessary. Whatever the form of commmity organization for health work may be, the health worker in the locality may well serve as the activator or cata~st for the organization of community effort. "It is ilnportant to POint out in this cmnexion that the organization of health committees by the local inhabitants should not be considered as an and in itself; it is on1y a mean s to the end which is the active p9.rticipation of the peoj:llo" in~tho health work of fueir community. It is therefore necessary to plon a series of activities to be carried out by the public through the initiation of the health committees in supporting too health progrlil1ll1le of the area."
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Planning and Assessment 1.. 2. Measures in effect to evaluate the results of health care services. The extent to which the organization of health care services is the result of either he8lth plaming following survey or part of overall national planning organized in a co-ordinated regional manner.
The following is quoted fran 'l'ecl'lnical Report Sari'es No. 55: "Planning and Assessment of Health Services. While the national health authorities are familiar in general terms with the major health problems in their respective countries, no s.ystematic health survey has been conducted in most countrie s. Healtb services have been developed :In most :Instances as a result of emergency calls to control epidemics or to meet certain urgent medical relief problems rather than frem careful planning based on surveys of health needs. However, s.ystcmatiC surveys and planning of health services on a national basis have been carried out :In a few countries, but for political or economic reasons the implementation of these plans has been delayed or :interrupted. "There are mruv questions to be considered in relation to the planning and assessment of health services. For example, in view of the great amount of assistance at present extended either tu internaticnal organizations or through bilateral arrangements in the sphere of health, are ma~ countrie s not reaching the point of samration with international personnal md projects? Are they able to assimilate such assistance far the benefit of the health of their peoples? On 13 March 1951 the Econanic am Social Council of the United Nations, at its twelfth session, adopted a resolution on concentration of effort and resrurces calling attention to this effect. This and earlier resolutions of the General Assembly and the Econonic and Social Council of the United Nations on the subj ect were noted by the Fourth World Health Assembly, held in Geneva in Ma,y 1951. Recogniz:lng that a major function of WHO is to act as a co-ordinat:lng authority on :International health work, the Fourth World Health ~semb1y also urged J<lember GoverIllll3nts to to promote the co-ordination of health efforts at national levels and to encourage agencies furniShing technical assistance to co-operate with \oRO when planning their activities. Mere co-ordination of these
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- 13 projects which are assisted by international agencies or foreign countries leaves something to be desired, perhaps. Since the protection and promotion of the health of the people is the responsibility of the government ccncerned, it would seem to be important that all types of health projects and programmes initiated or assisted by outside agencies should be integrated with the national health programme from the very beginning. "Shortage of adequate~ trained health personnel is the major problem in health administration today in almost every country. Are additional types of personnel needed or can there be cambinations of certain professialal !Kills in one person and, if so, to what extent? What is known about job analysis in this field? Should a health officer and his teclnically qualified section chiefs cevote a major portial of time to affairs of administration and business management? "The importance of periodic assessnent :in order to appraise needs and resources to determ:ine priorities, and to plan for the future, including shift:ing the e!II!-hasis possibly from one activity to aoother, is stressed. This approach has implications for the work of a department and for the community as a whole, besides provid:ing a means of enlisting more popular :interest and participation. Opportunities may also be discovered for transferring certain activities from ale agency to another or for securing increased interlocking of parts of an operation for increased effectiveness. Frequently, the gaps discovered are more significant than the duplication or overlapping. IIAppraisals are subj ect to scrutiny, and objectives sltluld be defined, although by-products in education and re-aligrunent may be more significant than a capacity to trace the effects of some activity :In terms of lowered morbid:i. ty or mortality, or :Increased health, longevity, or productive capacity. There are so marw factors to be taken into account when dealing with human life. Criteria may be suggestive, but should not be calsidered too significant as measuring-rods, even with careful testing, and must be related to time, place, and procedure. Self-appraisals by local committees are also growing :In frequency and scope with promising results. Many factors bear on the health and well-being of a populatial. Some of thElTl are capable of measurement while others cannot be expressed nunerically or quantitatively. Arnalg indices which are sometimes used in conducting administrative appraisals are popul!il;ion, culture, economic resources, sanitatial, medical facilities" health:Insurance status. pb;ysical status, mortality. and morbid!. ty."
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Training The marIDer :In which the undergraduate train:ing of the health services professional personnel is geared to the specific local health care services.
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The following is quoted from Tf'cr.nical Report Series No. 551 "Some problems of professional training. - The efficiency of a health department dcpends to a very large extent upon its ability to recruit suitably trained personnel. This subject has to be considered especially in respect of professional and technical staff, am it requires review at regular intervals because the needs of a health service, like all growing organisms, are constantly changing. A service may retain its general pattern for 2. number of years, rut the anphasis is constantly shifting in terms of time am place. There may be a broad general pattern of canmunicable disease control, for example, in all countries, rut the anphasis on the subject and method of operation will obviously vary according to the ~ of country - tropical or arctic, underdeveloped or more fully organized. If this is accepted, then it is clear that the health services have a vital, continuing interest in the scope and quality of professional and technical education." The following is quoted from Technict.l :::port Series !lo. 22, l::xpert Committee on Proft>ssional and Technical Education of Medical uhd AuxiE(;,l'Y "".&o1l11e" Rq)oJ>"" on the First Session: "Technical Trainin Perse 'lel in Public Hea tho The genera view of the committee, a ver studying relevant documents, was that parti cular emphasis should be laid on the social aspects of public-health training and the study of economic, SOCial, and working conditions as they affected health. These aspects affected the education of public-health personnel in three main ways: first, the training of undergraduate medical students; second, the postgraduate training of public-health officers; third, the training of auxiliary personnel in public health." II.
HEAL'lH SERVJCES ffiD COlll1UNITY DEVELOP}lEl;T Planning and administration of the categOrical health services as an integral part of a progrwume of multipurpose community developnent.
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The follo11ing is quoted from Technical Report Seriee r o. 83: "Certain Principles of Planning a Rural Health Service. The problems of planning a rural heclth progrwume were then ccnsidered, and the committee accepted tho essential principles put forward by one of its memers, as followSI
(1)
The advancement of rural health must be regarded as an integral part of a larger and wider sphere of community devolopment - schemes for village betterment, mass literacy drives, food-production drives, etc. The medical servicos must therefore work in full collaboration with other services, particularly the education, agriculture, and adm:inistrative services. It must be emphasized
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to the people again and again
that the provision for rural health services is their own responsibility and not that of a benevolent central
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The creation and improvement of rural health services necessarily involves the provision of curative centres (wi th beds) or even small I cct:tage 1 hospitals. Although these curative units must be provided, tre preventive aspect of a rural health scheme must be given overall emphasis. By example, by practice, and by precept intensive health educational measures to arouse and maintain village health con sciousness by me ans of baal til committees, frequent lectures, film shows - stress must be laid on schemes for the improvement of village environmental hygiene, proper water-supplies, etc. A rural health service must not be allowed to grow up ad hoc in a haphazard manner. It must be properly and deliberately planned and executed. It must, however, be flexible, i.e., capable of being modified to suit ,the' requirEl1len ts of different parts of the same terri tory. It is essential that the general directicn of the executiCll of a rural health scheme should be vested in a specialist rural health adviser at the national or intermediate level."
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(5)
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Please also refer to Public Health Conference and Study Tour documents Nos. 3, 6, 7, 8 and 9 •
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GOi"!!-M: lTY DEVEL.QPllElJ T
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" I John E., Grant Sununary
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Commmity develu?~tem, 1.5 tne technique fur s'~imulating the people of local communities to initiate action towards their own improvement. It is not commmity development mless it secures a co-ordinated approach towards solving the inter-related problems of the community. commmity development replaces previous separate categorical administrative approaches and separate levels of the co::unmi ty - municipal, district, state - are thereby brought under a common development control and geared to a common overall plan. Essentials: There must be a specific body respons:!ble for catalyzing the co-ordmation of separate agencies. This body must not be created wi thin ene of the agencies to be co-ordmated. Each agency must be represented on the catalyzing body, Basic premises: (a) iJlY welfare activity direct)y aimed to eliminate poverty, disease or ignorance is successful in direct proportion to its mtegration with multipurpose commmity development rather than when undertaken as an mdividual welfare activity, (b) Progress will be proportionate to the consumer's technical consciousness of unmet needs, (c) Organizatien of the administration of services for community development must be built from the village up and not superimposed, (d) Any national communi ty development programme should be pla.·med within an werall programme for industrial as well as welfare development. Principles to be folluNed: The community development programme must be based on the economic practicability of nation-wide extension. The economic baseline will determine the extent to Which gwernment organizations can afford tax-supported technical personnel and facilities, e.g. whether one physician per one or ten thousand population. 11 developmen t organization with co-ordinating oo.d planning functions must be established at each level of gwernmcnt. The success of assistance depends upon the extent to which it can mobilize voluntary self-help. The success of voluntary self-help depends upon the degree to whi ch technical consciousness is generated in the local community. The unit of organization must be technically self-contained to provide services, supplies and supervision. Its size must coincide with a previousJ.;y existing unit of governments Essential ste s for local initiation: The smallest developnen t mit is responsible for: (a village survey to provide an evaluation of local needs, (b) constitution of a village development council, (0) decision re programme and priorities, (d) in-service training of the subcommittee members respcns:!b1e for promoting self-help in their respective fields. The author summarizes the Indian comprehensive community developnent programme which he considers more comprehensive than that in any country.
COMMUNITY DlVELOfmNT John B. Grant.!t Underdeveloped areas are characterized by two deficiencies: a low economic level, resulting in poverty, ignorance and disease; and a lack of technical consciouSness of the public of how to el:iJninate these three social evils. The role of public administration in community development may be approached in two different directions; first, the contribution of community development to public administration, and secondly, the contribution of public administration to community development. The conventional concepts of public administration are based on the belief that the services provided by governments are a result of an expressed need by the people at the grass roots through the legislative process. Governmental services are accordingly authorized and organized for the sole purpose of providing services to the people •. However, universal experience points to the general slowness of progress of superimposed pregrama. This diagnosis that the ailment of lack of initiative and responsibility of underdeveloped communities prescribes that the treatment required is to activate people by their own desire for progress to organize a cooperative program of community regeneration. And, the yardstick by which the success is judged is the extent to which the communities involved have themselves contributed to the projects concerned. As such, community development might be tenned Operation Serenity. Col1DllUllity development is the technique for stimulating the people of local communities to initiate action towards their own improvement. It is not community development unless it secures a coordinated approach towards solving the interrelated problema of the communitlP. In effect, community development is an effort to capitalize on the potentialities of the human spirit and whese results are measured by the effort put forward in self-help. However, community development should be viewed only as part of the wider process of national economic and social development. Organized community effort whether by education, agriculture, health or communication, requires the three factors of money; personnel with specialized skills; and. organization for the most effective utilization of available funds and personnel. Community development is merely the most effective type of organized comunity effort, which replaces previous separate categorical administrative approach by each agency with a multipurpose a:Jmbined approach at each level of the community -muniCipal, district, state -- to assure coordination of development policy and plans. While separate departments are thus brought in under a common development control, they retain their own organizations and staff but geared to a common overall plan. The weakness of the Puerto Rico Planning Board is the absence of an administrative mechanism to assure that the Commonwealth welfare agencies are geared to and controlled by a common development policy. There are two essentials .for accanplishment of coordination and integration: first, there must be a specific bedy responsible for catalyzing coordination of separate agencies but not itself to operate them. Second, such a body is ineffectual if created Within one of the agencies to be coordinated. However, each agency must be represented on the catalyzing body. The foregoing applies particularly to underdeveloped and semi-underdeveloped countries. But, it should also be pointed out, particularly since the last war, there has been a large increase in the United States of voluntary association at the
*School of MediCine, University of Puerto Rico; and, Rockefeller Foundation.
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community level to achieve social and economic objectives. The motivation has been three-fold. postwar economic conversion; the necessity of lIone industry communities" to regain economic security; and, communities who have farsightedly been broadening their economic base. Puerto Rico has been cited in community development for its Social Program Administration, particularly the divisions of small industries, administration and civic employment. Puerto Rico would really have a community development p~licy were the program extended to the whole population and not limited only to resettlement communities. There is also the COl1lllunity Education Division in the Department of Education, with which we are all familiar. But both of these are fragmentary. In fact, most countries today have some aspects of Community development although, generally speaking, in a segmented rather than a national overall comprehensive program. The most comprehensive documents on community development are the seminar document prepared by lCA for the diSCUSSions held last June together with the Selected Bibliography; and "Principles of Community Development" Ecosco (1955). Community development to be successful must adhere to precepts of administration. These precepts consist of: basic premises; principles upon which a national plan should be formulated; essential steps to inaugurate a local program; and finally, provision for training and evaluation, which are essential to insure successful national extension of any comprehensive development program. The first of four premises is that any welfare activity directly aimed to eliminate poverty, disease or ignorance is successful in direct proportion to its integration With multipurpose community development rather than when undertaken as an individual welfare activity. Second, progress of community development will be proportionate to the consumer's technical consciousness of unmet needs which technical assistance can meet. Third, organization of the administration of services for community development must be built from the village up and not be superimposed. Fourth, any national community development program should be planned within an overall program for industrial as well as welfare development. The first of fi~e principles to be followed is that the community -'development program should be not only an integral part of an overall national development plan but the program must be based upon the economic practicability of nation-wide extension. This economic baseline will determine the depth to which government organization can afford tax-supported technical personnel and facilities, i.e., whether one physician per one or ten thousand population; one agricultural extension agent per five or ten thousand population; one or four hospital beds per thousand of population. etc. This economic baseline also determines the extent to which community development will depend upon voluntary self-help. The second administrative principle is the necessity for establishing at each level of government I national, state and district, of a development organization having coordinating and planning functions. Such an organization would include representation from each agency of government concerned in community development. Experience has proved that coordination is generally ineffectual when its responsibility is given to one of the agencies whioh itself is to be coordinated. The OrganiZation itself is not an operating one but specifically created to catal~e coordination among existing agencies. The third principle is that the success of technical assistance depends upon the extent it can mobilize voluntary self-help. In Asian countries, it is estimated that the present agricultural-social organization results in villagers being idle for 30,000 million days per annum. Many :\fprovements can be undertaken out of local voluntary resources provided they are organized and given technical advice and supervision. The fourth principle is that the success of voluntary
-3 self-help depends upon the degree which technical consciousness is genera~ed in the local community through the formation of villate cOl1Ullunity development councils, whose members are given sufficient in-service training to become conscious of local needs and the manner in which the local community can meet those needs with help from tax-supported facilities. The fifth principle is that the unit of organization for col1l11lunity development must be technically self-contained to provide services, supplies and supervision. The population covered must be large enough so that the overhead cost of these tax-supported services can be economically practicable but not so large as to require duplication of the personnel and facilities required for providing each major welfare service, Empirical experience places such a population at not less than 200,000 or more than 500,000. An important factor detennining the size of the unit is that it must coincide with a previously existing administrative political unit of government. This is essential to permit integration of the more intensive welfare services of cOl1ll!llll'lity development with those previously existing. The five steps essential for local initiation arel the smallest development unit is respCllsible for the following: village survey to provide both a benchmark as well as en evaluation of local needs; constitution of a village development counCil; deciSion by the council and officers of the unit on program and priorities, with the formation of council subcommittees for each welfare service to be undertaken; in-service training of the subcommittee members, responsible to promote selfhelp in their respective fields, to dev~lop a technical consciousness of the local needs. India, India today has the most comprehensive community developnent program of any country. I would like briefly to summarize the Indian Program in terms of fulfillment or non-fulfillment of the administrative precepts which have been outlined above. Community development constitutes an integral part of both the first and second Five Year Plans. There is a Community Project Admicistration under a Central Committee, whose participants are members of the Planning Commission. The Committee is aSSisted by an Advisory Board conSisting of the Secretary, Ministry of F-ood end Agriculture; the Additional Secretary, Ministry of Natural Resources and Scientific Research; the Secretary, Ministry of Finance, the Government's "nominee" of the Indo-United States Technical Fund; end the Secretaries of other Ministries concerned SUG as Health, Education, Irrigation, Public Works. The Comnnmity Project Administration is headed by an Administrator with an executive staff to advise him on all phases, and is responsible for planning, directing and coordinating the community projeots throughout tt.e country under the supervision of the Central Committee, and in consultation with the appropriate authorities in the various States. ·A State Development Committee operates at the State level and consists of the Chief Minister as Chairmen, with the Ministers for Development, Agricult\ll'e and Irrigation, Jiinance end such other Ministers as are designated by the Chief Minist~r as members and the State Development Commissioner as Member Secretary. There ~s also a State Advisory Board, the members of Which are the Secretaries of the principal departments concerned with the community development program. In states where a number of.projects are in operation, there is a Deputy Development Commissioner specifically in charge of community projects. In addition, there is an operating staff in charge of supplies, training, information, etc. All these officers work in close cooperation with their counterparts at the Central, District, and project levels.
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On the lower level, there is a District Development Officer Who is responsible for the execution of the community projects as well as the general development in
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1li.st.r:l.ct.. He opeTat.es under the direction of the State Developnent Conunissioner' with the advice of a District Development Board consisting of the officers representing agricul.ture, health, education, ~tc. The District Magistrate serves as its Chairman and the District Development Officer as the Secretary. The status of the District Development Officer is that of an Additional Collector. and
A Project Elcecutive Officer is responsible at the project'level for the rural The Project Elcecutive Officer operates under the dtrect 7 0n of the Distri~t ~velopment Officer or the State Development CommiSSioner. There :L5 also a Project Advl.sory Committee which includes "besides the principal officials concerned, leading public workers, a few repres~ntative agricUlturists the Chairman of the District Development Board, local representatives in the ' Parliament and State Legislatures, etc." The Project Elcecutive Officer serves as Secretary of the Committee. comroun~ty program in the area.
This brin~s us to the rural community or village. The average project area has a population of approximately 200 thousand and is divided into three development blocks of 100 villages each. Each block has an Assistant Elcecutive Officer aided by a technical team covering the welfare fields. A unique feature of community development in India is the ''village level worker!', who is assigned to an average of five villages with approximately 500 people each. The village level workers is t rained to become a link between the village problems and the nation-building services, He can best be visualized were Puerto Rican agricUlture extensicn workers as ful.ly trained in health and other welfare fields as in agriclllture and a ratio of one worker to each 2000-2500 population. Another unique feature in the Indian Program is that projects are initiated from the village up, instead of being superimposed from the government agency down. The program complies with the five steps essential for local initiation. The village level worker in conjunction with the program development unit first undertakes the village survey to provide both a yardstick as well as an evaluation of local needs. This is followed by the constitution of the Village Development Council. 'fhe CounCil, together with the officers of the program unit, decides on program and priorities with the formation of council subcommittees for each welfare service to be undertaken. Members of the subcommittees are provided with in-service training to develop a technical consciousness of the local ne.ds and knowledge of what must be met, and who then assume the responsibility to promote self-helf in their respective fields. Non-official consumer partiCipation in India's administrative machinery is assured through village council representation on the block council. These block councils nominate representation on the Project Area Advisory Committees. There is, thus, assurance of continuity of consumer representation from the village to the national center. The foregoing sketch of community development in India markedly shows fUlfillment of the administrative precepts previOUSly referred to, namely, the four premises and the five principles as well as the five steps for local initiation. There is also an independent evaluation organization, which issued a voluminous second report in April 1955. The training of personnel is being well provided at the local level. But , in this field India has failed in two steps I the preliJninary plann:ing did not :include measures to assure the quality of the teachers at the local training centers. This resUlted in wide variations in the success of individual projects. However, a single most essential step to assure the quality of training, and, which Ind~a al~o has not yet undertaken would be to assign a project in each state to one unl.versl.ty for development. It w~uld be presumed that such a university project would demonstrate
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a Unit with high standards, which would be the best assurance of the quality of the extension in that state; and, at the same time provide a field service center to train instructors for local training centers. The fundamental concept ot the COIIUIIunity Program is that the main motive force for its implenentation must come from the people themselves and that the \last unutilized energy lying dormart. in the countryside should be harnessed for constructive work, on the cooperative principle. TQe new pattern of rural society that is visualized is that of millions of rural families, organizing themselves in cooperatives of different kinds and taking deciSions as free agents practising scientific agriculture on the largest scale possible and finding supplementary occupations in a variety of decentralized cottage and small-scale industries while the State assists by organizing research, supplies, services and credit. The basic considerations are not merely economic. There are non-material values and social gains which are equally :lmp~rtant. /"The resource-requirements of the program are very large. For the integrated National Elttension Service, the Five Year Plan has made a provision of Ra. 101 crorea for the period ending March 1956. This is approximat~ly ~16Om. The United States Government have made a friendly and generous contribution of nearly $lan. towards this experiment, about $8.7m in the form of equipnent and supplies for the first 55 area project and subsequently, $1.9m. and :'4.9m in two installments. They have also made available the services of some experts. The Ford Foundatien has also been assisting generously in the launching and running of the programs, particularly in the field of training. Five training centers for training key personnel have been financed entirely by the Ford Foundation for the first three years and fifteen pilot develoJlllent units have also received financial assistance from the r'oundation. In June 1955 there were 45 Training CEnters for Village Level Workers. The course is one year. In 1953 the Foundation also agreed to provide $230,000 for setting up a Program Evaluation Organization. Overall, there has been Significant progress throughout the country under the scheme. Up to the end of March this year, 2-1/2 million acres of land have been recla:lmed and nearly a million acres brought under irrigatien. Several thousand wells have been newly sunk or renovated and 150,000 tons of fertilizers and over 60,000 tons of :Improved seeds have been distributed. Over 6,000 new schools have been started and 17,000 schools converted into what are known in India as Basic Education Centers which embrace, besides ordinary fonnal education, special educatien in agriculture and the crafts. Over 16,000 miles of roads have been built in project areas and there are nearly 500 production cwn training centers in selected areas. There is fullest expectation by the end of the first Five Year Plan :I.il March 1956 that the Program will have included 700 blocks with some 70,000 of India's 550,000 villages. In 1954, President Magsaysay established a community project administration in the Philippines, J!lUch similar to that of India, to take over and expand the very considerable work in commUnity development which was initiated in 1949 by the Department of Instruction. Ceylen also has a community development progr!IJII. These two countries, with the exceptien of India, have developed multipurpose community programs farther than any of the other 34 countries reported at the rCA seminar on cormnunity development. I wish there were t:lme to reView their administration in terms of the precepts reviewed in the case of the Indian program and to show that failure to follow these precepts has resulted in se~ented nen-comprehensive programs. Puerto Rico already possesses most of the essential potentials required for a successful ccmmm1ty developnent pro3l'am. Only two innovaticna would be requiredl
--"
• - 6 one would be to set up in the Planning Board, and at District and Municipal levels, the mechanism for coordination. The advisory development councils at each level would include represenl1ation of the consumer, as well as the purveyor of government welfare services. The second step would be to extend the scope of the present agriculture extensicn worker to enable him to serve also as the liaison between the barrios in which he is assigned and the other welfare agencies. This would require a careful study as to how much the present training of agricultural extension workers would have to be modified and extended. Actually, this is wbat occured in India in the two states in which they had developed agricultural extension workers when the community development program was inaugurated in October 1952. I would conclude by reemphasizing two convictions, The overall of community 'development program is more the harnessing of the human spirit; and, that material results are merely the means Whereby the cultural and moral goal is expressed. Second, that a multipurpose approach to the solution of community problems is much more effective than the categorical one, If these convictions are substantiable, then Community organization along the lines outlined should become an integral part of government policy and planning. Time is thE inexorable factor in social evolution. The future of Puerto Rico is in the hands of pres6nt events,
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'JHo/eST/lB APPENDIX l-g
Summary Three papers have been selected from the attached publication for consideration of pc.rticip;mts 9nd ",,0:1 is sUlIlfo1arized below. Community Devulopme,t Definod l
To emphasize the importance of conununity development in the world to-day, the author quotes the definition given to this term by the United Nations ;md the International Co-operation Administration. The fact that these two statealthough developed independently, reflect substantial agreement, suggests a significanco tlli~t neither statement alone could do. Cultural Fe.ctors in Rural Community Davelopment 2 Community development work requires techniques Which are just about as definite as those used in other fields. L basic attitude or approach to the study of community development is, however, also required and cultural factors are of fundamental importance. Whon facod with a problem affecting changes in village life, the first important thing is to isolate the two factors, habitat and culture. The author selects six principles of cultural changes that were drawn up by UNESCO under the leadership of l"Jargaret Head and shows how the introduction of such changes may set up a who16 chain of consequences. Community Devolopment Programmes and Methods) The author underlines the confusion which has arisen as a result of the loose way in which the term IIconununity development" is used. Community development in this paper is used. to describe only the methods by which the people who live in local villages or communities become involved in helping to improve their own economic and social conditioo.s <!lId thereby beccme effective working groups in programmes of national development. Experience to·-date is analyzed to shCM how the violations of some community development methods and procedures are most often due to ccrtai:.1 caUS0S~ Conversely, successful community development is most of ton, if not always, due to certain methods of approach which are enumerated. The basic prerequisite to the use of community develo~aent as ona of the methods of social and economic development is a knowledge that illiterate villltges, no matter hm' isolated physically and culturally, have self-recognized needs and have desires to satisty them. The various steps in community development are outlined. These include: (a) ~stematic discussion of common felt needs by members of the community, (b) systematic planning to carry out the first self-help undert~king selected by the community, (c) complete mobilization and harnessing of the physical, economic and social potentialities of local community groups and (d) creaticn of aspiration and the determination to undertake additioo.al community improvement projects. Each of these steps is discussed. 1 by L. M. l1iniclier, Chief Development DiVision: pp. ]-2 2. by I. T. S~nders; pp. 30-33
3 b¥
c.
C. Taylor; pp.
)~42
CIWIlB III TrrIJ:
The CClIIIIIunity D8velClpllent Clearing BClUse
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lJDiversit:r
or
London Institute
or
Edncatian bas publl.shed for
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title,
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with this iSsue, this publication llhich is
designed pr1s.ri.:q- to present current information
or
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to U. S. Operations HissiOll8 and host cCll1lJtry personnel. .u:t.1velT engaged in C""l!!!lIni t:r
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t.oais H. JU.m.clier .Ity DBYel.op2at DLvision otnce at 1'llbl1.c Serri.ces Intenatioual. Coapelatlon AdIIIiniatration v.!!hington. D. Co Chief. C
TABLE OF CONTENTS*
COMMUNITY tEVELOPMENT IEFlNED • • • • - Louis M. Miniclier
. . .. . . . . . . . . . . • • • • • •
1
TIlE COMMUNITY DEVELOPMENT GUIDELINES OF THE INTERNATIONAL COOPERATION AlJo!INISTRATION. • COMMUNITY IEVELOPMENT AND RELATED SERVICES UNITED NATIONS •••••••••••••• • •
3
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7 30
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CULTURAL FACTORS IN RURAL COMMUNITY lEVEWPMENT: A WRLD VIEIi • • • • .. • • .. .. .. • • • .. .. • • • • .. • .. • .. .. - Irwin T. Sanders COMMUNITY lEVEWFl1ENT PROORAMS AND METHODS. • • • • • • • • • • - Carl C. Taylor
34 43
Nm4S AND mTES. • • • • • • • .. • .. • .. • • .. .. • .. • • .. ..
iloilo
*Material included in this Review does not necessarily reflect the views of the COIIIIIIuni ty Development ntvision nor ICA policy.
COMMUNITY IJEVEWPMENT 1JEFUJED Louis }I. Miniclier Chief, Comnrunity Development Division A social invention labelled community development is changing the lives of millions of people in thousands of villages in the Far East, South Asia and the Middle East. It has become an integral part of the nation building programs of India, Pakistan, the Philippines and other rapidly developing countries. Communi~ Development is the term which describes a complex of processes now used by ma~ governments to reach and involve the bulk of their people in self-help endeavors to raise standards of living, increase productivity and achieve certain political objectives •
.
The concept of community development was clarified and redefined in 1956 by both the United Nations and the International Cooperation Administration.* The statemertts by these two organizations ,'hich are based on experience throughout the world were developed independently. The United Nations describes community development as the processes by which "the efforts of the people themselves are united with those of governmental authorities to improve the economiC, social and cultural conditions of communities, to integrat.e these communities into the life of the nation, and to enable them to contribute fully to national progress." It is defined by the ICA as "a process of social action in which the people of a community organize themselves for plannin~ and action; define their common and individual needs and problems; make group and individual plans to meet their needs and solve their problems; execute these plans with a maximum reliance upon commutti ty resources; and supplement these resources when necessary with services and materials from governmental and non-governmental agencies outside the community." Manpomr is the greatest resource of most developinc; countries.
B.r capitalizing on the imagination, iniative and energy of people
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community development is producing better health, agriculture and education. In India where it has already affected the lives of more than 80 million rural people since it "as inaugurated in 1952, there are impressive, tangible results. The stimulation of self-help and cooperation in the villages has resulted in the establishment of 12,000 new schools and 30,000 adult education centers, the building of 28,000 miles of new roads, the reclamation of 895,000 acres of land and the irrigation of an additional 1.5 million acres. *UN-Economic and Social Council Document E/2931 of 15 October 1956, Twentieth Report of the Administrative Co~~ttee on Co-Ordination to the Economic and Social Council, Annex III and ICA Airgram IeATO Circular LA-55, NA-52, FA-53, XA-357, dated October 27, 1956, Subject: Community Development Guidelines. - 1 -
Community development is also producing its own end results which, in the final analysis, may prove more significant than the tangible achievements. It has been called the "silent revolution." It is bringing about changes in human attitudes. It creates self-cOnfidence, respect for the individual and faith in governnent. It provides experience and skill in democratic procedures from which democratic local government and a responsible electorate flow. Both the U. N. and the ICA recognize that IIcammunity development should not be regarded Simply as a series of episodes embodied in concrete achievements. Success in these, important though they may be, is less important than the qualitative changes expressed in attitudes and relationships which add to human dignity, and increase the continuing capacity of the people to help themselves to achieve goals which they determine for themselves."* The fact that these two statements ~Jhich were developed independently reflect substantial agreement suggests a significance that neither statement alone could carry. Community development is coming into focus as a valid means of achieving goals essential in the world today.
I
*UN-Economic and Social Council Document E/2931, 18 October 1956, Twentieth Report of the Administrative Committee ,;>0 Co-Ordination to the Economic and Social Council, paragraph 14, page 5, Annex III. - 2 -
THE COMMUNITY D.£IlELOruENT GUIDKLI~* OF THE INTERNATIONAL COOPERATION ADMINISTRATIoN
"I.
Concept
'."
"A. • Community Development •.!/ is the term used to describe the technique many governments have adopted to reach their village people and to make more effective use of local initiative and energy for increased production and better living standards. Community development is a process of social action in which the people of a community organize themselves for planning and action; define their common and individual needs and problems; make group and individual plans to meet their needs and solve their problems; execute these plans with a maximum of , reliance upon community resources; and supplement these resources when necessary with services and material from governmental and nongovernmental agencies outside the community. Governments have learned that when local people have a chance to decide how they can better their own local conditions, better sanitation, greater literacy, and other desirable improvements are more easily introduced and have a more lasting effect. "B. More specifically, community deV'elopment is technical assistance at the village level in how people work together for better living. Its objectives are to help people find methods to organize selfhelp programs and to furnish the techniques for cooperative action on plans which the local people develop to improve their own circumstances. It can result in greater literacy, improved health, more productive agriculture. Its immediate concern is not only these results but what happens in the process of achieving them. The heart of community development is village organization and all of the techniques in how people are brought together; how they are democratically organized; how to get the individual villager to take part; how to get discussion and thinking started; how people arrive at the things they think they need; how they judge the priority of the things they want; how committees operate; how people are brought around to the decision that they can do something for themselves; how they proceed to get from a higher level of government the help they need. It helps to bring a whole range of technical knowledge to bear on the programs which the people themselves feel are necessary to their economic and social progress. Community development fosters a unified approach to the problems of the villagers. It capitalizes on and puts to work manpower, the greatest resource of underdeveloped countries. It produces its own end result in the form of experience and skill in democratic procedures. *Sent to lCA Operations Missions October 27, 1956. !lAlso known as: Village Development; Rural Development; Village Agricultural and Industrial Development; Community Action and Community Education.
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"c. ICA considers that community development is a direct way of bringing about self-help in the local population, an efficient way of multiplying the effects of U. S. technicaL assistance, a constructive ,my of developing an enduring base for a sound national economy, a successful way of giving the people a greater stake in their own development, and a sound way of meeting the increasing demand for a better life. "II. Host Goverllr.lent organization "A. There is no one organizational pattern ,'hich will fit all situations. The community development organization in each country must take into account the existing government structure, attitudes of key ministries and officials, existing or planned programs, available technical skills, and available financial and management resources. "B. )Jhen community development is being undertaken by a national government, certain administrative arrangements are required to assure a coordinated, rather than a segmented, approach to the interrelated problems of a community. This is frequently achieved by a policy level interministerial co~~ittee at the highest level of government (sometimes including a central secretariat), appropriate administrative organization at central and state or provincial levels, and provision of multipurpose village workers. These workers are trained to help organize comrnunities for self-help action and to serve as the bridge bett-men the villages and the government's technical services.
"c. Community development requires the carefully coordinated utilization of all available administrative and technical services which can contribute to the process. The aim should be for coordinated village program planning, with any necessary governmental execution in health, education, agriculture, and other fields by the substantive departments of government. It is not a substitute for the technical services provided by such subject-matter ministries. Successful community development activities will depend to a large extent upon the balanced development and l,ork of these technical services. "D. USOH advice to host countries regarding their organizational structure for co~~unity development should emphasize maximum use of available governmental institutions rather than the establishment of autonomous, self-contained new organizations. Experience has shown that host country organizations which attempt to have within the community development structure their own health, education, and agricultural components usually alienate the established ministries and cause vigorous opposition. Ministries of Health, Education, Agriculture, etc., should be responsible for the action programs in their respective fields. These ministries should also be responsible for the content of the training of the 'village level workers' insofar as health, education, agriculture, etc., are concerned. The central community development staff should have primary responsibility for the development of balanced coordinated training programs, in agreement with the concerned ministries, as well as responsibility for the general administration of the training centers.
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It should also have primary responsibility for the training of village workers in the techniques of co~~unity organization and group relationships, which f01m a substantial element in such training programs. "III. ICA Organization "A. In l1issions
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"1. The general principles for host country organiZational structure apply equally to mission organization. The full contribution of the technical services of the mission in health, education, agriculture, public administration, etc., is essential to a successful community development program. These substantive programs and that of community development must be complementary. If a significant program is to be undertaken, a senior comnmnity development advisor will ordinarily be required as the principal USO)'! staff member concerned with these activities • "2. The complementary relation can be maintained by the establishment of a mission community development committee, chaired by the mission director, with the senior community development advisor as executive secretary. Such a committee, composed of the heads of the technical divisions and other appropriate USOM personnel, advises the mission director regarding mission community development policy and program and the coordination of mission services for community development. In countries with substantial community development activity, a small community development staff may be needed. Health, education, agriculture and other functional technicians should not be appointed to the community development staff. As is the case in all other activities involving the participation of several USOM units, mission directors have responsibility for assuring that the functional USOH Divisions, such as agriculture, health, education, housing and public administration, provide services to community development activities. "3. The community development advisor has an important function in advising on the organization and techniques of community development. He serves as the point of contact with the national government community development component. He maintains liaison with all other groups--bilateral, multilateral, private foundations, etc., working in the community development field. In conjunction with other mission functional specialists he takes leadership in advising and assisting the host government concerning: 1) Balanced community development training programs for host country personnel at all levels, including specific substantive responsibility for training in the techniques of community action; 2) National and local community development structures; 3) Where appropriate, demonstration and pilot projects.
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"B.
In liashington
"1. The Community DeveloIXDent Division of the Office of Public Services of ICA/W (CDD) serves as a focal point in Washington for this activity. CDD assists the USOM's by: 1) developing guidance material on community development; 2) exchanging information and experience gained as the result of bilateral and multilateral governmental and nongovernmental programs; 3) participating with related technical divisions in the review of country programs with respect to community development aspects; 4) assisting missions in developing appropriate training methods and material; 5) assisting in the recruiting and the orientation of U. S. personnel for community development work; 6) conducting community development training programs for foreign nationals coming to the U. S.; and 7) assisting in planning and coordinating lCA-US voluntary agency community development activities." The foregoing Community Development Guidelines were sent to U. S. Operations Missions in 6a countries October 27, 1956. They reflect the increasing experience being gained in 23 countries where ICA specialists are assisting in furthering community development activities primarily by advising governments regarding methods of organizing and administering such activities, by assisting them in the training of trainers of village workers, by providing limited demonstration supplies and equipment and by financial aid to pilot projects. These Guidelines which were developed jointly by the concerned technical staffs, including the Public Health Division and Office of Food and Agriculture, in ~shington, also reflect the informal recommendations made by participants at the ICA Inter-Regional Community Development Conference, in Bangkok, March 1956, which was attended by 65 representatives from 22 U. S. Operations Hissions. The significance of this statement is enhanced by the fact that the United Nations and representatives of its specialized agencies clarified and redefined the concept of community development and related concepts at the 1956 sessions of its Administrative Committee on Coordination. The UN and ICA statements were developed independently. Study of the two statements reveals a high degree of agreement Which points up the growing understanding and acceptance of the concept of community development and its potential.
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COMNUNITY D.i!.VEWPMENT AND RELATED SERVICFS - UNITED NATIONS* The United Nations Administrative Committee on Co-ordination which includes the Secretar,y-General of the United Nations and the ranking officers of the United Nations. specialized agencies undertook clarification and redefinition, on the basis of recent experience, of the concept of community development and related concepts at meetings in July and October 1956. The results reflect the recent evolution of the concept of community developnent, and its possible scope. This report stresses the role of national services in promoting community development and the need for an integrated approach towards the utilization of the specialized knowledge and skills of the relevant national services. This Report reveals the degree of agreement reached ~ representatives of specialist fields and helps delineate the role of the specialized services, such as agricultural extension and fundamental education. As this document may serve as a guide to both governments and foreign technicians assisting governments in community development activities the complete text of the United Nations Report follows: "PARI' ONE CONCEPT OF CQ}INUNITY DEVELOPt-lENT AND HELA TED CONCEPTS I. NEANIHG AND SCOPE OF CmIl'UNITY D1WELOPNENT
Elements in the concept of community development 1. The term cormnunity developr.1cnt has come into international usage to connote the processes b.r which the efforts of the people themselves are united 'dith those of governmental authorities to improve the economic, social and cultural conditions of communities, to integrate these communities into the life of the nation, and to enable them to contribute fully to national progress. 2. This complex of processes is then made up of two essential elements: the participation b.r the people themselves in efforts to improve their level of living with as much reliance as possible on their own initiative; and the provision of technical and other services in ways which encourage initiative, self-help and mutual help and make these more effective. It is expressed in programmes designed to achieve a wide variety of specific improvements.
*ON-Economic and Social Council Document E/2931 of 18 October 1956, Twentieth Report of the Administrative Committee on Co-Ordination to the Economic and Social Council, Annex III. - 7 -
3. These programmes are usually concerned l<ith local cOll1lllWlities, because of the fact tha.t the people living togeth"r in a locality have many and varied interests in common. Some of these interests are expressed through fWlc.tional groups organized to further a more limited range of interests not primarily determined by locality.
4. The size of the geographical area to be covered by the progr=e will be determined by the nature of the interests to be served and by questions of economy and efficiency in satisfying them. There is very proper emphasis, however, on small rural COl/UllWlities because the local needs to be satisfied are c1 0ser and more obvious to the people than l,rithin larger communities.! In conseqwnce, the people are nor.nally more willing and able to make direct contributions to meeting these needs in work, in money and in kind.
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5. But there are other needs which affect a number of small communities. Successful action to satisfy such needs may require wider areas of operation and different types of organization. Active partiCipation of the people in this action necessitates that the people recognize the interests common to a number of coll1lllWlities and that suitable methods be devised through which self-help is expressed. ! / CommWlity development in urban areas 1. CommWlity development has been applied mainly in rural areas. But there is a wide and growing range of economic and sccial problems in towns and cities, particularly in cases where urban growth is proceeding at a rapid rate because of migration from rural areas. The question therefore arises whether community development techniques are applicable to urban areas. 2. One important difference between rural and urban populat ions is in the nature of economic relationships expressed in the latter in the fuller growth of a money economy and of wage-earning groups. }.nother difference is that there is seldom any sense of belonging to the urban community. Finally, in cities, welfare services and facilities such as schools and hospitals are more fully developed, and there are usually more volWltary organiz~tions giving various kinds of assistance. 3. Such differences in relationships among the people, in the nature of the needs and in the facilities, require different priorities and procedures, and the organization of government services in a different way.
4. The full significance of these differences needs to be carefully assessed before any conclusion is reached as to the applicability of the prinCiples and techniques of commWlity development to urban areas. - 8 -
6. If participation or the people is to make a signit:icant contribution to social and economic development throughout a COtmtry or territory, it should be undertaken within the f'ramework of' a national plan covering a large number of' the smaller collllllUllities. Within this framework, the gradual recognition by" the people of the inportance o:i" these wider relationships assists in the integration of the smaller with larger communities. This recognition, together with active participation of the people in local and group affairs, increases their natural interest in and capacity for political participation in national af'f'airs.
7. Success in community development programmes demands that the people emotionally identify themselves with these programmes. Such identit:ication (as is occurring in some countries) gives cOllDllunity development the character of a movement providing strength and a sense of purpose to the current of change over a whole country. For this to occur, political leaders and leaders of public opinion should give publicity to community development policy and actively identify themselves with it. 13. The role of the gove~elit is to plan and organize the programmes on a national basis according to a well-conceived policy and secondly to provide the technical services and basic material aid which go beyond the resources of the communities and of the voluntary organizations. Community develOpment and economic and social development 9. Conmunity developnent may properly be considered as a component of the wider concept of economic and social development. But it is cot of' itself suff'icient because certain development measures do not depend upon the participation of the people as members of the local communities. For example, economic development may require establishing a central bank, raising a foreign loan, buUding a main higbway or constructing a large hydroelectriC project. Social development may require national employment policy, labour or insuranee legislation or other protective measures complementary to those introduced through community d evelopmen t • 10. Community developnent, however, may have an important role to play in promoting economic and social development and in helping give it direction. This it may do in increasing productive capacity, in infiuencing the kinds of activities which the people undertake and in educating them as conswners of both goods and services. 11. Conversely, economic and so cial development makes possible or stimulates activities in communities which may greatly increase the general capacity of the people to help themselves and to respect one another. 12. It must also be recognized that economic or social developnent often introduces disturbances lllich, it: left to operate alone, may well weaken social coherence and so be conducive to community recession at
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least over certain phases. Through promoting collective action, community development may.keep community recession in check ~d help re-establish coherence at different levels and for different purposes. The nature of the co_unity development processes
13.
In relation to the people, community development is essentially both an educational and an organizational process.
14.
It is educational because it is concerned with changing such attitudes and practices as are obstacles to social and economic improvements, engendering particular attitudes which are conducive to these improvements and, more generally, promoting a greater receptivity to change. This implies developing the capacity of the people to form judgements on the effects of activities and to determine the goals to be arrived at, to adopt technical changes and to adjust themselves to changes brought about l:u outside forces. In actual operations, field workers (or practitioners) must be concerned with getting specific things done. So the immediate objectives of community development can be defined in terms of more literates, improved agricultural production, better health, better nutrition, fuller use of labour, capital formation in the fom of roads, wells, community centres, and so on. But community development should not be regarded simply as a series of episodes embodied in concrete achievements. Success in these, important though it may be, is less important than the qualitative changes expressed in attitudes and relationships, which add to hU'llan dignity, and increase the continuing capacity of the people to help themselves to achieve goals which they detennine for themselves. It is in this sense that community development is an educational process.
15.
It is organizational not only because people acting together are better able to pursue the interests which they have in common, but also because it requires the reorientation of existing institutions or the creation of new types of institutions to make self-help fully effective and to provide the necessary channels for governmental services. To be fully effective, this demands the emergence and training of a new type of local leaders. The value of organizing the people consists not only in the help which it may give towards achieving particular concrete results, but also in the general contribution which it may make towards increasing social coherence.
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16. Successful organization may be expected both to enhance the dignity and welfare of members of the community as individuals, and strengthen the sense of social security which goes with belonging to a group.
17. I f the full benefits of better education and improved organization are to be realized, two conditions seem necessary. First, the felt needs of the people should be t-aken into consideration. People will not participate in community development progra11nteS unless they are getting what - 10 -
they want. Accordingly, the first duty of those responsible for community development prograrnJl2s is to identify the felt needs of the people. They should also assist the people in making better judgements for themselves on wlBt their needs are and how to satisfy them. Finally, they should be able to identify needs not yet perceived and make the people conscious of them and aware of the importance of satisfying them. It should be recognized, however,that it may be impracticable to satisfy some local needs or that they may be inconsistent With government policy for the economic and social development of the nation. Secondly, various fonns of assistance are required. These include the proVision of technical advice, technical assistance, help With equipment, organization of supplies, provision of credit, or grants-in-aid. II. " THE PROVISION OF NATIONAL SERVICES FOR COMMUNITY DEVELOPMENT
Concept of the integrated awroach
18. The ver,r concept of community development elaborated above demands the use of the knowledge and skills of all the relevant national services in an integrated rather than an isolated or fragmentar,r way. To serve the ultimate objective of a fuller and better life for individuals Within the family and the cOlllll1unity, the technical services must be conceived in a manner which recognizes the indivisibility of the welfare of the individUal.
19. The major services which may make a contribution to this integrated effort are agricultural services (including agriculture extension and home economics extension); nutrition services; education (including the role of schools in community development and fundamental education); vocational guidance and training; co-operatives; handicrafts and small industries; social welfare services; hOUSing, building and planning; and health services. (See Part Two, below). 2). Integration has a second important aspect, namely integration within each functional field of various kinds of development measures.
21. The various actiVities carried on usually tu governmental services in connexion with, or of assistance to, camnunity development can be divided into three groups: (1) direct measures, (2) supporting measures, and (3) over-all development measures. These are discussed in Part Two to illustrate some of the key services which have proved their importance in the initiation and support of balanced community development programmes. 22. The complementar,r nature of these three types of activities requires that they be co-ordinated in territorial or national plans, St) that they may fully support each other.
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Administrative organization of national services 23. Usually, the services described above are organized in technical departments invested with responsibilities to further certain objectives, such as improved education, health, employment and labour conditions, social welfare, or agriculture. 24. 'Ib3 precise way in which ministries or departments of governments are organized, their relation to each other, and the manner in which speCific technical functions are allocated will be based upon the general social and political conditions, the resources of finance and personnel availa ble, the general structure of the national and loca 1 government authorities and the relation of each to the other, and generally upon the country's administrative and political tradition. Accordingly, it is inappropriate to formulate rigid criteria, or stereotyped "models". The solution to problems of administrative organization must be found within a country in the light of the conditions referred to above.
25. Success in carrying out cOllllllUllity development requires, first, that ministries and departments or servicing agencies should be orien ted towards the community development approach, as described in Part Two, and adequately equipped am staffed for their tasks, and, second, that their respective activities should be properly co-ordinated at all administrative levels. 26. Such co-ordina tion demands tw approaches: (a) Orientation of profeSSional, administrative and technical personnel to the community development approach in their own activit ie s, and towards the need for collaboration with others. These must be accepted as essential aspects of their education and professional training as well as of in-service training, and be given due attention in policy ·directives to governmental departments or agencies; (b) PrOViding a mechanism to ensure that all departments or agencies concerned participate in the formulation of policies and the planning, implementation and evaluation of programmes. In the creation and operation of such a mechanism, attention is required to such matters as (i) Formulation of policies for integrated programmes at the highest level so that authoritative directives can be issued to be followed by departments; Provision for continuing collaboration by heads of national departments, or agencies, to facilitate coordination of the services required for effective work in the field;
(ii)
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(Ui)
Detenn1nation of appropriate "programme areas· for community development activities, and administrative provision for continuing collaboration among technical and administrative staff in these areas; and Establishment of lines of communication and authority between the centre of government and field services, to ensure, on the one hand, that these are consistent with overall policies and programmes, and on the other hand, that there is sufficient fiexibility to meet variations in local requirements.
(iv)
21. Organization of activities of field staff at the local level will usually be consequential on the decisions regarding central and regional organization. Whether these deCisions and the personnel and f:!na.ncial resources available lead to the use of specialized wol1<ers at every level or to a generalist village level worker, the arrangements for adequate technical supervision of the local workers is vital to success and proper econom,y of effort. It is a sound administrative principle that technical supervision be exercised tv the technical departments concernea with the activity being undertaken. Departure from this principle is a frequent cause of confusion and conflict. An essential element in the training of local workers is the conception that they must not go be,yond their technical competence but call upon all supporting services. Interrelationship between administrative organization and org anizations of the peopie 28. Administrative organization shoUld not be regarded simply from the point of view of the efficient provision of technical services, but also from the point of view of stimUlating more efi'icient types of organization of the people, through which they help themselves. Organizations of the people, such as village councils or co-operatives, provide ageDcies with which administrative organization woms. There shoUld be a strong emphasis on partnership in their relationships, and a general objective should be to increase the degree of responsibility of the organizations of the peopl.eas they progressively gain in experience. This ~lies that the people should partiCipate in planning, and not merel¥ in execution.
-
29. As social, economic, and political development proceeds, the role of local authorities is likel¥ to become increasingl¥ important in providing the link between national services and organizations of the people. Training of personnel 30. Training of personnel is of particular importance because of the vital role played qy human factors in the process of community development, and because it is in countries where the shortage of personnel
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with the necessary qualifications is most acute that community development can render the greatest service. 31. The personnel to be trained usually falls into one or more of the following categories, (1) political and administrative leaders, (2) professional and technical personnel, (3) specialized auxiliary workers, (4) multi-purpose or generalist village level workers and (5) voluntary community leaders and workers. 32. The content of the training of all these categories of personnel includes both special and general elements. The special elelOOnts consist of skills, elementary or more advanced, in the various technical subject matters. The general elements relate to mental attitudes and to broad methods and techniques of education and of orgal ization; upon these latter will depend the very effectiveness of the process and of the success in incUlcating the technical skills alreac:V mentioned. 33. The technical services are naturally best qualified to traiI:l workers at all levels in particular skills, while the general elements may presumablybe the combined responsibility of the ministry of education, the technical ministries concerned, and the general administration or community development departments or their eqlivalents when they eKist.
34.
The closest co-operation must clearly be obtained between all these authorities in order to achieve the unity of approach which is basic to the concept of community development, and this should be the primary objective in any training scheme.
35.
As to technical skills, the degree of advancement to be aimed at will naturally vary with the degree of speCialization sought, this in turn depending upon the level at which particular workers are to operate and upon the general organization favoured b.r the government. ,Technical skills will usually be least advanced in the case of generalists or multi-purpose worlcers operating in villages, though even in this case serious dangers will arise if a certain minimum level is not reached. III. RESPONSIffiLITIES OF THE UNITED NATIONS ORGANIZATIONS
Policy, planning, and co-ordination
36. As was indicated in the preceding chapter, community development implies an integrated approach by the governments with the various national technical services working as co·partners. The same integrated approach is necessary among international organizations called upon to provide technical assistance in the field of community development. 37. The Economic and Social Council formulates the broad policy to be recommended to governments and to the co-operating specialized agencies
--
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and establishes the work programme of the United Nations Secretariat. A framework of ce'-operation of the United Nations and the specialized agencies in community development according to their respective fields of competence is thus provided. It is the responsibility of the United Nations Secretariat, with the collaboration of the specialized agencies, to prepare the general studies and reports which the Economic and Social Council nay require to discharge its functions.
38. There is general agreement among the United Nations org>nizations as to the range of activities for which each has specialized technical competence, and hence, primary responsibility within broad programmes of community development. In some fields, however, these organizat ions share responsibilities.
39. The United Nations has both a special competence in certain fields and a central responsibility for co-ordination. In assisting governments upon their request, each international organization advises the governmental department or departments responsible for work within the organization's special competence, and the United Nations has a responsibility for advising governments on general problems of administrative co-ordination.
40. Because of the nature of community development, the international organizations have a collective responsibility for advising governments, when requested, on community development policy and on the planning, organization and execution of programmes. It is for the United Nations to ensure that the necessary steps are taken for the proper discharge of this collective responsibility. Assistance in organization and administration of community development
41. The United Nations has a responsibility for advice on general questions of organization, administration and co-ordination, while the specialized agencies are responsible for advice on questions of organization and administration within their respective fields of technical competence. All the international o,rg>n izations, however, should assist in promoting good co-ordination at the national and international levels. 42. Every effort should be nade to assist governments in fully integrating the relevant specialized technical programmes within community development programs wherever the government has established such programmes as a major instrument of national policy. Conversely, governments should be advised to establish cornnnmity development progranmes only with full regard for the specialized technical progralJlllEls, strengthened or expaIXled as may be required, which contribute to community development.
43,
In advising governments on community development the United Nations dnd specialized agencies, as appropriate, should make every effort to ensure that this work is co-ordinated with programnes assisted by bilateral agencies in the country,
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Assistance in training personnel for community development
44. In addition to advising on organization, planning, and execution of community development programmes, international organizations are frequently called upon to assist governments in training personnel for community development in all categories, as indicated in paragraph 31, above. The training of senior administrative personnel for planning and administration is not often carried out on a formal basis in training institutions. Most countries are utilizing conferences, seminars, or other intensive methods for orienting and training such personnel in the cOllllllUllity development approach. In so far as this training is administrative and general rather than technical, the United Nations advisors on organization and administration are in the best position to assist governments in such endeavours. In so far as the content is broadly technical in character, the governments should utilize the assistance of appropriate specialized agencies. The appropriate international organization assists governments, upon request, in training the profeSSional .and technical personnel required at all levels in giving technical training in its particular field. General orientation of such personnel towards the community development approach may profit from their training as inter-disCiplinary groups or teams; in such cases, UNESCO's regional and national fundamental education centres have a special contril::AJ.tion to make. all multi-purpose village level workers or generalist village level liOrkers may in fact be assigned within a countxy to the Ministxy of Education, or to a technical ministry, or to a special department or an interministerial c01lIlcil established to plan and organize the collllllWlity development progral1J1le. The technical departments may assist in respect of the technical content in the training of such generalist village level workers. Where the workers at the village level are speCialists, technical departments will have responsibility for their technical training and for some aspects of training and extension education in their technical fields; but the departments responsible for the training of generalist workers will have a contribution to make in training them in cOlJllllunity development projeC'ts. The varied nature of the requirements for training thus indicated will affect the positions of governments on whether UNESCO, another specialized agency, or the United Nations is called upon to assist in such training. Whatever the decision, it seems highly deSirable, since the nature of the job to be done requires varying degrees of knowledge of many technical skills, together with the social and educational approach required to help the people organize themselves and part.icipate fully in the progranme, that the international organizations share the responsibility of assisting governments in such training.
45.
46.
47. The training of
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PART TI«l
TiClINICAL SERVICES CONTRIBUTING TO COMMUNITY DEVELOHlENT I. INTRODUCTION
48. The major technical S8l'V'ices which it seems desirable for natiOnal Governments to provide as an integral part of balanced cOllllll1lllity" develop'" ment have been listed in paragraIil 19 of Part One. The purpose of Part Two is to present a brief description of these sel'V'ices in the context of cormnunity development. There is no effort to provide an exhaustive list of sel'V'ices or definitions suitable for all countries but rather to provide descriptiOns of these sel'V'ices which may be helpful to governments lClich are launching new progralll11es or broadening the base of community developuent in their countries. 49. It does appear useful to makB a distinction in most cases between services prCNided directly to the people. supporting services. and overall development sel'V'ices. Direct measures include such services as agricu1tu:nl.l and home economics extension. health services. schools and lit'Jracy teaching. vocational training, promotion of handicrafts. oz-. ganization of co-operat ives. social sel'V'ices and other areas in Which the technician or practitioner works directly with the people of the village. S~rt~ measures are one stage removed from the people themselves litiIlV~ve such vital functiOns as training the practitioners, research and experimentation related to specific problems faced by the practitioners, and organization and administration of all the technical services involved in conmunity development. Over-all developmeIIl; measures may not have an inmediate direct bearing on tIlE! people as members of local collllll1lllities blt are. nevertheless, important for the success of community development. Some of these measures, such as national high_,. and power plant systems, fiscal reforms and over-all social policies, are noted in paragraph 9 of Part One. Others, such as land-reform and development of more efficient governmental structure particularly at the local level. may be essential. compla.ents of the direct services.
50. It will be noted that at certain levels there appear to be overlapping in objectives as well as in methodology in extending these services. It woul.d be unrealistic to attempt mutually exclusive definitions of these se1"'1ices, lIIb.ich by their nature are closely interlockBd. This underlines the importance of the collaboration and co-ordination of agency programmes at both national and international levels.
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II.
AGRICULTURAL SERVICES
(including agriculture extension and home economics extension)
51. A wide variety of agricultural services is essential to community development in rural areas. The general nature of agriculture and home economics extension programmes may be described, to illustrate the role of agricultuml services in community development. However, specific descriptions of the number and kinds of services provided by governmental agriculture and/or home economics extension units are dependent upon the general administrative arrangements adopted for promoting rural development, and these vary from country to country. 52. Agriculture and home economics extension may be described as methods of infomal out-of-school educational service for rural families. While a basic objective, in common with other services of community development, is educating and assisting rural people to use available resources more e!fectively, the primary responsibilities of these extension services are the promotion of continuous improvement of agricultural production; more effective marketing and home utilization of production; and management of agricultural and other resource.s in the interests of productivity and improved rural family living. Agriculture and home economics extension services carry out. thfllir responsibil:i:tiesthrough education in improved techniques or practices in all phases of agricultural and livestock production; farm management; primary processing, marketing and home utilization of agricultural production; nutrition; child care and training; organization of work and management of resources within the home.
53.
54. Some of these services involve direct participation of the rural people; of these agricultural and home economics extension are pemaps the best known. In an agricultural community, home and vocation are generally inseparable; hence in extension work emphasis is given to the participation in such services of the whole family - men, women and youth - and to the consequent development of local leadership. Extension services also provide guidance to rural people in analyzing their problems and in using the findings or agricultural and home economics research in solving these problems. Supporting services, or those one step removed from the direct partioip a tion of the rural people, must also be provided; exanples of these are the training of extension workers; seed multiplication and production of nursery stock; and applied research. other agricultural services, such as basic research, major irrigation and drainage works, marketing services, agricultural banks and the promulgation of land tenure legislation, are even further removed from the village people, but are also esser.tial for the successful implementation of community development programmes.
55.
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III.
NUTRITION SERVIClS
56. The basic am of nutrition services is to improve the nutritional levels of the people and thereby to Uriprove their health, well-being and productive capacity. Nutrition services help to co-ordinate policies and programmes concerned with various aspects of rmtrition in the fields of agriculture, health, education, etc., and are thus an integral part of community development. 57. A primary function of nutrition seN ices is the continuous appraisal of food and nutrition conditions in the country as a whole, and among different groups of the population. The resulting data enable food production and distribution policies and programmes to be oriented to meet nutritional needs. They also provide a basis for -planning special remedial measures, such as supplementary feeding programmes for nutritionally vulnerable groups (mothers, infants and chUdren in particular) and appropriate educational measures which will help to create an active interest in obtaining better diets and to encourage the best use of available foods. 58. Improvement in nutrition calls for a co-ordinated approach to food and nutrition problems at national and community levels; it involves action within and among cormnunities guided by advice-and assistance from the national level. Application of the findings of food and nutrition appraisals and research can be made by agriculture, health, education, social welfare services, etc., in planning and implementing their respective programmes for the benefit of communities. This calls for persons having training in nutrition suited to the tasks they are to perform. IV. EDUCATION
The role of education in community development
59. Education can not only teach skills and attitudes necessary for community development, such as improved methods in agriculture and craftsmanship, knowledge of ways of protection against disease, and inculcation of co-operative and civic attitudes, but it also provides the mental basis which serves as a guarantee of the continued interest of the people in their self-improvement. Education for community developnent can be carried out on various levels and with different groups of people. The role of the schools in cormnunity develOpment 60. The establishment of a prima[ school may be one of the first direct services in a community developmen programme. Sometimes it may itself be achieved through a combination of self-help and outside assistance, where, for example, the people build the school theRlSe1ves. Whether this service precedes, accompanies, or follows others, its effectiveness, in
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tefms of "community participation" will depend 01Y the extent to which school teaching is adapted to the complex of interests and needs of the community. 61. The school and its curriculum can be so organized as to make it one of the effective instruments of community development. In the school the children not only learn the usual basic Imowledge which in part will be applicable to the needs of their environment, but they might participate, through projects and club work, in activities for the improvement of the community m ich are commensurate to their ages. Thus they are prepared to becoma good producers, good community members and good citizens. 62. The school can readily become, particularly in smaller communities, a comnnmity centre where a nwnber of community activities, such as meetings, dramatics, recreation and adult classes can comreniently be placed.
63. The primary school teacher ~ himself, i f he is trained for such 1'1ll'POses, stimulate or even initiate community action, advise ani assist the specialists of technical services, follow up or complement their action. In fact he may be an important agent of fundamental education.
64.
The school can playa role similar to that of the primary school, thou on a hJ.gher level. In this connexion its civics courses and its extra-curricular activities can be made significant to community development.
Technical and vocational education in schools is directly relevant. It may take the ronn of pre-vocational training in the upper primary and lower secondary school years; or it may take the form of technical and vocational education within the secondary school or parallel to it, whether in urban areas (training for trades and industries, commerce, home economics) or in rural areas (training in agriculture, village industries and crafts, and home economics). It is of direct service to community development to the extent to Which students remain in their home communities (or return to them) after their training, provided the teaching of technical subjects is accompanied by social education. 66. Higher education, whether in the universities or in the various types of colleges and institutes, can be of assistance to community development by training the leaders and policy makers who can take direction of it, and by training research workers for the study of the many problems of community living.
65.
67. (Behind the school system will of course be a range of supportiny services, especially those for the training, re-training and supervis~on of teachers, for the production of school books and teaching aids, and the design and construction of school buildings). - 20 -
The role of fundamental education in community develOpment
68. Fundamantal education aims to help people who have not obtained such help from established educational institutions to understand the problems of their envirolll11ent and their rights and duties as citizens and individuals, to acquire basic knowledge and skill for the progressive improvement of their living conditions and to participate effectively in the economic and social development of their community, making full use of facilities and techniques brought to the community from outside. 69. The term is generally synonymous with "social education", "mass education" and "community education". It is not coincident with community development, but is to be regarded as an essential component of community development. 70. Community development may sometimes be initiated by a broad programme of popular fundamental education, perhaps with a focus on the problem of adult illiteracy. In this case, fundamental education is a first phase of community developnent, which should lead as soon as possible to a composite programme inVolving other technical services. 71. Where a composite community development project already exists, fundamental education will take its place among other technical services, in a narrower and more specialized role. It then operates in such fields of activity as adult literacy, the organization of library services for literates, of dramatic or recreational activities, or of educational programmes through the cinema and radio. It p~vides educational support to other technical services, for example b.r helping the agents of these services to prepare the community for the acceptance of new ideas, to make their technical knowledge accessible to the population or to test and utilize audio-visual aids. 72. Finally, fundamental education has important supporting services to provide. These may be categorized as: (a) experimental study and technical information on educational methods and communication techniques; (b) training in these methods; and (c) producing educational materials, especially for illiterate or neWly-literate people.
73. These services are closely related, and, while it may be possible to set up anyone service Without the others, to do so would deprive it of the mutual benefit which results, for example: (a) when training is based on experimental study, and followed up by technical advisory services;
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(b) .when educational materials are produced and carefully tested in the field, through experimental study; and (c) when the production of materials goes hand-in-hand with the training of those who will use the:H, and is based on their meds.
by a fundamental education centre. T'
74.
These services can, therefore, generally be provided most effectively
V.
VOCATIONAL GUlDANCE AND TRAINING
75. Vocational guidance services help individuals in solving problems related to occupational choice and progress, with due regard for the individual's characteristics and their relation to occupational opportunity. The purpose of these services is to give the individual full opportunity for personal development and satisfaction from work, with due regard for the most effective use of national manpower resources.
-c';
76. Vocational training programmes in agriculture, in addition to leading to more efficient production, may be expected to improve the lot of the people trained and raise the social status of agriculture as an occupation. A well rounded vocational training programme in agriculture will include training in related crafts and skills and thus help people to obtain supplementary or alternative employment. The programme will be the more successful if there is a close association of public services and interested professional and other functional groups. In the early stages of a training programme particular emphasis will need to be given to the creation of a body of trained teachers and instructors.
77. In order to be fully effective vocational training programmes in agriculture should normally include: (a) (b) (c) (d) (e) (f) 78. pre-vocational training in rural primary schools; agricultural teaching in rural secondary schools; technical agricultural schools, of a general orspecialized nature; short courses for general or specific training; training on the f"arm and, where appropriate, apprenticeship.; and agricultural extension. .-:-
Supporting services include: (a) the training of teachers and rural leaders; (b) the production of teaching aids and materials; and (c) agricultural research •.
79. There will be need for full co-ordination of the vocational training programmes with other activities relating to education and agriculture.
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VI.
CO-OPERATIVES
80. There are close inter-relationships between the co-operative movement and community development. Since co-operative organizations promQte and foster the spirit of self-help and joint action and encourage local initiative, they may play an important role in creating the necessary social and psychological conditions for community development. Conversely, as the process of community development continues and a new social ferment is created, the co-operatives may be expected to gather an added momentum and Vitality. 81. Co-operative methods can conveniently be applied to meet various specific social and economic needs of local communities. They can be used, for example, as a means of increasing production or income (through agricultural improvements, development of handicrafts and rural indust~s, introduction of rural electrification, improvement of transport, etc.), providing better housing and related facilities and promoting health, education and recreation. In many cases, multi-purpose cooperatives, in particular, may serve as a spearhead for the wider type of action implied in community development. 82. Furthermore, the structure of the co-operative movement, which, in many cases, extends from the smallest social and economic unit to national organizations, can be relied upon as an important means of securing the integration of relatively isolated efforts of local communities with the national action concerned with social and economic development. Finally, co-operative organization can provide basic train:!ng in democratic procedures and in the application of self-governing principles, thereby facilitating the establishment and functioning of local authorities. 83. If the manifold potentialities of co-operative organizaticns in furthering community development are to be adequately utilized, it is important that the govenllllents, in the less-developed countries, foster the co-operative movement and provide the necessary assistance and guidance without any prejudices to the voluntary character of the moveI1I'lnt. In view of the relatively inadequate Imowledge of the basic economic principles of co-operation and lack of leadership and initiative in these countries, more particularly in rural communities, the cooperative movement is not likely to grow or develop in the right direction without such assistance from the government. Among the initial measures to be taken by the govenll!lent in this connexion is the establishment of an official agency concerned with cooperative development. The functions of such an agency should include incorporation, registration and supervision of co-or- 'ative societies; they should necessarily comprise inspection and in son. cases auditing. In addition, with a view to -promoting co-operatives, par-. 'ularly in rural areas, the agency may be required to undertake, whe. necessary,
84.
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through the appointment of itinerant officials, certain essential services suc~ a~ the dissemination of general information on the subject, the ass~st~ of local groups to establish co-operatives, the planning and ~plementation of schemes to train office-bearers of co-operative soc iet~es and the provision of an advice service to co-operatives. The above activities should be supported by certain additional mea!lu res. These include the adoption of a comprehensive legislation, not merely for purposes of incorporation and registration of co-operative societies but also to ensure a sound development of the movement; the establishment of a national advisory council to promote closer collaboration between the government and the co-operative organizations; the training of government co-operative officials; the promotion of central and federal co-operative organizations; and the provision of facilities connected with marketing arrangement and financial assistance, including, wrere appropriate, the encourageme.nt for the establishment of cooperative banks and grant of special credit and other banking facilities by the state bank or similar institutions. VII. HANDICRAFTS AND SHALL INDUSTHIES
85.
86. Handicrafts and small industries have an important role to play in furthering. community development. The development of these industries provides additional employment opportunities and facilitates better utilization of material resources in local communities, and can thus contribute to the improvement of the standards of living of rural populations. Furthermore, the fact that this development process involves, to a large extent, the utilization of local resources and technical skills and encourages local initiative and leadership may lead to significant changes in psychological attitudes and social organizations, increasing the capacity of the people in attaining progress on a continuing basis. 87. The development and modernization of these industries often entails planned introduction of new techniques of production and methods of distribution. This process usually facilitates the integration of small economic units in rural communities with large-scale industrial organizations existing elsewhere, as well as the adaptation of the local community life to the general tempo of industrial and eccnomic development. Finally, the development of these industries contributes to the stability of the rural pO'pulations, not only through the creation of additional employment opportunities but also by making available to rural communities many of the benefits of mJdern technological progress. 88. The realization of the potentialities of handicrafts and small industries in furthering community development depends to a large extent on the adoption of an integrated programme of small industrial development. An important aspect of such a programme relates to promotional or extension activities which should include the following: (1) dissemination
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'-"
of infonnation concerning the social and economic importance of handicrafts and small industries and encouragement for the establishment of such industrieS; (2) provision of technical infonnation and training facilities through organization of training centres and itinerant demonstrations, establishment of pilot or demonstration plants and model workshops, etc.; (3) advice and assistance to multi-purpose village-level workers, where they are available; (4) collection and preliminary analysis of infonnation to facilitate basic researches and planning of development programnes; (5) assistance in connexion with the supply of finance, equipments and raw materials and the marketing of products, and (6) encouragement for the establishment of common facility centres, industrial co-operatives and similar institutions. 89. With a view to making the development programme effective, the promotional activities should be adequately supported by various other measures such as; (1) technological studies and research. inclUding, where appropriate, the establishment of technological institutes; (2) analysis of social, economic and institutional factors and assessment of the relative developnent possibilities of various small industries; 0) training of extension workers and other government officials concerned With sniall industries; (4) assistance and encouragement for the integration of various small industrial operations with the production programmes of large-scale industries; (5) provision of supp~ and marketing services as well as direct or indirect financial assistance including, Where appropriate, the establishment of special banks, finance corporations and similar institutions; (6) arrangement for the supply of" electriCity and Similar services, through, for example, the establishment of industrial estates; and (7) appropriate legal and administrative measures designed to secure co-ord:i:mrt.ion between various official and nonofficial activities concerned with small industries as well as between small industrial activities and over-all social and economic development. VIII. SOCIAL WELFARE SERVIC~
90. Social welfare services, although defined and developed in many varied foms throughout the world, include a basic core of activities, Which may make a significant contribution to community development. Conversely, community development progranmes of'ten create or reveal additional needs which can be met through application of the skills of social welfare wo rkers. 91. This basic core of activities iDc1udes assistance to families in solving both economic and social problems (such assistance may be either material or psychological or both); improving the status of women and youth, where required, and obtaining their fuller participation in com-munity life; strengthening family relationships by promoting child welfare and faCilitating adjustments to rapid social changes, particularly where the impact threatens the stability of the family and its social
- 25 -
security; helping individuals or groups in need of special care, such as the p~ically or mentally handicapped, the aged, children requiring special protection, offenders and delinquents, etc.; assisting the community as a whole to understand and meet its own social problems through social surveys and social work research, followed b.r organized community action. 92. The social worker, like the health or home economics worker and the teacher, is in direct contact at the local level with familieS, individuals and local leaders. His techniques, which are described as group work, case work, and connnunity organization, are fundamentally educational and organizational in character. Through these thechniques, he may play an important role in promoting a desire for constructive change on the part of the people, receptivity to other technical services, and fuller partiCipation in activities designed for the common good. 93. Social service activities which provide indirect or supporting contributions to community development include the organization and administration of governmental and private welfare agencies and the training of profeSSional, auxiliary and '.iOlunteer social workers for technical services. In addition to these services, there is assistance to administrators, technicians and other personnel in understanding social work concepts and methods. An additional group of social services, which may be described as complementary to community development, includes economic measures to strengthen family life and to maintain levels of living, e.g. social assistance and social insurance. IX. HOUSING, BUILDING AND PLANNING
,'
These services refer to a complex of activities concerning the physical environment in which a community eXists. This complex includes (1) the proviSion of adequate shelter; (2) allocation of areas "for industry, agricul.ture and residence; the provision of amenities, arteries of circulation and points of social contact; (3) the evolution of suitable building design, techniques and material; (4) the organization of the building industry and trade; (5) thS establishment of over-all housing policies and progrlllJlllles and of the financial and administrative machinery for their implementation; and (6) the traming of personnel. Thus, a programme of community development must concern itself with activities falling within the realm of housing, building and planning. Conversely, a housing progranme, since it deals with a universally felt need, can well be used as a spearhead of conmuhity action and as a lever for programmes of improvement in other social fields.
94.
95. Among the direct measures which the housing, building and planning services can contribute to community development are the use of methods ot self-help, mutual aid and co-operation in the improvement of shelter, community facilities, public utilities, and in road construction and the - 26 ........
-
establishment of small-scale production of building materials from local resources, as well as the improvement of existing construction techniques and designs. other d:irect measures include planning for the desirable location and orientation of residential areas and of the essential services and facilities, as well as the fomulation of long-term plans of physical improvement in relation to the projected development of the community within its regional setting.
96. Supporting measures which are necessary to make housing, building and planning services effective at the local level include the provision of information on the results of research and experimentation and on useful experiences in connexion with self-help and mutual aid projects in this field, and advice on the improvement of existing materials and methods of construction, as well as on their adaptability to self-help projects. Practical supporting measures may involve experimentation and demonstration in connexion with the layout, construction and maintenance of housing and conmnmity services and faCilities, in addition to the training of technical advisers for work on the local level, specially in connexion with self-help housing, community planning and materials production. 97. Ove1'-B.ll development measures in the housing, building -and planning field involve (1) the formulation of national housing policy and programmes and the provision of necessary resources and skills for hOUSing, collimUnity planning and the building industry, within the general framework of national development programmes; (2) the provision of advice and assistance in the physical planning for the improvement of the conmnmity as part of the regional ellV'ironmental plan, including fact-finding surveys, as necessary; and (3) social, economic and technological research and studieS relating to hoUSing, building and planning, including operational TeSearch and demonstration projects. X. HEALTH SERVICES
98. Health - defined as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity - is a basic component of the standard of living and is therefore a fundamental requirement. for community development. 99. In general, health services are designed to meet the health needs of an area, taking into consideration the social and economic conditions of the area concerned, and they" are rendered through intimate co-operation between health workers and the people. Experience has shown that this intimate co-operation can be achieved only if health services are properly integrated and decentral12ed, so that they provide front-line services for the protection and promotion of the health of the rural population. 100. In such rural health units, services for the protection and promotion of health of mothers and children; the prevention and control
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of cOllllll11llicable diseases; the sanitation of the environment· the treatment and rehabilitation of the sick and disabled, and the ~alth education of the public have been recognized as the basic provisions. To facilitate planning and eftective implementation of these baSic health services, supplementary services such as hospitals, laboratorieS, medical supplieS, vital and heal~h statistics, specialists in such fields as nutrition, mental health, health education, sanitary engineering and epidemmlogy, technical and professional training, as well as health legislation, are required at the state or national level. Under special Circumstances, health campaigns against prevalent endemic diseases or mobile heal. th units for periodical. visits to remote areas are other types of health· services commonly used by many- countries. In many parts of the world, national or state health authorities have taken the initiative in assisting the local communitieS to establish basic health services. 101. All types of baSic community health services require sympathetic support aDd active partiCipation of the people. To achieve this aim, an active progranme in health education to help people attain health by their awn actions and efforts is essent.ial. An effective health education programme should have specific objectives in teaching the public the necessary Imowledge of health to enable them to appreciate the importance of health in relation to social and economic development., to acquire a habit of healthful living, to recognize some major health problems of their community, to leam the ways and means of organizing their efforts in solving these problems and to make full use of the health services in the collll1llDlity. Schools and other educational establishments are logical places to initiate such a programme, with necessary sanitar,y provisions in the SChool environment for health practice. This calls for adequate training in health for teachers and fundamental education workers and active co-operation on the part of the educational authorities. 102. While rendering their domiciliary services to a faJllily. the frout-line health workers, such as nurses, midwives, sanitarians and other types of health auxiliaries from a health unit or a centre, have the primary educational role in encouraging family lUembers to participate in community health activities. Through active participation in health work, the people gradually gain experience and confidence in the value of "self-help" in the developnent of their own canmunities. 103. The success of an;y program for health improvelUent, such as the installation of a safe >later-supply, or a mosquito-control, a nutrition, or an immunization programme, depends on the understanding and cooperation ot the people. In areas where the front-line health workers have adequately played their educational role, organized comlUunity ettort for health ilUprovement has been demonstrated b.Y the voluntary contribution of the people towards the construction of safe water supplies, heaJ.th centres aDd hospitals. !local committees or councils consisting of comIII\lnity leaders have also been formed to work very closely with health - 28 -
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personnel in the area for the planning and :!Jnplementation of community health programmes, including the raising of funds for health work. 104. Plans for the education necessary to ensure this understanding and participation should be incorporated with health prograanes which should also constitute an essential part of social and economic development programnes of ~ community."
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.... ' CULTURAL FACTORS IN RURAL COMMUNITY DiWELOPMENT: Irwin T. Sandera* There are certain techniques of community development work which social scientists have developed which are just about as definite as those used in the field of horticulture or veterinary science. Therefore, it is important for us to be aware of this area of specialization. Just because we deal with everyday life, there is often a tendency for everybody to think he is already a specialist in this area of working with people. On the other hand, those of us who work in this area get more humble as we go along. lie often feel that we have answers but later we realize that these answers just don't work out too well. But by analyzing our experiences and by further study we can bring about further improvement. If we can get, along with the techniques, a basic attitude or approach to the study of community development, then we can make our own application much more wisely. Therefore, let us start with the term "Culture." The simplest approach is to think of habitat as the physical surroundings, and culture as what man has made in adjusting to those surroundings. lie can also bring in the biological, which has to do with hereditary factors. BIOLOGICAL FACTORS (physical heritage) HABITAT (physical surroundings) CULTURE (man-made social heritage) 1. Material (artifacts) 2. Social organization 3. Psycho-social facto rs A l«>RLD VIEW
The social sciences never made much progress until we learned to separate habitat and culture. We have our physical universe about us. At the same time there is an aspect of life which is learned, which is passed from parent to child. And if it is learned, it can be changed. In other words, it is not inherited physically. We can divide these cultural factors into three parts: (1) The material side of culture includes various artifacts. When we get ready to change this we deal with technology: how people plOW, the type of
lfReport, Rural Community Development Conference, theory and practice of ~al community development in the United States with possible application to the Village Agricultural - Industrial Development Program in Pakistan, Nor-th Carolina State College, Raleigh, North Carolina, April 1956, pages
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houses people have. and so on. So you might in one sense define culture as man's adjustment to his physical environment. (2) Social organization includes family patterns, economic systems, ways of governing, and so on, which become incorporated in the total life way. Culture is somet:iJnes defined as "The total life way." It is within this realm that development largely takes place. (3) The psycho-social aspect of culture includes beliefs, attitudes, mythologies, ideologies. or all the points of view that people have toward environment, toward what they use, and toward each other. The basic meaning or purpose of life is included under the psycho-social. Half the battle of community development is to make a satisfactor,r analysis. When you are faced with a problem affecting changes in village life, the first :iJnportant thing is to isolate the two factors, habitat and culture. Habitat does not detennine culture, but it certainly Influences the kind of culture which is developed. 'So you must analTile environmental factors. List in a systematic way the material needs that can be supplied, either from outside or through better development of the tools within the village. Ask what new organizations have to be set up or what old organizations can be used to take care 01' this program. Then move into the field of attitudes, asking, "What are the basic values that will be there to which we can appeal in getting the people to adopt this program?" The wo rd "civilization" is often used in an ethnocentric way to refer to a culture similar to our own. It is a mistake to go to a village and tell them that they are unciVilized or uncultured. So what we say when we go to villages is: "You have your own cultU1"El. Other people have their culture, but you through centuries have worked out the best possible way you could in cultivating this land, in arranging your human affairs, and in developing your ideas about life." That's where we start. "Now, t:iJnes are changing, we have found ways that you can get more yields from your crops. We know how you can get better an:iJnals •. ~e can help you send your children to school or overcome 'certain health handicaps." I think that is the approach that· has proved most successfUl. You start where people are. Then as they develop, they become aware of contrasts between their culture and others and that leads them to ask questions: ~ can't we do it that way?" They've gotten the idea from the outside. Then you take them off to teacher training institutes, and they bring back other ideas. No village. however, can import totally something that they see worked elsewhere. They have to bring it in and adapt it to their own provisions. I want to share with you six principles of culturu changes that were drawn up by UNESCO under the leadership of Margaret Mead.*
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*Margaret Mead, editor, Cultural Patterns and Technical Change. New York: The New American Librar,r, 1955 • (A Mentor Book, price fifty cents.) Quotations from pp. 288-289.
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1. "The culture of each people is a living unity in the sense that a change in arr:r one aspect will have repercussions in other aspects." This is the principle social scientists speak of as the inter-dependence of culture traits. If you change people's faming techniques, you often change their social organization. Think what happens in a village when a tractor is introduced. You begin to set up a whole chain of consequences. You change tile family organization in certain countries that I have seen, because the women no longer work in the field. Their attitudes also begin to change. As a matter of fact, a person does not even buy a tractor until there has been some attitudinal change. The specialist often does not realize this principle. He is so concerned in getting his own program across that he does not really care much what happens to other aspects of life. That is why I very much like your approach in Pakistan where there is consultation among specialists in the Village AID Program. 2. "As each human individual embodies the culture through which he lives, discrepanCies, inconsistencies, different rates of change of parts of culture, will have their expression in the personality organization of the individuals who live within changing cultures." Culture becomes embodied in our personalities. We are the carriers of culture. It exists only in people. Therefore, if there are contradictions in a culture, it is reflected in the personalities of the individuals who face that conflict. By introducing changes into a village, we often bring certain kinds of personality problems to the individuals living there. There are ways that this can be helped. by giving them a fuller understanding of what we are up to. If they understand these things. the people will not seem to be confronted by so many baffling problems.
3. 1I"0000en the introduction of technological change is purposively initiated. or promoted by individuals or responsible bodies. such purposiveness involves responsi·bility for the effects ••• " The effects that Margaret Mead points out are not only in :improved living conditions. but also in the total way of life of the people. Evezy little unit of culture we call a trait. A religious practice is a trait. A farniing practice is a trait. When you introduce a new trait into a society (such as a tractor or a new kind of religious practice) this trait has to be. integrated somehow into the total life. That can be done if you think about it enough in advance. It may not always get integrated the way you want it integrated • .For instance. the Fiji Islanders liked the alam clock very much. This trait (the clock) was integrated when the chief got one and wore it around his neck. It became integrated. not in the western sense. but as a symbol of importance. However. in the work that we do. we are interested in more effective integration than that. We must see not only that one or two people are using a thing but that it is accepted and linked with people's attitudes and beliefs.
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4. "As each culture is unique, and as each particular situation Within which a change is occurring or is to be made is unique, it is not possible to lay down prescriptions for what is to be" done in any particular case. It is only possible so to identify and describe the process which occurs that each particular individual or team charged with respo'lsibUity for planning, or executing, or adjusting to some type of change, may be able to act in tems of this process." The important word is trocess. If you are conscious of the slow change that you are introduCing, hen you can begin to make the adaptation as you go along. S. "All changes should be introduced with the fullest possible consent and participation of those whose daily lives will be affected by the changes." This is a wonderful principle to agree to. But how do you carry it out when mothers just will not do what they are supposed to do to help babies from dying? We see it in eastern Kentucky. Our state health department actually has to have the force of law at times to go in and force a change. So, you have to accept that principle within limits, but accept it as a prinCiple toward which you work. In our example, if we can get the mothers to do this without the authority of law, we will be far better off than if we have to have a policeman stand over them. So the principle is sound. The actual application is sometimes difficult. 6. "Every ••• change occurs through ••• living individuals, and it is with these living human beings that we must be concerned." In other words, improving livestock in a country is not really just a problem of improving animals. It is first a problem of improving the people, because to improve the livestock you have to go through the people. They are the ones who have to carry it out. Margaret }lead says that their aspirations and hopes are also tied in with this, as is their historically given environment and mental capabilities. With this as a background we can see that cultural practices are very important in programs of collll1\1l!lity develop1lent.
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COMMUNITY DEVELOFMENT PROGRAMS & METHODS
Carl C. TaylO1"* What Community Development lSI The loose way in which the now popular term "community development" is used has created a great deal of confusion. Many types of undertaking can contribute to the improvement of the productive capacities and living conditions of the hundreds of millions of people who live in the hundreds of thousands of local villages in underdeveloped countries. It is doubtful, however, whether it is either conceptually or administratively helpful to call all of these types of undertaking "community development." Needless to say. "community developnent" caMot be administratively promoted or practically implemented unless it is used to mean something less than everything that contributes to economic and social welfare and something more than a pious slogan. The seventy-five percent or more of all the people in underdeveloped countries who live in local village communities are so poverty stricken, so much in need of more food, of better hoUSing, health and sanitation, that any and all programs designed to meet these needs is likely to be called "eoliunwIity development." Because most of these people live in a relatively high degree of physical and cultural isolation, any and all programs designed to better their means of transportation and communication or to improve their capacity to read is likely to be called ·community development." In some countries, most of them are landless farmers. Land reform is a necessar,y condition to their economic and social advancement and therefore land reform gets included in so-called "~ommunity development" programs. All of these things need to be done but most of them are either the products of community development, plus other kinds of development, or they are conditioning factors in community development. They are not, in and of themselves, community development. Community development, in this statement, is used only to describe the methods by 1ihicq the people who live in local villages or communities become involved in helping to improve their own economic and social conditions and thereqy become effective working groups in programs of national development. The tenn community development programs is used to describe only those administrative plans and operational procedures which implement community development objectives. It is impossible for economically underdeveloped, or any other co1J1I'tries, to provide enough financial or technical assistance to make all the economic and social improvements which are needed and desired *Attachment A to Airgram USForo Circular L A-27, N A-IS, F A-20, elated 9/4/54, Subject: Foreign Operations Administration Policy, Concept, Methods and Organization With Respect to Community Development, prepared qy ~r. Carl C. Taylor in his capacity as Regional Community Development Adv~Bor, Foreign OperatiOns Administration.
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in their thousands of local cOl!llllUIlities. Many, i f not most, such improvements must depend on self-help local community efforts. If and when such efforts are aided, not only the manpower, but the ingenuity and enthusiasm of these thousands of local communities are mobilized for all kinds of needed improvements. Furthermore any' aid provided to such self-help groups is much more effective and goes much further because each local community usually supplies all needed manual labor in the majority of cases the foremanship, nearly always part of the materials, and quite often part of the cash cost. More important is the fact that once self-help activities are initiated the self-help group tends to perpetuate itself Qy seeking out and doing additional worthwhile improvement undertakings. Unless and until such self-perpetuating groups are developed, co~~unities as such have not developed no matter how many things have been done for them. There are enough programs now in operation in enough underdeveloped countries to make analysis of their practical operation feasible and profitable. Differences in these programs and the diversity of the cultural conditions in which they operate, instead of obscuring, helps to reveal their common denominators of success or failure. Their failures, or lack of success, and their violation of sound community methods reveal equally as much as do their successes and their use of sound methods and procedures. These experiences reveal that violations of sound community development methods and procedures are most often due to one or more of the following: {I) A belief that providing, no matter how, such things as water and sewer systems and community facility bUildings, specifying types of community organization, operating pilot plants or demonstratiOnS, etc., are the best methods of inducing local communities to undertake, or Widely partiCipate in economic and social improvement programs. (2) A belief on the part of many outsiders that because the,r can more objectively, and probably more scientifically, analyze the agricul~ural, health, educational, and other needs of people than can local villagers, therefore they can induce local communities to undertake, or enthusiastically participate in programs of improvement which they prescribe. (3) A failure to understand that they, and no one else, can do things for local communities and hand responsibility for them down from above; that such responsibility has to be developed within local community groups by doing things for themselves. Experiences have also shown that the use of sound community development methods and procedures most often, if not always, are due to the three following: (1) A belief, or knowledge, that the manpa;rer, ingenuity and enthusiastic participation of the millions of people who live in thousands of local villages, or communities, is imperative to national, economic, social, and political development., ~2) A knowled~e that even isolated and illi~erate villagers can be moblllzed to help 10 national improvement programs only if they are permitted to be at least partially responsible for improvements in their own Villages. (3) The
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establislunent and operation of programs to train persons who will live and work among villagers to (a) stimulate and assist them to organize self-help undertakings, and (b) act as a bridge or channel between villagers and the agencies of government, which stand ready to aid them in these undertakings. The basic prerequisite to the use of community development as one of the methods of economic and social development is a knowledge that illiterate villagers, no matter how isolated physically and culturally they are, have self-recognized needs and have desires to satis£y these needs. It needs also to be understood that i f these villagers are seemingly lethargic and not interested in change, it is chiefly, if not solely, because they have never been permitted to partiCipate, much less to lead, in programs for improving their own lot in life. They have been told u.r others what their needs were. OVerhead government, colonial or feudal, has provided for the minimum of these needs through a hierarch of officials who as often as not were also inspectors and tax collectors. As a National Director General of Health, in a country which has started a nation-wide community development program said recently, "We are completely reversing the direction of things. We have always tried to develop local communities from the top down. Now we are going to develop the nation from the bottom up. That is what community development is." Because local villages and communities, in economically underdeveloped countries, are so phySically and culturally isolated from the stream of state and national events, their chief concerns are about local needs. It is therefore easier to enlist their interest in local community improvement than in national development programs. If helped to understand that any organized self-help efforts on their part will be aided qy technical, and even some materlal,assistance, they become ready and eager candidates for community development. They put not only their manpower but their ingenUity and enthusiasm into all kinds of improvement when they know their felt needs are going to be met and they are going to have a leading part in deciding what shall be done. . T~e validity of these statements have now been attested by exper1ence 1n a number of underdeveloped countries where sound practical method~ co~ity development are being used. Because of tbese experiences ~t ~s poss~ble to specify the steps in tbe methods of local community d~elopment. Thi~ is not to say that these steps can be blueprinted and prec~sely followed l~ke the steps in building a house or that the members of a local community can, like an army platoon, be commanded to take them. ~hey are~ however, steps which any group of people, i f permitted and ass~sted, w~ll themselves take to meet needs which are common to all of them.
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Methods of Community Development The first step in community development is systematic discussion of common felt needs b members of the communit. Unsystematic iscuss~ons 0 var~ous kin s an on various top cs are continuously going on among persons and families who literally live, as they do in rural villages, all the time in each other's presence. Such discussions are, however, either mere gossip or concerned with complaints. It is only when discussions are systematic, even though among a relatively few representative persons or families, that analysis of important commonly felt need is accomplished. Such discussion is readily induced when local villagers have cause to believe that any organized self-help efforts on their part will be encouraged and assisted by their government or some other dependable agency. This simple but necessary first step is not taken when community councils or other village bodies are created by law or overhead administrative directives, as has been done in some underdeveloped countries which are trying to initiate community development programs. It is not taken when some technical agency or welfare organization decides to initiate some improvement just because it has the consent, or even the invitation, of the Headman of the village to do so. It is not taken by finding one willing innovator >lho >lilltry out one improved practice. Sound community development programs, now in operation in a number of underdeveloped countries, provide both personnel to stimulate systematic discussions among villagers and technical, sometimes material, assistance to organize community self-help undertakings. The second step in community development is systematic planning to carry out the first self-help undertaking that has been selected by the community. The most important things learned by the cOll1lll\l1lity in taking this step is that nothing by way of community developnent occurs i f a project is nominated the carrying out of Which is totally beyond its local community's self-help capaCity. The community may think its greatest need is canal water for irrigation, which water can be provided only by constructing a great dam a hundred or more miles distant from the village. This it cannot do or even help do. Or it may think that its greatest need is for more commercial fertilizers which would require the construction of a factory and the development of a market distribution system. The first of these is an undertaking for national or state governments and the other an undertaking for government or some business entrepreneur. Systematic planning for aided self-help community undertakingS leads to the selection of the t3~ of first project which, because it is practically feasible, will mobilize the local manpower and ingenuity of those living in the community. It leads to the actual task of enlisting persons who will contribute their labor and talents, and often materials and money, to carry out the project. It accomplishes realistic and responsible thinking about what should be and what can be done. I t is a step that starts to mobilize the community to do something for itself.
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All kinds of experiences have been had and are being had in the task of mobilizing local communities for effective action in those underdeveloped countries which are promoting programs of community development. In some countries, however, the government jumps in and does the job which the Headman or some small local group specifies as the first basic need. It may employ local laborers and pay them wages, thus using the community's manpower but developing no local community-group responsibility. It may pour in so much material assistance and so many outside technical experts that the undertaking is in no sense even a demonstration of what local communities themselves can do. There are other countries which are encouraging local communities themselves to take this second step. It is always, b.1 necessity, taken by doing relatively small community improvement projects. ,lith a small amount of technical assistance and the very minimum of material assistance, local communities are building hundreds of miles of village feeder roads, building hundreds of schools, digging hundreds of wells to supply both domestic and irrigation water, improving sewer systems, etc., etc. Equally or more important with these accomplishments is the development of the responsibility, initiative and self-confidence of village community-groups. The third ste in communit ent is the almost com lete mobiiization an harness~ 0 the sica economic and SOC1a otentiali ies 0 local community-groups. Once a goodly sized organized local group starts working on a project which if completed will yield o~ious and early benefits to the \bole community, members of the community who have thus far been only mildly interested or even skeptical start contributing to its successful completion. There are so many examples of this that what happens time after time no longer constitutes feature stories in the newspapers in some of the countries where community development programs are in successful operation. Unfortunately some state and national :Ie aders who have witnessed one or more local communities mobilize in this way jump to the conclusion that a whirl-wind nation-wide propaganda campaign, offering of community improvement prizes, or some other mass stimulation and mobilization technique can be used to start a rash of community development activities. Many experiences in this type of undertaking have also been had. They teach almost as much as do sound programs of community developnent. What they teach is that there is no substitute for what have been described here as the first and second steps in community development. Even more important they teach that the next and most important step is seldom taken as the result of furious campaigns of propaganda and competition. The fourth ste in communit develo ment is the creation of as iration and e de erlnination to underta additional communit rovement projects. Unt· his step is taken the universal problem of how to get local villages and villagers to desire and initiate improvements is not solved. Many community organizations promoted b.1 outsiders never take this step. But there are both good physical and SOCiological reasons why the majority of cornmunity-groups, which have come into existence and
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progressed by taking the three previous steps described here. do take i;his fourth step. The physical reason is. there are other improvements which need to be undertaken which are within the now developed competence of the group. The sociological reason is that every human group that has successfUlly accomplished worthwhile undertakings is proud of itself and tends to seek out and do other things to justify and feed its group-pride. It has developed team spirit, esprit de corps, patriotism, or, in Simpler terms. group sentiments. Even Charles Darwin asserted that sentiment is the cement of groups. This cement, because it is sentiment, not only holds groups together but makes them seek to perpetuate themselves. lihen they have developed it they seek things to do the undertaking of which will effectively perpetuate them as functiOning, aspiring groups. There are plenty of examples of community groups which never have taken this fourth step, and there are plenty of examples of groups which have. Two specific examples will serve to show why some so called cOlTlllIUllity projects have not led to the taking of the final step in ~ nmn1ty devel~nt. One is the experience of a country where the central govermnent urge local cOllllltlIllities to build community halls. In order to induce them to do so, it paid one half the costs. A number of communities organized campaigns which involved a large percent of all members of the comrmmity in one or another type of participation. In most cases these campaigns were sponsored by the most prominent citizens in the comnmnity. In most of the conummities where halls were built the community has done nothing more in an organized way and has even been unable to stimulate an;y great community use of the halls. In another experience, in a different country, an enterprising and altruistic government official tried to convert a dilapidated village of very low income families into a model community. By providing all types of technical advisors and a great deal of financial aid, he stimulated the villagers to clean up their streets. change their methods of sewage disposal. and even build new homes. The official now testifies that in less than ten years the village was just as dilapidated as when he started to change it. In this example, as in the other, the whole community helped in the project and some community improvement was accomplished. In neither case did the community seek out and accomplish other community improvement projects. But there are examples in underdeveloped countries where the final step in community development has been and is being taken. A comnmnity which started by building a small but badly needed foot bridge across a stream, built a half mile of feeder road out to a highway, constructed a school with crude poles, straw and mud, cleaned out a spring to provide a clean domestic water supply, or made some other simple improvement which met a COlllJOOnly felt need, has gone on to more and larger undertakings. These communities went on from the first project to another, and another because out of self-motivated, self-help experiences they developed not only self-confidence and competence but group pride and aspirations. It i.s out of such accumulated and cumulating experiences,
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successful and unsuccessful, both quite numerous, that sound methods and procedures of community development can be analyzed and fairly precisely stated. Before those methods and procedures are restated in something like a prescription for organizing and operating a community development program, two important facts should be stated, an understanding of which helps to guard against probable disappointment. This understanding also derives from the experiences of agencies which promote community development programs and attempt to use comnnmity development methods. The first is that to expect all members of a local community to mobilize, to promote and undertake the cOmmunity's first self-help improvement undertaking will lead to disillusionment and disappointment. Such an expectation often leads to all sorts of frantic efforts to mobilize everybody and a failure to go ahead when some smaller group in communities is ready and anxious for constructive action. The second is that it should not be assumed that just any local group in a community that wants to do something can be the nucleous of a community development group. Some groups are, and do not intend to be anything other than, selfish special interest groups. They may even be only a faction or a narrow clique in the community. There are numerous instances of agencies helping them and thereb,r dividing rather than mobilizing the community. The nucleous of a community development group must be composed of a goodly number of local citizens who are accepted as representative b,r the members of the comnnmity and whose proposed undertakings are for the benefit of the whole community. It is because of the necessity of starting community development through the inst:rmnentality of such groups, that personnel working at the village level are a necessity in any nation-wide community development program. Community Development Programs Some countries may not be basically interested in the results which local community development secures but some of them honestly are. If and where tl'>ey are, they should be helped to know the experiences in community development of the countries whose successful experiences have furnished the validity of the methods Which have been all too briefly analyzed here. Those experiences can be summarized in something approaching a prescription which a country needs to follow i f it desires to promote and implement a community development program. A countfY wanting to promote and implement a community development ro ram will need to recruit alar e number of workers from local vil ages, or communities, as grass roots village workers. The reasons it will have to do this is because i t does not now have enough technical personnel to help all, or even a small portion, of its local communities to develop and mobilize their potential capacities. Because of the existent cla3s structure in some countries, many of the technically trained persons they do .have are not skilled in working with simple villagers. Only persons born and reared in local villages, who are socially,
-,
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e?onomically, and intellectually not too far in advance of simple village people have been found to be effective channels between themand the t~chnical knowledge which they need, and the technical agencies whose assJ.5tance they must have. It will need to set u trainin institutions to train village level workers and those who su ervise o 0 th~s be:a~se ve~ ew 0 even the est v~l agers selected for village work are suff~c~ently competent to assist village people either in technical improvements or community development. They must therefore be given enough training in agriculture, health, sanitation, literacy education, etc., as will prepare them to render first aid assistance to village groups which want to improve both their production and use of goods and services in these fields. Village workers will also need to be trained in the methods of mobilizing and organizing village groups for effective action in any and all of these fields. They will need to be taught where to seek and how to secure technical assistance 'lhich is far superior to that which they themselves can render to village groups. They will need to learn what kinds and amounts of material or financial assistance is available to villagers, and from what sources. National and State Governments will need to develop competent technical institutions and agencies to supply dependable technical assistance to villb!e level workers. This is absolutely imperative and placed on the fact that this assistance needs to be emphasis should dependable. Village workers who by necessity are qualified to render only first aid assistance in technical fields must be backstopped by persons professionally more competent than themselves. These persons must be supplied by the technical agencies of government and these agencies must therefore be adequately staffed with a corps of competent technical personnel and must be dependable in rendering technical assistance to village workers and the local villagers they serve. Unless the two fundamental services of local village workers and well trained technical personnel are combined, a village development program is inadequate, in fact ineffective at either the top or the bottom and if it is ineffective at either it is ineffective at the other. Local communities cannot raise themselves solely by their own boot straps. They can do a lot by well-organized self-help undertakings. They can be stimulated to and helped in such undertakings by local village workers. But they must have the assistance from all technical ministr~es of government if they are to go very far in agricultural, health, san~tary, and educational progress. One of the chief services of village level. workers is to encourage villagers to request technical assistance. If these requests are not answered by competent technical persons from llational or State }1inistries, self-help village groups are frustrated and sometimes defeated in their self-help undertakings. A prescription for an effective community development program stated with the finality of the above three underlined statements is. not based on examples of a few countries which have perfectly operat~
>-
- 41 -
programs of community development. Rather they are based on observations of a fairly large munber of countries which have programs called "Community Education," "Social Programs," "Cultural Missions," "Helfare Commissions," ''Rural Centers," ''Rural Social Cen.ters" or "Village Aids" and only a few called "Community Development." They are based on observations of countries which have attempted to promote such programs with no adequate corps of grass roots village workers, of some countries which tried either to use untrained village workers or expected local communities to carry out improvement projects under the "remote control" of the totally inadequate corps of technicians Which various national ministries could provide. They are based also on the observation of some quite successful nation-wide community development programs and on the observation of some elements in other programs which provide proof of their validity. Above all, they are based on the judgment of a goodly number of persons ,Jho have had practical experience in directing and trying to administer these types of programs. They are stated with a degree of finality because the evidence is that they are fundamental procedures in the implementation of a nation-wide community development program.
-
- 42 -
NEWS AND NOTES
ICA COMMUNITY DEVELOPMENT PERSONNEL
Charles Wright, formerly Community Development Advisor, tripoli, is now Provincial Director, Benghazi. George Sarsnt left the U. S. in Noveniber 1956 for Lib7a Where ?e Wl. I be Area Community Development Advisor, cyrena~ca Province. Robert Galloway, Comnrunity DevelOpment Advisor, uSOlV'Jordan, is on temporary duty in Iraq as Deputy Comnrunity Development Advisor pending resolution of the Near East situation. He is assisting Shelley Turner who was named Chief Community Development Advisor this summer replacing Hugh Walker who left ICA to accept the position of representative of the Ford Foundation in Iraq. Pakistan Charles Horton, formerly Regional V-AID Advisor, has been named Associate Chief V-AID Advisor replacing James Green who is now Chief V-AID Advisor. Mrs. Jessie Taylor recently arrived at her post in East Pakistan where she is V-AID Home Economics Advisor. Iran Paul Phillips has been transferred from USIOM/Egypt, where he was Program()~:!1c8r, to Iran in BoveDiler 1956 as Senior Community Development 'dvisor. Mr.s. Lucy Adams, formerly Senior Community Development Advisor U50MlIran, Who was recognized by the Government of Iran for her outstanding service, is in the U. S. on leave. She departs for Korea early in 1957 to assume similar duties there. Theo Vaughan, Community Development Advisor, who is in the U.S. OD leave returns to his post early in January 1957. mss Lavinia Ke~s, former Social Welfare Ad~sor, ~o ~s now servtng as Chie , Community Development Sernces Divinon, is in the U. S. on home leave. She is returning to her post in January. Robert McMillan, after five years as Social Science Advisor in the Philippines, len the U. S. in Novembe: 1956 for Thailand where he will be Community Development Adnsor.
Korea
British Guiana Brazil
Thailand
- 43 -
Philippines
Ernest Neal, formerly Chief of the Community Development Division, TCM/India, has been in the Philippines since midSeptember where he is serving as Special Assistant for Connnunity Development. Charles Nelson, formerly of the Public Administration staff of USOMVPhilippines has been named Neal's Deputy. The Village Development Field Services is about up to full strength with the addition of two field officers, Robert Smithers, formerly with the Near East Foundation in iran, and Joel Halpern. Both will have study tours in India prior to reporting for duty in Laos. Smither's observations will also include Ceylon. The Field Services is headed by Robert Minges, formerly on the Connnunity Development staff of usoM/iran. John Herring has been nominated as a short-term Consultant to help launch a "community action for economic development" island-wide program. Arthur Raper, Regional Community Development Advisor, is scheduled to visit Afghanistan for several weeks in January. This is his second visit in the past sUe months. Louis Miniclier, Chief of Community Development Division, spent two weeks in December 1956 visiting u. S. colleges and universities in connection with personnel needs, participant training and the growing interest in urban community development. Miss Lucy Brown, Chief of the Latin America Branch, returned from a seven weeks field trip to Latin America October 1, 1956, where she attended a conference on The Role of Women in Rural Development and visited Rio de Janeiro snd frontier area of Parana, Brazil; Asuncion, Paraguay; Santiago and Chillan, Chile; San Salvador, El Salvador; Jamaica, and Haiti in connection with ICA social welfare and community development programs. Mr. Grover Kincaid, Resettlement Officer, who was serving as Acting Chief, Far East Branch, transferred to Office of Latin American Affairs December 17 as there was not sufficient resettlement activities to warrant continuation of this activity. Miss Brown is serving temporarily as Acting Chief, Far East Branch. The twice scheduled field trip of William Davis to the Near East and Africa was cancelled primarLly because of shortage of travel funtls and the pressure of work in Community Development Division due to staff shortages. It is anticipated the trip will be made during the fourth quarter of this fiscal year.
Laos
Italy-Sardinia
Ai'ghanistan
-44-
·'
:i
THE ROLE OF WOMEN IN RORAL IMPlIlVEMEBT
This was the title of a workshop held in Rio de Janeiro August 13 through August 25, 1956, attended by seventy-five participants trcm fourteen Latin American countries in addition to visitors from the United States and Canada. While the workshop was organised around the 'WOrk of the home economists, the participants included repr'esentatives of other fields concerned with rural family life, such as health, education and social work. This was the first workshop of this nature in Latin America. The workshop afforded an opportunity for individuals representing different technical fields and agencies as well as different countries to discuss programs, problems and solutions of concern to all. In addition, it focused attention on the need for more adequate education for women of Latin America, as well as on the vital need for activating programs of an educational nature directed toward the improvement of rural life in this area. The general program plan each day consiated of: (1) a one hour general session; (2) a group discussion; (3) a work group. Each participant was a member of Ii discussion group and a work group, with North American technicians serving as advisors. Topics which received the attention of the discussion groups were: ( a) (b) (c) (d) How can interest be awakened in rural people to stimulate them to help themselves? How can families participate in progr811 planning? How can leaders be successfuli:r selected and trained? What are the fu.ture needs for the development of work with rural _n?
Activities of the work groups centered on: ( a) (b) ,.1
Practical nutrition needs. Importance of visual aids in teaching. Rural hOl1llindustries. Methods of teaching people to increase, utilize and preserve the food supply. Helping people improve their homes.
( c) (d) ( e)
The recommendations include a number of particular relevance to communi ty development such as: . 1 ki in rural areas coordinate Ca) That all. professl.onal peop e wor ng that maximUm help may their work and plan over-all programs so be given to families.
- 45 -
(b)
That training centers far workers, both professional and voluntary, who are preparing to assist rural families in the improvement of their homes and communities be established in each country. That program planning for all rural workers should be based on studies of needs and resources. That technical assistance in evaluation methods be given professional workers in the countries. That courses on methods of supervision for rural workers be given.
(c) (d) (e)
- 46 -
ICA-VOLUNTARY AGENCY COMMUNITY DEVELOPMENT CONTRACTS
Jordan
Pilo~ and demons~a~ion ac~ivities under the NEAR EAST FOUNDATION/ICA con~act are continuing under direction of Mr. Hanna Khouri in spite of the difficult Near East situation. No American technicians have been assigned to replace Mr. Shook following the completion of his tour of duty.
Iran
Under the Master contract between NEAR EAST FOUNDATION and the Ministry of Interior of Iran, NEF may provide fifty-seven technicians for the community development activities in Iran. Approximately forty of these technicians are now in Iran under the direction of Mr. Curtis Spaulding, NEF Chief .of Party. The NEAR EAST FOUNDATION is providing five technicians for communi ty development in the Logar Valley. Three technicians are now in Afghanistan where Mr. Mason Beers is Chief of Party. A contract between INTERNATIONAL VOLUNTARY SERVICE and the Nepal-AmericanVillage Development Cooperative Service Joint Fund provides for four technicians to carry out training and farm demonstration activities in Nepal. Three technicians are presently working in Nepal under direction of Mr. Willard Patton, Chief of Party. An amended con~act with the INTERNATIONAL VOLUNTARY SERVICE provides for twelve American technicians to carry forward demonstration programs. Five technicians are now in Iraq. Mr. Donald Mitchell, IVS Chief of Party in Iraq is being transferred to Viet Nam to head IVS activities there.
Afghanistan
- 41 GPO,18.S3
•••• • liHO/CST/W J\P.'BflDIX l-h
COM1UNITY DEVELOP~iEN T HiD P.EIATIID SERVICES*
Summary The attached paper is divided into two parts, Part I relating to the concept of community development and related concepts; Part II to the technical services contributing to community development. Part I - Conuntnity development consists of two essential elamm tSI (a) the participation by the people themse1ves in efforts to improve their level of living with as much reliance as possible on their own initiative and (b) the provision of technical and other services in ways whic h encourage initiative, self-help and mutual help. Community development programmes are usual~ concerned with local commmities and have been applied mainly in rural areas. Participation of the people should be undertaken within the framework of a national·plan covering a large number of the smaller communities. The role of the government is to plan and organize th3 progrannoos on a natiooal basis according to a well-conceived pOlicy end second~ to provide the technical. -:cervices and basic material aid which go beyond the resources of the conuntnity £'n:i of the VOluntary organizations. Community development and its relation to economic and social developmer,t ,:re discussed. Examples are given to show the effect each has on the other. h section is devoted to the nature of community development and shows how this is essentially both an educational and an organizational process. The var'1~ activities carried out by governmental services in connection with community development can be divided into three groups: (a) direct measures, (b) supporting measures, and (c) overall development measures. These activities must be ~ordinated in territorial or national plans so that they m~ fully support each Qther. The administrative organization of national services will be based ge~erally upon the country's social and political coodi tioos and it is, therefore, inappropriate to formulate rigid criteria. The methods by which co-or~ation of tho various activities of the ministries, departments or servicing agetlcies can be obtained, are discussed, also the inter-relationship between administrative organizatioos and organizations of the people. I, sub-section is devoted to training of personnel whi ell is of particular importance because it is in countries whero the shortage of personnel with the necessary qualifications is most acute that eommuni ty development can· render the grcRtest service. The responsibilities of the United Nations and specialized agencies with regard to policy, planning and co-ordination of ccrrununi ty devolopmen t programme s Rre outlined. Part II contRins a brief description of the major technical services which it seems advi"sable for governments to provide as an integral part of balanced community development. The description relating to health services will be found on page 'Z7. Twontieth Report of the Administrative Committee an Co-ord1natltJrt· ted Nations Economic and Social CouncH (E/29Jl).
•
•
.' UNI1CI> NATIONS
NATIONS UNIES
WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
,
"CO'.lMUNITY DEVl!I.OHIENT AND REIATED SmVICES"
Attached please find Annex III of the Twentieth Report of the Administrative Committee on Co-Ordination to the U.N. Economic and Social Council (E/2931) dated 18 October, 1956 which Report was annexed to WHO docQllent EB19/52 dated 4 January 1957, presented to the Nineteenth Session of the WHO Executive Board•
•
Elml English Annex III Page 1 ANNEX III C01·llfu'NITY DEVELOPMENT AND RELATED SERVICES·
TABlE OF CONTENTS PART ONE
OCllCEPl' CE COMMUNITY DEVELOMNT AND RELATED CONCEPl'S • • • • • • • • • • • • • • • ·1. Jilaning and scope of CDllllllUnity d9velopment Elements in the concept of conmnmity devel~nt •• ..
· ..
1 - 47 1 -17 1 - 8 9 - 12 ~
Community developl!l!nt and economic and social d81'slopalllJt. The nature of
the
cOJlllllUIlity
developl1lOlTt processes • • • • • 13 - 17
II. The provision of national services tar col1ll1lUllity development. 18 Concept of the integrated approach • • • • • • • • • • • • Adminj.otrative organization of national services • • • • • •
3S
Inter-relationship between administrative organization and organizations or the people • • • • • .. • • • • • • • 28-29 Training of personn~l • .. . • .. • .. .. .. .. • • • .. • .. .. • • 30 - 3S
III.
R8s;Jonsibillties of the United Nations organizations • • • • •
36 - 47 P0l;i8J:' plaptrlng and co-ordination .. .. • .. ... ,. .. " ...... 36 - 40 As~. organization 8.'1d administration of e~~.developmBnt .......................... . 41-43 . "
..
~~'
.
,.
Assistan~e(i.'" :t.. r.,~ . . ~~;mg personnel for col1ll1lUllity developallnt. ,. d;: .
44- 47 48 - 101
~:;/, '
.'
PART TWO
TECHNICAL ~CES. CONTRIBUTING TO COMMUNITY DEVEIDPMENT I.. II. Introcio:ot1.(,~,"
.. .. .. • • • .. .. .. • .. • .. .. • • .. • • • .. • • • 48-50
•
••••••
III.
IV. V.
Agricultural se.~ces (in11uding agriculture extension and holl6 eCj:R1oiP-cs. exte.nsl.on.). .. .. .. .. .. .. • .. .. .. • • • • • Sl - 55 Nutrition serviJ .-.. .. . . • . .. .. ... • • • • • • • • • S6 - 58 .. Education • • , • • • • • • • • • 59 - 74 •
.,
'
<I
•
•
•
•
•
•
•
•
Vocational g-.;idance and tra:ining • Co-operatives •• • • • • • • • -:
VI.
·. . • •
•
• • • •
• 7S - 79 80 - 85
•••• • • • •
VII. VliI.
Handicrafts and small :industries • Social welfare se::-vices Health servicQS •
• ••
• •
IX.
Housing, oui:!.dill:; and planning • •• •• • • • •
. .. .
• •
••• • •• • 86 - 89 • • • • • • • • • 90-93 • • • • • • • • •
94-97 98 - 104
X.
• • • • • •
• • • • • • •
E/2931 English Annex III Page 2 Pl.RT ONE CONCEPT OF COMMUNITY DEVEWPNENT JJID RELATED CONCEPTS I. MEANING AND SCOPE OF COMMUNITY DEVEIDPMENT .
,
Elements in the oonoept of oommunity development 1. The term oommunity developmant has come into international usage to connote the processes by which the efforts of the people themselves are united with thoae of governmental authorities to improve the economic, sooial and cultural conditions of comnnmities, to integrate these communities into the life of the nation, and to enable them to contribute fully to national progI'::Jss. 2. This complex of prooesses is then made up of two essential elements: the participation by the people themselves in efforts to improve their level of living with as much reliance as possible on their own initiative; and the provision of technical and other services in ways lfhich encourage initiative, self-help and ~
Imltual help and make these more etrective.
It is expressed in progra!ll1les designed
to achieve a wide variety of specific improvements. fact that the people living together in a locality have many and in common. by locality. vari~'
/-
~
3. These programmes are usually concerned with looal communities, because.. .'JJ: the interests Some of these interests are expressed through functi<mal groups
-
organized to 1'urther a more liznited range of interests not pr:iJnariJ;r determined
4. The size of the geographical area to be covered •
by tt.e programme will be r-/'
getermined by the nature of the interests to be served and by questio~ d ecOllOIIIY and oi'.riciency in satisf'ying -Iohm'!. Thor'l" ~ ''B'':' rr"per emphas.i¢, however, on
,"
small rural communities because the local needs to lie satisfif.>d are closer and more
E/2931 Engllsh Annex III Page 3 obvious to the people than within larger oommunities. l these needs in work, in money and in kind. In consequence, the
p!3ople are normall~ more willing and able to make direct contributions to meeting .
S. -"-
But there are other needs which affect a number of small communities. Active participation of the people in this
Sucoessf'ul action to satisi'y such needs may require wider areas of operation and different types of organization. action neoessitates that the people recognize the interests COllDllon to a nUlllber ot oOlll!l!Ull1ties and that suitable methods be devised through whioh self-help is upressed.
6. If participation of the people is to make a significant contribution to social and economic development throughout a oountry or territory, it should be undertaken within the framework of a national plan covering a large number of the smaller oommunities. Within this framework, the gradual reoognition by the people of the This reoognition, together with active partioipation importance of these wider relationships assist!! in the integration of tlfil smaller with larger oommunities. of the people in local and group affairs, increases '!;heir natural interest in and capacity for political partiCipation in national affairs.
1 C~~ity develop~p in urban ·areaa 1. Community development has been applied ~ in rural areas. But there is a wide and growing range of economic and social problems in towns and cities, particular4' in cases where urban growth is proceeding at a rapid rate because of migration from rural areas. The question therefore arhea whether community development teclmiques are applicable to urban areu. 2. important difference be·~ween rural and urban populations is in the nature of economic relationships expressed in the latter in the fuller growth of a money eccnonv and of lage-earning groups. Another difference is that there is seldom any sense of belonging to the urban community. Finany, in cities welfare services and facilities such as schools and hospitals are more fuuy developed, and there are usually more voluntary organizations giving various kinds of assistance. 3 SUch differences in relationships among the people, in the nature ot the needs and in the facilities, require different priorities and procedures, and tha organization of government servic.s in a different way.
"
One
4.
The full signif:!.cance of these differences needs to be carefullyt assessed before any concl"sicn is reachad as to the applicability of he principles and teclmiques of COlnl1l1lnity dsvelopment to urban areas.
E/2931 English Annex III Page 4 7. Success in conmnmity development programmes demands that the people Such identification <as
emotionally identify themselves with these programmes.
is occurring in some countries) gives conmnmity development the character of a movement providing strength and a sense of purpose to the current of change over a whole country. For this to occur, political leaders and leaders o! pnbl1c opinion should give pnblicity to cOll1J1lU11ity development policy and actively identU)' themselves with it. S. The role of the government is to plan and organize the programmes on a national basis according to a well-conceived policy and secondly to provide the technical services and basic material aid which go beyond the resources at the oommunities and of the voluntary organizations. Community development and economic and social development 9. Community development may properly be considered as a component of the wider concept of ecmomic and social development. But it is not of itself sur!icient because certain development measures do not depend upon the participation of the people as members of the local communities. may
For example, economic development
require establishing a central bank, raising a foreign loan, building a main
highway or constructing a large ~droelectric project. Social development may require national employment policy, labour or insurance legislation or o~·· ~ protective measures complementary to those introduced through co~ develop.aftt. 10. Community development, however, may have an iJnportant role to . play in promoting economic and social. development and in helpine; give it direction... Th1a it may do in increasing productive capacity, in influencing the kinds ot. which the people undertake and in educating them as services. 11. con~umers act1i1iU~s
,
ot both genoa and
.
~. ..~,
Conversely, economic and social development makes· possible or stimulates
activities in communities which may greatly increase the general capacity of the people to help themselves and to respect one another. 12. It must also be recognized that economic or social development often introduces disturbances which, if left to operate alone, may well weaken social. coherence and so be conducive to conmnmity recession at least over certain phases. Through promoting collective action, community development may keep community recessicn in cheCk and help re-establish coherence at different levels and tor different purposes.
Engl1sh Anneltm Page S The nature of the community development processes 13. 14. .c.
liI/29'1.
In relation to the people, comnunity development is essentiall¥ both an It is educational because it is concerned with changing such attitudes am
educational ani an organLzational process. practices as are obstacles to social ani economic improvements, engendllring particular attitudes winch are comucive to these inprovemants and, more generallT, prorooting a greater receptivity to change. This illillies dewloping the capacity the people to form judcomnta on the effects of activities aal. to determ:l... , brought about bJr outside foroes. ~
*
cwJ.a
to be arrived at, to adopt technical changes am to adjust themaelws to chances . In actual operations, field. workers (or pr~ So the :lJmDadia,te titioners) DUst 00 concerced with getting specific things done.
objecti ves of cOllDl1llnity developme nt can be defimd in terms of more l1terates l iRproved agricultural production, better health, better nutrition, fuller use of labour, capital for nation in the form of roads, wells, comnunity centres, am so OIl,
But cODll1l1nity developmnt should n:lt be regarded elJlbodied in concrete achievements.
simp~
as a series of episodes ~
Success in these, important though it
be, is
less i!lilortant than the' qUalitathe changes expressed in attitudes and relatiollBl\1p8, which acid to human dignity, am increase tho contiruing capacity of the people to help themselves to achieve goals which they determim for themselvcs. sense that cOlIJIIUnity developnnnt is an educational process. 15. It is organi.zational not 0!lJ3r because people acting together are better able to pursue the interests which they have in common, bu.t also because it requires the reorierrt.ation of existil\'!: institutions or the creation of new types of institutions to DBke self-help ful~
It is in th1B
effective a ni to provide the necessary channels for To be fUll¥ effective, this demands the emergence ?nd trainLDg The value of organl.aing the people consists not
goverJJDental services.
of a new type of local leaders.
0!lJ3r in the help which it 16.
mar
give tuwards achieving particular concrete results, but
also in tho geroral contribltion which it may make towards iroreasing social coherence. Successful organLzation may be expected both to enhance the dignity aIJi welfare of members of the cOIlll1D1ni.ty as iaiividuals, and strengthen the sense of social
security which goes with belonging to a group. 17. If the full benefits of better education and i!lilroved organization are to First, the felt needs of the people be realized, two conditions seem necessary.
E/2931 English Annex III Page 6 should be taken into consideration, People will not participate.incommuni~
development programmes unless they ere getting uhat thoy wa rt.. the felt needs of the people.
AccordingJ;r I tho
first duty of those responsible for comr.mnity development. programmes is to iclon\;l.fy They should also assist the peoplo in making bottor judgelll3nts for themselves on what their neods are am how to satisfy them. they should be able to identity needs not yet perceived and make the people conscious of them and aware of' tho importance of satisfying them. It should be recognized, however, that it l1lIl¥ be impracticable to satisfy some 10c0.1 meds or that they may be inconsistent with government policy for the econollli.c am social cIoveloplll3nt of the nation. equipmel~,
F;LnalJ¥,
SecondJ;r, various forms of assistance are required. grants-i~id.
These include the proviSion of technical advice, technical assistance, hGlp ,dth organization of supplies, provision of credit, or
II.
THE PROVISION OF NATIONAL SERVICES FOn CONMUNITY DEVELOPI1ENl'
Concept of the into grated approach lB. The very concept of community dewlopment elaborated above delllLms tba use fragm~ntary
of the knowledge and skills of all the relevant mtional services in a n integrated rather than an isolated or way.
To serve the ult1matG objocti'lO of a
fuller am better life for iniividuals within the fallli.J;r ani the community, the technical services must be conceived in a manner which rscognises the indivisibility of the welfaro of the individual. 19. The major services l'lhich may make a oontribution to this integrated effort ere education (including the role of schools in communi~ developvocational guidance and training, social welf2J'e servicos, (See Part Two, below). co-oper~t1vcs.
agricultural services (including agriculture extension and home economics extension). rmtrition services, ment and fundamental education), hardicrafts and small industries, plaming, arrl health services.
housing, building and
20.
Integration has a second il!Jlortant aspect, nameJ;r integration within each Tho various activities carried on usualJ;r by governmental services in connexLoll (1) direct measuros, (2) supporting lOOasures and (:3) owr-all These are discussed in Part Two to illustrate some of the
functionnl field of w.rious kirrls of development measures.
21.
with, or of assistance to, community development can be divided into three groups: developn,ent measures.
l!;/... ';1.3:' English Annex III
Page 7
key services which have proved their importanco in the irdtiation and support of l:alanced commurdty devolopDllnt programes. 22. The conplelOOntary nature of theee three types of activities requires that they be co-ordinated in territorial or national plans, so that they ~ fllJ4r support
each other. Administrative orgardzation of national services
"
23. UsualJ¥, the servicos described above arc orgamed in techrdcal departments invested with responsibilities to further certain objectives, such as improved education, health, emplayl1l3nt and labour corxlitions, social welfare, or agriCulture. 24. The precise way in which ministries or departllJOm.s of governments are organLzed, their relation to each other, and the manner in which specific techrdcal fIr..otions are allocated will be based upon the general social nnd political
corxlitions, the resources of fina..'lce and persolU'lll available, the general , stricture of the mtiornl nnd loc<:l goverment authoritios and tho, relation of each to the other, and Generally upon the countryls administrative and political tradition. Accordi~,
it is inappropriation to formulate rigid criteria!, or
stereotyped "models". 25.
The solution to problems of administrative organization
,must be found within a country in the light of the conditions referred to above. Success in carrying out cor.ununity developnent requires, first, that mirdstries am departments or servicir:e ,ngernies should be oriented towards the conllJ,mity developlIDnt approach, as described in Part Two, and adequately equipped and staffed for their tasks, and; second, that their rO,specti va activities should be properly co-ordinatcd at all Eldministrati ve levels. '26. Such co-ordination demands two approaohesl (a) Orientation of professional, administrative and technical personnel to ~1ith
the community development approach in thei!' own activities, and, townrds the need for collaboration others. These must be accepted as essential aspects of thoir oducation and professional training as well as of in-sorVice trairdng, and be giwn due attention in policy directives to goverl'lDllntal departments or agencies; (b) Providing a rnechardsm to ensure t¥t all departments or agoncies concerned participate in tho formulation of policies and the planning,
E/293l English Annex III Page 8 implementation am evaluation of programmes. (i) In the creation am operation ~s y
of such a mechanism, attention is requirtJd to such matters
Formulation of policies for integrated programmes at tho highest. level so that authoritati va directi vas can be issued to be followed by department:.sJ !
(11)
Provision for cont:.iming collaboration by heads of national department:.s, or agenCies, to facilitate co-ordination of the services required for effectivo work in the field,
(iii) Determimtion qf appropriate "programme areas" for cOllllllUnity " "
developnent activities, am administrative provision for cont.irJliDg collaboration among technical am adl1li.nistrativa staff in these areas} a rrl (iv) Establishment of lims of communication ani authority 1:etwoen the centre of governnent an:! field services, to ensure, on the one hand, that these are consistent with overall policies and programmes, and on the other hand, that there is sufficient flexibility to meet variations in local requirements. 27. orgaJll,zation of activitieS of field staff at the local level will ul!llal4" cerr~ral
be consequent:.ial on the decisions regarding
am regional organization.
Whether these decisions am the personnel am financial resources available lead to the use of specialized workers at every levol or to a gernralist village level worker, the arra~emcnt:.s
for adequate technical supervision of the local workers It is a" sound administrative
is vital to success and proper ecol101lU of effort. principle that technical supervision ba exercised concermd with the activity baing umertaken, a frequont:. cause of confusion and conflict. tra1ni~
qy
the techOical departments
Departure from this principle is An essent:.1al eloment in tho
of local workers is the conception that they !lUst not go boyond thQir
technical cOlll>Otenco but call upon 1:'.11 supporting sQrvices. IntQrrelationship between administrative organization and organizations of the people 28. Administratiw organization should not be rOG~,rded
simpl,y from the point o!
..
view of the efficient provision of technical services, but also from the point of view of stimulating more efficient types of organisation of the people, through
E/2931 English Annox III Page 9 which thoy help thomselvos. Organizations of tho peoplo, such as village councils or co-oparatiVlis, provide agoncies uith which administrative organization works.
Thore should be a strong omphasis on partrorship in thoir rolztionships, the people as they progre3siw~ r;nin in experience.
am a
gaooral I
objoctive should be to incrolUJG the degree of rClspoll8.1'1lUity of the organizations of This i!l!plies that the people shoo.ld participnte in pl2.nm~, am oot morel¥ in ezocution.
I I
29.
As soclal, oconomc, and political dovelopm:mt proceeds, the role of local servicos am orc;nn!.zstions of the people,
authoritios is 1!k"J,y to ".JoCOJlle incroasinel¥ important in providing tho link between natiol'l!ll
Training of personnel
30, Training
of personnel is of particulcr i!l!porta.rco bccause of the vital role
,
,
pl,ayed by h=n factors in the process of community develop~nt, ani recause it is in countrios whore tho shortage of personnal with tho necessary qualifications-is
most acute that community dovelopment:. CIl.n rondur tho Gl'eatest service.
31.
Tho personna 1 to b(J trailEd
usual~
falls into one or more of the following
categoriesl
(1) political and administrative lenders, (2) professional and tochnical
porsonrol, (:3) specialized auxiliary workers, (4) rulti-purpose or generalist village level WOrkOl"S and (5) voluntary -community leadors and workers.
32.
The cont:.ent of the training of all those cdegories of personnel includes both The special olenmts consist of skills,elcmnt.ary or The general elements relate
special and goneral elemoats.
IMro adw.nced, in the various technical subject mattors. zation; upon these latter ~lill
to mental attitudes and to broad methods and techniques of education and of organidOp8IJi the very effectiveness of the procoss am of the success in inculcating the technical skills already mentienod.
33.
The tochniCl'.l servicCls are rr_turally best qu..,lifi.od to train workers at e.ll particul~r
levels in
skillS, while tho (leneral clelOOnts may proBumablJr be the combined
responsibility of the ministry of education, the technical ministries concerIBd, and the geroral administration or community developlII'lnt departments or their equivalents when they exist.
34. The closest co-operation must
clCl'.r~
be obtai rod between all thoso tluthorit1es commun1~
in order to achieve the unity of approach which is basic te the concopt of
development, and this should be the primary objoctive in any trdning schama.
E/2931 English Annex III Pe.ee 10
-;.
35.
As to technic:).l skillS, the doe;reo of ad w.nccment to be aimed at will natural4r
vary with the degree of speciclization sought, t11:'.s in turn depending upon the level !!-t lIhich particular ~lOrkers are to operate a rri \'lpon tho e;eneral organization fa VQ1l1"ed by the
eOVOr !l1lCi1t.
Technical skills will usualJ,y be least ad1llanced in the
case of generalists or r,ulti-purpose Horl:crs oporating in villages, thouGh evell in this case serious dSl1[?ors will arise i f a certain ·minimum lowl is not rot'-ched.
III.
RESPOiJSIDILI'rmS OF THE UNITED NATIONS ORGANIZATIONS
Polisr, planning, and co-ordination
36. As l-TaS iniicated in the precedinll chapter, CO!lll1lllnity development implies an lntecrated approach by the :;overnmcnts with the various nationel technical services workine as co-partrers. The sa:ne into crated I.'.p1)roach is necessary aoong
•
international orga ni..zations called upon to provide technical assistance in the field of oomnru.nity 37. deV\3lopi~errt.
The Economic cmd Sociel Council forr.mlatos tho broad policy to be recommeIXied a:::;encies and establishes the A framework of co-operation of
to governmtJnts and to the co-operl'.ting specialized work proerallllOO of tho United Nations Sa cretariat.
the United lations and tho specialized aGencies in comnmnity developlWnt according to their r"spective fields of competence is thus provided. It is the responaiWity of tho United Nations Socretariat, ,lith the colla boration of the specialized
aeancies, to prepare the general studies and reports which the Economic and Social Council may requiro to disc!large its functions. 3S. There is general ac:reement among the United :-ations or"anizations as to the
range of act! vitios for l1bieh each has specialized technicel oompetence, and hence, primary responsi:,ility '·lithin broad. proGrammes of cOlllDUnity developmelll!t. fields, however, these organizations share respollsitilitiCs. In SOIOO
39. The United I'lations has both a special competence in certain fields and a central responsibility for co-ordination. In assistillG governments upon their request, each internatiunal orGanization advises the governnental department or departwnts rcspolEible for work ...""ithin t:,C) orgaiuzation's sp"cial COlipetencc, aIXi the United Nations has a responsibility for advisic1C goverrnnents ~n senoral problems of admi ;ti.strati VI) co-ordinatio'1.
E/293l English Annex III Page 11.
4IJ. Because of the nature of cor'II.1u;,ity development, the international or::;anizations hnw a collective responsibility for c(l\1.sillB (lovcrrnnents, when requested, on eomLlUnity devulopTolmt policy a rd on the planill.ng, organization and execution of prO[~l'aJralS.
It is for the United Nations to ensure that the oeC6Ssary
stops are taken for the proper discharge of thJ.s collective responsibility. Assistance _in ,. orK.~~ation
and
adrnil~ation
of COloU·,lUnity dowleJlll!!nt
41. The United llations has a responsibility for advice on General questions at orea ni.zationl adr.!in:l,at,l'.?tioll am co-ordination, Hhile the specialiBed agonc1.es ere responsible for achice on questions at orGanization and administration within their respccti'IIC fiolds of' technical competonco. international levels. All the international orGanizations, however, shoulC. assist in prol1lOting good co-ordination at the national am
42.. Every effort should be moo to assist gowrlmmts in 1'ul4" 1ntogratill(; tho relc vant specialized tecbmcel pror;re.mmes wtthi.l COJ;u,unity developr,.,nt prOgI'8lIlIIIBS wherever the CO:l1cl'rrncnt has osta blishod such procrruru:lBs as a ajor instrument. at natioml policy. COn1Ol'Se4", 30veriTo16nts should 00 advised to eatahlish community technionl oxparJied C.S m~ be
de veloplillnt prO(lrallll'inS onJ,y uith full regard for the speo:Lalized pro:;raU1l1Ds, stre;:r,thoneu COnm.I:Uty developl'ent. 01'
required, which contribute to ~tions
43.
In advising Govornr.loltts on community developr.lOrrt the United
am
specialized agenCies, as a:>!)l"opriate, should make overy effert to ensure that this work is co-ordinatcd with prO:;I"eJl'I.l:)S &ssist.ad by bilatoral aGencies in tho ·con n1:.rJr. Assistance in tra:Lninc personnal for community dovolopmnt
44.
In addition to advising on orcanization, pla:1IunC. and execution of community
dcvelopro.1t programlllcs, international orU:lluzations aro frequent~ celled upon to assist covcrl1llents in training personnel for cellll1IUnity devoloPllJilnt in all ca.te(:ories, as irrlicated in paraGraph 31. a!Jove.
45. The traini!l[; of aenior administrative personnel for planning am adrrdn:l.stration is not often cnrrj.ou out on a forr.'!·.l basis in trainil1.C institutions. l-bst countries aro utilizinC conforo:lc~s. GOmil~S, or other intcnsive methods
~I
"'h,'!~l ,.. .:,;)
English Annox III PaGe 12 for orie!1tinc a:1cC trainirl[; such personnel in the cor,nllUnity developlUent approach. In so far as this trainin:; is adr.rinistrati vo £lad [;cmral rather than technical, the Unl.ted feltions adT.\.sOl's on orc'aiuzation a n:l administration are in the best
position to assist c;ovor)1Tlents in such emeu vours. .broa~
In so far as the content is
technic<:l i:l character, the ::;owrnments s,',ouldutili;1;e the assistaroe
or
appropriate specialized agencies.
4h.
The appropriate interIBtional orca.'lization assists goverrrnents, upon request, Gemral orientation of such
in training thw prof.;ssional and teelllricd personnel required at all levels in (living technical traininc in its particular ficld. as inter-disciplimxy eroups or teal,s; 47. personml towards the conmunity developr,13nt approacr. may profit from their training in such cases, UNESCO's rll(lioral and national fundamental eelucation centres ha w a special contriwtion to me. The training of all multi-purpose village levelllorkers or c;eneralist village ~Iorkers
level
r.>ay in fact be assigned within a country to the }tinistry of
Education, or to a tecillrical ministry', or to a special departmnt or an interministerial cournil estahlished to plan and orc;!l.nize the COmlllnity developroont progralJllile. The teohnical departl1Y3nts ri-.ay assist in respect of the technical ,ihere the content in the traininc; o.f such Generalist villaGe level uorkers. , responsibility for their technical trainine ani lor e::..;;ension educo.tioil in their technicc.l fields; for the trainillG of Generalist l~orkers
workers at the villaGe lowl are sp"cialists, toc!, "!\.cal departmants will haw SOl,Je
aspects of trainirl[; and
but the departlllmts responsible The varied nature of the
will haw a contribution to rrake in
traiuing them in cOL1ll1Urrity developi.Bnt projects.
requirenlents for traininG thus in:ticated will affect the positions of governments on whether UNESCO, aoother specialized agency, or the United Uations is called upon to assist in such traini~.\Jhatevcr the decision, it seems hieh~ desirable~ since the nature of tho job to be dOI~ requires wrying de,crees of knowledee of ~
technical skills, togother with the social antl educational approach required
to help the peoplo orGa nize themsol ws a ni partiCipate full;l' in the programme, that the 1nternational orGanizations share tho res)o .lSibility of assisting eovcrr:rnents in SUell trai iling.
~.
E/29.3l English Annex III Pa~e 13 PART TWO
TECHi:IC1U; SE!lVICES CO;"l'HIJUTIHG TO COD UNITY DEVELOPMENT I. INTRODUCTIOn
48. The major technical services which it seems desirable for national GoV'erments to provide as an inteeral part of balanced community development
,.
ha?e been listed in paragraph 19 of Part One. developroont.
The purpose of Part Two is to
present a brief <wscription of" these service.s in the context of cor,Jnunity There is no offort to provide an exhaustive list of services or detil1itions suitable for all countries but rathor to provide descriptions of these SElrvices .mich may be helpful to goverrl1lents which are launchiIl; new prograJlllil)s or I:roadaning the base of cOllmllllity development in their countries, 49. It does appear uS61'ul to !lake a distinction in most cases between services _ de'\lel~at.
provided diroctly to the people, supportiq; services, and over-all aarn.ces.
Direct measures include such services as aGricultural am home
economics extension, health services, schools and literacy teachiru, vocational
.-
1;3:-aininc,- promtion of hamicrafts, organisation of co-operatives, social ISElrvices and other areas in which the technician or practitioner works directly with tlle people of the village, Supporti5 measures are one stage relllOved from the people _themselves but involve such vital functions as training the practitioners, research and oxperiroontation related to specific problems faced by tho practitioners, and organisation and administration of all th". technical services involved in community dcveloprll3nt.
Over-all development
JnBasures
~
not have an immadiate direct bearillG on the people as members of Some of these measures, such as mtiollal highway ani power plant Others, such as lam-reform and development of more e.f.ficient
local communities but are, nevertheless, important for tho success of community development. of Part
117stBJIS, fiscal. .re:forrnS and over-e.ll social policies. are mted in paragraph 9
one,
govermerltal structure particularly at the local level, may be essential complemnts of thc direct sorv.l.ces.
E/293 1 English Annex III Page 14 50. It will be noted that at certain levels thore appear to be overlapping Itlethodolo~
•
in objectives aSllell as in be unrealistic to atter~t
in exte,Jdi::(; these services. delinitiol~
It would
mutually exclusive
of these services,
which by their nature are closely interlocked.
This unierlines the importance
of the collaboration am co-ordination of aeeney progralllnes at both mtional
and international levels. II. l.GRICULTURAL SERVIC:t!:S
(including agriculture extension and hOlOO econotdcs extension)
51. A wide variety of a6I'icultural services is esse i1tial to community developrent in rural areas, The geooral nature of agriculture and home econorrt!.cs extension However, specific descriptions of the nwnber ani !einis programmes may be described. to illustrate the role of a6I'icultural services in community development. of services provided by covernmental aGriculture and/or home economies extension
units are deper¥ient upon the general ad.rn1nistr.-tivo arrang$ments adopted for promoting rural doveloprne:J.t, ani these very fro!;, country to country. 52. Agriculture al1i hOl,16 ecorornics extension may ~)e
doscricad as methods of While a lilasic
inforrral out-of-school educational service for l'ural families. and aS8istinc rural ~)eopla
objective, in cor-nnon \lith other services of COToli".,unity developtll!Il;. is educatinc to use a '.Gileble resources I,nrS effecti ~ly I the rore effecti~
pril11ary rcsponsi:D.lities of these extension service:; are the promotion of
.contimous inrproVOTo18nt of aGricultural productiol",> and hOIlE utilization of production;
marketinr...;
am managei"ent of agricultural and other
resourO<3S in the int.erests of productivity and improved rural farniJ;r livine.
53.
Agriculture am homo economics el>.-tcnsion services carry out their farm mamgementJ primary
responsibilities throucrh educatier! in inproved tech;Iiques or practices in all phases of aGricultural an:l livestock productio:.; processine. nBrkcti~
am home utilization of a6I'icultural production; rutritio'1l or[:anizatian of 1.ark a;1,'. ;,Jamr,ement of resources
child care and training) within the hona. 54.
Some of these services involve direct participation of the rural people.
o! thesc aGricultural am home economl.cs extension are perhaps the best knoun.
E/4931 Englisll Annex III Page 15 In an asricultural COlO1r.lUnity, ilorcc and vocation arc ~elleral~
inseparable;
hence in onansia.') \lork emphasis is ;;iven to tho pc.rticipation in such services of the wholo fand.l<i· - me.'), wonDa and youth - anl to the consequent developl1Dl'It of local loadership.
E;ct.e:1Sion services also provide GUidance to rural pe.ople
in
ana~sine
their pro'.:ller.Js and in usinG the findircs or agricultural and home step rer..oveu trom the direct participation exa,,!,loe of these are the
economics rosearch in solv:\.ne these problems.
55. Supporti'lG serv:i.ces, or those of the rural poople, LUst
OiY,
also be providod;
train1D(l of mension lfor!ters; stock' and applied rosc2.rcll.
seed ltUltiplication and production of rurser,y other 8cricultursl services. such as basis research. evon further rell10vud trom tho viD.a/:e
rrnjor irrir,;e.tio," and eirairE.Ge works, marl:etl.l'l{l services, agricultural banks arrl the prollJU1~ation
of la;yl tenure leGislation,
arG
people, but arc "'lso essentiel for the Iluccessful impleront;ation of cOllll1llnity development pro~:rnr.u.lSS.
III.
MaITIOl; SE:1VICES
56. The basic ail!! of nutrition services is to improve the ll.ltritional levels of the people al'ld thGre·~·
to improve their health, well-beill{; and productive capacitor.
Hutrition servioes holp to co-ordinate policios and proJl'ammes concernod with various aspects of lutl'ition in tho fields of a::.;rlculturo, hoalth. education, ete •• am. are thus an intecral part of community developlOOnt. 57. 1.. primary :ru~-x:tiol)
of nutritior. sGrviccs 1s tho contimous appraisal of food ~lhole,
and !J1trition cO:lditions in the country as a tho populstior.. The rosultill{; data ena~le
mrl amoll{; different (;Toups of They also
food produ etion am. distribution
policies aIJi pl'OC'-'arnT;1eS to be orionted to moet :lUtritional needs.
provide a oosis for plaIl.'lil1C special remedial moasures, such as supplementary feediq; procranullcs for mtritio"IaJ.~ wloorable r.;reu;)s (IOOthers. infants and childron in p2.rticuk-u-) and appropriate .;use of availablo foods. educatio!1&l measures lmich will holp to croate an ac'ti vo 1nterGst in obtainillG bettor diets and 'to encourace the best
E/293 1 En..lish
Annex III Page 16 58. Improvomel:t nutrition calls for a co-ordinated approach to food and. it involves action l-1ithin guided by advice and assistance from the national level.
i;1
nutrition probler.lS at national and corrununity levolsj and amon<; coml'iIul~ties
Application of t..'10 findilluS of food and rutrition appraisals and rosearch can be made by ac;ricul.ture, health, educatio:l, social wolfare services, etc., in plannillG an:l iIrq;llcmentinc their respactiw prosramlncs for the benofit of col1l1llUnities. perform. IV. EDUCATION
This
calls for parso;lS havin[; trainill3 in nutrition suited to the tasles .they are to
The role of education in community 59.
de,~lopnent
Education can not olil¥ teach skills am attitudes reccssary tor community
dewloproom, such as improved oothods in acriculture am craftsnBnship, knowledge of ua;ys 01 protectio:l against disease, and inculcation of co-operative and civic attitudes, but it also provides the mcIItal basis IJi1ich serves as a guarantee of the contimed irrterest of the people in their scli-improver:E m. croups of people. The role of the schools in .col1l!lllm.ty deV\.!lopr~
Education for
cOfl1llll.1l1ity dcveloptront can be carried out on various levels and with differerrt
60.
The establishmont of a prinary school may be one of the first direct serv:ices Sometimes it may itself be achieved throu:;h
in a community developlOOl1t progralitlle, build the school thomselvos.
a combination of self-help and outside aSSistance, llhere, for exarople, the people Whether this service procedes, accoJlllnilies, or "cor,lDU;ut~'
follows other:>, its effect.iveness, in tcrms of interests and needs of the conulluni ty.
participation" "rill
deperri on the c::.."tem; to which school teacl.irlG is adapted to tho cor.plex of
61. o~
Tho sehool
111"',(\
its currimlum call be so or;:;£'.ni21cd as to make it one of the In the school the children not
eff .. ctivo instrur.lllllta of eO=lu.ty dewlopment.
learn tho usuol basic Icl'lOwlodge which in part Hill be applicable to the needs
of their enviro:'loont, wt they might participate, thrOUGh projocts and club work,
E/2931 English Annex III Page 17 in activities for the improvement of the community which are commensurate to their
ages. Thus they are prepared to become good producers, good community members and good citizens. 62. The school can readily become, particularly in smaller communities, a oommunity oentre where a number of community activities, such as meetings, dramatics, reoreation and adult classes can conveniently be placed. 63. The primary school teacher may himself, i t he is trained for such purposes, In fact he may be an stimulate or even initiate community action, advise and assist the specialists of technical services, follow up or complement their action. important agent of fundamental education. 64. The secondary school can play a role similar to that of the primary school, In this connexion its civics courses and its though on a higher level. 65.
extra-curricular activities can be made significant to community development. Technical and vocational education in schools is directly relevant. take the form of pre-vocational training in the upper primary and lower secondary school years; or it may take the form of technical and vocational education within the secondary school or parallel to it, whether in urban areas (training for trades and industries, commerce, home economics) or in rural areas (training in agriculture, village industries and crafts, and home economics). It is of direct service to community development to the extent to which students remain in their home communities (or return to them) after their training, provided the teaching of technical subjects is accompanied by social education. 66. Higher education, whether in the universities or in the various types of colleges and institutes, . can be of assistance to community development by training the leaders and policy makers who can take direction of it, and by training research workers for the study of many problems of community living. 67. (Behind the school system will of course be a range of supporting services, especially those for the training, re-training and supervision of teachers, for the production of sohool books and teaching aids, and the design and construction of school buildings).
E/2931 English Annex
III
PaGe 18 The role of funclruncnta..1.2.'lucation in community devolopllPnt 68. Fundamental education aims to help people uho have not obtained such help fror,l establis!)cd cclucati0:;al institutions to unoorstt.nd tho problems of their environmont and their richts am duties as citizens and indj.viduals, to acquire basic kmwledc;e am skill for tho proc;rossive ir,pr01'OllOnt of their living comitions and to participate effectlvoly in tho ecolXlm\.c alIi sooial developmnt of their community, maldnr; f1lll use of facilities and techniques brouGht to the co~nity
from outsido. It is not coincident l·lith cOIlIJIIlnity deVOlOPlIDnt, but
69.
The term is GOI¥ll'a~ synorvr,'£)us with "social education", "masB education"
am "oOlllllll1!lity education".
is to be re(>ardod as an essential cODpooont of comr.nn!.ty doVt>loplIDnt.
70.
Community dc-..oloprr.ont may sonctimos be initiatod by a 1:road proc;ramr.o of th~
popular fundallDiltal education, perhaps :lith a focus on illiteracy.
problem of adult
In this case, furrlalOOntal c.duc:>.t1on is a first phase of cOllllll1nity
devolopm:: nt, l1hich should lead as soon as possible to a coq)osito program!ID iIlVOlvin.::, other technical serviees. 71. IVhere a cerposito oor.lI.u;n:ty dcvelopr;c:1t. projoct alrcad;y exists, fundar'..ental It then operates in such fields of activity as adult educatien will take it,s place amol¥; other techpical servfces, in a narrower ani more specialized role. literacr,y, the orcanizationof librar,r services for literates, of draLBtic or recreatioml acti vitics, or of educatioll!:l pro,;rammos through the cinema and radio. It provides educational support to other technical services, for exar,ple by helpinG the ac;<..nts ef these services to ;)repare the CO\1i'.1Ullity for the acceptance of new ideas, to make their techni.cal ),ooltledco accessiblo to the population or to test and utilize audio-visual 72. ~>.ids. T
Fip.aliy, furrlarrDntd edu~tien has inportant supporting \;ervioos to provide. (a) experimont.cl stucl;;r and technical information on educational IOOthods and eO/llll1Unication tech niques (b) trainil¥; in these methods; am (c) producillG educational matLrials, ospecia~- for illiterate or rerl~ literate people.
These may be cateGorized as:
E/2931 English Annex III
PaGe 19
7J. These servicos are closel¥ related, and, whUe it which results, for cX!l;;¥llel
l1IIo/ be possible to set up
alV one service ll1thout tho othors, to do so waulu doprivo it of the I1Iltual beoo.t'it (a) when trail'l1ne is based on exper1llQntal st.~cV.. am followed up by" technical advisory services (b) when educational materials are produced and ()8l'ofull¥ tastcd :I.n ~a field, through e:x:pcrim:>ntal stucV, am •
(0) llhen the prodnctiol1 of r.1Btorials eoes hsIlli-in-hall1 with the trainina of those who will usc them, all1 is blsed 74. fundamental oducation contro. V. 0 ..
their needs
These services can, thereforo, gereralJ.Y be i)rovided most etfectivol,Y by a
VOC;.TIOEJ,L GUIDJJICE AND TRAINIlil
75.
Vocational guidanco services help individuals in solvinG proble11lS related to The purpose of
occupation:l choice ani progress, with due rogard tor the indiv1dllal's charactoristics anel their relation to occupatioral opporturIi.t:r. these sorvicGs is to eive the iIIlividual full opportulIit:r for POl'llonaJ. d.eveloplIDnt and satisfaction frOT,l 1"Iork, with duo roeard for tho most effectiw u'"' of national JTl81110wer resources. 76. Vocational trdniix; :,ro:;rarnr.les iil aaricu1turo, in cdUition to lead1na to more ofi'iciont productioll.
m..v
bo expected to illtlrovo tho lot of the people traimd and A well rounded vocational Tho
raise the social status of ar,r1ou1ture as an occupation. and thus help people
training pro(jI'amr.n in a[,'l"iculture will inoJ.ude trainine in related ora!ts and sId.lla to obt&in SUppl0!l131'1tary or altcrmti'lll'l elltllOYllllnt. II
programrre will be tho l1Ol'e sucoossful it' thero is
close association of public In the earl,Y
services ani intorestod professional ani othc.r functioml aroups. craation of a :JO<t" of trained tcc.cherll ani instruotors.
stases of a training prOGl'a.JJlIIe !-'81'ticular anphasia ,1111 med to be givon to tho
E/293l English Annex III Page 20
77.
In order to Jo fully effecti vo vocctiol'\-.'\l trnilli.ng
progr~s
in agriculture
should normally include: (a) pre-vocational training in rural primary schools;
(b) agricultural
teaehi~
in rural
SUCOrLLry
schools,
(c) technical a::;ricrultural schools, of a General or specialized nature, (d) short courses for geroral or specific traL1i.nel (e) traini1lfl on tho farm and, wI,ore appro;:Jriato, appronticeship; arn
(r) agricultural extension.
78.
Supportir~
services includel
(a) the training of teachcrs and rurd laaders)
(b) the production of. teachitl£: aid.s arli mat;;rials. and (c) llCl'icultural resenrch.
79. There will be need for full co-ordination of tho vocational training programmes with other activities relatil'€ to education and agriculture. VI.
CO-OPERATIVES
80.
There are close inter-relationships b0tween the co-operative J110vemant and Since co-oporati ve orGanizations prolllJte and foster tho ~
comnunity devclop"nnt.
spirit o£ self-hclp and joint action and encouraGe local irli.tiativo, they may comr.unity devolopr,:e!!l;. contimes and a 81. :-l3W
an inportant role in cree.ting the necessary social and psychological conditions for Conversely, as the proccss of comnnnity devclopllBnt social fcrrtlDnt is creatod, the co-operatives may be expocted
to gathcr an ad0.cd .;.nmcntum social an.! economc meds o~
<em
vitality. They can tc used, for exaLlPle, 1mprovemc~1ts,
Co-operative r,13thods ,can cO'l\C,;iently ba appliod to reot various specific local communities.
as a moans of increasiug production or income (throuch aericultural
devolopmont of :nmicrafts am rural industries, introduction of rural olectrification, it1provcmc:lt or transport, otc.), l,lro'vi.ding better housing and related facilities and promoting heclth, oducatio:1 B.nd recreation. In ma~
caleS
E/29~l
English Annex III Page 21 lIIIIlti-purpose co·operatives, in particular, may serve as a spearhead for the wider type of action implied in community development.
82.
Furthermore, the structl.\l'e of the co-operative _mant, which, in ma~ cases,
ezteDb from the BllIIIllest sOCIul and economic unit
to Dntional organizations, can
be relied upon as an 1.uIpOz1iaut means of securing the integration of relatively isolated efforts of local caa.unities with the natiaaal action concerned with social aDd ecOl1Olll1c cieveloplleut. J'inally, co-operative orpn1aat1on can provide basic training in democratic procedures and in the application of selt-governill8 principles, thereby facilitating the establishment and functioning of local 8uthorites. a~. COl
If the munifold potentialities of co-operative organizations in furthering
pm1ty developaent are to be adequately utilized, it is important that the
governments, in the less-developed countries, foster the co-operative movement and provide the necessary aSSistance and guidance without any prejudices to the voluntary character of the movement. of
In view of the relatively inadequate kDowledse
the ballic oconomic principles of co-operation and lack of leaderShip and
I,
initiative in these countries, mora particularly in rural communities, the eo-operative lIIOVement is not likely to grow or develop in the ri,gbt direction >
without ,such assistance from the government. 8~. Among the initial measures to be taken by the government in this connexiOll. is the establishment of an official agency concerned with co-operative development.
The functions of such an agency shoul~ include incorporation, registration and supervision of co-operative societies; and in SOllIe
they should necessarily comprise inspection vith e view to, promoting <;o.":,operat1ve,s,
cases a\l~iting.
In a~dition,
particularly in rural areas, the agency may be required to undertake, where necessary, through the appointment of itinerant officials, certain essential services such as the dissemination of general information on the subject, the assisting of local groups to esta~lish co-operatives, the planning and implementation of schemes to trnin office-bearers of co-operative societies aDd
,
the provision of an advice service to co·operatives.
E/29?Jl E1Igl1sh Annex III Page 22
•
85. The above activities should be supported by certain additional measures. Tltese include the adoption of a cOlllprahensive legislation, not merely for purposes of incorporation aDd resistration of co-operative soc1eties but also to ensure a sound development of the movement; co-operative orsanizations; the establ1Bhment of a national adv1sory council to promote closer collaboration between the government and the the training of government co-operat1ve officialsl and the f~cial
the promotion of central and federal co-operative orgcnizatlons; provision of facilities connected with marketing arrangement and
assistance, including, where appropriate, the encouragement for the establishment of co-operative banks and grant of special credit and other banking facilities by the state bank or similar institutions. VII. HANDICRAFTS AND SMALL INDUS'rRIES
86.
Handicrafts and small industries have an important role to~lay in The development of these industries provides
furthering cOllllJlUnity development.
additional employment opportunities and facilitates better utilization of material resources in local communities, and can thuB contribute to the improvement of the standards of living of rural populations. Furthermore, the fact thnt this development process involves, to a large extent, the utilization of local resources and techDieal skills and encourages local initiative and leadership mny lead to significant changes in psychological attitudes and social organizations, increasing the capacity of the people in attaining prDgress en a continuing basis. ,
..
87. The development and modernization of these industries often entails Planned introduction o~ new techniques of production and methods of distribution. This process usually :facilitates the integration of small economic units in rural communities with large-Scale industrial organizations existing elsewhere. as well BS
the adaptation of the local community life to the general tempo of 1n4uatrial
Finally, the development of these induBtr1es contributes to the stability of the rural populations, not only through the creation of
and economic develo~nt.
E/2931 Engl.1sh
ADnex III
Page 23 additional employment opportunities but also by making available to rural communities many of the benefits of modern technological progress.
88. The realization of the potentialities of handicrafts an integrated lIl'ogramme of small industrial development.
and small industries
in furthering community development depends to a large i!xtent on the adoption of An important aspect
of such a programme relates to promotional or extension activities which should
include the following: (1) dissemination of information concerning the social all4 ecODC*1c importance of halIdicrafts and small industries and encour~nt
for the establ1shment of such industries; (2) prov"isi011 of tec:mcal. illf'ormati<m and training facilities through organization of training centres and itinerant demonstra~ions,
establishment of pilot or demonstration plants and
~el
workshops, etc.; (3) advice·and assistance to multi-purpose village-level workc!rs, vbere they are avaUable,
(4) collection and preliminary analysis of
intormati011 to facUitate basic researches and planning of development programmeSI
(5) assistance in c=xion with the supply of finance, equipael1ts aDd raY 1IIIlwrials and the marketing of products, and (6) encouragement for the establ1shlllent of cOIIIIIIOn facility centres, industrial co-operatives and similar institutions. 89. With a view to making the development programme effective, the prOlllOti<mal activities should be adequately supported by various other measures such as: (1) technological studies and research, including, where appropriate, the establishment of technological institutes; (2) analySis of SOCial, economic and institutional.factors and assessment of the relative development possibilities of variOUS small industries; (3) training of extension workers and other government officials concerned with small industries; (4) assistance and encouragement for the 1nte grat ion "of various small industrial operations vith the production programmes of large-scale industries; (5) prOVision of supply and marketing services as vell as direct or indirect financial assistance ~
including, vhere appropriate, the establishment of special banks, finance
E/2931 English Annex III Page 24 corporations and similar institutions; (6) arrangement for the supply of electricity and similar services, through, for example, the establishment of industrial estates; and (7) appropriate legal and administrative measures designed to secure co-ordination between various official and activities and over-all social and economic development. non~official
activities concerned with small industries as well as between small industrial
1'lIl. 90.
SOCIAL l1ELFARE SERvrCEE
Social welfare services, although defined and developed in many varied Conversely, community
forms throughout the world, include a basic core of activities which may make a significant contribution to conmrunity development. development programmes often create or reveal additional needs which can be met through application of the skills of social welfare workers. 91. This basic core of activitie~
includes assistance to families in
solving both economic and social problems (Such assistance may be either material or psychological or both); improving the status of women and youth, where reqUired, and obtaining their fuller participation in community life; strengthening family relationships by promoting child welfare and facilitating adjustments to rapid social changes, particularly where the impact threatens the stability of the family and its Bocial security; helping individuals or groups in need of special care. such as the physically or mentally handicapped, the aged, Children requiring special protection, offenders and delinquents, etc.; assisting the community as a whole to understand and meet its own social problems through social surveys and social work research, followed by organized community action. 92, The social worker, like the health or home economics worker and the teacher, is in direct contact at the local level with families, individuals
. ...
,.
E/29-,l English Annex III Page 25
and local leaders.
His techniques, which are described as group work, case Through these techniques, he may p:!.,.y
work, and community organization, are fundamentally educational and organizational in character. an important role in promoting a desire for constructive change on the part of the people, receptivity to other technical services, and fuller participation in activitias designed for the common good.
93. Social service activities which provide indirect or supporting contributions to ~.
ComDID 1 ty
development include the organization and
a4aUa1atrat1oa
~
100exilAllltal and private welfare agencies and the tra:l.n1D1 ass~.stance
of professional, auxiliary and volunteer social workers for technical services. In addition to these services, there is
to
administrators, technicians and other personnel in understanding social work concepts and methods. An additional group of Bocia1 services, which may ba described as complementary to community development, includes
economic measures to strengthen f8lll1ly life and to maintain levels of living, e.g. social assistance and social insurance, IX. ROOSING, BUILtJING .AND PLANNDm
94. These services refer to a complex of activities concerning the physical environment in which a community exists. This complex includes (1) the prOVision of adequate shelter; (2) allocatj.on of areas for industry, agriculture and residence; the prOVision of amenities, arteries of circulation and points of social contact; (3) the evolution of suitable building design, techniques and material; (4) th'3 organization of the building industry and trade; (5) the establishment of over-all housing poUcies and programmes and of the financial and administrative machinery for their implementation; and (6) the training of p"rsonnel. falling vithin the realm of housing, building and planning. Thus, a C~nversely,
programme of community development must concern itself with nctivities a
E/2931 English Annex III Page 26 housing programme, since it deals with a universally felt need, can well be used us a spearhead of community action and improvement in other social fields. US
a lever for programmes of
95. Among the direct measures which the housing, building and planning services can contribute to community development are the use of methods of self-help, mutual'aid and co-operation in the improvement of shelter, community facilities, public utilities, and in road construction and the establishment of small-scale production of building materials from local resources, as well as the improvement of existing construction technigues and designs. other direct measures include planning for the deSirable location and orientation of residential areas and of the essential services and facilities, as well as the formulation of long-term plans of physical improvement in relation to the projected development of the community within its regional Betting.
,
96.
Supporting measures which are necessury to make housing, Quilding and
planning services effective at the local level include the provision of information on the results of research and experimentation and on useful ~xperiences
in connexion with self-help and mutual aid projects in this field, Practical supporting
and advice on the improvement of existing materials and methods of construction as well as on their adaptability to self-help projects. measures may involve experimentation and demonstration in connexion with the layout, construction and maintenance of housing and community services and facilities, in addition to the training of technical advisers for work on the local level, specially in connexion with self-help hOUSing, community planning and materials production. ,.
97. Over-all development measures in the housing, building and planning field involve (1) the formulation of national housing policy and programmes and the provision of necessary resources and skills for hOUSing, community planning and the building industry, within the general framework of national development programmes; (2) the provision of advice and assistance in the physical planning for the improvement of the community as part of the regional enVironmental plan, including fact-finding surveys, as necessarYI (3) social, economic and technological research and studies relating to hOUSing, building and planning, including operational research and demonstration projects.
E!2931· English Annex III Page 27
x.
HEALTH SEHVICES
98. Health - defined as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity - is a basic component of the standard of living and is therefore a fundamental requirement for community development.
99.
In general, health services are designed to meet the health needs of en
area, taking into consideration the social and economic conditione of the area concerned, and they are reZldered through intimate co-operation between health workers and the people. • 80
Experience has shown that this intimate co-operation decentrali~ed,
CSIl
be achieved only if health services are properly integrated and the health of the rural population.
that they provide front-line services for the protection and promotion of
100. In such rural health units, services for the protection and promotion of
health of mothers and childrenJ the prevention and control of cOIIIIIIIlnlcable
diseases I the sanitation of the environment; the treatment and rehabilitation of the sick and disabled, end the health education of the public have been recognized as the basic provisions. To facilitate planning and effective implementation of these basic health services, supplementary services such a8 hbspitals, laboratories, medical supplies, vital and health statistics, specialists .1n
such fields as nutrition, mental health, health education, Banitary 80S
engineering and epidemiology, technical and professional training as well health legislation, are required at the state or national level.
Under special
circumstances, health campaigns against prevalent endemic diseases or mobile health units for periodical Visits to remote areas are other types of health services commonly used by many countries. In many parte of the world, national or state health authorities have taken the initiative in assisting the local communities to establiSh basic health services. 101. All types of basic community health services require sympathetic support aad active partiCipation of the people. is essential. To achieve this aim, an active programme in health education to help people attain health by their own actions and efforts An effective health education programme should have specific
objectives in teaching the public the necessary knowledge of health to enable
Ei2<;;;1
English Annex III Page 28 them to appreciate the inportance of health in relation to social and economic deve.l.opnent, to acquire e habit of heal·;;hful living, to recognize some major health problens of thetr community, to learn the ways and means of organizing their efforts in solving logical places to ~hese
I r , r J
pl'oblems and to mak,' J:ull uae of the health <
services in the. community.
3chools a'ld other educational establishments are a programme, with necessary sanitary provisions This calls for a1equate training
in~tiate s~ch
in the school environment for health practice. ou the part of the educationnl authorities.
;n health for teachers and fundamental education workers and active co-operation 102. Yhile renderjng their domicil <.ary ser-... icos to ,.
R
family, the front-line
health workers, such as nurses, midwivcs, sanitarians and other types of hCdlth auxiliaries irom a health unit or a centre, have the priwary educational role i:J.
encouraging family t1et1bers to participate in conmnmity health activities. active participation in health work, the people gradually gain
Tb"':'OUg'l
experience and confidence in the value of "self-help" in the development of their own communities.
103.
~"he
success of any programme for health improvement, such as the installation In
of a safe water-supp'.y, or a nosquito-control, a nutrition, or an immunization programme, depends on the understanding and co-operation of the people. areas where the front-line health worlcers have adequately played their educational role, organizcd community effort for health improvement has been demonstrated by the voluntary contribution of the people towards the construction of safe water Bupplies, hcaHh centres and hospitals. connnittees or councils cons~sting
Local
of connnunity leaders have also been formed to progranL~es
,0
work very closely with health personnel in the area for the planning and implementation of community health for health work. 104. Plans for the education necessary to ensure this understanding and participation should be incorporated with health programmes which should also constitute an essential part ur social 9.nd economic developnent programmes of any community. including the raising of funds
WHO/CST/18 _-,PENDIX l-i
SOCIAL P?OGl.";CSS 'll-?OUCH COY'",XI?Y DEVELCd·;S;lT
~
The attached report which was compiled by the United Nations at the request of the Economic rold Social Council is prepared mainly on the basis cit reports and information received from governments. Chapter I deals with the polic-.r still in process of formulaticn and experiment of promoting a healthy and balanced development through local action. Although the report is ma:lnly concerned with the rural communities of economically lessdeveloped areas, it is pointed out too t tre need for :lJllprovement programmes is as great in urban areas where the most acute problems at' disintegration of canmmity and family occur. COllllJUnity development is desilPed to create conditions of economic and social progress for the whole community with its active participation and the fullest possible reliance upon the cOllUll1.1llity's initiative. Governm€llt resources, in money and trained manpower, cannot meet the needs of the rural masses without full use of local resources. Reference is made to the poliqy of concerted action of the United Nations and specialized agencies which is gradually being evolved and the assistance so far given in this field. Chapter II reviews in a broad manner, and on a comparative basis, local projects and programmes with particular emphasis on community welfare centres. These are discussed under (a) local projects and programmes in industrialized countries, (b) communi ty ~lelfare centre s in econanically under-d eve loped countries, (0) co-operative group living, (d) community projects initiated due to emergencie~ and (e) pilot projects and territorial schemes •. Chapter III is devoted to the evolution of national community development programmes and examples are given of the main types of national programmes in operatioo. In view of the rather short period of existence of the nation-wide programmes of community development it is not possible to arrive at definite conclusions as to the types which are parti cularly effective. However, it is felt that the following essential elements should be present in every national programme: (a) definition of national policy, (b) acbninistrative organization adaptod to the special requirements of such a programme, (c) scheme for the selection, recruii2nent and training of perscnnel and encouragemEnt of voluntary leaders, (d) utilization of local and wider resources, (e) research and evaluation. Chapter IV deals with the basic problems in application of community development methods and reviews methods vThich have been worked out and proved successful in all types of g€lleral and technical work at the village level. For the purpose of the review the methods are classified into five groups I (1) methods of assessing cOlllJ:lunity needs and planning, (2) Dlethod~ of c==icationi (3'r~::i' of ;fi'tlv.rdmrH1;l=uniti 'tc.rilitics thrClU(Ch self-.lmlp, (.4) ,me-'"~of ·provic l"1nc external -asc-istrnce arjd··"lR7"(~loping multi-purpose proframmes, and (5) methods of co-ordination of community development activities. • .......... 2
- :2 -
It is pointed out that while no unique methods have been evolved which have not been used in other fields, the rearrangement of certain elElllents gives a different character to the transplanted method. Although no comparative studies are available, a trend can be discerned tCMards greater emphasis on village level worl<:ers or community advisers and towards their improved training as well as for improved training of specialists in methods of working with people in local canmunities. One factor of tremendous importance is the overwwlming dominance of the local situation. Chapter V is concerned with the training of local leaders and personnel for community developmen t. The importance of a planned and integrated approach is essential and the need to take careful account at each level of local needs and problems and of the applicability of techniques and solutions to the local
si tua tion • At the end of the report some paragraphs are devoted to the deliberations of the Social Commission and the Economic and Social Council on the principles of community development.
-t'
/
HHO/CST/18 1'.PPENlJIl: l-j nrvffiCNl1ENTAL SANITATION PROJECTS IN JAPAN PND TAIWAN
SUllllllary
The Government of Japan with assistance of WHO has established a fullscale prototype composting plant in which both refuse and human excrement are made to decompose at an accelerated rate with the production of heat of fennentation which effectively pasteurizes all disease-carrying organisms. The op~ration of the plant has been extremely successful and the Goverrunent has placed on its proposed budget a sum amounting to $1 000 000 to subsidize similar plants in othor Japanese cities. WHO assistance consisted of the sel'Vices of a short-term consultant, a ::rnall amount of technical books and other literature and a special refuse grinder unobtainable in Japan. In Taiwan the Government has este.blished an Institute of Envircnm811tal Sanitation which has as its functions applied research, field trials, pilot operations and demonstration areas which will lead to standard designs acceptable both from a public-health and economic standpoint. One of too most important duties is to co-ordinate all environmental sanitation activities. The Institute is also training both professional and sub-professicnal personnel in order to provide a cndre of trained technicians who will implement the national environmental s~nitation programme. This is the first institute of the type ever to be set up in the Western Pacific Region.
.,
I ,
OUTLlNE OF 501£ WHO-ASSJ5'IED ENVIRONJENTAL SANITATICll PROJEC'IS IN THE WES'IERN PAClFIC REGICN
COMPOSTlNG OF ORGANIC WAS'lES Introductiall One of the major problems of public health, and one which is centuries old, is that of the use of htunan excrement that the health of over 500 million individuals are affected by this practice. In the struggle for survival, as faced by Asian countries a:lnce recorded history, the farmers have learned to utilize every possible resource and what have been considered to be waste products :In the Western world have been jealousq guarded and carefulJ.;v" used and re-used in Asian countries. The immediate reaction of a Western-oriented la:,yman or even public health officiaJ., is to emphaticalq discard this practice which is, without doubt, the inmediate cause of much ill health, suffering and deaths in Asia. On sober second thought, it is realized that to deprive the farmer who has not ei ther eccnomical~ or, in fact, access to the synthetic commercial fertilizer necessary to renew the fertility of the soil is to, in effect, starve him to death rather than to sentence him to ill health and loss of fertility. Composting Project in Japan! Recognizing that this major challenge to both public health and agricultural economics must be met, WHO assumed leadership :In agreeing to assist the Government of Japan in a pilot operation designed to reconcile the conflicting needs of public health and economics :In this field. With this end in view, WHO has assisted the Japanese Government in design:lng, construct:lng and operat:lng - first, a small pilot plant and later, a full scale prototype compost:lng plant in which both refuse and hlmlan eltcrement are made to decompose at accelerated rate with the production of heat of fermentation which effectiveq pasteurizes all disease-carrying organisms. The operation of both the pilot plant and full scale prototype plant in Kobe have been extremeq BUcces~ ful and the M:lnistry of Health and Welfare of the Government of Japan has already placed on its proposed budget a sum amounting to over Us$50~OOO to subsidize similar oomposting plants in sorr.e cities of Japan. Seminar on the Collecticn, Disposal and Utilizaticn of Organic Wastes I The techniques developed:ln the WHO-assisted Camposting Project in Japan, as well as other data from this region and other parts of the world were presented at the WHO Zmal Emrironnental Sanitaticn Seminar with the SUbject, "The Collection, Disposal and Utilization of Organic Wastes" I:mld in Taiwan in October 1956 and attended b.Y about 40 public health technicians from seven countrieS. The presentation of the data obtained in Kobe aroused great interest among participants in this Seminar and many statcd that the process and techniques discussed in the Seminar will short~ be introduced into their respective countries. It is felt that these WHO-assisted projects financed from the Technical Assistance funds of the United Nations have been among the many examples of the way United Nations personnel and limited funds provide a cat~ic reaction leading to widespread adoptim of new and economic techniques resulting in improvements to public health. In the case of the Japanese Project, WlO with Technical Assistance funds supplied, in addition to the services
}--
- 2 -
..
c! .its RcgioGul Staff, the ::ic:rviccs of a . .;hort-tc1:t1 -{"'::~ult.mt, a smell amount of technical books anu uther literature related to the subject and a special refuse grinder unobta:inable in Japan. Thus, for a total outlay of approximately US$25,7OO over a two-year period, the result:ing achievement in developing an improved process for hygienic processing of refuse and human excreta for use as fertilizer has had the immediate result of the Japanese Government will:ing to invest during the first year following the project the equivalent of tG$.5.0,OOI" and it is confidently predicted that, wi thin five years, every countr.' in the Region will have been stimulated to also utilize its organic wastes effectively and hygienically for the economic and public health betterment of the nations.
I
..
The sem:inar has been very successful in not onl;v providing facilities for exchange of technical information but also in stimulat:ing governments through officials attend:ing the seminar in taking action on these problems. The Governments of China, Philipp:ines and Sarawak are among those which are actively engaged in pilot or fullscalo operations for compost:ing organic wastes following this sem:inar. The problems of urban and Taiwan Institute of Environmental Sanitationl rural sanitation in China are . such as to present a colossal challenge to the public health worker. The World Health Organization is assist:ing the Republic of China in a systematic effort to solve problems of mvironmcntal sanitation in economic and efficient ways. Environmental sanitation activities in Ch:ina were divided among a large group of governmental agencies. The functions of these governmental bodies were :in some instances overlapp:ing and in other instances, there were vacuums, existing. There was no co-ord:ination of the efforts on either national or local levels. The World Health Organization has stimulated and assisted the Government to initiate the Institute of Environmental Sanitation in Taiwan which has, as it functions, the applied research, field trials, pilot operations and demonstration areas which will lead to standard designs acceptable both fram a public health and economic standpoint. the of the most important duties of inc Institute is to co-ordinate all activities having to do with environmental sanitation and it has been quite successful in this task which has already resulted in the more efficient application of budgetary funds and energies to the tasks confronting the Government. This Institute, Which is barely a year old, has already constructed within an area near t.le capital city of Taipei newl;v designed rural wells and latrines, inclUding school sanitation facilities which are expected to be the models far nationwide campaigns for introduetion of these sanitation improvements. A \0110 publie health engineer has been assigned to the Institute as Adviser to the Director and help
I I
I I
II I'
II I,
,~
• I,
, "
has been given to the Institute in the for:m of technical literature, transport and laboratory equipment. As a second portion of this project, tlJa WlO has assigned another public health engineer to Lead a team of engineers in the preliminary investigations, studies and research which will lead to the design of a water-borne sewerage system for the City of Taipei. During the progress of this project, both in-service and foreign training will be given to those engineers who will specialiZe in this assignment. This project illustrates the WHO policy of planning for the future by the fundamental development of programmes through applied research and small-scale operations. The Institute is tra:ining both professional and sub-professional personnel in the field of environmental sanitation to provide a cadre of tramed technicians who will implement national programmes for improvement of environmental Bani tation. This is the first Institute of this type ever to be set up in the Western Pacific Region.
•
•
vIHO/CST/18 I,; PENDJX l-!-:
• 11fu..RIA ERADICATION, Tl.IWlIIl!
Summary Malaria has for many years affected the health of the people and the productivity of the commmity causing constant and devastating loss to the economy. In 1952 a Malaria and Insect Control project was launched in Taiwan
with the assistance of WHO, the United States International Co-operation Administration (ICA), the Council for United States Aid (CUSA) and the Sino1unerican Joint Commission on Rural Reconstruction (JCRR). expanded steadily year The progranune
qy year and in 1956 the population coverage had reached The island-wide residual spraying was
a maximum of 7 million people. discontinued in 1997,
qy Which time the northern and north-eastern parts of
Taiwan and the formerly endemic townships in the western and southern plains were free from malaria. However, in order to detoct and eliminate residual
foci of transmission, a ,special surveillance network has,j:>een established. The paper contains details of the results of the spraying operations, including data on the decline in spleen and parasite indices.
A BRJEF REVIEW OF 'lBE MALARIA ERADICATml PROGRJili
m TAIWilN
Taiwan Provincial Malaria Research lhstitute
Malaria and Its Transmission in Taiwan
I
Prior to the inauguration of the present malaria cootrol scheme, malaria was considered to be the most important endemic disease in Tawan. Its distribution was extensive and its endemicity, high. It affected practically all the rural population of the island which was estimated to be no less than 5,500;000, or about 70f, of the total estimated population of Taiwan (8,000,000). The most malarious areas :In Taiwan were at the foothill regions of the central mountains. Here the spleen rates' origina~ ran from 50 to 100%, indicat:lng that malaria was a serious problem. In sane areas it was not unusual for almost every inhabitant to have one or more attacks of malaria each year. The population living in this region was estimated to be 1,500,000. Malaria was also highly prevalent among the tribal people aleo known as the aborigines, living in the mountains. This populat.1.on was about 150,000. Spleen rates sanetimes ran as high as 9'Jf, and the average parasite rate among school children, around 10f,. A third malarious area was in the plains •. Spleen rates here were between 10 to 5Of" and parasite rates averaged 2.5%. There were about 4,000,000 people :In this area. The ncn-malarious areas included big ci tie s and the western coastal region. Here the spleen rate was usually below 10f, and parasite carriers were very rarely found. The population living :In this region was about 2,500,000. In summary, it could be said that in Taiwan more than five and one-half million people lived in areas which were considered malarious. Until the start of the residual spraying campaign, Taiwan lad more than 1,200,000 cases of malaria every year and ~5,eee deaths. ~.,-
.'
...
There were 16 anopheline species in Taiwan. Fortunately, only one of these, Anopheles minimus, was a proved transmitter of malaria although A. maculatus was suspect. A. minimus bred :In clear flowing streams in the mountain areas, and along the marg:lns of irrigation di tche s in the foothills and plains.' The females of Anopheles min:!Jnus showed a great preference for human blood. After blood meals they commonly rested in human habitations, spend:lng the da:yt:lme under beds, beh:lnd furniture, and in other dark places. This resting habit made them amenable to control by residual spraying • 2. Eccnomic Importance of Malaria I
Malaria affected the health of the people and the productivity of the canmunity, causing constant and devastating loss to the econany. Here is a single specific example. Kao-shu, a rural township :In southern Taiwan
- 2 -
was not mcluded m the malaria control program until 1954. It had a malaria epidemic late m 1953. Almost every family m the epidemic area had at least one person suffermg from the disease. Marw families had every member ill at the same time. After emergency spraymg the epidemic subsided. A detailed survey was made of the economic loss suffered by the 5256 perscns m the areas hardest hit. The loss included man-days lost through actual confinement m bed, money paid to hire persons to carry out essential work, money spent to -placate the gods, cost-of mcdicme and cost of burial services for 2 deaths resultmg fran malaria. The average expenditure came to N'!$51.95 per person. The complete per capita cost of one year's sprayjng was NT$3.5Q. Therefore, the cost of a smgle epidemic, which might hit any place in Taiwan Where t~ spleen rate ran above 21Jf" was about 15 times more expensive than the preventive measures, which also would have reduced much suffermg. 3. What Had Been Done m the Way of Malaria Control in Taiwan: Durmg the 50 years before Taiwan was returned to Chma, malaria centrol was carried out Qy an exammaticn and treatment of cases through a network of anti~alaria ~~t' which m:anbered 216 at its peak, distributed throughout the island. echnicians made surveys and adm:inistered anti-malaria drugs, chiefJ;y quinine and atabrine. This approach to the problem was quite successful, but it never eliminated malaria. parasite rates were held at 4 or %. However, they increased rapidly when vigilance was even slightly relaxed. World war II brought about a shortage of funds and anti-malaria drugs~ Immediate results were rampant epidemics of malaria throughout Taiwan. 4. DevelOpment of the Present Programl By 1951 the development of new insecticides led to a new ccncept m malaria control. Projects m sardinia, Italy, Sicily, Greece, and elsewhere clearly demonstrated that malaria could be controlled if the :inside of houses and other buildings were sprayed with msecticides whose toxiCity was effective m killmg Anopheles mosquitoes over leng periods of time. In 1951 the Government of Chma seriously ccnsidered a residual spraymg program in Taiwan, and discussions were held with World Health Organization and with the MBA (now ICA) Mission to Chma.
A "Malaria and Insect Control Project" was launched m Taiwan in 1952. Under an ~'!'TOcr:lCnt signed by the Gevernment of Chma and the World Health Organization, WHO was to furnish technical assistance to the project. The Foreign Operations Administration of the United States (now lCA) and the Chinese counterpart, the Council for United States Aid (C.U.S.A.) extended assistance to the Government in supplying large amounts of DDT, spraymg equipment, and vehicles. The Smo-American Jo:int Commission on Rural Reconstruction (JCRR) supplied the project with funds for the technical training of field workers and to meet essential travel expenses in the years 1951-1953. The operational expenses were borne by the Provincial Government of Taiwan. Local townships shared :in the cost of labor for spray application, through a special budgetary prOVision of NITtl.OO per capita protected. The first spray:ing was carried out m 1952. This was designed to demonstrate the effectiveness of the residual spraying method and to develop a pattern for more extensive field operations in the future. The hanes of
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- :3 only 156,000 people were sprayed in 1952. (Map attached)
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The field operation expanded ten-fold in 1953, and the harnes of 1,526,000 people were sprayed. Fortunately, the annual peak of transmissim of malaria was not the same throughout Taiwan, so that the spraying operation was conducted successively in four regions; beginning in Central Taiwan in March, proceeding to the north and east, and finishing in southern Taiwan in Noveni:ler. Toore were 246 spraying squads organized for the 1953 operation. Cbe spraying squad of seven crew members was assigned to each population area of about 7,000 people. -'t this rate the spraying operation in a given area was usually completed within 60 working days. The foremen of the township spraying squads were local health station or township employees. The spraymen were employed only for the spray period and were paid from the township malaria budget. It· should be recalled from above, that a s~cial local per capita assessment of N.T. $1.00 was earmarked for malaria. It was felt that as much responsibility as possible should be placed on the local people. Crews were organized and paid locally. This resulted in a high standard of spraying. The sprayers were fellow citizens of the persons whose homes they were treating. The spray program was further expanded in 1954, to cover all malarious areas of Taiwan. These areas were occupied by a total of 5.5 million people. Residual spraying of these same areas (of 5.5 million people) was carried out once again in 1955. In 1956, the last year of the expanded program, the population coverage reached a maximum of 7,000,000 people. (Map attached). -'S the project became more expanded 'each year, supervision became more difficult. In its most expanded form, about 1,000 spraying squads were needed to do the job. This problem was overcame in part by an intensive training program far foremen on a regional basis. Subsequent to each regional training course each foreman returned to his awn township and trained his own squad. In 1957, the island-wide residual spraying program was discontinued. It would be expected that some of the Originally highly malarious areas of Taiwan would bear constant watching and they most likely would require additimal spraying after 1956. However, many of the areas which were covered in 1953 through 1956 would undoubtedly be free fram malaria. Areas showing malarious foci would be sprayed when such cases were discovered and confirmed. In order to police the island to identify focal infections, a special surveillance network had been established. One of the important units of this network is the malaria technic:i:an of the township health stations. He will accurately diagnose suspected cases of malaria in so far as possible. Thus, as the malaria rate declines and malaria disappears, the local anti-malaria technician who had been a spray team foreman or a tOliOship malaria supervisar would go back to his microscope in the local health station IIld become the "watchdog" to safeguard the progress he had made.
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5.
The Results of the Spr5Ying Operationsl In most parts of the formerly malarious areas new transmission of malaria was stopped after one or two applications of residual insecticide.
Infant parasite indices, (the most sensitive instrumEnt for measurement of malaria transmission) obtained fran a number of areas throughout Taiwan during the past years continued for the most part to be negative. Once new transmission was stopped in an area, old cases of malaria gradually disappear. The malaria rates, as represented by spleen and parasite indices in the endemic area, steadily decline. In the pre-operational (1952) island-wide spleen survey, a sample of more than 140,000 school children was examined. The results showed an overall spleen rate of 25.5%. After two years of residual spray- application a similar survey in 1955 revealed an island-wide spleen rate of D.~. In 1952, nearly 2fJ!, of the townships surveyed lad spleen indices above 5(Jf, (many even above 75%) and more than two thirds of townships had spleen indices between lO-5(Jf,. Whereas in 1955, the same indices in more th3.n half of the -townships examined fell below IfJ!,. Spleen Indices Above 75% Above 5(Jf, lQ-5(),l:
No. of~ships
1953
1955 No. oftoWns hips 1 (0.3%) 4 (1.1$)
Below IfJ!, Townships surveyed Overall spleen rate
21 (5.9%) 40 (11.2%) 237 (66.2%) 60 (16.8%)
155 (44.fJ!,)
5
1 25.5%
192 (54.6 352 1
D.7%
The decline of the parasite rate was even more dramatic than that of the spleen rate. An island-wide parasite survey was carried out on Dec. 17 every year since the first preoperational study in 1951. Annual data. was obtained fran about 150 different locali tie s scattered throughout Taiwan. The results of the observations showed a straight line drop of parasite rates fran the preoperational (1952) 9.8% to the post-operational rate of 0.2% in 1955. The distribution of parasite rates by townships before ani after the malaria control are shown in the following table. Parasite Indices Over 15% Over IfJ!, Over 5% Below 5% No. oftoWn ship s
1952
1956 No. of townships
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fJ!,
Township surveyed Overall spleen rate
38 (26.6%) D ( 9.1%) 20 (14.fJ!,) 48 (33.6% 24 (16.8%) 143 (100 %) 9.8%
0 (0 %) 0 (0 %) 0 (0%) 2 (1.33%) 148 (98.6~~ 150 (100 % 0.01$
~
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I
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The northern and north-eastern part of Taiwan and the formerly endemic townships in the western and southern plains are now free from malaria. Intensive searches for residual malaria cases had been carried out in the North and North-east during late 1956. This has been done by painstaking house-to-house visits. The examination of tens of thousands blood smears, collected from fever-patients and fran children born after the initial residual spraying operation revealed the lack of parasite carriers. It is true there are still some residual foci of malaria which are confined
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. 1 I I
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- 5to the remote mOl.mtain and foothill areas :in Central and South Taiwan. These trouble spots are, however, being el:iminated during tho active surveillance program. Not only has the program made sustained progress toward its goal of malaria eradication, but it has produced many other public health benefits as well. The residual spraying method of treating houses had been canpletely effective against sane annoying and potentially dangerous household pests, includ:ing bedbugs, fleas and cockroaches. To many rural householders these benefits were more noticeable than till absence of malaria, that the people for the most part eagerly welcomed the spraying squads.
Dr. C. T. Ch'en Director, TAMRI, Ch 'ao-chow
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'!'A~M<~~_~~~t.Qy'.,~.Q;l~
.,' l~: .}2.n. 1954 Pop. Coverage: 5 467664
PROGRAMME D'ERADICATION DU PALUDISME, TAIWAN OPERATIONS D'ASPERSION, 1952-1957 1952 Pop. Coverage: 156 217 1953 Pop. Coveragel 1 52f 306
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0
1952 Pop. protegee
156 217
1953 Pop. protegee
1 526 306
1954 Pop. protegee
. 5 467 664
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1955 Pop. Coverage I 5 500,000 (Estimate)
1956 Pop. Coverage I 7000 000 (Estimate)
1957 Pop. Coverage I 2 000 000 (Estimate)
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195!' Pop. protegee (estimation)
5 500 000
1956 Pop.• protegee (estima t1on)
7 000 000
1957 Pop. protege e : 2 000 OO( (estimation)
-. ~r[0/~T/18
I.PPn:1IX 1-1
_. Summary
THE I!llTRRNAL AIm CHILD lEffiLi'H PROJ?;CT, TAmAN
'."
The Haternal and Child Health p!'oject in Taiwan, which is sponsored by the Government, UNICEF and W'dO, has been in operation since 1952. The overall
objective is to demonstrate modern techniques in maternal and child care suitable to the socio-economic background of Taiwan. The main functions at
the present time are teaching and in-service staff training, maintenance of routine demonstration activities and technical supervision of maternal and child health work in health stat~ons.
Taichung City Health Centre is used as
the maternal and child health Demonstration and Training Centre and eight lis which surround the health centre serve as field training areas.
• I
REPORT
ON
MATERNAL AND CHILD HEALTH PROJECT IN TAIWAN (March 1952-May 1957)
-I.
INTRODUCTION
The maternal and child health project in Taiwan is a triple sponsored programme, being sponsored by the Taiwan Provincial Health Administration, United Nations International Children's Emergency Fund (UNICEF) and the World Health Organization (WHO). The agreement was signed in Manila in March 1952. The Commissioner of Health of the Provincial Government of Taiwan has the overall responsibility for the direction of the project. The Government undertook (n) to provide a parallel team, consisting of the best qualified personnel available to work in close contact with the WHO personnel and (b) to meet certain expenses of the project, such as buildings and equipment for new centres, administrative expenses, etc.
The World Health Organization undertook in the beginning to provide the international technical advisers and work in close conjunction with the national members. The team members have been as follows : Dr. D. Scoville Miss Vera \-Jatson Miss V.B. Kirkpatrick Dr. Denis Pirrie Miss Merle Farland Team Leader (August 1952 to June 1953) Nurse/Midwife (August 1952 to August 1955) Public Health Nurse. (August 1952 to June 1954) Team Leader (September 1954 to June 1956) Nurse/Midwife/Educator (Since March 1956)
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UNICEF provided equipment for the setting up of the maternal and child health centre and also aided in strengthening the maternity and paediatric wards of Taichung Hospital, provided vehicles, equipment, and other supplies for health stations. Milk was provided for mothers and children. When the staff from health stations return to their duty stations after the course in this centre, they receive these UNICEF supplies for use in their MCH work. The overall objective of the MCH project is to demonstrate modern techniques of maternal and child care which is suitable to the socioeconomical background of Taiwan. A MCH Committee has been est@blished in May 1952 in the Provincial Health Administration, and MCH services thus been initiated. The main functions of the MCH project at the present time are teaching and training, maintenance of routine demonstration activities and technical supervision of MCH work in health stations.
-, . - 2 II. DEMONSTRATION AGrIVITIFB
For the demonstration activities of I~CH, Taichung City Health Centre has been used as I~CH clinic, and eight Lis which surround the health centre were selected as demonstration areas. Each Li consists of 200 to 300 families and the average size of a family is 5 to 7. The following are the main demonstration activities in the centre. Ante-natal Clinic The clinics are held twice a week in the morning. Every effort was made to ask the pregnant women in the area to come to the ante-natal clinic. Pregnant women are asked to come early in their pregnancy, and to attend the clinic once a month during the first 28 weeks of pregnancy, once every two weeks from 28 to 36 weeks and once every week thereafter i f there are no unusual signs found . At the first visit of every pregnant woman to the clinic a complete physical examination is given by the doctor - including chest X-ray examination, blood test for syphilis. At all visits the mothers are weighed, blood pressure is examined, urine is tested and an abdominal palpation is made . Health education is done by both doctor and nurses at that time . All examinations are free at this centre.
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Doctor exam~m_ng Ante-natal Mother Delivery 24-hour call service for delivery is provided at the centre. The supervisors and trainees \'lliit homes and take responsibility for the complete home delivery. Cases with abnormalities are referred to the provincial hospital or to a private obstetrician for medical assistance. Only 20 Taiwan dollars are paid by a mother for home delivery. Child Health Conference This child welfare clinic is held at the centre twice a week in the afternoons . Mothers are asked to bring their children regular~ for examination. The doctors and nurses discuss the children with the mother during the examination. The importance of continuous health supervision for every child is stressed. Immunization of children is done also during the clinic hours. Immunization Clinic The immunization clinics are open for services twice a week in the afternoons . They provide diphtheria, pertussis, B.C.G. , and smallpox vaccination. Since 1954 the triple vaccine, consisting of diphtheria, pertussis and tetanus, (referr ed as DPT) has been produced loca~ in Taiwan to immunize all the children between the ages of 6 months to one year . The centre is also assisting this project by rendering DPT immunization to the children in th e area,
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Home Visit Visits are paid to ante- natal and post - n?t al nothurs, newborn babies, infants, pre- school D nd school children . H cn lth education of the whole fami~ through these visits is given much emphasis . Nurses and m idwives are welcome by families in the area .
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Doctors visit horne with their supervisor during the course at MCH Centre
1. 2. 3. 4. 5. 6. 7. 8. 9.
Introduction to the activities at the centre showing public health cartoons, etc . Toy making class Physiology of menstruation and fertilization HYgiene of pregnancy Preparation for delivery at home Physiology of labour Food demonstration Preparation for baqy (clothes, baby tray, etc .) Baby bath demonstration
i
There are many kindergarten schools wher e children attend for 2 t o 3 hours In this centre we organize classes for pre-school children between the ages of 4 to 6. The class is held once a week for a group of children 30 in number and lasts for 3 months for each group. The aims are in the mornings .
1. 2.
To provide a suitable place for the pre-school child to play with suitab~e materials. To lay a foundation for formal education which will begin when the child r eaches school age . To help the child in developing the sense of independence and s elf-sufficiency. To teach the child how to get along with other children. To help the child acquire at an ea rly age habits and attitudes towards healthful living that will help him throughout his entire life.
3.. 4.
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.. - 7 Lin M eeting . Lin is the smallest unit in the community and consists of 10 to One way of implementing health education is to approach this "Lin" as a unit. The meeting is usually held •. fter dinner time in th03 .weninG so that the housewives can attend with the~r children, even with their whole families. MeH and other health activities are introduced by means of health talks, nutrition demonstrations" and movies, and the subject is different each time. By means of these activities, as well as the social chat with their neighbours, the idea of healthy living is spread.
5 famili es .
Field Trip Monthly field trips to aborigine and fishing villages are being conducted with the trainees. These trips include child health conference for the mothers and children in the village, food demonstrations and immunizations. At the aborigi.nal village in Ho-ping
iving
We
examine
L-________________~__------·aining
courses are bein bb________-.~'=lc~pn-~c~unc~lnlv"v~D~ireer..~
1.
Three weeks
course for medical officers
. - 8 2. Six weeks
)
course for nurses and midwives from health stations
These are conducted at the MCR Centre. Practical and field work are provided during the courses and discussions with doctors, nurses and midwives on the problems in their health stations . For the practical experience at clinics and other activities in the centre, they are divided into small groups, each working with a nurse supervisor who has been trained in this work. Lectures are given by project team members assisted qy outside lecturers in special fields . 3. Four weeks refresher courses for private midwives.
In the past, domiciliary midwifery which covers over 90% of the deliveries in Taiwan, was limited almost exclusively to actual delivery with very limited post-partum care. These courses were commenced with the object of improving the midwifery services available to the mothers of Taiwan qy teaching modern methods of mother and child care and developing a closer relationship between the midwives and the health centres and stations . Midwives who have completed the course are provided with UNICEF delivery bags. JCRR assists with financial help for the courses, including a special grant towards the cost of three m idwifery linen bundles . Cooperation with the local health centre and stations is developed during the course and supervision is then carried out by a nurse/midwife supervisor in that area . The response has been excellent. attendance at all sessi ons is 100%. Registration for the courses and
Private M idwives ' Course
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Happy with the Bundles am UNICEF bag
With UNICEF bicycles
The progress of the training in MeR project is shown below Progress of Training in MCH Project No. of health station invol. 17 59 15 67 7 165 S7 23 23 144 (February 1957) No . of medical No. of nurses and No . of train. No. of priv. officer comp1et . midwives complet . supervisors mi~. complt 11 12
Year 1953 1954 1955 1956 1957 Total
10 13 95 20 23 115
9S 37 90 10 247
By the end of 1957, lS7 health stations will be covered and by June 1955, a total of 500 private midwives will finish the refresher course .
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- 10 IV. SUPERVISION OF MCH WORK IN HEALTH STATIONS
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The population of each health station is about 20 000 to 40 000. The staff differ in number according to the type of health station . The minimum work required for M CH work in the health station is as follows : 1. 2. Ante-natal clinic once a week in the afternoon combined with post-natal clinic . Child health conference with immunization clinic once a week in the afternoon. ~ week each, but these are flexible according to the type of health station and condition of the ante- natal clinic and ~hild health conference.
3. Mother's class and children's craft ono& 4. 5. A 24- hour home delivery service. Routine home visiting.
Health stations are advised to commence the ~ICH work with the Lin meetings which are the best and easiest waysof approach to the ·public . Home visiting encourages pregnant women and mothers with children co come to clinics, mother's classes and children's craft . The average number of attendance in clinics in the health station at present time is 5 to 10 mothers in ante-natal clinic and 8 to 15 children in child health conference . In rural areas, especially in distant places, it is difficult for families to come to health stations . For such places , a health room in private houses is utilized qy doctor and nurses who come by bicycles or other means of transportation. This serves as open mobile clinicS . In addition to this task, they are also encouraged to do ante - natal and child examinations in the health rooms . The public health work is limited mainly to the afternoon in health stations because they are busy with sick patients in the morning. Two types of supervision have been conducted 'by the centre. The health station is visited cv~ry six months after the staff have finished the course from the centre. The visit is made by the senior staff from the centre including a doctor, a nurse and a midwife as a team. The other type of supervision is the in-service supervision by a nursing supervisor from the centre, who may be sent to a station ~Ihere it is felt that some further help in planning and developing their work may be of value . She stays at the health station for one or two weeks working close~ with the staff . The MCH work in the health stations is gradually but steadily improving.
Supervisory t eam to Health Station
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I" V. FELLOWSHIPS
The following are the fellows sent abroad by the Government through the WHOjUNTA aid in this project : Name Hiss T.Y. Huang Miss F .C. Lin , y'
Hajoring course Midwifery Public Health Nursing D.P.H. Course &
Place Uni ted Kingdom Hawaii, USA London School of Hygiene and Tropical Medicine, UK Universi ty of North Carolina, USA United Kingdom New Zealand
Duration January 1955 to December 1955 Septanber 1955 to August 1956 September 1955 to Jul,y 1956 One year from September 1956
Dr. J.Y. Peng
Child Health
Miss L.P. Lu Hiss H. Huang Hiss C.R. Shih (Tainan Hospital) VI.
Health Education & Nutrition Hidwifery Teaching Midwifery
21 months from September 1956 One year from January 1957
FUfURE PLANNING
1. The training and demonstration project is planned to continue until 1960, assisted by WHO/UNICEF. By the end of December 1960, all 357 health stations will be covered by this training and supervision programme. The following schedule is the plan for future training : ~-
Proposed Schedule for MCH training 1958 - 1960 II
Year Month
No. of health st'n involv. Dec. June Dec. June Dec. June Dec.
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1957 July 1958 Jan. 1958 July 1959 Jan. 1959 Jul,y 1960 Jan. 1960 Jul,y Tot a 1
213 237 261 285 30;1 333 357 357
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;ledical officer Nurse or midwife Priv.midwives lilo.of Size of No.of Size No • of 1~otarf 0 0 class class Total class class Total class priv. midw. 2 26 13 12 3 36 :2 12 24 500
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2 3 2 2
12
12
12 13 12
2
24 36 24 26 24
2 2 2 2 2
12 12
12 12
12
24 24 24 24 24
12 12 12 12 12
180 180 180 180 180 1400
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Establishment of Maternal and Child Health Institute.
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A new NOH Institute will be established combining the present NCH project and the Provincial Taipei Health Centre. The building will be erected on the land next to the Provincial Taichung Hospital and I.C.A. has approved a grant of NT$8ClO ClOO for thi s purpose. New regulations for the institute have been prepared and are waiting for the approval of the Central Government. The functions of the Institute will chiefly include planning, supervision, research, training and education.
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Illustrations by Photographs by •
Dr. J .Y. Peng Dr. H.C. Lin lft,iss ;1. Farland
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Dr. J.Y. Peng
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!JHOjCST/18 f.p.rrl' DIX l'''m
CARE OF PREW_ TUllE INFAN 'IS, JAPAN
Summary In 1950, the infant mortality rate in Japan was 60.1 per 1000 live .or'
births.
HJOut 10% of these infants had a birth weight below 2500 grammes, of lh the spring of 1953 a WHO consultant in prematurity assisted
whom 50% diEld.
the Government in making a survey of the extent of the problem, the available facilities for prevention and care, and in advising on the programme aId services which could be developed. and fellowships for training abroad. The Setagaya Health Centre and lhfants I Rome was designated the national centre for the training of personnel l-lOrking in this field. Theory I I
WHO also provided equipment and supplies
is taught at the Maternal and Child Health lhstitute, maternity aspects at the Red Cross Hospital and paediatric aspects at the Setagaya Centre. The aim is
to tram personnel from the 783 health centres in Japan in the domiciliary care of premature infants so that eventually there will be sufficient personnel to meet tho requirements of a comprehensive national programme.
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ffiEMATURE INFAN'lS In 1950 the population of Japan was 83 199 637 and there were 2 337 507 live births. Seven to ten per cent of a birth weight of below 2500 grammes, and were consequently premature. About half of these premature infants died, and mortality rate for that year was 60.1 per 1000 live births. infant mortality was remarkabJ.;v improved and it was reduced live births in 1955.
in that year infants born had considered to be the infant However, the to 39.8 per 1000
In Japan, 14.0% of tre deliveries took place in hospitals, and 82.4% of deliveries were attended by midwives. In August 1951, the Japanese Government requested WHO for assistance in developing a programme for premature infant care. The request included services of a short-term consultant, fellowships and supplies. This request was disoussed during the second Regional Committee meeting and approved.
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An agreement between the Government of Japan and the WHO was signed with the follOwing objectives 1. To assist the Government to obtain knowledge of the causes of prematurity and to devise me thods of preventing it. 2. To assist the Government to demonstrate modern methods in the proper care of premature infal ts in an attempt to reduce premature infant deaths. 3. To assist the Goverrurent in the training of local personnel (professional am auxiliary) conneeted with the above-mentioned activities. As part of its commitments, the Government agreed to provide all personnel, including those in t.he Children's Bureau of the Ministry of Health and Welfare responsibl€ for the premature infant progrannne, those in the Red Cross Hospital Maternit,y and Paediatric Pavilien and the Setagaya Infants' Home, Tokyo, am those in the health departments, centres am units throughout Japan who deal with premature infants. Tl1e Government was to arrange also far the close co-operation of medical schools ald teaching hospitals am non-governmental professional groups. In December 1952, three fellowships were granted: one for six months in clinical paediatrios, with special emphasis on care of premature infants, was awarded to a medical officer for study in New Zealand and USA; another for six months in nursing (midwif€ry) was awarded for study in New Zealam and USA, and the third for six months in paediatric nursing, with special emphasis on care of premature infants, was awarded for study in New Zealand am USA.
In the spring of 1953, a short-term consultant on prematurit,y, Dr. Sydney S. Chipman, Professor of Maternal and Child Health, School of Publio Health, University of North Carolina, was provided by WHO to assist the Govermnent in making a survey of tre causes and the extent of the premature infant problem, the available facilities for prevention and care; to advise
- 2 on the progranunes and services which can be developed; to advise on the organization of local training for pErsonnel; to assist in the seleotion of oandidates for fellowships outside of the country and in the formulation of rna terial and supply list. The following background information is abstracted from Dr. Chipman's report: Place of Delivery: In 1951, 94.1% of all deliveries ooourred at home. In Tokyo aIrl kYoto the percentage of hospital deliveries was high due to the building of new, or the repairing of old, lying-in facilities. However in rural areas, it was unlikely that for some YGars to come, the peroentage of home deliveries would fall below 90%. Because of the structure of Japanese homes with few rooms available, ani frequently one central room served in rotation as an eating, living >nd sleeping area, home delivery and early care of tile newborn was rendered difficult. In 1954, 82.4% of all deliveries occurred at home. Attendanct at Delivery: 50100 89% of pregnant women were delivered by midwives in 1951. Physician-attended deliveries totalled only 6%, leaving approximately 5% in which the delivery was unattended or the record was incon;>lete. In 1954, 82.4% of pregn>nt women were delivered by midwives, and 13.2% by physicia'l s. On the other ham, in Tokyo and Kyoto prefectures, 20-30% of deliveries were physician-attended or at least supervised by a phySician. Registration of Births: The Law of House Registration in Japan states that the birth must be registered in the village or district office before fcurteen days had elapsed, following the birth of the infant. The birth certificate includes, in addition to the usual faotual information, an estimate of the duration of pregnanoy, >n d the birth weight in granunes. Number of Births, Birth Rate and Trend of Birth Rate: The number of recorded live births reached a peak of 2 696 638 in 1949 and had since declined sttadily to 2 005 162 in 1952. The live birth rate in 1947 was 34.3 per 1000 population, but in the intervening years it had declined to that of 23.4 in 1952. The live birth rate in 1955 was 19.3 per lOCO population. Stillbirths: In 1942 the reported stillbirth figure (95.446) was equal to 4% of the live births reported, whereas in 1952 the reported stillbirths equalled 10% of the live births. The stillbirth was 183.195 in 1955. Premature Infant: The mean birth weight of infants at the time of too Consultant's visit was 3100 grammes for males aad 3050 granunes fer females. 1'he se figures were slightly below those of many western groups. Figures for 1950-1952 from the Tohoku University Hospital in Sendai :Indicated that allI)ng 1951 live births there were 192 or 9.9% of the total with a birth weight below 2500 grammes. Further study of the rtports from different souroes revealed tha t of the annual crop of premature infants, 65 to 85% of them had a birth weight between 2000 and 2500 grammes. As regards survival rates of prematura infants, too available figures indicated an overall rate of 80-87% for all prematures. However, more meaningful was the study of
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..
~-.
- 3 survival rates after having divided the infants into two groups, namely infants with a birth weight between 2000 and 2500 grammes and those with an initial weight below 2000 grammes. The results indicated that in the heavier ani mue!} the numerically larger group, 89.5 - 93% of them survived, while in the group with birth weights below 2000 grarnmes the survival rate varied from 50 - 68%. Newborn Care - The care of newborn infants in Japan was almost entireJ.;v in the hands of the parents and the midwife. The amount of sup;rvision rendered varied from prefecture to prefecture~ but in general the midwife visited the home several times wring the first week • Infant Mortality - The infant mortality rate had improved remarkably in the past half century. From tht) report "Statistics of Maternal ani Child Health, 1952" published by the Children's Bureau, it was revealed that in the period 1942-1952 there had been a decrease in infant deaths under 1 year of age from 85.8 to 49.4 per 1000 live births. In the same period, the neonatal death rate fell from 34.3 to 25.4. In 1951, prematurity and congenital debility accounted for more deaths than pneumonia and the enteric disease group combined. The infant mortality rate in 1955 was 39.8 per 1000 live births, and the neonatal death rate 22.4. Hospital Facilities.- Hospital facilities for the care of all newborns, and certainJ.;v prematures, as judged by American standards were grossJ.;v inadequate. Separation of prematures from full term infants was practised very infre:quently. All newborn nurseries visited were overcrowded and t re provision of even the minimum standard of 30 square fet)t of floor space per infant was far short of achievement. Handwashing facilities were seldom available in the nurseries and. were inadequate outside the nursery. Other measures directed at the avoidance of infe:ctions were not in evidence or i f practised were not uniformJ.;v adherred to. Oxygen therapy was e~loyedvery infrequentJ.;v and on onJ.;v one occasion was its use observed. Incubators were few in number and in most instances were antiquated in deSign and construction. However, on two occasions, Japanese versions of the "Isolette" were in use. Most prellJ3. ture infants were fed directly at the mother's breast or breast milk from the mother or a wet nurse was given by gavage. Rarely was a formula of cow's milk used. Supplements of iron or vitamins were not given prior to one month of age. Nurse-midwives were responsible for the care of all,wwborns within the hospital and the overall responsibility for the nursery belong]to the staff of the departlnent of obstetriCS, wi th the paediatricians being consulted rarely, i f at all. There were no special facilities or activities for follow-up care of prematures in the out-patient departlnents. From the above information, Dr. Chipman came to the conclusion that in Japan the facilities arrl trained personnel must be increased ani improved for the eare of premature infants. Furthermore, there needed to be more awareness on the part of the h~alth professions of the magnitude and nature of this public health problem and of the challenge to all health personnel which it presents. Dr. Chipman was impressed by the achievements of public health personnel and by the keen interest and desire they have shown to make further progress in MCH gen"ralJ.;y, and in any new and special activity within the MCH field. Dr. Chlpman believed that there existed a tremendous opportunity to strengthen existing activities and thus provide a firmer basis on which to plan and. proceed
-4with a new pro gramme for the specialized care of premature infants. He recc:mmended that the best approach would be through the strengthening of the present prenatal and neonatal care progranrnes. Simultareously, provision should be made for the training of personnel skilled in the care of prematures and in tre training of additional personrel. The development of a nucleus of trained personnel, he believed, was dependent upon tre establishing of a national pilot premature centre. This development would be facilitated by the services of internationally trained personnel and the provision of equipment not available in Japan. Finally, Dr. Chipman recolllIOOnded the formation of national and local advisory committees ani the training, at allleveJs, of public health physicialS, nurses, midwives alIi other anCillary groups.
1.
To strengthEn the existing
I1Ql
programme, the Consultant recommenaad :
a) Studies to gain information cover ing the folloliing areas helpful in planning of furore progra.rnmes : i) The influence of socio-economic status, age and the effect of vigorous physical activities on the incidence of premature labour in Japanese wcrnen. ii) The type of lying-in institution or hospital best sui ted to Japan, alIi could prenatal superviSion be developed in such an insti tution. iii) The quality and quantity of care given to newborns by midwives.
iV) Immediate reporting by midwives of births to the health department should be encouraged.
v) Developing in mothers and future mothers, a concept of the importance of continuous health supervision of infants. A series of letters mailed to prospective mothers at regular intervals throughout their pregnancy was a device which had been tried elsewhere. b) Strengthening prenatal care. Dr. Chipman said that experience in the United States and elsewhere indicated that improvement of prenatal sur.ervision was followed by a reduction in the incidence of prematurity. There are many methods or devices for strengthening this care, smh as the establishment of recommended standards for prenatal care, augmental clinic services, improving training am practices of the midwives am more uniform distribution of midwives. Education regarding the nutritional needs of pregnancy was also a fruitful activi ty, since i t was generally accepted that the outcome of pregnancy was favourablY influenced by supplementing the diet of th e pre gnant woman. Exploration should be in1 ti ated as to how adequately the emotional needs of pregnancy are being met, if at all, in prenatal care as rurren tly relIiered in Jap an, Tre proviSion in at least certain rural areas of more lying-in agencies could serve as a stimulus to better supervision and care:iJl later stages of pregnancy and at the tiroo of de li very •
• •
•
- 5c) Strengthening of the care of young inf ants. Health supervision in early infancy was an acc~t ed goal of maternal and child health pr ogrammes. By tile development of this concept in Japan, early case finding of prematures would be facilitated. 2. Establishment of Prematut'e Centres - During too Consultant's visit, plans had been initiated am- th8 erectioo. of the physical plant for a premat1l'e centre at the Japan Red Cross living-in Hospital and Infants' Horne was in progress. He suggested that this centre be the national pilot centre am reoollll1J3nded the establishment of regional centres. Ultimate4r too national pilot cen tre was situated in the Setagaya Centre. Many centres would ultimately be needed in order to train sufficient personnel to meet the requirements of a oomprehensive national programme. The primary funotion,of a premature oentre was the training of personnel. Therefore it IIRlst be located in a hospital setting in which teaching pro grammes for all types of personnel were in progress or could readily be organized.
In Japan the only medically trained person concerned wi. th the care of pranatures was tile obstetrician and Dr. Chipman urged that the interest and service of paediatricians be vigorously advocated. The Consultant emphasized that the care of the newborn should be in the hands of phYSicians who were interested in an:! responsible fa' the care of children of all ages.
Dr. Chipman recommended that provision should be made far a follow-up clinic in every premature centre. The Setagaya Health Centre and Infants' Home becan e the pilot centre. The Setagaya ward in Tokyo has 400 roo popuJa tion. wHO provided equipment and supplies including a total of eighte&n incubators and books and other publications on premature infant care, and fellowships. bighteen incubalbors were lent to Setagaya Infants' Home and Japan Red Cross Iqing-in Hospital, and the publications on premature infant care were lent to the obstetrician and paediatrician for premature infant care. Of tile three WHO fellows, Dr. F. Saito retunEd to the MCH Institute, Dr. A. Mizoguchi ret1rned to the Premature Infant Centre, Red Cross Maternity Hospital, and Miss N. Sasaki returm;d to the Premature Nursery, St. Luke's Hospital. Theory is taught at the MCH Institute, maternity aspects taught at the Red Cross Hospital, am paediatric aspects at the Setagaya Centre. The aim is to train personnel fran the 783 health centres in Japan in the domiciliary care of premature infants. In December 1954, two additional WHO fellowships were granted: one fellowship for six months' study in premature infant care in UK am Denmark; another fellowship far six months' study in integration of premature prilb lems with M(}! administration in general in UK and Denmark.
During 1955 and 1956, no assistance was provided by 1lH0, but for 1958, the Government had requested WHO for a five-week consultantship on domiciliary care of JX' ema ture babies.
ilHO/CS~/H~
,\P?ll DL l"-n
REHABILITATIGI OF CRIPPIED CHIIDREN, JAPAN Summary
The programme for the rehabilitation of the physically handicapped 4~ S +"ar+"ed .... ...............
Japan 4n 1919. .r..
l: va 1 l.m. ~ . ~. "Th' . ~. lJ8.ry organl.ZaI.l1on, e .I\,ssocJ,.a ",,1.on f or 1,
Rehabilitation of the
Crippl~d"
set up a hospital and convalescent home for
crippled children, '/hieh provided integrated rehabilitation services, including treaWlent and caro, physical and occupational therapy, social services, educatiro and vocational training for crippled childrm. When war broke out trese
activities were discontinued and it was not until 1948 that the care of crippled children was taken over on a national scale by the Government. national services available are given in the attached paper. Details of the In 1952 a WHO
short-term medical consultant visited Japan to assist tho Government in surveying the needs and available facilities for the programme and a team of national personnel were granted fellowships. After trainint abroad the team was assigned
to the National Crippled Children1s Hospital in Tokyo which served as a
demonstration and training centre.
.A subsequont visit by a WHO consultant in
occupational therapy in 1954 revealed that the programme had been developed soundly with national and prefectural governments' interest in the improvement and expansicn of services. UNICEF has provided supplies and equipment.
-
REHABILITATION OF CRlPi'IED CHIlDREN In the past, as it was elsewhere, crippled children in Japan were left without proper care, treatment and education. In recent years however the public has been lJ3d to understand that crippling conditions in children could be cured, ar improved by early and proper treatment and that these children should be brought up as self-supporting m d useful citizens.
In 1951 it was estimated that there were 400 000 orthopaedically harrlicapped children under 18 years of age. The major causes of crippling were as follows : 1. 2. 3. Poliomyelitis Cerebral Palsy Congenital deformities 1B of bones and joints Trauma Osteomyelitis purulenta Rickets
4. 5. 6.
7.
It was Professar Kenji Takagi, Chief of the Orthopaedic Departrrf;nt, Tokyo University, who started a programme far the rehabilitation of tre physically hmdioapped in 1919. 1his programme was well received and supported by people in all walks of life. A voluntary organization, "The Association far Rehabilitation of the Crippled" was founded, an d set up a hospital and oonvalescent horne far crippled Children. This Association, later renamed as the Japanese Society far Crippled Children, is affiliated with the International Society for the W81fare of Cripples.
.. "
This institution had a bed capacity of 105 m d provided integrated rehabilitation services whioh inoluded troatment and oare, physioal therapy, ocoupational therapy, social servioe, education and vooational training for the crippled children. However, when war broke out, these activities were suspended and were to be resumed only gradually after the war. In 1948 the Child Welfare Law was passed and the care of crippled children was taken over on a national scale by the Government. The hospital of the Japanese Society for Crippled Children became the National Crippled Children's Hospital (SEISHI-RYOOCl-EN). A year later, another law, the Law far the Welfare of the DisablJ3d, whioh aimed at the welfare of physically handicapped adults, was enacted. Thus, the government programme covered the whole range of the physically handicapped, both children and adults. Services for crippled children Organization: The programme is administered at national level by the Crippled Children Servioes of the MCH Section, Children's Bureau, Ministry of Health and Welfare. There are 46 prefectures in Japan and the programmes at the . . prefectural 1; vel are administered jointly by health and welfare authorl.tl.es. There are four aspects of the Crippled Ohildren Programme : i) Clinic services _ Crippled children clinics were established in a nwnber of health centres in 1951 by a national-prefectural fund. One hundred and thirty-five of these health centres now conduct crippled children's
•
- 2 clinics. The cripple d children's clinics are used mainly for screening (casefinding) am diagnostic services with referrals to hospital centres. T~re are infrequent return visits and limited out-patient care. Prior to the establishment of crippled children's cliniCS, mobile clinics were jointly sponsored by the Japanese Socie~ for Crippled Children and the Ministry of Health and Welfare. ii) Rehabilitation services for crippled children
The hospital Illd rehabilitation centres were planned to provide integrated services of rehabilitation - surgicalarxl medical, physical am occupational therapy, social services, education and recreation. These centres, constructed with national-prefectural fund, now amount to 25 in number, with thEe total bed capacity of 2077. In view of the acute shortage of facilities the government is planning to establish a centre in each of the 46 prefectures.
.>-
'
iii)
Provision of short-ternl treatment by general hospitals
"
In addition to the national am prefectural hospitals for the crippled Children, some 230 hospitals had been designated to admit children for shortterm care. Services in these centres were limited and did not provide OCCUj:B. tional therapy or school for the children, but these services were useful in checking the crippling conditions in their early stages. Ore hurrlred sixty-one schools and/or homes for visually arrl auditory handicapped children, with education arrl social services only, were in operation.
iv)
Prosthetic appliances
Appliances Oihich included artifiCial limbs, braces, wheel-chairs, hearing aids, eye glasses were provided by public funds. Vocationa 1 training sel'vices were given to crippled children over 15 years of age. The vocations taught included: carpentry-cabinet making, prosthetic devices, shoemaking and repair, wood carving, l1llchanical repairs, etc. In August 1951 the GoverIW3nt requ(jsted WHO assistance in the form of technical consultantship and fellowships. '!his request was approved at the Regional Committee meeting in September 1951.
A plan of operations f CIl' a programme for the rehabilitation of harrlicapIE d children in Japan wa3 agre&d upon by the three parties: the Goverrunent of Japan, WHO and UlJICEF. The objectives were as follows :
1. To consolidate and expand the existing services for the protection againBt crippling and deformities of Children, and for the diagnosis, treatment, arrl rehabilitation of crippll d children, including:
- 3 a) protection against the occurrence of preventible crippling and skeletal defonnities before, during and after birth; b) ear:q recognition, medical diagnosis, and treatnent of crippling diseases in children, including allied therapeutic services, psychiatric and social services, education, vocational preparation am employment) in order that such children be given full opportunity to develop their abilities to the maximum am become useful and independent members of society; c) the development of a sound attitude on the part of immediate family members of crippled children, and of the general public, towards the problem of crippled children and children with skeletal deformities; d) co-ordination of the programme for the rehabilitatim of physically hamicapped children with that for the rehabilitation of physically· handicapped adults.
2. To develop the training of for these services.
local professional am auxiliary per 00 nne I
In the plan of action, it was clearly laid down that till intention of the Government was to develop am co-ordinate the programme for the rehabilitation of crippled children by the mobilization, organization am :integration (at both national am local levels) of schools, health centres am units, and hospitals and professional groups, particularl¥ medical practitioners am midwives, and thE; whole pro gramme included the following phases:
a) Education of the public and particular:q the imnediate families of handicapped children; b) Prevention, case recognition, medical dianosis am treatment of crippling diseases in children by consultations am hospitalization at strategical:q siillated zonal orthopaedic centres; c) RehabilitatiCll, education, vocational preparation, and eventual employment of handicapped children, by th3 tr ovision of such services in the programme itself,and by close co-ordination of other vocational guidance, training am plaCEmEnt services available in the country; d) Research and the training of personnel to work in all phases of this pro gramme. In the plan of operations the canmitments of each of the three parties WHO to provide for technical advice and international personnel to assist in the development of the programme; UNICEF to provide the necessary equipment am supplies not locally available in Japan; and the Governmant to provide aJ.l.4lersonnel, equipment, material, supplies and local expenses necessary for the project.
were clear and distinct:
Dr. Marcia Hays, Chief of the Bureau of Crippled Children Services, California State Deparbnent of Public Health, was sent to Japan in November 1952 as the WHO short-term consultant to assist the Government in surveying
- 4the needs ald availa:,le facilities for a programme, to advise the Government on its development, and to assist -the Government in the selection and placement of fellows. 1.. team of national personnel were granted fellowships in -the United States, as follows :
1. 2.
4. 5.
3.
Fellowship Fellowship Fellowship Fellowship Fellowship
in orthopaedics and physiotherapy (9 months) in orthopaedic nursing (6 months)
in medical social service (6 months) in physiotherapy (6 months) in occupational therapy (6 mon-ths)
lifter their training abrooci, the team was assigned to the National Crippled Children's Ho<pital in Tokyo ani was responsible for the training of personnel. The Hospital served as a demonstration and training centre. The UNICEF 1xecuti ve Board at its meeting in 1953 approved tre apportionment of $17 000 for the purchase of equipment and supplies for physically handicapped children's servic€s and training. UNICEF donated equipment and supplies including the follOWing: i.naesthesia apparatus Surgical instrumen ts an:! supplies Ci'thopaedic beds and cribs Medical literature. These equipment and supplies were delivered in the early part of 1954 in time for tIE start of the training courses.
In 1954, WHO sent Miss Marian Davis, Consultant in Occupational Therapy, Department at' Health of Calif(J['nia, to Japan as a short-term consultant in occup ational therapy to advise on tIE establishment of occupa tional therapy services ani on a training course for occupational therapists. Miss Davis ceme to the conclusion that too crippled children programme had been developed soundly with intense National and Prefectural Governments' interest in improvement of services and expansion into other areas of -the country. <Officials at the local level had shown great interest in the programme. Training courses at the National Hospital were well planned and the returned WHO fellows did a splendid job in utilizing the experiences gained abroad. The Consultant demonstrated treatment techniques and use of toys. The Consultant recommended that, in p:i.anning equipment for the classroom, the occupa tional therapy rooms, table s and chairs should be of at least two sizes or adjustable in order that the child may have good posture while ocC?,pied. The Consultant also recommended that out-patient services in hospitals an:! clinics should include physical an:! occupational therapy for training of discharged hospital patients who should return regularly for treatment an:! instruction in home treatment, check-up and instruction in the use of prosthetic devices.
- 5In April 1956, the Ministry of Health and Welfare submitted a request to UNICEF far equipment for tw~nty-three prefectural institutions for handicapped ohildren as an extension of the pro grame. An allocation of $56 000 was approved by the UNICEF Executive Board. For this proposed extension of UNICEF assistance up to 31 December 1957, WHO technioal approval was given. An addendum to the plan of operations was drawn up and Signed by the Government, WHO and UNICEF to cover the inoreased international commitment. (..-
No further assistanoe was provided by WHO in 1955, but a return visit of Dr. Hays as a short-term consultant is provided for in 1957. For 1958, the Government has requested WHO for a fe llowship for six months in the United States for study of speech disorders.
~·~.v/·v:"~/l"""
i.PPLl':DlX 1-0
TMCHOHA, TI,IWilN, CHINl,
SUIIIl11ary
I
Early reports suggested that the incidence of trachoma in Taiwan ranged from 44% to 9(Jf, according to re~ion. In the National Taiwan University Hospital in Taipei. 31% of all ophthalInic cases in 1951 had trachoma and in Kaohsiung in the south 80% of all ophthalInic cases attending the provincial hospital were trachomatous. Following a visit of a WHO shcrt-term consultant in 1952, the Government established a pilot project to serve as a trial and provide training for an eventual mass campaign. The pilot proj~ct proved to be a success and in 1953 a plan of operations for a mass campaign among children was signed qy the Government, WHO and UlHCEF WHO assistance has consisted of visits by shortterm consultants to advise on and assess the progress of the campaign. UNICEF has provided equipnent and supplies. 4
I
-~ I
•
, , \
The attached paper gives details of the organization of the campaign, the methods of treatment and the results of the campaign to date. The target
nUl11ber of children uas set at :2 013 000 and llI' }larch 1956, eighteen months after the campaign was launChed, 1 590 578 children had been examined and those found with trachoma treated. S~~ariGs of tho recommendations of the shorttor.m consultants are also given.
'lHE 'lRACHOMA CClIlROL CAMPAIrn TIl '1hlWAN, CHlN A
BACKGROUND IN:FORMlI.TICN AND SUMMilRY OF PROGRESS
'--
Trachoma was believed to be very prevalent :in Taiwan, Ch:ina. Ophthalmologists there reported that the incidence ranged from 44 to 90% according to region. lh general, it was more prevalent in rural areas, fish:ing villages and salt produc:ing areasJ and more :in the south than in the north. lh the National Ta:\l(an University Hospital :in Taipei, :in the north, 3:1% of all ophthalmic cases :in 1951 had trachcma. lh Kaohsiung, :in the south, ~ of all ophthalmiC cases attending the provincial hospital were trachomatous. It was estimated that about 19% were blind from the disease. The COl!l1lon methods of treatment were expression of follicles, scarification, the application of copper sulfate or silver nitrate or actual cautery. Treatment with suJ..f'onamides and antibiotics, though widely known, did not seem to have been tried regularly, prolonged sufficiently or tried on a large scale. WHO sent a Short-tem consultant, Dr. V:incent Tabone, M.D., D.O., D.O.M.S., F.R.C.S., to Taiwan :in September 1952. He spent 5 weeks there travell:ing extensiveq to exam:ine cases and to collect data on :incidence. He gave lectures to the medical professicn and to members of civic organizations. He was sympatheticalJ¥ received and supported by the Co-ordination Committee on Foreign Aid :in Medic:ine and Health. At the recommendation of the 'lifO consultant, and with the assistance of WHO and UNICEF, the Government implemented a pilot project to serve as a trial and provide training for an eventual mass campaign. It was desired to f:ind outl
1. ,,:1.:
2.
3.
4.
The type of trachoma which was prevalEnt. The :incidence of trachoma among school children and their family contacts,. The possibility or otherwise of treat:ing the disease on a large scale according to modern concepts of treatment, and the time taken to effect a cure. The difficulties to be encountered, and the best way of overcoming them.
UNICEF appropriated $10,000 for supplies. The pilot project was ccnducted through the Trachoma Control CEntre which had a director and a deputy, a part-time cl:inical adViser, a part-time laborator,y adviser and three teams each ccnsist:ing of an ophthalmologist and a nurse. The three teams were given additional training by the WHO consultant. The students in six selected schools, elementary am nomal schools, were exam:ined. Out of a total of 7021, 32SJ.. or 46.73% were found to have active trachoma am 1955 or 27.84%, llconjunctivitisll, the latter :included doubtful trachoma. They were treated with 1% antibiotic (aureomyc:in or terramyc:in) o:intment 4 times a day for 2 months. Cases were treated twice a day Where they had a haU-day school system. There were no complaints of loss of school time, discanfort, irritation or pa:in, no akin reaction or other manifestation of sensitivity.
• - 2 Surgical treatment - expression of follicles, curettage, scarification, application of caustics or actual ~qutery was not considered routine treatment, but reserved for special cases, carried out by the clinical adviser. Dr. Tabone went on his second visit to Taiwan in July 1953, and spalt a mooth assessing the pilot project. Of cases of "conjtmctivitis" 75.1% were declared cured and 193 cases were transferred to one of the four classes of trachoma. He fotmd that too difference in results in those treated 4 times and those treated twice a day was not very significant. After two months of ointment, an overall average of 42% of the cases were cured and 46.1% improved only. Of 141 resistant cases, cases which showed no appreciable improvement after two months of oin-:nta:\t, that received "Tresomide" - sulfameraz;ine, sulfadiaz;ine and sulfathiazole comb;ined, 66 were cured. Dr. Tabone said that "criteria of cure used were, if anything, slightly on the strict side". More satisfactory results were obta;ined among students whose treatJnent was better supervised. In the cases in the elementary schools, the number of those healed without scars, exceeded qy far that of healed cases with scars, because trachoma ;in the YOtmg was more likely to be at an early" stage and more likely" to heal without any trace. The WHO consultant felt that the nurses should have helped with ooalth educatioo. No instruction was given by tile teams to teachers, pupils, end too public in general on the various aspects of trachoma. Gmeral interest on its cootrol, was allowed to drop after-an initial rise. Examination and treatment of coot acts were not well carried out. Few were seen, and no attempt was made to reach thEl!l ;in their hanes. No comparative study was made of the effect of aureanyc;in and terramycin o;intments. The teams could have been more researchminded and they could have sent many more cases for exanination for inclusioo bodies. No epidemiological data were collected, and no new ;informa mon obtained on the factors that influenced tile incidence and severity of the disease. However Dr. Tabone said, "It is a clear po;inter that extension of tile scheme is not only" desirable but quite feasible. I am glad that the Government of China is anxious to proceed with a project for the cootrol of trachoma among all school children in Taiwan, and I feel that such an effort should be given all possible help and assistance qy international and other agencies who are in a position to do so. In the case of trachoma the greatest number of cases, and too greatest sources of infection are to be found among children of school age. It is fortwate that such a class of the population, is the one more easil;y reached, and more easy to control. Taking into consideration the available resources of the Government, as well as the possibility of UNICEF help, and after consultation wi til the Canmissioner of Provincial Health I.dministration, I am sti:mitt:ing a plan for the cCiltrol of trachana among all school children in Taiwan, and among their contactsJ the duration of the plan would be three years." In Taiwan the rate of school attendance was high. Dr. Tabone suggested trying on a small scale oily drops of antibiotics and paving attmtion to health education and improvement in personal hygiene and environmental sanitation. During small scale trials he had fotmd that the oily drops were not irritating and caused onJ;y momentary veiling. The Goverment accepted this plan. They estimated that the campaign among school children could be finished in 18 mon ths instead of 3 years.
'.
... - 3 In the plan of operations for the mass campaign among school cllildrm signed by the Government, WHO and UNICEF, the objectives were as follcwsl
.......
1.
The free exam:ination, treatment, and follow-up of all school chi.ldren (est:\Jnated to be 1,200,000) within 18 months} The free exam:ination, treatment, and follcw-up of approximatel,y 100,000 famil,y contacts of school children with a view to finding out how best they could be reachedJ By the above means, plus health education, substantiall,y
2.
3.
to reduce the number of cases of trachoma, conjunctivitis and the sources of infection. The project was to be conducted under the responsibility of the Government with the technical advice of W.H.O. The Taiwan Prov:incial Health Commissioner had the overall responsibility for the adm:inistration of the project. The Government established a Trachoma Control Committee ccnsist:ing of a chai:mlan and five other manbers, :including representatives of the PrOvincial Department of EducatiCXl, the Provincial Taipei Health Centre, and the Medical College of the Naticnal Taiwan University. This Committee was directl,y responsible to the Provincial Health Canmissioner and advised h:\Jn on overall policy and on the technical and administrative aspects of the campaign. The Government also appointed a Trachoma Control Officer, concurrently director of the Trachoma Control Centre, responsible for the day-to--day adm:inistration and supervision of the campaign, and the collection and analysi s of reports. There was a part-t:\Jne clinical adviser who assisted in tra:ining, and advised on diagnosis"trcatment, criteria of cure and on technical problems that arose. The Centre also had two statisticians. The Director and staff of the Trachana Control Centre was respCXlsible for the following tra:in:ing activitiesl (a) (b) tra:ining (3-day refresher course) of ophthalmologists from the 12 prov:incial hospitals} participation in the tra:ining of trachana teams by the ophthalmologists of the provincial hospitals.
....
The provincial hospital ophthalmologists trained at the Traclloma Control Centre were responsible for training all trachoma teams, for giv:ing guidance am supervision as required, and for giving special treatment to serious cases referred to them by the teams. Three hundred sixty-five trachoma teams, each composed of one doctor and one nurse or equivalent, were recruited from the personnel of health stations. There were 365 health stations in Taiwan. These teams were trained by provincial hospital ophthalmologists at twelve training centres. Following completion of training, each team returned to its health station and assumed responsibility for the trachoma campaign among the children :in schools without regular school physicians in the area served by that health station.
- 4 -
Each trachoma team was responsible for: (a) (b) (c) (d) (e) health education. instruction of school principals and teachers in the method of treatment and maintenance of records. examination and re-examination of school children and the prescription of appropriate treatment. supervision of the work of teachers in the treatment of school children. the nurse or equivalent in each team was responsible for urine tests for children receiving sulfonamides.
School physicians were also trained and responsible for the examination, treatment and follow-up of children in the schools to which they were assigped. The duration of training for trachoma control teams was 6 dqrs. details were as follows I (a) For doctors: The
1st day - 3 hoursl Lecture on diagnosis of trachoma and conjunctivitis and other infectious eye diseases. 3 hoursl Lecture on recording of diagposis and guidance for treatment. 2nd to 5th dqrs - 3 hours daily: Clinical demonstrations and participation in field work. 6th day - 3 hoursl Lecture on the trachoma control campaign and its operatioo.
3 hours: (b) For nurses: 1st day - 3 hoursl
Lecture on collectioo of data and reporting. Lecture on treatment of MetlDd of recording. trachoma and urine test method.
3 hours:
2nd to 5th days - 3 hours daily: Clinical demonstration and participation in field work. 6th day - 3 hours: Lecture on the trachoma control campaign and its operatioo. 3 hours: Lecture on collectioo of data and reporting.
•
. - 5All trachC1lla control teams were to work half a day five days a week :in tm first month of the campaign. Those health stations which had two or mere doctors worked full days :in order to speed up the campaign. The standard of daily achievement was to be 150 to 200 exam:inations per half day. Treatment of infected children was to start immediately after exam:ination. The trachoma teams wero to seo that the teachers got the ointment and sulfonamides needed for the treatment, and to ensure the t the teachers treated the infected children promptly after exam:ination.' Each teacher was responsible for the treatment of children :in his or qer class. (The size of the average class varied from 40 to 60.)
,
.
'
The routine of treatment in schools was quick, efficient and hygienic. At the appointed time the children who were to be treated l:ined up to wash their hands. An older child distributed to each pupil his own tube of ointment. The children passed before the teacher who took the tube from the child and applied the ointment in the lower lid of each eye. Tho child was then given two small squares of cotton or tissue paper. He returned to his seat and placed the cotton or paper aver his eyes, gently rubb:ing them to spread the ointment. The tubes of o:intment were collected and put away. The entire routine required about ten minutes for fifty children. It was repeated by each teacher four times a day because most of the schools operated :in two Shifts, and each child had two treatments a day. The older children treated each other. The average requirement of ointment was two tubes of antibiotic o:intment (3.5 grammes each) for each case of trachC1lla, and one tube for each case of conjunctivitis. Additional o:intment was given when this average ratial was found to be :insufficient. Empty tubes had to be kept and exchanged for a fresh supply of ointment. Trachoma cases were given ointment twice a day. Applications were to be given as soon as the children came to school and just before they left to go home • Children after treatment for two months were re-examined (first re-examination). Results of the first re-examination were to be cured, improved, unchanged, or aggravated. Cases found to be cured were dropped. Cases not cured continued to receive treatment for another month. Resistant (unchanged or aggravated) cases estimated to be about 'JJ, were also given sulfonamidcs ore.lly. The dosage of sulfonamide was 40-50 milligrammcs per kilo of body weight per day spread out as evenly as possible over 24 hours. The teachers assisted the calculation of sulfonamide required by different children. The duration of sulfonamide administration was 20 days per course.' Team nurses tested every other day the urine of all children tak:ing sul.fonamidcs. Cases showing any untoward symptom due to medication were referred to the doctors. The second re-examination was then performed. Uncured cases discovered during the second re-examination received treatment tor another month (i.e. a fourth month), wi th the administration of sulfonamides for resistant cases postponed till ten days following the last administration. This was followed by a third re-examination for the purpose of determ:ining the results of four months' treatment. Uncured cases were referred to the ophthalmologist at the nearest hospital for further treatment or operation if necossary. The duration of treatment for conjunctivitis and other infectious eye diseases (other than trachoma) was one month. The first rc-exam:ination was performed along with the first re-exam:ination of trachoma cases.
....
- 6 -
It was expected that at the end of eighteen months the number of cases would become so reduced as to remove trachoma from the list of public health problems in Taiwan. The 365 health stations from which the physicians and nurses were taken to form the trachoma teams wore to set up permanent tr~choma clinics and devote at least ano-he~ day a week taking aver from the teams the care of school children still under treatmen t ~.fter the four-mon th period. The work of looking for and treating new cases of trachoma would become ~ routine work of the health stations. At the beginning of each scholastic year, they would examine all new entrants of schools in their area which do not have school physicians, prescribe treatment and do the follow up.
The campaign among school children started in September 1954. Dr. Tabone went on his third visit in October 1954 and spent a month there to help
launch the campaign. At the time the campaign was lalIDchcid, a mass survey was initia ted to find the real incidence of trachoma in Taiwan. The procedure was as follows I (a) (b) (c) (d) (e) (f) Division of Taiwan into prefectures. Estimation of population in each prefecturo. Proportionate estimation of sample size (about 1 for every 355 persons). Proportionate estimation of required number of households. Random selection of the required househOlds. ,
Random selection and exanination of one person from each household.
..
'
Administratively, Taiwan was divided as follows:
r"~'"---""""'--'w. . w--'.w . '. . I--'---~~l MlIDici,pality City rristrict
PROVINCE
F--Township
Prefycture
.
------1
Village
Li
~ ~
Li ~
+ ~
, .. Hamtet ,
,
~ HouBe~old ~ ,
;, Household
,~ , ;,
Ltn I Houiehold 1._ Indrvidual
Indivi{o<dual
Individual
- 7 It was suggested that for the population of the whole of Taiwan, a sample size of 2?,5oo, if selected at random, would give a 99.7% Confidenoe Interval, and a reliability of :tJ.%. It was thus decided to work on a sample size of this magnitude. The mass survey results would be useful in the assessment at a later date, of the impact of the campaign.
For the campaign the estimated Government expenditures were NT$3,342,900 (eqUivalent to $214,977.49) mainly in the form of salaries, wages, subsidies; travelling expenses including per diem subsistence allowances; cost of locally available equipnent and suppliesJ stationery, record cards and health education material; fuel and maintenance of UNICEF vehiclesl and storage and distribution of UNICEF supplies. The Government also proVided office space, secretarial assist<flce and transportation for the WHO short-term consultant and met the cost of all his official telegraph, telephone and postal charges. With Technical Assistance funds, VElO provided the services of a short-term consultant wlD visited the project for about 5 weeks once a year. An interregicnal fellowship was granted to an ophthalmologist. The Western Pacific Regional Office of the WHO regularJ;y furnished the necessary technical advice and guidance. In this connectioo., WPRO was constantJ;y in touch with the appropriate technical sections at Headquarters in Geneva. UNICEF appropriated $327,000 for vehicles (station wagons), pocket magnifying glasses, antibiotic ointment, sulfonamides and absorbent cotton. The estimation of drug requirements was made as follows 1 ,
.
(a)
Out of every 100 children examined, 50 would be diagnosed as trachoma and would require treatment for an initial period of two months. AllOWing me 'blbe per head per month, these 50 cases would require 100 tUbes for the first two months. Out of every 100 children examined, 25 would be diagnosed as conjunctivitis (which includes doubtful trachoma) and would require treatment for one moo.th, total: 25 tubes. After two months sane of the cases in (a) above would remain as uncured or resistant, and soma doubtful cases classified as conjunctivitis in (b) above would be reclassified as trachoma. It was estimated that these would amount to about 25. Each of these would require treatment for an additional month, totall 25 more tubes. Uncured and resistant cases, estimated at 50% of the cases under treatment for the third month in (c) above, or 12.5, would require another 12.5 tubes.
(b)
(c)
(d)
Therefore for every 100 children examined, it was estimated that 162.5 tubes of ointment would be required.
A
- 8 Sulfonamides were for resistant cases, those which show little or no response to the local ointment treatment after the initial period of two months. Owing to the experience of the pilot project and to the reluctance on the part of local doctors to use sulfonamides in young children, it was estimated that no more than 30,000 would actually receive it. Assuming that too average weight of a child would be 20 kilos, it was estimated that 600,000 grammes of sulfa drugs WEre required.
An attempt was to be made to examine and treat, where necessary, 100,000 contacts of trachomatous school children. Bilateral agency, such as the Joint Commission on Rural Reconstruction (JCRR) assisted the Government in meeting part of its commitments conta:ined in the plan of operations signed by the Government, WHO and UNICEF. When Dr. Tabooe was in Ta:iwan on his third visi t to assist in launching the campaign and to observe the progress dur:ing its :initial stage, he was impressed with the organizing and administrative ability of Dr. T. C. Hsu, the Trachoma Control Officer, concurrently director of the Trachoma Control Centre and the interest, enthusiasm, conscientiousness, energy and drive shown by him and his colleagues, especially Drs. Y. T. Kuo and C. Y. Yang. Dr. Hsu was Chief of the Technical Division of the Provincial Health Administration and Drs. Kuo and Yang, Technical Experts, PHA, were seconded for the campaign. Na"tllrally, in a large size campaign such as this, the accurac,y of classification varied from team to team. Dr. Tabone noticed that there was a tendency to over-diagnose~ a reluctance to declare cases as cured and a dis:incldnation to prescribe sulfonamides. The co-operation between the ProvinCial Department of Education and the Provincial Health Adm:inistration was excellent. Dr. Tabone saw what great :interest the school pr:incipals and teachers were tak:ing in the proceedings and the enthusiastic way they were co-operating. Teachers gave weekly talks on trachoma dur:ing the campaign period, using educational material supplied by the Trachoma Control Centre. They tried to secure contact with too children I s paren ts when necessary. The objective of the plan of operations was, :inter alia, to exam:ine 1,200,000· school children and to treat those found to have trachoma with:in 18 months. At the end of 1955 an addendwn to the plan of operations was signed by the Government, JoIlO· and UNICEF for the expansion and continuation of the campaign through end of 1956. As a result of the addendum, the target number of children to be exam:ined and treated was increased from 1,200,000 to 2,013,000 as follows~ 1,200,000 140,000 215,000 or iginal estimate of children in schools in 1955. additional number of children in schools in 1955. number of children estimated to be entering school for the first time in September 1955.
.
...
'
,;-
258,000 - number of children estimated to be entering school for the first t:iJne in September 1956. 200,000 - estimated number of family contacts of school children who could be reached in the experimental project, for extending treatlnent outside of schools. Totall?,013 ,000
..
~
- 9 -
The Government estimated that its total commitment would amount to NTli12,406,750 (equivalent to $797,861.74). UNICEF appropriated another $342,OCO for tires and inner tubes, antibiotic ointment and sulfonamides.
By end of March 1956, 18 months after the campaign was launched, 1,200,000 school children should have been examined and the trachoma cases among them treated (accordlng to the original plan of operations), or 1,555,000 should have been covered (according to the addendum to the plan of operatims). Actually, 1,590,578 had been covered. The figures were as followsl School children examined: 1, 59b, 578 Cases discovered 1Cases
-
.:L 53.66 18.31
Trachoma Conjmcti-
853,499 291,441
vitis Treatment given Cases re-examined (1st re-examination) Trea-anent given Cases re-examined (2nd re-examination) Treatment giVEn 52,867,221 1,077,928 17,000,002 25,775 581,828 7,762,830 3 5,379 Cases re-examined (3rd re-examination) ;"" 288,568 oin tm en t days cases also giVEn sulfonamides ointment days cases also given sulfonamides
ointment days
. ,"
By the end of Jme 1955, 275 teams each consisting of a physician and a nurse were trained and working. Eventually, 365 physicians and 365 nurses or equivalent from health stations and 83 school physicians and 83 school nurses or equivalent were trained. Early in 1956, 448 teams were examining school children and prescribing treatment. Over 30,000 school teachers were giving health talks and giving treatment.
Dr. Ida Mann, l1.A., M.B., B.S., D.Sc., D.O.M.S., F.R.C.S., formerly Professor of Ophthalmology at the Un iversi ty of Oxford and nOW' Ophthalmic Consultant to the Government of Western Australia, went to Taiwan in June 1956 and spent one month evaluating the campaign. She was impressed by the magnitude of the campaign, the accuracy of the work mdertaken and the good results obtained. In her report, she said: "The organization of the campaign is excellent and the work of all concerned is of a high level. The results already obtained are satisfactory, and give hope that, with an extensim of the campaign, this disease will cease to be of much importance within 5 or 6 years."
• - 10 She was able to examine a sample of 1633 school children in cities, rural, salt producing and tribal areasl those treated September-December in 1954 at the beginn:ing of the campaign, and new school entrants treated in September 1955; and their family ccntactsl Results :in June 1956 after treatment, Sept-Dec. 1954 10.4% 14.2% 27.7 % 34.9%
Before Campaign City Rural Areas Salt Areas Tribal i>.reas 76.% 58.9% 66.6% 85.4%
New entrants, September 1955 62.2% 38.4% 69.0% 80.8%
Results :in June 1956
after treatment 15.1% 8.6% 32.6% 28.2%
::f
Dr. Mann found that the trachoma in cities was mild; in rural areas, moderately severe; and :in the salt producing and tribal areas, severe. The new entran ts were exrun:ined, only 4- 5 months after treatment. She believed that the results could have been better i f they were examined after a year. Because a certain number of relapses (:including reinfections) continued to occur and although the overall nel< infection rate was only 0.63% in some schools it was as high as 3%, Dr. Y= recommended that it would be advisable to re-examine all children at the beginning of the jr last term at school so that there was time to give them one final course of treatment if necessary. In this way one could be fairly sure that no child left school with active trachoma. i.s trachoma was hardly ever contracted atter the age of 12, to Dr. Mann this would seem the best way of ensuring freedan from the disease in the next generation. ~reated
Dr. Mann believed that treated trachana cases were re-examined and too early. She recommended that the assessment of treated cases be made /:) months and 1 year after beginning of treai1nent, and that the second course of treatment not be given for one year after the beginning of the first course. She recommended that local treatment with antibiotic oini1nent be cut from 2 months to six weeks. However, if small tubes of ointment continued to be issued, it would be better that two tubes should be used up, rather than treai1nent be stopped at 6 weeks and some of the ointment wasted. Dr. Mann recommended trials to ascertain the mllllJllum time of antibiotic ointment treatment which would give as good a result as the usual length of six weeks. She had the feeling that three weeks would be sufficient. The use of children of Grades IV, V, and VI to treat each other and younger children was working admirably and Dr. Mann believed this should be extended. She felt that it might be difficult and dangerous for a child of 10 or 11 to apply o:ini1nen t to a baby of one year, but i f antibiotic in oil were used :instead, the procedure would be simplified and no ham would be done. I f antibiotic in oil could be made available in place of the ointment,
r
one bottle could be used for several persons. There was also much less risk of waste than with oini1nent. The saving would be great. She therefore recommEnded that a change be made to achronwcin (without rwdrocortisone) in oil when the existing ointment in tubes were used up.
•
J
~-
..
-11-
The use of sulfonamides had not been sufficient~ tested and Dr. Mann recommended setting up a few trial areas where trachoma was severe. She suggested that the trachoma cases taking sulfonamides should drink plenty of water. No urine tests need to be done, but a watch be kept for vomiting and skin rashes. If this was found satisfactory there would be much saving in time, as the treatment o~ took two or three weeks. '-
j
To Dr. Mann it would appear that in Taiwan, as in other trachomatous areas, the major portion of the infection occured before school age. Therefore she believed that the percentage of new entrants requiring treatment would remain fair~ constant for some time, unless steps could be taken to treat the families, or at least the pre-school children. If the incidence in new entrants could thereby be steadi~ reduced, the trachoma problem would be well on the way to solution by approximate~ 1961. In areas with incidence over 50,1:, Dr. Mann recommended that blanket treatment be given, wherever possible, to the fami~ contacts or the general population. This would eliminate the need for medical examination. No follow-up examination was necessary, at any rate for the present, since the subsequent examination of school entrants would give the information in the course of five years. She recommended that the campaign should be at once extended to preschool children, fami~ contacts and the general population.
The incidence and severity of the disease and also the conditions and intelligence of the people varied from place to place. Therefore different plans of campaign would be required in the various places. The children in the cities were clean. The salt producing and tribal areas were insanitary and the children dirty. The children in the rural areas were in between. r
.<
Area Ci ties Rural Areas Salt Areas Tribal Areas
Recommended campaign Blanket treatment for all pre-school children over 1 year, Treatment of all fami~ contacts (except infants under 1 year) of all school children. As in Rural Areas. Blanket treatment of whole populations over 1 year.
While this recommended extension of the campaign would entail the immediate expenditure of more money and time, Dr. Mann pointed out that the ultimate end of the campaign could be Envisaged within 5 years, by which time the incidence of trachoma in school children should be reduced to 10,1: or lower.
·. - 12Dr. Harm thought that it would be desirable, though difficult, to continue to try to improve the standard of hygiene of schools. She realized that abolition of the damp towe~ habit was impossible, but felt that all children should thoroughly u~derstand its dangers and the use of dry rather than damp towel should be encouraged. Dr. Nann found thet: 1. Much of the conjunctivitis was viral and occurred between the second and third year and was not found in school children. One atta(-: appeared to confer immunity~ It was not sensitive to antibiotics. ConjunctiYit:..~
2. 3.
(D£.c-cerial) was not a serious problem.
The climate varied much from place to place, therefore there were no definite seasonal epidemics.
So she did not recammend that intermittent treatment of conjunctivitis be tried, but that i f and "hen an outbreak of bacterial conjunctivitis occurred in a school, the school teacher be allowed to obtain sufficient aureomycin ointment from the health station at once, to treat the whole school (or the whole of the affected classes if only a few) for 4 days, so as to stop the epidemic. The responsible technical section at WHO Headquarters in Geneva also recommended trying intermittent t~eatffient with antibiotic o:intment and oily drops. Consultations between the Government, WHO and UNICEF began in September 1956 on hOt, to implement the recommendations made by Dr. Mann and by WHO Headquarter~. Essentially the campaign Has to be continued and new trials were to be (Jet up as follows: 1. The mass campaign rur.ong school children including new entrants would continue, using the standard antibiotic o:i.ntment treatment, twice a day for two months. The trachoma cases found and treated were to be re-examL~ed six reonths and twelve months afterwards. The second course of treatment, if found necessary, was to be postponed until six menths, or better, twelve months after the initial t~ea~~ent. 5,000 school children would be re-examined during the 4th month after the first treatment and if found necessary, immediately re-treated. 2. The members of the VI grade were to be re-examined in Harch before they left school and given another course of treatment if found necessary.
..... '
-
.
.. '
- 1.3 3. In selected schools. the following would be tried under good supervision on separate series of 5.000 casesl i. antibiotic ointment. twice a day for six weeks. to be followed by a first re-examination at least 3 months from the end of treailnent. Needy cases were to be re~reated for another month. followed by a second re-examination 3 months afterwards.
ii. iii. iv. v.
antibiotic ointment, intermittently, twice daily, three days each month for six months. oily drops of achromycin without hydrocortisone. twice a day for 6 weeks. oily drops of achromycin without hydrocortisone. twice a day for 2 months. oily drops of achromycin without hydrocor.J.sone. intermittently. twice daily. three days each month for six months. oily drops of aureomycin, intermittently. twice daily, three days each month for six months. treailnent with sulfonamides only. if continuous and particularly good medical supervision were possible.
vi.. vii. 4.
."
Blanket treatment was to be continued among contacts up to 200,000 as trial where trachana anong school children was over 5o,g. They were to be treated according to location as followsl i. ii. iii. In the cities, pre-school childrEn over 1 year of age
cnly were to be treated, without examination. In the rural areas, all family members over 1 year of age were to be treated, without examination. In the salt producing areas, all family members over
1 year of age were to be treated, without examination. The standard treatmentwas with antibiotic oin"bnent, twice a day for two months.
...
5.
In family contacts the following trials were to be carried out
among selected groups of 5,000 i.
I
antibiotic oinilnem twice a day for six weeks.
1i.
antibiotic ointment, intermittent~, twice daily, three days each month for six months.
.. - • • ' .".:i
- 14 -
iii.
In the tribal areas trials wi th sulfonamidcs only were to be carried out under good medical supervision.
These were agreed upon in January 1957. At the time this report was written (10 February 1957), a secmd addendum to the plan of operations and incorporating the above, signed by WHO and UFICEF, awaited the Government signature. UNICEF agreed to provide the antibiotic in oil, using the balance of their latest appropriation of $342,000. Although the consultations were successfully completed :in January 1957, and the second .addendum still awaited the Government Signature, many of the recommended modifications and new trials were initiated as they were accepted, from September 1956 onwards. WHO plans to send another short-term consultant in September or October 1957 to re-evaluate the campaign and the trials.
.....
1ilid/cs T/18 I,PPENDDC
1-.,
'Sunnnary
TUEERCULOSIS Ca,mOL, TAIWAN
Tuberculosis has been a major public-health problem in Taiwan for many years. A pilot project of tuberculin testing and BCG vaccination of school children in the Taipei area ..Tas started in December 1949 with the assistance of the Joint Commission' on Rural Reconstruction and UNICEF. Up to the end of April 1957 a total of 5.14 million children had been tested and 2.93 million vaccinated. I, BCG laboratory was established in Taipei in 1952 and approved by vJHO in March 1953. The BCG programme in Taiwan is characterized by its close link with the general work of the health services as all team members also carry an other duties at the health centres.
i, mass chest survey programme is also in progress and up to the end of April 1957, 1 084 541 people had been examined and over 30 000 cases of pulmonary tuberculosis, previously unknown, were discovered. The first· tuberculosis clinic was organized in Taipei in 1948. Eight additional clinics, mostly attached to the health centres, have been established in th~ past eight years and personnel working in these clinics have been mostly trained at the Taipei Clinic. It is estimated that there are more than 7000 tuberculosi s beds now available for the military and about 800 for civilians. " .
WHO and UNICEF are assisting the programme,
.......
"
TUBERCULOSIS CONTROL Taiwan, China
Tuberculosis has been a major publio health problem in Taiwan for many years. Very little attempt had been made to oarry out any oontrol measures until 1948. 1he National Government of the Republio of China planned a nationwide tuberoulosis oontrol program in 1945. Under this was established the Taipei Tuberculosis Center. Following the transfer of the Government to Taiwan in 1949, many of the public health workers from Nanking were also transferred to the Province of Taiwan.
,,"
In 1947,. the tuberoulosis mortality rate in Taiwan was reported as 285.2 per 100,000 of whioh 233.1 were olassified as pulmonary. This rate dropped fairly rapidly, as shown by the 1955 mortality rate of 66.8 per 100,000 with 55.2 as pulmonary. 15% of ohildren reaohing 5 years of age were tuberculin positive as reported in 1952. (Mx: 5T.U.> 5 mm. induration as positive), These figures indicated a high level of tuberculous infeotion in the oommunity.
BOO Program A pilot projeot of tuberculin testing and BGG vaooina tion of schoolohildren in the Taipei area was started in Deoember 1949 with the assistance of the Joint Commission on Rural Reconstruotion (JCRR). The program oommenoed on a mass soale in May 1951 under the jOint support of JCRR and UNICEF. 24 teams were organized with one eaoh in a oity or a oounty of the Provinoe •. Each team consisted of one physimian, one or two vaooinators and one clerk, all trained by a WHO team, and each team possessed a motor vehiole provided by UNICEF. Fe:the first year, the worle was confined mainly to schoolohildren. Pr6·sohool popuJation was included sinoe 1952. Up to the end of APril 1957, a total of 5.Jh million ohildren have been tested am 2.93 million ohildren have been vaccinated. A BCG laboratory was established in Taipei with UNICEF and JCRR assistance in 1952 and was approved by WHO in Maroh 1953. Before that date, vacoine from ManiJa was used in Taiwan. The BGG program in Taiwan is charaoterized by its olose link with the general work of the health oenters. All team members are employees of these centers who also oarry on other duties of the health centers. Beoause of the ohange of oriterion of a positive tuberculin reaotion in Maroh 1956, rE~testing has been engaged in energetioally so that more children are being vaooinated. Mass Chest Survey Program A mobile 70 mm. photofluorographio unit was received from UNICEF in 1952 for x-ray examinations of tuberculin reaotors in schools. Another three uni ts were donated by ICA so a mobile x-ray team was organized in September 1953. The Taiwan Tuberculosis Association gave three additional units in 1954 so a
,
,~
- 2 total of seven units are now operating on the island. Up to the end of April
1957, 1,OB4,541 people have been examined by the team and over 30,000 cases of active pulmonary tuberculosis, previously unknown, have been discovered. The people examined were mainly from organized groups such as schools, factories and military installations. Starting from May 1957, these screening examinations will be provided free to all civilians over 15 years of age on the island. The cost of each 70 mm. film is estimated at NT$4.oo excluding the initial cost of the x-ray unit. Mass Sputum Examination Program Through the effort of the Taiwan Tuberculosis ASSOciation, a laboratDry technician from each health center was trained in Taipei in 1955 in the techniques of sputum examination. After the training, essential equipment was brought back by the trainee to each b,alth C€nter and cultural tubes were supplied by the ilssociation. Starting from March 1956, fne sputum examinations have been going on in every health center to supplement the case-finding program in Taiwan. Up to the end of December 1956, 28,600 smears and 13,152 cultures were examined by all centers, hospitals and clinics. Ambulatory Chemotherapy All sputum positive cases are now eligiblc to receive free isoniazid from the Provincial H6alth Ildministration (PHA) for one year. The only requirement is a positive bacteriological examination together with an x-ray film. The distribution is made by health centers and health stations on a monthly basis. Free x-ray follow-up examinations every siX months and free sputum examinations every three months are also provided by the PHi.. This program commenced on April 1, 1957. There were 297 patients registered during the first month. Efforts have been made to provide other drugs for canbined drug treatment instead of isoniazid alone and this may continue through rCA support in 1958. Tuberculosis Clinics The first tuberculosis clinic was organized in Taipei in 1948. Following that eight additional ones, mostly attached to health centers, have been organized during the past eight years. Personnel working in these Clinics have mostly been trained at the Taipei Tuberculosis Center. It is antiCipated that every health center will organize such a clinic in the next three years. Hospi tal Beds There were less than 200 hospital beds for the tuberculous in Taiwan immediately after V-J day. It has been increasing rapidly during the past five years, esp~cially for the military. It is estimated that more than 7,000 tuberculoSis beds are available for the military and about 800 for the Civilian. The Taipei Tuberculosis Center Hospital at Sungshan is providing surgical service for tuberculosis.
-,
.
•
- 3 i&iwan Tuberculosis Association The Taiwan 'Tuberculosis j.ssociation was organized in August 1952 with an initial Governm~nt eppropriation of NT$4,500,000. The Association has supplied laboratory equipment, pho·,ogluorographic equipment, x-ray arxi hospital equipment and supplies to various health centers and hospitals, and has, in addition, given financial assistance to indigent patients. During 1956, the Association embarked on the constructiDn of a second tuberculosis center to serve the northern secter of Taipei,
--,
Estimated Expenditure for the Tuberculosis Control Program in Taiwan, 1950-1956 Contributin~ A~encl
US$
NT$
Tbtal (NT$)
~ercentaSle
frovincial Government Local Governments JrnR
lCA, MSM/C
UNICEF wHO Taiwan TB ASl{ocia tion Tbtal
2 ,491,369 ,460,000 G 177,576 1,087,7 22 (equiv. NT$--- 2,956,640) 121,000 (equiv. NI$--- 2,014,650) 184,000 (equiv. NT$--- 3,063,600) 53,000 (equiv. NT$--882,450) 81 741 z405 US$535,576 (equiv. NT$--- 8,917,340)
25,491,369 4,460,000 4,044,632 2,014,650 3,063,600 882,450 8z741 z405 48,697,836
52.3% 9.2% 8.3% 4.1% 6.3% 1.8% 18.0%
39,780,496
,"
II':O/CS':'!lC ·PPIl ::., l-q
=.:
VENERLAL-DISG.ASE CONTROL PROJECT
Summary The venereal-disease control project, Taiwan was started in August 1953 with a view to providing services for all pregnant wansn and children and ultimately to establishing a comprehensive venere~disease control programme for the whole island. Assistance has been provided by W"dO, lli~ICEF, the Joint Committee on Rural Reconstruction and the United States International Co-operation Administration. Infonnation is given with regard to the health institutions participating
in the project, the training of personnel, serology and treatment, and the cumulative totals for the work done. This information is supported by detailed tables.
The project has worked closely with the established maternal and child health project and the prevention of maternal and child syphilis was stressed fram the start. Health education has formed part of the team activities. Surveys have been carried out in selected population groups and in two areas combined surveys have been undertaken in co-operation with other projects. During the past six to twelve months there has been a progressive improva~ent, both as to the quality and quantity of "ork performed by the various units participating in the project.
VENEREAL-DISEASE CONTROL, TAIWAN, CHINA
INTRODlmION The venereal-disease control project, Taiwan, was started in August 1953 with a view to providing venereal disease control services for all pregnant women and .hildren and, ultimate~, to establishing a comprehensive venereal disease control programme for the whole island. The WHO has provided technical assistance and some supplies, and the UNICEF, the JCRR and the ICA, USOM, have provided material and financial assistance. 2. THE PROJECT TO DATE - MAY 1957
1.
The initial period, 1953-54, was devoted to the necessary training of personnel and to setting up clinics and laboratories needed for making facilities for the diagnosis and treatment of the venereal diseases general~ available to the population. As of May 1957, 419 health institutions participated in the project including the 22 health centres, 368 health stations, 28 provincial hospitals, and 9 municipal and county hospitals of Taiwan, the Taiwan National Hospital and the Maternal and Child Health Centre of the Provincial Taipei Uursing School. The 21 serologic laboratories have been established, of which that of Shihlin served as the reference laboratory. a. Training of Personnel
...
~
WHO fellowships were granted to three medical officers to stuqy public health, majoring in venereal-disease control, abroad. They have completed their studies and have returned to the project. Two of the nurses have received WHO fellowships to study public health nursing, abroad, with special re~erence to venereal-disease control. Training in venereal-disease control was given to 429 health officers, 481 nurses and midwives, 21 laboratory technicians and 41 assistant technicians, 322 sanitary inspectors of the health centres and health stations and also to 65 physicians in the hospitals, 100 physicians of the Medical ASSOCiation, 1242 private physicians and 333 private midwives. The venereal-disease control team also took part in the training courses for 671 physicians, 494 nurses and 24 nurse supervisors, 384 health personnel for the aborigine districts, 282 medical and 225 nursing students. Refresher training courses are a continuing activity and two such courses have been given to date. Details are shown in Tables No. I and No. II of Annex I. b. Serolegy and Treatment
The routine serologic tests used on the project are the VDRL slide test.and the Kahn test. Reactive sera are quantitated with the VDRL test. PAM (procaine penicillin with 2% aluminium monostearate in oil) is the drug routine~ used for thf' • ·...,atment of syphilis and gonorrhoea. The routine treatment is 4.8 meg<>-mits of PAM given in two doses.
- 2 c. Work Accomplished
The cumulative totals for the work done to I1ay 1957 are shown in Table No. III, Annex I. 1 069 282 people have been blood tested and 76 271 (7.1%) have been found reactive. 76.2% of the examinations were for the rural areas and 56.4% were for women under 45 years, their marital partners and children. The average percentage of reactive sera for rural areas was found to be 6.7% and for urban areas 8.3%. For 1957 a target of 500 000 persons examined has been set for the project. 39 974 cases of syphilis have received treatment, i.e. 52.3% of the number of reactive sera found. However, for January-May 1957, treatment was given to 85.8% of the new patients diagnosed as syphilis. Data on the activities of the demonstration cliniC, Taipei, are given in Tables No. IV and No. V of Annex I. It will be noted that 94.3% of the 1387 cases of syphilis diagnosed have been treated and that the public health nurses have engaged in considerable activity. Data on the activities of the Serologic Reference Laboratory, Shihlin, are given in Table No. VI of Annex I, and those on the Health Education activities are given in Table No. VII of Annex I. d. Commentary on the Approach to the Venereal-Disease Control Problem
In order to provide the basic required services for all pregnant women and all children, it was necessary at the start to establish the clinics and laboratories mentioned above, which were placed in the existing health units. They incidentalLy also made available for the general population diagnostic and treatment facilities for the venereal diseases. The training of the vast numbers of personnel required was the major task and this required much effort and time. Training is a continuing activity. It is hoped that the work of the venereal-disease control programme will become an integral part of the routine Hork of all the health service units with the technical direction and supervision of the central venereal-disease control team. The prevention of maternal and child syphilis was stressed from the start. Steps were taken to work closeLy with the established 11aternal and Child Health project and to stimulate activities in areas not yet reached qy the Maternal and Child Health project. All health workers, including those in private practice, have been urged to carry out the blood testing of all pregnant'~omen and the treatment found required. The famiLy contacts of cases found among the pregnant women and the children have been followed up in the first instance. Other contact tracing has been minimal because of limitations of staff and the great difficulty in obtaining satisfactory contact information from patients. The Health Education activities have included newspaper articles, posters, radio talks, talks with audio-visual aids to co~~unity meetings including those organized as part of the specific surveys carried out.
~
- 3 These activities are in part responsible for the number of voluntary patients seen, but they are only the start of health education of the public, particularly with regard to the venereal diseases. As part of the training programme and now as a specific part of the attack on the problem, surveys of selected population groups including factory workers, miners, docksite workers, waitresses and entertainers have been carried out. In two areas combined surveys have been undertaken in co-operation with the relevant personnel to cover the venereal diseases, tuberculosis, leprosy, trachoma, environmental sanitation and other conditions. The treatment of the venereal diseases was carried out during the surveys. These surveys of selected groups.are a continuing activity of the project. Much effort has been put into stimulating the private practitioners, private midwives and nurses to make full use of the laboratory facilities of the project for screening their patients for the venereal diseases and information on the management of the venereal diseases and their control has been made available to large numbers of these private workers. Although some progress has been made, the response by them has not been as good as was considered desirable. e.
Some Special Difficulties of the project
The large number of venereal-disease clinics established in the islands and the special conditions of employment associated with the existing ceilings on personnel and. budget have made supervision and the maintenance of a satisfactory standard of performance especially difficult, particularly in the followup of cases and contacts. ,,,"
The widespread prejudice of the population, including some pb,ysicians, against giving blood is present as in several countries of the East. The widespread fear of penicillin reactions on the part of the population and of some pb,ysicians has been a real handicap. The problem of prostitution and of promiscuity is of major importance and has hardly been tackled. The existing special conditions in Taiwan with a large military and floating population favour the spread of the venereal diseases. Progress has been made in finding solutions to these difficulties. f.
Plans for the Future
During the past six to twelve months, special efforts have been made to appraise the working of the project and to raise the standard of performance of the several units participating. It was gratifying to note that there has been a progressive improvement reported both as to the quality and quantity of work performed. The targets set in terms of persons examined have been met and following on modification in the form of reporting of data from the project
- 4 -
it was shown that a high percentage of the cases of syphilis found were given adequate treatment. The standard of performance of several of the health centres and health stations has reached a very satisfactory level although some of them still need to improve their performance. It is considered, however, that it will now be possible for the project progressively to undertake activities to make it more effective in the control of the venereal diseasee.
",.
z-
- 5VD CONTROL, TAIWAN TABLE NO. I PERSONNEL TRAINED IN VD CONTROL COURSES - 1953/57 ANNEX I
,...... Period Trainees Health Officers of H.C. 4 weeks course 1 week refresher course ~sicians of H.S. week course 5 hours refresher course Nurses or midwives of H.C. 4 weeks course 3 days refresher course Nurses or midwives of H.S. 1 week course 5 hours refresher course Laboratory technicians 8 weeks course 1 week refresher course Assistant Laboratory technic ians ; 4 weeks course Sanitary inspectors 5 hours course PhySicians in various hospitals 2 hours course 36 40 :July 1953 :July 1954:Ju1y 1955.July 1956: :June 1954 ~June 1955:June 1956;MaY 1957: Total :
.
3 217
19 190 430 19
:
.Y
22 433 21
21
:
22 407 863*
. 3 243 13 :
21
22 4211459 90S*-
213 324 8
581 20 41 20
21 40l141 322 65 100
:
286 25 100
,....
Physicians of 11edical Assn. 2 hours course Private phySicians 4 hours course Private midwives 4 hours course 198
13
1018 175
38 60
1242
98
:333
* A part
of the trainees attended two refresher courses repeatedly.
- 6 -
in CONTROL, TAIWAN TABIE NO. II PERSONNEL GIVEN IECTURES ON VD CONTROL - 1953/57
ANNEX I
Trainees Physicians in training course of Institute of Public Health Physicians in training course in HCR Centre Nurses' training course at Taoyuan and Hsinchu Trainees of nursing supervisors Nurses, midwives and medical assistants of aborigines' districts Students of i'ledical School, Taiwan University Students of nursing schools
: Sept. 1953 July 1954: July 1955' July 1956 : Total : June 1954 June 1955 : June 1956 Hay 19.57: :
:
30
181 48
100 :
212
523 148 494 24
100 119 16 8
88
287
. 42 78 62 194 64 42
110
38
I
384 282 225
80 49
60 72
Many occasional small discussion meetings with health personnel are not listed in these tables. Lectures on leprosy ,Tere given to 92 private physiCians, 82 military medical officers and 16 nurses in the period January-May 1957. For training purpose "The Manual of vn Control for Physicians" and "The Manual of VD Control for Midwives" were printed and distributed. Filmstrips on procedure of STS, on how to conduct a survey, etc. were produced for the same purpose.
- 7 -
VD CONTROL, TAIWAN TABLE NO. III
ANNEX I
PERSONS BLOOD-TESTED AND TREATED - SHOWING THE GEOGRAPHIC DISTRIBurION OF THE MCH GROUP AND THE OTHERS
, ,MCH Examined : Positive Treated
Rural : Other : :
Urban Total :
Total Total : :
MCH
: Other : :
MCH :
Other : :
Total
:472,658 :343,116:815,774:130,784:112,724:253,508:603»442:465,840 :1,069,282 76,271 (7.1%) 39,974
: (78.3%) : (73.6%) : (76.2%) : (21.7%) : (26.4%) : C23. 8%) : (56.4%) : (43.6%) 31,594 23,544: 55,138: 11,184: 9,949: 21,133: 42,77B: 33,493 : ; (6.6%) ; (6.8%); (6.7%); (8.5%); (8.1%): (8.3%): (7.0% : (7.1%) : : 18,044 : 11,968: 30,012: 6,041: 3,921: 9,962: 24,085: 15,889
: (57.1%) : (50.8%): (54.4%) : (54.0%): (39.4%): (47.1%): (56.3%): (47.4%) : (52.4%)
About 76.2% of the blood specimens were collected in rural areas and about 56.4% were from women below 45 years of age, their marital partners and children. The positive rate was 6.7% in rural areas, whereas it was 8.3% in urban areas. The following table will show the number of blood specimens collected from private physicians, and those found positive. Co-operation project of private physicians with local health authorities of Salu and HSi-chi pilot areas is continuing. No. of STS From Sept. 1953) to June 1954) From July 1954) to June 1955) From July to June No. of Pos. Reactors
% POSe Reactors
490 4,703 6,635 5,525 17,353
95 990 1,347 912 3,344 21.1 20.3 16.5
1955) 1956)
From July 1956) to May 1957) Total
- 8 VD CCNrROL, TAIWAN
ANNEX I TABLE NO. IV
DEMONSTRA TION VD CLINIC, TAIPEI - CASES OF SYPHILIS DIAGNOSED AND 'I'R.EATED
.,.., New Cases Old Cases No. of: No. of: % of : No. of: % of No. of: No. of Pos. Treat-: Pos. p.1l-' Pos. Re-: Treat-: STS Reactors STS actors:actors ment ment From May 1954 to- June 1955 From July 1955 to June 1956 From July 1956 to May 1957 Total 2,854 2,691 439 424 15.3 511 116.4 1,792 :
527 782
15.7
396 401 1,308
93.4
1,250
2,873 8,418
524 1,387
18.2 16.4
76.6 94.3
866 2,908
666 1,975
VD CONI'ROL,
TAn~AN
ANNEX I TABLE NO. V DEKlNSTRATION VD CLINIC, TAIPEI· NURSItll ACTIVITIES
--
-
-
Number of Visits
Reason of Visits Referred by Volun- CC'n- Sur- Prlv. P. H. Hosp. or tat')' tacts vey Prac Nurse Clinic
Nursing Service
No. of Visits which responded to Home Letvisit tars
nate Frc;m May 1954 to June 1955 From July 1955 tc. June 1956 0'
&ld
New 'Total
l-I~ i fbme Let- IrnterSTS
Inj.~iS· I
ters Ivtew
5,288
I 2,471:7,759
1,925 260 2,521 326 I
47
27
35
177 137
3,64~ 12,2471178 I
; 434
1,024
71
100 404
i , 7,267 i 3,074jlO,1I1
11
10 , 80 I
I
From July 1956 t(, May 1957 Total
5,98312,986 S-,f'~ 2,536 258 1 ' , I
!.
i
i 17 I !
I
87 1 77 202 391
! , 18,538 8,531 27,069 6,982
844
! 57 I I
,
3,941 2,6741213 :1,1l2 I 1,304 71 I I , ! 802 , 122 3,824 2,674! 433 ! 971 i
i I
, , I I
333
!
-:
I
54
1
i ·
1l,411,8,097 824 !2,51 7 ' 3,130 264
1
, 837
Ii
,
l
~
,I
J
L
- 10 VD CONTROL, TAIWAN
ANNEX I
TABLE NO. VI ACTIVITIES OF THE SEROLOGIC REFERENCE IABORATORY, SHIHLIN
1. 2.
Participation in the USPHS Serologic Evaluation Study, F.Y. 1957.
Study of weekly reactive serum with TPI and TPA tests. This study was started in February 1957 and 60 specimens were sent to VDRL, Chamblee for TPI and TPA tests. Continuing.
3.
Special studies : a. Preparation of colloidol reagents for Lange Gold Test, the Cutting Mastic and for the Bengein Test. b. Preparation of hemolytic amboceptor by immunizing rabbits with the strama-proteins of sheep and goat erythrocytes. c. Preparation of Treponema antigen. d. Introduction of G.C. transportation medium.
4.
Supervision of 15 local laboratories.
,
.
.
-11VD CONTROL, TAIWAN
ANNEX I TABIE NO. VII
-. 1.
ACTIVITIES IN HEALTH EDUCATION
The main activities in VD health education since the initiation of the project were Production of education materials : Toe following were produced and distributed to local public health personnel and private physicians and midwives a. b. c. d. e. f. Filmstrips for health personnel Film~trips
5 kinds 2 kinds
for the public
Colour slides to be shown in movie theatres Flip-charts for the public Leaflets Posters Pamphlets Charts and illustrations for ex-~ibitions
5 kirns 2 kinds
3 kinds 4 kinds 1 kind
. -e....
g. h. i. j.
16 kinds 1 kind
Hanual of VD Control for physicians Manual of VD eontrol for midwives
1 kind
2.
Training: a. Lectures and practice of health education were given to the trainees of local health agencies and privote phySicians and midwives in the various training courses held by VDCC or institutions other than VDCC mentioned above. A seminar of health education was held for the chief phySicians and nurses of all the health stations. Lectures on health education were given in 4-H club meetings. Health education was made in meeting of prostitutes at Peitou.
b. c. d.
·
.
- 12 VD CONrROL, TAIWAN TABLE NO. VII (Cant.) ACTIVITIES IN HEALTH EDUCATION ANNEX I
3.
Health educators participated also in the following field activities a.
Organization of field works in Taipei-Keelung-Peitou Demonstration Area. Organization of pilot projects of private physicians' co-operation with local health authorities in VD control at Salu and Hsi-chi. Three village mass surveys. Thirty-one factory surveys. Thirteen aboriginese surveys. Blood examina tion of provincial t:;Qvernment employees. Blood 8xarr.ination of young age group. Blood examination of applicants for various govcmmental examinations.
b.
c, d. 8.
f.
g. h.
'.
,
, VD CONI'ROL, TADIAN
- 13 ANNEX II
ORGANIZATION OF TAIWAN PROVINCIAL VD CONrROL CENl'RE A. Ins tit utions : 1. Office of VD Control Centre 12 Foochow St., Taipei, Taiwan, China Tel. 2-60-88 2. The VD Demonstration Clinic In the Provincial Taipei Hospital 145 Cheng Chow Rd., Taipei, Taiwan, China Tel. 4-56-41
3. The Referc'lce Laboratory 130 Fulin Rd., Shihlin, Taipei, Taiwan, China. Tel. Shihlin 245 4. Twenty local serological laboratories. Distributed on the whole island, mostly set up in health centres but some in provincial hospital. 0" ,"
B.
Personnel : 1.
WHO VD Control Team Dr. Walter Frohlich Team Leader, II/HO iTD Control Team
2.
National VD Control Team Dr. ~·l.H. Chang, National Team Leader Dr. T .H. liong, Chief VD Control Medical Officer Dr. K.Y. Wang, VD Control Medical Officer Dr. S.8. Shih, VD Control l;edical Officer Dr. L.C. Hung, VD Control Medical Officer (on fellowship) Dr. P.N. >-Iang, Chief Serologist of the Reference Laboratory I'.r. F. \.Tang, Chief Health 'oducator Mr. M.L. Liao, Secretary and Health Educator Hiss M.H. ,lang, Chief, Public Health Nurse Miss L.C. Chiu, Public Health Nurse (on fellowship) l1iss M. Y. Wang, Public Hi30lth Nurse Mr. C.S. Hung, Public ljealth llurse (in military service) Mr. C.S. Liao, Chief Supply Officer
Besides these there are one typist, two clerks, three drivers and one handy-boy.
:.'HO/C.3T/li3 AP?ENiJDC 2
QUESTIONNATIm CN FlllST OBSERVATIOO TOUR
(You-are not required to give your name)
1.
Were you interested in this visit?
Very much
-'
QUite a bit
--'
To sorne extent
Very
--' -' -'
little
•
2. >
How were the introductory remarks?
Good
--' -' -' -'
Adequate
--,
Too long
Too short
•
3. What do you think of the refreshments?
Just right
Satisfactory _ '
Too elaborate
Jilsuf-
ficient
-
•
4.
Nay we have your opinion of the size of the sub-groups?
Just right
About right
-'
Too small
Too large
•
5. What about tll3 tour of the institution?
Just right
About right
-'
Too long
--'
Too short
-
•
-:
6.
How did the question and answer period appeal to you?
Interesting and provocative
-'
Satisfactory
-'
Unsatisfactory _ ,
Not worth tll3 time
•
•
HoW would you rate the interpretation?
Excellent
-'
Good
--'
Adequate
-'
Inadequate
, QUESTICNNAIRE (N FIRST CcmERENCE SESSI(N ,.-.:;
(you are not required to give your name) -
1.
Were you interested in this conference? What do you think of t~ physical facilities? How would you rate the interpretation? Would you kindly comment on the documented reference material and background information? The number of irrelevant questions and comments were: The relevant canments werel
Very much
Quite
-'
a bit
--' -' -'
To some extent
-' --' --'
Very little lhadequate Inadequate
•
2.
.
3. 4.
Good Excellent
Adequate
Too elaborate Adequate
•
--'
Good
•
Good
-'
satisfactory
--'
Too much Could
--' -'
Insufficient Far
•
5.
Of little or no conJ. sa:pnce_, Just right
About as would be expected _ , About right All that
have been less Too
too many Too short •
6.
-'
-'
detailed__, Should have been more Too
•
Did you have a chance to express your views?
Yes
-'
was necessary _, About right About right Quite a bit
-'
Should have been much more • Too
8. Was there enough opportunit,y for discussion? 9. Hm'1 was the length
Just right Just right
-' -' -' _,
--' --' --' _,
much Too
-'
little Too short
•
of
thi:.
conference?
long
-'
•
10. Did you learn anything or get any new ideas? 11.
I certainly
did
Some, but not much__, I doubt i f
Not at all _ . It did not
>"
" 12.
Do you think the group accomplished anything?
It certainly It probably
did
did
it did
--'
•
What improvements would you suggest for future meetings?
OVERt.LL EVlILUATION OF PUBLIC HEi.LTH CCNFERENCE J.ND SWIlY 'lOUR
(You are not required to give your name)
1.
Were you interested in this conference and study tour? Very much Quite a bit
To some extent
Very little
,-.
2.
When requesting the Regional Director to organize this conference and study tour, the Regional Committee, in its resolution adopted during the fourth session, mentioned the ":iJnportance of and benefits to be derived from group conferences and study tours •••••••••• 11
The justification for this project described in Official Records No. 66 of the World Health Organization contained the following I liThe standard of public-health administration, on which the success of public-health work largely depends, differs widely in the different countries of the Region and this affects neighbouring territories as well as the countries themselves. It is proposed to organize a conference and group study tour for experienced public-health administrators fram countries in the Region, preferably heads of administrations who will continue to serve their countries for a reasonable t:iJne. The conference will enable the participants to exchange experience, and outstanding public-health administrators will be brought in as consultants to speak on their specialties. The group study tour will cover a number of selected countries so that the participants can study one another's problems. It is believed that a common viewpoint and the better understanding of the various aspects of the pro blems can be obtained," Do you think the conference and study tour has served its purpose? I believe it did 3. It probably did I doubt if it did N:ot at all
If there are any objectives you feel were not fully attained, could you give
some suggestions as to how thsy could have been attained more completely as a basis for future planning?
4.
In addition, you came with specific objectives and expectations, Would you be willing to list them down and indicate to what extent each has been attained, using the words "r.dcquatLly", "partially", and "not at all"?
•••• 2
- 2 -
5.
How was the length of the conference and study tour? Just right About right Too long _ Not long enough
6.
Divisioo of time between conference (plenary meetings, group meetings, etc.) and study tour. Just right About right Conference too long__ Study tour too long_
7.
The preparation and assistance by and hospitality of the host countries werel Just right Satisfactory Too elaborate Inadequate
.....
B. The performance of the WPRO staff wasl Good Adequate Inadequate
Poor
9. The things I liked most about the cooference and study tour werel
10.
The things I liked least were:
ll.
Will contacts made here be useful to you? It certainly It probably
will
will
I doubt if it will
It will not ~
12. Did you learn anything or get arw new ideas? I certainly did ~uite
a bit
Some, but not much Yes
Not
at all No
13. Do you feel that your participation in the conference and study tour justified your absence from your job in your own country? 14. Have you suggestions for :iJnprovoment?
~ -&-
COPY
WHO/CST/18 APPENDIX 3a
W. H. O. Regional Office for the Western Pacific Manila
.Sir,
9 October 1957
I am writing to thank you for reCel.Vll1g the Public Health Conforence and Study Tour group. Ma:y I, through you, express my warm thanks to Drs. Soda, Yamaguchi and Hash:imoto, Messrs. Saita and Watanabe, their colleagues and to their associates in your various subsidiary institutions. Through their thoughtfulness, attention to details, hard work: and great efficiency they made the conference and stuqy tour in Japan highly worthwhile and contributed to its :immense success. The group was very grateful for the wonderful opportunity to see the good work that is be1ng dcne in Japan in the field of health and welfare and to exchange experiences and ideas. They greatly enjoyed the friendship and hospitality that was extended. It was appreciated that you and your Government went to considerable trouble and expense to provide the excellent documentation, facilities and services to make everything so very convenient, instructive and enjoyable. I have the honour to be,
Sir, your obedient Servant,
(Sgd) I. C. Fang, M.D. Regional Director
,--"
The Minister of Health and Welfare Ministry of Health and Welfare Japanese Government 1-2 Chome, Kasumigasoki Chiyoda-ku Tokyo
',,"
£QIT W. H. O.
WHC/OST/18 APPENDlX 3b
.
Regional Office for the western Pacific Manila
Dear Dr. Wu.
9 October 1957
I am writing to thank you for rece1V1ng the public Health Conference and Study Tour group. The World Health Organization is deeply indebted to you. Dr. Liu. Dr. Yen and members of the committee for the excellent planning and preparation. May I, through you, express my warm thanks to Drs. T. C. Hau, Y. T. Kuo and S. Chiang, Mr. C. T. Chen, their colleagues and to tmir • associates in the various national and provincial institutions who, through their thoughtfulness, attention to details, hard work and great efficiency made the conference and study tour in Taiwan highly worthwhile and contributed to its immense success.
,
The group was very grateful for the wonderful' opportunity to see the good work that is being done in Taiwan in the field of health and to exchange experien ces and ideas. They greatly enjoyed the friendship and hospitality that was extended. It was appreciated that you and your Government went to considerable trouble and expense to provide the excellent documentation, facilities and services to make everyth:ing so very convenient, :instructive and enjoyable. With kindest regards and best wishes.and again many thanks. Yours sincerely,
(Sgd) I. C. Fang, M.D. Regional Director
Dr. Wu Ching Director Department of Health lulm:inistration Ministry of Inte,rior Taipei, Taiwan Ropublic at China
WHO/CST/IS COPY W. H. O. Regional Office for the Western Pacific Manila
APPENDIX 3c
9 October 19'$7 Dear Dr. Bugher, Dr. and }Irs. Grant are leaving today at 2,00 p.m. for Hongkong. I am writing to express my heartfelt thanks to you and the Foundation for making it possible for Dr. Grant to come and serve as consultant for the Public Health Conference and Study Tour to Japan and Taiwan. Needless to say, we are most fortunate to be able to have Dr. Grant, whose reputation and prestige, knowledge and experience greatly contributed to the success of the project. As was expected, Dr. Grant also reappraised various aspects of '!he health care services in Japan, Taiwan and the Philippines and gave valuable advice which was greatly appreciated. We regret that he cannot stay for the meet:!ng of the study Grcup on Social and Preventive Medicine but my consultant and staff took the excellent opportunity and obtained his wise counsel while he is here in Manila just now. I believe that Dr. Grant was also able to assess tho situation in this part of tm world and to advise you and your regional representatives on fields in which the Foundation and the Board can continue to stimulate and assist. I venture to suggest that if it is possible the Foundation might cmsider sending Dr. Grant to this part of the world as a roving anbassador periOdically. We are extremel;y glad to have the opportunity of renewing Mrs. Grant I s acquaintance. We think that she is a wonderful person and an excellent helpmate for Dr. Grant. With kindest regards and best wishes and again many many '!hanks. Ycurs very sincerel;y,
l I
(Sgd) I. C. Fang, M.D. Regional Director
Dr. John C. Bugher Rockefeller Foundation
U. S. A.
WHO/csT/18 l_i'r'En IX ] !,
•
mFCRMATICN CIRCULAR
Background The Public Health Conference and Study Tour was proposed as a regional project during the second session of the Regional Committee which took place in Manila, September 1951. Similar conferences ?.nd study tours which have taken place in the Eastern Mediterranean and European regions have achieved considerable success and lasting benefits have been derived. During its fourth sission, the Western Pacific Regional Committee adopted the following resolution: "'IRAVEL S'lUDY TOUR
The Regional Committee, Realizing the importance of and benefits to be derived from group conferences and study tours in the countries included in the Western pacific Region, REQUES'IS the Regional Director to give consideration, where funds are available, to the provision of study tours in the countries of the Western Pacific Region." The following description of the C~nference and study tour appeared in the programme and budget estimates for 19~: "The standard of public-health administration, on which the success of public-health work largelJr depends, differs wide4r in the different countries of tho Region and this affects neighbouring territories as well as the countries themselves. It is proposed to organize a conference and group study tour for experienced public-health administrators from countries in the Region, preferablJr heads of administrations who will continue to serve their countries for a reasonable time. The conference will enable the participants to exchange experience, and oustanding public-health administrators will be brought in as consultants to speak on their specialties. The group study tour will cover-a number of selected countries so that the participants can study one another I s problems. It is believed that a common vieWPOint and the better understanding of the various aspects of the problem s can be obtained." ••• 2
4Resolution WP/RC4.Rl4 20ff. Rec. WId Hlth Org 66, 333
- 2 -
After consultations between WHO Headquarters and the Regional Office, it was decided that the ccnference topic should be "Comprehensive Health Planning" and that the study tcur should cover Japan and Taiwan. Health planning was the topic for the technical during a previous session of the Regional committee. 'top;\.'l, it is felt that the conference and study tour in dilaeussing it again, particularly as to hoW it is and Taiwan.' It is anticipated that special emphasis developnent. discussions which took place As this is a very important group would be interested being carried out in Japan would be placed on canmuni ty
The Governments of Japan and of the Republic of China graciously agreed to act as hosts. National preparatory committees have been established and the heal th institutions and projects to be visited were agreEd upon. The Governments have arranged for the reception of the group, assisted in booking hotel aCCOll1ll1Cdation and will provide staff to assist the regional office secretariat accompanying the group. They will meet some or all of the local transportation requirellllnts and will provide conference space, stationery and supplies, office equipment, etc. At our request, official entertainment will be reducod to a minimum, although there will be several cocktail and dinner parties. We are most fortunate in being ab).e to have Dr. John B. Grant serving as the calsultant to the conference and study tour, and the Rockefeller Foundation has kindly consented to meet all expensos connected with his consultantship. Dr. Grant was, unfortunate~ unable to visit Japan and Taiwan beforehand to see the' institutions and projects which will be visited by the group. He and Mrs. Grant are due to arrive in Tokyo from the United States of America in the evening of Saturday, 14 September. To keep down the cost of the project, no WPRO staff made special v1sit~ to Tokyo and Taipei, and all arrangements havo been made through exchan~e of letters and cables. This is the first project of its kind in the WHO il'es vern Pacific Region. Staff Tha Regional Director is sending the following staff members with the group I Dr .. C. Y. Shu, Regional Public Health Administrator Mr. J. P. Schellenberg, Interpreter-translator Miss P. Farre, Secretary All' inquiries and requests shOUld be addressed to them. It is hoped that Mrs. Grant will be able to serve as an interpreter-translator. It is proposed that the participants meet with the Regional Director on 11 September in Hongkong for briefing and to elect their officersl Chairman,
Vice-Chairman, rr.pporteur(s).
• •• 3
- 3 -
The group, accompanied by the WPRO ste.ff, will leave Hongkong for Tokyo on 12 September by BOLC. The itinerary is as followsl Thursday
12 Sept
1355 hours - Leave Hongkong by BOAC flight Bl,934 (T). in Tokyo Evening
2015 hours - l\rrive
Accommodation at Daiichi Hotel.
Friday
13 Sept
Momin£: l~ftornoon
Courtesy calls. Visit to City Health Centor.
Visit to Premature Infant center at Red Cross Maternity Hospital. Evening
2100 hours - Leave Tokyo for Kobe by express train No. 15 "Ginga" with sleeper.
Overnight on the train. Saturday 14 Sept Horning
0815 hours - 1,rrivo at Kobo. Visit to Kobe composting project. Luncheon eiven by Nayor of Kobe. Two-hour sight-seeing in Kobe by Japan Travel Bureau bus with guide, visiting Hotomachi Street and observation point on Nt. Rokko for a bird I s eye view of the port city, thence proceed to Kyoto, arriving in two hours. i\ccomrnoda tion at Stu tion Hotc 1, Kyoto.
Afternoon
EVaning Sunday
15 Sept
l10ming
Three-hour si[ht-seeing in Kyoto by Japan Travel Bureau bus with guide, visiting Sanjusangendo, Golden Pavilion and Nijo Castle or Hcian Shrine. Cheek out of hotel - the rest of the day free.
l.fternoon
Evening
2215 hours - Leave Kyoto for Tokyo by expre 55 train No. 14 IIlt'ojo" with sleepcr. Overnight on the train. 0003 hours - Arrive in TOkyo. Orientation and conference with Dr. Grant at Institute of Public Hualth. Visit to IPH, including WHO-assisted nursing project. Visit to National Institute of Health, including WHO-designated centers. Cocktails givcn by the Minister of Health and Welfare. Accommodation at Daiichi Hotel. • •• 4
Mcnday
16 Sept
Morning
Afternoon
Evening
- 4 -
Tuesday
17 Sept
Homing Afternoon Evening
Visit to Crippled Children 1 s Center. Visit to Rehabilitation Cqnter for J..dult Handicapped. Dinner given by Japan public Health Association.
Accommodation at Daiichi Hotel. Wednesday 18 Sept
Moming A1'temoon EVening
Visit to Health and Welfare Statistics Division. Visit to soc TB mass examination work in the field. Accommodation at Daiichi Hotel. Conference at IPH. Check out of hotel, rest of the day free. Leave Tokyo for Taipei by 0015 hours CAT flight eTl03 (S). r:J730 hours - Arrive at Taipei. Procoed to Ko-chi Hotel, Yangminshan. Heeting at Yangminshan, 1030 heurs addresses by the Prime Minis tor, Mini ster of Interior, Governor of Taiwan Province lend Chairman of Host Government Pre paratory Committee. Dinner given at Grand Hotel by the Minister of Interior. Night spont at Ko-chi Hotcl. Visit to l1cdical College, College of Nursing and Institute of Public Health of the National Taiwan University. Visit to Shihlin Serum and Vaccine Laboratory and Environmental Sanitation Demonstration Area. Night spent at Ko-chi Hetol. Free. )-..I I
Thursday
19 Sept
Moming Afternoon
Friday
20 Sept
Morning
ji
Evening
Saturday
;n Sept
Morning
Afternoon
Sunday Monday
22 Sept 23 Sept
Morning Afternoon
Visit to National Defence Medical College. Visit to Taipei Tuberculosi~ Ccntar and Tuberculosis Cont~ol project Night spent at Ko-chi Hotc~.
I
, •• 5
•
.....
'
- 5Tuesday 24 Sept Noming Afternoon Visit to.Tnipei City School Health and School Trachoma Control projects. Visi t to Hsi-chc Venne aI-Disease Control Demonstration Area and VencrealDisease Control project. Night spent at Ko-ehi Hotel. Visit to Health Center and Public Health Nurses Training Course, Taoyuan. Conference at Taipei liaison office, Taiwan Provincial Health Administration. 2230 hours - Leave by night train for
Wednesday
25 Sept
Homing Afternoon Evening
Kaohsiun/j. Thursday
26 sept
Morning Afternoon
Visit to composting project, Pingtung. Visit to Nalaria Control project headquarters, Chao-chow. Night spent at International House, Kaohsimg. Visit to Tainan City Health Center. Visit to Maternal and Child Health project, Taichung. Proceed to Sun-Mbon Lake. Night spent at Evergreen Hotel, Sun-Moon Lake. Sight-seeing at Sun-Moon Lake. Group discussion.
Friday
27 Sept
Morning Afternoon
Saturday
28 Sept
Morning
Evening
Dinner given by the Taiwan PrOvincial Government and Provincial Health Administration.
Night spent at Evergreen Hotel. Sunday 29 Sept
Morning Afternoon
Visit to Provincial Government. Visit to PHA at Wufcng and museum at Poi-Ko. Leave Taichung for Taipei by train. Nieht spent at Ko-chi Hotel.
Monday
Conference at Taipei liaison office, Taiwan Provincial Health Administration. Afternoon Free. Night spent at Ko-chi Hotel. Tuesday I Oct Morning Leave Taipei for Hongkong or Manila. The above itinerary is subject to minor changes. • •• 6
30 Sept
Morning
I ,
,
- 6 Japan , I
Among thc institutions and projects to be visited in Japan arc: 1.
Health and Welfare Statistics Division, ~!inistry of Health and Welfare. This is one of the bie£est statistical set-up in this region. National Institute of Health (NIH). This institute is responsible for research. supervision and control of biologics and antibiotics and for training. It serves as the national influenza center. WHO has designated it as one of its poliomyelitis centers. Institute of Public Health (IPH). This is the training institute of the Ministry of Health and Welfare. WHO has assisted this institute. particularly its departments of epidemiology and environmental sanitation and in medical social service. At present, a WHO nurse is assigned there. This instituto had accepted WHO fellows for traming,
I I
2.
~
r
I
3.
4. 5.
Tuberculosis Control. in this region.
Japan has probably the largest TB-BCG progranrncs
Premature Infant and Crippled Children Projects. These national projects receive soma assistance fram WHO and also from UNICEF. in the case of the crippled children project. They have become centers for the training of personnel for the rest of the country. Kobe Municipal Compo sting Project. This is a large-scale urban project to which 'J!!O is giving some assistance.
6.
Province of Taiwan The Province of Taiwan is in a state of omergency and it is on an austerity footing. Recently, a network consisting of government hospitals, hcalth centers and health stations has been e stablishcd. i\l1long the institutions and proje cts to be visited are I 1.
The College of 11edicine or the National Taiwan University (TAITA), together with its College of Nursing and Institute of Public Health. The Taiwan Provincial Institute of Environmental Sanitation (TPIES). together vlith its demonstration areas. One demonstration is of
2.
composting. It is believed that after visiting the largo-scale urban (municipal) project in Kobe, the group might profit from visiting a small sc"le project for rural conununities. 3. The Taiwan Nalaria Research Institute (Tl.!'lRI). Taiwan is well on its way towards eradication of malaria. Tho l1alaria Research Institute is now directing part of its attention to arthropodborne diseases. • •• 7
•
- 7 4.
Tuberculosis Control.is an integrated programme and includes preventive measures, BeG vaecination on a large scale, case-finding, treatment and epidemiological studies. Domiciliary chemotherapy is be:ing developed through tho TB centers. There is a laboratory for BeG vace:ine production in Taipei. Trachoma Control. This is a very large-scale campaign. The WHO provides the teclnical adviee and supervision and UNICEF, the imported suppli as.
5.
Many of the institutions and projects receive assistance in one form or another from WHO, UNICEF, JCRR ao%r US-ICA. ,.. The participants will seo institutions and projects operating under existing social and economic conditions and the attendant difficulties of restricted budget and shortage of teclmical personnel. It is hoped that thqy will have opportunities to exchange experiences and views, and i f requested, give advice and suggestions. Upon arrival, the director of the institution or project will brief the group. At the end of the conducted tour of the institutien or project, there will be a question and answer period. Documentation I. small amount of reference material has been assembled for the conferonce, aoo background information has been prepared en some of the institutions and projects to be visited. Short summaries arc attached to these documents. It is regretted that translations will not be available for documents which the Host Governments may distribute during tho study tour and that onJ;y urgent and short draft documents can bo translated and reproduced.
L
At the end of the first conference session and
th~
first field trip and at
the end of the conference and study tour the pa~ticipants will be requested to fill out evaluation questionnaire forms. The final report will be compiled in the Regional Office by the consultant and the staff. According to the WHO fellowship regulations, participants will be requested to suppJ;y follow-up reports for the purpose of evaluating the project • . ~
Travel and Other Arrangements The participants of the conference and study tour will be provided by WHO with round-trip plane tickets, tourist class, Honrkong back to Hongkong (in tho case of Chinese, Japanese and Korean participants - round-trip plane tickets between Tokyo and Taipei, tourist class), round-trip train tickets, second class wi th berth, Tokyo-Kobe and Kyoto-Tokyo and will meet the cost of the bus trip, Kobe-Kyoto. All other group travel in and between cities are provided by the Host Govcrnnents. The WHO will pay a per diem allowance. In the (Bsa of Chinese and Japanese participants, they will be paid half per diem when at their normal place of residence. The Organization will not meot the cost of passports, visas, portc:ragc and other gratuities. It docs not provide accident insurance
for participants and will not be responsible for expenses arising out of sickness, injury, other disability or death. Participants will travel by the category and paid per diem allowances according to tho rate established by WHO for recional and inter-regional conferences, seminar and training courses • ••• 8
· - 8 Travel and living accommodation will be comfortable but not elaborate or luxurious. We would like to apologize i f language difficulties, local custom and vary:ing ways of living ca.use any inconvenionce or embarrassment. Letters and cables can be addressed tal Japan:
'.
c/o }rr. A. Saita, Chief Liaison Officer, International Affairs, Ministry of Health and Welfare, 1-2 Chome, Kasumigascki, Chiyoda.loku, Tokyo cable s: S;,IT;', KCSEISHO TOKYO For
(your surname)
c/o UNICEF/WHO Liaison Office, 5 Chungshan Road South, Taipei, Ta:rnan cables: UNICEF TAIPEI For (your surname)
It is hoped that as a result of the personal contact achieved during or strengthened through this conference and study tour the health administrators will correspond more often among themselves in order to exchange infermation and ideas.
I
-.1.
CONTENTS Pag!"
Organization of National Health Administration· Laws under the Jurisdiction of the Ministry of Health & Welfare· ............... ... Finance of the Ministry of Health & Welfare··· Organization of Local Health Administration Health Center·· .... Population···················· .. ··.................................... ... ..................... ............... Vital Statistics··· ... ... ... ... ... ... ... ... ...... ... ...... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... .................................
1
2. 3. 4. 5.
2 3
4 4
-
6. 7. 8. 9. 10.
6 7
Life Tables in Japan··················· ................................................................... 11 Deaths by Leading Causes························ ......... .......................... ...... ...... ...... 12 Maternal and Child Health········· .............................. ................... ................. 15 Health Education·············································· .............................. 16
11. 12. 13.
Tuberculosis .................................................................................................. 17 Comnlunicablc Diseases············· ' ............................................. , ........... ' ............ 19 Port Quarantine························· Environmental Sanitation··················· .................... . .. ................... 22 . ............................... 23
14. 15.
16. 17. 18. 19. 20. 21. 22. .1
Water-Works and Sewage Treatment··········· .. ···························· .. ····· ............... 24 Food and Veterinary Sanitation··············· .. · .. ·························· .......................... 24Nutrition ................. . . ............................................................ 26 Dental Health··············· ........................ ................................. ......... ............... 27 Mental Health················································ ................................................ 28 Occupational Health ..................... .................................................. ......... ... ... 29 Hospitals and Clinics··············· ............ ................................................ ... ......... 29 Medical Care Personnel······ .............................................................................. 3() Medical Care Statistical Survey·································································· ...... 32 Pharmaceutical Affairs··· ... ... ... ... ...... ... ..... . ................................................... 34 Major Research and Training Institutes in Public Health ................................ 36 Public Assistance and Social Insurances······················· .................................... 3&
23. 24. 25. 26. 27.
~-
-1-
1.
Organization of National Health Administration ISlrUl'tllrt'
The Fig. ] below shows thp organizational
of the national health and welfare administration
in Japan. Thp idea of dose eoope-ration among tilt' fields of preventive medicine, medical ('are, social welfare- and so~ial
insuran('e are lwing maintaine!!. The Puhli(: Health Bureau. Medical Affairs Bureau. the Children's Bureau share responsibilities
and Pharmaceutical and Supply Bureau, togt"lher with
on health adminif'tration in the field of pre\"t"nthe medicine, medical care, pharmaceutical supplies. and maternal and child hygif'nf', respectin~ly. With the assistance of statisti<:ai services rendered hy the Health and Welfart" Stati):'tics Division of th{' Ministry, these Bureaus direct the health programmes
by gi\·jng
(Irder~
to tht' 46 lo(:al prefectural
~oyernments.
The following is
th~
organizational chart
as of 1 Aligust 1957.
Fig. 1. Organization of the Ministry of Health & Welfare. -Pt'rsonneJ Affairs Sl"rtioll I General Affairs Section Accounts Section Office of Programme Evaluation --Uffic.e of Chief Liaison Officer, International Affairs Minister's Spr'rr->tariat
---1,-'
'
H/'"alth & Welfare
0, atlstlcs .. .:'1
D'"
lVISWll
-
-General Affairs and, Field ?taff Seetion Reports and AnalYSIS SectIon -Tabulation Section - ·Administration Section -Planning Section -Planning Section Nutrition Section Health Center Sertion T uherculosis Prevention Section Acute Communicable Disease Prevention Section Mental Health Section -Quarantine Sediun
National Parb Division
-
Puhlic Health . Bureau
1- Environmental Sanitation Section En-o,'ironmental I Food Sanitation S(>ction Sanitation Divio;ionWater-Works and St"werage Section - Office of Veterinary Sanitainn -General Affairs Section M~dical Affairs Section !\1ana!;ement Section National Hospital Section ~ational Sanatoriulll Section Arrangement SeNion Offi(:e of Nllrsinf; Affairs -Offiet' of Dt'ntill Affai.rs I
.>
-Pharmat'euti('al & Supply Bureau--
-Enterprise Section Pharma(:elltical Affairs Section Drug Manufacturing Section Binlogi(:als Section I Narcotic Section - -Offke of Pharmaet"llticaJ Insp~etion - -Geneal Affairs Section Protf"dion Section Rehabilitation St~ction Life Improvement Section -Institution Section
--Social AtTain! Bureau
- Children's Burea.u
,- Planing Section ,I Chilrl Proledion Sl'dion I Materna! & Child Welfare Section -Matt'"rnal & Child Health Section
(Con'd)
-- 2 General Affairs Section H~alth Insurance Section National Health Insurance Sf'ction -Insurance Bureau Welfart-' Pf'nsion InsuranC't' Sectiun SE'amen"s Insurance S{'('tion
Medical Care Sedioll -·Olfi('(> of Acturial &
Slatistil'~l
Affair_..;
- -R .. patrialion Relief Bureau
I
'-(;eneraJ Affairs Sel"lion Repatriation Sf'ction Bereavf>d's P("llsion Planninf!; Sr-dion Liquidation S('ctioll (Ex-Army) Demobilization Spction ( ,,) Pension Business Section (II) First Pension-Sen'!:'nio£: Section (") Demobilization & Liquidation Section -Secollfl Pension·Srrf"f'ning Selion
Affiliated Institutions
--Institute of Population Problem" Institute of Public Health National Institute of Nutrition National Institute of Health National Institute of Leprosy Port Quarantine Offices National H08pitals National Sanatoria National Institute of H05pitai Administration National Hygif'nic Lahoratories National Hume for the Blind National In~titution of Vocational Rt'hahilitation for tht' Physic.ally Handicapped Nllli()nal lJomt' for thl" Juwnill" Training and Education National Institute of Mental Health -Regional Branche,.; of MNJical Affairs Bureau Regional Narcotic I m'estigators' Offiel"s -Local Repalriation Officf's
Local Branch Offices
2. Laws under the Jurisdiction of the Ministry of Health & Welfare 1. Laws on Administration: Ministry of Ht'aith & Welfare Establishment Law (1949) Health Center Law (1947) ~.
Laws on Pre\'f'ntin-' Medicine: Communicuhi(-' Disease Prevention Law (1897) Pren"ntive \' aednation Law (1948) TuhpTcuJosis Control Law (1951) Lt'prnsy Prevpntion Law (1907) Tra('hom~ Prevention Law (1919) Parasitosis Prevention Law (1931) Y('nereal Disease Prevention Law (1948) Quarantine 1.aw (1951)
3.
Laws on Environmental Sanitation: Enterlainment Fadlites Law (1948) Pnblil; Bath Houst' Law (1948) Hotel Business Law (1918) Friseur Artist La.w (1947)
Beauty Artist Law (937) Cleaning' Business Law (1950) Wat~r"Worh Law (1957)
-3Sewerages L:LW \1900) Waste Disp:)sal L:nv (19:14) Food Sanitation Law (1947) S!aughter House Law (19U6) Law Relating to Processing Plants of Dead Animals and Others (1948)
National Park Law (1931) Law Regarding Gravt"yards, Burial and Others (1948) Rabies PreventioD Law (1950)
.J.
Laws on Health Statistics: Regulalions Pertaining to Report of Still·hirth (1946) Ordinance Regarding Vital Statistics (1946) Regulations on Reporting of Infectious Diseases (1947)
5.
Other Laws on Public Health: !\1ental Hygiene Law (1930) Eugenic Protection Law (1948) Nutritionist Law (1917) Nutrition Improvement Law (1952)
6.
..
Laws on Medical Care; Medical Service Law (948) Medical Pradition{'fs Law (1948) Dentists Lnv (I9.t.~) Dental Hygienists Law (1948) Law for Dental Technique (1955) Public Health Nur!;e, Midwife and Nurse Law (1948) Law for Medical X-Ray Technicians (1951) Law for Mass~urs, Acupuncturists, Moxa-cauterists and ludo-orthopaedists (19..17) Law for Diss~ction and Preservation of Dead Body (1949) L::..'.',-s on Pbarmaceutinll Affairs: Pharmaceutical Affairs Law (1948) Law for the Control of Poisonous and Powerful Agents (1950) Narcotie Control Law (1953) Opium Law (1954) Taima (Marihuana) Control Law (1953) Awakening Drug Control Law (19;;1)
8.
Laws on Social Welfarp: Social Welfare Servin' Law (1951) Daily Life St'l'llJity Law (19:")0) Law for the Welfare of Disabled Per"ons (19.,19) Child Welfare Law (19-17) Disaster Rdipf Law C194i) Law for the Loon etc. of Welfare Funds for Mothers and Children (1952) Welfare Commissioner Law (1948) Consumers' Livelihood Cooperative Association Law (1948) Laws on Social Insurance: Health lnsuran(;e Law (922) National Health Insurance Law (1938) Welfare Pension Insurance Law (19..&0 Searnens' Insurance Law (539)
g,
Health Imu,"nce Law fo, Daily Wo,k", (19j3) Social insurance Medical Fee Payment Fund Law (1948)
3. Finance of the Ministry of Health & Welfare Annual budget of the Ministry with the comparison 10 the total national expenditures is shown in Tal-J~
1 in the next pagt',
Tahle 1_
Expenditure of the Miaistry with the C::>mp.Hinn of All Government Agencies. Expenditure d All Agencies Million Ye .
Exp~adit:.lr(,5
of
Expenditure of l\Iiflistry of Health & W ..lfare Amount
Fiscal Year
1937-31:1 1938-3Y 1939-40 1940-41
2, 709
60 187 ISS 171 187
3,288
4.494 ;:),860
19-U- . 12 I !::l42 -·13
oS, 121
:2.2 .,. 7 -I. ~ ~. 9 2. 3 d· V·
e' ."
8, 276 12, S:'i2
1943--44 1!::l4A-15
289 466 Gi2 1,928
0>
7 j
19,872 :n,496 119,087 21-1,256
c'
1915-16 1946-47 19--l7--:l11 1948-/!9 1949-S0
7, ;)61 13,413 24, 773 28, 182 35,314 -16,011-\ 72, 128
9. 0
6. I
473,1-46 741,047
6.3 3.2
19:')O-<'il 19;)] -,")2
3.8 ,).3
661.406 793, 707 92:;,:):6 L 027, 231 999, 880 1.013.300 1.031.900
5.8 ~-.
19.)2-53 1%3-:')-1 19;)4-5:; 1955-36 19;)6-:i7
73,176
84: 61:1
Q'.>
816
90,317
4. Organization of Local Health Administration E3.eh prt'fectural goverument and larger municip,tl III
gon:-!"Ilme:lt.~
haw their
0 ..... ,\
ht>:llth dcp:utment pro~rammes
ord(>f to carry out their ht>alth programmes in c::>mpli1.nce with the nnti ):lal p:>licies and by tht-' Ministry of Health & Welfare,
direct~J
Tlwse prt-'feeturul and municipal governments divide their p:11iti(::il lnundaries into several "health center distriets," and the local heallh centt'r is establi3hed in each ont" d' thOde districts, At present there are 7,s3 health centers in this country. For tht-' reason of geographical conditions. most of the health centf'rs have their branch health units within their health center districts.
5. Outline
Health Center
The first health center in Japan was estahlishd in Tokyo in 1935. Then, in the
followill~
year, the
Health Center Law was enacted and the HI-year programme for health center cunstruction was started. There wt'rt' :~06 health centers in 19-13, and had increased to 770 in 1944 due to tllf' amalgamation of all g:IVt-'rnmental health consultation agencies. The health center in pre-war days had only ht"ulth eonsultation in tuberculosis c::tntrol and maternal and child health, and maintenance of health of preservici" m~n.
In t9ri". public health work in this country was rt'organized. AC('ordingly, the Health Ct'ntt'r Lm-
was revised, and the new health center programme started.
Legal Basis Accordjn~
to the Health C .. nter Law, the local government is requirt'd to establish ht'alth et'nlPr,
and the national go\'ernmel1t is rt'sponsihle to share the cost. 46 prefectures, and 30 municipalitie", {Iesignatf'a hy the r.ahinet Orat-r. prnvidp tht>ir ht'alth centers. Direetor of health center is specified to
-5he the medical doctor by law. The character of health centf'r is defined by law primarily as community health service agency. and seconllarily as administrative supervisor based on the power. delegated by the ~overner or mayor.
Number. Standard Scale and Organization As of the t'ml of 19;;6 fistsl year, tht'rt' are 71{i h..alth centers in Japan, and 5 more health Cf"uters are expf>ct.-d to be built by the end of 1957. One ht'alth center is expected to cover 100,000 population, but actually it covers about 115,{)00 at present. There are three types of health centers, namely A-class, B-class and C-dass. At present. A-class health c('nter is expected to be staffed with 57, find has the building of 1,800 sq. feet. and also covers moTt': than lr,o.OOO population. B-c1ass health t:enlt>r is expected to haH staff of 47, and building of 1,150 sq. f("{'t and covers population of If)O,OOO to 110,000. C:c1ass hpaith center is exp!'etlO'd to have staff of 31. buildin::;: of goo sq. ftot't, covers less than 110,000 population.
Function and Programme The fUllction and progran::me of health center iuclude activities in the different fit'll!. All community health programmes have been integrated into health center activities. Following lire the hasic fundions, defint>d by law; Health edut';1tion; vital and health !Otatistics; improvement of nutrition and food sanitation; ell\'ironmental sanitation; public health nursing; medical social service; laboratory service; venereal disease and otht>r communicable diseases; prevention of tuberculosis; maternal and child health; dental hygiene, and other needed local health programme. (such as t>ouemie tlispase l:onlr01 1"1('.) As the routine programmf', the health consultation clinic. well bahy conference, mass chest suney. home visit. c(lmmunity health education, inspection and field supervision of sanitary operation are carried
on. The ht'alth education is integrated into every phase of routine process. Tulwn:ulosis control. insect and rodt'nt control. birth control are highlight programme. Recently, community organization proce!>s has bee-n eXlen!;iveiy developed for performance of all health programmes. Table 2. Main Health Cpnter Activities in 1956 (from monthly health center service reports.) (per health center per month) 79·[.6 173.7
Tuherculin test BeG inoculation Miniatllre X-ray examination Large film X·ray examination Culture of tulwreulolls badli Culture for fastness test of tuberculous bacili Maternity health examination Well baby coof('renee Individual mass examination Health examination for V. D. Immunization Home visit by puhlic health nurse ~utrition consultation Food inspection Bacteriological stool eulture
2,061.5
88.4 22.9 7.1
52.3 134.1 ~7.()
125.0
513.3
453.4 195.1 314.9
242. 7
Finance Health center is financed by local and national government. The item of national subsidy is divided into ::! c~leg)ries; that i!>, health center subsidy and programme subsidy. According to the Health Center Law. national government is responsible to share the !'.Ost of health center expenditure both recnTTtnt and non·recurrtnt. At thfo time of new estahlishment Df health center, nat.ional gm"ernmellt .~hare.'l 1/2 of expenditure for eon!ltruction and needed (,((uipments, and it all>D subsidizes 1'3 for running expenses. Local govern·
-
6 ment pays rest of ~xpenst's. In the national budget in 19:17 fi~cal year, health centf"r w(l.~iciy amounts 10
¥ 2,13.1,845,000.
::.'"
6.
Population
Table :1 below, shows the estimated population of Jap:lll, as of Oct.], 1956, Lased on the bit'si {',en!ms taken on Oetober 1, 1955, (Including Japanese nationals and foreigners in Jap3.tl). Table 3. Population by Age Groups amI Sex for All lapan. Total Thouoand
Male Thou&IIod 4-1.35~
Female Thou~3"d
All
Jap~m
90,253 8,805 1l,636 9,141 8,737
-1:J,9lI1
4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44
o to
4,5H ;:;,929
,1,631 4,4(}O
1. 291 :;, T06 1, i)09
4,337 -1,226
8.463 7,736 6,481 ;i,?05 ~, 006 .1,522
4,236 3,845
3,028 ~, 333 2,34:Z
3.890 3, -,1;3.1 2,~7()
2, 663 1.,33-1
~.
45 to 49 50 55 60 65 to to to to fi4 59 64 69
3,815 3,301 2,583 1,992
2,188 1,9!1 1,656 1,269 !)34 :;90 304 1,16
1,90;-)
1. 616 1,31-1 1,058
TO to 74 7:; to 79 ~l) to 84 85 years old and over
1.383 903 40S
793 ::d9 ~6~
138
43
93
Fi£;. 2.
Population by Ae.-e Groups in 1956 (Estimated on Oct. 1, 19;;6.'
Ma& I
) ;~ 80-B 75-1 70-7
85-
F $,jlG:-~
65-5 9 60-6 4
1
1
r I I
I
L
I
55-5 9 5H 4 45-4 9
1
40-44 " 3539 30-34 15-/s
r
I
1 1
I I I I
I I
I ,
0-/ 4 1 1 5-1 9 0-14 1
I I
I
5- 8
l 5.000
I
0- 4
5,000
Tlwusand
o
0
Thousa..nd
7 -
7.
Vital Statistics
Inspite of the fael that the nation-wide vital statistics survey has heen carried out sinet: 1899 in
Japan. no reliable data ""ere available for the years 1944 to 1946 due to the confusion of the last
World War.
Birth A,nulial '-hange of Birth Rate. 29 anJ 34 per l.l)Ot) Between 19UO and H119. the birth ralt' in Japan Witi:'
between
populati(m. but il which was Fig. 3. Annual Cbange (If Live Birth Hate. (per 1,000 p:lplliation) Rot.
rapidly rose tv :~6. 3 in 1920,
the highest rate since 19uO. But after this
peak. it had been declining as the years
Itfl .... anced until 1939 when the rate reached Ihf' lowest one (26.6), and from about
'OJ ~0
lY 10 it again started to rise. This increase ronsidereo to be dut" to the fad that the policy of the govt'rnment at that time "as to encourage the increase of birth. Durin!;" 10
10
3 years from 19-14 to 1946. the birth rate st-'t-'ms to have been consid£'rably low judgf'd from variou.~ reasons, althouf!:h no accu-
,I 1900
!9'O
1
rate data were availahle confusion caused hy war. Ths birth
"t-'call~e
of thp.
rate in 1947
,~·as
aboorFi~.
mally high, showinl!; 3/1. 3, hut slich an ex-
4.
Annual Change of Death Rate. (per 1. oon population)
traordinary rise cf birth rail:' is considered to be nue to the J't>patriatiou or restoration
of 'IOrn7:lJ family life of the people after thl:' termination of the war. After such an
extraordinary rise. to de-clint> rapidly.
tht-' hirth rate
started
and heeame 19.4 and
18. -1 in 19;);) and 19;)6. respectively. and this rapid decrease of thp birth rate may
I
II\.. i
lw due to tht' nf'erease of Ibe marriage, encouragement of birth cuntrol and the pro evalence of artificially induced abortions. (Refer Tahle 5 and Fig. ;j)
I~ 1950
I
-
8
Table 4. Vital Statistics in Jap3.Jl (Numi)f'r,'. (1900-1956",
Yt:'ar
· Popu IatlOn
I
Live
Births
Deaths
Infant Deaths ( under I yr.) ,
Keo-natal Deaths jMaternal (undf'r 28 Deaths
Still~farbirths! ria!2;es
?ays)_ 112, 16j 108,310 Uti, ~23
190U 1903 191()
H, 369, 900 1, 409, 979 47, Hill, ·100 1,442, 0()4
902,061 997,065
219,38.1 219, S07
6,20()
13i,
!l,~
1
3·1:3,91H
63. ()HK
6,18;) 6, 22H
142,092 1.'7, 3SS
3'17,518' 433, 946
59, HiO
49, 9.93, 600 1, 699, G9R I, 0:1:1, 3,:)11
27;), 396 2B7, 9;)3
1915
::i3, 902, 300 1, 78d, :121 1, (Ll, 1274 ;35,391,481 ;)G, tZ(), 000 36, .'!SO, 000 S7, 3;')0, OOU :is, 300, 000 2, OIl, 634 1,976,055 1. 953, 5GO 2, 028, 93:") 1, 98,1, 32G 1,409,371 1,279,219 1,278,120 1,323,648 1,2'1;1,343
125, 293
::19,O:iO i,158 7,181 6,56;; 6,89!l 6, 273 6,3()9 14--1,()35 138, 2!J4 132,230 :l-1I,542 :i4, (i71 1
HJ20 Hl'?l 1922 1923 192'1
334,381 3:12 326,6S1 333,12U 311,3:17 295, 88S 33~,
139,57I 136,267 132,757 135,423 126,299 121,15,1
;114,823' :110.385 508, 100 50;{, 660 :116,630
;)2, (il3
;)2,082
133,85;) 12.1, H31
so, 31.:1 D()~
:10,
19'?S InG 1927 19'?8
59,179, :WO 2,071,SGU 1, 199,936 60,180,000 2,089,9::17 1,1;')1,163 61,110, UOO 2, U-15, 828 1,2()1,847 62,030.nOO 2,120, -193 1,227,570 62, 930, 000 2,061,7201 ],2.11,041
121,394 12/1, 036
IY29 1930 1921 1932
288,301 291, 209 293,026 294,0.')7
lID, ;)66 116,160 115,609
:J,721i 5,76S
497, 959 182,907
30, 741 49,22,\
116, DI6 120,186 116,967 117,729 116,50;) 119, 575 1Ll,135 113,039 1El, ;')92 Ill, (150
;;,997 5,867 5,6S1 5, 667 ;:l,163 ~,
114,906 10-1,203 108,740 10~,
494,345 191,988 I
.:19, 6x9 48, 235 :iO,31O
1933 193" 193:1
62,872,496 64,82(),OOO 65,ROO, 000 66,790,000 67, GSO,OOO 6S, 69, 70, 70,
2, 070, 765 2,088,608 2,168,026 2,106,260 2,028,28!J
1, 1GI, 504 1,231,IS'1 1, HiG, 167 1, 184, ;:)46 1,22;), 402 1,132,371 1, 2:W, 023 1,198,400 1,250,093 1, 23R, 51-1
2S7,8-4G 27:'),6-1<1 255,701 256, .19,) 254,213
,183
102,830 103,309 97,930 100, 970 9.1,397
S'S~O
709
5Ul,831 492,09.:1 ;)]0,603 481,012 ;')06,937 3:')1, 03,?
,)0,316 --l9,8i'7 ;)0, 728 --18,;)16 --17,8U6
IY36 19:17
19.18 1939
661, 65-1 2.174,291 39U, 000 2,086,355 3()(), UOO 2,164,919 ;')90, 000 1,911,966 70,930,000 1, 883, 937
1
232,821 2H,538 229,911 219,943 201,291
8ll,092' 8~. 129 81,785
5,G9S J,3S1 5,4 1H 1,877 4,81~
n, 721 4:'),399 iii,719 43, H32 15. j,f\ -17, ~(J<I cI.S. GO.) 4;),:129 4.-~,
3:13, 518
11l,4HI
66K,336 332,103 5B,118
99,;;27 93,317 102,033 103,393 95, 446 92, i'o82
19-1-0 1941 194'? 1943 1911
72, :i39. 729 2,100,164 1, 176, 517 72,750,000 2,260,270 1, 1"10, 428 73,4;)0,000 2, 2Hi, 271 1, 137,845 73,980,000 2. 23;), ,131 1, 2()4, 802
73,86;:),001)
189,809 190,780 190, 162 194,551
:1,070 :1, 929
77,751 76,090 76,590
4, S8G 4, 542
GGl\ 184 7R3,858 G71,6S0 736. 183
tlJ2
194::; 1946 1947 194H 19·19 1950 19.'11
72.410,000 76,13:i,000 78,JOl,473 2, 678, 792 1, 138,238 80,000,000 2,681,624 9i)(), (-aO 81,XOU,OOO 2,696,638 9(1:), 444
1
205,360: 165,406' 168,-167 140,315
83,047 72,907
1,48.:l 4,437
123, H37 113, 963 192, 677
71, -185 6-1, 142 ,')8,686
",601 4, 117
031,170 999 S-I2,170 ~1.)3,
-;-9, ;")::11 79,()32 82. :i73
83,199,637 2,337, 84,~73,OOO
;')()7
2,137,689
904,876
8.18, 998 76:1,068 77'2,547! 721,491
1952 1953 19;)4 19::;;) 1936
85,8[12, 000 2,005, 162 87,033,000 1,858,040 88,293,000 1,769,S80
122,869 99,111 91,421 78, g ..jA 61:\, Sol 67,669
!11,OI5 17,580 12,726 3i'\,646,
216.974 217,2.11 3,417 203,82·'1 3,373 1 193,274 3,262 187,119
7L),081 G71, 90':)
3,691
676,99;1 (1H2,077 697.809 711,861 715,947
83. 6~9 H2, a31 79,021 7;:), ~2iJ 76, 7;19 73.267
89,275, ;')29 1,730,692' 90, 2:i3, 000 1, 661, 61:1
693,523 724,028
3,091
38,221
2,792
183,265 178,926
i 1, 767
Figures of vital statistics and the population Okinawa Prefecture. 1956 arc provisionL except
for
thl'
y<'ars
bC'fore
19.t3
were
shown
excluding in
neo-natal death, and
matt'rnal
dt'ath.
Figures of vital
statistics
-9Table 5. Vital Statistics in Japan (Rates).
0900-1956) Liv~
Birth Rate Year
1
Death Ratt"
Natural Incrf:'ase Hate
Infant Death Ratt Per 1,000 live birth ...
Nell-natal Di:'ath Rate Per 1.000
I
Mate,'nal Df'ath Rate Per 10,000 mllli birth
Still·birth Rate Per 1,(W:(I
Marrtage RatE' Pl"r 1.000 popu-. latlOn
--.
I
Di\'orc!~
Rate
Per 1,000 i Per 1.000' Per 1,000 j}()fnipopu' population lation lation
Iiw
births
I .o'
(li"e hinb .tlU·birlh)
lotai birtb. (Ihe bir,h
Per 1.000
.till-birth)
"0"
population
1900 l!:lUS 1910
3~.
8
:2:0.3
11.1
155.6 I
79.6 71. 7
39.8 38.~
89. I 89.7! I ,
L 42 1. ~G
'::U,6
:.!l.l
c ·' 1 l .,~. I
31.0
12.9: !
16~.O
.4.6
33.3 33.2
g'.71 1
1. 17
1915
33.2
20.1 2:=;.4
13. Ii
161.
° 69.4 09.0, 68.0;
1 7:l,2
8. t:
I. 10 0.99 ().9'1
1920 1921 1922 192:-!
36.3 33.2
31 .• 35.3: 3'1. O· 3:i.O 2-1. 7
22.8 22.5 23.0, 2L4~
12.4 11.9: 12.3'
10.91
166.2 169.2
167.2 2 };16.9 142.8 13S.0 H2.3 IG~.
66.7
192-\ 192;-) lY26 1927
12. 7 lo:!. 7 1".6 13.8 1<!·. "-I 12.9 1
63.6 ,,)8.
31. i 29,il
33.0 33. 7 31. ~I
6Q.8 h:').4, 61. Y
1
G3.4 '
59.6' .:it>. 6 ;;6.0, ii1.1' 53.6 ~3.
9.2 9.0 8.8 8.7 8.7
9.81
1
0.92 (l.S7 0.87
1928 1929 1930
33.5 ,
~t~,i
20.31' 19.1 19.7 19.8' 19.9 HI. 2 19.0 17. I 17.7 18.1 Hi.,s
5
28.5 2;)./,
37.2 56.8. 54.5 ' :'i5.7
8.3 7.9 8. ()
0.86 0.82, (),tUi 0.78: (I.
1
13S.21 1-12,61
26,5 26. h, 26. I'
1931 1932
3') .) 32. 9 31. :=; 2-0.0;
32.4
H.2
1933 1934 193::1
1926 193;-
;,0. H
~A ~I
13.8 11. 91
:n[' 9.4 8.8 1
124.;) 132.0 117. !I
50.2 32.1 ~H. 21
121. 7 125.3 , ,
48.8 50.9 ,is. 0 48.~,
25.8 25.3 24.0 20.81 26.51
:3 71 51. ,1 ;'2.8 50.:;
/.8 7.9 7.6 7.8
SO
,)2.8, ii2.3
8,
0.79
0. 11 0.77-
7.2 7.5:
0.73. (l.
71 '
17.0 17.0
14·. g' 12..t 13.7,
107.11 117.2
21.. 71 2/1,,3
8.0
SO.5 ·1!l.O ":9. :i
7.8 9.5 7.il
0.70 O.GS 0.6:) O.6~
1!13S 1939 19JO j941
2';". 1
17. / 17.71 IS.7 1;).8
26.6 29.0 ' 31. I 1
106.2 113.0; 106.7' 90. 1,
M.1 46.6
23. 7 :Y. I :Y'-.l
44.6 38.9 34.-1, 3 J , 3! ,
!9.6 -1G.3
7.7 ,
(J,6: O. G6! (J.
16.2['
191:2 19i3 I!)U
3(J.2
14.4..
15·4,1
12.71
23.0 20.7
St. 41 87.0,
30.2
16.3
0.'. HI \.l,-
-,1
13J 1
34:... 3i 31. (;! :!7.2 26.S
HI. 7
,I. 3
.-1:].71'
19.2
:;~J
9.1: 10.8 9.1 10.01 ' 1
O.G2
67 1
0.66'
19-1:) 19'16 1947 19,1,8 H)<!·9 19::1U
··'1
i
34.3 33.;-)
1.1.61' II. 9
33.0 28. I 2;).3 23.4 21. ::;
11. 6 10.9
:n.4 ~
19. 7 21. G
76, 7
~;; ~I v~.
,)
L,.71 lS.!J 16. I 15.7 15.5 16.1 J6.B
16.1
·1,1. 2 :':0.9
12.°1 11. 9 10.3! 1
G6. 7 8:'-. ~) ~~.2
1.02 0.99 l. 0 I , 1. 01
1951 195~
19::13 19:14
ZO.O I' 1H. <!,i
19:=i:'i 19;)6
19.11
9.9. 8.9'1 8.9 8 21 7.8 8.01 i
,. ') I .., 15. "1 14.4 12.6 11. 9' 11 6 10:<t,: 1
60. I 57.;; 49.tl, 48.~
21.4 2(.5 25.4 25.5j
92.3
8.6 7.9 7.9
0.97: 0.92 ,
90.S %.6, i 9;).8
11. 6 39.8
2"-.1: 22.31 ~3.() ,
rg
U.86 0.8/
40. 7
97.2;
8.0 l 7.9
O.H4 0.80'
Yital _qatistic~ rates for the Jears for the cOllyeuience of comparison pnplliatioll shown m the Tahle 1.
before
1943 were
recomputed
('xcluciinf!:
Okinawa
Pr.. fecturt'. tht'
with the post-war data. The computed fatf'.~ wt'J"e
based un
-
10-
Death Annual Change of Death Rate. In i955, the neath rate in hpll1 wa'.; 7.B per 1.000 popniatio'l.
which was the iowf'st one ever recorded in the history of vital statistic.-:; in this country. In other worrls. from 1900 to ahaut 1931), the death rale was around 20 e\"ery yt'ar. t'\ct'pt the high rate~ III
191:-:;
and 19~(). bf"CiilJSe of world-wide pandemic of infhlt'lI7.:1. showing 10.9 and 23.~. rl'.~I)f'l'IiH·ly. It hpl
llecreasing in the following yeaI_~ until it became helow 16 in 1941 clt:spite of the war. Afh:r the war. the Dumber of deaths ill 1948 wa~ under tilt'
million and the death rah~ decreased to \1.9, inspite of
fact that the (;onsiderahle incidenees of death must h:tyc happ:'ned during and dirt"ctly after the dS
war pf'riod. It furth/'r continued to decrea,;e as 10\"
to 7.8 in 19:i.1. In
1956. it wa:; ~. O. ;,ho ..... ing
:;Iight inCrl"aH·. Although thl"re may Oe many factor.; c()ntributill~ to Ihis dccreast'. it is ~aff' to ",ay that it is mainl~'
ht-"ciluse of the
prol!rt'''.~
of the sciencc of mcdicine and of public healLh.
H:t-"ff'r '1'ahll" :l
and Fig. 4).
Infant Death Anoual Chan~t' of Infant Dt'ath Rate. Thl" changt's lJf iurant dt'ath ratt's heen almost SdIllt' as the death have ,o~T
Fig.
J.
Annual Change of Infant Death Rate. (per 1,000 Ih-e births',
rates for
all ag!"s. Before 192.i. thl" infant death rate ..... as around 160 pt'f 1,000 live hirths eVl"ry year f'xcept tht" high ratl" in 19L8 1189.7), hecausl" of tilt" pandemic of influt'tlza. It declined ill til!' course of thl" yt"ar:; after 1~)2:l until it became below 100 in 1940, and rcacht'd tht' lowest rate of 39. H in l!):iS. In 19;:Jti. il was -lO.7. showing a little increaw. (Rl"frr Table .J anrt Fig. :).
I~ ) ,1... IC',I
.
I
I
I~.
I
Maternal Death Annual Change uf Maternal Death Rate. The maternal death rate around 19tHI wa" approxi·
malt'ly ,to pN to,OUO total births (li\"(> births and still·births), but il decreased eH'ry )'f"ar until it reached the low ratt' in 19-13, showing 19.2. Even thou~h some sharp inc-rease of matt'rnal death ratt' was expl'l'h>~j after the war tlut' to the increase of artificially induct-"d ubrlilln;" anrl in 1956. it wa~ 1::i.2. (Rt'fpr Tahle 5). it was Hi. 1 in 19f, .
Still-birth Annual Change of Still-birth Rate. .,f I!t:'~tation are ft'gi,;tec{'d. Th{' !"till·birth rate in Japan was around 90 pt"r 1,000 total Lirths (live births aud still·births) about in 19UO, and kept decreasing until it became about 40 in 1943. Aftt'r the war, in 1947. it again starlt'd to show the high rate of -i-l.~, and rapidly inereasl"d in the following years ano becaIlle 97.:! in 19:16. Su('h ine[t'ase is consiciered to be due to the Eugenic Prott'ction Law of 1948. This i-; pm\t'rI by the fact that tht' proportion of artificiaHy indu('t"d ahortion to lltt' t(ltal "till· hirths innea"~ ....d from 21.6$ in 1!.l4H to 53.59" and Sl. 7% in 19;;:1 and 1956, respecliHly. This is enongh to pro..-e how widt'ly the artifi('iul abortions han' lwt'n carried out tn Japan, and thi!' fact t'xplaini! that the incfeasinl:;" number of population are hecoming aware of tht' hl"avy burden of hig family. As tht' increase of artificially induced abortions is not desirous from tht" \"iewpoint of the maternal health. the gm'PrIlment (~Oll tra~,pl'tion.
In the vital "tatistics in Japan. the still·hirth aftf"r 3 month!'
is making pjfflrts to educate the people for ~afel
methods
of
-Marriage Annual Change of Marriage Rate.
"-
Tht' marriage rate in this country since 1900 up to about
19J:i. had been approximately between 7 and 8 ~r 1,000 population. except some slight irr~~ular
t'han{!:es before and after 1920. It went up to 9.5 in 1937 due to the war which started in the same )'f'ar. Although the marria~e rate went down rapidly, it <l.gain rose to 9-11 after 19,10. as the marriagt' wal'\ encouraged by the go\'ernment in thl' (..'Qunw of development of the war. The marriage rat~
in 194.7 after the war was 12.0, which was the hi;hest rate since 1900, but this is considered to be a tt'mporary stale caused by the repatriation after the war. h decreased to 10.3 in 19·19. and as a sam~
result of further decrease, it went down to 8. () and 7.9 in 1955 and 1956, respectively. to the level before the war. (Refer Table 5).
Divorce Annual Change of Divorce Ratf'. The divorce rate in 1900 was 1. :12 per 1,000 popul<l.tion, and
since then it kept decreasing until it became 0.62 in 1935. But after the war, il sudlll'nly rose again showing about 1. O. This is partly because of the increase of marriages after the war, and partly because of the new concept of the people towards divorce. In 1936. howevPT, th~ rate decreased to o. ~l).
(Rf'fer Tablf' 5).
8. Life Tables in Japan
l::xpectation of life at birth was 63.9 and 68.4 years for male and female respectively in 1955~ accordill{?: to the abridged life table. As it was 50.06 and 53.96 years for male and female rpspectinoly in 1947, the length of life has be-come extraordinarily longer than in 1947. The improvement is
largely due to the death rates in younger ages than in older ages.
Table 6·
Mortality Rate (qx). Ca) .
Male Age
(Per 10,000 Population)
Yt'ar I 1~91-1~9S
0 I
2
3
4
5 1
10 .5 :13 3') 26 1
15
~O
.,. -., RS 84 f(5
30 86 79
:1;';
:10
4;,
;-)0
,"i5
60 :~6;)
, 6;) [)1:]
,0 -I 74Sj
'>0- 135 91 6:i, 48 100 92 77 76 89 119 173 240 :-l.1.) 519 ;-67! 295 228' 142 100 101 15S 474 664 gO 376 3U7 287 35u 460 648 920 I, 291 1, ~47' 299 193 130 85 ;)7 23 42 114 IS4 142' 132 1:{3 166 222 312 .61 6901,047 19W UH7 860 :t~2 192 110 70 JI 20 2G 77 ~6 84 Sri 91 111 148 212 :J:J'> ;ill 7,jl; ,., 79 94 128 lX7 2Sl 423 623; :;50 Ig21 9g 75 52 ;{6 13 23 :is 78 76 -'> 1945 I 1u1~1 66:1 18. 111 74 30 3419 30 69 GG 6;) 7:{ 90 t21 178 272 419 629: 19:iO-19S2, :i67 US 89 66' ·16 31 11 12 :ll 42 44 ,15 % 73 107 161 248 ,106 617 19,')0 !")90 14:1 100i 67 -18 3~ 10 17 391 55 ;)')1 57 65 ~2 lI:l 170 272 4:~8 19;)1 7 I-I 31 44 4:i :i7 7;) 108 16·1 259 J76. 1311 9~ 71 ·18 ;l2 9 12 25 :H 36 39 49 69 101 1;)6 236 379 59.1; 19:i2 S05J 90 74 57 :~9 ')'"'
1,490 .\-17 1~H9-I9U:{ 11, ~6~ 369 lJ09-1913 1, (jOo) 441 H121-1925 1,620 485 1 U126-1930 I, .101 431 1 1~35-l936 1,130 370 19:\;-) 1,989 566 1
296 201 138 100 "-91 170 112 79 ::;:~6 1:17 103 71 261' 166 105 70 224 150 98 64
1
;')~
82
:t~
48 83 50 89 60 108 :in 98
95
71 82 H
8,
86
9::l 112 HI 87 10,[ 133 81 96 122 105 1~~7 77 96 127
186 2.'}6 178 245 164 229 lH6 26:1 175 250
351 512 328 476 392 ;)'(1, ::167 549
7..\5
698, 848, 8U4~
-"I
2.1
,
11!
-,
19:i:: 19'"),1
l!l:i:i
511 462 417,
87 70 fiSi
66 501
I
16
47 :16
53
37
~61 .)~
,
••
6~1
8 i)
33 28
32
-"
11 12
24 23
::12
33 29,
8
10
22
31
29 :w
36 36 32
4;)
46 41
65 60 60
99 157 243 397
96 [.19 226 :~28 9:l 1:12 224 3:i:i
646 51:1 :;61
-
14-
Tuhl'H:1I1usi!<
(all forms) Year
Accidf'ntal Deaths
Gastritis, Duo'
Nephriti:< Suicidt> an.j
BI,2 N R 159.7
BE47,48
I
denitis. Enterjti.~ and Colitis B36,43h
Nephrosis BE49 B38
'N R N R 1:10,7.
N 5,857
R 13.2 17.1
N 12,979
R 29. 3
1900
70, S72 i 9~.1It
,1)8,012 6a.27;11 21, H70 2·1, 190 ;3:), ~H4
1905 1910 19Ei
201. 8 224. Z 212.9 1
U4.2 206. ()
B,ORS 9, 362 lO,B7 10,614
19.9:-\1 26,347 38,69:-; :)1,9U
-I-?'. ;) 32. 7
112, Utl1 114,770
43.7 14· 9 1-6· 8
102,9<13 116,474 141.992
U6.1
loS. 7 18.8 19.2
71. 8
19Z0 1921 1922 192:~
99.2 103. i
119, ;")26 124, 112, :t~8
213.0 21~.
24,291 25,338 71. ]66 25, 557
43.3 11.6 123,7 ·13.8 41·9 42.2 47.6 41.6 4~.
1;')3. 126 lill, 990
272.9 :::67. 4 :!,s·1. '1
11,337
20.2
39,320 llO,409
8
li, ;)20 11, -167
2().3 19.9 19.3
106,3 107.8 105.8
117,036 93~
203.4 193.7
163, GGO 1:iO, l:l4
62,046 61,637 .1~1.
1924
11,244
19'2:) 1926
114,650 111, /28 118,112 118,J77
En. 7 18:'i. i 193.3 lYO.:<'
24.779 25, -lU 2!;1,102 Z:;.tlZ4
HO, ::35 13~),47H
237.2 231. 23:~. ~
12, 229
20·7
:lJ:1
100.3 9tL 2
12,461 12.817
1927 1928 1929 1930 1931 1932
148,171 1-14, 96~
242.:3
ZO. 7 21.0 Z1. 0
59,110 39, 3;:).:1 62, -t~J
97.5 100.6 103.2 93. ;)
6
13,012 12,718
122,221 lUI. 345 120,629 118,023 12;:),492
194. 2 183. 3 186, I 179.4 187.9
26, 412 26,0:;4
0
134,993 140.946 138. ·IOH
24ft :-1
.to. 8 40.3 44.6 4v. 8 41. X 43. () ·12.6
:nO.7 213.3 206. :~
13,919 14,322 14,725
20.2 21.8 22. I
64, 930 62,910 G3,79() 60,899 .19, G3S :19,059 ;)3,310
9S.J 92.6'
26, :;32 29.~li
1:~5.
761
22.4 22.1
1933 193J
129,202 126.337 110,599 119,3l:~
193. :( 1':-;6.7 Iv!. I
14.780 14,141 1:;. ;)Y!
130,262 130.763 143,8;')3 143.42,1 147.685 153,209 152, 019 153,250 160,398
192. S 190.4 206.:203. 8 209.:2 ~16.0
31. 680
21. ;) 20.6
89. I 87.3 80.S -.!') '} u_. v
19:15 19:~6
28, 721 29,928 29,951 31.483 29, lUg 28,147 28, :373 30. 959
171. :,
37, ~3~ ~o.
1937
118.460
IGS . .J 16:~.
14,270 U,HIO 10, i6G
3 :~
.')5,8.,13
79.4
1938 1939 1940 19'1l 194~
H.6 lJ. \)
IEi,4;'i5
6
17.
61, :J3S 3~,
111. Z:tl 106,889
1:;6 . ..s
15.2
31-: 74.6 67. 9 6:3.9
209.6 210. ';' 218.4
38.9 :19.3 4~.
Hi. -l
9, 831
13.6 13.3 12.7
34,142
9;;,3;'3 9:'i,648
131. 1
9,GS.s 9,363
49.423 :;0,598
I
130.2
1943 19-14
1945 1946
1947 1948 1949
1'16,2-H
187. '2 179.9
?8.471 38, 96() 34.2:i9 :1~,
'\9.3 48. 7 41. 9
101,4:34
129.9 104, 1 87. 5 82, 4
t2,262 12,753 14,201 16,311 1
1:).7 13.9 17· 4 19.6
,1;;,017
.)/.6
]43,909 138,113
83,264
36,561
168,8 IH1 . ..i
71, S16
33, 7tl7 26, 97~
43.7i 11. :2. 29.2
195() 1951
1:21,769 93, 307 70, 5.18 57,849 55.124; 46, 7:1:) 43, 7Rl
850
39.5 37.8 36 .. j 3ll,8 :~9.
G8,S4!) 57,214 40.139 ;~4, 4% 28, 289
110. 3 82. ~
31,968 31, 21:i :H,236 34, 812 :B, 2(i:J :)3, 133
67.7
1G,415
18.2 loS. 4 1
24, 701
1932 1953 1954 1955 1956
66.:) 62.4 52. :1 ·1H. ;)
.1:1. 1 46. 1 39.0 ;)1. 7
15, 776 17,731 20,635
22,108 2U.HiO
20.4 23.4
2·J. oS 23.2 22. 1
t1
19,311 19,122
:~7. ~1
22,477 21, 777 24.1
2 \. 4
36. 7
27,00(,
29. 9
19, 439
-ll-
Marriage Annual Change of Marriage Rate. The marriage rate in this country since 1900 up to about
1935, had heen approximately between 7 and 8 per 1,000 population, except some slight irregular changt's before and after 1920. It went up to 9.5 in 1937 due to the war which started in the same year. Although the marriaf!;e rate went ~Iown rapidly, it again rose to 9~11 after 19.t0, as the marriage was t'ncouraged by the government in tht' course of development of the war. The marriage rate in 194.7 after the war was 12.0, which was the hi~best rate since 1900, hut this is considered to he a temporary stale caused by the repatriation aftel' the war. It decreased to 10.3 in 1949, and as a result of further decrease, it went down to 8.0 and 7.9 in 1955 and 1956. respectively, to the same level before the war. (Refer Table 5).
Divorce Annual Change of Divoree Rate. The divorce rate in 1900 was 1. 42 per 1,000 population, and
since then it kept decreasing until it became 0.62 in 1938. But after the war, it suddenly rose again showing about 1. O. This is partly because of the increase of marriages after the war, and partly because of the new concept of the people towards divorce. In 1956. however, the rate decreased to O. t\O. (Refer Table 5).
8, Life Tables in Japan
Expectation of life at birth was 63.9 and 68.4 years for male and female respectively in 1955~ according to the abridged life table~
As it was 50.06 and 53.96 years for male and female respecti-
vely in 1947, the length of life has become extraordinarily longer than in 194.·7. The improvement is largely due to the death rates in younger ages than in older ages.
Table 6.
Mortality Rate (qx). (a).
Male
(Per 10,000 Population)
Age Year
, 0
1
2
3
4 138 112
5
1
10
li'i
20
25
:-10
:-1:1
40
,15
SO
55
1~91= 1898 1~~44;1-296, 1899-190311,569 1909-1913 1,50!)1 1921-1920,1,620 1926-1930 1,401 ' 1935~1936 I
369 441 4801 431.
1
201 2591170, 236 H7 2611 166 2241 150
100~4sT 79 711 70. 33 3')! : 1
'-86 79; 77 82 74 ,
60
65
70
i ~ ,
103' 100 98
1945
i~~~ 1948
1, 130j 370 205 135 91 100 92 77 76 89 119, 173, 240 11,989 566! 295 228 142 100 101 158 474 664 90 376 307 287 3S0 460 ;)7, 2:-1 42 1141 151 14 " 13? 135 166 222 312 11, ~~Zl §~~, i~~1 ~~ 51 :w 26 77 96 841 R5 91. 111 148 212 :i:=i0l 182 98 1 75 52 13i 23 58 78 76 73 79 94 128' 187 1
I
I
ng
: ; ~:I :: 1
12
52 82 48 83, SO 89 60 lOS 98 1
88 84 85 95 86
~J:~ 1121 141 186 256 365 511 87 104 133 178 24i'i 351 512 81 96 122 164 229 32R 476 87 105 137 1861 263 392 5711 77 96 127 175 250 367 549 1 1
745' 7451 69S[ 848 804i
,
36i
355 648 461 333 281
5Ul 7671 920'1,291: 690 I, 0471 511 7511 423! 6231 419 406 43H I 379 ,
1
,
1949 19.10-1952! 1a50 19"1 19.12 193:~
663 1841 1111 567 115 89 5901143 100' 576 1311 92 5051 90 74 _ i ~) 111 I
1
74, 66' 67 71 57
50 46 48 48 39
34 31 35 32 271
11 10 7 9
III
1
19 12 17 14 12 12
501 31 39
69
42 55
31, 25 24 25 22 1
44 3·1 32 31 29
66! 44 55 441 36 33
65 45 57 45 39 36 36 32
73 56 65 57 49
gO 121 178 272 75 107 161 24" 82 113 170 272 75 108 164 2:=i9 69 101 156 236 6:'i 60 60,
6Z91 617
665[
594~1 1
19;)4 1935
462 I 417 1
87 1 66 70 56 08, 46 1
53 37 47 35 36 , 28
26
1
81 II 5i
251 32 I
29: 29
8
10
45 46 411
99 157 245 397 96 149 226 328 93 H2 224 3551
646
5141 561
-
12 (h) .
Female
r Y~ar 1
-
-
0 -
--.
1
2
I 3
,
Age -
-
,20 ,
-
,
-
-
-
-
-
-
5 9H 81 761
10 "HI :18 40 :fi :{()
15
23
30
35
40 -
45 I j() -
---
--
5i'i -
60 -
63
70
'1~91-1~98 1899-1~lO3 ]909~1913
1921-]925 192G~1930 ,
1, ,109 1,4;;0 I,-HO 1,241
I. 338 4lG 2i1:l 1931 1
1
36O, 260 ,137 239, J76 263 ,121 227 1
136 173 117 147 1041 174' IVi };'16 toG , ,
7H 71
I i 60 90, !l8'1 102 64 96 99 100 76 10S1 1°'1 98 90 121; 112 lOS, 73 106 96 89 i
,
1933-1936 1945 1916
1947 HI.t8 1949 1900-1952 1950 1951 1952 190:{
992 353 200 \, ri(-j91 428' 222 96:1 244 161 766 32G, 190 :)64 17G 99 [lS9, 184 LOS -1,97' 116 88 526 116 ~19 S09 1 12!J, VI 442 90 Ti, 449 40:1
136 93 66 172 106 7·1 1 18 107, 109 fRo 18 -? ::i° l :11
,I
,-
2;)' 78 21 lSi 11 11 10 91 6 6 6 4,
,0 60 66~
70 96 1 91 1 81: 82 90' 9:') 121 \591 227 120 1~61 181 113 150 16111 179 220 280 3S:;, .10 .6 90' H' 86 90 10-1 137 1491 253 31! 691 771 73 1 70, Ti 82 III 144 ~21 561 7() 64 62 67 1 7:1 97 13-1 1 193' 1 I 1
1
1
110 118 121 1·16 107 114' 115 I:l~ 102' 1071 lOS 1:10 107 113 113 138 931 1011 102 126,
I
191, 28:~ 410 61S 185 Zfi:i 399 G07 173! 2·16 36;) ,166 l&t· 26-1, 3YR GI6 169 2-t21 371 :377
..
311 :i33 318 ",12
390 :182 3Js :120 293 ·149
,-
2'1 14
I 1
48 43 1 48
33
:29 :1I 31 28 2::;
22:
13i
48 28
69 53
-11" 401 36 341
18, 11! 10' 9,
371 271 ,
li21 :i8 ,19
09:
:37
10 49
421
61 SOl
19:34 193::;
8"' " 69 ;)6
366
31 54, 46 -12 3-1' (j6
?-,
2421
?2 :lO' -, 'rl 20i 19 "4 1G 1 I
:19
1
,15; 34
1
51 .')6 43 1 50 37 43 1
71 G9' 66
62 5:3 ::;3 -t3 46
186 2.':17 80 1151 169 1 275 88 122, 189 3tH 8-1 118' 181 ..,.-1 991 10Z 261
921 126 "
H5 4:i5
--1-6;) ,124
"
8
1:{1 25 I
30! 27, I
3:1
32 28
10' :1];1 34
56 66
75, 110 16G 268 ;1:33 911 U7' 223, 367 96 H3 2;{6 :·192
I
Tahle
I.
Expectation of Life at Birth.
(
0 \ eu)
Year --
~1ale
FemalE'
The 1st Life Tablf> The 2nd Life Table The 3,d Life Table Thl"' 4th Ljfe Table The 5th Life Tahle
1891 ...... 1898 1S99--H103 1909-1913 1921--1925 1926--1930 193ii--1!l36 1945 HH6 1947 1948 1!J4!:J 1950--- U132 19;:)0 1951 1952
42.8 -43.97 l-t-.25
44.3 -1,4.8;"5
4-t
,:i
42.06 -H. 82
43.2 --16.5-1
The 6th Life Tahle Abridged Life 'fable
lG.92
23.9 -4~.6
The 8th Life Table Abridg~d Life TaLle H
"
30.06 5::;.6
19.63 37.5 51. 1 ;)3.96
59 . .! :;~l. 8 62.97 61. ;) 64.9
Tht' 9th Life Table Ahrirlg-t'rl Life Table H H
iiG.2 59.57 iit\.O 60.S 61. 9 61. 9
63.5 G:i.i
H H H
1953 1954 1953
63.4 6:1.9
67. , 68.4-
9.
Deaths by Leading Causes
The leading causes of deaths in 1936 were vascular lesions affeding central nervous system, malignant
neoplasms, senility, heart diseases. tuberculosis, and pneumonia and bronchitis etc. Causes of deaths inf!reased from the pre\:ious year were vascular lesions affecting central nervous system, malignant
neoplasms, heart diseases, senility etc, whereas those decreased
weff~
tuberculosis, pneumonia and so no.
Table 8.
Annual Change of Dt>aths and Death Rat!'s by Leaning Causes (I900--1956). (Hate pt'r 100,000 PoPulation) (Con'd to the next pagt') Malignant Neoplasms Sf'nility Pneumonia and Bronrhitis B31, 13a, 32 Heart Diseases
Vascular Lesions affectillg C4~ntral 1 Year
Xef\'ouB2~ystem Number Rate
BIB N
B45a R 45.6 56· '2 6;:).1 69. '2 72. ,1
B25-2i N R
N 56,7G8 G4, :'i36 [-)8,168 :')8, 706
R 127. 9 136.8 116.0 108. 9
N 98,520' 1H,622
R 222. () 213.0 1
1900
()9,1198 7;;, ~146 (52, .s45
156.6 161. 125.7 158.6 160.7
190:1 1910
°
20,212 26,527 32,5GO 37,2\-)6 40, 102
127,9Bl 186, 6:~2
256.0 2:i3.5 407.2 292.9 287.2 268.2
31,810
J91:1 1920 1921 1922
67,480 8.7,860
125.2
3:1.,4I:l 3,1,401 37,27U 37, 145 1
'12,645
131.1 133.5 132.3
22,).510 lU4,393 163, 199
1
63.6 62.0 G:l. 9 66.4 6:>. -1
!lO, 194 \11, U87
40,351 40,578 41,387, 41,038
71. 9 71. 4 72.3
74,
~J27
160.3 163. oS 17:').7 162. 1 163.4
75. 206 75,763 73,15S 69,223 66,799 76, 522
HJ23 1924 1925 1926 192'{
9-t, 258 102,440 9:'), ~H8
131. G 125.5 117.0 111.0 120.8
154,338 157,8f14
1
41, 989 40,185;
73.0' 69.1, 67.11 62.8i 63.5
70.4 70.1
270. B 275.1 229. Sl 1
41,50:l
162,80°1 138, 101 151,956 1:l7, 122
39,731 37.796 38,786 39. 711 41, 3·121 40,9:'iG 41,697; 38, 784 39,897 42,283,
98, :-\15 101,300
42,33:1 42,627 44,267
16.')_ 8
70.3 99·8 71.3
248. 7 253.2; 240.7 200. 1 214.5 211.3 195.11
192R
102, ;i·n 108,014
165.3 171-6 16:t 7 165.0
123. :~ 124. ;)
64. 0 6S. " 64.1
1929
·13, "192 44.687
1930 1931 Hl32
104,5"10 106,976 lOG, 9-17 11ll,4-H
69. 1 70.0 68. (1
7H, 37:3 7;;,735 84, 774
151,4;;9, 127,784
118.6 130.8
44.306
1:38,474
64.3 58·9 59. 7
162. :3 16ri.4 16H.7
4::i,030 46,606
'.
1933
68.4 69.8 70. :l 71. '2 70.4
76, 736 82,452 86, :i29 78,421
116.6
139,014, 130,330
123.4 127· Y 114.2 130.8
1934 Ul35
114,192
47,732 -1-8,856
149,776 128,015" 136,897 l3(),922 i 143,017
221. 3 186.4 ,
114,268 117,
166.-1 16\).3 168.4 179· 3
39,628 12,65U 42,:369 47,192
62.5 57.7, 61. 3
1936 1937
,s·n
ci8,989
9U, 990 8·1,02·1 97,921 91,496
118,-156 126,540
1935 1939
130, ,196 127,523
184·0 17G.R
50,419 ::iO,21X 50,898 30,676 :11,6RR
71. 7 71. 1 71. 8
119· 4 138.7 133.2 122.7
196.7 l,sG.l 202.6 218.6 18!. 9
60.5,
66.9 66.5
155,06() 131,9:11
1910 19·11 19-t2 1943 l!l-U
69.9 71.0
89,()23 89.3:13 93,4:36
'17,166 1 4;'j,27::i 42,280 43,25:l 1
62.4, 58.1
124,786 12;'), 001
171·;; 170.2
122.8 129.9
124,915 127,322,
171.7, 173.3
52.693,
71. 7
58.9
1915 19-16 1947
101, 095 94.329 100,278 10;),728'
129. ,1 117.9 122· 6
53,047 55,677 .S8,769
67.9 69.6 71.8
78,9;i3 64,074 66, un ::i,s, ,112 :19.796 59,514
lUI. 1
136,524 78,911', 81,R12
174.8'
4,s, ;'j7G
1948
80.1
98.6 100.° 1
49,046
I
62.2 61. 3
1949 19i1O 1951 19;)2
80. 9 70.2 ,
127·1 12;'.2
64,428 66,354
77.4 78.·1
77,565 .,;):J;) 69
9:~.
2
105,858 110,3:"}9
70.7 69·3
__ J
82.2
52, 763 53,377 1 ;)3, 730 52,603 56,:177 53,128 1
64.5:
64.2 63.6, 61. 3
1953 19:14 19~5
116. :l:>1 116,925 121, 504 133,729
l28· 5 133.7
69,48R 71,578 75, :109
80.9 82.2 85.3
57,5R6 62,091 48,256'
67.1
1
132.4 136.1 148.2
67,514 61,334 59,932
77-6 (i9. S 67- 1
71.3 54.7
:~J 60.9'
77,721 81.710
87.1 90·5
43, 154 43,561,
48. :1
1
54,351
1
1956
68,3:!5
7S.7
18·3
59,066
(Note: The figures for 1956 are provisional. The international abbreviated list number of cause of Jt'ath is respectively shown together with each cause of death)
-1.1-
Tubt-'rculosis (all form,,)
Accidental
Deaths llE47.48
Gastriti~, Duodenitis. Enteritis ami Coli tis
Suicide lIE49
"\"t-'phriti:-\ and
Nephrosis B~8
BIt:'!
H36."-1L
N
H
N
R
N 58, Ol~
R 130, i
N 3,857 8.083 9,362 10, 137 10.614 11,337 11,520 11,467
R
N 12.979 19.931 26.317 3S,69:1
H
1DUO 190:~
70, R72 9;),171
] 59. 7 201. I:!
13.2 17. 1 1R. 7
63, 275 21, H70
134.2 206.0 216. 1 2;';6.3
29.3 I ') ') ~.
"
uno 1915 1920 1921 1922 192:i 192·1 1925 19~6
112, DiU 11·~,770
224.2 212.9
13./
102, 933
24, 190
I'Z3,91:58
223.8 213.0 :US.8 203. 4 193.7 193. 7 18:1.7 193. J 190.~
25,944 24,29J 25,338 71,166 25, !'iG7
44. 9 46.8 43.3 41.6 123·7 ·13.8 41.9 12.2 ,17.6 1
116,.-174 1,11,992
18.g
71. S
19.2 20.2 2().3 19.9
3-1,9H ::19, :J'W 6ll, "109 62,O-!6 61,637 ;19, 33:1 5~1.
09.2 1O;'i.7
119, i'i2G 12-!, 328 11 7. 036' 11'2,938 11-1, 650 111,;2~
153,126 Lil,990
272.9 267.4
10o,:l
163,660 150,134 140,3~5
284.4 257.;)
107· 8 lO:J.8
11.
2~·1
19. :J
24,779 25,414 29,102
237.2 23l. ?< 242. :)
I:!. 229
20. 7 20. 7
] 00. 3 m~.
139, . 178 14S.171 144,962 1:l4,993 HO,916 138,409 135,761
12, 161 12,81 i 13,012 12,71S 13. :1]:) 1·J,322 14, /2:;
1927 1928 1929 1930
118,11'2 118,3;-7 122,221 lltS,3-15 120,629
~l.
25, 82·1 26, .H2
19·1. :2
41·6 42.0
233.6 246.3
21. ()
° ,
110
:2
S9,5:lJ 62,·Ul 6~,
97. ;)
100.6 lU:-L :!.
:!O.:!
930
IS:'). 3 186.1 179. ,t 187.9 192.;; 190.4
20,034 25,053 26,532 29,817
·m. ,; 38.7 40.3
220. 7 213. ,,)
:2.1. X 22_ 1 ~2.
62,911) 6:i, 790
H)31
98.1
1932
118,023 12;'), -192,
2U6.
:~
4
60,899 .=i9,:=i:B
92.6 1 H9.1 ~';'. 31
1933 1934
130,262 13U,763 1..J.3, R:iii
31,68U 28, i21 29. 92~
44.6 16.8 41. " 43.0 42.6 44.6 41. [) 38.9
129,202
193 . ..j. 186. ';' 161.1 171.5
14.780 1-1. 141 1.1,394 14,270 12. 190 10,766 ~l,
12.1
126,337 110,599 119, :·H3 , l8. 460
21. 5
39,05D 53,510
19::l.3 1936 1937
20.6 22. 1
,sU. ~
206.7 203.8 209.2 216.0 209.6 210.7
193H 1939 1940
1"cU, 424 147,685
29,951 31.483 29.109 28,147,
168.4 163.6 156.8 147.4
:W.:l 17.3 IS.2 ]3.0
79. -!
IEi,155 111.232 106,889
61,
:1:);) ('j'J 'J
1:):-1, 209 152,019 153.2::10
38,31-: 54,142 49, 425
351
7J.o G7.9 (d.\)
1941 19..1-2
28, Si3 30, 959
3B.3 112. 1
95,353 95, 648
LU.l 130.2
9. 6:iH :1, :~6:~
13.3
160,39t-l
:n8.4
12.7
SO,398
1943 \9-H
19 !S
19-H:i
19-17 19-18
1-16.241 13~.
IRi.2 168.8 146 . .:1 UO. 3 82. 2 66.5, 62.452. 3
38,4i1 38,960 34,239
49.3 48.7 41.9
101, 4iJ4 83,264 7],546
lU,!::J09179.9
]29.9 101. ,. 87.5 82.4 67. 7
12,262 12,7!i3 14,201 16,311 15, 4IS
13.7
43,017 3G,5Gl 26,9';"8
,'i7.
(j
13.9 17· -I
1:5.7 11. 2,
19-19 19:)0 19;)1 19;)2
113
121. 769
32,850 31,968 31,21;) 34,236 34. ~12
39.5 37.8 36.-1 39.3 39.1 3i.3 36. 7
68, 540 57,214 .t;'i, !'iS2
19.6
,0. ,.,8 53,124 46. 7:33
93, 3o'f
IS.2 18. ·1
21,701 22, lOS
;")3. 1 46· 1 39.0 31. 7 2\J. 9
13,776
1953 19511
57.X4!.l
40,139 34, ,136 28, 289
17,731 ~O,
20.4 :!3.-1
20, 160 19, :ill 19,122
23. 2 22.1
633
195ii 19:i6
33,265 33. 133
22,477 21,777
23.2
27,OOG
24.1
21. ,)
-';.
Table 9· t",n
15-
Per('enta~e Incn~asc~ or Decrease in Death Rate;! by Selected Causes I
Internatinnal ahbrl'yia· list number
Causes
<;[
Death
Year 194/
Year 1951';
B12 BIB B45 a fi31, 4::53, 32
B25-27 Bl,2 BE17, 18 B36, 43h
BE'!9 839
Vascular Lt>sions affeeting Central Nf'rvous System !\.·falignant Nt>opiasms Sf'ni)ity Pnt'umoni'l ano1 Bronchitis Heart Diseases Tuherelliosis (all forms) Accidental Deaths (;astritis. DuocjPllitis, Enteritis and Colitis Sui<:ide Nephritis and Nephrosis
11. 5
10.9
+ + + + +
+
8.6 0.7
+
6.6 22.6 11. 8
+ +
.,3.9 8.3 13. :~ 18.9
27.1 33.7 7~. 1 13.3 7·1. 5 12.2 81. 4 17.0
73. 1
(Note: The ratt" for 193,1) wa.... supposed as 100)
fig. G.
Death Rates by Leading Causes in 19G6.
Kab. I V;uc"la. lesions a{fe~'iDg central ner~nus system
Senility
1955 Pll"urnonia and hroncllitis indudinjli pneumonia of Ihe newborn. A,><:idenla. indudilll': motor vehirle accidents. enlain di"" ..ses of early illfancy. exd"ding pneumon'" of IhD newborn QDd diarrhea of Ih~ newborn .... GaoCr;hs. dnodenit,s, enlerili~ and .-..lili,. ioel".l,n!; diarrhea of Ihe n"wborn ..
~ !95f; .................. .
Suicide and self·illflicted injury··
10.
Maternal & Child Health
Maternal and Child Health Programme Recelltly then- has bc>en a steady decline in the maternal and child deaths. It is generally considered that this cleclint> is due to the progress of !?;t"neral puhlic health programme, especially the expansion cf Ihe pregrammps for maternal and chiln ht'"alth, environmental sanitation, and wide ust'" of munern rnedi~ille.
The government activitie~ for maternal and child health proga.rmmes are run hy the local health centers, which indune the following services: 1) Mother and child dinic twice or four times a week tlnd the travelling clinic lwi~e a year (mothers' Ctls{'s about 965,000: children's cases about 2,76J,OO() in 1%5). 2) Visit to mothers· homes by puhlic health nurses (ahlHlt 1,4:19,000 cases in 1935). :n Opening of mothers' dasS("s (i,639 cases iII 19.'1.'1). Parallel with the government acti\'ities, the voluntary community aetivitit':s haH,· been encouraged since 1954. and the {:cmmunity organizations for maternal and child health were set up in ah:,:,ut 1,50!} cities and villages. For the- purpol'e of furthering maternal lind child ht"alth programme. the national government felt nece.~sity for carrying OLlt measures for (he sp~cial diM'ClSt>" in m()thers and cbjldren, and thert"forf', th~ government has planned the &ystem for t'arly diagnosis and treatment of pregnant intoxication, ri(:kets~ ano cop~enital dislocation of eoxal joints in children, in addition to the discovt'ry aniI care for premature iufants; this programme has been already carried out locally.
Physically Handicapped Children's Programme The proj:!:ramme fOf the cripple~" children has I;rown rapidly since 1948. The prcpamme i" run on a national-prefectural basis and indudes tht'" following fouT kinds of services.
-
Hi--
· I" -. 'lth centers ;) h ea Consu I ta.tlOfI C IflIC IS run by 13" . . .. 23 ,783 \ I'hildren rt'l'ei\'ed this serviet" in 1936. Short-ter m treatmen t by the de5ignat ed general bospital,; is pur('i~ast>d Ly th.e gm-ernmE"n_t under this proaramm e. This is aimed at the early trE'atm~nt of the disease .• Iodlll'h may de\elop to physi('a{ disabiliti es. 2, Fi1 children \I.·ere giH'n this lreatmt'n t in 19:13. (Fi~un',,; fur 19;;6 are not a,-ailablt-" vet~ Hospital. and.h;lmt "s for erippled chilrlrt'n. """hid) providt> inlE"grate d "t"Hic!"s of rc-haLi~ilation, art" being establish ed by ;')0-50 national. preft'rlur al fund. 21(1,:;;13 hed,,) .are now establish. ed, Prosthf'li t' applianc es are prm--ided under tIl{' prol?ramlllt". 3. 607 apphanee~ were prondf'd and 157 ease." rf"r.ei,-ed repair service in 193;). (Figurf"s for 19;)6 are not a\'ailabl~ yet) Tahle 10. Annual Change of Materna l Deaths hy Leading Cause;; (1931 ....... 195!i). - ---Rates(Pe r 10,000 Ii",,· hirths) Year Number
eaust's of Deaths Total Accident al disturban ce of pre~nanf'y Haemorrha~e during ehild-bir th Childbed fever Toxaemia !' of pregnanc y Otht'r dist'ase,; during child-bir th Table 11.
-----1933 I
--~--
19;)1
1932
195,1
1935
I
1931
1952 1%3 l!.l:J4 1955
~-r-
3,691 , 3, -117 3,3'n 3, ~62, 3,054 6-') ~)36 0_ 62;:) :169 588 1,02-1 ~31 931 H96 893 139' 26:~ 213 194 179 1,285 1,291' 1,286' 1,26l 1,116 HO' :,94 167 :172 393 1
17.3 17· 0 18. 1 IS. ;) 17.7 3.1 2_ 9 3.3 ~). U 3.3 4.8 4.6 4.8 ;i. 1 -:1. 8' 1.2 1.1 1.0 I. (l (l.S G.O 6.4 6.9 7. 1 6.5 2.2' ~.ll 2. u ~.2 2.3
Annual Change of Infant Deaths hy Leading Catl~e5 \l93l-19 55). Year ;\umber I
Rates (Pt'r 1.(100 liv~ births) ,-, -
I -
Causes of neaths Tolal Tuht"r('u iosis, all forms Syphilis and its ~\f'lJuelar Oyst"nter y Diphthl'r ia Whoopin g collgh Mt"aslr"5 Tetanus Maligna nt neoplasm Menillgit i.'l. except meningo coccal and tube:rcul ous Influenz a Pneumon ia Bronchit is Intestina l obstructi on and hernia Gastritis , duodenit is, enteritis and colitis and diarrhea of newborn Nephriti s and nephrosi s Congenit al malform ations fiirth injuries, postnatal asphexia and atf"le(:lasis Other diseases pe(,1I1iar to ~arly illfancy and immatur ity unqualifi ed Berib!'ri Accident
19;31 1"
HI.),)
1~,)119.'l~19,1319.'4195!l
122. g6S 99. 11-191, ,,\-2·1 78, 914 6.s, .sOl ,-) I. :) 19. 1 18.9 IH. fi 39. 8I 872 1, :n--t
478 145
1
--t~O
82 1
29RI ]76 .\8
361,
2,022 1, 3Wi ' 497' 86
3,40:~ 1,088 2,3H 1,179
S~5 1.064
20;)1 ]21 C)O
126 10-1 241
299 O. --l O. 1
481· 73
-1--16 ' G.J..
341 oS3
1, :~06 I7H
':';9:1 73
775 I
6-19 84
9-1 0.:2 0.1 0.1 0.1 0.1 H5 0.10.1 ' 0.10.1 n.11 36 1 O. O' 0.0 O. 0 U.O 0.0 252 n.9 0.7 O. ·1' 0.6! 0.2 9221.6 0.;511. 30.7 O.:JI 315 0.2 0.0 O. 2 0.2 0.2 R7 1 O. O' U. O· 0.0 o. 1 O. 1· 1153 O. 6 U. 4 0.4 0.41 0.3 1090.1 0.20.2 U.O U.1 8.4 1.1 I
~~ U.3 O. ~ 0.2
22,7961 8. 53718, :~;)416, ;;28,14, :)06 ,10.7 9,:~ 9. A 9.3, ii,174 ,'1, 07'1 :~, 216 2,601 1,819 2.6 2.0 1. ';' 1. ;)1 S~O! 69;. ~~~I ~n7 ~ 8~8, 0.4 U,3' 0.4 O.~) 14, 11810, 3L , 8,.);1 I G. 96~ .), 8~1 6. I :i. 2 4. 6 3. 9
396
:l. 4
O.~)j
2,239 1,216 t, 90')1 1. 7';1 l,825 1.0 0.9 ' I 1
r;,1 194 80,1 176 116 .'0 O. I O. 1 0.1 0.1: O.() 4,854 -1, 146 3, ~37 3. ·Ui6 3.fiG-l. 2.2 2.1 2. I' Z.O 2. I'
o. G ;
1.0 1. I' I
47; 33110. 611'36, 63331, 9K-! 2~, ItF 22. 1 :?tL :3 19. G18. 1 Hi. 2 1 I.
610 1. U O. .s, (1.6 0.:::; 0.4 1 2,066 2,mU, 1,8:J;) l,dS 1,73~) 1.0 1.0 1.0 1.0 1.1)
~,O:)lj ,1, ~14?
1.
1~~1
~"',!
11. Health Education Th~ local he-alth centers perform extensiv e health educatio n programm e in the field of ('()mmllnicablt-" dis{"ast" pr{"Hntio n. eare for infants, and insect and rodent control. and promotio n of em-jrollm entai sanitatio n. In addition, school health educatio n is performe d by sehoul authoriti es under the dir!'etion ()f the lor:ij] ".ducalio n hoard, whereas the industria l hygiene educatio n is conducte d by local lao or standard offir:e ... In the rural aff~a, agricultu ral extension serviee undn the direction of the Ministrv of Agricult ure and Forestry inciudf"s substant ial health educatio n programm e to the farmers. Radio broadcas t, mm'ies, slides and t-"xhibits are f"mploycd extensive ly. Summer seminars are held annually for training and for conferen ce, and the reghnal di::lcussion groups meet ofte.n for the f'xl'.hang!· of views and ideas. The prouuctio n of health films and !>Iides are increasin g rapidly for the use at health cenlers and for women's and young peoplt-"'s meetings .
-
li-
12_ Tuberculosis Th;:- deaths from ttl~retllosis continues to decreast'. In 19:16, there were 43,782 deaths, the ratio of which was 48. i'i per 100,OOU population, and it was the 5th one in the leading causes of death, As waiO in the previous yt'arl". the decrease was remarkable among younger age group compared to the older and productiv(" age group.
In ord",r to aiOcertain thl:' at'tual condition of thf' tllbl"rculosis prevalence ill the country, the rnment conducted the nation·wide survey in 19ii:~.
~o\"f'
fn this survey. 211 areas with 51. OIl population
\H're selected by the stratified random sampling method, and 99.3.% of the total populatioD of the areas were examined with Ta<Jiograph to get informations on the number of tubercuLosis patients. type of tuhen:ulosis. kind of treatment required, and the consequent re-quirement of the medical facilities. As a resuit of the suney. it was t"stimated that thl'rc wer(' 2.920,000 patients, 3.4% of the total population, who nt"ecled medical care. In and it ion to this ~roup. it waiO also estimated that there were 2,610,000 per!"<ms who needed r('st or care but nnt medical care. Dased on the result of the survey mentioned abcwe. the Tuberculosig Control Law (Law No. 962 of 19:i]'l was amended on August 1955. which now requires health examination for all population adove 6 years of age.
Tuberculosis Control Programme The tuhe-reulosis control programme as provided for in the Tuberculosis "onlrol Law has been car~ rit'd on throughout the country as the years passed. The brief summary thereof is "tMlen below,
1.
BUfh;:et The budget for the tuberculosis control prof!;ramme amounts to 14.9 Lillion yt"11 in 1957 fiscal year.
Thi~, however, is only the national expenses and does not include the expense:,; hy the prefectures, cites~
towns amI \'illages. 0.7 billion yen for health examination and vaccination, 12. S Lillion yen for man~ agement of public sanatoriu, and 1. 7 billion yen for grants to tuberculosis patients are providen in the national budget. 2. Health Examination ann Preventive Vaccination According 10 the Tuhereulosis Control Law, the teachl"rs and pupils in schooh. t'mployecs of factories and (ffices, inmates of certuin i.nstitutions, ann rt'gidents in the cities, towns and villages receive the free health examination. except those under 6 yt'ars of age. In 19;:)6, ~9, 881:). -193 persons, 1;3 of the lotal poplllation, received the examination. The case finding rate ther of was 0.35%. which was 0.11% lf'sS than that in 1955. Among the negaLivt' rt'actors against tuberculin, 6,133,455 persons were innoeulated with BCG vaccine in 1936. (Refer Table 12)
Tahle 12. l~O, (l
Tuherculruis Health Examination and Preventive Vaccination (19:11-1956).
--'---;: --I- Year Per"'on~
-- T b
E~~rni~ed
Persons I 1 Examlflcd I ExamW;rl\ U ercu ln est wlth wllh I received _ __ _ _ _ _ diagn05ed Exammed PosltlVe I Mlfllature Radioas 'fB case 1 BCG Vacci· 1 nation ' Persons__ I~a_'_t_o~s __ R~iC!W!.~y_,_graphy _ _ _ _ __ 450,628 606,695 638,630 720.339 755, (lIZ _ 132,4001 143.5-20, 142.073 151.251 130,3151 103,370 14,211, 785. 1.0,387,504;, R. 126. 176 6,619,814 6,095,178 6, 4~3, 455,
p;:On-,-
L
1%1 1932 19S3 1951 1955
6,641,742 7,691,9461 17,421,80-1 15.441, 656 22,426,290 19,754,843 10,696, 729j 12,419,467. :::1, 921. 8421 18,516,913 11, 322,039 1.1,295, 449 27,325,800 20.933.818 12.931.124 17.020,518 26,531,151 20,459,3151 13,127.234 17.922,6741 19;)6 _29, SSX, 493 _2_3,_16_9_,_5o_5_1_5'_010_,_8_83 __21~~36, 253
1
890, 3~
(Nntt': A year stands for the cltlendar year period, exct'pt 19S1, which coveTS the p('riod April-Decem er.;.
-- l:-l-
:1.
Reporting anti Rl"gislralioll
TaLl/" 13. Year
Heporting of TIlLt'n:lIlt).~is Cases. R(.p~led -i\u-mb-er
Thl' reported rast'S by the practicing mcdieal dcwtors to health authorities are shown in Table 13.
Tllber~~llo~~_C~s~
of
4.
Medical Cart'
1947 19"18 1949 19~0
2017, :,97 382, ~n() lG 1, 903 .)~8, .)~)(),
Tht' expenses for tht> mt'dical care of tubcreulosis pJ.tients are provided, be"ides with the private cxpe· nst':". with t:~t' granb by v3rinufl types of ~eial in.'iUnlllCe, puhlic a~~il'i:anet> programmp, and ,also Ly tht> gm'nnment,d grants nuder tilt' Tulwr<'ul(J~is Control Law. 1t il:< estimated that tht' iotal c"p('nse':: for medical carc of ail kind~ of iIlne.;s hy all kinns of ~()urce.'i, hoth plivate and pllblic in 19;);:), were 2/'1 billion yen, and among thf'm 63 hillion yt'n, nearly a quarter of the total amount, wus for tuhercul,)sis. The Tubcrculusi<i Control Law provides the I ('2 grant to chellm-therapy, surgieal Irt'atments of all eases. :i. Beds for Tub"n:ul(l;;is Patients
1951 1952 19:13 19:1--l 18:;~)
R29 662
:'i.%, 631 ,)0/. 2-! I .12~1, :iJ(;
::;1/', 177 .) I S, 1 12
195(j
Tahle 14.
Expenses for !\lr:dical Care in 1955 Fiscal )' {'dr (in Hillion yen) XII-Kinds of Jllness 271. n 2-1,. t Tul:erculosis
Fund 'Total Puhlil' A~~istance Law ,TH Cnntrol Law I-1Falth Insurance;; Patients
The heds for tuht'rclIio.'il::; patients continue to innf'Il'H' a~ shown in Tabl\" 1::;. The a\,prage kn~th of slay of tubt'rcujo,;i::; in-palit'nt,; became shortt'r a.~ ",hown in Table IG. Tablt' 1.'). Numbf:'f of 1'B Beus by Year and Manager a IIIna I (~lvcrnment
63.0 15.2
UR. :) l~::;.
3.1
3. l 3L3 13.4
1
TaLle 16.
Average Length of Stav of Tuht-'rclllosis I n·Patients ,
Year 19;'11
Total ,
N t'
I Local
Association
Pllbli,~
1
Pri\ate
Year 1951 19;;'~
Total
TB Sanatoria
TB Ward in (;/'nerl HOflpital 1H2 ~:!~~ '):-~,)I I
-
J~;:;,:W-l
';'3, (H2
11 • .:'iSS 19.2~6 2.~,45::;
2S,
·IS~
1;1, OS!:!, 3:!.flOcl' '2~'.
19:12 1~J:~d 19;)4 19;);)
I."i:l,
~(il
118,1'~--t1
76, ';'.'11 /7. '.-)42 81. :16r; H-t.2..Jt'
::I:;,~7(i
19;:;6
210,U62 236, 183 2::;2,::;03
R3.832
3Q,368 46,8,,(6 1 ,)2,361
11.1. !H;S 5:1,187 ;:;9,5EI,
636 3.},942
]
~fi:l
1954 Hl,"j3 1956
2G9 2<J:.! ;)GJ 402 38:~
369 2,;)::\ :)10
63.989
4.), :')711 ;''1,521.
J."i(J -GiS 126
316 313
:-Eii
304
Annual Change of Death Rate from Tuberculosis The death rate from tulwrClllosis "'as 233.2 per lOO, (jon population in 1918, which wa" the hi~he,;t ralt-' sinet-' 1900. It .decrea!led in the course of ypars until it hecame 179.4 in 1~l;\? But it again started til ri~e and hecame t'xtrf'mel~' high in 194::1, showing 230.9. Nn a('curatf' data wt'rt' availabi'e for the succeeding thrt't' year,.;. However, in 1917. tht' ,It'ath rate was rt'tlueed to 18,.2 and !<till eOlltinued to uecrf'use year after year, alld ill 19:)('j it hrl'rtnlt' Ix ..). It will be also nptt'd from tLl' chart illustratf'd hl"low that the decrease Df rlt'alh rate in the pa.~t 10 years are remarkable in tht-' younger age group.
Fig_ I.
Death Rates from Tuberculosis by Year and Age Groups_
Fig. 8.
Annual Change of Death Rate;; from Tuberculosis by Age Croups.
,rei
I 1-
1951: I~
-~ge
[0
JO
41
'--------O"'~,~
q,fe
(Per1(lJ'JQ!JP~P,JI~ror)
-
19-
13.
Communicable Diseases
Communicable Disease Control Programme The communicahle clisease control programme is based on the Communicable Disease Prevt>ntion Law (1897), Preventive Vaccination Law (l94l'l) , \"enereal Disease Prevention Law (1948), Tuberculo.'iis Control Law (1931), Leprosy Prevt'ntion Law (1907), Trachoma Prevention Law (1919;, and Parasitosis Prevention Law (1931). Particularly, the Communicable Disease PreYt'Iltion Law provides, in detail, clis~ases with reporting ol>lifo!ation, isolation of patients, disinfection of lilt-' plact's, and the specific nhligation of the local and national health authorities. Till' ditwast'5 designated by the Law an~. cholera, dy.~(>ntery. typhoid fever, paratyphoid fe\"f'r. I'mallpox. epidemic typhus. scarlet fen·r. diphtheria. epidemic. meningitis. Japanese "U·, encephalitis. ann plaguf'. In andition, thi' following 13 di!reases are al,;o required til he reported of thPir occurrence Ly the phy.~ician;;: inAUf~nza. raLies, telanus. inf('ctious dianhf'a, whooping cough. mf'mdes, acute poliomyrlilis, malaria, filariasis, y;·llnw fever, anthrax, tsutsugarnll!'lhi disease, and relapsing fever. Preventive Vaeciuatirlfl Law was put jnb eJT('ct in Hl48. and the programmes haye been carried Ollt for the following diseases; a. Periodical vaccination: 1. Smallpox-:) tinws: 1--]2 months after birth. nuring 6 months hefore enterillg primary school. aJlfI durin~ 0 month~ before ji!:raduating frc)m primay s{'hoo!. :!. Diphtheria-··3 times: during 6--U month!> after birth, during 6 months hefore f'ntt'ring primary sdu)ol, and nuring 6 months before graduating from primary s('hool. :·L Typhoid Fcver and Paratyphoid Feyer-during 36.-..48 months after hirth, and thereafter. once
,1.
a year up to 00 years of agl':. Whooping Cough-twice: durng 3 ....... 0 months after hirth,
and during 12---18 months after
the first immunization. h. Extraordinary var:cination; Besides the periodic immunization, the law pro\"idt's immunization for ppidemif' typhus, cholera .. searl!'t fever, influenza, alln Wt'il's disease at the time of their epidemics.
Table 17. Year Disea.;;e Smallp:lx
Numher of Pprl'ons received Immunization. 19:;1 Th.uu·".:>,J 1
... 1
Apr. 19:)0-" Dec. 1950' Thou""ndj
19:12 Thuu ... nd
1953 ThnuSlind
193.,1 l Thou""nd
I 1
1955 Tho" ..."d
1956
-
'Th';-;;~nd\ 4,311 1 26,9071
26,867 4:~,
13,6:1'1 3:1,49R 1
:1,471 30,9751
1,716
5,215 32,976
5,212 29,3801
Typhoid & Paratyphoid Feyer Diphtheria Whocping C()\I~h
676
30,164 'I,01S 1,398 13..1 , 1
3,646
3.770 I,G:)6
1
8.789
,1,66.")1
4,848
4,603 1, :14.,11,
266 1,1551
1. G15 1 ~70
1,939 Kgi
1. 419' 61
Epidemic Typhus
511 1
31;
-
Prevalence of Major Communicable Diseases Dup- to the I:onfusion soon after the World War II, dysentery, typhoid fever, paratyphoid fc\'er~ and diphtlH~ria, together with cholera. smallp()x, and epidemic typhus were prevalent. Most of them. however, dpcreaspd rapidly and are now well under cllntrol, except dY3entery and diphtheria started to· increa!'lE' in recent years and is IItill increasing. Because of the int';'"ease of dysentery since 1919. the goyernment eonducted natiun-wide surHY a.~ to the epidemi,)iogical a;; well as social factor" of dyspntery preYalen('c in ]9:):~. Again in 193-4~ t'pidemillic!!i(,J.i surny ''o'as done of "Ekiri" (Serioll!' brain foormptom tf dy.;;rnte-r), )I.·jlh ,'a:'ocular lesion). Thf'ir results art' a" fll11()ws: 1) Dysentery survey . 805 ~ct"as with IH7,02,1 population were selectf'd hy the stratifierl random sampling method. ThH>. revfOaled: a) ratr- of Tf~sronsc was !)4,45% and rate uf reservoir was O. ;,)7%, b) Shigella were iSI'hted in it. 3% cf f!iarrheu-patients, c) distribution of isolated strain was Flexner 2a :l::i.4, 2b 27.0, 3a 1:2.6 .. and Sonnei 12. G, and 21
Dysentery Survey
01 majority of the cases was very mild. IIgP
Ekiri ~;urvt'y Suney revealed: a) around 70% of patients were children, who were at the
(1f 1--'6
year~, and
h) faldlity ralt' of Ekiri was HI. 6% in male and 19.3;'" in female.
1',,].1<-
I~.
Anllual ChungI' of Cast'''' Dt'ulils,
eili('
Rat .. and Dt'ath Ratt.,., for Commllllieahlc Ois('ase,.;. (1!:J2U ....... 19:l6) Pliratyphuid Fever
(Rat .. prc 100,O()() p')puiation \
'0 c
CfJ()it'ra YI-':l.r Cl.lSI'.~ C::t~~
Upt"lltny , [kalil' Ca.~t' II ,
Typhoid Fnt"I'
Smililpox 'Death' Ca~t>
Hale 9.0
Op8lh ..
I Hat .. G.2 0.1 1.0 0.1 II. 7 {).O
(:a..,t'.~
I
Hat~ 2:-~.
I
lkalh . .
DI-'alh , Rate
' I 1
C.ISI'"
LJM' 1
I
Hale I
D
r-,I)1"o
,tl . : D,'alh ,I
Rate
C.\F>I·,
Cas,· Rail'
D~aths i
Rail' I Ca~l'''
Rul ..
Dt-'tJlhs
,Dr-ath ~ H ill!-
I I I I
,
1920 1921 1922 192:1
11,9G9
3,11;-
12,72::: 12, ,tU 1."),101 20,266 1.'S, ,2G I
0
29 7·t~ ,j
0,1 1. ;{ O. () 1,1 0.0 O,()
:--;;) 5,J~
.s,
1-1.s 1 1·1. j 1·1.0
."i;~,
:!2.2 Lli.!i
7,Hi2
:-)1 363 13
19'2-1 192~
3i).2 32. I
9,11°1 16 . 0 9, :197 1t). 3 H, (is:!. 1-I. i3
I I
19,91G 0H.9 S2, 2H7 I !EO :12, SHH 1 !ll.·l :iR,3:"'i6 100.1 I
7iJ6 I 97.0
1~,
07:{
I
21.:-; ~2.:I ~1. I
7, W, G, ~,~'ij 7,10.>{ :'i,2KH :i, :~:{O
11. ~lJt: 2 J. J I~, :--;.')] 1 2l. 7 1~, ~n:~
!:l.9 11. :2 12.:1 9. :2 !l. 1
78:1
702 7G7 676 :;97 '!4~ I
1.1 1··,1
3. JGG
5. , 1. G
729 I
I:;; I 1.2 I I
.sS9 1i79 1, 9'21 1,703 I
1 .,
20:~
n. <1
1.:--; I
] I. 0.')9
1.0
:1 2,9 :~.
120, 3yn 291 GD 1SR I
().:: o. ';" O. S 0.1 I O.:{ I
G:!4 2;)
1926
I 1
H,720 li,133
IG27 192R 1929
2 1 205
0.0 O. :1
U. () :1 1 ' 0.0
21, :)96 23, 196 30, 23()
2,1. \J 2K. :i 3:;.0 ·10.6 4G.fi
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4.-;, 7(iS 43, 9::\K
11 ,1 I U.2
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77. :l I 73. :1';, :,O:~ I (il. 1 11,99G (i7.7 ;~7, 262 :19.2 1
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1930
2 1
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1931 ]!::l32
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1939
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EpiJt'lllic Typhu" Ca;;es Cast" , L>t'ath:-;
• [".' l'y\~r
Diphdwria Ca~t'''; 1
Ratr
Dt'a t h Cast',' Rate I
Ca... r Rat.-
I
Deaths, Death I Rate
LIS" Huh. I Deaths' D{.ath' c· ,,1:>(''; Rate 1
- <:a,,(-' 1.7
Hate
D
('at
I IS
,D~ath Rate
I
C
a<;es
-
1
Case -I D I Rate 1 {'at \>;
Dl"'"ath
Hatf'
192(} 1921
66 171
O. 1 0.3 O. ()
1922 192:~
23 14 14
:1 211 I
(l.O (j.O (l.O
1921 ]925 1\j~6
0·0 0.0 0.0 fl. 1
:1 3
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1.02 g:~
U.2 0.:2
15,1 U 1--1, H~)
:';7.
~l
0.0 (l.()
\,
56~
2.7 3.2
107 1lI1 1~~ ~8-,l
0.2 0.:2 ().~
13,(;% 12, 'iL~) B,081
21'\ ;-l(i I
1,81:1 2, :i73 3,3Hl 4,148 ii, 727 .), GIn
2.1.7 2:J,1 22. 1 2:!.4 ~3.
::\, SOl 3, SSI
G.0 G.9
01~)
71~ 9:~9
3, :J30 3,37R 3,546
6.2 ;).9
iOK
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I,:HK 44~)
1.,1 1.6 1.2 2.3
:"i30 164
1.0
0.8 1.0 0,7
592 :)01
1,333
2. :J
1927
; ~::;
1925 192q
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0.0 0.0
:). :") ~1. ~l.(l
'·' I .J
0.5 U. i) U_,1 0.·\ :'.1
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6.<'\
:100 JIg ~20
:) 22.fi
3,:1!J:J 3, 62:} 3.913 .J,,!!)l
G.l (j.U
40t(
:;·1.,'-;
1930 I I
1931
1932 1933 J!)34 EJ:~j 1~)36
Hi I :1 :1 1 26
tl. 0
n.o 0.0 (l.U (l.O 0.0
0.0
:2
G . .! 7· I 7·J ().,1
:HX :{03 :i~7
:n. 3 :29.1) :t~.
~8.2
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o. ;")
O.H O. 7
273 236 212 171 208 168 165 165 239 599
0.7 (J.
0.1 :1
O..}
0.3 U.:1 0 ..1
-1,703 4,069
J.L,
0.0
0·0 0·0 0.0 0.0 0.0 0.0 0·0 0·0 n·U 0·0 O. t tJ. 1 I
6,U:'!'S
:1 I 1 ii I :1 1
6,4BO B, 257 12 631 Hi: 6HR 16. ~()6
~ l. I 10. (]
o. j O. S U.S 0.6
27fj ~~ll 2;~x 3.')~1
12. :1
;;
O. I () ..j
IH.9 2/1. 7 21.(j
336 401
21,811 28,:"iOIl
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4,582 '1, :lU9 5,118 :1,21[i
7.1
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29,992 2H,OSl
7 H.3
G.9 X.I 7.7 ().5
1. 1Xt) 1,30·1 1, UO:-; Kl9 9~'l:;
H137 H)3S 1939
16,707 17,602 19, U02
21.0 2:).ll :W·H 2:-\.1 2';".0
0.7 (J.G (). G U. '{
2:-1,117 2H,OO:~ 28, :\L~ :-~:;, FU:\
·10.9 41l. ·1
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O. ,I O. :l 1. S l.0 1. ,1 l.~
0.3 0.3 0.1 O. ~l 1.0 {j.9
2
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19,9:1'1 19.3:!.1 1'1, Y!l~ 12,6::;H 9, R~)J
.17:; :;d:-i :W,~
4,118 :;' 255 'l, i2tl
699 601 479 :"it\o KH6 70;" :""j24 ,143
0.7 U.OS J. ~ 1. (J .-
I. 1
7.4 (j. G (j,9
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6:t.~
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1;.1--10 UJU
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:!17 165
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6,3:1'1 2, .-1O:i 2,:WR
19-15 1946 1947 194R I
2, ,161 1, lOG 175
32,36(i I 42.5 I
26ll 3,3;;1 13:i 47 1~
;\';-l
4.1 0.2 0.1 0·0
2.9 3.-1 ':;.(
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0.2 0.1
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il.I.o ()(1. J tiG.2
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12 :'i8
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7, S2G 3,H25 :), :190 i,90:\
8 ;l.U 4.3 ' 2.0
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1952 1933 19:1,1 1955 19:36 (Note:
i6
0.0
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12,619 19,861 13, 41'lG .12,172
1 t. :1 22.:1
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11. (J 11.9 17.4
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1,19:-;
1.1
773 794
1, III 9U z.;:1\)
1.3 1. I I
(J.9 I
0.9 1.0 1.1
67(i (iJIJ
1.1) ().M
--.
492 3:16 302 ')"~
201 263 ·1, /':17 I, ~t'.:l
',' O. J O.0 " !).9
99 22K
0.1 0.3
1.6
2,620 1,177 2 130 , 9;")6
0.4 0.4 0.:1
S, 196 :.!, l.s~ .1, :145 I, ng
6.2 :!.6 I.l
3·3 1.4 2.9 1.1 1.7 O.~
I 1
is only for Jnpan Proper, exclusive Df Ukinawa Prefedllrf', Imt the numher of ca"cs and deaths for 1913--]9l:'i includ~" Okinawa Prefecture. Conseq:lt-'Iltly, thert' i:; some inconsistency in this taLlp; the number d ('ast-'~ were taken flom our MvrhHhty StatlstI('s, and deJlhs from Cause-of-D~:.Ith ~talistjc~ anrl Vital Stlltistic.~; deaths from ~mallpox in 1\),")0 induJ!'R one df'alh ""!lH·h aduaUy Olulrred m 19{9 ,HId WM; It'lnrted in 19:;0; one death from eho\f'ra ill 1\);)0 ~ml 1951 showll in table. actu;lly oecurreJ ill HlJ!l and was ff'porttlrl In l~))O und 19::51; all IS C,ISC't< of epHiemlc typhu,>, reportrd and tahulated m 19:)~, actually Ol:eurrerl In 19;)1.)
1.:) 1,593 1.8 'fhl' populatio:, used as the hasi" lif eomputation of these rates is the ('stimat('n \Xlpulation excluding Okinawa. Th~ number of oeath.<l for 1920.--1912 1:\. :;
Li.\
G2 63
!1l3
18,395
20.4
!lie'S
G10
U·7 0.7
196 IG3 lGl 146
0.2 0.2 ().2 0.2
2.0 2.0 4.1
1,7SS 3,69~
1,4;ri 720 731
0·8
--1, :);-18
1,373
5.U
~
Tablt' 19.
Cases and Case Rates for Rt>portahle Diseases. (Other than thust' in Table 19)
~kiJria
\'{'hooping: COll~h Influenza Poliom~-('liti~
'lI"J~le!'
4, 0.1 nr, n.1 16K ll. 2 26:) 0.3 47n o. G ".-,' o. ,1 ]X1. RGI 21;:;. () ;:;7,502 GG. 9127, 723116. oS 71. GO;i 81. 1 6U,:2.71 67,;i {jR,1:13 7J.G is,60G 9Z.9 ;;6,868 66·~ 45, 262 :'i~.ll tii, ll2,:.: 75. ~ 1-1, 131 15.8 loS, :;24 20,;:; ;i,938 7.0 1, 634 1.9 t-\9, !:l42 103. ·f 4, 141 .,. 0 IH,6;s9 :O.g 2-1,991 27. 2,2t:6 2.6 1,921 2. ~ 1,311 1.5 1, ·197 J. 4,2;'10 ,i. U :2., 317 :2..
,
, ,
Tetanus Rabies Anthrax Tub('rcul()si~
J.t>prosy
1,72.1 ~.() 1,..t3/'\ 1.7 1,2--13 1.-4 1,0-t1 1.') 960 1.1 99X 1.1 1:1 0.0 J 0.0 3 O.U 1 1).0 1 0.0 :2 O.C) 3 (1.0 3 0.0 6 ().D 1 0.0 590,662698. :2 S.s6, 6S1 682. 9 S07, 2H :>83. 0 S:23, 5:)6 .")93. 0 517, -ti7 ;)79. 6518, 142 SH. 1 18;:) 0.6 326 0.·1 315 0.4 333' 0.4 :):31 0.4 283 0.3 213 114. 5 91,68·1101,6 424 0.;) 8t 0.1 3H U. () --l3 (J.U 3-19 Gl 1.:i
1 6~, 708 19;]. \) 14!J, 067 173_ ~ 130, 2~3 149.7 1::'3, 460 J:1~I. H102, Trachoma 1,5~O 1.8 1-170.2 :-:;90.1 lU!) lJ.1 Infectious DiarrllPAl 100 0.1 97 (j.l 104 0.1 7--l 0.1 Tsutsugamu~hi Oisease 948 1. 1 1, :;00 1.4 1, ."):1"; 1. 'I 1, Sehi"tn~omia,.i1i JlI697 0.8 ponicu ·10 0.0 :J:=i 0.1 1~7 \1.:2 Fj[aria~i>l 71 0.1 Syphilis (~Jnorrltea
1, 4-12 !:I8
\. 6 0.1
O. J
Chancroid LvrnIJhop.:rufllllomuiosi!' lngllinalt"
77, (lSI ~n. 1 ;:10,528 ;')8.8 38,121 41.'-; Ti, 8~~ 3':'\. j 28.67:: :1::'.1 2,1, 32~-l 26, ~l 179, 11G~11. 7 158, 670 184- 7 140, ·1;)?1 161. --11--11. 4161(i().::' U-l, 5':'11 ;'0. -; lUi, 8421:!.9. 5 Li,9.JJ IS.9 II,!::lO!::l17.·1 1~,;)14 j·1_4 ?l,7Ei ~l.~) -I,6]() 5.2 :1,U(l8 3.,1 3():~
f). --l
:':OS
O.
'J
16:~
().2
12S
(f.
70
II.
-HJ
O. LI
14. Port Quarantine The Jlort quarantine st'nice in this country is hdJl~
carried out. in accordance with th(' <)uaruntilli' th .. Liiw cOllcerning: Special IllI'tances of thl'
Law of HEil (partially anwnded in Jul)' 19:')6) and QllurantilH' Law
rdating to Military Vessels, etc .. h)' the Quarantine Station;;. Branch Qllanlntinl'
Offices and Uctadlt'd Qnarantint' Offiees located at 34 seaports and :1 :~irport.'i. The set·up of thost' quarantin~
stations as ()f Vee, 31,
1956 are as follows:
Tanle :W.
Quarantine Facilities 1It St'aport:;; anl( Airpor!~.
a) Hakoda.!t:: Hiro.o;hima; Kobe; Moji; Nagtlsaki: Nago),;! : Sast'Lo; Yokoh.:tnl1 b) Hakata; Kago~bima; Miikc; O,;ab: Olarrl ; Shimizu; TokYLI'
a) Kamaishi; Kure; St'apon Statio)).., 1 1'2) L) Naze; r\iihama
Mai:wru;
11uroran:
Tokllyama-Kudam:ilsu; Wakam:ltsu:
Wakayama-Shimotsu; Yokkaiehi; '(oko,",uka
('-'I
.,"
Fushiki-Toyama: Izuhara: Yoron
Kushiro;
Mi~\lmi:
Niigata:
Shiogann;
Tl:>ukumi;
Airport.Stations
(4)
Itazukc; lwakuni: Tokyo (lJanf'dJ)
1. Tho.~e 8 quarantilll' stations. sho wOl in the colum~1 quarantine hospital. tietention honse, and (itotting facility.
(1) a) of Tault" :W. are equipped ,,'ith thl"
2. Those 15 quarantine stations, shown in the <column (1) and 9 hranch quarantilll'
23-
offi~es. shown
in the column
(2) a) have the equipmf'nt and personnel necessary for deratting.
3.
Those 2 braurh (luaranfine office.;!. shown in the CUIUrrlll (2) L) and 8 detached <fulrantille {lffice;>,
shown ill tht' eolumn (3), havt~ no su<·h facility mentiOIlf>d above, but are able to perform routine quarantine husiness. 4. Every station or offi('e is able to iB"uC the dNatting exemption certifieate. The airport quarantine service is Lt'ing carried out dt 3 airports shown in the column (4), and
S.
Tokyo International Airport (Haneda Airport) is tlesignated as the Sanitary Airport in Japan. During the year HfiG. 11. ~46 ~'e"sel); and 3, GI:! aircraft, im·ol\"in~ 708,842 and l~i1, 2g8 persons. respectively, received quarantine inspection, and those vessels received deratting work amounted to 1,225, and those received deratting exemption CPrtificate amollnt~d to 1,378, respe-ctively. During tht' same period, there was no Case of quarantindhie diseaM' as a result of quarantine inspection.
15. Inse::t and Rodent Control t;nder the present
Environmental Sanitaion
prodsion of Communicablt' Disease Prevention
L'lw. tht' eiti!"'s, towns, and
,'illagt"'s are responsible for tht' contr..,1 of insed~ and m<ients, under the techuical gllidan~t' of the
prefectural governments, with finacial assistance of the national government. At present each one of tht' loeal bf'alth center:,; have full·tim!"' staff to perform tt'chnical guidance for their OWI1
districts.
Ever sinct' 1930, the model districts have heen estahlished in various parts of thto cuuntry in order to demonstrate insect and rodent control programme, and are quite successful not only in pr{'venting im;j>(;t·iJornt' diseaspo~
for human-heings htlt also in improving the community lift' throlll'!b better under·
J'tanding and organizt"d eo-operation of the people for health problems. The8~ mudel distrids are also used for the rodent control programm~, which, with enthusiasm of the
(Oon:lluunity_ dre showing good result. The followjllp: tao}/'" tohows yt'arly inr,rease of tilt' mndel districts. Year 1~)50
No. of Districts
1.')0
1951 HJ3~ Lij:~
660 1, .::181
2,
tq~
1034 Ul3G
6,.::193
13,2-1,3 32,086
Being: ~neollraged hy the result in lllodd districts, the national government has started since 193fi three year pl:w of eradication of mosquitoes and flies throughout the country.
Nightsoil, Trash. and Garbage Disposal 1. Nightsoil Flush-toilet !>ystt'm is not yet widely developed nue to the insufficient ~ewerage bysteUi. NightsoH
collected arC' mostly r.arried to the farms for use as fertilizer. How(: .... er, snch nl':ed is decre:lsing because of the incrf'ase in using chemical fertilizer. In spite of that, quantity of oightsnil in urb1\n area is in.-;reasinp; be~aus~ of the rapid increase of the popuhtion. Consequently, m:ljority of cities are facine; today increasing difficulty for disposal of nightsoiL Sinrl'" 19.'i3. night~."Oil digt'totion plant.s ha"e been eonstructed in 26 cities, and 16 more are under construction in the other cities . ., Trash and Garbages /)ilTiculli~s a.re fell for t'mploying the method of hllrninl.\' anti burying of trash and garbage" b::'cau;.e
of the urbanizalion in many area of th~ country. In 19:)0, the prototype plant for composting of nightsoil and garbages was constructed in Kohe City under the a"sistanc(' of WHO and i.~ in operation at present.
-
2,1-
16. Water-Works and Sewage Treatment Water-Works 1. Poptllation s~rH'·d with wat('c supply system as of Octoher 1%5. Number Population ",ened
Urbans Rurals Privates
637 4,011 3,528
27,77U,568 3,14:3, ]9,15 2,701,349
Total S, ]76 :B, 677. :n:::. ,. (Note; "Rurals" means those so-called "small-scale wat(>[ supply systems. and "Privates" means tho.;;e belong to OtilN than muni('ipalities) Legal provisions to develop water supply facilities. Coner tht' pCMisions of Water-Works Law of 1957, which superseded the old Water-Worb Regulation of IX90, water lOupl'iy installation can he provictt'd by cities, towns. village;., :;indi(·alions. pri\'att's, pro\'inces. and other comlllunities so as to eleHl.te the standard of puhlic Iwalth, to impro\"f-' tht' en\-ironmental sanitation and to supply safe- drinking watt'r. '2,.
n
Subsidit-'s. The- Minister of Health & Welfare may sudsidize- as for the eRtahlishmeIlt of water supply sy,.;lem,
amI so-called small-scale waler supply system, within olle fourth of the total exp.. n ... e.
Sewage Treatment 1. Number of st"wage treatment facilities 7 (Oct., 195:1) 2. Amount of total flnw treatt"d 1,621,BOO rn 3 /day 3. N"mbe, "I popu],t;on ,,,,,,,d .i, 10G, 000 .1. Sewerages Law (Law N,). :~2 of December. 1900). By this law seweraf!:e instaUation call bf" providpd hy the jluhlic t'xpenf\e of citlt's. tow Ill" am! \'illa~es, anJ its rOllslruction is limited on th,· public land_ :i. Adminhitration according to the Cabinet D('cision made on 1 July 19;)7_ The administration of ~ .. wenl.gefo has beCDmf" s{'parated as follow.s: a) Ministry of Health & Welfare j", responsible for the sf'wage treatment, and b) :\1inistry of Construction for the- sewers.
17. Food and Veterinary Sanitation Food Sanitation 1. Food Inspe(:tion 3,913 food inspectors (indllrling 1, 9:~3 inspt'ctors bolding an additional po~t) are ~tatiom·d in the local health (;('nt('rs to work on 1. 535, 45~ food.handling e8tahlj~hments (including 9HI,513 t"staLlishmeots which do not nef>d to Ilt" Iicell:,wd). They perform inspectioll on c"tahli:,h ments and supplies of food amI drinks. 2_ Food PoisoniTlI; DurinJ!. th(' year 1956, tht' reporkd food poisoning eases are in total 1,6nJ imoldng 2t",28G patil"nts ann 271 dt-aths. As regards thf' eauses of food poisoning, ]52 cases with 6,914 palients an' due to hactt"riai infection and f'ntro-toxin, 9 ~ases with 240 patit'nts are due to chemical poi~oning, Z::6 caM'S witb 752 patients are duo:" to poison"u.~ plants and animal.;, anll others are unknown. As H'gilnls the type of focal caw;ed these poisoning, mostly they are fish, sheJl-fish and tht"ir products, amounting to 31. 4%, and ('er('.lls, vegetables and their prodncts. amnuntinl! to 15.6:-06, wllt·[t'as onl~' ::1.3% are by milk, mf"_ ~lt and their products, In 1956, there occurred very noticiahle food p(Jisonin~ cases, of which brief summary is statea below. 1) A my~tery disease at Minamata City. Kumamato Prefecture, Kyushu. occurred. This can bf" a kind of "intoxicating brain symptom" and it occurred among the people who ate too much fish and shell-fish caught in the Miuamata Bay, and the poisonous substan~f" i,; (~onsid~rerl to he S(·. or Mn. or other chemical suhi'tance. But it has not heen cleared as to tht' reason why fish and ~he-Il-fish in the Minamata Bay oolr became poisonous, and aetual causJ.tive agent. and tht' trt'atment method for this disease.
-~
.
2) In Yarnagur-ht Prt'ft'cture, poisoning cases due to wy-ht'an salin' was o{·curred. which was caused by the arsenic compound happenen to be contained in thf' sauce. 3) In Toky()_ a fcud poisoning due to Stereo!epis ISI'.hinugi was ornll-r{'li; thl> cause is considt'rl'd to Iw over-t.tking of vitamin A_ As tn the new eausative agents for recent food poisoning cases, fJatho~eni(' "(IIi and halophile bacterien have a ppeareJ.
n
~.
2.1-
Food Additives Chemical synthetics to be used as fOlld additives are fully controlleri by autho;izatio;\ sptt>m by
the Government, and they are listed up in the Enforcement
Regulation of Food S.mitatio71
Law.
Approximately, 150 synthetic food additives are authorized for use at present. The manufacturers or processors of synthetic food additives or its preparation are required to have .a qualified srlf-inspector
hy thl:' law. These specified additives an,;
In addition to the above mentioned cnntrol, the additional certification system is applied to <:ooi-tar .colours and other se\,pral food additiye3. required to be
tested
by
ea('h lot and to be certified by the Minisln of Health and Welfare or the prefpctural governor con('erned lwfore sale.
4.
Food
Pri~servation
Recently many attempts have been done to utilize antibiotic to preserve food, especially fish. Huwever. it is necessary to have further inv{"stigation nn the allergic conditions to whi<'h antihiotit;s may p;ive rise, the creation of mierohial resistance to antihiotics, and the effect~ on
the intestinal floni.
Under these circumstances. antibiotics huve been prohibited to be used in or on f~ as prest"natives since july 23. 19fi6. 5. Inspection for Imported Foodstuff The yearly amount of foodstuff imported in our country is alliIn! 5,881, 080, 000 tons and it is about 17% of whole imports. Since the Ministry of Ht'alth and Welfare is resplmsible to prevent possihle occurrence of health
hazard due In impl)rted foodshlff of inferior qualit)·, the food sanitation inspectors ha~'e been spel:ially stationed in the main sea'ports in the country to perform inspection and testing of imp:3rted foodstuff. During the year 1956, as a result of these inspections and testing, among all foodstuff imported, total of 280 cases (56,000 tons) were either not permitted for import, or destroyed, or ordered to be used for other purpose than as food. The main items of those inferior foodstuff an':, the Ileteriorated
rice. milk products contaminated with bacteria. confectionery containing poisonous food colmlf, and spoiled canned goods and milk products. In order that the inspection for imported foodstuff b~ carried out more effectively, thl" Food
Sanitation L:lw has brt"n rel'ently amended to require. in each casp when the particular fOO<i is to be imported, sending in notification to that effl'ct to the Minister of Hf'alth and Welfare through the stationed insppctor.
Veterinary Sanitation The following table shows the numbt'r of food animRls slaughtered and of carcases during the year 19i'i6. Table 21. No. of Food Animials slaughtered and of Can'asses Condt'mned Cattle ,
COllnf'llHit'd
(1953) Swine Horses Total I
Calves
Sheep
Goat I
Total No. Slaughtered No. prohihited from slaughtering No. of condemned earcasses No. of condemned parts (mt'al) ::\"0. of condemned parts (intestinf's)
680,7261 15
PH, i74,
33, R76,
5:~,
44211 2,149,675 ~15
H5,615, 3, :.!5;), 10S' !)
" 106
1281 1.08S· ~5. 690'
343
" H7 :~,
B
,191
132 3.632
9,909 202,902.
L 463 ~,
84 :.!,406
lll,465 97~,
057
-116
0:13
:12,302 1. 227, 31:i
.. -..t.
-::6 Rabies Control The rabie~ control programme is also under tIlt' Yderinary sanitation proe;ramme in our cOllntry, and tllf" im:idencl'" or rabif's and casualties then-from during the yf'ar 19-t'i following tabIt'. Table 2~. Yt'ar Incidf>ncr-' of Rabies and Ca .. ualties therefrom. ( 1945--1\-1;101 10
l~SG art' .. hoV'1l in the
\\0. of Cases of Rabies : 1\0. of Pcr,;ons hitten by Rahid Dot;"s in Dogs ~4
No. of Cases of Ra1if's in Men
19-13 19-1fi 19..t7
IG8
24 37
RG 129 387
I, [6
1910 1949 19:10 19!'i1 19:'!3 19:i3 19:)4 19:i:'! 1956
1-11 614
],617 1, EG6 677
74
,
867 319 2~~~
37 1"
389 316 178 ,j(
..
176 9" 2:~
" 3 1
0 0
6
lU
18. Nutritionist
Nutrition
Lic:en:sing of nutritionist is math" hy graduatinj! the training sr.hooJ of 2 to 4 years uuthorizt'n by
the Minister of Health & Welfare, or by successfully passing national examination for nutritionist. Then.. are 110 authorized training sehools and approximatf'ly :W,6R4 licensed nutritionists.
National Nutrition Survey The national nutrition survey has hef"n eonductt'd four times eyery rear del("rmine the f:f)ndiliOrJ uf nutrition of the entire popuiatiull. results of the snIvey. Tablf> 2~:. Appe.arance (Jf Physical Symptoms (%) Cities 19:14 The followin~ ~inel"
19.J.() in order to th!~
tables show some of
Whole Country Symptoms 1~);)-1
Rural Districts 10:16 2. ,1
gEiS
HJ;:iG
19:):1
19:;-1 2. G
1%:)
1%6
I
Anaemia HYPl'rkeratosi>.
2. 3
2. :1
2.7 :l.l .j.
1
1.9 I
2·0 1.9
2.6 3. :)
3.0
2. n :).4
'1.. 7
2.\)
2.9 2.4
Cheilosis Loss of [('fle). kn~e
j,_·rk
7 ..J 1.8
,. , 1. ;:; 4 ..[
5.4
9:
2.2 6.G
2.9 S. ~l
,. , ,. 1
3.1
9.4 V·
8.9 3.1 ,
S.
~ ,
Edemd Chrollie digl'stion disordf'r Bradycardia Delav(,d menstruation an'J anll'norrhaf"':.t Df'fil'jCIlC},
.>
1.7
1.4 1.4
1.9 -1.9
1.7 I. ·1
" "
, ~).
.> .>
•
6
9
o. r
4.8 2.8
4.7 ,
3.0 ~.7
2·3
2.3 9.0, 29.2 ,
3 " lU. -1
:).7 10. :'i ~.).
to. 2 25.2
9· oS 26.9 1
r.f laetation
:::(i.8
::-1. 2 3. 9
.,'
Pressure-pain 0" calf Non-symptoms One or more symptoms 73. 9
:;.4
0
n.5 22.5
77. G.I
81. 18.9'
81. -1'
81. 4
72.2 ::7.8
74. I :2:1. D
'V·;:)
24. 1
22.4
18.6
18.6 ,
:'(i 0
-
27-
C_ District Year Converted 'Ratio for Adult I
Table 24.
Intake of .l\iutri~nts (Per capita per day). Cities
Whole Cuuntry 1954
Rural Districts
1955
1956
1954
1955 0·88H
1956 0.888 0.844 25 45
1954
1955
19.'16
Protein Calories
0.895 0·853 22
0.902
(l.9Ol 0.R63 23 16
0.R77 0.841
- - - -- Animal Protein (g.) II
---. 23 J7 69
0.861
----------0.862 20 49
0.902
0.914 0.877 -
0.911
0.845 2;'1
24 ·15
--20 -
0.885
Vegetable Total
47 69 21 403 3,{)74
-50
2V
45 70 2:1
69 - I
----69 24 381
48
70
69 19 420 2, 122
70 18 43;'1
68 19 427 2,1:12
Fat (g) Carbohydrate (g) CaJoril"s (Cal.)
20 -Ill
22 405
-
2-J 384
385
2, 104
---2,092 2,010
2,02;5
2,034
2,176
,
-.
School Lunch Programme
School luneh programme in Japan began in 1946, and at present about 12,982,000 primary school ehildren (;)9% of all children) are fed, supplying about 600 calories and 25 g. of protein in schools. The sehoul lunch feeding for the middle school students has been commenr.ed since 1956, and as for the evening high school slUdelites since 19,37.
Enriehed Food The Enriched food hal! been strongly advocat~d by {he government in Japsn, tlud at the end of July 1957, the number of enriched fo:xl pt>rmitted by the Ministry of Health and Welfare in accordance with the provisions of "Nutrition Improv~mt'nt
Law", amounted
(0
1,240. Vitamin A, thiamine(vitamin
81,). riboflavin (vitamin B.d, vitamin C, calcium, inm etC .. are enriehffl ill tbf" folJowing foods: rice, flour, bread, noodle, bean-paste, jam, soft drinks. canned fruit. biscuit etc. In particular, enriched rice has heen encouraged for use in order to prevent malnutrition cause11 by the lise of polished rice, 1
warn of the rice contains 1.2--1.5 mg. thiamine and a hit of rihofla ..-in. and will be mixoo in polished dee at the ratio of 1 to 200 in case of use. Approximately IOU tons of enriched rice is now consUOlf"d every month.
19. Dental Health 1)
As of December 31. 1955, there are 3\' 109 dentists, of which 29,422 engagp.d in dental practice,
196 engaged in dental education, training and researches, ~58 engaged in government administration, and 1,~33 engaged in other types of work. There arc ,185 dental hygienists as of Dt>cemb~r 31,J955. and 12.444 dental technicians as of January 15,1955. 2) 1, 1~5 (25%) hospitals out of the total 5.119 hospitals ill our
country have dental facilities
as of Decl'mbl'r 31, 1955. Among 24,773 dental clinics throughout the country, 24,409 (about 99%) are private ones; others are national, municipal and juridical. 3) Preventive programme is carried ont by 3UO health centers out of tbe total of 783. For the
school childrf"n, ('ach school is requirt>d to appoint a school dentist for the eare and pr(lteclion of the childrpn in schools.
-:!.b --
20. Legislations
Mental Health
The- mf'nlal health programml' has incrf'asingly attral'teo public and profes.'iional attention in thf'Sf>
years. In aecordancf' witb tbt" recent d..velopmt"lIt.<: in a COIII'f'pt of mental di~ordf'r, the new ~ HYlfit'n~
Law was put into force in 1950, repealing all the previous
legislation~
which had mainly purprovi~iont'
posed tilt' fafe euslcd), of mf'ntaJ pati("nls. health services aft'· al'celeratt'll.
Cnder tht' new Lan', in addition to th ..
of
in;;liiutional eart' for the mental patit'llt.<:, thp community cart' and tht' prevt'ntivt' work in m{'Htal Servi('es for the mentally (Irficiellt children and child guidance a('tivitips an' prmi(iul under the Chilo Welfare Law of 1~JI7.
Surveys In Jllly 195-1. a stati;;ti('al !';urYCy was earrit'd out on a nation-wide scale to obtain Ihe b<t~ic dat.t on mental patients. A gwup (,f psy('hialri..,t~. whu had heen specially appointed for Ihe survey, t'xamlned aU ca!"e'; of mt'lital disurder in the ~cleeleo otrea!', altlHlu~b the neglil!;ihly mild cases were excltuled from the calculatioll_ Thus the suney clearly rcwalcd that the e!'timated numuer of mf'ntal cases was 660,000 in malt'
0.55%) anri6S0,OOll in female (I_11%),totalillg 1,300,000(1.48%) in tlw whole population. Houp:hly 15.5% of thes(' cast'S wt're founn .'iuffnin{!. from H-hizophrenia, 1. 1 % manic-depressive illnes~, \). (j~; eOlwulsive psyehoses, 1. 4% drup: addictions, of pSy('h05('S
due to syphilis. 7. :l% mental disordl'rs due
[0
alcoLuli"m and The survey also
H_ 5% mf'ntal dt'ficiellcy and 13.5% other types of mental disordl'r.
r{-'vealpl! that aholll 430.000 patients (excluding Ihost' who wen" undt'I institutional rart' at the time the survey) require institutional rarc, 46.2% of them sufferinp: from mt'ntal illlless. 31.6% rtlf'n:!~_ 25'~
tal Jt'fi"t'nl:~"
other rnt'"nta] di,;order!'. (j
In the Mpnt,li Ho,;pital InpatlPnt ~\lnil'y of July_ l~)f,G, about ()n~ fifth of all the nwntal ho:>pital inpatients anfl the ex-patients \'.-ho had been discharged during the preceerling month" of the datI" of lil("
sUI\"ey w{~r(' statistically :ma]y~ed, mainly on diagnusis, clinical picturel:l. treatmente;;, ete.
Thf' fj~\lrf'''''
in tbf' f.111owing: lahlt's show tIlt" PI'rrentage di . .,tri\.mti!)U of tbt' inpatients ami the tiischarged ex-patient!'.
1.
Age and sex
Sex .- 19
Total
6H and o\'er (:(j.4 5;~. () 3,.4
Both sex lnpatit"nts Mal~ Ff'rna]~
6_ 3
3.5 2.8 10_ n 5.9 5_ 0
7.3 4.9 ~ . .,\ 5. ~ 3.1 ~. ';" Di~chare:t"d
tuo 61.,1 3~. G 100 60.-1 39.1)
Both Discharged palit""nt"
SI"X
Mille Ft'rnale
rl:1.3
51.1 31. 9
2.
Diagnosi:; Stehizojlhren ia Manic·rI~pI(·ssi..,.t' illness
Epilepsy Other typps of p,;vchose~ P~ychont'uro;;t·~
P!'ycho~e" dnt" to syphilis PsydllJ:>es with alcoholj.~1l1 & drug addicticn
Inpatients 70.0% 3.7 :1.8 8.3
Patienls~
H.:l:-r: 10. J 2. ~l
Psychopathic personalities
2.3 4.2 1.4 2. !::l
5.9 6.2 7. :-:1 1.5
Mentl deficiency Other trpe~ of IIwntal disorder (Total) :'1. SonTce of tlIP paym!:'nt!'
3.0 U.5 !OO.
11. S 1.8 0.8 100.
of jnpalen\.~. K.:i% 31. 2 "14.0
Ol~lf'rs
AI! paid ty palien1 Hedlth and social insurances Daily Life Seeurity Lllw Mental Hygiene Law (TOln])
14.6
1.7 100.
4. Duration of stay in mt'ntal hospital (Discharged patients)
29-
Less than :~ months 3 months 6 months 1 year --2 years - 5 ·ye.ars and over (Total) Mental Hospitals
,t6.2% ~6.3
14.5 7.3 4.8
0.9 100.
The latclit figllft'" of the hospital uccomnndatimls available for m2nta[ patient:'; an: shown in following tabJt'. 1t implies that thN€' arl" approxjmatdy 6.3 mpntal bE'ds for each 10,000 inhabitants.
the
c
Mental Hospitals
Tahle 25.
Psychiatric beds and Inpatients Hospitals Capacity lnpatients
(\\farch, 1957) B-ed ~c_cl~pan~y
National & Prefectural •.• Private, Juridical Pf"rsons and others ............•. National & Prefectural ... PrivatI', Juridical Person". and others •••........... (Total)
:19 2~5
9, ·114 36,331 4,064 7,-411
9, .!I5 :~S. ~H5
100. G
IUS.I 89.0 105.4
Dpds in ~eneral hospitals
3,616
1,813 59, !fIg
334
57,220
103,4
Mental Hygiene Clinics and Child Guidance Tht're are .;!·O mental hy~ienf" clinks in this uuntry, which are pro\'ided hy local health authorities for peJ'S{lns in psychological difficulties IIndP]' thp Mental Hygiene Law. Child guidance services are also provided at the child welf..tre centers by local child welfar~ authorities under the Child Welfare Law. Mental Deficiency The number of the mentally df:'ficient c.hildren in care in 86 Homes for the F~edle·minded Children amounted to <t-,838 at the ~nd of Mauh, 1957. OnE' of the recent developments in the services for the mentally deficients is the opening of 6 Occupation Centers in thp large cities. National Home fOf
the Fet·hle·mindedis also to de set up in 1957 by the hand of the Children's Bureau of the Ministry.
21. Occupational Health The occupational health prn~rammt' in this counlry is basl'd on L"lbor Standards L'.lw and is imple· mented hy the Ministry of L:LLor. 2,350 labor standards inspectors work for the inspection of the
L O:lB, 248 fa:"tories which include the inspt'1.:tion of the ht'fllth condition oC the faciJititit's and warker5. Silicosis is the major problcm and the special cumpulsory llf'lIlth examination is p::'rformed. Thl'p3.tit'nts
.ure given henefits out of workmen'p; compensation sch{'me for their treatment. Under the the Labour Safety and Hygi .. ne Regulation, larger type factories Me required tu appoint the bealth supervisors duly licensed hy the government.
22.
Hospisals and Clinics
Mt'dical Sen-jet' Law prm-ides the detailetl qualification for hospital;; (medical care facilities having ~O or mor beds), while the Law does not provide such detailed requiremE'nts in lC:lse of dinics (.m:,dical
care facilities "Without or with less than IS! bed;;) and the anmjni"~lrator of thf'M>: clinics shall endt'avor not to keefl their patients mOTC
than 48 hOllrs except when inevitable eirellmst<ince exists.
The hospit-
-
30
als art! inspect.. d an d gra d \::<1 year y ·, 1 t professiona 1 sta IT,an d h aspl a managemen
-'
I
by tho. medical iD~p"ctors on the ballis of physical facilitjes~
,-
The insrwction system contrihutes greatl), for the impTOver-
ment of hospital Beryiees to the patients. Inspite of the increase of hospitals; and beds, the demand for more beds {"specially for tuberculosis and rnt"ntaJ patients are acute. The following tables show the statistics 011
hospitals arId their deds.
Table, 'Lt),
Number of Hospital!> and Clinic.s.
Hospital
G{'nera! Clinic
Dental Clininic
5,41)) (as of 1956)
51.349 (as of 1955)
LA,773 (as of 1955)
Table 27.
Number of Hospitals, Beds, and Bed Occupancy Rate. (Based on the Hospital Monthly Report) (1956)
a.
Number of Hospitals.
(1956)
Kind of Hospital, Numlwr of Hospitals (at the end of year) Number of B('cis (at the end of year)
Total
'Tuberculosis ISa~ato~ia 713
Mental
Hospitals 3')')
Gen2'raJ Lepro<;aria 'Comtnunicahlp Hospital :Disease Hospi_tal
I
5,418 559,249
I, 14, 260
I,')
4,,296
127,184
43,888
5.856
36H.USJ
h.
N umher of Bed:! anti Bed Occupan{'y Rate, Kind of
(l~'56)
ned Numl-wr of !It'ds
Total 559,2<t9
T B Bed 252,i'i03
Mental bed Lepro!iY bed clist'3se hejl !
'Communicable
Geneoral
b~d
54,866 104·7
1.1. 260
20,602
216,718 7'~-'
Bed OCf"upancy Rate
RO.7
85. 7
75.8
20.1 cf
9
Note: "Bf'd Occupancy Rate" refers to the number of in'patients per 1UO hf'ds capacity.
tht' official ratf'd
23.
Medical Care Personnel hal' alwdY" heen tht' matter of
BI"-ttt-'r standard of qualification for tht' mf'dkal care personnd weat conCern for the foverl1ment. The Fig.
---
y shows tht;' qualifications of ,·a.rioll" personnd at< of The difficulties confronting with the Cn-
1%7. Tables 28. 2Y and 30 show the !lumher of personrlf'l. vl"rnlJlen[ at prt'sent art' tht> concentration of medical doctors and dentists in tht' urhan arf'3S, lack of
quaJifip,d perl!oOllIlt'l in the field uf public health work. and the Sj~arceneS$ of public health nurse....
,--
Fig. 9. Sttludd.rd of Qualification for Medical Care Per:;;onnel.
31-
Tahl/:" 28. Physician Yf'ar
Kumb:-,[
d Mt"dicaJ
Cart:'
Pe.rsolltlt'1. Midwife.
Dentist
Pharma:·isl
--Public Health Nurse
..
1
Per Thousand
Per ,
Pt'r Thousand Thou ... nd'
Per
T
----
Clinical Nurse I
Per
---IPer
lota ',10 ouO' Total lu 000 Total 10 000 Total 10 000 otal 10 OUO,Total 000 Number p , Number p • Number 'p , Numhrr p" Number p , Number p , op. op. lOp. 01" __ Dp. op. ThOllund !
110
ThO}u"snd
Thollsand
1~1:-5:') 19:-56 193'/
;)X i
H. T
20
GO' 6'2 6:) 61
S.6
193" 19:·N
R.8 8.9 9. 1
21 22 2:~
2.9 3.0
25
3.1 3.2
27 28 29 3v
3 61 3. ~ 3.9 62' R.8·
12,1
4.1 -1.2
62
23 2:-\ ::!5
20.3
62
8.8 8.8 8.6 fl, ()
120 123 13, 1:10 1;:)9 147
17.7 17.0 17.9 1S.8 20.6 19.!::J
1940 1911 19-48 1949 l!:lJO 1951 1952 19!1~
65 6R
9.1 9.3 9.0
3.2 :1.4 :-1. I :3.0 ;)
:n: 32! j,j
4. :1 4.3 S.4 !1.5
-I -, 24 23,
61 63 70 77 75 78 99 127
n 73 76 84 8.3 9()
25: 26' ~7:
3.0 2.9
19:1-1
9Z ~lj
9_9 10.3 10 . .3 10.6:
8.9 9.1 9.9
Z9i ~H!
:lO
3.4 3.4 3.4 3.5
." 'J
16 17 19 :i0
8.8 9.4 9.0
16.7! 17.8'
!'j.6
25:
:i.8 :1.8 .3. ~),
::;1 .31 :12
19S.1
:ll :ll
;;.8, 0.81
27 30 36
:3 ,) 3.fi
3. II
149 154 207 272 2H4 306
l.Z "\.S -I. 6
3.5
40 41
134 133, !
9.2 11.6 14.6 15.2 14 91
18.2: 24. 1 31. 3 32. 1
34.3
Note: The figUfC.'i of clinical nurses as of the t':1d of as.o;istll.nt dinieal nurst's. Tahle 29.
19::;~
include male ('linie-al nurses and 18,781
Numbrf of Physician!' and Dl'ntisb by Type of Work.
(as cf the end of 19;:;5) 1\"0. of Physieians & Dt-Iltist
Physician :"Jumher
Dentist Number 23, 541 5, 344 537
Type of Work Owner of hospital or clinic Emplo}'E'rl in hospital Of clinic Teacher and research worker of clinical medicine Teaeher and f('"search w(}rkf~r of medicine othpr than dinical medicine Engaged in other public heahh "en'ice Others
44,642 32, 539 9,063 ~,OO-i
196 258 1,233
2.622 2.693 9-1, ;:)63
Total
31,109
,-
Table 30.
Numb('r (If Nurses ann Midwi\es Actually ellgagen ill the Work in 19:i(j Public H~atth Nurst's Miliwiv\".'i Clinical Nurses
Type of Work Administration and Teaching Hospitals and Clinic~
10 liS -l,,~3G
9U:; l~~,
·120 :nti
lL'alth Ct'nters J Iloustries Schools Citit's, Towm ami Villages Private Duty Otht'rs Total
:;,
~4S
It\~
7GG
l.
:n2
7,022
so.) 12,1:iG :);),71:1
1,
~)90
r
1:';(1,96:1
l'\ote: The figures of c1inic-al nurses include 1,021 mal"" clinical
nurses and 17, ;)70 assistant dinieal
nurses
24.
Medical Care Statistical Survey National bll~ed
The government has heen conducting
Health
Survey
(Family Sickness Survey)
and
Patient Survey since 194R. on a nation-wide scale
on the samplinl; mt'thud.
In the National Health Survey, we sample about ll),000 households or .lO,OUI) people in :WO areas in thi,:: country, and enumerate the incidence and prt.>Hllenc(' of diseasf's 3n,l injurie,;; among the nation by lht> type of diseast' or injur)" oc(~upation,
gt-!Ographic area.
economic' status.
St'x.
age. et<;, and
111;;(1
how those- diseases and injuries are- treated, and how much the patients pay for the trcJ.tments, In the Patient Survey, we sample about SOU hospitals (1/10 of the nation';; hO~pitals), 1, 000 ~ent'ral clinics
(l/so
of the nation's general clinics) and 100 dental clinics
(11~00
of
th(~
nation's dental dillies),
and enumerate number of in·and-out patients who visit those institutions by tyPt" of disease or injury, Sf'X, a~e, and the method of paying the chargt> for trf>atment, togethN wit;l the length of stay of
ho!<pital in-patients.
-
33-'
Tahle 31. Ineidenct" of Diseases and Injuries, and Sick Days among the People. (per 100 PopulatIOn a year) - - Incedenct;· Name of Disease and Injury Sick Days Ratf'" Total T. 11 . Infective and p:Ha!'iti,~ tli!'east"s Tlliwrculosis Ni'Qplasms Malignant neoplasms Al1ergi(~ endocrine sy~tem. metab::>lic and nutritional diseasf' Diseases of the hlood and blood·forming orp;ans M('nlel. psychoneurotic and personality rlisorderfl Dispasl's of tht' nt-'r':oIlS sy"tem and s!"ns!" organs (s.m.)i (s.m.)
liB. 3
2, 090. S ~83.;l
6.
~
0.4 II. 6 O.J 2. 1 0.2 0.2
220.0 20.2 11. 8
1[.
II. I. \1.
79.0 8.6
Disease of eve \'I[ .
.
10. 2 1.1 ~.2
18.5 245.8 62. I
Ill. \\.
Uisease of t';r Dist'3sell of the circulatory sy"tem Diseases of the respiratory system Acute nesopharYllgitis (c3mmon c[)ld)
37.1 lIS. 7
2.1 (s.m.)
D;""" of the ,Hg,";ve ,y"em
72.7 6:~. 2 27.6
388.5 277.4 395.1 ,)1. 6 128.7
.x
(s.m.) Diarrhoea and entt'ritis (s.m.) Dis(>asf's of teeth and teeth-supporting strU(:ture .\. Disease~ of the ~f'"nit.o-uriDary system (s.m.) Uist'ases of thl' lem3lc genital organs \1. D~'li\"t'rie~ and complicati::ms of pregnancy. ("hild-birth, and pllerperinm \II. Diseases of the skin and cellular tislmt~ J[. Diseases of the bones and organs of moveml'nt :.;: fT. :\ \'. Congenital malformations and certain diseases of early infancy Symptoms, senility and ill-defined (!onditions A!"t::idents, poisoning and violence Convalescent car plastic treatment and fitting of prosthetic devices Fitting of dental dcyices (,.m.)I
••• 12.6 1.. 0.8 O.ol 0.2 9. :~
37. 9 loot I 9.4
122.9 84.5 6.3
lH.g 16.1 0.6 {I. :;
0.1
97. g 1:=;7.1
19. -; 18.3
Note:
The Incidence Rate and Sick Days are (It'ri\"ed from thl~ National SurH7 in Nov .• 19:15.
Table 32. Th", Number of Path-nls \·j"jtt'd Hospitals and Clinics (p",r 100,OOn Populatinn a day' :-.lame of Di~ease
ami Injury
Total '10·IPatients
Patient~~atients
10u,.1
1
Total
3, a:I'1 651
-
0:13
2,8051
T. II. 1[.
\1.
Y.
\[.
Ill.
\lH.
1\. X.
\t.
.x ill.. YO.
.\Jl.
X 1'(. X \'1. :x \ll. YI,
Infective alld p:nasitir: diseases Tubr-reulosis (s.m·)1 (s.m.) Venen~al diseases N('oph.sms (s.m.) M~lignant neuplasms '\lIergic t'"ndocrine sy:<.tem. metab:}lic and nutritional di5eaSf>S Diseases of the blood and blood·formin~ organs '\lenla\. p;>y(:honeurolic and personality disordr-rs Diseas~il of the ner\'llUS sy"tem and sen,,!," organs (s.m.) Diseases of eyr(s.m.) Dist'as("s of ear Diseases of the circulat Iy system Dist'ast's of the re~piratory "ystem Acute nf>soph.uyngitis (co:nmon c;lld) (s.m·)1 Oi::.eases of the dige3tive system (s.m.) Diarrhoea and etltnitis (s.m.) Diseases of teeth and teeth·supporting structure Diseas!.'.:! of the genito·urinary system (s.m.) Dise:8f1t's of the fpmale genital organs Ot>liverie,; and complie8tions of pregnancy. ehild·birth, and pllt'rperillm Dist'ast'~ of the skin aud l'ellular ti~suf'" Oiseas!'"s of the b:::me:l and organs of movm!:'nt ~ \'. Congenital malformations and cerLain diseases of f:"arly infancy Symptoms. senility and ill·defined condition!=; Accidents. poisoning and yiolenc('" Special condition" and examinations without sickness (s.m.) Prenatal cares and postpartum ohservations Convalescent ear plastic treatment and fitting of prosthetic de, ices (s.m.) fitting of dental de"l."ices
31S
336
1
457
29 36 21
298 6 17 10 41 1 52
1591 23. ]9 l! IJ~
S 16
134 103 117: :~{)4·
14 5 2 10 9 I 19
323 130 101 107
78 ~60
295 74 ~lll
·126
1221 62 IR 27$ 73· 9
o
Iii 14 ., .' 6 2
23 182
21
.3 40
1,
2 19 3 3
o
Note:
Th~ number of patients are from th·~ HOlipital Patient Survey on the July 13. tg::i5.
Table 33. H ,w the Di!ica:o~s and Injurit-'s are Treated. (Bas('d on the National Hr.alth Surwy Total Number of Diseases and Injuries TJealed Nol Treated Consulted Physician Cunsulterl Dentist Consulted Acupuncturist. Moxa,cauleri",t Massagist or J udo-orthopaedist ;i3.7% In
i\0\.,. 195:)) 100.0% 97.3% 3.7%
40.9% -t.9"£
Treated by Home Drug Others _ I
1.7% wben Ji",east' or injmy counted one. )8
Notf';
trpa!pr!
by two or more kind of treatments, each of them i;.;
Table 34.
Paying Method for (Base.~
th~ C(l~t
of Trt-'atment in Hcspitals and Clinics.
on tlu' Hospital Patient Suryt>y on July 13, 19;)5) Total
100.0% lb.O% 71. 0% ~PuLlic
Self'paying Social Insurance Bendit through the Daily Life Sf'clirity Law Otht'IS Assistance)
6.9%
25.
Pharmaceutical Affairs
Inspection of Drugs, Devices and Cosmetics Tht' liecnsing system is adopted, facturers of drugs,
aceording 10 the Pharma('f'lltiaJ Affair", Law. De",idt's,
fur all mamJthe inl;tallatiun newly
devices anu cosmetics f r the- sake of quality .:ontrol. improv(~J,
of every injection manufacturing factOJY has been pstablished oy the Law. During tilt-' past year, the l\'Iinistry provioen
in accordance with the standard
I, ~J()O iUl;pt'etor.:. all
OVt-'f
the ,;ollutry. who inspeded
about ~.J6. 211 phces uut of 3~1, 3:)9 places (}G.!H:i7 manufacturcrs. 1~. S6:~ pharmacies. :~l:), 'is:) importers or "elINs, Ilnd others) under their sllperd"jon, in order to prevent aduiteratf"d or mil;branded
pharmaeeutial merchandist'l; to be sold to th(' puhli(',
The National Institute of Health is conduetinp; national assay on biologieal products and antibiotic: pre-paTation;;, while the National Hygienic Lahoratory is assaing: or testing sulfa drug~. anti·tubcTculo8i:-. pre-par,t1ions. contrat.:epti\"('s, and somt-' of the mf'dical .l('vices. Pharma~opoeia. National Formulary and Others The fouIth suppif·ment ed,ition of Japanest' Pharmacopoeia \'1 ond the second edition of National
Japanese
Formulary Kas puhlished in I'\larcb 19;)5, and its En~lish edition in Pho~phorous
March 19:i6, while the Minimum
Requirements for Bi('lq~ical and Antibiotic Prcparlltio:1s have b('e-n f('vist-'d.
Poiscming by Organic
Preparations.
The- or~anc-phosl'horolls pTf'paralions havp hl'!"n lIs!"d for a;::rinlitural insecticide:- since 19;)2. Ai!'
~
35-
.-
-
above all parathion and methyl parathion are especially danl;ero:Is, this Ministry establi.;;hed the technical standards concerning th~ method of their m1.nufacture. storage. use and elc. by the Cabinet Order. However, in spite of strenuous effort of the government. there have been many p:Jisoning cases and fatal cases, of which figures are shown in the following table.
No. 35. ,--
l\umber of P .. isoning Cases and Fatal Cases hy Parathion.
Year 1952 1953 1954 1955 1956
N umber of Poisoning Cases
._----
Number of Fatal Cases Suicides
I
Operatives
-I ~~ 5
Amount of Consumption of Parathion
Emulsion
111 1,564 1,887 1,409 561
397,922 kg, 7, 126, 669 1/ 15, 164, 691 1/ 14,714,000 " 15,010,000 1/
38,095 L. 449.954 481.293 682,463 fi27.667 1-
70 70 48 86
121 237 462
// ¥
900
1-
Control of Awakening Drug There has been no violation of the authorized dealers based on the Awakening Drug Control Law, but 5,232 persons were arrested because of illicit manufacturing. sale or possession of those And also, by this law, the raw materials (l-phenyl-
amphetamine preparations and the like, in 1956.
2-methylaminopropanol-1, I-phenyl-2-dimethylaminopropanol-1, phenylacetic acid and others) are controlled as nearly same as the awakening drugs. Nar~otic
Numher of addicts is estimated about 150.000.
Control
During the year 1956, the narcotie control conducted hy the law enforcement agencies resulted in sending 1, 748 persons as violators to the Prosecutors Office, which includes: 1, 06') cases (1, 575 persons) of violation of the Narcotic Control Law; 128 cases (140 persons) of violation of the Opium Law; and 27 cases (33 persons) of violation {]f the Cannahis Control Law. The following items have been designated as narcotic drugs, under Cabinet Order No. 100 of April 18,1936; 1. 3·-dimethyl-t-phenyl-4-propinoxy hexamethyleneimin and its salts, 3-hydroxy -N-phenethy lmorphinan and its salts. 4-morpholino-2.2-diphenyl ethyl butyrate and its salts, 'i-dimethyl-amino -1.2-diphenyl-3-methyl-2-propinoxybutane and its salts.
Blood Transfusion Service Blood transfusion service is being controlled by two laws. One ,)f them is "Pharmaefmtical Affairs Law" aiming at the maintenance of the quality of blood products such as the citrated whole hlood, unfil· tered normal human plasma, etc, and the other is "Bleeding and Blood Donor Supply Service Control Law" aiming at the protection of the doners' health from the ill effect which may be caused by improper bleeding. Thus. since 1951, there haye been 30 licensed blood banks and 33 hospitals such as Japan Red Cross Hospitals or national hospitals which are rendering such services within the respe' ctive hospital.
Production of Drugs and Devices The supplies of drugs and devices are not only sufficient for the domestic consumption but enough to export with the exception of only a very few items. The yearly production amount of main drugs and devices are shown in Tahle 36.
-
36Table 36. Items Antihiotics Penicillin Dihydro-Streptomyci n Chloramphenicol Chlortf"tra<:.yt:\ i n Salkomycin Trichomycin A~ents
(Jan .......,Df'e., 19;)6) -~
Production Quantity Billion LV.
31,116
37,566 9, R68 1,4U~
kg.
366
" " Billion I.V.
1,429 278,631 [,689,008 107,970 27, 997 81, -H~ 77,072 83,269 54,737
"
Anti-tuberculosis Sulfa-drugll
Sodi um-p-Aminosalicilate Calcium-p-Aminosali(:iltLte Sulfadiazine ~ulfaguanidin
kg.
Sulfat'hiazol Sulfaisoxazole Slilfaisomidin Vitamin Preparations I nSf'cticides Anthelmintic .. Biologi('s Vitamin B\ Vitamin C Diehloropht"noJlan i Henzenhexachloride (99% r,Lindane) Santonin Cholera Vaccine Dried BeG va(:cine Diphtheria Antitoxin Diphtheria Tl)xoid Influenza Virull Vaccine Pertussis Vaccine Rabies vaccine for Human Use Small-pox Valxilli~ Tf'tanw; Antitoxio Tetanus Toxoid Tuberculin Typhoid and Paratyphoid Vaccine Typhus Vaccine Unfiltered l\'ormal Human Plasma Microscope X-Ray Film 12:-< lU X-Ray Apparatus Centrifuge Lamps for Operation Sterilizer Apparatus Forceps Scis,>ors Operating T Itble Injection Syringe Injection Needle Dental Equipmt'nt Handpiece Forceps Acrylic Resin Impression Material Dental Cement Dental Wax Porcf'lain T()(){h ann A{·'ylir. Rf"sin TO{lth ALsorbf'nt Cetton I
19;),994 1,227,362
259,511 4,204 831 2;-,117,800 G7G 7, 78~ 117
" " " " " " " " " " " I. doses I.
4,923 28
10,546,800 679
" " " " do,;!."s I.
0 5,39H 10,336
"
689 27,397 27,600
" "
Medical Im;trllments
[,33[,OUU
9,20U 35, UUO 8,900 132, SO() H2H, (lOU
11it'{'·t'l' dozf'ns pit'ces
" "
409,000 21, (JUU
12,000,000 46,750,000
Dental Instrllmt'nts
20,400 70,000 43,000
" " ., " " " " " " kg.
Dt"ntal Materials
23,000 22,OUO 27,000 20, 700 ~~,900.()OO
" "
" " " pij'c('s p::>und meter
Sanitary Matt-riRls
Cam~e
2.9,037,70::1 112, 854. 00;)
l
26.
Major Research & Training Institutes in Public Health
The Institute of Publie Health Th(~ lnstitulf' cf Public Health was estallishcd in Tokyo Ly the Jonaticn uf thl" Rt:t:kt-ft'ller Fnunoatiol1, and c()wnlt'nced its wO/k in Milrch, 193!:!, under the Il!alla~ement of the Minil'try of Health and
-3, Welfare for the purp:Be of training public ht'alth personnel. 1:] regul.lr C:lUr~t's ami 13 sh:Jrt c:)arse-s have been offered and the graduates of those courses totaled 8,154 lip tl) July, 19.'57, the Imj,)tity of them being in governmental service, bath national and local, actively plrticip3.ling in the health programme of different fieldJ. The Institute is also extf'nding its service to the Japanese-speaking foreign health personnel for their p:)st-graduate work in ree",nt years_
The National Institute of Nutrition The National Institute of Nutrition was foundf'rl ill S~pt.
1920, in Tokyo.
The Institute mahs p~rforms
investigation and re3earch on the nutrition of food in Japan or eating h3.bit of the pnple. It al.n assay and analpis of enriched food.
The National Institute of Health The National IMtitute (If Health was founded in Toky" in May, 1947, for the purp~e of givine; scientific ba~kground
tl) puillic health administration.
Its main tasks an~ in dssaying hiological preparations. and in carryi:lg out tht" study in the field
of applied researches whieh Rt'~ional
h\:t\,~
direct bearing on public h("."llth programme of tL(" Government. "arjOll.~
Thp. imp::>rfance of the 1l1stitute has incre-ased much as it was designated as Iht' Centers- such at' 011
WHO
influenza and puliomyelitis_ consists of twclve departments and one sectiun, and on·r 400 persons
The present are working.
or~alliZl.ti()n
The National Institute of Leprosy The National Institutp of Leprosy was t>stahli1'lhed in July, 1950. in Toky" hr the purpo3e of rf'.~earch
work on pTophylactir.~ and treatment of Ie-pror-y.
The main activities are as follows: (::!)
(1) Studies on the cuilurf' of leprae blCilJi and
the inoculatio:J. in animals.
Studies 0 I serum
reaction in leprmy. (3) Hi~tnl'alhological studie.~ in thl· function of form tion of humin leprous info ection. q) SLldit's on improvement and synthe:li,; of agents apinst lepro3Y, and the ob3erl'ation (~)
for re3.ding the anti-Iepruu!! effe~t.
Studies on th~ metaholism in leprosy patients.
The National Institute of Hospital Administration Th~
National Institute of H:mpital Administration
W.lS
e3tabli3hell in Lne. 1949, in Tokyo to
nrry out the following works. (] I The educltion of the hospital aLlministTat:.>r. I:~)
The sun'ry and study 0::1 the h03pital
f __
admillistration. lion.
U1
The c:Jll~ction uf m:tterial~ an'\ the C')Il.';uit !ti:m aL)ut the h:>;,pit:d admini-trll.·
The National Hygienic Laboratories The laboratories at Tokyo and 03aka are (!~mducting the following: (except bioloe;ic:ds and antihiotics), de . ..-ic~s. t:t)3metic,; and foad. blishing their test standards. (4) (3) (1)
Test of all drug;;
(2)
Rese:uche.:; nec~ssary for ~sta
Research and ~llidance in the (~llltivation of medicinal plants.
Other tests ;'lnd resf>arches necessary from tht> anitary point of view.
The National Institute of Mental Health The National Institule of Mental Health was founded in 1952 in Chih.l as a re.~e "feh and trainill~ center in mental health. The Institute con~i~ts of the D~partments of Psychology, Phpiology and Morphology, Eugenics, Child Psychiatry, and SocioloE!:Y, and its shff includes p.:;ychiatrists, psychologists, and sociologists. For tht> purp:>se of clinical work and investigation. the Institute has op~ned the "me-
ntal hygiene clinic" in its building to deal with th .. ;;dults and chililren suffering from mental di.sordprs, and has b~en closely associated with tht' Konl)dai Natonal Hospital, which is adj3.cent to the Institute.
38
~
Organized training course has not heen provided yet because of the present financial difficulty, hut a number of voluntary trainees have been guided and instructed by the professional staff of the
Institute. The Institute'" Library has received a great deal of financial assistance from the W. H. O. in pur· chasing the books and other publications on mental health.
?:l.
Public Assistance & Social Insurances
For the reference of readers, some of the statistical data on public assistance and social insurances are shown below. Table 37. Nnmber of Persons received Public Assistance and Amount of Payments. (1950--1956) Monthly Average-
Yea'
Annual Total Amount of Payment
1950 1951 1952
-~:~~~~)~ ;~; --I 21,933,363 28, 858,01S 34,863,637 37,181,237 42,571,156 ~8,749
,
No. of Persons received Payment
Amount (If Payment Thouoand Yen
2,050,050 2,033,083 2,066,835 1,933,480
1,166, ]39 1,827,780 2,404,835
1903 1951 1955 1956
1,886,540 1,928,410 1,825,009
2,905,303 3,098,436 3,547,596
3,442,396
Fig. 10.
Recipients and Payments under Public Assistance.
~.
- 3"The following table !ihows a bird--eye view of all kind of social insurances, giving some informtion aoout the concerned laws with their dates of promulgation, responsihle agencies, the insurer and the insured people, etc.
Table 38.
Classifieation of Social Insurances. I I I
Law Health Insurance Law Welfare Pention Insurance
Date 1922 1941
Responsible Ministry Health & Welfare Ministry
Insurer Government, Union
Insured
Employees in the Government Ministry of Lahor
Law Unemployment Insurance
working place (compulsory or voluntary)
Law Workmen's Accident Compensation I "!infance Law Seamen's Insurance Law
1947 1947
1193-9 I
Health & Welfare Ministry Mutual Aid Association
Seamen Government employees Other -persons hesides those insured Daily workers -Teaclie'~s
Na~i~nal
Public-Service Mu-j-1948 ~ tual Aid Assodation Law . Ministry of Finance ~~~
National Health
Law
-1r nSUfance ! 1938 1953
II alth & Welfare Ministry
Self-Government Union, Other Bcidies Government
Health Insurance Law for Daily Workers
Mutual Aid A~sociation Law for the Teachers and Wor- 1953 kers of Private Scho Is Mutual Aid-Association ~for the City. Town and 1954 Village Officials _ Mutual Aid Association Law for the Employees in the 19:;6 Pllhlie, _~~~~rp~i1ie~ _
Mini~try
of Edlu'ation
Mutual Aid Associatlon
and workers of pr~ate schools
1---
Local Autonomy Agency Ministry of Finance
Officials of cities, towns and villages
"
Employees in the public enterprises --~-
Tn
following table. figures in "Coverage" and in "Pension" refers the data as of March.
,
~-
'fable 39. Coverage Fiscal Year No. of Working Places Thousand
Health Insurance Managed by Government. Benefit Medical Care (in kind) For Dependant Foe Primary Insured Amount Amount Cases Cases Thou .... nd
No. of Insured Thousand
Otheri------Cases Thoulland
Amount Million Yen
Million Yen
Thouoand
~lillion
Yen
1946 1947 194H 1949
86 93 129 141
1950 16:11 1952 1953 1934 1955 19:16
157 175 193 224 236
214 267
2.270 2,484 3.279 3,268 3,580 4.018 4.399 4.988 4.941 5,242 ~_p91
1,462 2,715
4. 128 8.491 10, 150 12, 39R 14,995 17.869 20.92,q 22,589 25,906
119 402 2, 754
7, 227 8, 638 !II, 766 15,281
20,585
1
27.900 30.345 33.321
450 6stJ 1,581 6.163 8, 407 !II. 831 13.220 15,669 17,605 18.623 21,3_~_
25 6;:) 473 1,985 2,553 3. 421 4. 791 6,058 7,211 7,609 8,627
382 603 892
42
233 957
I. 40~1 1,434 1,561 1.733 1,886 2,043 2. HI 2,125
2,521 3.453 4,329 5,473 6.656
8,068 8,553 8. 353
-·10 Table 40. ----
Health Insuranct" Managt·d -\,,;;(Iciatioll. Bf'nt'fit Medical Cart' (in kind) Fo, U~f~'_I1'~_ Foe Primary Insu(f'd Cast's C(ll'IO'", Amr.lllll Amount Thousand Million Yenl Tho,,.and MilHf>O Yen Otht:'r~
Cun'ragt' Fi~('al
No. of A,.;;sot'iation 5~7
Y€'ar
No. of Insured Thou'dnd
-----_.
Cast' Thou.ant!
Amount Million Yen
19·16 1~ 117 l!)J'" l!l.l!l l!I;;O l~,")1
2, ORR 2,2~i
69:)
ii;) i51 i.)!) 779 oS2u oS-" ,d
4,711 7,3B
2.6'10
2, 827 2,950 3,036 3, lUi)
10,989 12, 131 12,8:10
1:1;)2 1!):i:{ 1:l;) I 1!J5i'i l!J.iGI) ]\"olt': IJ
::;9--190i 924
3, 314 3, 220 3, 313
13,461 14, 707 16,021
16, ;:i(l1 18,16:3
- -3,516
103 4-') ,2,691 6, 624 7,977 8,892 1O,7(il 13,292 17,232 17,8:17 loS,S·B
23 ~. G9~
l;)G ? ']--
1.632
.1,160
777
S, ;)21 l, 280 E, 669 14,732 17,65::> 19, Ei9 20,740 23,051 J
~, J;);)
1,896 4.015 6, 7H9
91 49!l 1.4'3
4.102 ,), 1:13 6, S6!J 8,172 9, 3U9 10, GI9 10,5:13 10,431
3,1),")4
3, 1-11 4, 734 6,177 ';",18'1 7, 720 ~,3SS
7,5iS R.686 g, gO-l 9.157 9.62:i 9, 736
Figurt"s for Benefit are estimate.
Table
41.
Health Insurance for Daily Work(·r". n~!1t"fit
Cuwrage fiscal Yeur
No. of In~m<:,d
Ce.<;timi.lte,;) Tho"""nd
Cart" (in kind) Foc,'piiC,"i=m=.=ry Insured 1"0[' Dejlt"lIflant Cas('s I Amount Amouflt TI,(Iu~Knd
--Meflical
Others Amount Million Yeo
Million
Y~n
Tho" ...",,!
[l.1<II,on Yen
19:1219S I
:16?, ;)73 li70 748
23 791 1, 42~ 1, 'I:iY
10 !)()4
Ii 2-11 3';"2
12
1!):i.') 19:;0
2. 030 2,563
30 16
G69
"
• Table 42. Fis("al
Welfare Pension In5urance. Benefit Pl'nsion ;.Jo. of Pen.ioner Thoueandl
Year 1946 1~H7
Coverage No. d No. of Working place In,.;;ured T!:ou"and Thou"",,nd
Amount \lillion Yi'n
Lum-r--:-~u.m Cases Amount Thou"anoi Million
Y..
94
101
19-1H 194!1 19.")() IY.') I 1~I,')2 19:i;j 1!I,i..\
BR 167 186
1, fi 13 4, 791 5, 713
II. :1 I :i. 2 17.9
B 12 13:1 394
617 3:i:i ~lG
118
HS Hi·!
149 :.!Ui) 2:J~)
5, 738 6,113 6,613 7.03·1 7,790 7,883 8.227 ~I2
!):i.B 119.2 B2.!i
:12. R 49.0 70.1
724 :.:~:..: 1, ~Jl7
I,
87 97 95
:i:10 770 1.2;-;1 \, ,:-lot)
99 117 16:i 20~
2, 483 :1,4-t6 -1,340
I ~J.i:i l!-L')(j
2S-I26':; 2K)
liB. ·1 191. X
3,12'1
190
2, (ilG :!,719 :!, 7lG 2,313
/
Tahlp -13.
Unemplo)ment Insllranc[>. Bellt-fit 1;
J\o.O£ 101H 1!J~\)
Coyerage 1 • Working N Plact"s o. of Insured Thou .... nd Thousand!
rAmount Paid Million Yen
Weekll l1~l'mployell Thousand
139 154 167 137 208 230 23::1
:i,4HG :i, 703
19:iO 19,) 1 1932 19::i:~
5,B98 G,314
G, 1-149 7,68;1 7,921 ~,OG4
1\):14 19.i:i 19.16
242 261
X,
9.~
790 10,854 15,716 10,518 H, 931 16,153 22.028 Hl,03,s 1:=:.421
:ISS 9,17() 14,72(-\
:W, of)~) 2:1, -lU-I
12, 52·~
;{'i, :i22 :10, ~<H 2-1. :;\6'~
Nol(':
IJ
Excluding daily laborers.
Table 44. 1
H -
Workmen's Accident Compensation Insurance. Coverage
Fiscal Year
No. of ·Working Places ~2i)
1\0. of Insured
1-1
Bendit
Cases Thouu .. d
Amount Paid Million Y~n.
ThoUMndi--
19-18
1949 1950 1\)51 195~
~78
6, ~68 ,,196 (,559
R39 1,204
6, !JG9 I
316 340 372
1,517 1,547
2, -I5~ 5 S12 8: 297
1953 195.t 19J:i
454 491 S39
R,OSt 9,363 9,679
10, 763 11,746 13,928 16,111 16, 187 18,387
1,419 1,372 1,721
19;)6
5B6 Tahle ,15.
l~ji~
.1
1,693 1,937
Seamen's Insurance.
Cal
Ordinary Insurance. __~~era_ge
Fiscal ¥t'ar
No. of Shipowners Thousand
Benefit Lonp:-term Benefit Short-krrn Benefit Pension Lump-Sum Medical Care (in kind) Others No. of N f For P-rlmar), For DepenAmoAmo- I I nsuced I clarlt Insured p o. () Ama- I c enSlases I "--,--Cases unt unt unt C ,Amo-, C Amooner ase:;; Innt oases unt 1
~
ThDU9<\nd
194fi 1947
1.5 ~.
gO 8:~
Tho"-:--I-Milliol>' Thou· sand Yen I .... "d I!
Million! Thou. - Million Y~n ... nd i Yen
0
1948 19-19 195U
4.3 5.'\ 5.R
1:!2
1:!4 124
1951 1952 ]9:)3
,.
7' 131 1515 16 18 19 20 21 22 21
43.5 7 9.0
10' 17
6~i
Thou· .... nd
Million Yen
Thousand
Million
10 83 139 16H 205; 244j 467' 519 5-14
8.7 .t.5, I. 41' ., 5 ,: 91 2. ;~, I. si 1. 1.;'5
25 63 8~ 130 132
1041 23d -191 l .)75 1
19~
7, 29' II
7
3
5
464
G.7, '\ 7.4
141 144 154 IG2' 16:'i IIi
6:,3.11
4R6 516
2 ,361
15;
"'
16 38 .")6' 611 tiSi S2!
13
90 216 288 35\:1 505
1954 195:; 1956 I..h)
8.0 H. Ii
8.4!
11
726' 655 1~9 770 7l{~ lQ')! 901 1,032 1,006 1,115 231,1.0531,194 1
475 574
80 ll2 135 139
614 785 89R 91H
1
2U5'
681 766
90S
Unemployment Insurance. Coverage Benefit Cases ThoUS!l"d
Fiscal Y !~ar
No. of Ship-owners 1947 19-tH
No. of Insurt"o Thousand
Amount MiIl;on Yen
-fhou""",,d 1.9
,9 e8 92
19-19 1950 1951 19.32 1953
3.8 4. :l .f. 6 5.3
103 97 92 93 9'\ 9::1 IO~
5 73 200 145 l'-'~
5.6
5.9 6.0 6.0 6.
1951 1955 1956
.,
U9 132 107
...
90
\:IS 290 255 265 303 292 2-11 224
Tablt 46.
National Public Sprvi{'1" J\.h1tual Aid A<;so~iation_ B~nt>fi.t
J,ong-term Benefit FiSlCiJI Ye-ar
NIl_ of Ass'n
Pension
No. of Insured !'Io_ ~f AmaPensl- unt oner ;---
Short·term Benefit Others Lump-Sul~ MedicalCare (in kind) For Primary For Insurf'cI Depf'ndant Cast's AmoCases Amount Ame)unt Amo- C ases unt ! ases oot
C
Thouoand -Tho"Million' Thou-iMilli-;;-;;--Tho". .Bnd ,Yen sand, yen sand
I
-I Millio" Yen
ThonMod
Million
y,.
Thou-
.... nd
Million' Yen
1951 1952 1953
31
30 1
2, ,126 2, Sal
1
1954 1955 1956 ~
29 29 29, 26
2,590 2,634 2,6% 2, 04U
18-1 6,326 188 6, 735 IRS 8,274 191 8,398: 193' 8,4731
192 3,199,10,629 7, 105 8, 177 1ria 2, 77810, 87~ 9,443 R,984 102, 2,380 11, :~3611, 024-10, 857 1021 3,20-411,887 12, 84312, 112 80 2,87513, 2841-1, 15914, 462 ••• 1
2,037 2,929 3,297 2, 945 3,061 4,083 3,797 3,315 5,236 4,552 3,675 5,192 5, 340' 2, 442 4,238
... ,
-4:! Table 47. National Health Insurance. Benefit Medical Care
I-1952
Coverage No. of Insured Thousand
No. of
Unions
Cases Thou""nd
Amount Million Y"o
Cases Thousand
Amount Million Y .. ~
1953 1954 1955 Note:
1,990 5,1:11 3, 66Y
23,089 24,906 26,633
3,170
28.711
2D,2'i1! 34, 147 H,231 49,158
18,13\ 23, 734 542
1
31, 308 37,388
604 701
259 :141 47R
Figures for 19:16 are not availahle yt't.
-
T
Health Report for Japan for the years 1954-55-56
August, 1957
Ministry of Health & Welfare
\
:
Health Report for -Japan
(for the years 1954-55-56) Part I 1. Background information: a. Early hiStory of health service, and its evolution. The progress of health service in our country can be well explained over 3 period, i.e., the period before the 1st '!lorld War, the period from the beginning of the 1st Wo~ld
War till the end of the 2nd World War, and the' period after the
2nd World War. (1) The period before the 1st World War. This is the period when the foundation of current health administration and services was established.
'A.
In the year of 1'l74, the health administration
system was established. under the jurisdiction of the Ministry- of Education and the preparation was started to open medical education system based on the Occidental medicine, to establish licensing system for medical practice, and
to adopt westernized pharmacy system.
The compulsory smallpox vaccination for In the year of 1875,
entire population was put into effect in the same year.
the Bureau of Health was created within the Ministry of :lome Affairs, thus the ~-
•
responsibility of health service being transferred from the Hinistry of Educatior to the lfinistry of Home Affairs. In the year of 11'\84, 32 medical schools (30
public and 2 private) were established for the education of medical doctors. The control of acute-communicable diseases started in 1897, when the original of the current "Connmmicable Disease Prevention Law" was established. Then, in 1899 "Sea-Port Quarantine Law", and in 1900 "Filth Cleaning
Law",
"Sewerages Law" were established, together with comprehensive food sanitation regulations. ~
Thus the legislative and administrative background for the
preventive programme of acute-communicable diseases and for promotion of environmental sanitation was established.
.
-2In the year of l89S, the system of vital statistics was created by the establishment of the "Law for Horne Registration" which was almost similar to the current legislation. With the development of medical education, the nU'llber of medical doctor: who received regular medical education and .,ere duly licensed increased steadily and the need for legislation on the medical profession arose. Consequently in
1906 "Medical Practitioners Law" and "Dentists La,-;" were pronrulgated. (2) The period after the 1st Horld :'lar till the end of the 2nd World War.
'A.
The industry and eoonol:W of the country grew rapidly before the 1st World War and it further developed at this stage. Due to the rapid industriali~tar,
zation and drastic social rev;olution during and after the r;reat
it was duril
this period that many social legislation in the field of medical care were established. Thus in 1911, "Factory Law", in 1922 "Health Insurance Law" and
"Simple Life Insurance Law", in 1929 "Relief Law", in 1931 ''Workmen's Accident Reliev Law", and in 1937 "Maternal and Child Protection Law"were established. It should be noted that some of the basic legislation in the field of ~.:.....
...
preventive medicine were also inaugulated at this stage.
They were "Leprosy
Prevention Law" (1909), "Hen tal Hospital Law" (1913), "'fuberculosis Prevention Law" (1919), "Trachoma Prevention Law" (1919), "Venereal Disease Prevention Law"
f
~
(1927), and "Parasitosis Prevention Law" (1931).
In order to implement these
legislation in the field, various offices 1.,ere established and they were "Pregnant vlomen & Infants Consultation Office" (1919), "Simnle Life Insurame Health Consultation Office" (1923), "'fuberculosis Prevention Consultation Office" (1931) and "Health Insurance Consultation Office" (1934). In 193.S in order to combat
;,~ ~:'
f
f' ...
against the tuberculosis which was then the biggest public health problem, the
~
"Health Center" wa.s esta.blished by amending the Tuberculosis Prevention Law, wher
.0 - 3 the health examination and consultation on tuberculosis were to be the main function. Later in 1933, the Ministz-- of Health and Welfare was established and was given the administrative responsibi1ity on health, welfare and labor which formerly belonged to the Ministrv of Home Affairs. Under the new Ministry,
various social insurance scheme were established, which included the National Health Insurance and Seamen's Insurance. Under the "National Medioal Care Law" which was established in 1942, the local health administration that had been under the hand of police authority was made to be directly under the (3) J.finistl~'
of Health and Welfare.
The period after~ the 2nd \'I"orld War. Immediatelv after the War, the heal t!l administration both on national
and local level was completely l'eol'o;anizedo
In the Hinistz-v of Health ani
Welfare, Bureaus of Public Health and of Medical :.ffairs were created with the responsibilities respectively of preventive and curative medicine. child health was assigned to the also ,. ~ ne1~lv
Maternal and
established Children's Bureau, and a~g
the Pharmaceutical Bureau became res')onsi ' lle for standardization, inspection of pharmaceuticals, cosmetics, and biolo~cals.
and
On the local level, each prefectural govoMment estal:ilished health
departments directly under the prefectural ,,:overnors.
Their area were divided Health
into health center districts' according to the population of 100,000. centers in each of these districts were stren~hened
to be responsible for all
phases of preventive pro,ramme including communicable disease control, maternal ani child health, environmental sanitation, and food hYIY,iene. Existing laws were amended and new laws were created according to the arising need an:l the acquired kno;Iledge and experience.
.j!!.. b. c.
-4Basic policies and underlying principles. Functions and responsibilities of national, regional tnd local levels The responsibility of the rovernment for improvement 'nd protection of health of the people in Japan is specified in !.rticle 25 of the Japanese Constitution. It provides "All the nation have the right to have healthy,
cultural and minimum level of living.
The state shall endeavour to improve and
promote social welfare, social security and public health in every aspect of livelihood." Based on this prOvision, the l1inistry of Health & Welfare of the It formulates
national government takes initiative in health activities. policies, directs programmes, and supervise activities.
The local goverruoonts,
with their health departments, implement the prograrmnes under the direction of the national gover!lllent by their own health centers which are located in each of their health center distriC\a and which are resDOnsible to their connnunity public health programme. d. Brief narrative descripi,ion of main health problems. (1) Tuberculosis The mortality of tuberculosis cases in Ja'Jan, has remained approximately around 200 per 100,000 population for nearly 40 years since the reliable ~!:
statistical data became available.
But, after the World War II, the rate ~egan
to decrease rapidly, and in 1955, it becane 52.2 per 100,000, which is approximat, ly one-fourth of that in 1918. The decrease has been distinctly evident in the
group of young people, and the peak of the 'l1ortalit" conseouently is shifted to the group of advanced age. But, countr7-wide survev of tuberc1Jlosis, the details
of which will be stated later, reveals that the tuberculosis patients would form 3.4% of the whole population. Under this assumption we consider that
tuberculosis is still one of the most important health problems in this country.
(2)
Environmental sanitation. Due to the rapid urbanization in many parts of the country which very
often does not accompany proper sewage s:rstem, the problem of
ni~tsoil
and
~
,,_,L . ",,-
5garbage disposal has become one of the serious health problems. The project of
prototype plant for compo sting of ni'!,htsoil and garbages by Kobe city under the assistance of ~ stimulated the interest of the rest of the larger cities for the similar tvpe of the projects in order to solve their problem.' '-.. _ Several other
-
-...
cities have been working for the definite plan for the treatment of both nightsoil ani garbages. in the future. e. Any survey of health situation in progress or contanplated.
However the problem will remain to be solved for sometime
(1)
The National Nutrition Survey According to the result of this survey in 1955, it was revealed that
the ratio of those found to have sickness symptoms is 22.5% in whole country, 18.6;b':in urban area ani 25.9% in rural area. The bodv height, which was inferior at the end of l·o,st ~'Orld
war
comparing to the ante-war period, has been found to have improved during the past 10 years at this survey. However, the survev revealed that no improvanent
was made among those who went through critical !bod shortage period in their infancy period, i.e., in lII1l1e 14 to 17 age group and in female 14 age group.
I
The similar situation can apply to the body weight, i. e., no improveJOOnt in weight was made in male 14 ani 15 age group. (2) The Survey on Hospitals and Clinics. The survey has been held recently once in everv year. It was held on
r~ ,
31st December, 1955, to get the distribution of hosnitals and clinics for the establishment of them. There were 5,119 hospitals, 51,349 clinics and 24,773 dental clinics showing increase of 340 hospitals, 1,533 clil'ics, and 573 dental clinics, :from
those on 31st December, 1954.
a
,
--,,{', T "", • ~ (3)
-6The Survey on Patients in Hospitalization The survey has been held recently once in every year. It was also
held on 13th July 1953 to get the sc;ntus of the patients in hospitals and clinics, as the sickness survey below-:nentioned 1<'hich was aimed to get the status of the patients in the households. The patients estimated from the survey were about 2,847,000 of which 1,026,000 were in or at hospitals, 1,550,000 were at clinics, 372,000 were at the dentists'.
(4)
The Sickness Survey This survey has been held recently for a month every year to get the
amount of sickness, their therapies and costs for the therapies.
It was held for
a month of November in 1955. From all households in Japan, 1l,669 households were sampled at random. Showing the estimated annual a'llOunt, there were 178.3 sickness per 100 persons occurred, 20.9 sickness days per person for a year and 11.7 days per cas~ with Of the total sickness 97.3% were treatectitherapies, and ~% of those treated were by physiCians or dentists. The treated cases per 100 persons were
,.
~
estimated 200.8 and the treated days per 100 persons 1,617.5. The cost paid to physicians, dentists and the other technicians for the treatments, drugs ani other sanitary materials per sickness treated was 823. The cost treated by physicians was ~
1,909 and by dentist ¥ 1,282. ~ras ¥
The direct
annual cost mentioned above per person
1,652 for a year and the other cost
than the direct was ¥ 121 per person for a year. (5) The Basic Survey for the Health and Welfare Administration This survey has been held on 1st, of April everv year since 1953 for the purpose of administration. researchin~
fundamental matters for the health and welfare
~
-7(6) '!he SUrvey on 'fuberculosis Continued from the big surveys in 1953 and 1954, the survey was held in 1955 to stuqy- the changes in the illness and classification of guidance, expendi-
.... f
.;:
ture in cash, reason of not receiving treat~ent, etc. The results of the survev revealed that 37.7% of patients, who were diagnosed as requiring medical treatnent in 1953, received or had received medical treatment, ani that of these patients 71. 5% received only chemotherapy, 8.6% internal collapse therapy ani 4.7% sur"lccG. treaXnent. these two years was as follows. Course of illness during
23.5% of all p0.tients got better, 61.0% were
found no change, 13.3% got worse and 1.1% died from tuberulosis. (7) '!he survey on Tuberculosis In-Patients Out of all national, local governmental and juridical persons' tuberculosis sanatoria, 76 institutions were selected, and of all their in-patients the survey on illness, treatnent and cost of treatme:'lt h'ere held. '!he cost of treatment in hosuital of all patients not covered by social insurance (~) rangedfrom 10,000 yen to 13,999 yen. ~
Changes in method of pay-
ment were as follows.
ReCipients of social insurance, who were 43.0% of 3.1.1 patientr
at the time of coming to the hospital, decreased to 35.5%, and dependents of recipients, who were 8.1% at the time of comin~ to the hosryital, also decreased to 6.8%. Period after co"1ing to the hospital until the survey ~ras
nnde was researched tel}.
22.6% of all patients staved under 6 months, 34.4% from 6 months to a year and a half. (8) Period of 3-4 years was 6.8%, and over 6 years 6.9%. The Survey on Diphtheria Immunization Out of infants and children from 2 months to 12 years old in the whole
:<t
country, 31,681 persons were selected by means of sampling method and given the shick test.
Negative of this test was recorded as 38.2% (male 39.2%, female 38.2%).
,~.,
'.
I
~
-
- 8 '1l!e rate of each age under 5 years old w~s as low as 3ct% rut it increased gradual.1y as the age beca~
older.
Concerning infants, the rate of those under 2 months
old was 79% and the hi%hest, but it decree,sed as the age became older.
-:Jt
f.
Any current econo::d.c and soci al trer.:'s inn uencin'C til e heal t'1 of the population.
No comment.
g.
Any prog!'E>SS in research relating to the health of the pu!Jlllation.
National Institute of Health in Tokyo has been comucting several research projects including new type of biologics for tuberculosis. 1.1 1.2 Area of the country: General narrative on: 88,293,000 in 1954, 39,275,529 in 1955 and 90,253,000 in 1956 369,765.89 sq. km. as of October 1, 1956.
1.2.1 Population:
('1l!e figure for1956 is provisional). 1.2.2 Birth r~te: 20.0 per 1,000 population in 1954, 19.4 in 1955 and 18.4 in 1956
(The figure for 1956 is provisional). 1.2.3 General rr.ortality rate: 8.2 per 1,000 population in 1954, 7.8 in 1955, am
8.0 in 1956 (The figure for 1956 is provisional)_ 1.2.4 InfB.'lt nortality rate: 44.6 per 1,000 live-births in 1954, 39.'3 i"o 19~5,
a'1d
40.7 in 1955 (The firyre for 1956 is p:rcvisior.al). ~.
. Organization...,cp,d adrgj nistration of heal th services
a.
Organization and administration at national, provinei al and locd
=evels
(1)
N('.ticn~J.
lev,,:L
'!he responsibility on public health progra'llIlle is umer the Ministry of Health
am ..relfare, except- industrial hyciene which is under the Ministry of
Labor and, school health which is un:Ier the Ministry of Education.
-9In the Ml.nistrv of Health and '<leHare, the Public Health Bureau, Medical Affairs Bureau,
am
Pharmaceutical & Supply Bureau, together ~r:ith the
Children1s Bureau sl1are mai.n responsibilities on health administration in the field of public healt.'1, medical care, ,)~1amaceutical
supplies, ani maternaLarrl
child hygiene, respectively, with the assistance of statistical services rendered by the Healt11 and ;,Telfare Statistics Division. Since social welfare and socilli. insurance are closely connected to public health am medical care pro::;;ra"l.'lle, the close cooperation is bening ;(: maintained with Social Affairs Bureau <::':ld Insurance Bureau in the Hinistry of Health and Welf3re. The organizational chart of the sections and burueaus in the related to public health progra':ll'le is ShOl'i!l in the attached paper (1). Several research and training institutes related to public health belong to the Minist:o:-:' of Healt'1 and 'tie1fn,re. They are Ins~.itute of Public ~Ul".istry
Health, Nat.ionr.l Insti.tute of N'utri tion, National Institute of H8al t.'1, l';ational Institute "f L2.prosy, National Institute of Hospital Administration, ;'ioc'.;i'::>naJ. Hygienic l.,,'thor3.t .ory and its branch am National Institute of , 'I Ment,~ HE3J.".~'.
(2)
Preff~+,ural level.
The ecuntry- 5.s divided into 46 prefectures with tJ1eir
010.'11 !]:,YAl'"nn!":3
1:u
.... -
public elcctj, ')'1. in the fieli 0',"
B" national laws, the governments enjoy certain autc"1(''''''" bllt
health most of the programmes are sponsored by the natl)!vll Heal';;h Depart!'lents of the prefectures
government Hit': the financiel subsidies.
directly responsihl.e to their governors to implement the progr8lllJlle through their own health centers.
b. '!('
Health centers and health units One health center is established in the area per 100,000 population with
-
-
- --
----------
-10 necessary modification according to the _"eographical condition. are consisted of the followings: 1) Health education of the public Collection of vital statistics Guidance of the public for the i~pr:>venent of nutrition and food Its activities
. I
..)
. ~
2)
3)
snnit2.tion 4) 5) 6) 7) E~vironnental
I
sanitation, including insect and rodent control programme
Public health nursiru; for hOlOl8 vi sit Maternal and child health service to the 'lothers ani pregr.ant women Medi cal social service Laboratory tests al'ld examinatlon services Dental hygiene Consultation service on tuberculosis and venereal disease
8) 9)
10)
tl'umber of health centers and main professional st.?ff for the years 1954,
1955, and 1956 are as follows:
-I
h£ 1954 1955
No. of H.C.
Physician
Public Hecl.th NursQ
other B 27,613 28,053 28,197
l:Q. .t;.Ilc~_ 40,45~;
772 783 783
5,066 5,174 5,198
7,806 7,969 8,037
41,19;' 41,432
~
-
1956 c.
Function of the voluntar:' orga~izn_tlon ,ror:dnc; in the field of health, and their relation to the National Health Ad~~stration. 'ilie names of the major voluntary organization in the field of health are
listed below.
'iliey are their own professionpl organizations independent from However, their opinions an~
the influence of the government.
suggestions are
often sought by the 'SOvernment in fo!"1ll.llating the policies an::! programme which affect the health of the people. The Japan Medical Association. The Japan Dental Association.
,
-11'!he Japan Phamaceutical Association. The Japan Nutrition Association. The Janan Public Health Assoc.
The Jan an IJursing Association. The Japan '!'ubercclosiB ABSOC
'!he Japanese Association in Mental [{"alth.
'!he Founda.tion f0r' the Prevention of Leprosy. The Japan Hosuit&!. ABSOa.
-.
The Ja0anesc Association fbr
Preve~~ion
of Venereal
Di~eases.
3. Health
per:~~~,J.f_~
No. of hG2::' ·C;, p8rson:oel is as follows:
Year
Physicians
Dentists
Clinical N1:rse
Public Health lJurso
11id~~fe
Pharmacist
1954 1955 1956
92,442 94,563
30,659 3:!.,109
215,7::>S 224,4S6
31,309 31,390
91,753 88,210 •• •
51,132 52,418 •••
(data for 1956 is not available yet)
...
...
...
4. Financing of he31th services in 1954, 1955 a,."d 1956 a. National health budgets.
1954 ••••• 24,981,000,000 yen ••••• 2.49% of the total national rudget 1955 ••••• 25,321,000,000 yen ..... 2.48% " 1956 ..... 25,373,000,000 yer' ..... 2. 50% " b. Provincial health budgets. c. Local health budgets.
" " " "
"
" "
"
..-
Reliable data are not available at 'Jresent •
5. Health education of the
public
The local health centers perform extensive health education programme in the field of comrrrunicable disease prevention,care for infants, arrl insect and rodent control, and promotion of envirol1l'lmtal sanitation. Ir:. addition, school health
education is performed bv school authorities under the direction of the local education board, >;hereas the industrial hygiene education is conducted b" local labor standard offices. In the rural area, agricultural exta'1sion service under
-12 the direction of the f.linistry of Agrj culture 'lJ1d ForestI"" includes substantial health education programne to the ftJ..1·rrers. Radio broadcast, movies, slides and exhibits are a:tployed exte!lsiye1y. Summer seminars arc "eld c.:muall,r for trci'1ing and for conference, a'1d the
,
...
regional discu3si.on groups Deet often for the exchange of The at heal tJ.~ r,·~,',;·
viel;S
&'1d ideas.
"i0'1 of he'llth filDS and slides are increasing rapidly for the US< e.ni for 'I-;orneYl ~
c~nt ~'rs
s and young poople f s meetings o
6. Heal th legis] ation During thG peri.od of 1954-1956, three ne~l l~",S rel[.ted to public healthwm"'ll promulgated. They a>:-e 1~'1aste Disposal La,,-" (1954), "Opiu.'ll Lm-l' (1954) and
"Bleeding and Blood t onor Supply Service C::mtrol La,,,11 (1955).
7. stAti sti cal
service
The collection of health statistical data is the responsib:i.lity of the prefectural governments through their the national gpve~~Gnt 01'",1
local health centers. st~tistics
Subsidies from
are given for the
officers in the field. T'lelfare receives the
The Stat.istics Division of the Ministry of Health . .L
-
am
re1'0rts from all the prefectural govern'llents and does analysis and tabulation. The followings are the list of statistics required for regular reporting and surveys currently in progress.
,..
-
1) Vital statistics
2) Comnunicable disease statistics
3) FOOd-poisoning statistics
4)
Hospital statistics
5) statistics on artificial abortion 6) Health center statisti cs
!i'
7) Survey on medical
C~.re
by the social insurance
- 13 a) National health survey
9) Patients survey 10) Hospitnls and clinics surve,Y ll)
Surve:r
on doctors, dentists ::TId ph11.!'l'1£.cists
--
~
A. MedicyJ. care
A,
:!:..oce.!_
Totnl •
N11.t-1.onal 421 425 429 4 4 5 204 206 202
pc.;.blic a~enc"'r
Jurid.::.c:al
Priv~.t.e
---Hospitals of (1954 all kind (1955 (1956 J
pers:\?J.
4:.779 5,1l9 5,416 224 260 322 610 676 712 77 73 76 3,854 4;096 4,292
964 1,024 1,053 25 32
1;878 2,036 2,211
1,516 1,634 1,723
Mental Hospi-(1954 tala (1955 (1956 Tuberculosis (1954 Sanatoria (1955 (1956 ~
eo 107 15~:
115 117 132 100 136 151 1 1
33 89 (1'"" ,)'7
S·o
2:7 249 270 2
"'-
Disease
CorJllUlli cabl e (1954 (1955 Hospitals (1956 (1954 (1955 (1956
75 72 75 202 204 211 775 S3CJ
,
General and other Hospitals
[556
1,577 1,M2 1,786
1:,300 1:,300 1,439
;"
-
Number of beds in hospitnls: Hosnitnls of all kind 1954 461,927 512,688 559,027 Mentnl Hospitals 39,447 35,a41 43,$90 Tuberculosis Sanatoria 113,640 122,967 127,122 Cormnunicable Disease
li2§l2ita.l 6,2815 5,994 5,975 1955 1956
'i.-
-14Gen9ral and Other gospitals -----~-
Total
T.E. Wards
Disease
Co,,"~nicable W~s
Other
Wards
.1":..:1.954
--_.-_.
1955 1956
311,5S2 3/"7,886
7,402 8,409 10,956
96,422 113,216 125,566
1l,77.~
13,183 J.4,65 7
---_.....
_-
1'76,006 213,078 230,861
(195h Dispensary )l9~)
49,816
21;.,200
)
51,349 ....
, -' (, 1 0 1)tJ (da~~
for 1956 is not available yet) (aedical care is not perfoI'llled)
...
Health Centers 1954 ••••.•• 781
1955 ....... 772 1956 ••••••• 783
c.
ii.ehabilitation of the handicapped. 1)
For children Total facilities Py1J1i~
311. -r:-:~.j.i c,:j. Person
No. acgp;r,ga:ced
, ",. '~
-..... I
....
1954 1955 1956 2)
16 18 25
11
13
5 5 7 Public
18 National
1,226 1,349 1,703 No. accowgdMed
For ad1rlts Total facilities
1954 1955 1956
29 34 36
1 1 1
28 33 35
898 1,048 1,108
9. PfIDtal health, dentists. dental nurses and dental techricjaDs
1)
As of December 31, 1955, there are 31,109 dentists, of which 20,422
engaged in dental practice,
196 engaged in dental education, training
and
researches, 258 engaged in government aQ~nistration, and 1,233 engaged in othei
- 15 types of work. There are 485 dental hvP,ie:ti.sts as of December 31, 1955, and
12,444 dental technicians as of January 15, 1955. 2) 1,195 (25%) hospitals out or' tIle total 5,119 hospitals in our country Dece~ber
have dental facilities as of
31, 1955.
A~ng
24,773 dental clinics
...
throughout the country, 24,409 (about 99%) are private ones; others are national, municipal 3) a~
juridical.
Preventive progranne is carried out by 300 health centers out of the For the school children, each il~hool
total of 783. ~.
is required to appoint a
school dentist for the care and protection of the children in schools. 10 •
.!:ill!! 1) Maternal hezlth Pregnant wonen are given written statenerrt fron ",edical doctors or nidwives of their pregnar.cy, and ,,':ith these statcnent, the" are given "noteoook for nothers and infants" fro~
the 2.ocal health centers.
'l!1is note-book
entitles thS"'- to have free consultat1,on ser'rice fron the staff of the health center wi t'1 the necessary inforl'lati:m rec )rded in the bo::>k each tine they visit the health center. 2) Cl1ild heal th includin,~ school heaU.. ':. Parents of children of pre-sch001 age including infants are advised
-
by law to make close contact .;ith the staff of the local health centers and
receive periodical advice from the doctors and public ',ealth nurses.
"Note-
book for nothers and infants" which is mentioned above also serves in this instance for free service and for the inforr-cation records of the growth on the individual children. In school, pupils are required for periodical physical
exa.'!Iination each year by the school doctors and the results are reported to their parents with the proper advice to be fo11m<ed at home.
- 16 • ll. Health Cere for the chronoc sick 12. Health care for the aged
AlaI"':led with the report of the cases
fro~
vascular lesions affecting centraJ
nervous system be coning top of the list of cause of death, the special. advisory
...
~.
coomittee for the Minister of Health and Welfare was established in
1956 to
advise for the future policy, and as the funds becone available, to extend services to the vari:)us cases of the chronic sick and for the aged. Thus far,
"8everal national. hospitals in the different parts of the country have establish. consultative centers for either a spedfic or several tvpes of the chronic diseases including hypertension, cancer, and heart disease.
13. Occupational health The occupational health progralllT!le in this country is based on Labor standards Law and is imple:nented by the Ministry of Labo:::-. standards inspectors work for the in~Gction
2,350 labor
of the 1,038,248 factories which
includes the inspection of the health condition of the facilities and workers. Silicosis is the T!laj or problen and th3 speciel compulsory heel th excunination
-
-
is perforred.
'!he patients are given benefits out of worlmen's compensation
scheme for their treatment. Under the Labour Safety and t;ygiene Regulation, larger type factories are required to appoint the health supervi9:Jrs dul~!
licensed b,c the government.
14. Nutrition '!he local health centers have nutriti'lnists in their own staff. They
participate in the field of nutrition, conduct tra.ining cC)urses, and give personal consultation. In sane of the larger cities, "Kitchen Cars" with full
equipment of cooking utensils and the d8.'11onstration facilities specially designed for the purpose are employed for mobile demonstration in their own area. The supply of nutritionists, 102 schools are authorized by the government
.'
_"
~
-~~1.-
--",
"
for the training of the personnel.
'Ihere are 17,000 nutritionists duly-
licensed by the government as of J.956. 'Ihe national nutrition survey has been conducted every year since 1946. '!he result has been fully utilized for detennining the health pro~ramme ..nd th'
food production policy of the government.
15. Mental health 1he Ministzy of Health and Wclfa:e created a new section within its own organization specially responsjble for nental health in April 1956. During the period fror.1 1954 to 1956, tIle Ministry of Health and Welfare conducted two significant surveys on mental health. One was conducted in July
1954, and by sar.1pling survey, the mmber of r.1ental cases among the whole population was estimated to be 1,300,000. Of them, those requiring hospital-
ization for treatment were 430,000, including 130,000 cf the nentally retarded. The other survey conducted in July 1956, analysed was to find the types of the cases of the inpatients currently in rental institutions and those of the discharged ones with the additional infomation as regards their family relatiol ship. The dat& obtained fror.1 these surveys sUlJPlied data for the future
developrnent of the mental health prograrJllle in this country.
-
'Ihe nUl:lber of beds for mental cases has been lacking far behirrl the need. The government has been increasing the beds in the national institutions and fro!'! 1954 started to subsidise
to the nonprofit private institutions for the 'Ihe following fi~e
construction of the additional beds for mental cases. shows the improv~ent
both in increase and in utilization.
·:a. : Number of si ckbeds for nental disease
- IS _ ~tio of utiNl'!!lber of in-patients 1ization of sick-beds
Nu.':lber 0 f si ckbeds per 100,000 p'"."lpl.ll.g,t,io;1
End of 1953
31,606 37,S49 44,250
36.4 42.9 49.6 61.0
34,159 39,463 47,039 54, S55
10B.O 104.2 106.3 100.0
...
II
1954 1955 1956
" II
54,'i46
The local and private instittltions for the r.:tentally retarded chidren, ~
though small in nunber, have been
increQ~md. N~~er
Number of insti tutio!'.s for the ;:-,entcl.ly we;;..l( End of 1953 II
of persons a.dJ:lit ted
65 72
3,209 4,022 4,382 4,S16
1954 1955 1956
II
75 S6
II
In 1956, the plan for the establishment of the national institution and 6 occupation centers for the 'jentally retD-rded children was authorized. The mental health consultation offices and child guidance clinics for adults and children are now 39 and 112, respectively. 'Ihe lack of personnel to
staff these places are the major problem confronting the governr.:tent • • ~ 16. Alcoholism
and
drug addiction
Addiction by pheni1-!!lethyl-arnino-propan preparation caused seriouB problem in 1954. This preparation, which had been used by the specific workers engaged
in midnight labor at first, gradually spread widely aI:long juvenile delinquents ani students, and many acquired the habituation. '!he legal offences caused by
the addiction was alaxming the governnent, and the government revised the laws
ani regulation by prorldli-.g'-lI!! punishment for the offenders.
Extensive
-19 campaigns were conducted and developed through schools, o;orkshops and colllDIl.Ulity organizations against addiction. As a result of this CaJ!lpaign, this problem was rapidly improved thereafter, the number of the offenders decreased from 54,000 in 1954 to 9,900, the number of in-patients due to the addiction from 1,500 in 1954 to 250 in 1956. ,
The narcotic control in this countXj- is inspectors throughout the countr.r.
enfo~ced
by national narcotic
The addicts are estimated to be approximateJ:
40,000 who are mostly chronic in their J.dcliction.
17. EnviroIJJ:J.entaJ. Sanitation a. "later supply The water supply systen as of March 1956 is as follows: Distribution % to whole poun] atio;) 37
NU'llber of facilities The exsting system The system in progress .4
Population I.rJD1)lies w;'l,ter
3,776 12,035 20,811
33,766,000 41,807,000 75,573,000
%
Total
78
%
According to the plan, 74% of the urbnn area will be completed in the near future, while in the rural area, only 27% -Nill be covered. In order to facilita"
the expansion of the system, the governnent has been subsidizing the 25% of the total expenditure and the rest are granted government loan.
b. c.
Sewage disposal Control of water pollution Sewage disposal progra;:;me is jointly supervised by the Hinistries of Health
and Welfare and of Constructions, the latter being responsible for the sewage
pipes and drains, and the former being responsible for sewage disposal treatment facHi ties.
- 20 At present the distribution of sewerage system is poor, but due to the public attention in the discosal of night-soU
8m
garbage, the interest of the IllIlllY As in the case of water
local authorities has been drawn to the sewerage systen.
supply system, the I?vernDent subsidi"ls end loans have been offered. Distribution of sewerage systw_ is about 10 to the population; the actual condition and future programme are as follow: Area 9.l:a.1.D.~ I(
Poou1&\tj.0D WJCf.}t~
The existing system The systen in progress 'Ibtal d.
(ha.) 46,357 73,745 120,102
8,188,467 15,1313,641 24,002,108
Control of air pollution Owing to the development of irrlustries, adoption of more central heating
systen in big buildings, and imreased use of heavy oil bv more transportation, the problem of air pollution in bigger cities has become to draw the attention of the government. The national legislation has been under contemplation to be
enacted in the near future. e.
Radiation protection 'rne protection from ha~ards
of
X~rays
an] ra:l1o-active isotope for medical
use has been provided by the Medical Service Law in specifying the structure, equipment, management, transportation, etc., of their facilities. more extensive use of isotope, it has been conte~plated
Due to the
to revise the existing
law in 1957. f.
Hosuing and tm-m planning (no special oomment)
g.
Noise prevention The necessity for the control of Nise increased rapidly in the urban area.
-21At present several of bigger ci tie s including Tokyo and Osaka established cl. i;v ordinance for the prevention. h. Vector control No national progra'7lllle has yet been developed.
By the Cabinet decision on June 1955, the government started three year "" campaign for "Life without Mosquitos a..."li Flies". The encouragement has been· The followings are
gi ven in forming connuni ty organizations for the purpose.
the figures of such organization estaQished. 1954 1955 1956 i. Food control 'Ibtal of 4,550 food inspectors are stationed in the local health centers. The reported cases of food poiSOning in recent several years have shown IIRlch the same with the figure of 22,000 - 23,000. • CgmmllnicabJ e dj § eases control
5,922 areas 14,387" 23,824
"
Cholera, dysentery, typhoid fever, paratyphoid fever, smallpox, epidemic typhus, scarlet fever, diphtheria, epidemic neningitis, Japanese B encephalitis and plague are legally designated reportable diseases. In addition, influenza, acute-polio~eli
rabies, tetanus, infectious diarrhea, whooping-cough, measles,
tis, malaria, filariasis, yellOl; fever, anthrax, tsutsugamushi disease, ani relapsing fever, are also required to be reported of their occurrence. The
reported cases of the legally designated diseases in the past three years are as follows: 1954 •••..•••••• 134,924 1955 •••...•.••• 116,556 1956 ••••••••••• 122,784
- 22 It should be noted that the cases of bacillus dysentery have been occupying majority of the cases, with the, fi'r.lre of 98,810 (73%) in 1954, 80,654 (59.7%) in 1955, arrl 84,140 (68.5%) in 1956. National survey was conducted in 1955 and
the types of bacilli ,rere deterrilined as 2a, 2b and SollIle. ..
.,.
Diphtheria is another major coJ:llll\JI'icable disease in this country. reported were 10,490 in 1954, 15,557 in 1955, and 18,395 in 1956.
The cases
Based on the
survey, serious consideration has been given as to the current time of periodical vaccination for the children. ;~
Japanese B encephalities was 1,758 in 1954, 3,699 in 1955, and 4,538 in 1956. It :'hows the increase spreading all parts of the country except
Hokkaido (northern island). T.qhgmtgu scM ges
a.
Laboratory service on the national level. 1) National Institute Df Health Testing an:! research in public health. National assay on biolo.p.cs
and anti-biotics. 2) National f1ygienic Laboratory Testing and research on ;Jharmaceutical products and cosmetics.
3)
National Institute of Nutrition Testing and research on food and nutrients.
b.
Laboratory service on the local level. 1) Health center Laboratory Minor laboratory work required in their COnnnunity. srery health center
is provided with the facUi ty • 2) Prefectural Laboratory Major laboratory work referred to by the health centers. laboratories exist at present. 50 prefectural.
- 23 -,lIo<
). Use of radio-active isotopes
'lhe following tahle shows amount of radio-isotopes imported. C060 1954 1955 . "'-
P32 10,129 me 15,575 me
Il31 6,250 1:1<)
C14 95 me 141 mc
335 496 J:lC
CA!.5 539 me 735 me
Otber s 735 mC 15,669 me
2430 3,977 e
10,070 me
835 mc
Of the'se, about 6af, of them are for medical treatment, 2)% for research on agriculture and biology, laf, for industrial research and other 10% are for other purpose, -<.."'<,
It is a tendency that the amout for industrial usuage is increasing in
these years, 1. Food
ani drug control (no special'comment)
'2. Training facilities for health personnel
a
Medical care persollllel No. 0;£ FaQil:i,t:z 1954 1955 1956 students 1954 1955 1956 2,820 2,820 2,$2) 650 650 650 Graduates 1954 1955 1956 2,900 2,900 2,900 456 456 456
~
!1edieal doctor D"",tist Clinical nurse (A) Puhlic Health nurse Midwife Dental hygienist
46 7 161 28
46 7 161 30 15 3
46 7 161 32 17 $
4,457 ',,457 4,630 $50 265 60 910 325 60 950 365 2$0
2,612 3,383 3,595 608 141 201 632 1$6 569 266 266
,.
12 3
I
*
* 22$
* b. .,J(
'!he figures include those who succeeded in qualification exami!lation without reQ1ured regular training.
Pharmacists No • of FS!!Oi.liti!il:l 1954 1955 1956 25 27 27 Stud~nts
Graduat!il 2,29 8 2,298 2,29$ .
2,345 2,525 2,525
-.. . 3. Other health sem ces (no special c01'll11ent) 'h
-24-
Assistance in the health field from "!HO and other bilateral agencies
1) -...
WHO In 1954. total of 14 fellowships .Tere provided, which includes one
short-term fellowship for dental health seminar.
These fellowships were for
maternal and child health, mental health, environmental sanitation, tuberculosis control, international quarantine, epideniology, 'TIedical social ],lork, ~
food testing, drug assay, biologic standardization, international pharmacoppoe1a, vital and health statistics. In the S~'TIe
year, one consultant on occupational
therapy for cippled children for 5 wee.tcs' duration was provided. In 1955, total of 18 fellowships .vere provided, 7 of which are the short-term fellowships for the urba,., sewage treatnent se!'linar, nutrition 1ll'ld health education ser!linar a!1d nursing education seninar. Fellowship1s subject
fields wepe mental health, environme.'1tal sal'lit'ltion (composting), VD control, food testing, clinical nursing education, aneathesiology, hospital statistics, and cOlJlllunicable disease statistics, In the s arne year, total of 8,100 dollar
worth of supplies for mental heal til, environmental sa.l'litation, epidemiology and nursing education were provided, and one consultant each for environmental
-
sanitation (composting), epidemi01 og;' , a.l'ld nursing education were provided. In 1956, total of 15 fellowships ,,,ere provided, 4 of which are the short-term fellowships for envj_ronmental sanitation seminar. Fellowship1s
subject fields were nursing educat;.on, comnrunicll.ble disease control, TB rehabilitation, environmental sanitation (composting), water pollution control, training of sani tarian, hospital construction, medical radiation protection, and maternal and child health. In the sante year, one consultant each for nursing
..
'.. . I
- 25education (continuation from 1955), environmental sanitation (continuation from
1955), medical social work, water pollution control, and hospital administration were provided,
am
also total of 3,300 dollar worth of sunolies for nursing
education, environnental sani ta.tion, medical social work, and hospital administration were provided. 2) Other agencies We had received assistance from UNICEF in the HCH pro.iect for which the WHO had given a technical approval. In 1954 and 1955, total of 17,000 dollar worth of equi]l1lent and supplies for the "SeiBhi-Ryogo-En" (crippled children's home and hospital) were provided. TIle total of 46,000 dollar worth of milk supplies were provided
in 1956 for pregnant women and mothers needing Bilk supplies and for school children, and, for those farming people in Island of Hokkaido where severe crop damage was occurred.
25.
Any
plans :for future developmen t of heal th pro grarrvne
arrl
sem ces
(no specific comment)
.-
~r__ .
:.tt3.Ched P'\per (1) • • J
Or"'3;izat~
onM
f1y .... rt
'f:ir>ijtcr Viee-' -fi:1j.st~
DO'1utv "ici-· fil"ister I 1
1- Person'Csl ·.ff~.irs Sccti ~n I- "cncr~ . ..ff.".irsSect',on .·.ccounts'3cction 10ffice of Pra<sr,'l'1"lc Ev"lu,:tLm Officc of G"ief Liaison Officer on , Int~rn~.ti ,"'·n.it .ff,;irs '-I
i-
.... I
L...----------i-Hc lt1-! & ':elf.'\re Sb.tistics Div<sion O
I 1
,
~~
I i I 1 I
I
L
l{!:q.rs <$t l'iold stn.ff Sc~ti0l?Rc').;rt'S :md .'...,,~ysis Secti<otl.' T~.bc'l:tti ):1 .Sectj.:)O !!-:-,ti '""n:u, ?~rks Divisi.an (c0nsisted af .2 Sec,)
Cf GGr:'Jr.':l
I
I ~ :=i..'!.blic HeM th Bure ....u
-Plc.~:n.:; ·3ecti;)n f- :'utri t!Jon 'lecti'm I- Hccl. th !}-;'1t-::lr Secti '")n .-------l-TubcrCl1.osis Pravo?1ti'm Socti-:n f-·.cute CO:l""unicnbl", Diseo.se Pc-cventi'm ·50,=t5. :)n 1-·:ent:>J. Ho"1th sect<,on L ""'U1.r·':I,x'tinc 'Section
L _ _ _ _ _ _ _-'-___
8rwirorrx,nt:ll ,,,-,,'tete'.:>
· E
l)'visi
3rrTironn:nt~ S~itn.~'."n3ection
-Food S~."l. tC.tl ~n SectJ. om . ·~.tcr-vrorks :: Scwer~go Section Off:'cc of ".rctcr5_r~r:1" ,5"'-J'li t'!t~_on ~'1 or:tl ·.ff'.i!' s ·'lecM. on . :ed!. cnl .·.fi'urs Sect'. In
i-
-Jf]
I I I , , !
~b.n'''''l5c~-:(;nI'',
·Sec t~_:;In
Y:tti ·'n:1. 90s',i t:tl Section ~~-"lt!. ":'!.k:l ).':'.n.atoriU:-l -S:Jction .'"rr ",l;.~e·_-:.Jnt ·Sccti on Offic0 of '\u'sing·.ff"irs Offi co of D,,'1t;"!.l ".ff~irs
~I :?h:,.r;'l~Cql.1_ti.,_-:l __ .'_Su_')_J_l_'fr_Bu_r_0_,"_.1_1_____ Ph~.:..,.ce'L1.tic"'l :~f~'''; rs S-sction L Drt..l'S l.-:'.:."1Uf-c~....lrin~ Sccti0n
~'::!"'terCll-j, se
Scct!, on
I L C'lildrenl," 1fl""e".U
I
!
-Bi?lo;:ic"ls Sccti::m ::~rcotic Soct~_on O~ficc
of "'l".r '".cGuticoJ.. Ins::>Gction
r- PI :':.nin.c; Be cti:Jn EChild PMtccti:m Section ::...tern:u. .", (;hi1d "clfere '3octj,')O ~b.t!":IT.:'.l 11: C~1ild Hc~l th 38cti'Jn
(Beside ".bovc, t..'1ere ore Soc; -:J. 'offo; rs ~ (c:>nsist~d ,of 5 sections), InBt'r~.ncc Burc,·.u (c:>nsisted of 6 sect:' ..ms"nd 1 Office), 'nd Ae~::tri:"!tj I')n 1alirJf me,':'..u (e')n5ist~d of 9 seetions)
..
,
'"-
..
ASTES COMi'OSTING OF OHGJ.NIC W Kobe City Japa n. I . .~IlVoducti0l'l
tion of agric ul':'h" use of untre ated human ex c r eta f or the ferti liza count ri e s for cent uries . t u:cal crop s has been a conunon pr:l ctice in 1!1 any asian rces the prac tice is F ro:n th" view - poin t of cons ervat ior! of natu ral resou r ealiz ed that the colle c-£om mend abla but publ ic heal th ,,~orkers have long zatio n on the soil h as ion anc.c iistri outio n of nigh tsoil ii:ml it-s utili er of d ebili tating r esu::' t8d in th8 wide sprea d disseminc:.~i,on of a nu.nb d is8E.S Gr .• 6 c:. plan: . u'i.i..t rient s from the '1':10 abru pt v.,ithdra~~:al of t\is 30Ul'C l", :.'epe rcuss ions upo n the tota l agricu2.t1A~al cO::nr.J.unity C0121 d have GeriO cia~:; have hes~,'.:,atdd c;o econo my or a cou ntry and e"en "'),-,bl~,c : sP:"h off-:' : G'V;r.;;ve:-" a c''')['1b_:1clt~Or' 3, yea1'"'. ecomm end this dras tic meas ure ~ I!! ~"eC("'lt s in SOI:!C ;i."i ' r',')cu a '~o o f even ts have tende d to bL'il~g tr,ts p::'ob lera U Fa., <.1:." __ . \'6"Y :.f.d :n~e,n unacco coun tries . The trend to Clr:1 aniza tior. c.i.l.~·tc) l . : l . J "vhe s,,-! 'l8if.~_ ir..t.2· l opme nt of 1rlate rcorn cl se\""erag:~ syste TJs has oEal. ~:.. 3 (t:.sp '': •• 2 1 r:tio' colle l ~ncounter(Jd in t he logi stics of nig .tsoi rs, chea ner in s"IT'a' i!'lsta ;,C3:3 aX'" Q
intro duct ion of chem ical fert ilize ased de:na l:d for ,.igh ,-·, <_ alwa ys mort) conv enien t has l'esul V3d in c. decre n of far:~ers i::.~ ..1'ib : ted by the farm er . Furth ermo re, the youE ge;' gener G:':;lo aest hetic obje cti ons t o the use of this mate rial. and othe r orga nic The hygi enic utili zc.ti on of both human t:!xcret"" Dr n:a.1y ':i0T·. er.., -, er'c wast es such as garba ge and rubb ish has been studi to -:he p-ob::'':::TI ",. the past bu]; no prac tical and econ omic al solu tion the basic ph\'s ic;::'; c foun d. -t has been only in rece nt year s that proc ess 11","e b:'tl;'l ir~"r 'A_ Cal an,d hiolo gicf. ll prin ciple s unde rlyin g this c~rotio nal dr,s1.gr; :. ly stud ied and the tran sitio n frem empi ri cal to ~ • S"vl; c hO.si It is new belie ved that the utili zatio n of the.:; e esses fv" Cv ~ible. omic al proc C'ln resu lt in the desig n of prac tical and econ p::'od uct accep -:e. .)~e • l fin" a in lting resu es posti llg of orga nic wast ar. by the agri cult ural ist and the publ ic Ileal th offic hsvI" been : a:u e t use Trad ition al meth ods for dispo sal of nigh t - soil al. Refu se is 0 dieu dlj o n crop s , disp osal in booi es of wate r or ourior (if sepa rated as [;"r"o .ge) ispos ed of' by dump ing, buri al , incin erati on econo1"!ic or aeSvl~Btic as pig food . Serio us coje ction s inclu ding hygi enic, c an be rr.lis ed to any of tht:se proce dur(.) s . r8st in the g",n" ro.l The Worl d Heal th Orga nizat ion has a dire ct inte of r.':~hvsoj 1. It, y ciall probl em of' dispo Gal of orga nic \-;ast es and esp" rnme nt to ':,':f" , - ,. Gove ese there fore , agree d ,·: hen r"qu<.!Gted by the Jap::m \...~of ~ ;;1; " ct:'ve o'u,:e the in an envir onme ntal sani tatio n proj ect "'ith ".\FO" a (J~' t1.on opera ."n'i ies leadi ng to the desig n, cons truct ion , r.'!·U. , urbl1, c,na -:a excre n post i ng plan t for treat ment of bct>th huma is f:i1e £'ccel ,,!'<l" io!1 The basic prin cipl" invo lved in the Kob" proc ass c:;: org"" li,c sullo "a :es of a natu ral biolo gica l pheno meno n by ','hid1 ccmpl stab le a 1d simp le!' a r e broke n down by aero bic deco mpos ition into i110ru The deco mpos ition is c ompo unds read i ly avai lable as plan t uutriG~·s. eypOS(l grea ,,:r :.'l·GD. S expe di ted by grin ding t,he or8o. r.ic mate r ':'a1 5C 'fJ tJ OAr ;cll. 11 c ~ v a r too aera tion and prov idi ng forc<o:d aera tion to supp ly the fo r f~nne"tation. to 0 i cal b~t 1 rg A pilo t plan t, mnal l enoug h to be e c onom l ur:ti ated oper and 1955 eval uate the proc ell., was cons t ructe d early i n
,
.. 2
July 1956. The operation of this small-scale plant tegetll(;r wit.h labe ratory studies provided basic informatien with respect to the type of plant and eperating precedures fer the full-scale prototype plant. 0f the plant, refuse is carried by a conf.eyer belt past werkers ;·Jho re-
As can be
seen on the attached diagrammatic sketch and the mQdol
move those portions of the raw material which are net compestable lOr are operationally undesirable. These items include metal, piec",s ef wood ceramics, glass, rags and all large objects. The material then passes through a grinder of the "swing hammer" type. Here the material is reduced to a size of 12 millimeters or less. The ground refuse is then conveyed te a storage bin. ;,.[tor !-laving nightseil added it passe s te a six-stage "digester" 1rlhere it is slowly agitateci and move1 into successive stages by revelving "pushers". Air is ferced through the digestien chambers continuously by a blower and piping system . Under the present system of eperatien the material requires 48 hours te pass threugh the six st~;es. During this peried the exidation results in a release of heat which r;lises the temp8ratare of the Llaterial to PoS high as 70 e C(15$eF.) Frem the digester the material goes te curing bins vlhere forced air both cempletes the compesting proces'3 al:d allew for centrel 101' moisture centent ef the final product. After Curi'lg the mat;;! ri al is ready for saId. The Kebe plant is designed for a capacity of 2) tens ef refuse and 10 tens of nightseil per day. It utilizes the refuse of 56,000 perSOI'3 and the nightseil of 7,350 per59ns. As might be expected in any p:i.oneering project for translation of the result:, 101' basic biolegical research inte a practical opera·~ ion, many obstacles haVe been encount.lred and al~Jlost all have D(;(-,n surrounded. One of the Eource of the difficulties has beer: the hetereg,EWetlS n,,'tur(~ .- ef the raw refust'. This na terial c an a1d does very ill cr:aY':l.Cteribttcs net enly seasenablly but even daily and in the case ef h!:l!3vy rainfall it Gan very hourly . Anothoar problem has heen the :lesign of machinEry for processing, on a preduction-lin,) basis. a material Vlhi ch has charac t,"ristics unlike any raw materi.al ]:>",i.n[!, process by industry. 'i'he d ,~ sign and operation of.' both thE- }lilot an'.\ pretotyp·. l,lants have undorgone continual revision ba~dd on opc,rating experiencec OV8r c, l!eriod of a year and revi sions are still bding plb.nn(; d before the dOlo)ign can he accepted as final. The City ef Kobd anti the Japanese National Gove rnr.;ent have taker>. the leadership in earring threugh thJ.u vlorth,·1i.1L dev,"loI'i"ent and have recognizCld the neeesuity ef supporti.ng the- proj 0 ct th" C" -;1: ·~his n(,cessary but slow stage.
Substanti~.l
This has be8n +.he and th,; pretotn;e studi es , bas been €xperi·,mcc.' gained \'Ihen urban w:.:.st(~S to t.he soil.
achievements have ~lrd:J.dy heen macie in this r;T"oj l ct. flrRt t,ilot plant. for high-rate compClsting 1:1 ".aia plal'lt. designed on t,he b3.bi i:l of thf)sO} rralim5 '] C, l"Y successflll in producing.:: saleable (..nd pr0duc·::' . 'nw has been inv!lluabltJ ane', ehoulcl bring clcser tn :, d.e.y will be cellsiritJ red e13 v uJ.u:J.blo rGSOUl"CCS n!1o 1'(..c:,'c1ed
During the ini.tial p0r·:.o:1 elf O"'~l"':-~,.~ ()! . d ' ti,·" COI~ "Et:i :1g < . an~; onl;f refnse ha:-; b~en n 'f')C2:3S&d. . \'.TI H: 1 t.h...; ::::. ' "'-:1 ; ~:i c r . .- .... t·', O. . 1. pY',-/ced1).res 'l- "r~ 1"'on furt'l"';' r '.; " ..'. ~';""":lri ' . ~ ', . .J.·.c "'''''. ~,-:) "I ,. ....... l·~·~<:-,'.r. · ",/. 0 ..... :.. •. . .... ..... ':. ........ _ .... _, __ • -:··' ...,,,,. .... l ;;).\:t. ~G'-;;. •
~1
_~
(.!
.'.'"
__ . '
r.J"
~
rG i'l'~~ .:-~~) (.
lI·~r:h\., :: '~~_.
- 3 The characterisV cs of bot':", r-'=:vl material and finis;1ac. :::::>mp st are given in Table I. Table I: Ave rage Components of Raw ~.a-;;erial and Finished Compost
Ii a'!i)~A:~ ~ti.,'tl% Moisture (wet basis) Ash Volatil e Solids Inorganic Matter (Sa nd, Clay, etc.} Specific Gravity Ni t roger! (as N)
g~mRo~
50 - 60 La - 55 ~;.5
30 60
. .. 60
30 45 O<)h5 (, J,
- 45 - 70 - 4C - 55
1°
01.
0.:5 - 0.L5
- 0.55 - _. :)5 - 0.75
ci-
1
Phos phorus (as ?205) Potash (as K,..(:; CI N ratio N.B. : mois tu.:~·e
0.55 0.75
- 0.90 23 excepting
25 .• J 5
'7 .L .
Thl:J above val,les have been de'Ler-mined on a dry •
ba~is,
Of every 1, C00 k''::.ogra.ns of refuse v{hich enters the p::'ant, 303 kilograms are removed fo!' c>a}-,,~.ge 0:" disposal. The remai!' ing 697 kilog rams are ground and p:-ocassed X'f;sult.~i:g in a finished salea'ole pro~~uG'(j c f 376 kilog ran:s. The major plant nutrient co:-cponents of the finished. compost, averaged anti computed on & mo:!. st.u:-e· ·f:'6e bC.si.G, are as follows :
0.85
'. 0.82 % been e:c-cainec~ during t.he compo sting proce dure. It is axpecceci that uni from tempera'i:.-"lr6. of 6000 ,d2.l be mro.n-cained for ove~ t,'lO 110 ...1"5 ~n the r ou.t i ne ope ratio::. of ti,a pla."lt. F):"oln a hygienic sta.Tlc.;:cir,'G this implie s the effective pas'veu:-tzat.j.o!l of all pathogens for ..{hi ch ·i:;'lerm&.l death point s are known 5 .:'lcludir:g helLlLTcr. ova . Tabl e II pro'-;iies data or: ;mm'm thermal death point;s of various pat.hogens. lI'i"2.8 temp~.:."atu:,es a-::.tail:1'.:l i:t. -i,ce -prc~e ss w:t ll, of c\,;ul'ce, ciee';jroys all ir:.spe~t. ~?gga, :':"3:': c..e ~ __ (..L. "£-~ 1:0.0. 'I't. . e finished prc c.uct ~_s !~ot. att. rac tive to flies and if st.end9.!'" S of -;,,'l":\.~·~. cleE~'"'llii:1.css are mainta:".l .. -"d tilere should be ne ither ocioter: fly :10~' ::o.:sr.t ;l1.:.is:mce s c reated.
0.65 ot
%
t.s has been previous:._ mentioned, tempe ratures a s r.igh as 70 0 C have
IV.
CQ§':~
'1'ho:, cos'~ of "igh .cate compcsi~iD.b cannot be accurately determined until a plant incorporating "':.::. 'cte final design and opera-cing feat ures has been operated on a ro ..ctine basis f or a period of time. It i s beli-
,,
- 4 eved that t.he overall cost l'er capita or pe r unit weight of materia ls pre-cess er! ,vl11 be no t more t han the costs o' other and less des i rab le met hods of disposa l of orgalAic wastes . ThE' costs will be greatly influenced bv tb'l demand (anG. ~ hus the sellins price) for the finiflhe d produel , anQ by '·,he ma.rket va:"'ue of salvageable materials such as metal, glas~', rags, pap"! r J etc . The con st ruc"C ion cost of the Takcul1a1;su (Kobe) prototyp e plant was On a pe" capita basis this i f; $0.8" for each pe l"SO n serve d. The c(lPi tal cost. ,s $1 ,3GC: pe r ton of raw I'laterial processed per day or 1',4.I,5 per c;on i,er yro&.r . ~4$,'165.
The "'peratiIl(, and r.nintenance charge., on a plant of be abou~. $25 per (l'lY in J2.pan .
'~h is
size should
The end prodl: u ( compost) of this p 'L ant is being sold through the Farmers COlperative Ass oc i ation fo)" $2.2:! pe::- t on in bulk at the plant . This price has been Lxed by the Minist r y of Agl iculture. The Kob~ compostil.,,; p lant has been'inanced by the City of Kobe with assist ance by the natio al government . ', IHO provided the grinder whic h was unobtain",ble in J apa1 . The services of a recognized authority, Dr. . .. J. R. Snell ai, consu}. tan'. and f!ome tochnica l literature . Several fe llol1shlf& were al so pro d. d",d fer a , vanceo. study a bro ad by J apnne se ',t·e chnici ans . Mr. Y. Kaibu cti, Chtef, ~~werage Departrre'lt, City of Kobe has techn ic a l supervision 0.' tue pro, :ec'~ . li'J.r. 1. Hara i s Di rector of the Cleansing Bureau, City of ;Cobe unde" wh:.ch the pro J", ct is administered, V. Discussion The successful c·,mclu :io n of this artempt to process urban organic wast e s h ffi il!lPFl t ant ~m plic".t ions to Jap an and indeed to other count ries of the vTOrld . A pracl,ical, ~conomic ann hygienic me thod for producti on of organiC fe:,'cili:;er po ,nts th e: 'way to conservation of natural resources in th8 struggle to keep ?roduct i on of foon abreast of the natural growth of population. The ne d for C'r<"3.nic fer"Cilizer or humus in aJdition to synthetic 0 :' ch.:::mica fertlEzers hao, been repeatedly demonstrated to b" ne cessary '(0 maintair the fertility of agricultural land and to inc re ase crop yields. The des ign nj .n"ocerlur es deve lo ped in Kobe should be applicab l tl to many urban communitj "s th 'oughout t-he world • Although thi s plant is co nsidered to represen' a cO'ls iderabl( advance in the techniaues for utiliz ,:'ltioll of organio:: w.stes J.~ is probable that further advances will be made . ~hd.s plant h1wever represent.s a "break-:- through" in that it pre sents a practJ.cal method :o r rap~d (fcur dBYl'l compost~ng at costs compar a ble to conve ntional me t hod' for d i sposal of organi c wastes. The process has the advantage of re ,at ive simpliCity; the routine operation of a highrat e composting pla:-:; shou:l.d nresent less technical and onerat,ional difficultt es than the 'peratio n of a conventional sewagu t r eatr.'le!1t plant . It should be ~~P t in mind tha t; the utilization of night soil in t hi6 plant is conside re an illt"'r~m ev:rJt:!ule llt.. ClllU t..h"'L .:;.t ll(,ual.l.y t,'''''t> 'Clcl.t.--';:,.l is pI anr,ed t o be st<)planted by s l uuge frol!l sewage treatment plants . 'l'he co l lection and use 'f n i ghtso i l is a public healt h ha z a r d and t h e o nly pr actical, hygienit ', nd peI"Jlanent solution to t h e col l ecti o:l an d di spo sal o f human excreta i; )y tne instal lation of \-Iater-borne sewerage syst ems.
- 5 ." >-
Where ec unomi<: 0 '1' o t h(!r con s i ,i e :-ati.ol1s di-!.fer tht.' i :'rt.. !"(,dllct.\ .) rl 01' 1t1;lterbo rne sew(!!'age th(! compost ing pLHlt should be c:.ms\;,'ucti.:.:l aear to or on the site of f ut ur., se''IIag e t reat. 'ient works so t,n", l. :om'lage "Judge may b", eventualJ.y uti liz ,-' u fo r C Or.lpc) sting when Hi).t.e:'- borne sf,vwraii3 iE introduc-GQ . :.. commu;1ity c onsidari ng; compostln:!; o i.' its organic W.9.st"s shoul,} have an el\i!;:Lnee ring study p r epared by oompet"mt sanit.ary or public health iHl:,;L.ee,;:'s . This study sho·Jld include comparative studies of variot's m . . -~;·lC(":'::; ".:01" dis.:x)oal ~tnd/or utilization. of the£eITlater i :"5 witn due c'.;n8j~ , ..~_ 3.·;~ion bai llg ~ i ven ·~o e coTlomi c,T sani tary nnd aest.heti c facto 1'8. It :'5 ..:or:sidered probable that within the next fevi years "he presfmt im;erf'st by many communit.ies in improvi ng their wG.stes coll ection and dL;?.)sal ffietL:c:s ,:i11 be reflect,)d by the intr.:>duction of high :oat" comp<Jsv:;'ng proecss in many cities of Asia and elsewherE: .
... .. ..
. .. _ _...
fABLE II TEMPERATURE AND 'rIME OF EX?OSlJRE REQUIRED FOR DESTRUCTIOl OF SOME CO~4~ON PATHOGSNS AND PARASITES
--------------------------------------------------------_ ..--Reference C:':"gcmism O:Js6!'vations ---•. ,. -----,,----:--...---~-....---...
Salmonella typhosa
'1" gro'lt'l be"~nCl' , o'oC': a'ea''''' _ \. . './'.\. U.L....,. '_1 ... .1 ~.
Jo
\'~ith~~n
30 minut·~s crt. 5: -.;-6000 '.1d w:..thin 20 f:lincltes at 500C; 03e~royed in a short time in .:;ompost env::'rClL"l!e!1'C
"..J. '011 }7 . f.. _ p".,,,,. 's , _;: _ ..... •.• , '/{ vI. Cl:i.I,.S) j"::t~',-.:'(~,j:{ of oactel'i ~:r,gy: ',-eh ene, Phil~~s~~b!a ~ ~.,
Salmonella sp. Shigella sp. Escherichia coli
Deat.l 1tli':;hi:l J. hom- at 55°C and 1t:it.lin 15··20 m:~Lu-c.'~3 at, 60°C
"
Ent amoeba histolytica cysts
Taenia sagin<:.ta Trichi nella spiralis larvae Bruc ella abortus 01' Br. suis Hicrococcus pyogenes var . au reus
Q u: ckly killed at 550(;: : ~lstantly killed at 66°c Death within 3 minutes at 62 0 -63°C ,.nd within 1 hour at 55°C D·'ath within 10 minutes at 50 0 0 11
""'d 1e:r:o .... J b Ul'P' o )
~~!1"5") ..l . i) • . • . : .. oJ.
Compos·s' s vall~e overrated.. Publ. Hlth (Johannes,
1 " -.,."
70 •
Co ryneba ct e r ium diphtheriae Necator americanus
J:eath within 45 minutes at 550C Death within 50 mim:tes at ~,50c:
" B~lding,
D.L.( i9)6 )
Teztb ok of' cli:liC~] pa . . . ,c.: to: ..... -. . l . , je't'!
ro..:l.,: (~~~~_
Ascaris lumbricoides eggs
D .~ath
in le s s than]. :'lOur at temperatures over 50°C
"~v ~ M aX~J; ~~~ ..
\ .. I.~.J
Ro sellan' s pl"eventi ve medicine and hygiene , 7'ch ed. , New Yo rk 1956 .
------~-------
....-.------~---CCJ!pos~,ir;.g,
l?rom WHO Monograph Series
.T
o .31,
..:..
~ "
. ,
,or
HE , N A orI 0 NA L
IN S' TIT
V or E ",~
OF
,HE ALT H . . ....::.' .' :.:
_., 4 ~
i
~
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....
':
...
1 9 5 7
..:~ , ~'
...
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.
r.-_...
KA:UQSAKI- CHOJ .A1.~ARU. TOKYO, JAPAN
SHINAG.li.;,A~ KU,
....... "
.. :-..-'
O1i HEALTH
,1.
This Institute was founded 1n 1947 under the jurisdio~(inistry
tion of the
of Health and ·,elfare.
Though the pre-
sent missions of this Institute are primarily concentrated on the control of infectious diseases, of various other speoified diseases and of food stuffs, the Institute was given the official English name of "The National Institute of Health", because it was originally expeoted to grow up eventually to an institution comparable to the National Institutes of Health of the United States or the National Institute for r'edioal Researoh of the United Kingdom.
2.
According to the enactment pertaining to the establish-
ment of the Institute, It was assigned the follOWing functions. responsibilities and authorities. a. To conduct and coordinated research pro,jeots of national importance on the causative agents of diseases and their prophylaxis and therapy. b. To perform oontrol, assay and test production of the biologic preparat1ons, ant1biotlc preparations, materials for d1sinfection, Insecticides and anti-rodents wh1ch are related to prophylaxis, therapy and diagnosis of the diseases. o. Production of vaccines and serums which are not suitable for production by private concerns • .1
-:~i#i!#::~-~~~~~~-'-~~~~-:: •
'.
::~'
.
..
!
d.
To conduct various other research projects neoessary t-QI'· public health.
e. ;;.'
To be responsible for the coordination at national of research projects related to public health.
le~.l
3.
In addltlon to the above funotlons, this Institute ls
oooperat1ng. since 1948, through Its Branohes in Hlroshima BAd Nagasak1 w1th the Atomlc Bomb Casuralty Commlsslon sponsored by the Natlonal Academy of Sclence - National Research Counoll ot the Un1ted States.
4.
Thls Instltute was also seleoted In 1948 as the
N~~OaIJ;
Influenza Center snd salmonella and Escherichla center
wheD
The wor14~
lIorld Health Organlzation Inltlated its sponsorshlp Inthls wlde project.
In 1955 our Department of Vlrology & Rickett.1o8S
logy was deSignated by W.H.O. Poliomyelitis.
one of the Reglonal Centers for Lepto8~1~
Next year, the Reference Laboratory ot
rosls was establ1shed under the sameltDepartment. ~ ~ur
l;.ul te recently -
Department of 4acterlology also assumed the responsibility of
belng the National Center ot Enterlc Phage Typing to corresp0q4
with the International Assoolatlon ot Microbiological &Ocieti_ and the Natlonal Shigella Center ot W.H.O • . ,>~~.
5.
This Instltute regularly publishes the "Japanese Jouraal Science and Biology". formerly the Japanese Medioal
ot
t~dioal
.Toul!J1al", a bimonthly publioatlon written in English as well •• - 2 -
the "Annual Report" written in Japanese.
... 6.
The Nat10nal Inst1tute of'Bealth 1s organ1zed at
presen~
as follows: THE NATIOlaI. INS'l'ITU'l'E OF HEALTH
Organization Chart Department of Bacter10logy Department of V1rology and R1cketts1010gy De~artment
1-'
•
of
~erology
Depart~ent
of TUberoulos1s of General Bl010$1cs Control
--Dir.ctor.:....__ 'IV1ce-Director
Uepart~ent De~artment
ot Ant1b1ot1cs •
Department of Par8s1tology Department of Medical Entomology Depart~ent
of Veterinary D1seases
Department ot Food Control ,-- Department of Pathology I
~--
Depart:nent of
Chem~str7
~-- LIbrary Admlnl~tratlcn S~ctlon
-
Hiroshima Sranoh - Nagasak1 Branch
.~
- ::; -
,.'_._,.,
THE KEY PERSONNEL OF THE NATIONAL IN3TITUTE OF HEALTH
August 1957 DIRECTOR Saburo Kojima, M. D. VICE-DIRECTOR Keizo Nakamura, M. D.
DEPARTHENT OF BACTERIOLOGY
Chief - Hideo Fukumi, Ito D.
Divis10n Div1s10n Divis10n D1v1s10n D1vision
of of of of of
Baoteriology I Bacter10logy II Bacteriology III Bacter10logy IV Dis1nfectants
R1ntaro Nakaya Mannosulte Tom1.a. . Hidso KU:Jama Hideo Fukum1 :Jusumu Fujimoto
DEPARTl'EHT OF VIROLOGY
&. ~'.
RICKsTT~IOLOGY Chief - ~'assmi Kitaoka,
D. Akira Shishido NOQuyuki Takemorl Isa:nu Tagaya Karr:csahuro YoshlDO Hld'30 Fukumi MeBsmi F1taoks Kaoru Okubo
-
Division Division Division Divis10n
of Rickettslology I of Rickettslology I I of Virology I of Virolom' II ~ivision of V1rology III Div!,,10n of V1rolog;' IV Division of V1rology V
DEPAR'fi'l':NT OF ~;EROLOGY Chief - Ryosulte Murata, l:.D. Division Division Division Division of of of of IIllauno-cerology Leprosy Diphther1e Tetanus Ki~is~ige Ishizaka RyOS\U:B Uurata R~'osuj{e 1;:ura ta Kentero Kubota
- 4 -
.......• ,\
·." '.
".
DEPARTUENT OF TUBERCULOSIS Chief - Ken Yanagisawa. M. D. Division Division Division Diviaion of of of of Epidemiology BeG Tuberculin Chemotherapy Ml chiaki 1,~aeda Toyoha J,:urohashi Nozomu Asarui Koami Kanai
DEPARTl\~N'I'
OF GENERAL BIOLOGICS CONTROL Chief - Maaaeli Kurokawa, M. D. Youichi Iohikawa Yuzo Toyama 8higezu~Ji Arirna KaZllO Kuratsuka
Division of Blood & Blood Derivatives Div1nion of Safety & Pj70gcn Tests Divi8ion of Lterility Test Divi~ion of Biological Produots
LLPAlmlENT OF ANTIBIOTICS Chiai' - Hamao Umezawa. M. D. Division Division Division Divi8ion Division of of of of of Myoology Baoterioloe;,. &. Antibiotios Chemtstry ~o Ant1bIotics Assay of Antibiotios JurBs Pilot Plant Yoshiro Ok ami Tomio Takeuohi Kanji Maeda Seiro Yamazaki Teisuke Osato
DI:PAR~'ENT
OF PAHASITOLOGY Ch1ef - Yoshitaka Komiya, Yoshitaka Komiya Tetaushi Ishizakl KazuQ Yasuraoka
Division of Parasitology I Division of Parasitology II Division of Parasitology III •
DEPART.'·'ENT OF UEDICAL ENTGr'OLOGY Chief - Syoziro Asahina. Ph. D. .J
Division of Mediosl Inseots Division of Insecides
Syoz1ro Asah1na Kazuo Yasutomi
DEPARTMENT OF VETERINARY DI~ZASES Chief - Kiyosh1 Imaizumi, V. !"~o D. - 5 -
• Division of Zoonoses Division of Experimental Animals Division of Animal Care Motokiyo Endo Kenji Nakano Toshio Tanaka
- DEPARTMENT OF FOOD CONTROL Chief - Yuzo Toyama. M. A3r. Division of Food Control I Division of Food Control II Toshiharu KBwabata Nobuichi Morooka
D~:;PART'",;::T
:or-
OF PATHOLOGY Chief - Yasuyuk1 Egasira. M. D. -1
Division of Experimental Pathology Division of Pathological Examinations
Nobuyuk:i Uch1da Kouichi Takoo
1 ,
jj
DEPART!~T
OF CHEMISTRY Chief - Den'ichi Mizuno, Ph. D. Toru Tsumita Jun-Ichl Tom1aawa Tomoyosh1 Komal
1 'i ,
i
Division of Biochemistry Division of Biophysics Division of Biologics
LIBRARY Chief - Isamu Nagal, M. D. Ll brary Uni t· Translation & Ed1ting Unlt Kazuya Hasegawa Satoshi Ogawa
ADMINISTRATION SECTION Chief - Tsuyoshi ~akak1bara ASSistant Chlef - Yoshlro KBnaya Elzo Sukejlma Kaneharu Asaoka General Affairs Offlce Personnel Offlce Research & Assay Office Fiscal Office Acoounting Offlce - 6 -
Atsushl Takebaahl Masahiko Yokoyama Takayukl Sh1de 141 tsugu NakamUra Osamu sato
Purchaslng OUlae Custodlal Ottice
Klyotaka ota Aklra l:i:;21io
..,
HIROSHIMA BRANCH Dlrector - Hlroshl Makl, M. D.
.~
.-~
NAGASAKI BRANCH
Dlrector - Isamu Nagal, M. D•
.
~.. <.--,
Ie
•
- '1 - ,
"-
,.'
'II.
Prefoctual A. Assistant Nurso,
Sho vorlts undar the supervision ot: physicians and ~ee1onal nurses. This "",ton bas boon astablished since 1952.
1. License and .:egistration is done at l'rofocturaJ. Governmnt, Junior hjgh (9 Y"ar Gon. Ed.) - 2 yoar l'rot'ectural Exall. Nunbor of school ---- 552 (15 sohools arc closod at'present) acoroditation is done by P.r<>t'eeturaJ. Govorlllxmt. 1.3 ,'792 (t'ixed nunbor of ono gl'Ildo) , Nunoor of students . Nurloor at' actually working Hospitals (include san.) 1.3,662 (80.1$ to tho total nunoor) Clinics 3,.3.38 (19.6% to tho total =bor) III.
Advanced course for Ass istant Nurse Scheols offering 2 yoar courso of nursing for the Assistant Nursos vhe have 3 yoar oxperionce start in 195'1. Tho graduato of this typo of sohool is qualified to take liat:iDnal Exar.!nation. '
Background :lni'oroo.tion l'Ogo.rd:lng Nurs:lng In Japan Nurslng Situation :In Figuros ( Dec. 1956) I.
dept. 1957
Liconso and Reeistrotionl (National) PIlN -
30,830
M/
--
86,760
ON -
21.9,844
A. Nunbor actual.1.:t WOX'k:1l1g, nTll - - J.2,) 56. Shortagc on basis of 1 - 5000, ( -5894) Bo,-J:::'h Con'Gor 5, ?J,.5 (43 .1%) 4,935 (40.6%) "To\;'~~ en' Village 1M 53,7,\3 Houl-!Lh Gantor IlOG:'li~a1
7.82
Shortarc or Surplus _ 601 . ... ~~9:t.3
: .•r
Pri"::::'(,c P-.t'actico
2,529 48,'151 98,:134 (71.6%)
+18,529 ShOl-otago
ON -
136,965 HOGl'. &: Snu.
-3,586
Clinics (private
24,286 (l7.?1-)
phy8idans offices)
B. Education.
Evory school wst bo accrodited by ·.ho llaticnal GoverntlOnt (Ministry of Education and M:lniStry of Health and Wo1fal'O) Qccord:lng to tho ww for ooT., 1M. & ON .. (ww #203 - 1948) Accreditation hns roon enforced slnco 1950.
1. l-lin:inun roqu1re.pont ••• " ••• HIN. CN' + 6 nonths or rore (8 - 12 I!lOnths, is offored :In all, BohQcllB)' , 1>1)1 - - CN 1" 6 I!lOnthl; or rore (12 IJOllths "" ,,' )
f'~i .--\~
eN - - Sonior h:lt;l1 (:12 yoo.r G<ln. Ed.) - 3 yours 2. Nunbor of Schools , HIN
........
."'~I "
I
Mi, eN
32 Nunbor of Students 17 lIunbo!' of S'i,udonts 161 Nunbor of Students 1,. yo"r Univorsity 2 :3 year Junior Colloge 5 3 year HospitaJ, school 154
950
365
4,630 por year
O. Naticnnl E:xnn:Inat:iDn.
Tho liconso is offored only to thoso who pass thQ National E=-inaticn which is given twico " year for oaoh of tho throo groups. Jp'wra~g
giPado
8.3.5 91.2
85.6 D. SnlAry scalo:
•
•
Pe! 6QPtagg af 8\!:eeBSS 90.7 97.1 • 90.7 io
;!
'rho ,',,,t.ional atando.rd of tho first Basic salary for tho officials
of JiQ'oional Govornnont is established :In 1950. Figuros :lndicato trnthly P'IY. Em - . - 1>8,'1'00 - 9,(00 E, .., - 8,.,00·· 9$00 ON - - 8,900 (OGhor Modical porsollnol) Rlysicisns Dentist
no,soo 10,800 9,200
.F1m:rnasiat lJu'wJ:oionist Tho .laWYCl:
7,/IJO 9,200
"
WlIO llurs:lng Education Pl'Ojoct, Japan (Notos p:t'Opured for WHO study Groupe Sopt. 195'7) The WlIO Nurs:ing Education Project was planned follO\l:lng a visit of tho WHO Regional Nurs:\ng Ad'Viser to Japan ;L" 195~ and discussions with the !;Ovornmnt rogard:ln& their :Interest :in tho trn:ln:lng of toe.chors for clillical schools (oosio), publio health l1UN:b\g schools, and nidwifary sche-ola. Thol't3 has been an o:x:'oronUy ro.pic1 gl'eut.h of schools s:inco tho pass:lng af the Nuraing Law :In 1948 which prov:ldos for high standards or tro:ln:!ng. An extonsivo progrl\llll!lS' Qf train:!ng of toachers :in shert coursos noedod to be supplenontod by regular tra1nimg prograDDfls of longer ...meat;.,,,. Tho project "'IS dos:Ienod to contriwto to this dovelQptlIlDt ot longor COurODS. ... . . . G:...... -
Tho project began :In Septonber 1955 and will cont:lnuo until 1958. There are threo e1ononts. 1. The assignnont of a WHO ~!ursing EdUcator to work with tho NursGS at tho Instituto of Public Health and with tho InU's:ing staff at th~ !Unistry of Hoalth and \,e1filre jn thoir pregI'aIIms which prov:ldo gu:ldance to nurs:ing educators and schools throughout tho country. ;!.
Tho propo.ration of six nUrsos "ohrough followsh:!ps 1 Clinical InU'se (1955 - 56) Basic Nursing Education, USA. 1 Nurso-n:ldwifo (1956 - 1957) l4idwifery Education, U.K.. 2 Publie Health Nurses (1957 - 1958) Publie Hoalth Nurs:ing EdUllation, USA. 1 Glinical Nurso (1958 - 1959) Ba~ie Nursing Educ"tion w1th onpbasis on cl:inioal teach:lng, USJ,.(?). 1 Nurse-midwife (1958 - 1959) Matornity-Child Hoalth with enphaais on planning tho teaching of Matol'l1ity NurSing, Caneda(?);
,. Provisjon of teaoh:ing DB.teriols 1t !IUPPlelOOnt$ the A llUlrary of 157 iteIllS has been prev:l£led ta date. Instituto Library with booles, panphlots and ..thor daQUn;lntll .an thethroo areas of interest; Glinical nurs:!ng, Publio hoalth 1lU1'$1ng, and ~wUe:l'1. Education nothoos, currieulun plann:lng, sociology, OIIthropology, p8,-cholm,g. child growth and dove1op!!lent are represented. ~thods of 1'<lsearc;h and sanple. of research papors '11'" :included. Teach:ing oatoriols :lnolude filns, atlatOl!1ieal charts, dononst1'aticn items. Journale of nursing are from tho 11nited states, Danada, and the 11nited K:ingdolJ. Tho WlIO InU'SG has two counterparts. Mrs. (kada, head of the department of nursing, Institute of Publio Health Nurs·:ing who is in chargo of tho to(\chcr--tra:in:ing courses for G1:1nical Nurses and Mjdwivos J as well as an advanced course for Public Health Nurs". and refresher courBG for Publ1e Hoalth NursDs. I!1as Kanoko, Gounsellor on Nurs:ing,&1ro8l1 of Itldioal Mrairs. !Unistry of Health and Welfare, who d:Irocts the activities of five nurses in tho ~dieal Affairs Soct1ml and has advisary fcnctions relating to nursing in tho hospital and san1tor~ Soot.1onJl and ethers. -.J,. ztu. tho Wl!O nurso has an office at tho lnBtitute an<l,. nursing staff at tho Institute :in planu:ing the teachar tra1nJng aSjJOcts of the coursos and shares :In the teaoh:lng. She alSo. works with tho l!:in:l.stry nw.'scs \1.10 a.."C responsible for :lnservice tra:ln:lng ef nursing personnel :In tho 'VtIrious regions and prefectures and sho &ivoS short lecture series :in connoction with sono of the :in.serv~ccD cottt'sos.
....v.
Rogional DootingS for eduoational d1rectors and ahief nursos from all tho schools nrc held once a year. Tho WHO nurso has been able to eharo in tho planning of these neetings and tho preparation of mtoriala on school problena used in these metings. ,.~ I......u;:t
Thie division of activities reflocts tho j>u:rpose ~ project, whioh is to assist the govel'!lI'll3nt to strengthen basio nurs:ll:.;?,'z;:idw1fery education, to assist 1n develop:ing a post-graduate oducational programo at the Institute to proporo teachors and to assjat :in prov:!ding, a qualifisd faculty for the post-gradUllto progrQIJI:<) throug!l the provision of followships •
'\'I>.U":'\
~
r
0"
•
Instructors I COlU'SO for
C1mi~a1
Nursos and llidvivos
Institute of iUb1ic 1I0alth, Tokyo
A.
Tho plannm& of tho mstruotors COlU'SO /lor tho c1mical nurSeS and tddvivos is dow1oped by all the staff of tho llursmg Dopartnent at the Institute of l'Ublic lIoalth. 'Experience m pnblic health nlU'8mg, c1mical nlU'smg and n:lJiv1£ory is shared. Those coursos are ovaluated by thd total nurs:Lng staff. This ana year course to preparo teachers was startod m 1954 for
i'
graduate nlU'S08.
IlIwoors onrollcd arc as fellows, . Nurso n:lJiwivos 1955 . 1956 • Total
C1mieal nursoa 1954 1955 1956 Total
•
• •
• 9
• 14 • 38
• 15
J3 (7 p..ontha)
• •
9 22
B. Presont ppsiticn of graduatesl C1mical 1\1U'1l6e 24 :i.nstruot.ors ;l.n sJlllPI'>l.s of nlU's:i.ng J.. q1'~.". .,;;.m~~ ~;,. ~. ~, .+-At~ ~" - :,',~~~~:~f1'"~~~" -1t#·:,:,~,:~:~~",~,.·;,;,,,:~,~~; '·f':"r,,',r:'·~~-~~
,. ·.
•.
)i.cis';!."-'
9"1<1",,...,
Miawi;";~ ..' 7
15 ol:1n1oa.1 mstructors m l!Iaternity hospitals
1lll~Wuctorll :i.n
s,*,ols
at m:lJiv1£ery
c.
msant enrollnont, Sept. 10th 1957 - Aug. 22, 1955, C1mical mlrSOS H:ldwives 16 (2 frem Ckmavn) 8
\
\
,
Instruotors Course
for Clinical Nurses nnd Midwives September 1957 - August 1958
Aim
To preJXlra mrses and midwivos for teaching positions in sOOMl of nursing and midwifory v.s >roll as fvr suporvising positions in hospi"t.'\ls and "".temity hospitals. To nccomplish this aim, tho course is designed to deopen their knvwledge of nursing, tho totol heclth fiolQ, and related fields; education, social sciences, administration, ata. Also to :levelop teo.ching & plannine skills nnd to give thGlll nn opportunity to! work tOfJether on probloms of nursing & nursing eclucation.
Objectives
1) 2)
T·) help tho student gain ability to analy"o "-nel rmke plans in rmrsin" eduontiun according to her JXlrticular situation. Tu help tho .student gain ability in organizing content in courses and study sequence and make sound curriculUIll planning in cach situation in coqperotion with others. To help the stUdent unclorstond tenOOing methods and apply principlas of iaarning in her tssching of student nursos.
3)
4) Lonr,th
To help the student gain ebility in plllnnin{l clin1enl instruction in her own school situation and in putting. plans into effect. One year
Qualification of Students
lli.niosl Nurse
Midwife
1. 2. 3.
High School eraduAtion
1.
lI1e;h Scheol graduation Groduntion from 2 or 3 yrs. Nursing School and 1 yenr Midwifory School 3 yr •• experiencos in Midwifery
Gradun tion from a 2 or 3 yrs.
2.
Nursine School 3 yro. experiencos in Clinical 3.
~
3 year progrom is under new regulation
CUrriculum
, Subject 1.· ~
!!!o.
~~~
Tce.chers &:Uoo.tioD Frinc1plea of EduCEltion Educational Pa1ch?10gy Teacbin, ~!ethod
222
W. 30 2
30 21
Mr.
Hid" It"
Mr. Chihiro Tctsuno Miss Ilnruko Shibota
30 30 36 (45) 30
30 30 36 (45) 30 3
Counselling Curriculum nanning (Inc1udin;: Practice) School ~dministrntion
Mr. TaY.nyori Aoki Mias Shizulw Kin"shi ta Mr. Akira Wntambe Miss K. ~m Mr. Ichiro Tnkeda Miss llaruko Shibota Mias KiJ:>J. Kntsushinn
2.
Genoml Education P.H.Statiatics Mental Hoo1th Social Medicine Social Welfare Hoolth EduCEltion
ill 30 30 30 30
ill 30 30 30 30 15
Nr. Kijt"U ohi Tn chilre.wu
Dr. Koioo
Okn~",
Mr. SadM YokoynIln Dr. Michio Hashim,to Mr. Shukoi I\omiyann
Mr. Yuichi
N(lktu!!Urn
15
Tndao Miyasalm
3.
Protossionnl Ec1ucntion Frinciples of Public Han1th Administration of Public Haalth Nurein~ A("~n1strnt1on
m 9 12 9
~
9 12
Dr. Dr.
Kipshi Saito Nsgnmuna Soon
Dr. Mosnmi Hashimoto Mias Mitsu Kanok'" Miss Kikuko Ish:li Miss Tukak" Suzuki Mrs. Rikue Okucb Mrs. Sada. Nno:mo Miss Ynauko Uchidl1
9
Public Health Nura1Dii
21
21
Nutrition
15
30
Dr. Kunitnro Arilroto Miss Aya lila"". Miss Shizuk·, Muto Dr. Yukio YoshidG Miss Tokiko Yoshida
HOspital Administration CliniOdl Instruction
9 21 .....)
9
21
- 2 -
Admiriistrntion of.Nursing in a Hospital AdministrD:Gion of Hoolth Cantor History of Nursing
10 6
10 6
Miss K:I.m:i Yututo
Dr. Yabuki Hiss Horuko Shi1:eta mss Tashie Nagai Miss Shun Tnlrnhashi mss Koiko Tokiw mss Hana Takeda mss Ayako KAbeshinn mss K:I.m:i Katsushinn Hiss YM Sur,nhara Do~tors
& Proffesional 18 18
./Ldjustmvnt Principles ~d
Practice of Nursing
Modical Nursing . Surr,icnl Nursing
18 18
Communicable desaase NurSinS (Including T.B. Nursin5) Pediatric Nursing Gynecology and Obstetrics NurSing Psychiatric Nursing Clinicul Medicine ~te=ity
18 18 18
18 117
from Hospitals
Health and Nursing
51
D'r.. Shigek.i Takeuchi Th~. Isno Ml-:'s'L'.rnnra Dr. Minolu l.fure.nntau Mrs S!laa Nagano M.-tss Ye.eko Suzuki
Child Health ond Nursing
Dr. FIlmio Saito Miss Toshiko Shibata' Dr. Hotno Funakawn
Obstetrics
24 12
Hiss Hichiko Jbitsu Miss Miko Seya History and Midwifory Ethics Aclminis'~TIltiQn
Hiss Y"suko Uchidn Dr., IIbbuyosbi Hirai Dr. K. Miyazetki Dr. Shigo:':i TakoUchi M1.ss S1lIDJ.B Shimizu
Miss Kim! Katsushima Hiss Snku Kusano
of Private futsrnlt.y minic
.3
A5;3. Hospital Health Centor Nursing School
.ill
9w 297 hro. 1" 1 w
33 hrs
33 hra.
1 w
.3.3 hrs.
Maternity Hospital Private Joilternity Clinic Pre]w:~U!'&
9 " 297
Iv .3.3 1"
M.bj}' Institut:lon
33
- .3 -
Administration of Midwifery School TonchinC frnctice
111
:33 90 90
5. Group Study
G. 8.
SpociaJ.
!AJctl~ro
7. Fiold Tr!9s Stucly
} ) Toml
377
398
1,560
1,560
"'
riC,
Field practico 1 The field practice for the two sroups 18 arranged ;In a s:b:Iilar cannor, provid;lncr suitablo cls.ssrcon teach:!ng practico and practice ;In cl;lnical ;Instruction • For the clinical nUrsos. Tcach;lng practice is arranged 1c the 1st lIational & 2nd Ilat10nal Schools of 1I\U's1cg USing thoir facilities and student IlUI'ses. Eaoh Institute student has an oppertunity to toach ono class to her class mtes and anothor class to student IlUI'sea 1c ana of the abow sohools. J?ractice of clinical 1catruction is arranged 1c tho First National and 2nd National Hospitals for a period of 9 wocl<:s. ' For tho midwives; Facilitics for practice arc the Japanose Red Cross MLlternity School of Midwifery and Hospital and also 1 week oxperience ;In pl'Glllaturo baby institution. Follow1cg is a doscription of tho field'practico progranne for the clinical nursos (that for the Midwives iB smllar)
.'
The 1st step - 4 weaks Tho Institute student is "saiBnod as a staff nursoin a ward related. to hor llUrS:!ng subjoct for understand:\ng of ward adniniBtrat1cn, oond:!*ion of patients and IlUI'smg prodecuros •
•
The 2nd step - 1 week Tho Itlstituto student prepares plans of clinical instruction, she reviews tho background of the studont nursos when she will teach and studiBs the curricuJ.un of their school. Tlw Jrd B'top -
4 weoks
Tho Institute stud~nt supervisos and teachos her assigned students ;In the co.ro of patients. She usos in actual situation the princiPles of learn:\ng anJ tonchinr; nothod whieh sho has loarnod in hor classos. Sho nakos do il¥" reperts and a f;lnal report for hor ;Instructors at the Institute of Public Hoalth. Durinc; the ficld practico period tho Instituto stud~nts neat onoo a weok with thoir teachors to diBcuss their probloIJS •
•
Course in Health Guidance for IJurses, Health Educators Qnd NUtritionists April 16, 1957 - March 28, 1958
Purpose Tho courss in Health Guidrulce 1s to educate Public Heo.lth Porsmmd ror leadership at national and prerooturol lovels with omphllsie on the tC".chl11g fUnctions or Public Health NUrses, Health &luentors and NUtriti.1nisto o.nd to improve thcory and practice for the advancement or Public Health. Onayenr Qualification of Students University and Junior Colloge ';raduntes or F.H. NUrsing or graduates of Nutrition Education, PsycholoGY and Domestic Science. ~~
Subjoct Introduction to Public Health r.~lic
H2.1ll: 2
Dr.
S(!ii;.o
Health Administration
9
Dr. Hashinoto Dr. Usui Dr. Tachi.1.ro.wo. Dr • Tawi Dr. Oeuda Ml:- • Oga'1!l
Public Health Statistics . Fhysiolo:;ical I1;ygiene
75
15
Epid<>lniology
24
Dr. ~utsuda Dr. Mlyairi Dr. Yuasa. Dr. Dr. Dr. Surnoya K)u')
Microbiology
21
Ji.shiharo
Dr. T. Il., C.D. & fUrasite Control
Moriwnki
51
Dr. SomeJ."O. Dr. Kano Dr. Oshiro
C. D. Control Administrotbn
V. D.
1.5
Dr. YoshizaJd Dr. K;;>nishi
T. B. ?1rasltes Chronic DisSllse Control
:3
4.5 21
Dr.
Takan-o
Dr. Tatai
Dr. Hirayama Dr. Saki
Nutrition
27
Nakamura D:... Oiso Dr. z.1ogi
Dr. Dr. Dr. Dr.
Nolmgawa
TaknhD.shi Tonnbechi
Dr. Planned Fnrenthood
M1yaka
21
L'r • Hur.onntsu
Mr. Hinoue Matornity ond Chil~
Dr.
Dr. Ogino, Kubo
Health
63
Dr. Funakawa Dr. lbyash.i Dr. Takeuchi Dr. '"'Y.aruatsu Dr. Funakall!l
School Health
15
Dr. Tsulruda Dr. Mizuno Dr. Onishi Dr. Nill!l L'r.
Dent"l Health Mcn"l;al
9
P.oulth
15 18
Okuro
Occupational HYgiene
Dr. Suzuki Dr. Ishikawa Dr. Hirokawa
Environmental Sanitstioll
36
Dr. Horasawn Dr. Hashimoto Miss Konuda Dr. Iwnto Dr. NaJtsj ima Dr. Dr. V.nJGsui Komof..a
Food Sallitation
IS
Pbnrro.'l.coutical Sanitation Socinl Welfare AcT:d.nistra.ti()n
Dr. Sulcaaami
12
Mr. !{omiyruna
Hospital Administration Health Center Adr.dnistration School Administration Education
-
•
24
9 9 99
51 15 36 6
r-
Yo.hiro
Dr. Ynbuki
Mr. Ito Dr. Suto
Ec1ucntional Principle & Psychology Realth Education
{Mr. Suzuki Dr. Miyaeaka MrS. U~iie
Home Economio
- 2 -
PUblic Hoelth NUrsing
12
Mrs. Okada Mrs. Nagano
Miss Uchidn Seminar Stuc1y Fieln Practice at Health Center Total &
Special Lecture
60
127
132
864
PUblio H""lth Nurses Course Lecturo Nursing J\dI:dnistmtion Trond of Nursing &
Pragtice 9
9
lI'.lTsing Adm.
15
15 9 12
Nursing School Adm. (summor Course) Curriculum Planning (Summer Course) Principles of P. H. Nursing Nursing Suporvision Frinciplos & Methods of Toe chinS Infant &
15 15
24 27
15 24
15
.30
21 12
45
Pre-8c'1oo1 Nursin(l
24 9 24 24
.36 12
School llursing T. B. & C. D. tlursing Chronic Dis""se llursing & Industrial llursin~
.3 9
.3.3
12 6
J6 27
21
Special Lecture Selllinsr (whole group)
15
15
Seminar for nursing group Study Fiold Trip
.30 6.3 .30
- )
396
Field Preotioo Hoa1th Conter Hospitnl School
132 66
30 22B
Totn1
NUtrjtionist Courso
Locturo PracticG Nutrition Foods . Cooking '99~l?t1i7;)'ee~Jffl,;'i' Guidance f'or Nutrition Specinl Iacture ..' i "
Totn1 13B
87
51 :13 12 :''f' ,,'
42
75 42
3J ._~.
.:"',/<~~ ,.;"",,;··:i;i+:.;~i::;,,:~;~_:;_~, ~/.~t~~:f~;,~,\2li~~:;\'::::>,(,; "'.
,'./ :_~_:": l: ,. .,- .' 93
24
15 30
study
51 504
Field Prnctice H .... lth Center Ihspital School
60
3D 30 12J 624
•
Total
• • • • 'I: • • • • • • • • • • • • • " • • • • • • •
- 4 -
Honlth Educators Course
HFALTH EDUCATION OF THE PUBLIQ
1.
Fundamentol Studies, 69 hours (lecture, di6C\1ssion, practice) Social psychology, sociology, community organization, principles o! school education, principles of public relations etc. Methods nnd Techniquos of Health Educatio~ , 198 hr.. (Same) Motion picture, slido, exhibits, po~ter, panel, flannol bonrd, printed mattern, puppet show, etc. (A variety of disC\lssion methods are tou:;ht in the comblnod plrt of thi s course)
2.
3. The Professivna1 Fields rolatod to Hoclth Elducation , 12 hrs. Home extension work in agriC\l1turo, ndult educ.qtion etc. 4. Field Work , 213 hrs. Health center nnd health deportment. Field observation, special locture, somiDar etc.
5. others , 13 hr ••
. The 21st Public Health Nurse Course (4 IIPnths) December 1st 1956 Subject
.
J!!:!!.,. 6 13.5 9 9
1. 2.
Introductbn to Public Health Vital Statistics
Dr. Saito Dr. Soda Dr. Tllchilmwa Dr. IIorasawa Dr. Mltsuda Dr. Hira)'8ma Dr. Okada Mr. Suzuki Mr. Nakamura Mrs. Okada Mrs. Nagano Miss Kaneko
3. Sanitation
4.
Epidemiology
5. Mental Hygiene 6. Educational Psychology case Work Public Health NurSing Prine.
12 12 9
7. 8.
60
9~
Health education & Method of Teaching Miternity & Child Hygiene
15 51
Dr. Sato Mrs. Nagano Dr. _matsu Dr. Takeuchi Dr. Funa1<awa Mrs. Nagano Miss No""""
10.
11.
~ommunioable
DiseaSe Control
Dr. Coto Dr. Kono Dr. Mi",iri Dr. Oshim Mies Uchida
12.
Tuberculosis Disease Control
Dr.
KaWlmll'8
Dr. Konishi Dr. Shimmura Miss Uchida
13. 14.
Chronic Disease Control Industrial Hygiene
19.5
Dr. Tatai Mrs. Okada Dr. Salmbo Mrs. Okada Miss Nozawa
12
15. Nursing Procedure Lecture
30 10 . . . IO . . . . . . . . . . . . . . . . . . . . . . . . .
Field WOrk ••••••••••••••••••••••• Special Lectures •.••••••••••••••• Study • • .. .. . . . .. . . .. . . . .. .. .. . .. .. .. . . .. . .. ... Total
330. 176 18 9
................. 533
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SERVICES FOR CRIPPLED CHILDREN IN JAPAN
(R~VISED
EDITION)
-
Children's Bur•• u Ministry of He.lth and Welfare Japanese Government
JULY 1954
1 _.-
.'
.
Preceded by
long years of volunteer movement and s(;Tvices. public program for enactmc~t
crippled children in Japan was sct up with the December 1947 (cf. "\"oluntary 1vIovement").
of Child 'Welfare Law of
Though SID'.v in its early stage because of the post-war social chaos, the program
has developed pretty rapidly in these several years. The program is administered. on a national level. by Maternal and Child Health Section. Children's Bureau, Ministry of Health and \Velfarc; on prefectural level (46
prefectures in the country), it is administered jOintly by health and welfare departments of the prefectural government. The program, according to Child \Ve]fare Law. covers the crippled children under 18 years of age. while the physically handicapped Over 18 years are covered by Law for Welfare of Disabled Persons. administered by Social Affairs Bureau of the same Ministry.
EXTENT OF THE PROHLE,!
Several SllryeYR liaye so far been made on nation-wide scale. but each time the figures ohtained p~-oved
much smaller than had been expected.
To quote some of them. a national sampling survey on the exceptional children. which was conducted in 1953 under the sponsorship of .Children·s Bureau by a network of the child , ...-elfare \\-orkers. revealed the estimation of 129. ZOO crippled. 16.200 blind. 27.700 deaf, 78,300 mentally retarded. children under 18 years of age . .·\nother sampling survey on the crippled children and adults. which \vas made in 1952 under the joint Rponsorship of Children's Bureau and Social Affairs Bureau with
cooperation by the Japan Orthopedic Association, revealed the estimation of 10.1. 700 crippled children under 18 years. Howover, some of the surveys that were made on local scale and seem to be more reliable in Clccuracy, re\'ealed much higher incidence of crippling conditions. Taking into account all these data available. we put the number of orthopedically handicapped children under 18 years at approximately 400,000. As for the causative breaking down of the conditions. the following was shown by the ahove survey of 1952: Poliomyelitis Congenital deformities Cerebral palsy Tuberculosis of bones and joints Trauma Osteomyelitis and arthritis Rickets Rheumatic arthritis Other diagnosis
19.6 ;:'; 18.8 ::6 15_ 0 '};; 10.6 '}; 10.3
?;;
6. 1 ::;; 1.. 0 ;;;
0.8 ::; 17.8 J';
-
2 --
CURRENT PROGRAMS 1. Clinic Services
"
From 1949 to 1952 mobile clinics were conducted in various parts of the country under the joint sponsorship of Ministry of Health and Welfare and the Japanese Society for Crippled Children, Inc. (later came in the Japan Red Cross). Participated by teams of orthopedists, nurses, medical social workers and vocational counselors. these clinics demonstrated to the local people concerned method and technique of team approach in rehabilitation. r
As a result. keen interests were aroused in the rehabilitation services. and besides. a fact was uncovered that a large proportion of the cases, particularly in rural areas, had been given neither medical diagnosis nor treatment because of the ignorance and disgrace feeling on the part of parents. Stimulated by all these things. permanent clinics were launched in 1951 by nationalprefectural fund. As of March 1954 these clinics are conducted by 67 health centers in the country (total number of health centers is 783). and most of these clinics are open once every week. One of the major fltnctions of these clinics is in the early casefinding. which is striven after by personnel network and through publicity. For example. an instruction is issued by the director of Children's Bureau to the effect that the midwives are to be careful in checking on the motor-skeletal disfunctions of the newborn infants. and that if they notice any they are promptly to refer the cases to the health centers.
In a year from 1 April 1952 to 31 March 1953, 18,031 children received the clinical services. of whom the following diagnosis were given:poliomyelitis 3.669. tuberculosis of bones and joints 1.458. congenital deformities 3.783. cerebral palsy 2,325, trauma 1,204, other diagnosis 5, 562. 2. Hospital-and-Rehabilitation Centers for Crippled Children There are at present 10 hospital-and-rehabilitation centers (618 beds) strategically located in the country, including a quasi-national center in Tokyo; five more ones are now under construction and will be completed by April 1955, when the total bed facilities
will be 1. 060. The purpose of this type of hospital lies in providing integrated services of rehabilitation-medical and surgical treatment. phYSical therapy, occupational therapy. social service, education and recreation so that the crippled child may become a selfsupporting. creative member of the community. According to Child Welfare Law. 50 per cent of the construction cost is subsidized to the prefectural government. and the cost for hospitalization and related services is paid by public fund (on SO-national and 20-prefectural basis) according to the family's income. From 1 January 1953 to 31 December of the same year. 669 children were newly
-3admitted in these hospitals and 410 cases were discharged; public fund was paid for 487 . cases of the 669 children. and for 278 of the 410 children. 3. Provision of Prosthetic Appliances Since 1951 prosthetic appliances have been provided by public fund according to the
income of the family.
The types of the appliances include artificial limbs. braces. wheel
chairs. hearing aids. eye-glasses, etc.
Standardization as to the cost. types and structures has been set by the Ministry and is shown to the brace-makers through prefectural governments. From 1 April 1953 to March 1954. 3. 500 children were provided the appliances under this program. 4. Expansion of the Program a) Short· term Treatment by General Hospitals: As shown in the previous chapter. the total bed facilities of the hospital-and-rehabilita<
tion centers in the country are small, and. though additional construction is being planned. they are far too short to meet the existing large case load. public program for crippled children since 1954. The objective of this program is to achieve prevention of the handicap through concentrated treatment in the acute stage rather tha:J. to treat the established handicaps. To overcome this bottleneck. short-term treatment by general hospitals has come to be included in the
One hundred and sixty orthopedic departments of the general hospitals are contracted and designated by the Ministry for the program.
b) Services for Children Defective in Eye·sight, Hearing. and in Speech: Education of the blind and the deaf children has rather long history in Japan. Before a national scool for blind children and a national school for deaf children were established in Tokyo in 1909. several schools had been existing. As of 1 May 1954. there are 75 residential schools for blind children and two branches (71 prefectural schools, one national. and three private ones) and 86 residential schools for deaf children and ten branches (84 prefectural, one national and one private). Compulsory education system for these children was set up in 1948 and this waS strengthened by a new law of 1954. Besides these schools. there have been established, according to Child Welfare Law. homes for blilnd children and homes for deaf children, main function of which lies in providing care and social services. As of December 1953. there are 26 homes for blind children (18 public and 8 private ones) and 27 homes for deaf children (14 public and 13 private ones). Such being the case, public services for the children handicapped in sensory organs have so far been confined to education and social services, and medical program has not come in. In 1954, however, medical and surgical treatment for these types of handicap has come to be included in the public program for crippled children. The main objective of this program lies. like in the case of orthopedically handi-
- 4 capped, a). above, in providing early treatment for prever.tion of the handicap. The size of the problem is not accurately known. but the summarized report on ~
.
health f'xamination of primary and secondary school children throughout the country of 1951 revC'aled that. ~-\s 011
the average. 0.63 pe: ccnt of school children are defective in
eye-sight and 0.38 per cent arc hard of hearing. of }\pril.195-t, 140 ophthalmic departments and the same number of otolaryngologk of the general hospitals are contracted and designated by l\1inistry for the department~
program.
5. Yocational Rehabilitation ~\s
pre\"iously stated, prosrm for crippled children covers the age group from inf~t
to 17 years.
Though for the elder children some consideration is paid of vocational voc~tional
rehabilitation at the hospital-and-rehabil1tation centers.
rehabilitation program
has been rur. separately f!'om the eripplt:d children's program. The vocational rehabilitation program was started in December 19·1-9 with the enactment of Law for \Velfare of Disabled Persons, and it has been administered by Socia:
Affairs Hurcau. )''1inistry of llealth and \Yclfarc; on the prefectural level it is run by depa;-tnwnts of welfare.
This
p~ogram
covers the physically handicapped persons over 18 years of age and
includes the iollo\\Ting services: medical and surgical treatment. provision of prosthetic appliances, social case \YorK services and vocational guidance by vocational counselors. welfare g(.rvjces. and rel:abi;itation serviecs by national or prefectural rehabilitation center::;. Fesides, under 1.finistry o[ Labor. vocational training by prefectural sheitered workshops and also employment service are provided for the physically handicapP2d persons over 15 years of age. Coordination with these pro~rams
has been a matter of importance for the rehabilita-
tion of the elder age group of the crippled children.
TRAlNING OF PERSONNEL \Vitll the development and rxpansion of the program. shortage of trained personnel has come more and more serious, To cope \vith the situation, Children's Bureau has been striving to set up a ("Seishi-Ryogo-En") as a demonstration center. For this purpose the ?vlinistry has started since 1950 reconstruction of the hospital by governnH.nt ft:nd. (The hospital was once established as a private. pioneer institution. bL.t it lost its facilities by U:e fire of the war.- d, next chapter.) Fortunately. ",THO and CKICEF have extended the hand of assistance to the Japanese Government in cGnnection with this traininf, project. and a tripartite assistance agreement was ~et permanen~
training program using the qt:asi-national hospital-and-rehabilitation center in Tokyo
t;.p, ender this agreement. Dr. Marcia Bays. Chief. 'Eureau of Crippled Children
..
-
5-
Service. California State Department of Health, came to Japan as WHO consultant in November 1952; six WHO fellows made observation and study in the respective branches of rehabilitation of the United States; UNICEF is donating technical journals and books and a series of equipments amounting to $ 17.000; another consultant in occupational therapy is expected in 1954.
VOLUNTARY MOVEMENT As previously stated, public program for crippled children was preceded by long years of volunteer movement. long-standing campaign. This movement has been directed by Dr. Kenji Takagi. It was in 1924: that he launched a then professor to Tokyo University ?viedical School.
At that time, the crippling conditions were apt to be considered
a matter of disgrace, and the parents wanted to hide their crippled children from public view, which tendency often led to aggravation of the conditions because of delayed
--..
treatment. To cope \.... ith the situation, Dr. Takagi advocated: 1) Crippling conditions should not be remained an object of philanthropic services, but that those should primarily be an object of medical treatment. 2) However, medical treatment alone does not give a whole solu3) It is of urgent necessity to establish tion; it should go hand in hand with educational. social and vocational services, if a crippled child is to be completely rehabilitated. rehabilitation centers which provide such integrated services of rehabilitation. The campaign has gradually gained public understanding and support, and finally it has developed into a strong voluntary organization· - Japanese Society for Crippled Children, Inc., by which was established a hospital· and-rehabilitation center in Tokyo C"Seishi-Ryogo-En") in 1937. The opening of this pioneer hospital (105 beds) marked an epoch, and it served tu popularlizing the modern method and technique of rehabilitation and to creating public interests, Though unfortunately this pioneer work came to suspension with the loss of the hospital building during the war, the value of the new rehabilitation method has not been forgotten by the people. and its concept and technique was adopted in the Child welfare Law of 1947. Thus, this volunteer movement has led to the establishment of the public services for crippled children. The Japanese Society for Crippled Children, has gradually grown in the post-war period, and it was affiliated with the International Society for the Welfare of Cripples in 1919. The accomplishments made by the Society in these several years. were. in a word, in arousing and fostering public interests and support and in popularizing parent education through various kinds of meetings and through publicity activities. Worthy of note are the mobile clinics that were conducted in various parts of the country in cooperation with the Ministry of Health and welfare.
-
6 --
This action. as stated in the previous chapter. has later led to establishment of a network of the public clinics in the country. Starting from January 1954, the Society has launched a nationwide "campaign of New
'.
Year Post-Card of Friendship", in which 29,000 sheets of attractive post-cards were distributed through local chapters to the school children in the country. whic~
This campaign.
may be compared to the Easter Seal Campaign of the United States, is expected
to gain further more popularity in future and eventually to contribute to the improvement and expansion of the services for crippled children.
7.
\
IIOSPITAL SCIIOOL AND HO;VIE
FOR
CI<.IPPLED
CHILDREN
- - SEISHI-RYOCO EN -
, t I
, 2~)
t j
7 8 NENOI"':AMI-CHO ITABASHI-KU
S
TOKYO
JAPAN
'" I , Director: Vice-Director: Medical Director: Guidance Director: Business l'vlana.~er:
PERSONNEL
The total numcer of employees is 125. The staff are: Kenji Takagi, Fumihide Koike, Hiroshi Yamamoto. Kembi Koji Matsuoka Homma M. D. M. D. M. D.
Orthopedic doctors Ped iatric doctors Fsychologist Logcped:st Pharmasist X-ray technician Photographer Dietician Registered nurses
9 2 1
1 1 1
1 1 36
Physical therap:sts Occupational therapists Sp~ech therapist Vocational workers School teachers Nursery teachers Medical social workers Assistant nurses and others
7 5
1 5 8
" ,
7 2
27
,
Total
125
This institution was established by the Japanese Society for Crippled Children, Inc. in 1937 through long years of efforts by Dr. Kenji Takagi, then professor to the Orthopedic Department, Tokyo University Medical School.· His pioneer works demonstrated at the institution came to arouse interest among the people concerned, and it seemed that this kind of works for crippled children would gradually be set up in various parts of the country. Unfortunately. however. tbis trend did not last long with the outbreak of the World War II. Moreover, the institution lost the greater parts of the facilities by air raids. After the end of the war, the works for the physically handicapped children came to be taken up into the government program with the enactment of Child Welfare Law. As a step the Ministry of Health and Welfare started reconstruction of this institution in 1950 in order to make it a "model center" for the ones to be established in each prefecture. Since that time national budget has been appropriated each year for the completion of the facilities of the institution, its operation being assigned by the government to the Japanese Society for Crippled Children, Inc. with some amount of government fund to cover the deficit of the running ccst. Thcugh not yet came to completion, it is regarded as a "Mecca" for crippled children.
I
,
,
l I
( 1 )
,
Orthopedic treatment and nursing care: Surgery, pre- and etc. Physical therapy: Massage, various kinds of exercises including res:stive motion, electrotherapy and hydrotherapy, exercises in walking up and down stairs, ramps and bussteps, etc. Occupational therapy: Various kinds of gadgets, tools and musical instruments are USed for the training in fine and purposeful movements of upper limbs. Emphasis :s laid on motivating the children by attracting their interests toward the trammg; a numer of toys are devised and utilized for this purpose, particularly for younger children. Training in activities of daily living such as dressing and undressing, washing face and brushing teeth, eating, etc. is also One of the important services of this section. Speech therapy: Elaborate techniques are utilized in speech therapy for the speech handicapped cerebral palsied children. School education: Primary and secondary school education is being given by the teachers assigned by the National Tokyo University of Education. Teaching is conducted either in classrooms for ambulant children and at bedside for bed-ridden ones. Social and recreational activities: For the purpose.of fostering SIlund mental and emotional development of the children, as many opportunitiEs as possible are offered to participate in such activitiES as excursion, athletic meeting, birthday party, baseball and other sports, ceremony, cultivation of flowers and vegetables, music party, drama, etc. Prevocational and vocational trainin!!: Wood work, metal work, clay work, painting, dressmaking (Western and Japanese styles), embroidering, drawing, mimeographing. Social service: Social workers offer casework services to parents who seek advice in planning for a handicapped ch ild; they also correlate the complex program of the institution with the individual needs of each child. Mother-Child class: Approximately twenty couples of mother and their ylmng children with cerc. tral palsy stay in the institution for three months, in v.hich period concentrated courS2S of lectures and demonstration are given to each mother to ma 1(€ her learn how to [take care and train her child at home. This class has been conducted for three years and has attained excellent results. ( 2 ) PGst-op~rative
care, plaster casting, traction, fitting of braces,
;f.
CHILDREN TO BE ADMITTED Any child with orthop2dic disability under 18 years is eligible for admission on the condition that he or she is rehabilitative and educable. The bed capacity is 200, and the classification by types of disabilities are, as of August 1957: Poliomyelitis. . . . . . . . Cerebral palsy . . . . Tuberculosis of bones and joints Arthritis other than tuberculosis Congenital dislocation of hip joint . Other congenital deformities. Trauma . . . . . . . . Rickets ... . • . . . Other miscellaneous diagnosis 40
66 39 4 18 11 6 2 8
No restriction is set as to the locality in which the child is living; on the average, approximately 50 per cent of the inpatients are from Tokyo area and the rest are from other parts of the country, from Hokka'do in the north down to Kyushu Island in the south. The Inpatient Department is consisted of five wards: Surgical ward, Convalescent ward, Dormitory ward, Ward for tuberculosis of bones and joints, Ward for mother-child class. COST OF HOSPIT AUZA TION Cost of hospitalization, including all kinds of services is payed py public fund, partially or totally, according to the income of the family. In this case, 80 per cent of the public fund comes from the National Gov!rnment, and the rest from the prefecture to which the family belonf,s. In approximately ten per cent of the cas:s, the cost is pa:d by the family. In such cases, 50 per cent of the total ccst may be covered by the medical care insurance if the family is connected with some insurance program. WHO AND UNICEF AID Sincere appreciation is due to WHO and UNICEF for their generous ass:stancc to our program. We owe WHO seven fellowships (general rehabilition practice. physical therapy, occupational therapy, orthcp:dic nursing, medical s~cial casework, speech therapy for the cerebral pa~sied chidren, and vocational rehabilitation which is now under preparation), and two consultants (general rehabilitation Dr. Marcia Hays, Occupational therapy-Miss Marian Davis). We owe UNICEF contribution of equipment and literature on rehabilitation to the value of $17,000.
.'""-
The National Rehabilitation Center for the
Physically Handicapped (Kokuritsu Shintaishogaisha Koseishido-Sho)
Founded and Operated by the Ministry of Health and Welfare
No.1, Toyama-cho, Shinjuku-ku. Tokyo, Japan Telephone (34) 8193. 8194
1.
Histor y:
Just before the enactm ent of the Law for Welfar e of the Pbysic ally Handic apped Person s (Law No. 283, Decem ber 26, 1949), the Nation al Rehabi litation Center for the Physica lly Handic apped was founde d in Octobe r, 1949, at Sagam ihara, Kauaga wa Prefec ture, within easy reach of Tokyo. In Septem ber, 1952, ccnstru ction of a new buildin g was started at the presen t location, and we moved in it in April. 1953. The constru ction was entire! y comple ted in Octobe r, 1954. The buildin g and our service s might be said as one of the represe ntative rehabil itation centers for the handic apped in the Far East.
2.
Specia l featur e of our Cente r:
In this Center , the most suitabl e job is selecte d for the r especti ve severel y handic apped person s after giving medical, psycho -social examin ation; orthop edic surgica l operati ons are performed, if necessa ry, to improve or to minimi ze their disabil ities, and fitting artificial limbs or braces are given. Furthe rmore, physica l therap y, occupa tional therapy and limbuse trainin g are practised. Besides vocational guidan ce coverin g from pre-vocational training to vocatio nal trainin g, the psycho -therap eutic advices and guidances for the culture and life-im provem ent are given to develop their psycho-"ocial adjusta bilities . Integra ted and special ized techniq ues for the rebabil itation of the handic apped are given system atically and simulta neously . and selectiv e placem ents are given co-oper ating with other social welfare agencie s.
Fig. 1
3.
Diagn ostic confer ence:
Prelim inary applications which have been sent from applica nts all over the country are investi gated by our staffs from medical and psycho-social points of view, and propriety of admiss ion and possibi lity of rehabil itation are determ ined. Those who are considered as suitabl e to enter the Center receive personal intervi ew and detaile d tests. For those admitted future rehabil itation programs are arrang ed based upon the findings of each specialized field. (Fig . 1)
4.
Orthop edic surgic al operat ion: 40-50 percent of aUf
cases showed extrem ely chronic and fixed disabil ities; some have _. I -
passed over 20-30 years after first suffering from their illnesses, and yet their malformations and disabilities were a kind of reduceab!e or improvable ones by surgical operation. At the initial stage of our activity. we estimated that about 30 percent of cases would need surgical operation to improve their disabilities; however, recently we are estimating 50 percent of our cas~s will need surgical operation, due to the fact that the untreated severely handicapped persons are concentrating in our Center.. For this purpose, we have an a ir-conditioned, and color-conditioned modern surgical room of 50 square feet wide.
Fig. 2 In the septum between t he surgical room and the preparatory room a large sized glass wall is inserted to supervise the proceedings of operation. In this septum, a sterilizer and a salt water heater are installed. (Fig . 2) Patients surgically treated spend the days of recuperation on their beds. and. so far as the condition of wounds permits, bed exercises. pulley exercises for their physical restoration and functional recovery. the occupational therapy such as hobbies and light duties. the vocational training such as radio assembling on their beds are recommended, which contribute to early recovery and, eventually. shorten their term of hospitalization . (Fig. 3) A patient who could not walk for 22 years before visiting the Center, is now able to wa lk with braces and a cane after having several surgical operations to remove joint-contructures of
Fig. 3
-
2 -
his legij. He can, at present, go to gymnas ium and to vocational training work-shop on bis feet to attend short time training from his ward. In near future, be will be able to return to t he dormitory to enjoy everyday life among his friends.
(Fig. 4) 5. Prosthetic service: Most of the amputees and severely disabled persons are necessary to use prosthetic appliances and/ or braces. The highly advanced prosthetic app liances such as plastic functional arms and artificial legs with suction sockets for above-theknee amputees are made in this Center under the supervision of a specialized physician in the field, ut ilizing modern techniques and rnaterial::s in this country and co-operating to facilitate their comeback to the active life in a community. These appliances are provided for both in- and outpatients and prescriptions for them are g iven by the physicians in charge. (Fig. 5)
Fig. 4
Fig. 6
6.
Occupational therapy: It seems difficult to start vocational training for the arm amputees and the arm disabled immediately after their admission to the Center; moreover, sometimes we even f eel it difficult to find out their aptitudes. Particularly, in the case of the cerebral palsied, it is extremely difficult. Most of the arm disabled and arm amputated are receiving occupational therapy in the meaning of pure medical treatment at the initial stage of 3 -
admission, to adapt their needs for daily living
and vocational training, to accustom to their artificial arms, to develop their compensational functions and then create their suitable work act ivit ies . A patient who had suffered progressive muscle atrophy on her upper and lower extremities, recently admitted, are now weaving bags with vinyl yarns on her wheel-chair. (Fig. 6) A patient with disorder of both arms due to the cerebral palsy is promoting the dexterity and softness of his hands by means of clay-craft. (Fig. 7) To enlarge the range of motion, to strengthen the muscle power, to develop the co-ordination and dexterity of both hands, and to motivate them, many kind s of works, such as yarn-knitting, handicraft, typewriting and wood craft are employed along with their hobbies. Fig. 6
-,
Fig. 7
7 _ Physical therapy: To keep the hi gher capacity in the stage of various training in the Center and to keep the larger vocational ability after returning to the community, various kinds of physical therapy are practised, more stressed in the early stage and less in the later stage, according to their grade of individual disabilities, and the development of com· pensational function, the improvement of general physical condition and skills are aimed.
-
4-
The amputees and disabled of lower extremities are practising to walk with parallel bars or cratches, up and down the stairs, furthermore, go round the sand soil or irregular terrain, slope and narrow ways. (Fig . 8)
Fig. 8
In gymnasium. various kinds of pendulum tables. parallel bars. stall bars, mattresses, tools of basket ball, volley ball, badminton and table tennis are provided. Wall is colorconditioned and 1I00r is white lined to facilitate the training. Patients with spastic paraplegia drive stational bicycles to r emove rigidity and spasticity of their legs and~to get co-ordination and better muscle power. (Fig. 9)
Fig.
9
-
5
Fig. 10
Progressive Tesistance exercises are p ractised employing pulleys, strings and weights to~increase
the power of stump muscles and proximal joints; and to master their ar tificial
arms in use. On the other hand. dividing the patients into several groups according to their disabilities, the rational remedial gymnastic is given to recover their disabilities and to make their physical conditions tough. (Fig. 10, 11)
Fig. 11
Various kinds of indoor-games interest patients; they provide good physical and psychological influences. For the leg amputees and leg disabled, badminton and table tennis games are effectual in their recovering of the quickness of motion, co-ordination of the nenTa-muscular system, skill in balancing, and give good result for the development of
6 -
the will. (Fig. 12)
Fig. 12
8.
Vocational training: If the ul timate goal of the r ehabilitation of the sever ely handicapped should be their
comeback to the self-supported active life, the necessity of the vocational training must be strongly emphasized. However, even in the case of normal persons, to learn and master some skill or other in a shorf term is by no means an easy task, and a life-long effort might be necessary to complete the acquiring of skill. This is much more so .in the case of the physically handicapped, and, furthermore, to select suitable jobs a nd to establish
-
Fig. 13
-
7
adequate motion-posture in their jobs are particlarly essential, and the quality of prosthetic appliances and technical aids deeply affect the working ability of an individual. Also, in the course of being engaged in a suitable job, their disabilities may be more improved in some cases. Dress-making. A girl who has lost her left arm from above the elbow (short stump) is now able to 3.
stitch, to make a button hole and a pocket skillfully with her functional above-the-elbow arm_ (Fig. 13) b. Handicraft. This girl, lost both her arms at wrist joints, is now handling a weaving machine with her plastic functional arms. In such case as this, it is of great importance that the socket should fit to the stump perfectly, and that the supination and pronation of the stump in the range of full motion should be transmitted to her prostbetic appliances. A terminal device is operated by the opposite shoulder by a control cable, and grasps objects voluntarily. (Fig. 14)
"
Fig. 14
c. l\limeograph. The mimeograph is a suitable job for the handicapped, particularly for bilateral leg amputees and paraplegics. (Fig. 15) In the case of a right hand amputee, the left hand can usually be made possible to do the work successfully.
-
8 -
• Fig. 16
d. Shoe repairing.
The shoe repairing is a suitable job for the leg disabled~ and it seems easier to get Borne money comparing with other jobs. A polio patient who was unable to walk when admitted to the Center, is now attending to this shop every day from his ward, employing a wheel-chair, setting plaster of paris to both his legs after having several surgical operations for th e deformity of his legs. (Fig. 16)
Fig. 16
e. Woodcraft. It is considered that the works of wood engraving, picture frame. makin g and bookend making with esthetic sense are suitable for the severely disabled . A patient who
-
9 -
was unable to walk due to the spinal cord operation when admitted (it seemed he had a trend of neurosis) is now learning to walk again with simple braces and cratches. and endeavoring in this job. Further improvement in his walking ability is expected at the day of his leaving the Center. (Fig. 17)
Fig. 17
Bicycle assembling. The assembling and repairing of bicycles seem suitable for the upper extremity amputee. The superiority of the modern functional arms is proved in this job. (Fig. 18) f.
Fig. 18
-
10 -
g. Radio assembling. The intellectuality of a physically handicapped per son and not the degr ee of his disahility seems to be the key to decide whether or not he should study the techniques of assembling and repairing a radio set. The inserted pbotograph shows rather an ex:cep. tional case; a man who lost both arms from above the elbow (only the useless short stumps are remaining) by an electrical accident when he was nine years old, is now able to fit together a radio set successfully, using both his feet and several kinds of self-help-devices. In this case, the functional arms can not show high efficiency. The seem ing ly incredible development of the compensational function shown in this exceptional case is nothing else but the result of his strenuous training for a long period and, in addition, his strong and unyielding spirit. (Fig. 19)
Fig.
19
9_
Cultural course and supplemental school education:
Among the severely handicapped there are many who had not an opportunity to receive regular school education due to their long illness or difficulties in going to school. To develop their intellectual faculties and to give them necessary qualification for becoming members of community, and to g ive them the fundamental knowledge requested in their future jobs. schooling is held in early morning or evening. A bilateral below-the-elbow amputee caused by a labor accident is now learning mode of daily living, a book-keeping and an abacus-counting and, furthermore. he is attending the evening school to learn an advanced book-keeping. In the near future, when he completes his evening school course, h e will receive a training in job in some factory till his graduation. (Fig. 20) In Fig. 21, a bilateral above-the-elbow amputee with useless stumps is making calculation holding a pencil in his mouth instead of his artificial arms in the class of supplemental course. (Fig 21)
-
11 -
Fig . 20
Fig. 21
10.
Psychological rehabilitation service:
Many physically handicapped persons are apt to fa ll in to social maladjustment as a result of the ir inferiority feelings, and feel f rustrations caused by their physical disab iliy. So, the case-fil e of guidance clinic is filled with cases in which only the medical treatment or employment can not solve their psychological ma ladjustment problems. We have been also laying, in consequence, particular stress on the psycholog ical rehabilitation service of our Center. Naturally, the physically ha ndi capped per sons suffer from maladj ustment problems in 12 -
all their respective ways, and we are trying our best to find out the most suitable way for them to adjust themselves through, for example, disciplined group life in our dormitory. and activities of several clubs and recreation groups. Especially for the patients of advanced maladjustment, psychologists adopt clinical treatment individually, holding counselling and employing various phycbo-therapeutic techniques. (Fig. 22)
Fig. 22
11.
Life in dormitory:
Besides 30 patients who are living now in the wards for their surgical operations, 120 persons are living in two dormitories. Those living in the wards will leave for the dormitory when they have -become able to enjoy everyday life with others after the completion of medical treatment and those who are expected to have surgical operation move in to the ward. The group life in the dormitory is disciplined but comfortable under the
Fig. 23
-
13 -
leadership of a supervisor; and they are enjoying one year term in bright hope. ' All living rooms are constructed in western style, one room is shared by 6 persons, equipped with the beds of different height and a central heating system. (Fig. 23) Meals are prepared in a modernized kitch en. A bilateral above-the-elbow amputee has recently accustomed to take his meals wit h artificial above-the-elbow arm . (Fig. 24)
Fig.
24
Our Center, receiving many of the severely disabled, is equipped with specially designed'" accommodations though in the minimum demand. FerroMconcrete building with a central heating system is free from danger of fire. As a building for the cripples the one storied is desirable, but, in the case of the several storied like ours, handrails of stairs and elevators are absolutely necessary. Hand wash basins need leggy supports (Fig. 25), as the
Fig. 25
-
14 -
disabled of lower extremity has to put their weight on them. The structure of a bathtub for the disabled needs a special design, particularly for bilateral leg amputees and paraplegics: we designed to attach the slope with hand rails sliding down into tbe big shallow pool to sit. Deep tub is inconvenient for the leg disabled and leg amputees so that it should be made shallow . Persons with healthy legs and unilateral leg amputees use the ordinary, deeper tub. (Fig. 26)
Fig. 26
I The door of a lavatory is widened or substituted with a curtain for the wheel-chair users . The western and Japanese styled stools attached with hand rails are equipped for leg disabled and the space is widened sufficiently around a stool for the hip:or knee ankyloses. (Fig. 27)
,
~
Fig. 27
-
15-
12.
Organization: - General Affairs Section - Psycho-social Guidance Section
Director- Vice-Director- -Medic~l Affairs I SectIOn - Vocational Guidance Section - Prosthetic Service Section
13. Arrangement: -Second
's~
E 0
i7
floor
II 11'1
2
~
~4151 ~ 6
CD - @. @ Bed Room (!) Lavatory @ Dormitory-Supervisor Room
q
- First floor
1 ·13 0051 ~~I 2
CD- @. @ Bed Room Gl Lavatory ® Library
I
'~~ - First floor
U II 8
2
1 3141 J116171 3141s1~6111 6
8
g .)
i' ®
(J) Laundry @ - @ Storage
® Bed Room Dormitory-Supervisor Room 4 Lavatory @ Laundry G - @ Bed Room
2
6
~'P-
(IJ- @. @ - @ Bed Room @ Lavatory @l Storage Laundry
7
I~ I~ I ~ ~ rl II La.vo.tory Roof
CD Assembly Room @ Office @ Storage ill Entertainment Hall Bathroom @ Dining-room (J) Kitchen @ Office @ Lavatory 1 Auditorium
Elevator
®
Pent House
Elevator Forth floor
8 13
5 9 t. • I
Duty Doctor Room II 3 . Night Night Duty Nurse Room Meal Service Room G- @ (2) -~
~
Ward
...
Elevotor Third floor 12
CD Storage (£) General Affairs Section 9 Chief, General Affairs Section Recepti on Room @ Vice-Director ® Director @ Conference Room ~
Occupational Therapy Room eaJ Service Room
•
Eleva.toT Second floor
CD . . . . ® 8 16 9
Vocational Training Room
Elevotor
~ 1 13 1141 First floor
'loA
I +- Lavatory
I
212 II 10 9
8
® ® Gl
Q) Gymnas;um Zandare Gymnasium Lavatory Storage
u Z '
6 5 4 3
Pre-operation Room X-Ray Room ( Physical Therapy Room .. Doctor's Office 2 I [) Treatment Room @ Consultation Section Pharmacy Doctor's Office 9 General Affairs Section Chief Guidance Room @ Guidance Section @ Vocational Adjustment Section @ - @ Meeting Room
~
j
Q) Machinery Room ® Wood Work Room @ Painting Room Gl Plating Room
Ground floor
2· Artific;al LUnb Sbop
® Lockers
7 Basement
~ ii5 12
$
Pump Storage Elevator Barber's Night Duty Officer Room Staff Dining-Room Boiler Room Boilerman's room Bathroom Lavatory @ Transformer Room @ Storage
00
-
~7 -
&.
: ... }
, I
~
The i'reat.ment. Result.s during tt.e Last Three Years at
th~
National
I t
R13habilitation
Cent~r
for the Physically Handicapped in Tokyo
•
,
(From January, 1954 to December, 1956)
•
",..
.
, t Y8susada '!'akase
Dirdct.or of the National a~habilitation Cel~tar
in Tokyo
• , '.,
',.
..
~
. ....
......
'..
";-"
.~:
.~. t;: .' ,. . .... :
.~
'"'>.:,' .' ..,-:-,,~.,.:-:\ . ,'". ;~ .' . '.' . ,". '. ., '" ...... . , ':'
... !:r.:"'''''IJ-......__
.....
Staff-distribution in the National Rehabilitation ~enter for the Physically Handicapped. Director: (July, 1957)
Mr. Yasusada Takase (Psychologist) Dr. Masatora Hiyeda (Orthopedic Surgeon)
Vice-Director:
General Affairs Section: Chi;)!, II:r. Masuta 'i'arao (Secretary) 7, Secrataries 3, ~~cretary Aids 1, i';utritionist 17, Talephon-operators, Drivers, Coo:.ers
- ., a:l~ .,;~h,;=
• .{~
Psycho-social Guidanc;) Section: Chief, Mr. Hiroshi Ito (Social Case-worker:
4, Social Case-work",rs 2, tiupervisors in Dormitory (Soci.al Case-worker!;) 2, Psychologists 1, Secretary Aid 2, Nurse Aid!: in Dor,l.itory Medical Affairs Section: Chief, Dr. Hiron Wacia (Orthopodic S;'l'r&f:"'~"
, " ,
2, Orthopedic Surgaons 1, PhaI'l:lSceutist 6, Nurses 4, Physical Therapist,s (2, Gymnast:l, :2 ~;a:::flvuro} 1, Physical The~apy Aid 2, Occupational Therapists (1, Psychologist, l? Social Case-wor:~<)r) 1, Occupational 'therapy Aid Vocational Guidance S<lc1:.ion: Chief, Mr •. Fukuji Kinukawa (Vocat:!.onal C"W18~ ~
1, 7, 1, 1,
Psychologist Vocational Instructors' Secretary Secretsry Aid Chj~fi
, li..:lchinists &ll~ r
Prosthetic Service Section: Chief, Dr. Masatora Hiyeda (Concurrontly 2, 1, 2, 6, 12, Engineers Secretary Sqcretary Aids LiJlJb fitters Leather-;vorkers,
j
\~ood-workers,
The Treatment Results during the Last Three Years at the National Rehabilitation Center for the Physically Handicapped in Tokyo. January 1954 to December 1956) 1.
(From
Outline of the National Rehabilitation Center for the Physically
Just Before the enactment of the Law for Welfare of the Physically Handicapped Persons (Law No. 283, December 26, 1949), The National Rehabilitation Center for the Physically Handicapped was founded in October, 1949, at Sagamihara,. Kanagawa Prefecture, within easy reach of TokyO. 1952, construction of In September,
a new
building was started at the present location, The construction was entirely completed ~ervices
and we moved in it in April, 1953. in October, 1954.
The building .and our
might be said as one of
the representative rehabilitation centers for the handicapped in the Far East. In this Center, the most suitable job is selected for the respective severely handicapped persons after giving medical, psycho-social examinations;. orthopedic surgical operations are performed, if necessary, to imprcve or to minimize their disabilities, and fitting artificial limbs or braces are
"'-. given. Furthermore, physical therapy, occupational therapy and limb use Besides vocational guidance covering from pretraining are practised.
vocational training to vocational training, the psycho-therapeutic advices and guidances for the culture and life-improvement are given to develop their psycho-SOCial adjustabilities. Integrated and specialized techniques
for the rehabilitation of the handicapped are given systematically and simultaneously, and selective placements are given co-operating with other social welfare agencies.
-1-
2.
Selection for Admission:
Though, up to the present, 38 nhabilitation centers have been established ,by prefectural governments, we have as yet only one national rehabilitation '."'
.
center; the
applica~,ion5
for admission to this Center are sent in through Th", nwnber of the applications
welfare offices allover the country. -i: .
, accepted during the last 3 years and the respective number of the persons admitted and noL admitted are shown in Table 1. The selection for admission
is difficult, because various conditions, such as the capacity of the dormitory (male 78, female 48), the applicanLs' ability of going upstairs in the dormitory, the applicants' need of orthopedic surgery, the capacity of the jobs desired by the applicants, and so on, mUSL be taken into , consid9ration. The applicants who are hardly expected to acquire any vocaLional skill on account of his inferior intelligence or not adjustable to Eroup life in the dormitory on account of his extremely eccentric character, are screened. In Some OCCasion Where the applicnnts! disabilities are slight, they are
-,"
recommended Lu go to sum" other
in~titutions.
The disabh,d needing several 8S
kinds of rehabilitation services are considered for our Center.
the most qualified clients
Table I.
Number of the Persons Ac1mitt,ed 3ml Not Admitted
Total Nwnber of Applications Accepted Nwnber of the Admitted Number of Applications und"r Con51d3r3ti~L Number of Admissions Postponed Number or the Not Admitted
528 251
il7 9 151
". '
-
2 --
3. Age of Clients:
The age of clients to be admitted rrrust be principally above 18 years old. The average age of the clients is 22.0 years old (male 22.1, female 21.9)' as shown in Table III.
t""'" ., l..... _"
r
...~.;;,...
Table III. Age Total
Classification of the Total Cases by Age and Sex No. oi' Cases Male Female
t. ~"
I
15 21 26 31 36
-
20 25 30 35
299 143 92 38 22 4
175 89 51 19 12 4
124 54 41 19 10
Charges:
The clients are required to pay the charges for board (1,860 Yen per mont:hJ,.:;t; but those who can not pay are free of charge applying the Daily Life L~vr, 0eCUr.LI~
where ~'e cli'l'nts have settlements. receiving public assistance, 6 ',. "
--.--.....--
by getting certifications of the headman of the city, Before 1952, 38
% of
the clients was
% was 'lEe:
free only of the charges for board,
7 % was receiving other supports
49 % was at their own expence, but,
since 1953, the ntunter of the clients at their ovm expence have been ing, as se-3n in Table IV.
--- ..,.,-- Table IV. Charges for Board Total At Clients' Own Expence Receiving PubliC Assistance Free only of Charges for Board Receiving Other Supports
299 206 70 8
15
100 % 69 23 3 5
-3-
Type, Cause and Grade of Dis8bility: " Table V shows the type of diseases of the clients during the last 3 years.
Table V.
Classification of Dis0ases by Sex Total Male
·
.~-
,-"
,
/',
Type of Diseases Total Amputation PoliolJyelitis Cerebral Palsy Bone and Joint Tuberculosis Pyog'"nic osteomyelitis and Arthritis Congenital Deformity Burns Chronic Rhewnatoid ArtLritis Adhesive Spinal Meningitis Congenital Hip-joint Dislocation Arthrogryposis Progressive Muscle Atrophy Osteogenesis Imperfecta Deform-"ealed Fracture Spinal-cord Injury Bra in Darr,a ge Ostitis Fibulosa Endocrinopathic Bone Malformation Congenital Club Foot - Inherited Functional Disorder Obscurity
299 63 78 52
175 47 44 21
Fem31e 124
16 34 31 11
26 23 8 8 9
15 17 7 4 5 2 1
6 1
5 6 4
4 4 3 5 1
3 1 2
4 2 ~
3
,',
1 1
1 1 1 1
1 1
-'
'
1 1 2 1 2
2 2 "
,:
Of the total ca3es, 234 or 78 Were by trauma.
% were causad by disease, While 65 or 22 %
Most of the ampute>tion cases were cau3,"d by :,rawna, 46 %
by traffic accident, 33 % by l3bour accident, and very few by war-injury,
as shown in Table VI.
Table VI.
Sause oi' Amputation
r- -
.'
,',
Total By TraWTl3 Traffic Accident Labour Accident Incidental Accidclnt War Injury
63 55 25 18 10 2
-Jt.---
By Disease Tuberculosis Malignant Tumor pyogenic Arthritis Spontane Gangrene Raynaud l s Disease
8
3 2 1 1 1
Table VII shows the distribution of the disabilities and diseases of the, total cases, of which 26 the lower extre~ity.
% suffers
on the upper extremity, While 52
% on
",
Table VII.
Classification of Disabilities
-
,
•
T e of Disabilities Total R.ll .E. L.U.E. Two U .E. R.L.E. L.L.E. Two L.E. One U.E. & L.E. Two U .E. & One L.E. Two L.E. & One U.E. Two U.E. & L.E. Spine Spine & One L.E. Spine & Two L.E.
Total 299 30 19 20 25 32 91 21
Am ut3tion 63 20
Polio 78
5 5 2
6 12 3
5 13 3 1
9 10
33 2
3 10
39 2 "-
6 6
5 "
,'lonG & Joint C.P. T.B. Others 2 80 52 2 3 2 6 2 4 2 6 5 2 6 9 1 14 30 11 5 3 1 2 16 17 2 5 2
Note: U.E. , Upper Extremity; L.E. , Lower Extremity
The grade of disabilities is classified into 7 in accordance with the a"~acn
I
, j
list of the Law for Welfare of Physically Handicapped Persons.
Table VIn
,I
Shows the frequency distribution of the total cases by the grade of disabilities, and, of the total cases, 46 86
% is
above the 2nd grade inclusive" "
% is above the 4th grade inclusive. Therefore, we might say that our . The reason
Center has be8n receiving many cases of the severely disabled.
is considered to be that, since the prefectural rehabilitation centers had, ' been set up, the more severely disabled persons have been concentrating in our Center.
-5-
Table VIII.
Classification of the Grade of Disabilities II III IV V VI VII 69 66 54 30 10 2 2322181031 Total
68 23
I
299 100
tI
5. . :" ., ';
Medical Treatment:
- ..
:
.=- .,
... There are many cases of which the fixed deformities or disabilities are able to be improved vocationally
.. II II ~
II
by medical
tr0at~nt.
Table
IX shows the
:.'
.,,~t:. .., "
kind of the necessity of
m~dical treat~nt
of th3 total casas; of which
...
.:~ ". ,'" ,
:.
56.5 %is
possible to improve disabilities by surgicsl opGra~ions, and if
included the cases of prostheses and braces, 70 disabilities.
80%
is possible to improve
.. ;,
.
It must be noted that the possibilities of improvemeFlt after
x:eceiving medical treatment are ,)3 those of: cerebral flSlsi'.'ld.
% in polio cases, While only 29 %in
: J
; I , . }i~dica1
I
... ,
Table , ,
IX. Necessity of
Treatment Marucal Treatment Necessary Unnecessary 169 130 18 45
'",.. , , 'j
';~'" ,,,'.~, -'~'
TYpe of Diseases Tota1. Amputation Poliomyeljtis Cerebral Palsy Bone and Joint others
Total
~~ .. .'
.,
'
299 63
.~"
r .B.
78 52
7'3
15 28
5 37 1.6 27
44
62
35
Kedical treatment was perforlOOd in 93 cases in 1954, 113 in 1955 and 167 in 1956. The outstanding rest.:lt of mcdical i;reat.ment has bdcn making it possib1.e .• \
for the disabled of the lower extremities to walk, Who Could not When admitted. Of 52 case.:) 47 wore ab10 to walk When leavins thr, Center.
·Of these CSses:
'.
to',
(1.) 6 walking with brace:> and on.;! cane, after wnd-argoing surgical operation;
27 with braces and 2 crutches, after surgical operation; 1 with braces and ,~;,'
',:'
,
::
one cane, after surgical operatio~.
(34 cases)
(2) By means of surgical operation to release the braces, 2 became able to walk without a cane; one with CrutC'10S. (J cases)
(3) By mBans of braces without surgical operation, 2 became able to walk ~th
crutches; one with a crutCh; and one with a cane and a crutch.
(4) One became able to walk without any support after neurosis treatment; one with crutches. (2 cases) or braces. (,) 4 bilateral above the. knee a!"lputees 'became able to walk with prostheses.' There are still 5 cases now recoiving medical treatment in the ward; they will become able to walk in very near future. TGble X and XI show the type These did not need either any surgical
and frequency of surgical operationS to minimize disadvantage and reconstruct, th'e physiques. As for the frequenCies, arthrodesis and arthorisis are the
t-,ighest in number and surgical eliminations of contructures of the knee and hip f",llowing. Osteotomy for. the correction of the lower extremity is
frequently performed. The shoulder i\,,;1on 1;0
make it posuiblo to [oQlse t.h" p.ou·alyscd upper cldv;:~ntQ.;i8ouS
by hi.;; own iuusclc power of tho 3capu18., ,,[hich is b0ing p;JrfOn~lcd in r.:.-:cent CG.SO,~·.
vocationally, i.s·
_"_,,t~,~
Practice of' arthrodesis and tenoplasty for
the opposition of the thUTD.b inr;rca::;e in future.
Table X. Type of Surgical Operntions Dpe of Operations Arthrodesis or hrthororisis of Foot Surgical Elimination of Contructure of the Knee Surgical Elimination of Contructure of tha Hip Skin Grafting Subtrochanteric Osteotomy Neurotomy Extraction of Intramedullary Pin Lengthning of hchilles Tendon Shoulder-fusion or Capsulorrhaphy Tenoplasty Scratching out the Granulation Arthrodesis of the Wrist
Nos.
72 47 36
35 26 17 15 14 13 9 8
7
-7-
.J.'.'- .
~'~;;'-'-;.~~--::;;-~~~~~;"-;::~~ ~'7?;~t·~~~~,
--
''';-.
'<'"'"
......
' -
Arthroplasty of the Knee Repairing of ehe Stwnp Tenoeomy Amputation Osteosynthesis or Bone Grilfting Arthroplasty of the Hip Wire Truction Scar Resection Sequestomy Osteotomy Shelf-pl,,-sty Fasci2 Pr;;paration for Artl-:ropl:lsty Arthroplasty of tr:6 Elbow Enucliation of th"3 Carpel 30n8 Partial Tenotomy of th0 ~~edio-gluteal t'luscle Phalangeal Fusion or 18noplnsty for Onposition of ':'humb Arthrodesis of the Hip others Total
6 6
6 5 4
~I
" /
5 4 4 4 4 3 2 2 2 1 1 II
"
" ..~
373
Table XI shows the frequency of surgical op8rations.
Or. the average, the
operations are performed 2.2 times per perSO!1, 7 times at the most.
Table XI. Frequency 1 2
Freq'Jency of 3urgical Operat.ions (373 cases wi~h l5? persons)
Persons
4il 1.,2
3 4 5 6 7 Total
26 19 10
6 1
152
6.
ProsthetIc Services:
According to the report of William h. Tosberg, Tecr.nical Director of
Prosthetic SerVice, Institut.e of' Physical t':edicin8 and :iehabilitation, NeW York University-Bell~vuo
lIiledical Center, who had accepted our off8r
of the position as an instructor for the trainin[ 3chool on the suction socket above-the-knee prosthesis in Japan, the development of prosthesis
-
15-
~ ~,-,:; ":~·~··-:::~;:,~~~*~?~~~~~*~:~~;::~:::·;:.*t.?~~~t~~~-t~~ ~i:'>:"~~~; ."~ "S;7.\t:::~t.~-; ;"'~~Y*A".~ "<',
;".
."-~
Braces and Others Repairing
170
115 186 yen)
11313 1813 yen) (127,162 yen)
(271,457 -~~,
"l~
(176,542
.
~~-;:-:'"
~~
7.
Result of ths: Training for
FUllC~,
lcD21 :=tecovery:
...
However excellent the surgical operation 3nd prosthesis m:ight be, if the ,training for functional reccver:]' or in u:.::"i.ng prosthesis "is neglected, the ,"xpectcc result can not be attainllO succco"fully. Therefore, programme of --/
physical therapy, exercise and occupational therapy as well as vocational training must be arrang'cd adaq"ately For each individual. 50 meter running, high jwnping~
The records of ~iumping,
wid0 jW!lpirlg, cont,inuous one leg
soft ball ohrowinE:, repeating stretch :md flexion exercise of thF elbow i
in hangin8 positicn and stretch and flexion QX8rci3e of the elboW at "Ghe
prone are checked and evaluated regularly. .,
,
Table XIII shovrs the effect disability.
0,'
exercises cl1lssified according to th
Table XIII. Result Better Same Worse
j(G5Ult
of Exercises
Amputee 70 % 10 20
Polio
71,% 7 22
at1d~.1'
.
~
'~.
8.
Vocational Trait1ing:
-~:.(:
.-
The main purpose of th3 rchabilitOition has been laid on the comeback of the disabled to the self-supported vocational life.
".
Table XIV shows distribution of the total C·3ses according to the type of vocational training. Of the types oJ' vocalional lr:;ining, bicycle assemblWGS
ing was stopped in 1955 and oratch repairing
started in the end of 1956.
-
10 -
in Jopan is some 20 years behind that of Europe and the United states.
<', 'ij/'"
Our Center, however, has So adopted modem American techniques in limb
\ "\
fitting, employing wood for legs and plastic for anus, that we to the level of the prosthesis d"velop.:Bnt in the United States Within two yea.rs. Table XII shows the number of cases and the type of prostheses issued the past three yQars. Modern prosthesis such as functional anus, suction th'~Et
~"",-,
socket above-the- knee legs and soft socket below-the-knee legs are being made in our Center. Our prosthetic services are not limited only for the The mobile prosthetic services
admitted clierlcs but for tho out-patients.
are cor;ducted by our Vice-Director, who visited Okinawa in compliance With thE> request of the JiYUkyu Government in 1955 and 1956, 40 days respectiveJ.,y,: . in order. to provide Okinawan amputees with prostheses. prov:.Ded ir: 1955 and liS (besides 48 repaired) in 1956. accepted by Okinawan amputees with deepest E.::JDreciations.
.
<
131 prostheses were" Our services were
Tabl; XII.
Total Nwnber of Prostheses Manufcctured
"Preparatory training" is for the clients of pre-vocational training
Table XIV.
Distribution of Total Cases according to Type of Vocational. Trainin8
Total TailOring, Dress-making Tailoring Dress-making Handicraft Mimeography _Radio Assembling Shoe Repairing Woodcraft Bicycle Assembling Watch Repairing Preparatory Training
299 10 42
25
37 30 12
46 51 7 3 36
Of the amputees, below-the-knee amputees can go through any kind of Wi thout much difficulties.
Above-the-knee amput"es can also be trained
effectively in most jobs except the ones requiring frequent change of posture from squatting to standing position. Of the cases of upper e:x:r.l~~~J
amputations, unilateral below-the-elbow amputees can be engaged in the as nonnal people except few special ones. Bilateral below-the-elbow am.pu.te~
can be trained in daily living activities without serious dif.fi(!ulties, they can be engaged in knitting, book-keeping and non-precision works,·
...
---
of our graduates who bad lost his (lrms at the side of below the elbow has' passed the Jrc grade abacus eXBnination, and has been employed in ment business. Unilateral above-the-elbow amput88s, if sLitablc
arms or work arms for each individual's physical condition and job given, can be successfully trained in farm~1g,
radio-assembling, As for the bilateral
tailoring, dre9s-making, handicraft, and so on.
the-elbow amputees, training can be carried out most efficiently if the circumstance and job in which he will be placed in are determined in We had J cases of bilateral above-the-elbow amputees who mastered the -11adlva~,
technique to assemble radio sets Viith their artificial arms and their own
-.
I toes.
However, ttay need time 2
cO
3 times as much as che normal people
do to assemble radio sets, so that they are difficult to establish their own business imrneciiClt01y after leaving the Center. the sheltered workshops. mastered to USe a
They are now working in
rtllot;her bilateral above-the-elbow amputee has
LypewriLar of Japanese character with his artificial arms DOW
and his toes, and
is l,vorking at his formur firm.
9.
Employment:
~,~<
Among the problems of the rehabilitation of the disabled, the most difficult in Japan is that of employment. Table XV indicat0s the percentages of the Of the total ceses, h5
employment of trainees 3t discharge.
% is
employed
by others, 15 % s81f e;n;oloyed and 8 % sent to other vocational training centers or sheltered \'iorkshops. Though this low percenta;;o is of course
due to tha severe phy-~dcal handicaps of ou!' client3, people of our society are generally noc so onthusi3stic tc employ the disllb12d. out two reasons: 3conomical and psycholo",ic31. They would point
They consider, on the one
hand, tllat it ~night b8 "..1nprc;l'it.able to '~mploy the disabled and, cn the other, i t might be difficult to treat them, for they must be psychologically
eccentric:
Gepres3iv~,
nervous, prejudiced, and so on.
Table XV.
Knployment Status Nwnb<3r 228
Total Employed by Others Sent to Other Facilities Self-Employed . Returned Home
.
% 100
103 18
45 8 15
35 72
......
32
- 1·2 ',;-
10.
PSychological Problem:
Then, does the disabled as a whole have
so disgusting a personality?
Let
us see, at first, the Table XVI which indicates the distribution of int~lligence
of our clients.
Though it seems to show somewhat lower intelligence, larger percentages are indicated in higher intelligence level than the General standard; so
.., i
we can not and must not consider that the disabled as a whole have inferiority of intelligence.
Table XVI.
Distribution of Intelligence Number
% 100.0 2.0
Total Excellent Intelligence High Intelligence Average (High) Intelligence Average Intelligence Average (Lovl) Intelligence Low Intelligence Inferior Intelligence
296 6
Standard 100.0
%
27 4$
101
9.1 16.2 34.1 23.2
0.6 6.1 24.2 38.2
69 28
17
9.5 5.7
24.2 6.1
0.6
Note: 3 bilateral arm amputees were not tested.
The disabled are generally ocnsidered to be introversive in character. However, when we examine Table XVII showing the distribution of introversioo qIotients tested by the standardized extroversion-introversion test, we can see that introversion cases not always outnumber extroversion cases among the disabled. Far from that, We find much more extroversion cases among (This fact is considered not to be relate4
the disabled caused by injury.
to his disability, but to his extroversive character Which is apt to cause a careless injury.)
-1; -
rr"- . '" Table XVII. Introversion -59 60-70-80-90-Extroversion 100-1l0-120-130" .Q.
I~JP_·:.·
"
,
';";.
;~ ,
<
Distribution of 1n- and 9.:troversion Quotient, (V .Q.)
Total 133 10 11 25 36 51 166
,
44,1; 3.3 3.7
%
b;i Disease
~%2
B;t
TraUG1Et
~%2
8.3 12.0 17.1 55.6 18.4 14.4 13.0
l,.7.2 4.2 3.3 8.8 13.0 17.9
33.3 0
5.0 6.7 8.3 13.3 66.7 20.0 15.0 15.0 10.0 6.7 100.0
Standard (%) 51.0 5.2 5.3 9.l,. 12.4 18.4 49.0 17.2
, ,
-. :. .
55 43 39
13 16 299
4.3 5.5 100.0
140Total
52.8 17.9 14.4 12.6 2.9 5.0 100.0
\..:;...
15.3
8.5 4.7 3.3 100.0
Indeed, many of the disabled may be subjected to social maladjustment, and its underlying psycholPgical reasons Dr8 Lhe frustration reflected from the social devaluation and th8 insecurity feeling that they would not be accepted by the society. The disabled apt to t3ke 30me
irrational and temporal
adjustment mectanism such as escape or agL;ression in order to protect his self-estimation and unravel his emotional cov.,plexes lying deep in his mind, and expose several ma13djust,ed behaviors or atticucies. This adjustment c~aracteristic
mechanism seemS tc Gffiphasize his inborn disposition and· expose tendencies which would not be GO
dominant
WlleSS
he would not be disabled.
It seems 'Chat this mental mechnism is net special 3tatus only for the disabled but the same) as general popu12Lion. Of cc;urse, it goes without saying
that the most important factors for thc psychological rehabilitation are the mot'.vation of rehabilitation of the disabled, and the acceptance of their own disabilities, and the results of our investigation also affirm Joseph Levi's opinion ')3sed upon LhG Horschach TGst that the disabled who "
,',
\
have many anatomical responses (Anatov.,y Respunse Fattem) are difficult to
accept their disabilitie3 and Lhos.;) v,'ho have many F responses and aggressive anilnals responses (Neurotic Pattern) are campa ratively eBsy to go through
-1
~-
psychological rehabilitation.
We al~ endeavoring to rehabilitate the
psychological condition of clients by means of several club activities in the dormitory group life, and, for the clients who have somewhat advanced maladjustment, psychologists apply counseling and other psychotherapeutic techniques, to have become able to adjust themselves successfully to their, social lives,
11.
Acceptance of the Society:
As mentioned above, t-he liability t-o mental maladjustment of the disabled is not due to their disabilities but to the projection of insecurities, and. frustrations that they would not b8 accepted by the society., As you see in the Above data, the rehabilitation sCll'vices up to, date are considered as comprehensive allied sciences and can get sUGcessful result only by ,,,,,,,t,"n,!lj,, and integrated teamwork of 3cveral prefession.::ls and, above all, the people in the society are the most important fact-ors to put a honQrable period to " this rehabilitation activities, If thG people of the society do not. understand the handicapped persons
thc,roughly and accept them wannly and heartedly, the ultiIna te and complete social rehabilitation can not but cl.d in failure, even though all available. knowl"dges, techniques and endeavors of all needed specialists are able to be mobilized and a successful rehabilitation works is achieved in the Then it should be our last work to empha siza anci to bring to the of people of the society that tha di3~bled
is not necessarily to bc
as the disabled on the job despite the disability of the body, when the 'ibled are treated adequat"ly and traiI1ed prop"rly and pla ced suitably.
OUTLINES CF CRQlNlZATION AND BU>INESS IN DlVlSION <F HElLTH & WEIFARE STATISTICS ~.
"r 2_- .:-
""'" ~ ......
1mIISmy OF HIlLTH & WEIl'lR!, JAPANESE GOVERNMENT
lllgUst, 1957
, /
.~
&2,
1.
Central Government The health statistics in Japan has rested upon a firm basis
since the time when the Section of Health Statistics was established in the </r ~!inistry
of Health and Welfare in August, 1947.
The extent of business in the Section was rapid4r expanded in
>.,"
September, 1947, because the business of vital statistics was transterred to the Ministry from the Statistics Bureau of Fr:ime Minister's Office, with a view to making the most of the statistics for public health activities, and the business came under the jurisdiction of the Section of Health Statistics. The Section of Health Statistics was promoted to the Division of Health Statistics in August, 1948. The Division came to include
three sections, nsmeq, Section of General AffairS and Field Staff, Section of Anaqsis and Records and Section of Tabulation, Then, according to emctment of the Establishment Law of Ministry of Health and Welfare in June, 191:.9, the Division was pertained
to Minister's Secretariate and was renamed the Division and Welfare statistics.
or Health
Since then, the Division has been re~s
sponsible generally for statistics and health and welfare'administration.
in the field of
Among three eectiOZUl in the Division, the Section of C-eneral
Affairs and Field Staff takes charge of llaieon, co-ord1!lation, management of general affairs, guidance and control of statistics and surveys concerning the health and wlfare adm1nistration.
- 1 -
;:
-1'he SeQt1cin of ~~81s ~ana~Sis,
aJi.d -Re~j,
taliBs
preparation of Gharts and so forth of the statistics and And the Section of TabuJ.B.tion is in Gharge_
surveys of the same sort. of tabulation of them.
As of April 1" 1957, ceiling number of peraonnel in the D:I:v:i.slon was 718" Total. amount of budget for the Dlvisl.on in the fiscal year
of J956 was approxilnatel;y 356 million yen inc.l.udlng pe1'8!lJInel expend:itu1:'e and other~.
'Ihs
~mount
o(lcupied 0.4 per .;lent of the gener-_ Of' the tooal
a1 budget for thE> whol'; Hl.nistry of Heal:i",h and W",lfare.
3'56 mill:ion yen. 63 per cent, that is, 225 million yen was the budget
In order to ca;rry on b'll.Jinesi! of vital statistics IIIDOOtlll,y. adm:1.niilt:rahve. offit'ials of Legal Affai'f'i! Bureau and Distriot Legal Affai~s
Bureaus are app;:>int.ed
addHiona~
as administrative officials
of Minist:ry of Health and W'1'lt'arE'.
They nu.nber 296 in total and are
in ,barge of gl41.dance of those wIlo are ..nga.~d in preparat.ion -of
•
"ital statistics achedules
i-Tl
oitJ",
-tOW'll.
and '11'i11age offices.
In addition to ·'1.e organl>mentJ.oned abo·va, v:.here iEi established ti.e Health and WelfarE> Statistics Councn ail one ')f auxiliary organs to the Ministry accorCl.~<lg
~.:
to
prG\I'i~ionol
of ,- ,8 E,rtAbllshment Law a.:r'e
of Ministry of Health and Welfare.
Functions of the Cctaicil
to make research and deliberation, in response t.o the request of the Minister on :import3.nt matters ooncerning health and welfare statistics. The Council consists of committee and expert members.
Members of the Council are appointed by the Minister from among the personnel of government agencies concerned and persons of learning - 2 _
~
·~0"T,"',..o:--~':.,::-'!'~''i.-z:;~---•. <_t.'..~ ~-;tl,~~~' ':·~·:';-;."'~m 4:~
':'8lillf"~Oer'i$]lce.
~
C_cil MBa.series of-six. sub-oommittees
oalled panels as follows;' Panel on Vital Statistios Panel on Medioal Affairs Statistios Panel on Ptibl:!c Health Sta'tistios tf.~:~
{"~
Panel on Statistical Clsssification of Diseases, InjUl'ies and Causes of Death Panel on Sooial Welfare Statistics Panel on Sampling Technique. They are oontributing to the improvement of health and wlfare statistios in Japan by making suggestions. 2. Local Government ~
r l ~-
~
.-
kinds of useful and valuable
The business of health and wlfare statistios on iocal lewl are carried out genera~ by the division or the bureau oonoemed with health and welfare administrations in prefeotural governments and in offices of designated cities. Health oenters and wlfare
centers discharge their functions also in the field of statistics as local organs in the first line of health and wlfare administrations. On
some oocasions of special surveys, a number of
enumerators are appointed by prefeotural governors, i f needed. They are engaged in field works of these, surveys usually under the supervision of chiefs in health centers. \
The deSignated
statistios or other kinds of statistical surveys in the health and wlfare fields are carried out al1d conducted by the Mmistry of Health and Welfare in cooperation with prefectural governments,
•
~ M~ __
_ _ _ _ _ _ _ _ _ _ _ _ _ _- - - -_ _
-_3_'_~_'_______________________
health centers, wl.t'a.re oenters and
80
forth.
N~turalJ.y,
or statistical surveys of such a sort are much infl~nced bw ability of each organ on local level mentioned above •. Everyt1me, for this reason, much attention is being paid by the Division to strengthen the ability of those organs on local level. One of the most important
meaSUl'es for such strengthening is .found in the promotion and the :Improvement of their personnel. staff~m~bers
For this purpose, at present, 322
are placed in divisions or bureaus concerned With health
, administration and 51 staff-members are also placed in divisions or bureaus concerned with welfare administrations in prefectural governments and designa,,,d city offices throughout Japan. Those staff-
members are all asaigned by the national govermnent to be engaged in the business of concerned statistics:f'ulJ.y. At the same time$ in health
centers. there are placed employees subsidized bw national fund. Moreover, the statistical workers of City, town and village 0:f'f1.C&s wo are engaged in the business of vital statist~cs
are granted with local , I J
equalization subsidies of' the nat:;::mal governm,-'r<t.
. -,~
..
~
'~~;.
- 4-.
"'''-'~ ~
· .. '.
1. 'Current Business Most parts of the business 'in the Division of Health and Welfare Statistios are ooncerned with the business oonce1'll1ng periodicalstatistios. 80IIIe
In addition
to the business of this sort,
parts of it are oocupied by the business regarding research,
-:! ~.
planning, tabulation and analysis
~r
the statistics or the surveys
which. are conducted by the Division and other sections in the
MiniStry. ll.
The business -of latter kind is going on an inorease The Division always takes charge of giving advioes
:recently.
and oooperations actively even to other seotions in the Ministry in relation to matters of statistical fields. Ths DivisiOn ex-
,
ecutes this. charge of giving advices and cooperations mainJ;r through the evaluation, of the plans ooncerning statistios made by these sections. ,
The stress of the
~-luation
is laid upon the
points of keeping accuracy, avoiding dUplication, reserving effiCisney and securing expenditures, ete. In principle, ordinary procedures in statistical surveys or reports are to distribute schedules or report foms to field organs through local agenoies according to the f:iJcBd instructions and ~',
to collect the schedules or report f~ fillAld up agaiSl
,
through local agencies. In the Division of Health and Welfare Btatistiee, there
us
applied two different kinds of tabulating methods; one is manual tabulation and the other is meahanical tabulation. lither sf two
- 551
me+llods br both of them a\'6 ~pp1l9d'by characteristios of
-
PrMedtll'es of tab-Lil.ation and ta.bula;iitng equipment.. used in t-abUlat'LOll G~ner<l:C 3"8
,
ai:>
follow~.
pl'o<leduree in tabulation, PrOilEtC1U;.diSln
eLl
manual
tXlbliJal
ion
'''.'' SuL";:in1; ....~.
Calcula~ing
Totallcc;
(2)
Procedures iti meohanical tabu1a+;ion Recelpt, 0.1'
schedules
0('
report forms
Revie10ling of
Ca.lculattng _., Totaling t
~.~
PrE>paratiO!i of final
:.bles. 1'0>1
Tabulat.wg "g,u,1p1ienls
in use,
Aol+.rmatic Ke,\' 'pu',' cel3 ""'''.'.' Ajphabetic AutOJIliJ t,.l:' Key-punch Automatic Vet'.lfi<o.l' " ... Automatic Punching Int.expr8""'l' Reprodu(' ing _~,. ~y~plmche.3 ~ y Automat.l~ Ca (Counting SOL'cer6 Automatic Alphabetic Tablllators boo,' 0 "
73 1 1 1 ;>
'_' .. "
~.
pee. "
Automatic Tabulators , .. Automati,c SUlYC" .:'y PU!l'.:he 8
34 :3 :3 2
'l,'otal In addition tv the machines mentio!led "bove, +here ar", 20 micro-
film readers in the Diviilion. 2.
Specific Sorta of the Business.
1).
Preparation Qf Life Tables. The life tables which represent man;)'
aspects of lives of the
- 6 .;.
. age and mortality. statistics by age. plete hfe ldQle is thE' ba~Jil
The latest edition
or
com~·
The Ninth Life Table' the;r, is comput03o. on
of J9'JO"ndu8 !X'pul.&.i.lon and the vitaL stat:j.stics
du'.':lng the peri.)d fr)]!) O~t. 1, 1950 to Sap'_ 30, 1952,
Besides thL;> ed.ltion of complete Ufe table, anabt'idged life
published.
Injuries and Caull6s of Ded.,j;h I j
•
Regula'ti.otls Noo 1 of World Health OrganizaHon
"Nomeric12,i;ure
with Respect", to Diseases and Causes of Daa:th" and '"Manual of til", Int..e'l'1Jational Si;atls'tica1 Cla<lsUi·~t:!.,)!j
of'Dis""aBse, I!l)Ul'.les
ill th'" Gen...!'al AssemblS of WHO held in JuJ;y, 191.8,
The DividiM th8~la",sifi""
of Health and Welfare Statistios has been adopt.l.llg
cation based upon the WHO Regu1Jltions and Interna,h,onal List since 1950, and since then endeavoring the diffusion and the guidance of the classific,a:tioll. Recording ways of the death ,
certificate, selecting ways of causes of death and application of classification of diseases have been constantly directed and the clAssit'ication has been minutely Studied so far. At present,
the bUSiness concerning the revision of the classification which ~.'
'
will be put in force on and after January 1, 1958 is going on in
the Division.
- '7 -
3). --rhe Rules for Dealing of Statistical FOl'IIIlI :Ill Mhistry of Health
.
-
and Welfare (Ministrial Instructions No. 53, 1951)- has been adopted in order to avoid duplication of statistics and to :!JDprove statistics in the Ministry-through control of statistical forms as schedules or
report forms in surveys or reports. According to provisions of the Rules, the chief of each section or each division or each bureau has to consult v:!.th the chief
or
the
Division of Health and Welfare StatistiCS, whenever he is going to set or to revise any form concerning statistics. When accepted after con-
sultation, the sktistical forms are to be registered in the Division. The list of these statistical forms registered is published semiannually.
,
'~;. ,.... ~ ~ -.!..;;"'-~
.}).' ... ,0.";.7
... ~ . '-
- 8 .'-', .
,
.
CJAPri:R" m
OUTLlliES OF PERIODICAL STATI&tICS
1.
Vital Stoa.'tiilt:ws Vital StatlB'/'·i,,"s ill
~f . ~f 1:i """-"<
,~=d,ed
out in oroer
~o1.l
grasp
n~1'<l
of
vi"tal ewnt"Lu Japan. p~eso:ribed
The
<iY<ir.ent
of vital ataHs,\'.:iq, i,s main.l;y
in 'the Cabinst Orde1' Regarding Vital Stat:LsU<;" and t'O:l:'
i;;~ ',~
.
me Deta:tled Regulations
the Implament of the
om",>
Regal'ding
name~" birth, dea'tIl" stillcobirtho ma.r1.'1a.~ and divOl'OO ('totaled approximate~
4 millions in a
yeaI'
:I.u Japan) ar.. de<Jlaffld &:n~
registered in ui'ty, "town and village tlff:ices bytht! people a,,(ord:l.ug 1;0
provisions of' t;h" Koael!;:j. Law (Civil Regist,ration Law) and th", VitAl sta:tiatics'
R'3gula.tivns Regarding Declaration of Still-birth,
in Japan is derived fr.01ll vital statistios schedules prepared by th6 ·~iefs of cities.
towns and "l"illages as they rec9.ived +,hese de':llB",
ra'i;ions of vital events. Vital statistics is, in its first step, based upon a<>ti'ntJ."Ol of those workera Who are concerned with registration ne"t work spread wide~
throughout the !:lOUIltry.
In this sense .' vital statis-
tics can be said to be set up on an unique system as compared with has been other sorts of statistics. It~ov~ that vi'tal statistics ~n Japan is one of the mos't aoourate ones in the world. 2. National Health Survey The National Health Survey is oonducted for the purpose of obtaining -nvid information about health conditione of the people . in Japan through findings concerning ooourrenoe of diseases and - 9 -
~Uries For
andW8.7s·of • •
lII8d1~;1 -
_t.nt -ior- tJ:iem in their ~lJSallold.~ -'. ',.' •
thffsFvey.; abOut-:iofhoUSiulli hOuSeh6lds a.req~Ubie_-sa.BlpiSci--.at . =. -" '- '-.' randanfi0lll8l!i1p~s·1ll~."~~Ju. ~;,;.. ior;~alth'~ teJ,f~-!dmini~ . -" •
+-~
-~
~
••
~-
. •.
, s.tratlon.;
_:.~-~ _ hpe~generalf'
-".'
. ,. _ . . . . '- ·>.-'j:--i/·'" -:'" ~'- ?-.~-->.':..:;.-' occupatlone.J.
',~.~~ -.-~. 8tatusi:n!Jlitber and80r~of
,~:-~:.' ...:~
" ~ ...~... .'t-','
'"'-'.
diseases or injUries, waY.aIld c,oet :0£JI!Eldica1 treatment, amount-of liv.!.ng 6%p8nses, etc •• in thell8 houlI8holds are investigated in the Survey. 3. Patient Survey The Patient Survey is carried out in order to produce statistics about actual conditions of patients in various kinds of medical institutions. Thro:,ghout the count17. one-tenth of all hospitals
(about 500 hospitals) and one~undredth of all clinics (about 500 general clinics and 200 dental clinics) are selected as BBmpJes for the Survey at randall on the basis of stratified BBmpling method • . Condition of medical facilities and equip!1ents, sort of diseases and injuries, duration of hospitalization, way of payment of medical expenses and so forth are surveyed, principall;1 concerning outf:\3.tients and in-patients visiting these medical institutions. 4. Basic Survey for Health and Welfare Administration The goals 'Which are amed at by this Basic Survey are to institute inquiries into fundamental matters in the field of Health and Welfare Administration through the individual household of t,he people, and to select master BBmples for sampling surveys 'Which are -planned to be performed by the Ministry of Health and Welfare within the fiscal year concerned. For this Survey, about 190 thousand households,
:.t.;
-10-
,-,,::;"-,"
i"",,:!\*lu;Wdredth of the total aU over Japan are !l8leoted as samples -'.~-. -
r~
,""
:",
. ,....
'-,
_.' ..
.
--.
'
. ,
-
.
.
-
,,"'
: i""" &:t-nndomo "-,
They are 'interviewed by enumerators with question!! , . ' . . . -
'about ''c,
tberough estimate of
inOOllleS
aDd' spandings in
t.be
yreced-
.
~',~t.h .. the -azo8a i,f'arable Jands -cultivated,: nUlllber . . '. . . . ~.
of persons,
.
occupational status and other items needed and velf'are administrationo
fundamenta~
for
4eal~
There are included in other items, 0
-those which are changeable from year to year
This Survey is oonducted as of April 15 of every year by intervievs made -by enumerators. Schedules of the Survey are
forvarded to the Division after they are filled up by enumeraters through health oenters and the seotions conoerned with health administration in
prefectural governments.
The statistical data
vbich are derived from this Basic Survey are very .valuable and useful. The Division is putting forth efforts to promcitethe ,
level of the Survey u;p to higher degree year by year. 5. Health Statistics
1) Morbidity Statistios (a) Numeric Report of Communioable Diseases.
For the purpose of grasPing prompt aDd- accurate information ooncerning outbreak of cases of and deaths from oommunicable diseases, the Weekly Report of Communicable Diseases is prepared. The chief of each health center is obligated to prepare the Weekly . R~port -on Cases of Communicable Diseases on the basis of decla... ratioons fran medioal doctors and the Weekly Report on Deaths from G01'l!llunieableDiseases on the basis of death schedules of vital
-11-
..
,
s'i"..aUlltirss and to prt;oont them to 'the governor of othEirs '3"neerned. Re,eiving 'these weekly reports", the governor or
oth"l'S "uneerned a1:''' obl1ga,1>ed t" make and fO'!:'WI3:rd tho, Weekly Reports
(b)
Morbidity Schedule Repe.r
-,r c )IJlD1utlicable
D1seall6,lc
'"'hiS Morbidi':J S"hedu..ie Repo:rt is produ',ed on grounds of deo::la.C-'Ill,oe, .t'O:t'!ll5 fONa,-ded 1'0
healt.h <]enters by phySiilian6 who treated
Up\lO
t.ham,
Entries
ill
items of the de-::l.a.!-at:ioIi form
3.1'<l
Gopied in
items :Jf the mort'hty schedule in the health <lenter, and sohedules filled are forwa1'ded t.e) t..b.e Division of Health and Welfare Sta1>istios, Crmcerning tuber.:ul:siS and venereal diseases, numerio l'eport and morbidity s :h.,duJ,b rep;rt are alsv produced .1n a.lmo"" the _ a", "rlls,r kinds of cOlJlIJlI.ll1iga,ble d1Sdases 2) StavLstics on Food Poisoning Wl.th rega.rd to',~.$"S m~ntioned
way
above.
of 3nd death .. from food ptJlson.ing, the
r.'.lmeriC report and health ,center.
"9
morbidity schedule repor. are prepared iD the
The Weekly Rapo:!'i: of Cases of Food Poisoning is pre-
•
pared on the basis of daclara'tivns frau mooi;Ja.l doctors and t..b.e Weakly Report of Deaths from Food Poisoning Ls prepared according to death schedules of vital statistic;; L~
the h3alth center.
These :t'eports e.re presented to the Dinl!lion of HdaHh and W .. lfar'O Statistics through prefeetural gover:llllent. They Me sorted in the
prefectural level into weekly reports by urban and rural areas. The Morbidity Schedule Report on Food Poisoning is prepared with
- 12 -
~':¥
~i~·:-·.a.n - . ~;."
..
,.,
. ,.. ,
thellllD8 procedUres as tho. fcsr C<IIIIIIIJIIicable diseases, --. ./
provided that statistical reports originated from findings of the inspeotion carried out U,y food sanitation inspeotors. 3) Hospital Report In order to obtain the basio data oonoerning distribution
IQld aotualoonditions in servioes of the hospitals established
~8r the Medi~i Servioe
Law, the Hospital Report is presented
regarding all hospitals in 'Japan.
The items of the Report oom-
pioise name, location, type of ownership, number of beds by sort, number of patients
new4r
admitted, number of
pa~ients
disoharged, mon~
nUlllberof out-patients and so forth. andBm1ua~
They are tabulated
U,y number of beds.
4)
Report on BugeJ:do OperatiOn and Artifioial Interruption of Pregnancy. This report is prepared to represent number of the eugenic ;
.
operations and the artificial interruptions of pregnancy performed under the provisions of the Eugenic Proteotion Law. 5) Report on ManageJnent of Health Center. rhis report is made out to show aotivitiesof health centers. rhe original report consists of 16 kinds of forms. ;
rhe statistical,
- 4ata csriginated f'roal, this report include various sorts of :Important ,!ntormations conoerning publio health programs, as the health centersbares responsibility at the first line of public health activities.
6)
Administra.tive Report on Public Health -. -
-,
In order to grasp the information :in regard to affairs under the jurisdiction of Bureau of PIlbllc Sanitati:m, Bureau of Medi<3al Affairs and Bureau of Pha:rmaueutica.l and Supp:lJ", thll Administra-tive Report on Publln Health is prepa:r.9d. ---~-.-.'
'1
T"his rep':lrt oonta:ins
5~
ldnd",
of repnrt forms which aN designed to . describe a.ctivih.es in publ' " . . . . . hea.lth admtnillT.ration in prefectures and in designated c!~s.
• in~
7)
Survey on Med~l Institati0na
.-.:r
This Survey is a sort of the census taken on aU medical" ;>
sf;1tut10na throllghout the cotmt'7o v ...."
It is purposed to cla.:ritythe
diatribution and.. :ne :buprrovem.ent. of medi98.1 institutiong b7 ma.ny aspects of their charact-<Jrisi;ics. lo.-;at:ton, t;rpe of nel and the ·like. 8) oWller~p,
Items of t.b.1s Survey inclDie . equi~t$
spe.ciality.
nJ.Kllber of
pe~slp.
Survey on PbysiGians, Dentists and !*'-m9.eiRS. Thi8 Survey is a sort of th.. oensus
talteJ!an a.ll
p/I7!Iioians, f')'l'
dentists and J;i!armacists in
,1a.pEt:.,
'!'he
Survey 18 =ied out-
'he- purpose of cla:r·rtng cond±li10ns-arO'i1Dd t.bBm vith tJ1e 1""-8 about name, addre8s, pa&maIlent address, date. of registraticlD, type of qualification, sped.allty, type of emplc~ "lent
~
and s··
fo~.
-6. Social Weliar" Statisti" s 1) Administratlve Report or '3Q.:l:lb.l WeJ.fare
--.
This Adulipistrative RepoJ·t is prepared for the purpose of obtaining necessary information concerning welfare programeUllder the jurisdiction of Social Affairs Bureau and Children I s Bureau. This Report is c<DpOsed of 33 sorts of report forms b7 which
- 14--
2)
Survey- on Movemenl of Reoipients of the Assistance under the
Daily We SeoU'.'ity Law. l ,-_
Thi.Survey is ,carried o¢ in order ~ represent the distribuo1,
tion aM,<the DIO"8a:o.n, ,of recipients
?f ~llC assistance (';119
&~istuce
unde;
,:~3
Daily LJe Security
~w)
through numb«.!'",
and causes of op.. J.l.'1. mg. (llos:Uig and chang;! IJg of the assistanc ~ "
aM at the same trr:e it Is ahIed to olarity pr );<sesses of iI~1tut::IJIg
C0.., ,
in poor 'ldsses by the results 01' t;h" Survey. "
, e<shedules for op4tnn.U1g, closing and changing uF the assistanc<J liertved fram Mae records on recipi';rits in S)cial V",lfar'O '!'he Sclled~s 7
.,' are
Centers: executive ?rgalls of' the publlc assisi:an e. .rUled un are forwaroed to the Division of Beal' Statistics.
"
and Velfar.oo
3) Iocial Medical \;a:re SUrvey this Survey is ,onducted with the object to obts:in the data descriptive 01' oonditions around medical care under the soo:l.al ' eecu:r1t7 IIChames, uamely, Health' Insurance, .. .. Health Iusurance for ') , . '
.... :~..
f
__
_
.
Day Laborers, Seamen's Insurance, Mutual Aid Association, Life Securit7 aJ1!i Tuberculosis Prevention Schemes.
Dail~
Of all the
bills" for ~ical care presented to the Social Iusurance Medical Fee Payment Fund, some parts are selected as samples with the proportion of 1 per cent for hospitals and
0.'
per cent for clinics;
Concerning these ssmples, sort of the medical care received. name of the sickness cared, amount (points) of medical fee demanded.
- 15 -,
and other cha.:racterietics 'ci' rec~t8. are prepared on the basis of the bills and' copied in the micro-films. ,
"
'
"
~
1
- 16-
,
'.)
.'
i.
List ot ~riodlcalPublications (as of 15 AUg1l.8t, 1957), Late Edition onq. Date of Content 30th week, 1957 R81na.rks
C,Iassification Wetilly Weekq Report of Communicable > Disea.ses
. Monthly" Monthly Report of Vital Statistics' . . April, 1957
• • • Annual Report
Monthly Numeric Report of Communicable Diseases May, 1957 Social Welfare statistics Monthly Report Monthq R&port of Hell.lth & Welfare StaUstics . VitalStatiltics in Japan Apr., 1957 Apr., 1957 1955 with English
titles Annua1'MorbWt;y Schedule Report of CCII!!IlUIlicable Diseases and 1955 Food Poisoning . Annual'Report. ti~s'·
• • •
• •
ot Health St&tis-. 1955 1955 1955 Annual .
Annual Report an Management of Health Centers Annual ~spital
0
• • ;Annual·' Edition
Report .
~'T"
S0i01ai Velfue
statistic II
1955
,.
.. ~.
w1.tbEngliBh . titles
'ae~ot Basic &"elt~
Survey forBealth Adm1Distration Apr., 1956'
•
Report of Jledioal Instuut1aD BUt ,el aDd SUuel on Ph7eicians,
DeAtists" !'humcists
1955
-17-
CJAR ificat ion Allnua1 Editi on
'~Date
ot
'c.
Cont ent· Naticma.1 Healt h Surve y Patie nt Surve y Ninth Life Table s
Oct., 1954 1955 1955 with Ellgl1 sh title s
• . Other
•
- 18-
,
,
c
Date of
'. Statistical Data of Tuberoulosis . Outline of Public. Hea,lth in Ja.pan
, Mar.,
Publication 1951
1lem!!tks
Apr., 1951 Oct., 1951 En-:
Outllie of Social Welfare Administration a.s viewed !r0lll. Statistios
,, Report On Cost of Living (Report with on Basic Survey for SooiaJ.:Seo1l1'ity 1950) Oct., 1951 Outllie of Medical Care SUl'veys
aurveY
Jan., 1952
fUes
RePort of. Survey on~ patients of Tuberculosis in lIoJ5pitals Report on Medical 'Care Surveys Mortality Statistios by Ocoupation and Industry / Social Medical Car,e BurnT aDd Survey on 1«edica1Care UDder llatlclllal' Health ID8uraDce, '~ Report on Sooio-medical Care Survey and Iucome Redistribution Survey
Mar., Mar., Mar., Mar., .
1954
Feb., 1955 with En1955 {!ish itles 1956
,
1956
-~-
,
- 19 -
·f HEALTH SITUATION ~.
OF
,
REPUBLIC OF CHINA
(Submitted to W.H.O. as part of the report on World Health Situation part L)
,•
BY MINISTRY OF INTERIOR REPUBLIC OF CUIXA AUGUS'[' 1957
HeAr,TfI SlTUATIO,\ Ole REPUBLIC OF CH£NA
Contents Page
1. 1.1. 1.2. 1.2.11.2.2.
Background information ...................................... ............................. 1 National level ....................................................................... -.................. ,., I~rovincial
1 2 2
level········ ......... ' ..............
., .................. .
............... ............
The early history of the development of health service··
Basic policies and principles .............................. ' ............................... '....
2
1.2.3.
Basic data about Taiwan Province .................... , ............... -... , ..... .
3
2, 2.12.1.1. 2.1.2. 2.1.3. 2.2. 2.2.1. 2.2.2. 2.3. 2.3.1.
Organization and administration of health service .. ...... ...... ... ...... ... 3 Organization and administration at national provincial and local level··· ... ...... National level .. · ........ . . ........................................................
3 4
. ...................................................... 3
Provincial level········ ................. .
Local level················································ .......... ...................... ............ 5 Health centers and health units .. · .. · .. ·............ ............................................ Health center· .... ····· .... ···· .. · .. · .. · .. · 7
.....................................................
7 7 7 7
Health station .. ... ...... ...... ......... ...... ............... ............... ... ............ ............... Function of the voluntary organizations working in the field of health .. ··.. ...... Red Cross Society of China· .. ·.... · ......................................................... "...
2.3.2.
Taiwan Tuberculosis Association ................................................................ 8 Family Planning Association of China·.. ... .... ............ ......... ............ ... ......... 8
2."3.3. 2.3.4.
,j-H Club in Free China·
.. ......... .. ... ...... ....... ...................
8
3, 4, 4.l. 4.2. 4.3.
Health personnel..... ...... ..... ... .. .... ............ ......... ... ...... ..... ......... .......... ... 9 Financing of health service···· .................................... . National health budget ...................... . Provincial health budget· .. · ..
9 9 9
Local healtb budget··· ................................................................................ 10
5, 5.l. 5.2.
Health education .............................................................................. 10 School health education service ...................... .. Community health educatio"l service ....... ..
..................................... 10 . .....................•..•..•.... JO
6, 6.!. 6.2.
Health legislation ... .... . .............. . National level .. Provincial level· .. ·· ..................... · .. · .. ···· ........ ...................................... -1-
10
10 11
7. 7.1. 1.'2.
Statistical service Vital statistics.
. ....................................................... 11 ...................................................... ··,············12 ' ............ 12 .......... 12 .............
Statistics of health admtn is tration .. " .. -............. " .................. " ............. ,...... 12
8. 8.1. 8.2.
Medical carl' Hospitals' Health stations l'riYate clinics
..... ...
~
8.:1.
.......................
~
9. 9.1. 9.2.
Dental health, dentists, dental nurses and dental technicians ..... 13 Governmental
13
Private
14 .. ............................... 14
10. 10.1. 10.2. 10.:1.
Maternal and child health .. Maternal health .. Child health· School health·
14 14 15 ..................... 15
11. 12. 13,
Health care for the chronic sick Health care for the aged Occnpational health· Nutrition· Mental health·· . ............ .
. ................ 16 ............... 16 ............................ 16 18
14. 15. 13.1.
Department of Neurvlogy and Psychiatry of National Taiwan University Hospital,"
............................................... 18
15.2.
Division of Mental Health, School Health. and Public Health Nursing of National Institute of Health ................... . ChiT1ese Mental Health Association······
.. .......................... 18 18
lS.4. JS.5. JS.6.
Taiwan Froyincial Mental Health Committee-····· .. ,............... . Taipei Children's Mental Health Center
.. ......... 18
19 19
Training program ..
16,
AlcohoiIsm and drug addition· ............ . Environmental Sanitation Water supply ........... · ................ "....... ,'. Sewage disposal······ Control of water pollution ..................... -
19 20 .. .............. 20 .... 20 .. .......... 20
17. 17.1. 17.2.
17.3. 17.4. 17.~.
Control of air pollution Housing·
21
n ., ............. " ............................. , ............ " .. , ...... -, 21
1;,6.
Noise prevention ...........
-2-
17.7. ]7.7.1. 17.1,2.
Vector control··
21 . .......... 21
Mosquitoes .... Flies ... Bedbugs, fleas. cockroaches. and other arthropods
. ...................... 22 ........................... 22
Ji.7.1.
18. 18.I. ]S.2.
Communicable disease control ............ ' .......................................... 23 Brief history·· ", .. , .......... . rolicy against" small"rox, diphtheria, and rabies ..... . Endemic diseases .. ... ........ . . ........... _, ... .
23 24 24 ..................•... ~
18.3. ]8.3.l.
Goiter······
..
18.3.2.
Farasites .....
19. 19.1. 19.2.
Laboratory services· ..
. ................................................ ,- ..... 25 . ............... 25 . ............ 25
The Taiwan Serum and Vaccine Laboratory .. ······ .. · .. · ...... . The Provincial Hygienic Labora tory··
]9.3.
Other Laboratories··.······ .... -.... ' ..
........... 26 .............................. 26 ................................... 26 .................................................. 26 ············································w
20 21. 21.1.
Use of radio·acti\'c isotopes
Food and Drug control ........ . On Natio;Jai leyel·· On I'ro\"i'~cial
22.2. 21.2.1.
level
Food control······· ...................................................................................... 26 Drug control· .................... . . ................................................... 27 ···································m
21.2.'2.
22. 22·1·
Training of Health Personnel·· J 'ost graduate training
...................... 28 28 ...... 28
22.1.1. 22.1.2. 22.2.
Fello\\ ships to abrozd . General p'..lblic health training in the Institute of rublic Health Inservice training in specific fields···
28
23. 24.
Other heat \h services ........... aj:(ences Future planning
... ... .... ..
29
Assistance in the health field from W.H.O. and other bilateral ............ 29 . ........................ 29
25.
-'
-3-
1. 1.1. 1.1.1.
Background Information National level Historical The development of Public Health Service in China wa:; started with the attempt to stamp out scourges due to occurrence of epidemic diseases. In 1873 when cholera outbreak swept over Shanghai, a national law was passed to establish a Maritime Quarantine Service and to impose measures on cholers control. In 1910.
following an epidemic of plague in Northeastern Provinces (,Manchuria), a plague control bureau was established in Peiping, with Dr. Wu lien-teh as its chief. jurisdiction of the Ministry of Interior.
In 1911
when Republic of China was born, a department of health was created under the It's chief function was limited to the control
of cholers, plague and small-pox. Later on programme on training of health personnel
----
and provision for medical cares were introduced.
In 1925. a demonstration health Medical and paramedical
centre was established jointly by the city government of Peiping and the public health department of the Peiping Union Medical College. 1st Di5trict Health Station of Peiping. stations. personnel were first given practical training at this centre which is called the Soon that city was able to establish -1 such BLlt it was not until 1928 when With formation of the ministry, In the vast areaS of this continental country of China, similar effort
was exercised by various level of government. a Ministry of Health was created in Nanking.
over all planning for organized healtlt--15ervices and medical care for all the provinces and district was started, and the objective was to establish provincial health administration and county and city health departments. The first proviGcial health department eve·r established was that in Kiang Hsi in 1934. since then great advances in public services were made in many other cities and provinces of China, and several important health institutions were established in the years following and these included: 1). National Institute of Health 2). National Epidemic Control Bureau (sera and vaccine production) 3). Central Hospitals Health legislations were also formulated and the more important of these are: 1). Registration of physicians and other health personnel
2). Regulation regarding organization and functions of provincial. city and county health services 3). Epidemic Disease Control laws 4 \. Food and Drug: Control regulations Unfortunately, despite governments efforts, the comprehensive plan for promotion of this health services all over the country was deterred by the War II inflicted upon by Japan in 1937 which led to War II in 1941 and only ended by 1945. Fortunately, however, in these years the training of health personnel never
1 -
--J
ceased and competent health worker became available to rehabilitate the health condition of the great mass of people as soon as the waf was over. The followin.C! reports give an account of what has been done in the province
of Tahvan following 191). 1.2. 1.2.1.
Provincial leveL The early history of the dcvelo!)illcnt of health service. The health status of Tahva.n after the World \Vax II Government resumed her 2.dministration was in a ~tate (l~-lS"
when the Cl1inese
of rather precarious con-iP!o ~haml)les.
dition.
Under the privation of \var and the destruction inflicted by it. 12 of the de\'a~-«Hed
-
e:-;.isting provincial hcspit2is were practically been no health centers Or ~tations
There hc.d tl~e
aside from these hes;>irals. di~tricts
The maSs of populc,tion uri)an
had been dispersed to IT'C'untaincus million of cases in a year; 19,16 to 19·11. tions were
and had ju'-t returned to
areas bringing back with them malaria. small~-pox
Thus the indd2nce of n:.alaria spre2.d to and cholera epidemics lmIlledia!ely follo\ved I
causing the cccurrences of 6,-:2.1 cases small-po\: , aDd 38(;9 C2ses cf cholera in Imported also to the island were H immediately rectified (sec 16. 1. l£~'. ca~es
of plague.
These condiof the
after the eswbJi:::hment vaccil~e
Provincial lIealth Administration in
The measures tz_k.:::n at that time wa'S fre,hly made by a newly All the d. inking ,\ aters were chlorini~olated
to revaccinate all the population with small-pox established Frovincial Hygienic Laboratory.
ated ( and the wells with bleaching powder), a chain of 13 quarantine stations were established and an imported plague cases were were no spread of plague to redents. and tr-eated. sn"!all~·po,-
There cases
Thus in compara!iYeiy sho: t spc.ce of time
all these three epidemics had subsided without reuccurreJlCC except migation of population from the main land. 1.2.2. Basic Policies and Frinciples. This al~.o
which reappear in smaller number of cases corresponding to certain influx of was eventually tota1ly suppressed through constant erfort to revaccinate the popu!2.ce. The fundamental policies taken up by the Provincial Covernment ,,-as to introduce a net work of decentralized health services thrcug1:cut ti,e and curative health mea~ures is,la~d
so tl"at the
health services would be a\'ailable to all populace aD.d the preventive. promotive, could reach all the people. Thus. from 1(; 1"1 to 1933, .-./
a health station was set up at each village and tovt'l!ship with i.eIp of ].c.R.R. (see 2.1.3.'/ It took almost;) years before this scheme was cDmpleted
In the mean-
while the government with aid of M.S.A. has rehabilitated all the provir..cial hospitrtls. thus completing the ground work necessary to achie ... e tLe over all health care for the entire populace. The net \\-ork of the 333 health ~tation~
ne"
existing play
very important role in giving medical care to the rural areas where aborigines !i ve.
district~
inCluding remote
The government then ne"t plunged into t:le impl"o-
velllent of the services by the intensive in-service training programmes for the
-
2 -
health personnel including doctors, nurses, midwives, laboratory technicians. sanitarians, malaria control workers etc. Some were sent abroad for advanced studies in the fields of public health and hospital administration. A great stride in the advancement of the health programme was made after 1950 when the government enlisted the help of W.H.o. and UNICEF, and proposed the fullO\ving 8 joint projects. 1. 2_ 3. B. C. G. inoculation and T. B. control programme.
Malaria control and eradication. M. C. H. demonstration and training.
4. 5. 6. 7, 8.
V. D. control. D. P. T_ vaccination. Nursing education. Trachoma control. Sanitation improvement project. The work has just started and a lot of
Further efforts are being e'\ercised by the government towards the goal of further improving the health of the people. problems still remain. in the past decade. 1.2.3. Basic Data about Taiwan Province. Taiwan Province is an island prol,,-ince of the Republic of China, and lies between The following summaries the main work being carried out
:no
,13' to 25° 3S' North Latitude and 119" 18' to 122'" U6' East Longitude. The area is
The island is about 360 kilometers in length and 13:) kilometers wide. rather high birth rate and low death rate. shown as follown: 1954 ropulation 6,.197,73--1 37.09
35.961 square kilometers (or 13,885 square miles). It is highly populated and with The brief data on vital statistics are 1955 1956 9,473,511 44.17 7.90 ( -
8.149,101 43.83 8.02
9,0,7.643 44.57 8.46
Birth Rate per l.OGO Crude Death Rate per 1.000 Infant Mortality per 1.000
17.57 33.67
30.11
33.89
-
)
2. 2.1. 2.1.1.
Organization and Administration of Health Services Organization and administratioil at national, provincial and local levels. National Level The department of national health service is the llighest level of functions are: (1). Planning and implementation of the nation-wide health program, such as training
health ]ts
organization for the couatry and is ir.cooperated in the Ministry of Interior,
of health personnel, ur._dertaking of research and investigation in connection with puolic health proolems, registration of medical person~el,
foed and drug
registration and control. aQti-epidemic activities, etc.
There are subsidiary
-3-
institutions under the jurisdiction of the Ministry of Interior and also under the supervision of the health department. (A) National Atomic Medical Institute The functions are as followhg: a. b.
Clinical application of redioactive isotops for diagn.osis, therapy and research. Training specialists in atomic medicine International medicine. cooperation on the peaceful lL':ies of atomic energy In
c.
(B) National Institute of Health
-
Its chief work consists of training of health personnel and conducting public health research (C) National Narcotic Bureau
Its chief functions are nation-wide narcotic control and narcotic manufacture of narcotic drugs for medical use. (D,' Medical Supply Bureau
Distribution and allocation of medical supplies to various health organization.
IE) Food and Drug Bureau Registration and control of food and drug (2).
Cooperation and coordination with international and foreign-aid agencies. At present, there are five such agencies giving technical and financial assistance to the national health program, (A) World Health Organization IB) United Nations International Children Emergency Fund (UNICEF)
(C) International Cooperation Administration, USA. (lCA\ I D) The Joint Commission on Rural Reconstruction JCRR;: (E) American Bureau for Medical Aid to China
There is a Coordination Committee on Foreign-aid in Medicine and Health with 11 members representing the foreign-aid agencies and governmental medical and health agencies. a week.
This committee ordinarily hold meetings once
(3). Supervision of the provincial health administrations. 2.1.2. Provincial level. The Taiwan Frovincial Health Administration (FHA) has the overall responsibility for the puliJic health service in Taiwan province, including curative ar:.d preventive medical services. in-service training of health personr.el ar,d port quarantine. It is also responsible for the planning and supervision of the activities of the city and county health centres. The Provincial Health Administration also consult with the The relationship and channel of authority of 1. and 2. 4 -.J
international health organizations under the guidance of the Ministry of Interior and the Taiwan Provincial Government. the organizations are shown in fig.
2.1.3.
Local level. ;City and County)
At present Taiwan province is administratively divided into 17 countie3 (Hsien) and 5 cities. Each county and city government is headed by a magistrate or a The counties and cities are again subdivided into mayor elected by the people.
smaller adminbtrative units called district (Ch'u) in the city and village (Hsiang)
or town (Chen) in the county according to the size of the population. The county and city heahh authorities are called Health Centres (equivalent to county or city department of health, and are responsible for the medical and health services in their areas under the supervision of Provincial Health Administration and
their local "county or city) governments. A health stat;on is the health authority of "Ch'u," "Hsiang" or ·'Chen" and is responsible for the public health of the local area under the Health Centre with the
help of the local government. The health station may have ""health rooms" (substation) in the remote places of that area. The existing system of health administration in Taiwan is shown below:
Fig. 1 Pruvin<!ial Health Adu 1illi.8tration
Pru\·illcial Hospitals & Othcr Frln i Dcial Health Organizations I 1
JIealth Celltres
1-----Cu'u, Hsi3.ng or Chom Governments Hea.lth Stations
I~ou"ty anu City Ho'pita1' I··
Health Rooms
: Direct jurisdiction
." .. : U ndee supervision
-- 5 -
Fig. 2
System of the Health Organizations in Taiwan Province. '1'.11\\"1, PWI\·"CL\l. IIE.I1.Yn .lj,lll:-<ISTl11TJ(,:-<
(1957)
l'ir:-;1 !'.edlulI-Hnra] I.r·al!l!
]1,:-,\;II.t" o( En\ in'lllllcl,tai SUllitatlOli. ~-!l staffj
l'nll'illcial l{y~i"llic 1.a\Joratory (85 ::;taff; Pr(ll illcial )falaria Hesc,m.:h Institute' (-I~ ~taff) J'r(),"ju('ial Tail'!'] DeJIlOJI:-,tration Jlei~lth CClitre ~8:i! :;taff)
(', ':II~llTllli('ald(·
]lraltll ('llllrafi"l1 Ta'I"-; ('IL 1-11!1.~
J:nUleh hospital : lY9 stafl, '(i'::i ,~I:I' t'
Yi-lall
:71 (7S
~talt'
J I~: Il-c!,it ~aLltnli()1"
,.;taft' , ~t:lft,
Tli-d.lIl1)..';
::ICH
Ci,ia-y; QT:ar:l.lltltH' S(;rI ir'cS
T:liil:1I1
,]Hi _~Tair' , ](!~ ,'-;Tal"
al.iI
1\:a,,-1 siulI!..': J'il'~ -tHII;:": J Ilia-IiI'1! T:lI-t\l):! 1'{'11~-1'\1
:'Hi ,',15 ':)B
staff
~39 l)tai'f)
stn!,! :-.1 al" :-11\(1 :<lall
:,12 stafn (17 st.aff)
:-19
:,1
J'r"\'IlII.:::!l 'j';tiI'J:i '\1'11''I"II!!,I" JJ'·,~:·i:a~· Pr"rill~'::d l[';I-k'l ::\T('llt:1.j J["~],;la!
':)3
s!nfl',I ;"'0 stat'i,:
lHcllieal ~lll,\,li(s.
1'1'<1' ilWi:d I .',-~II(:II:!; 1":]lr\J~arill!11 1'nOl il:j-ia! '1':l1\l0'\ Tuhrr(;nJ,,~i;-; ('''lltr,,1 (',11:1" ... [ (~,:L]'ilht:l,r Si,!!I"!','; l:l
III staff I '92 staft,
',168 staff,
Health >\talilm.~
C, "llIt ','
T,
11.
L('sl',t;~If'
{'\)l,trol fl~ati()11
C. ll. hospital & otlif'rs
c:nrc',
Ta.,.,[ )
'-"111.11'
- ';111 C"llll! \'
Tan-I"aIL <'<'!lill"
1{~ill~':;_1l ('''llf'!_~
health at d trclllilcal
)IIOl,,-li cuUI,!." Tai"i,,~)])! ("'lildy (;]1:111'-'- LlIa COl!11]\ '\all-1' 'II {'OllllT:>' YIII.-]ill ('<lflilly .: i:l-\'j \:(l\llll\' -
'!',Iir,a;l \;()\lIlt~; Ka',-h~il!llg- r:"llIlly
I
T;~i-ITIIJ~
l';Il::!-tll1,~ r:"lIul \' '-"'11111 '
"
HI a-\,<.;ll 1'<'1:111'\,
Pt'I,~-~,U ""lil<l\'
'[:1:]'1'1 "i'.\ ('Li -1"1'~ n:,' Tai('I'lIl').,( ('11-_1'
'{'ailan ('i1\' Ka(l-Ilsillll')! eil\' Ya.llJ.!:-la ill-,,-SI.:;'1
Salt workers {listl'id II
8
__,
-6-
2.2. 2.2.1.
Health centres and health units. Health centre .-1.. health centre is respcm:;ible foe all health works in the county or city and
the functions are as follows: \1'..
Health promotion. This is to impro\Te the health of the people through the activities of health education. maternal and child health. school health. sanitation, food and drug control. and others.
,.2'. Prevention and control of communicable diseases.
This is to prevellt treat and cO!1trol acute and chronic infectious diseases and to make investigation and c'JDtrol of endemic diseases in the areas. (3)
l\fedical care and drug control. The health center is responsible for the administration of county or JllLllli·-
•
cipal hospitals, private clinics and dispensaries in the area . (4). Laboratory services and other activities.
The number of personnel are from :30 to 50 in the center but \vith additional staff at the hospitals. Health station A health ~tation
is responsiole
fOf
the health works in "Ch'u", "Hsiang"' or clerk. Every
"Chen". The staff is composed of 1 or 2 dcctors, 2-5 nunes or midwives, 1.. -1 health workers morning including nur~i'1C!; aids sanit~ry inspector and a clinic is held at the heatth stp,tion for care of patients. The fee
charged by the health statien is mini.mal and free service for the indigent is al~o provided. The afternoons C.re spent for pu:")lic health work, including clinics for maternal and child welf2.re. h~c.lth
education. school health. sanitary inspection.
home visiting. immunization. trachoma cuntroL venereal disease controL malaria control. etc .. A health station usually serves a popul tion be-tween 20,00C-30,000. 2,3.
Functions of the voluntary organi~(ltions working in the field of health, and their relation to the I\Tational Health Administration, There are se';eral yoluntary organizations which are closely related with the gover:nmen~al h=-~Jth
agencies.
The outstanding ones are:
(a\ (b) (c)
Red Cross Seeieiy of China
Taiwan Tt:berculosis Association Family Planning Association of ChinOl 4~H
d)
club in Free China
They are all under ~h~ slIpervisicll of the N(~tional Sccial welfare Administration J.nd a~sisting in \ ari..Jus plla'~es 01 the health work of the governmental health 2gencies. 2.3.1.
Red Cross Society of China The chief fUTlctions of this ~ociety are medical r'elief, mobile clinic for the poor area5. medical service for the offshore i~lands, and blood bank service. This
-7-
society has the provincial chapter in Taipei and county or city branches in each counties and city. various places. 2.3.2. Taiwan Tuberculosis Association This association was organized in August 1952. The chief functions -have beel to assist the government in various phases of tuberculosis control such as mass chest surveys, addition of TB beds, laboratory diagnosis, control of TB among the school teachers, relief for charity cases, support to the BeG program, training of TB control personnel, and public education. 2,3.3. Family planning Association of China This association was organized in August 1954. The principal objectives of this association are to introduce general health education into houses, to reduce maternal and infant deaths and to help parents in the sound planning on size of the family. Implementation of this project has been chiefly through the following channels: (a) the mothers' meeting of the elementary schools (bl mothers' clubs of the villages :"c; home visiting The as:::ociation works closely with the educational and health authorities of various governmental level. The nurses and midwives of the health centers and stations are core of the workers of the association. health education in 1956. 2.3.4. 4-H club in Free China The 4-H club was started in Free China in 1952. The U.S. 4-H club pledge has been adapted in this country with some modifications which reads as follows: "For myself my home, my club, my community, my country and other free countries, I pledge: "my head to clearer thinking my heart to greater loyalty my hands to larger service and my health to better living." This organization has been working through 35 schools, 78 townships with the membership of 23,809 boys and 2,733 girls. The activities of this organization, so far as health is concerned, has been to train the local club women leaders, with the help of health centers, in the basic knowledge of the prevention of diseases, first aid, home nursing, personal hygiene, mother and baby care, home sanitation, etc .. These leaders have in turn taught the club members in the knowledge they had members has been benefited by this program. acquired. About 1,500 female club About 24,000 mothers have been instructed with birth guidance, and about 300,000 women have received the These offices cooperate closely with the health agencies at
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3.
Health personnel Description
Number 4,049
(1956)
doctor herb doctor dentist pharmacist pharmacist "assistant:' dentist "assistant" midwives nurses veterinarian laboratory technician nursing "assistant" sanitarians
1.684 724 761 290
196 1.817 719
800 144 1,245 341
4. 4.1.
Financing of health services in 1954, 1955 and 1956 National Health budget (1956) National Health Administration Running expense
NT$200,000 192,000 800,000 800,000 120,000 360,000 120,000
Salaries National Atomic Medical Institute Oporation Salaries & running expense National Institute of Health Running expense Salaries Training National Narcotic Bureau Running expense Salaries Medical Supply Bureau Running expense Salaries Provincial health budgets _ Jear _
115,000 180,000 232,000 160,000 H °t
4.2.
isca
SaJaries 15.837,455.11.
e:\l)enst's
perational
OSpl
a care
1
I -( -
1954 __ _
--NT$--~T~-NT$--~I--NTS-
-
18,779.032.511
11,190,069.26
e:\1lendi t.ure ~NT$- -45.804,556.9
ot.
195~J_ 1956
-18.938:398.00-1-
19,459;;25.00,---18,927'o39~49'-57,324,662A9 2-I,101,;i42.~Or
20, 146,g;20~
20,660-,6-2-6-.50;--25,810,321.471
64,909,~80;; 80,43t,153.47
1957~ - -;;:228.703.00;- - 33,392-:;29.00(-
-9-
·1.3.
Local
health budget' Health Budget , erscnne I and Budget for running e:-:pcnce health act"ivities _ _ _ _ _ 1
Total budget
Year
of the Local Government
Total
I Fercentage to ! the total budget of G't.
Hl5-1
1.~8,1.::t!O.8rl.l0
1955 1',56
1-115,8~r(S5.00
:2~, l ~S.~6·!.;1 2,sA "'EU3/.0J
16,60,.162.20 ],.121,7,12.60 10.;;0'1.852,[0
4'i,0J6,926.9' 45,920,0'8.6-} 51.348,822.54
3.50;"" 334'<6 3.06;6
16'5,858,800.CO
:Y?J':j i';iO.S·1
.-~-'---~---'---_-_ _ _ _ I ,oj) The budget include:- tl'e budge1-s of the Jle,llth centers and health stations
2) Expenditures in bealth system and sanitation.
meCl_~ure
through Education and Reconstruction Departments
are not included. They include huge expenses on improvement of water supply
5 5.1.
Health education School health educat ion ~eryices. The main work i"5 being carried out at elementary scr:ool, kindergarten and nurseries. In Tai\\'an there are 1118 such schools (L\io5 and the school bOys total The b8.si...:: l1ealih kno"lcd,ge is giYen to pupils through the routine The schools also hold various JJealth activities as a part
to 1.200,000.
educational courses.
0:
school education. The school health e{lllcation program is spnnsored ~ointly Ly Provincial Edu-
cational and Health Administrations through the Cocnmittee of Health Education which also embodies mem!)ers from oiher organizations. In the county 2.11d
cily this program is c.'-'.rried om ;cint'y by the cepartment of
education and the he21th centre of that area. ,:}
-.... ,)
Community health edl!cation seryice':5. IIe21th ellucat.ion of communities is l=eing (,2..rried 1 y helding rreetings. giving p()pular talkl-L Olodes_ <',Tld
e,biJ:iticns.
This actlyity inc'udes teaching health Other organizations
~.
habits. care of pre.C!;H2nt wemen and chi'dren. flLitriticll. feed ~allita\ion. etc .. The services afe Illcinly done l:y the health 2gencies. also helping the health a.l:~encies in doing this \vark. such as educational. socia1 ,,·elL~re. and concerned offices of the government arE.'
6. 6.1.
Health legislation National level On the national level. the following Taw!'> related to pLll~lic health had been legally approved: The constitutional la'ws of all health organizations on nation<i1. provincial, Hsien. and county If>yel. The regulation on n- .:..ritime quarantine service
-10 -
The regulation on communicable disea~es control and reporting. The regulations on food and drugs. The regulation on narcotic control. The regulations on qualification and registration of physicians, dentists. of pharmacists, nurses, midwives and of other paramedical personnel. 6.2. Provincial level The provincial regulations are formulated in line with the national health laws but are adapted to the particular circumstance of the province, there are at present 16 provincial health regulations and are grouped into 6 categories as follows: A. Fublic health Regulation on the public health demonstration area in the county or city. B. Communicable diseases control i). Regulation on smallpox vaccination ii). The regulation of the prevention of communicable diseases in the school. iii). The regulation on the registration of dogs.
iv). The regulation on the prevention of leprosy. v). The regulation of the control of rabies. C. Environmental sanitation i). The regulation of the sanitary inspecting team in the county or city. ii). The regulation of the control of grave yard and crematorium.
D. Food hygiene
i). The regulation of the control of the artificial sweetening. matter. ii). The regulation of the control of harmful colouring matter in food and drinks. iii). The regulation on requirements of liquors. wines and beverages.
E. Medical administration 0. The regulation for the control of licensed doctors, ii). The regulation of the air-raid evacuation of hospitals F, Drug control i I,
The regulation on the advertizing of physicians and drugs.
ii :1. The regulation on examination of drugs,
iii', The regulation on the control... of drug stores, In addition to the regulations mentioned above there are 292 health acts promulgated serving as directives by the governments to make necessary temporary measures in pursuit of bettering or protecting the health of the people.
7.
Statistical service The statistical section of the Provincial Health Ad'Ministration collects and
-11-
analyses the health statistics of the whole province. 7.1. Statistics of health administration:
The section is divided into
two sub-sections, namely statistics of health administration and of vital statistics.
All reports of activities from health centres, stations and provincial hospitals are sent to this section. 7.2. Vital statistics: This section is responsible for collection. sorting and classification of deaths and births. Every death is reported in a punch card form and informations regarding sex, age, causes of death, profession. place of birth etc. by the local health centres. The causes of death are entered according the international classification of causes of death and injury. The data are analysed and the annual report is made.
-
8. 8.1.
Medical care Hospitals
Including branch hospitals there are 21 hospitals in this province with 2.860 beds. The number of private hospital is 66 with 966 beds. There are also National Taiwan University Hospital and hospitals attached to the various industries, mining cooperations and other organizations which provide another 966 beds. The number of beds, the type of hospitals and their location are as fol1o\\'s: Provincial hospitals: Description General hospilal I,ocatioll Taipei Chi-lung 1"i-lfL1l Hsin-cllU 205 110 8.\
Tai-chllng Cha-yi Taioan Kao-hsiullg Ping-tung
135 1c17 160 150 57
Hna-lien Yu-li TaitUllg
93 (Induding llmm<:h hospital) 49,~ InclllrfiJlj? 1 hrau~h hospital)
20 5~
J .eprOBBl'ium Melltal hospital T.R control Centre T.E. control centre Maternity ho~pital
Peng-hu TaipC'i coullty Taipei
56 891
280 110
Taipei TailJali
Taipei
179 81
Tot~l
2,860
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Private hospitals: Location Taipei city Taichullg (lity Chia-yi (lounty Tainan i::ity Kao-In~iung city Ta.ipei county Yi-Ian ('(lunty Chang-huR count.y Kao-Lsiung county Tntal ~llml;~r
of hospitals
Total number of l)edOl 275
12 H ~l
7 6 2 2 \ I
189 208 37 120
38 39
50 10 966
6\
8.2.
Health stations: They hold the O.P.D. every morning and serve as the medical care station in their localities. There are 368 health stations in each "Ch' u," "Hsiang" or "Chen".
8.3.
Private clinics: There are 3299 private clinics, 1573 herb doctor's clinics and 734 dental clinics in this province. Location Chi-Inng city 'faipei city HRin-chu CQUllty TaicJJIlng city Tainan city Kan-hRinng city Taipei cOlmt.y Tao-ynan county Yi-Ian (~01ll1ty Yun-lin COlJtlty Miao-Ji county 0hang-11lIa. county Taicllllng cf)nnty Chia-yi COllllt.y Tainan COllnty Kao-hsiung county Ping-ttlng <::vLlnty TIna-lien COllnt\' Tai-tur./! county Nan-tOll cotmty Perg-hu county Yang-mil g-~hm
The distribution is as follows:
! '--,!
Clinic
Dental clinic ---------
Herb doctor's clillie -_.
76 -173
19 151 3~
80 252
I
1--15 105 165
88 120
34 49
171 245
109 76 206
I
116 2:~1
152
I i ,
11 "7 18 [6 3[ 17 51 3-1 52
8:; 66 ]11 57 24 ·13
I
51 IDS 91 76 ·15
233 219 112 178
52 27 ~6
67 78 ~O
6·\
36 111 I
9 5
26 2
19 6"" i ----
10 36
I -----
5
9 12 1,573
, g, S.I.
Total
I
3,299 I
734
I
Dental health, dentists, dental nUrseS and dental technicians Governmental To prevent dental caries among the school children the provincial health administration selected Tainan city and Chia-yi county as demonstration areas since 1955 using fluorine for this purpose. 4,000 school children in Tainan city and 8,000 children in Chia-yi county are under observation. In these areas both topical
-13 -
application and oral administration of sodium fluoride are being tried separately. Three schools in Taipei were also selected and topical application of sodium fluoride is uSfd to the school children under the initiation of Provincial Taipei Health Centre. May 4th has been selected as a ··dental health day", and local health authorities carry out tl1e dental health education sen-ices with the close cooperation of the local dentists' association. 9.2. Private: Hua-lien Bible School held as Aborigines and trained 18 dental technicians. The Kao-Hsiung Practicing Dentist association is starting a fluoridation of city watar supply project. Dental~Assistant
Training course
10. 10.1.
Maternal and Child Health Maternal health Ante-natal and post-natal cares are carried out in the health centers, health stations. and provincial hospitals. The delivery services are mostly done by private midwives and midwives from the health stations and health centres at homes. Deliveries in hospitals and by private doctors are relatively the services done by practicing rr.idwives. true in the rural areas. Still about ·10:~ le~s
comparing with
of deliveries are atten·· This fact is specially
ded by family members or old mams who are not trained. services in Taiwan at the present time. Number Private midwives Midwives. in health centres and health station~ Maternity beds of the provincial hospitals Total births in 1956 1.309 562 119 414,036
The following is a fact reflecting the IT.aternal health
Kumber of diolivery {1956 , not available 53.857 ,33,437 witnout antenatal care) 4,630
Doctors and midwives in the health stations are now called for a refresher training in modern methods of maternal and child health at the MCH demonstra-· tion centre in Taichung. The private midwives are also haying the refresher courses at each health centre conducted under the MeR project. These courses
v.·'ill be comp1eted by the end of 1960 when all midwives from each health stations and private practices in the province 10.2. Child Health \",ill
have received the refresher courses.
The main problems are still gastro--enteritis. respiratory infections and nutritional conditions particularly around the weaning period. Almost two thirds of Immunization the patients visiting the health stations are children with mothers. The child health examination is done in the health stations.
-14-
of D.P.T. and l'omallpo'C vaccination are being carried out also. is done by the health centres. vaccination.
BCG vaccination
Fractically all children between age 6 to 12 were
coyered. and over 95.%' of the negative reactors to P.P.D. had received BCG Breast feeding is a problem at the moment because of the quality of Emphasis now is made to promote nutriSkim milk is being distributed breast feeding- is considered inadquate.
tion care of mothers during the ante-natal period.
to mothers and children by the donation of UNICEF.
10.3.
School health The departments of health and education of the Taiwan Provincial Government jointly sponsors in school health programme. for all the schools. There is a school health committee with 6 school health snpervisers who supervise the school health programme And in each school there is a health adviser in the staff, hea~th
with one nurse or nursing aid to assist v, hatever the given by health and concerned authorities. 1118 elementary schools with over 1.200.000 pupils.
programme being
Active program me were given to the
10.3.1. T. B. control All school children and staff of school were tuberculin tested. film miniature X-ray examination. ty large sized X-ray were made. ingly. children The negative reactors were given B. C. G. vaccination, the positive reactors \\ere given 70rnm, When these film shows any sign of abnormaliAll the cases thus found were treated accord-
It was revealed in 1955-3 that the tuberculosis rate for elementary school
age 6-12) was 0.52% and for high school students ;"age 12-18) O.Bye,
college students (age 18-24', 2.87)l·{ and school teachers and staff. 5.79.?o. 10.3.2. Trachoma control. \Vithin the period of 1955-1956 over L200,000 school children were examined for trachoma, and it was revealed that 54% are trachomatolJ.s and another 10% have conjunctivitis. All the positive cases were treated with 1;'15 terramycine or
1%
aureomycine with sulfa-durgs medication according to the plan recommended
by the W. H. O. expert committee on Trachoma. Past treatment reexamination revealed 7876 cure. Through these school children. the family contacts are being treated for trachoma.
10.3.3. 103.4.
Health education: (See 5. L) Improvement of school environmental sanitation: As a demonstration as well as for protection of health. emphasis was laid to give ample and wholesome water supply (including drinking water), and to install clean and safe toilet facilities at aU schools.
11.
Health care for the chronic sick There is no specialized institution (or taking care of the generally chronic sick, But there are provision of 4..000 beds for the chronically ill among the retired
-15 -
service men. and old homes with clinic and beds attached in the old homes. Elsewhere. chronically sick with leprosy were taken care of in a provincial leprosarium with 891 inmates at present, insane patients in a provincial asylum with 280 bed;;; and two T. B. sanitaria with total capacity of 300 beds.
12.
Health care for the aged There are several government supported old aged homes with the total capacity of 3829. The inmates are given food. board and medical cares free of charge. In those home there is always a dispensary, and from 10-30 infirmary beds, consulting physician and nurses are employed. In the event of more serious condition arising among the inmates. they are immediately referred to the nearly without charges· provincial hospital for care and treatment The great mass of the aged however stay at their own home and
where their young member of the family, relative or friends will take care of them. These that seek the entry to the government horne are those aged and homeless. 13.
Occupational health The committee on the inspection of industries has been established in 1951 by the authorization of central government. P. H. A. Departments of Reconstruction There are three and of Social Welfare. are responsible for the organization of the committee and experts on this field are included as members of the committee. inspection of the industries. ed regularly. lation. sections in the committee, and the second section is responsible for the health Environmental sanitation. medical care, etc. are inspectas far as health is concerned is Ii any unfavorable condition,
found. the industries will notified to improve the condition according to the reguTraining courses are held to teach the personnel sent from the industries knowledge. such as prevention of occupational diseases, on the basic health etc..
industrial health, communicable disease control, environmental hygiene. first aid, These people in turn go back and promote health conditions in the industries In the mining areas the hook worm control program is going on at the present time. The Examination of stool, treatment of the positive cases and the prevention local health authorities are carrying on the activities under the of the disease throu.gh the education such as showing slides, filmstrips films, etc .. P. H. A. such as physical examination of workers, treatment of defects, prevention of occupational disease, etc .. and in the mining areas.
14.
Nutrition Although there is no independent institute of nutrition, the nutrition survey,
- 16-
food analysis, nutrition education and some sort of research work has been conducted in several institutions and agencies. Their findings revealed no gross nutritional anomaly except for a significant degree of insufficiencies in riboflavin and thiamine among school children (The couse of this is beeing investigated). There were some deficiencies in ascorbic acid. vitamin A. niacin and iron among the same group. Animal protein in-take of the general populace is also rather low. These nutritional deficiencies become more apparent when the individual are prone to excessive physical burdens and going through certain as pregnancy. especially during the weaning period. phy~jological
stress such
There is also a definite nutritional deficiency among most infants For better cooperation and coordination,
a national nutrition conference was held in July, 1956 with 50 participants from 22 institutions or agencies. Besides, a working committee had been organized with 11 members including experts and representatives of education agriculture and health organizations.
To solve the problem 1. 2. 3. 4. 5. 6. 7. to educate the people to use germ rice utilization of yeast for food enrichment to encourage the plantation and use of papaia & qua va to introduce dark colored sweet potato enriched wheat flour to increase production of peanuts to work on food for children especially after weaning
Nutrition Education (1). Distribution of education materials
leaflets booklets posters slides
(Germ rice, non-fat milk, corn meal, enriched wheat flour etc.:1 (Food and nutuition, germ rice, etc.) (Six basic kinds of food. yeast, non-fat milk, germ rice '; (Nutrition improvement in normal school, nutrition knowledge for school teachers~,
(2). Training 3-week training coruse on nutrition conducted by the Provincial Department of Education. in local government. Ten-day training course on nutrition and dietetics sponsored by the Provincial Women's Association. The Provincial Health Administration has conducted several short courses on nutrition for nurses of the local health centers and health stations. The trainees were teachers and education personnel
(3). M. C. H. service. Through the 358 health stations where the maternal and child health services are regularly conducted the nutrition education was given to the
-17-
mothers including guidance on infant feeding.
15.
Mental Health The activities of the provincial mental health program is being developed with the close cooperation of the Department of Neurology and Psychiatry of National Taiwan University Hospital. Devision of Mental Health. School Health, and Public Health Nursing of NIH. the Chinese Mental Hea1th Asscciation, and Taiwan Provincial Mental Health Committee.
15.1.
Department of Neurol0.Q,;y and Psychiatry of National Taiwan university Hospital. This department has been growing up considerably during the recent years. Dynamic and team approach as the basis of teaching. clinical work and research took the place of the traditional genetic-constitutional orientation towards this field of the medical science. time clinical The growth of staff. the availability of a ful] social worker. better DepaL'ment of trained nurses Clinic psychologist. a psychiatric
-
and the establishment of a Division of Child Psychiatry and Psychosomatic in this stage contributed to building up of the P~ychiatry
NeurolOgy and
at the University as an up·-to-date teaching center.
An·.oIH! the various
events and facts took place and seen in this stage which can be considered as the markings of progress in mental health programme. the followings deserve special mention. 15.2. The Division of Mental Health. School Health. and Public Health Nursing of National Institute of Health. This division has greatly contributed to the mental health activities particu·larly in the extension programme in teaching school teachers. public health nurses and nursing students. The demonstration classes of this institute set up in Shinchu city in 1954, has greatly helped the school teachers and parents to acknvwledge the importance of emotional facts in learning and to change their philosophy in teaching and training the children. The publication of mental health booklets initiated by this institute in 1955, and still publishing now. has met the needs of the teachers and parents with great success. 15.3. Chinese Mental Health Association. The establishment of the Chinese Mental Health Association in April 1955 marks an important step in the mental health programme. The me:T.ber consists uf psychiatrists. psychologists, social workers. public health and psychiatric nurses, educators and intelligent persons concerned in mental health. increased in its numl::;er from 101 in 19S5 to 150 in 19S6. PuiJIication of Mental Health Bulletin (parterly was scheculed in 1956 and materialized in April 1951. 15.4. Taiwan Provincial ~1ental
Health Committee.
The Taiwan Provincial Health Administration set up the !\Jental Health Conlmittee, an advisory organ for the administration and planning of mental health programme in the province, in 1955. Children's !\.lental Health Center materialized
-18 -
and planning for im;>rovement of Governmental Mental Institute in connection with the Medical College is underway upon its recommendation. 15.5. Taipei Children's Mental Health Center. The founding of the Taipei Children's Mental Health Center materialized in March 1956 as the joint project of PHA and Medical College, National Taiwan University (N.T.U.), with the assistance of WHO upon the recommendation by the Mental Health Committee and by Dr. C. Grndry of Vancouver who visited here in 1955 as WHO Consultant for Mental Health. Developed from the Child Division ot the Department of Keurology and Psychiatry, NTU hospital. it now has staff consists of 2 part-time child psychiatrists, one part-time clinical psychologists, 2 fulltime social \vorkers, 1 part-time social worker com:.ultant. and 1 full-time public health nurse. This center serves as a demonstration center for treating behavior and psychosomatic disturbances of children. and as a teaching institute in child psychiatry for students of medical college, nursing school and allied desciplines, provides facilities and personnel for extension work for teachers, parents and nurses, and carries on necessary researches on child development and related problems. During the past one year from March, 1956 when the center was established to February 1957. the children with total number of 292 were consulted. and the number has seemed to increase in accordance with the increasing acknowledge of the community to mental health problems of children. The center has participated in 1\ursery School Teacher's Discussion Group which consists of volunteers of teachers all over in Taipei city who are interested in mental health problems of children. in collaboration with the Chinese Mental Health Association by giving didactic lectures on behavior disorders of children. their causes and treatments, and through group discussion with teachers. with some technical modifications. 15.6. Training program. The training plan for the public health personnel serving in the health centers and stations all over the island was scheduled and has been earring on since February 1954 as the joint project of ICA. JCRR, PHA and Institute of Public Health of Medical College. The Department of Neurology and Psychiatry. NTUH, and The Division of l\fental Health National Institute of Health, have participated in the training programme by giving didactic lectures on principles of human behavior. child development psychiatry, psychosomatic medicine and mental health. and through group discussion with the trainee about the role of public health personnel in promoting mental health programme in this particular community. The result of this type of discussion was evaluated to be greatly helpful to teachers. and will be continued in future
16.
Alcoholism and drug addition Alcoholism has not been a severe problem so far -' as the drinking habit on the whole are rather moderate) but there are special cases of drinkers which arc 19-
taken care of by various clinics. The drug addition was a problem right after the World War II. As the result
of the reported incre?se in heroine addict am an:.?; the population. the government promul.gated a very severe penalty Jaw against drug addiction. "Drug peddler" and "drug" manufactures are liable to years of impri~onment to death penalty. The peddler may be pe>lalized to maximum of life term imprisonment and the "addicts" are required to go compul~ory treatment by go\'ernment in addition to prison time. In the year of 19;)1, the provincial health administration estaolished a The problem of morAll dectors and meditemporary hospital at Keelung and r.ad treated the addicts. phine and its derivatives addiction has apparently subsided.
cal personnel are re~uired to purchase narcotic dru~s from a Natio"'1al Narcotic Bureau only and must kee) a good record of its llsa.ge, failin.g which severe penalty is imposed.
11. 17,1.
Environmental Sanitation Water supply Water works in Taiwan have been rapidly improved within these years. SuprJy areas no\v have been reached to 180 places and covered the population of 2,373. 288. This is 26.145)0' of the total population in Taiwan pro\"ince. i~
Total amount
of water supplied per day is 380, 893 cubic meters. water per capita per da:---. The largest water work
This is about 162.6 liters of in Taipei city and supply
117,000 cubic liters every day. There are 17.2. 4 water
Chlorination of water has been introduced in the
large water works and bleaching powder has been used in the small size works. examination centres in this proyince and examine water samples from the water ''larks regularly. Sewage disposal For a long time pa~t.
sewage from houses and indw;tries have been disposed Most of the night-soil has Half of this has been thrown into rivers and Recently the new sewage disposal Wu-feng: has adopted
into the ditches along the roads with the rain water. been carried away by the workers. sys.tem has been applied. is 0.03 MGD. sea, and other half has been used as fertilizer.
In 19::6 one residential area in
the septic tank system covering the population of 600. and the amount of sewage Same year the residential area of the pro\'inciat government in The MGD. In Taipei Tsao--tung built the sewage disposal system using sedimentation t.anks. etc.. population covered is 12.GOO. and the amount of se . . . . age is 0.5 sanitary engineer to ad\"ise this plan. 17.3. Control of water pollution Recently the water in the Chi-lung and Tan·-sui rivers has been examined. The work includes; 1. routine sampling of water at the same place of the rivers for bio-chemical tests, 2. measuring the flowing amount of water and ebb and flow, 3.
city a complete sewage disposal system is under planning WHO has assigned one
- 20-
survey of the sewage from the industries in Taipei city and make bio-chemical examinations. All results will contribute for the planning of sewage disposal system in Taipei city.
17.4.
Control of air pollution The problem of air pollution is not serious enough to call the attention of the public in Taiwan at the present time. using coal only in Taipei city. There is a regulation for the control of The industries are required to use the The main purposes are to prohibit to use coal as
fuel in commercial and residential areas. screening apparatus when coal is used. 17.5. Housing
There is a National Committee on Housing in the central government.
From
1953 to July 1956 altogether NT$66.160.000. has been loaned and 3,899 houses have been built. 17.6. The cost of one housevaries from NT$9,OOO to NT$20,OOO. All factors such as lighting, ventilation, drainage, etc .. , have been carefully considered. Noise prevention A regulation for the control of noise has been approved by the provincial assembly recently. The main objectives are aimed at shouting, singing, musical instruments. cracker, radio, microphone, noise in the industries. horn. etc .. The time limitation is applied to the cracker. musical instruments, etc.. and the amount limitation is to radio. motor, horn. etc. amount should not over 85 DB. 17.7. 17.7.1. Vector control Mosquitoes The unit used for the noise is DB and the
17.7.1.1. Anopheline vectors of malaria.
Anopheles minimus the chief vector of malaria on Taiwan has been effec-
..
tively controlled by the application of DDT spray to home and other nearby sh ue tures. year.
w
The density of application has been 2 grams per square meter, once each Vector populations have been so reduced, as to completely break the cycle In other areas only malaria control It should be emphasized that anopheline vectors have not been
of transmission in most areas of ,the island. has been reached.
eradicated. Ho\vever, between 1952 to 1956, residual D.D.T, spraying of houses covering to the maximum of 7,500,000 population's houses-hold were completed. The incidence of clinical cases of malaria which in 1946 was over 1,200,000 cases
had dropped to 486 cases in 1956, 17.7.1.2. Mosquitoes other than Anopheles. No direct measures of mosquito control have been implemented on Taiwan, other than those mentioned above, which were directed to mosquito vectors of malaria. Nevertheless the antimalaria control measures at first gave good results in control of mosquitoes in general. But as has been found elsewhere in the world. some of the species of mosquitoes on Taiwan developed resistance to DDT spray.
-
21-
ThIS is especially true of Culex jatigans the known vector for filariasis and perhaps the most abundant pest mosquito on Taiwan. In order to cope with this reto~dc
sistance factor an additional insecticide known commercially as BHC was added to the spray in 1956 0.017 gram per 5quare meter at gamma BHC 1. Its lasts at least for one month. Several other mosquito species such as aed~ aegypt_i are still susceptable effect
to DDT sprays. There have been some positive benefits in general mosquito control come from the anti-malarial campaign as a result of general public health education which accompanied the campaign by improving general environmental sanitation. To assist in bringing about measures to prevent the distribution of species of mosquitoes which may be transported by air craft, two technicians were .given special training in such methods at the Taiwan Malaria Research Institute. technicians \yere supplied by the Institute for one month in 1956. 17.7.2.
The
Taipei quarantine cffice and studied at the
Flies At the lJeginnin.g" of the antimalaria campaign the toxic effect of DDT. for most species of flies in and around homes and markets was good. veral species of mosquitoes mentioned above, resistance to DDT. control for several months. the case elsewhere. Studies were made in 1954 at TAMRI to learn more atout the development of resistance As with sehouse flies developed a distinct
The addition of BHC as previously described showed effective However the flies are indicating the development of This is to be expected as such has been
resistance to the insecticide combination.
oy
flie~
and other
in~ects
to DDT.
In addition .some preliminary in yes~tud)
tigations have been conducted to determine distribution, ecology and seasonal prevalence of those species of flies associated with men on Taiwan. A special was made at Chilung in this regard. Sufficient data were gathered to supply the
Chilung city Health Center with the necessary information for them to facilitate the improvement of public health services which would contriuute to environmental sanitation. 17.7.3.
Bedbugs, fleas, cockroaches, and other arthropods Bedbu~s
- At present the bedbug populations in Northern Taiwan seem to be Studies as to the reasons for this difference are The BHC--DDT combinations seem to be an effective
controlled by DDT but there has been a definite resistance developed by the forms in Southern Taiwan. being conducted by TAMRI.
means of control fOf bedbugs island'-wide up to now. For only bedbug control the use of BHC may be applied. Fleas - When fleas can be brought in direct contact with other DDT or the BHC combination, control has been accomplished.
22 -
.L.
Cockroaches-Control and eradication of cockroaches has been demonstrated in homes with the use of DDT and/or DDT-BHC mixture. It is necessary for these
insects to come in direct contact with the insecticide. In the antimalarial spray activities special attention was directed to spray application so as to assist in the control of cockroaches. Head and oojy lice have shown that they can be controlled and eradicated by use of DDT. This has been done by use of DDT powder destriimted by JCRR through primary schools. At Lan-·{u:, Orchid-Island,:eradication was accomplished by having the natives wash their hair with the DDT suspension used in Malaria control. The measure of control by DDT of other insects and arthropods than those specifically mentioned above is not known. and eradication effected. There are a number of insects and arthropods on Taiwan which may be involved with disease transmission such as. ticks and rickettrial and viral organizms; mites and various mite borne disease. the classic of which is Tsutsugamushi disease; flies of other than house and garbage infesting species; as well as those arthropods. which in themselves have definite toxic effects to the body. Among the latter are several species of spiders. The more complete understanding of what is involved by the many unknowns is apparent. And in order that the public health services may be extended, research in this regard is obvious and necessary, Undoubtedly there has been control
18. 18.1.
Communicable disease control Brief history The reportable diseases required by the national law includes, cholera, bacillary and amebic dysentery, typhoid and para-typhoid fevers. small-pox, meningococcus menin.g'itis, diphtheria. scarlet fever, plague, typhus fever. relapsing: fever. and raiJies. In addition to these the provincial re.gulations requires prompt reporting on the Tetanus, pertussis, poliomyelitis, Tsutsu~amushi
occurrence of the following diseases namely; encephalitis, malaria, and cai)le disease in the past years is shown below.
disease. The occurrence of the communi-
The occurrence of the communicable disease in Taiwan. 1945-1956 19-16 Pl:tgue
19-17
1948
1949
1930
1951
1952
1933
1954
1955
1956
I·' death cases
• 288 625 78 27 7
:l,809
death SmallI'ox cases df~th
2,210 1,561 5.193
39
14
9 1
315
1,725
50
173
o
o
o
-
23-
• T'll'uhoid & paratyphoid Dyselltery ea~\:l."
119 14
t\'mth eases ,J..a!h
166 13 312
276 42 4}3 ~
383 72 29" 10 5lJ~
221 30 268
213 20 173 20 -166
217 21
195 14
188 11
114 9
126 8 157
223
180 ~l S~8
;)8" ::5 1,IHl
105 II
75
3" 160 39 302 86
22 290 j
I
31 381 811 11
16
16
Diphtheria
Cn."l·~
17
718 125
771 1,191
ol'nth }ICll illj!()('oc"a I
59 ~·n
83 :JJ
101
80 18
g.) Gil
lIO 78
1"6 23 11
157
(:a".;:-\ <1t~at It (;a;-.rs
:::0
;17
27 10
mcniJlgitis
10 5
Smrlct feyer Rahies
" 0
7 :J 0
9
7 2
9 2 (1
" 2
9 2
5 2
0 0
....
(i"iltl! ra~l's
0 Ilut antilalile
0 8'-)
0 238 238
:n :3:l
92
102
:>2 :i:!
:::;8
50 50
.6 "6
,],.~, II,
92
83
101
58
18.2. 18.2.1
Policy ag-ainst smallpo:\ Smallpox
dipht~eria,
and ralJies,
The routin::: vaccination of infants ' .... hithin one m::n~th after birth has been a practice by qualified doctors 2nd midwives on individual Cdses. Health agencies make mass vaccination on infants twice a year, at spring and autumn seasons. Th,= m1.SS vaccination campaign for the whole popuiation is done once every three years. Since 1956. however the mass vaccin,.tion for general popubt:on was carried out every year to one third of the population so that in three years time every body gets revaccinated and the health workers do not ha\'e the congested period of work once in every three years. 18.2.2. Diphtheria In order to prevent the occurrences of diphtheria, D.F.T. triple vaccine inoculation is given to the children between the age of 6 months and 2,1 months. mass vaccination campaign is done twice a year through health stations. This One
booster dOSe is gh'en to these children v..-hen they oecome 4 to 6 years old. Diphtheria momotoxoid is also used extensively for the 2-:5 years aid children who have not received D.P.T vaccine. 18.2.3. Ranies The provincial regulation requires that dogs shoJ.ld be registered and then vaccin"ted once every year. team. Dogs not registered
",,·m
he killed hy the sanitary
Since 1936 Flury-Keler avianiz=d live rabies vaccine is l)eing used instead This trial
of Semple's vaccine and re,"accination is not required until three years later. This was tried in Yunlin county and the result has b2:!n sL<ccessful.
will be extended to six counties from l8.3. l8.3.1. Endemic diseases Goiter
l~J,J/.
Hyper-immun.= serum is also provided
from Shi ..lin Laboratory for human cases free of charge.
Survey was made in 1957 at the present Taipei, ·I'i-lan, Tao-yuan, Hsin-chu
and Miao-li counties to see the endemicity of goiter, School children in these districts examined. And 62.(16 of these examined were found to have simple goiter and control project is b~ing
conducted with the aid of the Institute of Public Health rroper treatment been given.
of National Taiwan University.
18.3.2.
Parasite Various reports have been made aDout the infestation of parasite from many areas. worm. Most common intesttnal parasites in Taiwan are ascariasis and hook Efforts to alleviate the condition was carried out "oy improvement of en~
vironmental sanitation, health education and treatment of the known cases. Mass treatment and health education are regularly given at schools.
19.
Laboratory sevrices The Frovincial Health Administration provides free small-pox vaccine. RC.G. vaccine, Diphth·-Tetanus--Pertussis vaccine to all people in the province needing these free of charge. diagnosis for In addition cerl'ain amount of rabies anti-serum, T.A.B. vaccine, The laboratory T.B. and V.D. are also given free of charge. There are 22 seroplague vaccine are provided free of charge to those require them.
logic IaDoratories scattered in the province, oeing either attached to the county or city health center or at the pro ,.·incial hospital. 19.1.
The Taiwan Serum and Vaccine Laboratory This laboratory is a jointly run institution by National Taiwan University and Taiwan Provincial Government, located at Shi-lin, and supplies the serum and vaccines of the local need. institution. I st section: C~ntral
There are 5 sections and one BeG laboratory in this
Each section is responsible for the following activities. supplies. preservation of strains and products. This sectlon is also assisting the venereal diseases control project of the PHA.
2 nd section: Froduction of bacterial vaccines. 3 rd section: rroduction of toxing and anti·-toxine. This section is studying the effect of maternal immunity to the new born babies through the
active immunization of pregnant mothers of tetanus. toxiod. 4 th section: 5 th section: Production of viral vaccines. Examination of biological products and their packing. Froduction of 1- PD and BeG vaccine.
BCG laboratory: 19.2.
The Frovincial Hygienic Laboratory This laboratory is located at Taipei city, and the main functions institution are chemical. pharmacological, bacteriological, and pathological e);aminations of the s.ampIes from the market send from various health centers, other public or private organizations or from the people. This laboratory is directly under F.H.A. Analysis of drugs, patert medicine and food is also carried out here.
-
25-
19.3.
Other laboratories There are clinical and chemical laboratories in the provincial hospitals, health centers, etc., doing routine clinical pathological examinations and water and food analysis.
20.
Use of radio-active isotope In May 1937 the La~islative
Yuan approved the establishment of a National The N.A.M.I. is res-
Atomic Medical Institute' NAMJ" the Ministry of Interior.
ponsiole for development of atomic medicine and guarding the health of our people. In addition to clinical services and medical research, the institute will also serve as the center for demonstration and training of personnel in atomic medicine and health physics. For development of the N.A.M.I. the governments has provided more than 252,000 sq, ft. of land and four buildings. arrives. future. The isotope laDora tory is expected to be in active operation in the coming spring when the necessary equipment Cobolt 60 therapy unit, super voltage therspeutic unit, X-Ray diagnostic \\'ill
facilities and equipment for the lOO-bed hospital
be purchased in the near
21. 21.1.
Food and Drug eotro) On national level According to follows: IJ)
the public health law, a National
Food and
Drug:
Control
Bureau is going to be resumed in this year.
The functions of the agent are as
Examination and licensing to each batch of new products of drugs, serums and vaccines both imported and those made in local. Examination of imported Research. processin~
(2) (.3)
or canned food.
21.2.
On provincial and local level
21.2.1.
Food control The administrative system of the food control is as follows: Taiwan provincial government - Provincial Health Administration I Control of foods and drinks of markets 1 - ' • ~Provincial Institute of Environmental Sanitation (Planning and demonstration for the control of foods) Provincial Hygienic Laboratory r Examination of foods and drinks)
-
26-
Department of Agriculture Bureau of -examination) - - Branch bureau Examination and control (Examination of the of the import and export food for export and of foods) control of their industries) Department of Reconstruction (Control and supervision of the construction of the food manufacturing industries) I
County and City government-Health centre (Examination, control and supervision of foods alld drinks) Ag:ricultural department (Control and supervision of the products for export and control of stock farming) Department of Reconstruction I Control of food industries) The extent of service for the past three years are shown below: ~~scription
Unit
1954 479,977 27,811 14,750 43,463 1,252,922
1955 53,873 4,720 12,015 65,587 1,211,099
1956 31,919 3,925 10,611 41,283 1,053,485
Examination of food samples case Food samples rejected by the case examination Visits paid for the improvement of hygienic condition of food time shops Supervision of restaurant time of number Meat inspection animal
21,2,2.
Drug control The Provincial Health Administration is responsible for inspection and examination of all pharmaceutical preparations on the market. ing categories. This includes the follow-
(11 (2) (3) (4)
Patent medicine. Official pharmacopaeid preparations. Chinese herb medicine. New and non-offical remedies
(5) (6)
Narcotic drug. Serum and vaccine preparations. The health centre has a mobile team which re-
There is a Provincial Hygiene Laboratory which receives referral specimen from all the 22 health centres. preparations for tests. gularly goes out to inspect the drug stores and seize the possible "condemned"
-
27-
22.
Trainir.g of Health Personnel The Provincial Government lay a great emphasis on the inservice training of all categories of health y\,-orkers nursin.'~-·aids, ran~. !in!!
from dectors . public health nurses. nurses,
midwives, and midwifery-aids, sanitary inspectors, laLoratory tech-
nicians etc.. They were called to demonstration centres for a short period of trainin.~.
Asides fro111 this . some were sent abroad for advanced training.
22.1. 22.1.1.
Post Graduate Training. Fellowship to abroad W.H.O . , 1. C. A., ha\-e been the main sources of fellowships award to the health pcrsoIl11cl of this country. There ha\"e t'een totally IS medical and health personnel trained in various fields of public health work. at U. S. A .. U . K., Japan Australia, Phillipines. };ew Zealand and other areas.
22.1.2.
General Public Training in the Instiwte of Public Health. This kind of training has been started since 195.1. T\\ 0 months of training in general puhlic health \\"as off erred Ly the Institute of Put lie Health. National Taiwan University !vledical College with the financial aid from JCRR and Taiwan Provincial Government, and outside lecturers from various fields. number of sanitary eng-ineers. sanitarians. and nurses. finished with ·175 pErsons trained The Trainees are chiefly the medical officers of each health centers and stations, with small There have been 17 classes
ry
this course.
22.2.
Inservice trainin.g in specific fields There have i=een several kinds of inservice training for some specific purposes conducted by individual projects. which is s!io,vn as the following table. (1952-1956.
"\'nlnl·.~ training
of j;"aillin:?
Dnrntjpn
I ('hw;f'g trnillcd I, 15
Per.sons traill€d
--- - .------- - - - - - -1- 1\U'.H. plt'y.qieians COIU'.'.;':
3 weds
151
~ur:'lill~
& mi,.lwifrry e()llr~t:!
traillillg
8 weeks
18
272
:;;J"nrr;il g- Supen isor~ tro.illill\! COHrSlJ Tracllorna conir,)l .1>. Cl'lltr()j
22
'·.n.
llll,. kel,.
tl'airlillg (·om':;'·
J1l11. It<;~" trch. trail,ill,!; (Jour:;!' Sanitftrialli'l training
v.n.
-l
I\~eki'l
II
30 11
------
cnur,o.o Ahnri<.:ilml I.ealdl workers trailoillg CQUI1!e
2 week;; to 12 we';k:o;
Ilwnth to year
12
550
-
28-
'23. Other health services There is a network of 11 quarantines stations along the coasts of the island including 2 airport quarantine stations, A total of le8 persons are employed in these stations, and the International Sanitary Regulations of 1951 by W.H.O. are
enforced.
24.
Assistance in the health field from W. H. O. and other bilateral agencies (See separate report of each project.!
25.
Future planning The emphasis to be stressed in the future as far as the health projects are concerned can be outlined as follows:
..
i\. Establishment of a full--pledged training center where all categories of health personnel could be trained within the county. this need.
It seems that the
Institute of Public Health at Taita could be strerrgthened to cope with B. Establishment of a Frovincial Institute of MeR for taking care of the over all planning and supervision of the IvICR for the 368 health stations and to carry out research in this field. C. Integration of the health campaign jointly sponsored with multilated and bilateral agencies into permanent programme of the existing provincial and local health units. D. Coordination of the provincial hospitals with health centres and stations, preferrably in regional basis, so as to make an area self-contained in health and medical services .
•
-29-
G E N E R A. L
I NF 0 R
~
A T 1 0 NS
National Taiwan University College of Medicine
Septembe·r, 1957 Taipei, Tei·~nn, China
Brief History of College of Medicine National Taiwan University
1900& 1919•
The Taiwan Government Medica]. School (a 4-year course given to primary school graduates) was established by%the Japanese. The Taiwan Government lVledical School was reorganized and renamed "Taiwan Government Medical Special College 11 • (a 4-year course given to 5-yea:r secondary school graduates) Taihoku Imperial University Faculty of Medicine was established and the Taiwan Governmen~ Medical Special College was attached to the University as a Medical Special Training CoursB. Taihoku Imperial University was taken over by the Chinese government and its name was changed into National T;;d.wsn University which is now composed of six colleges: Liberal ~rts~ Science, Law, Medicinet Engineering and Agriculture. And the former Io'aculty of Medicine was changed to the present College of Medicine. The Medical Special Tl aining Course, attached to the College of Medicin~, was discontinued in July, 1950. 1
19361
Nov.l945a
Sept.l946: Department of Radiology was inaugurated.
Aug .1947:
Institute of Pathology and Institute of Physiology were established.
Aug. 1948: The 5-year medical course (one-year preparatory and four-year medic~l) was changed into a 6-year course including one-year preparatory, four-year medical and one-year internship~ Aug. 1949: The one-year preparatory course was changed into a two-year premedical coursec Hence a seven-year course has been required of a medical student who mu8t 1··d a graduate of senior high school.
May, 1950: Vocational School of Nursing, a three-year course given to junior high school graduates, was established under the National Taiwan University Hospitalc June,l950: Three departments of Internal Medicine were merged into one Department, and two departments of Surgery into one. At the University Hospital the non-pay assistantship was abolished and a residency system was set up instead. A Central Laboratory was established in the University Hospital. The former Research Institute of Tropical Medicine, attached to this College, was reorganized and its works have been taken ·over mainly by two new insti·tutes. The manufacture of serum and vaccine is now under the charge of the Serum and Vaccine Laboratory, jointly operated by the University and the Taiwan Provincial Government. Studies of public hee.lth has become the specialized task of the newly established Institute of Public Health under the College of Medicine.
•""i• 1950& ,~. 1951:
Feb, 1953: Under the
U.s.
Aid the following improvement projects have been
implemented~
1) Reconstructing and remodeling college buildings and concentrating research laboratories · 2) Purchasing books, journals and laboratory equipments 3 . ) Sending faculty members abroad for further studies 4 ) Inviting American consultants in various fields to help improve teaching
lug. 1953: Sept.l953a DE;c. 1953:
School of .Phvrmocy (4-year course) wes started under the College of Medicine Adoption or "Block System" in modict)l education. WNl moved from 5 Chung Shan South Rood to the present site of the Department of Public Health and the two institutions have been fUnctioning as one unit under one director. Since then a tv.o-month introductory training course hE! s been given to 47l hevlth personnel on this island by tho Institute of Public Health.
The Institute or !1lblic Health
Feb. 1954: Aug. 1955 s
The Depe.rtmer1t of Pathology together r!ith the Institute of Pe.thology was moved to the University Hospit(1l. School of Dentistry, a six...year course including tv:o-yoar prodental and four-year dentul, was started fmd the first class of 12 pre-dental students was enrolled. It is under the College of •dicine. DePf;lrtment of Clinical Pathology Hospital. \lias
Sept .. l9551 P.,.Ut.o
estflblished in the University
1956:
School (Collegiate) of Nursing and School of Medicvl Technology, both a four-year course, \\'ere established under the College o£ Medicine.
COLLEGE OF MEDICINE NATIONAL TAIWAN UNIVERSITY ORGANIZATION
I.
School of Medicine (1945) Department: 1. Anatomy 2. Physiology
II. School of Pharmacy (1953) III. School ('If Dentistry (1955) IV. School of Nursing (1956) V. School cf Medical Technology (1956)
A. B.
Institute of Public Health (1951) Institute of Pathology (1947) Institute of Physiology (1947) a. Division of Physiology b. Division e"Jf Biochemistry c. Division of Pharmacology
c.
J. Biochemistry 4. Bacteriol.Jgy 5. Parasitol"')gy 6. Pharmac("'logy 7. Pu.blic Health
8. Internal
M~dicine
·····~~·---··
9. Sur gory 10. Gynecology & Obstetri(.S 11. Pediatrics 12. Neurology & Psychia~ry 13. Ophthalmology 14. Otorhinolaryngology 15. Dermatology & Urology 16. Radiol·ogy 17. Pathology - University Hospital
Medical Library
18. Clinical Pathology 19. Dentistry . -··-------·--··-·-'
National
Taiw~n
University College of Medicine· September, 1957
----·----- _..___....__,;....,__,!_ _ _ _ _ __
Position
Full Time
Part Time 5
Total ~ --t..~---··-,_,,_.,,~
Remarks •"-"""'*-· .... _.. ____ ....,.._ _ _ _ _ _ ,_ _ _
_ _ ......._ .. _ _ _ _ ,.._,.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .......
· Professor 28 1 -t~sSc;"Ciat~-----"-----~ 2
33
Three are now studying abroad
l
l 1
I-.Erofes§.Q.r__________~-------------·------~-------112r~.§-~_!!Q!L§!,.JJ.9Ii!W a broad Teaching 36 36 , ~ssistant ~-~------· ---------------- . --·--·------ ------·---- -····----·----
·---·------6--·------; 38 ----...- --------·--- --·--
---o;-e- is.. enii6t8cr------·------
I 1
[-------·----.
Total
ll6 --------·--~--
154
I ! I
I I ----..--------------------------------·-----------l P o s i t i o n F u 1 1 T i me P a r t
I T i ;;-;;--T-;-t-;-1-~ !
1----------------·---·· ------1
I--------------·-----· ---------------·----------·-------------·---------"'---------. 1
Visiting Physician Resident
31 81 21
-
----
9
-----
40 81
-1
.
1 1
~--·
Straight-~~t~;~-------------
-----·-------------·--- 21..,--~ __,
j
I
I ---·-··-·--------------------------·-·--·----------·---·-
Total 133 _____ _ _ _ _ _ _ _.._ _ _ _ _ _ _.. _ _,.... _ ______
9
I - - - - - - - 142 -----
TOTAL ENROLLMENT OF ~U COL~GE OF MEDICINE · AY 1957 (Sept., 1957) Medical School Dental Se·hool Pharmacy Medical Nursing Vocation'School Technology School al Nursing {All Female )School School (111 Female)
Year First Total M. F. (OS)
Premedical 59 53 6
Predental 9 7
20 2
9
15 8 1
7 13
-22 (7) 47 (2)*
Second Total M, F, (OS)
101 87 14 (42) Medical 98 81 17 (JJ)
21 11 10 (16) Dental 12 10 2 ---....-.-
37 20 17 (20)
9
22
6 3 (3)
Third Total M. F. (OS)
39 25 14 (18)
Fourth Total M, F, (OS)
Total 101 92 (26) 9 28
69
(4l
17 11 (10)
-
Fifth Total M.
F,
70 64
(OS)
6 (6)
Sixth Total (OS)
F.
M,
69 65 4
{S)
Seventh Internship Xotal 72
M,
F, (OS)
60 12
(3) Grand
Total
570 Mt ~le
124 Female OVerseas
18
37
~.9.t§~ ,.
791
F: OS:
*;
(The number of overseas students to ba first year io uutnown) · One overseas and ore aborigine
enroll~d
in thR
NUMBER OF GRADUATES OF COLLEGE OF MEDICINE IN THE PAST YEARS
i _
Y.ea_r : Total
!--
l~:JJll.y ! .;..'147 ' Tul -
; 1946
.
· !
i 1
Male j Female [_ !!:~Ei~--q~:nn:~~-------~i _Med~~-l:.._~~-cial Training Course j ·-i----+--~1§... j , E~~-le .. _ Mal~ j Female . !: I
I
: .
·•
·11 ·-
10
!I
, ...
~~~ !
s~
'., . i~ : j I
97 ___ ;,~
"· , I .,
j1
i
t.'7
I I
.
-
•
10 ----· .•
l
l I '
!
1
8 21
.
_ _ll1l;y___;__l07
I.::±---_j,.QJ-L,_L_
~----
1j
··-"--~~58
I
27
IJlJlL..l._._~_\__ 1951
1950
:
4
i,_-t..
- I i l ' J
1
I
School of Pharmacll Remrks Male l Fe~ma=le;::.__..,.•- - - - - - - - - -
I I
i 1
l ! I
1
0:
91
l. '
j July l .. 1952 •·. .., 953 uJ-
! 1
J 0
.
_ J
1.6 ---~-+--~~,;:::::~-4--___£~--_j_ ;
j I
-
I ! t' ' ,
I
39
3
AJ
4 -
I I
I 1 1 j i!
. •
~
! ;
' l t-!
F
i
I I j l · 1 --r--t-·.,--···t---l. - ! - - r
! j l
15?
! 1
156
I
1
l
1
15t
1
-
I ,. I ! I 1 I
i
! j 1
I
i Medical Special Trainin~ _!Course was discontinued
1
:
; 1!,
!'
This was the last graduated class of fiveyear course . '
~i=s:.-..&..:.:.ea:::r~-~----
H I
I ~o.~-~.J..14:.Y,__..._.:::.::::__ ,
-~~--__j_____~___ _l______-4---------J 1955 ! ! 1 1 · I
195z-r--~-~-~ July I 7l i 62 I
I
"lOO
i . 1
. ,_~
a7
I 1
l ?; : 9'1 i "' -·-;--.I.L--r~~--.......t. 9
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,
i
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--
I I
i
-
.
1
i
1
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l
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!
02.
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9
. 19l'?_I_T__ ·i ~--- ·1 ,_
~Lf-l8__,{~-~--~-2-~.\-:Q_,I o t t 1 ~·l .2 1 J,;1v 1 bts 1 1:. 9_ : ~ 1 ;
I
-· . _ -
. ; 1
--+· .· I
IThis was t•
-
(
-
~- year_Q_Q_urse
.t
_ ..
f i _.. ; r-. '"1
1
..
~
{
I
1
u
--
I 1
,._
I '
, I
~
_ These wer.e transfers an: jreadmitteg.§i~1?.- .. u
' '
, 11 ...
1
~--~--L___2~,__...L. 7LJ_. JL_1
1~~~!~~i \~~~})~·r~J=:a_ 1 7~cJ -~-~2~j______ l~~------.J__________: _____J 17
J>.Q_j_
.J.
~
12
\
1
ll
I 1
. ::
NTU College of iVledicine
goursfitL
ki...§£.!!lill~r....
Credits Lect. Lf.1b. Three People's Principles Chinese English Calculus General Chemistry General Zoolot;y Genercl Botv.ny .history of iilodern China 2
2nd Se.[l.Q.§ te.r._ Q;rQdits Lect. LHb. 2
TotHl.....______ ~ Lect. 4 8 8
JR. b.
4 4
4 1 1 1
J 3 2 2 2 22
4 3 3 2 2 2
1 1 1
22
3
-
6 6 4 4 4
2 2 2
44
-·-z;---
Ses; qnp.. ~!if German ktin Generel Physics "<iU~:~litetive Jl.na1ysis 0r£snic Chemistry Cornpar2tive Anatomy Internc.tiona1 Relutions & Orgcmizt:: tions '~u;;;,ntitive Analysis General Psyc!lology
3 2
3
6 2
3 2 2 2
1 1
3 2 2
1
6 2
2
1 1
4 2 2 2
1 1 1 1
2 3
1 2
3 29
14
---·--4
15
6
C.URRICULU1~
Tbitd Iee..r
01'" SCHOOL OF Ni!.'DICHU~ ---~·---------,--,..·~-*"'1§_!__§.9.1J.99.tyr
Credits Lect. Lt''b•
Total Lect. 6 2 1
Lab. 6 2 1
German
A.natomy HistologJ Embryology Radiological Anatomr
6 2
6 2 1
1 1 2
;,Jil~tcry Training iVIedical Ethics (Elective) Biochemistry I>hysioloa
1 2 (2) 1
(2) 1
12- 13
9
5 3 -2'----L10 7
5 22 - 23 ~
16
Fourth
Ie~
Pathology Bacteriology i\iledical Psychology ~ilitery Training Niedicel Ethics (Elective) Ph<,rmacology Parasitology Clinical Diagnosis FU.blic liealth 12
6
5 1
6 3
6 5 1
6 3
(2) 1
(2) 1
5 2
3 1
5 2
3 1
_.::;;.2_ _ _ _
5
3
5 2
3
-13
9
14
7
26- 27
16
Fifth Yeer ~;edicine
Surgery Dermatology Urology Ophthalmology Otorhinolaryngology Public Heelth Radiology L. P. C.
2 2 1 1 1 2 1 1 1
2 2 1 1 1 2 1 1
4
4 1 1 2 2
4 2 2
ilfedical l!ithics (Elective) Clerkship in tv.·o of the following four fields in ebch semester 6 Medicine Surgery 6 Pedis. tries Speciality Ophth6lmology Otorhinolaryngology Dentistry Clinical Pathology 11 -12 12- 13
1
6 7
6 6 6 7
-·---11 12-13 2 2 2 1 1
22-23
25
i:dedicine Surgery flublic Health Radiology Dentistry Forensic i~ledic ine i~¢ical Ethics(Elective) Clerkship in two of the follo~ ing four fields in each semester 1~iedicine
2 2
4 4 4 2 1 1 2 1
2 1 l 1 1
C. P.
c.
1
6 6
Surgery Gynecology & Obstetrics Psychiatry iiljetl!~lil£
6
------12 9-10
Rotatini Internship&
9 1.4 credits
6 12
18-19
6 6 6 6 24
Cur,rj,cul:~!lLQ.LSohof>J,_ of~rJIE!Q..i£.!!.l.Q
Third Year
First Semester (September to January)
Second Semester (February to June)
I
t_:_
~~~8 -~~~j--~~-~nd•y==r~ T~:;-~-~~~:~~i;~~J--~~~d~;-r·-;~~~ay ~ .::)_o
I
Physiolo::_j . 0
Bio-
~-=~-~~~11 - 12 ~·w-~~------•
1 chemistry Laboratory -------~-
Physiology
1
I Physi~-~---Bi~x
~~hysiologyl
Biochemistry Laboratory Medical _Ethics X
chemistry '
-~_.......__..,._,_.~-.....-
--.--
Laboratory Physiology
~---1
1 - 2 2 ~ 3
Physiol•gy X X
I Laboratory
1-·-·---·-1
3 - 4
Laboratory
4 - 5
Military Training
German
. x
free
Fourth Year First Semester (September to January)
,. . . . . . . . . 1 ~---
--·-··--··-··--~,
_________. . . . . . . .---·. r--------..----------. Monday
r··-·-----, ·wednesday T H 0
1
j
l Tuesday p
! L
Thursday 0 G
Friday
Saturd:;-l
1
8 - 9
I !
li
~--9-=lo---t 1---------1 I JO ....11 1-----11 -12 1
r----
·----..----~---,----.........;..."----! I
y
I
P A T H 0 L 0
G
y y _l
L
A
B 0 R A T 0 R l
r·--1-=-- 2 Bacteriolog Bacter1ol•gy . 1·-----+--- --..- - - - ! - - - - 1
'---------+---------~------~------2 - .3 -
~-
1
4
x
L~-5----'----
~ ----~
_ _L
. ·------·--·
Medical Psychology Bacteriologyi.Bacteriology ------·-Bacteriolog BacterBacteriology iology Military I I Laboratory Laboratory I I Trainin:_j_________J ... I
Medical Ethics
X
~
I
!
!
Second Semester (February to June)
10 -11
l-2 2 - .3
Medical Ethics
.3 - 4 4 - 5
X
Fifth Year First and Second Semesters :============-M::::-o=n=d=a=y=-----+'1 8 - 9 Medicine j
=---_-=T=-u-~~~~-~~--~ · · · -~-~~~-~-~-~~~sde,y Surgery Medicb.\:3 '
-1-~~,~~~-~~~~--.J--_·_F __r_i_d_a__ Y __ --· -~~C~S=a:-:-t=ur_,.~.,..a,....y""""'...,l .Su1·gery j
Radiology
~U~tg~t; )>
1------f--------+i__________--;----·-·--··--------- .............. ;------·· . ------------· ........... :.------·---9 -10 BLOOK CLERKSHIP; OPD & W!HDS (in 4 groups) .Medicine 9 weeks ee.ch Surgery Pediatrics Speciality: 9 weeks-. Ophthalmology i 2 weeks each Otorhinolaryngology : Dentistry _) • 3 weeks Clinical Pathology • \
11 -12 1- 2
Medical Ethics X
2 - :3 :3 - 4
I I I
4- 5
Ophthalmologf
J:IU-O.l.J.C
Health I: II:
J-lliornJ.norarynf 1 gology l
CPC
r:zi~
First Semester (September to January) Second Semester (February to June)
Four-weeks' Public Health Field Training during the summer vacation
First and Second Semesters ·----------~--------~----------~----------~---------~-----------.-----------, 1
'-ndav mv .,
Tuesday
I w • l eanesday
! 1
Thur s day
Friday
Saturday
:~~:8~~-~9:~~:~~~Me~d~J.~·c~in~~e~:.~~~S~u~.r~g~e~r-y_-_-_:: _ ~--~1\lle----~~~-:~~-_l_-__ -s~u~l~~g~er~y~~:!:~Ra~~d~i~ol~o~~~~~:~:t:of~f:.!~~~!:!~y:~~~T~) ;~ ~9 -10 10 -11 11 -12 1-2 BLOOK CLERKSHIP, OPD & W£ill.DS (in 4 groups)
Medicine Surgery Obstetrics & Gynecology Psychiatry
;
: 9 weeks each Medical. Ethics
2-.3
3-4 4- 5 Elective Elective CPC
* I: *II:
First Semester (September to January) Second Semester (Februar1 to June) Seventh Yea;r Rotating Internship
1) 2) l:)
1:3 weeks in Internal Medicine 13 weeks in Surgery ,13 Me~q, f? oz: 4,;weeks in O't>stetrics & Q;ynecQlogy {6 o;f<7 weeks in P'diatrics ., , _ . ~7 or 6 weeks eac.~: in twp <:>f the, following £our
t::c~;::!lo~h:
1;~"
Otorhinolaryngology,
Psychiatry,
.CURRICULUM OF SCHOOL OF DENTIS'IRY NTU College of Medicine Third Year lst 3emester Credits Lect. Lab. Gross Anatomy Dental Morphology Histology Dental Histology Embryology German Biochemistry Physiology German Dental Katerials Dental Filling Fourth Year General Pathology Dental Pathology Bacteriology Ivredical Psychology Pharmacology Dental Pharmapedics Public Health Clinical Diagnosis Crown and Bridge Prosthetic Dentistry Fifth Year . Crown and Bridge Prosthetic Dentistry Dental Diagnosis Orthodontics Operative Dentistry Periodontology Oral Surgery Public Health Predodontics Surgical Prosthesis Oral Hygiene Sixth Year Dental Roentgenology Operative Dentistry Oral Jurgery Prosthetic Dentistry Predodontics Dental History Ophthalmology T;l
2nd Semester Credits Lect. Lab.
Total 8 4 2 2 2 2 8 9 2 2 2 43
Lf
2 l
4 2 l l
1
1 2
1
ll
9
2 1 1 14
5 5
3 4 1 1 9
h 2
5 1
4 2 3 4 1
2 1 2 2
8 4 8 1 6 2 2
2 2
"-
2 ,..,
4 4 42
12
9
13
1 8
2 2 2
2 2 1 1
1 2 1 2 1 1 1
2
7 9 3
3 l 1 1 1 1 10
2 2 2 2.
2 1 2 12
16
6
5 5 4 4 2 1 2 _2_ _ 44
1 1 1 1 1
4 4 4
1 1 1 1
2
4 4 4
JCJ,
N. T.
Clinical Conference C. P.
c.
1 1 1 1 1 10 l?
Legal Nedicine Pediatrics
1 1 1 1 .Q 10
10 10 10 1 1 1 1 2 2 1 1 /r)
CURR!CULD!1 OF· SCHOOL OF PBARNACY NTU College of Medicine Fresh!l1l;ln Year ~~t? .. · ~er;teste:r · Cred1ts Le(it. Lab. ' "'
.~~~·· 4 8
'
J .•
L~et.. 2
Llll.b'
Three People's Principles Chinese History of Modern China English Calculus Physics General Chemistry Total Sophomore Year International Organizations and Relations Orientation in Pharmacy Zoology Pharmaceutical Botany ·:}ualitative Analysis Quantitive Analysis Physiology Organic Chemistry German or French Parasitoiogy Total Junior Xear Pharmacognosy Pharmaceutical Technology Pharmaceutical Chemistry Pharmacology & Bioassay Physical Chemistry Biochemistry
2
4 2
4 2 1 1 2
4 l
4 3 3 )
4 3 3
3 21
1 2
8 6 6 6
2 2
21
42
4
2
2 2 2 2 1 l 2 2
3 3 3 2
3 3 1
2 2 2 1
2 2 2 2 2 2
l
3 6 6 1
1 2 2 2 4 l
14
6
14
7
28
13
4 4 3 3
2 2 2
4 2
2
3 4 3 6
1 1 2 2
6
6 4 6
3 3 2 2
6 32
14 Senior Year Dispensing Pharmacy (including PharmD.ceutical Public Health & First Aid Bacteriology Drug Analysis Toxicology & Detection of Poisons Pharmaceutical Manufacturing Food Analysis Pharmaceutical L.aw Pharmaceutical Economics Pharmacy Management
6
18
6
12
I.a.t.in)
3 2
2
3 2
3 4 4
l 2
3 4
1 2 2 1
3 2 2 l
2 1
3 4 2
2 1
2
16
3
10
5
26
8
Freshman Year General Reg~ired
lst Semester Credits 4
2nd Semester Credits
Courses
Chinese 1nglish Three -People's Principles History of Hodern China General Psychology Natural Science, General Chemistry & Laboratory Physical Education (I) pepartmental Required Courses Introduction to Nursing Anatomy & Laboratory Physiology & Laboratory Sophomore Year General Hequired Courses Internation-'11 Organizations & Relations Developmental Psychology Physical Education (II) Departmenta_l Heguired Courses Bacteriology & Laboratory Introduction to Hedicine & Applied Pathology Pharmacology Nutrition Fundamentals of Nursing & Nursing J\.rts Obstetrical Nursing & Practise (1) Pediatric Nursing & Practise (I) Fundamentals of Health Education Junior Year Departmental Heguired Course§ Sociology Hedical Nursing & Practise (I) Surgical Nursing & Practise (I) Psychiatric Nursing & Practise Electives Senior Year Department~l
4 2 2
4 4 2 2
3 4
2
4
5 20 22
Credits 2 3
Credits
3 4
6 6 6 2 20 20
Credits
Credits
3
6 7
3
16-19
0-.2
6 6 5
20
Heguired Courses
Credits 2 2 2
Credits
Vital Statistics Obstetric Nursing & Practise (II) Pediatric Nursing & Practise (II) Ivredical Nursing & Practise (II) Surgical Nursing & Practise (II) Public Health Nursing Professj_onal Probl:i.ems of Nursj_ng History of Nursing Ward Manangement & Practise Electives
2
4 8
0-.2 14-17
15-18
0-.2
3 3 3
•
I History
and Development
of the Basic Nursing Program at
National Taiwan University September 1957 Early in 1952, n~tional and international nurses saw the need tor a collegiate school of nursing in order to meet the nursing needs of China. They
envisioned preparation of nurses who would be qualified for. staff nursing supervision teaching and·administration in nurSing. In the developnent of this school the World
,
.
Health Organisation and United States of America, International Cooperation Administration have worked together closely in preparing faculty and supplJ>ing needed quipment in order to make this school ~
reality.
The first class of stUdents was admitt.ed to the School of Nursing in the Medical College of National Taiwan University in September 1956, even though not possible to secure a qualified director until Febraary 1957. In the history of nursing education in China, this school is the first ~
was
civilian collegiate program ot nursing.
(The National Defense Medical Cent.er School
ot llursing was approved by the ltinister of Education to grant a degree ot nursing in 1954.) Nursing students must meet the same requirements for admission to the school of nursing as do other students entering the Univereity. are: The requirement tor admission
(1) graduation from senior high school (which mesns twelve years of general (2) a passine grade in a written examination prepared and conducted by (:3) presentation ot a
...
eduC<l.tion),
the MinistrJ of Education tor all collel(es ani universities, physical examination indicating physical fitness. The length of the program is four years.
During the first year the
students of the nursir..g school are enrolled in courses such as Chinese. l!:nglish, sociology and psychology together with stlXlents from other schools ot the University. In addition. a course in Introduction to is required of nursing students. principles and practice. r~ursing
caught by the Director of the School
The remainder of the program is devoted to nursing
.
-
'
.
-
•
-
2 -
The National Taiwan University Hospital which has been used by the Medical College as a teaching center for students in medicine and pharmacy will also be used by the nursilig students. During che five years of participation of the WHO nursing
educ,'l.tion teem the llB,ior effort has been directed toward assisting in the preparation of clinical units for the instruction of nursing students. The educational qualifications for the teaching staff of the nursing school are the same as for other university colleges and schools. minimum for appointment as assistant instructor. A bacheloes degree is the
Since there are very few nurses on
this Island who meet the qualifications for appointment to the University it is very difficult to secure suitable teaching persormel for this school. With the assistance
of WHO, nurses who are senior high school graduates have been sent abroad to canplete ,,-ark for their bc.chelors degree. At pre~ent
the nursing faculty consists of one As fellows return from study
professor, one instructor and one assistant instructor.
abroad, it is hoped that the faculty of the School of Nursing will be increased am strengthened. Objective: The basic nursing education program at National Taiwan University established in 1956 has as its aim the preparation & develoJXll'nt of nurses able to meet the unique nursing needs of China. At the present time the acute need is for well qualified nurses which includes staff nurses, supervisors, teachers and administrators of nursing. In order to achieve this aim the objectivslJ of the curriculum is to provide experience and guidance to help the students to develop: 1 Academic and scientific knowledge to serve as a basis for professional understanding and skills. Capabilities of working with the health team for the promotion of health, prevention of disease and care and rehabilitation of the patient in mind, body and spirit, so that he may remain a useful citizen. An understand of cultural and social conditions and their influence upon the individual.
"
2 "
3
-
4 - The abUity to recognize and assume her responsibilities as a citizen.
5 - Her potentialities an:! capabilities as an individual.
,~
INSTITUTE OF
PUBLIC
HEALTH
COLLEGE OF MEDICINE, NATIONAL TAIWAN UNIVERSITY 7:.AIPEI, TATI.VAN, CHINA
·SE:>.ptemberJ 1957 During 19h8 and 1953 the com,plete net wovk of local health organizations had been established over the entire island with the assistanc:e of the Joint Commiss;ion on Rural Reconstruction (JCRR), · Each county or city haa its own health center and each district or town has. ita own health station with the total of 22 health centers and 368 health stations in Tai'livan,. In a health center, the lead• ing positions are filled by medical doctor with dentistsj pharmacists, veterinarians, sanitarians and nurses holding subordinate posts" A heaLth station is headed by a medical doctor with a staff of nurse, midwife,1 sanitarian and clerk. But there were no overall public health training institutions for public health workers until the Institute o.f Public Health v-ras estab.lished, although some in.. service training courses w·~;:re operated SeJ?arateJ.y by different health agencies for special projects and sp(§del personnel~ In 1948, when Dr< J,, B .• Grant of the Rockefeller Foundation visited Taiwan, he was moved to speak of the great need cf some kind of a training program tor pubJ..:tc hcaJ.th personneL FoJlowjng conversations between Drr.. Grant and the late Dr,., F'u~ former ?resident of National Tai~:ran University,, a reorganization of the Institute of Tropical Medicine of the University and an. establishment of an Institute of Public Health ·w·ere d8cidod upon,, The reorganization was effected in 1951 and Dr, c. C,, Ma, Professor and Dean of Studies ·of the National Defense Med ... ical Center" w·as appointed the director of the Institute~ During 1951 ... 1953 more than U ~S ~ ~~25 ~000 worth of equipment and books Kere donated by the Foreign Operations Administration (FO.A) towards this training program~ In December ot 1953& ~~ Ma resigning, Dro So K~ Quo was appointed tho director by Dr~ Chien, President of the University., Fol1owing. two months preparation of planning in consu.lta.tion with Provincial Health Administration (PHA)., the FOA; the JCRR 3 the first clas;:t of the two months public health course for medical doctors working in official health agencies started in February, 1954 with financial assistance of these three agencies~ In May3 1955., after Dr<, Quo resigned as the director and took the position of Director of the National Health Department, Ministry of Interior~ Drc K.P. Chen was appointed director by Dr~ Chien, President of the University" When Dr~ I. C. Fang.1 Direoto.r of the Regional Office of the WHO for Western Pacific, came to Taiwan for his routine inves.tigation of the WHO projects in the spring of 1955, he agreed to consider favorably the strengthening of the Institute, the project to be started in l9$6e From the tenth class, starting in February 1956., sanitary engineers and sanitarians were allowed to attend this course and the curriculum was also modified to meet the needs of engineers as well as those of medical . docto~s~ In Februar,y of 1951~ for the fifteen class, public health nurses and other health workers were allowed to attend this course& This summer
(l9S7),
Dro Harold W& Brown, former Dean of the School of
Public Health, Colth~ia University, was invited as Visiting Professor of the Ins·titute through the Chi..'Yla Medical Board (CMB) to help the director :i.mprove the two months basic course and organize the six months advanced courseo The Un.h·ersit.y togethe:t' wl,th the supporting agencies, PHA, the ICA, the JC&'I:{ all a.g.reerJ wi~jh Dro Brmm' a suggestions on the rearrangement of the curriculum of the· t'$ro months basic course to 'Out more ernphe.ois on field training a."'ld team approach between medical doctors,, nurses, and sanitarial}so It was also agreed r?};>etweon sponsoring and supporting agencies that it wou+d take one year f'b1' strengthe."litlg of faciJ.itie~ of the Institute and for. ga~ £itllld ~.er....snoe' ·of the .staff a."ld for the establislunent of a lvell organiz.ed field training center to opera:te the six. months advanced course o ,,., 1-
l.
Administrative Structure Chien, s. L., Ph D. President, National Taiwan University Wei, H. Y., MoDe Dean, College of Medicine Chen, K. P.. , N.. D., MePeH3 Director of Institute of Public Health
2.
Departments of the Institute l) Department of Public Health Practice Chen, Kung ...pei. Professor and Head M. D., Keio University, Japan M. P. H., University of Minnesota,
u. s.
A.
Lin, Chia-chin. Lecturer M. Dll, National Taiwan University D. P. H., University of Sydney, Australia Huang, Po-chau. Lecturer N. D., National Taiwan University 2) Department of Biostatistics Quo, Sung-ken. Professor and Head M .. D,, s Taihoku Medical College ScuDo, University of Paris, France M. Po H., Johns Hopkins University, U. Wu, Hsin-ying. Lecturer M. National Taiwan University M. P~ H., Tulane University, u. s. A.
s.
A.
D.,
3)
Department of Epidemiology Associate Professo~ and Acting Head. Chang, Wen...pin.. M. D.. , National Changchun University M. P. H., Johns Hopkins University, U. s. A.· Lai, Shang-ho. Professor M .. D.,, Taihoku Medical College
4) Department of Environmental Hygiene Fit~geral.d,
Edn:und. Associate Profesaor and Ac'ing Head B.S.C.E., University of California, u. s. A. M. A., · Gartzaga University, u. s. A. · M.E.S.E., University of California, u. s. A. B. Sacred Theology, Alma College, Santa Clara, u. s. A. Associate Professor M. D., Tokyo Iinperial University, Japan
Ko,
Yualllioe~o
Chen, Mei-ying. · Teaching As&istant B. s., National Taiwan. University Ouyang, Mei-li. Teaching (sMstlU1t . B. National. Taiwan Unive#.sity
s.,
Wu, Tung-chung. Teaching Ass.ist~n,t B. E.,· National Taiwan University. -~
2.""'
·rJr.,··oBt1ECTIVES OF THE ...... ____ ).._ _INSTITUTE ____ _ ~·"'•!'"''"'·'·•·w,·"-~1\..,__•u~""'·"".o:~~."'·-~ .-..-.~.,...._
'l'he Institute of Public Health serves as: (l) a graduate school fq,r the general public health training of medical and non·-medical graduates in ,orde:t• to prepare them for administrative, field, teaching, and research work iil various fields of public health; (2) a teaching unit of the College CJ>f Medieine, giving instruction in preventive medicine and public health to un... dergraduate students of the Schools of Medicine, Pharmacy, Dentistry, Nursing and Medical Technology; and (3) a research and service unit of the ~llege of Medicine to promote the advance of knowledge of public health in Taiwan. ""'"''~'-IW·~·-<<..&.:J<"'.l!!.)."U.<qa,C•........ .,.~.·:.r,.:~~
Dl. POSTGRADUATE TRAINING COURSE
... :--....._Ul~...,.__,~~
far :for the all The ~0
This one year postgraduate course is made of four quarters (two months eac.h) plus one month's special study or research. The two months course the first. quarter has been repeated again and again in accordance with 1n~gent request from Provincial Health Administration, until practicalJ.y of the doctors of health centers and health stations have attended. program of the course is listed as follows: Item of Course ---"""""""'·~
....................._..................
lo Biostatistics 2o Communicable Dis. Control 3~ Drug Control 4o Epidemiology 5o Health Education 6o Industrial Health ,., Leprosy Control 8~ Malar·ia ·Control 9, Mater·nal and Child Health J.Oo Medical Administration lL, Mental Hygiene 12o Nutrition (
__
I I
"-·~r------·~---
AllocatCon of Hour · Field Trip Laboratory Lecture Total
-~
l. 2 2
. ·-·. ·~---·--16 8 2 t.~
Credit
1
---·--1------1 24
14 13 3 7 9
14 6 20
! ~ 1
..
4 4 6
12 6
6 6 12
4
8 6
6 6
i ! ! ! i !
2 2
1Jo Physiological Hygiene 14.- Public Health Administration 15. Public Health Entomology 16 .. Public Health Microbiology 17. Public Health Nursing 18* Public Health Parasitology l9o Sanitation 20., School Health 2l~o Tuberculosis Control 22.o Venereal Diseases Con~rol 23 .. Special Seminar Total
6 4 4 20
t
6 6
* ! 1
20 12
2 2
4 5
6
!
5 7 7 18
12
! .~ .! 2
5·
12
5 4 8
12 30
1! 3/4
4 2
14
18 12
10 6 8 .......
i ~
6
-
27
......._ ....
60
_______
-·-----·- ----185 ,
8
....................
____ 272
i
12
·--
.....
-J-
From February of 1954 to July of 1957, seventeen classes o£ the two months course have been undertaken at the Institute. 474 health workers, distributed as shown in the f~lowing table have come from health centers and health stations all over the island and have taken tbis course.
PROFESSIONS OF TRAINEES ~--.t."T':1''T.'·~-......--.,_··
* - - · - ·_ , __ _ __ ~portion
·- -Profe~-~1~;;--·--·~.._.,,.
.
.-~~~-
·:;:::.;.:
= - .
.. N~i~;-o-i-Traine;-
.......
~:w-.~ ....... ·--~$~. ·~~~
{%)
.......~;.......~...h;..w.:....,_.__
+ ~ Medical Doctor 2. Dentist
-.,...._____..x;: ... --~:...~~------«*r~'3t.::e:"'~--
424 14
89.4% 3~
3.
Pharmacist 4~ Sanitary Engineer & Sanitarian 5. Nurse and Midwife 6. Veter1narian 7Q Other@ *This survey was conducted in July, 1957.
7
7 6 3 ........
1.5% lo5% LJ%
l)
-----~·----------------_
____________ 2o7%
Oo6%
@ Other involves five health workers of the PHA, four health education
workers, two chemists, one entomologist and one psychologist.
----.....,..._-~-·-·
---·w~~-·,-.-.-...,_.,..~~-:tt,.,,~------------------;;......-ww@lt$Zit;
Position
--------------. .==-----=·''"__ ' ProportJ.on ,__,. . . (%) Number of Trainee 1l 15.0% 44
PRESENT POSITION OF GRADUATED TRAINEE
*
""''t)""'~~~
l. Health Center Director Head of Division Staff
4
33
2. Health Station Head Staff
3. Provincial Health Administration & ·Its Affiliated Agencies Head of Section Staff Chief of Quarantine Station Superintendent Visiting Doctor Resident 1
1.3 1
4. Hospitals, Provincial & Municipal 5 13 3
,5• Military Medical Service
General Surgeon Superintendent of Army Hospital Head &f Service Station Head of Administrative Division staff
68 -
3 4
45
11
5 1.1% 1.,7%
6, College of Medicine, NTU ?. Other Official Agencies
2. 8 -.1 2
Chief of Medical Service Head of Health Division Staff 8. Unknown#
5 -,.,,~"*-~
_.__.....__...._ __________________ ......--...--... . Total 474 H Unknown means health officers who have resigned and have no
their present jol;>. BUt most of them are supposed to be practJ.cmg J.n the private office. · -~ * This survey was conducted in July, 1957.
i~9rma~ion
ot
-4-
BASIC PUBLIC HEAL'UH TRAINING COURSE ATTENDANTS BY UNIT &. LOCALITY*
'll.otal
27
, ---,
8 16 39
19 12 20 13
25 Changhua County Nantou County Yunlin County
----··
J 3
30 ·---1---2.....;7 _ _ _-+---...;;.._-..........--J, -~-------------------~---------I
13
l
16
18 Chiayi County 1 16 17 ----·---..··----· _______ ,. . . _ . . . . . ..J-.-.------+-------1 Tainan County 4 26 .30 ----------------~---------------------------+-----------~ 26 Kaohaiung County 2 24 l -----·---{--------------!----------+-----~ Pingtung County 3 20 2.3 I !-------·-----·---. -----·-.................___ ·---·------1-------l 7 Hu~~~.'~:~. . 9..~~?~~----------- _____. ____:?_. . . . . .____J.......- ..----~·---1----------l Taitung County 1 i'""-""-·--•·-·----+---------j 4 5 r--........ -.-.... 0 Pcnghu County 0 0
.
..-···--------------..-----------------·------i-----~---
4
14
I
c ........................_ . . . .
----'"'"""''"'"'-'"""-
!-----.. -·-·-----·--·----·-
Subtotal 72 295 367 t---·----. .--------4-----~-l...-.-----~------1 PHA & Its MfUiated Agencies i---·----..·-·-·--..
6 ~1lg _M~~:gP:=-:::an=====::::F====4=·==:t====2=.===:i======~
---·-1-----------1--------......_-----........j
7 ---·-··--"""""--------+-------1 69 A:r:m;y Medical Service 1---·-· ..-·----·--·-··-------------·---------+-------l l----·----~-- . ---·--··-·-.......
Rrovincial Hospital
15 --------,.;;;._---------·..:.......·------+-------1 16
--~
. . . . . . . . . . . . ---..-·. ·-------------...,_.-------.........1-----·~rere
'rot,al.
474
--·
* The .
locality or ,.agency manti~ here i:nd.ioate the places: where tra.ineas working, l;ffOre they ,at~..,.,. the Ola$1!Le . .
.
.
~
TwO mo~e clas&es of the two months basic course will be ope~ated next year~ tn these two classes;, more nurses and sanitarians Will be accepted so that the class: can operate aa a team of medical doctor, nurse and sanitarian on field trips and in group dis-cussions for better unde!'standing of the responsibUities of each health ~rker. The modified program of the course is presented as fallows. : ·
MODIFIED PROGRAM OF THE COURSE FOR THE FIRST QUARTER
I Item of Course -·~···-••••""'''"''"'·•••··-·-··-··w-·-··-·•·----·
..-••·••••• ---··-·---
Allocation of Hour Field Laboratory Lecture & Trip Work Discussdon
.
_ ~_, Credit Total
-·-·--·-··-·-·-f---·----~-1---·
'
-·-;-·-·~-
11\ Public Health Practice 1) P~ He Administration 2) M" c. Ho 3) P" H. Nursing 4) Health Education $) School Health 6) Mental Health 2 o Epidemiology 1) Epidemiology
34
6
50
90
4o5
16
34
3
4) Malaria Control 5) Tuberculosis Control 3~
2) c, Da. c~ 3) Leprosy Control
I I I 4 8 10
6) Venereal Dis:.~ Control! Vital Statistics
6
20 30
l
4o Sanitation 5o Microbiology 1) Microbiology
8
I I
1,_,5 2
4
~--------
l--~-~-:~~~~---~~4~-~+40 _____ ___ -t---1-2. ...:,__.
I
14
I
I
18
I
..
------·--·-
__,
WEEKLY SCHEDULE OF THE COURSE FOR THE FIRST· QUARTER ( 8 weeks) 8:00 aemo·~~~L---~~~==~--+~~==~~~====~~~~~~+-~~~~~~
Wednesday EPIDEMI.
Thursday FIELD
Friday
Saturday
9t00 aom~ 10:00
EPIDEMI.
EFIDEMI. TRIP SANITATION
VIT •. STAT
FIELD . TRIP
a~>m,1------1
ll:OO aom•
MICRO.
MICRO.
SANITATION
P. H. P.
':00
p .. m.
4:00 p ~.~m. ~-.-.
______. .,.,_,: VIT. STAT ••• Vital Statistics. P. H. P. ••• Public Health Practice
EPIDEMI •• Epidemiology.
MICROo••• Microbi01Qg1e
- 6-
It is opportune to operate a one year postgraduate course, after which a graduate doctor would be granted a Certificate· of Public Health by the President of the University. It is hoped that this advanced course can be in operation one year from now when the teaching conditions in the Institute and the field training center are all ready. The program of the course $br advanced training is presented as follows:
1. Second Quarter
1-R>ur
1) Practice (all health work included)
• • • • • • • • • 2) Field trip to community resources for health • • • • 0 • 0 '$ (It • •
3) Vital Statistics • • • • .. 4) Physiological Hygiene • .,- • •
... e • o
o
•
48
0
•
•
0
• •
c
•
..
• .. 32 • • 48 24 3
• • • • • • • • • • • • • • • • •
5) Microbiology (bacteriology, parasitology & entomology) ••••
88 240
Total
hours
WEEKLY TIME SCHEDULE 8:00 Monday Tuesday Wednesday Thursday Friday FIElD TRIP Community Resources for Health Saturday MICRO. MICRO.
a,m~
PRACTICE 9:00 a.,m, MICRO. STATISTICS MCH., VD., STATISTICS T~B. SCH. P.H.Ac 10:00 a Sanitation STATISTICS P.H.Ne Lep .. . MICRO. 12:00 a TIME LUNCH 2: 00 p.,m<r+-·------~~-:;·~"'"''·~-,~":':'.~ 3:~
m~
pomQ
MICRO.
PRACTICE
MICRO.
4:00 pom.,1----
2, Third Quarter 1) Maternal and child health
--Class ••o 40 •• 0
A~cation~f . . .M
including school health • 2) Mental health 3) Nutrition o ".,
Hours Field...& Pract(llce. Tota:l 68 28 8 8 24 21+
•o• CQ~
••o
16 16 48
.""
••ou
4) Epidemiology including a·~~ute
communicable disease control S) Chronic disease control (V.D~,
~··
16
64 60
leprosy, cancer and other degenerative diseases included).uo 40
20
'"".. 7 . . .
WEEKLY TINE SCHEDULE Wednesday Thu:ttedW
8:00
&omo
t---·----=~--~~-------·---~----··------·-···-···~----------4--------+--------~ CHRONIC PRACTICE DISEASES CONTROL FIELD TRIP EPIDEMI.
Frid•
Sat~
9:00 aom•
10:00 a.,m. +-----~----
2:00
Lt]NCH P<~m•
·.J.-----...................................
3:00
p~m.
4:00
p
.m. ·
MCH
-~-----······--··-·---.,-··--·
. . .,
PRACTICE
MCH
EPIDEMI •• ~ Epidemiology, MCH., •• Ma:te:rmal. & ·Child Health. MENT. HYG ••• Mental Hygiene, CHRONIC DIS •• cChronic Diaeaaea Control
3o Fourth Quarter
C'iasS,·Tieid"&;. ....;. P~r-ac:.-.;t~i-c-e-•!fo~t-:-ti""'J.-·-·' 1) Public health p:!Zactice including public health a.dminlstra.tion, public health nuraing, drug control., medical administration and case study a•·~~·······~·o~···8··········••o
Allocation of Houra;
2) Health education including group dynamics ••
48 48 48
40 8 8
88
>6 24 72.'
3) Industrial health •o••••••c••••••a•••••••••• 16
4) Sanitation including m.a:laria; control • • • .. • • •
24 80
Total 160 WEEKLY TIME SCHEDULE Monday SANITATION 10:00 U:OO aotn!>
240
---
Tuesday
Thmraday
Friday
Sa:tUF."d/lU
P. H. P. PRACTICE
P. H. P. FIELD HEALTH EDUC GROUP DYNAMICS TRIP
P. H. P. HEALTH EDUC.
a.m.
HEALTH EDUC GROUP DYNAMIC&
SANI'L'A LUNCH
TIME PRACTICE
2:00 p.m. j,:OO p.m.
INDUSTRIAL HYGIENE (J •
SANITATION HEALTH EDUC ~ u •
PtHcP,. ()(I~· Public lle~th Praotic~,
He~th Education
•••
• 8 ...
V. UNDERGRADUATE TRAINING
. -..... )-~o; .... ....-f ...-.~--
The tmdergraduate training in preventive medicine and public health at the College of Medicine is the first responsibility of the Department of Preventiv-e Medicine. Due to the shortage of teaching personnel, the original teaching staff of both the Institute of Public Health and the Department of Preventive Nedicine ·got together as one teaching unit for both undergraduate and postgraduate trainingo The undergraduate training of medical student should receive the same emphasis as the postgraduate, since various health work in local health stations can not be successfully accomplished without the cooperation of local practitioners, Besides mere lectures, laboratory work and discussions on preventive medicine and public health, much emphasis is placed on the understanding of patients as social-beings and on the effect of social, economic, cultural and psychological factors on disease as learned through case studies in the University Hospital and actual participation in community health services. The curriculum of the course in preventive medicine and public health for medical students ia presented as follows: lo Sophomore 2nd Semester (34 hours; two hours a week, two credits) ·Hours Introduction to preventive medicine and public health •••~••••• 10 Ehvironmental sanitation, including medical entomology •••••••• 24
z.
Junior 1st Semester (34 hours; two hours a week,· two credits) Nedical statistics ., •• .; , ., ""~,~~a~ • ., o a.--·~. o ~ ••• ~., ... o•• , ••• 20 Prevention and control of acute communicable diseases ••••••••• 14 g .. " . . .
3. Junior 2nd Semester (34 hours; two hours a week, two credits) Social and preventive aspects of non-infectious diseases •••••• 22 Case conferences on these subjects ................................. 12
4. Senior 1st Semester (34 hours; two hours a week, two credits) School health and health education •••••••••••••••••••••••••••• 6 Industrial hygiene .. , " " ••• " •• e , •• ~ q • •. • • • .. • • • • • • • • • • • .. • •.• 6 Maternal and child health ................... o ...... o • • • ~. • • • • • 12 N11trition () o",..-:. o ~". o" v • .,. ~,.. ~ "~!}". o u c .o • • v. o. o 6 Mental health •$~•a••~~··~Qo•~•••••••Q~··•~~o•••~•o•~·•~o••••o• 4 & •• ..... (I . . . ., .. ., • • • •• , •• I)
\ t . ()
ll $
• • • tJ • • • "
S. Senior 2nd Semester (34 hours; two hours a week, two
c~its)
Public health administration • H>, . . . . . . . . . . . . . . . . . . . . ~ ~. 12 Prevention and control of chronic communicable diseases o•••••• 14 Health screening and examination ••••••·~···~·•••••o••••••••••• 6 Special setninar " o • • " o • I) • •
o.........
o ,. • • o • • • • • • • • • • • • • • • • • • . o • • • • • • • • • • • • •
2
6o Visits of Observation (no credits) The following places are visited under the guidance of their instructor on the week-end, immediately after the corresponding subject matter has been covered. 1~ Visit to water supply plant, sanitary well, sanitary latrine and restau-
. I
'
ranto 2) Visit to industrial factories, such as cigarette and textile factories and coal mine. 3) Visit to tuberaculosis sanatorium, leprosarium, mental hospital and isolation hospital • 4) Visit to orphanage, !lUrsery home and of.t'icial social welfare services.
-9-
5) Visit to primary and secondary schools; and a special school for blind and deaf-mute children. 6) Visit to various health agencies, such as municipal health center and station, venereal disease clinic and tuberculosis. control centero
7. Four Weeks Field Training (during the summer vacation after the junior year; four credits) Field training in preventive medicine at the University Hospital., .. .,2 wee~s
During these two weeks faculty member in charge of special clinics would assign medical students typical cases for further investigation of various factors influencing the cause and process of the disease by the method interview with the patients or their family in the ward, the outpatient department and at their home in collaboration with the Divisions of Public Health Nu:(-p:tng< and Social Service of the Hospital and the Institute of Public Healtho Field training in public health at the Provincial Taipei Demonstration and Training Center ••• ~, .. .,,. ~ ,, o?. "q .. o . . . . . . ,~ . . . . . . . . . ", .. ~"'.,co., • ., r. o ":'2 weeks Medical students work together with a team of health workers; medical doctor, sanitarian, public health nurse and midwife in home, school, community and clinic. They can get an idea of what practical public health work is and how important a role a practicing physician can play in public health f:teld as a result of th:i.s experience. In addit:ton to courses for medica:L students, the following courses are taught by the teaching staff of (3he Institute for paramedical students~ 1~
Dental students, Junior 1st Semester; two credits 1 two hours a week Preventive medicjne and public health ~···~••ooo~·~~~·•o•o~•·~·""" 34 hrs. Pharmacy students, Senior lst Semester; two credits, two hours a week Preventive medicine and public health •••••••••••o••••o•··~·~··~•o 34 hrs. Sophomore 1st Semester: .Principles of Health education oo u¢., n,..,..,., 34 hrs. Senior 1st Semester: Preventive medicine and public health ., ., ., .. r, 68 hrs. Preventive medicine and public health &oe•o••o•ee•••&••ooo~~oo~o~o
2~
3. Nursing students, (six credits)
4. Students of medical technology, Senior 1st and 2nd Semesters (three credits) 51 hrse
VI- RESEARCH WORK _.._.,....,._..,._ ..... Despite the sh~rtage of teaching personnel and heavy teaching schedule. in under- and postgraduate training, we are still conducting some practical r~search work in cooperation with various health agencies or independently at · the present time; such .as the establishment of normal range of physical growth ot school children in Taiwan in cooperation with Provincial Board of Education; ~ater pollution survey of the Tamsui River in cooperation with Provincial I !tt.stitut~ of Environmental 'Sanitation; Experimental program o:f hookworm cdisease "Control :m the coal .mine ~~ea in cooperation with the Department &f Parasitolo.. ~ and the Mine Hospital; an: experiment on transmission of human leprosy to monk~ys; prevention of endemic goiter by means of iocdized salt in cooperation with Hsinchu County Health Ce~tera -10-
The articles which have been published by the staff of the Institute since the establishment of the Institute are listed as follows:
1. Chang, 2. Chang,
3.
Chang, Wu, H. 4. Chang, 5.
w. w. w. Y. w.
P. P. P .. P.
Chang, W. P. Wu, H. Y.
6. Chang, w. P.
7. Chang, W. P. 8. 9. Chang, W. P. Chen, K. P. and other 10. Chen, K. P. c.nd other l l .. Chen, K. P. and other ' 12. Chen, K. P.
13. Chen, K. P.
14. Chen, K. P. Tung, T. c. 15. Chen, K. P. Tung, T. 16. 17. 18.
c.
Chen, K. P. and other Chen, K. P. and other
Chen, K. P. and other Chen, M. Y. 19. 20. 21. 22. Chen, M. Y. Chen, M. Y.
Huang, P. c. 'fung, T. C. 23. Huang, P. C. Tung, T. c. 24. Ko, Y. C.
Correlations between climatic factors and death rates in Formosa.. J.F.M.A. 51:46-56, Feb., 1952 Correlations between climatic factors and rate of conception in Formosa. Memoirs of Fac. of Med., NTU. 2:48-~2, Dec. 1952 Monthly variation of correlations between death rates and climatic factors in Formosa. Memor. F. Med., 2:63-74,Dec.l952 A statistical study of stillbirth, infant, neo-natal and maternal mortality rates in Formosa. J.F.M.A. 52:741-750 Nov., 1953 Correlations between death rate from diarrhea and enteritis and various temperatures in Formosa. J.F.M.A. 52:751-757, Nov., 1953 Statistical study of the crude, age-sex spe.cific and standardized death rates in Fromosa. Memoirs F. Med., 3:9-35, Dec., 1953 . Epidemiology of malaria in Taiwan. J.F.M.A • .54:18-26, Feb.l955 An epidemiological study of pneumonia in Formosa for the period ~1906 to 1942 .. Memoirs. F. Med,., 4:7-22, Oct .. , 1955 A study on the physical development of the natives of Betel Tobago Island .. Mem .. F. Med·., 1:168-173, May, 1951 Measurement on thickness of skin and subcutaneous tissue of the Botel Tobago natives. Mem. F. Med~, 2:1-6, Dec., 1952 Report on the quality examination of well water in Chung-ho Village with relation to the construction of dug well. J. F. M. A., 52: 16 - 22, Jan., 1953 Report on measurement of total body fat in American women estimated on the basis of specific gravity as an evaluation of individual fatness and leanness. J.F.M.A.52:271-276,May, '53 Factor analysis of subcutaneous fat in Formosan adult women with. special reference to nutritional criterion. Mem. F. Med. 3: 1 - 8, Dec.J 1953 The rice enrichment project in Taiwan. 2~ Observation on the applicability of "Premix" enriched rice to social customs in Taiwan. J.F.M.A. 54: 113 - 121, March, 1955 The rice enricr~ent project in Taiwan. 1. Evaluation of method approaching the people at Sung-shan district, Taipei City. J. F. M. A., 54: 291- 303, Sept., 1955 Prediction of bl~ volume and adiposity in man from bod1 weight and cube of height. .Metabolism. 5:328-345, May, 1956 Prediction of total adiposity from skinfolds and the curvilinear relationship between external and internal adiposity. Metabolism, 5:346-352, May, 1956 Similarity of vital capacity in terms of body weight less adiposity in beth sexes. Metabolism, 5:353-358, May, 1956 Control of Culex fatigans larvae with DDT, Dieldrin and Endrin. The Formosan Sci., 10: 7 - ll, May, 1956 The toxicity of Endrin emulsion to mosquito larvae. J. F. M. A. 56: 82 - 8), Feb., 1957 Cantharidin and its physical function. J. China Agric. Soq., 18: (to be published in Sept., 1957) Rice enrichment project in Taiwan. 3.. Clinical and bioc~emical survey.·. J.F.M.A., 54: 153-163, May, 1955 Nutritional status ot'the normal school students. J. F~ M. A., 54: 329 - .336, Oct., 1955 Vital capacity and chest volume index of some indusria.l workers in Formosa~ <J .F .M.A., 53: 79 - 81, Feb., 1954 -ll-
25.
Ko, Y.
c.
2.6. Ko, Y. C.
27. Ko, Y. c.
28~
Ko, Y.
c.
29. Ko, Y.
c. H.
A phenomenological study of perspiratio .inaensibilis I. On the method of measuring insensible perspiration wd.th Sautar-ba:lance. Japanese J. Hygo, 10:79... 81, Oct", 1955 A phenomenological stu~ of pers.piratio inaensibili$ II~ On the relations between insensible perspiration and several physical conditions.. in hun\an life. Jap. J. Hyg •. , 10:82 • 90 3 Octo 1 1955 A phenomenologicsl study of pers.piratio insenaibilis III. On the influence of some hU1l'lall behaviors.; in daily life upon insensible perapiration. Jap. Jo Hyg., 10: 91 - 98, Oct., 1955 · A simple method to judge thyroid enlargement. J.F.M.A. 5S: 377 .., 3B1., Sept., 1956 · . Studiea around endemic thyroid enlargement in Fromos.a from the standpoint o£ health geographJro J.F.M.A., history of leprosy control in Formosa. 5~ 72 ··•79, Deco, 1951 . The History of Leprosy in ChinaJ Taipei., Taiwan., pp9B, May, 1952 . Experimental studies- on transmiss:ion of human leprosy to monkeys I~ Symptomatic studyo International J. Lepros.yf, 23: 48 "'.51, Jane~ 1955 Vital capacity and chest volume index of coal-mine workers in Taiwan. J .F ~M~A ~, 54: 15 ,. 17, Feb., 1955 Mathematicail analysis of the growth of man, with s;pecial reference to Formosa., Human Biol .. 25:333-358,~~ Deco, 1953 Comparison of Death Rates,, Chinese Interior Policy. 4: 1 ... 5, Oct.,, 1953 Preventive medicine of chronic diseasea~ Today 1 s Medicine and Pharmacy e p 1 - 5., July 1 1954 Physiology and hygiene of fatigue,) Today' s. Medicine and Pharmacy_, p 1 ·• 4, Nova, 1954 Methods of Sampling Survey., JoF.M.Au, 55:1...6, Apr., 1956 Poisson distribution of school children's injuries and traffic accidents,., J.F.,M.A., 52: 356 •• 359, June,~ 1953 jfue Fo:ttmosan Science..
30.
w, s. Lai1
A brief
,5:
356 - 376, Sept., 19$6
.n.
32. Lai, 3.3. Lin.,
s • H. s. H.
34 ..
Quo, Quo.., Quo.,
35. 36.
liT. Quo,
39.
)8. Quo,
c. c. s. K. s. K,. s. K. s. K. s. K. Y.
Wu, H.
•. 12 ...
NATIONAL DEFENSE MEDICAL CENTER General Introduction: At tne end of World liar II, China s&cured her divorce from the semi-colonial status which bound her to Europe and Japan through the abolition of extraterritorial rights, but failed to attain the fre edom and national . independence that was hoped for. self subject to the political and econon~c
She found her-
pressures of the modern world, without p05sese-
,\ng the strength to withstand these pressures, far less to stand aloof and choose her own pace for national revival. Realizing that survival and indep endence depended on economic adequacy, China embarked on an extensive program of technological organization and training aimed at economic rehabilit ation and development. In eVfJry field, the critical need was in trained And, behind this deficiency lay a greater and
personnel r ather than material resources.
almost insurmountabl e obstacle, namely, the lack of qualified teachers. l'ledical t e chnology was perhaps the most advanced of any in China, thanks to its early development through lIQssionary effort. It was certainly the best known to the
people, for during the eight years of w"r, the ,.rmy Nedical Service and Red Cross were giving civilians (farmers and their families ) health protection and medical care along with the soldi"rs who lived among th"m in a war 'i'he bas~d
on defense in depth.
modern do ctor i s undoubtedly best suited to spearheiid the technological advance
into backwar...i rural areas, not only because of his technical knowledge but also because of his sociologic9.1 kinshi p t o the villag" medicine man or priest. A doctor alone can
iro mu ch, but aided by a medical team comprising nurses , technicians and allied workers, he can do a gl'-;at d",a.2. hlore -- he can cover the wor k of several doctors working singlehanded. All members of the team would have t o be trained , not only t e chnically but also The medi cal team could be trained at less
1n the scope and limitations of their duti es .
cost and in less tim" thon i t would take to train the equivalent in individual doctors.
r
During tne >Tar , about 16 percent of the qualifi ed doctors i n China (1,990) out of a tot al of (12, 000'), SeI'VGd i n the ar med forces , the remainder were left behind in the coast al towns at the b.;gil'J."1i ng of the war and Sl.I'ViCe, the majurit y f~ll
into Japane se hands.
Of those in
s.
WIO.-"
young praduatvs although a significant number were highly
~ cializ ed
soaff melnbL",'S t r om :ncd1cal scnools n,ld teaching hospitals who came from the The great bulk of the !'medical offic ers" in the army were
Japanese controll",d arGas .
c:.turally 1ll1c,ualifj ed; nnd only hy uhe organj.zation of medical teams could the meager
• suppl y of quali fied docto rs and other perso nnel be distri buted to all major sect. ,. Of tbe line, and at key evacu ation and hospi tal cente rs. The techn ic~l funct ions of the medic al servi ce were thus ~un by the qualif ied offic ers who were with very few excep tions civil ians on tempo rary war duty. The exp erienc e gained by t nese offic ers in medic al organ izatio n. from the handl ing and t rainin g of perso nnel to the provi sion of hospi tal and clinic facil ities , equi pment , me dical suppl ies and trans porta tion with the minimum of finan cial ~d lnete r ial suppo rt ; and espec ially the lesso ns learne d in carry ing out large scale preventiv e medic al measu res, in sorti ng and evacu ating sick and wounded soldi ers and civil ians in order to give prompt at tentio n to those most in need, and prope r care at the moat , pprop riate statio n, cente r or hospi t al aVail able, and in dealin g with tne problema ot r e condi tionin g and rehab ilitat ion under rural condi tions, place them in a unique posit ion to under take the t r a ining of the medic al perso nnel for the futur e. The Natio nal D ef ens e ment of a nationwid ~ M~dical Ce nt ~ r
was or ganiz ed as a cont ributi on to tne devel ophTIile its prima ry funct ion is to
progr oun of personnel produ ction. f orc ~ s,
provi de for the needs of the a r med
every indiv idual and every unit traine d is a The produ ction by tne NDMC of 75
pot entia l addit ion to the ci vilia n nledi cal servi ces.
dOCLors <ind proportional munb(.; l's of allie d medic al per sonne l annua lly, is tantam ount to provid ing suffi cient mediC al personnel ( tean~ ) t o take car e of the health of 225,0 00 or ;-.01'" poopl e eacn year. Li""ion and Histo ry: The NatiOl,c,l D efans e l'ledic al Cellt" r (N D M C) was offic ially estab lished in June 1947, ~ od,t r aliz" t ile act ivitie s of the A rmy M"c.1ic al College and the vari ous medic al servi ce 5caco ls GsLab li sned during th~ Stc cond Wu rld war in order t o give great er and more effici ent. sc-vi ce to the peopl e of Chi na . In t he sprin g of 1949 the N D M Cm oved to Taiwan with the govdr nmcnt of Free China. Today , it i s t he only cducRtiona l i nstitu tion on Taiwan that is concerned with the .,und" rgrad uate and servic e t r ainin g of tne eight types of m edica l perso nnel requi red both by the civili an popul ation and t he combat and se rvice unit s of t he arm ed force s. The eight cate go ri~s ar e : docto rs , uent ist s, nurse s, pha rma cis ts,laborat or y assis tants and eChni cians, me dic~l
maintenanc e worke rs, and hospi tal and
supp~v
admin istrat ors.
Ent.rance Requi remen ts, Curric ulum and Dur,-,ti on of _'l raining : For Wldergradua t€: training , we took i n la st fall a total of 226 succe ssful candi dates
- 2 -
for the
faculti~s
of me dicine, Clentistr,y, nursing and p~rmacy. s en~or
One hundred and
ton,-
five (145) of them were
.
high school graduatt: s and t .hey will be with U6 for four aD
t o six ye ars . (six f or medicine an d dentistry , and four f or nursing and pharmacy) with additional f our months of cadet trE.i ning. t i onal nursing course . The other 81 students were girls for the
voca-
Our plan for th" next academic year will be t o recruit
70
medical,
20 dent al , 30 nursing a nd 20 pha r macy students at the col l e ge level.
Eighty (80) girla
~ will
be a dmitte d to voc at ional schoo l of nursing .
Sixty ( 60 ) students will be selected
fr om in- se rvi ce pe rsonnel f or t he vocat i onal medicine course . The medi cal course of s ix y ear s consists of one year of premedica l training, two
year.
of pre clini cal , two years of clinic al and public he a l t h t r a ining, and a year of rotating imernship. year s . full'
J ocia l s cience s includi!lg social anthropo l ogy are given in the first four th ~
g r aduate s enter t he
~rme d
f orce s i rnruediat el y a fter gr aduation for similar
milit ar y t raining giv en to young men under t he Univer s a l l'd.li~c, ry Training in the United 3t"te s. The other ha lf a I''' given r lO side ncy t r aining in any of the three armed forces
gen6ral hos pi tal s f or a peri od of two year s , a t th~ end of whi ch the two halves change phe·c s for a sirniJe.r dur aUon. ht the end of f our y ears, the gr &.duate s will be qualified .-...r
t o "nter 'my of th0 a cademi c f i "lds .
Denta l s t udonts to.k" pr"ct ically ch~ Saille cours'-s as their medi e&.l counterpa rts in D.ddition t o t.h8 r£.tluired dvntal CQ1TS0S .
Tht. ir s(';; I'vi ce <.l~ d r t: sidency tra ining after
Nursing students ne<ld a year and
'1
half of pr e- nursing a nd didactic t raining, anothei'
ye :,r and a half for clinical and p'~bli~ h"a""t h nursi ng , wi th t ne f ourth year being entirely dcvO t 0Q to hospiLal pr '"ccice . This is th" only f 2. culty that takas in women under-
gr"dlUites , and the cndlliltes are not requirdd to s e r ve ill comba t f orces. Pharrr" cy student s s pend t hre e and a half years on chemist r y and pharmacy courses, t h" f inal six mont:ls being spent on hospit al pha rrnc.cy or pha rmaceutic f a ct ory practice. ove r 80 it,c",s of medic"J su[plies ,·,hich thi s i ,'land has t he ba sic facilitiea to lIlllIlufacturt, but a la r g0 part of th~ p )c;rarr. has not been impl "ment"d . w~
As 01" t he pre..-.
:ire encountering i ncreasj.ng diff i culti es in placing our pharloa cy gr aduate s. In pr<o viou 5 years and up t o l&st y e&.I', we had numerous vocational classes cove~
t he fields of Clild.cd
and prosthuti c dentisory, nursing, clie t eti cs , pJvsical medicine.
pharma cy, labor:".tor.'; (liagnosi s , l:""dic' l mn i nt Gnance , medi cal and hospital administrat1on.
:t .__________________________________________
~~ ' ~ l
______________________
~
_______________
~
and medical eupply administration.
They were all tour-year courses and the entrance
r "quirt>lIli>nt w as completion of the tirst three ot eix years ot 1I1gh Ichool eduaat.1on. In fact we still have three vocational nurling clalses and two clalses of Tocational medicine with us now. They will need t o be continued to meet the exigencies of war.
•
Due t o limitations of spa ce , statf and funds, we ar e not able to continue other vocational courses. The I<DMC has hitherto bean r equested t o conduct various other short courses the nbed arose in both military and civilian medic al spheres. 8S
Our statf have taken
an a ctive part in the training of over 250 school health nursea, as well al school lle c;lth physicians and administr0t ive heads of t he Tea chers' College and eight normal schools, distributed all oV er the island . This institution has recently been
included i n a t our of visit r equired of all prospective nor mal school graduates. S0m~
of t he administrative methods have been adopted by many of the normal schooll.
Some of our staff, particularly in preclinical fields, have given their assistance in t eaching concurrently at t he Taiwan University College of Me dicine, and Institute of Public H ealth, while a few of the latt er's professors, including one industrial C i)eid.st r y pr ofess or, ar e te aching our stur.Je nLs here. T~~ ching
Department:
The r esponsibility of teaching all t he college and vocational unde rgraduates, 's w~ ll
as in-se r vic e me dic :,l offic ers and enlis t ed men, is vested in fourte en Educat i onal pl anning, evaluation, and standar ds are in the hand. of
""!y! r t m "nts.
t el" n spe ct ivoo deans of m""icine , dentistry, nursing, pharma cy and service training. Thb t eaching of personnel and lepa rtm~ n t s
represent gr oupi ng of all allie d The Depart m ent of ~i omo rphics,
fi ~ ld.
t o ensure
econo~
~quipment.
for instance, unde rtakes
tn" t c.[' ching of various courses of bi 0l ogy, including pharmaceutic botany, gross and or phol ogy, et e., t hat of Bi ochemistry groups, the : icr oan' t omw, J evel opmental m .>
v:;ri ou8 br anch c.s of chemistry as well as pnysiologic chemistry under one departmmt. Par e_ sitol ogy , bncteriol ogy and pht hol ogy ar e gr ouped under the Depar tment of Medical tliomorphic s . Surge ry include s general surgery and the specialties as well as Similar grouping obtains in t he l.lepartment of Medicine.
obst£. trics an:i gyn ecology.
Some
of the departm ents are also engaged in the pilot production of certain
exp"ndables netlded by civilians and t h" 1:.rme d forces, such alii pyrogen-free flui d
- 4 -
typhoid-cholera vaccine, and pharmaceutic preparations in common use. Summary: The NDHC has thus committed itself t o a pioneer system of medical education whereby 8 branches of medical personnel according t o 6 levels of education will be trained simt~t an0 ously
by t he centralization of available prof e ssional t eaching staff and The educati on of all types of personnel required
Lho r{,t ory 0quipment anu suppli"s. by..... ,me
service under on" a cademic institution will a lso ensur" close and better th~
cooperation among
gradua t e . in the field a s compar ed with a het er ogeneou
f, r our' of gradua te s drawn fr om v:,rious scnools.
- 5 -
Five provincial. or public hospitals have tuberculosis wards.~ Each one of all the health centers has got a BCG team and a laboratory for sputum culture. Nine of the 22 heelth centers have local tuberculosis clinics organized during the last 8 years. It is our a~ to organize a tuberculosis clinic for every health center. A BCG laboratory was established in 1952, & approved by the WHO in 1953. At present, it is under the administration of the Provincia.l Serum & Vaccine Laboratories.
III. 1.
Control measures: Protection of the un-infected: Over 5 million children under 20 had been tuberculin tested and over 3 million non-reactors vaccinated with BCG. ·rhis represents a coverage of o5% of the population under 25 years of age. The vaccine is being manufactured in Taipei since March 1953. During the last two years the vaccine produced has been much improved in its potency; the viable units per ml. of vaccine are no less than 10-20 million. The post-vaccination conversion rate is over 95%· More importance is stressea in the vaccination of pre-school children.
2.
Detection & treatment of the diseased:
7 mobile and L1- st a ti one ry units using 70 mm. films are available on thB island. Every year 300,000 to 400,000 are examined. Starting this years chest survey work is given free mainly to unorganized general population over 15 years of age. Efforts are made to complete more bacteriological examinations. F'orthe treatment of tuberculous patients, efforts have been made to strengthen the surgical service of existing TB hospi tBls and ambulatory chemotherBpy is used extensively. Startlng from March this year, all sputum positive cases are eligible to receive from the Government one year supply of isoniazid from the local health center. Up to the end of August, over 1,000 such cases have been registered in various health centers.
3·
Education: a) Professional -- WHO and ICA. are assisting to send each year a few people to study abroad. Classes for practical training of physicians, nurses, technicians and statistical clerks have been held in Taipei. These workshops last fran a few weeks to 6 months. To supervise the taking of drugs regularly s.t ·home and to educate the people for examins.tion and to follow up cases we hs.ve been pls.nning to trs.in a group of lay home visitors. Public education -- Through our actual work and the Taiwan TB Association public education has been carried out fairly extensively. A great p~oportion of the population are well-informed about the activi activities of ou'r program.
·$ept.. 23 ,. 1 95 7
Addition of TB beds in public hospitals totalling to 1,000.
t.
Extension of sputum examination to all health centers.
Tnining of
personnel
in eve1·y
aspect of the control work.
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IWROJ 400 , 256.691
扎叫叫包括交除勞及其特Ji '1 支出
I 1 色拾訓練班脅用及學員宿舍 i主集費 lê_1舌仿疹祭品、被全材料、協辦人前 j聿給及其他。 é'_ 拾補助嘉義及台 R 防治伐。?且主工程是在 ,
什稅收入
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320 , 918.50! 99 1. 124.96 ,
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WORK REPORT TAIWAN TUBERCULOSIS ASSOCIATION Tuberculosis is a communicable disease and involves all the people in the community, so long as sources of infection remain. Up to the end of the last Century the fight against tuberculosis was conducted by the individual doctor treating tuberculosis in individual patients, and did not involve community effort. Today, with modern developments in treatment and in the control of the disease, the campaign is carried on by the whole community in a co-operative effort. With this background, the Taiwan Tuberculosis Association was organized in August 1952 under the patronage ot Her Excellency Madame Chiang Kai-shek. Following the example set by Her Excellency, many people in Taiwan with social conscience and good will were enlisted in this war against an old enemy of the human race. A lump sum of $4,500,000 NT was appropriated by the Taiwan Provincial Government as the, initial fund for the Association in early 1953. A major part of this fund was spent in the procurement of equipment and supplies which were required to strengthen Mass Chest Survey work, to equip new Clinics, to increase the number of tuberculosis beds, and to strengthen local laboratories in the diagnosis of tuberculosis. These supplies were distributed to different agencies without charge, and in compliance with their needs. During the last four years, the Association's work can be summarized as follows:
Campaign for Membership Up to the end of 1956, 591 groups with 64,212 people joined the Association as group members. More than one hundred people joined the Association as life members.
Mass Chest Surveys The mobile X-ray teams consist of seven units which were 1953. Every part of the island has been visited. Up to the 1,005,571 people have been X-rayed, including 380,486 military cases of pulmonary tuberculosis have been discovered where known that there was disease. organized in September end of January 1957, personnel. Over 20,000 it was not previously
Addition of Beds for Tuberculosis The Association encourages existing hospitals to establish tuberculosis beds. These beds are equipped with supplies given free by the Association. Up to the end of 1956, the total number of beds allocated by various hospitals to tuberculosis cases exceeded 800. For the existing tuberculosis hospitals in the Province, surgical and X-ray services have also been irnproved by the donation of equipment from the Association. 1
Laboratory Diagnosis of Tuberculosis Since a diagnosis of tuberculosis cannot be made on a single X-ray picture, laboratory examination is necessary in order to avoid errors. In 1956 one technician from each of the 22 Health Centres in Taiwan was called to Taipei for a period of two months training in the methods of laboratory diagnosis of tuberculosis. Starting from March 1956, culture media for the culture of tubercle bacilli from sputum has been supplied to various Health Centres so that this examination can be given free to the patients. Complete sets of equipment necessary for this work such as incubators, centrifuges, staining racks and stains have also been donated to all these Centres. Up to the end of 1956, 2,663 sputum examinations have been made at these Health Centres.
Tuherculosis Control in School I eachers In order to minimize the chances of tukrculous infection in school children the Association has worked out a Project with the Provincial Department of Education to provide free treatment for all cases of tuberculosis discovered among school teachers in the Province. Und~r the agreement, every school teacher and worker receives an X.ray examination each year. All those who are found to have active tuberculous disease are given free antimicrobials as indicated and the necessary. follow-up examinations for a period of one year. Those who need surgical treatment or who suffer from acute forms of the disease arc admitted to hospital for free treatment. Up to the end of January 1957, 34,364 teachers and workers have already been examined. 1,980 cases, or 5.8% of those examined were found to have tuberculosis. 716 were given isoniazid alone, 430 were treated with combined isoniazid and PAS, 48 were recommended to be admitted to hospital. This indicates that there were 3.5% n~quiring treatment.
Relief of Charity Cases The Association contributes funds for the medical care of indigent patients 111 various tuberculosis hospitals. Each case is limited to $200.00 NT per month for not more than six months. During the last five years, 448 patients with 49,974 patient days of hospitalisation were benefitted. A sum of $356,361.55 NT were spent on this programme. Besides this amount for inpatients, $7,855 NT were spent for out-patient treatment, $18,320 NT were spent for 52 beds erected in relief houses, and $46,000 NT were spent for blood transfusions for 12 patients.
Building the First Dispensary of Ihe Association in Taipei In view of the rapid increase in population and in tuberculosis cases in Taipei, it has been found that the only tuberculosis clinic, the Taipei Tuberculosis Centre, IS unable to cope with the demand. The Association therefore planned to build a new Centre in 1955 in order to meet the needs of the city. A piece of land was acquired from the Bank of Taiwan and constructicn was commenced in September 1956. A sum of $184,000 NT was spent for the land while the construction will cost the Association $1,575,519 NT. The Centre is expected to open in July 1957.
2 -
Support to BCG I eams From 1949 to 1954 the operation of the UNICEF assisted BCG program for Taiwan was maintained by JCRR. After withdrawal of JCRR from this work, the Association assumed responsibility for the maintenance of the 24 BCG teams in various parts of Taiwan. Each team receives a sum of $1,000.00 NT per month when a target number of testings have been reached for the month. During the last two years a sum of $320, 918.50 NT has been spent for this purpose. Up to the end of January 1957, almost 4.9 million children in Taiwan have been tuberculin tested and more than 2.8 million of non-reactors have been vaccinated with BCG. This vast number of BCG vaccinations will certainly change the picture of tuberculosis in Taiwan in the next ten to fifteen years.
Training of Personnel and Public Educalion The Association has financed various trammg classes offered by the Taipei Tuberculosis Centre. These include the training of physicians, nurses, X-ray and laboratary technicians. In 1954 and 1955, two physicians and two nurses were sent to Japan for a tuberculosis course offered by the Japanese Tuberculosis Association. "Diagnostic Standards and Treatment of Pulmonary Tuberculosis" was published by the Association and was distributed to all practising physicians in Taivvan. Consultation groups were also organized by the Association to travel on the Island to give lectures and clinical demonstrations to various hospitals and local physicians associations. Pamphlets and posters were printed and distributed for the community and for tuberculosis patients. Exhibits and movies were also shown in association with the mass chest survey work.
Christmas Seals and Card Sales Starting from 1953, the Association issued Christmas Seals every year. Ret urns have increased year by year, viz. 1953 $ 54,744.43 NT 1954 $ 158,454.05 NT 1955 $1,230,452.40 NT That for 1956 has not yet b~en concluded but Is expected to yield $1.5 million.
Financial Roport Income
(January 1953 to December 1956)
Government Appropriation Membership Due Examination Fee Contributions Seal Sales Bank Interest Miscellaneous Total
NT 4,500,000.00 625,977.00 774,181.00 18,134.07 1,538,713.64 2,010,293.30 66,426.00 9,533,731.31
3 -
Expenditures Initial Personnel Office Supplie:> Furniture Training School Teachers Project TB Centers Constn)ction BCG Teams Maintenance First Dispensary Medical Equipment and Supplies Maintenance of MCS Team Examination Fee & Other Clinics Supervisory Travel & Per Diem Laboratory Equipment & Supplies Custom Duty and Transportation Relief for Charity Patients Publicity Printing of Seals etc. Scholarship Miscellaneous Total
29,288.50 277,126.00 99,325.37 17,837.50 186,780.48 400,256.69 45,000.00 320,918.50 991,124.96 3,088,131.41 811,378.01 162,844.62 5,337.90 162,478.42 349,677.35 428,530.55 311,257.35 155,629.70 82,969.64 21,273.80 7,947,160.75 1,586,570:56
Balance
-
4 -
據估計本翁的有結核病人十入萬人，而會已發覺有為者不超過五吐為人，其他為人皆已有為而不合覺，著戶旦發作，往往治 療困難，贊錢費時，如何仗這部份病人早日發覺有病，乃是本省防森工作成敗的主要關鍵。現在本省所有的 X 光和檢驗設備早 已初具規棋，如何能接進為廣大氏卑服務，是中心課題之戶，為求檢生等及至社會基層之每一家庭和氏卑，則免費之檢益非在 所必行。
為人發現之後，必需有職稱管理其治療及改撿，和追蹤其家屬之性為可能，這類工作品需附設於當地衛生機構以免錯綜宮夜 ，但是工作得多，人員勢必增加，管界衛生組織建議本省每戶縣市衛生院下設立戶伶核病防治所、，負責拌理上項工作，為求對 病人才造者管理與治療起見，應收其早日實現。
過去醫師治為，每日二三十人，今日因診察方法之進步結核為之醫師則每天可為錢古人，同待發現為人亦隨之加多，需要 ..
其他各稜工作人員更多，諸如護士、技街員、檢驗員可記錄員、家庭訪純真等等人員，也均視我拉訓練以應需要o 本省卡介苗族稜工作實行已經六年 ，對於永舉結核病之發生，將有粒大預防妨力，如何使更多更年幼的兒童族稜卡介苗，
以發摔其效泉，亦為不可稍懈之工作。 無家可歸之開放性患者仍以繼緝設法于以隔離，以減少社會中傳奈之舉源。 以上所租來，為今日防森工作之中心課題，以目前本省的財力物力，并非可望而不可反者，鑒於政府已盡最大努力，雖逐年 增加防海經費，然以為人數目龐大，絕非政府單獨可以負擔者，我防海協令仍應本諸過去協助政府之原則，繼犧努力積極致力 決該項惜健衛氏工作，得快成此建國火索。
。
筒
三元六角四分。四十五年度發行之四十六年防縣票須待三月中方能給算，仿計約可指符戶百五十餘萬元。發行四次難每年均有 顯著之進步，但仍難獲各界之了解，而能會動勢幼投偽掠縛，且能等遂使用者為數不多，反需要社令人士的全力而且不齡的支
持，犬量弱輸造成熱心防海之間叭氛，籌符仿縣級費節省政府擔負，以完成防森工作。 本A 骨肉食氏因四十二年♂月獲符政府撥幼防品所專款起至氏國四十五年十二月底止，經費收入總額為祈台幣旭、五三三一、扣三 一元三角一兮，其中政府椅助費佔屯 ，仿海紀念品義賣收入佔立 -NCM W 弱， 弱 ，令員會費收入佔趴-3MW X
。
、
呻吟 W -SMW 光檢生費收入佔∞ -HMM 弱 ，各界捐款估。
v、
Mm -ZMW 弱，什項收入估。﹒三 弱，銀行存款利息收入口 -SMW 弱。經脅支出總額為訢台幣上可他四
L 孔
W ? NUM W MW 、戶， 一 呻吟，她什公 費 ( 0元之角五分。其中間甜付費估。 ﹒ 強， 弱 ，購置費佔。 -NNM 弱 ，特別費估。﹒立dm 弱廿 ，耕備佔戶主 MW k0 元豆角六 弱，一事業費佔2.3MW 獎金佔。 -EMW 呻吟，以上收支兩拭計結存經費台幣一、五八六、五 弱，文化教育費估。-2MW 、上屯二 元主角戶分外，本會可動局對僅訢台幣 KOA分。是項結存款內除應行保留之教育人員防治費新台幣入入三、 kkiz K的 入占川、 000 元，撫順街土地差額椅償費遠同 元入角五分，然截止本年度的抖了僅本會附設第戶結核病防治所營建費水付款 濟南路土地上房屋收購費的需新台幣四十餘萬元，其他應付永付款尚未計算在內，即使上年度發行仿海票收入一百五十其元， 應扣除係仰的教育人員防治費預算一百二十沌，元外，餘三十萬元即為本會本年度最可靠之收入。所以下年度本令之經費品會將成為 最嚴空問題?為須積極籌措，除即刻開源節流，並須加強勒草工作，件使工作總蜻採辰，且能維持長久，完成本省之防辦事會 ，造福千萬軍氏火車。妥據處年本會收支實況且案列經費概況報告表決后
今後展望
結核為在人類絕路的可能，因為各稜防治方法的進步，已有十分批搓而逐激接述。問題僅在如何在最短期間促其實現，以 減少人力財力的損耗。本省的防森工作，經過幾年辜的努力，和各方面的投助，在結核為死亡率方面，已經有很大繃著的改糙 ，氏周三十六年本省的結核病死亡率是每十萬人口死二百入十五人，四十四年則只有六十扣人弱，入年之中死亡率﹒如此生述的
下降，在管界土都是不易多符的，但是談到病人方面，則局勢的改變，就不會如此之迅速，相反的，因為很多的病人因防治方
法的進步而先決死亡，活著的病人便會相對的增加，故而目前這段艱苦的時期，勢必要努力扭過才能符到戶八個較好的境地 o
迫四五年卒，也各方面的研究，知道結核病的治療可以籍著格物而收到意外的故泉，晶晶夫多數的病人可以用熱物的治療，
不需要更改他原辜的生活方式，而快報健康，勢院的林位，又很拾收治怠憐的患者和需要外科治療的病人，你目前本省的情形 而言，已不需要再增加病床，而是需要翁粒的更有效的利用已有病床。對余學物的使用，希望更加哥逸，使病人絕不致因為經 濟困難而不能接受治療，所以免費的集物治療是勢在必行的。
••
穴」
持村里犬 AT 講演防品均常識，同時放映衛生教育影片。組織學生隊於街頭勸售防森紀念祟。印發傳單二十五萬份。
十、獎勵防森工作之研、究及選送臀殺人員出國進修
本會為求本省仿品均享曹建設越清理想，拉力獎勵替師人員對此加結核為之研究及著作，為深邊防森工作人材，，每年選送嵐呵護 人員出頭進修o四十三年還咕咚導師傅祖且，進去，按秀蘭:四十四年送進替師卒梯元，護主費月霜赴日本進修一。該員均已給訓叫起 圈，仍間尿服務機關工作。並法四十二年三月派楊組長忍橡赴日本校察結核病防治事業建設及保險剩度以及防券法剩，跨國從 並提出具體方素以供本省防游事業推廣之借鏡，四十三年又資助楊忠棒勢何赴西班牙出席圓際胸膛為科學會及防海令議，四十 J 五年會資助合大醫學院紫曙教授赴日講學。 十
、貧苦志 者施臀 工 作
為志救濟問題是一個最古且雞摸解決的社會問題，因為它不僅是為人的替格問題，而必須連帶其家庭之維持以及一施行手街 時需要輸入犬量的血液等會用的籌劃問題，所以這已成為推行防海運動的一大障礙。本令限法救濟之經費尚無法籌符基金逐屑 ，故暫時在全省公立勢院長期保持三封張床位，每月攜幼以不超過二百元為原則(不包括伙食費)，計已核准稽幼入十入來， 五年舉受益志者四四入人，總住院 a 數四旭、犯之四天，本今負擔詩集各視台幣三五六、三六一元五角五分，並於四十四年他月 K、 匙開峙椅功省之台北結核病防治院門診部門診患者，受忽﹒患者一他六人，本人骨肉計負擔替學費 台 幣入五五元。此外，並協助 省立，台扎扎救濟院與省立台北結核為防治院令她付給核病療接室及烏偕勢院增設結核為來，本令撥贈病床及附屬也借五十二份，以 h 收容會告誨，你之為人，且將月撥功每來營養費四十元，受 患者四六六人次，本會計負擔戶入、三二 0 元，伴以改善為志之伙食 計十二人，使用血液二 0 、
。益台四十五年起每月購用血淚台幣二為元，協助會告病人施行胸腔叫作叫什手衍，使他們亦能獲符最耕療法的機會?去年受急安 花五 0 公撮，本會負擔台幣四六、000 元。 ..
經費來決
本今抓晶晶四合四十二年領到省政府投幼防海專款一學台幣四百五十氓，丸，為充實本海防海設施及三軍等進檢皇之用外，其他 T 本 經費則以會費收入及利息收入充之 of向外界捕時關:A 從 符 其 拔 經 費 ， 實 無 其 事 。 弱 款 收 入 合 成 立 迄 今 僅 收到函際扶輪社等入 學令計台幣一一、入入 0 元且，故令務之推展至威，困難，尤其是從事為品吼叫救濟工作，在在 因需 此錢 本令台四十二年間指試行 仿飲料」界各國防海協會發售防海慈善紀念票為籌車經費之主要財源。先從計郎平持四次，前三次共計溺符合幣一、五三入、扣一 ••
/'-
i\.
、推行華盛 紛來工 作
結核為之診齡叫僅以X 光檢查尚不能確定為人是否從中帶笛，能否傳染別人。如泉驗來可以普進推行，不但能收獲發現最空 要為人之故采，而且可節省一華鹿犬的 X 先攝影材料的消花，減少一般人做健康檢盔的負擔。本會鑒法當前國家財政困難，人 VA
氏生活程度峰造降低，而締結核為仍直接成迫是每一個人，防治工作乃刻不容緩的事，的確有需要積拉而每進推行是項工作之
o 必要:于方面守節省每年鵡入 光攝影材料的大學外陸，另一方面因免費驗夜可收使人人易洽接受檢金 益在國外及本省購買 大社檢驗儀器及材料，舉持檢驗人員訓練班，調制各縣市衛生院工作人員，給訓從即分發各項椅助器材，益與各該院簽定令作 符淺，台四十五年三月起實花，也本令統製心結核菌垮接墓，免費足量供應各該院微咳夜培接檢驗，同時呼識，問掌聲師令作，並 印宣傳柏固標語五稜各五斗!張兮發各縣市衛生院所加強宣傳，力求普遍推行。因各縣市為籌備及宣傳工作進行之批梢，致上年
度僅檢 在三、六六三人，工作頗不理想，今筱仍得多方面改進，我極推行。 ..
九、防森工作人員訓練及衛生教育工作
推行防森工作彪看萱衛生教育宣傳工作及工作人員之訓練。本省防森工作人員甚為缺乏，致仗工作永能全面普通展悶，尤 其是結核病的療法，迫十年率已有顯著之進步，治冷府的新路不銜的發明而被採用。本人?為提高工作人員素臂，每年定期調村 各項防森工作人員，介紹，新的跨學常識。四十五年史也令政府與管界衛生組織簽定防務技術人員訓練計割，份制列經費預算，聘 請專家專台協同舉拌各項訓練。並份制印防海專叫什叢書兮發工作人員，侍供段時參考進修。對於一般氏卑反病人刑法堂教育，講 解防治常識及輔導治療，仗?般人對於結核病有正確的認識。激起人人警覺，個個防舟，以前抒發企氏互助互皇之精神。本會曾 編印防海常識秘扇三千份(每份十二稜)分贈全省各級學校可衛生峰療院所及社令教育機構等。又一編換「心結核病答客問」、「 時川縣病人須知」、「害人特悶禍記」、「防海常識」等防、海叢書，八司、給學校及三軍戰士，或收工本費等供一般氏卑閱讀，以資 按犬宣傳。假電台翩然拌防海講座，紅令檢生工作在各縣市鄉鎮從捌此舉拌仿海展覽令，放映衛生教育電影及教發宣傳品十餘稜五 十其份ho上年度又在國外婚入防海影片五部、錄者磯、幻燈機等，法本令四週年紀念時俄中山安放映電影二場，招待各界反本 o 兮兮員，同﹒時放映幻燈片一，用雄奇帶加解說明，頗收室傳效 采 上年十二月八日至二十四日一過聯令衛生處可教育龐舉拌「防 森逐動擴犬宣傳過」，發動全省各地同時舉行。'，該通活動 印發特刊，利用電台郎平辨率題講演、抬進閩台語格者創「平安是福 」'泉拌﹒苦樂欣賞會於節目中精拾防海宣傳妓話。濯製防券投語唱片一百張，分縛全省各電台及衛生院在當地各電影院飢令幻 燈姆拉丹輪流每場放映給鳴。全省中等學校翩然行防海作文比客，劉氏學校分別舉行持婦會計論有關各項防房問題。街﹒哼一所醫師、三 ••
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、教育人員 結核為 防 治 工 作
本會鑒份本省教育人員中結核為患者為教不少，因待遇微誨，鶴梁此為則不堪負擔其跨學費，尤其教員與學生生游相兵接 觸密悅，確規予以妥善防治及管理，方能防止學校中結核病之蔓延。特法四十四年十月聯令教育處、衛生處可農段會、教育令
o 是項防治經費由本會發行防海慈善紀念票款下撥丸，另立 等岫攸關座談，擬具防治計剖，且經政府核准實施，也本會執行持理
銀行專戶存入。會四十五年三月起先行展開檢金工作，拭主十二月底已完成百分之化十嫂。除合花縣、高雄縣、房東縣、台南 0 人 益經施以 X 光火 4月檢金 ou診斷 縣、澎湖縣永檢金外，計檢盎合花市等十 iz 縣市局教育人員三四可三六四人，其中三、一 -d給采發現有為者戶、化入 INAH 早 mINAH 治療者主?一(人，需用
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OM 戶年，第于次計發出特妨操 INA
4一 H 了 于 心 三 、 片 。 凡 騙 性 撿 畫 布 為 者 ， 每 三 個 月 或 六 個 月 複 撿 一 次 ， 每年規夜生四次，少者 片 ， P A S 、 二 屯 。 、 O O O O mu X供 先給 玲一片外接照檢主人數每 。呵。夜檢工作曲本會欲求各地方結核、為防治中心令作，除 二次，稜檢後診街病情再繼緝發 M絡 人給付十元之委北膏，已做過第二次改查者?也四人。其為情必須住院治療者也本會指定醫院分別介紹轉診，目前計有四十入
O 住院治療之為人?每月禎幼二百元反其所需之特效捧品，其必 人須蔣診，已有五人住進勞院，其中一人已施行胸膛外科手術 須施行手術者，戶切手椅費用及血液均由本會負擔，撿金給采及處神風情形依縣市分別并列份，后
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A T 如前背院十五屎，中俗、立合扎扎救濟能給核為療養室四十沫，烏偕務院十么， 來 ， 基 督 教 結 核現 為里 療接 院 三 十來，J 總計已核檢法們助 之百六十五來。凡每增加十來看另配贈使共戶口爪，每增加四十來者另恥總體會計戶台及為人率戶輛o 增加為沫四十沫以上確有 o X 需要考可﹒申，詩稿功夫 型 先 機 一 台 ， 獲 符 禎 功 者 計 中 郁 結 核 病 療 養 院 、 嘉 為 雪 給 核 病 療 養 院 椅 功 地 方 結 核 病 防治所小型 X 光 -所 AV O 機四合，台犬醫院胸膛料、省、又台北結核為防治院、台泉縣結核病防治所及基隆市結核病防治 各 符 禱 助 各 縣 市 為 衛 生 d A o 院、充實檢驗室設備二十二份，每份的位新台幣六仟依百元，包括離心器戶，台，孵卵器戶川自甘、浴繪 一 個 、 學 色 捧劑 檢 驗 用 其 試 2 三 日餘萬元。 管可紋路吶夜金、全球捧等。以上各項補助婚入之醫療檢驗器材計令新台 幣
、協助各醫療院學行患者診斷檢討令
高度咱們緻 o 計從迎合中、彰化、台南、海泉、澎湖等縣
本AT 為 提 高 診 街 水 準，以求越拾了紋。每年四次聘請防海專家組織一「診-療小姐」?定期從迎各受精劫之聲療院，舉行住 骨肉，協助研究院來技衍諸問題，並分別在各他舉行學椅專題講演兮，邀請當地勢卻參加，以激起工作人員 院患者為社診斷檢討 A 並編撰「結核病診衡與治療」、「台灣省結核為防治計劃」及「長 J 巾 ， O
期護理中讓去與為人的關像」三稜工作人員閱讀之叢書，計付印一萬冊，兮贈全省衛生導療院醫護人員反各地方時掌聲怖。
五、協拌結核品意測驗及卡介苗接種工作
本會繼農投入會之從台四十四年起輔助各縣市局卡介苗工作隊施行二十歲以下青年及幼兒結核菌素測驗及卡介苗族稜工作‘ 血。人，卡介苗族縫人數二、八一。、一入入人，將一工作人數每月由本會夫給工作禎 截至四十五年底止計測驗四、入入三 :47 功費，計核發新台幣二上四、四上他元豆角正。
立9
、增設本會附設第一結核病防治所
戶口光等進檢金工作，輔導新怠者說替治療，計軒在今扎扎市籌設第于結核病防治所，土地你永衛生處撥贈濟南路土地 為亂 λ 百餘，坪及本會收鱗該地上已建恭之磚造水造房屋各一九懼，一份與台灣銀行交務無順樹土地戶、。K 二 坪為建築基地。設計藍闢 )VA
平決四十三年十月完成，胡彼因土地斜紛引起訴訟，戶，冉拖延迄四十五年 K月方從符解決，也本會支付原個農兵裕等三入新台 幣一、八四、 000 元且，拉透出機置廢鐵，於是在兩年十月正式動工營途，也建設廳營建處系包工程，全部工程費的令新台幣
一、五上五、五一他元，預定在本年六月即可完成，正式辨理門診業務。
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二、推行集體的部X 光檢查且作
AX 先從退工作品千三輪?法周年 M 集體 X 先檢生工作，為本會中心工作之戶。四十二年本會以其金玉其五千元在 作 為進訢州 國 起月與衛生處聯令組成 X 先從過檢金總隊，特下 K 個分隊(每隊亂屬工作人員五名 1 工作率一輛，除駐台北、台尚可嘉義各戶 隊外，其餘年中總隊統一指摔逃過各縣市 0) ，會問抬迄今已完成逃避環島土地，主要的檢生對象是三軍戰士及學校師生，其 次是腎功入 AT 之機關團體令員，三軍戰士檢生免費，其餘僅收成本費五元，實為本今士掌龐犬的經費擔負o 故在由十五年♂月 起方改收成本費每人以台幣十元計算收費，令員、教育人員、學生，戒丰收費，三軍戰士仍為免費檢金。五年率計檢主照小片 屯入四、。他 0 人(包括學生一六六、一五 0 人 ， 教 員 四 旭 、 六 三 沁 人 ， 團 體 三 旭 豆 、 四 五二人，軍人三 K 二、入四沁人): k f A 販夫片四二、上入 0 人(包括學生三、于一(六人，教員三、二、尤屯人，團體戶占 川 、 二人，軍人戶旭、五入三人)。本會為 求澈成實施趣見，每當工作隊延過指定區域實行撿金工作之前，先派員赴該地區展開宣傳，來拌防海展覽會，放映電影，並深
入鄉鎮農村工作，同時召開地方座談兮，講述檢皇之意義，今鋪支持令作，以地方力會快進籌設防房中心，推動地方防森工作 。撿春一方淒 肯先年體拍照上十絡 X 先小片，有是似為社念，游行改盎叫你大片完成診斷發現新病人役，不詩人數多家或皇位遣返 即派導師分赴各團體，伯利指導就疇。 ••
三了一增設結 核為床 及 充 實 醫 療 檢 檢 設 備
防﹒森工作第一步驟是早期發現為人，第二步驟則須早日予以治癒，而本省公立替院，或、將來缺乏，或設備不足，永能充分 收容緒核為志者住院治療及持理門診業務，所以本令成立以卒，針對這個由航空之問題，拉力鼓勵全省公立醫院增設專絆拌理門 診，並劃出為房增加結核為來。同特鼓勵各縣市衛生院充實檢驗室設備協助咳來檢驗工作，並在當地設立緒核為防治所拌理門 u X 先機等替扁舟撿驗器材，以及在本省標將寸寸張病床設備，以各地實 呻吟工作，以也令整個計創之實施。由本會在關外購買犬 社 際需要分別椅助各該院。尤其現代結核為之治療方淒日趨進步，本省胸膛外叫什替師甚是缺少，去待迅速訓練補充，特鵡入一套 胸膛外科手術設備，裝革決心犯立台北結核為防治院，以供做結核外叫什之研究及訓練，透稿為息，以收其能早日脫離苦海恢復健 U M 每來包括織來一榨取、蚊帳戶頂可蚊帳加中戶付可毛毯-一件、 枕 頭 個 可枕頭套六個、?來早四件、乙 康。該項增設為來椅功 床單二件、滿腔將來一塊、體溫表戶口川、夜金加卅一個可紙來金二年用量，每泳金部椅幼物品絢價位訢台幣﹒壹仟貳佰元。計分亂 增設法省、立合為結核病防治院一二二來(其中上十五來不附贈其他配屬物品)，中﹒郁結核為來接院上十四沫，嘉為雪給核為海 各院六十來，關防部所屬療接院四十入來，家﹒融皆是所屬品給各院三百來，省、又今為醫院四十入來，省立花進醫院十六沫，省立澎 ••
在台花市。第一次令員夫人會通過一人計划意及工作計封，送來第一屆殘酷獄卒，並通過恭請蔣總統夫人為名譽理事長，先從聘請周至 T 諸 '扎扎名譽瘦﹒茅。 柔、鍾卒德、義斯、花幹丸、劉瑞恆、吳國禎可何作寄悔、蓋一顯光、鼠森、蔣夢麟、俞鴻鈞、革故可任顯 芳
組織情形
AWQ ，監察令務工 本人會以令員夫今為最高權力機講，以下設理事令，負責釐訂工作計封及編製預算，策 動 務之推行:監事 AY 作。也常務理事一人象總幹事，執行理事令決議索及徐帥加入骨的務，設副總幹事一人表助總幹事綠燈令務。益設業務、宣傳、財務
n 、總務四組分掌各組事務。本AV 工 作人員均以借調聘用為原則。
第一屆當選職員名單(四十一年入月四日當選) 理事長黃拍拍琴 常務理事顏春輝周石鍊昧、又份苦、添拼博 理事林謂之卷、垮火球夭順休雲龍 常甜耕地恥刑事劉傳車 監事許企德杜聰明洪許春持球 第二屆當選職員名竿(四十四年三月十日當選) 理事長黃朝琴 常務理事顏春輝 周百鍊 陶學錦 禹
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郭健秋
業務概況 、徵求會員工作
本會為擴展今務之推行，扮成立之始即品進社令熱心防療事葉之各界人士入今為永久會員，得集思廣益，從事防游事業之 建設，計徵符石餘人支持參加。同時在各縣市唐山徵棧關固體骨幼入令，已絆入令者五站立憫團體計六四、二一二人。
肺結核為是一稜慢性的傳染病，摔在低叮咚進步的現代，至今還汶有一稜旅絕的療法，所以一個人一旦受采椎病，中間可能
拖上好我年，終日戶均為魔斜纏煩惱，花費大會金錢食不用說，精神與身體的消拉史是空犬，尤其是它深入社會底層，致使多數 會上蝸蜻蔓延， 國氏的健康遭受成 AWO 窮人符病，因為而更窮，又好詩為忌縣以維持現狀，甚至於拖到不治而死。讓病苗在社 λ 到處傳揚，造成一般封給肺結核病的悠怖心理，這梭錯誤觀念的存在，對法國家社今建設的確是很大的阻礙，去須迅速到除， 以增進氏族因家的當時惜。
肺結核病雖然頑強難治，但最迫五十年卒，由於管理與治療的進步，其死亡率已大為減少:因此說明了肺結核為如能予以 適當之管理，防志決永然，早期品結治，是絕對有拌法防止杜絕的。几推行公共衛生工作，實統一項疾病的防治計割，為求推行
善進且成功，原是相當費錢的事當.，所以要防止肺結核病合然亦需要一學相當可觀的經費、永文功不可!一個國家的防森工作的
椎動，是不可能你的執政府少數的醫護人員和有限的經費在短期之內獨力完成的，而必須有社今廣大的力量舉支持，共同策動， 和防森工作變成三視社會逐動，為了台衛免受傳染，人人會動為防海逐動作後店，或貢獻技能，或解衰弱獻，這樣方能互助救 ，而不再詩為己叫聲，以維護犬多數人的安全，快使防森工作順利推行，人人的健康方有條障 •• 1.
AV 濟，品吼叫人及乙:仗不幸禪患肺結核病的窮苦人均能從符答療的機 苟，以及在休接期間個人與家庭生活的經濟問題能夠從符解決
本會成立之役，本若以聯令熱心防海之機關團體各界人士推進防游事業增進氏族健康之宗旨改組展開工作活動，至今將屆 五年，這五年辜的成就離我們的理想這很遠，但由於這個且可通防縣教育的問抬 「早期發現，早期治療，早期痊在 o 」已擊破 了戶般人傳統性錯誤的的游觀念，認識了肺結核病已不可怕!因此已激起了社令金氏的刊注意、同情與支持。所以已有許多機關
團體紛紛申請入令族受檢金，更有詐多人肯練悅解囊捐贈我們的防海慈善紀念祟，以財力幫助我們，本會符有今日，以及自梭 的繼結發展，唯有輯決社令人去企力及不斷的支持才能完成使命!
成立經過
氏圓四十一年之月間蔣總統夫人關懷金困軍氏的健康遭受肺結核為侵襲之威脅，乃本盯上月十主日在陽明山召谷中外人士 舉行防海座談人咿呀，即席倡導仿品所逆動，就召全氏提高警覺，消滅肺結核病以增進氏族國家的當強。同人等深品完成召，妥特發起 組織「台灣省防海協會」以主其事。挂在同年主月廿四日在陽明山召開籌備會，草擬人會章，正函邀右前何時誡人會議員、金省衛生 醫療機構主管、各界人氏團體領導者及社令熱心仿、游慈善事業之人士參加入會共策進行。述決同年入月四日正式成、叉，令扯設
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台灣街防海協會成、立五年家工作總報告
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Honorary President Madame Chiang visiting the TB exhibit.
BCG Vaccination to children under 20 years of age.
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the Taipei Provincial TB Control Center Hospital with by the association. equipment donated
SCHOOL HEALTH PROGRAM IN TAIViAN, CHINA September 1957
Intro'duction:The Provincial Den: c~rtment of Educe don began to stf'engthen sehool health work in the year 1951 by organizing a eommi ttee on school health and appointing a scnool health supervisor who was detailed from Provincial Health .Administration., To initiate an overall school health program 11
a short two-week training co1.-.rse for health teachers·. one from eaeh school; was conducted in the summer of 1951 with JCRR assistance. elementary schools 11 a total of 1139 teachers were trained. Out of 1242 Each teacher
served as a nucleus in his or h0r school for the development of the school health and health education progrr.uns. At the same time, the Provincial
Departlllent of Education promulgated a minir:rum program of school health service that should be carried out in all the elementary schools. following year 1 247 school health workers 1
In the
cons is ted of nurses 11 midwives
or attendants were trained in school health service for a period of 4 weeks • The number of school health supervisors was also increased to four who travelled all over tho island r:u1d assisted in the development of school health work and health education prog;-rcms. The emphasis on the cclucc,tion L:. h~;c,l th
and health service of
normal· school students who will become te ochers of primary §chools was ~"<
put si nee ·1952 with ass is t1(ncc from the ABliflAC.
A book on
11
School Health
and Health Education 11 was published for tee:,.hing purpose in normal school and has since been used as a text. · Improvement of sanitary faoili ties 1 health education,, and health· services in normal schools and· also in their practicing schools where normal school students :receive their practical experiE:mce in teaching, was pushed by provision of financial and technical assistances, periodic supervision 11 training or "onfereooes, and provision of necessary medical supplies end health educetion materials. In view of
the shortage of qualified health .instructors in normal sehools a:ud in other high schools as well as the need of health edueationists in the field of: public health$ the Depari::n'l6nt of Physical Education in the Univer ... in 1954*'
s
was reorganized to ine1ude a DiviSion of Health graduates il1,
l!id'!lQat:J..on. will meet
r.L,ods ~.mth. in the 'atl:pply 'i
health t0;.\ob,$#s f'or
no~l ~~ao,~l.l
tm1 t.Jt. the re~nt...:.at of he~~ •4utatt.oni•tr for htalth ac•noiet iu tM tut~e. /
I'
With YmO/tmiCJF tu~eul,osie cont!'ol, traobomt;i, e.n4 3Ulk PF9fVAmt, .~
1ehool health tervioe in all the
~lementary
tohoOll. haw bfen greatly
t.mprowd.
There are now a tote.! ot 1478 alenwntary tohools with 29,285 ~ p~roentuge
.tehool teachers.
ot school attendance ot school age ohildren
in faiwan h now 91%.
The percentage of elemlilntary sahool
·a~~b .· The
.Aeearialit and hookworm intestu.tion found Ql'llong 116 1 000 students in Hsinehu, .Yutilin and Pingtung 11:-eteotures we.t 7':1'/o e.nd 20f. respectively in 1954. '
percentage of dental caries found among the school children was 7~ in all
primary school children,
Some statistical information on schools and school
h@alth is listed as follows for refereneest 'l'I£.~.
of School
lio. of School
No. ot Students 1,336,024 (M. 723,916) (F, 612,108) 170,425 (1:. 115,.259) (F. 55,166) 3, 165) 6,935 (M, (F. 3,1'70) 65,903 (M. (F.. 51 ,406)
Elementary Schools
14'78 168 10 97
High Schools Normal Schools Vocational Schools
(Nursing, Agrioul ture, ' Business, Industrinl, Home Economics ) Universities, Collegos, & Taohnioal Schools
14,497)
17
22,492 (M.
(F.
18,599) 3,893)
Percentage of Studonts W1 th Leading Physical Detects found ~ong the entire School Children During the years 1951 and 1955
Phxsieal
De~eots
%in''19sl 22.70 2.40
%in
1955 lo27
Pedioul.oeils So abies
o.o4 ..-.o:c-"'"'.....
Tinea ot Scalp Trachoma & Oonjuno~~tia
.·1~··~~1..-, .
4 ..11
73.56 (1954•55)
64.00
(1955~56)
Percentage ot students with nutritional defioieneias found among 1019 elementary stUdents in in rval. area~ 4ving a IUI'WJ" dcme ~a 1914
Riboflavin Defieienoy fhi~ine (mild)
7\f/o
Deficiency
Vitami!le A
60% 10% 10% j
1Jiacin Defioieney .Anemi.a
lS% 1";1
,,...~j
J',*t
"*"""''
~en ~inimum ~
Standard ot Sehool '
H~ulth Ser~iees . . _.,. ''•'.
!~Health oducc.tion~
liealth clc.ss0s
'\'liSe~
.. ,1,;1' y~ oacn -.., . ·"· "'l'' . 1· . ..... .-.. .... r,.,, ~• ,~ss ctS ._s I ,~ . • .l. , •• c;,J.• B
Houlth talks ... once
!reek. he~~lth
·""" Integrc~tcd
and corrclt:,ted exercises~
teaching .. such r.s hso.lth so¥1gs.
plr:.ys
1
arts, oxtro.-ourricu:lur r.;ctivith;;;• eta.
:c::cal th monitors - 'iF.;<Jkly :rr.s.: tir:u~s for tr(dninE. Hcn.• l th hc,bi ts formc,tion me surcs ~~nd
pr:\cticcs.
'Iieekly health teaching theme prccra:n Yfith health por;ters, nevm bullAtin~.
aud related activities.
l1others and sister clubs orcanized by each class - tvdce per term. Individual talks.
Berning inspections - daily 2. Physical examinations! Hew students ··· required for every· student
Old students - 3rd and 5tb grades (n:.icrofilm chest exam.ination
by T. B. control proe;nc1) Re·,.exB.mini:\tion of physical dcfect;s - 2nd &.nd 4th g;rad,;s
3.
Correctior, of physical d6fects, cttrricd v'lt ire th•: scho·)ls: Pedic G0 8.1Ji.G s :~s
I
v -;;_
t~·-""eatmcrlt
by DDT
t,:·:1 (; n. ··~_.
Slllfur -
oi:ntrrL·~~rt..t
Tinea of s .l-c l r1 ;a.:o:::.: sc
tr0atrn~nt u:ndt.~r
by spocial Salicylic Solution truchor.n~u
Trach.o:rn8. s.r:.d co:n.jur:.cti vi tis ~·t.
cv:1trol
prccr&:·~l
J··Tonthl:y "'il6ir;hi2·1:. ~ ~nd bif..;.D..::lu£11 heit;ht B8o.surt)r:~·~:nt.
5.
ProvE::nti vc innc.cul::.tions: BCG - urLdcr ~~~~B,
Ccntrol
pror~rf;_y.-j
Srlull-p:")X Chol~·~rr~
~Tc.. ccir1G.ti\Jn
- :acv:; studt:rlt c.x1C.
uilCO
i-r1 0\.:"C)r;/ tv;o
ytJt~rs
L;J1d typJ:1c·id
j_n:1'1(Ci.J.lt.ti('n -
dono b:;r l:.. ~c:.~l hoalth oac~:J
stG.l.lC)YlS
e'"\.rcrv ,,
t:N~;
-..,rcnrs v
6.
AE:dicc,l scrvics in
tho~
scr")cls
~
First &id Refer
mu~sur~s
-
d~ily.
c~csos
for hospi tc.l
hc.~:l th st~'tion
or pri vuts physicicm ts
t:r~c.:,tiJ.cnts c
7~
Imp:t"ovC'1l6llc of school sc.ni t 2·oi1~tt
t:l..,n l:,nd f . cili:tios
~
Drinking water supply Cleanliness and orderness of school premises 8. School teacher and employee's health service: Conference~
and disc1:ssions in school health ... in-servibe training
in health education. Ppysical examinations and correction of defencts - X-ray exam. once a year. Sick leave pri vilages - for T.B. ce.ses only. 9. Reports and Redords: Statistics - report - monthly Records - standardized forms
... 2-
Ta.hran, d';·5cna·
{Addi1:donal report to lr::rJ:Ot s reoort)
\·:-ith a
Cor;trol Frojeet., Taiwan, was iniciated in August 1953 to pro-viding ,.ererea1 disease control services for all pregnant ::JO:;~:en ;.:n::d chi1.d:'on and: tiltirnately ~ to establishing a· comorehensi vc verere1:1l dic":a::;e control programrr:e. for the 1;,rhole island~ The HHO has provided technical a::::sista-c:r:.:e an:~ som::o sunolies, a11e:l the TJ.t.'ICEF ~ the JCRR and the ICA have nrovided r'3.tcr·!£.aj_ and :t'inancial' assistancoo .. Ver;s~·eal-,diseaE:es
vie~:J
2 .. 'a) V:J C~_,/~rc·:_ Center _. ': \
..
flt:e of 1ilFC' '7D Control
Team~
Oru cldv·isor o:t' 1'JBC' 1 \TD Control Yedical Qfi'icer_, '"·
or.;-·:.c:"'; of J'Trrtic'i11al 7TJ Team:
5
m:;c-iGnl of-ficers, 1 serolordst, 4 nubile he8.lth nurses~·· 1 hE:)aJth educator: 1 e;'·:~pnly officer, 1 secretary, 1 tMst, 2 clerks1. 4. r' :···1 .,.,, c q ·r•d on co h.·" ndv:_b 0;,;-. . 'J (.: ~) .... _,. " , .... ..L
n
......
(~
-'"
'-'
<::~
~
t.-'
'
rrain l~
f~::;tion
of the 'TO Ccntrol Centsr is
1hiki r:~; T):l.c-n ,;:1 VD c ')rtrol ·c::s.i::;ll\~
2.,
tno health and
medic~l
nersonnel on the mOdern 'JD control
method
3e · h"
being resp:>nsj.ble for the \.TD demonstration clinic s·co-p'lying drugs:- equinrr.en.:ts., rerY:irt f.ciririsard records t·o locc.l . . op:.;:n-:ies"· .:: dng loc·al h:::3lth and medical agerici.e~r
1-fD 'cc<rt'rol a.'ctf:vities
6.
·,..rnlfor:mi.n;;; rep~:::ting forms a:nd recdrd keer}itig rro.king e7aluatton of th·3 nrog;ra!TLme
7, ~·-\ •.oi
TrrD'"' ·, t· · , ' J.J,:;nno:nsc.r.?£ Ton c•· · ...J. n1.c (l} 111edical servic~ on YD (2)
as a tra:n::.ng cent~~ of 7D 0ofltrbl f r:;·~ ~:1nel
:"T
local hP.:olth c.nd medical
··~~
IrBl\'ing
snec~~.T
st!Jriies
i mei:tigai~i ng the ontacted :>er:s{)_ns a-n~ fol1o'f,r t'.lD the p<=\tii~nts::, )
:_ 'TD heRlth edueatior:a,
~' '
'
''
T~e
Re:fer:en<:;e Laboratory b~ing resno.nsible for stat1dard:i::zing,serologidal test.?of syphilis. . .
(2)
,as a training s~nter of 'JD, ;LE>bor.~tory te~bRloi,CJ.n eval:r:ating and standardizing the te<::lJTJique of the local te-e h mc i.<rns 0 s-pSdial study and rese!7oh .on VD serology. hio-ohemistry and micro. bacter]. ology~
(J) (.:;)
\.:::>,-
/',..)
. s upcr'v-i sing 1 0 c a l la bor<1t orie s.
r
_Local 'l.abcr:J,.ories
:rHcnty local laboratories Here .established in addition to the Reference L:-bo~::rtory~ di.striouting over the whole isl:ln:'i.a. .(c)
hi9 local 'health :.md midical insJ;.:ttutions;are participating in the rjr o;j·~o·'~ i !)(~ 1_, udi ng~'
(I) ( ,;\
22
he2~~th
canters
·.Z;
.363 b.aclth cBntc::cs ...... .i d "t.!T
. r.c-la . 1 h •t a l s o\n . OSPJ.
,\•,\ . +)
,., . . l ' -A/ murllC~l,P2~ .:lrrJ COUv•t.Y
h. ·+ l OSt"lv'-1
S
(S)
The.. 'l'"'hran N:::tion8.1 University HosnitP_.l :J.m the ?~CH-G.enter .r..£ ::kl'tt"J · . ... of the Pro-vincb.l. T-::!i':lei Nursing. School
'i-'.J.§DLnf~0p.§.;r;:r:~~1.£.n
1953 ~dth~ vi-21.v to nrovi:1ing v::mer-3al, se :1se contro], services f>or all progn'"nt r.rom:m and childrenr:nd., ulti.m::..tely;. to estc:tblishing l.J-19 service units. diStributing ov:3r thco Nhol·:; isl~m:"'· l'h:3 nroject 1·Jas started in August
Al1. i!rorldng service unit were r3q_u.sst3d to collect blood ;snecimsns from individ:J!ll case 2.S foJ!";ows. All OP:J D''BtL:;nts of children be3ri ng :?.ge grolilp*· i,• .;;., from 19 to y:.er.>s old atte .grouo·
45
(2) All po.ti;;n!:.s of AntG-natal CI;i..nic Cord blood ::t de~V?:r:'Y· All plzy :;:;i cal :1.n"~patient
ion at· hospital
3
11ass survey of spacial profession groups~ :url
SD
::;ci<?l
p_r,:;a vwro
r::;comm8ndod to
be c.onductsd by loc':J.l health agoncies
i.o~
(1) · prostitute, Dublic rc;staurant and tea room ..::ntertainc"Olr: h,oL_;l rr'<'J.id, food doalor, barb:;r, etc ..
(2)
factory ov<;>rkor free laborer sca-mc;n govcrP..rrt.nxt ornployeG
(3) ( 4)
(.5)
In order to reduce VD from· Tahvant a nur.bcr of 3 :rr.i:.l:L·m per:=: ons \·jhich are tho total nurrib:.:;r of from 19 to 45 years age group '\·.rill bo .::;zamin::;d by STS till tho end of 1960, Frbm tho iniciation to th·) ~end of 1957, ths ta:::~p;::fc m:rrrber cf STS Has sot L5 million.· So tho re~ining 1 .. 5 mi1L.on pc::: s:m' s 1.,;1.11 b:.: :;:x2min:;d by STS after 3 years by th,::; ond of 1960o Bosid:::;s this:> intcmsifiod p.:;rm-·m:.:Jnt '3ffortb to control sp.:;ci2,i 1-l.t',)fc::o:;;i<J::J grorr9c:," and beth rogi::;tc;rod or non:-rc;gistoc~d nrostitr:t::s Hili. . (:;mphas:..z,:;d ·':<J l~·c.s:l health t:ln:..·t-s, At tho sam3 tim?. tho bc~st w.:"lne:o t,.-, cc:.o\1-:::r VD :.s int·3r:sif:ving .. .. : .. .._ hJa1th education~ Continuous suw·'lY of oealth S>::lt.catic-::::>1 ::c2t als: 2.nd appJ.icablc tschnique and skill Hill bs giv::m to local ·Fc;:ckinv tmi.tsc ~
'
-,
'
'
On tho othor
ha;Jd~·th-:;c.qmn?.ign
of th:;
rri.~Litn.cy
sido 8J_so
stm~:>~c3
irorr; JtJly 19.57:
c oo:r'di nat i ng by t h:.; VD C o11tr ol C--:;Tit 2ro
In c'rdsr to :rn22t the urBctic<'ll r.::::od, a r3g:Ul"l.tion c;J :or ::::pc':l. ration,.
vJ 7
con'::.r··l is u:x:?r
To gGt the .Jff,:;ctiv3 r.:;sult of VD carrne>.ign, th::; nr·l.v-a.t.:; y;:c2t:;C,i n;::; doc~i~ors ?end midwivas r.',;_.~y C\ i:rnportant ro1Ge So -w:s are going- to r::;qu·:)st th3SJ :l:.rat::; practitio!:t::::r to particip?t.:; in ~JD carrpaign. For th·::; Dj-lot study jf t':lis ' progratmw;; Hst-chih Chen and 3a1u Ch::m Hero scL:ct::;d for this p:.~rpo::::ao Ard thG Hsi--chih Ch:::n st~rt0d l2st S:;r•t-3rrb:;L Up to A~:f:ust 195'1 311 s-;J::;cim:ns ever:.; coll.Jct:;d.,
' ... 4-
}
Tha folloHing table shm·rs tnotihly activit:i:c3s of Dl7ivate pt.!:!ctitibnsrs at <E>hi-ch:i:h Chen.
No. of STS 49 30 19 18 55 57 27 26 30 311 (1~JP)
}! o. of Reactor
:F~o .. '.~:'~ated
Dec .. 1956 Jan~
8 L~
4 7 1 1 20 0 13 0 2 ;~2 L~3
1957
F 3b. l~ar c J~.~·
1 2 20
r
~
1"ay
9 4 8
Jun, JuL AUf:,.
5 61
/
TOTAL
/F1
(19J:1)
Rsrrarks:
;to;L,
Porc:mt to th:; noou1ation of Shi-chih Chen., ' . ~
1fo2 • . Lbot.t one third of the rGactors requiring tr.::;atm:mt.
" LABO~TORY ·SEHVI.CE VEJJEREAL ois~::ASJ!: P~N·
.. · . i) WANG,M.D•
1958 . .
The GOv,erlliJlent .of. the Republic of China and the Worl<i. H.~lth ()rgatrl.~' zat-fon(~lijO) sponsered a VenerEW.lDisease(VD) ::~mtrol J>ro~ect. on th~ .bland Pro;;,; vince 9f'it:'~wan(Form()sa). Th~ project was initiated in theautum of' l953• TilE!. obj.ac:tives• of .t}lis project l>tere t!) t.rain medical and, ~ra!ttedil:.ll!-l perso~el iii the modern methOds of the detection, ;,reatmlmt and cont.rol of the venereal . dis.:.. eases. In the plan of operations for this project provisions were included for the es:t;a'bli~l:Unent of an ~sland-wide standardized VD serological laboratory ~:~ervice... '· . ... . wide~. It is sitJ.Iated abC>utlOO milef! .east and sol.\tli~st from tM mainl8Jld o f
·. .
Tai~n is an islanct
ot approximate:}.y · 2~0 D4les iorig l1nd 85 iniles
tqbac~o leaf al:l~·has••·a.l,llountain<:l'!s• area qovering ~bQu:t; .t~;,.thirdspf t}le islan<f.• · on,e,.;,third.·Of.:t;h~· is:l.~fid.a~ea J:s . coPs~d~J·ed ti:l.:l.al:>le.·. Its c~te· an~vegitation:
C}lina <and is.· iileP~~a'!;:e4 t~~.re i'rom/by. the Fortfl~an Stra.i'tt· It i$ .s~P~d~li~~ a· ·
vaey from temperate. in the north to tropical in t}le S<?\lth. I:t; has 4 major cit~~s -Ta:ipei(the ca.pital}artd Keelung(the major port of C3rttry)in the north;TMrmn: and K4:c;is.l1ung d.n. t.he> .south. The oiv:i.l:La.n population ~~'~ been estimated to .be · 9 11111.. ·lion. ..... Ce~ain: serological testf'l fo,r syphilis h~d. beeJ1 available .o11 .the island prior to the advent of the newlyspensor:ed YD program. T.h,ese tef!;ts,however were not generally·made.available to.the publip ~s th~re.was.a chargemade.for the test performed. The tests were of' questionabl~ ~eactiv:ity as ther~ had no conscientious attempt nade fo'!' the standardization thereof',nor hadthere been attempted a co-or~ination of these activities. .
Th.e plan lor the' 9I'~lj.nizatiop. of t~e isJ,an<i-#d~ laboratopt service coordinated with that f9r the establishment. ().t' the .~erieral 1J1) program. A Demonstration Area was established .to .serve .as .a tl'aii)j.fig area for. all. personnel. The area .comprised.Taipei City,Taipei Hsien:(PrE!fect~e) tl.~<i·the port. city K$elung. The VD Contr:o.l Cerxter was locate~ .at ~~chou Rd.,TaiPei C:tty(,t'ormerly at ,the Provincial.Heal.tli CenterjTaipei City),and a VD DEII,Il():Qstratiof1 Clinic was esta.blished at the Provincial Taipei Hospit~l~ .~. Re.t'erence 14bo.x'B:tory was organized and.. est(:l.blished at. the Taiwan Se.rum Va.ccine Institute,.$li:ifb.:in,Taipei Prefecttire,abOut t!'IO miles outside the city qenter of Taipei. · · · · · · ~s
A ~otal·of 20 iaborator:ies,in a(ldition .to tlie Reference Laboratory, \rtere e.stablished with. qne laboratory l.oca.ted 111 each of the.Hsien in addition to. one lal)pratory in each of .the. major cities. Four laboratories l>tere·p.la~ed tor the Demonst'!'ation Area: Keelung Municipal HE)8.;Lth Center,Nt~.tional Tai'Wan ~nive,rsity M.edi (a teaching hospital associated with the ~Uona.l T.aiwan University.Medica.l College),Provineial. Taipei Hospital(Both ·in Taipei City) and ·~heReference La.boratocy at Shihliri.
1) Chief' Serolo8!St')Reference La.boratory,Taiwan VD Control Cenver · Taiwan Serwn Vaccine Institute,Shihlin,Taiwan
INf>LE.NENT.I).TION dF THE PLAN OF. ORGANIZATION
~ pro&t"am o1~act:lvitif'!f! was planned and I')Ubmitt~d ~o ttJe Coli!misioner of Health Aciministration,through channels.,tor his i'evie_w and/or approv.al:O This progr~ was approved in July 1954. .. . · A training center for laboratory!'J:lers.onnel lf8.S established at' the. ;Refer·erice l.llbQrato:ry,Taiwan Serum Vaccine Institute,in Octo'Qer 1953. Twenty~ one regular technicians were trai11~d during, the six-month period.ending 8 May1954 antl sev,en during the period 29 Novemberl954 to 19 January 1955. 'rhe tech~cians wer~ given al'l intensive e~ght w~eks training in not only' ;the performance of the· serological proce<l.ures ·adopted _for routine use b'Ut .also. in the operation <>_£ a' serological. _laborato:ry se.rvices. The Referenc~ taborato:ry also activel¢ partid-: pated,.in the. training. o£ medicml and nursing personnel. The trainin~ inv<>lved the laboril.tory ·a$pects .of the VD progrlUII. · · · · '!;he firs;t ntaj<>r ta'tik undertaken was the · diStribution, of· equipment and suPe:. })lies to labOratories 11nd the establishment of service. Pi-iority l(B.s--given t() · th~e areas_from which.medica:J. and.tl.lU's;tng personneJ,_,e,te undergoing training. at the ,vn C9ntrol Cet~.'ter .. Follo...,...up visits w?re. lllll~e to all laborat6ries .to ascertain the pro&t"eSf! made in in!Plf'!t,hent;ing the service am .to· render ~uch asSistance; as. }1light l?E'! ind:tcatec\. B;r t,be _en<l. ?f the 2nd quart.er 1954,there were 1d lli'QQrato~ des ip t'illl operati<m•. TwentY:-f,ir~t 1aboratories ~re in operation at tile epd of t.ije thir<l. q\larter and. the twent;y-t:trst ·_labo;ri¢oey ;ini\'iiated its sereie. on 16 Sep-:: tem'Qer l9-54(in the fourth <ltillrter). · • . · · . ·. • The t6now:l.ng is a o£ the laboratories that were established. inaddi""' tton to the .Referen~e La~rat6:ry: ·. .. Pro~n~ial ,OhiaY:t):lospital Ohangnua 'ijsien lie'alth .Genter H~l,;ntsu Hy-gerd.c :Laboratory Hwalien-Hslen Health·Center Ka,oshung Mul'licipal Health Center Kaoshung Hsien Health Center 'Ke~lung Municipal H:<h Oenter(For,mer!y:Provincial Keelung Hospital)· Miaoli· Hsien Health Center · ~pu ijsien Health Genter Uatio~l Tl4lf8.t1 University- Hospital( Taipei) Prpvinci~l, Pef1gnu Hospita; .. Tai~~ung,J.f\ll'l:toipl),l.H~th ·.Center Tainan Hsien HE'!a1tb C~nt;.er ._· ta:tne,.n ~cipal. Healtl\ .cen~~r(F'ormerl): Tainan Hospi~al) Pl'QvitJ.cial Taip~i Hosp:J:ta1 ·· .Ta!LtUtJ.~ H,sien Health C~ntel' Taoy-en H~ien·Hea1th Genter Yelan Hsien Health Center ,. tutU.in HE!i¢n Heal-th Center
list'
Pintoh~ flsien Health Oenter(Fomer!y:Provincial Pillgton Ho~pital)
Tl1~ ~picco!n~ny:i.ng this. report shows·the distribution.of the.labora.tottes
over the.islan9.
.
~
.
it1g
w~.re
OF TilE !SLAW..WIDE .tABoRA,TORY Sli:RVJ:cE ~ th ~b~ '·pi:o;am for ~h~ ~tanCiarCiizatioil or t}l~ l8.boi-~t~ry ~~1'\'ioe,ihe f~If<>wP1.1.t'SUed: . . . . a.sta.'rldardizati.on of equipment 2.Standardi~ti.on
. S'l'~I)A:RDIZATION .
·of techirlque
J•stari:iar<iizati.op of antigens and reagents 4:.U'rliforin·reporting and record keel'ing. ;.Research ai1dspecial.studies 6.SupeM'ision.a)ldcpordillati6t1 of the S.ervice 1 •. Standarsfl~tioJi..,t>t• EQuipme~' .· in~pected the ·conditions atld f~cilities or laboratories over the island (or. the¥ iili.tiatiop · of'•VD la'J:x:jratory 'Set"''UP~ A detaile¢ report of thiS,.. field~itl\festigation
At. the beginning of 1953, before the•projecf, started, the. 'chief ser<>logist
was submitted to WHO...UN1CE!i' Liaison OfticerTaipei. . . . . .· . . ln the selection of J.a})()ratorJr 'e(luipment.,Qonsideration was given to 11long te:m: 11 planning. As. it W&s riecessal7 for the· technicians .iti many ()f the laborat()"' ries to<perform other routine laboratory WQrk in Mdition to VD·Serology,a n'Wilber ·or the iteii!S were of a time~saving type to help facilitate the prompt handling of' an island..,wide average or 35,000 specimens per month or 420,000 specimens a ;tear~ This number of' specimens represented appro:x:l.mately ;% of the total eivilian P()pu"'! lation on the island and waif agreed upon by the Commissioner of'. Public Health Administration. All equipment,glasswa.re,etc.,supplied to the laboratories was similar to that .used in the Raf.erenee Laboratory. The minimum but itidispensable items and quantity. were supplied from the Control Center to whieh. the Refer.~nee Laboratory served as an advisor# unit. 2~ .Standardization < T~e
o:f 'l'el:lhnigge . . . . following receired consideration: . . , •. (a). Traimng of' tecJtmcians. in the performance. of inoder1:1 13tandard •· serot~~ gi• .te~ts for syphilis... ·. (b) Pedodic chec.k of procedures used in the laboratories (c) An annual eval~tion of
test performance of each laboratory
(d). Refresher courses . ·(a) ?Jrainittg o£. Tecpriio,ians. A training Center was established at the Reference Laborato.ry. A mimeographed . Chinese translation· of t!te serological procedures ~sed. in t.he Referenc.e Laporatoey was prepared for distribution .to·all trainees. T.he technicians were . 't~ai:tled in the performance of .VDRL Slide( cardiolipin) and Kahn Standard(Cru<ie ). 'l'!1!13tf:l. ·+tt the appliCfltion of'.thes~ tests,the f'ollow:!-ng J."OUtine was adopted: the firllt .serological test was the \tDRL test. All. reactit1gand certain nopreacting sera we:r:e routinely titrated with VDRL slide te13t to. deter!nine .~he degree 9f rea~!:ti~ty.~ . Ce~ain non-reactive sera .were titrated to av,oid. the. missing of specimens with zonal reactions. '!'he. Kahn standa:l:'d test was performed upon all VDRL :r:e~ct;ing sera ~s a second t~st. All VDRL non-reactorlSI were reporteq as II nonrea:ctive( ... )tt. All reacting \I'DRL sera were repc>rted as "reactive(,£) or 11weakl;y reS:ctive(~) together with the degree of ref,lctivity determined. "All ser~(tested .•~th Kahn test were reported· as 11 re,active(f), weakly reactive(.;) or !lon-reactive {-)". Formerly used ter!ninology of positive,doubtful and negative was discarded
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· .. f:~11?~n~~~bE! r~C()mlllenaa~-ton of'; thl? S~l)coliUj;~~E!,ott ~e~:lqg.t. ~~k;~~l,'~ .· ot the WllO Expem:, Comtni.tt$e on Vener~l· Int'ection an!i .Trepohe:matoses ~· · ' ··.·. ..>' ,' . .. '
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.· ; ' ~~~- ~~#~atl~~ ·a~~~~ntit~ti~e %IfL tu~e ~~~t wi~• p~rform~~:~P~~.~~~n~l ;•. f'luid -~peoimens• With the receipt of' e. speotrophottneter in the. spring: of' 1955:, tot!l.l protein determination. upon spinal'f'luids ~s initiat.eli in tbedl.ef'erfi)nce Laboratol.'Y• · · .
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were given an intensive training: in· n<?t o.nfy the perf'ol'l1!8,nce of' tt}e .routine· tests ad<>pted at. the. Ref'ereJ1ce Laboratory but. practic(:J but prf!ctice bacter~olog:icaJ. ex~tion related to yenereal diseases and also practi~e in the operat:l,on .of a' se:I:'Qlog:ical laborat"<>ri service• · . · The drganized· training courses were sUillllleriZed as follows: A) Regular co.urse~ _P,m:!od. Qct.l953 .. May 1954
All
te~hnicians
~Pa5!£~n!nts 21. re~r .·technicians
LenJm!l.,.Q:f;,;.~QJ.!rse 2 ll!l>ntha · f38.ch .2 ll!l>nt~s
.each
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int.erested in VD ser()l().. 1!3.
4 technicit~..ns
who ~ere
l lllOnth each
Aprfl.l956 · (2 courses) April & June 195'7 · (2 courses)
20 regular technicians
l weekeach 1 week each
30 regular and assist• ance .t-echnicians
· . . N.:ew techl'J,icians or assistant technicians f'or re}?laeement or supple)ne~ were.. acce~ed any- ·titne for training at the Reference Laboratocy besi4es · those o~gani~E)d. tt'!!.ining. c<>l.U."ses: One .f'r¢1JI. .Provincial Taipei Hospit~ in 19~9· · ~d one from Tainan Hsien Health 'Center Laborat'ocy in 1~58. ·. · · · ·• · : ' '
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B~sides ·those SE)rological training; the Reference Laborat<:>ry par,\;ieipated in )ll8.fi1 tra'fr4ng cour~>es f'or medical doctors. and nurst}s .. eon'clucted by the. V D Control Center. · The .chiet"'~terologist of' the Ref'erence LabOratory ~s invited once in a tea.r to make. a special lecture on the VD .serology to the 4th yet~.r ~lass of .the mE:~dical students'of the National TaiWan UniversityMediealCo:Llege~;TaipE)i•
• .. ;\ , '$;f!Ol'!-~:)_;t. ~ft13~ the gomple"bion df the third training COUl:"Se :fo~ t!3¢hni.cj:atls(May ;J;9?4hthe •serological· procedures u~eli in. th~ !le:ference.• J.,aporatory.we:re · §ltalldardizeq~· . In thi~ proced\ll'e,specirnens With established .clinical .• d:J;agnof!iS;•• were used. The' VD Demonstration Clinic cooperated 'in I!Jaking. thf;lse specime~s ava:i..lctbl~. The VDR:t.< slide and Kahn sb,ndard tests were standair:'d;t.zed a,t a higll:J..ev.~l· • of test· perfc:>rlnl:lnce" These tes.ts were periodically checked .to. ascertain tha,t .the level of test performan~e had been maintained.. . . . • . . ·•• ··• · Appreciating the fact that technicians. trained. to per.t'orm certain labo~ •·... ratory ·procedures nay introduce errors :J;n tEichnique ·unless S\lpervised or checlceli, .provision Was.made forthE! periodic visitation o:f all laboratories . by the chief sero.logist of the .Re[erence Laboratory •. These visits were made o.1 an .average of once each ·3 01:":4 months lirid involved not .only a check of tb.e procedures employed but· the general .operation. of .the ·laborat()ries. All . 21 laborator;ies were ·operatfng in a. sat±sfa.ctory manner. • · · . (c) Annual
EV~I~tion
of 'l'.echnicians' ·Test .Performance
.· .. ··. •.·•····. · . 'l'o turther a.scertain wheth.ei' the technicians· were main~aipi,ng a t:tat.i~.,. [agt<.)J;-y ;teve:t. of test. performance, the 11Fir~;~t <lliina Sut"'Tey of Serological Tests to~ SyPh:i,;i;is{l) was••inf.tiated ill., Wovenll:>er 1954 atld .'\omple"bed i~ .Ja.tl.l955.• "' :~:_.·~·\~;:·: .·,<:::'·;· .·: /:·' ·'; ,· . ..:.·. - · . ·. . ', ·: · ':::'':.<: . ,' ·:·. -,-· f . '· · . . : . ... • "iw~nty labo:r:atories were entereq .·in il~~s Sl!rvey,incl.uding· the. R~feX'~!l .~e: La'bpratpry for the study• TM tests stu(i:l;ed ·.were .tt1ose rou~inely .. per~C?rlned.,.: VD.RL .slide and l{ahn ~;~tandarli tests;, ].finilli.Um ~atandardsfor both specifipit;y( the ... ·.· r~Pm'ting .o:.. nonreacting specimens as "non-reactive") a,nd rea,ctivity(the reporting of reacting specimet'ls as 11 reactive") were provisionally adopted fol' each test prior to the ·initiation of the survey. Participating la.bora.torie~ ~ere encoil.l:'ae;ed to attain satisfactory test perf.ormance rating With each of their tests entered fbr .evaluation. The minimum standards for. attainment-for each. te!Jt were: : : to '\)e no less than 99 .. o% to··'\)!'!. no more than 10% less t}lan .that attainell by the R~f'~:~nence Laboratory' with the same te.st and in. the ...$/:l.ilte s~eY•
A.; high ..level :of test Perfor,ll\ilnce ·lolaiS o'\)se~rved ~ong the J11 borator;.il;)s ~ . . ...·.. Nirieteen laP~'J;-ator:t:es (includ:l;ng .the.}\C!lference La.;bora,tory)a.ttained sa,.. tisfact<?ry test .per.t'orma,nce ratings With• the ~.RL slide t~pt< ;(}Jle +aboratQry :f'ail~. to meet tht:l• xn;L~ .~tanctard t<?r .6\pecitic:tty althougll itfl sendtin"by pe:r;centage were. sati~;~taoto:cy-;and. one laboratorY: Withdrew .from the study.,. ' ' '
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·that ~tta.ine(i<satiStactot';r test ratings With the Kahn standard test;. two· la,})ora.,., tories faile.4 .to .meet. tlle mi~.. stantla.rd for? r~activ-:tty altltol18h .• their;· .s~eci:fj,~·. ·city percentage w:ere satisfa¢tory-;and one lctboratory withdrew from the surtf,l:r~ · .oile l~boratol'Y railed to mee"b .the ~ ~t.a.ndards f~r, both tests;·: the . . . .. ·. . otner :J..a})o~atory f'~ileq t9 !)teet ~he"m:tninlu.l!l· sta,nciardfor ~ne. test~ The te!lhflicians :p~J:'!t'qWJtlng .the t.ssts in tfi~ fol'lller laboratory h~~ 119t he en tra~neli at •. the .Rete~ ··· ~fl.e La,poi'atoxj. He -was a,ub~;~titutiug ~or th,e regula%'. technician· who was a1:)~ent .. from d~y. •The.,·la.t"ber ).aboratory tec~cia.n had .been trained·. at. the· Ref'eren!)e labo t'at()t'Y,;. ·
·~,-~~ere were eight~m laboratories(iricludihg the Reference ~h<>ratoey)
The ..survey l#ls.c:omp],eted at ve.rt litt~e·.cost $n~qn~~;'~~~c~~~~~gcr~~~~.~;. ~ were .prepared. fro1n exces;s ser'Wn col:Leeted in the various·);ioorator1t:)S • . a.rter; .· alll'Qutine• t~sts ··1lad;oeen c;j;lJiple.ted~ They we:rre selleetecJ .at1d J>9<>~ed<bY: • typ~ :and frozen solid in the.·. freHzing compartment of the electri~. refJ;'iMra~o:rr ... Th~ se]:!ll: wei'e.'eoliectled fl:'c:>m these ··laoorato:rries at .the t.~e .o.t'. tl1e ped0d.i.6 :V::i;sits . and tl:'Ansport.ed .to ..the. Reference Laooratory:f<>_r.. f:tnal storage•·~$ •the:re., were.·. .·• ayai1~ble a supply of tubes .and rubber stopp@s,t1teret wafl no . need fot .~dd:\t~<>.rlei:l plli'Qhaaes~ Wi;th· ;the laboratories. using antigens and' rellgents prev.ioua:Ly ~Ppf:C>,Y~ ·. bythe Reference Laboratory,no lldditi<;mal suppl.y was indicated .. .Empty qigarr.ett!3. · can~ and newspapers were• salvaged for use in Pf!.cking .an~ mailing theun.known.speci.... mens• by regist~red parce1 post. The .only additional. cost..,there.foioe;wa~ .for pol:!t.":' . .·• . .··. . .· .. .•. .· .·•··. . .. . . . ···.. · . . •. > age . ·... ·. • . Similar .surveys we,re planne4 upon. an annual· baSi.s. · In apl:'ii .l9561an. e~alu-: at ion 's\ll'Vey was made .for the comparative study. of. the test reactiv~ty 8J!l0ng thl'! JiP<>ratol"ies. The quantitative testing of VDBL test was added to this s;ecorl<i>'eVa..· luation study. A special report was submitte.d to .the Regional Director regarding t,his survey in :which· a high level of the test · performance .was indicated. ~swve.t
· ·•· . The .ma:titteri~n~e ot a. sa.tf~taotory: level of test .P~~forman~e in'{olve; n~t;:t' on:Ly ttie ·.training o.t personnel t.o pr~per:Ly perform the tests an<\ ~ per:i.c:>(li¢ .<?heck of . th~•.· ~es'\1. performances .•·hilt •. tne. av&ilabiUty. ot . re:fresMr.courses;notr only ..tot- · ·,·• · , the corr.eot:Lon· o:f errors in technique> but training.· itt other VD labOratory work•. · .The'.tifue-to-time developments in>VDSerolog we.re giveninthe·'course,. This was· higltl:t llPf>reciated by ·'the · · - . . . participants.. '
·(.1\l~o see abOV'e 2(a)) •
3.. Standardization of. ,Antigens arut.~,&epj:.§. There was initiated the checking ot antigens and reageilttt used i.n. V D serology on. the island. These :l,t ems were checked .to ascertain flhether .they were ~atisf'acto:r'y. for use in ·r<mtine serology. All antigens u.sed in th~.is.h\nd4wide VD laboratory: service were· checked prio:t to issue P:v' the Referfilnce Laoorat9ry• Among the antigens checked were those imported anct preJ>ll::t<Eld:,loca:t:cy. 'to dat.e a "satis.tJa'c.tory for use 11 reP9rt had .b.een extendecl to 1'9lli' sltit:>Jner.tts o~ · ifuported; ·cardiolipin. antig~n .for .VDRL test (three shi~nts .from the Vnited &ta... tes and onefrom,Japan);three shipmet11Js 0filliported JQllin•standa;rd ~nt:tseni'rom t~e Unite(l Stat~&, and 0n~·>PI'e~red: l()cally(·. ttUnsatisf'actoey: 'for .Use 1! reports.' wer¢ extended to ·fi v~ batches ot ·Kahn standard antigen prel)ared locallY:• · Techn.ieians were·iMtru.cted•toUse'in.their rotuine tests on:Lycthose antigens at'!d. reagents llpproved b~ the Reference Laboratory:~ .
.· The~e was.~dop;tedfor ~se . by all labOratories a u,niform scheme the .rep()rting of >te:;t reaetions. rlre .1llflintenance of unii'o1'!11 simple reeoras. •s .·. ~1-: s.o a~opted. Two .. reports are P.tepared•.•lll0t1th:Ly bY' the tecnmeiatlf3 a~d· sublliitteci · ~~. 'both t.he ·Reference LabOratory and the VD · Control Cen&&r.;. One report inclUdes.< d~,t~ eono~i'ning n~t Qnly the xoltitne of Wol'k x:>erforliled during the mont'h bU.'~;' a 11 \:lreak•down" II thereof asrto .the SOl.lVoes o.t the specimens ,:tes.ted. Fcnur•cl~ssiw . fieations were. adopted: Health. Stations,Hos:pitals ,Pdifate Practitioners and •B~ veys. The second report involved an inventory repott concerlrl,ng reagent.s. . With the firstreport,,the>chief of the Reference Labqratory was continu.;. ousl~ kel)t informed. concerning labOratory ac:ti.vit;i.es. The second. 'report a;ssisted rnil.ter;ially in JMintaining a COntinUOUS supply of reagen\-S to. the laboratorie.s 1 thereby eliminating.local shortages. This infomration proved of value in main• ·· · t.liini.ng st'ock suonlies in Taipei.
to;
.. . ..... ,Ll\~er,in 195(,t~ese two r~pol'ts were comp~n~P.~nto,o11e ~nci~d~e~ ,t-,(};rit · th.e · c~.ssii'ication of .f'ir..st test and re-test cases.; Since J.llli 1957 ,thiS. ;cla$si:f:l."' catiqn,ha,s beel'l <\).dop:t~~ .• ·. . . . .· · , / ·.. ··.. . . ............... •··...• · ·. . ;, Tfi!l:)htl$cian~? were. in$tructed to.use in. their routine .r.eporting <,>f ~~st resuJ,ts' and reeo:t'4 .I<eeping that scheme aclPPt~d · by the Re£eren(l~ · Lagor.atoryt. · 'l'o fac:L:ritate in making a,<montply re.P.(>rt thv,s aciopted;daily log s~e~ts. of. t e :t t> p~rfq~~qe . we~e. supplifl!d t.o laboratories by· Reference. Ll\boJiatopr· . £or .• use ·.in classi.. · .fying and sJl1lllnerizing the :te~tre~u1ts on the test:i,ng day. This pro~edu,re.do'not- · · only eJ,inJ:i,na:te .an ~ccunrula,te(i wor~ at .tl:le en~I'.o.f. reporting period,~speciaily .t'ci.r those. heavily load.13d but basicall~ to assure a· correct informa:!:J..on; . •..-?
As no progressive labOratory service c~ long operate without an active ]'>articipation in reseiarch to .t'urthex· .improve its service.Jthere :wa,s ·. ihitia:ted a progt•am.of re.searches and special studies at the Reference LabOratory. Among the various problems ihit:i.ated or .in the "planning stage '' were. the .folloWing~ Special stud,iP&l a) Particiwtion in l:f!l~s survey and As~jsta."g!il' tg l.ab6ratox;:i lll. l'al'tici:' '. mtion o'(}fasp Survel• . . . . . • . . ·· ..· ... . . . . . 'l'he. Re.fer,el}ce Laborat.ory ;participatecl il'lntanY ~ss $Ul'Veys C()flclUI:)ted • by the VD 0t:?ntro1 Oenter and Health Centers. Assistance and guidan(}e was er.tven to · tne loc,al labQratories;in e'$tablis.I:>ing .a l' f:\.,eld. la,bo:r;'~tory u in conj\totiol'l w:i.:!<n s~rvey. Some o:t'<the d'a,ta thus obtained were shown in Tables 6,1 and 8. • .. ··· .·~·· .. • .· . The ''field la,borato:ryn served as a Source 9£ train:i.ilg for labQra-t:9i-Y'· .personnel in the· use of existing laboratory ~uipment to .estabJ,ish a mobile labora... t.ory £or bOth survey and demonsi,r11.tional. purposes. Two sucn a t;rpe o£ J..abo~atory units ha'lfe peen set up once at. Keelung Mining Village and once in Taipei Hsien. b) Compa.::rative Study involving oth~r recentl;r reported. Serological Tests · A comparative st~y .was initiat-ed ip. Febrmt~Y 195.5 in'lfolving t:h$'" VDJij,. slld.e(ca;rdio;Lip:l,n),Kl:l,p.e standard(cardio.) ~~hn $t~darq and MeinickeSlide ..• ... (~vittingen rnOdifi~aMon (l:>oth cr'l),de)tests. This st;ucty was tind.~r-l;aken ·(i)to cotttJ>are the e£.t'ectiveness .of these tests upon specimens. with an established .cUnical d:f.:a:gnosis,and(2)to ascertain'whether the Kahn Standard 'l'.est u.S,ed by the 1 .aboratory could be replaced by a. less time-cons'llllli.ng test wi:tho1.1-t a · .s.acri.t'ace of qwili . . . . . · ···· . . .service . ~
VDiq:; slide test as .a confil'l!i11tory. test by which .qualitative .·at'Jd quantitative. tests. wou1d be carried·out.,2) · ..· . • . •
2,$7~routine s~citnens.,tne. s~·up of· J{line standard""VDIU.. slide test system was sug• gest:l,ve. .fora poutine .procedure~ICI,ine standard test as a screening.proced~e and .
. .
.Oonclu.dl3<1 .from the res\llts. obta,ined with 43.3. cl~hical mat~ria;t.s .and
... ·.. · ... Portn~y's Differential 'l'est for Leprous ~?era and ~hilitic Sera·was t.r.ied on more tf1an 100 clinical.·ma:terials,but it seetttfi that n() di.t':t'erentiation can be Jllade on the borderline reaction o£ syPhilitic ~ nonsyp)tilitic.cases(1957) '' ' '' ; :. ; ~, ~ ' '
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·•• Recently the. Reference ·Ll\boratbry .nas been en~aging in a . ~t'JdY o£ eholipe,_VDRI. -antigen( origill8lly. developed. by-.· Dr •. Portnoy .tor·. Rapid· Plasn\j! 'l'est · ) $pl{~O~unhe.ated Sel'Ulll$. From the prelindrtary results,i~ seems that this pro.:. cedlll'~ was very promiss~ng for practical application and the antigen susP,et1Si()n. h~$ S'o .t'~ 'been able· to keep for more than eight days without.
. .· . .. !~ eo-~~:rat~on with 'Vf) Co~t~I.Center ~an. eJ>id~ologicai ~~e;s;'~b~~ . •._ prostitutes and other proJriiscuous women were cart"ied ·out/. in"Peitou(l956.h'l'~i~ Ci1;r,Keelimg City,~oshtu.ig .City(l957)and Taipei· Oit;y-(;t9;S)~ If1 th.is 'stuq:,'GO c~~~e was' made oy. t}fe Reference Laoorat·oey'. Throughout/ 1;hese · .• st'Udies)OO Meqitllll ~t·b.;P~~ase(Pehic:LUina.se,Difco ),PAB, etc was· used.· Positive ctiltt.tres weZ,e' ..idElll-) ·tified,.Pt:· motjh0lo~ of typical.colony,o:lddase test. and 'l"inally byvfermentat~?n,·· · test•·. Altogether 966 of pr6stitutesarid pz:omis'buous women were submitted'tor .· c\¥t~al study and tij~ 'positive cUlture rates varied troin 9.9% o£ Ta,inan C .i t ;r .to the highest 39% of Taipei Cit;r.3,4) . . . .. . . ,. .. ·. The author recognized that an Oxidase test with a typical mO;rpholog of colo~ ,is suf'fic~erit f~r the. indi.eation of 00 on the discharge obtained from cervix· eanal,\U'ethra(female)Qr Ba~holin gland. 'All of the typical (hd;dase 'l''ests were.:further confirmed as 00 by fermentation test With almost none exCI:lpl;ion~ TrichOmonas .Was .at ·the same tiloo examined on a s~ll: group of th. by randum sa.!JipUng and was found 26.9% positive.;in another. group of 'i'~ Room Gir;t.s, . .only 1.7% was fpund positive. Most of the latter group were teen-agers.; Ebcami·
., ;natiop was made on ·fresh smear o.n1y.;
~;e'Referenoe .Laboratorr·'pa~ic:l.Nlt® .fn th:e'Inter..;J.8.ooratory'.•serologic.·. •Etao· lua.tion Study con<{uQt:.ea by Vener~+ Dis~se R~tH!a~clf Labo.ratory,01tamble~,u~s.A•. • ·· The last Sh.ipment:for F~Y. 1956 ·of 2!) paired ~own s~ecimens )IS.S te~ted .with VJ)RL Siide1IO.ine Standard . and Kalin tests. The Cb.amble!i) Research Laboratory jucigea:· "· •••• ~the dupl.i,cate testing in Sbihlin LabOratory waS geiierally excellent.• The VDRL slide test 'was ope'rated i~ Both laboratories at a similar level. • : ••• • •• 11 .
><tJ!lh~*'~·m·.~.:§.l!to1mst.~a~uaM~Sn ··Stwtt for
Ff"h;!-9$t.•·
.
ThEi. Reference 'Laboratory .further particiNlted. in the study (•for F.Y. 1957, started in Jtayl9;6 and .comp:J_et~d in June 19$7 • The result,s hav~ .been. published by VDRt)Chamblee,u.s. and the IJ~rization of the comparative resUlts was shoWri 4.~ Table 4,. The Reference Laboratory contin\l'ed in partic~pa.ting in/thl:l sitllilai' study tor .i\Y. 19~8 · · e)•Ser6log3.cl!lvaluation of NetherJ.andNew·Guin~ . . The Reference LabOra'!;oey Undertaok a serol!)gl.c evalua.tion 6f. Netherland. . . N(iw Guinea. i~ June-;Beptemoer' 1957. 135 serum spec~ens were received and. tesiied · with VJmL,Kline arid Kolmer Simplified Tests( all cardiolipin). Fr6JI( t~e results o~tained• by bo!ih lab6ra'J;oz:7, the Reference·. Laboratory has ·an opinon that . tbe . · VDJIL t.el't performed at Netherland New Guir!.ea was 1110rt;~ reactive than that ootair!.ed in ..Taiwan. ·
shipedto U;s. tti:lsearch
:tn co-operat:J.on ·with vDRt, Ch~blee ,u.s.A.
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:tor TPI .and TPCF:tests' at Chamblee..;
l31;~er\im specimens· .haye beep . . .
It lt.is bee~ 1ltfo~zed for .some t~e that the stati:lard. se;rological tests·. for syphil,is are. not · sufficiently .speci.tic fCir syphi;Lb when performed upon sera frOim leppous Nltients. The Use of the TrJUlSnema J!!lli4l1Jrt AtW,utination · U upon s~ra from non~leprous patients has been reported s.pecit~c tor syp • .•· . . ·., · With the maintemance .of the N;t:ehOls • strain of Treponema; J>!lli4D in rabbits under climatic condit:tGns of 'l'aiwap Without/ the aid o£ air-condftiohi~ .:eor t;heir hGusing,there was undertaken the preparation of antigen for use in this test •. I n co-operation with the Inte.rnational Treponematosifl Center(WHO) at. the Johns Hopkins University School of Publie Health,Baltimore,M!:I.(U.s.A),there wa~ un4ertaken a
<>ll. 'l';ai~-· '1'1l#:~ ~t)ldy .·wa,sW'!d~rh~kenin 09nj)lrtction ldt.h a. ma:as :~Jurtey'made' at _the J>ro'll;~ncial ~ve:rmnent Leprosarium,about ·15_ Il)iles _out. side. of Ta~pe:r~. where &,1,3.~4%. ~nc~dence ot syphilis ;wa:s reported~ The rest9-£ was present eo at th.e · ••· 51st<·Qeneral AsseJ!lbl.y of the Formosan MedicalAssociation in 1957:•. f>)
,~iiij:,~ftcdete~~~e~tter the/lUW~es~ ·-.was :!Jp~oiJ'io'·foJ:-',syphihs 'llm~~g . lepe~$
. 'l'h~. sel'<>i!>J~i ~abgl'!lt~ry service Ul supervized by.the chief of the_ Reference I.aborato:cy.He is respon~:~ible t9 the chief of the VD Control Oenter,Ta.ipe;t for all laboratory activities. . . .. . ,· .. s\';tp,erv:Lsing, th:e .service;th~ chief of the_ Refe:rence I.aborathr.y not only maintains CIO%ltin\lo:Us irillo:rllla:t;ton cqncerning laboratory activities by means o· f ~n'liJWrt repo,rt.s(referl'ed t,o Pl'evio:usl.y)and the encouragement; of technicians to contao.t him.should a problem arise in which they are una.ple to al'rivl!! at a satiaf!l.ct.5)ry .~olt1tion~ b~. ~~~Jo b:r.. vi.~.iting El!lch laboratol';y on. an average- o£_ once each · ;tihree or 4 m()nfips(refe:t)red,to previousl.y). During these visits,not onl.y are the sel"o~o#ca:I;.. p:t)oce<fures .che(l~ed but tl'le general operation of the. labciriitories. is r~Y'i!;l~. ',1\d:rlso:ri' assistance i~ rendered to th:e Health Genter Directors and VD Cdritrol Officers" when requested._ . _ . ____ . . _. . · · ...•.. ·• ... ,',As '!ih~:re .~e presen~ geo.g:raphical_ dif,t!iculi;ie.~ • for the transmlssion of · :OPJ.J.i~dtea · b1o.od spe«;imens iri · s<>me areas served by the laboratories, satisfaetoey 'lf()t<k~ arrangement~ wer~ initiated. Utillzin~ _loc~:l. bus,r.a~roac}.,Jtiotor..cyc:I.es( allo9B.tr¢d b:V_UN!Cm &Jelm_to some·hea:t,tttcemersas.a-pilot ·plan):.and· mess!<!l:)ger se:VW,ces to transmit speciJnens to a key health station that in turn relayed tp.em: t_o .tl'le iabo_ratories in satisfactory condition after bei~ in transit about. t w o days, Recentl.y a· pilot stUdy wa,s ihitiatea for s~bmittirig; merthiolated _serum especial;L;r for· cord bloodtHi'l"om tnose'health stations tar 'off the labor~tot.}t. This means _that serum ·specimen has to be separated at the health station either by hand·OPerated•or electric--cli'nieal_ ce11trifuge. This p~eedure can preve)1t hemolysis Qf •eo:Uected bloo.d -( esp. qo1'd. bl,opg,} atid _ thus· avoid:' spailing of.· specimen~ once collected wtt:Lch .iS the most ~isagreeable to the laboratory and the sender~ · I~ eo..-operation With thE! chief of tl'le VD 00 ntrol Center,the :Lab5):t'atoey aci;;ivitiea.•on:th.e island are • c()ordinated with the gene·l;'al-·_VD program.· .. ,; . ·_ F0 1lol4ng the establishmeJlt of 2:L,.Ia,bo.ra.tories cool'dinated, .l4tb. ~he ~t~ai¢-ng pro~a.in$ at the. VI) oont.~l Center for me({;tca+ .and nursi~ personnel, i;P.er~.:was experi'encea···a• px<ogressivE!;increase ~J1-the·totaJ..·l:)umoer ·.c)r··s~~cimens tested. by the lah9ratories. All tests were Ill!lde free of charge. The dat~ was ··s'U!Illllel"bed in Tables ;1;,2,--3·, .·and Chart 1 and 2.·.· ·
.. In
· •••• •OlSCUSSION .•-.. · . . • r. s~~ndardized WJ sei-ological'laborato~ se~ces· have .beell in• oper~... tion in the_ United sta.tes Central America :for anumber of years..- MU:ch an~
conSt:t'Uct:J.ve g()od has .reslJlted there.:.from to 'both .physicians and labo:ratoey• . Th.e operation of' an accurate,dependaole and l"e!J.sonably promRt _ labora~f>:t'Y l!leM'ice cont.:t'ibutes Ill!lterially to the maintenance o£ not Only the confidence of the medical pro.fes&ion ~n that. servicebut. .cooperation with the general public he!llth programs in areas _served by these laboratories.. . . . _Making tteadily available these laborat9ry service free .of ~harge: to . t,he public thfough: the medical profession,greatl.y enhances. the opport~ties, for ~en~ral pu.'l;)lic·health.programs to reach the populations served in not Only detec- · i;li,ng.cases.of COp)Jlluni(!@.ble_disease_but.the:lr Control anq prevention~ c
Tab:Le );.~.~The progress,i.e" the totalspecimensteste<i,react9);'S,a~> • . percentage o+ react()rs .by·· the. Yetl.17 .fr9)Jl..l9$.3-..19~/. · · ·. • Tll.ble. 2 •••• "J;3I'eQ:-do~ 11o:f Table 1 by the. so~c~ ot. specimens,i.e,•. ·bf .. . . · Hea,lth .st;.a1;ion,s;;Hospita];s 'Private Pr&¢it~onel,'S ·.anct• ~.eYs• '.l'll.bl~ 3. • ••The specimens tested1 etc .bY area ~fid y~r~ • . . .. . . . Chart; 1. u .The progt'ess of the"1aboratory sei"Vd.ce:.. . ·.· •. ··.ohal1; ..2•••• The. graphic presef11;ation· o:f pe);'Ce~tag~s ~t• retl,~~ors.•by yeal,' Table 4 •••• 'l'he results o.f U.S'.P.H•SEY'a1uati~n study :for F.Y:.l9$7 ob· ·•· . . . . tain.G)i in Taiwan(~e:fererice Laborat:ory)•$llihlin) . .· .· ·.·.·· .•. . ·....'l'able <S •• • ll'he; classifiC~~.tiof1 of 349; 776 s~w specimens .b)'. }'l'Ofe~J~iiorf.
\> ;/
'·'
ofable>(. •••• ~is Of 9.)806 Survey ~Jpecimens .obtainEtc~ i.n the Northern 'l'aiWa.n ·and' Teat~ .at the Referen~e: Labor&t9r:v 1953,;..1957 . ....· · Table 7• ••••• An~s~s of< BlO(ld spec:ifuens ot. Sbi-chih 'tfllege:~Taipe; ..........•. · Prefecture and testea at the Reference Laboratoey ..in Deceniber . i956;..se,ptember 19$7. . . . . . . . . . .. . . .• ·. • •.. . . . \ ••• · '1'11.);le, s. ~··'!'he .lysi~;~ <>f 1.tl66'S~vey ·pe~en~. obtained ar ''.l'tid.s.an. . . . . .. Shi~;Taipei .fre.re~ure .and ·'l'ested bf the ~eferep\'.e La.tiQ~tor;y•. ·
....
gr<>UP,
•. ·.
•
·'
··•.·
· . · . ··
·u· . .· ·.· · • .·.•.•. ·... •
1n:
Fi~e 1. ~ .'J:Ihe ;Lo.cation o.f lalx>l'&tories. and poJ)Ulation; fi~s ,19,~ •.
"-\
)
l
t:hihtchu .. Health D!lpartmot~t Huallllrl Health Department
(b)
Pinotuno Pro:vlnclal H~spltol
@. Taichuno. Health Oep~rtmo!nt P.
® '
R•for<~nco Laboratory, Shihlln, Taipti~
® Taltuno Hecdth Department <!) {!) @ Taoyuan Heillth Deportment Yelon Health Oep.artmont
@ Taln~cl~l Ha~pltal @ Tal~on H~len H•alth bepartment Talp•l Provjnc;lo,l Hospital
(f)
Annual report by Taiwan Prqvlneial Health A'dmlnliltratlon;19S;l)
..·
.7otdl Jpecs. :7eJtetl . ~-.
!fear 19$.5~
numbeP Reactor J,.J.·q J
%R~
4Jfl
JJ.f·
JifS4, 118,126
2£857 18.5
llf55 .
4S~1Cf2 542,/0~
s1,627 4B,70J
//.}
!
.1956 \ ; ;
q.o 8.0 WANG
1''15 7
51 /;,34'1' 4C,754 ;•
. * =. lith ·'6·uarter
only
By P.N.
· I
Ttt#le 2.·~0i..rtrihution of Specimens 8y Sources .../'fJreiJ./<.-tfown'' of Table 1· · fear I
Hearth Stdtio.nJ
1/o~pita/s
·Private
Prd(litioners ·
SurveyJ Na. J~/?3
No. ,... .
%R '1\t>
No.
%R
No.
%/{
%R.
195!> ..
-
19.2 2£.407 41&7
-
20.0. .
4/q
!3. 1
fJ.Z.q_/8 Jq51J. 1:7,07/
/8.8
.·
.
22,2r_Q_ 1,_£.0.2. 3,4/q If.} JIJO 2J./. . .. 6,0.fq 1~20'1
7~f/q2 /q55 J0lli2 11.6 [J.6 10~'115 J-'l9J1 .. . JI6J/i.. 7J,J.J2 l'/56 10.0.
66~f!Stj
I£J64 141;7JJ 6~9YI
6.8
:J/,827
·,'!;
8.~$71
II. 7
l366 18.7 fl{)l/.6 I~J97
7,_3()8
4.8
. lf/27 ~-
~411'16
28;8?2'
8-4
.6_,262 ~537 . I
IIJ.O
l.$.4
'/Zfii.S 4.}· Jj928
.
•-
.. No.J'peeimens
No.'
ksteJ Reactot-s
2i7a;pei . I) ~, ( ' \,~
. .
))1/J /J./ .J~8{818.t '/228} /2.tf /IJI/114 1/.tJ 9&f?.l:
9.2 ~
·Shint.so · · 1~oyen
l<eelun1 11/iJ.()/ i
·
/O,tJ05 lf/.2 /6,fJII lf.7. 21Jif/ l2.J /2,)J1 tl..t . /h2J6 16JJ l'lto'ltJ~2 20;f23 BYl' . . . .· ·. 11J ·2J61& . . .
·
lf/antou 1) :;[ale. un1 · Cha n9hua ,,,,,··. . ·. ·h· .
lf_iinlln rbiityi Tainil.ll
city
TaintJ.n Prrf. J<aoshunj u'lj. tt~oshllllj Prel
6,72(1 1'1.2 lf/..61-2 !Jll 2Q,fl.f/li~2 2t747 f8 2,616 21.4 J5;fll 12.7. IJlJ6f·JQ.4 /J,,?/1. .8/l . . 2,,271l }/.} /4:,4}6 /0;} 18~!47 7.7 t4615 d.J . . /1,21/0 ll'l 41:,f66 /2./J 5})61 9.4. 64}?117.2 IO/If/tl 11i~ 6 21£186 9. 6 4.l428 §.ll. 4J/16J o.tl· /,137 2J.'I 24~!}7 6.8 19,267 6.1l IZ27J' 6~2 2,887 1'1.2 28,7'/J 7.5 }2}22 8.1 4l821 J.IJ 2/llJ 21J.B 22Jf87 'l8 l'lf/4 1.0 l6)1JI lf · lfl8 t/.1 1}/JJI 4.8 24l1Yl.J/l2!,80/ /1.}. ·
Plnjt()llj Pte!: .
'1.8 . 2.7'1? il>/J. tt$6)/ all- )!All f.8 24;114 6:'/. 8,ftf 14J J41i.lf. /tJ.2 4ZltJ27.4 14$61 5.1/. 2,JI2 24-ll It'Ill· zt~4 J~l-36 lJ.6 /.(6()/f./6.1/ 5/12() 17.2 11:.752 11/./ l7l/}fi1J.8' IZZ:?(l t/.8 . 1/181 2fl4 l}f7/ 12.2 l I~JJf 8/l &61f <il.9
2,1>6:
21.2 Jf~ol t'I;B 1~141 12.J ll/l21J
~ /Jtlrg:ut~rlef" only. .. . ·..· 1} ~lty~.tPrefecture comhineJ
lly P.JJ. WANG- .. ·
-1.3-
Table 4• U.s.P.H.S. Serologic Evaluation for F.Y.'l957 VDRL Slide Name ot tab. VDRL (Control) Taiwan (Shihlln} Washington Nevada New. Mexico Colorado California Test~ ea~o 1 l
-
Reprodu- %Reacti- Relative Rea:c!ivity eib!lity V:ty 99.50 40.7'5 99,.00 4lo50 t 6.75 100.00 99.00 95.00 99.00 99.50 100.00 100.00 98.50 44.50 4.3.00 .31.00 43.00 45.;75 .37.00 .39.00 4.3.75 .38.50 44.75 .38.;0 .36.50 .38.50
Percent Disagreement' More sens.Less sens'. Total
J.;o 4.. 50 4.00 1.2; 3.75 5•75 0 ·•. 0.50 4<>25 2.50 4.2; 1.;o 0.75 1.5.0
2.50, 1.00 2.00 )0.75 1.;o 1.00 .3.50 2.00 1.00 4.50 4.00 4.7; .3.SO .3;.25 0 0.25 2.(; 9.64
6.00 ;.50 6;.QO 12•90 5·25 6.75 .3.50 2.50 ;.25 7.00 . 4.75
·A ~.25 •• 9.75 f. 2•25
.;. .3.75
~gia . Dis'f!:tict of Columbia 100.00 Minnesota 99.50 Illinoia 100;.00 .1\.laska 98.00 99.00 'canada Oe!llllilrk 92,00 Hawaii 100.00 Mexico .98.50 Peru · 99.00 Virgin Island 87.14
Texas tttssoUri
:;. ;.co -.3.75 .. 1.75 f-.3.00 2.25 4.00 2.?5 4.25 2.·25 0.25 .3.75 6.25 1.25 4.32
. 40~50 44.50 47.25 42.00 .36.42 .39.50 45.50 .37.50
:;. •. :;. :.;. :;. ...
o.;o
4.00 6·•50 3.7;
3.00
6.rlt
5.00 6.2; 4.00 6.76 6.;o 15 .r.~;
;.;o ;.;o
Kolmer SilnElified VDRL(Contro1) l>r.Kolnter taiwan( Shihlin)
Test~ Cardio 1
l f 6.00 ... 1.7'1 :;. o.;o 6.00 2.25 2.00 .3.• 00 6.25 0.7; 2.00 Oo25 1.75 s.;o 1•51
99.00 92.00 ' 99.50
0.75 4.00 2.00
7.2; 6.25 4.00
100.. 00 Calitornia District of Columbia 100.00 98.00 ~rg:J.a 9g.oo Revada Wa~Jhington 99.00 97.50 CanaclEI.* ·Hawaii· 99.$0 99.50 ~moo Puerto Rico 99.49
40.00 42.50 46.00 .32.00 .39.50 .34.25 .35.75 48.;0, .39.90
£
f 6.;o - 7.50 i o.oo - 5.25 :;. 4.75 f 9.00 .;. 0.40
:;. .3.00
o.5o 0.25 g~25
3.50 6.;o 4.00 5·75 8.25 s.5o 2.77 9~00
2.00 5.;o 6.;o 0 1.26
Kline sttmdar.S '-test~ cardioal Taiwan( Shihlln)
I>.t-, Kline( Control) 98.48. 52.51 VDRL 99.00 ..54.00 99.00 46.50 42.00 47 •.00 4.3.25 51.00 44.50 5v.;o 43.00 4.3.00 52.00 49.50
:;. 1.49 - 6.01 ..10.51 - 5.51 ... l.5J.
3.27 0.2; 0 2.51
6.78
2.~6
5.5.3 7.0.3 . 10•05 10.05 Bo79 8.,04 7.54 8.29 11 .. 05 10.05 6.0.3 7.07
100~00 Arkansa·s Oalitornia 99.00 tlist:rde't of Colmn98.;0 bia. 98.00 ~org:J.a 100.00' ~~a$ Minnesota 97.00 100.00 •Ohio 99.00 Oregon 100.00 ~'irgin:l.a 100.00 Puerto Rico
10.05 . 7.54 7.54, 5;28 10.05 9.55 3.52 ;.o5 l~. 77
- 9.25 .. -
- 3.01
.8.01 2.01. 9.51 9.51 o•.51
3.27 0
0
8.79
1.00
3.01
o;.;o 2.51
2.02'
· 1(i:tlile5. Analysis qf34-'1,776 Survey Specimens JJy Profe~SJo.ns
fJrolessitin Gr()up . No. Testetf Reactors %R~ · .A .',.;ll·:·:.• .•. (!l. t.s,m.ale;.20~ ·. fq·q .~ · '1);9rs. old. • • • •. • • • . , 6/ 6.
-
6)404. 3:2 1~3lJS
. loyee.s ·Ci
G .·• ·.· . :~.v~rnme,t emp-
/ r }I1J ·· · ·· · ·· . ./, 7
&.f 3.6 tl8 Ill
.5.··.pecia.l Profes .• sir ., z. 11/ on.s•. . • . . . . / _, 21 . Schoo} Teacherc;,etc:·/2,622
oz4 IJ.l 451 104 J(IJ
Factory worKers··· 26,fl!6 Se.11men • · · · • · · · · 1, fl6.J
2,806 /{).6
· ./!rl,s (J ners · · · · · · ~ · · . To t tt
/,/11 ·
;:Jolrliers • · .... · · · 88,/{) 2 l
5)831 . /1,922
6.6 5.1
:rabie 6~ ~:1,$ or 9,g06 Suri'Ezy" Spec~ena obtiwl~ i.l'l. tl:le Northern . ~-
,19!>:3-1957 . .·.
Area_o:t'Taiwanand Test~d at.the Re~eren.ce,La}:)oratory in
..
.
. .
.
. .
..
.
.
. •.Grand total. ·· · · . Total persons tested : 9,806 · Total reactor$ .found· :.1,026 : 10.5 . .Percent r~ctors . Class:l:rictati'on o:r Samples . School Teachers •••••••••••••• • . 89~ Juni.Dr IU.gh Scho()l Studentsoo. 317 Cons~~iption •••••••••••••••••• 2,121 Wqrkers • •••• ,•••••••••• ,•••.••.•• 1,898
Male
Female/
.803 . 162
Total
Special-Pro:t'es-sio11s •••••••••• 193 Public Servants ••••••••••• .; •• 1,364 Miscellaneous ••••••••.• • • • •. • • • 330
806 483 413 18
0
1,701 479 2,121 2,704 . 675 1,777 348
9,866...... Cl.assi:t'ication by Age and.Sex
100.,0
·Group . · Total Reactors · .a;R : -~-t..i>]al . Reactor~. --~I.!L · · .$.J:2 ______ &&2____ z___Q.ea____ __..,.____Q._........J.2Q... :~.as
_Age
Male
.
Female.
1~19
20-44 ' 1,6~8 25-29 1,585 30..34 1,038 3.5-39 ·1,081 - 4·5=49 50 & Over ~L-
.33.3
·
--~47----s~--25:9I.~-br------u;-----~.9~
h:z~
·
. 7 54 106 131 198 96
2.10 . 586 . 3o.37 846 6.69 466 12.62 44:3 18.32 137 21.~ . 89 ~2
26 76 46 31 27 ·
~-
-~
4·43 .8.• 98 . 9,87 12.• 75 19.33
7,1~
401
88 ·. 21.95 762 10.7 ~-~ .,. 592
2, 85
. 10 264 254
-~~
9.~3
15-44
6,147
Q?::aphic presentation
...... - Female --}lale I I
I
I
I \
1\
\
\
\
\
I
....
·(;;) ~
""
I
I I
I
I I
·rq· ¢1.
I
C!t::
1.:
I
"
~- f(}
5
- u·;_. Table 'I • .Ana).y~is of. Blood Specim!'ns,.o.f Shi-chi v:i:l~ege,T<tipe:i. · Pre~E~,~ture lln~ ~ested. at· the •. Rt':-t•erence LabQratory in December 1956 - Sep1!ember. 19$7 ·· , ·Grand Total . ._ -~'"·---~~~,
Total Specimens. . Tested : Total Reactors .found :· % . Reactors ·
M a. l e Age Group .No. Specs. Rea~ors %R 2 less 15 25.0
r-
No.
Fe ~·
mal~. S~cs. Reacto"s
.%ji·
---~,.._---~-
15- 19 20-24 25- 29
42 128
4 11
9.~
93 212
8
------s•. 6
0
8.6 9.4 14.0
6 6 .29
2.8
149 150 108 89
14. 21
179
3.4. 21'!6
30;.. 34 35- 39 40-44 'l,-,
13.4
2t 17 20 26
19.4·· 19.1 2:1.4 22.0
78 39 ·----..... 22
1:7 8
2l..e 20.5 .....----......
45- 4,9
~~---~----
73
7 10
31.4 2l.3 io.l
50 & Over 118 Total ·s6s l~-
47 809
136.
91 74:
44
660
as
13.2
735
Table h.,,~he AnAlysl,s l,1~§ sJM.~y9J>~cin\~h~ b}?tjli~~ · · Taisari ·Shiali, Taipei and tested .by. the R~.f~ence. Laboratory ·· · ..
of
at
Thii.l survey took place .from April 15 to April 171 1957 artd as .a part~ o.f the combined public health survey,STS was carried out on the spot 'by th~ .field-laboratory set-up oy the Re.ference Laboratory,Shihlin .1. Classi.fication of specimens by Sex( Table l)and by Ma:rrital status('l'able .2). . ' Table·l, · Sex MALE FEMALE No,Spec. s, 564· 622. % sp~~.s,.... .•. ··--=Rea~c:,:::t;;!.jor~..::S:......;.·~%:;....:.:;Rea ct:=-·o='r...:~s:... 9 $1. . 9.0 52.4 6) 10.1 100.0 114 9.~6 No.Sf?§cs, Reactors 12.1 2•.7' 482
47 6
Tota~l"'----:1=-","='18'rJ6
Table 2,; Sex &J:rital Status M.A. L E Married · · · 11nnlarried FljMALE Married· Unmarried.' h
140
S6 7
2. R. ·Less 15 15 - 20 21 - 25 2.6 - 30 .31 - 35 .36 -40 41 - 45 46 ....50 51 - 55 56 -60 61-: .... 65 66 & Qver less :t; 15 -20 21 -·25 26 - .30 .3'- - .35 .36 -40 41 ..; 45 0 22 51 51 0
R
M
5
1 2
A L E
42 40 34 20 17
·;; 43
4 7 4 6 i$
' 6
3
5 5
11.6 9.5 17.5
0 20.0 9ol 5·9 9.;8 9.;1.
109 .39
4
25.0 .3.7
26 2 ·0 .3
o.o
o.o 0
Oo.O
o.o
11.8
)0,0
35.3
F
0 13 62 84 78 61 47 .34 42
8 1 0 7 10 7 7 8~.3
0 1 1 0
E M
o.o
7.7
12.. 8
u.;
A L·
46 ..; 50 ;, 51 56
E 61. ... 6; 66 &'Over 15<::-55 MALE FEMALE
.. -60
7 8 1
)8 9 13 269 .379
5
.3 2.3 39
20.6 19.0 1.3.2 12.1 2.3.1 7.4 ;to •.3
14·9
108 19 .3 0 1 0
;·
. ;.2 .3.3.3
4.6 o,O
o.o
l,
0
o.o
179 1.31
4 7
Male ._ Female . {1ale,~ ma..rrlecl
--- Female,ma.rrl et/
Jl-:f/() 41-JO SJ-60 60<..
AGE · fitv;J.pbi,c Presr;ntatlo n
of
Ta hIe
.8 ,
13 y 1tN. WANG
Informations of Hsi-q.hih...Q.lt.s:..n
Hsi-cbih Chen, locat ':d 21 Fmo oast of Tai:-ei City, is a hAlfwny toHn 0"'0 the 'Tainei-Fse1nng hir,:hH8y. (Ses rrans; Anrex 1 & 2) It has an area of &'3.12 sq. Km, and a s1"are of hsHk flyiYJf t.o the 2'orth-East• As the Hhole; it is in a srrall basin surrounding by hi11s -vri:th an exception in the \.\fest ern part vrhere there is a small nlai n tbrouf?'h v.rhich a rilrer flm·rs. The climate of the t0wn is like tl1at of Ye~ol1111g City·~ LG. mostly rain1y through the year but a tynhoon · wi11 not gi vc; it sort ous damages nor th•3r:.:J ~·rill h0 a very high and very loV>r texrperature because of the S1jrrounding mountains. The T-:;iry:;i-Keelung rail road and highway run through the main tolfrn of Hsi-chih Chen. Bssides these thare are several roads, vride enough for automobiles, loading to tov.rn from surrounding areas of Taipei Prefectu:rrB and sorno more Bl:'e und;:;r c onstr:uctt on. I<,Jelung river, ~..rhich f1oHs near the tNrn, can pass srr..a11 boats to reach Tainei Cj.ty. "
II •
Pe .\1.,'1le: 1) Populati or£1 Hsi..-chih Chen has a popu1ati on of 27 ,245l Administr2tively it consists of 21 Lis, 6 of 1·Jh:ich rrako the main town and th,.:; remaining 15 Us scatter in the surroundir1g ·:tr<3aSo Apr,ro:xirr.e1tely 9oP of tho inhabitants are the descendants of those who came over from Fu-chion of th3 Ghinesa mainland. The foll.OT;~i ng table will shovJ tho distribution of the population of Hsi.c'r:Jih Chen ·by sax -:i.n the past ten yc;ars~
Year:. 1947 191+8 1949 i950 1951 1.952 195'3 195L•. 1955 1956
~i<;ll~E?-
[.QJnale 10,708 10,857 11 ,L~l+9 11:261 11,841 12,424 12,601 12,957 13,512 13,512
Total 21,233 21,648 23.102 22,888 24,257 25t442 25,870 26,443 27,250 27 ,2L~5
10.525 10,791 11,653 11-627 12;416 13;018 13,269
13 ,L~86 13,738 13,733
- 2 -
2)
Occunation ,!,
The percentage distribution of the population ,by occunations is <vhoT.rn belm.r:
Agricultural Industrial and mining Commer eta 1 Governmental employees None Total
ots% 100~0}&
3)
Products Two main products of E3i-chih Chen are co~H and t<>a. The former is in the second rank in Tniwan and next only to Ju:i.-:fang in the amount of nroduction. The t<3.!l t-Ja s once produced ten tim3s as much 88 it is today and was eX'borted active1y~ The amount of annual production of other apricultural products me,at only haJi of the annual requirme.nt of Hsi-chih Chen. The follo~;,ring Table shows the amount of nroduction of some of the nroducts in 1954. H.tce corn
2 ,671+ ton 2,100 ton ton ton cubic meter
Vegetables
2t230 112
Lumber
520
Ll-)
Socio-economical situation The area of rice fields is 3,360 acres, the Vt3getable fiolds 3,023 acros., the forests 12,528 acres and the miscellan::Jous 9,5 acri.!>s. There are totalzy more than 20 largdr or smaller coal mims, a wrour,'ht iron faddr'IJ, 4 cokes factories, a carbid9 factory, two tea factori.::;s, two brick factories, an Amsrican coca-cola factory, 'Jtc. Sixty lsrg.) trucks are in S<:Jrvice.
- 3 -
.The annual income of each householrl of Hsi-chih Chen is shor,rn in the f ollm-.ring table;
A.:r:mua_l_ inc orne Less than NT$ NT$ NT$
KlJmber _of hou;isholds
P-::Jrcent household
1,500
324 1,125 2,753 631 256 134 12 21.4.
1,500 - 3,200 3p200 - 5,000 NT~ 5,000 - 7,000 NT$ 7,000- 9,000 NT$ 9e000 - 15,000
53.0 12.0 4.8 2.6······· 0.2 100.0
Total
5,2}5
As seen from this ta:)le only 8bout 2o% of the inh3bitants has an annual income of ~.;T$5,000 or rnor<:; and th,W are mostly owrJ<er.s of the mines or factories or those Hho ::JT''-'' in j ll·"ortant occ u·o3ti onal grouns. The living stan::lard of tt\o oth:;,r inhabitants is not h:i.r;h; a:oproxi:rn,t-ely 53% of the inhabitant can manag·3. 2J..% has to r,Jork h:::~rcl and $!o h<1.s difficulties in thair Uving. ·r·. r<::,~c,:· .. U.vinr· standard of th·3 inh<bit.qnts seems to be inf'1u:omed by the ;3itua+,ion or coe.1 rn1 re busiross. 'Phe ferrer may possi1J1;1 be imormred "rhen the l!:rt·b3r·" is good.• 5) Education The educational background of the be seen from the follov.ri ng hble. Population, age
20,851 i nhahitqnt aged .6 yrs. or more will
6 yr s. or more , : Nmber of :Persons, grr~duated
20,8.'51 J:.,1umb3r of p§rson, ung:rC~duated
or studying at nrese nt_ University Technical school Senior high school Junior hiR:h school Elem3nt2ry sc.hool Total Liter
126 122 513 7:8 5,787 7,266 (3-4.8450* (2.63%)* (1-J-2.5'+%)*
32 1.35 128 1-J-06
3,569 4,170 (19.99%)*
(not educated in school) 543 Illiterate 8,872
* Percentage
to the population, are o yrs. or mor<::,
/
.
... 4 Sleven thousand four hundred and thirty-six or 5LI-.83% of the pUpulation tetith age 6 yrs. or more have been 1 0re in school and 8,872 or 7+2.5lf/b are illiterate., There are n,ve elernentaYiJ schools and tHo high schools in Hsi--chih Chen at :oresent a:hd the total number of students are 3, 60LI- a:nd 963 respectively including those \•Tho do not reside in Hsi-chih Chen.
6)
Reli gi. on Hsi-chih Chen has J!.,o budc1ist ten,-;les and 13,900 believers and 2 christian churches and 135 chirstians •.
?)
Governmental institut:1.ons and voluntary agencies. There is Hsi-ch~r. h Chen office vrith som0 56 erflJj'loyees in the t01<m and the other g.over.nrnental i nstit ons are Branch of Taiooi Prefectural Police Department Hith five st.ations, storage of navigation Burearu, five elementary schools, trr.ro hj_ schools, etc. with a total nllmber (· of 382 en:ployees and 114 teachers. There also Health Committee, 1rJ omen's Club, Agricultural Asscciation, Police-Civic Association, Civil Defense Department, Seamen 1 s Association and Barbers Associatj_on.
8) · Public Places In Hsi-chih there are -bro movie theat:res, eighteen restaurants, six· ice:..:parlors, three billiards shons, twenty-one b:lrber shaps and two hotels. Although the general habits of inhabitants are naive as this place is ,rura1, 'l'a i~oei ond Keelung cities influenced this halftvay town to make the relationsh:i_us between boys and girls not very restricted.
ni.
H~;flth Orgau:tzat:, q~ctj_vities and Stat;i,stics:
1)
Health organizat-.t.on The only governmental hea 1_th institution in Hsi'"'"chih Che11 is the Health Station, which ~ras established in 1950, belong to Hsi-chih Chen Office ·administrabvely and is snnervised technicallJf by Taipei Pre:.. fectural th Center. It is di-rected by a -ohysicia;n and staffed with one each of Dllblic health nllrse, mi.dHi.fe, santtary irtsoector, assistant phnrmacist, rrlerk and handy-boy. The Health Committee f!}f Hsi-cl]ih Chen consists -of '? members, each of whom renresents the Chell OfPice, the Pol:ice Office, the Schools, the Chen \)eonle renre~entatives, the Physicians Association, the A_q:riculturalAssociat:ion and the H8alth. Sta.tion with aims of coordj:wtion b3t\,reen related at!encies in the hea1 t.h nrograms. There is Tainei Prefectural Physiclans .Association for the entire Ta:b::ei Prefecture and one snrgeon, one (!;ynecologist, six pooiatri.cians, one dentist and six mi.dv.rives t.tre p:reactising. In the to1m th.z;re are four 1?ha rmacies. There are also two herb doctors and three herb shops but they are not so r..relcomed by the inhabitants as one_ mi.e;nt except in a rural area like Hsi-chen Chen. ~1edical Sllperstitions a:ce not :'rn vogue. either.
- .5 -
2)
Activities of the health station The Hsi-chih Chen Health Station has been participating in -(A]'HO /UNICEF assisted Health programs since J11ly 19_50 for 1"Iala.ria Control ar:d NCH Project, since Harch 1954 for Trachome Control arrl since Apr. 1954 for VD control besides its rogular public hoalth acHvities anc1 routine out-patient Clinic. Hsi-chih Chen vra s sc3lected in Nov. 19.56 by VD Control Center as a domenstration ar&:l to develop more extensive rural VD control programs Hith emphasis of cooperation of-private physicians 1dth the h&:llth stat:i. on. Since the beginning of this p'roject the station has been carry1_ng out the job satisfactorily. For a quick reviei·J of health activities done by the h&:llth station 11 tables are attached together with those of vital statistics. (Amex 3-9).
3) \!later, garbage and oxcreta. There is a i..Yater plant 1-rith four filtering<cols. Since the reservoir is located on the h:iils of the southern part of Hsi-chih Chen only those who live in the town or in the south shore district of 1\:eeltmg river receive the benefit of Nat-:sr sum)ly. The arwunt of water suPplied is approximately 2,080 cubic meter per d~y. Yore than bi!enty wells 1..rere constructed by the village People and riv:}r rtJater is also utt}jzed. The garbage am refuse are 'disposed as r~JclamaMon. There ,,york sixteen garbage-men and the mrount disnosed i.s 33,000 Kg. a morrth in average. The human excreta Iare dis os03d by ville:we 1JGO'tJle as fertilizer. ' are five public la"~r~tor1:es in Hsi-chilnl Chen There are ten cemet oriss There
the total area is 303,888 sq. m.
- 6 .... Annex - 1 Hap of 'Tc:dr;:ran showi.ng the location of B;:;?i-chih Chen
0
\ \
~p \}
I
D Penghu /
( (
Ka ohsiung
Ci.ty
r1Lan
I.
~Hungtou
- 7 .,. .
Annex - 2
1:00,000
~
Rail .read Read River Towan Goal mine
/V
~
J
!l#
~ .'f!22Ji!!EI /x"'-
Keelung Rivex• To Keelung City Ta:i,pei-Kee1 ~mg
- 8 Annex (Table 1) Y13ar 19'+9 19_50 19_51 19.52 19_53 ,,
3
rth rate and dc:;ath r:Ste ir1
Birth rate ·oer 1,000 ')01Julat.i on 39.2 38.9 Ljl~.
-----Death
.....,-.-~
rate per _, 1 2 000 p?Pu1ation 13 • .5 12.9 11 • .5 10.4
2
Lt-6.6 /'
46.LJ. I.J-_5, 7
10.2 10.1 9.7 9.7
1954 195_5 19.56
.9 L!-8. 2
(Table 2)
Infant rnortaU.ty rate and maternal n:orta li ty rate in HsiChen, b;y: Y''>2r, 19.5.3....1956
Year 1953 (Half year Jul. -Dec •) 1954 1955 1956
per 1,000 Uvi
Infant morta' ity rate births
-· 57.1 5.5.0 51.6 Lk'3 • 0
mortal:i:.ty rate 1.1er 1,000 deltveries
1~terna1
6.o 3 0 0
·'+
- 9-
(T
,.-,\ _))
th in. J:Ist- c1:)
.
VP.-P tl .JV~,
r
'
l 9r~)-J ~··· __,_
-
9£i6 _./
0allS(0 of Deat11
]_i)'53 (J"u] .• -JJ~;c.)
195/--1-
195.5 19
--"------------+--:....Pneu:.conia D·::Jbilitas vitae ccm:-.
.3
5 1.3
1.0 11..
12
Aeute enteritis Tet::1.nus
13 12 1
6 1 2
10 2
3 .3 1
1 p
10' tbc. 1
3
2
lure T . --DJ
1. 1
1 l
4 Total
5 6_5
62 .
-----~---·-----·-· -~---- ··--~-----'....,.--------
. . . .··----....t.-------~
i
c e. u ::;es of r::a
Vurr.ber of nk?.ternal dsath Cause of Death A
1955
1956
1
1.
1 1
Annex -
5
(Table 5)
};atn csuse of death in Hsi-ch:'Lh Chen,
q;r
year, 1951.1,-1956
c
Cause of death Pneurnonia Cerebral hemor
Rank
N:/~~a~-~C'• L~No~ :~;;;;s;.. death icteath rB.te dr}:rth
l\!o. of Ca us::J-sp. Rank death death rate de:~th r0.c e
~~?5:~ 2lJ, 37 0 /
.
1 2 3 lj,
35 31 31 23 21 19 18 15 8
128
-
3 1 '
33
-- -·-
].21 129 00 /.7
5 1 10 lj..
91 140 :33 9'+ 109 64 60 105 l+l.
Ca mer -
-
1_14
35 '
-
Enteritis rt
___ so· 70
11L~
r:; J
27 34 16 26 17 31 7
....
___
2 8 6 7
125 59
25 29
n· J.s.
5 6 7 8 9 10 ~
2
SeniUty -Debilitus vt.tae cong. '1' ube:rcnlosis
96 62 l.J.LJ-
-
6 7 3 8
-
17
···-
..
16 28 11
-
-Asthma
-29 29
55
Ll.·
10
29
S (jC on::1a :ry
~n:eningitis
I
8
Tetanus
-
9
12
45
q /
10
37
- 11 -.
(rl'ab1e
6)
:·Jvrr';er
of
OPD :oatients,
at
Hsi-chih Health
Station
by diagnosist
1956
.. ,, : .... ·:r"*• . -.~....
Jb ;to tcta1 number of patients
0 C~TlTtOlJ Cold
217 109 107
17.46 9.. 4o 8.1+5
Brcncoi
97 72 69 63 62 '+J·
7.66 5.68 5 .. 42 4.97 '+<>89 3~39
35 31 28 21+
2.76 2.44 2~21
22 19 19 18 17 16 16 14 12 sis
1.78 1.73 1.50 1 .. 50 1.1H 1.34 1~26
1.26 1.10 0.95 0.86
; or Ju odena1 nl ce:.~ :rl tis
0 on,j Hnc: u~· ·His Avi ts mi ro.si 3
11 10 8 8 8 8
7 7 6 6 6
r vaccination
59 Toml
0.78 o.63 o.63 o.63 o.63 0•.55 0.55 o.'+7 Oo47 o.47 1+.66 lOOoOO
-- 12 -
Annex: (Table 7)
7·
Number of STS, reacto::>3, syphilitics reo,u1.r1.ng treatment and treatments at Hsi-chib. Health Station, by year, 1954- 1957 -~
Rea ctors "'TS (NeH cases)
...
Syp]:1i1i tics req. treatm• Per~-
Treatments (New cases)·
Year in persons
Persons
o1 JO
to Number of STS 18.8 10.4 11.4 10.2'
% to
% to Persons
1954 <Apr .. -DeC'") 1955 1956 1957 (Jan. -Jun~) ~,,_,
288 11092 1, 16i~, 11098 I
54 11L~
--
sons No. of STS L~3
Number of syphilitics requiring treatment ._ 100.0
14.8 9.0 7o0 8.2 . "';~
43 82 78
92 82 90
89.3 95.1 95.6
133 '1
____
.
I I
l86
----L·-·----
(Table- 8)
Number of STS blood specimens ::o11ected 'br the health station and. p:dvate physicians in i-chi'. Chen, by 11:uonth Dec. 1956-Atigo;. J.957.
1'Fonth Dec, 195) Jan. 1957 Feb. /
Nur be r of STS (new cases)
-
.. Total ~
i-Iealth stati )n 289
Private Physician 49 30
338 217 185 150 232 161 I
166 132 !
19 18
177
55 57
332 JuL 109 85 ----~-·-
27
.3:59 135 115 1,892
26 30 311
Total
1,581
~--·_,--...__..._.~~-----------
Anne;x (T&b1e 9) l~umber
8
of sclwol children examined -for :t rachol')'a, cases dlagnosed tJ'Bchoma, treeted and cured 1 Hsi-chih Boa"Jth Sta·r.ion, by year, 1954- - 1956
"---·Numb:·;-of -
,.7, · 'J.:~ar ~--··---
school children \ schoo.l chi1drf'_,n I! ~.t._·."' cases to bEl e:x:ami ned 1 examJ. ned 1 o1.a gnoscd ,hom2. (age S·-3.5 yrs.) Trac
I N~im~G;~----~ Fumh.. er I \
Number of cases tre2ted
Number of cases cured
~~:~--:::~:---·-+-~:~~ ·--+~ --------·'"~-----r·--------·-·~--~---
~--~---~-------~---·-r--·--·--------~·-·+--- - · ,6?0
1,556
-·----
1,253 1 . t. (4 m. ooserva :ron )
--
. ---r-·--I i
1956
o1.n / .
- - - - L•. '"...............~:. __.,._____,.__ ~_
~. l i ,_...._._____ .. J.... _,._. ____,-,,. ___..,___ ,... _._,___ __..
I ~
92~'· •
--r_____ 831 212 ?JJ 218 ,.,..
I(4 m. 672 opservation) ..... _.._
I C6
126 m. observation)
(Table 10)
:N r of Cho10ra, Station,
v-accinated agair:.st Small pox, and DP~.' at Bsi-chih BeaJ.th 1950 - 1956 ..
Y·::-;;..·---- Sma11-u o;_-·-i-··-r--~o;~~:;I·· Diphtberia
-
. _.,.,..,..,..,.,...""--"- --.. . -----+---------;DPT 689 23.5 250 250 2)0
1950 1951 1952 1953 1954 1955 1956
25 ~ 321 1,530 1,230 18~
230
I I
230
115 85
7,020 L~,
994
-~---~--~---------L----~------~----:--..,._--------
1,9q5
I
_
2,635
..
lL~
...
Annex- 9 (Table 11) Number of perscn: 8X1.rri ned
for malarit: plea smodium,
persons positive ar:::J. trcs.ted at Hsichih Health Station, qy· year, J950 - 1954
o·" .1. osit:i::/e
Number of persons treated
891 ..-
___I L .....,,
-
956
____ ..
607 226
...
.-..·-----·· .,
...
.__
75
J.95J and terrdm.ted in :i.
lt Lcn(; r r.l · .r1i'orr.mti. :1:
----- -- - -- ··- . -'1':: o~ ctr.n County is onv of thu 17 co,mties in T;_~in· ::.1. Province.
The
r:.rec. is ebat1t 1,200 so:;uc.r~: kilo~(jtCrl.i ·ilith the populction of •116,891 (l:J66)i
lifcstocV::s.
ow<~
•.:·-:E;,no:: , - - ·-0n tht... county hv0l , thu!"r is:. h.>lth c•::ntor w:Lth th·~
str:!.'f
Division is in chf',rge: of
h~c,ltl"'.
pro·"'lotl.o::.'l..
The; J<,oond IJivL;iun is in
cht,r;2;e of co:r-r"lunic .. •lL~ disvasL control m1d ur·.:iroiTf.1.vnt a l sc.ni te:cion.
ffi<:.;nt .
- ~ ---··
• -
-- -
-··-- ~-~- -- ·
__i___ - ·-
·-- · - · · -
·-
--1 - ~ - ~ - -
I I
!nrvrsrmd ;nrvr~xoN I ;--··- ... ·----- ·· 1 Dr. l !Jr. 2 Sunita1 Nurse riQD.s 2 >:idwivcs 2 Nurses
I
1ST
I
'
2ST
l
l~- TV3RDrs •o) • .1.) ..L ..Jo. ..~
.-
4'rrl- ,
·- - -- ·· - ~ .:
I DIVISIO.-'' ! 4 Busincs~
: ~BOR.i~-
-------------r-·-.. · -. _ __ _ _ .,
i
.
i
PERS. OFFICF:
1
i.c aowr:· OFF I C!~
'
TORY .5 Lab. ·.raoh-
l Dr. l Dvntis·._
1 Stc...t'f
l Staff
Stuff
1 Phe.rm.. 1 Inspoot. 2 J.ssistants 11Chen 11
nioit'n
Tht;ru aru l;) ";isia:rlg 11 or
Health Stutiuns in this oou.nty
with the tothl st1;1.ff. of 90.
All tho h·:.r lth st£,ti<.ms· haw the out-
pn tiont clinics in the morning c,nd tho puUic health work in tho rd't;E.;r• noon. The staff of ~a.c h hu~ lth
station run from 5 to 10 to tek0 cure
one to two
11
hunlth workers"; 11
,·_n on.; 1msin. ss ste.ff.
Thcro are 13
heal th rooMs 11 scattc.r 0"\mr th6 uborigina.l hemlets 11
and the rel""l.oto areas vii th one !'lid:.fifEJ in E:r.ch
roon 11 and some uhealth
workto:rs".
'!,'he works of the hr:;alth ro0"!1 are chiefly to take l.ile.re of the '1'•-,u physici<m· of the health :s te.tion
delivcrLs (:nd the i:!m!lunizations . visits the hee.l th room once i, W·. '.
k and tho out-pationts oomo to the heel th
room to seek for thG Medioc,l cc.ru. BUDGET: The sal ary of the public h;; a l th staff o.:nd th- running, ex:penses
o:f
t hE: whole county c om0 s from t he county
,; ov8 :r n'~".e:nt.
ThG oper a ting
t.~xpe n s e s
of the health ot:mtvr co!'lo from coun ty governmc; nt and thut of The annual bud:.:;et
tho he dth stations eo:mo from t no vill uge offic 0 .
f or public health of this county (FY 1957) is shoHn as follows: ii.. Se.lar ies NT~l,070,000
.• Running Ex:pens!3s - •· - -
NT$ ~.JT.~
152,400
C. ,)pcn\tion Expenses of Hed th Genter - - - - 1. Hedth promotion-- - - - - - -
:no ,375
NT ,rll0,05~)
2. Equipmont, supplios, Remodelling - - - - - - - - - -NT~ 88,G79 3. Co!!l!Tlunice.bl
disvns L control- - -NTilll,63::l
:.; .D.Ci • a. .Acute . b. T .,l-1. Control ~.
--
~.;-}' .;·21,136
:• JT~~l8
,240
Tracho::na
IJ
ontrol
i~T .. 21J 804
d. V.JJ. Control
-- - -
i';T;; 3,408 "1' .18,250
e. l-1a1aria vontrol
f.
~'.i.id
to .H .s.
HT .28 ,800' NT.. 215,987
D. Opc r:,tion :';;xpenses o.i.; Heult!-. Stl· .tions - - -.-
~----- - NT ,~ 30 2 ,000
~"1.
Gnsos and Dur.ths of DiphtheriD in Tr;oyuan County. Ag_~
Cc,scs 5 5
D"'cth l l
1 2 3
10
1
,
7 8 9
2
l
1 0
10 11 'rotal .t•. .
1
45
' '±
1;terrrtd and,'Child :d.cr.-lth in Tuo~·uun 00\mty. Totcl birth delivor;.;;d by the H.CJ. CHSOS C:lSGS
~.-n.d
~i.t>.
3,29:1
of
~•nte -not~ 1l 0<.!'<. c~rc
- -- -
- 2,195 676
of Post-nute:l ~.nte-m:tnl
:Jumber of Num.bcr
of Post-no.tf.l visits- - visits-
- - - - 4,273
- -
~
-
~
-11,672
c.
The condition of doli~rcries in Tooyuo.n Chon.
'1'ot l number of birth - - - - - :_.:u,-·~·:er
2,228 430
100 19.30
deli vored by thu i-i.C. rnd H.S.
Nuv:tbcr delivered by prt oticint; physicL.ns or nitiwives - - - - - l,3B3 r:u'nbvr doli Y<Jrud l:.l;y non-qu[1lifiod puoploIJ. :·. :;. Coutrol.
62.08
415
18.62
.'uqher of t u o ro ulin t e s ti;1_; "':u_·tb"-'r of ;_;ositivG roo.ctors
4.0 .1'70··
( -
- 24 ,783
Nunbor of : .G .G. vr,cciooti-:m - E. TrHchoJTI.: Cmttrol
141177
'h1:.1be r of neil en tr t:-·lC• ,•:U'lbOr of pt.~ pi ls
pHIJils
----
12.505
fJXrun i. nc ci
- 11,961 .. i: C•.S U S
lOC.l'
,·. n,bu r of co•:_junctivi +;" s ~:iu~·1ber
1,283
lOe'l
of suspecte d tn
Ci L O·
-- - -
845 -~ ,178
.,,..o 36.0
:uy·1hor of Tr-·cho:r:1e. cns t:: s f·iu:'lbGr of Tr[ chosa I V ··;umber of other conditions
08 3
s.a 0. 5
----
.5 5
:,u:-:1ber of posi tiw east.s fo:md Peroex.tage of p os i tive c r.s s s fonnd ... •_: umiJ.I:)r Of Olin ic nl O P.SL S
- ... ~ • -
l,OS9
6e 9% 561 634
found
?e:raentage of· tre ated e ases G. >al e.rin Su1"Y€.ilenea. Nu'!lber of peoplo suppot'l ed to 'b~:: ~'ia ittO d - - ... - - 40,898 -- ~ 25, 941
··:umoor of peopl e a t
ho10;;; while visitin.t
F~:rcentnge of p~;~oplL visited NUl'lt.bi
- ... -
4~.4/~
ef
~ople
hns h::d f e ·ve r
.. .. .. .. ...
Denti.st • .. -
.
-.. ..... ...
-. ,idwifo .. • .. - - -
- . - - .... - - -
- . ..
- -..
, . ....
Vit ~ l Statisti~s.
Popnla.tion lh.moorof births ;'; irth i~'tt'-rtber
r ~ te
per l ,000
- .. -- -
.....
.. .,. ..... ._.
o! d(. ~- ths r~
Crude da t'l th J.
te pe r 1 , 000
_ __ __ _ . . ,.
-.
ten lead1)lg ecus Gs of det.~ths. to tel number of de:. ths
1. tiennlit~: (162;- - - - - ·· 2. Cere be r d ho::1orx·l-;.[; g.a ( 82 ) 347
1.8.99
ll.l6 l0.30 9.81
3. J.--neumon.i ;, (107 ,108,10 D) - - .;..
339
.'
.,. lJiarrhe :. ,
enteritis :m r! r;r•atrie ulec:r (120 ) 305
b . l ulmom<ry tuberonlosis (23) A.. O+.her h~:. : rt diset.ses (25 ) ..
162
5.21. ~.,\3
--
l~ V
() • .voi'.rHi" (13:~·,131.1 · - - - - - - lC . G~--~~;~·;r
2.:37
.,
o:-:
d.L~;0Gti--. s:.rstcr:-"'- e:.nd po r i tor .iu" .J
. :··.d oth'-l' ·:cnL-ri t um.or:>
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.
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1 9 5 6
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- . _..
!=i:I1'fJEII! .
. BRIE~"'
REPORT
BY PING- 'fUNG PR. EFECTUBAL IIEALTH CENTER
.
. '
-
-
-~-
.
. t~ ID
. . r
1f .
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~'fr
I'll-•
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rb
/u
I'
~
.
司官
屏 鴻請與位置:
東
縣
輪
1
本是京、總為積為 2 r. 775.6003 平才公里 ， 1t孝心於臺 j弩之最南端 9 其四至是值 J散去世下: 經 j丟
cli} '"
•••
......…...琉球 7年琉球嶼喝端業經 120 20' 斜" 0
0
東!ð ~. "...."'" 0叫".><:.."'.... ..…﹒…攝:是~ 4年雄率山 I丹東經 120 5 告 '39" 0
、
經成“...…....……，高樹鄉當祭北端~1:緯 22 53' 仙" 南 極...呵。 _u ……... ,.
....但表錢之莖去南端 ;11:.緯鈍。45' 25"
人口與戰素: 縣、下設 F 孫轄市三三鎮工十九喊í (內山地八拉1\) ，全 32 現有人口 572..365 人事 9丸8鈴戶中農戶中有 5 九 538
燕莎
戶農民佔全縣人口百分之 67-\184 ，紙有一昆主千多 f占總人口百分之丘，縣 民從事商業者不了百分之 2 ， 3 ，從事 L 寫意只有 q 命之一 9 其中大多數為給廠 這且會由此可 j己本綠江二商比較落;是 9 夫多數之路、氏是幸農素為i_ o ~ 習俗與常教:
~~~
叫多萬夫家庭，民性別強儉樸 9 農家婦女州地和服裝做材料， 當有刻苦耐勞特神 F 社會風氣%.屯良，住氏多數佑你根傳下的多特嚴 會佛教基督教?天主教次之。
(1義教)
2 自 守，附閱
錄 A: Maps a:
CQNTENTS & Charts Distrib 的 ion or Medical and Health Services in Ping-tung Prerecture .' b: Organizational Ch aJ、 t or Hoalth Sorvicos in Ping-tung Pror. 。: Porsonllol Chart or Hcalth Con or and Health St 的 Ì011S. 七 d: Cruc1 0 Birth an c1 Doath Rate .i:ri Ping-tung Pro f. 1951-1956 e: Inci c1 enco or Roportable Communicablo Disoases. 19 丑 6-1956 r : The twclvc Chief Causos Of Doath in Ping._.:tung P 1'cr. 1956 g: lnfant Mortality kato in Ping~tu11g Pro f. 1951--1956 h ! The ton.Chicf CausoB of IUfan t Death in Ping-tung P l' Of. 1956 i ~ Venc 1' ial Diseasos control Report. (Syphilis) 1954-1957 (1) ;j: Venerial Disoases cont l' ol Repo l' t , lSyphilis) (2) k: T l' achoma control Roport. (1) l :TrtleTIOIIla COIlboI Report-{2) 。) m : No. of Tuberculin tested and B è.G vaccinato c1" 1951-1H56 11: D.n.T. Rcsidual Sprayings in Pi11g-tung pre f. o 1953-1956 0: Repo1' t of D.P.T. Vaccination. 1955_;1957
(戶〉馬車將﹒掠街生跎(所)公主臀能分佈畸形閱
(二)屏東縣衛生院組織率統
(三〕本將 #t~ 院研現有人員就花
(~)本韓逐年出生率與花亡率之比較聞 (3i.)本將逐年法定傅~其為流行，情形爵
(六)本將民闊羽十五等主要亮，亡原周詭計聞 (~) ..$.縣i是牟嬰兒死亡率說針閻 (入)本路氏關四十五年主品嬰兒死亡原閱純封閉 (九)本將逐年性病防治久作情形統計閱
(1)
(7) 本縣逐年，城為時均工作成績說計閻
(2) (1)
〈堂)本峙，逐字砂耳旦時治工作說計閱(學生部份)
(主)本躲進Jf砂眼防治工作說詩詞(學生家屬部份)
,
(民業部份)
(2) (3)
(~美) ，本將逐年防治工作情形說計鷗(學生部份) (主)本路i是年 D.D.T.t這費對家及情舒工作情形關
(1三)本撤退 -'D.P.T. 混合疫苗接發 L 作統計關 (~起)本縣、逐年婦幼衛生工作統計關
t..
f{t
在
(一)本將退學人口 ili i.率 '.Æ -è:-比較統計表 (二 1 本且是連年，法建立傳祟病?皮抒情形說許在 ( E己)本將逐年性病防治工作統計在 (切)本>>k:逐年砂耳其防治..l...-It 統計在
(1) (2) (3) (的 (2)
(E.) 本路逐年防治工作統計表(學校部份 )(1) ﹒(民眾部份) (六)本將逐年 nP.T 混合 J是品技﹒稜且作統計在
(上)本將 i是存在犬馮主主 fG 注射 r..作統計在
(入)本縣逐年 D.D.T. 噴射工作分 .1!T 在 (尤)本將按年預防按自投入數紋，計表 (.J“)本蔣氏閻四十五荐皮婦幼衛生工作就苛求
(土)本縣街生試騎史最近三五手工作統計表 (主)本將閥掌聲師 p 牙醫師 9 助產主. ，各種恭商分佈統計在
B: Tables a: Comparative tablr Of Birth an c1 Death rates ill Ping…tUllg pref. 1951-1956 b: lncidence Of RepOl沌的 10 communicable Diséasfs , 19鉛… 1956 c: Venerial Diseases controlReporte (Syphilis) c1: T 1'achoma Rppo 1't. (1) ~2} (3) (4) 討 咕 t( J 枷 倪 叭 扭 e 1'c 在 凹 e: No. 以 1 … 1956 êÌ 1 95 0 fT ub u li l1 teS dand B. c.G V 泣 ω0 n 叫 ed. 臼 巴叫 0 1'叫七 O 叫 fD.P r: 恥 仰 R ep 愉 叫 仿 3m]. 10 195 生一1956 og S given Rabios Va3 iÒ l1泣 g 恥 :N 抗必七位 叭 0.0 fD 伊 h: Analysis Of D D.T. Resi(hnl 8Tn ying Ope~atìo l1. 1953-1957 i: No. of Illdivi c1 ua1s givon prophy lactic 1noc111a位 011S all c1 Vaccinations. 1951 戶可 1956 j: Activities of Mat err; a1 an c1 child Hca1tli. k: Activitios 01 th e p ing-tU l1 g Prefoctural HýgieLc laboratorics. 1: Dístríbut ío11 of Gano l' al p l' uctican. Den f, ist nnd Private U1 idw if ín pi ng 可 tu~g pre f• 1953 ,
寄:
,;!'l r延 e 洛港.$. ，'ÌN 東 鄉鄉鄉鎮:鎮 d島市 揖1
I有炭絨壞性湖屏
Iγγγn
4、
Org~h.îzafiorial cha rt of Heal th Services 恆的時一 tUl1g.. Prefec tU re
課
第
I
"
4"、羊，
.,
#
"'.1. 所
;抖抖邊綁
vi 去悠村街也笠 l i
(二)互主墜金主監笠盟主金主丟
,
使暮村衛生TA 夫或村
赫耐住
持忘掉冬
鄉鄉鄉
! I I
一
課
第
禮村街車室 PJ阿 i 4'" þ wi
4
呀恭村
三七九，芳、之哼哼等三三
-()
i!
第 疏祈禹滿半
輩革
liu材山、鄉
葬品村 HNi
沙講村
p
球閱升州城
鄉$tìi~榔綁綁
L Health 旦旦控
I I I I I
﹒內對被村， l 阿烏村 德丈村 hqi
Health Center
,
A多一
擇峙，地村
課
4"
iiH 弟
四
求社村
" i
#
家村衛生笠 義村 hFL
說灣村衛生玄
i絞
﹒嚐mv
...
111111it
~
吼叫 、
涼山村， 制
9
。 1! 此都鄉 4少
位與村衛 λ 或潭村 式村 aFh品 r 發村 i
一 ﹒里游鄉 Ii
-?
… ii 高掛鄉 ,p 當f
P
合榕村衛生笠!望品村衛生笠 wj i iι切泓為村，
#
|孟
一 ii 峙吼一鴻﹒榔
質
f n 村 衛生笠 一!內精榔1.莘 4'"
, ,
… ii
長治鄉
一「升林村 叫
一
1
文啟村衛生室
Pi 高丸村， l
刀旦村衛生笠 #
1
人掌管路寬
… 萬巒鄉 ii li
llh 凡佳村， 幽
i
士文村 什向鄉 i
歸崇村 γ!據台綁 ii fi
9
J 三三
平端村衛生室!獅子村衛主室 'i #
立一地﹒鄉 鵡家、鄉
i
丹路村 一… t 內文村
i !l
為管村
,.
海社 村升
，街 村
衛 生
i球舍、林
村村村
束島問
室
i …!蝴呵!
i!
券日鄉 il
,
獅子鄉 fi
牡升鄉
,
#
#
站
,
j
何結叫
~r伶坑村
,
9
ip l諾伊糾們 法 「
車
J 抄
室
,
p
5
461手皮
(四〉、工求將 i逗得出生于學與死亡率之比誰 Crude birth and death ra tes in
6
Ping 叩 tung Prefecture 1'951一-1956
60.
卓生卒
千 分
Birth Rate
之
.~\~一 ‘畫
.'"問吋~-嘲叫“他舖甜甜個腳甜甜切制"帥"“..啥叫h叫樹一向洶吋甸甸祖』 呵呵-向他"-.
; 元亡率 Death Rfit臨 20.
內心切勾心一 月，也許叫一哼一一-一………咖…肉，一叫 一一句句句
叫阿~的白白的哨的心--_.叫戶呵呵……
ω 心明 h
司"。 心…一句…屯
一……
………一_.. 。
?
01. 穹 合
三F
皮利一〉
41 1952
42 1953
43 lP54
Year
44 )955
45 )9150
(血本辦法定傳承弱決/(-t，~1會形處決 工 NC; DENCE
Qr REPORTABLE 至2
CO的 MUNiCA8i~ ÐiSEASES. /J4Þ寸YSd
安茅。。 )..拘
意;
@愛 iLHO以 ll @ ~夜梢，對幣購蜈瓷
@白候 @天花
ÓïPHTHERiA SMALL1'OX
STiNAL
E1iDEMIC
1可 iNi NGiHS
CE 其EB肘，
1
l::5:fI
@侮寒11對海寒 @斑疾 @總 指工熱
TYTHGJDaPARawmoia DYSENTE~Y SCARLετ 宇EVeR
@
學
11Ji>
1: 戶仗。 令。
uf:@ir\ij' ，'，十 \j/'， 20 -t
iJ@fy'|xilJJFir\!@工， /fi\ -… 、
I >:
...
I
八十.
,;- --"~'f ~~~-1
、三十
，來
羊皮→哼
什 5/，〉〉 泣 k 注注、 ::X Iij，: 立 1 ; L: ……"
86
.3 7
\招
39
一抄一~抖抖穹~Jiii.
梅州的
þ...
人數 Il NU 鬥 iEt
{大)本縣主要丸亡原 i海統計圖表 :此濁的十呆得 THE ，~ CHiEf CAUSES Of tJ EATH iN fiNq TUNq 13".56
8
gq
,
(()O
J/.. ðlJ
fl_ Ö{)
氣為
。
CASE Of DEATH 死亡A1
炎|病嗎
臟
縣!
J答:
ijJ
圳、 O'f tlEATJ:!S 每卡J.jλ口死亡身
NO， 仰隨時H1;RA'
>tRJOi伐。 00
fO "P
241 .2-(,SJ' I J..1 、 n
9
.兔死者勒時之 infant o a vi &Bb
J-11
&eiu
VJ
Rate
1951 … 1956
唔，，本
膏且 有甘心
令
分
rlJ 96。
78.1 夕6。
77 ‘ 596。
79.6796。
70.2996 0
71 。吐 296 。
62.S佑。
AFTO 村田
.I 、 1956
I
-J 氏
一甜叫蚓、
一國
民闊甜可于一Jf
悔?
1951
1952、
1954
10 氏關切十五牟
The λ數
10
chief Causes of 知fant Death in Ping
… tung
1056
持
名
Cau '8a /Or l1eàths 兌亡吉、文于氣了
No
1i一~-于一兩一-i 一一一 I十字
otTI5eàÙl~… I
I
424\
33主21 τ
反〕干干'1
26 川的。 9，
5.09:
JJ
{九〉本縣遂年，陸有防治工作畸形 γ、 2 、 (>
600
CONτROL
1' ROJECT B..
19..位一 1'958 NO、 lE5TED
JAA、 O (JO 主 0、 QO 且一叫咱--
StYfHiLìS
人三、學危..m..教
..，..C 三將毒違者欲， >>IACl NOS 印 smnøfit
~陽性JiJ1毒、數 NO、'REACTO.R
/0,00 8 ØðO
9、三泠揀欽 ND、 T~EAT印
.-
'iLpaev
,0 O
'，叫
-w
丸。。
Aν
，川，
UJ以 Y此 U法 M故國 U
-Anm 年 Y A 刊， 、-
J
、挖一本 (mw 泊 品
杖 nu
A、 8、 C 、 D 、
反J 函、g十四年2支
A.
ÂJl竭四+jí 左手表
B、 C 、 D、
ß. C‘ 9 ‘ 人 反J I聲四+六斗 1957
凡
JH 、 rr』
扒 71 m
今
1955
195b
3
(+) 百分比何 '、‘
本將逐年性病防治五作成積統計 V.D. Control Project 195 生一-1957
10. ._廟"欄凶，﹒
陽性反應卒 96 0:[ 事、
Reactor rate
。.翩翩-。
者
卒 Morbility
• 。
。……“…...。
,'þ ,.0
療
率 Perc白的age t~eated
8• \
. o-
r扎
)、
。
‘‘ to 、 ‘ 三 ?看‘. 玲 、 i
6.
\ •• EIJ et 、巴， ‘
電
V 、.
I
‘宮、1 ‘
pa vbB ‘、電‘‘‘ ﹒ ‘ i'
‘草、
電‘
•• ,1 :111s 、1
、 EI--
4.
••
‘、
‘11. ‘‘ •• 。
，1 ‘1. ‘‘ ιs 1
寸
•••
、、、
、、
. t
、、\‘ 、
。
、九\
-1
、、…、九九
1γ\ 、 、、
14\ ~。
、
、、"。 衍，剛 AA
尋皮尉→
two
56
.‘? 訂
4" QU
弓
f
申
.....t-:)
• ..
J
叫 -a 峙V
-4
.w
ndvo
6 晶晶 kh ﹒
T句 E A且
到
Year
U 丹
i
句
î~
,
(主)本縣、攝氏學校學生砂眼仿治成績統計鷗 Trachoma Report for the J?{}riod戶 rfrom Sep. School ! ~hif(ilreñl
1955 to Jan. 1956
人
總檢查
數 60.000
lni tiaJ Exall1 ina tiO l1 一
學 一 生 結月莫夫 檢 查
50.000
人 數 宮 。
1:恥
• Conj 一…， 一一
第一次放查
Ist Re-cxamìnation after 2 l1l onths treatmont
.
人 數 4齡
40.000
C F哼3
第 ì]; 之
m n c v ,_.
。 門 E
。 怯 ts , Z夕 凶 。 告
.
一
1: :Þ 10
不丈 司令
自民
才3
心 30.000
抖õ' t EED Z U
“ 妒~ 令 軒←-
人 數 。 出
印 C D
S' 20.000 穆
.
數
3廢 λ、
魚 ?
生 是主
Conj 一 求 :Þ 1 '0 癒 一 :"ι 1 '0 戶r;j
n11c1 Re.examinatio11 after 0110 再 :當一
第二 2起注金
J
ollths further treat ll1ent
吋 q屯
也
.... 寸~
。 許柯 吋 門
口
z
2:
言 怨 呵
. t
受
一
。 仰、 同
i廢
寒冬 .戶
第五;.k_故金
ECE D 恥 p“
d
許 r 哼 +
ct>
出
已 句
。 自 2 月
CEE O
<+ (!) 已d
M tb p.o þ ~
告 。 OS 肯 2 2U •月 ∞許 S 可 EeS+MG
足，ZK 圍發
COl1 j 3求 旬 r 已+ r ,tn A CEDdi藤 K 抄古
][rd Re-Exa ll1. .aÎter Îourth ll1 0nt s treat ll1 ol1 t
稜 H>再
任屯
今..
s
þ ffz-tz tb
10.000
們 E油 個
<+
癒 的
∞ C D
。:=
CP 已J
4cz4 p υ
.
同數 一 主 d宮 t 2 a
旦人
þ t-; CP 已J
。 函 江 •b þ" 時 CP 、
癒 的
臣:聽 ，J曰 C 么 Dd
|2 C 門J ‘k. 民國四+.Ji.存一月
þ
E C寸 時 rDD , 令
已吋 ED d
回期→
氏閻甸回平九月
十}月
c1 ate
Sop. 1 9 5 5
NoV. 1 9 5 5
D3C
. 1955
十二月
Jan. 1 9 5 6
‘
i ':~~~~月玄宗 i 您認哥還
i狡您還 !若_._-著 片干去 、育‘d 、 斗 F 一
患 需 、
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治工作統計表 fl Jl:.) 1955-1958 梅毒患幸人數 及 1有? 治
(島民國強3 年 9 月五 4() Jf 8
veneriaL Control 全縣 ，f.;怠人口數 I J儉血;人數 hl 宵分
Prozect
1
梅毒反應人說 及百分比
療 宵
平皮
別
入數 分比
(牟皮底)
Fb|
分
H:.
及
氏國四十三牟皮
538.941
21.805 4.05 知
1.928 加 84 96
1.389 6$3796 1.162 3. 哇哇夕6
1.389 6.37% 1.036 3,00796
19
5 通
氏閩、切十四年皮
562.343
33.796 心。 196
1 ,, 877 5.55% eûû~。
1 9 5 5 民簡明 f 五年度
鼠忌jj 一一(一一-1:一一一 i 一…一……2.008 叫一一!一一 7.25形
806 1.9 296 176 1. 91 96 …一一 -1元…
1.956
心 79 96
1-可志高立足~-I--一一兩三而…… l 一一一一一五千山…!一
…于心已一
195 7 可.，... .N'_ 學吧，樹倒閉關瞞-可
23
(四)產主笠主題堅持和軍學生哇哇哇支手、叮;何受益主ZL(1) Tracho.ma Report for Séh601 children 故|槍|撿 j 學 i 錢!受 j 性可別!結
放 l時i
是|治| 對|時 I 夏旻恥|闊 i
查 ~ 沙別 1
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kiE!豆豆國二三L---I二二--r-三三!二主~L豆豆豆， __3_0. 831 =~~~I 區(而!二區副479 仰)站泊 叫.刊吋心 學 1; I~ 有哩 1_5i 自1121 也哩 1_1_~!~_~_ ~_~~?~ω 峙的 I 1 叫一一些 81___1~ 你哩!一心 71 5~1721 207!LL 13 5.6 訂 叫 oω 2 71川 O3 敝 ω 一心 一一一 豆扭台諮 -&-巫尪查! 童 惜 .8 61 4主旦服 竺令 I ←\三_.1 ι_.1 二三_.1_山」土 .96 6 9 Q判 1 ι 1 i ι ,; 泛釗1門柯存￠札，--土去盟坐封!」立虫到 ~I d!i必封!逛坐到豆坐討 三 2~'_I 且已~4; 扭 76 一 …---一干 I叫 全!嗎昏 |滑雲 毀毀煙嘍嘍 1 4 7 向.叫 i 1土一 J.~衍 而圳 哲蚓 瓦哇而;函 j j 汞 函耳 1-0 云 斗函豆且 已品函 1. I 引11; 什Ij 什圳6 2ιλ 0.7 丘 3 1 -10 4 1 L7 社 汗! 1γ ! 7 …句 恥叫 縣 |曰~，庄主 i恆 I 7. i 忌 戊 竹叫 叫I Iι 7 J到笠釗1= i 二_1_1仁 i l丌 27 一♂訓 心 已 計的 志♂叫 1. 各 !仔 7 Oω! 2吋 5 巴改叫|墊堅旁 1 ~Y 闢笠住吋仔墊到?如|門恤門塑侈 11 面，-的口而區8 」二二|三 I _:___~: I--__~_♂通!豆豆豆11 可 懿 i仔 I 1= -L 11026 你 7311 88 的.喲 !Hì 42 6'1 1. 叫 2 叫例如 I 9. 肘。 1 5.566115.7571 90420' 1 訂閱司 16.506 il 宮內改 I~;關 1 3區7 ;|廿五 i 二1二二一:心!可可區… 1 討 閃 -------1
宇 l情主 l佳主們引迫哩吋墊封|一司可j 函!且函」瓦 I斗函兩 5tl「可長而而 iζ.6 兩 函函 i i 聶z[z …叫!丘 μiι …已叮…示弘而叫 祠 bι ♂耳而!「心一 j L 已品兩訓r石 μi 祠詞71 予 iL;i 示祠 已1函 i !必斗兩函而示示互 可 r 斗益孟孟 i 沾 5 逅!區豆函副玉示-_.口二二三一_?[~忌函!垮 j 4. 吵令j i 川 衍 了 |圳背訓!笠蚓聖1 互到丘釗l仁于-1于于 ----1 一! 一 ! 一一 ! 一 …|一 4~681- 80 99; -2~93， 45.361--8~9-61-57:251 叫 791恥。1( 肌， 28170 ， 92 Ù3. 叫 GAd !5.712! 別生 3 2| 言!專利總數 1 5; \-912區;而 !-jGid:ii9(1: 11-0~-945! 一叫 ~l:]-321 2.4321 的:681
一
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竺 ll 反查|叫---二工亡~~--[~---~ 1 _ _γ;了f~Q:-311 0.511~ 叫尺函!五:771-4~~.4_81豆豆!三日~~81三ifs iFl?ci 望!憎 I_~型 1_笠你-1861.124!17od9.m17.m! 向 3~ 旦出一些出些 I_~~I 啞叫一 61 I 4.374!12.6~2 5 的 8\ 川! :31 l 26.64! 削 3 i i立?三副主任~士~_~:-5'Q_1I--4. 0 一__ 1 ____ i Ji Z Ei| 主!到二一:一___J_____I 是|叫喊 總數 I~ 叫 wi1 叭叭 11.457111 的~_Q06j_ 5.219\ 4271 176\ 13 喲， 8271 糾吋川 51 I 3.314\ 3.016 --------I-----l----r '3.8110571 ω[兩孟 31' 25:79l 斗忌區95 ii且是j之一「下一 -1 i …
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(2) (對中莘民蹋 45 牟 5 月 16 間是豆豆 415 年 12 月 15 日)
24
Trachoma Report (for Schoolchildren's family) 11 常還是 !I 發人
第 1 ，~，息
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(四)本縣氏裘砂目表仿治統計;表 (4) T1'achoma Repo 1' t. fo 1' The seventen 牡
26
立也 i 糾正l 雪!寫 總人口J 數
丹
~Q1
(.五)求將;述三手持海工作統計 (1) NO" of l'uberculin
tested
and
B.C.G. Vaccinated
1951-1956 '
SchOOlchildren 甲 、、巴
學校部份
委員
J乎
EL 民間益。學
受制駭人數 i 受騎針人數 i 陽性人數!陰性人數 ，應湖踏人數
已受接種卡介苗
成%汲%|及% 一……一一--~."---，_，一一一一，一一一一
及
,96 日 2生 .642
7L 2生 .642
96
一‘
一一一一
39.476 45 , 707 89.37% 一一
I
34.794 88.1496 一一一一一
I
10. .152 29)1896 6.669 39.7%
195 1 民聞是 1 年
'10..， 8296 戶 一一一
吋 7 0.• 82 96
…
17.922 18.699 95. 8396
16.80.0. 93..7496 56.765 96.37夕6 一一一一…卅一一
10. .131 60. .396 33. 0. 58 . 58. 2496 一一
10. .131
一一一叫一一一一一一一一一』一一卅一
一一一一…一---
一一一一一一
民關通 2 存
58-9 0. 2 64.356 89.9996 ~…一一一一一
23 , 7ú7 41~7696 ….一一……一一一一一
32.96.3
W帥--~于闕-可瑰，可喝，咽-由自團"一一、-------冉一
1 953
~---一一--一一一一呵-_._--喝一、-
民國丑 3-于
42.387 43.460 忱。 5396 一一一一一一 「一一一一一一句…一一
40..0. 80 9是 .56%
23.790 59. 3696 14.729 44~7696 區甸甸
16.29 0. 40.6496 18.178
16.290
1 9 5 4 氏簡 4 4 字
34.827 35.32 0. 98.6% 一一一可…一一層 h …4 一一…
32.907 94.4996 4白山山』白自呵，即如-甸甸-~"_'._.-吋扑酬---幢幢-
1 955 氏鷗 4
←一一一-一一一
5 $f的 .36 0.
28.372 的。 696
27.337
10.452 138 喝 2396
16.885 61.77第|
16.70.0. 6HQ9%
195 6
I
96 ， 35其手
28
(五)守本縣:逐年仿務工作統計 NO. of TubercUlin Group 受測驗人，數 應測驗人數
(2)
tested
and
B.C.G vaccina ted • 1952-195.ß
t... \、"---擷 門玉宇
氏采部份
Civilian
4'1 度\〈\\
是 J絞針人數
陽性人數
能性人數
是接梭子介苗
及
手4 23.606
Jt
96 20.979 88. 87 96
JL
% 6.051 28. 8496
Jt
。 96
1t
步6
氏鶴 4.1 年
14.928 71.1696 44.523 7:3 .1196 一一一一… h
13.157 62.71% 4是 .339
51.279 195 2 氏國 4} 年 134.~591 46， .5 侷 一 一一一 一一
81.755 60.74% 39.723 是8.862
60.900 74.49夕6
16.377 26. 89 96 一一…一一一一一
1 953 氏閣 4
72. 8196 15.964 的 .38%
3 .1F-
33.064 83.2是何 呵_..._-】戶-“...-可啊伊---明神情恥叫且可咱也可E
17.068 51.6~96 2.307 內
15.996 48.3896 一一一
1 954 白這
81.1396 一
氏國 4 4 年
6.345 11.150
一一
5.250 82.749屆 一一
2.943 56.0696 8.135 69.1796 ,
2.938
…
195 5 一一一一
56.91% 一一一一
43.94% 3.626 30.S3% 難
55.9696 一
氏閱 4 5 年
16.154 21.348 75.6796
11.761
8119 69.0396
字
1 9 5 6
72.8%
2:.9
(六)本縣 D.P且混合疫苗接發工作統計
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期
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1-1161-1 LIGI-ITS OF - LAND REFORM IN TAIWAN
Hui·sun Tang Chief Land Reform Division
JOINT COMMISSION ON RURAL RECONSTRU<;:TION TAIPEI, TAIWAN, CHINA FEBRUARY 1957
CONTENTS HIGH LIGHTS OF LAND REFORM IN TAIWAN pp. 1-9
ESSENTIAL
POINTS
OF
THE
URBAN
LAND
REFORM PROGRAM IN TAIWAN pp. 10-15
HIGH LIGHTS OF LAND REFORM IN TAIWAN Beginning from 1949 the Government of the Republic of . Chin<\ has introduced in the Province of Taiwan a series of meas~tes for rural land reform, of which the ultimate objective is the realization of Dr. Sun Yat-sen's land-to-the-tiller ideal so that the fruits of labor may be enjoyed by the cultivator· himself. Rural land reform in Taiwan consists of three phases: ( 1) rent reduction since 1949; ( 2) sale of public lands since 1951; and ( 3) land-to-the-tiller program implemented in 1953 and completed within one single year. This program of land reform, to which the Joint Commission on Rural Reconstruction lent technical and financial assistance, was carried out step by step by peaceful and democratic methods. It was a bloodless revolution whereby land in the rural districts was gradually transferred to the actual. tiller in order to better the farmers' livelihood and bring about a more st~ble social order in the villages. Taiwan is a predominantly agricultural region. One-fourth of its total area, or 2,160,000 acres, is farm land; 4.8 million, or 53 ~?J of its population, are engaged in agriculture. Owing to the density of population, farming is done on a small scale. Each farm family cultivates about 3 acres of land on an average. In Taiwan there is only 0.2 acre of farm land to every inhabitant, ·but in the United States there are as many as 2.5 acres of farm land to every inhabitant. In other words, there ·are in the ' 1
United States 12 times as much farm land to each individual as in Taiwan. It ds obviou.s that given the limited a:t;ea of farm land, which has to supplythe food, clothing, indtistrial niaterials, and a large part of the resources of foreign exchange for more than nine million people, a higher degree of agricultural production is absolutely necessary. Before the introduction of land reform in 1949, only 33 per cent of the farming population were ownet. .farmers and 24 per cent owned part of their land. Therefore, tenancy, was predominant in the rural areas, and the conditions were very ·unfavorable to the tenants. Rents were at least 50% of the crop harvest. In addition, tenants had to furnish their own fertilizers, farm equipment and farm buildings. To lease a land they had to pay key money and to keep it they had to renew the lease every year. These factors, together with .the small acreage they cultivated, had made it very difficult fot them to earn a decent living. The results of such a situation were discontent and unrest in the rural areas. · In order to prevent Communist infiltration of the rural districts and to stabilize the social order in the villages, land reform was urgently necessary. That was why the then Governor of Taiwan, General Chen Cheng, who is now our Vice President, decided in 1949 to implement the 37.f>.?ln farrn rent reduction program as a first step in land reform. Farm Rent Reduction
Farm rent reduction inchides two difkrent aspects: limitation of rental rate and security of tenancy rights. Limitation of the rental rate means· the reduction of the farm rent on private tenanted land to a .fair rate. To reduc.e
the rent, we fixed in advance a standard yield for each grac1e of farm land. This standard yielc1 is not necessarily .the actual harvest but is closely related to the soil fertility and productivity, on the basis of which all paddy field and dry land are. divided \nto 2() grades. With the standard yield definitely fixed, we set the new 1;ental rate at 37.5% and all rents are to be no more than. p .Sop of the standard yield. Suppose a tenant has leased one, }lectar:e ()f fifth-grade paddy field. Its standard yield is fixed ~t 10,000 Taiwan catties of rice. Formerly the tenant had to pay 50% or 5,000 catties. of rice to his landlord. After rent r~ductio.n, he pays no more than 3,750 catties of rice 1 being 3!.5%' ()f the .standard yield, regardless of the amount he actq.ally harvests. Thereafter, the.amount of farm rent to be paid byev~ry te:n,ant is definitely fixed, and all surplus farm products over a:n,d above this fixed amount will be his to enjoy and will not be. grabbed away from · him by the landlord. This new situation serves as an immense stimulus for the farmer to make improvement:) and increase production. In addition to the limitation of the rental rate, the program also provided for the security of tenancy rights in several ways. First, tenure of lease was lengthened to a minimum of six years. It is renewable at the request of the tenant. Any landlord who arbitrarily terminated the lease before the expiration of the period would be subject to penalty. Secondly, key money which used to be paid to landlord was abolished; whatever. key money had been already paid should be returned to the tenants. Thirdly, advance payment of rent was prohibited and the amount of rent at 37.5 ~b of the standard yield, its kmd, purity, date and place of payment were all clearly stipulated in the lease contract. Finally, conclusion of.new lease contracts 3
and rev1s10n and termination of existing lease contracts by tenants and landlords must be duly registered with the GoVern.; ment in order to be valid in the eyes of the law. All these provisions are being strictly enforced by the Government. Since the implementation of the farm rent reduction program, a total of about 300,000 tenant families, or 45% of all farm families, have been benefited. The effects of the reform were most evident in improved living conditions in rural areas. Formerly, tenants did not have enough rice to eat; now they have not only enough rice to eat but also some surplus to sell. Formerly, they wore threadbare clothes, which are now replaced . by new and better ones. New farmhouses can now be seen in the countryside and more children are sent to school. The most beneficial developments on the island are seen in increased rice production and the increasing number of tenants who have purchased lands with their own savings and own their own farms. Sale of Public Farm Land After the rent reduction program was carried out on private tenanted lands the Government turned its attention to the vast public lands in the Province on which a sizable farni population was working as tenants and farm hands. The Government had no reason to ask landlords to sell their holdings to tenants while the Government itself and government~owned corporations held large estates. To set an example, the Government proceeded to sell public lands to their '· incumbent cultivators. ' In Taiwan there were about 400,000 acres, or about 20% of 4
the tQtal area of cultivat.ed la11d, o:wned by the Government. Before . the reform, 59 '7b of this vast public land were under tenant operation while the remaining 41% were tilled by farm hands employed by government corporations and agencies. Of those tenanted public lands, four sales were held from 1951 to 1953. First priority of purchase was given to farmers then tilling the land. The price of public land offered for sale was fixed at 2.5 times the value of the annual main crop yield. This purchase price was to be paid in semi-annual installments spread over a period of ten years by the tenant purchaser, whose annual burden including both the installment payments and farm land tax should not be higher than the 31.5ro farm rent paid by ordinary tenant farmers. Up to the end of 1953, a total of 150,000 acres of public farm land had been sold to 121,953 tenant families. This program for the sale of public land may be said to have set an example for the subsequent compulsory purchase of private tenanted land by the Government and its resale to tenant purchasers.
Land-to•the·Tiller Program As a preliminary to further land reform, a general land~ ownership classification throughout the whole Province was undertaken.. This task took two years from '1951 to 1952 and produced 6,000,000 index cards which show all details about the location, area, grade, category; owner and user of every tract of land and the total area of holdings of every landowner. After this was done, a land reform bill was drafted by the Government for legislative action. From the first drafting to the final enactment, this task took ten months from March 1952 to January 1953. On January 20, 1953, a private land purchase 5
pfogram was enacted· by the Legislature of the Chhre~e Government under the title of "The Land-to-the-Tiller Act''i TJ;w La11d"'to-the-Tiller Program is a democratic and reasonable one. In essence it is a measure· for the purchase of excess private .tenanted land from landlords and its resale to tenant farmers by the Government at a fair price. R was carried out according to the following principles: l. E?;ch landlord was allowed to keep three chia ·(about 7.? cH~res) of medium-grade paddy field Of twice that milch dry land. Tenanted holdings exceeding that limit should be purchased by the Government.
Z; A..\1 tenanted land under joint ownership, with· certai11 e),(C~.{\t~O!\?,
would be subject to compu..lsory purchase .by. Qc;w~xn!llent to be resold to present cultivat01;s..
t):H~
3. Religious institutions and ancestral worship bodies were permitted to retain double the area of land a.s .was permitted to individual landlords. 4. Lands after• b.ei11g purch<:~;S:ed sho.ultl.:be resold, along with il;nm~wqble fixtures thereon, by the Government to tenant fanners who had been tilling them. 5. ']jh,e lands s}:wuld be purchased and resold at 2.5 times o~ tl:\e v:t:Ol?· according to their respective grades. The value of h:\'liwovable fixtu~~es should be assessed by farm tenancy coll;\rni~tees and local governments. 6. The Government paid to the landlord 70 .per cent of the land value with land bonds and 30 per cent with stocks of government-owned industries. The land bonds bear an.annua.L interest of four per cent and are redeemable in'rice and sweet 6
potato in 20 semi-annual installments over a period of ten ye::tl!§>· · 7. The farmer purchaser acquired ownership of the land after his first payment, but may not transfer or sell the land until he has paid the land value in full. 8. A farmer .c(l.n own any amount of land he actually operates with immediate members of his family. However, a landlord who, besides leasing, a part of his land to tenants, also tilled the remaining part of his land himself exceeding the maximum reteption limit. should not be allowed to retain any portion of his .land he had leased to tenants. program which takes lands from private proprietorsJ;~ri~t by confiscation but by purchase is apt to fail if no adequate and acceptable device is provided to pay for the land thus purchased. In this respect, Taiwan is different from othfr~ countries which have implemented similar programs, in that she has developed two unique payment devices under her program, namely, the commodity land bonds and stocks ()f government-owned industries; The bonds preserve the value of amortization payments against possible inflation and the stocks of government-owned industries are used to divert a part of the private capital tied up in land to the field o.f industry and to stimulate the development of private industry by transferring some of the state enterprises to private ownerS1tip. To meet the. agricultural production conditions on the is~· land, two kinds of commodity bonps. are issued: The rice bond and the sweet potato bond. The rice bond is expressed in terms of rice and is used tQ pay for the purchase, ()f paddy field. The sweet potato bond is expressed in terms of sweet potato and is used to pay for the purchase of drY land. Both kinds of bonds are 7
A land
.~~,form
redeemable in: 20 . semi-annual installments in 10 years at an interest rate of four per cent per annum payable in kind. The rice bond is .furthe~ divided ·into three kinds: redeemabl~ entirely in commodity, redeemable entirely in cash, and redeemable partly in commodity and . partly in cash, according to the type of paddy field purchased. The sweet potato bonds are redeem~ble enti~ely in cash by converting th~ sweet . potato crop into cash according to the market . price prevailing after each crop harvest. Both bonds are redeemed twice a year by the Government. Four government corporations, namely, the Agricultural and Forestry Corporation, the Industrial · and Miriing Corporation, the Cement Corporation and the Paper and Pulp Corporation, were sold by the Government to landlords to cover 30% 'of the total purchase price. The face value of the stocks was issued in local currency, NT$10 per share, to be paid in one operation at the cash equivalent of · rice and sweet potato payments converted according to their market prices prevailing at the time when the capital value of these four corporations was assessed. A definite ratio was fixed by · the Government for the number of stocks each . corporation was to issue to the landlord. After all stocks were issued, new stockholders meetings would be called to reorganize these four government industries into private corporations. This Land-to-the-Tiller Program started operation in February 1953 and. was completed in January 1954. A total of 343,000 acres of excess private tenanted lands have been purchased by the Government and· resold to 194,823 tenant ·farmers on the island. Each tenant farmer has :acquired an average of 1.7 acres. These tenant purchasers represent about 50% of the· total 8
tenant and part-owner-farmer families. As 1iS1t~shlt>!&£f~~~ a~~Ve-riJ.~ndbh}~<;f a~ch!~k?lnent~?: j;he most profound and p:l~aSllJ;"able'. effect produced by . the program has ·to do with iiriptioV:~rnenl~ ~n fat1.ri itehadcy . conditions and farmers' living conditions. Before the reform, 38% of the total prtvate fa:r-m Janel were under, tenancy1• After the reform, t}lt} aJ;ea under tenancy 'Yas reduced, to 14% of the totatprivate farm land. By )955, the. number of owner-farmer. f?.milies in 'faiWfl!l, had inc:t;eased. to 56% of the total numbe~ ~f farm families ~n the province as a whole and the number of tenant families • and farm . hands .had firopped to 17% and 5 o;o, rAspe,.ctively, the remaining 22%. being part~owner-farmer f<p;nilies. •Along with the reduction in the number of tenant farmers and the area of tenanted lands, improvements in the living conditions of the farmers were also noted. Tilling lands owned by themselves after· the reform, these fariners value their farms sd il:iu'ch tlie more and become more interested in increasing their .production. They have become· more willing to use their savings in .building .new farmhouses and. to put more .fertilizers and labor on their farms. Out of the 316,776 new owners of land, 126, 310 have built and repaired 430,000 rooms in their farmhou:ses in the 1949-1955 period. During the same period from the implementation of farm rent reduction in 1949 to the e11;d of the .sec.on,dyear after the completion of .the Land-tothe-Tiller program, 129,489 farmers have bought water buffaloes. No\X.: 129,421 farmers own pedal-driven rice threshers instead of· borrowing one or threshing :riCe by hand. These achievements have greatly contributed to . the economic progress and social ;:' ;, :' stability of the island, and they have .been made possible largely through the implementation of the Landtb-the-THler Ptogra.m. ·'
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9
ESSENTIAL POINTS OF THE URBAN LAND REFORM PROGRAM IN TAIWAN With the gradual development of commerce and industry since the retrocession of Taiwan to China in 1945, there has been a parallel growth of cities on the island. This development has called for the use of more and more urban lands and boosted their prices. During recent years, there have also appeared in some urban centers speculatory and cornering activities by profiteers in land. This might not only retard the development of industry and hinder municipal reconstruction, but also give rise to serious social problems. Hence the necessity for urban reform. The basic philospohy of urban land reform, as envisaged by the late Dr. Sun Yat-sen, is to take away by tax all e.conomic rent from land and unearned increments to promote public welfare and the proper use of urban lands. The program consists of the following steps: 1. Assessment of land values to lay down the technical
basis for the reform. 2. Taxation of land according to its declared value to take away the economic rent of the land from its owners. 3. Purchase of land by the government to prevent underdeclaration of land values by landowers. 4. Accruement of unearned increments to the public. After the program is enforced, land in urban areas would 10
no longer be an object of speculation or cornering, landowners would no longer be al,Jle tp. enjoy the fr.uits of l<J.nd without laboring for it, anP. city people in need of land could easily have access to it. At the same time, the revenues derived from taxation of urban lands under the program could be used for the betterment of public works and promotion of social welfare for the benefit of all city inhabitants. To implement the above reform, the Legislative Yuan of the Chinese Government enacted in August 1954 a law called "The Equalization of Urban Land Rights Act.'' Following this, a series of rules and regulations were promulgated by the Chinese Government to supplement the provisions of the Act. On the basis of these laws and regulations, the Taiwan Provincial Government began in January 1956 the enforcement of the urban land reform program. The total area of urban lands affected was 19,000 hectares. In each of these areas, a city plaiming project has been carried out by the local government. A brief summary of the essential points of the program follows: (1) Assessment of Land Values Since the purpose of the urban land reform program is to tax the economic rent of land and unearned increments due to social progress, the first step of the program is to assess the values of all urban lands as a basis for taxation and the eventual purchase of urban land by the government. The land valut:~s were assessed on the basis of the values declared by the owners of urban lands. The assessment was conducted through the following steps: A. To provide landowners with a frame of reference, the local government first of all investigated the market values or 11
the incbtne' valUes 'of urban iands,by distl'ictsi sections;'and.lati<il c1ite~~des;· Followlrrg this,' 1 these assessed'valu:es were classifiied into different grades arid submitted to the Urban Lands EvaHiatiorr Committee f<k evalttation, · approval 'and public' ati!loun'ceriient. ,' ' ' j ;
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B. Within 30 days after the public am10uncement of the assessed values by the local government, every owner of t,rban lanc1s was required to declare . the value of each plot of land he owned ip. urban areas. The values thus declared.' by tli~ landowners were considered as statutory val~es 'uncler 'tlie urb<m land .. reform program. ' ,, 'ct•.; ,· ' '" ··, '. '·'' ! . ' .. i
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C. However, to prevent owne1.:s of urban lands, from ,undeJh declaring, t.heir.land values, thC; Government migpt notify tpe owners to make a second declaration if the value as; first declared was considered by the Government, to be too low~ If.th~ v:altl.e declared, .for the • second time was still lowe.r thai:n the government-assessed value by 20% or more, the Government might purchase the land according to its declared val1.1e.c '
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D. The values of urban lands will be reassessed if, after the lapse of two fU.ll' years sirlce it'S preceding assessment, its value has fluctuated by more than 50% either above or below the va1ue as originally assessed. To implement the program, the .Taiwan Pr.ovi.ncial GoveJ.7.p.ment trained in January, 1956, 241 land officers from the 2.2 hsien and city governments on the island. From February to Aprih field investigation and assessment of· land valUes were carried out in the 61 regions designated. On April 12, 19'.56, th~ govermnentvassessed land values were approved and announced by the various Urban Land Evaluation Committee~ iii various 12
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on.
~h~. ~slan<;l.
• During the period Jrmi:l ,Apri112 tq. May 11> ow11ers of urba1,1 ,lands were' :to declare .. th~. · v~lu~ of tl;leir .;lands. Uudng · t.his period, ninety.-six .per cent of all, t11e owne:rs owning. ;252,809 plots of urban lands ii:l the. 61 regions affected duly wade the required declarations •• The value.s declared by the owners .·were· mostly close to the government-assessed values. To pay fdt tfre purchase of urban lands by the Government, 'there were isstted NT$15o,ooo,ooo worth of land bonds carrying an interest rate of four per cent per annum and redeemable in five equal annual installments over a period of five years .beginni11g hom. the second year of its issuance. ( 2) Taxation. of Land • According to It.s Decla,red Va,lue a,n.d Unearned Increments
After the vah.re of urban lands has been assessed by the Govethmeri.t, there comes the next phase of tfre program- taxation of lands according to their declared values. At this stage the Govern.rnent collects the. economic rent and unearned increments for the public. This is the major function of the urban land reform. Taxes on urban lands are of two kinds: the land value tax and the land value increment tax. These two taxes are determined and levied in. the following manner: A. Land Value Tax: The land value. tax is to be levied on ;the basis (}f the value declared by the own.er. For lands below the initial point of land values subject t·o prpgressive rates of taxation,<n the tax rate is 1.5 per cent of the total value of (I)
The initial point of land values subject to progressive rates of taxation is the average value of 0.5 hectare of urban lands in the respective hsien and. cities .<m the islan<:l.
13
lands owned by any owner in one locality. However, £or lands exceeding the initial point of land values subject to progressive rates of taxation, the tax rate is progressive with a rate of 0.5% to be levied on each additional 400 per cent increase in its total value until the total cumulative rate reaches the maximum limit of 6.5 per cent. On lands owned by absentee landowners, a land value tax double the prescribed amount will be levied. The land. value tax went into effect in September 1956. In a period of one and a half months, over 90 per cent of the amount due for the first half of 1956 were collected by the Taiwan Provincial Government. B. Land Value Increment Tax: When land is transferred from one owner to another by sale or gift, a land value mcrement tax is to be levied by the Government. The purpose of this tax is to appropriate for public enjoyment the. increased value of land after subtracJing . any cost incurred by the owner in improving the land. The land value increment tax is levied at the following rates: 1. 30% on increments below 100% of the declared value.
2. 50% additional on increments between 100 and 200% of the declared value. 3. 70% additional on increments between 200 and 300% of the declared value. 4. 90% additional on increments between 300 and 400W of
the declared value. 5. 100% additional on increments over 400% of .the declared value.
All incomes derived from the land value increment tax 14
should, according to law, be used for national housing and social relief and welfare programs. This tax began to be levied on August 1, 1956. In addition to the tax, the Government may purchase at their declared value such lands whose value is considered by the Government as under-declared at the time when they are transferred from one owner to another. The payment method is the same as that for the purchase of other under-declared urban lands. ( 3) Promotion of Land Use
Parallel to the levying of land taxes, the Equalization of the Urban Land Rights Act provides for the utilization of urban lands lying vacant in urban areas in the following manners: A. The local government will set a maximum limit not exceeding 0.1 hectare to the area of vacant land that may be owned by any private landowner within urban areas. B. If the area of vacant land owned by any private owner exceeds 0.1 hectare, he must sell the excess portion of the land within two years from the enforcement of the urban land reform program. C. If the owner fails to sell the excess portion of the land he owns, the Government will compulsorily purchase it for resale to another person for use. D. In case any vacant lands wen~ owned by the Government or government agencies an~ leased to private individuals for use, the' same maximum limit of 0.1 hectare will apply and the excess portion will be taken back by the Government.
,/
15
Sep乞.
25 , '57 TAMRI, Ch 'a o-的呵 1957
G'enera1 info lT.l.ation 1. Genera1 1.1 1.2 工 .3
of 七he
sprayi_!!g
pro 眨巴id空三也EJ叩nsh旬，
da七a
of
Kan申七釘19 '1' avmship b立. :
Land Area in sq. No~ of Vi11e. ge No. of Subvi11age 小.
2
24 .53 8 1.15
1.4 1.5 1.6
of
Fqr;位主 es
. 1 ,185
PO.f道泊位on
.. 2
11, 034 Aug. 16 - oc七. 6 , 1954 Ju1y 11 - Sep七. 17 , 1955 Oc七. 1 - Hov. 15 , 1956
Previous DDT Spray
2.
1951 DIJI' Spray Pr ocram of Kan-ting Township 2.1 Designa七ed
a) 的
Spra:" Area this :?e ar ; No. of Vill月e 七o be covered : Popu1a悅。n 七o be pro七ec七ed : I
7 8, 172 NT$ 7 ， 6∞ .00 (NT$ 0.93 之1. 00)
c) d)
Ac乞u.al b吋 get appro鴨d
No. af
111αrkers
: (2
lh forer.旬 n ，
& 4 he1pers ) Hs;en He alth Cen七er
8
operat叮S
2.2 2.3 2"h
Foremen's
d叮土地七he period
祉'aini.r宅 、商品
,
.:;
Aug. 詔-14， '5'( in pmg-七，u，ng City.
，~~~ll:1uctC(: 1:,.1 T'i n~-tung
Opera七ors f training was conducted by AU[;. 19-24, '57 的 Kan七ing Village.
Kari.. . ~:iT11!， Ba l'll+‘片司令!>.+， ;們n ñ'lr' 1ng
趴lI' U七ion
of spraying
opera七 ion
schedu1edj
Opera七ion star七ed
on Aug. 26 , and 七。 be acconp1ished by Sep七. 30, 1957.
2.5
Supp1y; a) 1.115ec七icidesj Mixture of 68.2% DDT & 0.6括了 -BHC i'later dispersib1e p冊 der ••••••••••••••••••••••••••••••••••. 9hO kgs. (Equiva1en七七。 115 伊S ﹒ per capi抽)
2s 6
: 6 hand compression sprayers & one L.P. sprayer. Spra;:;吐nc in Li-she Vi11a 伊拉的arted on Sep乞. 24 and schedu1ed to be cOr.lp1e七ed by t 'Æ errl of this I1lonth.
的
Sprayers
) IE 恥的 l 唔， ω 乍(? ,Ls;L.
/H t?-9/1
I
L't{.;J :芯吉站~ 'ê)叫立dρ
/00ιτ〉戶
d 品 蚓 J 一 彷助馴圳歹砂訓訓 J 圳 圳 'A 叫!叫 f
茗罵z l 尹盛 歹向站仰 t叫 I 叫 )0 叫d 〉唔卓妥多
=三~ 制旬吋l抖斗4抖+4H+
到刊上。五13 日 d
9N n上9N !d I d \H.sNJ\~位.
eNLLN\7\~
:1 0
dtl州
fbotographs taken in Taiwan (Clrlna) during the World Health Organization Public Health Conference and Stud¥ Tour September 1957
-'
VISIT TO THE NATr ow TAIWAN UNIVERSITY MEDICAL COLLEGE I
Dean Wei JIIlking introd uctor y rellllU" kB
,
Dr. K. P. Cben. Direc tor of the Insti tute of Publi c Healt h. givin g expla nator y remar ks.
Miss Yu, Director of the College of Nursing, giv:ing explanatory remarks.
Dr. Bierdrager of Netherlands, leader of the group, conversing with Dr. K. P. Chen, outside of the Statistics Laboratory of the Institute of Public Health.
•
The group leavin g the Medic al Colle ge.
VISIT TO THE NATIOHlL lEFENSE J£DIC lL CENTRE
NIH: BiOlllO rphics am Medic al BiOlllOrpbics Build ing
NIH}
recep tion room
NDM:::
~s1cs
Labor atory
NDtIl Pharmacy Laber atory
•
5 NIHJ Library
NDMC Diete tics Labor atory
VISIT TO THE TAIWAN PROlm:;IAL MAIARIA REmARCH OOTITurE AT cmo-cHa-I
,
Dr. Downes of Australia being introduced to Dr. C. T. Chen, Director of the Institute.
•
Dr. Yun of Korea.
Dr. C. T. Chen. being introduced to the group by Dr. Bierdrager.
, Dr. C. T. Chen, giVing explanatory rem ark s.
The grrup during prelim:inary session
at the Institute.
~e
group visiting the laboratories of the Institute
\Dr. Bierdrager looking at some of the open air exhibits.
~. Cherry and Dr. Bierdrsger looking at tbe open air exhibits.
Jlr. Bierdrager discussing sp!"l0/ers with Dr. H. H. Chen at' the Institute.
Sone mElDi:>ers of the group resting in the compound of the Institute. L-R: Dr. Yamaguchi, Dr. Grant, Dr. Wu, Dr. Nolasco and Dr. Downes.
A. sprlo/-iIIBll of the Institute.
Dr. Seijo with Dr. C. T. Chen.
The group getting reaclif
to leave
the Institute
Outside of a house about to be sprayed with DDT; Dr. H. H. Chen reading paper.
In the front yard of a spra,yed.. Dr. C.T. Chen, giving explanatory rerna.rlcs.
Spra,y-man IZ"eJ:Brlng the DDT sOlutiOn.
inhabitaJt,s in the yard at a house about t o be spr~d.
Sane memers of the group in front of a bouse about to be sprayed.
Dr.
Grant talking with Dr . C. H. Yen.
Three members at the group, L-R: Drs . Seijo, yamaguchi am Grant.
Leaving the yard of a house already s p r a if e d.
Group photograph taken with the Mayor in front. Pingtung P:refecture Gavernlll!nt Building .
•
Duscu ssions in tIie P:Ulgtlll~ Pret.c t.ure GoverlUlllnt Build ing
The Mll¥or of Pingtu ng mpldn g uplan ator;y remarks
The
Direc tor of the Pingtu ng. Healt h Centr e lilakin g expla nator y remar ks •
•
•
一 括一(一計制止
J J I U\ … ι UA M i J 僻 靜
刀 一恥 l， jt 「 協廢 f rlhh 心
I
! j
臺灣省灑疾防措觀說 鵬MAlA削酬酬 IN TA酬 REPUBlI C DF C酬 l削57
J -h V '(UU， A車 . f . 昕
: 1
韋斯蘭:P.I:
1;i' ront view of thc Taiw aIl Provindal Malaria Research Institute (TAMRI)， ιhao-chow， Pingtung , Taiwan.
F占ffS計劉受益姐鐵長維1!l<本朋致謝(富起縣衫綜那〕
!,orkers. being honored by a township mayor for eradicating malar阻.
National
曲d
international
曲 ti-malaria
Staff l]1 embers of Tl1e Taï'wan iji:ovin(.iàl Malaria Rescarch In stitut e.
中:所工作問
λ
For.n er ::i overnor C. K. Yen laboratory -orks at TAMRI
JÆ~ìt~省政府的主辟股崇海洞察本所業務 0"[
世界衛生組織益集各國專家套價本省I!hIi1l情形(時民圓圓 I
Taiwan inspectmg
十三年十一月〕
WHO' éxperts visiting TAMH.l in l\ ov. 1954.
A g... oup of Vì", t-namese t個 hn 插曲 s m 3.lclng $"I..n l'iilp剖神fl dur:ng a 2- mon_~I~ _~I國na QD õt 長 nti 回國..a nn .，，，叮當咱自 at TAMRI, 195S 臺灣省建房耳l 完所組成車說
*/JIí，而站工作提Ti1<鞠祖〈當者目中~~租車iì
直轄，歐府\J，肆茁主i，~一怯于屬此可﹒回{jf*區接!Jt
是去掉在三T 家 J旻噴射計*\ 1952-1957
吾吾灣防痞計量l 執行車說是L
DDT Spr.ι.yirr ûpcrations in Taiwan, 19 ff.2-1957 1952 旻益人白鹿
Organi:cational Chart of the Malaria Control Operations in Taiwan
Organizational Chart of
TA耳ffiI
1953 要聳人口飯
1954 旻益人口服
r. 民國41年 5 月一民間45年 8 月 May , 1952-A峙， 1956 .,,_.41
Pop ,
Covera召 e:
Pop_ CO \i crage: 1 ， 5詣， 3C6
Pop. Coverage 5,467,664
156,217
r -) ,.;. E包
』
為 ) 哺均曙/
1日 55 要盆人口 1Jl!I:
1956 要各人口w!(
1957 互每人口 1Jl!I:
n ，民國 45年 9 月至現在
。/
Sept. , 195日 to date 色il，喵彷'1. IA" ~-~叫 __ 1 .。楠，
Pop. CoveraJe: 5,64C,325
Pop. Coverage: 6,728 ,465
Pop. Coverage: 1 ，7日O ， OGO
一貫
n. 民國 45年 9 月至現在
1955 賓益人口數
1956 受益λ 口 ø
1957 至益人 口!)!'(
Sept., 1956 to date
Pop. Coverage 5 ,64C ,325
Pop. CovE:: rage 6.728.465
Poç. Coverage 1 ， 7日 0 ，1)(; 0
(E ::õ timat E:-) 約 2錢竄 ä
-- ,"""" hFL
一 叫肘"岫
-_ T.山，~，
t龜寧ft~ i'::.
一 岫M'
匈鼠，奇心
-- …『叫 A..訕地鳴﹒
學
,"
.
p
r
i苟延汁~!各從工作人買 2、
1952-1956
f,f .ji;，防建計費l 所用器材祺品來源 1952-195~ 首詩 m研 ~fi可(省政府) 物們 安全分躬/英俊會
1952.1956
ff~在防建計;f'!i有收容材恭品
1952-1956
Personnel for the Taiwan Malaria Control Project as shown by Year, 1952-19ff6 民國 41年 民間 42 扭民間 43年民間 44年民間 45年
SOUrces of Equiprnent and Supplies Provi4e <l for the Project,
Eq:.tipment and Supplies Used or Consumed by the Pr官 ject， 1952-195~
I且1tlt
1!!界衛 生組絨
攝氏 起全吐
計
物件
處國 41年民間42年民冒 :43 年民間44年島國 45年
1952
1953
1954
1日 55
1956
Arti cI es
TAMRI CProv. Gov't) 60
ICAκ;USA 2 ，鉛5 料*
JCR,R 10 5 勢持
WHO 5 贅，學
RF 5 時
Total 2. 5 75
Articles Jj~悄話 75')巨 DDT (公嘲) 泊J.5D DT consum剖，
1952 16.4
1953 173.7
1954 636.5
1955 67J.7
1956 746.7
.-..............
11
II
l~
75?;'; DDT 14 65 75~óDDT
(全噸 〉
in metr ic tons tons
*
“
Ma
ìn metric tons 0 1,578 2,763 9 60.8
52
57
GG
在 596γ.BHC (公嘲 ) 65;6γ- BHC in metric 服描式直到捧
70 帶 1.5J日持 2 ， 251 苦;<
22
27
34
自
f}J~月耗 6.5~區~-BHC (么嘲)
500 普希
100
瓣醬
35
Spraye間，
Comprcssion 721 一 -l':' 8 梧帶
4,3G5
6.5 ?6Î" , Bt.I C consumed , in metric tons 所用 I~描式嗤射器
250
2,668
3,132 12
打「過式噴射桿 Sprayer宮， Lift~ J: ressur e
721 2 .略轉 l 勢給
Compr田 5100 spraye目 used E再用車制
耳輛
Vehicl目
12 2.430
9
VE: hicles used S:Xl X' lE240 費轉
的吉普掰品1 O-:X)J 程 控)
Anti;malarial drugs , 1CC (,'s 耐I話
1,000
*持
勢助消耗站站雄劑(1 000 位裝〉
371
6年i
87
257
4;12
Anti. mqlarial drugs consumed , 100 lJ 's 著，~摺購買甜苦自樂辛苦 ，卡母奎因，克檀肇事及擔擔平 G
Note Anti.malariaL drugs include paludrine. camcquine. chloroquine. and atabrioe.
d色仿、居首十'Ïfl!經~來
L持
INTR C>DUCING 'fAMRI The Ta 缸IW2 缸凹 n Pr 叩。仰 vmc 口Ia叫1 計 巾 d ι h 間 e Ta 剖 岫 2 t
Sources of Fu nds for the Project 民間41年 1 日53
Ma 叫la 盯 n 且 a R揖e 臼 盯 a 閃 r ch Ins 前 ti此 吋 t Jte (TAMR 則 1 ) is an organi 旭 za 剖 Uon a 昂1ia 刮 te 吋 d 岫 t 。
.Il( f1!4211'
民ilI43{1'
民間44年
民悶45年
1953 10.30
1954 10.30
1955 15.65
1956 2'1.78
Tota!
10.30
US$
45 ,940
239.870
953 ,760
604， 69 ~
439 ,330
2.2 83.59 )
US$
47， 5日 D
440,800 49,100 44 ，郎。
951 ,180 50 ， 46日
616,(80
474.430 3,810
2.429,99J 151 ,610 174.QOO
USs USS
48,2 40
45.000
34. !A:0
25.500
25.5 ')0
US$
186.680 1， 922.7日)
773 ,770
1.889.400
1,246.270 19.5~4.100
943 ,G70
5,039 , 191
7,959 ,850 19.4 6J.920
23.369 ,370 72且27.01'J
Founda 刮 ti 叩。 n > assisted the Govemment in 刮 at 甘 祖.c1】 t ki 叫 口 1 ng the ser 口 1。叫 us ma 叫I3. ria problem evident in Taiwan Q!ter World War II. The Institute headquarters was 1established at Chao-chow. Fing.tung hsi 站 en > Three.f 扣 01 地 d resJ;on 悶 Sl 油 bi 山 li'~ 可 y was borne by TAMRI: a) . 切 t。 血 ca 盯 叮 T ry out the invesι'ilga 缸 dve work nece 閏 s 目 s ar 門 y in de且 fini 叫 1口z咚伽 ma 叫la 盯 na pro 。曲 bl峙 em and the pr.l~d~1 mc~~s - ~f ~.~~t~;k;' -b;.t>~~. ~自in the anti a malaria technicians and other recruits from 1。臼1 îieal山 sta'.i ons in the techniques of malaria control by residual spraying , as wel1 as GUpelrv Úli lng the field work;9an d to evaluate the effec. tiveness of field operatioos through out Taiwan. I TAMRI h 祖 吋 2 d emerged from the pr 閃 即 e pa 盯 間 r atory n耳 ~g'e: of layl( 呵 f 臼。叫 undati 岫山￡ ω ，瓜 r 悶 and mak 乞口 H 呵 pr 閃eli 叫 . ml悶 r 叮 y 址 s tu 凶 di 悶閏'" 吋 r efe 前 ren 凹 nc 凹 e 岫 t 。 malaría and its 吋￡叫 宜。旭 ke up the major respons ibility oJ the malaria cO:l'trol and eradication campaign in T iJ wan which has been we l1 advanced to date Total elimination of the dise 3.se from Taiwan now 申 emfi to be within sight Major activities and f lU1 ctions of TAMRI d uripø the past eleven years that have elapsed sjnce its inception m叮 be outlined in three 刮 .tl"c~î咱 periods as fo lI owing: 1. P .,. iod of Foundinll' and Exp世 im間t: Nov. 19卜 Apd l ， 1952 DurÎng this period TAMRI was primarily canct. med with gathering data , making malat; a and anophel ine surveys as well as with the ex perÎ 咽 en t of malaria contro l. The new an í: imalarial drugs such as PaJudrìne. Chloroquir珊.0呵也 10r<>qUi帆 and Camoquine were s t udied in reference to their suppτ ess i vc and therapeut ic effect in ~In study areas at Chao.chow , Taichung , and Keelung. Anti.mosquito measur且 sucli as DDT ~r閏 fðunl spraying in houses. larviciding in rJ ce. 面elds :::.nd ditches. and automatic flushing in ~tr'ð:l m Î!i were also conducted on an experim entaI scale in certain areas of Taiwan. During the pè l'Îod main financial support came from the Rockefeller Foundation , JCRR ::m r! th e Provincial 昀"，(!.f'n m.c，u;.
〔叫tedto rt page>
;昆蟲部份 ( Entomology Section
山睡一帶的圳將是坐 iW ，主要 li1'íi 在組介者/"~扒拉故 1 ;投 直想的發生划。
山閥混是湖水街屁也 可能 i!J1.生 /"j謹小iif!m 及 );1til
稻田是中 1何區蚊最適宜的授生吻。
|眼前 d底下是J~H'Ý1!'敏書 iHl~聖'tt椒;休息的地:ñ. plac但 of Anoþhel， 自
m歧。
Rice- tìeJda are favorable . breeding
Streams Or ditches along the footh Hl areas are .i deal breeding plac目 of Anoþheles m;，閻明悶， the chie:.: malaria transmitter in Taiwan.
Seepage pools in footh i1l areas may 11so breed Anopheles 州拉 ;11tuS 缸ld several ι 世ler spedes of Anoþlzeles.
hyl canus
si~sis.
Undemeath 6ed is the most favorable daytime r自 ting place of Anopheles mînimus.
建間利用水牛寫到來揉按 Ý1S 蚊。
在研l內組閣u輛紅菊E盟軍F釘'UH按 ﹒搬到H buffal。
昆蟲披紅人只在訕地你是是 ~;<}j肯在r，r:;;a， ;j竟
有 高噴射過的地區內作 L巴斯巴因1 民黨顱，來鎧~Iii!蚊:ff否判
;本所 ~t; 帶研究有II[IJffi開生活史。 Studiesιn
Night collection of adull anophelines using water as bait.
決原施。、
俄宜的 HW，~ ilii"" -J DDT 之刻糙。
DDT 發生抵抗性。
life- histories of varicus
Dissectjon of anopheline mosqu;toes and identi 自 caticn of specimens conducted in Entomology Laboratory.
A team of 阻 tomology technicians ccnduct :l. ng bioIo..:ical test in field to check the effecti....eness cf DDT residue on treated wall s.rfaces.
:lusvine's test is being conducted to determine whether
anop)eline mosquitoes collected from the sprayed area have deve oped physîological r田 ist血 ce to DDT and other insecticide~
beging dcne , as a pre1iminary to fulure works. speCJ 屑。f 刮目 are
臺灣農村位是，牛才的內是妓種類Jl.比例 矮小是妓 Anophel 的 min，im_U8
位反內 J妄， .連絞盡問禱，已 r;f
換山仿;Ji主實 i蛤區之候，)、 4;1; 紋減少情形
Specie s Cornposition of An op.h el e.. Popu!ations in Rural Houses and Stables of Taiwan 1952-1954 年間於 1 ，118 住J室， 1.049 牛棚內始 梨 花台蚊之分析 Ana!ysis ò:f 筍， 656 Specimens Found in 1 ,118 H o uses a nd 91 ,738 Specimens Found in 1 ，且49 S包b! e s， Apr. 1952- June 1954 I HOUSES(ßA時，
Daytirne Resting P l.:..ces of Anopkel臼 minimus 1952-1954 年悶在1. 118 之分析
〔氏國 41 年三 45 年〉
住屋採集乏 14，466 雌矮小 ~\ì峽
A. minimus Popul.ation in Chi-shan Ar ea, 19lí.2-19li~
Analysis of 14,466 Female kwρheles mimmu:; Co!!ected from 1 ,118 Houses , 1952-1954 L 何嗯1I"'('Wrj(jHJ.~tO .... JI，跑遍.".，，，
1.
屋內成虫iJ!!(
Adults in Sprayed House
9 OZ4
,
"。﹒'‘ 6Z. 1I 8 11.13
1::1 E 叫
~
IU2
叫 曲可~ Qoor9Sp ， Cø>Ip，每個問阱
W .....M . lI U 5"1 A, hp t. DIIU ' .圓"由
'..
、 16.09 2.fõ2
ZO， 2 剖，皂.93
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、延中 4已是紋里E 在 DDT 噴射徒的牆壁上， iì;. .ll企其，fjl，蟲均力
全/~ ;去f 產各種，是紋:tt DDT 之成受性比較(氏國 45 年至 46 牟〕 Relative Susceptibility to DDT of Various Species of AnQphel甜 in Taiwan. 1956-1957.
全灣;{‘矮小;車妓分布國
Biological Test with A. min. imus & A. k. sinensis on DDT-Sprayed Structures in Field. - to 15-minute-contact on plaster wall with 91-94 day old
1955年 5 月一1957年6 月
Distribution of A. minimU8 in Taiwan
Wi!d temale _a nophe)ines captured one day earlier. 1- ， 乞，手. 4- , 24- & 48-hours Ïn ortality. ty : Tai-chung. Te.t A. mi且imu.
. D 暉 .1.4èt minim臨 d甲 車 峙，且，于身居叫 H
May 1955-June 1957. 成蟲〈噴射建築物〉
Adult from sprayed structure 15 min. 5 國.11.
。18Ck 恥-岫 Tø-n!ll hlp ， f有呵，仙1'1 0 H，回[口.09 % DD T) @ DiJt, lct
成蟲(隨射建築物以外〉
A. h.. sinensis
15 "1且5 min. 1 min.
Adult from other than sprayed structure (0.20 "10 DDT) (j)
U咀 E
~
_
A.
“ !'l-fJl
.ro ,
。城.Iln . Von.9 ~，，"n- 的 CJII
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% OO T) (3)
None ，可 、倒
A. maculatus
.et"'.....""，肘，Ht 口 .58% DOTI @ I
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A.
SUbDicl 曲 Indefinìf喝
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..
Altl>t珍喝紛國晨f.
+，矗蚊
(1. 57
or. DDT) <D @
4 . hyrconus sinensis
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ENTOMOLOGY SECTION and at the begining (1952) of the }l project , the rnedical entomology laboratory made its contribution by actics oi auack on the transrnüters 01 malaria. The fact that Anophel時 the chid malaria vector , was established on the b3Sis of the 面 ndings m dissection of a to1: al of 84 , 120 anopheline mosqu i tCJ間， which were n hous曲， water-buffaJo she' -:: ers and out . door resting plac自 selected in 當 01 the island. AHer it had been det Er mined that A. minim阻 was th ea vector , two important facts about the resting habìts ot this speci目 vered. These were: 1) that within a house the majority 0'1 the chief tor was to be found in the bed-roorns , and 2) that among 16 typ峙。f '"恆， classified for observation , “ underneath bed" was the most preferred , ce of A~ minimus, followed by "underneath furniture" , "r∞?'， and “ wall ~ meter from the ftoor". Th目 e iací:S were dεrived from detailed records of cimens oi anophe1i ne mosqu i ‘0 臼 colle.:.ted irom 1.118 hous E::S scattered over I. Studi目。 n seasonal prevalence of anopheline mcsquitoes revealed different of A. minimus seasonal peaks in varìous localiti臼. The fact that the insectidiveness of DDT residues on wa l1 s lasted longer than one year , was proved to ilso in Taiwan. by periodica l1 y conducting biological t自ts by a modification ond's method , using w i1 d caught anopheline mosquito間， and by maldng year lnopheles collect ...m s from 晶 xed r outine stations. With these established facts
as well as effectîve residual DDT spraying program was
料他線，均
住做民
成跡
路轉毅等在蚊從街 串 賣的
。宙
, preparatory phase (1946.1951),
用本摸及力在發 D ~告本則 ~W 在上自並。床多做給所用品在
間以隸
2 對方
蟲。
鏈。期底 l臨大M!毆胡啟究
During the period of malaria control by residual DDT spraying (1952.1956) , the members oÍ the rnedi叫 entom叫y 1伽r伽y carried 叫 intenslve 1s1叫 -wide pheline surveys rather frequently , and rev ealed that the DDT Sprayings were so
攝寫詩單單許是 E 草草是吾吾費品盟主了當審時在群島市昆 物見，趙武翻中授認 D 午十 D 時各。研其在性定 後 覺策始
前所誠主置于耳環生 D
.防軍然控 J1~ 于不此I.!í:詩也采 l 苟且 i咱京
;泣立泣 叭:??六咒 r tUTτ3t r 立 立; : 叩 c on 叫t 山 in 叫 2
Z:立了rZtiEJUtZE早已Jtztzttomhrr;2:指: la叫aseoftheJL:nmely 川eriod m叫a eradíc叫 WM
巾 . bu 叮仇制 叫 a 岫。 blo l 。∞。吋 d.
Du 盯 nn 汀 mg 昀 t he 旭 I at 牡 !e 叮 r ha iÍ 。吋 f t he sarne period , biological tests by
:::泣立:r;ft: 沾 tJ;: 立 立:泣;立泣:立立IL J 口!立泣泣扎 UU: Li一μ 已 比 t;ζ?: ♂♂ 江心沁;;斗沾 立;立泣:立 lJ ;r 唸唸詰認;?2f 叫:r 扎叫:扎沁口 芷芯:::已」 L z! 亡忱;只咒;立:;立 :5;rzT;2;心1 吉:::叫 ♂ :2 尺 J 1ι be 巴f 臼。r 閃 e
vector , A. mim)m品， did not develop serious resistance to DDT, although strains of A. Iz. si 酬的 from some 10叫ities showed relatively high tolerance to DDT. In the of has jt 叫 b嘲 n 吭叭， “枷。 rt 尪 S o{ 吋 th 吋 削 e me
i ( } }
傑作述發小情~揖 T 工並，劫持呆且瓶底內做係 八 從軍防司E
;fizzizzii起!哈拉紹說?卅一 供除草陸 有 ，眩，。至人現各 4 本及，花住現接二地配初叩
j
未在避之至于本力至且後額有地采省以發拉宅兩路。住每期
話置于對時孟畫面。絡。每蜜蜂持語言?君主
i
撰 E 2 替 E2 治lf..
the eradication of malaria frorn th悶悶land is attained. Such unfavorable findings w i1l immediately be followed by investigations and research work to 直 nd 叫啊叩iate counter.me山es. D盯1時 the same period, studies on arthropods of medical importance , other than anophe1i n凹， will be done as a pre1i minary to future work , 51) far as time 泊的剖 lable
峙外省總人有區巴滋幾射堇鐘以最 : 更重~:Ít話。媒
.;;<外究
;
喜韓§ 白 ;鋒 2 ?持 22 軒 T §詰 z 豆諒 i ?捍; 未地「 蟲般
噴前之尺 • 'i膏。 S賀他叮疾
i
毒品
要堂?
書市置
于惡
毒里品主惡毒空寂撞車 Z 屋物故坐他小步解常 JTZ 內前盛面息路，剖懂 ， ‘g，
考于尚跡間提 ~W 閻惟巳 食品 未象時 說宮里」 其給
是尿是全部份
Parasitology Section
工作人員正忙於撿查ffl!lJi原虫血片
防 ;Jlï工作λ 目前'1r1"'Jl覽山 ~'N;fi進/、 偏僻山 l悶，砂行任r~j Sometim臼缸 ti-mala市 wo 巾 rs must adventure to c1 imb up thelmountains or ford rivers in crder to perform their duti自
Members of Parasitology La boratory busy ín doing rnicroscopic examinatiûn of blood smears.
不 ï J1j;兇 J r 1H，下再 ﹒滴 u'ut在 -:~n實地 n 否.Ji!l疾發生
誤入伺 ~i，I，，，Hi;.月 T!):正見 了1種抖病人
Elood was being taken from the infant's earlobe to determlne whether there is any malaria transmission going 00 in the an:a
Visit lo remote rural houses (or ~ever case and infant survey.
向正在捉到老紡樣風般7壘
工作人 民 正在 7月E病iif
;司咒末 j! '~1J綿lJil ñHIJJ1iTì
~ñ 1 1l;在主哩~1J'~lnlr 鵑花&t!'崎l
Taking blood s rr. e 3. rs from an old \'~oman with history of fever.
TAMRI technician maldng case investigation.
Splee :1 palp 3. ti cn was beJng pre-school children survey.
C(
nducled on a
Schocl chilrlr~n be:ng palpated and tal<en blood to make smears.
;~or
e. nlarged spleen
全省同時是足虫 ;f}Jl 壹
Simultaneous Island-wide Malaria Parasite Sllrveys 民間 41
妥，叮叮是政Qt~.巴區域閱( 46 年〉 Malaria Sun"ilI ance Map of Taiwan , 1957 F 己 倒 45
i Jõ 12 月 17 回
民叫 43 年 12 月 17 月
ir
12
IJ
17 U •
December 17, 1952
D(>cember 17, 1954
Dece Jnber. 17 1956
缸叫 悍鼠 赴蚓帥"叫唸卅 M 仙 向i凶 r 岫 .r， 臼 』
.亡三 J' 仇叫祂函 P 恥叫仙川"叫肉叫叫， 圳 .吋 4 岫吋 F.“
ζ: 三〉 隧椏 : 紅 ~:ilr 叫叫 C三三? 企帥扯 M 益 前您伶 肘，.汀 f1rJrrrfy? 蚵心I嘲喇j
。v 成 ehe
A--zo JO 。
OA M 時
仿 μ食的
~
。 唾
'i?
。 ~ A 5%一
示肘，盼翟度﹒
f:1 原虫學 ， 團
'i3 159b一
可
Parasite Ra tes
1096-1596
臺;均已進來流行情形
-
.........This boy úas an . Qrarged srr--一一 due to malaria. Themarklng 1\ abdomen shows th , size ot e' enlarged spleen.
0.
A 5?6-1096
x 0'-
Malaria En.demicity in Taiwan
電L
防治前 Before Control
1953
瘡疾防治質施兩年後 Two Years After Control
1955
全省 F 特制企未辰，芋﹒齡兒竟是采房~~情形 195 ，~-l95S P. es,* of Island-wide Simultaneous Malaria Parasite
早在山區 2-14 tz 兒女將 IJt 及志，呆尿虫訓E Spleen and Malaria Parasite Surveys in the Oi -shan
s.:rveys 胸查日1!1
Am ong Pre-school Ch i1 dren , 19[2-19[6
Distri怯t， 2 -14 Year Old Childrfi划
訊前日期
師級則有相平均叫做儉在改
融牢 DDT 蜘r.間 parase. .位
縛勵兒童入敏 No. of
翩翩 Positive 也「一 偏[J fi~ 'I!~概三閥混在 U~ rt~ 扁了 Pv. 375 Pf. 669 Prn. Mix. Total Para. Rate
DDT 面而 J~J
NO~ I)f
之2 .
survey '-~ ~'lIn.'
mmmed
Number sp4eEEBNumber
ra扭
A EammsMHJCD叮 spr. f竺 2. Z4 1 ,953 L705 23.04
Date of Survey
!o明日hi p..; childr曲
jnchded exam:ned 13! 13,885
DDT sprayed
瓜l.!l坑萃訂了一謂缸，于-52.28 June , 1952 aumi
Demcn回 ra t.lh l1
Area
學
ifj;指著蔥 ~.
rJ
~ 伊
: ;第 霞位道
,
:
磁7J
」是闊的年 12月 17 日 1951 , Dec. 17
恥
70 1. 198 8.63?6
L7品且221.U
EIOWES酬， 0.13
., .,.;; ~_ \)
~J
民間41年12月17日 1952, Dec. 17
14:
14,213
532
718
34
41
J,385 9.7406 Mac. 9.Nov.13 , '53
JEItt?rTLMllsmI16μ77 F<Ii"J~~午5哥 2.235 11.45 1.37 2,235 l~商45年6 .JJ May , 19月 5
\ug..S恥 I 0.40 呵 -Sept.. \ug..Sept
一一一一---一一-一一----一一一 也坐墨畫室翅盟上 民凶43rp2月 17 日
June , 1956
2泊2
6郎
1172，Z920. mtu耳..S句t
14: 14E
14,614
90
68
10
5
173 l.! 8?6 Mar. 7.Sept. '2 7, '55
1954, Dec. 17 民間44年 12月 17 日
14,759
12
9
5
4
30
0.2[)06
1955. De c. 17 民國45年 12月 17 日
Mar 19.Dec. 3. '56 15C 14,825 0 2. 0 0 2 O .01?6
Former Check Area 民凶41~67j一寸五百一-44.47 June, 1952 民體42年6月 l,4 88 43.4 7 June , 1953 民間啊'6月 1.叫 2ι75 June , 1954 民囡44年扭 1,765 18.98
1.99 2.04 1.62
1,452 1 ，4布
幼.32 15.79
1翩 1.767
划 0.74 0.21
.ug.. S叩 t..h .ug..Sept" 1 ..L ug.-Sept., ]
1必 1. 13
1956. Dec. 17
民掛45 年6Älune. 1956
Mav
呵呵
1 ，聞
訊剖 ,...,-- ' ~
]，9∞
Jug..Sept. , 19
d鈍.;.1> ~ fJ'."p...,....,. .，P..qP.，..... 、"'''帥、...，."、.，， -、“門，再.，....，. ~I\d> '、阱，、阱，站，‘昌，闕，祖國徊.......... "'"屯，向區.........同-~蝠，“_ .品，也~~ 也. .叫.~_ ..... “ 一
~一-~"-可開唔_ .峙.-....甸回甸甸甸、 l
- -- - - 1
(Continued from pr由iOtlS Page) 2. Period of lsland.wide Mnl叮 ia COl1trol by DDT. Ma y, 1952.1956. In the beginning of 1952, TAMRI was ready to launch an island-wide malaria control campaign using DDT 閃 sidual spraying jn houses. In the 白ve years from 1952 through 1956 a11 houses in the malarious' or potentially malarious areas were sprayed one to five tirn且 Various organizations. both national and international , such as WHO , MSA , ICA , CUSA , JCRR, and various levels of the Chinese Government have partìcìpated actively in the operation. ]n the larg且 t field operational year of 1956, -a total of 7.862 persons participated actively in the campaign. Total expendiur閏 throu. ghout the 5 yea呵， period was NT$ 72,227,010. or US$ 5.0狗， 19日. This intensive anti 仙 t 間 m ma was able to reduce the 站 i sl 旭 and. wide mata 盯 口 r ia parasite 悶 r .t 峙 e 。吋 f 9.8~ 悠~ ín 1952 to 咄 t hat of 0.0 仙 IF% 巨 in 昀 1 95 鈞 5. ! The number 吋 ma 刮 la 缸叩 口 r 悶 1 a 臼 c ases "i n 1952 自 e stimat 扭 ed 刮 a t 1 ，20 ∞ 0，0 ∞ 00 person 閻 5 has dropped to about 1.000 persons : with ωm1 咕叮叩 的 c 閃 r os 缸 ∞。恥吶 confir c 口 口 z me tha 刮 t once the most devastating 出 d isease in Ta 剖 iwan has hec ∞。 me a di 旭 sease oi CUr 口 1。由 si 怯 ty or 1i 口 t tle 叫 pub1i c : health ímp。叮 rtance in 1956. 3. Period of Is Islld-wide .Malnria Surveillance, 1957After malaria has been well controlI ed , TAMRI now undertakes a bold program of completely eradicating the disease from Taiwan , th us to prevent the resuregnce of the d的 ease in future. Th 浴 血n be achieved by an intensi 日 ed malaria surve i1l ance program through detection , treatment and elirnination 01 all residual malaria cases or foci. lt is planned that (1) DDT w i1l be sprayed on rather a limited scale unless an emergency spraying is required in the case oi active transmjssÎcJn; 。) a11 TAMRI and Io c:: aI anti- malaria workers w U1 be mob iI ized for malaria case detection by blood survey in potentia I1 y malarious areas; (3) medical or non.medical persons are requested to report all suspected 臼ses of malaria; and (4) elimination of disease will be achieved by radical treatment of malaria cases and bJanket treatment of the total population in proved or suspected m剖 aria transmission foci. Towards this end. we sincerely hope that the continued support. assistance and guidance will be rendered by national or intemational persons or agencies. as has been the case in previous DDT anti.malaria control campaign.
P ARASITOLOGY SEC宜 ION
:站 h 芯控 ?sr?1草 rh 忱 品:扣 t :ZμtιL 忱 1Tr 訊 71i品LrMd2?zraJιh 加岫 B祖e 閏 閻悶 扭 s 帥 ept:e 咐 r阻 e lh3 耳 叫 t抽 c nr:4ι:r它i誌已f品泣扣 ?eh 品?哲恕'~~ hicζch a咒 d 副ifficult 個問 cH and whe 問 pe叩le Ii間 under low ~conom 記 cond ition.
nt of -he campaign. Some methods 哼。yed in Taiwan 加加伽臨essment inc1udeωinfant bJ叫 S口恥， (2) annual pre ﹒叫∞1 Lc.~~I-*_n _bl叫 5U 間 ys， (J) bj.ann 叫叫∞l 山 Idren s訓 een and blood sU-leys , (4) village spleen and blooá'surveys. and (5) f叮叮 case surveys. These surveys demon. s叫 ed 且岫伽 抽 h 刮 a t ma 祖叫 叫la a 盯 ria transmission was succe帥的 intrrupted <l nd that malaria incidence was gr叫 y reduced 二γDDT h叫se 叩raytng 主ow啊， there ar 到ìII a a number o{ 地 I mal 叮 nmum \n 悶 閻 Ja r:ζ;as 弋立rJ:立叫 inη 叫iw 叫 卸 a n 岫岫 曲 d 叮 a υfror y 叮叫 Y n m r
2317立:江 iL;話:UJ;rz:出::zrzzJ:ZZZiatm;IZ
Th~ Pa_rasitology Section discharges duties relat岫 t。但 rasitological asp且個 of the campa咖
眶里 腎病臣，何在 山及新且前被質 ~吾 m tp 側盟舍IlHL iill 一仰者草酸施 草草思量 JL 接到 ι1 日 ，干染泛宣謹 Yî 在
l
被控崎崎哥哥爾 ~!:Hltl! 安人，頁，克 D~耘
.靜聽叫苦糕架 AE 嘉措 F a m-d 位置童醫 于認亨 idF 畫的t@ 丟*1<且按 t 主 紹者病從「是矗 ~川~~慰r.~哼 E 丹你 g 訶 n 嵐位甚 j 句甘眨 t 椅曹 5 例上旱有?，
! l,
…
盟誓萃 n 密配。~ ，，1 話 之在亦武而走 T
23 芯倒削苦 lÞ~ 叫你 覺前人述 R 官及。 自捏捏布泊你芯hf'* 閉伏數方且體鎧 D
I
) )
趕軒單農糙護尋柄志草仿 F 器好亨益 d§ 嘉御服穹 詔雲露 配J'(悅于川 色 心 LK2
;;21日叮叮ZJFZtpM:zzfLii旦出Itii吋jbittma謊話iiez; ;挪動三組討臨 時 of cO J. fi Í' red ca s.es in add岫n to (1); (3) in Pofe l1 tial .Malaria -Põ~i， -Q-~~-~te~Jii~-fa~t-~~d'J f~;~;'~~; surv可 b' hou阻 .to.house v，剖峙. O. P. D. V1S旭"l;lon 崗哨11 as epidemi 岫F咀叫 1 inv 峙臼甜 sti但tion 泊 i na 吋 dd 副'此卅削 廿 t 咱。∞ 3 n 恤。(刊 t 1】 í a r1: (昀 勾); (仰 2 4) in Actì 旬 間甜 M 岫切 '0/削a 拘伽 ιg 口 C
MGIZia斗立志itzztzrAmATt-1:立的白I Me;如:品f悶悶
mfZZ'品h品ZF211比5;詰:只tztJtLeZLnZZTJTZ:在2詰rzdzr 品;于1.JJ as a
正131:這FZZSvzzsi謊言:;;是:2:在:jfEEZZi謊言 j ii;;iiifi m已Jc
i
i
E 品 jiPG 斗l 幸在中 i哩!告以 月 4
iiii;11
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紹了此lzZZ;1:為甘心:23:站立止血叮叮叮?nz戶口; gr已叫 3眉昀1站 d且伽 m且…(1)帕 仰
with ant:-malarials 吋 affected population including mιgrants ;5 carried out in Active Malaria Fo日， as w:ll æ such other control measur臼 as may be ind;cated W此h referE:n目扭曲se de峙訓。n the following mf:asur晶恥11 be 咖叮叫(1) pass!ve 臼se
53濤說8; 革 giitEB Z早 濁的 . ~ i波 省級 iìl~ ει.. . 曹'- ，汙
每時間哩!你 ν ，:~!
iiilM!~ji l句吝!!ti'JI l 可圳 利s: λ I~! ' ; 咐，安
抗正站誼餒 。究
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﹒ 血跡 z 卓 式推
盟冒趴 i
叉者已~!此 h 措鍋
I l
y
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諾紛蓋;拉 跨室訴章 T: i 草 1l 僻不扶熱飾 φ 臨
Section
在各地l扭射工作時所位用各式'117>位
Practicinz spra;'íng te c!mique 1n a !i e!d training center. -
Va~io~s tY J:"自c.f spraye目 used
10
:cr: T
sprayin主 operation
in Taiwan.
Spray c l'ew:; a n"i\'ed at a rural huusc 10 slart spraymg
I
•
Spraying l: ndernc 3. th bed; a çood spray c e. n .not be attained unless o~erators have a good skill and paíience.
噴射工作人口對于 il~ 床下?吉布誠地方，都要潛入于 J~)rp射。
每戶睡?別先富~~量也侵略嘗輒w笠，在們附注明rrt! M 日期及IIJ)射的"i'合使:i<< Aíter tl'Ïe c。πl}:le1i cn d spraying , the spraying date is
DDT
"Hf ;1i超自若干;可叫1 抽~."是品 1"~)- ， J
~h jitl，工作你用主拉國
/)iiJ 力山氏說I驗崖，在化3租車輯3:: J1 盛餓時勛。
V:hi C'1 臼 used
íor the maJaria campaign.
painted 00 out-side wall and the certificate is pasLed by the foreman after his care~\l l inspection on the spray.
DDT samples collected from sprayed suriaces are checked in laboratory , usíng Alessandr Ìl d Test. 噴射且作隊組織
DDT 噴射工作防形 1952.1956 Summary and An a )y ses of DDT Spraymg OperatiOI凹， 1952.1956 明自 民間41 年民間42年民闋的生" ~I認44年民間45{r:
DDT 噴射位份分析 民間四斗F一 -Jj1_岡 P.9'li{~
Spray Squad Organization 1. 使用 1 架挑 f立式 ， 2架~縮式 t~i 射器
Descriptions 1. "Mmil::J 1.1 D8始日圳 1. 2 結束日期
1952
1953 3月 9 日
1954 2 月 15 日
1955 3 月7 日
1956 3 月 19 日
Ana lys is of the Cost for DDT Spraying, 1952-1956 I 來@ íiU By Sources of Fu nds
Squad with 1 L.P. & 2 Hand Sprayers
Period of sprayin s: Date started
J;'i y - 14 S-;,'
7 月 14 間
9 月28 目l1 }j13 日
.Mår: '9
pt.- 28
-Ñó;':-13
10 月 31 日 I) ét. 31
Feb. 15
Sept. 27
9月'z7日
Mar: 7 Ma::.19 12月3 日
Dec. 3
Date completcd 2. ~施區城
Areas învolved 17 10 21 ,682 86 1郎，653
2.1 忱地際市股
21 262 659 ,6C6
21 264 630 ,632
21 315 730 ,468
No. of hsiens and municipalities invoJved 2.2 1'rl，;1;輝胡故
2.3 哩[射鹿島柳』且 2.4 費每λ 口)}k
Nõ. of townshi r- s :nvolved No. of structur è; 5 sprayed No. of population. directly protected
156,217 1,526 ,3C6 5,467,664 5,640,325 6,728,4 65
3. 岐肘工作 2.1 工作人!.z:
Operation No. of worl~ers
2;'7 eng i,jßed da) s in a regi(.'n in metric tons
1,770 50.93 173,707
6,265 48.21 636 ,5C9
6,498 46 ,63 670.678
7,659 44.63 807 ,529
3.2 每區平峙工1'1' 曰 l]'(
Average
v.'ork i. ng
49.8 16,359
3.3 消輯，75， (， DDT 甜白白， 75!1~ DDT t臨帥 tne d
~:')一一鑫華 11. ß且用 4 架壓縮式噴射器 H.缸ld SprllY 凹S
3.4 的制 世間
〈譜，到幣〉
367, 155 4， 11且，705 16,668 ,413 17,692,793 19,335 ,425 sQunil with 4
Tottil 4. m備分折
c個t.
01 aprllying NT$ ysis 一一. ß.æ_一且由一一 791 li.創L一-品且是
.. ，.s;:t.Irn"峰， 自剝 削。"
Per structure t..
日間抽。óÕti申削 7"月~ DDT c. onsumed in metric tons 304 劍 ~m ( 斷必幣) τilta l
-一~ã'!晶司-τ'13.宇宙
間間盾，可呵，啊....-
山，再﹒
367, 155 4,118,705 16，66~，413 17,692,793 1日，335，425 1I.使用 4 架壓縮式噴射總
cost of spraying NT$ 6 1 1 , 7.9~
ι 每llI!分折
Per structure analysis (平方公尺 ) 且
叫 每恕草哥盟幣告s pe 盯 r s廿叫 uct盯 -4..2~每宰￡摔幫前R 例呵 S u 吋iU!Oil同 回 sprayèd
a397L 37177 a437L 5I483 96224 75943 no
Squad with 4 R缸，d Sp~ayers
1I.支出別 3且la rged c3銘'tr_:un.L'i國 ~'''markj ng 0 11 ~ãTII品叫亡三3 組~ I size - of E盟 ，似削 酬 ，
肉unuQuquRu
引
闊的
305 2
ByE玄penditure 0:品品哩主昌』一
P
。。旬，缸"。
387L
per structure , M
337
4.3呵L常聽岫阻 pÐr …re u 幣Fh227刮去追 P叮…叫 grams
8.,.> 7
7C6 AA可
“ 國總司間?姆:他叫 per .叫咱 by spraymen a 館在?tpi扭 曲a1y曲 且1 白的且PtEms且去'fßl 個p i川 M • 5.2. 館已轉 J1l. D.nI:l~~﹒) rechn i 回 I
1. 57
-Doo' used
l'前回 p ; 固 ，llT1目
42.4 78.5
14.0 ε87. 3 3.的 旬，“
4k16. 42.0 且
83.3 2.87 旬，
日每頌增FUZtf點 6. !'l1l對縣一 'A ~小時油T1't!剖面紅 ， ，(平方公尺】
2喝 _~ 276.8 吋 0f 叩 e 前 ra 甜 剖 t tio m 叩 。叩 m ， 96 區
255.9 凹
262 ,6 17.1
Z
晶H 心耐踹:前前甘品l品品踹;剛rTγ! 一' '6
20.8
事辛辛辛 臨一一一樹 ' ."p'. :.JI">oI'''ooI'lo-.J1""，~ ''''''''''''''''-..Þ.......'coI''_''""，"......."""，IocJ1'~岫\oJ>"""~'\oI''''''''''''''''''''''''''''<\ooP''''''_''f\oPf\oP''-'''_''''''''fI.oI''''''''-''n..r....，.f\oP<I.;J>rw:"""， 甸 甸甸甸甸甸甸四
幸
的泊
4. 位
A
且可 叫 蚓、‘ A且 'Jq'94 缸。， U
TnHdqL
2470
12
旬，缸肉，“
。叫 f 肘田 e 司叩 p 間tt 曲。r 甘 trn V'，組 t 阻 o 臼 t 。t 叫 剖 a 1
time
噴射工作人頁訓練課 程一竟是l 1952-1956
Summary of T :caining C0 '.1rSe3 for Spraying Operation PersDnnel, 1如2-1956 項目 民間4年民間42年民國43年民國44年民間45年
Description 1_ 詞 S!~所做 一 Site of trainjng 2. W1DI< ---- ~ N\:mber of cJ 2
1952 1 1 1叫
1953 4 6 1 ，28~
1954 6 Jl 6，3的
1955 5 12 6,578 35 1個
1956 17 25 7,795 35 214 1,078 6 ，晶8
3. 受叫人 n~
f甜甜草草只 H討價 n
:N' umber of t 與F甜甜耳~H1 fíil除
29 ←
28 159
suner 28
Township su pervisors .r oremen .
271 9日 4
881 5,238
908 5,446 188 9C6 21
個加拉
112 7 in e缸 h trainiug cla 臼 28 for a: tual field spraying E
4 年別的l 協議當 E
Numbér
tó 呵u a d& o rg扭扭 ed 捌if.i:ifJi 益jii 0-----
輯 2.5 4
們 873 21
225
-.
1,065 21
-]而 umbf.r ' óf -s明白色 Ol'ganiz~ :l 。 perations
6.
HÑûÏÌiber' of hsiens & municipalities involved. 側i註 : 著每一除自制除一人，明射白 I~I人 ﹒叫工二人組戚。助工不會加受制1. Note A s qu ad is comp osed of 1 forem曲. 4 operators 曲d 2 helpers. Help fL rs are not included
實施縣市緻
17
in training. DDT 噴射入訓練課程
Summ.....y of Curriculwn Subj 凹t Ma批er for the Traüting co歪扭CS of Supervisors , Foremen , & Operators 科目 串串市督11~ P\
*
緒 鍋督沼只帥
個時軸
IlJ!!M且 H
Subject
Hsien
supervis。間也 Township
Supervisors Foremen . Operators 小時 hou間 小時 bours
'抖疇 hou月 行政及-般討論
-')、時 hou自
6 gen 叮al
G
6 2
6
Administrative and }原虫學 Par扭扭 tology
::iiscussions
s H field and field 10 l \)
昆虫學 1且可E及 'ù習
一EntoÏñõlogi fec 血 d 嘖射冒雪具融解及1'r羽 其他積 1串串技 t居1
s.praYlng- -equlpment le c. Fielιspraying
14
)8
az 1
technique
記fIii件梢的生
6 16 70
Recordihg and repor tjng
督導方式及ir.，討 監i拔 一 5upervi50r ;t t叫 ntQ阻竺旦旦士竺旦 æ. 昕 一一---
7 -一一一一一一一 42
一一 42
42
Total 仰 望 .本 1;寺煤油\t捏在本所~-~行
Note
Spedal course held at Cours目 conducted
TA?\~且J ，
料也叫封}行
locally
ENGINEERING SECTION Th e: En l; in eering Section is d îrectly responsible for the appli且tion of maiaria control m s recomrnended by the malariologi臨 and entom伽gists. It concerns m叫 with the e ffi. c:.ency and ecomony in the field app1i cation of recommended m臼 sur臼 rather than the asse3sment of effectiveness of the applied measure i. malaria con廿01. ln the present camp叩加 co叫 of malaria has depended upon the use of DDT r叫叫 house spraying as the main method of contro l. with antî-malarial 訂 ugs as a supplem( otal m臼sure. The resclts of basic epidemiolgi臼 1 studies conducted by TAMRI prior t o the inauguration 。f the pres~~t ~~~amp~;i-i~ j~~cÍic~t-ed- that 2 gms~of-te~Ími~ai -001' per sq~~~e-;;e1:-e~- ò-i 叫ace ar目叫ed once a year bef的 the p帥。f the b叫阿 of 叫or m個quit咐 IS an effective dose resulting in the e血口 ent control of princ pal malaria 甘 ansrr.i tter 1n Taiwan , A , mini:叩α. Before the 5tart of annual spra ying operaticns. the malariologist made areadefinitic'D fr the projected spraying coverage. white the entomolog叫 determined the t ime 。 f sprayir..~ application in different part s of Taiwan and gave instructions regarding places for spraying inside the house. Beginn:ng from late 1951 through 1952, the Engin~rjng Section devcted its entire staff and t~me for the study of some basic r equirements in the planning of the island-wide res idua i. sPt'"ayin耳 目 mpaign. In the end of 1951. an extenstve is land- wide housÎng survey was carried .)肘，廿lrough which ass臼sment of house patte rD. and house construction in each repres回 ta;:ive area , and measurement of inside superfici E.l areas per occupant of the house d~. This provided valuable information in the scbs 閉口 ent planning with reference to the ::orr:.I= osition of spraying squad , allocation of squ乏自 per unit number of population 怕 be p::，otec叫 period of 缸.tllal field 叩叫叫 as we:l as types of 叩開向叫 the叮 曲 t eiIicient us e under different 1 0且 1 cond itions etιThe paper plans were th 肘。ugbl y t ested :ru t èuring the first ye a. r's spra ying operations , • e . in the dem onstration project 。n Chi-sh祖 and Chao-chow areas in Ú~52 -which prov iC. ed answers to various technical pr恤m5 w:th 閃gard to DDT re州al spray呵 prograrn. Th~ fir計划 s.scale spraying 且 mpaign was launched in 1953 with a population converage of 1 ，52且 306 living in the most malar叫JS part of Taiwan. The spraying program was further .ext四~_e_~ t~ c~ver the .æ.~白居♂ .500.∞o people 帥 a11 malario明 areas cn Taiwan in 1954 叫~~~~. In t?e year õj':; spri于ìn~g coverage ，的蜀， the tota1 popu lation coverage ched 7，冊。，000 people. " In -::he DDT spraying ope rations , the basic unit is the "Spray Squad". 扯 1t 旭 is ∞ cmπm 。叩 呻 lp。臼 sed of 叩 one 扣 f。r 閃 e阻立凡'仙叩恥 era叫 ( “ spr 叩nen ) 叫 a nd 叫 t wo he 帥 p e。叩 pleζ 叮 'r 凹 p。r 吋tI叩。叩 n 恤 t he 叮 re 凹。f. A no 。盯 rma 于1 operational pe 訂 口 r iod i 3 6ωo 血 d ay 抖 s Toεt.)wnship having three 恥 more spray squads , one superv阻叮 was assigned in addition to a f oreman for each ' spray squad. Towns l:i p s upervisors and foremen were usually pe ", manent staft members of the local hea山 stations or towns峙。冊ces. The r e-呵呵剖 bility of co汀lducting the spraying program in the hsien (prefecture) rests on the sho"ld肘。f h目臼 supervisors and th eir proVincial counterpa巾， the TAM眩目nior technicians. The tra i ni呵。 f foremen and townsh ip supuv削rs was one cf the irnport阻t functions 國 TAM Rl and -implemented chiefly through the En gineering Section. The Þrcgress of work was reported t o the section 1hrough weekly a nd mcnthly re turns by 叫叩ray 問叫伽叫h tow帥 íp and hsien süpe鬥叫s. An 喘口削 reporting wa 缸 s devised 句 bY 恤 t he Engineerir 呵 Sectio 。叩 n 扎， 阻 So 前 a t 血 y tir 口 me workera ∞ ca 叫 Jld 恤 be 閏 e st 旭 ab 圳1i 咄 s he 吋 d in a matter of min 叫 刊 1 吐 u te 峙 S. At the end 01 a field 。叩 per 阻 atìon pr ogram. fJl al re戶口 was prepared by the sectîon.lmpor! ant among ~he items in tbe final r酬t yvas 恥 ma憫。f "cost an枷is". It was found that the per 凹pl旭叫 for DDT
……
此輩革 一聽
望重要買食常該，直 蟲都講暐批卦。
賞自 跑回~
.1 屯 ug.-Sep t.， j
司空間星星蓋在雪路軍委空 L 對平方缸向用宜施人州站四計。列 j l ‘ ug.-Sept. ，
於表當年美」仰鄉 昆 明防十間所各 付
龜皇室主要是暴宇自琴聲或是真 : 叫 S削 D 功 書里省闊 D 雪里以組每 M 全料很單盡可 \ug..Sept
哥哥雲呼毒品是 ZE 主穿軍在 遊以 D 質至揖 iflll lUl 人 ;:) 霓
.!
~ι~~ 內 D 質便飯 一 且是省。蠻聶 1 1 ~吳祖 ~r T 用閉關地鄉肪 比讓 禱磁 。實其;ßj鼠近驗血+經翻
J! 及 隊
壘
所施品，防耐人為專制
呆跑 藍 D
獨 D 完民主耳。 雖 以閥完
1草 「
i 謂生'!:~闊隨 D 哇六至成本 D 噴 工家祖凹， D 竄十以， , T
消方嘖干T 五 n~ 嘖用{芋，年
種慶開十將 T 偏工後悶
著磁 芋 I蛤
茵射故作，民射闊天持七制作
拒
絕路巢 噴 間，
亦錯。起她工時 寫 fn )-j 在射逝 l<)
，噴作 人 ~!E先全絞
i 叮用
旬
HJ 札 DDT 紋屋防斜哩舟 山"中， 年F 在京省緻 旭 贊施DDT 闡射 明 區域，及撞定噴 射役之詞幼 等 于
凰 "
射會防原區需;時 D 器是之 l民 在 此 J 質iJ&\ïíf.f:士請 m 防射
l_) J革遵
守有反
惜
輩 0
在國泌
都Z
況丙用。閻明州
B 空 λ 產品主孟晶
泌￡害 。 JIj •
生創佈
T 人 那射閻佈吧
此
!商外一器始j;{按地時本 ~收 ~增人帶 'f 地始棚且
方
以 口品 1m ，
，兩~于
三是?可空軍搞自籌 全其
輯i 期
~真價
吧，且經住一 2揮
留寶貴 哩!用 I壘 ，
誡 自
分賀詞1 所阻 'IJ 趟著他 ι 支待 于 世擋住 晏方 工付大 以 明敏的 車h~在
-r 負 訓l 主1<1荒 年品
手較
T 噴宗約射且樂 E射
屢吾 經 t i ￡草 豈 敘 宜 了 ， 面如 說以
中凹 ，~十 ~六 內 年
? 人 ， 朋 ! 明 ， 盛邵 L 工梢 使 每時二 :;ñ 由 能 時期年
立起 塑，
且，草 棚l 缸，起積再
Cj住所總有全則
，必
盟軍
T 財叫什外 1 111 一分音 計劑 是基的 投 射 人 滔滔 每治 方[i 品等拷工哩哇 ; 1' 他 一盟軍 @!這付。問作射﹒行人雖 起草且
用直
是貨幣在路胡繭
用運阱。個省霞
估懿
逗靠自?晶干室主審 、各 佔 4 E
eSl 泊 dua 正: hû 此 旭 ζ 阻 s 恤 e 叩 sp間叫 yl 呵 1
。吋 1 eq 咖 叫 u 申 1 pm旬靶 lt and ve 咄 h 血 扭 i cle 划曲 S，叩4ρ 抖 er 鬥 Vl 出 剖 s i。阻 n et 比 C.， has var: ed 叫 sIi啥 ght 甘 ly eve 叮 ry ye 臼 盯 a r， gi 廿 vmg 祖 average 吋 0 f approx 刮 imately NT$ 's 草 -p er caita protected
“
勇宮 成E 擔 E
以接
' 0
病草太 :R 應單阱'
克省 -~ ilÆ 助商"
亨目響喜王盟喜寧華
話間
嶺蟲府趣，厄地憑 γ
Front view of the Taiwan Provincial Malaria Research Institute ( TAMRI), Chao-chow, Pingtung, Taiwan.
*
I!JT
WI
:!1t
M~tt!WJ:Jt~JEr&.'iiffi:~~*;'YifZ~ c ~E«~'*-~**l~~) National and international anti-malaria workers being honored by a township mayor for eradicating malaria.
S t a ff members of The Taiwan Provinc ial Malaria Resear ch Institu te.
i>:
FJT
I
flO
IFIJ
A.
Former Governur C. K. Yen o·i Taiwan inspe cting laboratory works at TAMRI.
G-!~~lfJ~iJ :Jc:;tt ~ti. *''N~w;:4s:frfr~~i'?;
!· ;w:DDT 'ij.ffi_ "ft ~,l it}11'1 1952-1957
-it
/;~ t;j :;!;
it t·J
))!.
·fi
*
A sr oup of Vif' t· nam ese tec hn icians making spleen palpation d.ur;ng a 2-m nt bs' training on a; anti- malaria operation at TAl\'llU, 1!J55.
;f.:Jifr,ijj ·rC:.If'l:mi~P.1if4! < T.~H~·Jii!iJ"' ·'f)
~.! 1:/tifJ.~~l).:t.:AIJ ~ n::F JiCI'\1 ill I-P~~*&fr&'¥E
fjf. ~
of- /~ .:tJ• Ji!; ~~ EJI Jt J;fr f.JI;:(.\ -~~ f}G Organizational Chart of TAMRI
TAIWAN.~ ;f ,j ·It Sii @ ~OVINCIAL CAP!lAI.
DDT Spraying Operations in Taiwan, 195-2-1957
Organizational Chart of the Malaria Control Operations in Taiwan
1952 '!ilr.f)\1=1~
1953 ~~;.,t:::j!).&
1954 ;:[~.A.t:::l~
I.
li'i~4li-!?-
LEGEND
~
#lj
5 J~-J:f; ~xl45I.i=- 8 J:1 May, 1952-Aug., 1956
Pop. Covf::rage: 156,217
l'op.
Cover~ge:
Pup. Coverage:
.....
0
e
..!'l.JJr!rG. I~
ti!UNICIPAl iTY
L5L:6,3C6
5,467,664
-- - - ~UN.JCIPALITY BOUUDARY --HS15l BOUNOAR'I
HSIEN SEA'1' $11.
w 1955 ''li.il~tJ..rJ!JiX Pop. Coverage :
195G '':J:f,SJ..rJ111J. Pop. Coverage: 6,728,4 65
"
1957 ~:g:}..r:Jl})P:
ll .
N~\45$
9 fl £JJL1'±
Sept., 1956 to date
Pov. Coverage: 1,700,0(;0 (Estimate; _ _ _ Administrative
5,64C,325
ftli:O\~
--thannel
SPRAYING FIELD SQUAD
~~ ~~ o~ l-=t I1t p~ ~(£ ~fi Fore men
tt. lfTUlt -··· · - · Tecllr.l ca l ~·c ha n ne l
~~
j}~ jJ~
Township Supervisors
i{JiJ;i,·F,I.l lnt&rnotloMI As:r1atc~u.:e
IP
oj !1~ ~
BJJl
Sp10ymen and . Helpers
~;Ji.f:<it~ll\~f:.IL..I..ii'/'-~l~i~
1952-1956
·'iff :51:! ~'H.t-;;h:~'\M l.flZH.,"f..,w, i!t ;/!r. 1952-1956 1~1, ~14411'
1952·1956
iT:5C.~-ht1t'fiJ;'jiJ 4'E~~;f.!*J'a 1952-19li6
1952-1956
Numbe1of Personnel for the Taiwan Malaria Control Project as sho"'n by Year, 1952-19!}6 -~
Sources of Equipment and Supplies Provitled. for the Project,
Equipment and Supplies Used or Consumed by the Project,
§
Jill, ~ §
J\'Oic]41if-
~!"l'l42 ff
.BOI'%143if-
'ategory & 1tle -IRI Personcl:
----------------------------Trl9'i'fifiAI¥1 ""AJJ ..... - .... ......................... ... . ,,l;IJ.Affi'l .. .... ... ....... ............. ... .. 'rofessional Jl
1952
1953
1954
1955
W•'''J45il' 1956
V!'J§.'!iJF:;r F', c'rTJJxln ! tr.w 1 'i'
/il?\).j:'fj
ffi1 11:; ~lli'ilZiid:
~t
!j1q
f::
.l:I;,\¥P.l41if-
B:;j!ili\42W.
.R;j!!f.43{]0
.B'.;h~\44qc
~jlM45{f
-----------ll
Articles
Ti\MHI (l'rov. Gov't) UO
L!:Wf:ik ICA/CUSA 2,365
JCRR.
WHO 5
RF H
Tolal 2,445
Articles
1952
1953 173.7
1954 636.5
1955 670.7
1955 746.7
13
14
14 fi5
75% DDT (0~ ) 75%DDT in metric tnns
* X·
***
10 -~* 5
**
16.4 75;?6DDT consumed, in metric tons
.uxillary ;l.;<. -...!"\ iet1 Personne ;!%J1J'&'i!;l.~
65
q596'Y ~ BHC ( 0P.mi ) 6_5?6-y- BHC in metric tons I:Vi;~i·i;iK;IItfJ,!\hl:
70 1,5)0
!<
2'1
34
3.
Sprayers, Compression Jlll·,·, ;,f.:l~~ hli*
2,251
** ** 500 **
75 100 -X* 4,355
l>'d1'J~i[ 6.5?-t)y-BHC C::L:.~iUD
60.8
6.5%r- Bqc consumed, in metric tons 250 1,578 2,763
2,668
3,132
S"perv isors
"t.A@. vnship Fersmel: ~'PiiltA.n ~~w_~;~~xn
Sprayers, Lift-pressure
721
·X·
721 8 240 -H
Compression sprayers used
' en· profes:onaJ (9,upervisors)
........ . 254 155
160 873 155 3,489 1,716 (i,4!:)\)
185
229 1,>;65
]J
1~·r•
Vehicles
1 690 * ~
**
12
IMrJi''im Vehicles used
12
4\i'i
I!~ .
............ 31
(~~~en_~ ..... .. .. . -abcrers
d ,· j.il-{l~~k-~l! ( lOO·J :tff: ~g )
( tec,h~cians) 11/,'HJ;j-"" ....... ... . 126 (spraymen) fl)J T .. ... .. .. . . .. 50 ( helpers )
155 1,013 481 1,993
89 3,825
Anti-·malarial drugs, I GOG's
*'*
2,430
·* Ffi if!Jl'iis!ili~~~ ( 1000 f'i/:i!f) Anti-malarial drugs c<•nsumed, 1000's
371
654
87
257
442
4,263 2,102 7,862
l:iii,.t: l':ote
*~~ .:~'} ~j!·~. Local produ<. ts ~-* ~l"'ii!J!~
1.782 6 ,700
TOTAt-425 -----* ~ ~ ~ J. ' .f. ' ,c ~ ,-------------~=·e
' --------
Made in USA ~ -* i · 2,305 ll•~J!•J• SOC PVJ[[!UJ •• :i,ii:j'(.;\ '1.865 Ji•!f!Ei-\~i:i~·'t:Ji~ 0
·*,&;!J~'~Jti'11§ S!JlfM • -FQ:¥ 131 • ~:ll¥1ll'~&!JlJiM'\2J"" Anti- malarial drugs include paludrine, camc quine, chloroquine, and atabrine, USA, 1,865 were made
**
i.~: i •i, 'NPJi'T.ff!fcl~fll.j}'.J
ull time service throughout the year.
!!rving full tin'c for approximately 2 months a year.
Ou t of 2,365 tons 5GO were imported from locally.
ff ~ !l3k¥lfo.i ., of fuds !f~!lf.'J~
~
t
ff
~
~
I
* 1955 15.65
~ .13.\~1454~
Sources of Funds for the Project B:;~;41:t!'. 195~
lNTR'lDUCING TAMRI if!· Total The Taiwan P r ovincial Malaria Researc h Instit ut e ( TA MRl) is an organiza'lion ai'ulia t ed to ihe Taiwan Provin cial Hc:>lth Administntion. It had its incep i. ion in 1946 when the Rockefeller Foundation ass is·ted the Government in attacking th e serious mabria problem evident in Taiwan after World War II. The Institute headquarters was e stablished at Chao -chow, Ping-tung hsien. Three-fold resr;onsibility was borne by TAMRI: a ) to carry out the inves ~ igalive work necessary in defining the malaria problem and t he practi cal means of attack ; b) ·to t rain ·the antimalaria technicians and ot her recruits from lo cal health sta cions in the techniques of malaria control by residual spraying, as well as supervising the field work ; 9 and to evaluate the effec tivt:ness of field operations throughout Taiwan. TAMRI had emerged from the preparatory s t age of laying foundatic..ns and making prel i minary st udies in reference to malaria and its control t o take up the major responsibilii y of the malaria con 't rol and eradication campaign il1 Ta iwan which has been well advanced 'tO da·te. Tot al elimination of t he disease from Taiwan now seems to be within sight. Major ac ti v it ies and f u nctions of T AMR! during the past eleven years that have elapsed sin ce its inception may be outlined in three dist inc t ive periods as follo w ing:
Bel· •:42f!c 1953 10.30
.t~~l431! i
.RJ!-1'!44{[:
1954 10.30
1956' 24.78
10.30
nverson Rates, .JS$=NT$
.!IOF.\iRR'f lineS! ovenment
US$
45,9-10
230,870
953,760
604,69)
439,330
2,283,59).
'£'3'.£-!i'JI'.it!?i.'i'ir ICAf:.USA ~1R1~
US$ US$ US$
47,500 48,240
440,800
951,180
616,(80
474,430 3,810
2,429,99)
49,100
50,160
151,610
JCRR ·, fl,W.:j!,\_tf'*Ji~
L Pe:rio:l of Founding and Experiment: Nov. 1946-April, 1952 45,000 44,0CO 34,GCO
25,500
25,5)0
174,')00
WHO t:~!
11-r
US$
186,680
773,770
1,889,400
1,246,270 19,5~4,100
943,G70
5,039,19)
T otal
: ~5' \'}lliiPiln (NT$ Equivalent)
1,922,76)
7,959,850 19,46 J,92·J
23,369,370 72,227,010
During this period TAMRI was primarily concerned with gathering data, making malaria and anopheline surveys as well as with the experiment of malaria control. The new an·c imaiaria1 drugs such as Paludr ine, Chloroquine, Oxychloroquin e , and Camoquine were s t udied in reference to their suppressive and therapeutic effect in certzi n s t udy areas at Chao-chow, Taichung, and Keelung. Anti-mosquito measures sucl~ as DDT residual spray ing in houses, larviciding in rice-fields znd d·itches, and automatic flushing in s treams were also conducted on an experimental scale in certain areas of Taiwan. During the period main financial support came from the Rodefeller Foundation, JCRR ;:.mr! the Provincial Government.
(Contin11ed to next page) 1
.··---·--Q; !R
--- ---, b'-...
;ft. J,'Jt ~~ %p ' !/] Parasitology
•
Section
Ii'FAW.JE'!tff'~~:s'~~IJ'(.!fl_llhJ:J Members of Parasitology Laboratory busy in doing microscopic examination of blood smears.
i\J:iif!:t.rfr: A ~if.lJ~'/¥;JJi'Ji!' IlJ:/,~~i'illt A f~1Mi.Li i i',J , 'Mi i1U1.i Sometimes anti-malaria workers must adventure to climb up the mountains or ford rivers in crder to perform their duties.
;{F.!J.!! 1 JU f:!FF;* -1111 1!\lt1& J=:tf;~J~{i -&~*~-~ Elood was bf:'ing taken from the infant's earlobe to determine whether there is any malaria transmission going on in the arEa.
iit~A1fiU!H~~"J~/,\J infant survey.
~y~ ~~k~'l\wgA
Visit to remote rural houses for iever case and
1n1 iJ:ft1:l:~·~fr~tr: m, ~~~ Takin g blood sn;eus f r om an old \':Oman with history of fever.
J.:J'i'J\. ~ 't il<{f ;l~jf-!JiJli)~ TAMRI technician making case investigati r,n.
iV'Ialf't: !. :~f)'ti~1\~i 1 :'!fi: I1Jiii·~ Spl Pe:J pa lp:J.tic n was b ei n g c <n cl u ct e cl on a pre -sc h oo l children s urvey.
J)fi'( ·I1'F. :•,.~ Ji'' 'JI•rt.WJ ?O.iH1"1it Scheel chilcren ce:nL~ palpaced ior enlarged spleen and taken blood to make smears.
·:~ ; .. / ii -ir.r; A !Ji iJJ_, i:& ~~, l@J
± ~i j3) Hf :I[ fi ±; iJb1 §: Simultaneous Island-wide Malaria Parasite Surveys E: h~ 41
c46 ;r- )
Malaria Surveillance Map of Taiwan, 1957 I•: i·~l 45 11: 12
:iJ: 12 Jj 17 [1
R\lt~ 43
::r· 12
)] 17 I:J
)J 17
II
December 17, 1952
Decembe r 17, 1954
Dece111ber, 17 1956
0
11{? 0
J3!.®.~WfV:iJ..IJ'.!iiJ!!ll:k
~flf.\!Jljjjt'J.l~o
f\j!JR<fl : Parasite Rates
II! 15%-
10%-1596
•
596-10%
.
This boy has an 'nlarged sp due to malaria. Thenarking 01 abdomen shows th size of enlarged spleen .
• Jlt !JSm!Liill:.tf:njilJb~*: ---
!\
!_. /;r ;J:J; ~1. ~!.L 1t HI Malaria Endemicity in Taiwan
M I%5 ~ ~-
:W ifl ~ u·
1953
ii<!i~iWifn'YiilliWJir~1&
Before Control
Two Years After Control
!6)a#iJ>l.f;: f ... /J, ~/i"k Sc,-{J[ At;J1. !.¥- :t.. Hr ff) 195!~-1956 Surveys Among Pre-school Children, lU!il.-1956
~AJ.1 !~ 2-14 riU'G·Jr R~il't )lji!;:Jtc If?. :.'c i;\ft_ Spleen and Malaria Parasite Surveys in the >Gi-shan District, 2-14 Year Old Children ;J i,j 1'r fi i ~J )!)[lit~\'
Result of Island-wide Simultaneous Malaria Parasite
DDT
'.~'[l}J:f{j/
'. 1
, .. ·.;,•,1 11 1)] llale of Survey
1Dr'.~i!!:Jf&
Survey date P8.ra.
Number examined
Spleen rate
A. E. S.
No. of townships children included examined 139
.i\umber exa1nined
)Jarase rate DDT sprayed
Pv. 375
---------------------------669 84 70
Pf.
Pm.
Mix.
Total
Rate
DDT sprayed
Rl- ~i4Hr:6J1--D687. Jq·.N~(J .6 J J
l ( i ·'.:, l:l;l'l'~)jl711
Demonstration Area 52.28 J un , 1952 June, 1953 June, 195·1
2.24
1,953 l.'il!fi
23.04 \ug . -SepL 1e152 Ei.W
13,llH5
1,198
K.li3?6
1.7<15 2, ,~Tl
Ul7 1.16 11.45
l!lfi I , Dec. 17
JU·'1·1 3'FS IJ 143 1<1 ,2 13 532
ll. l:i •ug. fi. ·IIJ ~cpt. ,
J• H::11: 1 12 1Jl7U 1%2, llec. 17
778
31 Mar. 9-Nov.l3, '53
J 32 660 •J.;jiJOh
~··H4 '1'5 JJ
t< i·l:n
12JJ1711
145
14.·119
24s
:n7
46
.1\ !av. 19.:; I ·:I .,. , ~ '1'8 I I June, H/56
2.l35 2, 292
1.37 Ll7
fi.t :::
u 1g.-Se pt. \ ug.·S •pl
I ~J:;:!, I lee. 17 N I·'J.J:I 'I. I2)Jl711 l!Jfi l, Ike. 17
Feb. 15-0ct. :'!1,'54 147 H,r; 1·1 9D 68 10 5 173 1.18;',; Mar. 7-Sept. 27, '55 148 14,'i!i9
l l.'ll.,,i~•E}\'!':}11(1~1& :
1\! .. 111 ·1 12JJ171-i SPLEEN RATE
12 Mar. 19-Dec. 3. '!l6
8 0 0 0 (Continued from Previous Page)
~
l'ISG, ]lee. 17 I\'}'J~5;1
O..er
75%
10-25% 0-10% Mountoi]
~~=;~~
12)jl713
150
14,H25
2
0.01?6
l9!iG, Dec. 17
Former ' h eck Area I\CI"''I4l!t'6) J 1,419 44.47 June, 1952 J( \·,\42i( ' 6)J 1,486 4:-\.47 ]Lme, 1953 J \JV',43(j :6)j 1,526 26.75 June, 1954 J 4 c\44f l'.5 JJ 1,765 18.98 May, 1955 L\fi\45f.;6) J 1,893 9.24 June, 1956 - - - - - - - -- - - -- - -
1.99 2.04 1.62
1.152 1,476 1,663 1,767
~0.32
15.79 ug.·Sept., 1: :!.41
1.42
. ug. ·Sept., 19:',. 0.74 .ug.-Sept., 19St,
1.13
1,900
0.21 •Ug.-Sept., 19
P ARASJTOLO<~Y SECTION The Parasoln1ogy Section discharges duties relative to parasitological aspects of the campaign which involve activities ;n reference to: (l) a comvrehenslve study on local malaria epidemiology; (2) definition of areas to be covered by DDT spraying operation; and ( 3) the malariometric assessment of the campaign. Some methods employed in Tctiwan for the the assessment include: (1) infant blood surveys, (2) annual pre-school child,t;;'n blood surveys, c;;) bi-annual school children spleen and blood surveys, ( 4) village spleen and blooct''surveys, and (5) fev~r case surveys. These surveys demon· strated that n1alaria trtmsmission v..'as successfully ·intrrupterl and that tnalaria inc~dence
2. Period of Island-wide Malaria Control by DDT, May, 1952-1956. In the beginning of 1952, TAMRI was ready to launch an island-wide malaria control campaign using DDT residual spraying in houses. In the five years from 1952 through 1956 all houses in the malarious· or potentially malarious areas were sprayed one to five Umes. Various organizations. both national and international, such as WHO, MSA, ICA, CUSA, JCRR, and varinus levels o; the Chinese Government have participated actively in the operat;on. In the largest field operational year of 1956, · a total of 7,862 persons participated actively in the campaign. Total expendiures throu · ghout the 5 years' period was NT$ 72,227,010. or US$ 5,039,190. This intensive antimalaria campaign was ahle to reduce the island-wide malaria parasite rate of 9.8;?6 in 1952 to that of 0.0196 in 1955. The number of malaria cases in 1952 estimated at 1,200,000 persons has dropped to about 1,000 persons with 492 microscopically confirmed malaria parasite carriers in 1956. The campaign was so successful that once the most devastating disease in Taiwan has become a disease o·i curiosity or little public health importance in 1956. 3. PeriDd of Island-wide Malaria Surveillance, 1957After malaria has been well controlled, TAMRI now undertakes a bold program of completely eradicating the disease from Taiwan, thus to prevent the resuregnce of the disease in future. This can be achieved by an intensified malaria surveillance program through detection, treatment and elimination of all residual malaria cases or foci. It is planned that (1) DDT will be sprayed on rather a limited scale unless an emergency spraying is required in the case of active transmission; (2) all TAMRI and local anti-malaria workers will be mobilized for malaria case detection by blood survey in potentially malarious areas; (3) medical or non-medical persons are requested to report all suspected cases of malaria; and (4) elimination of disease will be achieved by radical treatment of malaria cases and blanket treatment of the total population in proved or suspected malaria transmission foci. Towards this end, we sincerely hope that the continued support, assistance and guidance will he rendered by national or international persons or agencies, as has been the case in previous DDT anti- malaria control campaign.
if
was greatly
reduced by DDT house spraying. However, there are still a number oi residual malar:a cases present in Taiwan today: from .Tan. 1, 1956 through July 31, 1957, more than 600 malaria paras~ite ccnriers were detected from some 200 villages in 104 townships in 16 Hs;ens. Most oi these were located in remote valleys :1nd foot hills which are difficult to re:>cli and where people Eve under low economic cond:tion. At the last stage of malaria eradication campa ·i gn, malariology section takes up the most important role in the s <rveillance operation in al:ove ment:tmed !ocaLt'es as wel l as 'formerly hyper-and meso-endemic areas. Eeg:nning from FY-1958 strict malar;a surve:IIance measu,·es have been imple· men ted, with an objective to accon1pLsh an early eli 111 ~naLon of res:clual n1alar;a fro1n Taiwan~ ·in a total of 1,268 villages in 163 townsh;ps which have been class;fied ;nto Acfi'iJ.3 .Mnfm·ia Foci, Potential Malaria Foci, an.:l Formsrly Malarious ATeas. The fl!JT res:dual house spray;ng program as a major control campaign has been discontinued and has been change:l to a ser;es of control measure~ includ · ing (1) radical treatment oi proved cases, (2) prophylactic drug admin;stration to the members of family and neighbors of proved cases, (3) emergency house spraying when ind;cated. Mass treatment with anti-malarials of affected population including migrants is carrlcd out in Acti;?o?. Malaria Foci, as well as such other control measures as may be indicated. With reference to case dete:tion the fcllowing measures w:JI be observed; (1) passive case reporting by all private and public medical institutions and pract:tioners of the whole province; (2) in FormeTly Malarious Areas, monthly fever case survey among school children and mon·thly follow· up of confirmed cases in addition to (1); (3) in Potential Jl1alaria Foci, quarterly infant and fever case survey by house-to-house vlsits. C>. P. D. v isitadon as well as epidemiological investigation in addition to (1) and (2); ( 4) in ActiV£ Malaria Foci, sem1 ~annual mass blood survey of all mhabitants including migrants, besides the measures (1) to (:J).
Entomology Section
U--1~11- -Wi'U'J U ii ~'IL'J.L:C:;j}} ,t"!lr b/fl~/IJJ :J} :'M" :l:rf.:\Pl ' l'" ~~ n-:J-1:1! ,
I x;;,J
ii!i,~J
I,'{
,wrJt~;,q~~~,Jdfii(;{t!!. ''fflW~~ 1 -'f~'N.ii!J!YJ
&JiJU'.
ffiiEE!)f1:
1
[;;i['iciJ;I4'J(}tJRj@J1fr'J~!'J:J:![1o
YM1tYo Seepage pools in :foothill areas ma y als o breed Anopheles minimus and se veral ether species of Anopheles.
Streams or ditches along the foothill areas are ideal breeding places of Anopheles mi.nimus, the chiel malaria transmitter in Taiwan.
Rice· fields are favorable breeding places of Anophdes
hyrcanus sinensis.
IIJJ:J;j~I•J;T Jil:J:-~'l'ifgJl)[ffi':i'dl~~ W:~.W.!'r'J.I'i:l!.Ji" u Underneath ~ed is the most favorable daytime resting pl'ace of Anopheles minimus.
~r::J;frJJ[J Vl"tii:·J!l:*:l*'!IJJJ:!~ o c iS
Night collection of adult anophelin es using water buffalo bait.
R~3tma
!~' i1T§){q\ilt7:Ewlt1!Xtfli'IDz~*@fi'1!<i. ~ ''· !11'!
E,!,.atzv~: A.L1 :trt~J !IJJr~9'.1~1~9.1Jfrb :i11:''·'1. X<' ;£0CiirnU'dl!!W]r'I',J DDT :;·9-'lifi&o
Dissection of anoph eline mosquitoes and identification of specimens conducted in Entomology Laboratory.
:ri'?1''{f!HiW8J:i12f.·J !kJ i'r i..E:It'iBl75([ .t.\:;c'>\!!i)l, DDT ~i'LH.tUii:ltE o
3f<:t"'f,;7~Wi'i!i!:((f?i''H
;t>.:fiJii>P:fl'iifr~1'f~MlTI !i{i.41?i31:: .
A team of entomology technicians cc ndu cting biological test in field to check the effective11ess cf DDT residue on treated wall surfaces.
Busvine's test is being conducted to determine whether anop h e line mosquit oes collected fr om the sprayed area have developed physi ologi cal resis t an ce t o DDT and other ins ecti· cides.
Studies en life- hist or ies of var icus species of flies are beging dcne, preliminary to future works.
Anopheles min.inzus
·:i- ? ? ;£. i:i" 11 Ji , tr,n r*J 1:i\: N. :f<f; ;;;~;ru-t- if'I Species Composition of An.vol~ele.~ Populati.ons in Rural Houses and Stables of Taiwan 1952-1954 :1·f-".Oli~' 1.1181±!¥., 1.01 ' i '~VII;~ j · -:IJ~N~~ttZ:J.l-~Jr· Ana lysis of 25, 656 Spec imens Found in 1,118 Houses and 91,738 Specimens Found in 1,049 Stables, Apr. 1952- June 1.154 HOUSES(!t4;)
+
{i.£ ~J :1& 'h:i\: :P.i :t ib'H!?- ·~.o P!j· Daytime Resting Places of An.opkeles minimus 1952-19541f.fl~:(:r: 1.118 {J.:J§.U *;~ 11,466 tif:ftJ:t;+J;,~'It): L )}~J T·
iit- J-, o}J.il;~ !~~~~ :.t i&,J·:t~!I'l iA ~-H1 ffJ ~ ~4Ur .2.45-:-r-) A. min.imus Population in Chi-shan Area, 19E·2-19fi'6 I. ,!£jlqJl.X;hJ)lk Adults in Sprayed House
c
Analysis of 14,466 Female kwpheles mimmu:; Collected from 1,118 Houses, 1952-1954 1 PAOPORT!ONS ACCORDING TO VARIOUS ROOMS
NO, Co-tw, Sp ,
M: A. mlnlmllll
20,25!
79,9:3
c : Sitting Room
S: A.hyrc:onuG etnena11 L: A. ludlowil
4,127 :il3
16 ,09 2.00
T: A tossel/atua
1. 70 1109) I SO)
0: Others A onnLAorl• A. splandld~•
94 (53}
0 . 37 {0.21!
(0 .78) (O . UI !.O.BO)
(17) 110! ( 8) (I )
!V.07) IO .CG) (0.0~)
1100)
A. eubplctus lndolinltu•
A. ltucotpt\yr~U ][,
(0.00 4)
TOTAL R. PROPO!HIONS 9Y MICROH.\BITATS IN HOUSES
14,461 100.00
STABLES(Jt- .JI!)
20,6~6 /00.00
II. NO, ~ . 4iflr 9~ , 92.
l](i~IAJiJJ!£1)1!(
A:Undtrnloth Bfd
9,767 6:A. hyrc011u1 alnonsia
Bl,72.9
l:A. ludlowil 1:A. les•ellotua A. maculctue A. annuler/a
430 0.:3~
C:l.rldtrneoltl Shl!f 0: Wall, o~1rn E: Wall, 1•2m F1 Ct~inq
2,1611(. 2,314 1,7152
14.96 16.00
;
085 4 . 19' 42!5 409 2 .~ .
. ,.. :
Larvae in Ditch l~-~: II 1952 UlttPI"')'ecc 19~3 !S~4
eorrv. Sp,
195~
)9)0
so
~ Sp,
~Corn~
s-~~1 CarQetery
So~. <:om~~ c~
<\05 (370) (48)
o.cJ (0 .411 {0 . 05) (0 , 07) (0.00))
G:Fr11
Becnn
H;(:ootallllt
2,83
A..&Pel"'didus
(67)
A.subpiclusindorlnltus A. jtyPQflonti co1'14idiensit TOTAL
I
II ( 01 I II
1: Othlrft~ettlC~i-4t Shelfelo J: Far~ lrnplemet1t K:Ciol"* L1 Wall, 21!'1+
... ~7 5
2.08
I" ill ,. • • 1111
,, )l
ll
~OOCFSFAAY
Sl:roytd
~~~Cor;. 1t~Hhl Sebl;llw
{-111tl
Jl l i } I
~II'ITI)'
0"90
: 1, 29 1.43 1.20
~ .' v ~
I
~~.{6 c:raa
~~ana
~ ~.
_ 1
(0.00) (0.001)
M: Mot.ql.ito Nat N: canopy of Bed 01 Other s..r-t~Kes
186 207 IU
r ! ..
,· ,,
,, ,r
1,11e
r.rr
,r
91.730 100.00
TOTAL
14,4118 100.00
:. 11.. o/ .¥ Jit :ki. Jl. A DDT
"Jt M1£i. ti] kHU: , iR. .!\&- .Jt i~ ~~ ;;J.J }] Biological Test with A. min.imu.1 & A. k. sin.t:n~is on DDT-Sprayed Structures in Field. - to 15-minute-contact on plaster wall with 91·94 day old Wild female anophelines captured one day earlier. 1·, 2-, 3-, 4-, 24- & 48-hours mortality. ty: Tai-chung. Test 15 min. 5 min. 15 lllin. A. h. sinensis 5 min, 1 min. A. minimus
{·;·.;:·t, 1;
,'~- l·l,_.;{ ~l:df
DDT .~~1\·t·):Ht,f<. ( )\.~45 -'"f-_i46-f) SnHI~CJit:ihility
Hdative
to DDT
1955 i:~ 5J1-1957'r !'6J=I
of V111·iouH Spceies of AtWflltcles in Taiwan, 1956-1957.
Distribution of A. min.imus in Taiwan May 1955-June 1957. • .fiX;@ IY!JJif@.~~!J?;j
c
)
Adult from sprayed structure
Check ~.1.41t
o A. minimus
filG~ Clrz~!flj(j!l;~!J?JJL1,9'~)
!~-~:;~~~:~'!"""'hlp, Ping-tun~ ~a~·~~!.~!:.~!~ohon Dlotrlct
Hoi"' (0.09 % DDT)® (0.20 % DDT) <D
Adult from other than sprayed structure
"'~;iill; Larva ><
A.
ludlowi
s:,~!'..!:;~~u~;~:l Townolllp, Plr>j-lunQ
Holen l 0. I B % 0 DT) @
!!l! None
/l I
71 / .
I
A. tesse1atus A. maculotus A . sub pic Ills lndefinitus
l / i
I
17
7
i I
i
I/ // /
<I'Ut.t <\.
hyrconu5 sinensis
~b Co /
. i
/l V 3nrs
i
!
// I ..,,..¢ 4hrs
_1 - - - 1 - - -1 lhr
I
:;:::. - ·
.... . .... --·---
2nrs
24hrs
48hr!'
ENTOMOLOGY SECTION ~
in mind, an .economic as wt"il as t•ll<-dive f('sidual planned. "Curing the pel iod of ln:ll:il ia conlrol by residu:ll
lll>T spraying program was
preparatory phase (1916-1951), and at the begining (19 52) of the
I lilT spraying (1952-1956),
>I project, the medical entomology laboratory made its contribution by acUcs of attack on the transmitters of malaria. The fact that A:nophel9s the chid malaria vector, was established on the basis of the findings m dissection of a total of 84,120 anopheline mosquitues, which were n houses, water-buffalo she!Cers and out· door resting places selected in .; of the island. After it had been determined that A. minimus was the a vector, two important facts about the resting habits of this species vered. These were: 1) that within a house the majority of the chief :tor was to be found in the bed- rooms, and 2) that among 16 types of cats, classified for observation, "underneath bed" was the most preferred .ce of A. minimus, followed by "underneath furniture", "roo?', and "wall ! meter from the floor". These facts were derived from detailed records of cimens of anopheline mosqui;oes collected from 1,118 houses scattered over L Studies on seasonal prevalence of anopheline mosqui toes revealed different of A. minimus seasonal peaks in various localit.ies. The fact that the insecti · ctiveness of DDT residues on walls lasted longer than one year, was proved to 1Iso in Taiwan, by periodically conducting biological tests by a modification ond's method, using wild caught anopheline mosquitoes, and by making year· lnopheles collections from fixed routine stations. With these established facts
1he members oi 11)(' lll<'di< :d t"l'''""oloi:Y laboratory rat• i•·d out intensive island-wide
anopheline survtys Jallll·t f"''JII<'Illly, :111<l 1cvealed th:il !he DDT sprayings were so l'lfcctive that !Ill· '""squii<H'~ ol 11. lnini;nus harl [llal'lically disappeared from houses afler the inili:d :lPI>li,·;ll;""· allhou;:h limitl'il llllllllll'I" S of A. minimus larvae r onlinued to breed i11 Sllll'l' l<<l":>iilie~, and their adulls, presumably fed mostly on water -buffalo hlood. Du1 i11v Ill<' Iat:1'1 h:ilf of 1ht· saint• period, biological tests by llusvine and Nash's ll'ch11iqu<' were conducted, usin~ an11phcline mosquitoes collected from various loc;ditil's llm>ughout the isl;incl, and il w:1s found that the chief malaria vector,
A. 111inimu.~. did not dcvclo]J St' l"i<His res1sla11t't' lo DDT, although strains of A. h. sinensis lro111 so111e h>calities show"d relativt:ly hi~h tolerance to DDT. In the lasl phas" of the project, nallll'ly the llt'riod 11f malaria eradication, which has just hegun, dltii"l sot the members of ll11· medic: II t•nlill<iology laboratory will be made
to detect unusually hi!!,IJ , or increasing pollliliition ol I ht· chid malaria vector, and in· creased toleran<"<' io insecticides which I h" main 111:il;11 ia vt•clor may show at any time hcfore the eradication o[ malaria fw"' this isb11d is attained. Such unfavorable findin g s will innnrdi:li:ely be followed hy inveslig:tlions '"'d research work to find out appropriate counter-measures. During the san1c pc1·iod, studies on arthropods of medical imporlann·, othe1· than anophelint•s, will IH" ilo11" as a preliminary to future work, s<> far as tinJC is available.
~-~-
Section
I'J IJJ::r rr-AH!k'¥1..11/J. kHH'vFc:iVIifm Practicing sprayiP.g technique in a fie!d training center. Vario~;s
;fte:l:ti!IIJJJd.J T ('i,it!J Frlf{~FIJtl-~ lit) :1\@ tnes cf sprayers used in I:I:T spraying operation
in Taiwan.
l'fitJ:t-JT('p~UU:Iiil:*-*r,~ttr.w Spray crew3 arrived at a rural house 1 o slart spraying.
~/f,]Tfi:~A ~:f;:.ffDDT;ffi ,'i\?ii¥Jl't~rt'Mi)·0if,~*~!:1t1fril _r_ (i:
Spraying crews weighing DDT, making suspensicn, filling in sprayers, etc.
10li?1.TflroA:lw~=:r.:ri~Gf,p;;;r-75t:~.tt!>1J,
'tf>*f!i.i\ l' l;t>?SJ o
tJ]:Filf/$,1};J%~:(kd:l~H~lfl l:-fl:1;:ttrf ,:E: ~~ flij,i:J:nJ J i~':i1j F l ~Jl &if' J:;.//):71;:~ tltj~·i:
Spraying t:ndernoLh bed; a f:OOd spray can not be attained unless OJ:erators have a good skill and pa!ience.
After the com~Jeticn c[ spraying, the spraying dale is painted on out-side wall and the certificate is pasted by the foreman after his caref,vl inspection on the spray.
DDT ~~ !W~1~F!~*"=F:r;';!/',H'il~c:i~.i'M'b • ·.'>bJ liliJ:tJiJl.tf;f;Ai!!tU:t. • :ff·1Ufi'fr,J•1Ji"'.':.FU3i:~~~~;'jm o DDT samples collected from sprayed surfaces are checked in laboratory, using Alessandriui Test.
Bh $! I flo; {(' lfJ }ji 'l~<f:i V :hicl€s used for tl:e ma!aria campaign.
DDT "J!t -M .:r..1'i' t-tr ffJ 1952-1956 Summary and Analyses of DDT Spraying Operations, 1952-1956
".It ·M I?J:k\43{JO ll:;Ji'i\141f. 1954 1955 ~~!!.~1451f
_1:._
1'f iW- f',n J'.i\
DDT "IT AHt ~)· ~'/ iJi' ~f]l~l~lf.--~J'CJl!R] P91iif Analysis of the Cost for DDT Spraying, 19E'2-1956
Spray Squad Organization 1956
rsr 1. 1.1
i1
Descriptions
J£;r'Y.I414 1952
.!1';j~42i.]:
1953
I. 1-J~J [j g•jj(: J:l!::c~.25\g)],J$*l(i:r.~l~{ "J4 i?~ Squad with 1 LP. & 2 Hand Sprayers
r.ffllJll1dlll
Per iod of spraying
Da[e started 1.2 il*il€1 1JIJ J Date completed 2. 'N'nW,[;';!; tc•Q Areas involved z.I'f[ejJU!t\~~ nmz
11/J'bfrLillll
7!=]14[=1 July 14 9J128B Sept. 28
3)') 913 Mar. 9 11)]13 Fl Nov. 13
2f]15F3 3.A7B 3Y]19B Feb. 15 Jl.1ar: 7 Mar. 19 10D3Hl 9f/27D 12}j3B Oct. 31 Sept. 27 Dec. 3
I. i!IR l.!U By Sources of Funds
*
17 10 21,682 86 184,653
21 '
21 264 630,632 5,640,325
21 315
No. of hsiens and municipalities involved 2.2 ~111'1iili~~f~jil:)Y. No. of townshi~s :nvolved 2.31!MM~I¥.!:1t!~ 2.4~~AI=l!J&
262 659,6C6
730,468 6,728,465
No. of structm.os sprayed
156,217 1,526,3C6 5,467,664
No. of population directly protected 3. l!i)!:@ti('r: Operation ?.1 Il'r:A.\i& No. of workers engaged
2C7 49.8 16,359 367,155
1,770 5C.93 173,707
6,265 48.21 636,5C9
6,498 46.63 670,678
7,659 44.63 807,529
3.2 'WIN4~J~o,I.I'U I] \Xr ?.3jf~,';€75.%'
Average V.·ork'llg da) s in a regil'Il DDT ilqi%{ 75% DDT cm,sumed in metric tons
3.41!llf:!W0FFJ
Cif,J,,C,J:\q~)
4,118,705 16,660,413 17,69Z,793 19,335,425
Total cost of spraying NT$ 4. ffl:tJ#£-.f:lf Per structure analysis 4.1 #.f.t]!i+Jall)}il';IJ;~, 6.82 No. of rooms per structure 4.2 E.i::f:.ml.mfilr (2f-JJ0I'\.) 2 305 Surface area sprayed per structure, M 4.3 m.t:lf!2f-:!:5g{:E.l3!;1!f'x 7.02 No_ of inhabitants per structure 4.4W:t.il1ffi DDT 10 (~~£-) 566 Technical DDT used per structure, grams 1.10 4.5 ~~W.tll!~:!<'fA 1:Jf9I& --Man: b.'oi.ir.labou_r,spent per structure by spraymen 5. mABf!r Per capita analysjs 42.4 5.1 BJ.)>.EiF,f~I~MTii.f'ffl (Zf'·Jii'::R) 2 ~urface area sprayed per capita, M 5.2fB:N:¥l)ffi DDT, C05J') 78.5 Technical DDT used per capita, grms 5.3 'l!f: 1-...~f.G't!l !FJ, ('l,ij':,;:~IJ-1:) 2.46 ost per capita, NT$ 6_ ~~Mili'I~A-;J.rc.\'"TI~~MTIU;';_>::, C2f-1Ji'::)"_) 2 276.8 Surface area sprayed per man- hour of spn:·men, M 7. :fj';il)Nl;j,H';]ft'i3':Ii'I'P~lli'd f'T7Jft 32.0 %of time spent for travel to total time of operation, %
II. 1~ffl4 ~~~*frJ:i:\;uli£ljfjiiffi 7.9?.
7.97
8.86 401
8.83 387 9.21 767 1.47
Squad with 4 Hand Sprayers
II.
By Expenditure
x H.l ]IJ ~i- ~":: __ • I
337 8.-27 7C6
365 8.29 724 1.43
~ Mr~F"TRAINING 3 ·!JZ% ~ ~~TATIC
8.94 798
~ ~THE~S >AB'Io c::J ful!:.~s:o' ~ ~g,:~ EQ~Pf<OO 3.1•%
1-57
1.5:l
I
I
. \ ~
43.4
{4.0 87.3 3.05 255.9 20.8
44.8 89.2
42.0
9'.8 2.70 229.2 22.4
8:U 2.87 262.6 17.1
3.14
267.7
19.0
"j;f -#jt.:r..1'f-' J-...ll! J_}'j
~)1\fJ\ti,)\(_-;f_t-
t
~-
1952-1956 ~Jill;142f[:' £\;~43{]: l\:[, ~4411 ' J.\1:·~45([.
~------~ ENGINEERING SECTION The Engineering Section is directly responsible for the application of malaria control measures as recommended by the malariologists and entomologists. It concerns mainly with the efficiency and ecomony in the field application of recommended meJ.sures rather than the assessment of effectiveness of the applied measure in malaria control. In the present campaign. the control of malaria has depended upon the use of DDT residual house spraying as the main method of control, with anti- malarial drugs as a supplemental measure. The results of basic epidemiolgical studies conducted by TAMRI prior to the inauguration of the present campaign indicated that 2 gms of technical DDT per square meter of surface area, applied once a year before the peak of the breeding of vector mosquitoes, is an effective dose resulting in the efficient control of principal malaria transrr.ilter in Taiwan, A, minimus. Eefore the start of annual spraying operations, the malariologist made areadefinition for the projected spraying coverage, while the entomologist determined the time of spraying application in different parts of Taiwan and gave instructions regarding places for spraying inside the house. Beginning from late 1951 through 1952, the Engineering Section devcted its entire staff and time for the study of some basic requirements in the planning of the island-wide residual spraying campaign. In the end of 1951, an extensive island- wide housing survey was carried out, through which assessment of house pattern and house construction in each representative area, and measurement of inside superficial areas per occupant of the house were made. This provided valuable information in the subse9uent planning with reference to the composition of spraying squad, allocation of squads per unit number of population to be protected, period of actual field operation, as well as types of sprayers and their most efficient use under different local conditions etc. The paper plans were thoroughly tested out during the first year's spraying operations, i_ e., in the demonstration project in Chi-shan and. Chao-chow areas in 1952 which provided answers to various technical ·problems with regard to DDT residual spraying program. The first big- scale spraying campaign was launched in 1953 with a population converage of 1,526,306 living in the most malarious part of Taiwan. The spraying program was further extended to cover the lJp_u es o!':r5,500,000 people in all malarious areas en Taiwan in 1954 and 1955. In the year ~sprt?;fng coverage, 1956, the total population coverage reached 7,000,000 people. In the DDT spraying operations, the basic unit is the "Spray Squad". It is composed of one foreman, four operators (spraymen) and two helpers. One squJ.d can serve 7,000 people or portion thereof. A normal operational period is 60 days. To a township having three !16 more spray squads, one supervisor was assigned in addition to a foreman for each) spray squad. Township supervisors and foremen were usually permanent staff members of the local health stations or township offices. The responsibility of conducting the spraying program in the hsien (prefecture) rests on the shoulders of hsien supervisors and their provincial counterparts, the TAMRI senior technicians. The training of foremen and township supervisors was one cf the important functions of TAMRI and implemented chiefly through the Engineering Section . The progress of work was reported to the section through weekly and monthly returns by each spray squad through township and hsien supervisors. An efficient reporting system was devised by the Engineering Section, so at any time cperaticns and location cf workers could be established in a matter of minutes. At the end of a field operation program, final report was prepared by the section. Important among the items in the final report was the matter of "cost analysis". It was found that tbe per capita ccst for DDT residual house spraying; covering insecticide, labor, transportation, training, depreciation of equipment and vehides, and supervision etc., has varied slightly every year, giving an average of approximately NT$ 3 per caita protected.
I
I
· I· + ~ l ""' Q
\
Jill
;;
"
"'""'''"'
"""""""'
l1
i
I
Summary nf Training CoCirse3 for Spraying Operation Personnel, 195'·2-1956 § -~p;q4l{:fC:
Description
1952
1953
1954
1955
1956 17
1. HJIIt,l\iJ:';])i}f!Ji!.:: Sit:: of training 2. :fiE~ :t\1. mber of classes
11
12
25 7,795
3.
~iii!!AF\!%1:
Number of trainees t~*.TIT1¥~1}.;I 1
HO
1.284 29
6,306 28 159
6,578 35
Hsien supervisors 189 908
~~f~ill:'~il'H l ill'!!(~
2H l,G78
Township supervisors 28
271 984 44
881 5,238 177 873 21
Foremen
11J!l'!Mw
Spraymen
112
5,446 188
6,468 22!i 1,()65
4. :tli-·wii~BlEiiJTMii1C'l'f Number of sgl1ads organized in each training class 5. *'t'l'~-llil!t'tMI (-tfor;t:;J"~\ ltx 28 Number r•f squads organiz ·e :l for a::tual field spraying operations
254
9(6
6. ff:fif[l\%rlfl!Zt 1iliJ~;±:
Number of hsiens & municipalities involved. *jj'£-·p:j<f±J~Jf[1;\-)\.,
2
17
21
21
Note
I!Jil!JI;j L\[!l[}.._, JJ:!JI.=J\tilffilfZo fliJ::C::f§tJWfi:fiJI[o A squad is composed of I foreman, 4 operators and 2 helpers_ Helpers are not included in training.
DDT "gf ·•1+ JdJI\.i:~J*-.,fl Sum:.na:ry of Cluriculum Subject Matter for the Training Cma-:::u!l of Supervisors, Foremen, & Operators
1'4
!§
Sub.ject
%f:rn'li:f":lm * ~21 ffiJ'Y,'Iff'+f.ii. ** 'i!ff r>Jll ** ~~·rqJ L't ** Bsien supervisors 'Township supervisors Foremen Operators ']>!~;!['
hours 1'Jj&&~J~f~J~
']>IJ:!f hours
6
Administrative and general discussions @~~
Parasitology m~-~~&l ~
s
Entomology lee. and field
u !0 !0 !)
111it:M@!J, iii&W~&2 l 'r''~
Spraying equipment lee. and field Field spraying. technique Recording and reporting
1",'}l)l,nJ~!M1~ t!''.
18
;-12
iz"dGJ~~fCJ--.t\!% {2'iJ:· · ,~;,0/j~R_~c];ji\l~ ;:&:
16 ---'(o)
Supervisory technique and evaluab:i;i ~~;!
Total
rtf
42
---------42 42
Nil '1: * Note
t;;f:f;f;,il~fi'1±4;:Jiiili!r1·
Special course held at T AlVRI. 1E~tl!.1j2;'H1·
**
Courses conducted locally.