1373 "
enclave "-not
foreign
nor
domination of any kind, neither
indigenous.
I thank Mr H. J. Dolman, retired chairman, Mr J. P. Turley, present chairman and managing director, Mr E. Short, secretary, and Mr J. Harvey, manager, and Sister C. Taylor and her staff of I.T.O.; the Department of Employment, local and national offices, the Department of Health and Social Security, the South Western Regional Hospital Board and hospital management committee of Glenside Hospital (both now defunct), and the local authority of the City and County of Bristol and its successor. REFERENCES 1. Early, D. F. Lancet, 1960, ii, 754. 2. Resettlement Policy and Services for Disabled People: a Department of Employment discussion paper for the National Advisory Council for the Employment of the Disabled. Department of
Employment, 1972. 3. Department of Employment. The Quota System for Disabled People: consultative document. H.M. Stationery Office, 1973. 4. Department of Employment. Sheltered Employment for Disabled People: consultative document. H.M. Stationery Office, 1974. 5. Brooke, G. C. Br. Epilepsy Ass. J., Summer, 1962, p. 9. 6. Wansbrough, N. New Society, Feb. 27, 1975, p. 522.
Point of View MEDICAL AID TO DEVELOPING COUNTRIES K. K. DASS* THE controversy
over
the
partial non-recognition
Indian and other medical degrees in the U.K. would
of not
have occurred if receiving countries had never accepted aid, medical or any other. For one thing, they would have retained their sovereignty and taken concrete countermeasures, instead of merely expressing indignation. What is more, the problem itself, of doctors, engineers, and so on, flocking westwards, would not have arisen. Aid was doubled in each succeeding 5-year plan of India, and growth was halved. The fifth plan has not yet got off the ground in spite of the largest ever dose of aid; meanwhile the growth-rate has become negative. Had even the modest growth-rate of the first plan (with practically no aid) been maintained, the national income would by now have quadrupled, cancelling out the economic lure of the West, which is the only reason for the
migration. The correlation between increasing aid and decreasing growth-rates is reminiscent of the days when the weaker the patient became the more he was bled. The reasons for the correlation have been worked out in great detail by some outstanding economists, but briefly it is that aid depresses the national will, which is the prime mover in a country’s progress. The history of aid in the medical field bears all this out. The first massive dose was meant to eradicate malaria, but malaria is on the way back. It permanently increased the population who re-
occupied and deforested
vast areas,
causing ever-increasing
floods.
Without aid malaria would have retreated more slowly, but population control and proper drainage would have gone along with it, thus maintaining Nature’s balance. Another large expenditure was on family planning. Ignoring indigenous achievement, which was concentrating on sterilisation-15 million vasectomies so far* Former Secretary
to
Family Planning.
it
The superimpose Western " expertise ". now the pill have all been expensive failures and have damaged, perhaps beyond repair, the sterilisation programme, which is the only hope for countries where men accumulate and wealth decays.
sought
to
rhythm method, the loop, and
Government of
Medical research is another field dominated by aidThe result is that 80% of it is leisurely fundamental research, since the lack of budgetary pressure from the home Government makes actual achievement un-
givers.
necessary.
Aid through W.H.O. is no better. Although India and other developing countries contribute something, the budget is largely met by Western countries; hence they This accounts for W.H.O.’s interest dominate policy. in dope, traffic accidents, and cigarette smoking, which are of little consequence to the majority of mankind, who suffer from communicable diseases, malnutrition, and
overpopulation. The main blame attaches to the developing countries or rather to their governing élite.1 They are aware of the disadvantages of aid to their countries as of the advantages to themselves. While " negotiating"" for larger and larger amounts of aid, they hope to attain ritual purification from its pollution by condemning it and praising self-reliance. The question is often asked: What would happen if aid stopped? An indication can perhaps be found by seeing what happened when a deliberate decision to go it alone was taken. When 10 million refugees came to India from Bangla Desh, offers of help were received from all over It was decided that all doctors and nurses the world. (and all other staff) must be Indian, and so with one or two exceptions they were. It was thought that the whole operation would collapse in chaos and pandemic. At first this seemed very likely, but those responsible for the policy of self-reliance hung on, and gradually order-not some sort of order, but of good quality-emerged. Cholera was brought by the refugees, but the percentage of deaths remained about 17 (which is normal for the subcontinent) and it did not spread to the rest of the country. Malnutrition of children-again brought by them-was satisfactorily overcome. The squalor, flies, and smells in the camps were replaced by neat rows of grass huts, well drained, and without flies or mosquitoes. Administrators, doctors, and nurses from Kashmir to Cape Comorin worked unitedly and with dedication. A point to note is that all this was achieved only when the established " leadership retreated and was replaced by others of the type who respond to a crisis. Removal of aid would cause a, crisis of similar proportions and. a healthy turnover in the elite. To come back to the partial ban on Indian doctors, the question of their going abroad would hardly arise if medical curricula were built around our own needs. Our doctors would then learn how to operate camp hospitals in grass huts (as they did on the Bangla Desh border, with fewer deaths and sepsis than in conventional hospitals), how to use cheap indigenous drugs, including those used by Indian systems of medicines, instead of the expensive products of the multinationals (why " multi " ?policy is firmly in the hands of the parent company based in its own country), to prescribe yoga instead of any drugs at all in some cases. The medical colleges would concentrate on producing such G.P.S instead of an everincreasing number of specialists. These doctors would remain attached to their own environment, rather than transfer the benefits received by them at home to foreign countries.
themselves, as clearly
"
India, Ministry of Health and 1. Dass, K. K.
J. trop. Med. Hyg. 1974, 77, 275.
enclave "-not
foreign
nor
domination of any kind, neither
indigenous.
I thank Mr H. J. Dolman, retired chairman, Mr J. P. Turley, present chairman and managing director, Mr E. Short, secretary, and Mr J. Harvey, manager, and Sister C. Taylor and her staff of I.T.O.; the Department of Employment, local and national offices, the Department of Health and Social Security, the South Western Regional Hospital Board and hospital management committee of Glenside Hospital (both now defunct), and the local authority of the City and County of Bristol and its successor. REFERENCES 1. Early, D. F. Lancet, 1960, ii, 754. 2. Resettlement Policy and Services for Disabled People: a Department of Employment discussion paper for the National Advisory Council for the Employment of the Disabled. Department of
Employment, 1972. 3. Department of Employment. The Quota System for Disabled People: consultative document. H.M. Stationery Office, 1973. 4. Department of Employment. Sheltered Employment for Disabled People: consultative document. H.M. Stationery Office, 1974. 5. Brooke, G. C. Br. Epilepsy Ass. J., Summer, 1962, p. 9. 6. Wansbrough, N. New Society, Feb. 27, 1975, p. 522.
Point of View MEDICAL AID TO DEVELOPING COUNTRIES K. K. DASS* THE controversy
over
the
partial non-recognition
Indian and other medical degrees in the U.K. would
of not
have occurred if receiving countries had never accepted aid, medical or any other. For one thing, they would have retained their sovereignty and taken concrete countermeasures, instead of merely expressing indignation. What is more, the problem itself, of doctors, engineers, and so on, flocking westwards, would not have arisen. Aid was doubled in each succeeding 5-year plan of India, and growth was halved. The fifth plan has not yet got off the ground in spite of the largest ever dose of aid; meanwhile the growth-rate has become negative. Had even the modest growth-rate of the first plan (with practically no aid) been maintained, the national income would by now have quadrupled, cancelling out the economic lure of the West, which is the only reason for the
migration. The correlation between increasing aid and decreasing growth-rates is reminiscent of the days when the weaker the patient became the more he was bled. The reasons for the correlation have been worked out in great detail by some outstanding economists, but briefly it is that aid depresses the national will, which is the prime mover in a country’s progress. The history of aid in the medical field bears all this out. The first massive dose was meant to eradicate malaria, but malaria is on the way back. It permanently increased the population who re-
occupied and deforested
vast areas,
causing ever-increasing
floods.
Without aid malaria would have retreated more slowly, but population control and proper drainage would have gone along with it, thus maintaining Nature’s balance. Another large expenditure was on family planning. Ignoring indigenous achievement, which was concentrating on sterilisation-15 million vasectomies so far* Former Secretary
to
Family Planning.
it
The superimpose Western " expertise ". now the pill have all been expensive failures and have damaged, perhaps beyond repair, the sterilisation programme, which is the only hope for countries where men accumulate and wealth decays.
sought
to
rhythm method, the loop, and
Government of
Medical research is another field dominated by aidThe result is that 80% of it is leisurely fundamental research, since the lack of budgetary pressure from the home Government makes actual achievement un-
givers.
necessary.
Aid through W.H.O. is no better. Although India and other developing countries contribute something, the budget is largely met by Western countries; hence they This accounts for W.H.O.’s interest dominate policy. in dope, traffic accidents, and cigarette smoking, which are of little consequence to the majority of mankind, who suffer from communicable diseases, malnutrition, and
overpopulation. The main blame attaches to the developing countries or rather to their governing élite.1 They are aware of the disadvantages of aid to their countries as of the advantages to themselves. While " negotiating"" for larger and larger amounts of aid, they hope to attain ritual purification from its pollution by condemning it and praising self-reliance. The question is often asked: What would happen if aid stopped? An indication can perhaps be found by seeing what happened when a deliberate decision to go it alone was taken. When 10 million refugees came to India from Bangla Desh, offers of help were received from all over It was decided that all doctors and nurses the world. (and all other staff) must be Indian, and so with one or two exceptions they were. It was thought that the whole operation would collapse in chaos and pandemic. At first this seemed very likely, but those responsible for the policy of self-reliance hung on, and gradually order-not some sort of order, but of good quality-emerged. Cholera was brought by the refugees, but the percentage of deaths remained about 17 (which is normal for the subcontinent) and it did not spread to the rest of the country. Malnutrition of children-again brought by them-was satisfactorily overcome. The squalor, flies, and smells in the camps were replaced by neat rows of grass huts, well drained, and without flies or mosquitoes. Administrators, doctors, and nurses from Kashmir to Cape Comorin worked unitedly and with dedication. A point to note is that all this was achieved only when the established " leadership retreated and was replaced by others of the type who respond to a crisis. Removal of aid would cause a, crisis of similar proportions and. a healthy turnover in the elite. To come back to the partial ban on Indian doctors, the question of their going abroad would hardly arise if medical curricula were built around our own needs. Our doctors would then learn how to operate camp hospitals in grass huts (as they did on the Bangla Desh border, with fewer deaths and sepsis than in conventional hospitals), how to use cheap indigenous drugs, including those used by Indian systems of medicines, instead of the expensive products of the multinationals (why " multi " ?policy is firmly in the hands of the parent company based in its own country), to prescribe yoga instead of any drugs at all in some cases. The medical colleges would concentrate on producing such G.P.S instead of an everincreasing number of specialists. These doctors would remain attached to their own environment, rather than transfer the benefits received by them at home to foreign countries.
themselves, as clearly
"
India, Ministry of Health and 1. Dass, K. K.
J. trop. Med. Hyg. 1974, 77, 275.
