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.f ~ -- ... "" ::....:;.;~ . ~ ::: ~.;( ...... · ..;.... _.... _ EASTERN MEDITERRANEAN REGION Health is a human right by Dr Hussein A. Gezairy Regional Director, WHO~ Regional Office for the Eastern Mediterranean

ach of WHO's six Regions tainable. Hence, we are always trying has its own special to generate more resources, knowing features, but those of the that it is crucial to work out the most Eastern Mediterranean cost-effective strategy in order to Region (EMRO) perhaps achieve the greatest impact. Our makeE it unique. It stretches over large strategy in EMRO for the most areas of two different continents, yet effective utilization of resources has has more elements of homogeneity three main features. than immediately meet the eye. Nine­ teen of its 23 Member States are Targeting Arabic-speaking, and Arabic is widely The first is, targeting for Health for used in two other States. The over­ All. This can be done geographically whelming majority of the population by defining certain areas, such as throughout the Region, with the districts or governorates and then exception of only one State, follow concentrating on their development the Islamic faith. so that they may be used for health The Region has a wide variety of research activities and as demon­ ethnic cultures and social traditions. stration areas. Targeting can also be Some of its Member States are in­ done functionally and operationally cluded in the list of "least developed by focusing on priority programmes countries," while others enjoy high such as immunization, control of rates of per capita income, enabling diarrhoea! diseases, acute respiratory them to provide health services which infections, maternal and child health, are among the most sophisticated in and water and sanitation. These pro­ the world. The Region also faces huge grammes can be used to spearhead problems. You can read in this issue Dr Gezairy was one of the founders of others and can serve as vehicles to about two wide-scale refugee prob­ medical education in Saudi Arabia, and carry other components of primary lems and how the health situation was Saudi Health Minister from 1975 to health care in an integrated manner. resulting from each is being tackled. 1982. Eventually, financial targeting by pool­ Several countries have suffered from Photo WHO/A. Badawi ing resources from the various pro­ many years of warfare, causing untold grammes into an "umbrella" primary human suffering and enormous health care programme will allow material losses. Natural disasters are large areas still lack safe drinking flexible use of resources, in a way that not uncommon; when they take water and proper sanitation; immuni­ satisfies financial regulations and at place, as happened recently with the zation of children is still far below the the same time meets new needs Nile floods in Sudan, the health target figures for this stage in some arising out of changing situations. situation suffers tragic consequences. areas; persistent endemic diseases It is against this background that we seem to defy all methods of treat­ Basic needs approach in the Eastern Mediterranean Region ment; changing lifestyles have meant The second feature of this cost­ are working to achieve the noble goal that certain societies have acquired effective strategy is the basic needs of Health for All. Fewer than 11 years the diseases of affluence without approach. This requires that all separate us from the year 2000, the shedding those earlier diseases that sectors set their own priorities on target date set by the nations of the they inherited from the days of meeting the basic health needs of the world for the universal achievement of poverty. The list is too long to include people, namely, basic education, pri­ this goal. It is undoubtedly a massive in this short introduction. But if we mary health care, housing, water and task that we are undertaking, but I allow either despair or complacency sanitation, adequate income, healthy believe in the resourcefulness of the to overcome us, our efforts will end in food and security. We who work in nations of this Region, which will total failure. Therefore, our determin­ the health field should be the pio­ enable them to attain whatever objec­ ation must never be shaken. The task neers in making progress toward tive they are determined to achieve. is achievable once we are on the right satisfying basic needs. If they are not Given the right motivation and a wise course. satisfied then an improved health usage of available resources, man can Resources are perhaps the key status cannot be achieved, not even if achieve results which, at the outset, factor in any plan which aims to bring the most modern hospital were to be may seem beyond all expectations. about a real improvement in the built in every village! Yet if these The enormity of the task is enough quality of life. Once resources are needs are met, morbidity and morta­ to make us despair. Rates of maternal available and plentiful, their proper lity will drop considerably without and infant mortality are still too high; use makes every objective seem at- even mentioning the word "hospital."

2 WORLD HEALTH, July 1989 Intertwined with this basic needs Health for All. To mention but a few, approach is the encouragement of we have developed an action­ Cover: Taking blood self-reliance programmes, in which oriented, school health curriculum samples on the the community plays the leading role which, when put into effect, will doorstep to test for in defining its needs, developing indi­ enable teachers and pupils to take malaria in Saudi cators, managing the programmes specific action in support of their own Arabia. and providing support in kind and in health and the health of their families Photo WHO/E Scheidegger cash. and their communities. Aware as we are that the most common cause of Health care approach morbidity and mortality is people The third and final feature of this themselves, we in the Regional Office strategy is the district development are working hard to develop a pro­ IX ISSN 0043-8502 system based on the integrated pri­ gramme which will encourage people World Health is the official illustrated mary health care approach, and this to lead healthy lifestyles. We are also magazine of the World Health Organization. we are actively promoting in the very positively exploring the spiritual Eastern Mediterranean Region. dimension of health, with the aim of Editor: This is not all. We are taking other involving religious leaders, Christian John Bland very important steps in support of and Muslim, in the Health for All Deputy Editor: movement. Other steps concentrate Christiane Viedma on making medical education com­ A busy prescription counter in Sudan. munity-oriented, on using national Art Editor: "/ believe in the resourcefulness of the languages in medical schools, and on Peter Davies nations of this Region, which will enable identifying the right leaders for the them to attain whatever objective they Health for All movement. Since our News Page Editor: are determined to achieve". objective stresses the word "All," the Philippe Stroot leaders of this movement should be Photo WHO/M. Sentis drawn from all sections of society. • World Health appears ten times a year in English. French. Portuguese. Russian and Spanish. and four times a year in Arabic and Farsi . The German edition is obtainable from German Green Cross. Schuhmarkt 4. 3550 Marburg. FRG. Articles and photographs not copyrighted may be reproduced provided credit is given to the World Health Organization. Signed articles do not necessarily reflect WHO's views. World Hei!lth. WHO. Av. Appia. 1211 Geneva 27. Switzerland.

Contents Health is a human right by Hussein A. Gezairy ...... 2 The well-being of pilgrims by Jalal Aashi ...... 4 The plight of Palestine refugees by Robert Cook ...... 8 Afghanistan after the turmoil by Mumtaz Hussein ...... 11 A happy ending by Ghada Hafez ...... 13 Environment at risk Centrespread designed by Ulfat Hakky ...... 16-17 A sporting partnership by Adil Salahi ...... 18 Communicable diseases by Mohammad Helmi Wahdan ...... 20 New lifestyles, new diseases by Muhammad AI-Khateeb ...... 22 Mental health adds quality to life by Narendra N. Wig ...... 24 Health education through religion by Abdulmoneim Aly ...... · . . 27 Teaching and learning materials by Khaled Munaymani ...... 28 When X-rays are too costly by Atarod Modjtabai ...... 29 News Page ...... 30

WORLD HEALTH, July 1989 3 The well·being of pilgrims by Jalal Aashi

very year, as the time of to visit Arafat, a few miles away from mage is a visit made at a specific time Muslim pilgrimage ap­ Mecca (Makkah). to the Inviolable House at Mecca. This proaches, and pilgrims This attendance is the most central is a reference to the Kaabah, the black arrive from all corners of ritual of the Haj - the Islamic pilgri­ structure at the centre of the Grand the world, every point of mage. Around one million of them Mosque. Pilgrimage also involves the entryE into Saudi Arabia has to cope arrive from countries as far apart as fulfilment of certain rituals at specific with ever increasing work. By air, sea Indonesia and Canada. But whether times and places. and road they come, motivated by they come from China, France, faith and a long-cherished desire to Jordan, Morocco, Nigeria, Pakistan, Mecca (Makkah), the focal point of pray at the Kaabah, the blessed the United States, Yugoslavia, from Islam, attracts pilgrims from all coun­ mosque towards which Muslims turn anywhere else, they all have the same tries where there are large numbers of in their prayer wherever they are, and purpose. To them, this is the journey Muslims. The Grand Mosque occupies of a lifetime and they want to make the centre of the town, and within the the most of it. That is, to fulfil their Grand Mosque is the Kaabah Dr Jalal Aashi is with the pilgrimage as best as they can and to sanctuary. Ministry of Health. Saudi earn the reward given by God to Photos Camerapix London © Arabia. pilgrims, namely, forgiveness of past Map rep-roduced by courtesy of Equinox, sins. In purely Islamic terms, pilgri- Oxford, UK. ©

ATLANnC OCEAN

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1·500 501-1500 1501-5000 5001-15 000 15 001·50 000 mare than 50 000 205 - Ill pilgr1ms UA E Unll8d Arab Emlra!es scale 1:35 000 000 INDIAN OCEAN To them, this is the journey of a lifetime their pilgrims as they arrived back And on the third day, they all return and they want to make the most of it. home. Today, this is not necessary to Mecca to prepare for their journey thanks to the efficiency of the health home. Photo Camerapix London © services provided. Fully equipped hos­ Neither Arafat nor Mina is a built­ pitals are available in Mecca and up area. No one lives at either place Medina (Madinah), the two cities all year round, apart from these five Once in Saudi Arabia, the overseas where pilgrims mostly stay. All cases pilgrimage days, so the pilgrims live in visitors are joined by an equal number which need medical attention receive tents. The Saudi Government has to of local pilgrims who also want to fulfil the proper care. provide abundant water supplies in this religious duty, which is one of the Pilgrims have to take a specific these areas to cover all their needs: five pillars upon which the structure of route, spending four or five days in ablution, purification, drinking and the Islamic faith is built. areas which are not populated for the sanitation. The question of sanitation These two million people, together rest of the year. On the eighth day of is of the highest importance, especi­ with the many thousands who are the lunar month of Thul-Hajjah, they ally these days when pilgrimage engaged in the numerous services move out of Mecca. Some proceed to occurs at the height of summer when required to ensure the safety and Arafat, a flat area surrounding a small it is excessively hot. So facilities are well-being of pilgrims, have to move hill, about 25 kilometres away, but provided along with all the support within a limited area and go from one many stop half-way at Mina where services required to ensure proper spot to another in order to fulfil the they spend the night. All pilgrims have waste disposal. rituals at the prescribed time. To to be at Arafat on the following day, ensure that every pilgrim who arrives spending most of the day there, in the Kingdom of Saudi Arabia is engaged in worship and glorification Seasonal health centres able to fulfil his religious duties on of God, and praying for forgiveness. Pilgrims coming from other coun­ time and without difficulty, a supreme This is the pinnacle of the Muslim tries spend on average two to four committee of pilgrimage, headed by pilgrimage. weeks in Saudi Arabia, passing their the Minister of Interior, has the task of When the sun has set, they travel time equally in Mecca and Medina, coordinating the efforts of the Min­ back towards Mina and Mecca. They apart from those five days of their istries of Interior, Health, Pilgrimage stop first at a place called Muzdalifa, a religious duties. As both cities are of and Religious Endowments, Munici­ short distance from Mina, where they medium size, the problems of conges­ pal and Rural Affairs, Transport, Post spend the night, sleeping rolJgh, be­ tion can be easily appreciated with the and Telephone, and Trade, together cause there is neither tent nor build­ influx of these huge numbers. The with the Saudi Red Crescent Society. ing. Shortly before sunrise, they emergency hospitals already men­ Understandably, health is given a continue to Mina to start a day full of tioned are complemented by a net­ high profile among the services pro­ activity, with several rituals to perform. work of seasonal health centres which vided by the government. An out­ They spend two or three days there, provide medical care for all cases break of any communicable disease during which they also have to pay a reported to them, and give advice on among the pilgrims would not only visit to the Grand Mosque in Mecca. how to avoid health risks, especially represent a problem of great magni­ sunstroke and heat exhaustion. At the tude for the country; it could be height of the pilgrimage season, all carried abroad to create a major All photos in this issue which are not these health centres work 24 hours a health problem for other countries as marked WHO or © for copyright are day, providing a wide range of well. In the past, many countries had entries in WHO's 40th anniversary medical care, dispensing medicines to apply a system of quarantine for International Photo Competition and not forgetting to provide dental

6 WORLD HE ALTH , July 1989 The well-being of pilgrims Every prospective pilgrim must fulfil specific health requirements. Those from overseas may be required to produce vaccination certificates against certain diseases. Photo WHO/E. Schwab care to any pilgrim in need of it. Even before the earliest pilgrims arrive, special committees formed by the Ministry of Health make sure that the accommodation provided for pil­ grims in Mecca, Mina, Arafat and Medina fulfil all the conditions neces­ sary to protect the health of the visitors. This is a clear instance of the basic principle: "Prevention is better than cure." This same principle underlies the special effort made by the Ministry of Health to monitor the world epidem­ iological situation in order to formu­ late at an early stage the specific health requirements which every pros­ pective pilgrim must fulfil. Pilgrims from overseas may be required to produce vaccination certificates against certain diseases. Vaccination campaigns may be arranged for residents of the pilgrimage areas and for prospective pilgrims from the Kingdom, whether Saudis or mem­ bers of the expatriate community. Rigorous surveillance and monitoring are in force to discover any cases of communicable diseases or food poi­ soning, so that the patients may be isolated and preventive measures may be taken to bring any outbreak of a communicable disease swiftly under control. Moreover, the health authorities maintain close contacts with their counterparts in Muslim countries in order to provide valuable health edu­ cation to pilgrims, even before they embark on their journey. Personal and public cleanliness and sanitation are given their due importance. Guidelines are provided on what food to eat and what to avoid, the impor­ tance of eating enough, and avoiding fatigue and over-crowding. Adequate measures are also taken to reduce the risk of fire and accidents, and to deal ~ with such cases as arise. It is not an easy task to ensure that the great number of pilgrims who gather every year in Mecca and Medina can fulfil their religious duties without being exposed to serious health risks. The fact that, year after year, the pilgrimage season in Saudi Arabia remains free of epidemics indicates the high efficiency of the services provided, and the success of all the measures taken by Saudi Arabia in dealing with a potentially serious situation. •

WORLD HEALTH, July 1989 7 The p6ght of Palestine refugees by Robert Cook Director of Health, UNRWA

?re~ ~ale . :re· fu.gees shot child care, supplementary feeding and years in Lebanon, its medical person­ mclttdimg: one: ag.ed 14 inoculations. But now many clinics nel have had to respond to many - two with c hest have become more like field hospitals serious health care problems, and in wounds, one with an in a war zone. some cases the Agency is still provid­ abdominal wound ... ing mobile medical teams to visit areas twoT male refugees shot with plastic where refugees have fled for safety. covered metal bullets . . . five mal1es. DT Robert Cook was for­ During its almost 40 years of exist­ inclu:d'fng two aged 6 and 12, beaten meriy Senror Medlcat Officer ence, it has had to deal continually . . . two female refug,ees, one fom­ in WHO's DivisLon of family with emergencies. months pregnant, treated for tear gas H~a~th in Geneva. Since UNRWA began operations in intox:lication . . . soidiers entered May 1950, WHO has been responsible UNRWA school and expfoded tear gas Working with local hea}th care for the. technical direction of the canisters . . . factl

WORLD HEALTH , July 1989 9 The plight of Palestine refugees

"special hardship case" programme (except in Lebanon, where it is ten Checking on the blood pressure and a general welfare programme. years) after which the children can go of a mother-to-be at a clinic in a The former provides food and other on to government or private second­ poor quarter of Gaza town. necessities to about five per cent of ary schools to complete 12 years of the refugee population - widows, education. The Agency has some Photo WHO/Michel Biihrer orphans, the aged, the mentally and 350,000 pupils in its 635 schools, physically handicapped, and the with a teaching staff of 11,000. chronically sick and their dependants. Lacking funds for construction, the mandate repeatedly renewed, for the The general welfare programme in­ Agency has been forced to rent problems of these refugees have yet cludes case work, emergency aid, buildings as schools that are rarely to be satisfactorily solved. The current training of adults and the disabled, suited for classroom use. Another mandate runs to 30 June 1990. activities for pre-school children and major problem at the beginning was a Unlike other UN organizations for women, and promotion of dearth of qualified teachers, so dependent on vbluntary contribu­ income-generating projects. Relief is teacher-training began as early as tions, UNRWA does not fund projects, also provided on an emergency basis 1952. Since 1956, UNRWA has turned but finances the operation of schools, to a wider refugee population after out 12,560 qualified elementary clinics, and feeding centres for the wars and during times of civil strife. schoolteachers from its centres. And it refugee population. Its budget covers has developed a programme of in­ a staff of over 17,500, supplies, and service training, run by an Institute of other essentials needed for providing Renewed emergency Education staffed, at the higher levels, health, education and welfare services operations by UNESCO-appointed experts. of a kind generally provided by gov­ The 1982 invasion of Lebanon by The development of vocational ernments. Moreover, these services Israeli forces led UNRWA to mount a training began in the early 1950s, but have to be continuous: any dimi­ US $60.3 million emergency relief funds raised during World Refugee nution or termination of a service, programme, which was continued Year (1959/1960) gave it a much­ even if necessitated by funding defi­ until 1984. Further hostilities called needed boost. The number of voca­ cits, can have political implications for renewed emergency operations in tional training places at eight training and hence serious consequences. As subsequent years - operations that centres has been increased to more one financial crisis has followed on were carried out under conditions of than 3,000 (of which 592 are occu­ the heels of another, the UN General considerable difficulty and even dan­ pied by women), and some 35,000 Assembly, through the UN Secretary­ ger to the Agency itself. Currently in artisans, technicians and profession­ General and others (for instance, a the occupied territories of the West als have graduated from UNRWA's working group on the financing of Bank and Gaza Strip, it has extended vocational training centres. The UNRWA), has made various efforts to its relief programme. Agency also provides 350 university obtain the needed funds. The UNRWA education system pro­ scholarships each year for young UNRWA's relief services consist of a vides the first nine years of schooling refugees. •

10 WORLD HEALTH, July 1989 Afghanistan after the tunnoil by Mumtaz Hussein

he tragedy of Afghanis­ Most people, particularly in the Commission of Refugees charged tan is probably unique countryside, have little or no access to with arranging shelter, feeding and in the annals of human preventive and curative health care, multi-sectoral care. The refugees conflict. Long years of and the numbers of the disabled and register in reception centres and are bitter fighting have handicapped have increased. Health then directed to the areas demarcated causedT the death of almost a million manpower has been severely for future "settlement". There the people, permanently disabled tens of depleted, because training program­ similarities end; the actual program­ thousands, and disrupted and mes have been interrupted and mes for care of refugees differ widely. destroyed most of the country's infra­ trained personnel have left the In Pakistan, most newcomers are structure as well as the vital agricultu­ country. settled in some 300 refugee villages ral sector. Almost 45 per cent of the and provided with food rations, population have been forced either to materials for shelter building, clothing seek asylum in neighbouring countries Dr Mumtaz Hussein served and financial subsidies. The Afghan or to flee to safer areas within the in several capacities in the Refugee Health Programme is a colla­ country away from strife-torn zones. health services of Pakistan borative effort between the In the 1970s, Afghanistan was government of Pakistan and the UN ranked among the least developed and with WHO . He is curren­ High Commission for Refugees countries of the world but its meagre tly WHO Senior Adviser to UN (UNHCR) and is responsible for provid­ infrastructure and services were begin­ Operation Salam. set up to ing adequate preventive and curative ning to expand and progress seemed assist the Afghan refugees. health care through the strategy of feasible. But nine years of war have primary health care. There are now brought even this progress to an end. 217 basic health units and 41 sub­ Despite the Geneva Accord signed in The refugee population in the host units delivering basic health care in April 1988, fighting continues. countries brought with them the same the refugee villages. Secondary and Meanwhile, some six million people burden of health problems in addition tertiary care is provided by the host have sought refuge in the neighbour­ to their pressing needs for food, country's national health institutions. ing countries of Pakistan (3.5 million) shelter and clothing. It is to the credit Some 2,800 male community and the Islamic Republic of Iran (over of both Pakistan and Iran that they health workers and 1,600 female 2.3 million). Another two million are accepted this humanitarian challenge health workers or traditional birth internally displaced. The deterioration willingly and readily. The international attendants have been trained. Disease of the national infrastructure, com­ community, too, has responded bined with the loss of human generously, easing the stresses resources, poses awesome problems imposed on national infrastructures, Two Afghan refugees receive treatment for Afghanistan and has imposed particularly in Pakistan. fearful strains on the social and at a well-equipped reception centre in Both Pakistan and Iran have estab­ Iran. economic policies of the host lished Refugee Commissions in the countries. Ministries of Interior, with a Chief Photo WHO/UNHCR/A. Hollmann In the health sector alone, the situation is alarming. Infant mortality stands at 185 per 1,000 live births and maternal mortality at 329 per 10,000 births - four to five times more than that of some other developing countries. Life expectancy is estimated at a mere 30 years. Malaria, tuberculosis, diarrhoea! and respiratory diseases are major health problems, and preventable childhood diseases exact a heavy toll. Safe drinkjng water is available only to a very small percentage of the popu­ lation. Poor environmental health conditions combined with a low liter­ acy rate, particularly among women, promote high morbidity, infirmity and mortality. Against this depressing scenario, the destruction of recent years has disrupted practically all the opera­ tional disease control programmes.

WORLD HEALTH, July 1989 11 Afghanistan after the turmoil health plan was formulated to help Iran cope with this heavy commit­ ment. UNHCR has been contributing US $7 to $10 million in the health sector alone. As in Pakistan, WHO has been instrumental in planning and putting into effect the UNHCR-funded programmes. The Geneva Accord signed in April 1988 brought forth hope for Af­ ghanistan to return to peaceful condi­ tions and the UN Secretary-General established in May 1988 a special Programme of Humanitarian and Economic Assistance, later named UN Operation Salam. Prince Sadruddin Aga Khan was appointed Coordinator for the planning of this monumental task. The international community responded enthusiastically, both morally and in material terms, and UN agencies were asked to cooperate actively with the coordinator.

Technical assistance WHO has signified its commitment to assist Operation Salam to the fullest extent possible and has pro­ vided technical assistance for assess­ ing needs, for planning and for ascertaining how health care could be · made available to Afghans irrespective of where they are located. As all three countries concerned are Member States of EMRO, the Regional Office has contributed greatly to developing Operation Salam's health sector pro­ gramme. This includes epidemiologi­ cal surveys and programme planning for disease prevention, treatment and control; restoring health facilities and their equipment; training health man­ A woman health visitor examines an registration, are not accommodated in Afghan refugee in a tented reception organized refugee villages but are power; and re-establishing the logistic centre in the North-West Frontier dispersed into towns and villages, and supportive mechanisms required Province of Pakistan. mainly in the border provinces of to sustain the restored health services. Khorasan, Sistan-Baluchistan and Kir­ Progress so far is encouraging, Photo WHO/ UNHCR/S. Errington man. Some 250,000 are lodged in despite the severe constraints. Many spontaneous camps, having gone to tons of medical supplies have already control programmes (malaria and these locations on their own without been airlifted to Kabul for the assis­ tuberculosis control, and immuniza­ passing through the registration pro­ tance of vulnerable groups. Resources tion) have contributed significantly to cess. The registered refugees receive have been allocated to strengthen a general improvement in health. For identity cards and are free to work in health facilities in some areas border­ example, the infant mortality rate semi-skilled and unskilled jobs. No ing Pakistan, particularly in the fields among Afghan refugees is estimated food or monetary subsidies are given, of nutrition, immunization and control at 87 deaths per 1,000 live births. and health needs are met through of diarrhoea! diseases. As a prelude to Apart from UNHCR, WHO has contri­ established national health facilities. starting a community-based rehabili­ buted by providing expertise and Because of this, and because they are tation programme, orthopaedic resources for disease control (particu­ widely dispersed, it is difficult to gauge workshops are being set up in three larly tuberculosis and malaria) as well exactly their health status. However, provinces. as by making WHO staff available for both in Iran and Pakistan, the level of These are some of the basic and coordinating and putting into effect health services provided is qualita­ urgent steps taken by the UN in health care delivery. Non-governmen­ tively and quantitatively better than general and by WHO in particular, with tal organizations too are significant that previously available to the the active support of the international contributors to the programme, parti­ displaced Afghans. community, for recovery and rehabili­ cularly for primary health care and But Iran's national health system tation in Afghanistan. They are training of health manpower. has itself come under considerable intended to help a traditionally proud The Iranian government's strategy strain, given Iran's own problems of and self-reliant people to build a for refugee care differs substantially in development and war conditions. By strong, stable society and to erase the that the refugees, after preliminary 1986, UNHCR became involved, and a scars of this terrible war. •

12 WORLD HEALTH , July 1989 law, for support. This lady said: "This is the method we have been following for ages and with every child born in this family. We are going to stick to it Ahappy ending and we require no service from any­ one else, doctor or otherwise!" But the young woman at the centre of this by Ghada Hafez ordeal appealed to me for help, saying: "Please doctor, save me. They have been trying everything for six t was my first night in a rural I spoke to the village birth atten­ hours and they do not realise that I mansion where I was spend­ dant, who took a defiant attitude. She am dying." ing a couple of weeks on had been attending births in the At my insistence, they allowed me holiday with my family. But all village for over 35 years, and the to examine the young girl. It was thoughts of holiday disap- mothers did not want the services of a impossible for her to give birth in her pearedK shortly after I went to bed. doctor. The young woman herself was condition. The cervix had not dilated From the street came cries of "Doctor! very pale and in great pain. She was enough for the baby to pass through. Someone fetch the doctor!". I hur­ screaming: "Help me! Get me a She needed some medication as well riedly put on my clothes and werit doctor!" as a doctor's help. outside. When I mentioned that I was a Impossible to give birth doctor, I was quickly taken to a house Dr Ghada Hafez. Regional nearby and ushered into a dark, Adviser on Mother and Child It was a typical case of pregnancy at poorly ventilated room full of women. Health at EM RO. was for­ a very early age. The girl had not yet Amid the chaos, voices gave unre­ reached her fifteenth birthday but had lated suggestions such as "Bring some merly Head of the MCH been married for ten months. She hot water," "You must help yourself," Department in Hama. Syrian had not been examined by a doctor at "Why do you not pull it?" "And push Arab Republic ( 1 961 -1 980). any time during her pregnancy. At the hard." One of the guests told me that and Chief. MCH and Family same time, she was required to help a young woman was in labour with Planning. in Dubai. United with household duties, including pre­ her first baby. At that moment a Arab Emirates ( 1 980-1984). paring lunch for the men working in blanket was spread on the floor and the field and taking it to them, and the pregnant woman was helped to lie she was clearly undernourished. on it. Then the women got ready to I tried to persuade the birth atten­ The girl was not aware that a health lift her up, explaining that the position dant that I wanted only to give of the baby was still high and they whatever help I could. The birth Mothers and children wait patiently for wanted to shake the woman as they attendant - let us call her Umm a consultation at a village health centre. lifted her in the blanket to help the Ahmad - looked to the lady of the baby to drop. house, the young woman's mother-in- Photo WHO/P. Boucas A happy ending

centre was available in the village where she could have had some tests and have her blood pressure measured. She said she was too poor to pay for such services. Yet these services were available free of charge. The health centre would have advised her about proper diet and about whether her pregnancy was normal or not. She might have been given some tablets to strengthen her body. When I explained that it was vital that the young woman be moved to the nearest clinic, the opposition was very stiff. They wanted to wait until her husband arrived from somewhere. I explained that by the time he arrived, it might be too late to save his wife and their baby. I tried to get Umm Ahmad, the birth attendant, on my side, but she protested that she had always used the same method in attending childbirth. She accused doctors of being too quick to make an incision in order to dilate the cervix, and said that it was not unknown for doctors to give young women medi­ cines which stopped them from get­ ting pregnant again.

Unsterilised tools To my horror I saw a knife near where Umm Ahmad sat. I asked her what she wanted to do with that knife, and she said that it was for cutting the umbilical cord. I explained the danger of using unsterilised tools, which meant that either the b.aby or the mother or both could contract teta­ nus. Support came finally from an unexpected quarter. The young woman's father-in-law arrived and he allowed me to take her to the clinic. This case had a happy ending. I was able to give the young mother the help she badly needed and to deliver her safely. The girl's mother and the other ladies surrounded her in a joyous mood after the distress of the night. As they talked, I took Umm Ahmad aside to assure her it was never my intention to take her job away from her. In fact, I wanted her to come along to see how delivery could be conducted in a health centre in clean and sterilised conditions. Her to the centre for an early examination. fact that I managed to establish a long long experience would not be wasted, I tried hard to make her understand relationship with Umm Ahmad and but she would be able to get clean that she could be a link between the with her family. Working with birth cotton wool and proper medicine to village population and the health attendants like her and training them use in cases when the dilatation of the centre, and that this link could be is absolutely necessary, because cervix is too slow. beneficial all round. through them we are able to reach Umm Ahmad listened attentively. I It was well into the morning before I every pregnant woman in every vil­ told her that she could be of immense got back to the village to which I had lage. Getting the Umm Ahmads of help; when she saw a young girl who come for rest and relaxation. My first this world on our side is of vital was pregnant, she should insist that night was sleepless. Nevertheless, I felt importance in saving the lives of her family give her the proper nour­ happy because I was able to save a newborn babies and young mothers. ishment and allow her enough rest. young life and prevent an unneces­ With suitable training, birth attendants She could be of even greater help if sary tragedy. can recognise their limits so that, she herself brought the young woman An added bonus for me was the when there is a difficult case, they are

14 WORLD HEALTH, July 1989 two to three weeks and stresses the Women's lot is often hard in the Eastern importance of maintaining cleanliness Mediterranean region; bringing water for the family takes time and effort. at the time of delivery. Furthermore, we teach the birth attendant to look Facing page: ·~ happy ending." A t ,,ti~J~/~(.,I,~L.,~~);i..::-~..: for symptoms which help identify Palestine refugee beams with satisfac­ . .., r-, cases which need medical care at the tion as her baby is weighed at a child . ..::./'{.,~'·'/ ~:,, health centre . health clinic in Syria. We have had a very positive re· Photos WHO/ P. Almasy sponse on the part of governments as well as birth attendants themselves. We have already expanded the Pakis· the ones who persuade th2 family that tan experiment to include Egypt and the pregnant woman must have the Syrian Arab Republic, where more proper medical care. than 4,000 birth attendants have been In my present job as Regional trained, and last April we convened a Adviser for Mother and Child Health meeting of an Advisory Expert Panel in EMRO, I have a chance to expand at the Regional Office to expand the this early experiment into a regional training programme to other policy with the overall objective of countries. having a well-trained birth attendant Training birth attendants is only the for every village. Voices were raised in cornerstone of a full programme opposition to this policy. Within the which has several components. If the medical profession, there were those birth attendant identifies a serious who objected to training illiterate An Iranian poster offers family planning case during labour, will she have women in the art of child delivery. But advice. access to transport to rush the woman although medical services have cer· Photo WHO/B. Zeppilli to the health centre? When she tainly expanded in most countries of arrives there, will she find a doctor or the Region, at best they cover only 50 We have had an extremely encou· a qualified midwife? Will the neces­ per cent of the population. People in raging experiment in Pakistan where sary medication, blood for transfusion, mountainous and remote areas do birth attendants were trained in an and experienced staff be available? not have access to even the basic area of several thousand villages. The The programme must be a complete minimum in medical care. They are rate of maternal mortality in that area and well-integrated one; but the bound to continue with traditional dropped to less than half its previous trained birth attendant serves as the birth attendants, if only because they level over a relatively very short early warning system to prevent un· have no alternative. period. The training course lasts only necessary tragedies. •

WORLD HEALTH , July 1989 15 ENVIRONME

AIR POUUflON: Traflic exhausts and industrial fumes need strict controls if they are not to threaten health

SOUD WAS1E POUUflON: Cities are growing at such a pace that essential often cannot cope with!;- ~,. ~-~::::t1~~~~~~;!!~~ ~NT AT RISK

WA1ER POUuriON: Clean water is vital for good health. Salegui!J"ding it calls for individual and community action Asporting partnership by Adil Salahi

. t was the first day of January event itself was of secondary impor­ books and magazines, and we run 1988 when I walked into the tance. The paramount objective was meetings, workshops, and courses of ·office of the Deputy General to convey a health message from a health education. We try hard to get ][ Manager of the Olympic Club different platform, thus ensuring that the mass media always to talk about in Alexandria, the Egyptian it reached a much wider audience. We health. We sponsor lectures and hold city which is host to WHO's Eastern discussions at schools, clubs and Mediterranean Regional Office social gatherings. Yet somehow we (EMRO). The discussion centred on Mr Adil Salahi is Public seem unable to bridge the gap how we in the Regional Office could Information Officer at EM R0. between getting the message across to . establish some sort of cooperation in He was a journalist with the people and convincing them to make health advocacy with the Club, which Arabic daily newspaper the behavioural changes which was in the premier division of the Asharq Alawsat and the BBC should, in theory, result from acquir­ national football league. Two hours Arabic Service, both in Lon­ ing such knowledge. later, I was in my office working on a don, before joining WHO in We have been speaking about proposal to arrange a football 1987. immunization for years, but mothers tournament for local clubs and still neglect to bring their children for schools under the slogan "Smoking is vaccination. Long before medical the enemy of health." in WHO often speak of community research established health risks of Altogether, 34 teams tooJ< part in participation as an essential element smoking, smokers themselves felt that our five-day tournament, which was of the primary health care approach tobacco smoking might not be all that restricted to players under 15 years of to Health for All. We start from the good for their health. Today, despite age and played at the Club's ground. indisputable premise that people have the massive evidence condemning The final was indeed a grand affair. a great interest in their own health. It tobacco as an enemy of health and Two days earlier, the teams repre­ is not only that everyone likes to be despite world-wide campaigns, senting the two leading clubs in healthy but also that everyone should Alexandria, Sporting and Olympic, be willing to take some positive Special T-shirts identify runners in the were decisively knocked out in the steps in order to be healthy and to EMRO Health Run, staged in conjunc­ semi-final round by two teams of remain so. tion with World Health Day this year lesser standing. The final was staged So we try to keep the issue of along the Alexandria seafront. at the Alexandria Stadium in front of health in the forefront at meetings. a big crowd as a curtain-raiser to the We issue press releases, newsletters, Photo WHO/ A. Badawi premier division league match between the reigning champions, AI­ Ahly and Olympic. A cup made specially for the tournament was pre­ sented to the winners by Mr AI Gawsaky, the Governor of Alexandria, and Dr Ali Khogali, Director of Pro­ gramme Management at EMRO. That evening an item on the tournament was included in the main news bulletin on television. Ten weeks later, on the occasion of the First World No-Tobacco Day which coincided with WHO's Fortieth Anniversary, 7 April 1988, 800 people of all ages took part in an eight-kilometre cross-country run. The route took them along the seaside, passing in front of the Regional Office on their way to the finishing line in Alexandria Stadium. As in the football tournament, all participants wore WHO shirts carrying messages explaining the dangers of smoking. Egyptian 1V devoted a whole edition of its weekly 25-minute programme "World of Sports" to the event, underscoring its health message. In both instances, the sporting

18 WORLD HEALTH, July 1989 The world's first health organization

ew people realise that the present Fpremises of WHO's Eastern Mediterranean Region have been a centre for international cooperation in health matters for some 150 years. In 1843, the first international health organization was established in Alex­ andria, Egypt, which came to be known as the Quarantine Board or Conseil. In 1926, after the International Sanitary Convention of Paris, the Board became a regional bureau of the Paris-based Office International d 'Hygiene Publique (OIHP), to which it transmitted epidemiological intelli­ gence on an area ranging from Cyprus to Sudan and from Malta to Iraq. After more than a century of active existence, the Quarantine Board handed over its functions and its stately building to the newly­ created WHO to become the Regional Office for the Eastern Mediterranean. In 1949, when EMRO was estab­ lished, its membership included Egypt, Ethiopia, Iran, Iraq, Israel, Jordan, Lebanon, Pakistan, Saudi Arabia, Syria and Turkey. In addition, France, Italy and the United Kingdom participated for several years as rep­ resentatives of certain territories, namely, Aden, Cyprus, French and Italian Somaliland and Sudan. smoking still persists on a huge scale "I can fly - with a little help from a Turkey and Israel transferred to the - especially in developing countries friend . .. " Study of a Pakistan athlete European Region in 1952 and 1985 respectively, and Ethiopia transferred where people can least afford it, from by M R. Owaisi both the financial and health points of to the African Region in 1977. Other view. Even among doctors, a sizeable countries have joined EMRO - Libya (1952), Yemen (1954), Sudan and minority still smoke. I cannot forget Tunisia (1956), Kuwait (1960), Cyprus the sight of a radiology specialist can also be of immense help. The alliance with the sports sector and Somalia (1961), Democratic looking at chest X-rays with a cigar in Yemen (1968), Afghanistan (1969) , his mouth. is so important because sport has a Oman (1971), Bahrain, Qatar and the There are several factors which multi-sided appeal to people. The United Arab Emirates (1972) , Djibouti help perpetuate this gap between drive for excellence which motivates (1978) and Morocco (1986) . knowledge and practice. Perhaps every sportsman and sportswoman, Today the membership of EMRO the role models which young people stands at 23 countries: Afghanistan, some of these factors exist in our Bahrain, Cyprus, Democratic Yemen, make-up. Many of us tend to be look for in superstars and even in local heroes, the competitive element Djibouti, Egypt, Islamic Republic of complacent when it comes to resisting Iran, Iraq, Jordan, Kuwait, Lebanon, a particular desire. It is always more which is central to all sport, the Libyan Arab Jamahiriya, Morocco, convenient to adopt an attitude of "It civilised method of releasing energy Oman, Pakistan, Qatar, Saudi Arabia, won't happen to me." and aggression, and the pleasure Somalia , Sudan, Syrian Arab people get from practising or Republic, Tunisia, United Arab Emir­ watching sport - all these contribute ates, Yemen. Behavioural change to the appeal of sport and its influ­ To bring about behavioural change, ence on human behaviour. If we add something over and above the provi­ to this the fact that sport and health sion of accurate, reliable and up-to­ have a mutually beneficial effect on date information is needed. What each other, we have the making of a influences human behaviour is as perfect alliance which may perhaps complicated and multi-faceted as prove indispensable in the 1990s. human life itself. So our approach to The 1990s will be a particularly public information on health should important decade for the cause of be as broad in perspective as human health, in the run-up to the year life. While this is not easy, it is not 2000, the target date chosen by WHO particularly difficult. Forging alliances and UNICEF for achieving Health for with certain groups which have a real All. The pace must increase, and impact on people's way of thinking partnerships with those outside the and behaviour can rapidly yield immediate field of health will be of The handsome EMR Office in results. The sports sector is one paramount importance. The alliance Alexandria. important example. Other sectors between health and sport is one Photo WHO/A. Badawl such as religion, the arts and literature partnership that can work wonders. •

WOrlLD HEALTH, July 1989 19 should be vaccinated against meningi­ tis before they arrive in Saudi Arabia and, if not, they are offered vacci­ nation on arrival. People living in the Communimble diseases pilgrimage area, in the cities of Jed­ dah, Mecca and Medina, and who come into contact with the pilgrims by Mohammad Helmi Wahdan are also vaccinated against meningitis regularly and no cases are reported among them. The other cornerstone of disease ifteen years ago a major Vaccination is one of the corner­ prevention and control is information. outbreak of meningitis in stones of prevention and control of The spectacular success of the Egyp­ Brazil would have conti­ communicable diseases. More re­ tian programme to control diarrhoea! nued unabated had it not cently, immunization against meningi­ diseases owes much to the thoughtful been for a large group of tis was carried out effectively in and intelligent use of public informa­ schoolchildrenF in Alexandria, Egypt. Sudan, where the population of Khar­ tion services. Here is a programme The children's involvement was toum and surrounding areas received where all the necessary ingredients for admittedly indirect, but crucial none­ success are present: the seriousness of theless. In 1973 they were the the problem, the simple message, the subjects in the first wide-scale exper­ Dr Mohammad Helmi use of public personalities to deliver it, iment to test the effectiveness of a Wahdan is Director of the wide variety of methods employed newly developed meningitis vaccine. Disease Prevention and Con­ to give the same message, the WHO supported the study, in which trol at EM RO . Prior to joining effective use of all information chan­ 250,000 schoolchildren were vac­ nels. At the same time, oral rehyd­ WHO in 1979. he was Pro­ cinated and their progress was fol ­ ration salts were made available lowed over a period of two years. fessor of Epidemiology at the through all outlets. The result in After the first year, it was clear that the High Institute of Public practical terms was to reduce by half vaccine was extremely effective. It was Health. University of Alexan­ the rates of infant mortality. then, in 1974, that a major meningitis dria. Egypt. The national programme to control epidemic in Brazil began to cause diarrhoea! diseases in Egypt can be international concern. claimed to be the best in the world. It The credit is really due to the late the vaccination in 1987. When men­ has demonstrated the value of using King Faisal of Saudi Arabia. Aware of ingitis broke out across the country the media for health advocacy. It is no the successful results of the Alexan­ the following winter, Khartoum longer concentrating only on the dria study, King Faisal donated four remained free of the disease. curative aspect. It gives equal if not million US dollars to send the men­ In Saudi Arabia, meningitis vacci­ greater emphasis to prevention, using ingitis vaccine to Brazil. As a result, nation is particularly important in the experience gained in the use of the epidemic was successfully con­ preventing disease at the time of the the media to drive home to mothers tained by protecting those who were annual pilgrimage. The health some very important health messages vaccinated. authorities insist that all pilgrims about nutrition, breastfeeding, per- A solar microscope makes diagnosis of importance in the control of epidem­ caused immunized individuals to be­ certain communicable diseases easier in ics. When the public are made aware come carriers. Many people resorted a Somali clinic. of the presence of disease in their to more dangerous practices such as community, they can play an impor­ taking antibiotics as a means of pre­ Facing page: A routine blood sample tant role in prevention and early vention. taken from a schoolgirl in Jordan, detection. People will respond to the Lack of information is equally detri­ where school health is integrated with challenge of preventing the spread of the health centres. mental. If, for political reasons, health disease if they are told how to avoid authorities withhold information Photos WHO/Michel Biihrer and WHO risk. Often this requires no more than about the existence of disease, the seeing that houses are adequately results can be tragic. If a disease which ventilated and avoiding crowded can cause permanent infirmity, men­ sonal hygiene, cleanliness and using places (as in the case of diseases of ingitis for example, spreads because only safe water. the respiratory tract), or simple clean­ of lack of public awareness, the In fact, EMRO was the first region liness (as in the case of diarrhoea! and number of cases left . permanently to discover oral rehydration as the skin diseases). disabled may be multiplied many best treatment for diarrhoea. Early in times. This represents enormous the 1950s, Professor Samir Najjar of Fully up-to-date human suffering, not only for the Lebanon produced a formula for oral patients but also for their families. rehydration which differed only It is also important that doctors and With a higher incidence of disease slightly from the present oral rehyd­ health workers be fully up-to-date on and a greater number of permanently ration formula, and in 1962 a training the presence of disease in the popu­ disabled, the burden on a country's course in oral rehydration was lation they serve. Without full and health services and finances is ulti­ organiZed in the Anfoshi Hospital in accurate information, symptoms may mately heavier. Alexandria, Egypt. Unfortunately, be misinterpreted and conditions In spite of major advances in these pioneering efforts were not wrongly diagnosed, which of course prevention and control, communic­ destined for wider application. That leads to the spread of disease. able diseases continue to pose a would have saved the lives of millions Misinformation and contradictory significant health problem in many of children in the intervening period information confuses the public and countries of EMRO. The real chal­ until oral rehydration salts became the can only be detrimental. Recently in lenge we face is not lack of scientific standard world-wide treatment of one of the countries of EMRO, it was knowledge but using the knowledge diarrhoea in the 1970s. wrongly stated in the media that the we have in the appropriate way to Public information is also of vital meningitis vaccine is dangerous as it stop the spread of disease. •

WORLD HEALTH , July 1989 21 New Hfestyles, new diseases by Muhammad AI-Khateeb

ahmood was in his evening work period. Suddenly he felt occurs either in the form of angina, early forties, an op­ a strange pain in his chest. He tried to myocardial infarction or acute circula­ timistic, happy-go­ ignore it, but it kept getting worse. A tory failure. lucky sort of man. heavy lump seemed to be perching on Mahmood's case is typical. We all He never gave his chest, and severe pain radiated hear about such cases, and the pre­ much thought to the additional kilo­ from the sternum area to his left vention of coronary conditions grams he had put on lately. He did shoulder. He was short of breath and features regularly in the world press. not practice any sport and indeed felt sweating heavily. When he could not The disease, which is ratper new to irritated if obliged to park his car at developing communities, is creeping some distance from his destination. steadily into all our lives. He had moved from one clerical job Or Muhammad AI-Khateeb A study published in 1988 by AI to another and was currently working is the Head of Health Educa­ Bahrain Research Centre revealed as an accountant in a private-sector tion at the Ministry of Health, that in 1984 cardiovascular diseases firm . He repeatedly failed to give up Bahrain. were responsible for 26.35 per cent of smoking, but eventually turned to mortality in Bahrain, but by 1986 the low-tar, low-nicotine cigarettes which figure had risen to 33.35 per cent. appeared in the country after legisla­ bear it any longer, he cried for help. Just 4 7. 7 per cent of the patients tion laid down that nicotine and tar His wife ran to his rescue, an belonged to the 40-59 age group; conten( in cigarettes should not ambulance was summoned and Mah­ 77.9 per cent suffered from obesity, exceed 0.8 mg and 12 mg respectively. mood was rushed to hospital. After a 83.5 per cent had a family history of One day, Mahmood returned preliminary examination, the doctors cardiac diseases, and 86.2 per cent home from work, ate his lunch and sent him to the intensive care unit for were smokers, of whom 42 per cent played for a while with his young treatment of his coronary condition. got through more than 20 cigarettes a daughters before going for his usually A coronary is the widely-used term day. short afternoon nap, after which he denoting insufficiency of blood supply In Oslo, during World War 11, would return to the office for the to the heart. It is a syndrome that coronary diseases were less prevalent

22 WORLD HEALTH , July 1989 than during both the pre- and post­ physical exercise; and stress is Drawing up an integrated national war periods, no doubt due to the common in our daily life. strategy for the prevention of non­ change in diet imposed by war condi­ The question is: How can we communicable diseases is both advis­ tions. People had to eat less meat and formulate prevention programmes? able and economically justifiable. But dairy products, but more fish and fish When faced with the threat of a prevention of such diseases cannot be products. Such a diet was similar to contagious disease, we immediately achieved through the efforts of health that found in the food of Eskimo set out to vaccinate people, even officials alone. Health education has tribes in Greenland, who are seldom though many of them are not likely to to be made accessible to the entire afflicted with coronary heart diseases. contract the disease. Likewise, in population, and non-health institu­ Japanese fishermen too, whose diet order to combat coronary heart tions and the various mass media depends almost totally on fish, very diseases we need to appeal to all the should be mobilised to this end. rarely suffer from such diseases. population and urge them to change Research data yielded by national as their eating patterns. Numerous well as international studies show that High-risk cases experiments have proved that a posi­ early intervention can make the pre­ tive change of habits and lifestyle vention of disease possible. As for the link between smoking leads to a decrease of coronary cases. Though the past four years have and cardiac diseases, it has been Prevention should come from witnessed a significant drop in the rate proved that nicotine and carbon mon­ within. Proper nutrition needs to be of cigarette consumption, there are oxide are factors promoting arthero­ taught in schools at all levels so that serious indicators that a large percen­ sclerosis. This causes harmful fatty students develop the right eating tage of young people are smokers. deposits to form in the internal lining habits. A great responsibility rests with We must try to get rid of such of the arteries, which in turn lead to a primary health care physicians to unhealthy habits which have recently narrowing of artery walls, or even an identify cases of hypertension among afflicted our society. occlusion that obstructs the flow of their patients and provide them with Perhaps we should not conclude blood. It is important to put such facts treatment and follow-up care. Fast­ without a word about Mahmood, across to the general public in a food restaurants should be instructed whose case started this discussion of simplified manner. Moreover, coro­ to serve the kind of food that contains the effects a change in lifestyle may nary heart diseases are aggravated by vegetable fibres and unsaturated fats. have on health. After spending some such factors as high blood cholesterol Individuals should be encouraged to time in hospital, Mahmood was finally and hypertension. Indeed, a smoker practise sports, or at least walk discharged. His health has generally who suffers from high blood choles­ regularly if they are short of time for improved and he has lost weight. He terol and hypertension is a high-risk exercise. Indeed, prevention is crucial, now knows that he suffered from case - a potential coronary patient. and sound healthy practices should angina due to cardiac functional What is needed, in fact, is not a be well inculcated in childhood. insufficiency. He is following a diet new scientific breakthrough, but that is calculated to rid him of much rather a sound use of simple edu­ Our diet plays a key role in our of his excess weight and, on the cation of the public and a more long-term health - a fact that is often advice of his physician, he has also humane and understanding approach forgotten when heavy fatty foods are set started taking exercise. He managed by health care providers. before us. to stop smoking, since he realised that The primary health care physician Facing page: A pregnant woman has the so-called safe cigarettes are not should give potential coronary her blood pressure checked in Bahrain much safer than ordinary cigarettes. patients a simple but thorough expla­ - a wise precaution. What's more, Mahmood is now a nation of relevant facts. He should prominent figure in the Bahrain Anti­ not ignore a patient's obesity, since Photos WHO/A. Badawi and WHO Smoking Society. • overweight may be a factor in promot­ ing hypertension, high serum choles­ terol and diabetes. Everyone should know that natural weight gain ceases at the age of 30; from then on one should always guard against gaining any additional weight, for instance by increasing physical activity and re­ fraining from eating high-calorie foods, particularly fats. Moreover, pre­ vention programmes must be intro­ duced early in childhood, since this is the formative stage during which habits are developed. Recent social development - such as bigger incomes and greater availa­ bility of a wide variety of commodities - have led to changes in lifestyles that threaten health. Coronary diseases are on the increase because of changes in diets; people are eating more fats, carbohydrates and animal proteins; fast-food restaurants offer hamburgers, hot dogs and fried · chicken; the intake of salt from canned food is rapidly increasing; easy transport makes for a lack of

WORLD HEALTH, July 1989 23 Mental health adds qua6ty to life by Narendra N. Wig

t was a new day in the life of workers had been specially trained. services. This attitude is based on Mohammed Karim. He was As he listened to the teacher, Karim deeply held fears and prejudices 11 years old and studying in a broke down and between sobs told his against mental illnesses found in ][ local village school near teacher how his father had been kept many communities, mixed with ignor­ Rawalpindi in Pakistan. He in chains for the last three years and ance and wrong information. In many was bright in his studies, but there was everybody said he was possessed by countries, even the health admini­ gloom in his house because for three evil spirits. That evening, Karim per­ strators still think that mental illnesses years his father had not been well. His suaded his mother and his uncle to are not common in developing coun­ father would say strange things and take his father to the rural health tries, or that for these illnesses the occasionally get violent and clinic. modern health services have nothing aggressive, even hitting his own family to offer. The facts are to the contrary. members and neighbours. He was According to WHO estimates, at least mostly kept in chains in the house. Dr Narendra N. Wig is 300 million people are mentally ill in The whole village knew that he was Regional Adviser on Mental the world; 50 million or so have possessed by evil spirits but treatrnept Health at EM RO. He was serious mental illness, and three­ at many religious shrines had not Professor of Psychiatry at the quarters live in the developing helped very much. All India Institute of Medical countries. Some friends had suggested taking Sciences. New Delhi. before The situation in the countries of the him to the mental hospital in Lahore, joining WHO in 1984. Eastern Mediterranean Region is no 300 kilometres away, but this was too different. In any small village of 1000 difficult for the family. That morning people or so, one can easily pick out the school teacher told the students They did this the next day and the four to six people who are suffering about a new mental health education doctor confirmed the diagnosis of from what used to be called insanity programme. He explained how seri· mental illness and gave the patient and are now referred to as psychotic ous mental illness is wrongly con· some tablets to take. Within two disorders, an equal number of cases sidered by many as due to possession weeks Karim's father started improv­ who have fits or epilepsy, and an even by evil spirits, but in fact mental ing and by the end of two months he larger number of children who are illnesses are like physical illnesses and looked almost normal again. But the mentally retarded or handicapped. can be treated. A new mental health doctor advised him to take medicine The prevalence of neurotic and service was now available at the local for a further year. stress-related disorders is five to ten rural health centre where both the Mental health is often one of the times larger. When studies are made medical doctors and primary health most neglected areas of the health in primary health care settings, the figures are more revealing. More than 25 per cent of cases who go to primary care physicians have no demonstrable physical illness and their symptoms are probably related to psychosocial stress. This is true in both developing and developed countries. In most of the developing coun­ tries, mental health services till recently were greatly neglected. Often the only mental health facility is a large mental hospital outside a big city, a legacy of past colonial days. Most such hospitals are over-crowded, under-staffed and badly managed. Finances are always scarce. The poorer the country, the worse the mental hospital. Such institutions have further strengthened the

Some 25per cent olmentalillnesses are probably related to psychosocial stress. Left: An unemployed Tunisian labourer. Facing page: A doll shares the plight of a young casualty of war in Lebanon. Photos Theo Janssen and Hussein Mohd Haider

24 WORLD HEALTH, July 1989 care available and accessible for all in the near future, with special emphasis on services for the unserved and underserved rural population; - to enhance the use of mental health knowledge in general health care, social development and improv­ ing the quality of life; - to encourage community participa­ tion in the development of mental health services and to generate a spirit of self-help. By the end of 1988, more than half of the 23 countries of the region had taken steps to develop such program­ mes. Afghanistan, Democratic Yemen, Jordan, Sudan and the Yemen Arab Republic, have started up similar pro­ grammes and followed them up with multi-sectoral national workshops. Countries like Egypt, Iran, Iraq, Somalia and Tunisia have also embarked on the programme and started many activities. In the WHO/ EMRO mental health programme, stress is placed on self­ reliance and using approaches which are appropriate for local needs. For example, for the delivery of mental health care in the vast rural areas, instead of depending on highly trained professionals, the countries are using the existing infrastructure of health - that is, the primary care physicians and health assistants and workers. In Afghanistan, Democratic Yemen, Egypt, Pakistan, Sudan and Yemen, a large number of doctors and health professionals have been trained in the essentials of mental health care and now provide mental health services to thousands of people in the remote and previously unserved rural areas. Only two or three essential neuro-psychiatric drugs have been provided to manage these services. The experience of Democratic Yemen is particularly interesting. Here there was only one qualified psychia­ common man's attitude of hopeless­ with only a little extra expense on trist, who worked within a traditional ness in the face of mental illness. essential drugs and additional training mental hospital in Aden. Now, under In EMRO, some early pioneers like of health staff. This work has now the new mental health programme, Or Tigani El Mahi of Sudan tried in been replicated in many countries of dozens of doctors and health workers the 1950s to break this gloom by Asia and Africa. have been trained and sent out into suggesting the integration of mental the field. Instead of remaining in the health into general health services, Rapid progress mental hospital, a team of mental and even involving traditional healers WHO now encourages countries to health professionals now visits the in the mental health care programme. develop comprehensive national poli­ far-off governorates and regularly In the late 1970s, WHO arranged a cies and programmes of mental supervises the activities of this pro­ multi-centred study on "the strategies health, covering all aspects of preven­ gramme. for the extension of mental health tion and treatment of neurological Another significant activity is the services in the community." This and mental disorders (including alco­ school mental health programme. It study was carried out in Brazil, hol and drug abuse) through the first started in Rawalpindi division in Columbia, Egypt, India, the Philip­ existing primary health care services. Pakistan. Professor Mubbashar and pines, Senegal and Sudan, and con­ In EMRO, this movement has made his colleagues of the WHO collaborat­ clusively proved that it is possible and rapid progress. Pakistan was the first ing centre visited schools in the rural relatively easy to treat serious mental country in the Region to develop such area and trained many teachers in illness like psychosis, epilepsy and a programme, which now includes the simple principles of mental health. depression through the existing health following objectives: The teachers were in turn asked to services near the homes of people, - to make minimal mental health educate school children in mental

WORLD HEALTH, July 1989 25 Speech therapy for a slightly handicap­ consequence of the mental health between mental health professionals ped boy in Abu Dhabi. programme. and religious leaders. One modern Mental hospitals have too often mental health clinic is held in the Photo lbrahim Khalil Adawi been isolated from the family and the large house of a traditional healer in a community. This trend is changing in village near Wad Madani. Every week Eastern Mediterranean countries. a mental health team from the health, for only five minutes every General hospital psychiatric units now government hospital, consisting of a day, concentrating on three slogans: encourage family members to stay psychiatrist, medical doctors, a - cigarette smoking is injurious for with the patients. This is happening in psychologist, social workers and a health and is also the forerunner of Egypt, Pakistan, Sudan and many nurse visit this centre. After consul­ other addictive behaviour; other countries. In fact the relatives of tation in the clinic, some patients seek - mental illness is not caused by evil the mentally ill patient are a great further religious treatment at the spirits or by the curse of God. Like help in view of the very limited house of the Sheikh, who is a renow­ physical illness it can be treated; nursing care available in the wards. ned religious leader of the com­ - many children have a physical or Furthermore these relatives and munity. This is a good example of mental handicap. It is not nice to patients together form a good harmonious and mutually beneficial laugh at or make fun of a handicap­ example of a therapeutic community. relationship between modern medical ped child. You should try to help the The potential of the . family has not services and traditional healers. handicapped child. been fully used in the health services; In the countries of the Region, These slogans have been im­ involving the family is important not a new mood of hope and optimism mensely popular in schools. Teachers only for the seriously mentally ill but is emerging about mental health have put them on school walls and also for the mentally handicapped services. Ignorance and fear about also on school report cards which are and for the care of the aged. mental illness is declining as mental seen and signed by parents. The A further development in the patients are seen to be getting well in impact of this programme has been Region is the use of religious institu­ primary health clinics without greatly very good. Children, who are often tions in mental health programmes, disrupting the life of their families. the only literate persons in the vil­ especially in the field of drug abuse. In More and more countries are now lages, have carried these messages a number of countries like Egypt, willing to give priority to mental health home. They have even identified their Iran, Pakistan and Sudan, religious because they see the importance of relatives who were mentally ill and teachers and institutions such as psycho-social and behavioural factors brought them to health clinics (like mosques have been used in such in health and human development. the true story mentioned at the start programmes. In Egypt, there are even As one of the slogans in a country of this article). What is more, the drug dependence clinics functioning programme proclaims: "There is no acceptance of all health services has on the premises of the mosques. In health without mental health. Mental increased in these rural areas as a Sudan, there is close collaboration health adds quality to life." •

26 WORLD HEALTH, July 1989 Health education through re&gion by Abdulmoneim Aly

chieving Health for All to religious instruction. This calls for beginning, and a consolidated report requires much more a clear religious pronouncement of the findings of the entire study is than just setting up a on certain practices from a health made by yet another scholar. health centre in every perspective. This method of study has enabled district and providing a The first title in the series is The the University of AI-Azhar to achieve a highA standard of medical care within Islamic Ruling on Smoking. This 114- sort of consensus on the Islamic view easy reach of everyone. page book is divided into ten of smoking. This gives it a much A key element in the primary health stronger standing than would have care approach to Health for All is been the case if the ruling was given health education, which seeks to bring Or Abdulmoneim Aly is Act­ by only one scholar, distinguished about a change in behaviour patterns ing Manager of Health and though he may be. Eight of the by making essential health informa­ Biomedical Information at scholars reach an outright "forbid­ tion available to all people in a simple, EM RO . He joined WHO head­ den" verdict on tobacco, whether direct and effective manner. It is quart€rs in 1976 to establish smoked or chewed or used in any hoped that people will thus be moti­ the Arabic Language Unit and other way. The other two have vated to evaluate their habits and served later as Chief. Office of classified it as "strongly reprehens­ practices, and will modify them Languages. ible," which in Islamic terminology is a according to the requirements of shade less than forbidden. health protection and promotion. Needless to say, the verdict is based Behavioural change, however, is chapters, each written by a different primarily on the harmful effects of too complex a process to be initiated scholar from the University of AI­ tobacco on the health of smokers and simply by providing a set of facts. The Azhar in Cairo, Egypt, which a few on the health of others. Other con­ motivation to break a habit must be years ago celebrated its millennium - siderations are the fact that a smoker much stronger than the force of habits 1000 years - as the most famous seat or the pleasure derived from a certain of Islamic learning. Each scholar practice. The spiritual dimension can argues the case against smoking and Children at play in Egypt. The culture in be highly influential in this process of gives a ruling on its permissibility on which they grow up will have a pro­ behavioural change, and has indeed the basis of the hard facts submitted found bearing on their attitudes to been considered by WHO's governing by WHO. A summary of the verdicts health. bodies on several occasions. In May pronounced by all ten scholars is 1984, the World Health Assembly given in a separate chapter at the Photo Marina Brodskaya adopted a resolution recognising the great role that the spiritual dimension plays in motivating people's achieve­ ments in all aspects of life; the resolution invited Member States to consider including in their strategies for Health for All a spiritual dimension in accordance with their social and cultural patterns. In a separate resolu­ tion on WHO's public image, the Regional Committee for the Eastern Mediterranean requested the Regio­ nal Director to prepare health and biomedical information that empha­ sised the time-honoured cultures, values and traditions which char­ acterise the countries of the Region. Three booklets It is within this framework that .EMRO has published three booklets in a series called "Health Education through Religion." Recognising the sway that religions have over people's thought and behaviour, EMRO is seeking to make changes in behaviour serve the purpose of health protec­ tion, while at the same time showing that the required change conforms

WORLD HEALTH, July 1989 27 Health education through religion .

Teaching and learning materials

eaching materials are of obvious Timportance to health personnel in any programme aimed at promot­ ing health personnel education and community health. Health Teaching Learning Materials (HTLM) is the name that WHO gives to written and audio-visual aids used in the edu­ cation of health personnel and in health promotion. In most countries of EMRO, good quality and appropriate health teaching and learning materials are scarce - whether they are needed to train health workers and help them to acquire new skills, or as aids to health workers who will work as health educators of the community. Efforts to provide health teaching aids have been made in almost all countries, but they are far from meeting the pressing needs. An exchange of information and exper­ tise is therefore of vital importance. To help promote such an exchange, EMRO, in January 1986, set up the Health Teaching and Learning Material Clearinghouse, an informa­ tion bank which serves to support the development and sharing of good materials. There is often too Mobile cinemas attract a crowd to hear waste disposal is underlined very little exchange of materials among advice on healthy lifestyles in Iran. strongly in this 25-page booklet, writ­ countries and even among institu­ ten by Or Abdulfattah Al-Hussaini tions within the same country, so the Photo M. Farrahi Al-Sheikh, President of Al-Azhar Clearinghouse facilitates the dis­ University. tribution and use of materials, parti­ cularly in health programmes based squanders money on something The third title, Rulings on Animal on primary health care. which is of no benefit whatsoever, and Slaughter, takes the form of a consoli­ WHO also helps countries to the fact that tobacco smells bad. dated report on the findings of several assess their need, so that they can The second title, Water and Sani­ meetings and discussions culminating derive the best advantage from the tation in Islam, explains that the with a seminar held in Jeddah, Saudi resources that the Clearinghouse health approach to water and sani­ Arabia, in 1985. The seminar was offers. Countries are encouraged to develop self-reliance in designing tation is identical to that of Islam. arranged by the Muslim World materials produced in Arabic and Thus, when a Muslim takes positive League and EMRO with the collabor­ appropriate to their health training steps to ensure that water remains ation of the Institute of Veterinary programmes. clean and unpolluted and uses it Medicine, a FAO/ WHO Collaborating EMRO publishes a newsletter rationally, he does not merely fulfil the Centre for Research and Training in entitled Health Teaching and Learn­ requirements of hygiene, but also Food Hygiene. ing News, which appears two to The booklet, 25 pages in length, three times a year and is distributed fulfils his religious duty. The benefit he to all Member States of the Region. gets is both material and spiritual. The outlines religious and health require­ This acts as a means of information same applies to personal and com­ ments concerning animal slaughter. exchange among countries of the munity sanitation. The need to keep By doing so, it makes it easier for network. water unpolluted and to ensure safe Muslim minorities all over the world to Khaled Munaymani identify the meat available in their local markets which they can eat. This Dr Khaled Munaymani has been with WHO for 31 years and is now Techni­ makes a highly useful contribution to cal Officer, Teaching and Learning the solution of a social and nutritional Materials at EMRO. problem which could have serious health consequences. There has been much discussion of the spiritual dimension to health. There is no doubt that it can play an important role in health promotion. Many activities are being undertaken throughout the world based on the special position of religious leaders in their communities. This series pub­ EMRO's three booklets on "Health lished by EMRO is a pioneering effort A workshop on Teaching Learning education through religion." which represents just one example Materials in libya. of the effective use of religion in Photo WHO Photo WHO/A. Badawi health education. •

28 WORLD HEALTH, July 1989 When X·rays are too costly by Atarod Modjtabai

ave you ever thought The simplified X-ray machine can is also simplified. With the BRS, a of how much it costs deal with over 80 per cent of radio­ small hospital can provide X-ray to build a modern, logical examinations at a large central services without employing a fully fully-equipped X-ray hospital and nearly 100 per cent of qualified medical radiology techni­ unit in a general or those at a small local hospital. It can cian. A local health worker who has specialisedJHI hospital? Many of us be installed in one day in a simple undergone a four-week training answer this question by saying that room, and is designed for trouble-free course can operate the BRS machine X-rays are of vital importance in the and develop the films . The operator accurate diagnosis of a large percen­ works in cooperation with the treating tage of cases of illness. So cost should physician, who is provided with a not be an impediment which denies Or Atarod Modjtabai is diagnostic manual designed to help people their right to proper health Reg.ional Adviser on Non­ the general practitioner to interpret care. Governments owe it to their Communicable Diseases at the radiographs. It deals only with the people to provide them with basic EMRO. pathological conditions most likely to health services. X-rays are not a be seen in patients at rural hospitals. luxury; they are a necessary aid which Between 1980 and 1984, EMRO should be available to all people. functioning and mm1mum mainte· pioneered field trials in three coun­ This argument makes a strong case. nance even under difficult operating tries of the Region: Cyprus, Egypt and But to provide enough modern, fully­ conditions. It uses ordinary mains the Yemen Arab Republic. Since equipped X-ray units to meet the electricity as a power source, but also 1985, 62 BRS units have been needs of all the population remains works from batteries with various installed in hospitals located in many well beyond the financial ability of charging systems, including solar countries of the Region, and EMRO many national health authorities. panels. The X-ray output is powerful advisors have visited each hospital to Nevertheless, diagnostic radiology is enough to produce radiographs of all ensure their proper operation and an essential element in a modern parts of the body, yet both patients use. system for the delivery of health care. and operators receive lower doses of Pioneered by EMRO, the Basic In other words, a wide gap exists radiation than with most other Radiological System is the simple yet between what is legitimately needed systems. sophisticated way in which WHO and what is practically possible. Con­ If equipment is simplified, training hopes to offer better radiological sequently, a large sector of the world's coverage for people in all parts of the population is deprived of basic world. It offers suitable equipment comprehensive health care. Simple X-ray procedures can satisfy 90 and methodology for remote commu­ The diagnosis and treatment of per cent of the radiological needs of nities or city slums, and thus can chest diseases when guided by radio­ developing countries. play an important role in improving graphy are much more accurate and the diagnostic facilities in support of effective than when only a stetho­ Photo WHO primary health care. • scope is available. X-ray examination also permits a bone fracture to be more quickly realigned and treated. In fact, for 80 per cent of radiological examinations, simple X-ray pro­ cedures carried out with relatively inexpensive equipment are sufficient. Adopting a pragmatic approach to the problem, WHO developed the Basic Radiological System (BRS) specially to bring X-ray technology to areas which were lacking it. WHO recognised that, in order for hospitals to provide X-ray services, the equip­ ment itself as well as the techniques involved must be simple and economical, both in terms of finance and manpower. Offering low-cost, good quality diagnostic coverage, the BRS meets these conditions. It is not only a machine; it is rather a compo­ site of an X-ray machine, a darkroom and a training scheme for doctors as well as for machine operators.

WORLD HEALTH, July 1989 29 ...... •••••• ...... ••••••• ...••• ...••• ...••• ...... ••••• ...... ••••••...... ••••• ...... • ••••••••••• ...... ::: ...::: ...... :s::::: ...... ::: ...::: ...::: ...... ::::: ...... ::::::· .:::.:::...... ::::::: ::::::: . . ...••• ...••• ...... ••••••• ...... •••••••••• ...... •••••• ...••• .•...... ••••••••••••••••• . Editor: Philippe Stroot

including the project's 0 WHO award for objectives. geographical I s coverage. target groups. 0 health education 0 duration of activities. per ­ .<::: sonnel involved. and Q_ monitoring and evaluation An annual award in the of efforts planned/ Women speak out on smoking. field of health education in undertaken: Tobacco: primary health care has been 3 description of the health Women at went to the only restaurant in established by the World education activity being Paris. Aux Deux Canards: Health Organization Its pur­ carried out as part of the added risk where smoking is totally ban­ pose is to reward outstanding primary health care pro ­ ned: AI Azhar University of contributions made by any ject . which should The world's second No­ Cairo: and the Swiss super­ person(s). institution(s) or emphasise the planning, Tobacco Day was celebrated market chain Migros. which nongovernmental organi­ implementation and on 31 May, the date on has never sold cigarettes. • zation(s) towards strength­ evaluation phases. and which it will henceforth be ening Health Education in highlight the innovative held every year This year's primary health care. The approaches being used special target was the female award consists of a cash prize and the impact of the edu ­ smoker. with the slogan: Sasakawa of US $5000. to be used for cation on people's "Women at added risk". continuing these health edu­ behaviour. Events of all kinds were Health Prize cation activities. and a Only a health education organized in most countries ceremony in commemorative plaque. activity still in progress will of the world to mark the day Candidates for the award be considered for the award As its instigator. WHO was no Tokyo may be nominated by any The education may pertain to exception and several events national health education any aspect of primary health took place in Geneva for the Representatives of the ten authority, a former recipient care lt must be innovative in occasion. A round table winners of the Sasakawa of the prize. or by any indi ­ its planning and implemen­ brought together women Health Prize since the awards vidual institution or non­ tation. as well as in the evalu ­ from different professions - began five years ago came governmental organization ation of the activity's impact doctors. teachers. journalists together in Tokyo in June for concerned with health edu ­ on the health of the people - to discuss the problems a ceremony as guests of 90- cation. However. the United concerned. related to tobacco and how year-old Ryoich i Sasakawa Nations family of organiza­ A jury of international to deal with them. The role A wealthy Japanese tions and members of their experts in the field of health that can be played by women industrialist and benefactor. staff are not eligible for nomi­ education will select the reci ­ as models within the family Mr Sasakawa initiated the nation. pient of the award and as educators was parti­ awards. within the frame ­ Nominations must include Nominations for the 1989 cularly emphasised. together work of the Sasakawa the following information award must reach WHO with the importance of Memorial Health Foundation. 1. name and address of the before 30 September 1 989 women's magazines. through to reward outstanding inno­ person(s) or institu­ and be addressed to their cigarette advertising or vative work in public health tion(s). Division of Health Edu­ positively by the information and to encourage the further 2. brief summary of the pri­ cation and Health Pro ­ they give their readers on the development of that work. mary health care project in motion. World Health dangers of smoking - some­ Each year. the which the health educa­ Organization. 1211 Gen­ times the two in tandem . US $100.000 prize is given ­ tion activity is integrated. eva. 27 Switzerland. • As is now the custom. Or sometimes shared by more Hiroshi Nakajima. the than one recipient - to a per­ Director-General of WHO, son. an institution or a non­ awarded medals to some of governmental organization the public figures and institu­ judged to have achieved not­ tions which have played a able advances in the health prominent role in the cam­ field. particularly within the paign against smoking and strategy for achieving WHO's have "defended the WHO goal of Health for all by the ideal of a tobacco-free year 2000 through primary society". Other medals - health care about 40 in all - were In a keynote address at the awarded simultaneously at fifth anniversary ceremony in other WHO offices around the Tokyo, Dr Hiroshi Nakajima. world. The recipients from Director-General of the outside the health sector of World Health Organization. medals for "acts deserving said: "There are very few international recognition" rewards for the efforts and ~ include sportsmen (Pele. the dedication of people working s Brazilian football star). air­ in public health. The Sasa­ E lines. journalists and enter­ kawa Health Prize provides if tainment stars (Michael Falk. both incentive and recog­ -=---==--~-:-:-:~----:-~~------the Danish rock musician, nition." The Soviet Minister of Health presents Or Nakajima with a set of surgical and the American actress. The ten prize winners. who instruments made from recycled titanium Brooke Shields). Awards also each received the award

30 WORLD HEALTH, July 1989 during the annual World Health Assemblies held in Geneva. are as follows: Nevvsbriefs 1985: Or Jesus C. Azurin. a former Minister of Health of the Philippinnes. * Or David Bersh Escobar. Nursing development. The College of Nursing of the Director of Health for the Universitv of the Philippines has just been designated as a Coffee-workers' Com­ WHO Collaborating Centre for Nursing Development in Pri­ mittee in Colombia marv Health Care. At the inauguration of this new centre. Or Sewa-Rural. a voluntary Sang Tae Han. WHO Regional Director for the Western Pacific. organization in Gujarat pointed out that the global network of collaborating centres State. India. for nursing development was still verv new. its first general 1986: Or Pietro Corti and Or meeting having been held in 7988 in Maribor. Yugoslavia Lucille Teasdale Corti. who The second general meeting is scheduled for August in have worked for two Copenhagen. decades at Lacor Hospital in Uganda Distinction for Dr Nakajima. At a WHO forum on Or Amorn Nondasuta. a "Oualitv of life in the elderlv" held recentlv in Kvoto. Japan. former Permanent Secre­ Or Hiroshi Nakajima. Director-General of WHO. was presented If you would like to tary for Public Health in with the "Fourth International Award for Research on Adult obtain the catalogue Thailand. Diseases ... Established in 7985 bv Or Kozo Okamoto. Pro ­ of WHO publications, The Ayadaw Township fessor Emeritus of Kvoto Universitv and Member of the Japan Committee. which has Academv. this award has been given to Or Nakajima for his or receive sample promoted and developed contribution to the prevention of cardiovascular diseases. The copies of other WHO health activities among a three previous recipients of the award were Or Bjorn Folkow. periodicals which you wide network of villages in Or Michael Brody and Or Waiter Lovenberg. Burma. want to evaluate be­ 1987: Sister Marie Joan Appointment. Mrs lngar Bruggemann has been fore placing a sub­ Winch. Coordinator of appointed Director of the WHO Liaison Office with the United scription, please con­ Health Education Pro­ Nations. New York. She succeeds Or Gururaj Mutalik. who tact: World Health grammes in the Aboriginal retired from the Organization on 37 Mav 7989 after 72 vears Medical Services of of service. Organization, Dis­ Western Australia. tribution and Sales, 1988: The Indonesian 1211 Geneva 27, Family Welfare Movement. * Alcohol abuse. The a community-based Swiss Institute for the Pre ­ Switzerland volunteer organization set vention of Alcoholism. in up in 1967 in Central Java. Lausanne. has just launched Dr Christian Aurenche. a a series of amusing cartoons BACK COVER French physician working in which a wise ostrich in Northern Cameroon. delivers a number of mes­ Nurses in training in Ubyan 1989: Or N iu Dongping. sages against alcohol abuse. Amb Jamahiriya. The effectiveness of this tvpe Director of the Yuncheng Photo WHO/J. Mohr Stomatological Hospital in of communication has been Shanxi Province. China. • broadlv confirmed in manv countries of the world. • WORLD HEALTH Votre foie vous remerciera for readers everywhere si un jour par semaine, Since the start of 1989. two-year WHO Education vous ne buvez pas! ~~~~~ and three-year subscriptions are no longer being offered. Readers for Health Prize are invited to take out one-year subscriptions at the -rates given Nuclear rockets Above: Never on a Mon­ below. day! says the wily bird. USS D Sw.fr. D turned into medical He adds: "Your liver will One year 20.- 25.- instruments thank you if one day of WHO also offers its "Health Hori ­ At the Forty-second World zons" combined subscriptions to the week you don't drink both World Health (ten issues per Health Assembly which was alcohol." year) and the quarterly World held in Geneva in May. Pro ­ Right: Under the heading Health Forum. fessor Evgenyi Chazov. the "Keep straight on the The annual price will be: USS 0 Sw.fr. D Soviet Union's Minister of road," the ostrich tells 52.- 65.- Health. announced that his the habitual drinker: "No government intended to 0RDER FORM thanks. I'm driving!" Please enter my one-year double the health budget as subscription to from 1991. thanks to the Non merci, je conduis! ~~)'>~"'-' World Health savings resulting from 0 reduced military spending. To Health Horizons 0 illustrate his point. he pre­ I enclose cheque/international sented Dr Hiroshi Nakajima. In the next issue postal order in the amount of: Director-General of WHO. "lnformatics." the new science of computer-borne with a set of surgical instru­ information. has infiltrated all aspects of modern living to ments manufactured with a remarkable degree. The health sector cannot ignore Name: titanium recovered from one these new developments: on the contrary. it should Street ...... of the Soviet nuclear rockets exploit the possibilities that informatics can open up. This that were recently destroyed. is the theme that underlies the August-September issue of City: ...... ,. as a symbol. he said. "of the World Health. victory of life over death " • Country: ...... World Health. WHO. Avenue Appia. WORLD HEALTH, July 1989 1211 Geneva 27. Switzerland