University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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Medical Care For All Walter Faggett We as new physicians are inheriting the privilege and prob- lems of providing the highest quality of care to all patients. lt is imperative that our role in this capacity be clearly defined and enhanced by an awareness of the medical and social needs of the present day society. We have received the finest technological and scientific medical preparation in the world and must, from this point on, determine how we can best apply our 'knowledge and training in meeting the challenge of the health crisis so im- minent at this time. As leaders of the health team as well as of the community. the physician is in a uniquely strategic position to mold and con- ceptualize improved methods and organization of health care delivery. He is free to determine his own level of commitment in seeking solutions to this growing problem, whether in his own practice, local medical organization or in community work. There is a need for professional guidance and commitment in assuring that the practice of medicine within the physicians sphere of activity is as efficient and competent as his training and ability can provide. The traditions of medicine are very well entrenched and are resistant to criticism and re-evaluation. The Hippocratic oath was written to provide guidelines for the practice of medicine as it was known during Hippocrates' time. Revised abortion laws and rapid advances in medicine such as organ transplanta- tion and artificial biochemical synthesis of life itself force us to re-consider our interpretation and application of this sacred document. Indeed the exclusion of the physician's social obliga- tion to the patient community in this basic document of medi- cal practice, emphasizes yet another inadequacy therein. It is very apparent what the critical nature of today's health problems demands. That imaginative new philosophies and programs must be undertaken to assure use of modern concepts in the practice of medicine. Dr. Marion Folsom, speaking at the White House Confer- ence of Health, stated that health is a basic human right and that comprehensive, continuous and personal care should be available to all. ln this abundant society, he noted, we have the resources, capacity and obligation to do this. The costs of health care today have skyrocketed to three hun- dred percent more than the rates of ten years ago. Now most Americans are a disadvantaged majority with Medicaid and Medicare offering better protection to the indigent than the coverage required by the general public. Some method of co-operation between private and public in- surance plans must be sought to provide better health protection for all people. Increased protection will result in increased demands for medical care with further straining of the already inadequate medical care system. A very real health crisis is developing. The 180,000 physicians in private practice handled 844 million visits in 1964, and the patient load is increasing. Better utilization of paramedical personnel and more efficient delivery of health care must be effected if we are to provide high quality health care for all people. This is our challenge and we accept it with serious concern. Besides clamoring for care for more people, the public is demanding improvements in the quality of medical care. Succesjul or not, heart transplantation and other advances have whetted the desires of people fir cures and better care, desires the medical prrjession must work bard to satijy. For example, South Africa's Christiaan Barnard whose feat is more notable for its courageousness and impetuosity than technical achieve- ment has fred this already awakening interest in and scrutiny of medicine, phenomena unknown a few decades ago. In a slightly dwerent vein the three pictures at the right show the progression of another problem, the parking problem, from a time thirty years ago when it was non-existent to what engineers deem-probably incorrectly-to be a solution to the confusion which 10 all medical students experience so painfully now. The connection between parking and the next essay is quite tenuous but like many well-worn memonics, it may prove benejicial due to the remoteness rj its reference, That connection lies in the following slogan: TROUBLE PARKING? SUPPORT PLANNED PARENTHOOD More to the point, one of man's greatest problems to- day is his inclination to multiphi. While not evident in !VIontana or the Upper Peninsula, the pressures of numbers are felt in urban areas and countries like India. Consider what Roger Grekin feels about the problem below and then turn to pages 15 6f1 59 for an insight into the opinions of several other Senior medical students.

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Medical Needs Abroad john Lipson Externing in an isolated area of the United States or serving in a foreign country was probably the most exciting part of medi- cal school for twenty-four members ofthe senior class. Members of the class of 1968 went to places as close as Haiti, and in such diverse locations as London, Liberia, Nigeria, Ethio- pia, and Formosa. Each saw a different segment of the medical problems of the world and yet each came home with a better understanding of the medical needs. Most returned with a desire to someday return to the place where they had worked. The mo- tives for going ranged from the search for adventure and excite- ment, to humanitarian interest, to Christian Witness, yet all shared in expanding medical knowledge and understanding throughout the world. Liz and l spent four months in Liberia during the Hrst half of the senior year. We worked at the Ganta Methodist Mission Hospital which is a thirty-Hve bed bush hospital, but practices modern, western medicine. My wife taught in the school of nurs- ing and l worked in the clinics and surgery. The lasting memories we bring back are not of the specihc diseases and problems. Rather they are memories of the friendly people we encountered and their desire to advance their country into the modern world. And yet, in their desire to advance, they are utterly frustrated by lack of education and lack of a skilled working and middle class. To be considered literate in Liberia, a citizen must have a second grade education, yet less than 1405 of the population meet this requirement. Because of this, it is very difhcult for the people to be their own storekeepers, mechanics, bankers, teachers, nurses, and doctors. Those who are educated usually enter gov- ernment service or fill managerial positions for foreign-owned business. With this lack of education, it is not surprising that the medi- cal needs of the country are served primarily by foreigners. Church-sponsored medical missions were the first to provide medical assistance. More recently, other groups such as private industry and the Peace Corps have begun to provide medical care. For the developing countries to have their own medical school is a major problem. There are not enough physicians to staff a medical school or enough college graduates to make up a student body. Nursing education, however, is a rapidly expanding field. New schools are opening to train high school graduates to be reg- istered nurses and to teach nurses new diagnostic and therapeutic skills. The nurses, in many areas, are serving the function of physicians in tinding and treating disease. The changing medical emphasis has changed the type of for- eign medical assistance desired. The need for the foreign mission- ary doctor in the bush is rapidly decreasing. Rather, the develop- ing countries are in need ofthe specialist and the educator to help them create their own medical and nursing programs. They need American physicians as consultants, both in person, by letter and radio. The hope of the future for the emerging nations is the develop- ment of their educational facilities, so that each country may be able to train its own people to supply its own medical care. The class of 1968, through the bonds established during the foreign externships, may someday be leaders in the promotion of world health. 1 ..... . Young, bright citizens of many countries are gradually developing their own medical training programs. This male nursing student is learn- ing maternal and pediatric care through the Ganta School of Nursing. 9

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5i 'i 37' REBER T I gmrcrcftlf . iufrllrlrftflfll Hlllllllfifll mul!!! Hills :llI!ll!lIl1ll Hlllllll c mm., Ill lllll Population Problems Roger Grekin It appears that medical advances may be preventing modern- ization of under-developed nations. The New York physician treating malaria in Nairobi, and the Canadian Hghting cholera in Indonesia may be thwarting the progress and well being they are trying to bring to troubled and impoverished countries. The logic and simplicity of poverty and hunger in the under- developed world are starkly obvious. There are too many people or not enough food, and usually both. Most of the poorer coun- tries are trying desperately to accumulate some surplus from the land and convert it into economic improvement, but in general things are getting worse, not better. India's yearly increases in food production have not matched her population growth in this decade. An obvious first step is population planning, and many am- bitious programs are being attempted, but they do not seem to be working. Despite the efforts of a large group of talented men, the poor people of these countries are not being convinced of the need for fewer children. It is inhnitely easier to save an infant with tetracycline or IV fluids than it is to prevent his birth. Medical programs in Asia, Africa, and Latin America have been highly successful and infant mortality is lower and life expectancy is greatly increased. Without attempting to discuss the moral implications in- volved in saving or not saving life, it can be safely stated that chances of developing a poor country would be better with a high infant mortality rate and a short life expectancy. Fewer mouths to feed means more chance to build excess capital and savings. The path toward industrialization is fought with difficulty and the odds against development for many poor countries are long. If we are to make the odds even longer by saving lives that consume food, we must at least be aware of the implications of our actions, and weigh the future chances of development against the medical needs of today. ll