The Peace Corps and a modern school of medicine have a lot in common.
They both grew out of an idea. By the end of the 19th Century the idea of modern medical education was in the air. Johns Hopkins University first started to put it into practice. In the early 20th Century the problem and prospects were presented in a national report--by Dr. Abraham Flexner. And the spread of modern medical education followed. From the day that first modern medical school was established over 70 years ago to the day Yeshiva University founded the Albert Einstein School of Medicine in the mid-twentieth century, we have seen the power of an idea whose time had come.
The Peace Corps came into being in much the same way. It was a response to real needs. The idea of this kind of overseas service was in the air in the 1950’s. In 1960, Senator Humphrey and Senator Kennedy and some other members of Congress offered bills proposing it. There was a report recommending it. In 1960, President Kennedy established it.
What was an experiment is now a going concern. It has met its first tests. In three years, over 110,000 Americans have applied to join it, more doing so each year. Over 13,000 Americans have served in it -- more than 10,000 now are serving in it overseas in 46 countries. Practically every country has asked for more Volunteers with two dozen countries on the “waiting list.” President Johnson has now asked that the Peace Corps be doubled, from 10,000 Volunteers a year to 20,000 Volunteers.
But it is not by the number of Volunteers that the Peace Corps is measured. It is by the -quality of those Volunteers, by the work they do, by the ideas they carry out. And in this there is no field of action more important for the Peace Corps than the field of medicine.
When I first visited Africa and Asia in 1961 to discuss the idea of the Peace Corps with interested heads of state, I found that the first requests were for doctors and nurses. Along with that they requested teachers. Those have continued to be the two primary requests. We have sent thousands of teachers overseas but so far, we have been able to send only a handful of doctors and about a hundred nurses--and yet the requests for medical personnel have continued to come in, with great urgency.
Some economists scoff-at the idea of giving priority to medicine in an underdeveloped country. Or at least they would limit medical attention to programs that directly increase the productive capacity of the country; for example, a program to eradicate malaria. Curative medicine, so that theory goes, is a luxury in a poverty--stricken country.
But the Peace Corps has not accepted that view. We are engaged in anti-malaria programs in several countries, and we do give great emphasis to preventative medicine and public health education. But we have sent doctors and nurses into provincial hospitals and rural health clinics in Ethiopia and. Togo and Sierra Leone and Malaysia, to treat patients, to staff curative medical centers.
We have done so because we take the doctor’s view, not the economist’s view: we believe that every man alive, every woman and child alive, has a right to the best medical care available. We have done so because we believe in individual human dignity.
We believe that this idea of human dignity--if recognized and made the organizing principle of a society--can release creative forces in a society, can actually increase the productive capacity of a country. America is an example of a country dedicated to this idea of the inalienable right of all men to life, liberty, and the pursuit of happiness. Hasn’t a great part of our productive energy come from this idea of the rights of all men?
The Peace Corps itself is an embodiment of this idea. The “volunteering” principle is one way it can be applied. Another powerful way of demonstrating a genuine concern for each individual is through modern medical care. The medical profession and the Peace Corps have this aim in common, too. So we should welcome the desire by the developing nations to provide modern medical care for all their people. And we should do everything in our power to help them make a reality of this.
But these countries are up against some hard facts that call for some new ideas. We know how difficult the challenge is at home to educate health personnel in sufficient numbers to deliver health services to a growing society. The challenge overseas is far greater. In the United States, we have 23 physicians for every 10,000 people. In the rest of the world there is one for every 10,000. In Afghanistan, there is one physician for every 52,000 people. In Ethiopia, it is one for every 170,000 people. And even these figures do not give the real story. Most of these physicians are concentrated in the great cities. In vast areas where I have been, areas as large as all New England, there will be one physician for one million people or more.
It is obvious that just sending physicians from America or the West to the developing nations will not close the gap. There are just not enough doctors to go around. If modern medicine is to be brought to most of the world’s people there will have to be an original and imaginative approach that will enable the job to be done with a thin line of trained medical personnel.
We need a new idea and a new program. After three years of trial and error, we believe we are ready to move ahead in providing part of the answer.
The answer lies in universal health education, with effective medical programs, medical centers, and medical personnel serving as the central source for this public education. Just as the Peace Corps has sent thousands of teachers overseas to help developing nations achieve universal school education, so now we must help them make universal health education a reality.
For this, the health problems of the particular nations must be carefully identified and effective programs for national action must be planned. These programs must be designed to involve relatively few highly-trained medical personnel. But they must engage a great number of others throughout the country.
Such programs are possible. The Peace Corps is already participating in some. In Thailand, malaria is being eliminated. With technical assistance from the World Health Organization and the U. S. Agency for International Development, the Government of Thailand has undertaken a comprehensive plan to wipe malaria from the face of the land. Peace Corps Volunteers are participating in a DDT-spraying program. A Peace Corps physician is serving as technical adviser to the Volunteers, most of whom are liberal arts graduates with a major in the natural or social sciences. They have been trained in an accelerated training program not as malariologists, but as working technicians and organizers of the work. They give impetus to and leadership to a much larger number of untrained Thailand personnel.
We are doing much the same thing in Malawi against another enemy: tuberculosis. A plan to control, treat and prevent tuberculosis in the new African nation of Malawi, the former Nyasaland, is now under way. The University of North Carolina is now training a group of Peace Corps Volunteers who will work in the nation-wide anti-tuberculosis campaign. A Peace Corps physician, working under contract with the University of North Carolina School of Public Health, will administer the work of some 40 Volunteers, most of whom will be liberal arts graduates with only brief public health training. They will work with-hundreds of Malawi health workers and thousands of Malawi citizens.
In Ethiopia, we are approaching the same problem from another direction. We have supplied Volunteer physicians, nurses, lab and X-ray technicians, and pharmacists to two new provincial medical centers. In addition to providing the only modern medical care in areas of several million people, these hospitals are developing into teaching and training centers for Ethiopian nurses and hospital technicians. And, in addition to the hospitals, there is a public health education program spreading to the other towns, and we hope, ultimately to the countryside throughout these provinces. For this work, the Peace Corps has sent in teams of community health workers. These include a few trained health educators but consist largely of liberal arts graduates. These Volunteers are working with Ethiopians to help the communities identify their health problems and to help organize action. The action may include mass testing or inoculations, or health education in the school classrooms, or sanitation enforcement in the streets.
Through programs such as these, we have found a way that the high skills and training of medical personnel may be multiplied by the action of many others. We do this in the Peace Corps through health teams with liberal arts graduates under the supervision of physicians, nurses, or health educators. And this multiplier principle works in the developing countries as large numbers of untrained citizens carry out health programs under the direction of the scarce medical personnel.
Let me make it clear that the Peace Corps needs and can use as many trained medical personnel of all kinds as possible. But, faced with the shortage of such people, we can break through this problem, by using the liberal arts graduates, giving them accelerated technical training, and putting them to work under trained medical leadership. For this, however, we need that leadership--we need hundreds of doctors and nurses and skilled technicians.
With your leadership, we can expand our health work to a much larger and more effective scale. We are therefore launching a new Peace Corps health program to involve hundreds of physicians and thousands of other volunteers. We hope to see at least 5,000 Volunteers engaged in health work.
Here is how we expect to do this.
This last year, during this period of experiment, we have had nearly 100 physicians serving with the Peace Corps, either as Volunteers or as staff physicians through assignment from the United States Public Health Service.
We must double that number next Year. And we need to go on from there to at least 500 Peace Corps doctors. With 500 doctors we can put 5,000 other Volunteers to work effectively overseas.
The multiplier effect will go far beyond this. These programs will involve hundreds of thousands and ultimately millions of citizens-of the developing nations.
You have known for 20 years or more that hundreds or thousands of doctors are needed overseas. So you may well ask: What is different about this new Peace Corps health program? And what are the terms of service that would make the enlistment of doctors possible?
We believe that the scope and effectiveness and potentiality for mass health education of these Peace Corps programs go beyond the noble individual experiments that proceeded them. Most of the Peace Corps doctors who have served so far say that it has been the greatest human and medical experience of their lives.
For the doctors who choose this service in overseas medicine there are great rewards. They see diseases in one day that it might take a month or a year to see or they might never be able to see in the United States. They experience a period of intense general practice--dealing with the whole man, in fact with the whole medical problem of a whole province or country.
We realize, of course, that most young doctors have accumulated necessary debts and often are married and have children by the time they finish their internship. Also unlike other male Peace Corps Volunteers doctors are more likely to be drafted even after age 26 and even after marriage and children.
With these special conditions in mind we are taking action to make it possible for doctors -- young or old -- to serve in the Peace Corps.
First of all, the members of the Peace Corps National Advisory Council are considering the establishment of a new foundation to help Volunteer doctors carry during their Peace Corps service the educational and other debts incurred in their long medical training. They should take such action at their January meeting.
Second, the Peace Corps has a special authority to enroll as Peace Corps Volunteer Leaders the doctors who will give leadership to Peace Corps medical teams. Peace Corps Volunteer Leaders may take their families with them overseas. We would hope that the wife of a Peace Corps doctor could serve as a Peace Corps Volunteer nurse or teacher or technician or general health worker. But in any case we would be able to provide travel expenses, living allowances and health care for her and any children.
Finally, we have proposed to the United States Public Health Service that it permit its commissioned officers to serve overseas as Peace Corps Volunteer physicians -- that, in fact, doctors be recruited and commissioned in the Public Health Service for this purpose. As you know two years service in the commissioned ranks of the United States Public Health Service fulfills the Selective Service obligation.
We hope that a large number of doctors will volunteer for Peace Corps Service through the Public Health Service. They would be commissioned as reserve health service officers. But, while serving as Volunteer Peace Corps physicians, they would voluntarily forego their salary and special benefits and receive the regular allowances of Peace Corps Volunteers or Volunteer leaders.
Let me here pay tribute to the Public Health Service and its little told but essential role in the Peace Corps.
From the beginning, the Public Health Service has been responsible for selecting healthy Volunteers and for maintaining their health in every Peace Corps country. The Public Health Service has provided Peace Corps staff physicians to carry out this task. At present, there are some 70 such Public Health Service-Peace Corps doctors stationed in 46 countries. They have done an outstanding job. Besides responsibility for the Volunteers health, most have engaged in their own medical projects in the host country. A Peace Corps surgeon operates twice a week in Ethiopia; a pediatrician attends a children’s clinic in Ankara, Turkey; an obstetrician supervises Peace Corps nursing midwives in Afghanistan. Many of them have participated in planning the medical projects we are already undertaking. As we move into health programs on a much larger scale, they will play a key role in planning and in project leadership.
As the Peace Corps expands, we will continue to need central staff physicians in each country. But we will need an even larger number of Peace Corps doctors serving in volunteer medical projects in outlying areas--serving as volunteer leaders on the terms I just described.
You can help us develop and carry out this program -- and in doing so you can help the free nations of the world develop themselves. We are not just asking you to do something for yourselves. This is something you can do for your country.
Look Magazine reports this week that the Chinese Communists are told by their Red Chinese bosses, before they go on missions to Africa, that the Peace Corps is Red China’s greatest headache in Africa. Give us 500 doctors--let us carry through this new Peace Corps medical program for 5,000 volunteers--let us carry modern medicine and public health to millions of Africans and Asians. Let universal health education become a reality--and the Chinese Communists will have more than a headache. We do this not to make the Communists sick but to make the world’s people well. Give us a healthy world--in the full sense--and Communism will finally disappear from the earth in every sense.
