BOLETiN de la’
Oficina Sanitaria Panamericana
Año31. f Val. XXXII t Enero de 1952 9 No. 1
INTERNATIONAL HEALTH*
BY G. D. +V. CAMERON, M.D., D.P.H.
Deputy Minister of National Health of Canada
It is a great honour to be invited to address this combined meeting of the Directing Council of the Pan Ameritan Sanitary Organization and the District of Columbia Medical Society, and 1 wish to thank you most sincerely.
It is always a great pleasure and most rewarding experience for us of the Federal government service of Canada to visit Washington. We have many friends here, not only in the Pan Ameritan Sanitary Bureau, but also among Dr. Scheele’s staff of the Public Health Service. In fact, this relationship and the benefits which flow from it could easily be taken as the main theme in a discussion of international health be- cause it does exemplify how simple it is for health workers to get on with their jobs when there is mutual confidence and common purpose. But 1 know you wish me to tell you something of the wider field of international health. 1 will do my best; however, 1 must warn you that there are only a very few men in the whole world who have the compre- hensive grasp of the subject which would enable them to do it justice and 1 am not one of them.
It is most fitting that this meeting is under the joint auspices of a medical society and a health organization. This fact symbolizes the unity of purpose of the health profession. It may seem strange to some of you that this point is considered Worth mentioning. However there is a great tendency in our profession to splinter into the component specialties, often to the extent of forgetting that we belong to one group governed by the same ideals and dedicated to a common purpose. The health ofhcer will not attain his objective unless the practicing physician
* An address before a joint meeting of delegates to the V Meeting of the Direct- ing Council of the Pan Ameritan Sanitary Organization and the 22nd Scientific Assembly of the District of Columbia Medical Society, Washington, D. C., Octo- ber 2,195l.
2 BULLETIN OF THE PAN AMXRICAN SANITARY BUREAU
accepts his responsibiity to practice preventive medicine. And it is equally true that the practicing physician cannot perform the complex job which falls to the lot of the health officer.
It is this indisputable fact which has led to the very cordial relation- ship which exists between the World Medical Association and the World Health Organization. My friend, Dr. Clarence Routley, the General Secretary of the Canadian Medical Association, who did so much to bring the World Medical Association into being and who was their fir t Chairman of Council, put it concisely when he said that the WHO could not possibly accomplish its aims without the wholehearted support of the doctors of the world. 1 know that Dr. Brock Chisholm heartily agrees with this view and welcomes the collaboration of the W.M.A. Again may 1 say that the joint sponsorship of this meeting is significant and encouraging.
Discussion of international health at once calls to mind the great killer plagues which have afflicted mankind since the begirming of his- tory. Some of you have had recent experience with malaria and yellow fever and know what they can mean to thousands of people over im- mense territories. However, for most of us who have not had such flrst hand experience, it is easy to forget the significance of these dis- eases as understood by earlier generations. You will find a study of the late Hans Zinsser’s vivid book “Rats, Lite and History” helpful in this connection. There is one chapter on the relative unimportance of gen- erals which underlines the fact that disease can be a much more effec- tive killer than warfare and that epidemics have done as much to shape history as military campaigns.
Our ancestors understood these things better than we do because they had frequently renewed appreciation of what epidemics meant in terms of fear and misery and wholesale death. It is only natural, therefore, that the earliest beginnings of international health work centered around the idea of keeping diseases out of countries. It is an interesting fact that attempts to do something about it on an inter- national scale were begun at about the same time in Europe and in South America.
The Emperor Louis Napoleon convened a meeting in Paris in 1851
to discuss quarantine, but it took the opening of the Suez Canal in I 1892 to stimulate real action. In this case the driving forte was the fear
that direct commerce with the East would bring cholera to Mediter- ranean ports. The result, after much palavering, was the establishment in Paris of L’Office Internationale d’Hygiene Publique in 1907. The principal function of this Office was to keep the members informed re- garding infectious diseases-notably cholera, plague and yellow fever, and on measures to combat their spread.
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Junuury 195%‘] INTERNATIONAL HEALTH 3
Sanitary Organisation and Bureau. Many of you have played vital parts in that story and can take a just pride in the results.
Regional health conferences began in South America in 1873. They have been repeated at frequent intervals since then. Standardization of quarantine procedures and arrangements for reciprocal epidemic disease notification were the main topics of discussion. Again you will note that the central idea was to keep disease out of a country.
Quarantine is still sound for certain situations but we have gone be- yond that now-a-days. Just as the concept of preventive medicine has stirred the imagination of the medical profession and is gradually leading to the adoption of sound procedures for the avoidance of sickness, so in the field of international health there is well based hope that a number of the most destructive epidemic diseases can be obliterated or suppressed to the point where families need no longer live in dread of them.
This positive and aggressive approach is sound preventive medicine and sound common sense and will certainly appeal to al1 of you. If this were the whole tale of international health, it would be a good one, but there is more-a new concept has been added in recent years. It is now accepted as reasonable and proper for those sections of humanity who possess special health knowledge and skills and devices to share these possessions with their less fortunate fellow men. This is an immensely important new factor in international relations, pioneered it is true over many years by voluntary organizations but now vigorously sup- ported by governments through technical assistance programs and the like.
Doubtless some of you will hear attempts to rationalize all this along lines of expediency. This brand of cynicism is all too prevalent today. Fortunately, we who are here tonight belong to a profession which is not in the habit of apologizing for its ideals and aspirations. They are well known, they have stood the test of many centuries. Let us be thankful that in the slow evolution of our race we have arrived at the point where nations can band together and declare their intention of working together for the advancement of health.
It is a curious reilection on our intelligence that our famous World Wars 1 and II provided greater stimulus to rapid advancement in inter- national health work than any other events in modern times. Each brought in their wake frightful conditions of disease, misery and squalor, which forced us to do something about it, and in a hurry. Following the 1914-1918 War there were millions of deaths from typhus in Eastern Europe. Typhus is a disease of destitution, and has been associated throughout history with the general collapse of community Iife as a consequence of war. It ran freely through vast areas and called for heroic measures to deal with it. There was no DDT in those days.
4 BULLETIN OF THE PAN AMERICAN SANITARY BUREATJ
The League of Red Cross Societies was founded in 1920. But it was not until 1921 that the Assembly of the League of Nations set up a Pro- visional Health Organization. This became a Permanent Health Commit- tee in 1923.
The League’s Health Organization provided epidemiological informa- tion. It operated the Singapore Bureau and broadcast information on occurrences of epidemic disease by radio. This was all in the earlier and well established tradition. However, in addition they assisted in the exchange of health personnel between nations and helped governments to improve their health services.
Throughout the story of international health work, as is so common in other similar types of human endeavour, there runs the strong note of philanthropic effort. At one point in its career the Health Organ- ization of the League derived forty percent of its budget from the Rockefeller Foundation. In addition to dollars the Foundation gave a tremendous impetus and wise guidance to the work through its very remarkable corps of skilled experts.
The measure of the help received from this group and from institu- tions such as the London School of Hygiene and Tropical Medicine and the Pasteur Institute, to mention only two of many, will never be known. We can be certain of only one thing and that is that when the way for concerted action was prepared by governments, the people to do the work were at hand and got busy.
The health lessons of the first war were well learned and you know of the brilliant results of disease control in the Allied armies during the second war. The parallel protection of the health of the liberated civilian populations was equally dramatic though not so well known. You should get Dr. Soper to tell you about the control of typhus in Italy.
Even before the second world war had ended, UNRRA was brought into being to deal with the urgent human problems already clamouring for attention. The Health Division of UNRRA picked up and carried on the jobs which because of wartime conditions were beyond the re- stricted reach of the Health Section of the League and the International Office in Paris. The late Dr. G. H. de Paula Souza of Brazil was Chief of the Section of Epidemic Control. Aid of all kinds was given to coun- tries which had been overrun by the enemy or were in desperate cir- cumstances because of the war. This assistance extended around the world and many millions were spent on it. In addition, UNRRA looked after such technical jobs as negotiating new codes for international quarantine, including a code for aerial navigation.
Jamar y lQ52] INTERNATIONAL HEALTH 5
This is neither the time nor place to labour over the details of the gradual evolution of WHO in its present form. Sufficient to say that after five years of patient planning a truly remarkable agency has been set up with headquarters at Geneva and six regional offices. Support for this organization comes from all parts of the world with one excep- tion-Russia and her associates have withdrawn. For a whiIe they attended meetings and sent able people as their delegates. Their reason for withdrawal is as well known to you as it is to me.
The place of the Pan Ameritan Sanitary Organization in the present scheme of international health work is of particular interest to us here. It was originally contemplated by some that the PASO would be com- pletely integrated mto the WHO. Other opinion held that something more in the nature of a partnership would be best. It was only natural that the Pan Ameritan Group should not wish to relinquish the instru- ment which had served them so well for so long, at least until the newer body had proved its capacity to serve their needs equally well. The result has been an agreement by which the Pan Ameritan Sanitary Bureau functions as the Regional Office of the World Health Organiza- tion.
You will readily understand that a comprehensive examination of these organizations is much too great an undertaking for us to tackle here. It is proposed, therefore, to touch briefly on a few of their salient features chosen because they give us an insight into the true nature of these great enterprises.
To begin with, what about the men and women who are running inter- national health work? First of all they are technical people. The younger ones are recent products of our medical training centres and research institutions. They are people with a mission, otherwise, they would not tackle such work. They are capable and trustworthy, or their ex- perienced superiors would not turn them loose in areas and on jobs of great potential danger.
They are young men and women with a purpose and in a hurry. The older and more experienced members of the teams are about the wisest and most interesting and alive people you will ever meet. They appreciate from blunting experience the true significance of tradition, custom, superstition, inertia, poverty and al1 the other facts of life. They know that the ways of life and whole social structure of Iong es- tablished societies cannot be changed overnight. And above all they know that doctors and health technicians working alone cannot solve al1 health problems because many of them have an economic or edu- cational basis.
6 BULLETIN OF THE PAN AMERICAN BANITARY BUREAU
lost his tonsils and it al1 cost a good deal in doctors’ fees, but he still had the ringing noises in his head. One day he went to a shop to buy a shirt. He asked for a size Gfteen. His temper was pretty short, the ringing noises were pretty bad, and so when the clerk in the shop tried to argue hii into taking at least a size 16 or preferable 164, the sufferer became very emphatic, “1 always wear size 15; will you se11 me a size 15 or not?” the clerk gave in, “al1 right sir, if you insist on size 15 you may have it but don’t blame me if you have ringing noises in your head.”
Possibly one of the best ways to judge international health workers is by their policies and the way they go about their jobs. For example, they insist that encouragement of self help is essential for the sound development of any programme. They are no more eager than you are to carry the limp and unwilling.
This attitude has characterized international health work for many years. The great foundations have always taken the position that while they were glad to help start a school or health unit or research institute and give it a running push, they would not undertake to carry the project indefinitely. They assume that if a scheme is soundly conceived, it will be carried on through local resources.
This same policy is formally recognized by both the WHO, the PASO and other United Nations Agencies, such as the International Children’s Emergency Fund. They insist that to the greatest extent possible, the cost of a project shall be borne by the country or countries directly benefiting from the work. Needless to say projects are so designed that they can be fitted in as working parts of new programs.
As further evidente of a sound approach to this work, here is a quota- tion from a recent WHO document.
“Another point which ought to be stressed is the desirabity for many coun- tries to use, more widely than they have done in the past, certain well-known, tried and proven techniques for preventing or controlling diiease. The efforts of the less-developed countries to catch up as quickly as possible with the skillz and techniques recently evolved by modern science are entirely understandable, and service rendered to this end is one of the proper functions of WHO. Never- theless, the question should be raised as to whether some administrations, in their zeal for using the most modern methods, are really doing everything possible to utilize techniques which have proved themselves in the past. Some of these techniques, often inexpensive, are the ones which have led to the ad- vancement of the more highly developed countries.”
There is, indeed, plenty of evidente that the men and women who direct international health work are possessed of the hard headed realism so essential for success in their work.
Junumy 19&2] IINTERNATIONAL HEALTH 7
forget that many of the devices iu common use in our communities, such as the provision of safe water and milk and the proper disposal of sewage, have contributed enormously to our present standard of living. We know that these procedures will save lives, especially infant lives. If we were to go no further, therefore, than to assist many parts of the world in raising their standards of ordinary sanitation, a tremendous amount couId be accomplished fór the improvement of health.
But we can go much further. Consider what has been achieved by the use of smallpox vaccine, of diphtheria toxoid, and through our anti- tuberculosis campaigns, and so on. There is in fact a great deal that can be done by wise experts capable of adjusting programmes to the state of development of the areas being assisted.
Some of the most dramatic successes in disease control have related to those transmitted by an intermediary vector, commonly the mosquito, or louse or flea. Malaria, typhus and plague are in this class.
To take an example: in 1929 or 1930 Anopheles ganzbiae mosquitoes crossed the South Atlantic from Africa to the North Eastern Coast of Brazil. The tiny invaders made themselves at home, increased their numbers, and prepared for an all out attack in the form of a malaria epidemic which was launched in 1937-38. They were so successful in spreading malaria that they almost wiped out the population in North Eastern Brazil. No one could know how far they might spread the dis- ease. Thousands died and many more thousands were reduced to such a state of misery that the whole economy of the area fell apart.
Fortunately, the brilhant success of the campaign in Brasil to eradi- cate the Aecles aegypti mosquito which transmits yellow fever encouraged the health authorities to launch a programme with the declared objec- tive of wiping out the gambiae invader.
Dr. Fred Soper and Dr. Bruce Wilson (the Iatter incidentally 1 am proud to claim as a Canadian) of the International Health Division of the Rockefeller Foundation collaborated with the Brazilian Health authorities and played a leading part in the campaign. In their report entitled “Anopheles gambiae in Brazil, 1930 to 1940,” there appears this paragraph in the introduction:
“The present report will attempt to summa rize the most important points in the history of gambiae in Brazil and to describe the organization of the con- trol measures in 1939 which resulted in its eradication in less than two years. It is to be hoped that this one of the most interesting chapters in the medical history of this century will not have to be rewritten.”
8 RULLETIN OF THE PAN AMERICAN SANITARY BUREAU
The introduction of DDT has revolutionized our attitude toward the vector transmitted diseases. Referente has been made to the control of typhus in the civilian population of Italy behind the advancing allied armies. In Greece, a new outlook on liie has been made possible for thousands through the use of this insecticide. There is no shadow of doubt that well-planned and meticulously carried out programmes of insect eradication can change the whole future of large areas of the world through the suppression or possibly complete eradication of some of the worst killers known to man.
Although much has been accomplished and great things are possible, nevertheless, we know from past experience that new methods or im- proved methods will certainly be discovered if the way is prepared for our scientists to tackle the jobs, which brings us to the subject of or- ganization for this work.
One simple way to explain the function of international health or- ganizations and their relationship to their member governments is to point to arrangements for health work in a federal state. The analogy is not exact, of course, but close enough to be helpful.
In my country there is common agreement that primary responsibility for the general health care of our citizens rests with the governments of our ten provinces. They also regulate the practice of medicine. Specific exceptions to this general rule are maritime quarantine, the care of Indians and Esquimos and so on which are the responsibility of the Federal government.
While our central government recognizes this very broad provincial responsibility, it takes the view that it has a concern to see that a high leve1 of health work is possible in al1 sections of the country and supports the provincial departments of health to this end. This support takes the form of technical assistance and specific grants in aid. At present my Department administers grants to the provincial departments of health amounting to about thirty-five million dollars a year.
As you doubtless know a somewhat similar program is in effect in the United States based on the same concept of federal aid to state departments of health.
The technical assistance part of our Canadian program is essentially a consultative service. We take ful1 advantage of the federal system which makes possible the exercise of initiative by our Provincial Departments. We convene frequent meetings of health administrators or technical experts from the provinces and in this way learn from each other’s experience, and whenever necessary reach agreement on common stand- ards or procedures.
Janúury 1&%?] INTERNATIONAL HEALTH 9
is carried on partly through its own staff and partly through a network of collaborating laboratories. A good start has been made on an inter- national pharmacopoeia. One of the most recent of these enterprises is the establishment of an international list for the reportmg of mor- bidity and mortality.
Strong emphasis is placed on fellowships and other means of training to strengthen local schemes.
Also the WHO has been recognized from the outset as the health expert consultant to the United Nations and associated agencies such as the ILO, FAO and UNICEF. As events have developed this function has assumed very large proportions and makes heavy demands on the staff.
So much for the technical coordination side of international health work. It is hoped that this necessarily brief glance at the task will convince you that there are jobs to do which can be done only by a competent organization enjoying world-wide recognition and support.
Turning now to the financia1 assistance side of the program, we find a situation which does not fit into our analogy in al1 respects. In place of the WHO and the PASO making grants to their members in a manner comparable to the system of grants from the Federal Government of Canada to the ten Provinces, we find that the international health or- ganizations are called upon to act as the technical consultants whose job is Iargely to counsel regarding training and orientation of programs hnanced by funds contributed by the Member Governments through various technical assistance schemes.
There is no need here to attempt to describe the intricate pattern of international economic aid which has grown up in recent years. You have al1 heard of the United States Point Four Program and the Colombo Plan and other such schemes. It is sufficient to say that from these sources there are now available many millions of dollars every year for inter- national health work.
When the WHO carne formally into being in 1948, it had a budget of five million dollars which was allocated to admiitration costs and programe, including materials and supplies. In contrast to those. simple days consider the situation reflected in the following from the introduction to the proposed programme for WI30 in 1952.
10 BULLETIN OF THE PAN AMERICAN SANITARY BUREATJ
WHO’s own effective budget for 1952 amounts to about 7.6 million but it may well turn out that they will have to provide the technical guidance and see to the overa11 coordination of a programme more in the order of twenty million dollars, in 1952. The inevitable effect of this is that WHO must spend a larger share of its income on staff and ad- ministration.
In passing it should be mentioned that scarcity of trained people is the main bottle-neck in international health work just as it is in many of our countries. Unless the WHO and PASO can develop new training centres abroad, which they are of course endeavouring to do, this deficit will have to be met from our present inadequate numbers of new trainees. It is perfectly evident that a greatly intensified effort is being made to raise the general leve1 of health throughout the world, but surely it is equally evident that a movement of this magnitude and complexity calls for the very best we can produce in the way of sound, hard-headed, realistic organizations. Coordination becomes a serious reality where you are dealing with a situation such as has been mentioned, that is to say, where very large sums are being contributed to the work by different agencies. Those who have spent their liie in health work know that small sums of money can be made to do a great deal for health if sensibly used. It is equally true that vast amounts of money can be wasted by the inexperienced be they ever so well-meaning, especially if they have not had the actual subduing experience of producing real results in the health field.
In conclusion, the present situation in international health work as 1 see it is this. Experienced men and women of great skill and judgment are available to propose schemes and direct the work. There is ample evidente that a great deal can be accomplished in raising the general leve1 of health throughout many parts of the world. Tried and trusted organizations have been set up for this purpose. Governments are demon- strating their willingness to provide the funds. If co01 heads prevail and the accumulated wisdom of our health workers is properly utilized, there is not a shadow of a doubt but that great strides will be made in the field of international health.
Let me remind you again that we are members of the health profes- sion. It is not for us to rationalize these high endeavours on any other basis than that provided by our Hippocratic oath and the pledge which has been adopted by the World Medical Association for the initiation of new doctors, a part of which reads as follows:
“1 will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.”
Enero 195%‘] SANIDAD INTERNACIONAL 11
SANIDAD INTERNACIONAL (Swcwfo)
El A. señala las ventajas de celebrar la reunión bajo los auspicios conjuntos de una sociedad médica y una organización de salud, lo que simboliza la unidad de propósitos de la profesión sanitaria, punto de gran importancia si se tiene en cuenta que ni el funcionario de sanidad obtendrá su propósito si el médico no acepta la responsabilidad que le corresponde en la medicina preventiva, ni el m6dico podrá realizar la compleja labor que corresponde al funcionario sanitario, hecho este que ha conducido a las cordiales relaciones existentes entre la Asocia- ción MBdica Mundial y la Organización Mundial de la Salud.
Relata la importancia de las epidemias que han azotado a la humanidad desde el comienzo de la historia y señala el interesante hecho de que las labores iniciales de lucha en escala internacional, comenzaron casi al mismo tiempo en Europa y Sud América. En el año 1851 se celebró una reunión en Parfs para tratar de cuarentenas, pero fueron las obras del Canal de Suez, en 1892, las que activaron este asunto, ante el temor de que el comercio directo con el Este propagara el c6lera a los puertos del Mediterráneo, como resultado de todo lo cual se fundó en Paris, en 1907, L’Office Internationale d’Hygiene Publique, cuya función principal era mantener informados a sus miembros sobre las en- fermedades transmisibles, especialmente el c6lera, la peste y la fiebre amarilla, y las medidas para combatirlas.
En Sud América las conferencias regionaIes sanitarias comenzaron en el año 1853, repitiéndose a intervalos frecuentes, estandardizando medidas de cuaren- tena y notificación recíproca de enfermedades.
Hace resaltar el dato curioso de que las Guerras Mundiales 1 y II constitu- yeran el mayor estfmulo en el rápido adelanto de la labor sanitaria internacional Después de la Guerra de 1914-1918, ocurrieron en Europa millones de muertes por tifo, enfermedad de miseria, asociada a trav& de toda la historia con el fracaso de la vida en colectividad, como consecuencia de la guerra.
La Oficina Internacional de Paris no estaba preparada para hacer frente a ese probIema. Se celebraron conferencias; se envi una Comisión del Tifo a los Bal- kanes. En 1920 se fundó la Liga de Sociedades de la Cruz Roja, y en el año 1921 la Asamblea de la Liga de Naciones fundó una Organización Sanitaria Provi- sional, que en 1923 se convirtió en Comisión Permanente de Sanidad.
En cierto momento, la Organización Sanitaria de la Liga derivaba el 40% de su Presupuesto, de la Fundación Rockefeller, cuyo notabilfsimo cuerpo de ex- pertos imprimió sabia direcci6n a las labores de la Organización. Jamas se cono- cerá la inmensa ayuda prestada por ese grupo e instituciones como la Escuela de Higiene y Medicina Tropical de Londres y el Instituto Pasteur, para mencionar ~610 dos de ellas.
Antes de que terminara la Guerra Mundial II fu6 fundada la UNRRA, cuya División de Sanidad se encarg de las labores que debido a las condiciones de guerra trasponfan el reducido radio de la Sección de Sanidad de la Liga y de la Oficina Internacional de Paris. Se acordaron nuevos códigos de cuarentena in- ternacional, inclusive un código de navegación aérea, pero todo esto eran medi- das provisionales. Se convino celebrar una conferencia internacional en Nueva York en 1946 con el fin de fundar una Organización Mundial de la Salud como organismo independiente sostenido con fondos suscritos por los gobiernos miem- bros.
12 BOLETfN DE LA OFICINA SANI!FARIA PANAMERICANA
cias había prestado durante tantos años. Se lleg6 a un acuerdo por el cual la Oficina Sanitaria Panamericana funciona como oficina regional de la Organiza- ción Mundial de la Salud.
Manifiesta que la polftica de las grandes Fundaciones, al igual que la de la OMS, la Organizaci6n Sanitaria Panamericana y otros organismos de las Na- ciones Unidas, como el Fondo Internacional de Ekuergencia para los Niños, es la de ayudar en la realización de ciertos programas, que una vez en marcha deben proseguir con recursos locales.
Recuerda cuánto han contribuido a mejorar el nivel de vida el agua y la leche puras, la adecuada disposición de basuras y lo que se ha conseguido me- diante el empleo de la vacuna antivariólica, el toxoide de la difteria y las cam- pañas antituberculosas. Que en 1929 o 1930 el Anofeles gambiae cruz6 por el Atlantico Sur desde Africa a la costa Nordeste del Brasil, exterminando casi la población de esa región, pero por fortuna el gran Éxito obtenido en la cam- paña en que los Dres. Soper y Wilson colaboraron con las autoridades brasileñas, para erradicar el Aedes aegypli animó a las autoridades sanitarias a emprender un programa de erradicación del gambiae, y menciona que la introducción del DDT ha revolucionado la actitud hacia las enfermedades transmitidas por vectores.
Hace referencia a que en Canadá la responsabilidad principal de los cuidados de sanidad en general corresponde al Gobierno de las diez provincias, que tam- bién reglamentan la práctica de la medicina, con excepción de la cuarentena marftima, el cuidado de los indios y de los esquimales, etc., cuya responsabilidad corresponde al Gobierno Federal. Dice que en la actualidad el Departamento a su cargo administra subvenciones a los departamentos provinciales de sanidad por valor de unos 35 millones de dólares anuales, y que en los Estados Unidos se lleva a cabo un programa semejante basado en el mismo concepto de ayuda federal a los departamentos estatales de sanidad. La parte de asistencia técnica del programa canadiense es especialmente un servicio consultivo.
La OMS ha sido reconocida desde sus comienzos como el consultor experto en sanidad, de las Naciones Unidas y los organismos asociados, tales como ILO, FAO y UNICEF.
Los que han dedicado su vida a las tareas de sanidad, saben que con pequeñas sumas de dinero, empleadas con juicio, pueden realizarse importantes obras, y que es igualmente cierto que pueden malgastarse grandes sumas si se carece de experiencia, sobre todo en el campo de la sanidad.
En conclusión, expone el A. que la situación actual en el campo de la sanidad internacional, a su modo de ver es que se cuenta con gran n6mero de hómbres y mujeres de gran inteligencia y buen juicio para proponer planes y dirigir traba- jos; que existen numerosas pruebas del gran progreso alcanzado por la sanidad en muchas partes del mundo. Que se han fundado organizaciones de gran ex- periencia y crédito y que los gobiernos demuestran su buena voluntad para suministrar fondos, de modo que procediendo con cordura y utilizando los conocimientos y habilidad adquiridos por los trabajadores de sanidad, no hay duda de que se avanzará notablemente en el campo de la sanidad internacional.
