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Journal of the National Medical Association. 1985 Dec; 77(12):963-5.The goal of "Health for All by the Year 2000," adopted by the World Health Organization, will be pure rhetoric if all sectors involved are not sensitized to the problem of famine in many countries in Africa and other 3rd world nations. The medical profession should be made aware of this goal, both on national and international fronts. The case of Ethiopia is discussed as a valid example of a "diseased third world," focusing on the famine, other medical problems, and the health system. The last emperor of Ethiopia, Haile Selassie, was swept away by the 1974 revolution. The major cause of his downfall was the 1973 famine, which the emperor wanted to conceal from the outside world. A military government took over, espousing Marxist ideology and aligning itself with the Soviet Union. Famine has been endemic for decades; the last famine in 1973 claimed over 300,000 lives. The country never totally recovered from the effects of that drought, and as early as 1981-82, major relife organizations were warned of another looming crisis. Some of the causes of the current crisis include the absence of rain for 3 consecutive years that paralyzed agriculture, poor and primitive farming practices, and deforestation. It is estimated that the land area covered by forest has dropped from 16 to 3.1% over the last 20 years. This has adversely affected the moisture-retentive capacity of the soil. Other man-made contributory factors are the civil war, the resulting dislocation of the population, and administrative mismanagement. 10 million people now face starvation; 300,000 have already died, and 1000 per day continue to die. The attention of the international community is justifiably focused on the immediate task of providing food. Yet, the full medical aspect of the famine and its consequences have not been adequately handled. Assuming that international aid will effectively prevent further loss of life, the survivors will face a host of health problems, epidemics in particular. Most of the feeding camps and various refugee centers are overcrowded; elementary sanitary facilities are lacking. There is a critical shortage of vaccines and other medical supplies. The vast majority of the Ethiopian population suffers from various preventable communicable diseases. The leading 10 causes of morbidity diagnosed in 1976 were venereal diseases, helminthiasis, bacillary and amebic dysentery, gastroenteritis, leprosy, malaria, tuberculosis, schistosomiasis, trachoma, and influenza. WHO reports that health expenditures represent only 5.7% of the total budget and that only 20% of the population are vaccinated against smallpox, yellow fever, DPT (diptheria, pertussis, tetanus), measles, tuberculosis, and polio.
Bulletin of the Pan American Health Organization. 1985; 19(3):307-14.The basis for the Pan America Health Organization/World Health Organization Expanded Program on Immunization (EPI) is provided by a resolution (WHA27.57) adopted by the World Health Assembly in May 1974. The program's longterm objectives include: to reduce morbidity and mortality from diphtheria, whooping cough, tetanus, measles, tuberculosis, and poliomyelitis by providing immunization services directed against those disease for every child in the world by 1990; to promote countries' self-reliance in the delivery of immunization services within the context of comprehensive health services; and to promote regional self-reliance in matters of vaccine production and quality control. The EPI, which requires a longterm commitment to continued immunization activities, is an essential element of PAHO/WHO's strategy to achieve health for all by the year 2000. Immunization coverage has been included among the indicators which will be used to monitor the success of that strategy at regional and global levels. As of April 1985, available country reports showed that immunization coverage in the Americas had improved considerably since the EPI was launched in 1977. In 1978, for example, only a very small proportion of the children under 1 year of age (less than 10%) outside the US and Canada lived in countr ies where 50% immunization coverage with the EPI vaccines had been attained for this age group. By 1984, over 55% of these children were living in countries where at least 50% infant coverage with DPT and measles vaccines had been attained, and over 80% were living in countries where at least 50% infant coverage with polio vaccine had been attained. Immunization coverage generally improved between 1980-84, especially in the 12 smaller countries of the subregion with populations of less than 130,000. In the period since EPI training activities were initiated in early 1979 through the end of 1984, it is estimated that at least 15,000 health workers attended EPI workshops. Over 12,000 EPI training modules were distributed in the Region. In 1983 and 1984, the Cold Chain Regional Focal Point held special training workshops on cold chain equipment maintenance and repair in Bolivia, Colombia, and Nicaragua; technicians were also trained in Brazil. In Northern America, Canada, the US, and Mexico have the ability to produce all the EPI vaccines, and the first 2 are self-sufficient. Most countries have made notable strides in improving and expanding the cold chain, although cold chain failures have been identified through investigation of vaccine failures. During its 6 years of operation, PAHO's EPI Revolving Fund has placed vaccine orders worth over US$19 million. At present, all countries in the region are receiving adequate quantities of vaccines to cover their target populations.