Apartheid medicine. Health and human rights in South Africa.

Human rights and health care under apartheid in South Africa were studied. Human rights violations, such as detention without charge or trial, assault and torture in police custody, and restriction orders, have had devastating effects on the health of persons experiencing them. These violations have occurred in the context of a deliberate policy of discriminatory health care favoring the white minority over the black majority. South Africa's medical societies have had mixed responses to the health problems raised by human rights violations and inequities in the health care system. The amelioration of health care for all and prevention of human rights violations depend on ending apartheid and discrimination and greater government attention to these problems.

KIE: In April 1989, the authors visited South Africa under the auspices of the American Association for the Advancement of Science, the National Academy of Sciences' Institute of Medicine, the American Psychiatric Association, and the American Public Health Association. The purpose of the trip was "to assess the effects of apartheid on the delivery of health care and to examine the roles South African health professionals have played in helping and hindering the promotion of health care rights." This summary of the group's full report covers: 1) health care under apartheid; 2) medical education; 3) human rights violations and health professionals (including torture, hunger strikes and restrictions, harrassment of health professionals, the physician and the prison system, and the impact of detention on children); 4) the response of the medical community to human rights violations; and 5) concluding observations.

A question of conscience. Physicians in defense of human rights.

KIE: The vital role physicians can play in documenting physical and mental abuse of political prisoners, treating and rehabilitating victims, and preventing the punitive use of medicine is exemplified by the actions of three physicians whose stories are told here. Wendy Orr, a South African prison physician, took her complaint about police torture of political detainees to court after her superiors ignored her reports of prisoner abuse. An internationally known Chilean surgeon, Pedro Castillo, has been arrested twice for his work against the human rights violations of his country's military government. Soviet psychiatrist Anatoly Koryagin is reported to be near death after several years' imprisonment for his activities against involuntary psychiatric commitment of dissidents. Nightingale and Stover remind physicians of their obligation to protest the misuse of medical skills and urge support for professional organizations actively engaged in human rights issues.^ieng

Selective primary health care: strategies for control of disease in the developing world. IX. Poliomyelitis.

Poliomyelitis is an acute viral disease primarily afflicting children. It can be very mild, permanently crippling, or fatal. In the developed nations, poliomyelitis is controlled by the use of trivalent vaccines: killed virus administered by injection and/or attenuated virus administered orally. The latter is cheaper. A combination of the two may be required in some tropical countries. In many developing nations poliomyelitis remains endemic and prevalent, especially in children; 37,747 cases were reported to the World Health Organization in 1979, but greater than 200,000 cases probably occurred. Socioeconomic improvement and public health measures (i.e., immunizations) remain the major strategies for control. While global eradication may be a more distant goal, poliomyelitis could be controlled better. Effective programs for control include safe, efficacious, and inexpensive vaccines; methods for successful management of vaccine delivery systems; commitment and training of health personnel; public education; commitment of funds; and research to improve vaccines and their delivery. The major obstacle to control of poliomyelitis is failure to immunize an adequate number of susceptible children. Development of strategies for immunization is crucial to elimination of poliomyelitis as a major world health problem.