Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 12
Communication in the Third World:
A One-Way Street
Jim Bascom
Over the last decade there have been radical changes forced by the Internet and
the exponential growth of health sciences information. We see an increasing speed
of change in economic, political and social sectors that seriously impact health services.
Much of the impetus for the acceleration is atributable to the maturing of
applications of the computer, especially in communication. The developing world
benefits and suffers at the same time from the effects of technical and scientific
progress. Too often we see chaos come out of well-intended but inappropriate order.
In 1985 the developing world and the countries at the end of the era of communism
were banned or increasingly unable to access Western mainstream medical
information particularly as presented in paper journals and texts. The problem had
achieved crisis proportion. At the same time they were either politically prevented
from publishing their own material or excluded from publishing by the rising cost
of paper and ink while their own economies were failing. Research was increasingly
short of funds, and the citations of literature from developing countries decreased
40% over the next ten years.
At this time I was working in Saudi Arabia and our well-funded library was
cutting journal acquisition because of cost. I joined with a young computer expert,
and we put archives of medical journals on CD-ROM discs in an effort to provide a
cost effective and paperless media thus facilitating the distribution and storage of
information in the health sciences. This provided a collection of about 10 journal
archives that were a first in full text searching and included all images. However by
1990 the Internet was becoming a communication wonder. In 1990 to 1994, while
living in Romania we placed computers and modems in medical libraries at seven
universities that established Internet access. This facilitated communication with
the rest of the world that for decades had been banned except in a very controlled
and limited way. Within two years the uniqueness of the computers we introduced
was gone. The universities and individuals had acquired computers and were connected
to the Internet and developing their own applications and access.
By 1994 the CD-ROM discs produced by our company and others were being
transcended by the increasingly cheaper useful content available on the Internet.
In 1995 I started visiting Tajikistan in Central Asia as part of program funded by
USAID and administered by the American International Hospital Alliance (AIHA).
This program matches individual hospitals in the USA with similar institutions in
the NIS (New Independent States) and Russia. In both Romania and Tajikistan I
worked primarily with the universities of medicine to again connect the schools
with the rest of the world via the Internet. Civil chaos reigned in Tajikistan and the
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.