Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Communication in the Third World: A One-Way Street
program eventually had to be terminated. While working with the universities there
and in Romania it was becoming increasingly evident that there was huge innovation
and brilliant adaptation on the part of the professionals to cope with socioeconomic
problems. Civil war claimed Dr. Yusuf B. Ishaki, Rector of the Tojik Medical
University, as a victim of assassination. These severe circumstances were stifling any
efforts to continue delivering health care to the population. To some extent they had
been innovating for years within a system of health care that was intent on limiting
services and cost in inhumane ways. There was no recognition of the brilliance of
these efforts or discussion of legitimizing the innovations with Ministries of Health
that were still emulating the past. I tried serveral mechanisms to surface the good
efforts without success. Indeed the notion of surfacing these efforts was
anxiety-producing given the firm hand of the government still present.
In 1998 I initiated efforts to publish a journal of international health that has its
goal the introduction of a body of literature that was derived from the “Third World”
with an emphasis on surfacing these unique and worthy efforts to deliver the highest
level of care in the milieu of social, political, and economic depression and often
chaos. This effort is ongoing but fraught with attitudes of wanting to replicate the
research and reports of the Western literature and a diminished sense of worth regarding
the local efforts to cope. I have since expanded the communication and
participation of developing areas to include Indonesia. The representation of Indonesia
as the largest Islamic country in the world and regarding population the fourth
largest country in the world is miniscule in the world literature. Hard times have
fallen on Indonesia, and although it is recovering it has a long way to go. Our efforts
to generate literature for the journal have resulted in some response. More importantly
is the notion of an electronic (Internet-based) journal has caught the imagination
of the Indonesian Medical Association that is starting its own journal, JIMA
(Journal of the Indonesian Medical Association) on the World Wide Web in year,
2000. Success has been realized in a little different way than anticipated.
This saga is related to illustrate an evolution in “developing country” communication.
Priorities over the last 15 years have been shifting very quickly driven by the
technology of computers and the Internet. We started with delivering Western originated
information on paper and progressed to CD-ROM, and then to the Internet.
The next step in that journey is beginning to occur which is the legitimization of
presentations of journals from the developing areas so long excluded from the world
literature. The University of Norway is hosting the publication of the Ethiopian
Medical Journal and other initiatives are being planned for Zambia that has tried
and, for economic reasons, repeatedly failed to publish their national medical journal.
The initiative to publish reality in cancer therapy for India is just starting with
the Austral-Asian Journal of Cancer that is discussed further on in this chapter. Both
the British Medical Journal and Lancet have been especially supportive of initiatives
to support publication of material from developing areas. Pediatrics, the official journal
of the American Academy of Pediatrics, has along with other US based journals,
been leaders in innovation from being the first to offer a CD-ROM-based archive of
its journal to publishing its journal in other languages and now offering both a
paper and Internet-based journal.
There is still a role for the paper based journal, but it is difficult to define the role
in a context any wider than local or national distribution. Each country is unique in
computer accessibility and stages of development. The fact remains that paper publishing
is relatively expensive, difficult to store and cumbersome to move about.
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