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of the

'i'mO; lff'KilA

H ;·; A L T H P L A {: :-: I N G M I S S I O :n I 1': K O R :rJ A

MH/D/63. 52

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LOHDON SCHOOL OF HYGIENE AND 'I'HOP ICAL MEDICINE

I".lcorp':lrnt::i.:1:;,; the "R. oE' s Ins t itute

KLPPEL STHI:Er,

STREBT ) ,

~'l . C.. 1 •

2 Cth Novem~er , 1952 .

1Nc fol'ward herPwi.th the Report of t :.10 'i'F.:0/ 1;TKRA Hea l th Plannin,; Hi ss ion in Ko: ... ea , :;,r epa1 ... e c1 in n c c o ;_,clan c e with t l7 e ins tr1.lC ti o n3 in

your l ette1' of 28 July, 19':i'.? .

The ~isston as ~emb l ed in 1erova en 20 Ju l y and ~eceiv~d verbal ins truc t ion s fr ~. m y ou. a:-:1d your staff . I t l e f t on :2? Jul~t end after c a llj_ r1g at the office o.f :;he .Ve stern Pa cifl c Re.:::; :io n o f ·:·vao arrived i:i:i Zorea on 7 Av ,:,.rnt . It l eft Ko:··8D on 11 Oct;cbe r and. sub s eqv. e nt l :r re - assembled i n Londor. where t.1c r e nort wss co , ple ted on 26 NovAmber _, 1952 .

We have nt t e"':_, t ('d to ·.0 1E' 1rn re co',nnc nd qt 5 ens rh :l ch w-J 1.1 both ensure the establj_shment of f!ati s fq c tor~- ei. •. '.'l.l t h C('nd ·~ t/ o n3 in ·?:o:::,ea a :id. be withi.n t he e c onomi c c rrn a c i.t y 0.i:' the c ountr y wi t!·. t. :1e init~_ al he l-r: of UN}·JJ A •

:':Te w 1.s!1 t o c:x 1Jress on~ 0 c e -r a-:-- "- l'e c l 1t:i c n 8.f' t rio unf9.llin3 h0 J. :) and c ourt e q r "ibi c h we r e c ei.VEJJ. l'roi;1 Id.inlRtfTS 811ll ::._~fl.cers of t he Korean Govc r nnAnt , Gover n ors a·xL t hoi r staffs , tle l0cal aut horities , the rr1ecJ i c :1 1 and allied pro .t'c:::: s l ons , a i;d :•rnny ot'r.er i ·1d:i viduals and a E:socia t lons , ir;e 'non l d ' J.so l~l:. e '~o a d mo'.v l ed <;e t '1c assist an ~e we re ce:i. vcd f ro:n UNKRA ard L'.-CAC }: c--f f -tc~ als .

• W . P . Forrest -

Dr . Bro c k Ch isl-iolm, World Health Or ganizatio~ ,

Fa l ais des Na tio ns , Gene v a .

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C O· N T EN T S

PART I

INTRODUCTION

The Mission Conditions in Korea

A PP.00-PAJ:11:L'.:~ OF Rr.COITSTRUCTION

Sta tement I 1mne c1i a te Measures Lonz;-'l'erm .Uca.sures Late Measures UN1ZPJ1. Activitios

OPGAJ'TISArriot-J Al.fD ADi.,1JJUS'l'RATION OF THE HI '.ALT"rl S:'-PVIC/S

The Government Her,l th Services Voluntr:: :-y Associa tions

II THE J:-1.THLJ;C HE,'tJ!U[ DISl"fl-TSARY - TW · FUTUP.}~

III

IV

V

H::ALTll UNIT

Public Feal t b Dispensaries rrhc Heal t h Unit

STA'I'lSTICS AI'!D RSRlRTS

PUBLIC HEA"!:,TH AC'l'WITH ;S

Introa4ction Tbe Sa. ni t a ry T'nviro:nn:ent and its Control lfat crni ty and Child 'i•elf a r e Disea ses of Ma jor Socfo.l ImportG.nce

1.c::.;-orcAL CARI:

l\Iedical Pr act i ce and its Auxiliaries Hos pital Service:s Cu r a tive Vlo r k i n Hea l th Units Eedica l Rehabilitation

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Chapt er

VI

VII

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CONTBN'l' S

Continued

:I!.,l)UC.1-1.'l' I ON I N ~\illDICTIU;; ,~ID ALLIED SUBJECTS

Undcrgi--adua t e M<..:dica l Eduoa tion 11iedical Coll c.:ges Probl ems of Iv1cdie:'ll Eduoc.tion Postgraa.uate Medical Ecucc:1-tio11, Dental Education Nursing Zducation Pharmacy }:o.uea.t ion Scheme of Rehabilita tion

SUPPLY Af1D FINAlTCF

}<.: y_'Uipnent 1rnd Stor es Medical Litera ture Some Remarks on Finance

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81 82 86 90 91 91 93 93

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97 100 100

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C H A P T E R I

I NTRODUCTION

THE MISSION

'l'he Mission was constituted by the Director General of the World Health Or ga.nisation (WHO ) in conforr:tity vd,th a Letter of Ar:rangement between the World ITealth O~ganisation and the United Nations K1¥rean ~eoon.st:r1,totion ;\gency (UNK..qA), to advise on t he ways in which t ~e l a tter organisatiQn could issist the Government qf the Republio of Kore <;\ in the rehabilitation izf the hea).th and health servi~es of th~t country. The brief was enlarged by rieference to the Resolutions of the General As,ser.ibly of the United Nations at its 314th plenary meeting en 1st December 1950, by t he policy statement attached tp them, and by a detailed Letter of Instruction reoetved from the Deputy Agent General Qf the R~oon5tr~oticn Agency dated 4th August l952,

Missions with oo rnpara,ble errands w.re despa,tohed 'py the United ~Tat ions Food and Agrioul tunnl 'Jrganisat:Lon (FAO ) and by the United Nat:i,ons Educational and Social Commission (UNESCO), but the prese1;1t Miss:i,on diffe r ed in its m1,1ch smaller size 9 h!'l.vi;ng three members i and the shorter pe::'.'ie,i :pro:posed for it - threc­months. The i~str~cticns given to t h e Missiqn required a study and proposals on principles anQ ~utlines of exe0utive werk 1 the detail to be filled in by more specialised stnff who would undertake i,he ta,sks which the~r h:1.d t horns elves drawn u.p in ful],., This wi,11 cnsµre t hat t he persons w::.o w;i.11 help the Government to carry out the scheme will be t hose who 4ave actually pr epared t~e detail. It is h~ped tha t t he proposals made are sufficiently preoise for th is p~rp9se, Th e despatch of a group of speo;i.alists for a lqng study wou+d have necessitated a preliminary a.seumption Qf the nature of the s~ecialisms involverl which, in ou~ opinion, would almost certo.inly nave proved inncou;ria te.

The Miss:i,on was originally briefed ;in Geneva; the Lep.der later o onferrG<I with the Dire:iotor General of the Reoonstr1,1otion Agency :i,n New Yorl~, o.f;ter whi. ch t he Mission assembled at the Western P3.cifio Region of WHO in r:;anilla and conferred with '\;he R3gion<:,l Direoto:,;- on l. August, whence :i, t arrived in Korea 0n 7 August. It then made direct contact with the United Nati,ns Commission fQr t he Unifiqqtio~ a~d Rehabilit~tien of Korea (UNCURK), with the Uni t ed Nations Civil Assistance Command in Korea (1:JNCACK), with the Reconstruction ~gency, and wi th the Governr:ient of the Republic of Korea . The te;r-ms of reference required that any scheme of :,;-eoonstruction should be in opnformity with that Gove~nment's wishes. To ensure t his and the attainment of full information the closest qontact was mo.intained with the Government throughout the stay in Kore~s a senior official of t he Ministry of Health continually accompc1.nying the Iviission as liais on office:i;-, and numerous discussions were held with t h e Ministers a,nd qthers concerned, Visits were pai d to al-1 the Provinces of the l'.l'.)ainland a,nd t he City of Seoul, where 011re was tnl::en to ascertain the gpinions of t he Governors or t he Mnyor, and of local senior officials, and to i,nspeot t he institutions or problems which they r ec ~mrncnded to us for study as well as thos? suggested by previous ~eview. Bqth formal and infernal meetings were held with r epresentatives of t he Korean Med;i.cal Association, Dental Assooiatiop, Nurses' As~ooiation, Pharmacists• Assooiati~n and Wqmen's Association at the National and Provincial levels, and with pther groups. At these meetings the mn.ny prpble:ns which occurred to the Mission and those raised by the others were freely J;iscussed, Individual discussions wore held with the Deans and

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staff of Medi cal Colleges and with the senior staff of i nstitut ions of all types.

The Mission considers t ha.t by the c or.ti.nuous m.:t i nt enancc of t he se many cont :=.to ts it wo.s o.ble to ass ociate itself with Korean op~nioul and for this reason believes t hc t its recommendations should b e acceptable to it. The discuSRions were very frank and cordial, and t he Missien wis): es to r.oco;i:-d t he f<'.ct t hat without this open discussion e..nd cordiality, f"or which it is dee:ply gr a teful, it; could not have arrived at conclusions which had a r easonable 1r osR3Ct of mee ting approval.

Sever al consultations were nlso hel d with t ho leade r s and members of the ? AO and UN"SSGO Missions, the inter ests of •.vhioh to s9me extent overlapped with its own, a s in the fields o f nutrition and metioal education, an~ w~ioh gained evidence relevant to t he wo r k of all . Corn.i;-,011 knowledge was pool ed c..t t hese mee t ings and overl c.1,pping ir. t h e final re port .s was o.voided by mutua l definition of spheres of interest~

The work in ICorea was oor.1pl e te cl in early Ootober, t he Leader l eaving ~rn 11 Ootob er for London where the Mission reassembled to comple te the writi~g of its report,

CONDI TIONS IN Ko:qz;,

Sonsider a tion was necessarily limit ed to s outhern Korea, though it vrnuld be a oistake ever to loso sight of the fo.ct that this i s r egc.r dcd by Kor e.:1ns as ::i. re.rt on1y of the country which needs r eoonstruotion , Its people ho.vc ~ long hi story of c ontinuous oultur.al n.tt9.inment , s r,re~d over t ho4so,nq.~ of years and various ly te~pered b• tho ethics of Buddhism, Confuoianisn and Christianity, and t hey have a very high standnr d of personc.l rolaticms and r e~pec t for educ a tion, The y ur e prcdominantl~ r ura1 , only 15 per cent living i n t he l arge to·,ms I o,nd mostly live in mnall villages in houses with a oharaoteristio internal fo r m a.nd t y;pioally clean. Th e commones t crop i s ric e , :11.n:ost always associRted with t h e oulture; of' beans and green yege t ables whi ch o.ssur e some variety in t he di et, The agr i cul tur ?..l cGono;·,1y , po.rticulaPly of t hese latter orops, is founde d on a tr~ditj_onal a pplication of all waste nitrogenou,s r.i.at ter to t he ln.nd, and mos t houses a.re provided wi th l atri~es t he oontents of which a r e used in t hi s way, Though t hi s prnotice n~y have a hi gh ngricultur~l yalue it r esults in almost universai parasitism with 11 variety of helmint~s of whi ch the r ouncl~worm is t he commonest. 1hose living b y t he sea. or rivers each much fish , nnd in so::ne degr ee it is wi dely e.:i. ten throughout t he oountry , but t he nutrien t v~lue is to s6me extent offse t by the fr equenoy of i nfe otio~1 with Clonorchis and PRr n.goni:nus worms. The tradition of olean living has h owe ver served the ~eople well in other ways 1 and a dense and s t eadily increasing population ha s resulted .

Reoent di sturbanoes of t h e ec onomy include t he departure of most of t he t eclmio[l.l n.nd professional groups after liberation :f;' rorn Japanese rule in 1945, and a tide of war which has p~ssed t wic e over most of the country an d four times over parts of it. There has be en gr eat physical dest r uo t~an which , toge t her with the impos sibility of full reoc cupation of Se oul where many of the institutions ~re concentrat ed , has greatly r educ ed t he physic al faoilitie s Rvailable, and part icul~rly the educational f acilities. Floods of refugees and displ aced ,arsons , numbering i n all about 2.6 millions or 13 per cent of the tot~l pnpulation and including nany s~ verely injured peop;t.e , resented a vast f eeding and housing problem and constituted i denl nu~sory beds of infectious disease. About half the medioal gra~uat es of t he c ountry were ~earuited t,

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tl10 ArJJ.y . 1;,1ater supplies and pu.rific r-.tion plants were damaged. Environmental services in the town broke down following the loss of transport, personnel and other re qui r ements . Supplies of drugs and other materials came to an end , and i ~flation of the currency des troye d the financial structure of both ~edic~l and health services~ The results included epidec ics of typhoid , dysentery, typhus, smallpox ::i.nd encephalitis; gross· mo.lnutrition of large sections of t he population and pr ob"l.bly, t hough the statistics to establish t he point arc lacking, a general deter­ioration of heC'.l t h and increase :i.n mortalit ~;r J::"'artic ·c1larly i n t hat du o to t uberculosis .

Tb.0 Go,vernment ef Korea 9 liberally helped by t he UN Civil Assistance Conr.1and in Korea using Civilian Relief in Korea supplies , has met alJ. of these problems in some way , and some in o. vory satisfactory manner . The goverpmentnl organisation and institutions have been supported at all levels. Though the r epo nstruction of institutions has been impossible, those evacuated from Seoul have b een rehoused in t cmJor ary o.ccomr.iodation elsewhere, mainly in Pusan~ Food, clothing and shelter have been provided for t he displaced and destitute on G soale sufficient to maintain life but on a quite inadequate standard for • good he~lth, An immunisation prograw~~e amounting to 70 million inoculations combined with a delousing progranm1e has halted t he major epidemics. Water suppl:i.es o.nd environmentn.l servi0cs hnve been restored , in some oases almost to t heir previous stn.ndard . Lost and damaged equipment in hospitals has been ~artially re placed. Drugs, dressings? etc . have been supplied in libernl quantity for t h6 treatment .of t he distressed, and t he hospit~l system has be en reinforced by the opening of over 500 pu~Lio dispensaries . Tho Mission is critic ~l of sone aspects of t he work carri ed out, but no Qrit i ois6 can overshadow its enormous value.

The Civil Assistance Corru;rn.n.d supports the Korer,11, Government in these nnd other ways through the medium of~ headqu~rters matching t he governmental organisation, fiel d teams including medioal ar.d sanit c..ry staff in every Province and in Seoul, a supply erganisat ion and a t ransport system. The ~econstruotion Agency had moved into Korea in 1951 and vms currently ope r a ting under a Memorandum of U:qdcrstanding with the UrT Co:n;::iand in c'.. first phase during whi ch it rum given only a lia ison an<l pl ar.ning function with a potential subsidi ary executive role, The second phase was to start 180 days after the cessation of host i lities whe n full responsibility would be assumed by the Rec onstr\lction Agency. The long de l ay in t he cessation of hostilities had prolonged the joint exis te ·'.1 ce of t he two org9.nis:1tions beyond expectation, and although the Civil .l\.ss j st3.noe Command 'JO.s undertaking worl~ which had long-term as well as immedi&te obj ec tives, it seened to the Mission that t he enfor ced delcl.;::,r in the co:.1/Uencement cif reconstruction measures by t h e organisation designated and intended for t hat purpose was re grett able . Such work shoul d be executed t h roughout by a single organisation , ~nd delay or division of responsibilities ~t the start can only confuse and de tract from th e value of effort.

The population which ha s undergone these happenings is estimated a t 20.53 millions, living at a density of 215 to the square kilometre, about t he same as that pf partially industrialised Japan (223)~ a pproac hi!lg t hat of wholly industrialised England anc Wales (290 ) and double t hat of India (109) . For an al1:1ost entirely agrioultural country Korea is t herefore very densely peopled a nd must a t ::i.11 times ho.ve difficulty in being self-sufficient. The p~pulntion i s , moreover, increasi ng . Census records in the past referred to t he entire country, the populat ion of which inoreased at a mean annual rate of 1,74 pe r cent. There is no reason to expect this rate of i ncrease to lessen, particularly in the absence of eoonQmio stability, and increases to 24 .4 millions by 1960 and

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to 29 millions by 1 970 ar e to be expected~

Vit al statist ios ha ve been notably de ficient since'1944, in which year t he birth r ate w-as 31.8? t he dea t 1 rat e 21.2 and the ~nfant mortality r ~te '115.6 pe r 1,000 births. Infective and parasitic diseases a ccounted for 23 per cent of deaths in 1944, the l as t year of r eporting ; di seases of t he respir :1tory system -mainl y pneumonias and bronchitis - account ed fo~ a further 20 per c(lnt. The oorresponding figur es i n England and Wal es were 6 and ;LO per c ent . Pul:non2.:ry tuber culos i s is an i mportant indi vid.ual cause of denth t hough gr cri,tly varying est::i.mat eG of the actual mort~lity have been m~de ; c onst~ntly recurring epidemic diseases, i nqludi ng oerebro-spinal meningitis, smallpox, ent er i c, typhus and diphther:i,a have caused a vnri:1ble but high :no;rtality. Nutri tionc1.l conditions a.nd j_)ar n.sitis1~1 1:ms t be reck oned as very impor 'i;ant causes of illphealth a s tho country has commonly e~perionce4 a 7~ungry season 11 and holmi nthic infection is almost universal.

The essence of t he pr esent situation is t ha t the country is not packward but contains most of the ma t o;i:-ia l for ::-iedic:il services of a reaso:1able st:i.ndard , tho'J.gh their ut::i,lisntion has been prevented by happening/:\ of tho l.ast t e n ye r,rs. Ther,e is an e~aborate syst e~ of medi ca l educntion cnp~ble of providing a sufficiency of dootor s 9 and ~lready a higher r a tio of gt aduate doctors to gener al popul ation than exi s ts in raost other countries ~f Asia exo ept J apan, The position of allied and s~bsidi ~ry staff :ls, h owe ver, not so good : nurses n.ro rela tively few in ntimb or and th eir position i n the ~edic a l and socinl structure is unsatis­f actory; dentists and phnrmaoists ara tpo f e~ for t he needs of t he people, and t he great variety of subordi no t e sta f f from laboratory technicians to mRintenance peo, ~e is viftually non­existent. 'rh:i,s deficiency ;ls ,3. ttributablre to the pattern of emp~oyment during t he J ap2nese r eii ze cnd no t to a ny lack of educability in Koreans , as l,as be on shown by experience in training the KoreD.n a.r r.1y . 'rhe public heo.l th s~rstem i s weak 1 its administration is uns atisfa ~t ory largely because t he~e is gr eat division of r esponsibility whi ch i nv9lves, amongst other things, a comp]. ete break i n t he ehanncl of technica l res ponsj,bility between oentral govern:rnent ':l.nd loc':tl authorities, There is no properly qualified direction of p'Ublic heal t 1:1. work at proYinci.::1.l a nd lower levels. Recently the Ministry of HeRlth has embavked on a programme of est ablishing pro totype institution~ a.s modeis to t h~ country, but for administr.ative r easons they are divoroe d from the eduoa tional system and i nadequately i ntegr a t ed i nto gener::1. l work and so lose much of their va lue. Medipal treatme nt has b een primarily in the hands of privat e pr a ctitioners, reinforced to a $mnll extent by a hospit a l s ervice, Privnte practice has, however, beGn very greatly hamper ed by lack of s upplies and physical de struction of its ma t erials in t he repent ed battles which h~ye affecte d al most all of t he c ountry. The hospit~ls, eve~ t hough small, are not operating to their full capacity, and it is app~rent t hat t ~e public has little confidenc e in t hem . The Mission s pent much effort i n trying to analyse t h e reasonR for t his , and c oncluded t ha t t h e terms of s ervice of hosp:i,. t al s t aff nnd t }le nature 0£' t he nursing provided were essenti~l c au,i9es. Tho hospit al service has b een greatly e;Laborated by t he f or !:1ation, of n l o.rge n,ur.iber of public health dispensaries wh~oh have done admirable work in t he fi eld of epidemic prevention but which, again, do not nppear to have the full confidence of t he public, and i n a ny c~se oarry out a cura tive function only.

The town popula tion was not unreasonably served with medical facilities befor e t he war. ?here was then about one doctor to every 6,000 people wi th an equal number of low grade doators and herb doctori9 pro.o tising traditional Chinese medicine . 'rhey were mostly aggregated in the towns and engaged in private practice,

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ofte':1 wit h quite c onsiderable nursing homes or h ospitus . There wer e government hospitals in t ho main towns bcit t hey ca t ered lar gely for the section cf t he popula tion ~bl e t o pay for tre~tmcnt, wi t h minor p:covision for t he indi gent ; i n some pl aces t :1ere were Red Cross hospitals 9 volunt .qr y agcno i es , and s:r:,eoialised institutions suc h as i s ola t ion hospit als , leprosari e. [\.nd tuberculosL=:; hospitals. The co uJ,1.try- dweJ,ler however may not h-J.ve gt;t.ined :nuch &.dvantage fro m these owing to t heir distance from his h0rqe.

Su::;,porting those services were six Me dical Coll.eges, t hr ee nc:.ti onal and t hr ee pri vo.':te, whi ch had a potential out-t-urn of between 400 and 500 graduates eac~ year, Tho heal t h services were of e. much more .t rimitive charaote:?'.' 7 th e oeptral organisation controll ed J,arge ba cteriologic o.l ';tnc!. chem;i.stry '.Lo,bor o.torics of good s t a,ndar d~ but t h ose a t provinoia ~ level were much smalie r ~nd less sat :i,sfe.ctory . Envirqnmenta }. scrvic os v.re r e provided in t wns, usual ly on a, simple scale , wh:i, l s t t he pensonal, s ervi c es were in an embryonic stage , I s olation o· i nfectious diseaoes w~s carrie d out on a major sca l e , t here being nu~evous hosnita l s or block s for t he purpose, and 1any l eprosnri a on whioh th; bulk of t he Mini s try of Health budget was expended ~

Thi s framework has b een b o..dly c..ama.ge-. , ;Ets temporary s1.1,pport has been t he r esponsibility o:l; UNCAOK while :i,ts '.Pc bui lC:ing will be t he d\lt y of t h13 Kore l'.n Gover:::i,:nent ai ded by rn;-r:Rt. , for whi ch the Mi ssion was :required to ;pr cpwe pl ans. It a ppnoached its proble~n by t he suc cessive s teps of:

(a) exe,mining t he present medic al a:id public ne~ith services tn t he broadest meaning of t hese t er ms;

Cb) preparing a s t a t ement cf t he obj ec tives of reconstruction wit hin its t erms of reference;

(c) devising an o~tline 0t t he way in whi ch t he Korea n Government 7 wi t !'J. the help of UNK;Rt-,. , could ,9,tta in t b ii5 object i ve, including a st~t ement of t he tntermediat~ measures needed dur~ng tpe transition p oriod .

The first of these is necessarily a dis cursi ve sta t ement constituting the background and juGt i fioation of t he recommendations, but is n.ot necessary fo;_~ t he unclerGt andin.g of t heir gener a l form. The others constitut e between then t he recommendations which it was t he Mission's du t y to formulate . They oe.n be re:..d without t he b.si.okgr ound and as a matter of conveni ence ar e brought toge t her in the foilowing ohapte~, though proper understanding r equir es a r eading of the entire t ext •

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CH APTER I I

STi1.TEMENT

V.'hile r ec unGtr a ctio:i in t~1e f i eld of h\Jalt ::. i s n e cessaril;y a :.:.- L f_ Latter , tho Mission was enj u i :".1.ed t Q c c 11s id.,.;r a f i vc - y..;ar t e:cm f ur the purposes of this rep8rt. The gen8ral c bj~ct ive at t he ..:nd o f th2.t tim0 i s the p l a c i.ng of' t h e pubii c h0alt h s 0r v ices and medical service s on~ sta ble f oo t i ng , on as h i Gh a c t andar d as is a tt ainable within t h e p~rioa a ~d as is c onsuna~t with t he a b ility 01· t he i ore .:tn Government t o maintai n a:;.-l d i mpr ove u.pr.m pr o.Jab l ~r with n c, more than n 0 rmal int orna tiJ:.:wl aid., il1 a f or 1i1 whi ch is e.ppr~ .r;rio t e t o l o cal cL·ou,nst ai2c cs and t r ad:'_ti::m aml i s a c cc_;;itabl 1:: t ,:, the Ko r,qan Guvernme;: t a nd puople .

11h;i.;3 definit i on do c;s 1lc-, t x·0fe:r t :, re_ple c e 11ent of previous struc t ures , ma t0riaJ.s m1ci staff th.; :•.gh such re ~j:t.a c emen t i s a ne c essa1·y p0.r t of ro co;:s t ru ction . '.i:h e d;df icul ti e s t ilf OEg!"l which t he country has pas.sed j_n c :i.adc mann.ge.'.:·10n t r.:.s a ,Japan-::se s ub sidiary s t ate up t o 1944 , dep:,rture c:: E,0st of t :1e t e ch n i c c:-.1 and pr o f css:Lonal s t a:f; f in ],9it5 , c.iv:i.s:i,oµ o.f th-.) co un t :ri;y i ntc t wo \V1~.0lly artificial par t .s 1 v.nd bitt e r w,~r fare ,::.liti->st t hroughout t l10 l o.rid . 'I'h e s e hav e pr odu ced s0 c ompl ~o~ted a picture t hJt a wider parspo c tiv e of r e c onstru c t ion mus t be ad:., p t ed: us ing t tie existing f 0nn do.-c io11.s and i n c orp:.-irat ing all availa,ble illa te r i a ls , but rl',)t slr.wishly fo l l owi ng nn y pr~vious pat tern .

Korea is a l reaciy one c: f the Des t denso l y peopl ed a gr ic ultur a l areas of t he ~ar ld and it will b8 imposs ib l e tc ~c at t he n ee d s of a povula tion which continues to ex pRnd indefinitely at t he pr esent r a t e . E:1r l y s t ab i l isu.t L Jn C8.1mut be h oped for , and pr opaganda t owarda t ha t end :f;r 0~ the K0r ccn c ~ver n~ent itseli , jef ore e c onomi c s t ab i lity is gc,ner a ll;Y r qcogn:i.s e d , or a t any t imo fr::nn udside ur ga.n :Lsa t i ons, v.· ,)uld pr oba"olJ be u1::0J,.css and r::i r:,}1 t v i tiat e the chances of later wr,r ;;: e.nd .sh•.:iuld not therefore be atteiilpted. '!'h e de ,~,ogr aph i c and .s0 cial st udi,rn w~"i ch i 'or,,1 tie basis of pub li c edu cation ca.111p<;l.igns in t i,.~,. i:; r espect h::c.v e c.l:..· c ad :; been started and should be furt her un c 0uraced ; t ~e ful l emanc ipa tion of w□Lle4 a nd th e pr ovision of e1.,ploy1.1<.mt snitc.bl-.:i f or t h0r,1 shuuid. also be k e p t promi nent ly i n vivv: in t h s;; g1:;ne:.."a.l s c >eme c£ clovelo pmen t of t he countr~r , I n the mean tirw the as sun pti0n vlill bo m01.de t hat a c ontinue d grov:th wil,l oc cur and t he populo.tion .:10..y r eac h 01: exceed 29 mill i ons in 20 ;year s tine . Th i s c.:.i1c.ld !,erlnps b0 s u r,por t e d but would sure l y r aprc scn t t he limi t c f t h e oapacit y of t he count ry wit hout ext ensive i ndustrial development .

11.'h.:; .-:or };: cann::.i t s uc cs;;ed i n t h0 reconstruct ion per iod or surv i v e af t er it unl~ss the e conomic s t a bili t y of the countr • is r es t or ed, and unless government S8rvice i s a ttr ~ct ive t o good men anxiou s t o make n o ~r e0r wi t h i'-1 i t . Ln e s sential r;rcrequisi te is thoref o r 13 t he a r range~ent c f ter□s o f service for s t aff , pr oviding r eas onable se c ur i t y o.f tenure I suffic i0nt 01:iol umen t, end f r eedom of t e c hnicall y qual if i e d p0oplo of c.11 gr c.des f r o;.i tr ansf er t ,::i n on-t e c hnica l appoint~0nts exc ep t a t t he i r own wish .

Th~ r o is no single measur e whioh by its widespr 0ad application wo ulci r0sul t i n a dr&J1;.;1.t ic i mpro v Gment in pub l i c heal t h . Irn:J.0ed t his i s no t the obje ct i ve , but rat hLr t o put t he country and ~ta peopl e o:n a s uund. f ooting i n health mat t e r s so t : a t t ~ey -r:1.0.y res t s e c ur e from risk of ~a jar epidorai c s a n d hav e the power to ut i l i se and en j o y su ch resour ces as t he c o un try has. _:, gener a l r eb uil ding :1.nd

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improvem0nt of envirorn;:l::)ntc:::.l sanitati0n, p\:- r s0nal l1calth se:rvices a nd medical services togethsr with a ctive campai~ns to all eviate so:11e of t he morG pressing probleps whi ch now pr esent t hemselves is needed . Work of t his natur e could be succes,sfully initia ted w:::.thin the period of rec ons truction and oould be expected t o a ch i eve it s i m.;.:iedinte ob j e cts though it wculd no t pr oduce r e:1v:,r kab l c chane;os in death r a te s ciuring that ti1:te . Xoreover the wor k c ould be so pl ann;:;d that its c ontinuation by t he Korean Go vurnLlent af t er t he end of spe cial int~rnat i onal aid would bo qu~te possible , t ho ugh some pr oje ct s suc h ~s t ne c~notru ction of a Sc ho~ l of Hygiene would deservo help after ~ay tc ~ay a id had end0d ,

'rh0se r csp0nsib l0 Em.s t bear in mind t wo c onv ercing .s~ri8s of ;;1easur es , eventually flowiILg :i,nt o each other but initially distinct. One series is chosen be c c.::.use the !.1GG.5ur es are ur gent, i 1:u::ediat e l y p~ a ct icable, basi cally ~o und and preferably with an appeel to tho public , stiDulating it to support furt her ieas ures in t he belief of t he ir effic ~ cy. Tho ~thdr series is sel6ctdd re gar dless of it s itued;i.1:-te urgency or prc,ct :'. c a'.Jilit:,1 , but be cause the measure.s c ons t i tute t he fou~datton of n sound syst8D providing a healthy environ.,ient , necessary welfar e SCJ.'Vices , fre~do u f' r o:.:i epide;.nic and end~uic diseases , and :facilities :('0r treatr;ent of ·tJ-ie sic k .

Ma i ntei1a.n c 0 of nutr ition . '.C-lis i s not con.side.red ns c.. ,specifically i;ed :i. c a l :.:::atter cmd is not i'urthc.r e labora t ed , but it canno t be igm.,rod t ha t it is the fou_:dati:m of all healt h . i-1ni.n twn 2.n c 0 is r equired in spe:cic~l group s s uc h as r ef ugees and displac ed p.:ir s ons n s vrn ll G.s i n the ge~1.0ral popul::i.tion be cause Stl ch gr o ups constit u t e f o ci of disuase affecting bo t h t he1..1Se lvos ar:.rl the popuL1tion at large .

Pr0vent~~1_-~f ;J1ideuic and ond01lic d iseases . .:,.n 8lab •Jrate an,d tm c cessful prccr an.:10 of prev ention h,. s b•:oon built up by UNCJ'...CK , chiefly b i:l.sod on i :;u:mnisation c:. nd del ousi~1g throue;l1 th o o.gency of t .ho newly es t ublish0d public h~alth di spensari0s. The c oi1 t inuation of t his pr o graLw~ wil l b8 n~c0ssary f or a nunb~r of years until s ounder . .ie t hods o f liniting disc:ase tr c.;:rn;:iis$ion can oe substi. t uted . Dur L:g the r ccons t~ uction p0riod it c ould well be amplified to c over end0 mic diseases as well as t h0 epidemi c ones with which it i s now l a rg0ly o o~c s rned . ~ sajor cu~pai~n ueains t helpint h i nfe ctions, n wide oxtensic~ o f BCG vrcoinatio~ agains t t uoefc ulosis , o.nd the es t a.b li:::,i1r:.1..:mt of a systen f or t l,G tre ~~ t m•J 1.1 t of vo n,erec: l · discrnses aL1ongst t l:1J g 011~r3.l r,ublic ar0 ra c e,(i1;:10 11ded .,

Enc h of these 1,:uasuros i s el9.boro.tdd in Chapter IV of Part II . The c&,.~rui cn a 6ai:rnt pc.rasi tis?:1 i:-.1 j Gstified by t ho oxtr c\e pr evclanc e and iuportauce of p~raaitic d iaeo.ses and th~ r ~c t t hat it c nn b0 und0rtnk011 with little olaborat ion of servic es . It would require supGrvi2ion by i nt~r national s taff, de tailed l ater, but uost of t he work c ou~d be c arried 8n b y existing staff aided by suburdL1at cs v:ho could bu tro.incd on t he spot and with ense . The ext ension uf BCG vucc i!rntion :..2 ;.::io.de ycry desir::1.bh: by the increasing ;frequoncy of t uberculo sis and the i nctoility of the c ount ry t o ins titut .:,, o th or ua jor :.--,1ec:-..sur us t o c oi.i.r.Lterc.ct it , but maasurcs whi ch c onstitute t he core of a contr ul o.nd tr0at,.ier1 t u.e oh&:.1.is::1 2r e sugges t ed o.s l ong-teru ueasu~ es lat er in t his cho._::; tor. It re qui.;.10s a s pe cialis t in tub erc ul osis to l-:ie pr ovid0d by UNiCR.ii. lend an invi tati0n t o WHC t o sand o. vi.siting ts a,.1 t J deu.onGtrata ;.;1tjthods, :i.,ni tic. t a training; , and presc~ibo i~ furt no r detail the l ong- ter~ ~aaaures to be adopt ed • The ca:- pnig::.1. ;_:gainst v o11er eal diseases is c,lso ne cessitated by t:1eL_, fre quency, by the difficulty of se c uriµ g ~dequc t e tr 0at ~an t end the de..ng~r t o the co:..:,Junity of insufficient tr ea. t rJe;nt. The ult i r,1a t e wo ohanisD would be by the pr ovisi on of spe cial clinics ~sao cia t ad v,i t h Health Uni ts nnd hospitals , but iw1.1ediately a cn7.1pa.ign could be

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base d on hospitals and soue oela cted public health dispensaries.

Supplies . Thii:., progr aGi.iO should i n clude eqt: i p;:ie:nt, ;;1edi cal stures and il t er ttture , and should huve t Le obj 0ct i v" of tmppor ting h •:)S J;i t al and si~il ~r ins t itutions , uedi cal and d ~ntal c ollegoff, the national lu.bo·r.:1t ories , nurLd.ng sc hoo1'3 1 and. pr~vate .,?rc:,ct i tio:nert •::;f 1:1edicinE: and dentistry. I t wil l r equire thJ per Lanen t Sbrvi ces•of 4 Suppl ies Offi cer 1 the teupor ary appoint00nt of off icers wit h special experienc e of laboratury rmd hospital equip,nent, /ilnd assir:3to.nce fr ::im a vi siting ~e~i cal iibrurian .

Hospital equipacnt inc luding b e d s , bed- l in~n, heating appar a t us ~ au t :..J c lc:·.vos and sterilisers , c:'.nd norunl uedical, c~:r[;i c c.. l and ph a;rno.c0uticaJ. ;c1.:>.terinl chould be b .:.rned on .: tnnd2,:td lis ts ;for 20 , 5 0 and 100 bed un i t s . Gu pplies should be issued af t er i4ventory of equipi::.ent in han.ci D.nd it 1:w.y bu r cughly estip .i·cc;d that supplies oquivulent to equipping four or five t housands bbds wil l bo n e eded . The ::-~ur sir.g .s c h:)ol equip1.11,rnt n0 ,1 ded wilJ, 'o-.: eqniv_alen t t o ah10s t the en t ire n..:ods of 16 Gchools with a c apac i t y of 1, 200 pupils . The equi pme;.1 t f (ir 1..,edi.ce..L mid der .. b ::tl c0lleges and -/; 1 \'3 1o.bor a t ori~s is speoic:,lisedi d,etnil"'d s_f;ecifi:;1.1tio:n. wi_ll r Q:~yi r e full pr oliuinary survey b;:,, a Stipplies Officer w:Lth ,.:;pe c j_al exr,e1·ience . R::i ugl-1 Qstim:. t ee.: cd.n :q e bo.s~d 01, thu f u ct thnt S'..,_.1..:·,vho.t m'.1re t han h t:tlf t i1e equipkent for six cedic~l coll eges with a t o t al st udent enrolJent be tween 2 , 500 nnd } , CCIJ I al:i. t.'.-ic equi pns1}t fer e, dvnt al c ollege anc~ pha.r:;iac y c ul logc, and virtue,lly esll t hq eq .. ,ip,,wn t for c1. ,:1njcr bcct 0r L ,logi c1:,l and v ac cint.: pr odt~c ing 1,;~b 'Jrc.t:)r;y ,md a r,mjo r c.benis try l a bor ~tory will need r eplsoijment.

ConGm,klbL.J LL._;d::i, cal s t u.1.:es are necc.1<:;s:0.ry fu r b::, t h puoli c o.nd priv D.t e practice 1 .nnd the suppor· t of the L "tt c1• 13houl0 div ert a considerublo lend ~hich wo uld , ot~erwise fall on publi c institutions . I t j_s .sugg1,H,ted t hat th..:: r, :..' osan,t ?,nnu al i ::1por t n t ion t h r o:.igh Government a i:1d CRIK cho.nnels should bu i ncreased by ROC•ut 2] per cent, a nd init;ic.lly one-third 0f t hif., t o tal diverted 1;; .:J p r ivn t 0 pxi nctitioner,s pref(;rab l y thr0ugt a c uor,0r&t i·1e :,iov~r,1ent or gnnis0d within t he Medi cal and Dental Ass0cia~iuns . All supplies to publi c and privat e destinat ions si:iould be costed , ~~bli c i1ist::. tuti0ns should en ch be gi vcn a c 0ili ng of e~:pendj,ture wi t l:in wl.tich t l}cy c o uld i ndent for supplies . Hateri~ls ~~stined for pr i v a te pr ~ctition~rs should be pnid f or a~ r c1asonnbl0 p,rice s 1 r eceipt s being handle d c. oc ordin:g t o th0 me chnni sw ruling f or sulo of 0th0r r e lie~ goods . The prqportiona going to t he t wo t ypes of user co~ld b 0 adj q s ted on experience, und a c :.:;ns~cant e ff o.1,·t rn::.d0 t o r es t ore t h0 no:rnal ch::uu10ls of trade .

Suppl ies of liternt L,re s hould be brought und0r t w·::i 1Jr ogr/J,i.1:.:1es , i mnediat0 ct~1d long .... t eru . Innediate pr ovision is n a eq.ed in the c a se of t he text books c,nd jcu1·m-:.ls for .c.Wdi. c a l schooJ,s with about 450 stud,;mts ii:1 each of t wo pre - uedioc.l ::i.nd. fcur ;;1edical years , and f or a d.ent al c o ll t:::f;e o.nd. pLo.r1..,o.c y c ::i llege wi tl., about 1 0 0 students i n eac h on n f :::>ur year1;, 1 · coursG . Th ey are o.J.s0 needed for the curren t use o:f a nc..jor bactericlogical laborat or y and n cheuistry l nbo r r'.. to:ry , 1 6 nursing s chools 1 and 2 , 500 t o ) , 000 graduate d8 ct ors uctually in pro.ct ice 1 The prifilru:'Y l e.n~ungo need e d, is Engl iE, h , wi t h, German , French C...."ld Chinese , if a,vnilnble , c..s seconda,rioa . Init i a l "' t o ck for institutions nLed not b e on a costing basis though repl a ceuents and. aqdit~ons shouid be . Distribution to pr a ct i tioner s through · oqoperntive organisc..i,;ion wi thin t he professi0nal Asso cia tions , unq. p0ssibly 0v en the esti:tbli shJ:;10nt of s r.w.11 p,r ovinci a l libr.arie s t o ensur e the i;1a:r.:imun utili ty of books suppliEl.1 1 i s sugg e s ted.

Vaccines e onstitute a s pe cial c a t egory of supply and t h ey c ould 1,o . .i•ge ly be nanufnctur e d :J,.o c ~:.lly and wit h gre a t advantage . For t hi s r~ason t he r es t or a tion o f t he v u c cine so ct io~s of the :i-Jnt:i,.onnl Lab or at ory fo r the Preventio4 of Infe c tious Di seases should 1;)0 given a v er y high priority as regards s tructur e , eq_uipn0nt nnd

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nw. t erinl s . The f ellovIShips to member s of its st o.:ff f or f urther s t ud y i n !lss::i.y pr oce s 3e s nnd o t her subj e cts r e la.te d to vc.cci.ne p~ oduct i on s h ould &l so be expedit ed.

Tr a inin~ . i'1o. j o r trr.:i.inin g sch e,,1e s :.i.r e ur gen tly re q uired f or s ani tet+'i ans, w2.. t c r wo r ~:.:s a ta.ff, o.:ad public he a.l th nurses , w~1ile less er ones a re requir eo. for zrn;,1er ous ~r oups i n clud i n g Heo.l t h Un;i. t 1ne q.ioal o f iic ers , nurse ~midwiv es i n health unit wor k , tub er culo s is workers and other s . The mn jor one s o.r e aeeded to f i ll a l mo st tot a l deficienc ies , t o 1IBe t wh~ch n hish output c ould b e ~e pt u p from s peci!?,l s qh ool s dur iug t he recon 1:~ truction period, t h.e su-os e que n t s ,uc,ller r epl a ceme nt n e e d s b eing .supplie d, b y n ormal on-t h 0 - j9b tr u.i n i ng .

The i rmr,edi ::,t o aim shou].d b e t he establishment of t hree schools f or sanit c,ri(u1s , y;a t yrwor k s o pe r e.tives end pu~l:i, c heal th nursas , e a c h op er a ted b y v i s ;i.t inz; i n t erna tion2. l s t o.ff . T~10 SEtnitar.ia ns s chool s h oQl d b e b ased on t h e exe cutiv e m~nage~tent of a haa lth area b y a health offic er a nd t wo snnit ;:,r i [),ns , n l l v isitin g sta f f . Co i.,r.s e s of i ;r11.3 tr uction s h oul d lo.G t ;:1 i x mon t hs , 2.nq should c ontinue on 0.1:.

i n tensiv e sea l '? un t il a tr a. i ned. ,,1a n e xi s ts f' oj_~ e ver y gun , mi..inicipal nn d p~ovin ci[ll po s t o.. s we l l a s f or s uc h Iie a l t h Cni·cs r:S-have by then been e stablished ~ :;&t e r work s t r ainiag s hould be on t he bas i s of a major wa t~r wor ks manased by a vi s itin g engine er and t wo or three ass i s t a nt s , and shou l d cov er nl l t ne te c hnologies i n v olv~d i n ro ut ine :na,nagomen t of wn t e r wo r lrn and wa t er distribution s ys tems . Ptiblic heclth nurs e t r aining c nn on ly be carr ied ou t on t he basis of a l o c a lly o perating c o~ pl e t e s ch eme of per sonal public healt h service s . },i'c r this r e 3. .son t ho e s tublishu ent of th e Nution al Healt h Unit proposed. i n C.hapt e,r I I of Fa r t II and t he appoin t ,11eu t of t he visit ing Health Unit t eam t here s ugges t cJd should be expedj_t e d D.s ::iu oh E\. /3 J?Os s ible 1

Th e e x t sting Rur a l Hyci ene I ns t it ut e of Kaej on should a lso b e s up ported and t he publi c heal th nur se train i n g o.lr e ::i.d y pl a nne d t her e encoura ged in all pos s ible way s .

Urb an sanitnr y i r.:pr ov e :;;ent, ru l l restor a tion of transport for s ca venging _and cessJ)it clear ance i s t h 0 mo s t ur gent u rb a.11, n eed , c..nd may b e estima t ed a t 90 per ce n t of t he r equ irewent e f or 2. ~ million p e o ple , Any spe c ialised vehicles should b e s ui t a ble for h3ndlca ding . Ce i:1 e n t f or t h e c on s tr uc t i on of l o c a l col],e ct ing d u1:1ps is also needed. Compos t i ng 1:ih ln t.s s houl d. be con s truc t e d i n two or t h r ee t owns where they ca n be kept un d er close observ a tion, a nd a s e xperi enc e i s gain ed in t heir oper at i on they should be ex t ended t o ot h ars .

Tr e a t ;11en t of coEw~o n a il.r;:1en t s . Conve r s i on of t he e x i£;; t i n g public h e o..l th dispensaries t o fi e :_, l th Un i t s i s de s cr ibed i.n Chapt er II of Part I I . In t he me ant i Be t hey should b e ut i l i s ed f or t h e tr e a t ment of co mrnon ail u ent s a s well ns t h e pr·oventiof.l of epiden i c a nd en d emic di seuses . They c oul d we ll b o r einf or c ed by uob ile cl i nics, originclly pos ted to t wo prov in c e s 3.nd t c... ot h ers when suc cessful exper i en ce h a s i.:Je en g:,in0 d wit h t he or i g i .i1 als . They shoul c;i a l s o b ,a s upport e d by c.u,1b u L :n co s , or i g :.:..n a.lly one to e o. c h pr ovi 11c e a nd u a jor ci ty , fo r t h o t r anspor t of s ,J riou ;-·ly ill pati'"nt s to provinc~a l hospit a.ls .

1£-establi,shnent of ;,~edi cc, l edu cation . i , scher0e is det; o.iled in Chapt er VI of Par t I I a nd i s dealt wit h a s lo ng-t er□ policy in t his Part, The i 1~.10 di a t e s t e ps o ±' reo peni ng Se oul Un;iv e1°sity Medi ca l College i Kyung Puk h edi c D.1 College, illl d se c urin g relea se o f r;1ei;1b erp of t h a i.r s enior s t a f fs f r o1;1 m0 u y ser vi c e should , ho we v er, b o g ive n a v er y high pr i ori t y , a n d work should b 2 s u ppor ted a s nwch a s possible till the l ong-t er n policy can be pu t i n to e ffe ct.

This i s r e l a t ed to l o~g- ter~ na e ds but coul d

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be s t o.r t od o. t 011 0 0 rm d is i n f a ct an e cse n ti a l pr oli !;1innr y t o t he lo n z -t cr ,.: pr ogr n.Ll.:.le . I t i s c onsider able ; diff ic ulty r.1ig-h t b e ~xp0ricnc e d i~ i t s iupleLlentn t i on or i n g t o l ~c k of fluency in the J£n s l is il l ,'.ngu ei. L,<J , whi ch n o s t F0l l o·.,;rs no ul d n c 0d. i1h i le none sh ,) uld b e a ppointed who c ould no t pr ofi t f or t his re ~so n , it wc ~l d be a l oss to t h 0 coun t ry if th t! selection i n t h G en.ct t u rned 0:..1 fluunc y· in ~nglish nnd n ot t rue s a it&b ~lit y . to a v oid t h i s , and becc us e t he progr m;,"10 i s c ons i d or ab],e , i t wo Lll d b e worth w.tilc t o off or irn:; tr uct i.on in En g l i s h ~!S o. ,11r e l i1.1i n a r y t o thoE,e wi t h a n original gr o·,.md ing i n t h e l :.:tneuaGG . 'i'h e c oi1v e r s ion of t he y ounger ,.1e1:1b ers of the co1,1i:mnity to Engl ish a s a s c i bn tif i c l eiguage would Llnke t his o f fer Ll8re

v a lw:,blo t o t heir e l cl e r s an d 0n cure c )n t inuity of e d uca t ion . '.L'h e n t te:1t ion of UI~~SC') iG a.r a rm to t h is ·r e c o.r.ir.lanclc.tion ::113 t :1is field of e d u c a t ion i s wi t h i n UNESCO r es ponsibilities . In cho osiilZ Fellows s tr oss s hould be l aid on ensuring t h~t t hey h ~ve previously been e n gc--ged i n the s,1-e cial i ty c on c orll..:id (ur.lec;s no such peopl o o.r e uv ::..:i,lao l e) , t hc1 t t h ey c;. r e • o;f h i gh int e lle ctuuJ. s tc .... p di:ng a.r~d have good basic tr c.i n i n e , t h ~·, t t h e y n D-y b e e ::-:pe ot e d t o r e t ur n t o n,;;ipoint::ients clpproprin t o t o the fe ll.c•ws h i p g r nnted, E~ nd t hc-.t t hey b1v a suf f ic.ient flu en c y of l &ng Ll nee t o prof i t, The ob ject o f t 4 e fellows h ips t o the s t a ff of ~edi c a l c0lleces i s t o en a ble t h~u t o s t udy syste□s ot ~or thnn t l1 e J apnnose under whio:.1 t h e:; h .:w e b een o r ouc h t u p , £~n d t he y shoul d no t t he~ eforG go to J npr n . No ot he r J, i o ita tion i c plac e d on t h eir d e s t irw tio::1 .•1n d no l i i.Ji i h ,t i on o f u.ny typG on t ne dc s t inc..tion of othe r groups . l elloITshi ps er e propose d ior thG f o llowing gr ou ps f or whi ch an c,1)pr oxi 1w.te ) r c gr au.r.10 o f c'i. e s po tc h is gi·re1:.. , but t h is could b e v c;r i 1;, d n ocortliL6" t o ci rc uns t :::m c es .

Period of :i,~ellows h~

1 Yfir ur Me d ico.l

Pos t

Of i' ic or o f H1.,H,lt h

6 i;ron t hs St nff of ,iedi c c,J, , d e n t a ;I,, an d piw.rL1a c e u t:". cnl co llc.gos - non...-

Ye:.,,r

1 2 .3- ~- 5

5 5 2 2 2

c linic ~ l u s well as c l i nica l 20 20 20 20 20

1. ye nr

l year

6 1;,ion t hs

6 rJ.ont h s

1 y e a r

1 y0 0.r

l y e.:::..r

l y ei..tr

6 month s

l y 0ar

s t ~ff of Nu.t:iono.l La boratori·cs

I ndus trinl h ygi enu o:(fic ers

l-'1e di cnl librar i .:::..21s

Sup pl i e s officer

Tub --: rcu l osis of fiO t.lX'

Le pr os;y o~f icer

Gynne oolo5is t nnd obst \, tric ;i. nn

S ::i.ni t ,::u•y Er,.gi neer s

Nurses

Mi s c Gl~a uoous

6 2 2 2 2

l 1

.,.. 1

1

l

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1 1 1 J. l

l l

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1 1

,...

....

2 5 5 2 2

3 3 3 3 3

'J'ot et!_

16

100

11+

2

2

1

5

2

l

2

16

15

170 .,.,. -

Shoul d it not prove p ossible to ensure tha :LJ:1:.:10di.'.l t e peop0ning of Geot: l :1iedicc .. l College over y effort should. b e i:1.::cde to gr a.nt fG l low­sh;i.ps t o a s high a pl;'o portion as po soible of t he sLtf f of' t hat Co l l ege i Lmc dia t e l y .

•

- l2 -

Rehabilitation of the disabled. Thi s is regarded as an immediate measure becaus e of its moral ~nd political signifioanoe and t he large numbers of people needing help, The subject is discussed in Ohapt~r V of Part II 9 and requires;~

(1) Provision of services and equipment in a Rehabilitat;ion Centre to be s e t up a t 1ongnae,

(2) The appo:i,.ntment of a visiting orthopaedio surgeon to survey the problem, draw up detailed spepifications of materials and staff vequired, and on his advice:-

(3) The appointment of a viaiting rehabilitation teem under hi s leadership ,

LONG-TERM · MEA,SURES

The long-term p:rogram.me oan be assisted by UNKRA and would. be imposs i ble of fulfilment wi t bout t r.at heJ.p, but it should essentially be a gover:unent l,Jrogramme and not one pressed forward independently by an euts~de agency. T~e basis of it lies in some rearrangement of government orga,nisation anC: particularly in e s t ab], ishment of terms of serv':i,ce for staff whioh shall continue after the end of inter­national aid , measures which oan only be qarrie d out by Government itself t hough t he Agency qan stand by to ~dvise and heip in them~ The ones which appear to be necessary a,re d\;?tailed below.

Or ganisationa l measures, Th e ess entiaJ, po~nt of ~eform of or ganisation i s to ~nsure direct oor,11nunioation on technica l matters between t he Min:i,str y of Health and al;I, government medio 3.J. staff in the provinoes. All healtl:l work in th E:l provinpes should be under tµ e control of a med,ioal officer specifica l ly tre.ined in public healthl t ephnioally responsible t o t he Ministry ~f Heal t h , and pref er ably be t he t ask of ~ Burea_u of Health in the provinoial government. Hi s appointment should b e di reotly controll ed by the Mi ni s 1;: J'.ly of Beal t h and he shou], d be gt ven adequate emoli.unents an~ security of tenure. It i s desirable that other t echnica l officers working for government in the provinces should also be directly em:p;Loyed by the Minis try as members of a permanent staf f seconded to t he provinces. The Minist~y of Heal t h should mai nt a in direot control over thEl NqtionaJ.. Laboratories, a.n epidemic control. service, and of t he teac hing hospitals a tta cµe d t o medical colleges, associa ting it s p~ot6type schemes wi th t~em, It should further encour age t he attainment of high standards of health work by pr qvincial governments, pref erably by a system ©f matcning grants tG a pprqve d schemes .

To ac hieve t h ese and to remedy ether weaknesse s it is recommended i n the text ef Par t II t ha.t the fol l.owing organisat;ional changes 13hould be made:-

(1) Th e creation of the post in t he Hinis try of Health, below the Minist er and Vice-Minister, of Chief M'.edioal Offic er, the holder being res ponsible f o~ all executive action subj ect to the pol.icy of the Minist er.

(2) The cr eation in t he Ministry of a Bµre au of International Health ,

(3) The unif io~tion of su?piy mechanisms of all types in the Bure~u of Pharnace~tical Affairs 9 i n a section headed QY a specialist Su~plies Officer,

..

- 13 -

(4) The creation ol' n. cen Lrnlly ernploJ ed cadre of' heal th officers, public hen1th 1, ~::-ses and sani t arians for secondr.1ent to provincial appointments.

(5) The creation of an Inspectorate of Factories and Mines in the Linistry of ColiiL1erce . ·

16 : T:1:le creation of a Bureau of Health at provincial level, in Secu:'.. 1 and possibly in the larg-er cities, i n dir6ct communication wi th .,he Minis t ry of Heal tp.

(7) The appointment of a f ully trained Health Officer, eraployed by central Governmeni:,, to each province and to Seo -1, and ~hE · appointment of Assistant Health Officers under them.

(8) The placing of teaching hospitals, as dis cinct from the Colleges with which they are associated , under the Minister of Healt h and the creation of cen tral and local liaison systems to

ensure coordination between the t wo 1/Jinis tries involyed in medical education.

(9) The creat ion of a Medical Council to con trol standards of medical education, and t he revival of the Nursing Affairs Co.mr.ri.ttee.

Financial Measures. Budgetary syst6ms and +nethods of financing need overhai..l t.o ensure a re asonable allocation cf funds to health, and control by ,..,he Ministry of policy and standards Lhroughout the country. I t is proposed in i:,he text of Part II that :-

(1) Budgets should be reviewed with t he object of allocating ~he following rrdni~un proportions of income from taxation t o heaith ran tters : Central Government 5 ,per cent, provincial governr,.ent 10 per cent, IDll..£ and other local authoricies 1~ per cent. With the object of attaining a eqvernmental expenditure on all health work of' about 15 r.dllion dollar equivalents.

(2) Gen eral Government support to provincial governments should be in the form of payment of salnries of key techntce.l staff and raa tchinf er an t s for npproved schemes.

(3) Overhaul of the accountin~ sys t.es of hospi tals and other institutions, including provision for accounting for the cost of all aid supplies.

Revision of terms_ of_service .i... and_rne chocls of _rnintmemt of _staff. 'l'he establishment of sound conditions of appoincment, followed by reasonable emolument and security of tenure is much needed. It is suggested tha t all senior appointments should be made by the Minister and after advertisement; in t.he case of senior hospital officers a preliminary recomr:iendation sho~ld be made by a medical co.mr.ri. ttee and passed through provincial governrnen v for co.r.i.uent . The . terras of appoin i:,ment should apply to all gr ades of t echnical staff including sanitarians and sho uld include freedon from cransf'er to non- vechnical appointments except on request. Salary scales are not here recommended , bit t hey should be such as to enable ,.he holders to maintain themselves and their families in suitable circwnstances without additional support, and should be higher for heal t ~ officers than fer other grades in the service of the ~linistry of Health.

Esta9gsh~nt_of ~-Ij~lth_Q_nit syst~. Revision of the public healch dispensnry system into a health Unit system is advised •

•

..

- 14 -

The executive act i ons to this end would be:-

(1) Cr eation of a National Health Unit out s ide Seoul city .

(2 ) Th e i nvit a tion to t he oou:.1 try of a vis iting Realth Unit t eam , preferabl y as a unit fr om ~n e country now operating the syst em, nnd arrangement for it t o operate the National Unit on a matc hi ~g basi s wi th Korean staff.

(3) Survey of the country to decide the location of units so that each could be made r es ponsible for t he care of some 50, 000 t o 70 , 000 peopl e .

(4) Establishment of prototype Health Units in eRch province, utilising the Rural Hygi ene Institut e at Kaejon and t be National Hospit al at Onyang as nuclei in t heir respective provinces,

(5) TraininG of s t aff, incl uding d~ctors, health nurses 1

nur$e-mi.dwives , and s anitarians :i;n the national a'1.d prototype un;tt 1? , and t he;i.:r sub13equent pesting to public health dispens:1ries to· oonvert t hem into Hcci.l t h Uni t s . · ,-,,

( 6) Expansion of 'the f unotion_s of ;1i s pensarie s so sta ff,¢d .• , . ,

Re-estaqlishment of medi oe.l, . dental 1 nur$ing and pharr-ia6y - educatiQn. The ultima t e fo r m of ,medical educat ion whioh i s forese en does not l

·greatly di f fe~ f r om t ha t whi ch_ pr evious l y exist ed and has been dislocated by w~r. Modi f i~a ti~~s sugges t ~d include t h e re f orm of t he curriculum fr om wi t hin aft er staf fs h::1. ve been given t he opportunity to s ee the syst ems used elsewhere; the enla r gement and r adio:1.l :improvement of teaching hospit a},s ::i.nd 7 in part i cular, t he immedia t e provision of more hospital accommodation for Seoul Na tional Unive r sity Medical College, t he ~bsorption of Seoul Women's Coll ege i nto Seoul Nati onal Uni versity Medicil C•llege, and consideration of th~ nee d to initiat e a medic a l college at ~ne of the universities , now without one, The programme is considerabl e but i s ' ~radticable within a limited term and could be one of the most r eward\ng forms of r econstruction,

Tl:, e oxecuti vc st eps ad~ised are: -

(1) Th e urgent r eopeninc bf Seoul and Kyung Puk University Medica l Col leges and r elease of their staffs from military service, foll.owed by t he r eo::ening of Ewhc\ Medic al College ,rn d. t he offer of incorp~ra tion ci Se oul Women' s Medical College in tho Pnivcrsity Me dical Col lege , with an agre eme~t on the adequate admi s sion of v: ori:ien.

(2) Survey of t he structures, s ervices, fittings, equipment, ma teria l s and libr aries of all medicRl, dent a l and pharmacy eolleges recognised as suc h in June 1950, complete restora tion in aocordance with t he s urvey but wi th modif ica tion of ward systems to a pre­dominant public ward type . Simil~r r estoration of hursing schools approved on grounds o: t heir 1:>ast standards and the hospital faciliti es open to them.

0 ) Construction of a new teaching hdspital 1 or expans ion of an exi s ting one , in Seoul t o provide a t least an additional 200 teac hing beds .

(4 ) Invita t i on t o a comple t e visiting hospit al team, physicians. surgeo:c1s , obs t etr i cians , nurses, tec hnicians, auxiliat'y , admin­istrative and par a - medic al s t a ff to cooper at e in the work of tho tea ching hospita l s ass ocia t ed with Seoul Medical College, participat r fully in medical edu3ation and operat e a ma j or nursing school. It is prefer abl e t hat this should be a compl e te team arrivir:g as an

i

- 15 -

inteerated group , an d. the Sc ::mdinavi :m co untries who hnvo off ered n 2. t0 r i :.::.l h e l p of t his type w.ight be invited to consider organising re. Sho uld t h i s b o i apossible the feas ibility of ar:ranging independent ~edica l 1 surgicul, obstetric ~l, nurse training and nd~inistrntiye den onstrntion te aliis should be reviewed.

(5) Th ~ c,ppointment of v:i,siting nursing instructors to Chun H.7.n o.n d I(yung Puk Mo dicn l Collc~e.s.

(6 ) Enl argo~ent of a provincinl hospit a l near one of the universities o.nd not n,ow associ2,tad with n uedic rd collegu a.s a. prel:i,n inary step tow~rd,:; O_i?e;r.ip.g a. new college ,

(7) I r.1ple::1ento.t:i,.on of fellows .d.p , equipH 0 nt e .. nd l:i,bra},"y r e cor:m enda tions [\lren.ciy made above.

(8 ) The org~nis~tion of the following a ctivities in close connection with uedical college s ; c.. c 0i;1bLicd do1;i:i,.cil:i,.c-ry and hospit e,;.l nw .. t ern;i.ty servi ce; tu'J erculosis con trol and tre a t ment centr8; and venore o.1 dise:.:\se s c e ntre,

( 9 ) Ji. t D. l a t e stage in reco:r..struction D, v:'..siting thorc. cic surgery dc uons trc. tio n te ~.n sho uld be i :1vitod to wor k in Seo-ql Medic a l College ,

Ro-est nblishuen t nnd refor;,.1 of hosp;i.t a l syste ::Hs. ThG 6·encJral _policy ii1 r og[,.J;'d to h ospitals is dis cussed in ChD.pter V of Po.rt II. It i nvolves:-

(1) A surv ey of hospitals with particulcr referc~ce to the needs m1d popula t;i.on of the areas t hey serve. On the b o.sis of t his survey, for u ul0.t:i,.on of c:-, progran1:ie of hosp:it ..:l reconstruction c.md enl.:i.r e;erilont.

(2) Physica ;l. survey followed by reconstruction of approvud provinci::.l h ospit :-:.l s , ~:ith r.iod.ifico.t:i,.on of s tructur e to pr ovide la;r-ger wards , i np,roved st :df quarter s , and ,uat'3rnity, paedio.tric, and tuberculosi s se ctions , a n d for t ub erculosis and venereal diseases clinics .

(3) PrE,)pa r o. tion of st o.~1do.rd E! qui, pment ;Lis ts 1 c.m d. i:lventories of a ctua l e ~uipment in hnnd , deficits being made u p .

( 4) Revision of t :1e s;;rste:,1 of adr.d sq ion of t he indicen t, by the tra i ning and appo i n t cent of hos pital a l mone r s .

(5) Tho other me :.isur es of st ,:i.ff v.ppointinents, revision of terns of s e rvice , nurs e tra i n i ng , and supply h a.VG already b een recQ,.llilended o.bove .

Re constitution of priv a te pr a ctice. The muin ueasures for supply and liter a t ure h(lV 8 ~:i.reo.dy b e en advised a bove . Lny additional ste_ps possible should be t o.ke n ~o reinforce practice and to strengthe~ t he inf luenc e of th e Me d;i..ca l, Dent a l and Nursing .Associations po.rticulnrly in s ci0:1tific Lmtters.

Re c onstitution of l o.bora tor y services, The two Na tional Labo.)'.'atorie . were and co uld b0 t lrn keyqto ~e of epidc i-:iic and endea :i,.c d~seaso prevent:j..on and ur gentJ,y need r es tora tion to t his position. ln r.1aking t h is reconstruction,the possibi1,ity of their ultimately being fused to constitu tu t ho nucleus of a School of Hygiene on the periphery of Seoul shoqld constuntly Pe borne in mindt The ex0cutive steps advise d n.re;-

-~-----~--... - . ·-- .. --~ - .... - -

- 16 -

(1) Physio ~l survey of structures, services, fittings and equipDent us for @edic~l colleges , end r es tor a tion on the basis of t his surv ey , par ticular emphasis b eing 1£\.id on the urge3:+t r es t or ation o±~ f .:: cilit;i.. 3s for vaccine produ ction.

(2) Appointwent of n vi~iting en~oLlologica l tean consisting of an entowologist and nssistunt entou ologist, virologist and tecb.ni oi o.n to fora n deoonst~ntion ip.se ot .,-borne disea ses uni~ i n t he b 2.ct clriologi cc.1.l l nboratory~

(3) r :.1pl eiJent o. t ion oi' the f ellowshi p , equip:::wnt and supply ,re c onue:1dat ions alrec,dy 1-:10.de .

Est ablishnent of a odel i~sti t utions , sugg'es t ed :-

The follow~ng a ctions a.re

(1) Incorporation. of th e Nc. t:i,onal Venereul Diseases Centre in the University of Seoul Medi c e.l Colleg0 o.f ter t he teaching hospitals h ~..v e been placed under th e Mi n i s tr y of Health.

(2) Th e provision of s pe cia l assistan ce to t he National Lepr osarium wi t h t he object of ensuring r,r oper s t andards of admission of inf e ctiv e c a ses; u~equa t e cas~ rec or d systews; syste.;i.ati c ::ind scientificully coptroiled tr eo.t:.1Emt; a grioultur::tl or other occupation ;for t hose inr.1c. t es abl e to underto.ke it; pr.aper isol,at i on of i nf ants a ~1d un inf e ct ed c hildren f;r-om cases ; and dischar ge of non-infectiv e ca ses.

(3 ) The early r cleo.se of Inchon Tuberculosis Sanatoriwn, its complet e r es tor ,:>.tion and subsequent suppor t .

(4) L:1ple:wn t c.::.t ion of the pr evio·1rn pr opo oe.l s on for r.1ation of r..iodel HeL.l,th Uni ts .

I 1:1prove z.10n t of ,mt er supplie s in qur,.ntit y and rrnality. Schemes ne ed developnont ;for both r -qr al and \1rban l;iUpplies , t he fOJ;'~ler based on r roduction o~ sto.ndnrd d0sign 13 and subsidi.s0-d supply of ac.t erials and f.i,ttine;s , t he l atter on surv ey followed by ~geJJ.ent an d i ~pr oveuont, Thu exe cu tiv8 oe ~sures advis e d a;r- c; -

(1) 11.n engineer ;Lng survey of all urban supplies r-.s regwq.s souroo , colL~otion and pur i :t' ioa.tion syste;:is , and distribution sys t e:·:is , and i n r esp e ct of c..deqm•.cy and quo.].ity •

(2) Pr8paration of det.:a.i:)..e d plc.:.ns for the improveuent of all to ensure n. n ini1J.uu1 supply of 20 gallons of wholes ome water per h~a d per dny to all users .

(3) ;.lloca tion of prioritius fo r impl u1i1Emt n t ion of these pl8.ns on a 25 - yoar sohe ;:1e 1 .:1nd oor.1::1encen1 er.. t of construction vJOrk on that s che r.10 ,

L;,.TE ME_.S URES

The r.1easur0s a lready sugges t ed are int en de d for implementation during t he perioo. of r e construction , here defined. ns b e ing about · IJ.ve years • By thn t t ir10 t he Korean Goverm;1ent should h e.we t aken over o.11 t ho wor k W1.d it is ho ped t hat it would be .:a.b], e to maintain it without int crnatiqnal he lp. There are , h owever, s one neasures whi c h are ne cessarily ext remely s;t.ow or prolonged and for the co;.npletion of whi ch continuing rna t eriCll a i d coul d b e offered. Those for eseen as coning w:i,thin t hi<,3 c o.to gory are t he cons truction of a School of Hygi ene , continuo..tion of vmt erworks c9nstructiqn and sanitary i r.1proyeqent, and feJ.lowship prograr;m1e E; 1

Ul'ilffiA ACTlVITEi;S

'J.'he general activities of UHKRA would. lie i...'1 the support , and. in some cases in the execution of the r ecommend8 tions a lready rna d.c for i nrrned.inte , long-term [(nd late nee,rmr es . This s ec,tio:q is concerneo. i n the physica l activities necessary f or that suprort.

Visiting stuff inte r nat i o~,lly r ecruited, During the interim pe riod befo're UNKilA a sswnes full r esponsibil;i.ty for interna."j:;iom::.. l assis t o.noe som.J of tlw heal t h norkers pr,esently seconded. t o UNCACK inay cont inu,e, Hmvevcr, wl'wn the tir:1e comes t o impl(:;1neut the r ccommrncl2, tions in this re:pcrt the sui t r.b;i.lity of a.JJ. s t r, f f should be c:x:a1;,ined ce-refully t o e11surc t hat they c.r e t horoughly compet,mt t o unde rtake t he responsibilities t.mvi sagc:;d. The pr esent II field" hcr.~l t h teams would continue u ntil they arc n ~pl 8.ced by th(:: visi til18 e.ss ista nce recomm,md.cd, or until the Kor en.n gov·,;:rnrn::nt orgnnization cn.n opernt e ~:ithout their a i cl ; both f'o n ;10 of c.ssis t rnc e vrould be g r adua lly climi nislle;(l r.,nd ulti10cri t .::.:1y Pithd;t'2,,n1 by tlw end of the r econstruction re r i od, t hough thd t i ming cennot be fo r etold. The staff ,.'o;r-ki ng a t the centre, prest'.1-:-n b].y in the ,Minintr,y of Health, woul d g r r.duc",ll y increr ... sc by r ec.s on of: -

( 1) The tr~'..nsf.::: r of p,1r:i,phcra l furictions t o the cc;ntre a s loca ~ ~ss i stance b ec ome s l e ss ne eded .

(2 ) Att2.chuent of specific trn.ining unit s for wpich ther e is no present equivo.l cnt.

( 3) The !1.t tD.chc:1(; n t of s11cci:;_l i s t 1c.a.vis c rs , ,·or :;:;t.ng with th Government but on t he ~ta.ff of UNiill.A .

( 4_) The bringing of ;::1edica l supplies , ,or k s pi.:l cifipa lly under the Mini s tcy of rh::2.l th a nd 11ot as part o :i: a gcneml Govcrnmc~t supply s ection o.s a t present, ::m d

( 5) The enla r g er;1e:?1t of i:;ho :pr es ent engineering ::; cction, due t o !increa se of tndning func tions, ad.di tion of specific w,~t eITrorks survey ~ct ions, a nd th,e 1-+ndcrt::i.ki:ig oi' e.,ll construc t;i,ona], eng incer;i.ng design requ,i:r;cd for t h e hea l th s e it"Viccs,

tt the end of t pc pc11iod 2..11 staff would be c entml, or working in c entrally con:trol l ca proj ects, a na. t :-1c fo llowing schedule is b c:. sc:d on ul t i r!l:'\. tc f or r.i: -

Chief Medica l Officer t o ill!XHA , r-1-10 will a ],s o be chief a.dvisl,r to thc Ministry ot Heal th.

hiedic[tl Off'ice::r: s·~ssista nt to n.bovo . lfodica l O ;fficcrs of Hct.l t h ;

?iledicnl O ffi ccrs:

I,1or ass ist,.mce t o pr ovinces and l a rge citi es: UJ? to 12 ;:1ight be recrui t ec1 if obt t.:. i nabl0, 12 t 0r pr ot: rcss ively reduc ed in numbers , 1 su11ervising parasitic discns es cn.mpaign. 1 in ch'l r g o of si:.ni t a r,iaru::; 1 tra:i,ning, 1 spcci::cl is t a clv;i.ser 011 tuberculosis, 1 s pcc:i.c1 lis t advisor on r:JD. t 0rni i;;y 2,.nd

chilrl ucl farc. 1 s yiec i nlist ndviscr on l eprosy. rrovincin.:J .. P.nd gcn,.ral dutios officers origina l l y· 12 , l r ter progr,:;;soivcly r educed in num,bc r s.

Aclviser on institution ancl hospitQl m:-m.agcment~

Chief Nurse: Nursing Instructor$: 10 :Pr ovincia l nursing advisers.

2 nurs~ tutors for Chun Nam rmd K,Yung P.lk Colleges .

Chief S D.nitnria n : Sanitarians:

... 18 -

2 for sanitarin_~s' training school. 2 for pnr a sitic diseases t ean. Pr ovincial o.nd gen er .'.l.l duties sanitarians, ~rigi~ully lO, l a ter ~rogressively reduced in num.~ers .

I

\ Chief Sc:.nit ary Eng:i.necr: fil Sru.1.;i.tary Eng:i,neers: 1 i n ch ge of wat er works tra.:..ning school

o.nd :-:iai t enanc e tr o.. i:!:l;ir.g. 1 speci is t i p char ge water survey.

Engine er:L"lg In.s tructors: 2 for wo.iervJOr ks tr1:,i r.. i ng and for r.iain­

Dr nwi n g Off io o 2, Survey St aff , eto .:

'l'e::iporo.ry Staf f :

Supply Officer Storekeepers ;

Ter.1porary St Gff:

t ennnce tr :..~ ining . \ \

Not ppe cifi.ed . I I

'l'he s9rv;i.coe, of sev0r ::-..l s pecialists wi th knowledge of \ 'b uilding , electric::.l i ns t :..t],­l a tions, wat~r ;::,i'ld heo.ting installat ion w9uld be nae d'e_d .

1 for headquarters stores. 1 for pi• ovincia l wor 1: 1 inven tories, ch ec}:ing and tr c.:l..n ing . The se~vice s of specialists ~n l abora tory fittings o.nd SU f,p ly, and hospito.l fittings and s v.pply would prob o.bly b e needed at first. '

I nvi t nt ion of dev.1onstrntiun t en:.1s and 13peciali sts.

(1) Combine d demon,s tra tion t e e.m . ;·, ·. ajo:r- team comprising a full sta ;ff of r hysic i ans I s ur g1q ons I obst e tricians , nurses, ndmiui strato: and auxiliary and par a ... medic:1.l st o.:t'f for wo:rk ir+ $eoul 11edica l College Hospita l,

(2) Hea;t.th Uni t t ean . .1 :;ied;icnl off icer , public health nurse, midwives i3.nd sanito.ria.1J.s.

(3) Tub e;c cu],o s is t ec:u-.1, Compos i tion to b e s pecified. by WHO.

(4) Reho.bilitat ion t ean . Originally represented by ap orthopaedic surgeon who would s ve cify t he spe cialisms to be r epr esented,

(5) I nse ct-bo:,;-ne disen.se s investigation t ea.1,1 . Entou ologist, assistant enton olocist, virologist and a technici~n.

(6 ) Thor a cic surgery t e a ,:i. . This t eam would be r equired late in t he progra:-1m,e xo.d is not here s p e cif ied in detai l .

(7) Medica l libr o.rinn . To b o i nvit ed ,1.s early as possible.

Provis ion of f e llowshi ps . Th e det ail of this .r:;rogramme has a lr eady b een spe cif:i,ed . It amounts to J,68 fellowshi ps in fiv e years.

Su pply. The normal s u pp~y needs ~xcluding special re~equi pment of l nb orr,t ories , :.iedioc..l colleges and hos 9ita l s i s esti[4.::i.ted a t init iall y 25 por cunt gr ea t er thru1 the present o~e , Library supply i s de t a iled undor l :nmcdi o.t e Meo.sur es •

. .

. -- -------

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Survey nnd rocons t.cnction of institutio~. This includes t he f:11~ reetorat ion o f .::. tructuros , services , fittings, e t.{ u. ipment and origina l s toc k of expendi ble supplies of the i n s titutions listed below in order 0£ priority.

(1 ~ Th e Me dica l Colleges and asso cia t ed hoepita l s of Seoul, Chun Na,.1 cc::id Kyung Pu~c Hat;i.on '.ll Universities .

(2 ) Th e Dent ·:-..1 and Phc,ruacy Colle e;e s of .Se oul N-'.1. tiona l University .

(3) The Nn.tion, ,l La.borc.tory for the Prevention of Infect ious Disel:',ses.

( 4) The National Chen istry Lnb 0r o.tor y .

(?) Th o .N c, tional Public Hee.1th Centr e in Seoul.

(6) Sever c:mce cind Ewha Me dic ::'.l Colleges . Tho reconstruction of Seoul Women's M0dic~l College b e i n g depe~dent on ~olicy .

(7 ) Inch on Red C:r;1oss ] ospit '.l l and S e oul Red Cro!:,s Hos pi t .:.:.1.

(8) '.['ongno.e Rehabilit a t;i.on Centr e .

( 9 ) Proyi n cia l hospitals e,pp~·oved after survey and re gro.di ng .

(10) Nursing s chools r e cogni sed as such at t ho start of the war and c onsidered sui t able for r econstruct i on .

Construction of n ow b uil,dings , or conver s ion. Provision of a n Gxtra 200 b ed cc.pacity in c..sso c L ~tion ,Ti th S eoul Uniyersity Medicnl College, in a no w b u:i., J.,ding on t he origiµ c. l s ite , by ne1: c ons truction elsewhere or by convepsion of t he Isolat i oµ Hos pita l.

Enlc,r g cuent of nurse tnd r,upil-nurs e a ccoru:iodation , and of the School of Nur s :i,.ng c.t Se oul to provide o. No.t i onal S ch ool 8f Nursing .

Building s for a National He,~lth Uni t 1 and prototype uni ts in each pr ovin o0 , to s pe cific :; tion previous l y discuss ed with ano t her g ov er nmen t in !1sia operating t h is n e ohunism,

Extension of _p rovincia l hospi t a l s ap,r ove d for the purpose to _provid0 se parate maternity sections , a1~d, a ccolUL'iodn tion for t uberculosis and v enereal diseases c~inics where it is neces s ary .

Provision of trans port. Gurb uge clearanc G and c esspit clearance trucks 1 90 per cent of r equirer,ient s ;for 2 ·.? ilillion pe opl e .

:.mbule.nces - one for eo.ch provip_c0 a nd Em jor city.

Ho bile clinics - or:i,ginC1.lly t vrn , possi b ly incr0ased l a ter to t en .

All of t hese with 5 year s tock of sp~~ es ,

Wat e r works expansion . 1'hc sca le of s u pply and support for t llis prograruue vrill b e co:1siderable but c a nnot b e even roughly estiL1ated unt i l specia l surv ey hns b ee n made .

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C H A P T E R I

O"RG\NIS l\.'l1I01'if AND Aff1TNISTR11'l'IO!{ ---0:F' THE HEALTH s.;mVICES

The efficient execution of tha work which comprises the health service of a country demands the closest collcboration between central and local govern~ent on the one hand, and voluntary agencies en t he other. T:w de gre e of · such oollabora"!:;ion varies beb:een individual countries but t here can be no do~bt t hat the best results follo w a close a s s ociation betw0en these two.

Modern healt h work has beoo~o so co~tly tha t it is ne longer possible t o expe ct vol untary agencies to bear a considerable part of iti but nevert i ele s s t he personal voluntary s ervices of individu~ls a nd associations can b e of t h e grea test value in t he ope:;.~ation of healtl1 schemes on a nation':Ll scal e.

THB GOV:1i;HN~-1ENT EE.AT,'113 SER1!ICES

As in most othe r countries t~ese ~ervioes in Korea a re administered at t hr ee levels - at the centre i n t he Mi~i stry of Heal th of the Nat ione.l Goverm;1ert 9 in t he Provino os and ln Seoul by the Bureaux of Social Affairs and locally by t :o. e shis 1 ) or ~E!?.,• ( 2)

During the Japanese regime, whi ch lasted from 1910 to 1945, public health was~ function of t h e Bureau of Police to which was at t ached a s eparate section on s anit a tion to deal with public health problems. Institutions such as the Serum ~anufo.cturing Institute at Seou). ( t he present; National LG.boratory for t l e Prevention of Infectious Diseases) 5 t 11e Seoul Hospital 9 the I mper:i,al University of Seoul, asylums for t h e deaf and t he biind i and a leper hospital, were under ~he direct control of t he Governor General, whiie qt t he provincia l l evel a. s anitary- bureau wo.s att3,.ched to t he provincial police division 1 and the work wao extended to t he local level th~ough t j e county polio & bureau.

The American Military Government, whi ch J,.asted from September 1945 to May 19L~7, changed, the system of public health administrat:j.on by abol~shing t he health functions of the Bureau of Police and subs tituting a Bureau of Health ■ Shortly after wards welfare functions were added ~o t he Bureau of Hea lt~ and t he design~tion al tered to the Bureau of Heal t h and Welf::i.re. A Departr:ient of Public Hec>,l t h and v'!elfa r e was establ ished in ea.oh province corresponding to t he org-'.lnisa tional e.rrn.nger:-ient a t the qentre . A qhange :i,.i-i designation was subsequently effected 1 changing the term bureau at the centr e into a depa rtment~ and t he departcents in the pvovinces to bureaux. The supervision and control of t he national institutions whi ch had b ~en a func tion of the Governor General was entrusted to the Department of Public Health and Welfare.

Following the Ame rio -1.n Milita ry Government an Interim Government was establ i s hed and lasted from ,June 1947 to August 1948. During

(1) shi:

(2) gun: the major division of a province, roughly but inaccurately transla t ed as •1oounty 11 •

.,

..

•

... 22 ..

t his period the Cen+.ra.1-. J,e;,e r t r,wnt of Publ:.c :realth a.'Yl d We lfare was cont inu ed b:1.t the rnm'cs :c oi' provincj_al b u:i:-eamc was r e duc0d from ten t o f i ve.

\vi ➔; h ti1P 2.stc.'::i..:..:! ·::hnen t of the G:.ve:rn.::1En t of -the Republic of Kore 2.. i 1 L1.1s"'.i. st j.SJ10, :;J1 e Jentrf'l TJq: -::tz,-t:·n0n t oi J:--ublic Hec:.llth and Wcl f ~r e wLs red~ ced to the stat us or a bur eau in the Ministry of Sociu ::'. il.ffs.i.1·8, f~f·;e r u. s :10r t pe:r ;;_od of oper cJ.t:i . .:in t his arr a n gemeµt was :i;cunr'l. u:':lsnt5.1:;f 2 ,·, tcr .f a11cl. a r.1.u.~t1c r of ·n1:::ci 1,~::. r:.ss o..::iations pe t it::.oncd t he i'J:- .tj_(, n c. l J..sscmb ly r t~r:.1u c tint~ ·:; i..: c"c" eation of a s e par""'te ML1istr~ o~' E~n.:l th. In Mr-"r e l1 19'+~• '.:: ·i-: P:·esid e n t 3.p_proved t he Bill pasAe d by cb e nene1·u.l .AE..a -3,.:tl;:,r c ·,ec.t i.;._g ,1 Ministr y of He a lth but no chcnges '.1er0 effected in t l11: p::-:: oviac:i.a'.1. ad1 .. inistratio11 wh ere publi. c '..1•.n:,lt r.. c 211; +im.:e d to be under t b. e jur isdic t ion of t he 1•1:inis ter of $J cLtl Affai:..'s.

The f::- -.1q-:J. e,}.t ch nnges in 'tht: -idrin:i_t,tr 1.,t i0:nal arrc1ngur.1ent undoub t eJ.ly cr·c ri:~e d .::wtny dif f i cuJ:t::Lcs , •.nd so:10 c:3.e;:;r e e of confus ion in t he n.inds cf Led:i. c c.l p er c op,s and the p;ibli c ~

:Ct wcu l,l~ aJpE::::i..r t ho.t cert cd.n public i.100.lth func tions c 9ntinued t o b e V' €lsted in the pol i c e d0 pe..r t me nt as wr·.s the cnse during the Ja~ane ~~ r e~:i,ee . In a 9~:J:.' -CE'.. i n E_Ei ( l ) t hat VJ[l.S v is;i..t ed t h e information was giv en b y the rhigon l 2 J that he was expec t ud t o r eport ca ses of oor:miuni,cable dis0~st o t h0 myun O) of fi c e as well a,.s dire ct],y to t he police • '11h:i,.L Wi,;i,S c 01-:-..:i:ir-nie7 -at £, p•.)lic e s tc.t i on whe r e ;it wa$ o'bserved t ho,t t h 1.:: r e was an e;p :i,,domic prev ention s ection i n t he police of fi ce . The t r ans:f er of healt h f u nctions fr-orc1 t he bureo.u o:l;' police t o th e nev,rl y creat ed M:j.n;is try of Health has n 0t been g iven ful l ef ;f ect.

Cl';lr t a.i n specif ic f unc;t :i.,o ns i n 11egard t o t he control of v enereal diseases a~ e a l so ves t e d i n t he pol i ce. This i s influenc e d b y the er:w r goncy c ondit ions o"j; t ho pr esent t i 11e , bt:. t it is nev ertheles s t o portant t hnt w~en c ondi tions re t urn t o nor mal t he c ontrol of the se diseases als~ shoul d be und ertak en as a pur e l y public h e a lth measure. Rl;;l ferenc e t o t b.:i,s is made in a s ub s e que n t chapt er dealing with t he v e~ereal di seases .

The change in t he s t a t us of t he h eal.t h service by the r eduction of the J;)~par t me nt of ;publ::i.c Healt h n.nd Welfa v e es t a bl:i.s{led during t h\';l Ju~er ;L cnn Mili t ~y Governnent to b~eau s t a tup under t h e Min;!.s ter of Socia l Af fai r s i n 191+8 r.iust b e regarde d as unf ortunat e . It is, h owever, t o t hi:; credit of the Gov ernment t hat i t quickly e s t ~blished a :r-iinis t !'y o:i;- Heo.lth when repr esen t ations we:re mado d el'.i.landing the creat iQn of such a Mini s t ry.

I n all of t he a dru;Lni s t rat i v G arr a:tgenents t hat exis t ed from the J a p an.;s e period to t :ne end of t he I nt er i m Gover m1en t t her e Wl;lr e pa r a lle l a dmini s tra t :i,v e orgun:i,sr, t i ons a t t h 8 c entr e and in the provin ces ensuring a continui t y o:t;' D.ction. I n ~he p:Vcse:n, t arr ange ­ment t her e i s no p ?-r a l lu l or gani sution o. t t he pt ovincial leve l, and in c ons e quence l i tt le benef ~t ca n a,.ccr ue f rom t he ner e creation of a N:i,nistry of Hel:l t h a t a N0-tiona ]. Gov er nment r1ev el. It s e e ms strc)..nge t hat the r;1edi cal ass ociat i ons which na.d made r ep:resenta tions f or t he creat ton of a c ~ntrul Mi n i s try of Health did not continue t o make r cpr esent rlt ions f or the necessary pr ovisi on of an efficien t public h ea lth or gn.ni satioµ, a, t t he provincial lovel. The eff e cts of

(1 )

(2)

(3)

';['he smal lest ad:1inistra t;iv 0 divis i on; roughly transln.t e d a s 1h •illnge_ n . I /

' : I

The headman of a r hi.

Th e next s mallest div:i,s i on , ro1..1- gh l y t:-ans l a t e d a s "pa,rish"•

.,,

I

- 23 -

a divided responsibility are r eflected in the rJUnner in which the hospital services are adLunistered in the country which is referred to in the chapt er on medical care.

In Lhe cabinet form of government which obtains in Keren it is inevitable tha e, the Minister of Health suffers from the handicaps, namely, that he is in charge of the most recently created Ministry and also that his Ministry is not in a pos:i,tion to implement effec­tively the health policy of the Government, for which funds are voted by the legislative assembly. One wonders whether Ghe very low allo­cation of funds for healt h work, am~unting to less than one per cent of the entire budget, is influenced by these factors.

The Minister and the Vice-Minister function as head and deputy pead respectively of the Ministry. As these posts are political appoint­ments they cannot be held for any length of time like technical posts held by officers in the public service. Consequently a sound long-term prograr,1ITle of healt~ work is more difficult of realisation.

There is, furthermore, a lack of coordination of the work of the bureaux of tµe ~J.nistry, Adr.ri.nistra tions attempt to overcome these shorccomings in different yays. In most English-.speakin~ countries there is besides the Minister and the Vice-Minister, eenerally known as the Parliamentary Secretary, a technical head of the department who is in. charge of all sections or bure~ux and is not liable to change on political grounds. The designations applied to such an officer are director~general, d,irector, 9-eputy minister, surgeon­general and chief medical officer. The title which bes L indicates the functions of such an officer is director-general or director of health services. Besides coordinating the work of the various bureaux such an officer functions as chief technical adviser to t. he Ministry.

Another procedure whicp aims at similar results is the appoint­ment as Vice-Mj_.nister of a senior qualified technical officer who i: not affected by political changes. Such an arrangement exists i n the Philippines and may be r;1ore suited to the conditions prevailing in this country.

In view of the increasing importance of international health work it is desirable that a separate Bureau for International Health and ~uaran~ine should be created in the Ministry of Health. Korea is already a meP1ber of WHO apd of its Western Pacific Region and it is more than likely tba c for a nwnber of years to come there will be close association between the government of the Rep~blic of Korea and other in t ernational agencies within the field of health.

A system of comple Le central &dninistration is as undesirable as a systeP1 of complete autonomy. Long- ~erm results in the fields of maternity and child welfare, health education, environmental sani­tation and epidemic control are dependent on local responsibility devolved from the centre through an appropriate IJJ&chinery .

For purposes of administration the cocID t:.ry is divided into nine provinces and one special city (Seoul) which has the status of a province. Each province is in charee of a Governor who is appointed by the President and is assisted by a Provi~cial Council elected by Lhe people. In the provinces there are a number of bureaux through which the various subject s are dealth with. Generally, bureaux are established for Home Affairs, police, Agriculture and Industry, and Social Affair.s. Health is the function of a section under che last named bureau.

In the Section of Health there are subsections which qeal generally with medical administration, epidemic control, sanitation and pharmaceuticals. It is more the rule tnan the excep~ion that

.,

- 24 -

ther e i s only one medical man in t he whole provincial organisation, and i n one province he adminis t ers 4 hospi ,.;als, 63 dispensaries and 2 l 6prosaria in aqdi t icn to directing public health activities such as sani ta~ion, epidemic disease control, BGG vaccination and health education.

The provinces are di vid';;d in co ci !.:.ies calle:l. §!gs and counties cal led &uns. There ar e 19 ~~ and 134 counties or gun~. The g);:Ils are f urther divided into !!E~ and Il\Yuns. A shi has a pop~lation over 50,000, an~ a population over 20,000 and a ill¥~ a population l ess than 20,000. There are 75 UES and 1,449 &.,U!l~•

Tqe application of t he English term 11 county11 to a gun is misleading as Ghe fil!,D, unlike a count y, has no elected representatives. A ~hi, a ~l!:!E and.!¾£ have a Mayor or chief and an elected Council~ In the case of a gUB,, qcwever, thene is only a gun chief or gunsu appointed by t he Governor.

~ and~~ are subdivided i~to tongs which are also called rhis. In these ultimate subdivisions there are ~g chiefs or ~higons who are elected by tqe people but no elected council,

Taejon is an example of a~ and has a population of 120,000 exclusive of t he r efugee population which nl,mbers nearll 30,000. It has a Mapor and 22 Counciilors elected by the people. The Mayor is elected by the Councillors and 0he Vice-Mayor is appoin ted by the President on the recommendat ion of the Mayor and Provincial Governor. As in the case of uhe provincial adlTJi.nistration t here are a number of bureaµx. Those a t Taejon comprise Home Affairs, Industries, finance , Social Affairs, and Construct ion and Military Drafting. Heal t h ca~e under the Bureau cf Social Affairs, the Health Section of which had three divisions, Medical Adn'tj.nistration, Disease Prevention and Sanita t ion.

As alread7 stated, a gun has a S,Wl chief bu c no eldcted Council. In Unsong &~, which is one of tQe ten in vhe Province of Chung Chong Pukto and cover s t he areas of 9 ~~~ with a t oLal popu~ lation of about 100,000, there were two main divisions, Home Affairs fil\d Industry, under t he gun chief. He~lth ca.me und~r Home Affairs and had three divisions, Medicine and :Pharmaceut icals, Sanitation and Preventive Medicine. There is a total s t aff of ' 52 in this ~un, without even a t rained sanitary inspector in charge of health~ matters.

The administration of~~ and uEs is simil~. There is an e~ected Council and an eiected Mayor and health is a function of one of t he ~dministra cive divisions. No traine¢ p4blic health staff is availab;te in the ~, UE~ or €';}-lD§. and f requem;,ly not even in the shis which all have a population of more chan 50,000 persons. --.

Witp an organisation of t his kind at the provincial and local l evels it is imperative that the medical chiefs at Provincial Headquarters should be men of the highest calibre . At the present time none of t hem have had any Jrnblic health training; they command litt l e respect from the medicai profession and are more or l ess divorced from the Ministry of Health. These conditions are not conducive t o efficienc work and mus t be r emedied.

The creation of a bureau of f ublic Health at Lhe prov~ncial gover nment l evel wo1.,.ld be in accordance with all the previo:us practice and experience in the country. The medical ehief of the province should be t rained in public health and should belo~g co a t ransfer able service under ,.be Ministry of Heal th in ovder that some measur e of tmif9rmi ty ~y be secured in the ~ovk cf all the pvovinces . Such an arrangement would also provide a trainin~ ground f or medical administrators who may be r equired t o fill t he ~igher posts i n tne Ministry of ijealth at the centre .

,.

- 25 -

There is generally only one qualified medical officer in the provincial governmenc . In the province of Kyonggi-Do which had a pop4lation in the census of 1949 of 2,740,594 ~here is only one medical officer. The four divisions in the Section of Publia Health, namely Medical Adm.:i,.nistration, Epiderni'c Control, Sanitation and Phar­maceuticals, arc all in charge of laymen. This province adrninmsters four hospitals, 59 public health dispensaries and two l eprosaria.

In the capital city of Seoul which is of provincial status chere is onlr one medical officer in charge of the Preventive Medical Subsection in the Bureau of Social Affairs. In a large ~hi like Taejon the chief of the Puplic Health Section in l,he Bureau of Social Affairs is a layman and there is not a single qualified medical man in this administration. Dnder such conditions it is impossible to carry out any form of effective public health work, several qualified people being needed to carry such large rcspon~ sibilities.

At the gun or count~y ievcl conditions are no different. Public health is a funct:i,on of the Bureau of Home Affairs and all the staff engaged on public health work are laymen. In a new scheme for the developmen t. of public health work i c is desirable that the local health units which are recoPlfJlended in another seccion of this report should be vested wi t:.h as much responsibili ::-y as possible within t he framework of the general policies of the Ministry. Through such units a cooperative schefilf; of work involving the central government, the provincial governmept and the people in the fil:£~ could be successfully carried out. As the mosl., essential requiremen L is craincd personnel it is most advisable that the cen Lral government should create and maintain a cadre of t rained medical and, subsidiary pe:i;-sonnel, com­prising sanitary inspectors, public health nurses and nurse~midwives, from which recruits could be seconded to man the various units in the country wher e they wouil.d remain as central government employees. In such a scheme the officials would have a greai:,er secur:i. t y of service and would also have the opportunit~ of applying for posts in other ~~ or provinces, which wo uld be an inducement for greater effort. The central government could render :i.ts contrihl.,.tior. to the operation of health units by paying the salaries in full or in part of the trained pe~sonnel engaged.

VOLUNT.AR Y ASSOCIATIONS ---- ------~ The non~governmcntal associations concerned in the fi eld of

healtp are: the Korean Recl Cross Society; the Korean Women's Associ­ation; t he Korean Medical Association; the Korean Dental Association; the Korean Nursipg Association; the Korean Midwives' Association; and two others of much less significance to health: the Korean Yo uth Associations (of which there are two) and the Korean National As;,ociation (an association in which the membership is usually men and which is labelled as patriotic).

Ko;:~!!._Red Cros~iety. As might be expected, the financing of all Lhese organisations is at ,.,he moment a matter of extreme difficulty. The Korean Red Cross, which exis ts on volnntary contribt.:tions without support from the govern~ent, is going t hrough an extremely difficult period. Normally che Red Cross Society of a country which is involved in wartime oper&tions can rely upon contributions from Red Cross Socie r, ios in other coun ,_,ries, and on supplies arranged and shipped through the operat ion of the Committee of the Interna ~ional Red Cross in Geneva. In Korea a difficulc position exists b6cause all aid goods f~om abroad go into Civil Relief Supplies to Kvrea, which are distributed through t he Civil Assistance Command and t:.he Korean Governm~nt. Tho Korean Red Cross

I.

·------.: ··- ~ -...... ____ .,__ ___________ ,...... ____ ,... _____ _

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Society f ee l s t hat t his is a crippling arrangeoent. However, deprived of norriJ.al s ources of supply fron outside t he count:r y , the Red Cross Society by one Deans or ano t her does run hospitals and clinics ,. The Red Cross Hospit al in Seoul is a priue exarJpl e of wha t can pe done even under t hese difficulties. The Society owns what is p:i;-obab l y t he best tuberculosis s apato:i;-ium in t he c ountry, loca t ed sane 1:1iles south of Inchon. At t he moment this i nstitution, which i s virtual ly undano.g0d, is in t he hands o;f t he UN .A~a i Gs . The equipnont is daraaged but not entirely dep~eted except for non• specialis,1d Gqui~oent such as beds l blanket s , l inen , cut lery and t he like . Soi.ie spe cialiped equipment wh=¼ch incl udes u l aundry, one of the bes t s terilisers seen by t he t- i ssion in its t .o ur, and t he equip~ent of a good central kitchen , r emains i nt a ct. It is unders t9o d t hat t he Cai~ad;i.an RE/d Cross would. b~ will:i,.ng t o provide al], t he nec essar y equivm~nt and some, raaµi tenance supplies for t his hospital, prov~ded tha t it were set up t o deal with tub erculosis in chil dr en , This proposa,l~ whi ch we, b~lieve hue consider able Llerit, i s still under r eview by t he Korerui Red Cross Soc:i,ety.

'l'he r €/ ).a ti.onsh:i,ps between t he So ciety and t he K9recm Ar my are not entirely tho;se which prevail betwee.µ t heir anal ogu0s in other countries . The Kor0an Re d Cross do es very 1.itt1€/ pure rJ).edica l work but has done a, very c ons:i,.d.erable amount of wor k rn:1ong r efugees 2nd displ.a ced persons~ who pre~ent a v ery -;l.urge proq l en , It cla ims t hat so f ar it has ca~~d for about two raUiion refug~es. In addition , it does a l:i,.mit ed m:iount of we lf a,re work by p;i.~ovision of co2f orts ruid r ecreation in three Red Crosp HQspitals in t he ~eighbourhood of Pusa.µ.. Thtp fO Dainder of ;Lt o c1. ctivities a t t he moment ;i.s lini'j;etl to arousing inte:r~ s t c .. nongc~ t Kal'.' ean women t o he l p ;in, .refugee wor k ; wor k i n connection with Ar my hospitals ; th~ collection und di s tribut ion of extra fo ods in .A,r1;1y hospitals, and ocrt o.in ot her not well. defined welf nI'e activities . It cooperat es well wi th t he Kor ~an VJonien's Ass oci,ation witho1,1t signifiqc.nt overio.ppi nc .

It i s desirable to redefine t ho funct ions of t h~ Kore o.n Red C.:i;- oss Society so tha.t it mi ght p:j..ay t he ;fu::)..l part t hat Req. C-poss or ganisat:j.ons have pl ayed wi th s~ch s~gnificc.nt s1.+ccess in other c ountries ~ This wil]. :i,.nvolye a fresh es t ir:10.to of it s cnpac:t.t y anq. , it is t o be hoped , sone :vcvis i on of the pr esent pr ovisions in Kor ea concerning Int ernat i onal Red Cross charw,e l s or aid t hr ough t he Int ernational League of Red CDos s Societies .

The Korean VJ0v.1en 1 s Association. In LlO3t of t ho provinces visited by t he Mission o.p. or-,por t uni t y wns 11.'.}.de to int erview the locn.:;t. leaders of t he: Wononl s Associo.t io;p.. This , :;Like many other such associutions, hr,s been ost c.blish.:id by fl. ct of t he Nnt;i.ono.l Assem'Ql y , but d:j.d exist pefore the Act became ~aw . It w~s fir s t sto.rt od in 1919e By l aw the Asso o~nt i on is i ntimately conn~cted wit h the Wonen 1 s Burea,u of the Ministry of socia l Af f airs . The financing of the Women•s Association has be en subject to t he usual extr eme f'luqt~ations ~ At one tir:10 , i timediat.., ly before t ho war , t her e was o.n off icer i n char ~e of women ' s af f airs in ea ch gun a.11.d in s or1e places t her e were officers in charge of wo121on ' s ?-ff ,:d.J"S a t o, lower level in myunG nnd ups . For meply these office:r;-s wer e paid by t he Nat ?_onal Gov\3rr.1:1ent "t"B';r-oush t he Women I s Bur eau of t he Ministry of Socinl Affair s , However , t her e is n ow no budge t a,nd t he.se operations ar e di s cont inued except i.;,1so~~ as they oan fip.d ~upport by the local chapt ers of t he Ko;r ec..n Wo1.10 11, 1 s Ass ociation coni;;j,r:111.:Lng to pay an officer , nomino.lly of t he woril:n ' s Bur~nu ,_ ut iun ! ~ o;i:- ~ l evel as t ho case n~y be, Jf they do not find it possible t hen the officer s cc:mnot 1;:>e paid . Thesq per sonnel of t;he E:i,nistny of Social Aff aiv 13 are ~al.].ed insimupto:i;-s and are us ua.l.l y dcmnnstrgtors in the techniques of social work whiph can as s:Lst t he wol'.)le n of t he country.

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The objectives of the women's Associat ion of Korea o.re :

(a) t o raise the sta tus of women :j_n Korea ;

(o) to carr y out adult educ a tion , with part;i.cula r ref erence to wor.1en; this objective i n cluded health educ a tiot,1. of t he public in itc true sonse ;

( c) t o promo t e inprovei:;:wnt .i,n t he condition of women a t a ll l ev e l s of society .

Owing to the e c onomic and ;financial µifficulti es w1:iich hav e beset t he c ountry since the b egi nning of the y1ar and ev en before it, t he Women ' s Associa tion now finds itself virtual ly withoµt finnnce. A;ri und. February , 191~9 , t he Asso ciat:i,on was entitled to collect a bo ut 200 Non per fami l y; howuve,r it wa.s t hen, decr eed t hat though 40 Won could b~ r e t a i ned by t h0 Women's lurno c;i.o.tion , 8 0 Won had t o go t o -the Korean Youth /1.ssocintion , anq. 80 Won to t he Ko~ Nation.al Association . In 1949 the Kor ean wor:ie n Js ~ocia t:i,on held o. c onv ent:i,01~ at which i t was agreed t hat each member should pay 200 \'Jon with tho r ight of collecting 100 won !!lore fr on ot her f enale ne11ber s of t he fa;J.iJ_y , b4t t his vms not very su c cessful, and by 1952 v crj' little money had b een collected., '1';10 organisation has been ~rns t a i n~d t h~ ou.gh t hese econoo ic nn J fimmcia l viciss;i.. tudcs by c onsi derab].e s4bscript ;i.ons f,rora leadinG wome:1, in t he c ou n try, but the popition is r ;;:i.pi dly arising wher e t here -:.rill b e little or no funds ava ilable f r ot1 these vo~unt ~ry sources , Ma jor c onstructive work is no longor possible bcoaµse v e~"Y little E10n e y i s 11,v a,ilnble f or tro.ini nr, , and menb ers llavo very wisely dir e ct ed their a ttention t o small-.sc~1l e work in terus of c orJi;orts for Wftr v e t er ans and police .

The post-wa r pl ans o f th i s Asso ci,ntion c a n l;)e s ummar ised os follows;

I

(l) Adult educa tion f or wooen , i n clqding healt h education 6f t he public~ It is i10teworthy t h~t th e r epr esont a t;Lves of the Lsso c iat ion ure keenl y a wnr 1;: of t he ne cessity for co oper a ting centr.c.lly and l o c a ],.ly wi t h ey ery Gov ern:aent organisation c onc erned i n t h is oost i mpor t ant objec t iv~ , especially t he Mi nis try o~ Health, the Mini s try of .E;ducation and the Minis try of AgrioulturE/ .

(2) I mpr ovenent in the condition of the life of women , Th;Ls i s envisaged as a pr ogr ~moe of r a tionalisa tion of do~cs tic work, of cooper a tion acongs t housew:i,v e~ and t he gen eI' a l r aisine of the level of t he status of ~onen ,

(3 ) WidQsprond propaganda to ensure tha t t he women of Korea real ise what deuo cra cy ne ans to t hem .

( 4) The es t nblif;;hme:nt of t h;ree ;no.t iono.l b1•o.ncheEi ,- urban~ industr i o.l and ru~a l ... thqugh t his or d er does no t i nd,i Qate any r e l a tive i mportan ce; t he £ celinu; of t he Ko:re c.n ·vromen' s · Associr~tion i s thnt t he p!loblems of t hese t hr ~e groups ~e sufficiently sepa r a t e t o nerit separat e t;r- e o.t ment.

The Korean womep 1 s Asso ciation is a l ay organisation of considerable significance t o t he further ance of public health and it i s rec ommended t lw.t the 1Y1intstl;"y of Healt h make every possible use of t h is oriennisat ion particularly j,n ;i.t s J?rogr ammes of p.ea lth educa tion of t he public and, of occu pat ionnl health..

Asso cia t ed with t his n op.- gov ei;-nn:ien t a l or gani sation, and c o::1.E1ented on here f o:r r e a sons of convenien c e , is th e Women I s Bureau of t he Ministvy of Socia l Affairs. This is t he only ;;3u,rcau of t h'e Gov er nment whi c h c1e·a1s · with v1on~n• s a ffe.irs and c ons;i.st s o;f t wo sections, Wo;nen ' s Affai rs , and L:i.ving ]inprov ement. Th e latter

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appen.rs to be the only single foco.l point which i s conc erned with tho i u prove11cnt of living conditions in Korea as distinct fron iuprove­a ent of e c onomic condit i ons . The BureQu does some work in connection with child~en , f or instnnce it promotes and as f a r as possible within its linited budget finances th e ceremonies on the 5th May, which i s known o.s Children I s Day. It c onducts once cl- yeo.r a Vl9men' s Jnsti tut c on behal f of t he Women I s Associ~ltion, lasting Et week and for rurul l,eaders and ir~structors frou the pr ovinces. However, it is in danger of f a l l ing int o abeyo.nce beco.use o;f f inancial c on ditions under whicn th,3 Wor;wn ! o Bur E;au is findi:p.g it i mpossible t o pay local ins tructors ruid will now find it i r.lpossible to f i nance the a.nnua l Institute. It could, print us eful f,i;!Llphlots b u t for bµdgeto.ry difficulties ..

Th1;1 pos t-wo.r p lans of the Women ' s Bureal{ a!'(;) c onne cted wit,h:

(1) war widows a,nd orphans , pa;r-ticularly with r eference to housing and organised welfare ;

( 2 ) t he so- c a ll~cl war prostitutes, t heir rehabilitation and reinteg:ra tion into t ho co::n;~unity; and

(3) printing and pr opaganda .

There apponJ;'s t o be no conflict betwe,m th0 Wonen 's Bureau ot the Minis try Qf Social Affairs and the i{orcr:.n Wo;nen 1 s .\ssociation. To an outside;i:.~ it (:ppear s a t fir s t D.s t hough t he ;Korean Wome n I s Assoc i ation i s a 1'.'.le r ~ pas~ive a r n o;f Goverr...uent but on oloser enquiry it nppe a rs that they are not so rnu cJ1 1u0ster 2.nd servant as partne r s . We c onsid0r,howev0r, tha t t h~ r e should be closer liais on between the Ministry o f Health and the Women , s ,'.\.ssocintion and the Wom~n • s Bureau.

I n t he po.st, govcrnnent provided an. annq D .. 1 sun o;f lO, 000, 000 Won ~OJ;' t he Wooen's Bure o..u which wa s largely used t o enable the m to consult with the~ locnl orgnnisat i ons, Fo:r th e pr esent year the Women I s B-11:r eau is a tit horised. to provide t he 13a,mo budget but so far i s unable t o d o 9 o,

The activi:ties of th e '.(orean Medicnl, De.n,ta l, Nur r..; e,;i, ai+d Midwives' Lsso cia tions are des cribed in some de t a,il in Chapter v.

Re con::1endations :

1. A new techn;Lca.l , non-po;Liticnl, post o;f Chief Medi ca, l Officer should be cr ~c.t ed in the: Mini s try of He a lth , t o se cur e c ontinuity of technica l Ol;w r a t ion a.Did to coordin ate the work pf t he bureaux.

2. An o.ddition~l Bureau of International- Heal. th a nd Qlla ro.ntine should be created.

3. Bureau~ of Hea~th shoul d bo estab l ished in pr ovincia l government s , and pref er ably n.lso ; ir). t h e citie s and larger shia. l

4. A p er ~D.nent c s.dre of heQ.lth of;f ioers, public ,health nurses and sani t a ria.ns should b o er.1pl qyetl ; by the M;Lnistry of Health, for secondment to provincia l appointments.

5. Medic a l gr n.duates now e1:1pl oyed as Provincia l Health Offi 9ers i5hould be giy e n tra ining in public he0.+ t h , ~hose selected as suita ble b c ;Lng se~t abroad for t h~ purpose Qnd othe~s trn.ine~ loca .;Lly. ;;.11 such p os t s sho~:i..d eventually be fill,ed by central gov er:npent s tatf with a )?UQlj,o :henlth, t:r,a ining·.

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6. The qualified medica l staff of provincial health departments urgently needs increase, by appointment of assistants to the Provincial Health Officer~

The past of Hea:,J.th Officer should be a full-time one, no priva t e _pr a ctice being permitted to the holde;r. Eraolu1;ients shou:I.d be s uf fioien,t to attract and hold go od 1;ien, a.nd groater'than those paid t o ou,rative staff.

8. Organisation at t h? peripher.y nC:leds complete overhaul and r e cq;;1Stiti.::.tion . The reasons and proposed raechanis1:t are sQt out ~ Chapter II. The work of thQ Health Up.its there pl"oposecl should be on a cooperative basis between centra l gover nment, pr ovincial governments o.nd local authorit;i0s. Offices should p:r eferably bolong tq c1 trans fer nb ],.e s13rvice centrally ad1:iin$.stered.

9~ Cen,tral g9v ernr::1ent o.icJ to provinoiD. l o;rganisatio~'1. could u.sefully t ake the fo;rm of payment of whole or part so,;Laries of officers in a.pp;r-oved schemes , sµch payne;nts bQ:ing match~d by pr ovincio.l payment of other expenses.

10. !J.'he pr e s ent c.llooa.tj,on o;f funds for hoalth work in the na.t;i,onal pudget should be pr-ogressively inorea.sed to a t l e~s ~ 5 per cent of the tot al.

1+, Th e fi,mctions 1 oper v.tion , and i::ethod of supply of the Korean Red Cross Society $ho4ld be exo.i.;'.\i ned , and modifj,ca tions made to give ;Lt a great er fre c:doo of c:::.c tion a.nd ac cess to supplies than it now 0njoys.

12, He a l,th education wo:rk carried 01.1-t py the Kore :.n VJonwn , s Association and the B·1.1,reau of \7o.:nen I s Affa :i,r r-. in the di;nistry of Soci~l Affairs should be more activel y supported by the Minis try of Heuith.

l3. Re c ooni;mda tionG on the ad11i ni,s trc1t;i,on of hospita l s e:rviccs are incorpor a t ed in Chapt or v •

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CH APTER II

THE PUBLIC HEALTH DJ;SPENS.t.RY THE FUTURE HE.i.LTH UNIT

Th e pr esent locc. l exe cutive or gans o:f he :::lt h work are :.iany, including s rmit c.rio.ns e r,1pl oyed by pr ovi n ce s , cit ies , t own s , ~ e,nd s n nJ.,+er u1:it s _, c..nd 1;tl so t he p11blic he,:lth disrensury whi'ch 'hus ca r ried ou t u uch epi dewic control and i s int?ni.led t o provide prev entive per sonc:.l service by clini~ and do,J.ic;ilio.ry w:::irk. It i s our c onsidered opi n i on tho..t t l10 or ganisation s hould b e chc..nged by t he pr ogr essive developc ent of the s e dispensaries to c arry out :=1 J..J., ],oc ctl h oc.1th work 1 bo t h envirom"!~1:tc,l nnd pEH' G0;1c..l.. On full c onv -r sion they would c onstit ut e Hca ], th U;ni t s , a:-Ld t o 1;,pc,~d t heir oonv er ,s;i,on n qcle l Hertl~h Ul+its s ho ul,:'. be i.J.1$t:i,tut ed o.s soon as =4s feasible to act as pr o tµty p~s c..nd training c ontree ~

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Tho He e.1 t h Uµits i n a province wou],d eome under t he d,ir eot con trol of tho Pr ov i nci c,l He e.1th Officer and wou;l.d be linked to · the provi.J.1cic..l hospita ls, the vfho ],.~ orgm:.i 1sn c orn;; tituting t he normcl health sE::rv ice of t h0 pr ovince. They .;ci11ld unclert ,0.ko SP!le qurn tive work but t h is would be s~condru-y, t o t he 1:1~-1.in pr ~ventive i'un ct~on . '.!,'he dispensq."ii::S 'H0r e c1. ey 0lope 1_:;_ prim~il;y for energency cur c..tive work , ~ut oonstitut 0 ~uch a g oo d po t ent i a l nucleus for heµl th work thnt t hey ileJ;'it n nint;;;ncm o0 o.:n.d olo.,1;>oro.t;Lon to this encl,~

PUBLIC lIE1'.1.LTI-I DISPENS:.RIES

The ~re sent s cheme , initiated i n 1951 1 visualise d t h e establishnent of ? 0 0 Publ;i.c iiealtl:\ Dispe.:1sar:i,.es ruid in Augus t l952 there w.ere 406 distribut ed t h:rour;hout t r1e p,;-ovinoGs. .A c n,ref ul s t udy we,s n ud(;l of t he wor k i n g oi a l o.r ge nu 1~~I" ~n diff erent pa.i;-ts of th e c ountry to dqi t or z.:ine t he s cope of t heir a,ctivities o.nd t he possibilit:j.e s for thei:i;- future d.evelop,.1en t.

i1ltho1.1,gh t he pr e s ent s ohe r,1 e;; of public heal th di spe:.'ls a ries wo..s on],y initi..:.tod in 1951 a similnr t y1)e of work hac, b oen :Ln operation sin ce 1 947 ~t t h o National llealth Centr~ ~t Seoul, t he Kyongsang Nar:1do Pr ovin cinl Heal th Ccmtre a t PusC\.n nd t he Chollo. Pukto Prov:i:ncie,l Contr e -::i.t Chunj u.

An tl.upo;rt a nt crit erion in, dG torn ini,.n,g t he s :i.ze of the area t o be a tt a ched to a dispensc.ry is t h e pop1Jl a. t;i..on · t o be s erved. Cons2-d!;,lr 2.blo v c,.rin.tions hav e b e e n n oted ; t he pub.::I,i c h e a l th dif?1)en13ary in Suwon City in I(yo:n,f;g i-Do served 24,000 peopl e as con trasted with t h e p opula tion of 85 ,000 served by t he dispens afy i n Wan Ju__, gur+ of Ch ol l :c. Puk to. The s iting Qi' t h e public h<:;alth di s pensc..ry_ buildinc is a l so i .11port a :at and d i d not o.ppe :- r to ha ve rece ivod t h~ attention it deserved. The es sG n t i&l c onsid er a tion is t he <; onveni..un c e of the peopl e t o be serv e d . J..t Chonju i n Cho).la ;pv.kto t h 1:1l:'e wer e t hr ee i.twt;i.tutions of t h e sa,,:ie k i nd , t h e Chop. ju Pr ov;i.nci ::11 Hea lth Centre, the Hn.n j'4 gup. ? ub lio Health Dis pensary nnd t h o Chonj u City Pub l ic He o.lth ' Di spcm.o.ry , all loc o.t od wi th;Ln a r i:ulius o! ci, f e w hu,nd,r.J d yard.s . Son e d.:i..spensn.r:i,e s were loc :1t od in ;rn1:w c iatio.n with re;fuge e oa np~ , o.:nd t h ough "\;his ma y be des:i,r o..b],e and oven n e-cess ru.-y under e :.rnr gency conditions , the 13iting of t he,% dispensaries will hnve to lrn revie rnd whe71 c onditions bopooe nore stable,

The nat u,rE; of the builclingQ utilisecl wo..s on t he whole satisf nct or y und pr ov:i,dGd t h e ne c ~sso.ry acco~u;,00;ation for t he activities t h a t wer e being c .::t7:"d,ed out~ In, o.i1e ins t -a..l'l oe , however,

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a rur a l public hecclth dispensary was S8en sharing premises with a her b dispensary , ::i.n obviously unsatisfa ctory nr ranger.ient.

Tho pr oposed a ctivities laid down inn r:iemorandup issued by the Hi ni s tr y of Hee.l th are :

(1) r e l ief dedicnl ca:-e ;

(2) inv estig~tion and reporting of co:rrn:µ1icable diseas~s;

(3) i::1:;m ... 11.isation and Vi:'.. cc;i..nntion v;ork;

('+) report;i..ng of births, deaths, and causes of 4e a th;

(5) he nl t h eduqa tion;

(7) visits t o hoaes , school s , refugee c anps c.nd refugees.

The abov e list c omprises a nunber of usefui n ctivities in the field of pr eventive and curo.tive modicine. In none of the pub lic her.1th dispensaries t hn.t were e:rnmi n ecl was r:my kind of q. prelimi nary health surv0y cci nducted 5_2 the .:i.r ea, assigned for t he dispensary . ~-'.:nowledge of the exist :i,ng med.i cc.l and pu'Jli c health probleus is of vital impor t a n ce, not only t or the detern ina tion of a 11rograr.1r;1e of ef:i;'e ctive wor k, but a l s o fo r t he ev.::t.lu c1t;i.on of t hf;l r c;sults of t he wor k c r-.rr:i,~d out . In t h:Ls respe ct t he v;i.t o.l st o:t;i..s tics are oi' l).::i.r aqount i nport .~n c e , but at n o disper1sary wq.s it possible to oq t ,St :y1 t hen fQr the area served by it.

An atteJ:1pt WE' .. 9 :-,lade to study the v:..tal s t a t is tic s in t hr ee ~ypes of c...reas , the c apito.l city of Seoul, c1. shi ancl rm u p . Ovd,.ng t o the l arse s c l' .. l e m8vo.mont of peop:).o dur:i,ng t he ii:u3-t two years no :re:J.io.b l e figure for the po pulation wa,s q.v a ilable. This na t ur ally yitia.t ed t he bir t h and de a t h r c:.:. tc s c onputed ; t he de a tp. .r a. t es presented , V(.~ying fron 9 to 12 pe r 1,000 , we:re not consis t ent with · t he oondit:i,01:..s th e. t were observed.

Instructioni5 have b een ),.a id d,own on the map.ner in which b irths a,nd inf ant deaths shou;J..d be :r egistered for ner nnnent residents? te1:ipor2..ry re s i dents and ,re;t'ugee popul ationq, but they nre not being O'.lrried oµt in a uniforr.1 n~cUm6r. The i nfant mortalit y rate o;t' about 3? per 1 1 000 b:i,rths .t;or t h1:1se a;reas must be a cce pt ed with a great deal of reserv a t ion .

The work cu~ried out in the c.isp~nsar;i,es v o.ried accor ding to the l ocation, an d the type of staff en6o.ged . i.11 we,;,e doing dispenso..ry and i nmi,misation wor k , The :iia jority were a l so doing B CG yo.ccinntion or :11.:i.king o.rrD.ng0Bents for i,t. Sorn,e were doing tub er c ulosis and ve r.i.ere4 q.isease s worl:: but v ery fe w vrore doing o;r-gc:i.nised home vi.s:i,ting in c onnect:i,on with l.,10. t 0r-nity and child wolf o.r e . The genero.l ;i.apression cre :.,te d W'.lS t hat t he work c o..rried out was not c o;,1:'.rn11suro.t e wi th the st D.ff and facilit ies t hot were o.vnilo.blo , and th L: t the co.r e of m0 t hers and c hj_ldr-en r e ceived v er y J..:i,.ttle c,t t0ntion,. It wus nl.$0 diffi cl,.\lt in nany inst o.nces to ;reconcile th1;: fig~res of daily attendances tha t wer e . given with t he records of exc,1,1ino.t ion r.nc. treat ment t hat were av a :i,.lab le.

The stc,nd.nr d r~-i niuun sto.f;f ns r ocomnen,ded i n t he )'.ileworandum of t he Ministr;y of · Health is o. s edi c c,l o:i;fice:r, one nurse ond two n.ssiqto.nt nurses. In sev er o.l i ns to.nces it wo.s noted t ho.. t additional st c:.ff h:.--.d bee1: engo.ged and wer ~ bi:;i1lg pai,d ;froi;l othar s ources t han oent, ~l government funds,

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The no.. i.;.1 featur e regarding s t a ff wet s not t hat the nuwb er of offic er.s wa s i no.dequa.te but thD.t t h e qua lity was poor, It wa,s report e d t o us t hat the officers pa id fron centra l governnent fun ds were all on l.\ t er..1_porary b a sis, a n d t his fact .r;w.y expl a in t he poor s t andard of wor k t ho. t wa s observ0d. It will, ho1.'rever, f !.'.Qilita t e t he t er n :i..nn tion of the ser1V';ces of offic~rs wh·.) hnve not prove d to b e s a tis;t'actory wh en a pern anent orgc:.nisution is cont ,,mpl o..ted ~nder ncire s t::i.ble conditions. Not a si..'1gle 11eclioal office:r i n clw.,rge of ~ clis_;;iensary ha d had even a..'l'l elen entary cot;rae of postgrc.du.s. t e tra in;i.ng in pub;ic health. The n:ur s es who were engc,ged r,er e ge n ern.lly very poor; seve;ral were very young a.ncl had h a d n o tra ining r1hatsoever, even in general n~sixi.g. This was part i cuJ_ar;I.y surprising a s it was leru."nt ,frou soqe nursing schools thnt gra cl~a te nurses wh o h a d O•.)mpleted t heir tro.ining were without ~:np],o;y-raent.

The ue t h o d of financing the puolic hea ltn dispen,sar;i.es is o'oviously c:;, ;L.,1E; o, ?,t e ncouraging local peop],.e t9 support their own henlth i nstitu t;i.on s an d su. pplement:i,ng th e funds prov;L:3,ed by centra l governn ent. VJ;i.th t :1, ese obj octs in v;i.e ·.v the ce::itr o.J, gover m1ent has guarantee d t he pa y:-.ient of t h e 1Jinir:1um st4f f o.t r c. tEi s of 3,000 1i!op p E: f da y f or t he do ctor,, :; ,500 Won pe r d 0.y for the nurse a n d 2,500 Won p er d c..y t o e c.ch of the t vm---::i:'ssist ants, 'I'h e guns wer e e:xp ,c) cted toprovid e a cco;;ir1odei.tion for e n pl oy ees nnd t he 'puild;i!lg for tne dispensary~ They were a l s o expected t o su~pl e::H.:nt th e s a J,.2-ries by providing ric o , fi.ie], 0nd other b enefits to t he staff. : .. s will be noted l n t or, t his SUJ?l) lernentar y i n como;:; hc.s not ::iecm f orth coming owing to tliffi cult ie; 3 whi ch a r e perhe,p,$ bey ond the o::m trol of th~ gu:n.s and t h e r:i.yuns. ~he delay i n t he pc.yL1ent :)f s a :l,c.ries from the na ti'onn.l (;l :z: ch e qu e.1.· x1d t h 0 i1:.n.bility t o suppieu ent i n comes :j:roLl gun con trib u t i,ons h a v e liad a de l e terious effe ct u pon the morale of ~he o;f; f j,cer s en ga 5ed.

iv!ed,:i,onl c ,1.r e ;\ss v9i ::1tions for :n c1.;n inte e;r etl :Ja.r t of the pul;:>lic h ealth dispensary s ysteq .:..:p.d their c onstitu ti,on is c.et er ~-;,incd l a r ge l y by t ho fir:. :..,n ci. i'.'.l oblig c.tion s i mp os ed o,n t h e guns. J.ccording to r egula tions ::i,dopt ed b y the r,~otl ica l c o.r e ;J, s ociatio·n, of Challa Puk to t h e a i rJ.s of the J.ssocicction c .. r e t ::.i i ::1plement t h e c:. ct;l..vities su0gest ed by t he Minis t.ry of He a l~h. Honb8r s hip of the .As s ocia tion is open t o h o·:.i,sGhold e l.' S oi' th0 p.J.rticu J,.o.r gu~1 Ol:' g tL'1S con cern ed if t hey h a v e b een in ,resi d eI;. ae for a p~rioq' 0T1iot lessthai+ thr e e n onths, and it i s l : duty of eli,:;i b l e hous eholc.er s t0 join the 11.ssocia tion.

Th e o±; f :i,c e b e o.r cr s are n chair mn.n, vioer-clrn.i,.r :c1.o.n , nine to ten councillor/:; , t vv'J i n s p0 ctoi·s ,1.nci one g enera l. af :t'D.irs officer. Al-1 ar e hqnorary worker s ~

The i ncome of t he J~ssocia tion i s derived f rom, ,Jea bersh i p fe es, dona tiQp.s fror.1 cho.r it o.b],e per s ons w.1d. tho 1J.obile an d L 11::10bile propert y v eq t e d i n the ).ss ocia tion. ~.1:1e c ontribu tion e.uc from t h e n er.ibo.1;'s i,s l a i C: down a s:

1st cla s s . 2 0 h o ps of polisheJ. ric e per yea,:, • 2nd cli::'.ss : l O 11 !! II !l II n

3rd. class : 8 ii It ii II i i II

ThEi Presi dent of t h e Vvan gj u gun I:Ur;ilic Heal th Di s pensn.ry Aasooio.tion , w:1i ch covers six Gyu:w-; e x p l ci.ined t :10. t und er existing conditions due s i1 h i s Ls s ocic:i. tion c.r e collect e d in ca sh and. thn.t 2,000 VJon is c oll e ct ed fr on eo.ch r.ie ub er. He ha.d ostimo.ted t hat with a populati0n of 85 ,0CO it would be pos sib l a t o colle ct o. sura of 20,000, 000 Won, bu t dur i n g t h e t wo u onths t his Ass oci ation has ~een in exist q.1 00 h e ho.tl si1 oo e e de d in colle cting only 20,000 ':!on. The As s oc;i~lt;Lo;n i s n ot fulfilling or i s unabl e to fu:l,fil itsfiao.ncio.l oblica tions o.s or:i,ginully con templatea .

,

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The doctor in chnr§:e of the Wanju [-ill Public Health Dispensary collects a charge fror.i patients who have no menbership card and are no l, re::;is t ered as refugees. The a.verate charre is 1,500 ~2£ for one day's medicine. He has collected 30,000 Won durinc· this sane period. --

The s~pervision of dispensaries is entrusted ~o provincial governments through~£ officials. When it is realised that pu.blic health wort in a E:!::£ is a function of its Hone Affairs Division, all the off icials 61' which are layuen, it will be seen that there can be very little technical guidance in the operation of dispensa­ries fror.: chis source. 'l'heoretically the chief of the Heal th Section at province level, who is a nedical ~11an, is expected to visit and supervise the aispensaries, b_,t ::.n fac t tha ,, is vory ra:vely done, if ever, As in the case of 01:.her helath activities Ghere was little evidence of supervision and coordination by officers of the central governnent. It would seer;; that even in the appointnent of staff whose salaries are paid by- the central governriient , no control was exercised with the result ::.hat not infre4uently unsvi C·able officers had been engaged.

The aduinistr.ation and execution of :.,he work in t-he dispensaries rests, the:::-efore, aluos t entirely with lqcal officers who have had no public healtl'.\ training ano. are not in a position to develop "he work on correct lines and to the best advantaee . S. ch an or[a.11isation ce.nnot -..nder take nodern public heal1:.h work even on a very eler;,entary scale.

We, therefore, recor,J!.10nd th <-. c t he Pub;).ic H011l th Dis:iJensaries should be remodelledand converteci into Heal th ·uni Gs, '.Che Dain J.0 •.,nctions of a Heal th LJni t are preventive but u~1der t.he special circunstances prevailin[ in Korea curative work of an o _tudoor na Gure .oi[ ht be incor­porated as a separate sect ion of its activities .

A Health Unit should serve a population of approxi hlntely 50,000 to 70,000 in a curefully defined c.rec, Wherever pqssible the bo undaries should coincide witp those oL' existin"-~ adminis trative divisions. I t may be practicaLle to take t he area of a g~!}. for the operation of a Heal th Unit , provided the populn tion dces not exceed the lirJi ta cions recoli1.laended; i t _w.y be necessary to have ruore than pne Heal th Unit within the boundaries oi" larger g,.ns .

As Health Units are intended to cover the rural and semi- urban areas of' the country, it is visualised t pat the capi :,al city of Seo ul and che shis will develop their own health services with advice and e:uidance -from tne central §'OVerrn~1ent , on a municipal basis with corrilnunity and personal services suitable for urban areas ,

'.Che total number of Heal th Uni ts "Ghat will be needed f or rural ana semi-1.,rban areas will be abou c 370, less than t.he present nuraber of Public Health Dispensaries, as 1..,he t otal of such population to be served is abou L 22 million.

The successft...l operation of Heal th uni ts depends very largely on the availabili r:,y ol t rained s l;aff. h.t the present -r, ime there a re no trained officers in any of the required grades . Iu will, therefore, be necessary to apply che scheme i n progressive stages, es l.,ablishing a model Health Unit in each province to start with, as a pilot project. There are already two places where such work has been started, the Rural Hygiene Ins t i t L,te at Kae jon and t he Na cional Hospi tal at On ·an1: . The model Heal1:.h Units of these two provinces mi cht be started on the basis of these i nstitu1:.ions.

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I n pre po.ring a lis t of areas for t he early establishr.:tent of Healt h Unit s , p:t.a ces n ow without l:.ledica l f 2. cilities .should _pe g :i,.ven prio:i;-ity, The tot a l nu:-1per of nyuns in t he c ountry as r eport ed in v ariou s do cul:l.ents Vctrie~ fro1':i 1,449 to 1,531, of which 840 ore r e ported t o h nve no doctor a t a ll, · Pl o.ces wh E:re t here are :w.ny such uyuns s):1oul cl :r;-eceive a hi gh priority.

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It is very desirab l e tha t before 2.ny Units u.re 0sto.blished the who~e area -t;; o b e covered by them should be surveyed and the b our~do.ries for each of t '.rnn def inod I even t hough the fu],l r ea.J,iso.tion of the sche::10 r.w.y t ake il ;Long period. This wil l avoid. t he sub sequent a ltera tion of boundaries and also .i n dica te to the aut horitie s c oncer ned t he full r equir 13n en-ts in :.1en zy.d non0y :i;-or t he project.

The pubJ,.ic he nlth fun ctions ,7hich c:t Health Unit undert akes oonsist of a.!l i nitial de t a iled survey of the o.r ee. ; t h e .:1nal ysis, stu.dy an;d L 1prove;:1ent ot :wr "i;>id i ty , mort a lity c..nd othe:r r e <rnrds · of vit a i sta t i s tic s of t he a r ea ; i 4 provenent of the s an~tary env:i,..roru, ent; iJ.11 t h e o. ct i vi ties associ<7.t ed wit h e p i dG ;,,1ia pr ev entiqn 1 i ncludi ng i.::1.mu nis3.tion work; ;sc:: t ern;i.t y ruid. c h,:i.ld welfnr e 1 i n cluding school health wor lq and healt h educ a tion c.nd. tr .s.:i,.ninc; . E'or sµch a COlJp;r-ehep.sive list of c.ctivit ies a trc:. ii-J, ed st aff is essentio.1 1 and s hould compr;i.se the fo~lowi~g:

(1) A medi ca l officer t~~ined ;i.n pu~~ic healt h work 1 who will be iµ cha~ge of tho entire Un~t and a lso carry 9ut the puolio heal t h func tions of t h0 Unit .

( 2) One assistan t :;1edipnl o;u·icer for cur c.tiv e work and for assisting in qli~ic and so~ool ~ork .

(3) At ],.eas t one publ:ic he2..lth n-µr se t o be in charge of t he nur s ing a ct i vit ~es and also to supervise dpui c :i.l iu..ry work.

(4) FivG or six s a n:i.t a r y i nsJe ct or s .

(5) Tell t o t we lve nurse - n i dwiv es .

In the early stages it will be des i r uble a nd even ne ce ssary to ge t sone f9rei6n sto.ff . ~rhere €U'e sever a l pountr:j.es of a sta tus 1noro or ;Les s c ou p3.r B.l;lle with Kor e ::. whore t his tyj_)e of wo;r>k has b ee n ca rr;i. ed out suc cessfull y. It would be advantageous to secure one or n or e such t eru1s e a c h c o6prising a uodi ca l off~cer of he4l tb, public heal t h nurses, san:i,t Q,ry in,spe ctors aud ,:iidwi ve s , r:ho h nve had pr D. ctice.l 0x r,erienc e of t ld.s t ype of 2-ctivity to wor k in co],labo:cat:i,.on w~t h ;L o co. l staff in soEJ.e o;i; t he se Units .

Facilit i es should be J rovided a t t he e~vlies t opportunity to tra in ~~l classes of s t a f f lo0nlly . ~t l~as t one o f the Hea lth Un;Lt s s ho uld. be developed on t he 112<. tio nc..l l evel t o serve as a pr ot otype and as il t e a ching centre. Tta l o cat i on of t he pre s ent n &tio~a l cent~e a t Seoul canno t be r ega~ded a s snt i s f a ctory for t his pur pose, Such ~n institutton should pes t incofpora t e within its lj,nits c..n urb a11- o..riea qo::abining a shi, an up and sev e r a l myuns 1 It should a,lso be so ;1<;:what l n.rger than t he standard unit a dop t ed in other part s of the co\l,ntry and be l oca ted with in a di s t an ce of about 25 ni:I,es fr on ,Seoul 1 whi ch is t he chie;f 1:i.edica l tra ining centre in. t he coun try, .S¼o h o, s:i,tµ :::tion wouJ_d make ~t possible t o u~ie the fc.ciliti es av a ilab le in t l1e tra ining of undergr aduqtes and pos t -­gr a du.ate studqnts in he~lt h work~ The nprra&l r outi~e tra ~ning a t t his cen~r o would be ~or subsidiary 1.ied:i,ca, ;L per s on..11.el s uch as sanitary inspectors, public he r~ l,t h nurses ilnd, nurse- mi dwi ve s. The reason for s u ggesting t he chan.ge of site f:r on Seoul, t o one so;ne distanc e D.WQY fr o~ t ):1e captt a l city is t o se cure conditions which would approximc..i; e e.13 f Cl.I' a s po i;;s i ble t hose whi oh i; he of;fic~:i;-s would uec t ~ith af t er tl1ey have b ee n t:r;-a ined , Th t s tra ining centre s hould

,,

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do all the heal th work for the local a'1thori ties in i ts area and t here should b8 no other heal t h crganisa cion workin£' within i ts lird ts.

Since pL.blic health is the prirrJE.,ry ·~-0£.ion of Health Uni t s , i t woL,ld be appropriate t o allocate their control to the B .'.r eau of Preven t, i ,·e Medicine in the Ministry of Heal th , rather than to that cf Medical Affairs, which now con crols t he public health di s­pensaries . In viei1, however, of vhe fact tha v bo t h curative and preventive work will be .. .mder '-'aken at these Uni ts, it will be essent i al to keep a close liaison be t ween the Bureac;. Chiefs of Preventive Medici ne and Medical Affairs.

The Health Unit c.spe of work has been successfully applied in many countries durin~ che last 25 years, and it is our belief cha t it will pr oduce "he sarnE beneficial re sults in t his country. Detailed in.t'or11ation on tne operation of t he Health Unit sys ten i s given in the neahh lJnit Guide publi shed bJ the Government of Ceylon , and we recorill!lend t haG it be accept ed as a general guide to procedure .

Re cc:JIµm.endatio;2_s

1. The present pl...blic heal1.,h dispensari es sho ,_,,.ld be µrot'. re ssively rue,dified to form 5eal th 0nits, t he nature , duties and staffi.g 01' which are des cr ibed in the tex L.

2. A mode l National !iealth Unit sho l d be e s tablish8d within 25 eilE::s ot' Seo , __ 1, siightly larcer than the standar d ty1:.e and n-,odified for tro.ining pur:poses .

3. A visitint: team shoul d be asked r'or to opera ue t he National 'Cnit, macched by Korean s , aff.

4 . Pro '-'otJpe Unius should be s tarted in each provin ce , those in Challa Pukto and Chung Chane Namdo beinr on the basis of the Eur al Hy1.7i ene Institute at Kae jon and tp.e Ha"ional Hospi tal at Onyang respecc.ively.

5. Staff t r Qi ping should be star ted as soon as is possible and should include doctors , p~blic health nurses, nurse~rr~dwives and sanitarians .

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CH~ PT ER III

STATISTICS i,ND REPORTS

The colle ction of d0n ogr c.phic 2.n d v;i. t o.l sta tis tics is tho busines s of t he Stntistics Bu.:re a,u of t he Office of Public Infqrr:1ation, ,.;no.logous · to the Office of the Re ;_;istrn.r Generc.l in r.1 0.ny other coun tpies . J. census hc\S been h eld quinquen~1inlly :j,n t he pns t, but t he first one r oted o.s a re nsonc.b l y 9lose count was t hat iµ 1925 whilst t hnt in 1930 was r o.ted o.s conplete. The quinquqnn:j,Ll series wc1.s broken by t he ho~ding of ,~ census in +944 , a n d. t hen int errupted b;y- the po..rtition of the count,ry. L count wa.s ;,:mci.e, however~ o;f t h e pe o pll;l of Korea so½th of the 38th pµl'o.l;Lel in 1949 , D.nd th;i.s was followe d by estiwo.tes of the populatiop., the l ~s t a s ~t 1s t Mo..~ch, 1952. The tisures fr on 1925 onwru-ds are s e t out b0low:-

Ye ar .(\re a Po .:_:lUla tion R~Lll'.l1 ks ....--.-.-.. ~ _ ___,.

1925 KorE1 c. 18 ,543,326 PG\.rtia l count ;i.9;, o , I 19, 685,537 Full count 193,5 ii 21,248 ,864 " I!

1940 11 22, 954,563 fl " 1944 II 25,120,174 " 11

:i,949 Sout hern Ko;r-e a 20,166~756 ll II

l9,52 II ll 20,526, 70!5 Esti;;iut e

The incl:'ense in popul a tion ip ;_)rogr ~ssive and r npi d . The rat<i; is perhaps r.i.o st r eliab ly est iL.o. t ed 'Jy co::p::,ris on of the :f'igures f o~ 1 930 and 19L1-4 1 betwee:1 whi ch dates t l10 :.:.1ec::.11 c.nnua l r nte of in.crease wa s l,. 7~- per cent.

Forec[tst s of future LYJ.crea.ses are n 8 tor:i,ouGl y unsafe I anq this clwr a cter is enhanced oy t he c.hanges ;in t errj_ tori,,._ l Qoundc..ri cs o.nd the dislocD. tio+i of We of t he, pe ople. IIowev 0:c, ;i.f the r a te of incr eas~ fo,1;'. Koreo, c.s a vrl:\olo bet ween, 193 0 uz1i;l 1944 were to continue in southe.i;-n KOl'e a for t b,e noxt twenty ;f:i,ve yec,rs, the popµl4t;i.on woul ~ f ollow t he pattern be~qw:-

1949 J.955 J..960 1965 1 970 197.5

Poriul2.. tion ·t iviillion~')_

20.2 22.4 24.4 26.6 2 9 . 0 31. 8

It i s ?+OW proposed tq t c.ke n full c-ansus every ~e n, years with t he nex~ in l.96 0 l and to elnb oro..te t hose dc cenn:i,;11 count s by i nforual and roµ gher i,nt er ued;i.::-.t e c ounts ev er y tan y e ::.rs st urting in l955, Prelim.,no.ry steps to t his encl. ru~e alreo.dy beinG' taken and deserve to be supported~ ·

Th e rure , . of Korea s o~th of t he 38th po.ro.l],el is 93 1634- s qu.::u-e ld,J.ouetres 1 end the density of popul ntion in 1949 wa s thus 215 per squ:ctre kilo;:ie tre or ;556 to t hl;l squ['.re .r:1ile. Comparative fig'UJ;'es for sone othqr countries are:-

Count~

u~s·A· Philippine Islands India Ceylon Jap..-m J.:ngland and Wa l es Southern Korea

Density rer square kilometre

19 65

109 111 223 290 215

The dens i ty of population is extreme, particula rly when the prt::dornina ntly ag ricultural na ture of the countrJ is rcmembcrf,d. It :i_s only a highly orga n~sed and v e r,.J efficient system of agriculture which has a lloi.:Ie d the c ountry to support such l a r ge numbers of people , and i f this vvere a llm:ed to degener a t e there would be ineyital.J J.e s t a rva tion amongst t l1e mass es . Reco:m.-:ienda tions on this subj ect a re in the province o f _the :B'ood and !.gri cuJ, tura l Organisation Hission, but the present 1PHO Mission ,muld fai l in its r espons ibilities if it did no t point out that all h ealth is p;dme.rily dep,.mdent on food, and its adequate provis i on demands the clos es t of a ttention,

Re~,::i rds o f births a nd dea ths 2,re like-.. i s c col lected by the Statis t ics Bureau of the Office of }'ublic Information 1 The s e ev ents are compulsorily notifiaplc throughout t h e c ountry , t he responsible person b e ing the head of t he hous ehold conce rned, \·!hile pr ovision is made for r e co;ru.ing ha;1yienings t o t hose not corni ng ·.-.i. thin r ecognised househ olds . Lxamiriation of the s t a tis tics s u ggests tha t r eporti:IIB ,,3.s reason:-1.bly compl e t e until l9Ji.4 during t he J apanese :regime , v:hen loca l collect ion of' i nfb r:rr.& tion ·,;as a police f unction,. Aft e r 1945 there was an abrupt chaae;e in the numb ers of notifica t ions rrhic..11. mn.ke subsequent :i:'tgure s difficult to t a.ke a t thei r fac e va lue, and enqui ry i n the c o~ntrysidc r ev e:::.J. t;d t hat notifications ·.vere in some pl a ce s not made in rural areas and were only doubtfully complet e in s orn0 of the t mn1s . The ~)ubl ishcd r e:9orts e11ded with tha t fo;r 194_8, ,iar l\avinz obst'l--uctcd s1-1hsequ c:1t colla t ion, but the figures whj_ch follo,;1 shO\ r t he na ture.: of tlw ab rupt chang e and consequent unrel i ability of r ecent sta t ist ics .

P e riod Birth Der. t h St illb irth Marriage Divorce r a t e rate- -7a~ rat e r ate

19~.0-L,4. , ay eragc figw:c 3~.7 l c1, . 8 5.0 12 . 0 o.35

1946 16 •. l 11. 9 0 .1 1,2 0 .1 1947 22 . 0 9 . 0 o,;i, 2. 2 o.], 1 94_8 18.6 9.3 0 ,1 1,7 0.1

I t is clen. r t ha t t he mos t i mportant a ction n c\jde d. in this s rhe::-c is the ilnprovemc.nt of 1·erortine , and until t h is has b een carried out there is little point in · l a.bora t e ha~1dlin,g of the data .

The c~·.usc of d(;:e. t h i s c urtifiablo a t t he tj,mt.: of notification, a nd t he obj ect of securing c c rt:i. fica.tion by a mea.ical pr a ctitione r i s l a i d d m·m in l a\7 and a ttcm1:t ed in pr a ctice . Many deaths c a nnot, honov cr, be c crt:i.fied by qua lifiea. pr a ct i tioners, n.nd circumstance s make t he a c c ept ance of cc rtificc.t es f r om limi t ed a.ac t ors and herb doctors inev itable ; in conse q_u cnce diagnos es must b e acc ept ed n ith rese rve , As p r c s ,:cmt ed t hey shoK a v e ry high ::iroportion of deaths due to infective and par as it i c clis00.s cs , 23 per c ent ofthe t ot a l, the next l n.rg..:.st g r oup b c;i.ng disease s of the r es -c1 i r a t o:ry sys t em ',,hich account ;t'or 20 l,.___, r c ent. Pulmo11.ariJ tubercuJ,osj_s vm.s c onsider ed t o ha v e caus ed a death rat e of 35 per J.00 ,000 persons in 1 94.8 , a f igure which could. b e i mmedi a t e l y doubkd to c ompensa t e fo r, inadequate notifica tion of death~ and probably des e rves a conside r able further increas e bc for0 it. r epresimts actual _happenings .

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Infectious diseases are notified through provincial governments to t he Minis try of Health, Rece nt r ecords show the following number s :-

1947 1948 1949 1950 1951

Typhoid 8 ,250 5,062 5,641 7,210 819575

Paratyphoid E)7 183 11 125 886

Dysent ery 563 1,328 855 52 41 001+

Smallpo;x: 182 1,147 7,747 2, 347 43,213

Typhus 1, 831 1,806 1?227 1,821 329211

Diph t heria 762 2: 243 l i066 732 29534

Sca r le t fever 18 37 12 2 84

Ger e bro-spinal 164 menin gitis 77 136 50 224

Pl &gue 0 0 0 0 0

Cho],er1;1.. 0 0 () 0 0

Epidemi c cncephaliti s 0 0 5? 6l.5 5 27

The influence of t he war in enhancing epidemic dis eases in 1951 is clear ly c;J.i s cernible . In r e s pons_:; to this increas e UNCACK carrie d out its maj or immuni.sation progr a mme, Full figur es for 1952 fol],_ ovdng_ t lrn.t programme a r e natur;,lly not ye t available, but both t D0 partial f i gures a nd per sonal observation and enquiry show t hat t he pr e s ent year has been an unusua,lly healthy one in respec t of these disenses except Japanese B encephalitis, whi ch became epidemic during t he l a t e sum;ier. The fi :n. n.. l f i gur e s for t hi s m-'3.y exce ed t hose of 1949.

Mor bi dity st~tist i os of a mor e genera l na ture are compiled in dispensar ies and hos pitals 7 nnd r or orted to provinci 'l.l and other headqunrt ers , A hi gh propor t i on of the diagnoses arc vngue and uncla ssifi abl e I as i s usuo.1 i n. such stat:i.stics c ollect ed in m:::i.ny ot he r co1,1.ntries 1 and no point of importa nce emerges from t h em.

Offic er s of t he UNCACK t ea~s collect t heir own sta tistics of notifiable dise~s es f or submi s sion in connec t ion wi t h t h~t or g,,_nisa tion' s pro grar,illle of epider1ic control, and t here is probably more effort t o check these fi gur e s and t he nature of t he diseases t o v;hi ch they r ef er t han is usunl in governmental figures, They s how t he same gener 2.l pat te r n of disea se incidencei and have been hore pas sed over s ol ely b e cause . t he govepn~ental figures give a more continuous pi ctur e over a s eries of years .

It ha6 b een suggest ed t h~t t here i s a weaknes s i n t h e collection of vital sta tistic s b y t he Office of Information and of others by t he Mi nistry of Tieal th 1 it being s ugges t ed that the Minis try should t ake over both t hese functions . The division does now 9 however, seem to lead es sential~y to weaknes s , and no recommenda t ion for n ch~nge is t herefore made . So f nr a s both the offices ar e concerned, and nl l t ypes of statistics, the ne ed is for more ac cura te col lection of basic da t a in the field a,nd for tho operation of mor e eff icient che cking mec hanisms than now exist. In t ho field of vi t ~l statist i cs the public n ~ed ed~cation in the importance of notifiaa tion 1 after whi©h t):l e compulsory aspect of the law s hould aga in be brought into force . Death certif:i,cates could be al -frered to show the medic 2.;I. qua],ifications 9f the certifying person,

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and it i s suggest ed that the causes of deat hs certified by gr adua te doct or s mi ~ht well be classi fi ed separ a t el y fr om t he totals c er tified by a great var i e t y of gr a des of peopl e . The r e i s often delay i n the not ifica tion of infect i ous di s eas es , i nsepar abl e f rom t he f a c t t ha t many peopl e do not rec eive a tt ent i on from qua l i fi ed medical me n and t hat channel s of com+nunicat i on are s low. Thi s cannot be gr eat l y impr0vcd unt ii me dic al servi ce i s mor e evenly distribut ed , but t here is ro om f or more ca r eful che cki ng of t he ac t ual dia gnoses wh en re por t s a r e r eceived . St a ti s t i c s r each central government t hr cugh a varie t y of channels , sorr.e of t hem pas s i ng t nrough t he newl y l ai d down ones and oth er s pas s i ng t hrough t he old police channels . I t i s notabl e t ha t t he l att er of ten cons t i tu t a a more s peedy means of co;um.uni ca tion t han t he othe;rs ~

Th er e ar,e many mat t er s of r epor t fr om t h e f iel d to c entral Gover nment on other sub j ect s t han a ct ual disea s e i ncidenc e, and covering :i_ n gene r c,l t h e whoie r ange of financio.l and a dr.:ii ni s tra tional control of medic e,l wo:rk . I t appeo.r ed t ha t t he number of r eturns r ender ed was greatl y in exces s of t he a ctu9.l nc.:ds of t h e si tuation and t hat in many ca ses t oo f r equent re t ur ns wer e demanded . The pos i t ion has been f urther compl ~cat ed by t h8 na t ur al desir e of UNCACK for r etur ns and to l ay down t he fo r m in wl:. i ch i t ne eds t hem. It was not possible t o mak e a c ompl et e r evi ew of t he whole system of returns but it cl early needs a ~adic~l over h~ul witn the ob .ieot i ves of cutt i ng down t heir num~1er and s i mplif yi ng t he channels t hrough whi.ch t hey p3.s s . This 'Nould i nyolve an initia l and period­ic al r evi ew of retur ns by a seni 0r government official , pos sibly assi s t ed by ~ small c ommittee , '

Th er e is at t he ~Q~ent po sys t em of payment to medic al pra cti tioners for not ifi cations of i nf ectious diseases . Bot h t he spe ed, c1.nd c ompl et eness of notif ic a tion mi gh t be impr oved by t he payme nt of a sma l l f ee as i s t he pr act i c e i n many other countries .

The Minis te r of Heal t h dpe s not a t t he pr eaent time i ssue an annu~l report on t he he~lth of t he Republ i c; the many difficulties encount eped since the f oundation of t h e Hi nistry pr ovided a more t han adequa t e expl~nation , T~c pr epar ation of an annuo.l re port is, however 9 ~f gr eat value , no t only to t he :publiQ t o whom i t i s add~es sed but to t t e of f icers i n t he Minict r y who ar c t her eby r equir Jd t o mako a periodi c~~ a s s essment of t he s t a t e of health and of the v2.l ue of t he mea sur es t h ey ar c t ak :i,ng to i mprove i t . I~itia~ly such a r eport c ould be small i n form and deal wi t h essent ial point s onl,y . Subsequent enlar gement c ould occur a s need for i t was shown and public i~t eres t i n t he sub j ect increas ed .

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C ?, -AP 1 'ER IV

FUBLIC HEALTH ACTIVII'I J.,.;S

Introduction

The general organisation of public h ealth services has b een dealt wi t h in a previous chap t er. The present ono , while making i nc i dent al mention of organi sation, deals with the gener al sanit~ry environment of t he pe opl e and its control 1 a nd t he welfnre and p0r s ona l servioes dir ected to t he alleviation of the ilis of parti.:mla1'.' groups e f people.

The commonest diseases of t he 001,.ntry ar e those a ttributable to unsatis f actory sanitary surroundings, and particularly to the unsafe disposnl of was t e matt ers. Typhus ~ dys ent ery a nd non-specific ent eritis a r e normal everyday occurrenc es and a lso occur in t he form of epi demic s which may be extremely ser i ous . Perhaps more important than t his is t he almost universal infe station with worms of di ffe r ent t ypes. A survey of the country carried out by the sta ff of the National Laboratory for the Pre vention of Infective Diseases showed tha t 94 per cent of t he total popul ~tion ~er e so affected , the commonest par asit e being the ordin3.r y r oundwo,rm whi ch was pr esent in 82 per c ent of those examined . HookwormD and thread worms were common , and t he flukes affecting t he live~ and l ung we r e widely distr i but ed~ t hough more pr evalent in riverine territ or y than else­wher e . I t is pr obable tha t if t hi s survey had been confined to country dweli ers excluding t ho s e living in towns, i nfes t a t i on would ha ve been fo un.d to b e universal. Typhus is a common recurrent disease and is attributable t o ver minous infest a tion during the winter period. The r espiratory diseases ar e not dir ectly attributable to insanitar y s ur r oundings but constitut e ~n extremel y i mportant group of inf ections , whilst ce;rebro-spinal meningitis 7 which must be included epidemiol ogically a~ongst t hem , i s r 0current in epidem~c form. As a matter of hypothesis only, this misht be associated with the common method of warr.iing t he house . by means of n_ hot floor, which mus t f acilita t e t he d;r-ying and dust dispersal of organisms, which is known to b e a common rout e of infectj,on with these d:i,s eas~s. Pulmonary tuberculosis is wides pr ead and &ppears to have b een increasing consider ably during t he l ast few years a/'3 a r e s11lt of t he impo verished and under-nourished s tate of a cons ;i. derable part of the populatiqn. Se v~r al inseot-borne diseases occur, including malaria, fil ar iasis, enc ephalitis , ~ous e typhus 1 mi te t yphus and possibly haemorrhagic fe ver. Though studi es on t ho iv incidenc e have been i nitiat ed t he r e i s , as yet , no organised system for their control.

The general standard of personal cleanliness aimed a t in almost all sections of t he conmunity i s high, and the Mission was gr eatly impr esse d by t lle cle~nlincss of o~othing , of person, and of domestic int eriors which it saw in all grades of society. There is moreover a traditi9n of sanitation in t he form of sewage and wast e disposal 9

whilst sanitary l aws are on the whole obeyed . Despit e t his inclina tion and tradition the ac hi evement f all s short of r equirements for a numb er of co.uses, t he chief of which are inadequa te water supplies and facilities for personal cleanliness during cold weather, and t he a co epte~ for~ of s ewage dis pos a l t hrough the direct placing of waste matters on t he land. J'. n the summer washing of the person. and clothes i s largely carried out in natural wat er courses -it sel f an undesirable me t hod unl ess s pecial prot ection is given -but in wi nt er e ven t his b eoo~es impossible and the gr eat majority ~f the population who ar e unable to a fford wa t er hea ting unavoidably allow t heir s t andar ds to drop. I n some t owns there ar e communal · ba th hous es, but a l abour leader esti~at ed t hat in t he winter the a ver age worki ng man wa s not . abl e to g~ t a bath mor e than once in ovar y one or t wo months, and the oonsider nbl e cos t involved (2, 000 Won) made oven t his difficult.

\ \

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In thes e circumstanc es th8 care of t he environment i s particular ly nec ;;ssar y . Ther e are many wa ys in which it could be improved , but ther e is no doubt tha t t he t wo mos t important -although the mo s t a.ifficul t ... ar e the improvement of water supplies unt i l a liberal quantity of who1, esomc water is available to the entire popula ti on, and improvement of me thods of seuage disposal, to both of which f urther r e f erenc e is made below.

THE SA~I TARY ErTVIRON~HT AHD ITS CONTROL

Rausin_£• The normal standard of Korean housing is good, and even hous es of r elatively poor people include at l east one~ usually two, rooms which are constructed on a s pecial nhot floor 11 principle and ar e k ept scrupul ousl y clean. However, slums have grown up in most t owns , and t heir characteristics ha ve b een accentuated b y overr crowding following war destruction and the movement of displaced persons 9 which has increased the population of most towns by 25 per cent and of s ome by nearly 100 per centt

Effort s ha ve b een made to r eme dy this by tousing schemes; 10,100 houses have b een built and 7 \ 000 are under cons truction in towns 9 whila 13,700 rural houses ha ve b een replaced 9 in addition to t he r epair of many t housands of houses nnd t ho cons truction of roughly 23 9 000 s helt c:i;-s for r efugees .

Good as t he s e schemes ar e , they a re insuff'io.ient to nieet the demands of the s ituation and the principles followed qould b e improved. Hous ing schemes normally involve the free aiiooation of lumber a:::id othe:r; essentia l r.10,t erial.s, with tha cost of heavy construction work , whi],e the would-be occupant pays for light construction a nd finishing processes at an approximate oost of one million Won. House s muot be cons t:r;uct ed a ccording to g:i,ven type pla ns , 0f which there ar e four, and all of whiqh ar e good, giv:i,ng a habit~bl e and sani t ary dwelling of acceptable pa ttern, There does no t appear, howevor, to b e sufficient c ontrol over the gene~al lay­out of settl ements, and some of those oncountere d presented serious f aults, including over~close arrangement of houses, lack of latrines 1

ins ufficient f oot-path provision, and insanitary well surroundings~

The I1ecominendi+1g of housing schemes is beyond t he province of this r eport a part from pointipg out their n ecessity on a large scale It is within its province 9 however, to emphasise that such schemes should be carried out on a basis not Olnly of house plans, but also of sit e pl ans and s pec i fic a tions dealing with wa t er supply, latrine ~ystems, and r oa d and path arrangement. Th ey shoul d moreover be sub j ect to i ns peqtion to ensure coflplianc e wi th requirements a nd sati s f nct or y s t andar ds of co ns truct i on,

It may b e not ed that t he government of yholla Pukto, and possibly of other provinces, ha s prepared plans of farm-house c ons tructi~n which include general lay-out of as s ociated buildings, l a tr i nes a nd wells, whi ch could well s erve a s a model for schemes of t his type el s ewhere.

An important function of a public health department is to concern itself in the standards of housing a nd vi~lage and town lay­out. · Tho obj ective to be aimed at includes the submiss~on of all pl a ns f or public~y supported work to the public health department f or i nspeot ion , ~dvi ce and ultimate approvQl. It is not possible to carry this out to its f\lTl and - proper extent ow:tng to the e~bryonic na tur e of provincial public health de partments, but as a nd when they develop this should be an i mportant part of their r e s ponsibilities,

Water. Th e rural population of abo~t 171/2 oillion people relies on wel l wat er, as do a c onsiderable proportion of thos e living in

•

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towns, which a re only pnr t ially serv 0d ':Jy p i pe d sup,Jlios. The \"Je lls used are o:f 1; unifor ,:1 typo which hc'.S obviously been encoura ged by au t horit y in t he past, and chiefly by the displ ay o;f sto.ndarcl designs. They o.re op011 sho.llow wells pr ovided y1ith c:.. p<"-r ape t and c oncrete surr o und , and tyr,icnlly unlined fr or.1 the surface downwards. :,.lthough t he E: ubsoil v,9. ter wiJ.i c h they t c,p cannot i) e guo.rante e d c.s s .'..l.fe it is pr ob ab ly usuully so , but t ho channel f or infection of the wel l though l balmce of surfe.c e wc.t c:r i n to its uppe r part and throu~h cont rn:iination of bucke t s is w;i..de o pen. L very co;nside::ro.ble pr ogr amme of repair and improve::.1ent h ci.s bee n c arried out oy th e Korean Gov e rnn ent with the help of UNCACK o.nd has 1,10.t erially impr oved, t heir gener a l standard, but it mu e t be c ont inu0d over o. nuubor of ye ars before the position i s r0ally satisf ::-.ct or:y . It i s sugc;es ted that star1dard de signs should b e pre po.r ed ;_)r ov;i.d in5 , cmongs t other t h ings, fo;c i npervious lining o f t he u pfJO:i;' pa:i;-t of the well o.nd for the p:rovision of per nan ent buckets f:i,;i~ed by chnins which cc'tllpo t re c.dil ;y b!:l r aaov ed or substituted. It may be po ssib le to enc o ur n ge t he construction of a satisfa ctory type by t he subcidised provision of con 9rate r ings and cenent for their f:i, x t ur e , nnd. t h;i.s should be the subj" ot of s tudy by th e s anitat;i.on de po.rt::ient .

There a.J;'e 55 p :i,ped ,mt er supplies, which n+'e bµ lieyed to s .crvo a b out 2 .5 :ail.lion pc.:>ple . ll'hey we:re 1:rnch d.c.magecl in t he war but t heir r ehabilit a t ion hr,s lJe1=1n energe t i c a lly undertaken with the help of UNC.i,CK, the s :r eat rm j orit y now be;i11g in oper a tj.011, Their general chara ct er was d iscussed wit:1 the hencl of the Sa~1:i,.t a tion ,S ection of UNCi:.CK nnd w;i.th o ther officers while t he s upplies 1;1. t Seoul, ?uoa~i , Taejon, Song ju, Kwang ju a~d T:.:i.egu wer e i nspe cted in detail and t he ir r elcJ.tion t o o the:rs i n the ;>r ovin c e di s ct.issed w~th the local s anita tion aut l1orit;i.es of t h e sovern1:1ent and u:r•w;;.CK.

The 5~ systems are re port ed t o h c ve ~ r a te~ capacity of 265,000 n e tric t ons per day , of whj_ ch 150 , 000 a re suppl:i,ecl t o i nclustr;y and t he r ei,1ainin6 15 0 , 000 to hou s eho],d s o.r r ublic faucet s . T}iis is equivalent to a daily suppl y of 14~4 US gallons p0r h eo.d of t Le y opulation serv ed. , ;:iut :i,s bel i eved t o tJe o. c onsi der able over-e stimate ns suppl;i.os have pr obc.b ly mt been worki ng t o their r o.ted capacity f or sev 0r c..:i. ye c,rs while t he u sar po pula tion i c c er t ainly grc o.ter than t hat esti;-10. ted.

Typicn],ly , t he so supplies a re derived ;f r om hil l c o.tc h1J.ents 2nd held in i a f oun~ins r eservoirs whence t h e wat e r is l e d thr o u gh s low saµ d filt Grs t o t he distr~b u t io~ systeLls , whi ch in no c a se serves the entir~ JJopul a tion . Nos t goe s to a. lL1it e d nu;;iber o f priva te h ouses but ther o £',re publi c ;fauoe t s ; even so in densely p opulated to wns a c ons i de r ab le par t of t he population r e lies on well wat er . The n ctual delivery of t he st1p£;lie s e:x:&:nined 1 c.ftcr sub tr a ction of i ndustr:i,a l use , y ::iriecl fro n t hree t o ten gallons per he o.d of the po pul o.tio~1 e sti,J.o. t ed t o utilis e t h6:i1. In ;,1nny cases piping syste2 s werq de f e c tive antl distributio~ t here~y lic ited.

Th;;: raa jor-ity of t heso s u _Jplics were ne,t d es.i.gnad t o serve the entire por,ulat ion of th 1:: t o ms , beinc in-condocl for industr;y- and a limited privil oged, c l a ss whi ch wns c.t thnt tir.w no..in:t.y J apanese, and fop t his int ended ~urpose ~ost wer e juilt on excel~ent principles. Tho;y a r e now i nadequ~t e by reason of po pul a t ion incroas es, an increat i n t ho pro portion of t he po pula tioa c a l ling on t h e a , and de;octs of oaintennnce. Jt is apparent t ho.t t his l as t h::is in r.1any c ..1sei5 peen of a v ery pqor s t nn C::.ard , t hough UNC,cC K hns mnde s trenuous efforts t o i mprove it . The criticism applie s t o control systeos, chlorina tio1 ::tppar ?.tus , .Pir;inK ,'3ys t en s , an d a sso cio. ted u ach;i.nery s uch a s pumps ; as an ex cG.1pl 0 , ch lorina,µion c"cpparatus hns been fitted t o a ll the wa t e r works exc..wined , but was only a ctur:lly in work :i,ng order in· t wo of t !'le six vis ;i.tod. The f ault appeo.red t o lie pr incipa.lly in i Gnoranc e of ne <;: h nn i s c. , ae t hods of ad jus t ment, and suipla repair -t he ordino.ry kno wledge and r.w.ip.tenan ce wor k yl'hich i s often taken for gr a nted put is here lacking .

'l'he ~uality of o perators wr:: s enquired into o. t all insr, e ctions . O:r;. e e x c.:,1pl ,3 HO.S encounte:red w~1ere the wo!' ku w..:: re ;i.n the h,;,.nds of e. skilled engi neer w:10 h i;J. cl unde r h i s chur50 s ev -~ro.l o.dequ t.1toly tro.j,ne<.~ ,,~ssi s t c.nt s , D.nd on t his schene t he genor nl stcJ.ndnrd of ,.lG.intlmance u~s h i Gh • Eowever 1 al tho ugh there ~oy often be c tr~ined eugi ~ee~ in t h~ pr ovin cinl govern□ent office r esponsi~le fo r water supplies, tho:ce is cm nL.1ost invo.rLlb le i;ros,s L1ck of lilen of t :1e s l;:illed .'.'.:\rtisc.n ty p0 wit h sufficient knowledge to be ontrust0cl with the da,y t o dc.y hand.i.ing 0f wc\ter vrn r k,".l anrl with t ho 1:1c: inton:.mce of ,:rnso cio.tccl me chino,vy 2..nd c:.,1:1.rn:cnt us , in conseC:i_ueµ ce de t orioro.tion o:i; p0ri0dicP,l bre nl,;;downs of purif ic::1.tio ::1 c...ri.d d. i s trib4tion s yste::is is i..'1evitaw2..e . !~s ::-~n o:x;c-.:..1plc , on one Gyst ei:1 whi ch wr:>.s sui,ervised by an enGir~eer, o.ssistad by three pr1.rtly tr~inE:ld 11ei1, r.m ~ C •. CK 13e.nit c.ry engineo;r csti,n:::·.ted n pr uper n er.:cl fo r u. w.:1t0r.-wo~ ko chi,ef 0nd 3;1. skilled r:1en; J.5 ;i.n :.. L.L:d,nter.:.c.nco se ct ion , 5 ur p._ft stten, o.nd l,l in r,.n orer 2ting n;i.d t e chnio~~ 2o ctio~ ; an esti~ate Dhioh appeare d r easoncb l ~ . It s0cr.1s t h~,~ d i a c:;.~e pn.,."l c::. 0s of t hi s order occur fre quently ond are r es ponsible f or Duch of th8 unsntisfc otory na t ur e of t he supplies.

'.2he pr ovisi o:1 of t:rb nn rmt Br su_?plie2 n.dequo,te in both quantity a nd qu~lity i s one uf t he firs t principles of ~ublic honlt~. They he.we t heir benefitB i n ¥i1,+UY other wc:.ys t t rm tbi rcld uction of nlime:1t;;,ry i nfe cticn i by the i m~iro vei.::.ont of' _b)orsc rw l I c(or:iestic nnd urban cle,::..nli ness I t he r osults of vrhich were se ..:rn, in t he d r o.;.1 .. 1.tic irip:rove1:ent i n public h ea.lth in Gr e.::, t Br i t o.in in the se c ond }1.::\lf of the l ns t c 0ntury following t he wi desr re~d introeuction of nde qur.te sup_r: lies ~ nnd in D;wn;y o t ~1 0r coun t,;ies.

The pr o ceos of \vo.. t er s0.1Jf'li11g: .:t.i,1Cf a11c.. lys i s i s r .. lJl"cECl"'ibed function vi' the _:J r ovin ci~,1 lo.bor a t or·y I out c!_o 0s r:o t c,ppeo.1" t o be carried out . Unclc.r the influence of UlfC.,,.c 1; , ~t_p};.'.:!.r ,,, tu .:1 Lir t he estiwc.tio:µ cf res i dual c h;t.or : .. n e J:v:cs been Gu1,r:1iod in no.s t ~' . .reo.s , but it s r ,.)utir:.e p0ri9dic ,:i.l us e is on unusuo.J. h c,j;reni n g . 'J.'he c.na lysis of j?i ped wnt er suppl;Las i s r-n essenti::::.l 1,art of t heir funotio1:i11g r.nd should pr operly ~c c~rried out bo t h by the wnt er c.uthority nn d by t hEl health d0.ri;:,,.r t r:ient, '/he v:::iter aut hority should c.n0 ck t h e rroper functic,,ni!~G o:l;' its pur it' icatio:n wor irn ;~y V-c;J.'Y fre qu0nt estimations oi' residual chlorine l:!'ld by bc.ct0ri,J l o;:_;i c :1.l __ ,.n:.:.ly s es of w,).t or dr mm off a t t he f aucets t o de t e ct i upcrfections in t he distribution sys t e□ . The heal t h dep~rtwont Ehould carry out r outine exami nations o t t h0 fnuo e ts an~ ~ya pr ocess of sa~~ling dis t~ibuto its i us;1q ctions ov E:: r t he on tire ri.re~~ sl;lrved i i;i. th o cour ::-:e of n ye ":r. In t he :)r esent st '.-:t o of ho.:1.l th J.ei:;2..r t ments ::mcl proyinci n.l laboratories 1;his is m t o. r,r o.ct i col poi:,,s i pility , b ;i_t it should bu d ovelo _ped G.s soon c.s t he ~ursnns an~ f ~oi~itiEs ere avail able .

A gener~l policy of i ~Jr ove~ent of c unicipcl wa t er supplies should. -'l i r:.i a t the provision of 0, r:.2ini::.mm of 20 gallone of v,;hole s cne wat er per h aad of por ul~ti0n t o nl l t own due l ler a . ~hi s would r equire t ho s urveying of al l water coll e cting .syste:w.s , rJur;i.,fic e tion _rJ lo.nts and distribution syr;; te)j1S , o.nd -~)r1;; pnrin 6 o. pr o::--;r o.,-,i.;ie of dev e;t.o puont :.:·or ench . Priori tie,;; of \'To r k should t h0n be nlloc:,ted 1

the highGs t .Pl,"!i.orit ;/ boir~b given to t hose o.r 00.0 wl~oro t he suprly i s · ne st iu~Cequo.te in qu o.ntity , nnd t ho se c ond priorit ? to those ar eas where t hu quantity couid be □ater i~lly i n creased without gr eat c ~pit a l o~penditur~. It is rcc o1.1~ende~ thut work snould bounder­t c.:C:en on t h:.s :i;' ,Jrt .hwit :1 l a ~1d t h0 develo p,::ient .i/ t' 0 ,:;r &:-,~1.'1e started o. t c.. spee d vr!1ich v;il:'.. purr.iit it s conplct i on within otod 25 yee.rs. Such a pro 6--ra;_;i_.::.w will involve ::1c:~jor c o.pi t8.l ex penditure l;mt i t .should not be fo r gotten t hat in ;x ,s t countries wa ter suppl y is r egard ed ~s ;financ ially self ... suppo.:c ting Urcugh t he levyint; of water r :::tes. Thi s was pr cbD.bly 011cc the c as0 i n Koreo , t hough the ec 0no:ilic break­down lrn.r.-; now 0z1tirely disloc ':l. ted t l:.e s;y-.ston, which doscrves r estoro.tion .

A t r aininc: s chel.ilo is 1wcdod to provide t8chnicici.na f or the prv pE- r run:.d,nt; , E1a.intenanci:.i ;:q-1 c1.. n c r uo.l enJ.ar Gerncnt of purification

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syste,.:.s , pu:-1 _1:, j,_._11g a;,.irw.' c tu 1o a.nd. dis tril:i u t ion syst 8,;_s . O;i.e n,,j or m:! t 0r v,or :.:s c ould be t c.l:-:n;_ over rmd operu.t ed as a r., e h ool st::i.f fed by i ::1.t er­r~a.tion:_: l i rLc t r u ct or E . Thi s sqhool should ha11,d l -.:: , '.ll t he t e chno logi es i nv0lv0d. in wat er nr,nagc::1,::r1t , i n c l u di ng t ;lose of :_a i:. t enn.n ce o.nd r Gpa.;i.r of pu::!p:i.u,g r::E~ ch iner:· , :,nd dr af t s ;:,:an2-hi p . It s r u J :i,ls shou l d b8 t he exis t ing st3..;ff of ,K.t er w::>rks r:ho o.re c,t t lie r.10t11;mt inaclo o.uately t.i;- Ll.in0d , t oge t hor wit :1 c.d::':.i tiono.l ::•e ople - .:_J o l':ls i '.:)ly r e c e1:tly de1:1ob ilis0 - who wi l ],. be :ie cess::..:ry to br i.i."1 6 t he staffs Ul> t o t heir r,r o_;_.ier n u.uber. T!10 CO).u;se ot i1 ... strt,c t :_on woul d vn.r y a c oord.ing t o th e t echniq ue s t ::rn6h t, bu t i n n o ci::se wo·ilc. it be of le13s t han t h r u0 r.1,.:.; n t hs dur a tioll .-.~1il s t in n ::,n~/ it would bo of six i:.10:.::. t hs . The ob j e ctive should be b y a t;:i.'o c es.s of i.u.tcn.siv e tr a ining t o turn out ::Je n wl-.o c r e fully skilled c..nd eelf-rc licmt in t heir f ;i.e l d . Mu9 h good ho.,s be,m don e by t he 1:.J riof l"e f resl1er c our ser., giYen by m•w; .. cK and t ypico.l ly l r,,.s ting a ~ew t"tnys , but t hs ensuranc e of pr oI_:0 r uai n t enan ce after t he end of i n t e r no.t i on o.l nssist m1 c e involves ;::rn ch more 01 :.:i.borute i ns tru ct ion ,

Sewc1,ge . The tracl:L t i cn :md econo1:1y of ngr i cultur8 i n Xor eo. i s l o.r gely baso C:: on t i1e i ::11,,edinte r e t ur n of o.11 nitrogen ou s mEr~ter to t he s oil . In ~Joth t own cu:d. rur nl c:.:.:-o as wc. s t e !i:[,t ter i s co.r efully c onser ved for u l t i m~t e di~e c t d i s r os ~l on t ho fie ld, wher e it is l c rge l y use cl 011 t h e ,:mbsi cii c.~r;v er e., p$ ,su ch a,s v eset ~,blos v.nd bel.l!fS . Thi s t r :~dit ion is ~CJ' g0 ly r esponsib l e f or t ~10 h i gh i n c:i, uen oe oi worn infe ct ion s l~ncl of ,.::l.n~r ot iwr c. l i:;'!ent o.ry dise,:.,c e .s . Though it is tradit i :m&l it i s 1~ot c 01' t c.in t h.'.l t it co;ist i tu t eo t he wos t c f f ,.) c tive me t hod of ;f'erti],:i,sc tion . :i;;ur o.i:,e:::.:.n ex;:eri.nent sugges tr; t hc. t t hou gh pomi,osted uc.t er i c, l ;:1f'.y have a lower n itr oc enou s c ont ent t hn.11 f1" esh, it is pr odu c tive 'J f '.;c s r c :"'.. t.::,1" fert ilis c.tion t hr ough im};J:cov ei:.ent of soi~ struct ure . .• few expe:t i nen t s i n c ::ispost i ng ho.v e ·:.:i oen cHrr ied out m1d ct :0.1,.;. j-::>1' one w::i.s be i ng ini tia t ed c. t Kvio.ng ju o.t t he t i::1e of t he Mi ssi on , s visit. Such ex~;0rL1ent s shoulJ. be enc our aged but it i s pc~rt i c ul .:'!.rly desir .:.~b l e t hat c:;.eri culturc. l ,rese o.rc ~ wo;r kors should i n ves t iga t e t he s ub j ect wit h t he pE,rt i cul o.r objective of def ining a r.,o t hod of production wh i ch ensi:,res t h o gr uc, t es t fer t i lisc:..t ion of t he l and wit h t he r,lj_ni1.m::1 r is]: t o t he i n :·w.bi t .::.nt s .

Rur c.l c o:Ti} Ost:i,.ng s chomes c oul d ;_·,robab l :v b e c c,r rie J out by loca l coope .J;' a tiv o effort, b u t i:1 t owns t he y dc:;wnd ::iunicipal a ction . Municipalities havu a sys t e1.1 oi' c olle ct:i,01i whic h i i3 , in nli.:aost all cases , ::.nacle quo. t c :md. r einforc ed by t 'J.e work of r r i va t e contr a ctor s . The :r,r,iss i on p.oted this wit i1 r ei;ro t as it i:rnst ;L11ovitably J,..01·:er t h e s:mitary st2.nct.::.rd.s i nv olved . 'rhe r.rnnici 1"2•.l ity shoul d. un<ier-t nko t he clear an ce of bo t h sewa;;e 1:q:1d refus e , ut i li2,ine; a.s !'i1ilch as possib l e f qr c o:1post nnd h 0,icli:P.[,' t :ie rei:~:;.indor u :1d..:. r ::i.;: 1.;2.~ov 0d. co!1d.i t i 8ns u n t il it c an be u13ed . The l a trine s , whi ch e.r .:i c.t .i:Jr esont n10s tly u n ,sat is­f a cto;i:,y , s ho ul d b e iri~)r oved by t he ) r epar ,:.t i on o:!; c\..l:i-r oy ecl pl airn , t he o.do11t ion of which should pe obligo. t or y il1, u r b a!l ure a ~ . '11h e i n t roduction :);f v ::l c u1i::.1 c lec1r a11 qe t o closec:J, cont ::::.inor s oi1 tru ck s i s do sir .:i.b l o and ooul d. l;>e s t o.r t i; J i n s or.10 p~t s of t ow;:rn wh:L ch n ow h av e r e l o. t ;i..v bly high r c.t oc..ble va l ue; , wit h t he ob j e ct of its ult inat e wider ext l:)ns i on .

As o.n i r:i.:wdio.t e n easur e it i s i:.iport o.n. t t h c.t w.unicir,µ. l clear ance s l1::m l i be re - os t nb2.ished. a.pd t o thi,s e nd trat+s;po;r t :I;' or t he pur po,se , n u ch of which hes 'been lo s t dur i n g t he wo.r, sh,:rnl d bo ;i;;u_iediat ely res t or ed .

S ca v enging Su;.~v ices . ,'cs r:it h the sevyagc f t he tradj, tion of the coun try 'i s t hci. t t h 0 b 0s t r, l ;;.c e f or t h e go..rl;>o.ge i s on t he ].o.nd, and traclit ione..lly i t i s r e r,i.oy ecl ·effe ct i v e],;y o.nd. q_u.1, cJ:r..ly . In to1,1ns i t i s nor nally carr i e6. by householders nt :t'c-gulc. r int cr vc.J.s t o dur1ps wld.,ch wer e a t on~ t ii.1e cle:::i.r ed r egul~ly by t fle +oc c. l a u t hor:i,..ty , b ut t h e loss of tru c k s durini; t h e war ho.s great l;v r edu.ceci. t?10 i requericy of c l ear anc e . Rer,1 ov,a l :my b e dir e c t to f ar ns Oi" t o ;:na jor dw.:1ps , which t ypic a lly a ot as t e□porary clear u~ ce depo t s onl y , t he nat erin l b e ing qui ck;J,y r emov ed b y f or11er s an'.l i !1 ·s ome o.::i.s es deli v or ed t o t h eu on paymen t of o~rtagG .

.,

The position h c'.s been complic:::.ted by UN "7or cus' garbage which cwnt .'.:lins a 2,T e-:t t qs-1.nntity of po.,ror and tin which c c:nno t be disposed of i n t his wc..y, but whi ch h nve a considero.tle marketable v;::~luc. It is e ~,gerly collvcted 1:.mcl where unco n trolled. is taken t o n gr eo.t vnriety of sr.mll unnuthorised cnnps - the:i."C :i.re sc~;i.d to be 60 a r ound Pusan - where it :i,s so;rtE;;d by .L.1r:i,vate individnals 1 t h uo p;r oduoing nn inso.nit o.r y nuisance. It hus , however, b een put on a.-ri orgcmised basis i n TCle[;u ~ wh vre it i s colliqcted by th e ;-,1unicipnlity and taken t o o. s ingle depo t t o be sorted und t;1 r c:mtro],, The c cnsidero.'u le rev 0nu0 fr oui sa;J..v c..ge is used t o suppo:rt t ho Sunito. tio;r. DcpnrtmE-nt of t h e C:i,ty.

J;n prin ci1,l0 t he systen -Jf disposal is unobj o ctiono,ble if pro purly ca r r i ed out, ~ut it n &a ds t he r es t or a tion of transport a tion pr eviously u c0 d for clec,;r c.n ce and lo s t cluriµ G the vmr, o.nd. the provision of pr oper concrete cont a iners, Fith~otection ogninst rats, for =!,.oc :11 stor o.go before clenrnnce. Lltho u gh disposc..l on l rmd is µot obj e ctionnb:i.e , thE; nat -:;rial c ould be us ed with aquo.l economy in the pre pnr o.ticn of cur.:pos t, t .ri ereby aiding t he sanitary disposal of n ight so;il.

F'o o d Hy ,c;ie n e, 1'-iuch V0f;o t,:J.b le food is contn,:1i~:2ti.::o. :::. t sourc e by t he rne thoC: of'-fw-tilisc,tion by night 13oil vrhich is co::mon , cmd pnrticulnrly so i n ,:1::i.:rb,t gar ~ens. Tho incidcn c 0 0;f; c.s c ::;,r iasis i s shown on survey t o be 82 per cent of tlrn po;,ml c1.t;o1~ t hroU:'3Jhout the country. In;foction with Cl_<?E,?_r,2;-1:::._~!l. ~~~-1!:..':'.?:E. ~u1d Po..r P.gonLms :~0s t er;,1ani~ i l.3 pr e v alent in c ert uin p:'..r 't s , cl1 i e: ~ l~1 o.lor:;6 the ba;..1k£ of t 2,.e ,J.a jor rive~s , and. t ho u gh t ho 6 011 .aral inciden ce i p l ov1 , 6 . 6 Jer qent, tl1e local ;i.11.qid.enc e is sowJt i i:10 s hi ,:.)1 and reache s 36 . 9 per cent in c-\11 ~ea nq nr Taegu . This neuns t h::-t t ~:m ch o f tho f i sh c onSlll..:led is c ont anino. t ed a.t source• F'oocl, is r e t aile d l o.r g~ly in ;·1cirlwts, the r:w.nagenent of which is one of t hE:: r e cogn;j_sed functi 1)11s of t he Sani t 2,tion Sub ... ,Se ction of the 3ur e:au of 6o cial Affairs, n ow n atively nsaisted by the Sanitation S0ctj.on of UNC.\G K t e~'.ElS . l,\)o d is n ornc.lly uncovered ::\nd no t pr o tect ed in ~ny way but t hure is usua lly an nctiv e e ffort to 1.1::i.int nin sone stc:1.nd::::.r d of olea11liness c f ,sur r oundings a ncl r e duction of f;l.i es , rt c c.1::pctic;n r,1ctde difficul t qy the com1op. ;cough ;a.8.tu;re of the pnvin[; and inr,d,'.)qU:Lt e fc..ci.l :..t ies , ~Cher e nre Lw..ny s,J.a l;l. resta urants c1round 1311ch uar ke ts, ;:,md c onsiJ.0r in6 t he ir circm:i.ot4 1ces th e sta ndard attained is ~odar n t cly sati s f a ct ory. ~ recan t inteasive drive to s equre cleanliness in th\:) hanq.ling o f :!;' ood in r es to.urcmts nnd other ;,l o. c ,:;s h::i.t: b0on ini ticLt 0d by UNC.'..Ci: , ancl ,:i.n excellent rnnual for the use o f i:rntructors ht,E:1 '.:> een :f,r ou:.i.ced. 'rho :i,:i':lod::j..a t e e ffects t o be expuctcd ::'l.r~ s.:,n'.l,l but i f del:i,ber :ite inst r u ction i s continueq with deter:.,i n..:ttion t he $ffo ct .s shoµld be cu::.mlnt:Lve and ulti;;1c.te],y of c onsidernble v 2. lqe. Provincin], l c.bo.N.torie s h 'lv o a. ,s one of t hEl ir functions t h0 r outine exe .. mino.ti on of food.s fo r o.dult c r n.tion o.nd for b a ct or~ol og~co.l ~ lpurity. Courses ~~ teq hnio 2l tro.inins in these subj oct s r~r e given t o t e chntci.:-ms by the Hrstiono..l L:::..b or atory of Chex;ii s try o.nd t he Ho.t iono.l :r,,,J·;0r ~t ory for t :ic 1-Tev cntion o;f Ir..feotious Diseases. The tise :1:,dc of . t h ese ,service6 o.:,pe.:::.r s to be swo.11 but t hey constitute a found:::,tio:q on which :40r o c a n be built .

Insect s ; ... ssocic, t ed, with Disens e . The i ns ect-borne diseo.sos which occur in KoreC'.. include .:::10:l nrio. , ~ilc..r:i.n.s is, J .:.-..pnn ese B encephnli tis, louse-typhus 1 nite- ty 1Jht1s , !'elapsing f ev er and h a eillorrhD.6ic fever 1

o.nd t hoi..i0h pl ccue h~1s not b<fon r e corded it i s r~o t certain tho. t it is ab1;3ent i it o ccurs on o. lo.rge sec.le in neighb ouri:1g 9ountrie13 o.nd oould r e a dily b o i nport 0d into the country,

lhe epidehli o logy of Jo.po.nese B enoe pho.litis is sti~l in some ways unc0r to.in, and that 0f hn emorr hagiC fever is v 0ry little uµ ders tood . The loco.l (;:pideuioloi;y o.nd distribution of r.:.ost of the others deserve turther stLlJ,;y , part,f.oulnrly 1;,10.l ar i o. concerning wh;i..ch it is i1:1poss:j.ple t o ge t reliable ela te~. / It is knovm t o occur i n n. very i~r e g uJ,.o.r a4.:";, circui,jscpip e d disti•;i.but:i.0n, beinCT c.;:,s e nt fr or.i 1:ic.ny G.reas 1

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but spl~en r a tes runging fron 2 per cent to 24 per cent are to 0e found in the broad rice gr owing areas of Kyongso.ng Pukt o, and possibly sini],ar cunditions occur e lsewhere .

Tyf,hus i s n a rr.w,lly recurrent in winter epider1ics of v~yini; size. l'h"re are no standa.fd arrangenents ;for d.isii1featc.tion but UNC.sCK ha s undertaken a wide delousing schece by the u s e of DDT powder as well us f.'. Ct ive i r..ir.mnisn t~on of t he po pulation ago.inst typhus , and. these maEt,SUl;"os ho.ve gr uatly restr::dned the incidence of t h.::d; dis0ase. It has b0ei1 s hown t.h&t the louso has developed, o. par ti"~l res:\.f,tanc e t o t lw ac tio~ of DDT nnd. r~J.thoug.\1 there il;l no preceq.ent t o go on it is possi b l e that the utility of this ;Lnsecticide nny steadily decrease. Ul t;,i.i:w.te c ontro;J.. ;Lie ,s in the prov:i,.si.on of o. liberal vrater sgpply, which ho.s b eon sugc estcd claewhere .

The Nat iono.l Laborat ory for the Prevep.tion of Inf ectious Disea ses is sk,ffed, iUJ,d eci,uipped to deal wi~h t h e b a ct oriological c.nd parasitologicnl a speqt of t hes e disenses , thc u; h i mpr ovement is to be desir ed , btit it i s not c;.. S s::i cie. ted with c.ny e:xe cu tive orgc.nisntio:q . It is not stn;ffed or equipped to qea.1 with tL o epidei;;_i o:i_ogi caJ. &"l d

entomological aspects in a satisfactory CC:.!L'10r, and it s work cannot be complete until t i'1i.s i s renedi e d. '11h0 b o. ckgr o und aud bo.sic tr o.ining n eed.0d by o. skil+ed ento.:.1olot::,i s t are u,nu,su :.:.lj there are no f nci],itie13 f or them ix1, Korea np.d it :i,s unlii::ely tho.t o.ny Xorear1, ho.s attained the111 elsewhere, so th0.t ;.:po duction of c. fully suitab le Korean st a.ff withi;n t he n ext few years i s unli!).ely.

~h0 study of th ase diseases with a view t o compl ete e~ucidntion of t he ir l o cal e i:; i cleniology a n,d d:i, st,ributj,.on i s an L..portant c.spect of public health workl a.i.1d it is suggest0d t lw t c-.n :i/ltornational team should be appointe d to t he Nnt:i,.onnl Lnboro.t ur y , with a cc ~s~ t o hospital beds f or t he observntion of clinical cnses, for t h is pur po se . It shou:).d c 9rn;3ist of an ontol.'.lologist , as sistc.nt ent omol ogist , virologist and technician, e..;1d should, wo r k f c :r a per:i,od of three t o five years. Durin6 thi,s ti:li1e it shoulcl 'P.,o p,1 ssible to give ,werseo.s trainine; t:, a Kor ean vir ol ogi s t to ;re l=' l n ce t he internatiop.ul one on his depo.rttire, and t e chnicians could be t~aine4 l o cally , ~n effort should ~G made simultuneous l y t o find. an app;riopri:..-vl;e Kore r.::.n for tr ninint, as an entomo l,o gist, but it would ~QVG t o co r e c ognised t h c t t his migh t ~e impossible. Inclino.t:i.on ;Ls (l[:.senti::,J., ~1110. is not commonly found. It mu s t be supported by 1t good gre1.dur: te tr cdning iµ general zoology, o. s9ho9l bei ng; chosen with l l mo.rked ex1Jerd.~wntal-biologica l rnt):ler than systenw.t ;L c ;J,ec.ni,ng . I n addition , 'Ji.le o;r two yem-s post-gro.dun.te experiencq undc:c supervi,sion woulr:1 1;,e d e s ir. c,ble b ef ore underto.king independent wo.:.~k c.. s ru1 entoe olo gi s t. To start th;Ls _r:r ogramme frolll the basis of n high s 9hool educ a tion, ri.1i gh t b e too prolo:1s ed :for c.n UNK_-q_g_ a ctivity.

Ro de n ts. Rodent s are a com;10n feature of the t ovm wid cour+tryside, and their in:i; oads on f ood s t o ck s riust :Je c onsi der able. They he.ve not been SJ?0cifico.lly incrir.:in.:::.ted i n. the tr.:msmission of di .sec.so i,11-t hi s countr y ap.d, in pa.rticulo.r , bub .)nic 1~l o.gue hes not been reported . They may act aa re servoir,s of sev er al serio us disco.sos; plague, ty phus and ';v'eil 1e disease be:i,ng conL1on ones. ;] crub typ.qus has beGn re port ed , but on onquiry int o t h o j,.nc:i,den c o of t he various ;ro dent­b or;ne d:i, s e a sos the Mission felt tho.tit was encountering more a ;Lack of infor :2ation tho.n <J+J.Y r ositive evidenc e of the l ocal ho.rralessness of th e ;r n t populutiun. Whqt ever the p;resent position, there is undou 0t0dly o. poss ib:i..lity Pf\ introd1,1ction of these diseases n.nd par tioulo.rly of pl ague , Th:e wnr d:::t1.··10.i;e uhich ha,s been suffered by nany ports a nd other town s .ruid t he failures i;n ou.nicipal cleo.nsing work; :f; olJ.ow;Lng th e we-,.-,:, t;r ently increase t he risk of mn jor e pidenic occurpence. The po tent;i..o.lii;;y call.13 for pecr t:i,c-q;I.a r vigilo.nc0 in rodent contro l n~d f or the routino bncteriolog;i..pal exru;ii,..'lation t o detect the o ccurrence of pl o.gu0 01uon,g r c..t s and fle a s, or its prob:::;.b;Llity o.s shown by f1E. o. prevc..lence.

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Jndu,-:=: td .. c,l ar.d CJ ccupc'. ticnnl Ccmdi tionE_. The mci.in industry of the c ountr y i s n.cricultur e ; t he other s were principa lly i.n the northern t &rr it o:cy , nnd in Kyon ggi-Do . Those in territory now c ontrolled by thG Koro ~n Gov ernne~ t ~re r e l atively SLlail and mnny of the□ h a ye been br ou ght to a standstill; they i n clude a tex t i l e industry , the f c' .. bri c ntion of rubbor coocls , ;.1.nµ ,:iining-, tun.;s t an, c onl o.nd e ther ;:1iner o.l s be:i,ng wor ke d. Virmy of thE: fn ct'or ies n;re suall, e :·1ploying v ery fe ;.1 wor kers , mid a re t herefore difficult to su) ervise. They

, e :~1pl oy ed 269 , 000 workers bd'ore t he outbr'e o.k of wur, a1 th '.:l u gh the n u:.1bc r :i:s now r educed to 1 91, 0 00 by t h e closure of uo.ny fo.ctories in pl c:. ces near t ho ;_1ili to.ry zone.

The e:x;isting l aw was ena cted un, ~l~r Milita r y Govorn;_1ent a nd will 1.-1robn'ply b e :i;-o Pl aced by a b;i.11 shortly t o be brousht before the Nnt;:i.onc.l .:~ssenbly . The operative 0;_1 0 de a ls with .w. chin~ so.fety, t ho mrum;f a ctur e of plpsphorus [19-tches , wo.fk:i.ns hc u;rs, qm_i;l oynent o;f juvenil0 l ~,b our .::md wo1:1en, o.nd s;i.ck and pr egne:.nc y l eav e. It does n o t i n clude :re qui~euents for pr o tection against s pecific industrial risks, for t he p r ovision of first a i d f a cilities, or f or mn~tary control of f actories oth r t han in broad gener al ter~s. It is n o t ab l e f(U'ticu ;:t. urly t hat si1icosis and other risk s o;f Dining ure not c ov e r ed by tho l aw . No fnctory ~nspcction sys tei;.. is l o.id c,cwn and it docs not app00.r t q exist ,

Desri tG this, an e;x:nnple has been 13et by t he Honopoly Durenu, which is t ho depc,rtnent of go ve:rnµent proc essin~ t ·obacco . One o f its fact 8r ies was visited at ChonJ u. In t 1is fact ory ,1, 600 workers, o.bo u t 6 0 per c ,mt of whoi1 are ;·,m;10n , o.re enployed. Thi'; design of t he f ac t or y is go 0d . It i "' well pr ovided wi th washing a nd l o.trinc a rru11:;ci:;1ents . It h.::ts ct sirJple day nur sory under unsk illed s1J.per-vis i cm , anJ. includes a f ;_illy oquipr, ed di1;; pec1sa r y r un by n do ctor ass i sted by o. phnrnncj.s t and -~we ql.lalified nurses with one; unq1,J.a lified a ss:j.s tunt. ';I:he dispensary de .;!.ls w ith sickness n t work, industrial i n j uricis cmd i s also t h o foc c.l po;Li1t of n. 0ont;r-:i,but 0ry insul;' a nce s c l10ue l;'Un for t he benefit of worl-~ers nnd their depend,9.:·. ts.

Th i s ex~~ple is not ge~er ully f ollowed, and i n textile wor ks vis ited t here wcs no sro ci .::1. ],. safety or w0 ;l..f&re provision, althc ngh tho i n dustrin l rii sks vrnre srn1ll . ., s pecic l v;i..sit was paid to e. coal q ine and the welf ~re of workers was sµbsequently d iscussed with t he P-.cos;Ldent of the c onpany uncl its :~1edico. l officer , vJorkers were h ou sed in good qu a lity h ouses i~ well l a i d ou t se ttlecunts provided with conmuna.l bo.th houses , whi ch o.re nc ces sible t o work0;rs nnd their de pendants free of cost,

The u ino wns c. sir,1r l e one of t he i n cline tn·e , produoing ruithr a ci te and fruo fro n inflt.u..1.::11:;>La 6a s. Drilli:1J wo.s by the dry pro cess with no sys teq atic dus t c o~trol. Vontilation w~z naturcl. There wal;l no sanita tion in t h e ::1ino . There was no ne ch::mism t'or the provision 1 first ::d,d o. t t he ;.J.ino , but o. di s po ,.rno.ry was provided about u B;ile nwny . There were no pit hend b a t hs , but bnths were pr ovided in the nssociatod, v:iilo.ges . 'I'here wns no exai:tino.tion of wor kers for s ilicosis .::md no d e.t o. :an its i n ciden ee., A dispensary was 1::,rovidod i n t he v;i,llc.ge , wher e c c.re is given t o workors and their f a:.i1ilies free of co s t i it has f ouri treatwent r o o~:1.s f or in- pat;ients, e.mougs t whom vrer:c t wo peopl e rec (J v ering fr oo fr a cturep of the lei; and. one r e c ov eri.n~; ;t'ron a. serio us in ju;ry to t he s p ;i,11,0. The lil.::tnc1.ge1.1ent of -:;hese oo.se;s ha~l been undert a.ken without adequ;:;lte f ncilitieG s uch .::i.s X-ra y oxo.n i nntion a n d the s ur geon responsible was s a i l t o b e quaiified by ex.::i.wino.tion only.

Tho i npor t ance of t his st ~te of a ffairs is fully u~precio.tod by t he coc pany offici o.ls and the Bcdi cal of f ioc r wh o has been C:_ppo int~d. t o r e;:::c dy it T 4nd who h as received 1,u~lio h~o.lt:i !ruir.Ling in the Unit ed Stut es . f-J. s~rvc y of the n ines, inchiding so.r ety pre c o.uti0ns 1 hc..s bec;,n L!G.d o by o. wei:il;ie;c of tho US De part r;ient o;f f"Jj..nes,

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and t 11 e company now propose s t o overha~l the sys teN conple te l y, providinc; t :iO hospit a ):: ec,.uipped wit h X-ray apparatus arcd thr e e c1 inics sta.,1:' f ed b:'t do c t ors for t heir total of 1 0 , JOO wo:drn r s , and ar:rar •. gi ng periodica l exan:i nations includ:i,ne t he to.king of a radio­gr a ph o:f t he chest, &nd the ; ·,1st a llat ion of v;e t dri l ling and other saf ety precaut i ons . The c omptmy is said to be committed t o t his proz r a 1ru,1e t hou :._-11 it r:i.v.y be dela yed by f:i-.nanci a l and e quipment d~.:f f;i.culties.

Yor th0 gene r 2,.J. i ::11)rovement uf condit i ons in i ndus tr y t h e first r equir~uept is the specific tr a inins of ~edica l off icers in industri~l hygiene. One .:~ peoia lii:;;j_ng i n mine work .should b e eurlo:·ed by the r:ii ning companie;:; and ano t her to e s t a blish e.n ins1,;eotorate of n ines and f uctorieE, within the Ministry of com;.,terce. '.''he fir .s t function of t he i nspe ctora t e would be to carry o u t a deta;i,led s Lirve y of condition13 :j.n :i,nd.ustrios , pnrticul a r ly t hose wi t4 specia l haz&.rds and. to prepa.re o. c:.ll;:iplete ;revision of t he l cw den.line wi th occ'..lpationa l conciitions I o.i :.:1:.:.:a3 C:t t c-. level of s t andards s:lit ably h i gh but strictly enforcen.ble wit:.J.in the circums t ances of the country. The se cond function wo u ld be t he wdnt en: .. m ce of tho fl e s L-.n d,trds by 1:. r egular inspe ct ion of f~c tories 1 for whi ch pur pose f ac t ory inspect o~s would have to be t ~ailied. These L :.. c to:r y inspe ot .:: ;:•.s are co::: cerned mrdnly t.nd in t h e first plB.c e with the mai n tenru:ce of s ::..:.±'e conditions of eill.plo;y-w.ent . The;i.r pr ovis ion is :no t the re99onsibil:..ty of the Hinistr;y of Health but would ,pr \lSLE10.bly b e t h :o1 t of the I-linistry of Coru:aerce and Indu E1 try, ,u~d t h e s u gges t ion i s rrw.o..e t hC\ t t ho be,s t i ;:1sp-actor s are r e cr uit0d fro i:1 t he workers i n t he pc1.rticuln.r i ndustr y t o b e inspected. However, t he Mini s try of Health h~s n res pon sibil ity , to s upervi s e t he s anitary envirom:-;ent in which t he wor kers ha ve to ca rry out their dut ;:i.es, for v1hi ch F ... ir pose it will be ne ce ss.::l.!'y t o give e ome special training- t o s o.~it ru:~ y inspe c t ors of good quo.lit y. It i s pointed out, however, t hut the r e s 9onsibili ty f or i ~pl eme~t ing tho requir ements :.-:, e t up b y these s a ni.to.:,:, y :~n:::.pecti:ms ;m,;.s t lie w:j. th the ministry c onc 0rned and the indus t r i a l ent er ririBe c on c erned, aud ca nnot lie with the Health Inape ction Serv i ce.

This progr Ll!.11;1e would r etm~t in t ho def i a ition of a nuh1ber of safet y p:re c,:J.ntions d.esirc~bl.e in in4ustries :1s c. whole, but ;;lining is c. rie ld in whi ch i m.: .. edinte l", c tion cc uld b 0 t c,k e :,1 y.rithout ftu~ther survey , u.nd ev0r y effort s hculd. be m.,:i.de to a ct on t he r e commoµd-'.l. tions m2,de in t hi s respect by t he offi c0r of the US D0pl-;.rh1ent of 11~;ne s , and t ha propc,su.ls put forwn;rd by t he compnny a lrec;.dy r eferr ed to. I t i s ,said th1.1. t an ext er.:. ,s;i..or1 o;c' ::cii:lin,~ i ,s pr o pos..3d , :.Lr,. wh ich cnso t he i ns t a llation of adoqun te s ,.cf €,;;y a:.1d. w8lfetr8 r,10 a sur0 9 , of appr ol,)riate ho using and meciical cnre sho u.ld bG l ooked o.q. ,:.c 1:.1 a nec es.so.r y pe.rt of t he work.

Sani tary staf f . Org1:mi se.tion hes been di.:.: cussed :in c. se po.r a t e ·chapt er :..1.nd will not be d escribed a g2.in exce pt to 0 r,1_phasis e t h e difficµlties produced by the indirect lin es of o.u thority concerned.

The 1rlni s try stc..ff includes three of~icers with cv0r;:,eaz pu'blic he al t h trai n:Lng , one of whom l1c;. s hc,d specia l instruction in s t o.tis t i cs illld cpi J.eni ology . At the pr ovincia l level one :necµ.cn.J. officer i s r esponsible for a ll ced i c &l and public health services, c..ppointod dir e ctly by t he provincicll governor, poseibly not o. pevnanent ci vil sorv o.nt 1 and t:1picr;lly without pub.J,J..o h ealth training. 1Jnd -J r t1in t l:e1"0 is :1 s mdt c.t i on o~: i' ioe r who is n.gai1i repr esented b y c:.. sanitation o:i:'f io er n t t l,e g;un l ovel , who r.io.y have workins under hi m f:' nnitax-y i 1w1;e c to r s wl10 ·m t ypicall y pr ovided on a basi c; o;f one for 0i::~ oh provinc e , city , to·vm r::.nd gun .

There is n n inistry instruc t ion th~ t tho □ e sanitary inspectors should no t be t r nnsferr0 d to other du tie s in o t he r d epartLlents, a nd t h ere a r c .,,rr o.21ge r.10nts fer t heir oxnu i:1. 0.t j.on c..nd c:_ua.l ification ' for t he t itle , but :n.o arrangenent l'3 for• tra ining 'I which must be gained by the ap~rent i ce ship system and by persopa l

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study . Most of t hese provisions are generally ignored t hou gh t h e exar:~ina.tion syste !:'l is practi sed in sor.ie provinces o.nd . cnsure.s a certa in ru:iount of e lement c.ry knm·:ledge. The result i s tha t de spite c~eful enquiry the rJ.issi on has been t.J.m~ble to meet a sa..'1it a ;r y ins pector who wo uld be-. deened suito.bly trajJJ.e d µ.nd other­wise appro pria te for the post in most other coi.intrios.

This group is essential to the practice of ~ny environraental care and in f o.ct constitutes the ·wor king i1e chanis1ii of a ,sQ.Aito.tion dcportu ent, and u:ritil t h:Ls l .:cck is rm::iedied there c: an b e no r.mrked impro~ement in public SLU1itation.

The i~nedia te r eoedy for this situation lies in the tratning of s anit ary inspe ct ors on a considere,ble s<;: D.le. An adequate initia l c o.d!'e would consist of a t l e a s t one to every gun , town and city with a dditiono.l nuab 0r s for the ma jor citj_es, but t :10 ul·t:ima te n~;:nbers requir ed vwuld progrcssiv c. ly incr e '.1.se as t he proposed s ch eoe of Hee,lth Units i s dev e lo ped . Th e proper mechc:.ni sm lies in th e cr (;)ation of a soh oo;l. f or ,s ru: i t o.ry inspectors world;ng 1:,,y intensive m.e thods and ~n~er th0 c ontrol cf ~.nt ~rne tiona l sto.ff includi~g a m~dical officer of heel th and two or 110r0 snnitC1.Ty- inspectors. Th:L,s ,s chool shoul d be sit uat e d on the border of a tow~ und its st a ff should be rcC?,r:,ons ible for a ll exe cutiv e sanita ry wcr k in o. large neighbouring are r"' wit h a popula tion of 6 0,000 to 7 0 1 00 .·, r>.nci inc .rnd:i..ng both tovm nnd country dwellings. Thq or igina l pu pi],s should be the existing untr ni n.:: d sa.pitary insp8ctors tn r;ro~ ps of noout 50 1,1ndergoing a c o ur se of instrt1,ction l as ti;ng t hree mon t hs . As t hey beoa.11e trained and ~e t ur nc d to t h0ir nor mc.l c,uties ndditiono. l people to prov ide the ne c e s s o.r y nu::ib0rs should be to.ken under inst r uction , po s sibly on de n obilisa.tion fro i:, t h e o.ruy . '.l'his s chool should be contir..ued until the sugge s ted cudre is full. Vhan t his h a s bee~ a chi eved t ho intensive tr c::.inint; pro gr •ai:11;10 cquld, be nbnndoned o.nd nor rml trnining under t aY:-cn. This wou;J,.d 'o e in o. sv,o.ller s cho ol 1 possibly loc c.. ted in n h e a lth unit , t aki,ng t he nm).ber of pupils re~uire;d f or pr ogr essive expor~sion of t he s ervice .::md re pl.c.cenont o;f losses for u period of six no n t h s t r aininc ,

Lo.bor c.tor y Serv j_c,.,s. Lt tho nc.tiono.1 ;Level the provision for invest ­iga tion of ,rndem:i,c ·D.nd e pi~ei::1ic dise :"J.ses c.ohievod. n high .standard b efore t h e wnr. Tho Ho. t:i,on oJ. Institute for the Prev,rntio!l. of Infectious Diseo.E;,ef3 wa s in Seou;I. , but ;is now wo1: king i;µ un,sn.tisfo.ctory occow:1odu.tion in t ho neighbourhood of Pusan . It is in the chru'ge of n cnpablo dir c ctoi, who has received good tr aininz , with n sto.ff of nine qu o.l ifi &d people covering t h e subj e cts of bact ufiology , biolo gy , PG+ r.J.s i tol,o gy , virology , pr.l. t,holo c:;y, pro du otion of v n.ccines and ant;i.. .. tox:i,na. In °S0oul t h0 l aboratory ' undertook v a ccine pro duct ion on o. lc:,rge se c.l e , being t he na in source of supply for t h e country . It also undertook t he investigation of e pid~~ic nnd endec ic diseases , carried ou t t l10 tr :::cining of t e ohni ci r:ms fo r 0nployr.1ent in pther l ab or a t orie s and wa s :1 r es~arc h centre. ·

The buildine;s i n Seoul nr e of v arying c.ses , so::ie being dila pida t ed, o.nd occupy a J,~rge conpound . Th0re is lit tle direct war damag0 , but t here h a s beo1i a g;r:, nv e loss of 0qi.1ipn 8nt , 1.:mch of which h :::~s b een found usoful by invc,ding forces ::md r emoved, and other pc_rt s of which h e .. ve been l,oot0d or undergon~ det erioration; th o los s os include 1::n jor i te r.1s nnd there h a,s been much da:na.ge t o expensive 1.1ac hi n er ;;1 • On e:.ppra.iso.1 it s e e ,Js t ,nat t hi s i µsti tut e was of high quality c.nd t hat it should again oonst:Ltute 0.11 i wport nn t keyst one o:f public he c,l t h wor k . Tho tr ::: .. inin6 of severa l me.mber 9 9f the s ta.ff, h ow0v er, could be e ;xt en ded with a dv L~nt .:::.ge . A progr amme has been pr epo.r e d which i ncludes t h e tra.ining of t.hreo senior staff medbors i mu edi,a tely nft 0r t h e wc..r , a nd f our mor e on their raturn. The Mission ro c oULwnds that this progrc..mme should b e carried out . It is :1.lso re connended ei;l.sewh..ir e il'.?. t !:i s r eport that &n entoillo;l.ogical unit s hould be a ttached to the ;l.a boratory.

In pa r olls:;; l wi th a.nl t o s ome ext ent c oDplenent o.r y t o t h i s institl,l.to i s th e No.tio:.12,.l In.s titute :if Ch 0Lri.st r y in . ooul which

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lK.ndl0d, c.Jilong other things, much nutritional wor k ruid food uno.lysis nnd 'o iol~gico.l 0t:i.8;..1i .s try. It wo.s housed in a. l a,rgc specic.l~y cori.s truc to d bu;i.ldip.g, elo.bor a tely fitted and 0quippod 1 and capable :if dee.ling r:i t h c. w:..de r cl;.'1.go of chernico.l work nnd vm s staffed :in o. s cale cokp:i.rable to t hc.t of t he other Nationa l Lo.bor n t ory . It has suffered r el::.tivel;'/ L1i nor dir e: ct dn:,mge but a g .:1in ther e ho.s b ee n JJ.uch loss of e~uip~ent.

Both t hese l oborntories deserve the fullest r~habili tntion such c..s is s ugges t ed e lsewhe;r e for uudi cc.l collage s , bec~use t hey <'-I'O

i uportnnt ke y units in t he he a lth ~conouy of th o c o unt r y and can s er v e o.n e concnic function b y t he productio n o f va ccines and oth er Jnteria l s which ~ould other wise need i ~porta tion .

In the propose d s che2e of reqons truct;i.on which was put before us by t he directors it was s ugges t e d thnt these two inst i tutions should b e f use d with e.'.,. ch other on c.. n0w site 1:ioro disto...rit fro m the centre of Seoul, fir stl:: f or t:1e co-ordina.ti<;:>n of their l r.,boratory fun c tions G.nd s e condly ::..n order t hat they mi ght serve as tho 11uc leus of a School of Hygi e110 a t which honl th sto.ff shonld be t r ained. '.l'he dila.pidQted stat e of t he buildings of t he b n ct cr iolo gy l ob o~atory will .::iv ontu .::i.lly ne c essi t rcte r:m ch no·:: c :ms tru ct;i.on and there is :io obj e qtion in prin ciple to t his bein[:; 0~1 [;. new site~ 'I'he present building of the chemis try l abor '.:1.tory is an 8Xcol. lent olle specic,1.lly designed ;for t hu purpose, o.nd it W:)Ul d be dif f icult to substantiate o. s chcue for its ir.inedia.te poi:;bwr r e constr1.: ctio11 on a. site n.djc.cent t o the bacteriology lc.boro.tory whe t .h0r th t1. t v:ere renoved or not . The intention of fusion of t he t wo u~its is 1 however, s ound a.nd plans for r e construc tion ot t he b~oteriolosy l ~bora.t ~ry s hould be dr ~wn u p i n a vw.y \'Jhich ·.vill Ltllovr t his to t o.}:e pl 2 c e who::.-;, c or.ditions are mor ~ ne.:1r ly nor filal.

A labora t or y exi s ts a t t he cc,pit o. l of ec.ch province but is of a v er y di f feren t c ::d_ib r e to those c:0scribed , b eing i !1 the ch:1r ge o;f t e chnicians wor king m~dcr t he autho:-;i.. t y of t h0 provincial ue dica l officer b u t without dir c: ct supervision b y a. po.tho l o0ist or other me dical m£m . The t e ohnic:i,rms o.re tr&in0d c.. t t he t wo I.,i:J.tional. La bo;r .::d;o;ries , t heir t r d.ning cover ir-g .::i. wide ro.nge of subjects , i n cluding ch'"mi cal .:ud bacteriologicc.l r..nc.lysis of food c.nd water , the b ac t er ioloGi c::,l and biocihe:e-.lico. l pr ocusses of a hospital l abor a tory nn d gene;r~l b a ct e;r ioloc y. In fact, th e gr eat bulk of theiE work lies in examining smear ,s nnd ser o. fror: the venereal dis ea.se clinics 1 and only occasionally i n other exauina tiona . For instance , t he s t aff of on~ laboratory i n one ;.1011th exa.2inea. 2 ,459 s n co.r s , cc..rried out 430 Kl eine t es ts on sor a , and did about 20 other ex::..,.1L1c..tions s u ch o.s blooq. cou,n t , for the l ocrd h o s pi t .::tl. 'I'h e l c::.bor o. t ory provision I wh;i. oh a t the n i tionul l ov e l is c ood , i s t herefore inadequa te u t t he provinoio.l l evel, It is not D.blo thc:t there ure v er y f8w .. wdic c.. l nen engaged in po.th olo5y or b ~~ ct oriol ogy i n ·i;he provin.00s , none be i ng encountered by t he Mis s io:1 outside the Universit y Colleces and 1~:i,ss i ons . Until wore provision is un.d e for work of t his n c,tur o ther e r.'.lu s t be 1:iar ked Qiff iculty i n both t he execut i on of publi c health work a.nd in the tre~t ment of p~ti~nta.

!\. pro gr a.ll:10 of inprove1.1ent of provinci.::11 l o.borµ t ories i s s.;iriour:;l needed 1 tho ob j e ctive being that they should undertak e ull the l nbor a t ory wor k of the hco. l th s o.J;'vioes incluiiin6 r outi110 food , imter 1

entoffiologioa l and ot hor exn::unations, partic ipate in diseas e survey s , und serve an ndvisory fun ction in t he pf oven tion of di seo..se. Thi s procr a.mw cc.nnot be unde t aken hurriedly. 'l'he fir s t step required i s t he tr a ining o f nodica l hl0n i n b 2ct er iolo t y , biochefili s try and the r.~aintennn c e and operat j_on of l ;:;.bor nto r iGs whi ch i s an appro prio.. te f unction of tho t wo No..tionql L~borator ies. Only when this ho.s b een unde r t uken s~ould t he provincial i o~or ntori0s be enlarged, Gnd t he post of provincio.l f ~t holosist created. This pos t woul d ca under t he Medi cal Offi c~r of Health wi t h pr ovis ion for dire c t technio c cont c.ct wi -ch t he directors of t he t wo Fo.tiono.J. Lctborc:tories,