Acute water shortage and health problems in Haiti.

During a severe drought Port-au-Prince, Haiti, lost hydroelectric power for 10 weeks. This led to water shortages in areas of the city dependent on water supplied from electrically driven pumps. In a study of the impact of water restriction on disease, 400 families were randomly selected from two urban areas differentially affected by the water shortage. Disease in children was found to be related to quantity of water used, socioeconomic status, employment of head of household, and family size. The methods used in this study are recommended for the investigation of the relationship between water quantity and health.

National service in rural areas: the case of Colombia.

Sending new medical school graduates into rural areas does give underserved populations access to modern medical care, perhaps for the first time. However, these young physicians usually spend most of their time providing strictly clinical services and are generally eager to leave at the end of their assignment. Some have referred to this practice as "parachuting" a doctor into an underserved area. An alternative is to focus first on building up permanent health service facilities in rural areas that are staffed by appropriate paraprofessionals. The young physician can then play a much more important role, serving as an administrator, researcher, evaluator, and teacher of the local staff; his clinical activities would generally be confined to the more complicated medical problems that arise. Such a model has been implemented in Kenya and Tanzania. An informal field assessment in Colombia has indicated that this model could be effectively applied there as well; indeed, it has been the hope of Colombian policymakers that the rural intern would function in such a way. However, this would require developing the nation's system of health services, as well as providing specific training aimed at preparing the medical student to perform his assigned role.