｜

ＮＥＸＶＳＬＥＴＴＥＲＴＨＥ ＡＳＳＯＣＩＡＴＩＯＮ ＯＦ ＭＥＤＩＣＡＬ ＤＯＣＴＯＲＳ ＦＯＲ ＡＳＩＡ

漂い

♂♂　　　　　　%〃♂　　　%%%%%〃♂　♂惣2j;??:21j雲ﾂ］

j

］　参　　　　｜

AMDA INTERVIEVV:

ProfessorAree Valyaseyj

Prof.ルee Va6/asevi graduated medjcjne from Sjrjraj Ho5μta/ Meical Co//ege

jn 7957. 771en，/le contjnued llj5 5tuφ/al哨eLﾉ雨ver5jty of Pennsy八/anja wllere

lle eamed 昂5Dφ/omat Amerjcan 8oa�o臼)eiatrjcs jn 7957 and D.5c.rMe哨

jn 7959.為fier /le relumed lo T11aj/and，11e jnjtjated many sludies in tわe fje/山

of nufrjljon， c畑/dわea附l and /aler a＆)ruraj commu函ty deve/opmenl. Hewa5

1/le Foundjng l:)ean o白11e Facully of Medjdrle， 尺amat昂boぷHo5μla/.For削s

excdent wQrks and 5ervjces， /le /las recejved many awar(瓦jnc拓治ng哨e 01jl-

式andinR Sdentist Award from the しﾉ・ve�ぼQessen nMﾖ51 Gemarが，1/le Natjona/

8est尺eseardlerAwa�from t/le Natjonal尺esear(iCoun(j/ of 771a而nd and

t/le Magsay5ay/xwa�lor Commu�ly£eader511φ.771oug11 /le reljred jn 7986，

11e j5 si/very actjve and worj(jng aj;con51j/tanl lo many naljona/ and jntemaljona/

orga削zaljon5.

IN THIS ISSUE

EDITORIAL

THE CHILD SURVIVAL INDEX 1985

THAILAN[yS GROWTH

　　MONITORING PROGRAM

P2

P3

P7

MEMBERy CORNER

NEWS＆NOTES

四阿

AMDA NEWSLETTER

A MONTHLY PUBLICATION OF THE ASSOCIATION OF MEDICAL DOCTORS FOR ASIA

PURPOSES

I.To publish informatlon about AMDA activities.

2.To provide a venue of communication among

　　AMDA members.

3.To be a forum for AMDA members to express

　　ideas and comments.

4.To　publish　articles　about　health　care　and

　　community development

EDITOR

NipitPiravej，刀la池nd

ASSISTANT EDITOI勿

Praphai Piravej，7?la1∃ndAntonio C. Sison，Philippines

EDITORIAL BOARDM.S.Kamath.lndia

Tsuyoshi　Kawakami，Japan

Ewan　Murugasu，Singapore

Christmas Tanchatchawan.Thailand

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に□☆

回

締拙以緬|面前

ＥＤＩＴＯＲＩＡＬ

D｢.Nipit Piravei

　　　Happy New Year 1989 to alI AMDA members.

May the new year bring new hopes and successes

to all of you ！

　　　As the firstissue of this year， we would like

to present something special for the members. For-

tunately，we were able to get a rare opportunity to

interview Professor Aree valyasevi，one of the Mag-

saysay Award vvinners of Thailand. Though he has

PAGE 2 AMDA NEWSLETrER

retired，he is stillvely active and busy. This exdusive

interview forAMDA Newsletter was given just prior

he lefi for New Zealand for an intemational meeting。

　　　ln the interview， ProfessorAree hastouched

many aspects of health and community development，

but above all on the topic of child health develop-

ment which is his specialty. l believe that all of us

would agree that the general well being of children

will reflect the future of the community. Howevr

we shall learn from Professor Aree that there al･ぎ･

stijltoo many risks for the children in the ruralarea

to overcome in order to grow up. Although the

discussion　concerns mainly with　Thailand，l　am

certain that his philosophical viewpoints may be

applied to the situationsin many other Asian countries

as well｡

　　　Child　health development　is a　hot issue.｜

believe that a lot of mem･bers may feel eager to

express their ideas.So please send in， weare con-

sidering devoting one issue of the newsletter for

this topic.

The Editor

3 N0.3 JANUARY，

1985５５５８８９９１４４５５７８９９９１１２

６６６６６６６７７７７７７７７７７８只）

９９９９９９９９９９９９９９９９９９G）

98.3

98,4

98.6

98.7

98.7

98.7

98.7

98.7

98.8

98.8

98.8

98,8

98,8

98,9

98,9

98.9

99,0

99.0

99.0

99.0

99.1

99.1

99.2

99,2

AMDA NEWSLETTER PAGE 3

present， the life expectancy of Thai female is 65

and of Thai male is 61 years. The next to be con-

sidered may be the crude death rate; it has decreased

from　10.4 per thousand in　1970 to about 7 per

thousand recently. More interestingly， the major

causes of death have shifted from infective causes

towards　non-infective　causes.Among　these　are

cardiovascular diseases， malignancies and trauma｡

　　　　　　　　　　　　　　　　　　　　　contjnued on page 4

｜

心

｀､ノ

The child

survival index　The basic measure of infant and child survival is the under-five mortality rate or U5MFUnumberof

deaths under the age of flve，per l,000 1ive births).A child sun/ん/a/rate perl,000 ♭,rths can be simply

calculated by subtracting the U5MR from l,000.Dividing this flgure by ten shows the percenl∂gθof

those bom who survlve to lhe age of five.The following table shows that percentage child survival rate for

allcountrles in both 1960 and 1985.

Percentage of those bom who survive to reach the age of five

AfQhanlslanMali

SierraLeone

Malawl

Guinea

EthioplaSomalia

Mozambique

BL｣rkinaFaso

AngolaNiger

Centra卜AfncanRep･Chad

Guinea-Bissau

Senegal

Mauritan旧Kampuchea

Liberia

RwandaYemen

Yemen，Dem.

Bhutan

Nepal

BurundlBangladesh

日白nin

SLJdan

BOIlvia

Tanzania，U.Rep，of

Nlgeria

Halliuganda

Pakistanoman

Lao People‘sDem， Rep･Zaire

Cameroon

Togoindia

Cote dllvolre

Gha･na

LesothoFgypt

1960

62.0

63.0

60.3

63.6

65,4

70.6

70.6

69.8

61.2

65.4

68.0

69.2

67.4

68.5

68,7

69.0

78.2

69.7

75.2

62.2

62.2

70.3

70.3

74.2

73.8

69.0

70.7

71.8

75.2

68.2

70,6

77.6

72.3

62.2

76.8

74.9

72.5

69,5

71.8

68,0

77.6

79.2

70.0

1985

67.1

69,8

69.8

72.5

74.1

74.3

74.3

74.8

75,5

75.8

76.3

76.8

76.8

76.8

76.9

77.7

78.4

78.5

78.6

79.0

79.0

79.4

79.4

80.0

80.4

７３６７８０２６８００８

０１１１１２２２２３３〔ｊ

８８８８８８８８８８８８

84.0

84,2

84.3

84.7

85.6

86.4

Zambla

Peru

LIbyan ArabJamahlrlya

MOrOCcolndonesla

Congo

KenyaZimbabwe

Algeria

HOnduras

Tunisla

Guatemala

Saudl ArablaNicaragua

South Africa

Turkev

lraq

日olswana

vlet NamMadagascar

Papua New Guinea

EcuadorBrazil

Burm8EI Salvador

Domlnlcan Rep･Philippines

MexlcoColombla

Svrlan Arab Rep･

｣Ordan

Mongol旧ParaQuay

Lebanon

Thalland

AIbaniaCh,na

Sri Lanka

venezuela

unlted Arab F�rates

Guyana

ArgentlnaMalaysia

conljnuedfrom page 7

AMDA :　哨lhat is the present health status of

Thai people ？

Prof.valyasevi :　Undoubtedly， the health status

of Thai people in general have improved remarkably

over the past 2 decades. To make it more obvious，

we may consider some of the statistics.Let's start

with the life expectancy. About 20 years ago， an

average Thai would live for about 50 years. But at

1960

77,2

76.7

73,2

73.5

76.5

75.9

79.2

81.8

73.0

76.8

74.5

77.0

70.8

79,0

80.8

74,2

77,8

82.6

76.7

81.9

75.3

81.7

84.0

77.1

79.4

80,0

86.5

86.0

85.2

78.2

78.2

84.2

86.6

90.8

85パ

83.6

79,8

88.7

88.6

76.1

90.6

92.5

89.4

1985

86.5

86.7

87.0

87,0

87.4

87.8

87.9

87.9

88.3

88,4

89,0ｏｓＱ（ｎ

（Z）CXD（7D

CXD

Ｒ）６

89.6

89.9

90,1

90,2

90.3

90.6

90.8

90,9

90,9

90.9

91,2

92.2

92.7

92.8

92.9

93.5

93.6

93.6

94.4

94.5

94｡日

95.0

95.2

95,5

95,7

95,9

96.0

96.2

Kcrea，Dem.Rep. ofKorea，Rep.0fPanama

MaUrltlusUrLJguayRoman旧YugoslavlaUSSRChileTrlnldadand TobagoJamalcaKuwaltCosla RicaPor↑LJoalBulgarla

HLJngarVPolandCubaGreeceCzechoslovaklalsraelNewZealandALJstrla日elQiumGerman Dem. Rep･11alyUSAGermany，Fed.Rep. oflrelandSinQaporeSpalnunitedKingdomAustrallaFranceHong KongCanadaDenmarkNetherlandsNorwayJapanSwilzerlandFinlandSweden

1960

88.0

88.0

89.5

89.6

94.4

91.8

88.7

94.7

85,8

93,3

91,2

87.2

87.9

88.8

93.8

94.3

93.0

91.3

93.6

96.8

96.0

３７５６００２４０４３５６５７５８７０３２０

７５６５５フ／６６５４７７６３６７７７６７７８

９９９９９９９９９９９９９９９９９９９９９９

co�nuecHrom page 3

Apparently，the reasons for such a change are related

to the increase in the proportion of elderly people，

the more industrialized of the country and perhaps

also the improper adoption of sonle..Westem life styles｡

　　　　Next，we may look at the infant mortality rate，

anotheraccepted important indicator of social de-

velopment.According to Ⅵ/HO recommendation，

developing countries should try to improve their

infant mortality rates to under 50 per thousand live

births.Thailand　has actually achieved this target

with a figure of around 40 per thousand in 1985.

However，we should　not satisfy with this figure

because it is stillabout 3 folds higher than that of

most developed countries， and we know we can

do better.And if we look closer， we would find

that perinatal death has now constituted a major

portion of infant mortality. This means that we have

to　encourage antenatal　monitoring and　improve

our obstetrical care especially in the rural area of

the country｡

　　　　Among children， the statistics also demonstrate

the marked decrease in the mortality caused by

infections diseases， especially the preventable groups

such as measles， whooping cough and diptheria.

The rapid decrease of moderate and severe protein

energy malnutrition is also encouraging. However，

the rising rate of dengue hemorrhagic fever， the

persistent high prevalence of hepatitis B virus carriers

and the emergence of HIV （Human lmmunodekiency

virus）infected patient5 are alarming and constitute

the major problems to be tackle next｡

　　　　ln brief，the overall health status of Thai people

is much improved. Nevertheless， we have to under-

stand that Thailand is not a homogeneous society･

At least，the country can be divided into urban and

rural area5.　1n　my point of view， the enormous

improvement in health status of Thai people is mainly

concemed with the urban people. The people in

the rural area are subjected to a lesser degree of

change.

lnfant mortalityrate of Thailand by regions

Regions　　lnfant mortality

(per l,000 1ive births)

North

North-east

Central(excludeBangkok)

South

Bangkok

57.8

52.8

39.0

39.4

26.5

(Source :　Thai National StatisticsCouncil， 1985)

Q : ln 1988， what do you perceive as the major

advance in the health care development in Thailand ！

A :　l am afraid that l could not point out a single

major advance that happened　so acutely in one

year. Actually， the process of health care develop-

ment in this country is rather an evolutionary process

than a revolutionary one. ln that sense， lwould point

our that the most important achievement over the

past decade was the change of the national he-lj･11

plan from a りnarrow base broad top” to a �tｦr6

desirable “broad base narrow top” system through

primary health care. ln short，the narrow base broad

top is the system that emphasize too much on the

sophisticated medical technology but pay very little

attention to basic health problems in the community･

So most of the govemmental resourcesⅥ/ere used

at the tertiary medical care level which usually serve

only few people. This was the system in the past.

Now，we have succeeded in establishing the broad

b.ase system through primary health care and the

emphasis on the local community hospitals so that

the rural people are novv rnore accessible to go-

vemmental medical services. This has brought about

the improvement in the community sanitation， the

more awareness of basic health problems and so forth.

　　　Howeyer，with the population transition and

the changes in social structures， we are now faci,～，

more and more diseases of the elderly and malignancies.

This means that our health strategy need further

modification　again　to suits the futUre　problems.

lthink the strategy now should be to build up the

top while maintaining the firm base. The present

medical curriculum needs modification as well. ln

health development，we can not stand stillbecause

the system is so dynamic.

Q : ln 1988， what do you think is the most im-

portant health carerelated event thal happened

in Thailand ！

A : Again，this is difficult to answer exactly. Some

may say the success of cardiac transplantation， others

may raise the success of other sophisticated medical

techniques. But l would like to mention about the

National Health Assembly taken place during September

　　　　　　　　　　　　　　　　　　　　　contllnued orlpage 5

４ ＡＭＤＡ ＮＥＷＳＬ日‾｢ER

｜

｜

｜

co咄･nued from page 4

12-15，1988.1t was a comprehensive meeting that

brought people not only from public health and

medical sectors but also experts in education， agri-

culture，economics and social development， together

and discuss about the direction and strategy of health

development.The most important impact of this

meeting is to bring about a better awareness of

the　present　problems and　emphasize the　multi-

disciplinary approach to tackle the problems.

Q : vve all know that you have a great experience

in child　health development， what d6 you think

is(are)still the majorhealth problems among Thai

children ？

A : Although l have mentioned that the mortality

fr⌒m　infection is decreasing，infection　is still the

k4Jing cause of child lmobidity， especially in the

rural area. This includes respiratory tract infection，

diarrhea and other viral infections. Also of important

is the recent surge in the incidence of dengue he-

morrhagic fever which is the top killer in the school

age children. Parasitic infestation is common though

it is rather chronic and indolent in nature. ln spite

of the fact that severe malnutrition has generally

disappered, we now have to face the milder degree

or subclinical form of the problem. lt i5 interesting

to say that just opposite to the rural area， we begin

to 5ee the problem of obesity in the urban children.

Q : Because you have done a brilliant work to

improve the child nutri量ionalproblem in rural area

of Thailand， whatdo you think about the present

status of this problem l

A : l would say that over the past decade， we have

quite successfully tackled　down　the　problem　of

severe malnutrition. But this is only the tip of the

iceberg.Vvhat stillpersistsis the portion under the

surface. Vve know that minor deficiency of some

nutrientscan be a problem too. A study in lndonesia

shows that in mild degree of iron deficiency with

anemia or without anemia， the child　may have

impairment of motor function and he may be more

VOL.3 N0.3 1989

easy to get fatigue. lmpaired cognitive function and

short attention span in school children with mild

degree of iron deficiency have been shown in a

study performed here in Chonburi. Another example

is iodine deflciency. lodine deiiciency is not equivalent

to goitre. Vve leamed that a 5uboptimal　level of

thyroxine can produce physical sluggishness， lowered

prQductivity in adult which can be reverted by adding

iodine to the diet.ln growing child　and　in　unbom

fetus，the result of iodine deficiency can be irrepar-

able damage to both brain and body growth. For

vitamin A， mild deficiency can cause impairment

in epithelialization and immune system. ln children

with such a deficiency， they are more prone to

have respiratory tract infection and diarrhea｡

　　　The reasons l{}r the persistent nutritional problem

are certainly the poverty， but what should not be

overlooked is the problem of improper food habits.

For instance， in some part of the country， people

still(:onsume large amount of food containing phytate

and oxalate which apart from having no nutritional

value these compounds can interfere with the ab-

soption of other nutrients. Therefore，we can see

why education is so important in solving these problems.

cｏｎｔｉｎｕｅｄon page 6

　AMDA NEWSLETTER Pj

rnntinued行om page 5

|ron，iodine， and vitamin A deficiency

｀WIノ

｀-

Areas of high prevalence of vitamin A deficiency and xerophthalmia　　　　　　　　　　　　　　　　　　’－　　　・皿皿－(literally “dry eye")゛among children， 1986

0ver500,000childrenUnder 5 lose theirsighteveryyear.　show si9nsofmoderatev趙min A defi(jencyand are

Withina few weeks of becoming blind60-70percent of　thereforemorevulnerable to㈹ectious diseases.

these children die. Anadditional 6 to アmillion children

Africa

CentraはSouth America

South Asia

Southeast

Asia

WestAsia

EastAs厄

Prevalence is a significant

health problem

An9ola，Benin，Burkina Faso.Chad(north)，

Ethiopia,Ghana(north)，Kenya，Malawi，Mali，

Mauritania,Mozambique,Niger,Nigeria(north)，

Sudan，Uganda,U.R.0fTanzania,Zambia

Bolivia，Brazil(northeast)，曰Salvador，Haiti，

Mexico

Afghanistan,Bangladeshjndia,Nepal,SriLanka

Burma,Kampuchea,lndonesia,Lao People's

Dem.Republic,viet Nam

oman

Reports of sporadic cases callfor

close monitoring of the situation

Algeria,Botswana,BL｣rundi，Lesotho，

Madagascar. Morocco,Rwanda,Somal胤

Senegal,Zimbabwe

Equador,Peru

Pakistan

Malaysia,Thailand

Egypt，|｢an，|raq，JOrdan， Syria,Turkey, Yemen

China

－

゛xerophthalmia applles to all ocularma�estations of vltaminAdeficiency:

difficutty of seeing in dim light、 dryin9of the conjuctlva、foamy patches

forming on the coniuctiva、a hazyor 9ranuiar surface、 a pebblydryness

apparent on the comea､ comeal ulcer油on、andretina目eslons.Prevalence

ofthedeficlencyisgreaterformalesthanforfemales.

Souにa.･≒ｒｌ｡。､､。､。４､。。、ｎＨｒｎｎ抒ｎｉ ｎｆ ｗｌｔｇｒｎｌｎＡ ｄｐｆｈｅｎｃｖ． ｘｅｒＯＯｈｔｈａｊｍ旧ａｎｄ

　　　　　ｎａ帥むoり∂/わ励c加ess‘ρのpos∂/だyateりツ∂∂ΓρのｇＧｍｍｅ�ｓﾘρpoけ

　　　　　tocountnesl'. Wodd Health

oman､zation(NしﾉTﾉ845旧V．ﾘ､February

　　　　　ＩＱＱＱ。ｎパrnnQtrQrpnnΛZHnﾉ目ＮＩＣＥＦ ａＳＳｅＳＳｍｅｎｔＳ、

i函i‾＆iiiency disorders (IDD)゛in

the developing world, 1986 estimates

780 million

AT RISK“

180 m曲○∩

　ＧＯＩＴＲＥ

　3 million

　CRETINS

disability resultin9

deie;lts，slrabismus ’【squinl】，nyslagmus.spasticity，neuromuscular

weakness，endemic cretinism，and intrauterine death （spontaneous

皿1･，-4:一一ss;ssa･｡iarlalrhildrQnhnm to iodine-daiiCient motherS Can-■--■■■■㎜㎜-I’

abortlarl，mlscarfisg91.Childrgn bom to ia6ina-d●licisl

　　　　　　　　　　　　　　　　　　　　　　－　　　■　●･･jtjl●IWII●････wﾐ=●･･－�‾j‾‾”hav白variabled白grees of ment白|retardation,ranging from the mild forms

up to marked cretinism.Prevalence of deficigncy is grealerlor females

than lor males，

゛゛Livinginaraaswherethaenvironmentisdeliciantiniodin8,solhatlhe

soil，watef， and bolh animal･and vegetable foods hav8 greatlyreduc白d

iodine content compared lo other areas.

SQぼCa. ‘jGC-SCS programた]rかleαy11roj�jIod1lrlS d6配II6rlCydlSOderSjln

　　　　　ｉSdS哨4)jlngWQrがI，Zかj0，19S6yljQdne de5CjlalCy djI｀sofdersiln

　　　　　South-FggtAsia’I，WHO，?9S5.

Prevalence of anaemia゛ among

children and women， 1986

Percentageof childrenunder 5 anaemicPercentageofpregnantwomen anaemic

Percentage ofwomen 15-49 anaemic

゛Ana8mia is deiined as a haemoglobinconcenlration belowwHO

reference values ior age， sex and pregnarlcy status

SoUrce,1 Ds Ma6yer. E. arldM,4dj･elsl- ie!7man. ¨771Sprevaj6nCs�anasmjla

　　　　　j‘rlがISWOrjdII， WOrld H6a泄I

SlaljISljICSQUar拍哨/.ｖｄ．３８,nQ.3，

・㎜㎜■7986pQpLJばjGQ,･UNPopulatl1Qn DI'vsISjQn 6助lma飴s.

Q: Atpresent，which particulargroup of children

that need the most attention，as faras health pro-

blems are concerned ！

A : l would s.ay that the more urgent attention

should be paid to the pre-school children. The pre-

school period (afterl year to about 4-5 years)can

be considered as the foundation of life'because it

is the critical time for both somatic and　mental

development川f there is any disturbance happened，

it may easilycause sorTlerTloreorless permanent

changes that can severely debilitate the chil(汽future｡

　　　　　　　　　　　　　　　　　　　　con面Ued on page ア

6 AMDA NEWSLETTER

｜

49･2％

3rd degree

2･1％

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VOL.3 N0.3 JANUARY，1989

64･8％

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The second group that we should considered is the

pregnant women because the fetal period is ajso

very crucial and we know that some degree of

nutrient deficiency for example iron deficiency is

stillcommon among the pregnant women in the

rUral area.

　　　　To attack the problem， lthink the most im-

portant step is tocreate awareness among politicians

and government. Vvithout strong political conviction，

we shall　never get sufficient　resources for child

development.just saying that children are the nation's

future is not enough. lt's high time policy makers

realized that the budget for child development is

a kind of investment for the country rather than

just routine expenses. 0nly after we recognize this

basic concept， should any strategic and 6perational

planning begun and can be expected to be really

effective.

Q : ln the recent years， the rapid economic growth

in-Thailand has bmught mudl pmud to most people，

do you agree that economic growth alone is ihe

majordeterminantin s)dal and health development:

A : Undoubtedly， economic growth is very important

for the development of a country. However，ljust

want to emphasize a little bit that the figure of

gross economic growth does not mean so much.

To reflect the real economic situation of a country，

we have to stress on the distribution. Actually，｜

have the impression that the gap between those

who have and those who do not have is increasing

at present. So our answer is a more proper distribution

of the economic gain. ln addition， economic achieve-

ment or money alone may not be enough for health

develoβment.い/e stillneed other things forexarTlple

education.

continued on page 8

m

｜

continued from page 7

Q : whahhould be the majorstrategies to booster

areal community development ！

A :　lfthe aim of community development is at a

better quality oHife， we would find that the essential

strategies towards that goal must be very comprehen-

sive.The emphasis on only one or two aspects will

never be sufficient. As a matter of fact，the concept

of real happiness is so broad， so variable and .philo-

sophical.To make it simple， you may agree that for

an individual money alone doesn't mean happiness.

So do the reillcommunity development. To achieve

a better quality of life，at least the community needs

better income， better education， better health care

system，appropriate　social.values- and　above　all

better morale.l　personally　have an　experience.

Some years ago， we had carried a community de-

velopment program in a model village in ubol(North-

eastern of Thailand).After we started the program，

substantial　materialistic development occurred　in

the community which at first brought to us much

satisfaction.However，when we retumed to the

village sometimes later, we found a lot of new problem5

such　as　gambling，drug　addiction，quarrels　and

even murder ！

Q : At present， what do you think is the most

urgent health problem of Thailand i

A : Actually，there are stillmany important health

problems in our country，but if you talk about some-

thing urgent］would say AIDS problem｡

　　　The infection of HIV (Human lmmunodeficiency

viru5)has become a worldwide problem. Though

we have only few AIDS cases， we have at l,こ1

900 cases of asymptomatic HIVblood positive sub-

jects who are mainly intravenous drug users. XA/hat

is alarming is that the rate rises so shar口ly that it

nearly triples just in one year.　lt'shigh time the

govemment brought out more effective measures

to contain the spreading of the infection｡

MEMBERy CORNER

DR.Kuni lwai

　　　Happy new year;

　　　l　have been working in　Karumai　Provincial

Hospital since April in　1968.　Karumai　is a 5mall

town，located at the northem part of lwate Pre-

fecture.Vve have 77 beds in the hospital，and l am

working as a doctor of intemal medicine.

lsee ahd talk with many patients，medical staff，o「

stafroHocal govemment everyday， and l am facing

every kind of problem， not only medical problem，

but　also　economical，social，familial…sometimes

l fee目t is difficultto settlethe problem.

　　　lthink every doctor and medical staffhas the

same problems as me in his/her daily work.

　　　lam eager to meet and to talk with you about

various problems at the Conference Hall this August.

ＮＥＷＳ＆ＮＯＴＥＳ

　　　　The First Live-in Nationa目ntersectoral vvorkshop

on the Health of Youth will be held at the university

of Life，Meralco Avenue， Pasig，Metro Manila from

February 21-23， 1989｡

　　　　The workshop is jointly sponsored　by the

Ⅵ/orld Health organization， the Presidential Council

for Youth Affairs (PCYA)and　the Association　of

Medical Doctors for Asia(AMDA-Philippines).The

purposeof the vvorkshop is to promote direct parti-

cipation of yout'h leaders and representatives from

governmental,non‘govemmental organizations and

the media in di5cussing youth health problems and

the current responses to them in order to plan actions.

●AMDA NEWSLETTER

㎜･■|■･㎜a■･■㎜■’㎜-’-･

VOL.3N0.3 JANUARY