Jones Margaret
Med Hist. 2016 Oct;60(4):514-33. doi: 10.1017/mdh.2016.58.
This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization's internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance.
本文依据世界卫生组织及斯里兰卡的资料来源，审视了自1948年独立以来斯里兰卡控制结核病的诸多举措。它特别关注了1966年实施世界卫生组织社区导向型结核病控制模式的尝试，该模式试图通过将控制措施融入一般卫生服务来建立一个横向结构的项目。其目标是创建一种具有成本效益的控制方法，该方法依靠简单的细菌学检测来发现病例，并在最近的卫生设施进行治疗，从而将病例检测和治疗带到缺乏专科服务的农村地区。在20世纪40年代末和50年代初，斯里兰卡已经建立了一个由胸部诊所、大规模X光检查、住院和居家治疗以及为患者提供社会援助组成的专科控制项目。该项目既降低了死亡率，又提高了对这种疾病的认识。本文揭示了试图将世界卫生组织国际设计的模式强加于斯里兰卡已有的结核病控制结构时所面临的障碍。世界卫生组织方法的一个重大障碍是缺乏资源，但同样重要的是，现有的医学文化不利于该模式的接受。
