{"value"=>"<p>MEDICO (Medical International Cooperation Organization), the medical arm of CARE, began under the sponsorship of the International Rescue Committee in February 1958. Its co-founders were Peter D. Comanduras, a faculty member of George Washington University's School of Medicine, and Thomas A. Dooley, a former U. S. Navy physician who had assisted in the evacuation of refugees from North Vietnam in May 1954 and returned in 1956 to establish a hospital in a remote part of Laos. Comanduras's research in the mid-1950s on tropical medicine convinced him of the need for a non-governmental medical organization that would replicate on an international scale the work being done by Dooley and by Albert Schweitzer in Africa. After corresponding for several months about the possibility of starting such an organization, Comanduras and Dooley met in the fall of 1957, and from that and subsequent discussions, they created MEDICO, with Comanduras as its secretary-general and Albert Schweitzer as an honorary patron. A Medical Advisory Council (later Advisory Board), comprised of representatives of various medical professional organizations, helped to establish the criteria for MEDICO programming and offered specific recommendations based on their areas of expertise.</p> <p>From March to June 1958, Comanduras met with government officials and health care workers in twenty-five nations to discuss MEDICO's potential role there, while Dooley embarked on a lecture tour to raise funds and attract volunteers. Response at home and overseas was positive, and that summer and fall, MEDICO sent teams of medical personnel to various sites in Laos, Cambodia, and Jordan. By September 1959, when it became independent from the International Rescue Committee, MEDICO also had short-term and long-range projects underway in Afghanistan, Kenya and South Vietnam, and had participated in emergency disaster relief efforts in Morocco, Peru, and Chile.</p> <p>Dooley died in January 1961, and without its energetic publicist and fund-raiser, MEDICO soon fell into financial difficulties. That fall, Comanduras proposed a formal affiliation between MEDICO and CARE. Since 1959, the two organizations had been cooperating closely in countries where both operated, with CARE supplying materiel and MEDICO the personnel. Each agency was amenable to the merger, and in March 1962, MEDICO became a service of CARE, and Comanduras its assistant executive director. Kester L. Hastings, MEDICO's executive director, became an assistant director, based in Washington, DC; his chief responsibility was the recruitment of visiting volunteer specialists (VVSes). Wells Klein of CARE oversaw the placement of long-term staff and related administrative matters. (Henry Selz replaced Klein in 1963, and was succeeded in 1964 by Leonard Coppold, who held that position until 1979. For more information, see the organizational charts at the end of this guide.) MEDICO's Advisory Board continued to provide overall medical programming guidance.</p> <p>Freed from having to raise its own monies, MEDICO expanded its ongoing activities in the countries in which CARE was active, particularly Afghanistan, Jordan, and Algeria. In the 1960s, it started programs in Honduras, Tunisia, and the Dominican Republic, where CARE had been working for some time, and sent teaching teams to Indonesia in 1968, a year after CARE began operations there.</p> <p>During the 1960s, MEDICO began moving away from what one CARE A. E. D. called \"the 'jungle medicine' of Dooley\" - the establishment of hospitals and clinics in remote areas where most people had never seen a doctor - toward the postgraduate training by MEDICO contract staff and volunteers of their counterparts at medical schools and hospitals in metropolitan areas. Contract personnel usually served overseas for two years, administering and overseeing teaching programs, while VVSes spent one or more months at those sites, offering their expertise in such needed specialties as anesthesiology and orthopedic surgery.</p> <p>The international approach to Third World health care began to shift in the 1970s toward a focus on comprehensive public health education and on the provision of primary health care (PHC) in regions without ready access to sophisticated forms of medical treatment. Although it favored service to rural areas over urban centers, PHC differed from the earlier Dooley/Schweitzer philosophy in advocating the incorporation of preventive measures such as better sanitation and improved nutrition into a health care program, and in stressing community participation: rather than furnish doctors from outside, health care workers would teach basic medical skills to the traditional health care providers of a community, e. g., midwives.</p> <p>In recognition of this shift, the MEDICO Advisory Board sponsored a workshop in April 1976, \"Future Directions of CARE-MEDICO\", which resulted in a set of recommendations that included: a wider use of medical paraprofessionals as well as doctors; more attention to preventive (as opposed to curative) medicine; a focus on rural rather than urban health care; and increased community involvement. During the next few years, CARE and MEDICO staff members participated in various regional and international meetings on health care, in particular the World Federation of Public Health Associations conference in Halifax, Nova Scotia in May 1978 and the International Conference on Primary Health Care, sponsored by the World Health Organization and UNICEF, in Alma Ata, USSR, in September 1978. Attendees at the Alma Ata conference drafted a series of ten statements, known as the Declaration of Alma Ata, which set a goal of a worldwide acceptable level of health by the year 2000, through primary health care \"in the spirit of self-reliance and self-determination\", achieved with the help of local and national governments and private organizations.</p> <p>The immediate result of the new concentration on primary health care was an effort on MEDICO's part to work more closely with CARE's Program Department, particularly on its health and nutrition projects. Most MEDICO Advisory Board members and staff, however, were medical specialists with little public health experience and no clear ideas on how to proceed in changing MEDICO's direction. Additionally, budgetary constraints prevented plans to hire a full-time PHC specialist to coordinate CARE and MEDICO programming and to add such specialists to CARE's mission staffs, while rising operating costs and a decreased demand overseas for highly trained medical experts gradually reduced MEDICO's use of visiting volunteer specialists. By early 1983, the VVS program had come to an end.</p> <p>With financial curtailments and without a clearly-defined role to play in CARE programming, MEDICO gradually ceased to be an active division of CARE. Today, although three former MEDICO Advisory Board members sit on CARE's Board of Directors, MEDICO exists essentially in name only.</p>"}