Foreword

Article Outline

• Copyright

Before the Second World War, more than half of patients who saw a physician saw him in their home. This allowed the physician to see the patient in the context of family and community, and to get an understanding of the patient's home environment. Physicians no longer make house calls, and because of time-pressured clinic visits, we often know precious little about the environment from which the patient comes or about his role in the family and the community. As American medicine has become increasingly impersonal and high-tech, more and more medical students and doctors are choosing experiences in developing countries, where making an accurate diagnosis is more heavily dependent on their 5 senses and they cannot effectively practice preventive medicine without knowing the patients and their families and communities.

In this issue, Drs. Kristine Torjesen and Karen Olness from Case Western Reserve University, both experienced leaders in international child health, describe the state of the art in this field. The successful programs that they summarize use a “bottom-up” approach in which communities and doctors work together toward the change that they desire. The authors show that such programs can be both successful in the short term and sustainable over many years. Their article should be required reading for any child health practitioner boarding a plane to practice medicine in a developing country.