You may Dr. Hunter, we are very happy to have you with us. proceed as you see fit by either reading your statement or inserting it in the record and giving a summary. STATEMENT OF DR. THOMAS HUNTER, CHANCELLOR FOR MEDICAL AFFAIRS, UNIVERSITY OF VIRGINIA; ACCOMPANIED BY DR. HENRY VAN ZILE HYDE, EXECUTIVE DIRECTOR; AND DR. HAROLD MARGULIES, ASSOCIATE DIRECTOR, INTERNATIONAL DIVISION, ASSOCIATION OF AMERICAN MEDICAL COLLEGES Dr. HUNTER. Mr. Chairman, I prefer, if I may, to introduce my statement and then discuss it, and perhaps use less time than just reading it. The CHAIRMAN. That will be very good because we are pressed for time. However, we want all witnesses to understand that we don't want to do anything to curtail you, but we are trying to preserve time as much as possible. Dr. HUNTER. Thank you. (Dr. Hunter's full statement follows:) STATEMENT SUBMITTED BY DR. THOMAS H. HUNTER, REPRESENTING THE I am Dr. Thomas H. Hunter, chancellor for medical affairs of the University of Virginia Medical School in Charlottesville, Va. I am here today in my capacity as chairman of the Committee on International Relations in Medical Education of the Association of American Medical Colleges. The AAMC represents the combined interests of the 88 American medical colleges, all of whom have a keen interest in the International Health Act of 1966. We have carefully reviewed the bill under consideration today and find ourselves in full approval of its contents and intent. As you know, medical educators in the United States have played an active role in international health affairs for many decades. Their activities are summarized in a study carried out by the AAMC entitled "A World Program for Health Manpower," a copy of which I would like to submit to this committee for their consideration. The report was completed during the latter part of 1965 and was presented to the Agency for International Development which had requested the AAMC to carry out the study. Since the beginning of this century, we have been involved in a wide variety of international activities designed to increase the world's supply of medical manpower. These activities have been supported by private foundations, by the U.S. Government, and by various international health agencies. Since 1951 AID has supported contracts involving 9 American universities in 10 different projects planned to strengthen medical institutions in developing countries. In addition, many individual faculty members have been associated with both short- and long-term assignments throughout the world. For the past several years, the AAMC has had a division of international medical education which was established to broaden the role of our medical colleges in this worldwide effort to improve the availability of skilled health personnel everywhere. Through the efforts of this division, a complete roster of American medical faculties was established to determine the availability of competent individuals to serve in international health activities in any of the medical disciplines, including those allied with but separate from the medical schools themselves. You will be interested to know that there are approximately 6,000 names on this roster, all full-time medical teachers who have expressed willingness to devote a significant amount of time to international health work with the majority willing to serve for 1 year or longer in projects where their skills will be of value. The present bill thus represents a logical extension of our activities and interests. It provides a device for increasing the effectiveness of our participation in U.S. programs abroad. In the past, there has been relatively little opportunity to fully utilize the increased knowledge gained from overseas service because there has been a very limited international career service and an inadequate mechanism for utilizing the vast experience gained through our global efforts. Almost all of the participation by members of our medical faculties has represented a departure from their domestic responsibilities to which they must return with the disadvantages of having been abroad while rapid progress continues at home. Many American universities have become increasingly concerned over their inability to take advantage of these unique opportunities to add to their own knowledge and to enrich the entire university through their international activities. On every university campus many students and faculty members have a sense of devotion to the problems of the world and a desire to help in the efforts to improve the well-being of their fellow men. Until now the opportunities to be of service have been restricted and there has been little reason to encourage their laudable interests. Our contributions to developing countries have not been limited to service Overseas. Even more significant has been the training of health personnel from other countries. At present there are over 13,000 foreigners, mostly from developing countries, studying in various health programs in the United States. Many of these are in the universities and their affiliated hospitals where foreign medical graduates are learning the arts and skills necessary to develop effective health programs in their own countries. We have felt handicapped in our own universities by the absence of curriculums which are designed specifically for the special needs of physicians from developing countries. We welcome the opportunity to provide an atmosphere better suited to their eventual needs. We have become fully convinced that international medical problems are strikingly different from our own and require a level of understanding which cannot be satisfactorily obtained through existing programs of instruction. It has also become clear to us that international health problems require the ful attention of highly competent people who can work here and abroad with full support by our Government and the health professions both within and outside the universities. Programs which depend entirely upon brief service abroad by even the most competent experts have very limited value and are too often insufficient or even unsuccessful. It seems likely that in the future all American medical schools will add to their curriculums studies in international health and that some will have relatively large programs in what has heretofore been an occasional activity. We are pleased with the support provided to improve our utilization of knowledge and skills through the presence in our universities of highly devoted individuals who have already become familiar with international health. If we are to train physicians and others for careers in international health, we must design a new concept of education which will draw on the total resources of the university. Although this will add new burdens to faculties which are already under great stress to meet growing responsibilities, we are willing to meet this important commitment. However, you will appreciate the fact that new responsibilities cannot be met without concern for other responsibilities we have for training, research, and service within the country. Every medical school, whether private or State supported, has long-term plans which require careful attention to the growing demands for expansion of faculty in the further development of existing programs and in response to expressed needs for the university to play a greater role in the provision of total health care to the community. Any diminution of support in other phases of their programs will have an inevitable deleterious effect on our ability to participate in the development of an international health corps. We do believe that the American medical colleges and Public Health Service can establish an increasingly effective partnership in a better program for world health manpower. The International Health Act of 1966 is an important step toward strengthening that partnership. It has our full support and our pledge of full cooperation. Dr. HUNTER. I think perhaps, sir, it would be useful to identify myself a little bit further as well as the organization I am representing. I am chancellor for medical affairs at the University of Virginia in Charlottesville. I have had a deep interest in international aspects of medicine for many years, starting with part of my own education in England in medicine before transferring to medical school in this country. Later on, at the beginning of World War II, I was sent to Latin America to learn something about tropical medicine at the time when we suddenly found ourselves involved in the South Pacific with diseases and problems that we were not equipped to face. A crash program was instituted at that time in which I took part, taking a course in tropical medicine and military medicine at Walter Reed followed by 6 weeks' field experience in Central America. Then, in 1960 after going through the various steps to becoming a dean of a medical school I became president of the Association of American Medical Colleges, which I am representing today. I felt as president that one of the things I wished to stress were the opportunities that existed, it seemed to me, for exerting much more influence on a world scale in the field of health and medicine than we were doing at that time. At the annual meeting of the association all of the deans of Latin American medical schools were invited in the interest of establishing better relationships with them. Some 35 deans came to that meeting. Following this, the Association of American Medical Colleges, which is the organization of medical schools in this country, comprising some 88 medical schools now as you know, established an international division and I have here with me Dr. Van Zile Hyde, who is the executive director of that division of the association, and Dr. Harold Margulies, who is the associate director. Both of these gentlemen have had extensive experience in the foreign field. Following this I had the opportunity to spend 1 year of sabbatical in South America in Colombia working for the Rockefeller Foundation as a visiting professor of medicine in the Universidad del Valle, a new medical school in Cali, Colombia, and had the opportunity to experience at first hand some of the things I had been interested in and talking about before. I felt that, having talked so much, I should find out for myself what was involved. All of these things have led me to feel all the more strongly that it is not only for humanitarian reasons, which I give great emphasis to-I think the people of the United States are humanitarian and that their genuine humanitarian interest needs to be expressed-but, I believe also from the point of view of enlightened self-interest that it is highly important for us, no matter what the domestic pressures upon us (and I agree with all of you that these exist), no matter what domestic pressures we feel, a certain proportion of our effort must be devoted to our contribution to world problems and especially in the field of health in which I am interested. I believe that the very survival of the race depends almost above anything else on helping the developing nations to enter the 20th century with us; that contributions of health to this are inescapable, inextricably mixed up with the population problem, and with economic and social development in these countries. For these reasons I am delighted to be here representing medical education, medical schools in this country, in support of this legislation which I think is an important step in the right direction. I must register one slight reservation and it has to do with the other pressures on the medical schools to which you have already referred. The Secretary yesterday used a very apt simile. He said that this program did not require new construction, as you remember, but that it could ride on the back of other programs. I believe that was the phrase he used, and that is what is envisioned here. This is fine so long as the back is a strong back and I am expressing the sentiments, I believe, of most of the deans of medical schools in this country in being firmly behind this legislation, provided that the other commitments to strengthen medical schools in this country are carried forward and that, in the efforts underway to attack the manpower problem which is at the heart of all of these programs, that other measures are not jeopardized in expanding our efforts in any field. So, with the reservation that the medical schools need all the support that has been envisioned for them in order to carry out the multiplicity of new demands upon them, this international effort has a priority of its own and deserves our attention no matter what the other pressures are, and I do feel that the numbers of people involved here will not be a substantial drain on the medical manpower of this country. You must remember that already we are in negative balance, if you will, with 2,000 foreign physicians being licensed in this country every year and contributing to our own domestic services, and we are, as you know, training many others who do go back. So, I feel that this program is very important, that the training of these high-level people for the Career Corps in the Public Health Service is of central and catalytic importance in that these people can be assigned to the World Health Organization in much greater numbers than they have in the past and strengthen that body which I agree with you, Mr. Rogers, is of great importance in this whole field. There are some other activities of the Association of American Medical Colleges, that I should like to mention very briefly, which I think are directly pertinent to your understanding of the setting of this legislation. One is a document I am holding in my hand and of which I unfortunately do not have copies sufficient to distribute at the moment, entitled "A World Program for Health Manpower." This is a report of the Association of American Medical Colleges to the Director of AID, Mr. David Bell, prepared after a study which the association undertook a year and a half ago with extensive deliberations on this central problem, with recommendations to Mr. Bell as to the efforts in the field of medical education which AID might make. The central theme of this is that we cannot possibly provide the health manpower for the whole world. That is clear. We can't train them all here. We can't send our own people all over the world, and the main thrust of our effort, therefore, must be in helping with the development of institutions in the developing countries themselves to train, on the spot, their own manpower of the type that they need. In essence that is the theme behind this report, which I think is a very carefully considered statement. I believe that the program we are considering here fits in very nicely with this, that the high-level people envisioned for the corps of the Public Health Service are central to the staffing of key spots in our own services in the World Health Organization, the Pan American Health Organization, and so on, in order to make the implementation of this sort of thing possible. There are many other things that I might say, Mr. Chairman. I am obviously enthusiastic about this and I hope very much that you will see fit to recommend this legislation. I will now be glad to entertain any questions. I don't propose to be able to answer them all, but I shall do my best. Mr. Moss (presiding). Mr. Rogers. Mr. ROGERS of Florida. Thank you, Doctor, for your statement. I quickly scanned your prepared statement and I would share your feeling that, of course, we can't ignore world health. We must participate in it. We have tried to do that I think fairly well in this country. I think you say in your statement we are now training some 13,000 foreign nationals in the health field in this country presently. Some 2,000 are licensed-2,000 foreign physicians. Dr. HUNTER. Per year. Mr. ROGERS of Florida. Per year? Dr. HUNTER. Yes. Mr. ROGERS of Florida. And many more are practicing that are not yet licensed. Dr. HUNTER. In residencies. Mr. ROGERS of Florida. In residency capacity, which has caused a concern in my own feeling. What are your feelings on that? Dr. HUNTER. I think this is shocking, frankly. I think for this great Nation to be a debtor nation in a field such as this is shocking. There is no easy solution to it. I believe, on the other hand, that it bears very definitely on all of our plans for expanding our own facilities for health education and that we constantly are faced by this added deficit when we look at the needs in our own country, and I believe that we should go much farther than we have. I must, sir, register deep concern about some of the cuts that I see in the President's budget that are going to hamper our effort in expending the development of new medical schools now underway in this country and the expansion of existing schools. Mr. ROGERS of Florida. This causes me concern when we are presented with new programs and having difficulty, perhaps, fulfilling existing programs for our own country. Dr. HUNTER. I share your concern, sir, but I must say that, in the balance, I feel no matter what our domestic situation, and it isn't that desperate in the spectrum of the whole world, we have an overriding obligation to do more than we have been doing in the field of international health, not that we haven't been doing a great deal in some ways, but the need is immense on a world scale and pressing beyond belief and I truly believe that the stability of the world to come depends on this facet of the total developmental scheme and that we must contribute to that. Mr. ROGERS of Florida. I understand that and we have been contributing to the World Health Organization, Pan American, AID, Peace Corps. Dr. HUNTER. But on the manpower side we have not been contributing much. Mr. ROGERS of Florida. About 250 I guess. Dr. HUNTER. No, to the World Health Organization, only a handful. Mr. ROGERS of Florida. But I think we have about 250 working overseas. Dr. HUNTER. Yes. Mr. ROGERS of Florida. And these are of the Public Health Service? Dr. HUNTER. Right. |