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This paper is divided into three parts. The first contains a brief description of the past and present distribution of physicians in the United States 1) by levels of care in the four United States census regions, 2) by community size in the nation, 3) by areas, according to the median income of the population in areas within an Eastern state, and 4) by the four main sections of a metropolitan region in that Eastern state, i.e., the business district, the inner city, the middle city, and the suburbs. Past and present distribution of physicians is analyzed, and it is shown that there is an increase in secondary and tertiary care physicians and a decline in primary care ones, with a growing concentration of physicians in the larger communities, in the wealthier areas, and in the suburbs. In part two, it is postulated that the present strategies for change based on the “market” ideology implicit in most types of health legislation (CHP, RMP, PSRO, HMO, COLC, HCRC, and others) will not correct, but may strengthen, the maldistribution. Indeed, these pieces of legislation respond to different constituencies that make up the main loci of economic and political power in the health sector. It is postulated that it is precisely these loci of power that are the cause (rather than merely a symptom) of the maldistribution of resources. In part three, alternative strategies for change are presented, with recommendations for 1) shifting the planning and regulatory powers over the health sector from the private to the public sector, and 2) democratization of health institutions, with control of these institutions by elected representatives of both those who work in them and those in the communities who are served by them. The possibilities of adopting these strategies in this country are discussed in the light of some international experience, and with consideration of the present economic and political realities of the United States.

One proposed method for delivery of primary health care to underserved areas is the establishment of family health centers connected administratively to hospitals. This paper describes the development of a family health center by a community hospital to serve a town which had previously been unable to attract a physician. FOR DECADES, SOME HEALTH AUTHORITIES have advocated that hospitals play a more vigorous role in the delivery of ambulatory health care. They maintain that the present hospital, as an integrated entity, has the means to organize and coordinate a health care delivery system and to establish quality controls and, in addition, serve an educational function.2

This paper offers descriptive data in the fields of ethnomedicine and ethnonutrition from a community of Ladino (non-Indian) in Guatemala. The data were taken from questionnaires obtained from 102 mothers on 506 living persons. Though no health facilities exist within the village, 3 midwives are in the village who deliver most of the children. (They charge the equivalent of $3.50-$5.00.) Most women deliver in the village, which is usually quite safe unless the complication of delayed expulsion of the placenta is present. No special dietary precautions are taken by the mother during pregnancy in this culture. Midwives are engaged around the 4th or 5th month of pregnancy, and the midwife makes monthly visits after that to feel the fetus's position and prescribe various herbal and patent medicines as required. Delivery position is usually kneeling or squatting. Women bathe 8 days after delivery, and sexual intercourse is resumed 2-3 weeks later. Nearly all women breast-feed their babies (only 3 of 506 infants were not breast-fed according to the survey). If the woman cannot breast-feed her child, a bottle method is used rather than another women's breast. Mothers nurse up to 2.5 years without cultural interference. There is a taboo against nursing while in another pregnancy term. Weaning is generally accomplished, therefore, by refusing the child the breast. The child's diet is suited to the devleopment of his or her teeth, with milk-soaked bread and gruel constituting the diet for the first 2-3 years, after which the child eats the same diet as adults. Sickness and disease in children in San Antonio are most frequently attributed by the villagers to worms; hence, the baby is force-fed oil upon birth to cleanse the infant of worms. Edema is also a serious child health problem. Various native medicines are described which are used to treat childhood illness in San Antonio.

One of the principles of Primary Health Care (PHC), Community Participation is a process through which the stakeholders influence and share control over development initiatives and the decisions and resources which affect them. It is a complex issue that has been studied widely and continues to be of great interest among community health workers. This paper presents a brief review of various aspects of community participation. It then illustrates how it is practiced at Duwakot Community Hospital, Kathmandu Medical College, Duwakot, Bhaktapur, Nepal in collaboration with the local community. Key words: Primary Health Care, Community Participation doi: 10.3126/kumj.v6i4.1750 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 526-532

This paper describes part of an education experiment at the University of British Columbia at Vancouver.Six final-year medical students spent approximately 12 weeks in a community. Their time was divided between the hospital and various doctors' offices. They answered a simple questionnaire to describe their experiences and commented favourably upon the opportunities for direct patient contact, learning basic skills, informal teaching by both family physicians and consultants, and the variety of work available.They had the opportunity to follow up the progress of the patient and learn the natural history of common illnesses. They achieved their basic objectives. We conclude from their reports and informal conversation that the experiment was successful and recommend other institutions to try similar programs.

Increased demand for mental health services has focused increased attention on the nature of referral relationships between primary care physicians and psychiatrists in the delivery of psychiatric care. Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, this paper focuses on issues involving the extent to which internists see psychiatric conditions in their practice; the extent of referral to and from psychiatrists; the most common conditions referred to psychiatrists; the most common treatment modalities used by psychiatrists; the most common reasons psychiatrists refer to internists; and internists ratings of satisfaction with various aspects of their psychiatric referral relationships. A contingency model is proposed as a framework for further understanding the process. Specific propositions to be tested in future research are presented.