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Editor,—The article by Campbell and Gove was timely and excellent.1 I am working in Bolivia to implement the programme developed by the World Health Organisation (WHO), “Integrated Management of Childhood Illness” (IMCI), as a means to decrease the high morbimortality in children less than 5 years old due to the most common illnesses in each region by appropiate and integrated management.2
The programme has been adapted to the needs of Bolivia and we have already run a workshop, with the participation of paediatricians from all over the country. The Bolivian Health Department is very enthusiastic to start the IMCI programme as soon as possible and is one of the first Latin American countries adopting it.3
The main paediatric health problems in Bolivia are respiratory infections, diarrhoeal diseases, tuberculosis, malnutrition, anaemia, malaria, and infections in the newborn period.
Right now the Health Department, the Paediatric Society, WHO/Pan American Health Organisation, Unicef, US Agency for International Development, and the Bolivian medical schools are working together to make possible a full scale application of the programme. We have just held a workshop with the participation of the three Bolivian medical schools to analyse the possibility of incorporating the IMCI programme in the regular training of medical students. This way we could reduce the cost of training graduate physicians and provide doctors coming out of medical school with a good knowledge of the evaluation and treatment of patients.
I attended a consultative meeting held in 1996 by the WHO in Geneva, with other experts from around the world, where the feasibility of applying this programme in medical schools in underdeveloped countries was discussed, and we all agreed with the importance of incorporating the programme at different levels of the medical school curricula.
It is important to emphasise the input of developed countries to ensure a scientific basis behind these programmes and, as Campbell and Gove said, to be aware of the problems faced by physicians working in underdeveloped countries. Also, when training foreign students, both teachers and students should learn about the integrated management of childhood illnesses, something that many standard textbooks do not mention.
Addendum: as of January 1998, the IMCI programme is being implemented in our medical schools.
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