GUATEMALAN INSTITUTE OF SOCIAL SECURITY
"An autonorious institution"
GUATEM'LA, C. A.
HOSPITAL SURVEY OF TTTHE REPUBLIC OF GUATEMALA
PART I
BY
Henry W. olbe, 1. D.
Prepared in Collaboration with:.
DEPARTMENT OF COORDINATION
OF HOSPITAL PROGRAM,
Guatemala,
December 21st, 1948
(
C ON T E N T S
Letter of Presentation.
History of the Hospital Progran . . . . . 1
Population Factors. . . . . . . . 11
Modern Ccnccpt of the General HospitAl. . . . . 17
Becd-Death Rntio in Estinntion of the Size of Hospitals. 21
MIin Principles Underlying the Hospital Program . 29
Hospital Regions. . . . . . . . . . +4
Gencr-1 Hospitnl Heecds of the Republic. . . . . 46
Charts of Recorrcencd Leds . . . . . . . 1
Rosure6 of Regions. . . . . . . . . . 68
Respective iolos of the Instituto onc: the Ministcrio in
the Nlation.l Hospitral Trozran.
Priority of Construction of 7ospitnl Units. . . 74
Tuberculosis Contrl ProEr .. . . . . . . 2
Tuberculosis Sta.tistic . . . . . . 94
Recorrend-.tions for Tuberculosis Beds . . . . . 104
NMnt7l Diseases . . . . . . . . 122
Cor'r.unicrble Dise':es . . . . . . . . 131
Private Hospitl Facilities . . . . . . 135
Mal ria . . . . . . . . . 137
T r.nthertic Typhus Fever . . . . . . . 149
Onchoccrcosis . . . . . . . . . . . 152
Rehabilitation . . . . . . . . . 175
Medical! Profession. . . . . . . . . 161
Nursing Profession. . .. . . . . . . 17C
Other Professional Scrvices .
. 9 9 9 9 . . 9
175
Analysis of Report Subr-itted by Dr. Kolbo, on October
30, 1948 .............. By NoIerga-rd & Craig
Hospital Consultants
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cor't st.i. pending I
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Histcry of t6c rtior. :.l ospittl ProS'.:t.
Field st. .s of om'it)l r-gors.
3irt]Y. r: .ie-1 i- vel' tc' to size of hc"pitls.
1 orbiity b- r:- discussion.
rofssior.i sI:ri. c(.: o th c'ourtry.
Trinir.g .
Tub-ercul. -s orn-rol w.ror::r.
Sprciaol 1re 30 ,- as Ty.s Fcverr, Oncl ocr-
cosil C. r c', Lepro- .
Ro1b.bii ol s_ i.
Visit_; n-.; sc s v::,vi,,-.
.odcrr co:,, t of td',- :c r-1 hospital.
Priv: t c, ho it:. f t : .ci -it cso
I -. no crl : i: or t'-.
submit rcpo'cts th:.y.
v-ri-s ~or.b- cts listed cbcve and will
.re oe pltecF.
Sincerely ycurs,
--y/apc/
Since the Tr,.rnt.ticn f the a :vc report cater Octcber
305 1948, the fcll -vir. si::jects havc teen cc:r-lctel anC inccr-
oPrntoC in this -rli'ir-ry r 1c-;rts
1) History .: the IUticrial Mspita! Prc rar:.
2) Lirth : r '.nths in rc.lati -n tc size cf hospitals.
3) 'ro>fessi'"r.1l service c -f the ccunitry:
',. :i'-: Panr ursing, inclucin Visitino Nurse
Service.
4) T-lcrculosis ccntrcl rc rr.:: including Statistics
-i Rccor-r ,.n1'ticns fcr Hcspital beds.
5) h'alaria.
6) ]'cnt-1 "isc 3ose-.
7) Ty1hus lever n' Oncchoccrcosis.
8) rhailia'. t n.
9) l.:cirn C,-.',opt of the Genoral Hospital.
10) P 4vWv.,, H:'s-'it l f--ilities.
The Constitution of the Terublic of Guatoemala promulgated on the
11th of March-, .1. .crees in it, Article 63'
"That there be established a vster. of obfliatory Social Security.
The law will rc'ilate it. objectives, extension, ard the form in
which it shall be 17-,t into effect. It will comprise at the least,
provisions for protection against disability, old age, death, dis-
ease and wor'- acciden-. Contributions will be made by employers,
workers, a~nd the State".
However, as ar as 123, Guae, cala was interested in Social
Security. On February 7th, l.-3~, a convention was held in Wash-
ington, D.C. between re--rcsentatives of Guatomala, El Salvador,
Honduras, Nicaragua -ndC Costa ',icr to consult on the standardizat-
ion of protective laws for -or'-err, The -rc.-ltant agreement bet-
ween the countries: prrov`-ded th`t 'aw-s of social Security be passed
within Ei 'h.-. months of te ffect-, ve date of the agreement. Gua
temala approved the Pgreement Ln ''ay- 1925.
In-1045, G'uateral. ren-o-cd its connccion with the International
Office of ''ork. An intnrsivc st..y .:, ade of existing Social
Security systems c-Cd c.f ncvw techniques and rocedurrs recently ad-
orted in tih fiel o.- ci-,l icurity. For this purpose., towards
the close of lQ14?, there was organized the Commission on Social
Security as a division -f t e inistcrio do Economia y Trabajo with
a memborsYim ccnisti'- of Lic. Jose ?61z Ecnnett, Lic. Salvador A.
3ara ia,) Dr6. Cesi- T.icz. a.d Ing. Jcrre Arias.
The ,inistorio dc coronaa y Trabajo received several proposals
fro. forei.r insur:.' .omp'.ni.s cf international nrostige request
ino authorization to '-a. tihe necessary studies in Guatemala for
the purpros( of subrmi iin t to the i overnnont a complete plan of
Social Security. One o the offers wa- accepted by the Ministerio
de Econon'_! 1 0;raa jo0 -rd as n result, studies w.re started by
Lic. Oscar r--r hcra Str.bor, ard j.r 'ler Dittel, Latin-American
experts in the field of Socirl Socurity. While these studies were
under wv.y, the insurance company withdrew its proposal. However,
the studies continued *r-.d ,cr comrlelted by the express order of
Dr. Ju-.n Jos Arcve.lo, .rs-idcnt -f ,th HePublic.
Barahona and littel worked in clo:.c cooperation with the Commission
on Social Security, ?Cd on the corplction of their studies published
the comprehensive report untitled "Eass de la Sesuridad Social en
Guatemala". This.. report, rccoimended for Guatcema., for the first
tirime in thr history f? rocil .-ccurit-, the systr. of Retroactive
Protection and `-iniiimu. Trot-ction, he excellent and outstanding
results obtained thu_ far -.. ith this syste- are a tribute to the
experience and v., ,sion of tho authors of a modern concept of Social
Security.
In October 1916-6, ithcr w.was src _,croto No. 290 or the Organic
Law creating the institute Cuat.cmlteco de Seguridad Social. In
the Larl-y part of ove. bcr of the same year, the President of the
- 2 -
Republic and the Ministor of Economia y Trabajo, Lic. Clemente Ma
rroquin Rojas, appointed' Jose Rilz Bennett, Chairran of the Board
and Lic. Oscar Bprahon- Streber, President of the new institu-
tion.
The attention of the Institute was drawn without delay to the hoAs
pital and public health problems of the country, in accordance
with Article 62 of the Organic Law creating the Instituto. This
Article has the following provisions:
Article 62.- The Instituto and the Ministry of Public Health and
Social Assistance shall constantly coordinate their work, with
the object of avoiding a duplication of efforts, economic burdens
and services,
Such coordination shall be subject to the following fundamental
standards:
a) Joint planning for the better utilization, maintenance, ad-
ministration and development of medical and hospital resources in
the country, or of those that either may hove available in a given
moment and in accordonc, with the needs and extension of services
of both;
b) Joint planning for the best way to crry out without loss of
time, in epch section of the country, sanitary and preventive
work required for the correct application of the different types
of benefits, with special emphasis on general diseases;
c) Sale, at cost, of the hospital services which the Institute
needs for its affiliates, qs long as the respective hospitals are
not administered by the latter "nd are the property of the State;
and,
d) Joint planning for tn.e best wry to achieve the gradual unific
stion of the befits to be granted by the Institute with the san
itary and assistance services of the State, under one single sys-
tem of Social Security in conformity with the principles set forth
in this law.
Actually, the need for a complete reorganization of the health
services of the country had been recognized for many years. How-
ever, official steps were not tkear until the First Medical Con-
gress was held in Queznltennngo during February 1946 under the
auspices of, the Minist.r.o de G3lud Publice y Asistencia Social.
The recommendations of t-h Ledic.l Congress were outstanding, a
copy of which is presented;
-3-
PRINCIPAL RECOMM_ gJDATIONS' 07 T:IT MEDICAL HOSPITAL CONGRESS
1.- It is recommended that a system of modern hospitals be cons
tructed in the Republic to provide adequate hospital care
and public hPalth services.
2.- In order to carry cut the abcve recommendation, due consider
ation should be given to the opinions of of experts and tech
nicians in the field of hospital construction and operation,
who shall submit a preliminary plan at the earliest possible
date.
3.- For the construction of hospitals the Congress recommends the
division of the country into zones to be determined tentative
ly from recommendations presented to this Congress, which
shall be submitted for study to a commission named by the
Ministerio de Splur Public- y Aisistencia Social, to be formed
of capable members of professional standing.
4.- It is recommended 'hat, fr the realization of the project
recomrcnded above, the government of the Republic obtain an
internal loan.
5.- It is reconmm.ndcd ,at the revenue from the lottery of Asis-
tencia Social be r-laced at the disposal of that Ministcrio
for the amortization (refund) of the internal loan.
6.- Pending the fulfillment of thu above recommendations, the
Government shall provide all the materials, equipment and
personnel rcquirocd by existing hospitals in order to improve
their services and shall endeavor to provide one or more
services for tuberculosis in said hospitals.
7.- Hospital projects currently under construction shall be tech
nically revised to accord with recommendation No. 2.
8.- That in the general plan of construction of hospitals be in-
cluded those for chronic cases ard convalescents.
9.- That out-patient cdpartnents be established in all the hos-
pitals of the country and in other localities where necessary,
and that existing out-patient departments be reorganized, and
coordinated with hospitals under the supervision of the Direc
ci6n General do sistencia Social.
10.- That free pharmacy services b. established as an adjuct to
out-patient depart-.- nts in accordance with regulations form-
ulated by the Medical Society, the Dental Society and the
Society of Pharuacists.
11.- That a period of six months of social service be mandatory
previous to graduation for students of medicine, pharmacy,
biochemistry and dentistry.
12.- That stuis in 1oci-Il Jucurity bu -rtended effectively
with the view to integration into the hospital program.
13.- That each hospital have an administrator with recognized
technical 'r pc:aration.
14.- That the number of Eistrs of Charity of the Comnunity of
St. Vincent cf Paul, currently working in existing hospitals,
be increased and that they be technically trained in rrder
to collabcrotL -. 1 ,-it 1 r. r"".
1.- That th... rantin cf scholarships tc physici-ns, pharn.acists,
engineers,9 architects, Cdntists, nurses r.d technicians in
the various hospjit-al services be furthered and encouraged.
16.- To estimulat,. ( encourage the nursing profession through
the establishment of the necessary schools of nursing.
17.- To establish the fcllowino services in the hospitals of the
Republic
a) Well-atpoint, d phar acies to be headed preferably by
professional pharm" cists.
b) Dental ser-.icos, with dental in-partient service if war-
rented by th,Y sizc of the hospital. Dental out-patient
service and ibonatology service for adequate treatment
of in-patints.
18.- It is reco.00.n(cd that a xineral formulary for all hospitals
of the Republic be clabcrrIc..
19.- That the notion cIvancec in this Con-ress on "Adopting stand
ards for the rcption, x-niriaticon nnd treatment cf
patients" bc consider_ a -.rIliinary plan for discussion
by the Commissiorn char-;-d C .ith formulating; the General Code
for the hospit !0 of te. Republic.
20.'- To establish nobild. dental clinics.
21.- That for the b_,tter functioning of hospitals th're be est-
ablished
a) Cor;.plcte clinical "obrrvation of every Jn-patient.
b) Officially u-ified laboratory techniques.
c) R-tion-l n r controlled therapeutics.
d) TIopital snc- .1 service.
e) Creation of a,-eny for public relations.
22.- That a cornissic- a-mppcini.,C by the Ministcrio de S-lud Pa-
blica y 'isistnci 1Socil study the motions presented by
the School of 'hcrracy rel(ativc to the creation of a Hos-
pital Supply Dep-rtment, and that said commission submit
its report as soon as possible.
23.- That the Institute of Legal Ncdicirn be established.
5 -
24.- That a doctors' seniority register be created for establish
ing eligibility to hospital posts, with special considerat-
ion cue for rural and departmental service, and governed by
the Rules and Reulations which shall be enacted to this end.
25.- To encourage the creation of, and to give material assist-
ance to, the hospital activities of private institutions
and employers' associations.
26.- It is recor.-.ended that substitute hones be provided.
27.- To encourage the exploitation of farmlands as a source of
revenue for hospital services.
28.- To encourage the cooperation of departmental authorities,
and the medical ,rofcssion in public health activities.
29.- That the Health Department's budget be adequate for the
devclopnoent of its program.
30.- To enforce the laws and resolutions currently in effect
regarcding medical care on farms, shops and factories.
31.- To promote th, country's natur-l resources through the
following :
a) A commission shall be appointed which shall bc composed
of physici ns, chemists, engineers and technicians to
be charged -.,:thhe study cf hydrclogical conditions,
the detcrmin:'tion of therapeutic indications, and the
planning of construction n projects, promotion of tourism,
and th. re( etcive finance programs.
b) That university curriculr include the study of the a-
bovc rcnti'nc resources.
c) That publicii- be intensified to popularize these
resources.
QuczaltcnangFc February 16, 1946.
- 6 -
In order to obtain a complete and realistic hospital plan for Gua
:temala, the Institut t-urncd to hospital consultants of recognized
reputation. An inquiry covering the needs of the country was sent
to several of the foremost North-American hospital consultant
firms. A copy of the Inquiry. dated May 5th, 1947, is given after
the services of NTeerca, rd & Craig and Dr. Henry W. Kolbe were en-
listed:
EXHIBIT "A"
I N U I RY
May 5, 1947
(Tames indicate assignment of responsibility)
The Guatemalan Institute of Social Security is an autonomous or-
ganization established in Guat, cla under Congressional decree
N1295 of Octobe-r 30, 1946, for the development and administration
of a national system o- Social Security. The Institute desires to
avail itself of the services of a Tospital Consultant and a Hos-
pital Arch-itect te-por-rily or pcrmani.ntly to carry out the follow-
ing hosbitrl program;
1. Preliminary survey of hospital facilities required in Gua
tomalr for covered worK'-rs under the Social Security Law. (Kolbe -
Neergaard & Craig).
2. Preliminary report of recommendations for a national hos-
pital building program for the Institute to meet the needs out-
lined in the preliminary survey of hospital facilities. (Kolbe -
Neergaard & Craig).
3. Specific hosnpit-l building project for the gradual dev-
clopment of the preliminary report of recommendations for a nation
al hospital building program, which must include the following
parts with reference to each 'searate hospital:
(a) Preparation of a Medical Program which will include a
narrative presentation of the various clinical services; administ-
rative units, nursing units, service departments, laboratory, X-
Ray, laundry, kitchen, cut-patients, pharmacy, -tc., with a.n estim
ate of the spaces required for each section included in the project,
and recommendations for th' study and approval of the Medical
Progr-.m; (Kolbc N-er'ard & Craig).
(b) s"commendatiafs for an "Administrative Procedurc for th-
Hospital Plan" Lc be prripalred simultaneouslyy with the Medical
Progr-m, which will include general or specific advice on the pro
cedure to be followed for the study and approval of the various
phases of the hos-pit.
the entire program, to, (Kolb, Neorgaard & Craig).
(c) V.'ork Program' for the. Hospital Project, with a detailed
analysis an'r outline ol a11 coordinated work to be developed or
planned simultaneously vith the construction work, indicating time
requirements, nature an' extent of work to bc done, duration and
-7-
cost. (Architect EnEineor Ieergaard & Craig).
(d) Prcliminary 'lans for the Hospital Projects, which will
include plan of site : d ri.tation of the building functional
plans for each floor-; orspectivc of th. building. Architect -
IToergaard & Craig).
The services cf -r approved -esritl1 Architect will he
required in the prp--r tion of thc rreliminary plans. The ..Ins-
titute may requirai at least three- prrliminr.r- plans before ctnal
construction is unc'ert_.oen. The "Adrinistrative Frocedure for
the Hospita-l l-.n" rust include recommenda-tions f'Lr the study .nd=
.-pprov.l of t- "frlir in.ery Plns". (Architect Nergaa-rd &
Craig Kolbc).
(e) Complete Fin 1 -1 7.ns ard Srocifications, which muct in-
clude: srructurl l--ns, fi-nal Architecct rrctive cf the
building ncd :.levtion; r"odel of t buildi-i to sc- -l- Cloctric
insttll-tioris pl-n 1 'n; rc J nil c.lns; r lu bin.r l-pl=ns dors a.nd
winCowss; cormmunic tiorie ;rrec"'i-. rl-.ns. det- eied
pllr' of 1uilt-in r"' et- such as utiliTy Ceniets comntrs
shelve. a borato, ii-l rh.. cy c-bincts. lockers', Jrtc.
landsc'pii -. -t.' ,ring; det-ile.d and complet secifications
descri7inc teo or-11- of r.terials to -e used fcr the structural
worlk conptl,_te -.eci.:i.-.tions ifor .11 :.a.teri-.ls n' finish for all
nill work co-,'.te .. 'ification. for hardw:6.re; complete specific
.tions for p'-int n o.r ..cti'cn com'l.te r-eceific tic. fcr
-luibing in stall--tiorn -ork, n d f-ix-d s-rit-ry eauirment; ccr -letc
spncifications for .-ower stations tr .n :fcr;ers, circuit panels
anid electric inst.'-ll-tions, rocfinS -,.t. ri-al, pl -sterin- an we'll
materials5 floor, c0ilir -r d r:.rti ion '-t-ri- 1.o :t.irw-.:'y lt2
and iron fixtures, liJ.hting fixtures (l..:ps, ir .c.ots, etc'.);
instructions r'or lndse-~in- nd -rc Crin (Architect r.ein.cor
ecrg.-.rcd C.. -i )T
(f) Equipment _pecific. tior.;: Co' Wl te srtciic .tions, with
illustr-tiorns 2.oi desi'-C whrW'cvr *. C -.C-" fcr tie _rr xict i_
connection with rlcheni ; installations fr th bilin which
must include X-Ray, I.boratory, :.urgcry, laundry9 stcrilizers
kitchen, lir- n, furnitiu,, of ice furnitur. etc. tc. (Architect -
ngincers -rg.. rd .. Cra-ij).
icv.abl,. cquipm-rt .nd s-rppliL.s by Dr. Kolbe.
(,) 'nu-'.l of i.cu ai:oetdatoi.ns FrcparaLion cf a manual of
instructicr's :nd rcornii ndaltionsr for thc purchase of the equipment
.d '..tri.al, for .rinistration and r.n c m-nt of the hos-
pit-l, nit r.frn- staff, clirnicol records, purchasing in-
ventorics, account i: -tctat.ic,, s,-nitary cd ucation, regulations
Governing the c lc" 0aff, f rs .n s etc. (Architect Kolbe -
Cergard a Cri0)
(h) Ti:.1 Schedule sti':-'tcs regarding the duration of each
phase of t.h :.-or: progr-r and coordination with the rcsncctive
component parts rf the 1ospii::! project. (Architect Neergaard
& Craig).
(i) Trainin^ F:ror!. in ducatiornl prograTn for the tr-.ining
of the hospital st-ff, s.lction rCeuirtcrCjts of' c-rdidC-tes, qunal-
ificc.tiols -reC oporice. Fields of study -nd r7coma--nded train-
ing centers. Dur-.tion of s peci-lize stu.ics. Ccst cf th~. tr.in-
ing or scholrrship prc: r-. (Ko-b,3 r>g7r.r' &: Crai2).
(j) Cost Estir'-ts; An stii-.tc must be submitted of the
construction cost of th hst .!al and cqcuipimint, including Con-
sult.-nt's .and .rc-it t's fes. s well .'s cost of cocrNic tod
work promr m. ('.rchitct r...~ard ; Craig).
If you are in a position to comply with thW :.bove ruquiro-
,cents, I would g-rertly Tpprci.te t- h.ve reply frorl you with
r stiwt,_ iof ti'.. n: cost inv..d in carrying out t.- .bove
pro.r.m s..per..t,.ly for
Pairtr- 1; rnd 2
;.rt 3, :;.etions () to (j)
If your r.p.l I .: ;." tifactory, 'rr'nf r... ts will b, d-. by
this institute. fc- irora. .icussion etie, i-nbeo -f our
staff -nd your fi ... ,.:r c c. lo t' of th. hospital prog' .-
surv.:y is cjm'' nf' d.
Sof w nr oir. of your. i
I-STITUTO CT.i AT I:TiCO br b/.GL lDAD OoCIL
(nSD)
itS . S; -^!L. i io ;tTR ER scrv
Aftcr .n c..rful "l.uy of svOrl 'rops-ls. tc Juntio Dir.ctivA
of Ic Inslitufrwt. accu dd on t-o., choice f the fir. N.1 oprgnT.t.rd &
Crvai of -or]' : Ci t,,K be:cac e' of their reslige rnd eatensivus
expri-ec, i_:- !-';^ cois uetion of r.od._rn hospital;. In crder to
m,;.1:: the fiel.. survey on w..,/hic:, ,ouled bo b_,sud the national hospit.!
pl..n, it wv.-.s con:;id.r"..or di r::ir 1,. to ,bt-in the services of a
conult<,r.nt vlto w.s '- iliar wi;,n hospit-l conditions in ilontin-Amr,
ric,'-, ;.'rf.! p,.-'.rticulto.'r.ly in Gu t'.-2'.l-. For this purpose the ser-
vicu;s of D',. Koll. ." h-d wo'],3 d for several yeors in various
Latin: peric-c:- ccuntri j. incduig.- two years in GuC.temal., werc
obtained.
The field survey to determine the health needs cf Guatemala was
startc- in April, 19CL. The ,robKlem was considered under the
following' main headinrsn
I. Survey of the Hospital I eeds of Each 1e'ion.
II. Recommendations for the National Program of construction"
of hospitals.
III. Specific hospital projects.
IV. The list of ,obile equipment and supplies for each hos-
pital unit planncd.
In order to determine the hospital facilities needed in each reg-
ion, the following studios wcre hade -
1) Total facilii-ics ncedec
2) Existing facilities.
3) Analysis of needed aic. existing' facilities.
4) Professional services.
5) Role of the Institut.o in the hospital program.
6) Role of the rinisterio ac Salud PuTblica y Asistencia So-
cial in the hospital pro7'r-.m.
As a result of t< .&urvey, recommend- tions were made for the
national 1'ro rr.mi of cc *strucLion of hospitals. These consist of
two -hasoes first, to provide t-.e hospital facilities needed by
the Irstuhe binist;rio; and second, the order of
preference of construction b,:;o on the rogroessive needs of the
Institute, the ned' c." the inristcric in rcrder of urgency, and
coordination between the rogr.-s of construction of the Instituto
and of the Iinis-erio.
..elizin t--c i;-o rt-n.ce Df public health in conb-.tting disease,
the Instituto decided t[o conccntra.t- on the fields of Malaria. Tu-
berculosis, and Vnerc-'.1 s. ss which are serious problems in
rat al. 3peci-l cc-iratior was -~Iso '-ivun to special dis-
ases such as mental i sese, S .: .ver, Cancer, Onchocercosis,
..and Lrosy. The i--crt.nc' c r h'bilit.Ation in thu system cf
s~.cial secuci:ty ws r. cognie .. an Sp--. stuCy of this field
was rmide.
ThM field su-vey ha- a its o je.ctive the setting ur of -n int-
ugrated ho-spital system br sec on hosn ital ru'ions. Vital statis-
tics including morbidity and r-.--.lity, topogr .hy of the country,
composition of th7 peopl, boh r .ci1, anrd economic, and trans-
portation facilities, mncludinT: r-oads, bu service, and railroad
wcr' taker into consid ration. .om-lLt- studies vere nr-dc of cr-
is-i.: hospitals inclunin, gen..r 1, tuberculosis, mental diseases,
conta' ous oard leprosy, .rivat. hospitals, and public health cen-
ter;:. bXyhaustivc st~ .-s were -ae .: ith rgr.rd to the personnel
av.-ilable, such a. phy icians, n.U-ses, and technici ns in all
fields of d-.Oicine.
ecor-mendcations have i..n .ad.c wi h rne ard to the ,ersonnel needed
to oprate a NJatioral steL c-t' 'spitLls, Recomnmendations for
n.' constrcw-ic ho >e- :- P "C cnn:,rvativ...ly since. e; a:.'ble
10 -
statistics were found scant and inaccurate for the planning of a
ten-year period of hospital expansion. It was recommended that
specific -plans for hospitals should allow for considerable ex-
pansion as the need became evident.
The field survey covered all Darts cf the Republic. The first
trip was made on May 31st, 19S8 to the municipio of A-atitlan.
This trip covered all :municipios in the vicinity which would be
covered in the spher- of influence- f Afatitlan.
From June 3rd to June llth the departamentos of Zacapr, Chiquimu-
la and Izabal were visited.
From June 18th to June 29th the ccwpr.ta-ntcs of QuezaltenangC,
San iMarcos, Totonicapan, MHuhuetenango, and El Quich' were visited.
From July 10th t.. July I4th, the departanentos of Tscuintla, Suchi-
tcpequez, and Retalhuleu were visited.
From July 22nd tc July 26th the deartrentos cf Jalapa, Jutiapa
and Santr- Rosa wcrc visited.
From August 4th to August 10th the acpartamintos of Altc and Baja
Ver".paz anid '1 Frogrrs' wre viited.
Fron Au-ur-t 17th to Au.ust 21st t (c .,rtr.entcs of Sac-tepequez,
Chira-lt n'.n0o, and Scl-'1 wer,- visited.
A special trip was .de to San Ju.n Srcatc-.-quez in the der.arta-
monto de Guate:r- to1 stuFy the Colonia Infntil. anc surrounding
nunicipios, on October 4th'.
The Ficld :urveCy .-a" -.de cdnr'n'; : rainy season which r:adc travel
morcr difficult,' but resulted in a better unidcrtancing of the
transportation difficulties of t. country. total dist--ncc of
approinat,_ly 1COOC hrs. uas tr-velled.
The firm of Nof rard "- Crai; w:as k1._pt 'i'c.-. infr1-,d f every
s-agce of the fi eld s-rv. Consul.tio wer held ir e7w York
City and in .,tl;-.ntic Ci iy in SeCtumber of 19Q8, with officials of
. .- r ...".:. Cr'i; ,. .cil. co-'isson of th.- Institute and Dr.
Roolbc. In ove' ber, 1 LC8, Dr. CraiG "rd ,r. -strm.ann, Architect,
visited Guate;-.al for i -ortar'- conf;.. roncs with C-".te- alan author-
iti-.s. Thy also r1a. a. tour cf innp-cticn which covered the de-
parteanntos of Grt.rtal, Scat&-equez, Chiralt.na.ngo, Solola, To-
tonican :a, :e!- a ct 'ulou, S!u chitecc:u: ...Ld "-scvrintla.
This trip wa.- of the rtet i-prtce to the visitors since it
gave then fi-ust-hand krhowled. c of hcsEital conditions and hospital
con: truction_) boi, in ti. hi:hlancd ccact'l areas of atc coun-
try.
The hospit. l pln .. vh r, -ultiL from t.i field survey and.
the reco;r-nclations c-.ra'or .: Crai; is at the tine of this
writir, under *"arefrl -tucy ly h-opita.l cpverts of the. Institute
and th,- "inis-i ric.
- 11 -
POPULATION FACTORS IP GUATEMALA
The main population factors in statistical form which influence
hosrit-1 -lann i ubitt in th field studies of the hos-
pital regions cf the co-,untry. Th.se include the following:
1. Total -opulation for the years 1893, 1921, 1940 and 1946
with the average annual rate of change.
2. Density of population by dearta.-entos.
3. Population by sexes.
4. Conposition of population.
5. Births ani birth rates for past five years.
6. Deaths and death rates fnr "c' past five years.
7. Infant a.nd child nor tality numbers and rates.
These statistical studies arc -better submitted for each hospital
rei,;ion, so that they nay be rca'.ily available in the evaluation
of present hospital facilities and be used in the estimation of
the hospital facilities neiudo... General conclusions based on
figures for the entire country would be misleading since consider-
able variations exist in the differentt regions of the country.
This chapter deals with general considerations of the country as
a whole rather than with specific considerations of individual
hospital regions.
Statistics show that there has been a steady increase in total
population from 1893 to 1946. The population of the country in
1893 wa,: 1,364,678. In 1946 it was 3,604,083 (estimated). This
increase is found in all departar.entos.
There is .r almost cou-l distribution of males and females. The
census of 1940 reveals that there were 1,660,048 males and
1,623,161 fem-ales. Variations in the hospital re-ions are shown
in the resrective field studies.
_in important consideration in the incidence of illness and the hos
'ital facilities ne.Oce is tihe ag. composition of the population:
POPULATION 1TY LT .:'D SEX
0S Y S N U M E R P E R C E N T A G E
Total Male Fe:1ale Total Male Female
1Al LgEs 3,283,209 1, o0.48 1, 161 100.00% 577 a.l
Under 1 year 105,076 53,070 52,006 3.2 1.6 1.6
1-4 408,852 207,424 201 428 12.5 6.3 6.1
5-9 486,179 249,612 236,567 14.8 7.6 7.2
10-14 430,900 227,028 20c3,879 13.1 6.9 6.2
15-19 342,451 168,402 174 049 10.4 5.1 5.3
20-24 276 941 142,411 134,530 8.4 4.3 4.1
25-29 246 ,484 119,572 126,912 7.5 3.6 3.9
30-34 205 ,62 101,927 104,035 6.3 3.1 3.2
-39 189,276 94,343 94,333 5.8 2.9 2.9
0-44 1569710 79,391 .77,319 4.8 2.4 .2.4
- 12 -
.GES :Y YEARS
+5-' `9
50-54
60-64
65-69
70-74
!75-79
8c-b4
85 an. over
lUnknown ageo
N U M B E R
Total Mal
122, 956
89,05%
66,271
67,493
35,105
19,992
11,320
11,042
3,190
63,0I:-5
4 ,0C 72
133,335
33, 961
9,262
5,1 30
5,?12
3,580S
1,h-81
59,511
!-59,786
32,936
33,532
16,515
10,730
5,890
6,530
45,364
1,709
F E R C E N T A G E1
Total .Male Fcmal
3.7
2.7
2.0
2.1
1.1
0.6
0.3
0.3
0.2
1.9
1.3
1,0
1.0
0.6
0.3
0.2
0.1
0.1
1.8
1.4
1.0
1.0
0.5
0.3
0.2
0.2
0.1
It is significant that a r Iati-vly hi:h percentage of the population
is fcund in the young er "rou'. The life expectancy in Guatemala
is considerably lower than in th. -nited St-ates. As a result, hospital
fa-cilities fcr the chronic sicl 'u ncot.-olic -.nd ceencrativc I.is-
ceass past 45 years of a. -r not n ,'cc. tr the sar'c extent as in the
United States. In the 1.-,r cr.mr-try, 26.7% co the population in 1940
was over 45 years of go. s is eiu e.:&ectcd to reach 31.4) in
196C. On the ther han Ir. at: in 1910, :.nly 131 of the pcpulat-
ion was cv.r 4b years of -
Eirth an.."_ 1o-th ratc ".ust bt t1;' int, consideration in 'ctCrnining
the hospital necds of th' c .! : uni Studies :f th.se factors are sub
nitte9 in thi field stu'y r... ::r. In -.aiticn in the section "Bed-
Death 2-tio in e-ti:"tiorn f si" :- hospitalst,, birth hn death
st _,tistic., for the ast ,.: rs ,. -resnted for each epo.-rtanento.
.r i.rortar.t f-ct.r is t. r-.lativ._1- hi- infant anf childhood :-ortal-
ity rates. The average in- i. nrtality rate f-r the country for the
year 1939-1941 was 107.7. Th. average childhood mortality rate for
the --o e n riod w. 45.3.
The cconc'.i c ocrosi jon .
irrcprtance. Based on thIe
in' firlures
thi. "-ulation is factor cf the -'reatest
r,"nerr-" co. nsus of 1940 there are the follow-
In -griculturoj :.n C. -'t
In other "ctiit.i.s '
o iJviti s.
750,oco
190,000
940,00C
Th,se fi-ures sh-w that pp-rc-.in':1 o of the population is en aed
in agricultural ,ctivitio. .hus, tel l-. has a 'r :Kocinrantly agri-
culthur1 docnomy .:r'. this fact. is rf i.- greatest inport-nce in hos-
1 it planning for the country.
The racial ccnosition of
rcijon, but this subj.-.ct 1
last census of 1940, the p
h" popul .tion is ccnsidcrre in ech hospital
I:rts lurLther discussion. According to the
population of Guatonmla consisted of tl.. fol-
13 -
lowing:
Ladinos (Blancos y ,westizos) 1,457,122 4-4.33%
Indigenas 1,820,872 5~.46%
Others 53250 O.16/
Total;: 3,283,209 100.007
As Larahona and Dittel have very well shown, the reported figure
for ind.genas is undoubtedly lower than the true figure. They
point out that accordiJng to the census of 1921 there were 64.08%
indfgenas. There is no reason to believe that there has been so
significant a drop in the number of indigenas. Thus, in Guatema
la we have a population which consists of a majority of indigenas
or Indians. In addition, a large percentage of mestizos are
intermediate in custom s and culture between European or Spanish
culture on the one hand, and Indian cultures on the other hand.
Probably the reason for the confusion with regard to the number
of indlgenas in the col'ntry is due to the fact that there are no
definite criteria 'for ,:istinguishing between the indiogena and the
ladino. Until basic criteria arm established variable figures
will be obtained. Another factor which confuses une picture is
that there is no single Indian- culture; rather there are many
Indian cultures.
Lie. Goubaud Carrerp hrs 3rointed out the basic differences of the
various Indian culture, in the country. He mentions the following:
1) Lan uage.
2) Dress.
3) F coaomic.
4) Social organization.
-5) Religious organization.
6) C-omatic differences.
The differences in lanEuage, as an example, will serve to show
very plainly that the "ndian population of the country is extreme-
ly hetorocenous. This is a factor of considerable importance in
the public health educ--ation of the people, which is so essential
for the success and ucomplote utilization of the facilities of the
hospital Lystem. The able below shows the diversity of Indian
languages .spoken in Cu-temala.
7 '- T0 0
GW i temala
34. ;tcpequez
Cl'i 1tenango
El .greso
3sol-: i
E:L. ich6
TQo t-:'.c-r'an
QUt, c1tenan-
go
Sap arcos
Sa,.ta Tosa
ES--uintla
Stichitcpaquez
R talhuleu
Alta Vora-:az
C ak
-uiche chicu.l
0.41
0.3
2,2
0.4
45.2
6 .0
9 .0
30.1
0. 7
1.7
0.5
2.1
0.0
1.3;
50.4
80.8
O. c
35.7
1.2
1.8
0.1
7.9
12 .o
9.2
0.2
?zu Lsua r
.1211 tcca-
-
3-..
7 e-r
DEFA 2T/i.TOS
Guate ma la I
Sacat;cicquez
Chim1 alt c nn-go
El rror'- soo
Sol ol1
El Cich: ,
Toton ic j, n
Qu, It tonn a o
Huchuc to r o
Salr 'alrcoF
SeP ,a t'.io;a
Sty .;.tcpeoiuc,
Ret ] mul.'u
Ala V or p
'0 U F F 0 i ,,a :
('kl hc1i 7oco ...hi ....C .1 2 .
0 .1;
1.
0.2
0.1
-
-
-
-
-) 2
0.1
0. .
i O*
-. --- -- . ,T
.7L 1-
Chinl,] i oii ,u tr.o
El : t'o.r;: ;'o o
olol1 .......
El Quiche ....
..L.. .Ja I I a j
Kean c...... n al
)~
33.4
1.C
1.1
iC.
"ther Infis 'ilict~s
C.2,
o.1
0.1
0.4
:".6
S-
0.1
~?'*~ ~1
C' ,~
~ .6
4.-i
Shuf Iili
- 2 -
lr-CnT-AGlE OF POPULATION WITH
INDIAN LANGUAGES
Totonica iLn ................. ............
Quezaltcnango ...........................
Huehuetenango ...........................
San Marcos ..............................
Santa Rosa ......... .....................
Escuintla ...............................
Suchitep. quez ......... ..... .....0 ...
Retalhulcu .................... ........ 0
Alta Verapaz .................. .......
96.1 %
66.7
72.5
62.0
0.6
12.6
63.2
47.0
93.7
According to the census of 1940 there are the following figures
on languages spoken in Guatemala:
People who speak Spanish ....... 1,777,814 ...... 54.15%
People who speak Inrian ........ 1,49,745 ...... 45.656
People who speak European ...... 6,650 ...... 0.20%
TOTAL ........ .................. 3,283,209 ...... 100.00%
It is apparent that the problem of public health education is
ctn- .:l'rably complicated by the hetcrorgoncity of the people of Guatemala.
Edl-- ional measures must bc devised to conform with the customs and lan-
gt': of the different sections of the country.
It has been mentioned that the economy of the country is prodo-
Lnantly agricultural. The table b -low is submi-tcd to show the divi-
lon of the population into urban ancd rural groups.
'T r
Acpartmients Total PFqopul-tio UrPn rba ura1 Population
Guat emla ....... 319,197
l1 Progreso ..... 65,302
S-- -. .-pquez .... 83,024
]L. i:-itonango ... 177,123
|scuintl. ....... 176,280
Sta Rosa.. ...... 169,774
,.0Jo1a .......... 86,625
Totonical dn ..... 92,292
iuczaltcnango ... 233,655
S-uchitepquo: ... 182 162
t-.lhuleu ...... 69,974
I-n :'arcos ...... 204,208
uchuetenango ... 176,480
0ich,0 .......... 158 662
*ja Verapaz .... 96,182
Lta Vrapaz .... 282,562
1 Pet6n ........ 11,475
zabal .......... 83,153
acapa .......... 145,797
hiquimula ...... 144,011
alapa .......... 124,855
utiapa .......... 200,016
OTALS ......... 3,283,209
190,034
17,340
5 ,05O
67 064
20, 747
37 r76
27,5o6
75',671
16, 675
23,945
30,34+9
22,362
15,797
25, 251
6,251
25,467
32,105
22,307
31,278
38,914
854,435
109,606
47,732
22,857
109,331
154,448
131,485
58,896
75,960
156,553
136,809
52,731
179,396
145,665
135,946
80,133
256,710
5,o61
56,855
113,289
121,278
93,320
160,978
2,405,039
16 -
Note. The previous Table is taken from the 1940 National Census.
The group known as "special population" was not considered.
The figures for urban population are higher than the actual si-
tuation warrants. Urban population as given in the table above include
the populations of the cabeceras of all the municipios of the country.
However, the majority of these cabeccras arc not urban in the modern con-
cept of the work as relates to the nunber of inhabitants, their economic
status and the degra:c of industrialization. These figures, therefore,
cannot be accepted as a det.ernining factor in hospital planning fcr the
country. After a careful study cf this situation, it was decided that
YIore accurate estioations of the hospital beds needed would be obtained
if only the cabeceras in i;hich arc located hospital units are considered
urban.
In conclusion, population factors in Guatenala which will influen-
2e hospital planning are as follows;
1) The steady rtte of ex-ansion of total population.
2) Relative quality in numbers of males and females.
3) Relatively high percentage of population in younger age
groups.
4) High infant and childhood mortality rates.
F) Heterogeneity of population with majority of"indigenas" who
in turn are heterogeneous with regard to language, customs,
religion, dress, social and economic life.
6) Predominantly agricultural -nd rural character cf the country.
17 -
J : ,. '. .'._ "- ,"Ji A
3ir.r-. th( ;en-ral i's 5 r s tht all-i ;ortant unit in an
intr ratedc hospital s. 1t it is e .s. tial t':, t its ro ] bN
vwel undrcstcod, 'Thir 1ve beer irru.1 :.ab books and ar-
ticl-s on tnc history c" t- vel.: .-":t of th-, general hos-
pital. This chapter will conf:in.e ic I to discussion of
the' f'unctiors of the( r.e2rae hospit -. an. recent trens which
have r-.sulted in a r-. d or0, i ne-'t.-nt role for t;i .-neral
hospital. The fur.cticr- o'" .tli g-er i bhspital are
1) Co.'r,. of th. -ic ,.
2) Educ-.-tiec.
3) R.sor.,ch .
l CATR: OF T- SITCL. There hs b.en :- definite ch-rnge with
r -rd -to tjhi -;rctio-. of t-.e r.nral hospital. 1ithir rc-
lativly f-.J years, th, : r.t of this f"urtion cas greatly
epa.ded, and : a r.' 't co.pita. systems ,t undergoing
co r i crabi ch:r.:',. Oriy rr hort period, ros-'ibly tvcnty
.aCrs ago, the .:. :r .-- ita s-rvc fcr .:h tr atrent
of n.r Tr dis3. s3e oa. Cas.s f_ contagious diseases,
tub.rcosi:, .nt1 t i sol--. cases venereal
diseases .r... ..ot ': i ..c:o SI-n .- Lr that tii:L thir,- wvas
Ss-carcity of ho-.it -i :ilitis f' the L-.tt.r typ.,s of
ca? sS patient." .. r recourse e. 7:ce 't to recover or die in
their os 3 Ithout th :r proved chance of 21:covcry by cans
of hc.pita .-2t:a .. l:1. c. f t,. non-:-driosicn of conta-
::< 1s:- '---'f.i u t ....
:.ous c oth r -if.i t t'ypet o"a ce..:es, irn ,-any countries
there develop "ch.-i of p.cil. hosTpitals, based on cli-
nical service., Thu', special hospitTals v:ur built for cye,
ar, nose r throat cases, a. ';t;s of vor., orthopedic
casos, car r, obstc'tri o h., chrenicc cases rid convalescent
cases. In < addition, rr industrial concrrs built hospitals
for industrial .-.cr-iclnts nd t:'.atret of thi ir er*,lovYcs.
r aditior, to th: 'ospitci-,- just :ntione.c other hospitals
w, re built .,'or tuberculosis, r rvous nd rental discU.ses, pe-
diatric ca':s, co-.-uLnic- bl: 'i as and vcn..rcl disease.
Thirtn sp. cial b it -s v c.bee-. rtionred .l of which h
1.r bu.it or th. c:r- of :-lS3 -ith ci. 1 conditions.
Thb.e functions of aractic l.y A:1 these s -clca hospitals ry
be SeCved in the ..-r lat ,r .CnrIl hospital. Soe se-
c'. hospitals a. nec ..-.ryo It is dSsir-ble to have sepErate
f: cilti cs fo-: th tu L rculous -nc for cases -with nervous and
renta:-' dise'rs(.:. Hou..ever, venr in the.- ty-os of case the
.r-.l r hospi.a subs.U-... iirport-at function; with pro-
.r facilities in the .'.r hospit- .ny of these cases
ay b trca-ted sa-tisfac::r-rily. Froqu, .rtly cases of tube.rcu-
losis rust be 'et i'- ... -cencral hos it~1 until space is avail-
:hbl. in :tub-re- es .a 'pital or .r- toriur. Short-term
n "rvou- and -::.tal c,,-e nr -r,..rtain conditions are better
tru.t d, fro- the psyco'-cl ocal effect or the patient, in the
genera f hCSit.. ASO f. ciliti.s r.:ust be availablee in the
general hospit ] '. care o ,r.ier ent cases until trans-
f.r can be rd.. to -. intal hospital.
18 -
There is little logic in building: and oipr-tinr special hos-
ritls, witho the e" tion ae above. Spe cial cas- can
rccclv.- bat er treat b, in t ;,..r rl 1-o:ipital where all
vari.tics of cons-ait .tion servi-,-. -nd ecuipnt are .avail-
able. Speci:1 hospitals are rsive to operate in r_,lrtion
to the nu:b r of -atic.its try-ed, b.-cause th. a.verac. daily
census is inv.lii bly cosidcir::.,l lc v.(-r than in the ecncral
hospit-1. ihe io.crn trend ir_ t". hospital field is to avoid
th construction of 'peci-l ,osr.it.lis and in r.any cascs to
aba.-don s-ccial hospit-ls in c-istcnc In the hospital system
of Gua.tc a., spcciCa1 c-,siti-s ill lay no part except for
tuberculous oqiit:.- .L.... hospitas ,for r.rvous nd r rntal d-
s.acss. All other conditions -vi11. be trc.ated in the general
hospital. This decs not si, ify th:-t .ll disc;;scs rust ne-
cc. sarily be under one roof, r on th.. sai:_e \.zcrd. Separation
of cas s
g-nural hos--.ital. This is pr :ticulc.rlv true for corY:-unicable
disease and tubc rculosj :. 'c.vcr, t-csc units ,r -.y be integral
p-rts of the: n rar hoL,;:i. thou-h rl c: d in soparatc wards
or buildirns.
Th,_r-:forc, th. care of t-sic- in :.n r hospital r-ust
contain services for th. -:'u trct ..nt of all A-ti "nts
acdr.ittcd. Th.- g-_ ner-. pitr. not '_ 2t .tic entity but
r-.ust develop in rc'or rcc witi-h n:y .-'iscovcrd tchniques
and -'iscovcraies in t-. I '.ld of i.cdicinc~ The >tncra hos-
nital is the hub of t'. inte" e hos-ital systo. and is a
rt of th. -ro r-m c o ecordin..tion -ith tuberculosis hospitals
and nervous nir cnt J. isc-._. hospitals. The general hospital
a-so play; its at i: :h.. :1'icl' of prev- tive disease. Fro-
v.ntiv, r I dicinc uhich -] so )be designated. -s public health
c.*cilit:ies occ; oC. c the --uc-tiors of the gecrra1 hospital.
This ph.e of -, : cir :, ].inical d c .rt:.-nt cf th,: go-
na..ra oIp-it .1 sil j_1 -. to he p:rtcnts of .-ecdicine, surgery,
ob ;tutrics, e.di. strict. .tc.
It is fcrtuna.t- th-t t o ,:-od rn conc-t of the -encral hospital
can fit into local cod.tiors -i:- G-ct..al With the possible
-xceptior of GuatcLE.7a l_ City, it would be unicono'iical ,nd
unfeasible to bu:-ld Tor, than ,..-. hospital in a cornunity be-
cause of the l].c1 .f su-mfic .: ur-:b of spe.ci l cases and
th. ]- 1 of sp -ci Ii-,:tio'n.
II. EDUCATIC_. An- i.: rt.:n functiion c t-he general hospital
is thic dueation of -,ofessiona1 -nc n n-professioncl staffs.
Internus, r.si;.'ents, rd :e..dic-i sturnts -re trained for th-
fut.:re practice of priv -t:. r ir i e. Graduate nurses student
nurses, atteL. ants o.d rcti.c: urs,_es ust receive their
practical tr I-in.: iC the bcspi:1 i.I accocr .nce with well
rc-gul-te.d progroJis. crpi-al ad inistrators also obtain their
practical training ._.:c rir.:c in the hospital.- The train-
in:- of r-odical students, i' i,-h.arccd by affiliation between
large hospitals ard th' .dial school. T-is -a.rtnership is
of inesti-: b v., v. 'e- t both. The radical school is given the
r::.ans of ninOvidin- th. clinical training as needed by its students.
19 -
The hospital. irs by th services of th: students and also
by lccvrtion of it.. et L, words as -. tochin institution.
Tho clinica- confrronc, r hd in th.- hos it.i -.rCe n ir crt-
-nt fe.aturc in th. odro-.tion of ti- str.ff :orbrs, internes,
residents stuntsts rild outsid,.. hyt/icia ns. At regular in-
tervIls, C_ rdicral .uit i rY -_ by co-ch deq,-rtr-ent rf the
hospitl-.. 3.rvices 7.C i.i'rov.. C.i t. r"ticr.ts bon-it.
The. !rrgc hospital should .I.n0,:"'n continuing- rprograr of
education of doctors in -riv-''.t r..ctice b. r-r.ns of r-fresher
courses in collaboratic;- with th-. r-- dic-1 school. Th- duca.tion-
al7 function of the bl-it.l l"- its r"'t in t-- o,;--.ticn of
nr:;i,- schools, r ctic-.1 n.:., training courses, training of
t,.chnicn! rscnnel r1nd in s orvicL-tr inin' -rc.r.;..
FiF,'.:"F!'TT Th. grcnp rlc hos-it.1 -7. cvid, the livir .nteri.l
for rosc rcli in 11 f i.:-s o) rcdicin... It is st'ffcd by
the physicians- ho crr. e rry on s )uch r .rch. ow -thc
of tr.-.tr.rt, n. tl .icr .'.r .. drugs boccr,_ -ecepttd cr Orc
discard-d on t. rcmsul .s o u i study in the hospital.
In f'inithir, this dis c s'icr f.w wi.ords r$C 3-c -. i d-i Ls.. s5s
and other -" -cts cf ; .; r' h-sp'3.it-l c ,c -rT .:,.;rc,rio-to:
cr uS' . sts C ._l O..
1) Co: unic bl. i culd bc tr ..td in ciocial u-rds
cr in s '-tr .-t., r .
2) P- ti.j ti v' t'-; rl, or; r. tubcrcula)is should b,. d--itt d
r.t of i-c ati r r.c- ti-s, ri-- -- t r t chnirl, s
in order to .rot. ct Tr7, o c c thr tiJ...nts firstt
infection.
3) Adr.iscion of n..rvo.e -nd. r.rt-l d -s cases for di0 -
nosi. ;nd ['C tb.- t ;.] rt of ths uti.n s 7wh c r,.
not in rccd of lon-t. i stituti ont t .-r.
4) FL.ntr 1 hyi. n, clinics 'ould c :'tblisd ui : 5c'u.. t
a ti.rt dc,'.rti crt I ;- n rso nn. is v-.il ".b .
5') Int
P-ils -.n n. rv cu; d 'i-- ,is n h ',sitnls fcr X-
ch nj;. of consult, t ionr acrvie.s.
6) Chronic ,rs.o.. .c-o tr --d in the :-.:n rl c-C -it-1.
W.r: n ', "::s-.ry. 3 t : .. rds or buil'di: -s s-tculd bc .- c
.v ilr for h,. s.
7) T..1, shculc. b -. l.is for co-r.v' sco.t p.it'nts. Gc-
n,.r. hcrac:]i :.t .o-snt carry on thin sLrvice on the
r .gula.r hosri :-' 1... E:,.vet r, ir !.-r c hcspit-ls, s-o-
2i.l units or s' : -. F'vJ:.ions tr- ....osir.bl' in crder to
p.' rboor: for 0ct.t S, s.
20 -
8) The out-pti t deparrt:.'t sbhuld bca -'rt of very
neralc hospital. This dca: tr.nt serves the following
purposes"
c) c.r of' transient illnesses.
b) discovery of dis-ase i- incipient states.
c) voiu.s, unn_, ckess ry h spi.ta, !ization.
d) rovidecs fcllow-up c.ro :-fter patient's discharge.
e) c:-re( of chronic disc'.se c."scs not reouiring hos-
'it1 iz-.ticn.
f) rvisists Cf :ti nt. for physicians to evaluate
treratnc nt,
g) public h.,rtLh activities.
9) Rch..bilit".tion pro-, ";' s sh]. be c'.rriLd cut in p.-rt in
the ,;cneura hospitcl. i irl-y t'-is vill incl.uddc ndical social
service, occup...ticn.l th,..r,y -.n ysic thera_.p y. The value
of the rch-.bilitatiorn cntcr for rest-'in the r.tient to :
fuller r.casure of hyscl a.no. rer3t:'l h ltb will b, discussed
ulsowherc in the rcrort.
10) HI-.r.th oduLcation should consist of continuing progranss hor
pati nts c:r. pub 3uch rrs .rc .cific in th-t they
.rec dir ct.,i. -.t t'.' p .ti .rt, his r: ] tivs ". friends .nd
visitors. The pro[ra,~ : 1r, .:- in th t they reach the
general public. Printed. teri'.l s1ho'.d b- saupplec.nted by
de: onstr0tions -r. 3 -cii 'rr.up r.etir C or clc.sscs, or-
ticila-cly for :.,-buln -ti. :, The IT-ticr.l os ital Systec
should estchbish a tral -.cy throu h which basic r-.terial
for hebaltbh ducrtirn ",oulcld be upli. d to hos' it'als for a con-
tinous y ar-rou,. ro.;ri
11) Phyr-ic. C.aij.n tior.s :-nc h. _1\th rc-otion Trogrc.r:s should
be provided for hbpiCa, 3' rsonn. as wil c-.s foe: the. general
public.o
19) In "ub lic -. t-- ativiti. t.re 3l-'d be r.c irto-r:ted
rograr tr icr.(' 1b7:--tory services, tub r-, lsio control
rgrar v r c ie.: control r''': 'l aterr 1 nd child
h 'th, ,r.r .. -,t. t _' p- *r ccrrricable diseases,
arc santr'-tic: .
13) The scrrl hcspit-r sou-ld i'r cov de co icit cooe(rativc
srvice propr, to corIri c n risc ,a .th edctior r..vci-tivc i o-
icine, visLtiy'- nurse -Lrvice' :r-bi it -ti'-, proper records
-rd ro.rbiditp- :.orrtirtU
10-.E.L71.2L -..q> .I.zz C
C A/
In detcrr i t -, th s- -
corru it .'-. rcr 2. .---
icipat t - -
Acr C IC c o i
it- 1;-" cJI7!.'- -. i-! -- . .: --= -- . ..-
- tor L o c_ - ,-_
i -i2.--i -t ,
It t7" o" c7 nc ..... --
c l hp iT .ltt. t 7.2 .
of th- rt'. as. for r- - - --
0_- -r g to ,- "- - - - -
v cr issil i -t.. -- -
F a i r l E i ,-" .'__ "' 7 ... . .. . . . . .
A fcr;'ul.-. t'; .rri .
sT --are :root -ofl t v-: T
~iCj -^ urc. u.x 3 f t ., 7- v, .
. ]o"-'it.-' is ',-" r -o.A :
cristructic '... r
C.n irta S, t' 2
,.E3C, ir ]? -7ogw- -q : ->
Thi- r. :":- r -
7I FUl l' --cr '" . .. . '
.. . .. : --" -"
. I. I .- .
in L \ n
. --1. .- 7
1it: iF t : : .h .9 1 Ai : "
t".I ,. l. Lr_, \,t ." ,I e. ... ..-'. U .. ,
- -,
~7 3- -
kF -
- - - i-
- .~-F* -
p -- '----
A- -
3
,le.th' of stay, ,;y be ,:.r ., co po ti.).cl with :ood o'edical
care, by efficient adrinist-. tior, ~.f.rr:- to the cut-patiernt
departrcnt as soon the tient;i'j concirtion p- .its, and bI- the
institutions of P. visitir-- nur. service.
Kcdical discoveries ,.nd i,-rovr.:rt :,:. help ir decreasir:: the
need for bed care and tc rth os ity cf the -f --ticrt in thc
hospital. Statistic. revea-l that recently iscOvered drugs : ave
considerably shortened th.i poriJ ,(- hos-it.lizatior in certain
conditions. cv.: thoughts in h. -:t,.r-c-.r. f surP;ichal cas
have also tcrded to rT' ,uc.C thi rioo of hc'hsitealization. The
sar. e situation is true in obstetrical cas's. Only a few y,..e.rs
0ao, the arvcr.oe ;tay of the ncr' -. at.rnity ca-se in the -rini-
ciial hospitals cf 1ev Ycrk Cit;- vas ten days. In rest of these
hosp1itl.s t- .vt rae. ,has been r duced to five days. It
is thus seen that the nrcd for hospitLlization has undergone
drastic revisions in line with thi, attituCdes and th..i acco.-rlish-
u.nts cf th: radial pr, r .sian.
In (.sti- .ati the nui!-.'r of beds nc.dcd in a hospital., surveys
Jin various rrrt- of' tc e "-.ad 3-tc"- h:-.ve found tha the ruber
births r.-. .aths i '-h. cr o.r.ity r.ay bt used. This is the
b,--s, o-f th fa'lous t icbh..i -n Survey which is now bci.ng applied
v|idely. The .tti-tics or .,,.rths revcl- thi_ need for obstetric-
b beds. The nu- br -" .cata. inric tes the rcunt of hcs-ital
-.re need. The dc-.t :cate i-. c r Ccellnt factor for :casur-
i, the v ri:-tions -n :i-,-.ss due tr health conditions and
,to ,;-: distribute on. In hospi.! "vcys bh-sed ron the birth
t factor ',.ti 'tic "'av. shon blat 250 days of GCneral hos-
pital c::e a:r needed fo ,.c -' oth whichh occurs ir the hospital.
This has been four true ,n u c, it, ls in : all parts of the United
States vith v.ryin:- bJirt' -.,d ._th ra. .. This -ay be express-
ed as occupied, beds p.- --th, .-r ti .rcunts tc C.'. bed- per
.ch hospital r.- ath. loar-; fi.:.u:. lso 'es into cn-sider-tion
the nur-_br of births vibich t.e pl: cc in the hospit 1-lo The for-
rula is callGd the b -d1 t r tic. Th. use of th, bed-death
ratio is b.sd o the actual n cd for b.ds asrd is arrived at
fro c. rful tu'. ~i: sL -ft itics r te th.. on population.
It would sce tih- t t. h. b.,-:th ::.tic uld provide a scientific
for..i1 for eterr ini th: bcd n:e -s GuateL a. Unfortunately,
a study of tc vit:. it!' stics and '*, -it.'.1 stati tics in Guate-
r::1a sho v clearly th1t .2 i. i ,oss.i .' to use this forr ula. The
Sfor'la iJ of value ci.l irn coi:- riti- h-rc hos-ital facilities
.re ar widely usCed thi in Gu -te. f .' Pcr exanrple, in the Ii-
chi..-::, Survey it ias ant:.%:ipted t.".t 0 of all deaths in the
corrunit-y wculd ta! : 'c i th;. hopi ;-. nd that 100% of births
,ould KU ; place I. th. osrit 1. Unfoi-tunately, this is not
true in Guat' rala whic c--n 1e re' i- s.. n fror th. statistics
given below:
I .. 1, 'Ci-. r, -:0 !'T ":" .. .i L'
1 .-4_5194 o _i47 c,61- -_,,-,;_ j 1946 1 96,
G;-. -- 14,964- 15,41 16,567 17,052 18,877 44.27 44L:.9 47.1-4 47.46 C5.41
El Pr c:,rso 2,3540 ,302 2,436 2,4?5 7,499 36.58 32.85 34.13 34.00 3L.34
-z 2, 9 2,49 2,37 2 ,41 2,745 30. OS 29.12 29.68 28.36 30.82
h. :1 n o 473 5,272 5,380 5,628 .6,081 29.r,2 28c4F 28.69 29.62 31.26
Lsciuintl.-. 3,9 1 4,292 4',736 4,878 5,816 22.19 23.71 25'.9 26.47 30.95
Snnta Ros.7 'i- 635 i,772 4,984 4 ,75 5,418 26.19 26.60 27.37 2'.72 28.55
Solol6 3,823 8 3,59 3,703 3,639 4,19F -2.43 39.30 39.82 38.60 43.30
Totcnicr- 4,649 4,271 -,192 4,638 5,2 4 .3? 43.64- 42.02 45.79 5C.07
i ,74 7,219 7 1 7,9 8462 32. ...37 264 32. 80 3 3.99
,95 r,95 5,. ,75 2 1 25.4,- 3
:.--.:.',l 2,022 2,49 2,678 2,7-2 2,89: 35.9 5 34.74 36.10 36.49 37.77
S 8,05 9,17 ,13 10,36 1. 37.07 .2 4.2 4
uh, .0o '1,'6 9 024 9,878 10,2'- L,?95 47.78 46.08 4 9.11 4.52 9.16
.; i; :-' i,7 8,481 8,74 8,771 9,4C '?,. ^. ) .,8 K-7,39 50.0o4
S73 2876 43 3,2 71 8.86 3.94 31.21
Al v',z 7,90 7,248 7,791 ,o68 9,327 26.39 2 .14 27.05 27.90 31.43
ri 5P8 481 -c6 34- 680 3.14 40.70 42.1. 3-.63 .3.84
TI.1: 1,)-25 1,4'.;4 1,656 1,679 2 ,13 16.90 17.08 19.64 19.30 29.41
Z 2,8 ,2 3,32 209 3490 19.8 0 18.88 21. 59 20.7 21.97
C-i. i .. i ,63 4,806 5,036 :-666 5,929 30.59 31.03 31.86 28.94 35.62
Jlp --. 3,182 3,237 3,725 3,303 3,729 24.32 24.39 25.36 24.C4 26.48
J, ti.pra ,214 5,559 6,557 ,358 6,846 24.95 26.23 30.38 2.8.7 30.22
Tcttls: 112,027 111,319 118,712 1209727 133,831
24.
F-"A2 ,, ,
U T.. '7-I TO TO'' ] i: --'iTnT i:i I. -. .IRT ,S i .- C
o -T--- -- --- -I 1
iy ,c-lp:! ,877 3, 309 2,-18
o_ ,oc
aco c'cuz 71:-5 183 6.67
hi - n* ~ ---- ---
Ssc ntIi-,' ', l6 152 2.61
:-(in. o.on p158 -.--..
.(-,r ,_ 0 4-] 5....
< t.nic:-p,-2 ? 29 17 .32
A.,.. nr ni-) 3 62 175' 2.07
uitu o bi 108 1.91
_'-." ul cuo9 69 2.38
;-. .-os J 22 .21
., .in nango 1,' ', 50 .47
'1 O-ijch6 9 ,48. 21 .22
1 t 7
11.,- v.r_ -.' 9,3 7 120 1.28
..1 tn "(0 2 .29
I;' -1 9 31 *3.50
,n '.9 96 2.75
Ch -i;l-. ,9 23 .39
J72 29 .7
-, 8)+6 68 .99
TOTP LS- 13 1 D50+43
Lirth r-t... in oi :. for -. Rlic 3.77 ,"
It will b-. ,-rv,.7 'rt nly 3. 77 11 j irths cc r in ri
hospit ct.s of the cout- T. fi .:_d blu O ch lover if
it were not for th. ..rt..t of t ... which' shows a
figure of 2C.18. :. .r to, Sec-tie'pq-.cs,
wit.. p:r'.ntr c ",f 6. 7: i :: ih ver._g for the
country,. FrO" d cr"i .r.T "'., ],. '" gruso, ChiDalto-
-nrgo, ". ; ol,,. : t irths i'U hospitals.
3-c -v-r, t,. :. c.-*u ,*.- "". ,' l ., .: ,le oPrti.n 1ntCo ,on-
tinc, no .oi,-. ', c.-n "orro .this figure of 3.770
A:ith :. 'i.r .' f C, isd i. t1ic ati' r n u]rvu.y. It is
,vidc W. thc't L, f-'.ct'" ,: .nnot b,.. 'iced in r hospital
::Ur fo" -C-,, --q
.1). .,
.
7- 7
'-r.- O,. 7";:
T, C'.3 :t.i'.
r, |.
[-, t-. ...
S ... 7: ;- .
c -. 1 ._ -1 ,_
i-7- S:.-" 1^(
E;.-"'- "
7..:r L
9'-
3)9
-* '9-' -L '
,,.' ".* .7' 2 ;'.7_:,'
-:- : ::- i^ o
- ,
*-': .1 r- 2 *--*.
C.93
17/- ,- 'o r
-..
-, 5 23
1 ^2 3 -O c
%,l944
1C95
199.5
1,634+
2,6,-,
2,31-5
1,9-15
- Ci 1-*,
9-'
^^;1
39 /'-
...5. :-2
(.7'
5 '
I- 9,.c -'
9) ')3
..-L' . : 5 .
3,- -''-,. -'J
1J4 19Y^
97?3 9317
97S 1,009
1 '
2. -c ? C -. 5
1,.2 1,?-
911
5f 9'
29260 2,
z--
**. *,- ," 7i -i
-! t : r",
2
. > 2- o 9 .
* "1-; I.t 1 :. -*
l c2 .-}.c
, ',9'
-. :10L'O
-2 -L,12 ,0. 9o
!472 7 m 43
1,0 1.82
1, 2. 72
2, c. 5.co0
2, -'i- 4.37
'7 /
4'9, 51 7.
1 r.'-,7 9.
13..79 2,G6
2.,04 3.19
2,6-! 3. 3
3..7 1: .02 2T:-
1.72 1.64 1i4
6.6 1 .435 17
6 7
-.26 P.6 n. ?7
3. CO
I-7, 27. )6
i 21' 2.3 5.20
2. r1o" I 'o5
3-- 3.19 3.2
1..9 21< 4
: s, 74,052 62 19 9,73 61 ,64 63,538
iL947
13..
4.9-
3.14
4.-12
17 C'
2- 5"
4.i
7. .3
7., 6 -
2.17
3.19
1
DEFAR' R'-NTO
Gu-tcrrm .
El P..ogroso
Sac(i:cpaque-z
Chi- 1-tnanrgo
Escuinti'.
S-ntr. Rosa
To Co unap.i
Such'itur'cq,^::
rc t lhi eu
Sal.n M-arcos
El riich
Alta V.rap
El Pet er
Izabol
ZO C. V
Chiquni mula
J-.lalpa
Jutiapa
:TI I T tTOSPiTAL P'ERCEITTAGE
8,287
1,060c
2 948
3 148
1,993
2,615
2,903
4, 977
3 243
1,336
5,499
4., 851
4,029
2,0 56
3,817
304
19040
1,370
2,004
1 27 S
2,661
1,568
0
172
0
182
0
0
29
201
172
108
L4
44
19
31
57
11
34
128
54
12
19
18.92
0
10.68
0
5.78
0
0
.998
4.03
5.30
5.88
0.80
0.90
0.47
1.50
1.49
3.61
3.26
9.28
2.69
0.93
0.* 71
63,538 2,8U5
Dg^'i ;{L;' i 7"- l n7 i g lgLR" [^ Z
Tot als :
IIDICES CF 1OBTWLITY BY DEPIA~TLiENTCS
DErhLTL1YENTOS 114 1244 1Q+ 191+6 197
Gu tenrmla 2 .6 8 25.C7 25.28 22.8? 22.14
El Fro;roso 19.42 15.49 13.-7 13.72 14.14
-c-tecoqucz 23.71 1. .', -17.82 17.58 1 .C7
Chirmltor-n. 20.15 1_ .0 13.77 25.3 1: 15
Escuinti_ 17. ,. 1- .65 17.85 1-.67 1-75
Sa nt,. I-s 14.8 10.59 9.97 9.84 1C.50
.3c!S 28.5b 21.01 24.13 3C.20 27.24
m ot-,ni c.pn 30. C1 27.26 24.02 31.42 27.82
quu alter --c 27.c 2-( .2 18.47 18.67 1 .99
Suchitapuquoz 20.40 17.92 18.54 17.21 16.28
RTt-.Yhulcu 28.' 23.72 23.72 21.69 23.92
San M-rcos 27.22 24.08 .7.81 22.39 23.60
Hu..huctor,-non 27.78 21.23 18.48 21.48 22.51
El uich7 27.46 19. 74 17.22 21.91 20.89
B-j Vcrr.,.-z 20.13 16.06 13.96 13.50 1 .71
Alt: Vi rn 23.6u 22.97 1 .78 14.06 12.86
3rtn 31.39 39.,C 35.59 23,58 24.08
I.'-'- 13.33 1.38 "13.27 10.7 11.43
Zac.p" 10.(8 .'.12 8.74 10.30 8.68
Chiduinulr. 15.3 14.92 11.94 12.61 12.C4
Jl"p. 11.64 9,.30 9.44 9.1C 9.07
Juti:L'. 13. 2 1C.[5" 9.76 9.26 11.75
SIn.x frr country: 21.1 18.83 1-7.37 17.41 17.29
28.
The oyv'_ .t-ti-ti: sh.., th t only 4.5' of r.11 deaths .in 1947
occurred in hospit '.. The D -:rti:ento of GuatcEralr. hrs the
highest crcecnt, _e with 15.>2$. Five other deprrtr.entos, n1-
r.ly S .c'..t quez. Escui.a tl, uchitTpccquez, iet'lhuleu .nd
Z--c.:. "re r.' ovw the v r:e.. 111 othb.r .---rtor:ntos Irc be-
low th wthh :. u rep-t.d iin 1 rrc :reso, Chir:.1tcnin-
o, ont. rto_ .nd 3 1o1. Aj .in it u:t b7c mentioned th-t
und'u'tcdly so'.. .ths f iJbit:.nts of these four deplarta-
rnt-s ccurr-..' ir hcs-'itr c..i-, their limits. The conr"-
riscn cf th, fi,-:ure uc- 4. for 4ut3:-lr. with 5C0 of antici-
".tec'. '-ths in th I chi;:. 3i.rvcy shows that the dc-th factor
r-nnct b. usc i: the hospit.- '.urvcy for ,Gu.teretla.
It v -.s .-,c 's-ry, thtr' rc, t use ,,,ul!-ticn -s the 1; sis for
, sti1-ting ,,h n'u3: ..r 1 -As -c-cic.. Beccr usc of the ucr usc
f hc spit~i facilitji. .s shov, l. the a".-o statistics,
estiai-t.s ron the nutl' r Pf 's,' nccde vcre r.adc very c(.nserva-
tiv- ly. Cthcr f1-ctt r- w.re r-ls t -ken into consider-ticn. such
:-.s the c'-, I.sitior f tn-< iopul-ti'n, dce,. ic l, v1ls, avail-
i.bi-ity Cf ^rsonncr ;. :-i:bi.col conosi \dr-tionr "nd tr;'.ns-
,,rt,.utin fcilitis. TT.soe factors -vre dotorrinccd hy field
Jtui1s of t1 the dce'rtarentos cf th Repulic.
An itc"r-t.. sit-l t ster iT s. 1-nned -s to providee the
-ct c.iLc"l r;-rvic.. 's i'l t" ".11 lh,"itals, largo o-nd sn5.ll.
THccver. it is 5vius i't 1-.:' c h-it-s -n rffor i-cre
: -.. rvi tv' --_.1.l h1,-s-.it-.ls. The pror lc':e is
.' ir -i.: tL: ::'vic: -v- i-. in th lar .:c hospital to the
s 'll ho spitl. ho:.pit-] re ior is .'o plarnneo th:-t the re-
:ion.-lr hc it-1 sh..l be _1 to shI'rc its extr;-. -ervices i ith
the othor h -;pit-.ls cf t-o ro; i.n dceondent u-ron it. This is
done by rak:in.- o.v-ill.:e to th. r:ll h.-spiit- l nec:sry con-
sultr.tion servi-ces. One ,xr-Tie will. smrvL tr :-how vbnw this
is possible. The region,-1 h.s-,'ital will hvrve on its staff a
R.diolo;ist. The i:edic. _:i;t J s r,- :-i' l. f.r the D --rit-
rent ,f t di'.] y i. th. ri..: r-l hi- _i.- .s .l_ "-s X-Roy work
in the sr:.ler ,erlndjit h. s-it-ls. TI rdicli ist su erviscs
the cLtivitices in a11 the hosT'i 1s. He; interprets X-R:ay films
:'ni sh,-uld ..'.ke 'peric.'iec visits -in turnx to the other hospita-ls
in th-. hcs-ita.1 re :-ion. crt.-in -. ount cf intfrchance of
eqiii nort is -1-o -si T .s .ry L .. -ecnstrratcd by the use
of the c lctroc r-it r- A Co rtr.ble i..chine which caon b.e rouLght
to ..11 hospital s in the. ri-eicr will take care of this I-1'- of
r'dicI service. Ini cs, 5e where inter;-h:ncg of services -rnd
equi] r:nt docs nt sCuit tLi necessities, provision is rc.de for
thc trr-.nsfer of such, c-.'- [rr.:T thi; sr:-l 1 hospital to the larger
hos pit.. u- to th. level of the control hospital. Additional
Ses h.- vc -:c provided in the '.e -. rtarcnt-l regional, and
certr-l hc'spit-ls f".r such transfers.
2?.
August 30, l948
kAIH PEII Ci:- U<. L .LY2].G TI7 CLPFITAL
It was recognized by all concerned ir t'-- atioral Hospital Pro.
grar that a :ur; of t-e hospit.- needs of Guaterala would be
dissirilar in nature' to survey- s .a e ir other cou tries or sec-
tions of' uch court-rics. 3t~n rds which have beer widely ac-
cepted ir hi"hly organized cor0-unities would not be applicable'
to Guatemala which -i"s 1 recr:-. tly agricultural. In order to
make a complete survey it was necessary to prepare a work pro-
gram which was based en the fu'rdContal principles underlying
a hospital survey with the necessary modifications to accord
with the specie! problerc.s encountered in Guater.n.la. Since the
recormnt. tions upon the completion of the field wor'.- are based
upon the data obtained in accordance with the wor]: program a
copy of the latter is inscribed?
Y ORT YROGTA1 CF 3UTI V T-E I AT T AL HOSPITAL
P!QOGE.^]
The work prorar,,. of oth Survey for the Fatior al Hospitl Pro-
gram will be directed toward' the fulfillment of the services
stipulated in the contr2 .t. nr oly
I. Survey of hospital F-cilities Recuired in Region.
II. Recorjm'crcd"iors for a Iational Hospital Building
Prograr..
III. Specific Hospital Projects.
IV. Lists of I ovable Enuipmernt :cnd Supplies for Each
Hos,,ita.' Unit Planned.
It is proposed to carry out field n,/o'- in each departamento'with>
the capital as the center of activities:t This will ensure cover-"
age of the er.tire country. Function.' hospital regions will be
determined upon the analysis of all.data and need bear no rela
tionship to the geographic lir-its of ceparta.mentos. The field
work commencing in a capital or majorr city will fan out in all
directions to the furctior l bhopital limits of the region,
cutting across departaer.ctal :lines as required.
The field work. will rvanoce fr-o Guatemala City, the economic
center of the country, toward the' agricultural and densely
populated regions of tha Occidente '.d the Forte and proceed-
ing from thernce to the Oriente nd. finally to Poetn. Modifi-
cations in this program will bc made to comply with the over-"
all plans of the Institute and to enable the Planning Phase
to get under way, as crly as possible.
Barahona and Dittel h-ove divided the country into six, zones
for the progressive tension of social security to the in-
habitants. This division will serve as an excellent guide '
for the order of'the field work. However, it must be. kept in
mind that variances between th. two will be inevitable since'.,
30.
the fcrcr-r i'- b's. o: crncr .ss, w-ilr tr latter is based
on fur1ctii'.:. 0 ] c-,it.. - 1:C2irs.
Th- furctior-1 hc -t 1 r01icr -I1 :
orrihy -;'- intc-r . tior into the
1.1 dtcrr-incd by population,
r.cticnei hospital! systcim.
I. Surv-c r of Tcsrit, A cJLitis EP 4 ruired in Rj ,
A. Total Fr"'-:liti s Rc, uij2d6.
B. _xistin F'"ilitics.
C. Ar'lysis of Tc-t -n' txitir, Facilitics.
D. ProfCssionci S
E. Rol of' Irsti.'tco
7. Role 0of iristcrio.
A. Totjl Fa.cilities ~t'uir'Cd.
1. Gcne&i-.1 c0rc, i:cl.cJ- spcci -iti. s.
2. Lonr-tcrsr ilrnossc s.
3. Acute comrTtnic'b1 r i' .ns s.
4. Convalescence
5. Tubc::cu'lcis.
6. Psyc-irtry
7. Crnccr.
The scrvic ,n no -r,- J r:1 o l -torr:
runir.icb_ disC. -n cvr. sc:cc
cOrL0inity b]. 'is 1i"- ir -.t .ticr i- t' r
t12
illnesses, aRcute oEr--
-1c be considcrce on a
rationrr hospital sys-
S..c ccrsidr,.tin : Jill bie 1 *ivr t" ..- xccedinly important
-ri b -rs in G'. l-. ir..: -.:i Tuburculosis : nd Venero .cl
Di f:: ', 01j- cussc : -r :" L the 01ork Pnrcr'' .v.
Tot 1 faPcilitics RcBuarcd \vill beC Cct.rincd frou th. follow-
r 1-
1. Populaticn by ar;. groups
1900.
ss: for t.n-ca-.r -periods since
Ci rLi' `'IC.'Tu.
2. Corposition anr Distribution.
a. LD.dino Populaticn.
b. Iri n Popul;tion.
3. EconorJic 3t-tus.
a. Urban.
b. Rural,-.
314
+. Relati -rship between por-ul ti, cci .1 status mnd ecoronic
status.
5. Trzrsporta.tion facilities.
a. Railroad.
b. Roads.
c. Bus services.
Relaticrn f these .'.cilities to population centers.
6. Births. Sto-.tstic for p.:t .ivc ycars.
*. Nurbcr in -cc-.h roclitic- subdivision.
b. N u: ,r in h-s-it:- :. cities .
c. ]vurb .r in hor-..
d. 1umnber per 1,OCO population in each politiciL subdi-
vision.
7. Deaths. Statistic' for .pst five yecrs.
_rsbo., ir eb" ,litic : :ubrlivisiacr.
b. iu'uber ir ; f ...: *: litics.
c. Dul to Pr: vA t;.b lc DiJ.- CS.
*. iorbiity. SHeti tics for p:st five y(E.'s.
u. I' r bo rp'r 1 0(' popul' ti or for rorc prcvl.r1.nt diseases
in orlitic^3 subrivi icro,
Be Cristir Fociliti- -s.
1. Hcpit 4 :l .
b. C ap, city.
c. o F';-r:b of
d. Pc rc, t oc.
e. Perccrt or
f. F'ur'cr of
i. Loe;cst cd,
j. Avcrra.e dc
1. Births in
1. Deaths in
Im. F\ ., 1bcr of
n. Residence
-: 3" '7 "nod -o "'.-*h ser-ice.
Dc'u"r- c-f bc.. c: c t.c] 4 s' v-icc.
_cu c.rc. of . bcCs.
...ti..t. nnilly for post five years.
'Ily c J' -. .urin : st five years.
il cc' cr; c.u.i.. p .st five yv. ars.
:ly cerss 1urin) P, ast five ycars.
y st;-y durirs pr'st five ycers.
19o?.
19,-7 ar- ,est? retc.
a0utop sie s.
of pcatic..-ts by oc.litic.l subLivisions
(toin, city, runicipic, d. rta:cr.to).
o. EducLtion ctivitj.es vrdicel, n2r: i: : tech-
nicicrns, -osritl pr.onrrl.
p. Floor plcn bi' sc..o,, iF crveilablc.
q. Physical structu:C.
r. St.-tus of e-ruiprc.t.
s. Laboratory tc:3ts pcr;'or'mc( sndc special cxairinations:
1. Urinalysis.
2. Blood counts.
3. 3'rolo icsal.
4. Parae itolo ical ear-inartiors.
%. Bacteriolof ical exar nr tio: s.
6. loojd her- try.
7. 3edir'enttion tests.
8. Coagula tion tire.
9. Bleedirr tire.
10. C' -atric ucortents.
11. Basl nrtaboli-e] r tcs.
712. .KG's.
13. Tissue re -oft.
14. r-r, a s.
!f. Oth':" -r*:, ?.tioer,
InfTr' tie'r abn-o t- tc obt-i.rd fror all. hospitals, i-cl;uding
-, :.-, tu ber-losis, r:nt S1, *ont-ious disease, leprosy, ca-
ss d l.u", bhospitt1 uportc private charity or irdus-
t.r.- l ,-rg.:niz 'tiors, etc.
2. Public :_-alt; C.rt... .
C. Loc: tion,
b. T_ o, .ciliti'-s.
c. L bo,- to'ry crvices.
d. Cord:'tier of p'ty:ial pl't.
Luipr ent.
f. Frmornrnl.
.r Annu':.- report ,fo:- 1944 ,.
C. Analysis of Total and Existinr. Facilities.
This coalysis will be b sed on thb' data collected under Scctions
A, B, -n'r C.
Recoo -.rn -.ations ill be nade urier the followin- headings
2. Type of hospital .
3. Bed capacity.
Depr inr u-cor locat ion sin e et:d availab," professional Tper-
sor I el, no1tcs ill be .isti c as C central, Regional, rnd Ru-
ral, -.r. t-e services available ir eac- will be noted. Public
health activities 3ill bc intcarated irto the hospitals of rc-
giora1 ard rural rani.. All hcnpitals -ill be integrated into
a Laticnal Hospital symtcrr.
Data vill be. as-. rbld ..ith r- :,r to available sites, tcrpMe-
r .tire :rc h'i-iditly v'-- i.-tiois, revrailing- bree s, and presen-
cc of utility service such a"; lectricity, water and scwerase.
D.Professicnal Services.
1. Physician,.
a. lTunbcr#
b. YIur.ber of Ecai'rits rnd nature of special tiEs.
c. Number of physicians enrscc in existing hospit-ls.
d. Fumber of physicians enraged i.- public health fa-
cilitics.
e. Yu; ber o' intcrn s rcd r sidcrts in cw.istinr ho3-
Dit- s.
2. Dentists.
a. Fi.rbc r.
b. PIurmbur cngr :;ed in ce:istinr; hospitals.
c. Number cr'egje in public health facilities.
3. Graduate FurscS."
E. Listing of schools for graduate nurses.
b. Iurber c.ritte dlurirs arst five -years.
c. Nurb'r gr', uatcd during past five yesrs.
d. Nur'ber in -ctive pr-ctice in hospital region.
f. Furber cr- ,oycd in public health facilities.
g. Number uitL --pnecil trri.in: rd nature of train-
ing, and type of world: c",r7ped in.
4. Public Health Nurses.
a. Number in crich public health facili-y,
b. NIumber -ith .pcci-' trairin 4 arnd nature of
training.
5. Practical yurses.
a. schools, number of stuCderts a"dritted and zra-
duted.
b. Nur-bcr in hospital r' gion.
c. Eui ber ir hospitals.
d. Fur:bcr ir public health facilities.
e. Tu-bcr ir private duty.
6. Laboratory Technicians.
a. Eur ber.
b. Number rer-isterd -1d urr-c.'istered.
c. ru--ber ir hospitals in region.
d. Number in public health facility s.
e. Number with special training.
7. X-ray Technicians.
a. Iurber.
b. Numbecr wit] -pTc 14,- training.
c. Nurber in hospitals.
d. Number ir public health facilities.
8. Comadronas (micdivcs), Graduates.
a. Schools ,ith nurbci admirtted and graduated.
b. Number.
c. Number ir hospitals.
d. Furnber in public health facilities.
e. Number in private duty.
9. Physical Therapists.
a. Fumbc r.
b. Tumr.br vith'G special traini-n-.
c. Number in hospit-als.
10. Dictitians.
a. Number.
b. Nurbcr w -ith s pEcia tranir-s.
c. ~gTm-ber in hospitals.
1.1. Pharracists, I3. :-i.ste.:ed.
a. Iumbre-r.
b. Number wviti special training, .
c. Number ir hospitals.
d. Nurbcr irn publicc health facilities.
E. Role of Institute.
1. Estimation of Hcspital Facilities Required by Institut
a. Based or needs for the succeeding ten years.
b. Based on pl r: for ;:tension of benefits by zones
to all p-rt of the country.
c. hodificatiors of plan of extension to bc consider-
cd.
d. Lccation end nui-1ber-r of ins :ed by city, town, etc.
e. Recornmnndations for hospitals to be built by Ins-
titute.
F. Role of linisterio.
1. Estiration of Hospital F-cilitics to be provided by the
'inisterio essentially the difference between the fa-
cilities required for th., entire country ard the faci-
lities required by the Institute.
a. Based on needs for the succeeding ten years.
b. Recommendations for hospital facilities to be
built by the Ministerio.
c. Hospital facilities of Iinisterio and Instituto to
be integrated into one functional unit.
Recommendations for a National Hcspital Buildinr: Profram.
A. Objective is to provide hospital facilities required
by the Institute -_dc the 1 inistoric.
B. Order of Prfef:_.rcc of Construction.
1. ased upon the progressive reds of the Institute.
2. Bascd upon t,-r needs of the I inistcrio in order of
urer cy'.
3. Integrration of the construction schedules of the
Irstituto and the lir.i.toric.
III. Specific Hospital Projects.
A. Medical progranr for c-ch hospital.
B. Administrative Procedure for the Hospital Plan.
To be completed within the period of the contr-ct.
Vorl: on this .-hr.s of th,: project will continue
conco-,itar, ly with the field wor:.
C. I'Enua! of instructions ar. rccocrcndrtions fcr
the purchase of uincrnt acnd r. tcrials.
D. Nanu.- fr the ir.r ir.t cf hospitals.
E. Traini. 're:t.r f'r r:.brs of hospit..l- staffs.
1. List of hospital perscrnnel tr.ired cr re-
ccivin- trainer a-t pr se-t ti:e fiel_ s of
tr .ini'" ,.
2. Rccor..encrtions .ith c!-.ord to number end
type of t'c.itio n t- .incd per-onnel required.
3. .Recor.nnctoens vith r, ..rd to places of trrin
inf.
)+. Qualifications recuired by prospective train-
ees.
5. Esti a.to of the expense of the training pro-
IV. Lists of I.ov.bl- Ecuiprcnt an SuTn~lies for Each Hos-
pit l Unit P1 nned.
V. h.ternity andr Ifant Care.
This L-rvice i- of the f;rctecst Jir.portance in the medical
pro';ra: of the Instituto. L.deouate provisions will be
provided in th- 2-nneral H-espit l pre-nhatl and po-t -
natal services-, in the public health 'section and the cut-
patient dep,.rtri .nt res-c.tivCely; deliveries in a separate
specially epuiped, r-ternity w;'d. Visiting nurse ser-
vice is also ,7 A d-.ic d-.'le valuc followin-- Cish.arc
from. the hospital.
36.
Care of Infants, in accordancc -vith ]modern concepts,
has bean delegrted to the PeAi-trician vho is res-
ponsiblec for thc child -'p to the a:e of twelve years,
Both nursing services in the hospital, and facilities
in the out-patient departrant will be provided.
VI. Consideration of sc>cic- diseases:
1. 1alaria.
2. Tuberculosis.
3. Voncreal diseases.
4. Typhus Fever.
5. Onchocercosis.
6. Psyc hi.try.
7. Cancer.
8. Leprosy.
leprosy -will be consid red in the survey although it is a
)roblen of relative r1inor irportnce in Guatenala.
I'ALAB IA
a -ric will be considered froi._ t'e -ru:vcrtive and curative
ispccts. The pr vencive asp( ct will7 be taken care of by the
[public health f-c-1liti s i_ the Institute hospitals os as cl
cs by direction of a national- cariair:n a-ainst this disease
from a certral dciini.trative office. The curative phase will
be ta-ker care of by th- provision of hospital beds, out-patient
care, ad hor:e care -.s indicat-.d.
TUBET'RCULOSIS.
Tuberculosis is best treat-:d in special hospitals or special
hospital units and theo will b4: considereC in the survey.
The rain crphr is in th; battle againt tuberculosis should be
in the field of public alth. Case findin.- studies, segre-
Cation of active cases, a national tuberculosis program and
the tr inircn of perserr.el, all play vital roles in the battle
to eradicate tuberculosis.
1. Role of Institute.
2. Role of hinistcrio.
3. Role of Anti-Tuberculosis League.
4. Study of statistics with rce- rd tc incidence, case-
finding, 1 r Cea th rates.
E. Evaluation of c_:isting tuberculosis facilities.
a. Hospitals.
b. Health centers.
c. Other.
6. Recorrm nationss .it rc-o-rc to facilities required.
a. Location.
b,. Size.
c. Administrative control.
7. RecormmendaCtion ,,with regrd to training of personnel.
v r .'.L PDIT3T.3r>3
Venercal Diseases .i:. be tro.tad in the. out-pationt depart-
ment And -ublic health section.of the. general hospital, and
beds nwill be provide": for cascs r~ouirin: hospitalization. A
national cC-r-iicn fro- central ad-iristrative office i.- al-
so essential in the battle against t-esc diseases.
TYPHUS FEVER
Typhus Fever will be ccrnb-tted by the public health sections
of the Instituto hospit-.ls, nd patients will be hospitalized,
xlmn indicrtct, under strict septic, isolation precautions.
OLCI ORC0O3IS
Onphcccrccqis, c condition. of cor. iMcr.blc irportonce i- the
r-c-ions hi..rc it is cir.,-c, ill be handled by the public
h?.lth secticr of the Institu'co hospital to the ultiratc ob-
jectivC of its r -dicytio", r.r9c beds will be provided in the
hosAitel rs n*. ed.cd.
PSYCHIATRY
1. Role of Institu>t.
2. Role of Tinistrio.
3. St-ti stics wih ..:cgrd to incidence.
4. Evalu-tior of ce-istin-; f-cilitios.
5'. Reccur-cnd..ticis with ri :.'rd to f:cilitics required.
6. Rccormm-icndc.tions ith rjar to tro inirn. of personnel.
CP' CER
17ccd for cancer ccnt,_r for consaulttior, teaching and training
will be consider,-d ir the survey.
VII. School of Troeiic.:l cdicin for Teaching.
School of Tropical kcdicine for tcachin... cnd research, Mith a
sufficient number of bes for hospit.-liation of selected cases
of the vr.rious troric-. disc1scs found in Guatera!i, will be
considered in the survey.
VIII. Rehabilitation.
The subject of Rehabilitation vil7l be discussed with re;.g:rd
to the basic principles of r t.-tional pro'rcn.
IX. Visiting: Nurse Service.
This service will bc discussed as a part cf the nationall Hos-
pital System.
37.
A. CorrclatiLiUi Ltcen Survey and Objectives of Institutoe
a. Frecuent consultation vwith officials and technical
advisers of Institute.
b. lior! Program is flc:7ib.le and subject to modification
as result of such consultations.
c. YIonthly progress reports to be submitted to Instituto.
XI. Relationship of survey toc objectives of the Yinisterio.
a. Corsulta.tion with officials of the Ilinisterio.
b. Survey directed toward i-Cir' the -inistcrio in
acconplishir- its objectives.
c. Integrrtion of objectives of Instituto and I'inisterio.
d. Reconoendations for Ea Itiorn l H-ospital System, in which
will be included the hospital units of both the Institu-
to r-nd the Minis-;erio.
XII. Study of Professional Services.
a. ,edicinc.
b. uNursing.
c. Dentistry.
d. lidwifcry.
e. Laboratory arl ^-ray.
f. Pherr' cy.
g. Dietetics.
h. Physical thercay.
Study of the nrofessiornl schools.
The work program has served its purpose very well r-n only r-i-
nor modifications have been mrade in the course of the field
wor' which covered every section of the country. These nodi-
fications in no way underrni the. p-rirciples upcn which the
survey has been based. A brief description of the organization
of the future hospital systcr is in order. It will be observed
fror a perucal of the iork program that the latter is essential-
ly the study of hospital regions. The hospital region as re-
connmended for Guaterale consists cf 4 hospital units with close
integrration between thoso units. The hospital units may be des-
cribed as follows:
1) Central Hospital. This hospital is affiliated with the Ke-
dical School and has the facilities for teaching, consultation
and research. In Guatcr.:- t Y-o is c-ly one cor.-unity that
will heve the recuisitc profeCsioi:al p-rsonnel ran' facilities
to serve as the central hosnit.l, !ard that is Giatc -ala City.
The Roosevelt Hospital will serve as the central hospital for
the entire country. It jll :-revide the fc-llcwinr services:
internal medicine, F:ajc s-rcery, obstetrics, pedi-trics, ne-
dical specialties, surgica' s-ecialties, psychiatry, cancer,
comnrunicab]c diseases in.l--din, tuberculosis and venereal di-
sescs, t-eching fciiti_.es for odical stu;.ents, interns, re-
sidents, nurses, technicians, :nC post-,raduates, roontegenology,
laboratory services including pa thologyr bacteriology, serology,
end chemistry, physicthcrapy, dentistry and dietetics.
S38.
2) Regional Hospital: This is a fairly lrrge hospital, lo-
cated in a hospital 're1 ion to be d>terr:ined by the. survey,
whose size will depend upcn the need of the region rand the
professional personn,.-l -vail.abl. It will provide all or sorec
of the following servirs, ag-ir -< ndenrt upon the profession-
al personnel available: Internal medicine, r'ajor surgery, Obs-
tetrics, pediatrics, -1on.uniabl.: 1 i'e:-es including tuberculo-
sis and venereal diso escs, cto-rhirnoiringclogy, dentistry, phy-
siotherapy, rentgcnlogy, labor ;ry ireludirng pathology, bac-
tcriclogy, s'rology r. cheoristry, teaching facilities fcr rnur-
ses -Cd_ interrnes, dit tics, in public health services (des-
crJibe. subs.crL-r.tly).
3) oepartc es tal hospital : This is 1 hospital located in the
capital of th dcp.rrt- ento. Its size will vary accordin- to
local. c..-..s as detcrr ,c[ by the survey. It will provides the
following sCrvices Is: ,: r l r.cdi cine, major surgery, obstct-
rics, cd:itri:. C(.rr b2..- diseses, oto-rhino-laringolcgy,
d-ntistry, ph i.';- ..r-y, rocntLcnology, laboratory including
pathology, b:cteriolog serology nnd chemistry, and public
health services. Th:i: -ty e of hospital is interrecdiate both
in size andr facilities between t he rcgicnal hospital und the
rural f-nd its faciliti s .ill vary. in accordance with size
and athe necssities of the people it will serve.
4) Rural ITospital. Thji is a slac hospital whose size will
vary according to loc-l nr: ds -s detrrr1in4d by the survey. It
will provide the following s..rvices: Internal medicine, encr-
ge.cy and r ino surgery,, obtetrics p~oditrics, dCentistry (if
professiorn-1 personnel is available oto-rhino-laryngclogy
of 1:inor degree, rocnt ::nclo y, routine laboratory services,
u' public health services.
Public Health Facilities. Thesr facilities are incorporated
into the regional and the rural hospital. The arbitrary di-
vidinr line between cur-tive ,rnd- preventive medicine has be-
come non-existecnt and their ircorroration into one institu-
tion avoids duplication of services and personnel. Only in
a large city like Guaetco- a City because of the volume of work
is choere any justification f,-,r separate facilities and then
there must be closc integration b tvcen the facilities. The
following public health services will be provided by the hos
pital: Clinics for r.aternl an- child health, contagious di-
seases, tuberculosis, ven..rca disc-ses,c internal parasitism,
public health education ard sr-itation. For isolated commu-
nities mobile clinics should bN used whenever possible.
The plan for Guatema-a eliminates the so-called health center
which is described in North Arric.an integrated hospital plans.
As I have described p -viously, public health facilities will
be incorporated into th,; various hospitals. The health center
as understood in the Urited States is the unit located in iso-
lated communities with a few hospital beds for obstetrics and
emergency cases. In Guctemala it is jus-C as well to consider
this a rural hospital.
The ~rtcrtdLrT.i1T. c. -"cribc abovc is the Plan
whiicth hus rcocritv-l" b( cr adopt-cc ir rost ,rManced sections
of' thc UnitcCO StEc'rci Ir principio this 1'lan -will servc
olc or Gu turno~ hwvr 9 to1~-1 conditions as
eccvcr2. by tL: si-rvey it ic to includC ti-2 fa-
cil ity 1 no-wr, Del- artmcntael dsic1clocribcd abovo
-whi-eb xzill 1)o locetcOino tii e-'(-c cr' s c:f th.dcr~rtr.rcrtl -s.
Th. rclationshoin b tvc t:. V- rious 1-Z.Oiori fo-cilatlis Tlrly
CEPTIRAL REGI(N All, aD'IP1-TiTTPTALT7 RUR~AL
It rl~ bc O-Ce 01 c. t, t>; -,t r c~'n~i 11 '-1 1-
f~o~iL'~~ V -.-~ -~or"~c p rfj.% 2i* r.:c.- of I>
1 c i 3va js; bqm.':Cv'r, I5 h S I -. rc vent y
ThOO it~1 fellilis 'C K> "( > o.Hc,.cvcvr, it 't
.t 2( o.o i ~zcKto the Ccr ral 1-is-
& t S~' S'tc' uch C,--Sc !rv~riCeby
C t .vs c>-1clOC 311 veIC N~-. r
S1 S c t sc, -fcO~ct-icr for
Su .1-nC!y in(J I
ul it '1r'foor, cc cv -: _~~~ ~ ifl,~CC tlV.
bc ocduc,,t...K :-r(1 croilr k- to '.'l tlr .; 1 '"1
which such etjTV1 i~- r:d
r'cjor~rnei<7co ~ r c.L~Y. TlV cs(. ,rin-
oiICS re ir ~cc ~~1- Y 1 o~~ oofi'l The CL5itl
of c:-ru r r or.~.fc~i f:~ rinci-
Wv ( LO' AiOJ2 in r f o Prnnv):tc
v. dynaruic -an realistic procrrn or the people of Guatemala.
t. brief discussion of t' -s-c princirpl fcilOSI.-:
I. It was decided that the nurbe-r of hospitals required be
kept to a minimum and that such hospitals should cover as
large a sector of the population as possible. 'The reasons
for this principle are fairly obvious: It costs less to build
one large hospital thrr several srall ones in relation to
the number of beds -provided r&.d the services rrcde avcilabic.
Slarge hospital is -mre econor-ical t operate then scvcral
irall hospitals with an equul number of beds. It promotes
the concentration of the best personnel in relatively few
units to provide th> people with thJ best possibl.. ndical
service. This is particularly! important in Guatecrala where
there exist sevcrc scarcity of physicians, nurses and tech-
nicicrs. Finally it avoids duplication cf equipr'cnt ard other
facilities. However, core-.rcni e cf this principle hcs been
necu ssa.ry because of thc e-era,'hic chrracter of th. country,
th- custor;s of the various actions of the. country and the
lack! of adequate trans],ortetion facilities.
II. The second principle is the provision of adequate medical
services for -.ll parts cf th.. country. The present hospital
syster; in Guatcial. urder thl, Vinistcrio dc Salud Publica y
Lsi3st,.cia Social ccr-riss hsp:'itrls located in rost of the
capitals c' the depart. nts. There is no doubt that these
Carrs rocuire such units. However, the combined population of
all the dcpartrentac capitals -s of December 31st, 1946 is 402,052.
Vhe cre, therefore, dealing with situation in which consider-
able thought r:ust be given to th .: pproxiately 3,000,000 inha-
bitants of the predonin-rantly rural sections of the country.
It should be noted et this pci't th"-t thre(c departr-cntcs, na-
rely, El Progreso, Chi -t ..nanc and Santa Rose have no hos-
pital facilities at all. These depart-rentos have a combined
population of -51,230. It is n-t C-ent to cor.vcy the thought
that those people or r put it v-er rorc br-.dly, the 3,000,000
inhabitants in ru:.;l secti-onS, 1d c-t rcciv. rCdical assist-
ance. They trv. frr their s t tth,- d.c partrental hos-
pitals. Unfortur.:: tely, statistJ.cs show that the distances
a-e too rr-at, tlii trasprtrticr facilities in rest parts
of th- country arc toc poor -rd th.- pLoplc are not sufficient-
ly hospital-conscious to cracl- th. hospital units whichh are
,in exister.cc. It is necessary, therefore, to place hospital
units \ here they rre avail-ble to n,.p1i in all parts of the
country. This has rec.t the recomrrnd--'tion for the construct-
ion of srall units in areas vbich arc isolated and in which
are.as the inhabitants would not nrc..iv rdeet. nodical care
unless such units icrc mode a.vilabl tC thern.
III. The third principles .hich ui's the survey is the in-
corporation of public- health f-c-iiti- s into th- 7cr.eral hcs-
tital. This ill _.void dunlication of buildings ac.d facili-
'tics. It avoids the dispersal., of traircd personnel into en
excessive nurbD.r of units. It closely irntcgr:tes curative
andc preventive n-edicine. The hospital i- the comr-unity will
srve s a center of c-r : tiv icin blic elth .i-
vitics and public hc-eath education for thi- population -. which
it serves. The following public health services will be pro-
vided by the hospitals Clinics fcr r:terusl -nd child health,
contagious dicsccase, ]alaria, Tuberculosis, Vcnereal discescs,
intestinal pr-sitismr, public health education and sanitation.
Ono of the. ru.in objectives of the survey is to r.:c recoricn-
dations for th construction of hospit-.l units, on the basis
of I:c'ticn, type -.rd size.
L,,,cticn v:.s dctorrincd by a crr(
.-ach sectJ.on of the country. The intcr-rclationship of units
in d;.p-rtancntos to nciigh'bcrtin. regirns nnd the country cs ,
w-,hoi wavs carefully cc: -siderec. All units in C- l'spiita r'cian
h'vc LCn closely intc,,ratcc witl co.ch rth-r. The renns of
tro.nspr rta-tion surroundoinr '-:cb onit dinctinr tbhc, vail-bility
of its facilities t tc t popul"-tion it serves hvc played -~n
irrort.nt part in thL l-'c-tior of thb units.
The siy-c of -c-h unit h-s becr ditctrrined by two fa;ctrcs, n.-
rnly, the category of t{h2 hospital, that is, whlthLr it is
crnt'r-?, rc-gion-l, dp_ -rtmrcntal cr rural-, rnd by the pciulaticn
it will sc-rv. Kcdific.ticns havc been r--dc in -ccordance
with t-c cor-pcsitior -" the population that is, rolativc reties
-,f urbAn i',c ruc'-l Ipul -ticns, .-n the lacdino andc indiarn po-
ul -atins. After t in' th. se factors inte, considcr.tion,
n vrrthclcss the size cf a hrs--it.l uit dccrnds directly upon
thi., size of the population it serves. The latest census in
Gui-ter. al- ws taken in 1940, Therc is ruoson to believe that
there are inaccuracies, although of a relatively ninrr deccrc,
in this census. The rost recent census figures vrilable- r.rc
those of Deccnber 31, 1946, 6wich ar- fi-urcs b.sod on tbh
1940 census. After areful thcucht or this xtrer-:ly import-
mnt racItor it has boon decided to use thO ,'.tiaated figures
of Decer-ber 31, !946,. in calculatin.n th jize of hIsrital
units.
There arc rany :cascns for thi.-; deccisio.n: Tr formulate a
survey of the. hospital ne.ds of Guatcnla fov- th- next 10
year period it v.cu le r. ces:try t :stim -.t thU : U o'ulaticrn
of ,ach section of t.. c.unt:- for 1958. Since theem fi, urcs
-ould be based on th. c i::us Cf c 940 they wruld be obviously
in.ccurat. evncl to ra : ate' do'rce thnn t t. fi ulrc, of 1946.
S..condly, ther, ;;ill b a now c.nsu- t ken throu hut the
country in 195C. This c, mus can be r.-1 an :-ccur-te one.
Thoer is only a short -riod be tcn th' tip o of coUletion
c.f th; survey and 1950. .Sto.nd rs ,hil ore adopted at the
]ire-nt ti. crn be P .soL. t.o d, b..: _in5 the. bhosital noeds of
th- country on the bosi: cf th- *-curate fi -ures to be ob-
Oined. in 1 90. F-v urJIts of the total numir-ber needed in the
country will be planned and completed before the erd of 1950.
S .el ed for purposes of economy to -proceed conservative-
ly in the hospital program' for Guaterala. Hospital units based
or the epher.ercl figures for 1' 58 would increase appreciably
the nur-ber of beds provided without any assurance that all of
th-r. would be utilized. On the other hand by building 3sraller
units, by allowing_ for future exp?-.sior. of 20% in the larger
units and up to 50% or r.ore in the sr:aller units, it will be
possible to supply the reeds of tle Gurteralan people for. any
anticipated increase in population durir' the next 10 years.
Another reason, of the greatest ir.-portance, for the decision
to use the population figures of 1746 is severe scarcity of
physicians, nurses and technicians in the country. A grardiose
program which would provide an excessive number of beds based
on estiratcd, inaccurate figures for 1908 would be .unrealistic
because of the lack of sufficient trained personnel to staff
these beds.
A conservative approach to the entire problem which correlates
the size of hospital units with the economic resources of'the
country, the availability of trained construction workers, the
increase in, ard the irproved training of professional person-
nel and the education of the people cannot fail to be success-
ful.
Last, but not least, an intensive and lorn,' p'rograr. of education
of the people in persor!l hy::ine, public health benefits and
the use of hospitalization will be necessary. In regions of
the country where the irdex of illiteracy is high, and where
the people live in.accordance with ancient customs, particular-
ly anrong the Indian population, the educational program will
undoubtedly extend over a period of rarny years. It would be
folly to provide more beds th-"n the people of the country
are prepared to use within the next few years.
IIUS1IT'L HG.GIO]^
In or.er to unerstand the re ional hospital plan it is necessary
to have scr'o unfcrst-.nLinr If th. -njinistrative -mrr animation of
the country as a whole The ntir'. country comprises an are-. cf
108,88-9 square kiilor-otrs with an cstil:.ate -opu.rulaticn es of Dec-
ember 31st, of 1946 :.-f 3,6L4,c33. It has a density of 33 in-
habit-.nts per square kilc-ect r with o:trc'c variations between
'iffcrent pn.rts of '-he cucmitry. The vari".tion is front the lowest
figure of 0.31 in El I it.n to th.; hihest fi -urc of 189 inh:-abit-
-nts per sonurc kiie-rter in the dertc"'..nt of S,.ciuctc'_eouc.
F-r "c'ninistlr" .:lve r x, t: c country h" c bcn divir1- ir-to 22
-c-art"o'.nto;:. i', ."-rtaont"! has its a"pit.l which is 'nc.wn
s th, c.A.' .cr- :.. o:"rt.' ont-. Ti e'-'rt-p ntc 's Cividc'
int' uniciics c...h Lvin .n urb.n ccnt'r of varying c.izc in
which minst~a'-'. ive .v rins ri' ccari._ cut. Th'r,- .rc 315
:-:unii ios in l: -.! : 1. The la:1 st ci iy in the- country is the
City f C-. .. '1 he'.' i the C'.i.ti-l .r:' in which the n tional
TIn *1i'rinin ; h.sriJi" r.-icns overly WattcpIt was ra1c to retain
,q..elrtnr-;i..'.1 nai"' i'st ativi u nit- intact but in :anyv cases it
wac: not --o'sibl.2 t11 1 so ,.'.-pit,. 1-o>un'ary lines on iaps, people
,h- rcxuiru r -.ic1" .j ill -:recur. such a.iC in the nearest hcs-
it-"l unit-, or a oit .1 1" ,whi; ic 1catec in the cornercial
cnter Cf t il- ':uni;:,. Te rs:..'vey therefore- has .er ttcrTinId
hospiital rei r" in 'e-ora-, a. il h the customs -f the people.
-vr il'-bl rcea r' f tr ,''-or i.'tion on s-oci'al rn cecononic factcrs.
The f~ila tuy has sh17Y the a vi ability f ivi lin- the country
into seven h< sital vre iLeaso o:ital region is an area of thec
country wi', si.'l'-ficil cpula ;. ctn with natural m ogranphic bounc'.-
rrilcs9, an- vh se int _-C-1 ar: cr inter-connected both scci-lly
Seccno:(.ically, b : .s c.: existing tra-nsecrtation j i cilities.
_The r-ical f1 cliti [ a3l 0ocmital 'irn's are inteoratc< in-
ot- one nrtiu 1 hospital r r -r -. .
The hospital re ic's v:ith their -ou_. rics ar the follovin:
RGICO I. nprisJ th upar La -..ni os of Gu.atmnala, ]. [ro'r so,
S-.c'.t p"::ue scuint...-. n -. C -altcn1n1o, wit-, tIhe
yco, iir :r- ochut'..
,IL.0I IN iiC''lra. r 2-.:'. ,p-.'r: crnto -f 'u z'al c.nnl'o (exclu ins
the u-i'ici'i : f C' -at,. r:lu., 5 nr va, ol' '.ao Flo", s
Costa Cuce:' El ]P-']r); Totronic'pn Sololo f vi-
chi, '-floelit nan"- ", ,' "a. c2 (exclucdin; the "munioc
pies of _'_it_., Fr lj iJ an- e' s ).
C!SCICN III. Coripris-s th .rt ,ento-s of eotalhuleu, Suchitepo-
quez ca.n t4- nunicii'.a. 'coa.tci-ue, Ccnovan Florce:
Cost Cuc: rn r' T a]r-r .r the ..e .rtT -into of Quczal-
tcna.ngot .., tChe 7 uiicLiio of _'l-yutla, :ajapita, and 0-
CO6 of tie ce -rt'ront o' a>r ?arcos n- the -unicipio
of I oc4-huta te D. P:.:.',t n-c:L.o of Chiialtcn'nCo.
REGION IV. Comprises the departa-ent-s of Jutiapa (excluding the
nunicipio ,. .. u. Blnanc,.), Jalapa and Santa Rosa.
REGI ON V. Corprises the departreentos of LBja Verapaz and Alta
Verapaz,9 with the exception of Panz6s.
-REGION VI. Conprises the ,deprtanentos of Zacape, Izabal and Chi
qui:jula, (inclu.1in;7 the nunicipio of '.E[ua Blanca of
the depart. ..nto of Jutiap, the municipio of Pan-
zos of the d.partar,-ento of -lta Verapaz).
.ECGION VII. Compriscs the deeprtm'nento of El_ Petcn.
In the description of the seven hospital region, it should be
observed that Region VII comprise, only one departr-ento, El Pe-
ten. This is net a hospital region in the true sense of the word
since it is a practically undeveloped area of the- country with
the trc.endo-.s rea o' 3~5 84 square kilometers and with a popul-
ation of only 12,2.4 arcording to the latest cdnsus sports. How
ever, it has been listed as a hospital reolion because of its goc-
graphic isolation an" Inck of directt contact with other parts of
the Republic.
apq
45.
SISTEMA HOSPITALARIO
REPUBLICAN DE
GUATEMALA
C. A.
REFERENCIAS
HOSPITAL CENTRAL
HOSPITAL REGIONAL
HOSPITAL DEPARTMENTAL
HOSPITAL RURAL
LIMITS DEPARTAJIENTALES
LIMITgS DE RE8IONES HOS-
PITALARIAS
0
$
9
cz--
FUNCIONAL DEL SISTEMA HOSPITALARIO
4
'4
4
Hospital Central
Hospital Regional
Hospital Departamental
Hospital Rural
INTEGRATION
DE GUATEMALA
GIT'1 TL I 03FITAL 7'D CF TH-T REPUBLIC
The Fational Hospital F-rogran is plarned to provide Guaterala
with an integrated regional sy-terl of hospitals. As r-ention-
ed in a previous chapter, there arc three r-in principles
which have 'uided the survey, narely, the construction of a
-iniriur number of hospitals each covcrin; as large a sector
of the population as possible, the provision of medical ser-
vices for all parts of the country, and the incorporation of
the public health facilities into the general hospital.
The country has been divided into seven hospital regions.
These regions were detcvrined b0 intensive field work thrcugh-
out the departments of the country. Each region comprises a
functional unit based on population, the composition of the
population, the custers of the people and the social and eco-
nonic relationshipsof the region.
Under present conditions there car be only one Central Fos-
pital for the country. This hospital necessarily will be lo-
catef: in the city cf Gu-terala as no other city in the country
is of sufficient size, nor has the professional personnel to
be considered as the site for a central hospital. Therefore,
Region #1 comprising tie Departarentos of Guatevrala, Sacete-
peouez, Chiraltenango, el Progreso, and Escuintia, has a cen-
tral hospital, a regional hospital,, departarnental hospitals
and rural hospitals.
Due to the fact that Guaterala is 'redominantly an agricultural
country it has not been possible to concentrate medical fa-
cilities to the extent that would be possible in a highly in-
dustrial country. Added to this factor the problem has been
complicated by the relatively poor transportation facilities
which are prevalent in rost parts of the country.
Another factor of significance is that hospital units nust be
planned in order to rakc available public health services.
As a result of the field work, spheres of influence for each
hospital unit have been listed. The hospital unit will serve
the population of its own sphere of influence. In each hos-
pital region have beer located: One regional hospital,
departerrental hospitals and rural hospitals. As mentioned
previously, Region #1 also has a central hospital which serves
for the entire country.
These hospitals are de:-e.ndent ore upon the other. Cases be-
yond the facilities of the rural hospital are referred to the
departmental hospital; in turn, when indicated, patients of
the departmental hospital are referred to the rore complete
facilities in the regional hospital. The central hospital in
Guatemala City serves as a referral center for all hospitals
in the country. However, the majority of such referrals will
be from the regional hospitals.
V r-r'-c' tr .- %Frri: ti, 1u' rt 1, : 'c.c' hcyita
uli:t 3 _t Sa o ';' C,'-
.. it"] r d..cs ~.f - '_ -.pS a r
s.. cr :c.uLr rctsit c' 5 L f C ci-'7 ,i-" --, i',r
. L'- -r'' t 'iurip-" :r' r ' .- r 1 7 . 2 tr -
z ss.. -tr su v y r on t1' r -. :
. i ," r 's :c-c i2 t c i- : t:.:: t i l r'i
arc tc bi. built. I'c cr-' 1 : the --:r i cent. c 7"ule.ti -.
This cenc( Tt v.'ri: s fr; t'' stcT-(er. s 3 r: 1- th. Dt.r-
-. rt of 3t- t't. i. c-" th c ,urtr_ vi-_ c -suses
-cer, qs cf the r.ur. ci i ... 3i;" th .. .15. i ic i i
Cu: t r:rl-, I is crr ic,( rcr- t; Anv 31 ur 2- c4rtc-;. I: es
Cut c' 0.- t t r
Jtor... /s t I c oted i 8 1 C" b- I:? iVc: u7 t a
Jin1,1 tr-rt tire otc irJ. t it _. 7 r h.v -c -rn c
tC,, w-orC." Tc cCr 3,. 7 Tr. urb-: ir .t:.r i C, t size 2f
]hcsp'jtfls would ivc nit -rro.fecus pictur: cf the bc3 itol
^;bc r s.rve: t, i 'C 7._rticr *f , :cco air :
, il.y .v Cil".ble t, t ,rtir- u-c l -tic- ,f t'h-: c -: ? .- .,
... . r ,-ccr-
Fr'lloiu ".: 1 th_, i- t -17
...hc list cf .r. Fit : -,. S -
ffrr Cc ,l -i ,' .- -
-it Is:
Fci_ Dc; '-r rt't rt ll r'1 rl. r
For rur -. o r]ul: tirrc ij. '.ch
--,e '- in r. _1
Of t, <.sti ..(1 ni! .:r '. '.
Of ,_ ,. C i. t,: *^ .' ", t J
10^ ..re ass .-... ts t,- rI ,.i 'i
Ft ., L- o T' i he ; Li ,-. 1 l-
t: 1 "'2. :. .i1o
1', r ,- .% r r ,.
4 ,: .r 1,CCC 20--ul-i
the city ir. which: it-c t.c.
-3 ]''" "r 3,000 "rul ti", cf
the C t cr t-L-. ir i:. 2 -
"'-5 a
1] b- or 1,0COC
i_ tic: .
*: 1i' r r-.-' hcspit-.l, 20' -Q -
S.. r v l. 'r-.cloi] h -,c 1 u. cr .l
- @5r uo chi3 'n 2 Ax31iCCe
Il coytr. of tr c ct. r -f Gt-.-t C : :- .a v'ith v-ryir:' cc -
vcr, v ,i.'ti :. ..: t b r b dsI r uir:.d
:ir. r-(c ::.:.. vi t t ti. c.n ic st tus of the
pcol( ry r :i nt -"ti,.-'. toro. CIi .itu
(. 1; ii w, il ] 1. .-( '. Rl .'.'i'. n ] i" : 1.- cr th, st:-n-'( rds
.. s 1rc-LIy dc:; rib.d.
In Rc .,i #2 th; c :, ,..-n .: rsid.r~-bl v-ri-ti' r frc the
..r-i: st n r. -o I t r ccrT'ri ir t' D p. rtrc rts
.. . 7 ,t C 3 r -i r .-s T t.ri... .. 5 i c ,
arnd Huchuctr,.r: < cli v stly r : : t
Indi-.n are: a.riculturna pou] .tin.o The Irdir.s in r1-t r rts
'encus cu s Clti -I '-.i i f i litcr-cy -nr,
th.rc for, vido-pj~ r i-:rcrr.cr cf hc:pi ls, -ublic ih .1th
crvicc : c t:. bcnficf. to be durivud fror. tl nm. Until such
ti o ic c h --.- the __- t- -,' usi,-' t st:c _tart-
;.is ra cl ;r. i t cuty, ult ir- ly n r 1-.7c
urb :r of ncccu-- ied b.'s Th..... c fc.r this r. icr, t
st-d .rs h;v-.v b c- -in. r-. The sct,:frc s for thL urb-n rc-
t 37 T. r -- --
fcr t'. rz.r ul ti r, t 1. i -l b i...ti.
cn t-' b. sis of' 1/2 dcc p.r 1 000 OO -cprulatir. T'. .r-e tWC
(.xc c tins t t this. Ttl-. rur".l io -ul tion ir the .r b:: of
influ,-nc. cf -: Cu.z .t n .r _cfTpitr. '-. cern c-~s 'rcd
.nI the brsis cf 1 b r. ;cr 1,000 rpul-ti-n sirce t- s isit-.
is . rf r .l s' t ./ith t.he *,it,.st ty e (. Cf s rv. i s f.r
the -ecrl, it s.r.s. <-.r 'c .. ee7 eCcu < ti
hu si-iS 1. is in t'. i nis -. the -: t f Sn K- r-
cos cn thK, r,.- tr th- st0 Ti3 s- ticr : h tr is
r l livelyy fl t n "'. r r. .cd tr. rt tion r 'cilit s
3c utt U;: -tc'r "," 2'' .c'. -_ e'-.n o. .* >2y \ '~., fre' r12
dir st'.-ns. T-- -.f tPL ru-- y-cu -'ti-n in thi s" r-
-.f influence .3 ...,- cc. sid : n th b.sis f 1 b 3- p1r
1, 000.
The -,.;it L urit *- cc- c. f1- t nr.j'.ch-l in th.: D. -.,tcr: nt1 c
of Solozl", c.rit ': r. cO : ...ir to It d.Si b r nctcd
tl-ht in this n..'. influen. tL..r .. listed na less than
17 -unicil-ics. H.- c :v. r._ t cc > tirn cf 3?. -rti-:c -.titl.n
th. -re -l v7 ry ;-.- l 1':t1 with r.. -' fc.o ;Cfl- .ti n andr tc
sizo Th~T. c cor"i c th sc :"unici i .' r.,.. .c .c. ir trc
r-.-:inrs f TL.kc Atltl'%, t- S I srvci s tlhe .in trins-
t.ti r i'-ltty b t. c ifrcnt -crici2ics! F-nrj.-
ehu 3 b.. 3 n h scn .-- th.. :t- th. Cs-i.' unit to
scrv. the i.uniciFric h-,rdi, -i:-' L- T .: :t itl-n b).cus, it is cn
th- n! re .h. - G -t. tc r..r s the c-st -nd
: t t' t. It is ly 7 s t
frr.! t :c -rt- crt, it-1 i 3, 'l.-. In .. r t- si- rv
- pcFur.i tn.'s f ,thi' hi. 'f in lu. nce r runc 'h srvic
t .rnti :. rT.-l-r inc.:.rv--: .c11 --rts c f L3 Atitl:n
.ill_ b 1. ini lc 1 n : .
In i-h cc c N' .uTl-u / *lt' .oh I e-t. U :i, the D:. -o rt .n.to
f S5l.l', he hTcsit uniit i2 c,"'3id3,r, : oi:net upnC thU.
' cp:-rt-ro. .nt-.. bestitr l T! tenicol. r.;..n c!r.: .yc t:.:c rI cons
f1r this: tc ,opi'. f t] r r. ciit s f K hu S.:tE.
C trin" It'.i-C c'n '".n'd .c i:C.j cll r Cr u 0pon Totonic-nn
.thn Sold,'. I- '-- to Srl" 1 lo ng -nd
difficult. '. .ni.]. i z-cc 2. Ttrnic a in.
F r r the,. crrt rcrtal h1.o,:it ]l c b.- I c-c ted in Sa.. ".rc-s
th. i-o;l]atir-.s of Sc 3' rr s -r. S'.n Fcdro Sctcj cqutrz h11v
bcL. considrcd urb-r with the. st.n.T. cf 3 b.ds, per 1,000.
In r-in #3,C C t-cr., -t- t r. bc' f : -
-rt.i r ntr h, bfn c'- -; ;" ;. rtr er .-]f.t r .- vc..ty1
cf its urb-n cp tici: its .I rt ncc -.s ccrrcrci-1
-1nt_ r. C ascs iy i, C'-t a- rn-ui.r ir-' 2'r.-
- 4, t r service vill r- . g c.c J- it l -t
f:-_ z--t..r'.n<:- rT ,c ] ini.. -.f '-, -: ~t. 7t c r-_,-.structj :.1_ is
unit.
Ayutil iris b. r inlu,. ir t' list A tho'u U no further ecns-
truction is n,.t( d. Th unit in Ivui war's ori':irally ,built
tc .rv Public lt- crt.r. Hi.vc3r, it is so ;l1nnrd
thL-t bL '.s r' 'c -it .1 c i : c-. be incluJ c d. According:
t th. tnrd- r i opul -.-ti-s it this spit! uit v ul
rc-ouir sli' t- y ur'cr 10 b, s. -1.vcr9 it is nriLt c si. r .
7-c-. ... t .. un t. it;. 1 t -n 10 br eds. Actually,
. ul-tin "t In f I.yt' "ni Oc6s y be. cccnsider-
S-: 0 '--; .- .--e ;iv f-r t,.. tvc runici-
"'_r rc thi L"L-:' .l-- ir 'r ,,lc .
I-;'.Eltorn n:-: ]r-.- .-*.e,. tir'.'! d i, r t-L,, li-.t. Hcavcr, the 1 i-
nistr.rir d -. ,3-1tc '11lic- y ; A A.i st< nci. Social brs lborn build-
inr : lar.c b :i*, i urit this pl-co W-.'ich i'- close tc
c nip] tici.
T h rL.;uler u t:.nd *rs hi.v bvor uisd f, R i tn n This rc-
g:ior hs scv.,r-l '.'iv'._ -11. s .. 3 cf influcrcc vhich
s- 7a1- -- /i
n, v.vu.:t _.t l ss b- t< 1;: t-1'-c. intr 2. is :_._..cr ticn because of
t]-^.j; i ;,-.lntJ '.r f.', t1. r *':s 1uniti-.., Th_ so nr,. San Luis
Ji. t- ;:r. u1ccb'c- c-vu V2iris.
Fi;r t-. .... .. .. it j-- 3-. r.:"_ t rt:r p -rul ti:,_ .. n has been
fi ure: n i... --s ;f /2 b: .r 1,000. This is due t the.
- t th- t tr-. -r':-: t i- rci .ti s .r, v. r- ccr n i the dis-
2t-;-C S -. t 'r: t i rii. .. d 3ftr
t.cea ,e.t in ti re, o-f influence.
F'r 1. :. enl hr-cii 1 in C, '' t-,i' h.s bin cnsider-ble
v;-.jtic;_ itn th, st:nd': ''. F,-i iL. :runicipics of Chisoec rnd
San A ust-t Lr.nquin th. '1 -C 1/2 b,:. -C 1,000 has been
u:.d b; c-uc rf pcor tL 2 rt -tion -c ties, en'- distr.ncs,
rn .. 1.-;' f t.-cc c' :: ; f "c 'ple The fi ure
Ct'./n r Ste F.dir C rc:. F r tl- rt r ,uniciil. i in thC
C: t.'r sph .- .. f ir i..n ., -... r 1,000 f-r th rur::i p o-
-ul-ticr h-: ,- ..n .sd. Ir -21 c"e th': v ri-t. in this
sAh. ,f i lu,.r v b L-- r, - Tcific :i-_ fll dj c ob-
t in. d frcr. th ..fi . 'L -.- cit r--. --._ tr._nsportction frc-
cilitie.s, dict.nc.s :p,. cv:-..,rc1ition ,f the. :oul;.tion.
49.
In B,* r #6, tbc hsit-1 u it i 7 TLi- r.tcn h-rs h -- rf
irfluure. cf: -iir" rur3-r:.- cf Livin stcr re -. .-
tr in the Dr r-- t tf I -r i-- .s, in thi D crrt:.-
C~rt f A1t. Vcrrr-z. --', is t c f.r fre r r:.- hs-i_
unit itn LIt. V- r-z. it is 1. r i- t Livi st .
by ..r s cf t 1. C- -'-. I 1 -r-. t I D; .
This rhcrc ,.f irri n is I :'- I. v r ;iz7 Out in .-. -
fcr tbu.- ist rt Crai' '- uv -tc; r cer. uric-ticr s, 1 -urnch
scrv- ic,- f ]r t is .... ,- 1:' si--,'i psbl T-: rural
-ul. i- r h-s bc c- c .l-t.. .: t:-. -.si -f 1/2 b d i:or
th' us -- .
Frr th: urit in icrtt B-.rr. tL. r-? -. :-1ul-ti :-f tlc
iTur.ici].io cf i A r-1,: .- ,.. r u. -_ -_ -. tl-- c.si 1/2
b.c ]L.r 1,000 b.-cr'.usc -r r.c rt of t:e .oui tin is 1 ,r-vc
by th: Unit:L Fruit Cr., ry Hc"a-, iti t :uiriu.
7-cf unit ir Gual]... t' ru 'c-u tirc- cf t',-, r-unici:ic
f TLs : tc b-sis rf 1/2
1,0GC0 :.. t ui sit-1.
,_.: I -it-0 Init- t 1 i t D rt- : f -
i: lni.t d .-: t,
ulticn scv. is r Yt', ,. 1 v r- 596 vitl n urb!n 'ti :ulr-
ti'r 2f oi'rl 1 930. : 3t ti.-:; f th Ze:.: Hs:-itl
b': i -t 2---, r b. c c ; fr: th_ 1 'U, ci ic cf
Ri Hco: co i -vr, : T. I :; ut c fro. .i.unic -ticn
'-it Z :e-,.- ... in r- :-i '- < I- 3 : 't : ,. t, _'r c . the
ivt bt t t i n ir tS r v s csn.
It i eu.it :- i t f tris L-.,& i er.n b> s3r rv l
b the hr s .it'./ C-: i Z1c-. .'. C bri' 3 cr ,.i.structi c
o.'v r t,.. r vu.r. F,7'r 3. ti- ." b,.i! it-1 ; t h-s b r
-c .t in Ri ,ncb in or 7 rv (.-v "s sC I-l ruzCcncy
co!:t:.r -1r.< t, rvi .ub3.i l a th s1rvic, ; to t -, r-:nnicirio.
Ir RF :i,-r #7, t-c .cs-.it unit ir. Flcr,:s h- bc sti -.td
t- r d 16 b .o T 't b s. r..' :1-7 st i .rds. Thb e
;.-ininto.ri, c,. S-lu- r :u,-> _,' i'nteiai- 3cai..l is nildin-:
" ^ ;-itf.: u 't ir thi!S l :" it 1.it. C' V C ,r i r-bly :- :c b c s
. .. . 17 .. :, ,. l'.. ^ ti' ; - B ,ry.
Thi '(.icn 1 :hic-]h c n :i .' v tIT D,. r
ccnt"ins -.p'r ir. y 13/ f -. Lnti. ..r ocf Gu tcr:l:.
Its tct-l J urula 2 .r j. -un, r 1 I, 000 r- t "-eil'- -.rc sc-tt -r-
i t- r'-1 h(- ..l t'-i. ,'. ', : -*.": ]cv..'* vr5, t, ilncit. c c of
dis. ', i r1 ul .r, 1 Bri", Dy. i -,1 Typhcid FIever
is hJ-i ' 4 s 1ibly I t f 3 f ct,- : t i lu. r c"-p t_.l
.inist..ri' t. bui] ., : b -i'-l s tc bc incicat d.
E-C -'ED FOP,
A)) iUl. HOSPIT LS
T 'SSIGTT'D TO DEFi'TEITTTL IHOSPI 'L
LOCATION POPULATION SPHERE OF INFLUENCE POPULATION BEDS i7EDED 1 _i S CP C 1,
-TTT ALS CAP7-CIT
DEPTO. DE GU 'TIMA~L
Amatitlan 5,025 Tmatitlan 10,255 50.3 10.1 40
Villa Nueva 6,655
Villa Canales 21,346
San Miguel Petapa 2,073
40,32'
San Juan Sacatepe- ,154 San Juan Sacatepequez 29,674 57.3 11.5 46
,uez San Raimundo 7,637
Chuarrancho 5,200
San Pedro Sacatep6quez 6,328
48.839
TEPTC. DEL }-.:, 30
San Agustin icasa- 3,878 San aigustVin Lcasaguastlan 15,638 26.1 5.0 22
guastlan San Cristobal icasaguastlan 2,595
18c233
Sanarate 5,+499 Sanarate 16,867 34.1 6.8 28
San intoniu La Paz 6,264
23,131
:,PTO DE CHIMNLTENINGO
San Martin Jilotepe- 2,848 San Martin Jilotepeque 32,036 37.6 7.5 31
que
Tecpan 6,166 Tecpan 24,133 51.6 10.3 42
Santa Apolonia 4,22)
San Jos4 Poaquil 10,813
39,175
S1n ..dro Y-oocp 3,691 San Pedro Yepocapa 12,210 28.9 5.8 24
(in s-h..r of influence icatenango 9,301
of Untiu" ) 21,511
HOSPITAL SITES AND 1'TEP OF BEDS RECOM
.) RUR L TIOS-IT.LS (. Continued)
POPULATION SPHERE OF INFLUENCE
POPUL TION
BEDS NfEDE,
BEDS ASSIG ND' TO DEP .:TiENTL.L IOS:TT L "
HOSPITAL C CITY
DEPTO. DE ESCUINTLA
Santa Lucia Cotzu- 4,103 San Lucia Cotzumalguapa 34,308 50.8 10.2 41
malguapa Siquinald 8,318
42,626
Puerto San Jose 2,028 Puerto San Jose 11,263 18.6 3.7 15
Iztapa 3,372
_____________ 14,635 ______ ________
DEP:.RTM3N .ClL HOSPI ATS
B3EDS FRQ : RUTL BEDS AS-IGN E TO S IT LM
UJC TION POPULATION SPHRS OF INFLUENCE POPULATION BEDS IEL3E IIOSl-IT LS REGIOi.. OS _CITS L CAPACITY
]T PROGRESO 3,573 El Progreso 11,337 394 I1? 5.1 47
Moraza'n
Sansare
El Jicaro
7,735
6,779
6,308
32,159
Chimalten'ngo
El Tejar
Zaragoza
Patzicfa
Santa Cruz Balanya
Patzudn
Comalapa
San indres Itzapa
Parramos
Escuintla
Pal{n
San Vicente Pacaya
Guanagazapa
Masagua
La Democracia
La Gomera
14,736
2,220
8,038
11,942
2,698
17,836
18,161
.,052
3,445
88,128
,221
9,485
8,021
-8,707
10,244
9,670
100,09742
100,090
106.3
113.
17.8
12.4
112
13. 12.8 115
LOCATION
,-- "'
-IM.iLTENANNGO
3CUINTLA-
9,108
6,876
D) DE2_T_-T.E 2-1 Z-OSI-ITALS (Coritinued)
LOC TION POPUL TION SPHERE O? INFLUENCE POPULrION BEDS -TLEEDL BEDS FROM RURAL EDS -I-TI'.ZD TO LOS ITIL
-HOSPIT ILS REGIONAL HOSPITAL CA -CITY
LNTIGUI GUiEl*.Li 14,495 Intigua Guatemala 24,235 131.4 5.8 13.7 124
Jocotenango 1,979
Pastores 3,808
Sumpango 8,750
Santo Domingo Xenacoj 2,858
Santiago Sacatepiquez 6,437
San Bartolome Milpas iltas 1,240
San Lucas Sacatepiquez 3,702
Santa Lucia Milpas Altas 1,618
Magdalena Milpas Altas 2,401
Santa Maria de Jesds 6,288
Ciudid Vieja 8,372
San Miguel Duefias 4,098
San Juan lotenango 7,132
San Antonio Aguas Calientes 3,474
Santa Catarina Barahona 1,548
87,940
C" ...T.L I D C-77T" IC- IT7L
FOR TEIC :ITI DOS I
LOC "TION POPULlTION SPHERE OFW TILUETCE POPUL TION BEDS NEEDED :-L, FR7OM RU' .L IDD2 OM AD .' iLI- CA -CI-
iHOSPIT.L DEP. HOSP. ZED SERVICES T"..
3UAT IALA 198,137 Guatemala 210,627 868.7 21.6 44.0 65i7 1o000
M-oosevelt Hospital Santa Catarina Pinula 5,673
San Jose Pinula 9,346
S:n Jose del Golfo 3,164
Palencia 14,764
Santa Cruz Chinautla 5,382
San Pedro Aya-mpuc 8,400
Mixco 11,746
Fraijanes 5,382
274,484
HOSPITAL SITES AND NUMBER OF LEDS RECOMMENDED FOR REGION II. 4,
A) RURAL HOSPITALS
LCCnTICI POPULATION SPHERE OF POP TION BEDS BEDS ASSIGNED TO DEPARTMENTAL HOSPITAL
INFLUENCE NEEDED HOSPITALS CAPACITY
DEFTO. DE QUEZALTEANNGO
San Carlos Sija 946 San Carlos Sija 12,272 16.1 3.2 13
Cabricdn 5.792
HuitAn 2,970
Sibilia 3 338
San Francisco La Uni6n 31019
270391
Malacatan (2) 2.163 Malacatan 14i966 42.5 8.5 34
DEFTO. DE SAN MARCOS San Pablo 9,376
El Rodeo 5,361
Catarina 8.373
38.076
El Tumbador 762 El TuriLdor 18.274 19.4 3.9 16
Nuevo Progreso 11.110
Sn.Rafael Pie de h Cuesta 5.658
35.042
Tejutla 1.068 Tejutla 7.962 28.2 5.6 23
Comitancillo 10.951
Sipacapa 4.335
San Miguel Ixtahuacan 8.350
Concepci6n Tutuapa 14.738
Ixchigudn 4.563
50 899
Tacand 895 Tacand 20.303 18.1 3.6 15
San Jos6 Ojetendn 4.973
Sibinal 4.403
Toctitan (Huehuotenango) 1.867
31.546
ZPFTO. DE TOTONICAPAN
Momostenango 4.25f Momostonango 27.161 25.9 5.2 21
Santa Lucia 3,132
30.293
A) [UIL HOSPITALS (Continued) --
LOCATION POPULATIOil SPHFE OF IPFLUJICE POPULATION BEDS BEDS ATH.'ULD TO HOSPITAL CAPACITY 5
___~______________-__________ _`_____EEDiD .DELRTFiL:TT ( THOSPTTAL_____
DETiTO. DE _HUE-U-T C _.,T
San Ildofonso Ixtahuacdn
San Juan Ixcoy
1.193 San Ildefonso Ixtahuacan 8.076 26.3
Colotencngo 8.369
La Libertad 7.908
La Democracia 3.713
San Pedro Nectd 8.369
Cuilco 8.747
San Raf.el Petzal 1.552
San Gaspar Ixchil (+)
Santiago Chimaltonango ()
697 San Jurn Ixcoy 5.307 27.3
San Pedro Soloma 9.376
Santa Eulalia 9.187
San Matec Ixtattn 8.705
Sa Rafaol la Indoper dencira /4 .929
5.3
Santa Cruz Barillas 13.592
51,096
:ar hiruol Acat1 n 1.919 Sacn iiue Acatan 12.292 24.5 4.9 20
San Sebastian Coqatan 4.741
Jacaitonan-o 7.740
Monton 5.391
San-- Antonio Ihuista 3.461
Concopcion 5.831
39.456
39=56===.--------------
Joyabaj 1.462 Joy'baj 22.846 19.9 4 16
Zacualpa 9.446
32.292
Santo To ds Chichicas- 1.477 Sto. Tom's Chichicastonango 32.666 19.9
tonango
Santa Maria Nobaj 4.129 Santa MIaria lebaj 15.087 38.4
Chajul 7.871
San Juan Cotzal 9.483
C'Ln6n 6.559
San Miguol U-spantn 17.617
56.617
4 16
A) RURAL HOSPITALS (Continued)
LOCATION POPULATION SPHERE OF INFLUENCE POPULATION BEDS NEEDED BEDS ASSIGNED TO HOSPITAL 56
DEPARTIE.TAL HOSPITALS CAPACITY
_______ ____ ----------------------------------------B--------------------i -,-----------------------
DEPTO. DE SOLOLA
Panajachel
2.017 Panajachel
San Andres Semetabaj
-Santa Catarina Palop6
San Antonio Palop6
San Lucas Toliman
Santiago Atitl"an
San Pedro La Laguna
San Juan La Laguna
San Marcos La Laguna
Santa Cruz La Laguna
San Pablo La Laguna
Santa Clara La Laguna
NahualA 1.050 Nahuald 20.991 18.6 3.7 15
Sta. Catarina Ixtahuac&n 10.765
31.756
B) DE7ARTIiNTAL HOSPITALS
LO( .T.A POPULATION FL OF LUENC P0OUL-TIQN BEDS NEED. D BEDS FROM RURAtL NEEDS .. I TO HOSPITAL
_HOSPITALS REGIONAL HOSPITAL: CAPACITY
SAN iARCOS 4.399 'San Marcos 15.468 51.2 21.6 7.3 66
325 San Pedro Sacatepequez 12.411
7.824 San Antonio Sacatopequez 7.757
San Crist6bal Cucho 4.449
El Quetzal 5.749
La Reform 7.072
Tajumulco 10.380
63.286
TOTONICAPAN 6.932 Totonicapan 33.199 53.1 8.9 6.2 56
San Crist6bal Totonicapan 11.311
San Francisco El Alto 11.515
San Andr6s Xecul 5.386
Santa Maria Chiquimula 10.291
71.702
4.6
2.521
2.691
708
3.031
5.892
10.878
2.823
2.115
576
1.228
1.171
2.351
35.985
B) DEF:.T/T; T.,L HOSPITALS (Continued)
LOCATION POPULATION SPHERE OF INFLUENCE POPULATION B4DS NEEDED BEDS FROM RURAL BEDS ASSIGNED TO HOSPITAL 57,
HOSPITALS REGIONAL HOSPITALS CAPACITY
HUEHUETENIANGO 6.305 Huehuetenango 17.032 51.1 15.7 6.7 61
Santa Ann Malacatancito 5.580
Chiantla 14.380
Aguacatin 11.096
Santa Bdrbara 6.020
San Sebastidn Huehuetenango 4.594
Todos Santos Cuchumnatin 7.677
San Juan Atitan 4.426
70.605
SANTA CRUZ DEL 4.143 Santa Cruz del Quich6 21.140 43.1 15.7 5.9 53
QUICHE Quich6 6.990
Chinique 3.523
Patzite 1.424
San Andr6s Sajacabajd 10.064
Sacapul s 10.889
San Pedro Jocopilas 7.178
San Antonio Ilotenango ,.629
65.837
3.904 Sol old
Concopci6n
San Jo Chacayd
Santa Lucia Utatldn
Santa Maria Visitacion
18.338
907
774'
6.034
633
26.686
23.1
4.6
2.8
S) i: 1: I : . HOSPITAL
LOC. TION POPULATION SPHERE OF INFLUENCE POPULaTION BEDS NEEDED BEDS FROM RLRAL BEDS FROM DEPART- HOSPITAL
HOSPITALS ENTLL HOSPITALS CAPACITY
37.230 Quezaltenango
SalcajA
Olintepoque
San Miguel Siguild'
Aimolonga
Cantel
La Esporanza
Zunil
Cajold
48.891
6.234
7.069
2.258
5.056
10.873
3.362
4.271
5.621
241.4
28.9
274
SLOLLA
QUEZALTENiNGO
C) REGIONAL HOSPITAL (Continued)
LOCATION POPULATION SFkhL OF INFLUENCE POPULATION BEDS
San Juan Ostuncalco 16.493
Palestina 5.105
Concepci6n Chiquirichapa 4.639
San Mateo 1.154
San Martin Sacatep6quez 8.762
129.788
----------------------- r population for unit atQuezaltenaango is
(2) Hospitals are estimated on basis of 1/2 beds
1,000 rural population.
(+) These municipios were forned ofter December 31
(&) Rural hospital at Nahuald is dependent upon Tc
HOSPITAL SITES AND :'T'. OF BEDS REC. TTED FOE REGION I
O) R I HOP IT LP
LOCATION POPULATION S% S I OF INL, CE POPULATION BEDS
DEIrO. D, I.T. LT-.TLU
San Feli-ne Retalh-leu
DEiTO. DE _id 'LRCOS
-yutla
San Felipe Retalhvleu 10.551
2.802 San Martin Zapotitl-n 2.777
Pueblo Nuovo 1.559
El aalmr (u tenango) .o62
26.349
ayutia
Oc6s
4.015
6.137
DE Chicaco 2.580 Chic. o 26.822
Chicacao 2.580 Chicacao 26.822
San Miguel Pandn
4.349
31.171
NEEDED BEDS FRON RURAL BEDS FROK DEPART- HOSPITAL 58.
HOSPITALS MENTAL HOSPITALS CAPACITY
asked on 1 bed per 1,0001,
,r 1,000 rural population. MalacatAn is based on 1 bed per
1946. Their populations are included in other municipios
onicap n.
:I
NEEDED BEDS ASSIGNED TO HOSPITAL
DEFARTMENTAL. HOSPITALS CAPCITY
1.9 6.4 26
I-
4
6.1
10 (2)
36.4
A) RURAL HOSPITALS (Continued)
LOCATIOII POPULATION i: 0rL OF INFLUENCE BEDS ASSIGNED TO DEPART- HOSPITAL 59
POPULATION BEDS NEEDED MENTAL HOSPITALS CAPACITY
Patutul 2.962 Patutul 15.762 58.8 11.8 47
Santa Bdrbhra 23.535
San Juan Bautista 2.971
Pochuta (Chimaltonango) 10.526
52.794
B) -DLEf RTMEITAL HOSPITALS
LOCATION POPULATIONSFHEIE OF TiFLT'TCE POPUL .I',i; BEDS :ZLDED BEDS FROI1 RURAL BEDS A-IG,--ED TO HOSPITAL
HOSI ITAL REGIONAL HOSPITALS CAPACITY
COATEPEQUE 7.025 Coatepeque 28.839 95.8 1.2 9.7 88
Genova (Quezaltenango) 12.836
Flores C. C. 6.700
Colomba 28.422
Pajapita (San Marcos) 501
81.816
]T. i L-nL.U 7.566 Rotalhuleu 21.374 76 6.4 8.2 75
San Soebas
S:-n ndr6
Champeric
Nuovo San
El isinta
C) -1I, ..L HOSPITAL
LOCATION POPULATION SPHIF
RE
tif.n 7.024
z 9ulud 3.383
s Villa Soca 6.426
o 2.808
Carlos 12.571
l _7.21L
0. .799 7=Z
OF INFLUENCE POPULATION BEDS NEEDED BED FROl RURAL BEDS FROM DEPART- HOSPITAL
HOSPITALS MENTAL HOSPITALS CAIAC ITY
15.398 1iazatenango
Cuyotenango
San Francisco Zapotitlan
San Bernardino
San Jos6 El Idolo
Santo Domingo
San Lorenzo
Sam ya c
San Pablo Jocopilas
169.5
29.714
12.260
9.997
4.742
3.955
13.401
4.723
9.190
6.848
19.1
17.9
207
E
. C) REGIONAL HOSPITAL (Continued)
BEDS FROM RURAL BEDS FROM DEPART- HOSPITAL
LOCATION TION POPULTION SPH OF INFLUENCE POPULATION BEDS NEjEDED HOSPITALS MENTAL HOSPITALS CAPACITY 60.
San Antonio Suchitep6quoz 21.174
San Gabriel 2.145
Santo Tomas La Uni6n 3.719
Zunilito 1.476
123.344
(2) Revised to 10 beds. This unit is already completed.
.HOSPITAL SITES AND NUMBER OF BEDS RECOMMENDED FO,1 REGION IV
A) RU-LL HOSPIT-ALS
BEDS ASSIGNED TO DEIARtT- -HOSPITAL
LOC TION POPULATION SFHEFE OF INFLUENCE POPULATION BEDS IIEEDD iTD.L HOSPITALS CAPACITY
DEPTO. DE JUTLA
sumci6n Hita
Yuapilto-peaue
6.158 Asunci6n Mita
Santa Catarinn Mita
1.637 Yupiltepeque
Atescatempa
Jerez
El Adolanto
Zapotitl an
26.329
18.702
7.049
8.161
3.313
4.914
4.717
28.174
57.5
31.3
11.5 46
6.3 25
" Jalpatagua 1.516 Jalpatagua 10.185 53.9 10.8 44
Comapa 14.365
Cong-aco 7.205
Moyuta .14,854
Pasaco 4.270
50.879
DEPT0. DE JALLPA
Mlataque scuintla
5.268 4ataquescuintla
San Rafaol Las Flores
San C,-rlos 1lzatatce
8.250 San Luis Jilotepeque 16.414 33.1
22.905
4.099
4.346
31.350
42.0
San Luis Jilotopoquo
6.6
A) RURAL HOSPITALS (Cobitin ed)
LOCATION IOPULATIO SPHERE OF INFLUENCE POPULATION BEDS --pE-ZED BEDS ASSI'-9ED TO DEPART- HOSPITAL 61.
MENTAL HOSPITALS CAPACITY
DEPTO. DE SAiNTA FUOS
Chiquiaulilla
6.188 Chiquimulilla
San Juan Tecuaco
Taxisco
Guazacapain
Nueva Santa Rosa
.oue iNueva Santa Ros.i
Santa Rosa de Lima
Casillas
Pueblo Nuevo Vifias
2.329 Pueblo 1iucvo ViSas
B) TDEJ .2jr L -.L.
LOG -TKT,_T
POfULATION S2 1 IE OF -TILUENCE
POPUL.1TIOU BEDS NEEDED BEDS FRON RURAL BEDS ASSIGNED TO HOSPITAL
HOSPITAL REGIONAL HOSFITALS CAPACITY
JALAPA 11.355 Jalapa 50.376 117.6 15 13.3
San Pedrc Pinula 28.870
ionjas 9.881
San Hanuel Chaparron 5.605
94.732
CUAJi I UI L. 4.402 Cu4jini""ilpa 14.832 82.1 26.4 10.9 10.9
Barborena 24.503
Oratorio 10.975
Ixhuatan 14.683
Santa Cruz Naranjo -.105
73.098
120
C) RE,:-!:;.._ K~.-!TL7
JUTIAPA
7.623 Jutiapa
El Progress
Quczadta
Acatenpa
53.236
10.896
9.829
8.850
82.311
10.6
24.2
28.6
155
67.1
25.453
4.360
13.621
11. 26
54.688
13.4
17.366
7.155
12.149
36.670
42.3
17.776
22.3
4.5 '
HOSPITAL SITES AND NUMBER OF BEDS REA N DED FOR EGIOiT V
S) ['ll: ^ H 0'. IT ._L ..... ....
BEDS ASSIGNED TO DLL..T- HOSPITAL
LOCATION 'OPULXTIiOH EF L OF INFLUENCE POPULATION BEDS NEEDED ilT.1 HOSPITALS CAPACITY 62.
DEiTO. DE ALTA VERAPAZ
San Miiguel Tucur-d
665 Sain liguel Tucurid
Tanahi
Senahi' ( 2)
1.447 Sonahid
Cahab6 i
Chahal
DE TO. DE BAJA VERAIAZ
Rabinal
4.661 Rabinal
Cubulco
El Chol
Gran c o
19.684 62.8
19.275
5. 61C
53.34i
B ) .. ', L i -
BEDS FROM RURAL BEDS AS3IGED TO HOSPITAL
LOCATION IO0?ULATICON 1 i- OF 71. ______ POPULATION .:T'7 ._ HOST11 L ICI-L HOSPITALS CAPACITY
SALI:'a, B.V 4.456 Sal .. 20.&3 5C8. 12.6 7.1 65
San Jor6nimo 5.463
-urul"h 16.358
San Higucl Chicaj 7 _43
4?.734
__C) i- CEI'1iV'.L 1; i .IT_
POPULATION SPHEIRE OF IirL L7I'
8.808 Cobln
Santa Cruz Verapaz
San Crist6bal Vsrapaz
Chamolco
San Pocro Carchd
Chisec
Tactic
San Agustin Lanquin
POPULATION BEDS NEEDED
45.924 193.8
6.378
20,996
19.666
92.634
1.718
8.474
9.610
205.420
BEDS FROM RWLXL BEDS FROi DEPART -
HOSPITAL :' L HOSTITALE
11,2 7.1
16.220
21.637
21.637
23.1
4.6
32.5
33;258
20.152
5. 069
6.5
26
12.6
LOCATION
COBAN, A.V. (-G+)
HOSPITAL
CAPACITY
213
(2) Senah'u, lural Population 1/2 per 1.OOC., 63.
(+) Cobdn, 3/4 bed poro 1.000 population for Cobdn and San Pedro Carch,. 1 Bed for the other municipios.
1/2 bod per 1.000 population for Chisec and San Agustfn Lanouln.
HOCQ- TL SITS AND ', OF L RECOl ENDED FOR REGIOIT VI
A) RUEiL HOSPITALS
LOC-TIOI,
DE!iTO. DE IZ L
Living st on
BEDS ASSIGNED TO DEPA:T- HOSPITAL
.O. UL TIOI TH ,RE OF INFLUENCE iOULLTION BEDS NEEDED E- TAL HOF ITALS CAPACITY
5.280 Livingston
El Estor
Panz os
(Q) 16.396 26.4 5.3 22
3.805
6.086
26.287
DEO r. VDE zAi::
Guat-ln 5.889 Gualn
L Uni6 on
LOS .."1ntes
Ca>a rs 2.664 C>bte
To cculutd
S-n Diego
JTocotin
Esquipul~.s
Rio Hondo (Zacapa)
(Tentativo)
1.693 Jocot2 4
2.151 Esq'uipulas
Olbpa
Concepci6n
Quczaltopequo
1.930 Rio Hondo
(~ )
34.742
Ii .L ."r
714G.2
70.82'-
71.0
14.4
17.700 38.1 7.6 31
4.813
4.453
* 4UO
27.177
19.489
46.666
14.C11
10.712
8.550
16.0043
49.316
14.596
50.1
53.8
1l.4
10.0
10.8
3.7
(0) 1/2 bec' per 1.000 of rural population
(E) 1/2 bad per 1.000
B) DEPARTMENTAL HOSPITALS
LOCATION
POPULATION SP t. .I.r.... PCPULLATION BEDS NEEDED
fiE fFRON RURIL EEDS ISEIGNED TO
HOSPITALS REGIONAL HOSPITALS
HOSPITALS BEG TONAL HOSPITALS CAPACITY
PUERTO BiJRRI(-_
17,155
Puerto Barrios (L)
Morales (2)
CHIQUIMfULL
12,447 Chiquimula 35,614
Agua Blanca (Jutiapa) 15,477
San Jos6 La .Irada 6,193
San Juan Ennita 5,884
San Jacinto 7,542
Ipala 11.929
82,039
106.8
20.8
12.8
115
C) REGIONAL HOSPITAL
LOCATION POPULkTIC1: SFPER. OF INFLUENCE P0-ULATION ZUUS IESED BEDS FRONT T-.L, BEDS FROM DEPART- HOSPITAIJ
HOSPITALS MENTAL HOSPITALS CAPACITY
ZACAPA 15,856 Zacapa 54,527 1CS.1 25.7 22.3 157
Estanzuela 5 .8
60,375
(a_ Puerto Barrios, 4 beds per thousand for the city.
(0) Morales, bed per 1,000 to Puerto Barrios.
Other medicJ nads proved d by Quiritu- Hospitc1
HOSPITAL SITES ND TUi'.BER OF BEDS I-CCi ]ILiD FOR 1 -- VII
A) L.T.L, HOSPITAL -----
LOCATION POPULATION SPHERE OF ITLLUE;CE POPULATION BEDS NEEDED HOSPITAL QGJPA-.CITY
FPTEN 1,653
Flores
San Jose
San Benito
San Andr&s
La Libertad
San Francisco
Santa Ana
Dolores
San Luis
Sayaxch&
2,755
690
1,040
1,434
958
1,040
183
625
2,661
868
12.251L
12. 25L
17.9 16
27,308
208,11
48,119
89.4
5.3
64-67
HOSPITAL
CAPACITY
9.5
68.
RESULT, OF HOSPITAL SITES ;IT)D LTUMBER OF GENERAL HOSPITAL BEDS
RECO'TiEKNDED REGION I
A) RURAL HOSPITALS POPULATION SERVED HOSPITAL-CAPACITY
1. Anatitl0n 40,329 40
2. S-n Juan SacatopL-quez 48,839 46
3. San A.-ustn Acass ustl.n 18,233 22
4. Sanarato 23,131 28
5. San Martin Jilote-cque 32,036 31
6. Tecpan % 392175 42
7. San Pcdrc Yopocapa 21,511 24
8. Santa Lucfa Cctzun-3.'-upa 12,626 41
9. Puerto S-n Jos6 14,635 15
B) DEPARTMENTAL HOSPITALS
1. El Prccreso 32,-159 47
2. Chimaltenangc 88,128 112
3. Escuintl. 100,090 115
4. Anti-ua Guntcnala 87,940 124
C) CENTRiL HOSPITAL
1. Guatenala (Rooscvclt Hos-
Tital) 274,484 1,000
D) PRIVATE HOSPITALS
1. Tiquison.te
2. Hospital Ariric.no
3. Casa del Nifio
4. C-sas do Saluf.
863,316 1,687
27,899 320
57
32
169
891,215 2,265
Number of general hospital bods per 1,0CO population: 2.47
ce.,
REGION II
A) RURAL HOSPITALS POPULATION SERVED HOSPITAL CAPACITY
1. San Carlos Sija 27,391 13
2. Malacatrin 38,076 34
3. El TumbC.cr 389042 16
4. Tejutla 50,899 23
5. T.cand 31,546 15
6. Mo s t.n.n, c 30,293 21
7. San TlC,.fcnsc I t-hunc.n 1+6,73L- 21
8. S.n Juan TI:coy 51,096 22
9. San Miruel Acat'n 39,456 20
10. Jcy.--j 32,292 16
11. Santc Tcnls Chichic,-stn.-nco32,666 16
12. SPntr lrh Nbj N6,617 31
13. Panaj- chel 35,985 19
14. Nahuald 31,756 15
B) DEPARTMENTAL HOSPITALS
1. San Marccs 63,286 66
2. Totonic-rn 71,702 56
3. HuehucttnanLo 70,60 61
4. S.ntr. Cruz el Qich 65.837 3
5. So 11 26,686 25
C) REGIONAL HOSPITAL
1. Quozaltun~cgo 129,788 274
967,753 817
0.84
NuiQor of
70.
REGION III
A) RURAL HOSPITALS
POPULATION SERVED
HOSPITAL CAPACITY
1. San Felipc Retalhulou
2. Ayutla
3. Chicacao
4. Patulul
B) DEPARTMENTAL HOSPITALS
Coatercque
Ret.alhuleu
C) REGIONAL HOSPITAL
1. Mazatcn-nmo
Nurmbr cf general hospital beds per 1,000 population: 1.26
26,349
6,137
31,171
52,794
81,816
60,799
123,344
382,410
207
483
REGION IV
A) RURAL HOSPITALS
POPULATION SERVED
HOSPITAL CAPACITY
1. Asunci6n Mita
2. Yupiltorcque
3. Jalpatagua
4. Mataquescuintla
5. San Luis Jilotepcque
6. Chiquinulilla
7. Nueva Santa Rosa
8. Pueblo Nuevo ViHas
B) DEPARTMENTAL HOSPITALS
Jalapa
Cuajiniquilapa
C) REGIONAL HOSPITAL
1. Jutiapa
Number of general hospital beds rer 1,000 population:
45,031
28,174
50,879
31,350
16,414
54 688
36,670
17,776
94,732
73,098
82,811
531,723
120
98
155
655
1.23
72.
REGION V
A) RURAL HOSPITALS
1. S.n Miguel Turuc6u
2. Eencahi
3. RaMbin-l
B) DEPIRTM-NTAL HOSPITAL
1. Sal-1r, B.V.
POPULATION SERVED HOSPITAL CAPACITY
21,637
58,069
53,343
49,734
C) REGIONAL HOSPITAL
205,420 213
388,203
Nunbcr of ccncral hospital beds Ier 1,000 population:
1. Cobin, A. V.
0.96
734
REGION VI
.) RURAL HOSPIT ALS
POPULATION SERVED
HOSPITAL CAPACITY
1. Livin' stcn
2. Gualan
3. Cabanas
4. Jncot5n
5. Zsquipulas
6. Rio Hcn-'-
B) I". I' ., '7 L.. .... '; h.L_..
1. ru.rto B-rries
2. C hiOqui.l .ula
C) R,,N.,L HOSPITAL
1. Zac.p
D) P-IVAIT- HOSPITAL
1. Quirigu
411,816 568
120
411,8 16
Nunbcr of c.ncr.l h,-:sital LCs ->,r 1,000 population:
REGICH VII
-) RURAL HOSPITAL
1. Ciudadc Florts, Po-rn
12,254
12,254
Numbor of f'enorol hospital L.Os pr 1,000 population:
26,287
70,823
32,406
46 666
L9 316
14,596
27,3C8
82,039
60c,375
86
115
157
688
1.67
1.30
RT3Kr, T : :....- r ,- -.Tf" 0 ,: T- : .: y-O ,.
TIOhJTY X C ./. 3.':.!.. O.. SJ IT.,L UI.Tis
.t th. r s:i ti l-. --t_., 4 1-t-s- it- S--t -i. iS nC.r the
control, -' f tl-'.. '.ini-.r t <. S-3 luc bli.--- y i sistcr.eir Social.
Thi, IrstiluiC GCu,.tor.> t' ,C ..:'.,Si b 5rc ,'., is ovidill,
cert-ir- 'c"'i.e s rv n';: u -" Lly r ,.:-c :1c -r_,scrt tjre-,
ich I "-r u i, i - -j:r '--" it l fa-
cil-ti.- ^ r o vri bi.. o
'rI c p-tionrl ,ir.-^plt; r: .;r i :-,
t T r,, .,tL : n1 :~,,; .i.,
V r i J L r j r -
3 c. .i I. t-1-. t :,:nsti t
: d i ~ ': c i c
.t f t r s '
i[ '.r -l .i' Il -" "*I 'C" r -i "
titutc vi 3? .. t,. ';ti. .. < ;-.*
if r ;:t v
tc :.ll r f'T s t7 vhic ,!. ',s,
c 'or'ncnir,: wi t1, t- D, .- .
S '- its -'- ctl ,,. th. pro--
-la.Bcth
S t- - ti- ,.
: 1 ', i ,1, ,si_3 .:i,- durl /
_. 3 in irt,:r..:t .::7_ lir in
--._' "s *f th country, The
: J t, i ; C h,- dl-
.10 C?. hu !ed:cal
i... -or i.s
'- -. v-" '-. 'fcr l--
*"'7 .. . i: the Ins-
Sri Tub.. rcu os i,
; i- th . :Lo
-, -I-
(11
-f:I Cs
HIc cvtr, with-in t- J c to -it
v cy i. ll 1V E' r 3 c ,.ri" ii: t"'. fc,... n. .
\TC ". 'Ij -j 1. .i-.? "..] ...
l .r;;c r'" .." of the c-r-n . ill v. '.* nv r. ,c i.r thr.T
tutc .-n' te Institst ,11 re., 1'_ (co >l:t hoc..it- f:
to cnrry on its cco: --. -' l -sin- -.. ,," r -
The field w :: of L- v
cxistJrn., ho;si itrls now m u : :i n
ir: inadoqu-.t by T .: ; 1 ... .
ucd. In other ords,- it 1 : : :.
hc spitals vit r.w .rp:' -.i uni ;o .'. tic'.
rat hc,-tir. 1y l r" r- v th r i.r t0 ri:n.c .ld.
ing tc' nec vil hr'v.c. h. bu L c cc-rc '1-..
a>rcrs now uncover, .
, .- <' .y all i-hc
S uind riblica
Sc '1, 1 ;bl -l dc'-i
, op cal' tiorns of
'b!
Accori. t ic 62 u v -'c.'ri- S uT-rty, eventual-
ly cli bospitn' .utio. \..ill b .c .r t-. Institute a-s a part
jcf its f-r 4cM-I-- ''.S -: -".L security. Hr-cve, the-rc
will inev-itably -' tr..: iti.c" .ri during which tire the
Irstitutc I,:. h v 1 1 t r.l: ..- -t. ai.d the ljnisterio
will ;:I-so havi hcsspit 'is uncler : ts I.n- juri-: ict; cin. Every
at 't s o d t s b-o-. I t: 1 r-".;,'.; : '! ."s
sho-rt -s pcssiblc. I rvc clc:. --Ti ; ,c b3A. si on.al
period the ILinist ri' ri'. t-, Iti -rt cn and rust work in
. suir-
ds .
I.-:sti-
c:.7 ..ios
ve
co Q an t V 0 1
tu acc,.3:l ,.1.1 c .
i.:c'ic 1 c1 t L-i
W .-.4 ] .T r n cr
" 1 ;>.;_' i "*," 2 ,- 2
To: list c'f rne he-. 1
-ic .tcs th rsy-ctiv
t4. h iis Lar. Sin "
t th, '"r t V c in
7r" cci ...a" "i c "tl.'-
tie;u.N.''. y ti'n"c -u ,: c '"
.' l "c -' r :
T ,-" :l. L it mt i 0
M rC .,:o A --
. i
,.: .1 J .. .;
" --" 3 ;*,r' U '\ -r 1
.- t 1:t .n -
3 rt r JSt -
TV;: .i-Moi.r hospI.tAl
fil -- j -i- : -yt .'.1 L thcr
- :c .- -L. 1, 7 r .W d
. 5*- *,-.:i' ? e,
.".. . .. )m f reti r J ly
TF a-;, O: f',r 1i',, r, nent Any
rmziovtv"; c. r 0: ] iristric.
S- "I 11 f rcti-r -s
: i ini str tivc
:. i ( 'ini, o r..
( ' TB T i'* 1( / p '. V TPI IThi 10
. Escu.irt .
2. 2Li 167
3. Chi ltnr-:c 1 .'
3+. El lrc.' rc '+7
?. 3en Ju-. 3 lt '+
.. M AC. 3 7 s2-> 15*
6. A1 1r.t tI 3 1 S0
1 o ].-.'. ,. 3"' ,','Si. 1 5
. T cr IT
S.Sr" 1 .- 66'
12.Sci' 4. 25
13.T t nO 0ri n w6
17.71 Or 1 S -!
TI -T 1 >117J: T-ud'1ICC Y
fIl I U T. 01 BE'S
1. -IC ,,v -pT- iT]. 1,.000
., 3T -rtc. 28
. 3- *L ,'. tIr i'c- 2 .... :u-3-
U 22
3 r .r Jilot -c'uec 31
3o ..-. ]"-..2 Y : n 2)+
-S-1' II.
,3 r C-,s W oi A 13
*- '15
:0 N; 1...!_
11 h t. :;c 21
12 3 ,; IL ..;.' m-SO1c 21
13 3- '_ I c r. 22
141 3 '. 1 Le t'O 20
C .. -. --:i .- i
.S. JI 1 -6
17 3 '. T(_ .: .s C;i.cLi c. .s-
-" t- .: 710
L" :n .r III.
1 ...t-lhul<.u
19 3r FcliJL
20 PF'-uilul
-t lbuli
21 Cu- iinir .il. u
22 J-: -:
23 ..su cin I :, "
24 Ch ,u.. u..il.-
,IfT /
" '( 'l VI
29 Cliri io,: -
30 Gu '- '_.n
T l, l 1
1... ._ iT.. n r
li C "
20 Ayut:
21 C .c..."
. T#( TX,
22 Juti .
.- 23 J 29t u 1
1 20 2,4 lyl,.l u
4-S 25 F v i -nt- l.s.. "
!J1+ 26 FL.:_ I u', vO Vifv-s
27 I -t ,.. scuintl
2C 3' L-is Jiil-t&&cmuc
213 29 S3 .1rn
67 30 3-n 1 i':u 1 Tueuri
r31 Z c ,-
115, 33 .i: H:onic
35 J.- t -tn
36 Litvin :'t(nr
;..C2'IC VII
2,2f6Q Tot 'Is .
Thi..s, tc TrT it .,t -w h'- v i .. 7 tl rstr cor,_risin,-
2,26_ th l ini..rio C b C., Thcr,. r (- ccrt-Ain
hc^-y ite s S t..r; unJ (.'..:. :ir. _:-;t, which a.,c of prilC in-
tcr- st tc th- I sttu.. be t ..r rt-' t i l':c in-
dustril :'n1 cr. rrci c TE.-, r-.. t "ht iCOS( t.v IIcs-
pit:-.1 -.nr t ,- h-"'s it 1H in i L. Or :-. JutiL"' Z-c5 -.., -nd
Cotc; couc. H.:o:..,vcr, t.. ; iniX i..: c .1 bu1i::ldinf these ho]spi-
l I t the prr-s' t ti .- '1.i' o s l' v.- ,: it. which nc-
s- -ril_ vij l s rve -; th. c;.rt-p- hc-s;it.-l ,r "-n"-. .in
- t- ,'nti.,- :hos.i-t1 o.. r ,.-f Gu ti.-i i b T-ir u.ilt
b t -I.ntitut of ,nt J. c. ..-. r f*-.-rs urdcr the control
i. supervision V of th, 1 i 1t-u Tio. Cor .tructioar cn this hcs-
.it.a is f-irly i 11 r, v..,c.i : r is su;:jcct to r. :r'pr tc
ccntr'ct bcti cn t< C-uovcrir-cct of Gt. ..rl -rc IrnstituLu
lf I'r-,-7...-A :.ri- n _,ff-i- i T: .: -f S*fit-1 ir! I -st. r-.nsio is
nc tr eo -,llctjonn .rc: .-il] -LV l'- -*.:- ir, c r -tion in the nr? "
fut-ur- H w..v r, co .ctior, t- Z7 I- Jut-i-r. -'n.i. Co -.
i- pc."-n ('jt' .y'-, '-:. t -.. .ur'o. The:,- is still ti hec for
,:. c.c T. .tive ~rrr' -.i <.t (ti".u.. t: IrstittiLtO "-J thi i inis-
tUTr.. t'' cor et.t th6 c'ratructi. : th1-s- hoCs],Ciit-1 units.
OrC crily, if th' r. ic <.t irc1-.y st-rt.d the cons-
truction of th,.L c ;'p'it- 1 it; th-y would vc i cn listed
in the: Inhstitutco colu_,rr
207
88
10
30
25
34
18
341
27
26
19
157
31
15
43
41
22
16
2,379
77.
-7.CO ITT'" :..,, CO CCT '' T. .CT C F J 7.l 'D
It is .vi<..nt- th.. G .v-.'. r .. ,i/-, Dr in- or r ar. u ".nd lor.;
.:rn;"r-." o' h :c5.o o.. str *cti Jr i rder to r"' vic. neededC
h. r-it f-ei ":ties f' ... .. f thi ort -y. In this
" rrT i ,th t: stit.vtc Id t... :fr.i-rt -:L ->. i T vit-lly
intr-st It is ssr.ti C1 c crstructI i
.n rd"rly f~hicr 1 c .tt. coor-.in-ti, b'l_ L e',c the
Institute, r.c-d th. I ,::ri tcri, s, ich:rt Lv.-a t, 7ly .. -6rificd
Sn. i:-.. 2-- 5.:1 r t:- c''t ~i c, ,artry sh:. ciwr c.r As
,,c ".rt <.L Cii .. i- y wfih one hos'-'it:l :1,r" priority
of corat- Cti cf h It1 its 2 .t n-it..( ir- .r list.
--cr- rt .-i ri r i '. ; -Ut t tv. -.-... t ir ccnsidcr-
It .* 1 '.'iri>._l th .. Irr l o .r hi sTJtr.! ur.its 1* st-rted
first : (- th y c, r 1 ..;- -. .. s b 1f tihe ornpt ti ;on,
:. ~' th_ ,i '.__ r units *-.. ',;.; "f t u1 r t i on
0h.x 1er u'11t'o. t -. in !r, intW0t
Si,' .t-_ sy t r.. I i. ,rr-r r- .t , t s- ir.r cons-
trcti t.t 11 th. il7tl :h- n t s-it 1 rc-
ri*-. '' v l oi 1 th- aU tir.o 1 is .culc facilitrtc
th: .tn,'i;o ; Sci'" s curL bcr- its tc t-, rc.i.n at
t h e t v. .. .- i t sje r v i, : r ,.v l . i G cfr r n l
th. :st h:s b::or' (T i' frr" the vii"o:nt i f ivin: priority
tc 1.0 i .-cor:_" c ,. .h -. v -'--- 1-rs th- Ir.stitu-
tc. J .th--: h tl., c0- riry h ..n ..-v- .- ir- r .icrs ct-ch
dI..p rt- rt -y 'I b r,-r -: ,'r s t. ur-i ir, r--. ir. 'f .ns i 'r
coi" tr' ..ctior.
It will n:t:.c, i bt'U i s.t, t'.:'t th.. ,'rs't nossiti-l listed,
-l 6 sncl3 iv, rs i.'-il : 'cy under cn-rstructin
Tby T. I nistcrio, : '-; -is fr th- -t .r ra-.sn th t they
.v. th it It is intr,.. stir.:
t. .t. tL:t the fir.t lv h th1 liSt -r lc t..ced
in I..'-" urb" n c.-it, ,"; it, h l. . sS: th' 'n 1',ur c_- c-i ir''- hos-
Qu-r.1tnr: is lii, s 7 : -inc,- the InT-titut- hrs clrcry
t.-r ..d i' -"ctivt ti. --th .ity:. This losrit .! is so c
r 1.;ior.- ,o:pit-_lo -Ai .. t rt r i c ..:-.' h it-.l only c n-
ti;i. 2-r d Co't'-" ",: .r d2 r 'on th,;. list, n rrrcly in 0c-
siC UC 16 '.n' 17 .rI-s .ti.vcly. Tho r.assn vhy those two
L .s it..1 nic- l e r- c"'ivn c1 .h- riri ty'2 is th'-.t these
cc runiti. -Ir-"- - .. ...it u:-.i s suporiir to the
ver' : O L'-tcw '_lr l S t -C.l
Escruirtl. is directly ,v 'ue.i lte:n.. is th re1 t hospitr.l
to -e cost tc. ; -s t *c into rccorunt the f:-ct th-t
tbc Instit.to ..s. I.. y ext c.. its bcneifts to this reo.
Ft 11, l.ii -sc uintlt- *-. -, ., lic:-t Curt.jinlcuilr.p- El Pro-
S .rd Chi -t? TELir r ttively hJi h places onr
t. list r u tc t f.ct t.t the" n ,.-rtr ,.nts h:'vc no
I-) spit rnits r.t h .rt ti e. It is the-..fore, ur -f .nt
-tht cnotrictirr or t ~: st-rt. -s r y -i
ossi .... T-is is p-.ttiicul-.r y tr -f th- -.rt:re t_ cf
: t-, s- which h- -'r -re b. c -r ,,n'.nt unn th.. Gc-
nriA fsit-l f : ti ". cf its sick. Drn'- 11947, 29418
J.ti,- i tr-v.]cc fr -r:.- ]3 ; tc thic G n .r-.l Hr- s it!.,
1 cT :.-sc sent 1,038 :.tint; to to h s( l- siit-l 1uiring
t-h sa y... ... ._ This -. .s -. t i. 1 f 3456 ,rticnt from
th.e1 two d'rtr.r-tts thi.h h-n bicn .n ir- -crtmnt f-ctc-r in
th- scrlus overcrr-irv r f thl Gucn-rA-. Hcspitrl. Of -.11
the bees in the Gen...--I H '.pit-. 12,7 5.$ wi.rV occur: cd by in-
hbit-ats of those two -rtran..t. An ci.r .xir'tc figure
cf 115 'bods ..-vo to be st : .sj e for th,. p-ti.rnts corning
frc'.. DSnt,- R,,os-c a, El ProTrcso. This is .n "-verrt-e figure
-n ... si -nifics th-t r. .r, rcir-bl: nurbcr :f -cition-! bheCs
-re( in use fror this iur: s' -t r-v -rtiul -r tire. It is
s-.f:- t c-'cul.-to t-t st c t40 b-ds -.r,. n- c.d in the Gc-
nor-t.l -spit-l tc t-.. 'r. of th "ccs -f t,.. tw C"t dc -. rtr:cnts.
The c..C.Vit H cs.-it- hcr 1 dc will t.:.. over the w ork of
i .... G.:-r...rl Hos( ita: ': v.J i] i'v. r ].:- crp city of !1,000. Of
this r;Cr, .:.il st t i l tl-,..s winj only
850 b.rs f -- .: 7, ^. -,-ts [-l- tb[ hL .r it- un-its in
-tt
o:n .. 3- r,: Tl Fr, 3 ,.- .. ti., ti'-.c tir- th:t the
Tocsv-.lt VT...ital i- ." 1 t' Pm crtitn it is c:.rtain thrt
tihore -il. bm
S s. c.-s c f Chir t.- o is 1" o ur;c nt ta3 3I.nt ,- i'r:
El Pr'.rc.sr since r. -i.vc. fu w ics '-o fro n that d]opartnent
tt- the GenCr-l -- 1. Thi- is u,. t- t;. fct th.t Chir a1-
tone-n...... i nc Ch< h at- urit !< ad in Anti.-ue. Ho.;,-
L lit . 1 1n L H-
v..r, t -s .': rt, nt n t -t i'- 91 376- ib.-.1it r.-ts -r- it is
ovi ..nt tt t hcs]it:- i.it:. r. -:'cntly ncde. d.
ThI.. ct.,tu. ortt f ti- Occi-uns, a-r low on the list because
":h -ih ir rd-'rinr-:I bL ndit n pul.ticn, -rn the -gricult-ur-
"-eter f h-tL- -- -c -.... th-r : -S'o_-s fr th itr low
-ri-vrity. D-Le th t::r rt .ti-r facilities, ti-
cui-riy in t d-cr.r; t of 'ucuc t1.-nnr-r and El Quichd, it
is r difficult fcr t;;. c t-. re-.ch spit<- units. As
i.. -* r,..- iiv,: is r:.t,. f illit-c-.y, -. the In -ir.n
1op]il-ti ns c, in- t n:;c v ly t, t-. i .'n ci7nt ccl )stoi .-
i-r,..:-r ].ri'd "f :."lth f:d c-ti -ll -c ss-ryt in ehese
- t n--_ the pc .t hs i- 1-crnscicis.
79.
Puerto EB.rri.s is pi-cd l. st n th list. This ccs not
undcrcstirotc the ir'port nce
trary, both ithe Institut, and the I inistcric are so vit-ally
interestaL in the r.-o, A. ... :3 cf this area th-.t they h-.ve
cooperated in the crqtructi- n : rvi sirrn-l hospital
v1hich will he shortly c r:1 eted. t wcv ar, this provisional
5bspit-'1 ir 'c j f '-rvic f- r c-vr-- years sr that only
relatively 1-te ir the crtructir ,rc1r:r will it bh nece-
:.;ory t. crnsif.'r '. p'rf'ra.t lh.spit-l urit for Puerto BarriCs.
Th -. .:s rst -r_ tc' Livi7n A-tE or ic is 1-c -t. in the de-
t f I.- 1 < _. '.ur'..,t cn the ,rartmcntal
; -it t' h ultir- -t..ly l,.c-td in Iu:-rt E rrin. C or-
trLct' 0 I :. hbc'it 1 ui.- in Livir st-n is ruoclecndiec' :.s
scOn ,'s i "**:si ,c.o
It wvill b, obsc'v-, frCn ti' c list t1'.-J thi tit? 1.f hr 3spitl
units -. c-.O le-:. r i. .cti'-: [ a jb ccro-s. The
r..- scn f this is t- _-ccuro'c h.. cnstructi f such
units ir a c-rr-ti-n with t' c nstructi.n of thi 1-r -r
hesc it lI units ir t'. c. ccr :, L-. th .ci:..rtrL.nts In ;.
7rcC -i- "f this .-tu- thi:r- t n(e .sa rily 1.. onsilcr-
-.,l fl['xibility in c. ,;tructi Cr rlns.
Or:. : .a nwill o.p t ..r.1 .- thi 3 l -"r: Let us t!.c thec
,:"t. if. Zcf .. The h"s it-L unit in the city of Za-
co h,:. ... -..y '. ;t-tec F. -.' .r, it wiJl be sCme time
:f: itis cor1ctecd. The -r thrcc sr.1 tcuns n-.rely,
Gu: '.n, Crb.:- s n' li H:-rcl.. vhich h-.ve, been recor'-reondcd
for I '-itl.. units in 1t'c r tr ..nt. It would bu .- mistake
t stI-t C- rstructi;rt ' t -. ts 't Lhi, present t since
th-ey \S utl 'c c]rTl .. ]r ; th- l :- cr unit nt Z saca1.
DC -n.ir u.cn the s-oc f c. stt-ucti n cf the la-rc units,
th s T.-CHer units in I l r-ur.] sccti -ns shulcd be
trrtcd latcr I ith thT bjctiv ,f c'r. ctin thi ::a at t-C srce
tir tihrt the lc.r;':cr on0 s E.re clCC cl td.
Essenti-ily, the liist i-re ses th .. i .'ility f st-.rtin:-
construction on th-. ,.r units in 1i].rt-rt ur. r c snt rs
and then ir-'ccodin', trc 'iC sr..ll.cr Units f( r the rural po;,lul-
ft'-, /. Anot'>r factor f ,i'porcenc& in strrtin, the cons-
truction schdulc in thn- s n rnncr is th-t one must tr:.c into
considerati-on the numb-c:.' of workers cv-ilai'lo in any particular
c,.urnity s well .as ti. r.vail. ility f construction materials.
3y stLrtin: c. nstructi,-r in sC. v.:-Cr... ,:-e rtr onts -t the sore
rti it 'ill ssibi tc co' '!t the p-ror.r. ore ra -idly.
-' th= viewpo 1int c0 r'Tod public r la tions this also is
desirable since 0Ii parts of th country will be r -rdc aware of
the :tional hospita- c ro: ra1 TolIe will bec no feelin:- of
ne.lect on the part cf he pe1l' e of -ny cormrunity bc,-usc of
r..i -'roross in :ne c. runitr ad r bsnce o f activity ir
their otr.
fPA7 @11 ....
col.r -:ur J ty.
S. icrity of cor traction
;0. -eocscv't : c '- it 1 1 3 r 3"t- uc;:9 7 :itlin
3. t"-' c n uc C
3 jut1 p''""ifr C C,'j liiLr,GCue.
6o Flo rcs.
7. I *] ton n .0 3 r C 'C ,ij 31 ,
3.o .cin l. t L.ci .... ::"; Pto. S ;, Josd
1. C4il-:. Ch.L-ui: ulill. kcv. i-t- Los,- rueblo
u6.vo i- .:.
l Prc; 2cso .' r-c 3 .t u-tln.
11. CAbi. -l- Cn,'r: T ;c- i ; 3- l Tr ,'n Ji cte-er.e
"r F c '"r c Y ; --o c .
20. "--.et -..'ulou 3.:L IcIf i 0 t ,lhulcu
13. Ch.iqui_ ulS oi ip ul -.s; Jcot'n.
1.' J "_ra ~ 1'i-4.t uo4euiJ t 1.. .n Luis Jilot..pc-que
16, i i
C -, i : r ... -- -
20. c t ; . ".. u Ixcoy
21. .ic. I< ic '.t T.e :s Ch ichi c.stunanco.
2.. P 3A7 . Li .
"c 9 j core . -' --- r_ .. . -.---, 7 ] I. -.
c. *cintc .....-t *, i tiv.. a- -r.vicin. o
-i- scr ; to ~' 7 l i A -'A isA7 j th.. co'c rn of-
Ct *hcC IrAit:ut 'i-A.rit.c ri" In crccr t. c--.rry Cut
itA '.n-ruction Tor.2 ,. 1ri. stit.t ,ill. h-vc to sct up a
l.ir.. d ortrA nt rof r ..u,:in . o architecture. The Insti-
.i t i -, t 11 -tr r: L t cni t f the
r ticl_ -_ c. ; t :Lt or ti-cv-c .-. < Ecr"' :.ticu '-r.;--r:_r cf the
I._-:tit i;.. n t c fi isi- _.ri :-.3 ..c: ,cint:, cut. Such
coordination n. corr-l..tio c ,o. Cainn Ly the setting
:I Pl Trin' B. -r .ith rc n '.i,.]. in of thk Institute
1:.D Uchc "iAnistcricE. T<- Pl.:n.r1. ., rc. should consist of
phy_ ir-Ls, A.n inPerj y:' .ry : rs whh thorou. hly fE-
ri:t ,,ith the hospit-l r o"bl .s 2f the country. The BoC-rd
.wol : r, onsr .c ?7 Clicy .n,' '. _',.-1cci r:c- .tions with
....- ..'. tr Iin-r. i- ... c.A E.ith th-n funds ov-il:-ble to
th. In-titutt '.rd the I : i .t .io. '-c D .rt. nt A-f =Cr incerin.-
and -rrehit ctur 1houi 'c-. :rr v:.r.t. siinco it .ill be rs-
I onsibl for'. the :-i.,ir c.i: cr."str -ction of the new hospitals,
81.
Since the National Hospital Program is essentially one pro-
:-rar for which the Institute and the Mihisteric are both
rcesrcnsible, the planrnin .nd' construction of hospital units
should be entrusted to one cremnization. The Department
of Engineering and Arch3itecturc of tho Institute when proper-
ly organized and adequ-tely staffed should be entrusted with
the construction program for the entire program. By -this
oeans the program of the Institute and that of the Ministerio
will bl(corc a single prograr.. which can be carried out with
the cgreatest dispatchJ and ,nsurec thb-t the r.ame high standards
will -r'vail in all h-7itals cf th, country, regardless of
.whether fcr the time !,ing th.y .r. listed as under the Ins-
titute or the Minist rio.
T 1 313
TG" ,^..rc lo^oi..; wT. '.f'i-] ;.,, OSl0 i
. -. it C: A I
_C S.S contra!l rc r-- K m i ", -
rlj 1 f
I.S 3C. FC 0 7t"12'L ,.' _'' t. 1-
th. t' rcilc' i pr b .
tu '; Cl i cCrP.r
Tz 1< -, i C C I:,
rlU r llJ. I orJ i "
S. i i1'
<.ci 'r .' :. ;"* i ]. i ".'' rL;:' U :_- !. .;..- t
r - ": } "
43 _9 "
:I: r. I. : o <- --, -
-" ? w 1 ',. .- .- ' .f J L "
;
The NY wt i
j; ^ i n ^ 2. I' ', in- m 1
: ,c : : : t ; ., :, L" : P w 2
S 1 r o t i -- 'A
T. .ty
A r I ,
..l TO -
itP- o
r I "r-y (., "o ". V social
t truc to-
I 0. 1 : 0. 7 c ''r -
'o 1u 1" .. ,'.*.1..t'Lr. i ]i,< rEcco-
*1 ''*,. t v }...: ', L i 'L rot
-. j -1 r o t
I .-
S. ( j '- .t ( 1
**". y 'i *-;- "l' 2" Sc-
" t ,--t it is
i ,i.. i.3,C". -
1 ^ 5 .r .-i- 'e 3 tc-
: ": ;< /I c C T.pariscr v.itn
.1 i,.v. ;, V L: *ti';or "u l<-_ n...:'. co "-
St G.1- it
;( is O : .'try
>l. Y t ;r.t r cf tbh.
I- -:iF i nr Srv3ys
f-, in cthLU r
I c ..r 1 rc :r.; t. ', i: t :.Lt .rcul 1osiY
i '-,t L .... !" -' 1 '1 1- 7'. V1 vi,'ij' IS
-11 c c in r '. 2 i o '. " cf t h.- _ in-
Sivi i .' .i t' "r o
. .i ". :.. .. iv .., 1. j1 ; c ir 1 :W"b W ; . .. ini. ,.i-te Y ,.: 'h 'rs
" h-i- f-r- : ,.. c l r w ci- .
C;,
O
Y
83.
Another significant corsireration in und-r.:tanding tuberculosis
is t 1at the "reat t ru ,:.r of "ses occur during the aost pro-
1.uctiva perio(. of life, -etwen th, rccs of 1.5? ne 4r With
th,. prolonged i..llness ir. iviu 1 ] life and farily life becor::e
disr; uptd r' ir th1. vst -jority of cases publicc financial
assiCtancc is rc,- s.rry. T_ b r ?u s:is is -d:i.c especially prc-
valn.t duriy. the chilt .-E'rir r:' r.. its r. esnce in itself
is :. contrn-indication t -:. r nar ercy.
The role of hered.ity irn is'"s. h as b,.ne-, x'ustively d'is1
icuss.3 an tib. cc '' '.'i f opin io'" isj ti'" L p ssibly a cuscCp-
. t i. i.ity t' biLu -:r
:-,"c it. '"F is not. i rit:. 101ocvt r, it is probable that
re ity p' .- v r . .--t in th -ie -.s uch i:ore ir-
-, "t ; e :. .r -., i' "u t o n triton, cron win: of
:* -i r. .. c.ic c- T.,.i.c f-crtc .rs provide fa-
SI I' - 6-' 7 F' tb i >' sh'15 -- rultipli".-tilon, nr spcpr Ri
St' l.r It : i .iant th.t t study of
S ... !s iI vr" ious c-untri :: rli Eurcli n n the 1nitc;' States
'c t :t. th..:' s .'o' rcsv3 rtp in the incidfncu of
:tu1 rc i.os I7on. bon ef c. ntro ~ ,, ', ri dical services
:. in tituted. Thi'j: 1' L ndc bt. *ly ,s dr e to i2-"prov od
'. -!,-- ,in.. :, 'Ci]' .1 ._ ; .'-. i -. .r iT -. 'r" : inl -.
st-r 'd f .l It 1 l-~ f C'itun t to t.c' e
t- nroby'< r of tb. ro i;: .; t frcr th sci,<-rtific -sprct
isr. : rd t .. .. 1 7: 'is :,.r' w:ichi soil t.-> tu-
b .rceP Ir .- l''ynri.n t -y.
Ic ., .app'rnt thrt t... rculosi s -;;r-at tcll of the wealth
of the coi:.1nno ity. .ot c' ;v d.- i p...v.. nt the infected in' ivi-
C..1 r'i orh ':.b t ,- rust 1. . .: -* .' tr'._ t.'-d over
on' rics of tr.... F thin pu:c t. bocrlosis clinics,
hV si :i !-.-, -rn -n. t ro ;? in, '- .rc -' rain
aon th. calth of t-- ctn un.ity. Th0 -cr ...ff.ctive a tubcr-
culcsis control pr -'rr: i- in .prov. ntinr', dis.ssc, proportionately
loss .ill b,. the cost to th. col .nity, -"nd the price of person-
l nd f aril suff. rir:
c.r th Lo .ncrt r ofn tfh d,'.rse i- 2;o 5 ,,c1.l }nowln it would seeor
n-.tual th-. ccuritix .. w..l .ent-usiastically institute control
rra both fir th r 'o-l finan-cial factors involved.
---vr, th-: r, ri. I: s "; 2o: plt co-ntrol which rust be
ovrcore. OrL of 0 th n :c --ori-- is i: nr-r-nrce cf th- disease
by th '. pu'tlio Th*:, h at' y in j D -.' tis.l or,..not envision it. d.ay
x:hIn he ,ill o ill. i''-tion .: th : public is tho wecpon to
owvrcor.c this barrier. s1c:on. ir ortant barrier is medical
n.L-ct. Th individual in many caes having only sigh-t synp-
tor"s does not avail hians tif of rt;dical' ca.rco until. his disease is
far advanced. During this early prid h. is infecting r.any
persons with whon h.- cc.r:-(.c in cr -taot. In r. ny communities there-
arc nc adocu-te : edial fr.ci-ti. s bo trt tbe- tuberculous.
There rust b, clinics to '-'" th: d'.C. nsis,3 physicians of iuhcr
e ccrt-in nu.boer rust e :; pec:ie].y rair d in tuberculosis, and
there rust bc hospitl'.ri cr t. -Lt>nt. Education of the public,
and r 13Ss surveys to di':.(.vcr th- tu'-rculous patient are usc.1css,
and cvcn harr'ful if the cans of trc, at cnt ,nd- cure arc not
available. In other vrs, thi, tuberculosis control program
can not be effective unl ss all r.ecsur,,s ndcl facilities are
available to prevent _i ,cover, and treat the tuberculous.
The problem, however, d- ..s n-t enc with reasurcs of prevention,
education (f the public "n sn. r uc .tion -rd' tr 7atr,-nt of the
tuberculous. The probe .:-cs rot end until the tubecrculous in-
dividual has been r,-stc:* d to cityey "s a productive merber.
This coal is not casy t( r, a.h. Thorr. rust be a i'ell organized
depr.rtrent of Tr'be-ili tr~-ior. to -acc'o 'rlish it. Rcha-bilitation
1oces not start bhen tI -tirt is or t+:i reacc te recovery. It
strrts at the v.ry ti' -: 'h- 1 th li nosis is first rade. It
starts '.-.ith the cuc -eti; of th, tubrculous individual with
rea;' tr, his discsost the '-necr,:li nature of tuberculosis.
It passes through tbc ph :s of yi.pathetic understanding cf
thi. patient's pc.rsenal ,r'('I farily pr bler.s, throu h occupational
thirajy, 1'hysi'.l t.ihri- -"en jndiat f, vo etional training
She nee scary, tc pr-pa t!c i i .vidu.al fr the rens of
W.-1arinr '"is live]yh-ccd, "r fn1a:lly the' pla-crent cf th.: in.iivi-
S3] in position cc'.p" ib3. jitb hi physical con- ition, thus
enabli ir- ii- t( be.cor .-arniir ri'r of sccciety. After
all 3he above phases hav. l.cn tU .b n into consideration there
is still another ph-s.: the -rcatet importance. Tuberculosis
is a chronic iseasc .it. fr- .cu t r.cur- rnces. It is therefore,
nec,-( ssary tht t the tuer .;.1ous F-tint be followed fcr lor- pe-
ri cs of tir,. after his .!.sa is .p.trently under control.
Such foll.,w-up is exerci S. by : c.ns viiitinp nurse service,
radical and clinic scrvie,- arc: 3]- b-rat.,ry exar.inrtions.
At this point9 it is v\.1 to, li ':s the irportarnce and. necessity
ef -- crtr-I tub. rculosi' regit r. By such a rc,;ister in a
crun-tr.y f the nature ,c- sic c' Gu.te.r la, the extnt of the
pr.ob1 will be rec;,'niz . The c"-_.-:- :hi ich require r cdical
supe-rvision eith r of .-ctiv. atsia in hcnpitals or arbula-
tory nature by r, Fan, of nr":- n rv:i .s and clinics would be
know.n. A proper -mnd dr ii,te fPL ..ov-u system of cases would
.- po.-l. t tistics )or11 h-.:c r -pcts rf tubcrcu-
losi vld i-.-'- -v. ila] within a cr .ar:-tively ,hort tir-e.
The preo, nre.s frr s-tti- up sueh a register r.r verry simple.
TUBERCULOSIS CONTROL PROGRAM:
Althoum'h th.' contr-.ol prc"r' i ect dismu:Is,-d under certain
Phases or objectives, it I.; sir, -1 prrc'-ri -nZ rust be tackled
in it, ,ntirety. Th. v.-ricus ph- cs are int.rr.]I tC.d and close-
ly cepen.ent one.. upon the cthcer. The ojective. 'f,the prograr:
1) PrEventicr.
2) Di7.-r.csis.
3) Trcr.tr .nt.
4) uEuc, ti r.
5) Lchabixl.itation.
6) llow-up ca-re.
7) 1(-s --rch.
1) Pr evention. It -r -r t r ubrculosis it is necessary
to finm thb tubrrculous .'. fir:;t. T,,r,. 'a, two ncans of doing
this. The] first is to "i-uly th., crnt- cts of' the positive tuber-
culcus osc since thi in.i'nce i-f th "isce'se will bc highest
in this rurru. Th1 secce ns t e ss cz sc-findinr survey.
Ui t" r. -..tly, cse-fipn:' smur-y -frj very e-XT .nsivc. The
cO:.-tin .i- .ci f tuL..r..-ei : c-r .. cnly by the X-ray
with th. rcc. ssry i t. ry t-ts-. BcrrCr. th; usc cf the
,hoto-rc nt- n x-ra-y ]"r t plt, l+4" x t 0e takcn.
Hvowver, with tc'he hoto-r' .,'eri' :-:-, rn incx'p sivc ;.ncf pocr-
f- l w.t -C, i.. th.: t U-tti .. .t tu. ,r l-l :;i-7 h o t :c r_ -vril-
'.. T:is -quipru nt h. -.: il 7- -. ', -r- tical to ccn-
'uct r s- surv.ey. -f t : r -i r. v :: lw cost.
Si c surv-y ir rd, r ,- r ,. t v. .u h ulc be i e
nst 'rcups .n(' ii. i< u iti T. the ti-crcl].e s s inci-
, ,cC 1; h:" 1, :it. It t: I ..r : i tli -t ,. inci''.ncc of the
i .:;, n: -t -- -.-, t _r-l hcsplit- is hi* her
a..r for t.. r ci.-t: t -r .,. -. It i; Lher.: f r hi -7ly re-
ccar ..nc th-.t 1 p-ti'.. L p, . f ion t"I tI.. c'n.r1 7 spit-
1 -h's-,7 1 iv.. t ut c- t U A th r r:rcn- in '..hich
th irci c. ,' th: .13. ac is "r.. l.y bIj i: th. a roup that
Co0 us in c> nt..c with in Li. iu.! Fn 1' ..c-u.> cf thb na;-ti) c, of
thir w-r. 'This iInc :i- -, ph sicis, intrnt.s,
l-nur:s r h._ i -. .C si. -T- i'i..nc cf tu:tercu-
ICSi iS -1 c hi;h in in i in : ;-i ", -rcups. This will vary
in .iffrcnt courtric ,, 2 '' iir.'l 1 U.trics. Hrlcver it
is f 'un' ncr'lly tr ti .-" 2 v' -.r._ i ,osec tc the in-
h-1l7 tio r "f si].ie;cus 1 -t ri.s :v ribly brv a hi" incidence.
Inr Gu.-tI3 r .-, crofil st. i..s shi b. 1 :d. f the incidence of
tub- 1.. is in thn v-i '- ,-. in n', -r s "f the. c untrv. Per-
hapT~ tLhe hsl-st inci. f tt..: relu si' is f.- n:' in rent'.l
t :-..rci is: : Ui r civ f-r. n :-- r ti-n ix r-, survey
stu V i s. ith r .:r'. t .. it 1 th. c'ntru l pro '-r. is ..a-.
tiv'ly sir c l..
TIe f'llc in -' :' -- r A ': n: ...
1) RPntir ch. st plt' in a11 '_>i.icns to s..ncral hcsritals.
) Ar mission ,h': L-nt.rvt ch 'd vt pi ts "Sn -1 .ti.nts of
r tntl isio 3. h3sp:t'.l nf ciustcyd:i :. institutions.
c-v --- r tJ.. o.rlul. Rat.
4) The ilntituti'n c is5l-ti.'n r crutins t- th, tubcrcu-
lou_, c-s to .- .- tU eth'r pa-tients, an to
protect bhospit-. rs, 3nn, 1>.
86..
,) A C l ile t: ., t,. r -1 1 ploy..e consisting of:
a) c o t- .,,-.. ...: <-. r: ti n ri;-l-yr rt with routine
lb.ratcry irn ti, i s.
b) rcutir; ;:-hb st pl. '.. :1 -. ..nt.
c) t'bh rculin t r-ti, ,,1 ..r :.. t-. ti of
.rp.yr- -nt,
d) medical st-rvic .
o) follow-up physiJ'-_, cI .r I inr.tor, n) chert plat,- at re.ular
interval s.
f) h.clth file cn .. cb ., cycc.
I '.-s surv .ys with the ac t3 r, ,nt:..i unit is ocf the f-'rctc-st
v:. -lu. in ic'cv rin" c 'cs :i t,' u 0cn. cr2'- popul' tion. The can-
p,,:i in thi:; ri',r houl' h1' st-rt d in tch r'..;ions of the
cc-urtry \:hr- ti.. i;rci1 nc ':- t-u. rclc 'is is hi-, st ?.nd then
r.:.c.-.. .r.r ssivly thc r--_irrns cff lover incidence.
Ir Gu-'tr ': ru:_t ccr ;i.u-, f or t -r-. sr.crt?.ticn f-ctor in
ti- ,. c.nnr cctir_:. T'.e p1 t r.. entorn chine is ? 'clictc_ na-
chin, nd cnn'.r.t 1:' r. Lvr ..bad rc ..s. Necessarily, it will
hrvc. t( be utili.,.. in 'h- 'r.: 'hcr thr r .chinu can be trans-
'rt-. Frwvcr, 3s .- .s irrovC, rlor. Parnd rmorc of the luss
ca ..sil ptr rt r' t'. con',Jtry car be reached. In the follow-
ir': sector tb' L.xttt f t tuburculo.sis in Gu-tei rl.' will be
cl.rifi'd th;.t pr cr ssi ts in casec-findin surveys to
pr(cec frc r'ic t, c.Ln, in th1,. (.r'dr cf incidence will
beco, .c r-bvi' ,us.
It r st 7lyf 1-- .C. -r. r'. th-t r-vcntion inds upon
firir; th- .: c ictin cf the c-3u frc- the
Srnr,l p culti-r. 1 'h u thi X-ry r]-- the 'inosis
cf tu icrcul si, it i tic.'- rt..r ho.t -ri, s hcthcr
Scst is positive cr -tivc- Ther cfCrc, :.11 '-c.cs discover-
d t, hr-vc tubL.rc-u-lo.us lcsirr- i Ts:; surv.:ys Vrust have toe
necess, ry cY;r-_intiors t dutcrrin: -;!. t1cr thoy arc positive
or n.f;:.tiv., Fa-ci_.itc;. for .'- Irb r t.-ry exar:.inations rust
Cbe i.r-c:e .v-.il_.b c
ilUnder t, :r ,vc,tiJvo Su r-f thi' c,-ntrol prcr-rar it is ne-
cussa:ry to r.ntion th, jr'port"c:,c, of r"ilk ,-s c'arricr (cf tu-
berculosis. Yilk scrv, s a r..c.-s (' ,preard of Lovinc tubc-r-
cvl-.osis.: These ffoct. r.': i'nly infnts a'nd childrcn.r
IL ur'us 3x:3 t be dc-.ptd t- t .rculir.-test all hords rn to
,. strcy infected. 'nir-. The d--.r .f bcvinr tu-,crculosis
will v.. -.ish vith t. u'nrv. .---tcu: -r-ti _n rf -*ilk.
T' rrcvcrtiv. phb'" c.i:t .ft witbhcut fw w'rcrs about
LCG vaccinati'n. ThL v :. I '- 2 "- vI r''inc hTs !-con thor'ul-:h-
!, ,'iscu--sc.c over c. ,. J', rf r-ry yo r but t. i. cd-ical
1-prfcssion h1-as not arrivI '-t p:s '.tivL. -nclusions with r,-.ard
to it. In r. any parts cf Eur1-c<, t is used widely -one ccord-
ir; tc rrcpcrts with 'ci results. R eiv ly v l tly it s3
been adIcpted by rany rby',-icians in Latin Aricrica. The rXdical
profession in tbh. TUnited StcteL. is rather c;uard'c in its state-
rents on its v-luc. It -till is rnt convinced that the BOG
87.
vr.ccir-.tirr is f' va,. 1 rventir :Mc.r ry tuberculosis
e r Ucr-es:,- its spr ... .'.vcr, v re -contly, it ha-.s looked
o::c -indly upon the 2: .:.. V5. riers : ,is evr lon-_' pe'cicds
1-f til "re b.ir~ c-.rri rn b t-nr ine the ,xact place of
the v.ccinfltion in tl, -ttle r:inst tub rculc sis. -ecently,
it h-.s eern felt b',y si tuberculosis experts th: t the vrcci-
n:.tion should be uscd in cr-run ties here the jncidi(cncc is
";p'ci.lly hi:h, ta3s c;(11 as in cc tJ.in professcrl cn.r. indust-
:rirl1 .-r'u.s whcrc a hi., iicji.ec is -_s frulric The final
docisi(.n with rc[.rd tc ;h BC(i v-cin-ti rn in this country will
ic "..c by the |]" 'LCJ 3 s f r1t h t. .:!oln
2) Dicn(sis. This i bs ....r p;rti-ly i-cu:?sed urdcr
ircvcrti-n. The i, port cr r- t-h ch9st l-t( r.nc'1 labcretory
.x-i tin--rs h- I* bcn_ r t .t. ith; ut rc -,c!-tin! si.'_c (f
thI- f'-cts i. nticn.d i s d Lir; I: t 'iscl;s in r.crc
inti: ... ,t;.il the c. in c'f i f-_P .3Ls s i.t refers to a tu-
bcrcu].sis ccntrr r i. ,r:: s]'..cJfi ly _- it refers to
Gur.trall-. Th. ch'. t t. ,Lthe 1+1" x 17" l tur, r the
S:-.ller rlt r .;r th. --t, .ntcn-unit ust b intcr-
Ir.P..t / ihysici" 1,. i:: t ciir r' .in such wcrl. It is possible
f r c l tr.ir ... :... 300 .rnd 00 fills Cd ily
vith hrt, !...t..r ur.it. Thiusc fi.-l:s rust be processed at
a cer`t point r.nC tL .terr. t .: b,, the .-r-.y specia.j t.
Posit .ive fji ] will r, tl I.-" 1 I" r.l tc. It is the
erjlc e s p iv-_ i ; -f tI -ri ic-r *- cr ri.r
n Gu-.te r shcul. b. te <- l r ':. ion-] 1in. s. This
survey hs "ivi dc tU .n''y intrt ever :-os-:1 r, d
on ; _' rt of -n i? t r.t-t. hos ,pit-i. ,-. H s. it' s -.ithin
c ch r r t ior .h v. ]eer 1 frt: ,. t -.-a .-e aib to
th.e entire popu. ti n ,. t, i F _' hc..pit .L v.il1 I-ve
Ir, out-rptn rt :1c. rt I in V::hi .iia e ir.orporl te. public
e-ltath service;. Of v-- 2rv-ie tul rclo.is will be one
of the roast i-:port;-.r, r -t-s -uiPrv.' er b< .'-.ee froe thceo
hospitc._F: -s r, center. T: .. fi-rs '' n11o" 1 bc sent to the re-
;ion-al hospital wv;lcrc -t!re v:i. e. I ::v:T .il-e tublerculosis
specialist. Co rplete ecocrs rr very irp.ortrant in such 1 a sct-
up fnl the fo3. ow-u.p on )positive fil 1 ill etj t in the
success or f{ilur f th: r re.
3) Tr..tr-nt. th: te-t, rt ir tu o' ? Zorrises to
1) Te r-i ,.N l c ::n .
y o' cinr ithe tubercul';. p. Lert in t'' hec it,-1 he is re-
rov' or the -oru .t serve 7 z, focus of infect-
io. The open a.,. rus1. he sr'e:. ,"t. until his sputum has
beco):'e native. In th hospitJ, the prti:nt is t;,u .rt the
hyicnic pf',cc utions to linit the spr.er(d of infection. He is
also taught the nature of th: di_~;eS-oi. The ri-,ain purpose as
far a's the tube:rculous i-i'ivi,] is concerned in entorinr the
hosrit-.l is to receive tre.1-'r-t for "is 5_diseasc. Tuberculosis
88.
:1:. no lon';r a dis: C to be tra-t-.. rc ar'ly by ret, holio-
t h.rrpy, and dictctir althou h th; y :re irportant factors
ir: storir the health of the ai nt. However, our treat-
or unrcerstrcdinrg of thb dis,..-sc in 1-.tter ycers, rainly thanks
to the X-ray r.-achin '' r evolutioni- the tre,.tr ant of tu-
barci'losis. The dis.- sc nc,: re -ui-s expert reoic' l and. sur-
-ical tis catrnt, ar this tr .ta:rt car orly bc .-ivcn in the
hospital vbhich hs the nc,.s.-ry facil-tics, couiprcnt nd.
trained rcrsonnel:. It is t,--..rfor, obvious thUt the tuber-
culosi s hospit'! is 1 t ,r] oint of thin tuberculosis
contCrol pr:r. T mni '.t of .c '.U.ospitss their lo-
c-:.tijn r thicj- -' ity n-- 'c i Ga'terr.l will bc dis-
cu ss' 1. tr ir thJ 3 c ort.
By -.1 "u.-to.7 ,:t it. s ':i; t-h., cre :-n < supervision of
th: tu'-.ruou. L"ti 7 '--c net r'cu-irue hC' irc1iz.-C tien.
', i.en s tc . ruires hospital! or
:*' ty r- -: r t ju' rt c.f thl physician
h 1 irt .'' p c .ical sirtns nr-' syrptons, the
X-r" fil" t.-. I' cr.tor finCDns Th. T .h .. i ultory cr-3c
is t.. -.t." i. t. .tir prtr 'nt f the -mpital. It
is jr: thJis h->sc t -' t. i hi ::th nurse ." s her rost
ir.p'rt-nt r..c T .. : \ is a, ii ... ory, either after
hosrit.li on, ri t u' r'rin, ospita-lizaticn, rust be
fo llo.l;c u' p:-.o 'ic Ly .t:. h .1 01 c. nsiderc -pparently
cure., *C 'ru -.-'-t vi :' to t. hor) of the pntirent are nece-
ss?-ryo Th public h ith nurs.. is ,sponsiblc for such vi-
si cs i, obtain th c ;o. C 'r-tir) of th'.. ptcnt, to p.rsuade
,the. r--:.hc- of tbC r -il t' 1' r -t to" t-he cut-patient copart-
Sci-t f'-r t.;:intic -.n to c- h the srpcil c aiene "rd
central :casu-., ir i hcu..o: ti'ich ar'- necessary tc safe-
au.r. thin r c c" the fTi' .-.- -n't crntractito of the
) Edua:-ticon. I{;ncr-nc- of the public is the -n-t.tst
of th. diserse. A 1.1 infr'. -Publc o'..r.s a.rrc of the
nat- .' of the Aiscasc h. .n; r ccrbal.ti ., it. It is
in this 'f1 .' th t th Li c on 1 c: intr'r 1- Tuberculosis
can >.-rvu it; r t ii aorta .t function. Education of the pu-
hTeuI should e ir.t tn.'iv-c.ly '- rrjcu. out T;y i.cnas of the
pr."ess, r-dio, cinema, 1 frplLtsL posters, etc. Those should
Snd -il .. to th.. : to crcu-hout the country. In
order to re.-'- tin .- i ir., C us orul:'ti suitable lite.rc'ture
in the ini. ous 1 r u-r :-s ..cLld 'e -repare:. Literature
of this n-t- :' wu istrit te nsf t cut-pa-ticnt
c. rtr-.nts of hospi--ls cr. by plic e lth -r visiting
nurses. The La'ue c-n so ,ppr iracticin0 physicians
of the control pro--i-a f tih -a cies available for the
diagnosis n(d t~: Ctr nt of tie.nts, c: of n vw devclo-rents
in the field. The l, ;uc cr exercise :' :.t influence in
clvcatin-: the stnd res of tain -.tr t an-;i in carp.i;-ning for
adequ: to f'ilities. The L_;-e.- ca' J.or aid in training of
physic,-ians: n-urses, t,, chnici"ns -i social service worl:ers by
e f. .'ns of cbolarships,; athoL.'i,b thL Le -;uc has been in oxist-
ancc only short tirL it hr- r- .c notchl: stues in this di-
recticn. Another service tl-.nt the. Lc.-u r ay render is the cor-
nila.tion of -ccur.-t. -:ti S trl_ or, inL '. e nce, r:orlidity .nd
mortality .
5. Rohabilitato-r. The r:h.bi-:it:tionl f "tf. tuberculous ray
be ro.fin. the r-i: hy-..c -rticnal vocati-nal, and
econcr-ic rlstcr:tion. ic -r~- -'-r c" rebC:ilitatic.n starts when
the diagnosis is fir-t 7 d. o- continues until th, best ulti-
r.atc. objective hes bel> chic, C. In crer to be effu-ctivc a
specific pror"r-: is r..sr.ryo T:. r'in points in such a pro-
,-r.i: arc as follows:
a) At tbi tire thb- the `i.:rcsis is first i:a(c the 'ticnt
rut b r- assur- .uit r<-'rd t the nr-tur. of th di-
c'.s :r_ th.: ; .trcn-" j s .sibility ,of- .. .:c C. p.rogncsis.
b) 'I:. cLcinoic soci:- rcl-ti(cnshi-: of the in7ivi'..ual
to is f.;.ily -. t- his cc.r:-unity iv.st 1o invcsti -.ted
thorcu i. ly. Since c, h.. lis-. .su-lly r q'.irc0 1cn:'
tr t -.nt with .r.c fro: productive -ctivity r-ost cf
the c''cs i.ill i -.i.:- finr ci:.l "ssist'.rcc The work-
or w. hs no r c,'jri' rcs,:'urcs f'cr the support of his
f .ly i 'th b r -. h t 'l his riY' rust be
,".. "-y cn :-.r .'. o It is .ce sary fcr th-t 3c cia!
w.,cr1^r v-,hc_ i c: cb-r.' f this --sp ct to :.i.r the fiend-
shiY ( cc.nfi _-C c. t -ticnt -*r.. fa: ily
c) Inr th, hopil th' tint' c-.tion it'h r.ard
tc hi3 ccrlt, n i- t ,.'n t.-.1.o hcn the .cute phase
of th, --<. ov..r th, :-,sc of rc hnbilitrtion is
"-ctiv ly ...u. Thi nrc:'it:.s definite pro.ran
for tl- rti:nt n csit.. Thi Ti pror-r passes
thr-n b th,. Th-'s of crccu-.ticn-. tcrr.py, -nd physical
th-r.py V r, tb i' in-ic'-t. By i.c-.ns of cccuprtion-
1 thr --py, -i-nt -" strt:. or tb- .-th for voca-
ti rn--.! an.- ccn- re t -: ti.n.
C) During th 1-. tr C.ri t'he l_,.nt' s tay in the
hcspit-l, ar r :.1__ n h': n> C nicr rec -1l supervi-
sion -s n r -:- -t" c-., ve -tionar training- plays
its Tart in h -.- r.ster--ticn. ., a -erral mnc'.,r of so-
ci ty. In r-.ny ".'-s th patient will b unable to
return to hi I fc:r cccu- tin :c-u.sc of the far ner
of a r..curr.c'. Such ?as.s have t r be reteaincd for
oth- r f c. n te L v ,ith thir aptitude and
their physic. -' cn "ti cn
.) The final h ': in the rehabilitation. progr:.-; is the
pl-c nunt of t9- r tu-erclous .-ti- rt in suitL-ic job.
Fc. thi pure th ". c,- c in-ustry i s ssc-.nt-
ial. In .or c- s .. :h I.ivi-.- r-y b oble. to 'tart
onlr y iith p-.rt-t:.;-- .1:. t b -r u-lly increase .d
to full tii s 'I c:nci.tior i.oproves. Education of
rp',.loyce-s to thi ; end r '. in c by confercnccs bct-
wen Lhe re _ical 'cial uc..r!r :'nd the cr'. loycr. Evcry
effort should be 3 P..de to. rtc-'i: th, patlint -to painful occu-
p.tion f. : -.ly s poss '*i ; i- .toy o- the greatest
ecoor1ic iT 11 o '. e cr ot- : 1 .... '.-. t t.e. n' t.on.
. o o o]. o ,- . <' .... '-' t :' 1- control
pro'r.r o_(1d !',- b( cr .i. : ':-rcvj.c ;:.y 3b c .' t- c close
irnter-rcletion :i An.c ; r C r-rr:.. TI: r1vist be or-
.a.nized "cie -ti:ic, 1 ,:o t -. 'i e t'. nt i s urd r surveillance
until he is C: p] rc) -t i' :.-'.uercy o,'' r cu renc s
in tubeirculo i i .. r; j ; ,. '- y. It J '. safe;uard for the
p t nt Trd the co? r r ..irr.r '.'s ; or cover i on of E_
nc;":tjvc STp t.'". ,o r i.vo .-,- -.scov, .d e rr y .-d tch. co-
..';ary tr 't nt a.c .c ;..rt n c:n ; institutesc,
. ,T r "r -ic: tl< "- .: "f '..orb i ttin tY'c
5i,34 > c 1 X0' ti V0 T_.(y s. ''he
* r 1r .L' t" jC' 1cmcbl. N'w
in .. c.. cattly stropto' ycin h s
prov-d v l_5 i-. 1a t'.' i L:. .r s a r tvo3irclosi2. Rcse.arch
is posibl.. -. t ruined peronn ?. .ar- r.odcrn
hosit' r 1 b.. t *. t.se become available Gua-
t .P ; il _. ,- i .1t"f 1: co r. 'c th, n-at (ons thici,
.. : i t t 1 ~ . r'' t -cou of u t a'.rity
w.., t,. the u] t', lctc nb- ; [ve r *;'' ^i .', r,:,-d cation.
A i tubc-r' ulos control ,' r'-] .i its cr:r-l aspects hc.s been
describedL ATr-lif') .i nof r o.o of t," :tatcyc'uts is of
v U_ .
In ordc6 to hno th. r, .of t bt-rc.- ]'sis in Gu-atcnals an
~At t''is poiit it -y oin h ttitic re ne-
7 ... The ...... Ii .- t -.3- will dt r, ine thes
Cil1 s hnv 1 i o S .ri or .- loc:tio] o' rnd uchrai
f'c' its' .s i 7 s c3 ? i Ic ; L ,.. 7 o control nLsurerc. ohich re
TsCr] .-'? t- o t.' r .a tho r fi'.t d vid, . ly in con ii orin. a or-
S'l1 .. P .iulo i. r to t h tot, .
n b r of c '.-' t c 1' b' _ctr- icd
by t. institute or .' -' -t 1 ::. :t- t .1 r i. o c -c s.
The f7:.ctors i.i thL ...'- <. : tb-r:u osi :'v,7 b.en 11.ht-
ly to-ich d upor. It : .- --- b n i *- t- .. .
of tube rc.ul7ols it'.f .0, by *. 1 c1uir test
.horc.. t 'here 37re l.t l ;'w c s. 3 f" cli r c:i tube'crlo-
sis. The iLttcr i3 t ,.., ,. ,. 7 i :0o
tubercle ac. li .i i'i .. i 1 :: 1 o -C l .:- t rc; tIc
fr ctors in ] ti '-', t- :. i c:-1] -t ,rcu] osis?
91.
Age is sn airport nt fctor -.3 .I b:. r in statistics as
re sented subseouentlyo T-e .--usness of thec source is in-
port-nt. The r ore acv'--me t] 1 si vith the gr water number
of tubercle-s b.ci.li ii thb i.-.l i; ir pcrtant factor as
to wh- their conta-t-: .,i L er .. t,.- d::- ,-se. The. d-uration
and inti .cy of -zp sur ... -tiv c~ '.. : 1ays its part.
Occupatior and. co noric -ta:: -rtilrly'the- latter, are
of th ire .,tst 1.ip rt e r.. v. r rc-C'y :ccer discussed.
It hUs been cati, tcct c -t 1.;' of th tno l population ir
th: United States c v; "r th.rculosis of varying
dec-res of clinic- act viy oCf this nur'b- r .-roxj! atcly
C.5$ rctuire r,'dical sr rvi Ad c port -f ti: Deprrt-
Ser t of H- lth -nd e':-. :i.: of the St-t. .of Icw ~ fork
published in c1.1 s,.t thdt ir IrtsJ dt l sc hos it .s
3.6- of the pati .t' v. tul.- :elois r .-iinr' ,tive L:ue-
dic-1 car. The .ar: .po-'t r.'::: t;: t 2., of the ir,, tces
in SC t I.t 0choo. '-or "I;.ly ,:-'f ctiv,. h5 vc clinic" 1 t:Wber-
cul.osi.. Tn '--( ti cr + th f .rc .ve, ". J.% in rc td.
(diCt se ho pit'-l *:: .-, 7" O_ Yor i C:rt lly d/ f.ctiv.s
hav-' tubor'.i osj 1 ro :., :ni", i.:nifi.cnce nd ; r:.uir on-
ly lii..j4tc(d G cj- I C. vI.v J.c:]' o
The nurber of dec -I t.. 1ru.osie., is 1-2 ir oriant ir dex
is [to the -val-ro t *usc. It is cstt tcd ti-I
or every ..nnu_ t 'roi rculojsi there r. t-i cases
in thr- ca '- i."n rty.
It is obvious tha-t '. ..-r' control rogr:.- can-ot be
put into effectt I tho.' s- . ent nuiL, of tr'-incd physi-
cin ns-, nursesr soci-; 1" 'r .'- njcirms 'nd othi-r personnel.
In -G-ster.cl ther. i' -c r'e' of : -rofcs.-onis: in al1
types. A trainin.. pro.. to '-pply ti c-utr'y e.ith sufficient
personnel v ill be ne..','-:-. f-r -. ctiv control erogran.
In a-ddition to t,-oin. c c ; *.rnn-1, al Inistrr-tive
and secrctaricl- p,.-,rsonnl 1 5i b.J n -;d-d.
A tuberculosis control --0r b- ..Vl.Q.to i the folclo,w-
ing -anner:
1) Inter-al betbt 'i.:- o ;, :n hospital cC-ission.
2) Sta og of i .-:'. or ,: : ion.
3) Length of s-:y hospI ,1.
4-) Clinical sttu-" s' L:.. ttus on disci G .e froi
the hospital.
5) 1ur-ber of ro'it v *t-''-- astes a-t hor- e, .nd
6) 1iur b r of activ-:.':':-, n, vor hospitalized.
health education xhi tly dtqrli ins the success of the
control program ri-:.y be v-. uate' "s follos:
1) The n- r- b c i -
2) T.. n. ? b- r o -. . : .1 o ,--.., for : ..d.- cwl c with
Irly rmrpto:.
3) Tr thoro .- : ,.- i tio. o, '.rily cont-.cts.
)+) The prcr rtn -. : .sic ., :i-ie c.scs to Joos-
'it: -s.
) The 'bc-r of r ,r-hc -: C- .s ur, -. -;. ic-l su revision.
6) Tbhe crrIr tnn., : .. of t, rha itatin pro-
7) The- Ttivity of :-vi .
Clinic or o;-p;-ti: ri Y
follos:
1) The rnn.-l rup b
0" <:,.tqt]hs o)r .,;',-..
2) R;t... of r,.w c '
3) t' -; o c ,'2 ..3 :
4 ) F r, .'.. 1 [ :. of ..
5) .A-;. 1i tribt- .
Y,:rvf., .'PC-L
-.y bc v-luatcd as
So xiir;tionsc in relation to the number
i :,cur d.
:E]._r} vi-hu; ] exc in'd.
1 '-s's rnrwys .; ~ v' .i U
1) Frcrortior .-
2) rff- iv) s:v rc
urs n: _-v ..,- .r t.
Proportion of r
rcriortion
Proportion of r.
pCoryV31ion
Stardards rust b. -,dot
ports fro-_ all r.rts o.
The following celassificc
I o. i '- 1 r .' ilc .
T'c7 -u . 0
group.
,'r oo' [- '7 ; ;- : in '- :o
<.cti,-.-;" : :; :i t.ctali-' od.
.' ".j t,_..r bi ./b.i h. G]tb v\-
'O ior -r .y ii.tcr:r -trt cr 3 tint r'e-
t '. a entry .I 7t r -,.rly ..v'alu ted.
tion '.cu' ; bo:;
1) Teg.--v. A'"
2) Healed :ri-cry c, 3 r..-:.
3) Evidcrcm of i..-i- -._ctio: 'ulro1..ry tuberculosis.
a.) li-ir cl-.ctive; inr ctivc.
b) Kod.'.:- 1 'nc. active;, ir active.
c) Far -dv'-.du cd- .cti..;, inactive.
d) ArrIc-t:.,
c) AppF r, 1:- h.' -..'
4) lon tnuberculous u_ r i...'e,, pathology.
5') Cardi -or.-'--hic :-; -- .
6) OthLr :.bnor; -.lit, ir-volvin, bozne, ni:-phrarm, soft
issue, ed:i sti a .
The above cl..sscfic tior rust t:. into consideration the his-
tory of the- cs. c rnd ,. er-ti cr fijndinJgs.
93.
It br , bca~i ~r odt ~t,- t2,j-'it1 lri slfou-1Id servc
as umitc in ulost iA0is rr L1rol -,- o io -cvc-.r,
Srust bc- cr Ot(II bcod-, to ccooC'inatc ran
-oirclct tu h tii cr- ,iS. Fo, t'-I-is puroposc-
a c,-r-t-- l brc1c A clC- itt. c: ig .i~l It
is tf t tV''7L,--(-y cc. I rt~ cr. 9 ~h
col rittc~u of th fOr'o1 '' 1-t, co of' Tuburculosisl
~ in~t' io ~ 3cucl*1' "::i., t S0-rail, Con~z jo Tic-
flC c01 o t. UV~t..W F A tL;L ,,Tcional
cor~~~~trCbo P nrmi1_2 irrlust-ry, and
sclhools- TV ',OO1' V ~1t V o S~.L1
for rue. sc -,fuiAl 1'r o,.
TU EL CU T C 3 T 3
T. I13TIC3
Strtitic s c.r-: th rrt i it. f tub rculois -. re
canr.t ir Guitec: r. Thc' t-- ril--;l. "r irc r'.ctc
ranc nort crtircly .ccur-.t. Du t t sc city -hysici..rs
rcnd ci-.nrostic f-ciliti 3 ir. I .'-rt -.f country cr.s-s
of tu..rculcsis .:-. t c'uf. C T-,- rt,:; incidcncc shcr.s high
r-t v : -n stick ciliti. r. u -i r .-r la. r-.tcs
hr- such 2 "il iti s 1-cli r i _-.U -t.. I.cv rth.lcss,
si -.fic-t irf-r t -. y b t'-.i- c fr,:r c'rcful study
of v. il bl' tt. .t t 1, .- .. r:t s C r such study
i..l. ht tb.} :rit f -,.. i;'" c.i r t:vc .... tl-(it is cssc'tial
ii. th, ,..v lcr;1 c t "., h -:- it'-I syvtcr.
TLBLE 1' TU T T CU I 31 T 3 T DE l .-T T3 .. REOIT TED BY
L. DI -CCIC l G_ DT -3T DI3TICAL
rr_, -r- TO,
19':3
19_w
19105
Gu tLr- l1 520 5! 612
El Frc-icsc 6 14 15
S3eC t: r,.z V4 427 51
Ch] '. rr* -o 29 30 23
E cuirti -.. 10 97 94
S3rt. R. .. 39 50 30
:3, !I :. 14 11 12
Tot'ricr. .n 1- 32 25
Quczal tc rr.n, 106 125 103
Suchit :'iu-z 6o 98 124
c talhulku 40 +3 37
Sarn I. -rcos 72 6 61
Huchuotenn-.-nc 22 13 17
Ouich] 9 13 11
B-.j:- V r.'--z 16 7 10
A1 t, VurC' -z 98 116 64
Frt r 6 2 -
Iz :.b-,1 18 20 19
Zc_. l-, 1-- '8 35 29
Chiauir-ula 18 28 30
J,-.!: -r, 1.0 8 11
J-ti -n. 16 13 8
TOTALS: 13 T 19 3-' 3"
1 a46
633
6
51
20
89
40
22
67
117
113
43
60
17
18
10
86
6
23
44
30
14
10
151-9
1247
1421
.11 forr.s of tu.-.'cul sis are included.
