Posts Tagged ‘industrial medicine’

Kaiser Permanente and Group Health Cooperative – Working Together Since 1950

posted on March 22, 2017

Lincoln Cushing
Heritage writer

 

“Permanente pediatric clinic at 515 Market St, San Francisco – nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot.” ILWU Dispatcher, 10/13/1950.

It’s official. Kaiser Permanente has acquired Group Health Cooperative, making Kaiser Permanente Washington our newest region, the first in over 30 years.

Although this merger is brand new, the two organizations began collaborating more than 65 years ago. Group Health Cooperative of Puget Sound (they dropped the “of Puget Sound” in 1995), like Kaiser Permanente, was always a mission-driven organization that approached health care in a very different way from traditional fee-for-service medicine.

In fact, few know that our common roots go as far back as 1950, just three years after Group Health Cooperative’s founding.

The relationship began in 1949 when the International Longshore and Warehouse Union [ILWU] approached Kaiser Permanente (then called the Permanente Health Plan) about taking on their membership. Initially it was the 20,000 members in the San Francisco Bay Area, with the understanding that it would soon be all of their members on the rest of the coast, from Seattle down to San Diego. Permanente and the ILWU had been in discussion since 1945. Among the many advantages raised was “The hospital’s facilities are open to all groups with no segregation of patients because of
creed or color.” Imagine that.

“Permanente Health Plan Recommended by Oakland Council for Future Contracts,” ILWU Dispatcher, 6/15/1945.

In a 1974 interview, Kaiser Permanente founding physician Sidney Garfield, MD, reflected on this earliest relation between Kaiser Permanente and Group Health Cooperative:

We were rather anxious to get the membership of course, but we couldn’t spread our service that far. We did have a service up in Portland, so that was fine. We got the doctors up there to accept those members, they wanted to do it too. In Los Angeles we had no service. We had it in Fontana, which is quite a distance away, maybe 70 miles from San Pedro. In San Diego we had no service.

[In the Northwest] what we did was arrange with… a prepaid plan up in Seattle, Group Health Association [Cooperative] I think they call it, so we talked them into taking on Longshoremen up there and there was a prepaid plan down in San Diego, a small one, and we talked them into taking on the Longshoremen, and we tackled the Los Angeles, San Francisco, Bay Area and the San Pedro area…

An article in the ILWU newspaper The Dispatcher January 6, 1950 proclaimed: “ILWU Coast Longshore and Shipsclerks Welfare Plan Goes Into Effect.”

The Pacific Maritime Association began making a 3 cents per man hour contribution to the Welfare Fund on December 26, 1949.

Hospital plans go into effect as of February 1, 1950. Permanente Foundation’s Health plan will cover the San Francisco, Los Angeles and Portland – Vancouver areas. There is already a setup in Portland similar to the one in the San Francisco Bay Area. Permanente will open a clinic in Wilmington, Calif., immediately upon the ratification of the Welfare Plan by all locals.

In Seattle, Wash., the Group Health Cooperative of Puget Sound made the offer of medical care on the same basis and at the same price as Permanente.

By year’s end, 90 percent of eligible ILWU member had signed up for the plan. It was voluntary; the Permanente Foundation Health Plan was committed to offering “dual choice” to groups, so that no member would feel resentful at having something forced on them.

Group Health Cooperative communicator Pat Bailey adds this point:

This contract for 2,200 ILWU enrollees for Group Health came at a time when the Cooperative was cash-starved. But as already noted, with the new enrollees came pent-up health needs. Before long, the waiting list for hernia operations numbered as many as 50.

“Anne Waybur of the ILWU Research Department interviewed more than 125 longshoremen, clerks, foremen and their wives in San Pedro, Calif. to find out what they think of the Permanente Health Plan coverage and service.” The Dispatcher, 1/5/1951.

It’s hard to overstate the deep impact that this contractually-negotiated benefit made in the lives of the ILWU members.

When the plan began, there was a big rush for treatment of such illnesses as hernias and hemorrhoids, conditions the men had suffered with and lived with for many years. They hadn’t been able to pay for medical care on their own. A 1951 brochure produced by the ILWU about the Multiphasic testing examination noted that “…many of our members have not been to the doctor until they practically collapsed on the job.”

A March 10, 1950, article in The Dispatcher put it this way:

“The Welfare Plan is the greatest thing since the hiring hall.” That’s the opinion of D.N. (Lefty) Vaughn, Local 13 longshoreman, hospitalized here under Permanente. Vaughn told Local 13 visitors last week that if it wasn’t for the Welfare Plan he would have had to sell his home in order to pay for the major operation he’s getting for nothing through the Plan.

An editorial three weeks later further explained:

Life can be beautiful if you’re healthy is the way the ad men put it. There’s no doubt they’ve got a point, though it’s oversimplified. Health is no fringe issue, not when you are required to make a choice between an operation which will allow you to go on working and living, and the home you must sell to pay for that operation. Longshoremen no longer have to make such choices. More than one home has been saved since the medical coverage section of the Welfare Plan became effective two months ago.

Kaiser Permanente and Group Health Cooperative– partnering to help working American families get good health care since 1950.

 

Short link to this article: http://k-p.li/2mUqseU
T
hanks to Robin Walker, ILWU archivist, for help with this article.

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Kaiser On-the-Job: Streamlining Workers’ Compensation Care

posted on April 22, 2014

Lincoln Cushing
Heritage writer

Previous part: “Injured on the job! The history of Kaiser Workers’ Compensation care

Beginning with Dr. Sidney Garfield’s pioneering developments in occupational medicine in the 1930s, and Henry J. Kaiser’s expansion of that care for thousands of workers in his seven West Coast shipyards and Fontana steel mill, further advances in programs for handling worker health care evolved as did labor in America.

After the end of World War II, the composition of the national workforce bagan to shift from blue-collar to white-collar occupations, and the percentage of the Kaiser Permanente Health Plan devoted to industrial care waned. Still, in 1967 over a fifth of the Permanente Medical Group’s (the entity of the KP Health Plan that represents doctors) income was derived from industrial medicine.[i]

Yet a prejudice about this sphere of medicine had grown where many doctors had become cynical about both employee and employer versions of injury. As PMG Director Dr. Cecil Cutting ruefully commented, “…we practice Industrial Medicine in a manner which ranges from half-hearted to reluctant, reserving our active interest and most attentive effort for the care of Health Plan patients.”

"New Occupational Medicine Clinic" Planning for Health, Santa Clara Valley edition, Winter 1994

“New Occupational Medicine Clinic” Planning for Health, Santa Clara Valley edition, Winter 1994

KP developed a bad reputation among insurers as being uncooperative in processing the admittedly large amount of paperwork required for industrial claims. Dr. Cutting found this unacceptable, and sought to overhaul and invigorate its industrial medicine practice. He hired the respected and experienced Dr. Walter Hook to oversee the creation of Departments of Industrial Medicine at all major medical centers, each headed by a Chief.

The efforts paid off, and in less than two years the number of industrial patients grew from 21,257 to approximately 33,892.[ii] These departments were not clinical services, but handled the reporting and billing functions required to process workers’ compensation claims.

 
Kaiser On-the-Job

During the 1980s California employers saw dramatic workers’ compensation cost increases. The workers’ compensation system quadrupled in size between 1983 and 1993, from $2.5 billion to $11 billion, and efforts were made to contain costs and streamline services.

KOJ-NW clip

Still from video story on KP Northwest KOJ, 1996.
Click on image to see video.

Kaiser Permanente responded with a program called “Kaiser On-the-Job” (KOJ), first started in the Northwest Region in 1991. The program was implemented with the goals of meeting employer needs to decrease employee time lost from work and to help reduce health costs related to workplace injuries. KOJ now covers more than 300,000 workers in the NW Region’s service area.

To achieve optimal patient outcomes, it incorporated prevention, case management, clinical protocols, and return to work programs with impressive results. Between 1990 and 1994, the NW Region reduced average loss time per claim by more than two days and achieved a cost savings of $666 in average cost per claim.

The program was so successful that it received the Northwest Region’s 1996 James A. Vohs Award for Quality.[iii] Soon afterward, the Hawaii Region started opening KOJ clinics on the islands of Oahu, Maui and Hawaii.

This approach was soon adopted in other KP settings. Dr. Doug Benner, Coordinator of Regional Occupational Health Services at the time, remarked: “We had a system that just wasn’t working for employers, and wasn’t working for our physicians and staff either…This model goes a long way toward fulfilling our members’ expectations for access and service.”[iv]

Kaiser On-The-Job brochure graphic, 2012

Kaiser On-The-Job brochure graphic, 2012

KOJ later expanded to California in 1993 when Northern California started building dedicated occupational health centers integrated with our KP program, eventually opening 30 KOJ centers.

In January, 1993 the first of the new KP “one-stop” occupational health clinics opened at the Bayhill Medical Offices in San Bruno. A network of occupational health clinics were fully equipped and staffed with physicians, nurses, and physical therapists specialized in treating work-related injuries. Whereas injured workers frequently used KP’s regional emergency rooms as a first resort, they are now directed by their employers to seek care at the Occupational Health Centers.  

Kaiser On-the-Job occupational clinics in the Northwest region were featured in KP’s Perspectives video magazine, promoting the innovative provision of “comprehensive array of services for the workplace.”

Four KP Divisions (Northwest, Northern California, Southern California, and Hawaii) now operate KOJ programs that share many of the same clinical guidelines, care philosophies and processes, and – most important – the same commitment to integrated managed care.[v]

Work will always pose hazards. But the treatment of injuries on the job, which was the spark that in 1933 led to the eventual formation of Kaiser Permanente, continues to be one of the many ways that this health care organization serves this nation’s working people.

 

Short link to this story: http://bit.ly/1i7dUup


Special thanks to Dr. Doug Benner, Coordinator of Regional Occupational Medicine Services (1993 to 2011) and Connie Chiulli (Director of Operations, Occupational Health Service Line, Regional Occupational Health, TPMG) for help with this article.

[i] Newsletter from the desk of the Executive PMG Director, June, 1967.

[ii] Newsletter from the desk of the Executive PMG Director, March 1970.

[iii] <http://kpnet.kp.org/qrrm/perf_imp/vohs2/winners/winspast_desc.htm>

[iv] “Designated Occupational Medicine Services: New Model of Care for Injured Workers, Opening Soon Everywhere,” Contact, 12/1993.

[v] http://xnet.kp.org/permanentejournal/fall98pj/works.html

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Prevention of worker injuries a Kaiser Permanente tradition

posted on January 2, 2013

By Lincoln Cushing, Heritage writer

Kaiser wartime shipyard dress code poster. Henry Kaiser archives image.

In 1930s America, manual labor of all types– farming, construction, and manufacturing – was dangerous. In those depressed and troubled times, anxious workers were glad to have a job despite the risk of injury or death. Statistics of the decade told the story: workers were killed at an annual rate of 37 per 100,000 employees.

It was in this environment that Sidney R. Garfield began to offer industrial medical care for some of the 5,000 men working on the Colorado River Aqueduct Project in 1933. Garfield addressed the problem head-on by encouraging safe work habits and identifying and eliminating hazards. Garfield, bent on keeping the workers well, actively nurtured a culture of safety awareness and accident prevention.

Garfield’s vigilance to ensure a safe workplace – key to his early preventive care philosophy – remains a vital part of the Kaiser Permanente Health Plan he started with Henry Kaiser almost 70 years ago.

Garfield and Kaiser found synergy in providing health care for Kaiser’s 8,000 workers at the Grand Coulee Dam project in Washington state starting in 1938. That was practice for the real test they faced in maintaining the health of shipyard workers during World War II.

No time to plan for war industries

This safety cartoon was in the Richmond Shipyard No. 3 employee handbook in 1943. From the Lisa Killen Collection.

With almost no time for preparation or planning, Kaiser hired almost 200,000 new employees to toil nonstop to support American and Allied war efforts. Henry Kaiser ran seven West Coast shipyards and a steel mill in Fontana, Calif. His workforce was not composed of the usual sturdy males with experience in the trades – those men were serving in the military. Most shipyard workers were migrants from the South and Midwest, and about a third of them were women. Many were disabled. Few had held industrial jobs before.

The Kaiser Shipyards managers instituted several measures to reduce workplace risk.

One approach was to take care to assign people to the right job when they were first hired. In early 1944, the War Manpower Commission contracted with Permanente Foundation Hospitals to compile data about the physical requirements of each job in the shipyard. This study resulted in a 627-page reference guide called the Physical Demands and Capacities Analysis.

This illustration was published in the Bo’s’ns Whistle, the Portland shipyard employee newsletter, 1943

After workers were hired, they were not placed in a job until managers could fully understand their physical capabilities. The job placement guide helped avoid assigning someone to a job they couldn’t physically handle.

The “Plate Acetylene Burner” job description in the guide reads: “Climbs 6 steps to and from assembly platform twice daily, and walks within 500’ x 65’ area to stand, stoop, reach down, grasp, lift, and carry up to 35 pounds of “burning” equipment (women), and up to 75 pounds (men) to place where burning is to be done (25% of job).”

An article in the June 1, 1944, San Francisco Call Bulletin noted the study’s long-term importance. The manpower commission’s regional director told the paper: “The technique (methodology) on which (the research) is based will be invaluable in the postwar period when thousands of returning service men and women will have to be fitted into new jobs.”

Another strategy was to conduct ongoing worker education about occupational hazards. The weekly shipyard newsletters regularly featured cartoons, articles, contests, and photos about the right and wrong way to perform any task. The Richmond newsletter Fore ‘n’ Aft published a “Safety Boner Contest” cartoon created in the nearby Marinship yard (Sausalito) asking readers to identify hazards. Although 112 errors were intentionally drawn in, a zealous reader in a Vancouver (Washington) yard found 118.

Changes in law, technology curb hazards

Death and injury from industrial hazards such as coal dust, explosions, and asbestos have declined markedly in the past century, partly due to changing modes of production and partly due to progressive legislation.

One key step was the enactment of the Occupational Safety and Health Act in 1970, which helped accelerate an already improving work environment. In the 22-year period prior to OSHA’s existence, death rates dropped by 38 percent from the 1948 rate; in the first 22 years following its creation rates dropped by more than 61 percent.[i]

Hazards change. The most significant workplace health problem emerging in the late 20th century was the array of musculoskeletal disorders caused by repetitive stress. And today, in the health care field, other dangers lurk, such as needle sticks, exposure to contaminated human fluids, and getting injured while repositioning and lifting patients.

LMP works for reduction of KP workplace injuries

This is one of KP Northwest Region’s series of posters highlighting how employees can make a difference in workplace safety.

With the 1997 birth of Kaiser Permanente’s Labor Management Partnership, worker safety programs took a huge leap forward. The LMP’s Workplace Safety Initiative, launched June 21, 2001, was the most comprehensive and ambitious effort to date, with a goal of reducing the number of workplace-related illnesses and injuries by 50 percent over the next four years.

“Too many people in our organization are being hurt on the job today,” said Dick Pettingill, then-president of the Kaiser Foundation Hospitals and Health Plan in California. “This is unacceptable to me, and it should be unacceptable to all of us.”[ii]

The next year newly appointed KP Chairman and CEO George Halvorson and AFL-CIO President John Sweeney called on employees, managers, and physicians nationwide to make their workplaces safer. “There is no reason why we should accept an environment in which accidents are occurring,” Halvorson said. “We’re all going to work together, in Partnership teams, to improve the safety of our workplace.”[iii]

Hundreds of trained two-person teams from labor and management toured medical centers and regional operations facilities in “Broad Engagement Walk-throughs” sponsored by Southern California Region’s Workplace Safety group. The teams talked to unit staff who also responded to surveys to help identify workplace safety issues.[iv]

KP HealthConnect® joins safety campaign

“My name is CONROY. I was created for the sole purpose of getting you to watch for me and my important safety messages.” KP Northwest Region campaign graphic, 2011

New technologies also demanded workplace safety planning. In 2004, the Kaiser Permanente HealthConnect® workplace safety team partnered with stakeholders in Northern California to minimize any negative ergonomic consequences of the new national electronic health record system. Equipment at 34,000 workstations and hundreds of nursing stations and exam rooms had been modified or replaced, so the workplace safety team developed customized carts, wall mounts, and other adjustments to make sure that the upgrades were safe for physicians and staff.[v]

One way the LMP plays a valuable role is through the site-specific unit-based teams and other natural clusters of workers with similar jobs. In 2004 the Los Angeles Medical Center’s Lift Teams (specially trained staff members who help nurses and physicians lift and move patients safely) reduced the number of workplace injuries by nearly 45 percent over a three-month period.[vi]

By the end of 2005, the Southern California injury rate had declined 29 percent – short of the 50 percent reduction goal but still a significant achievement. Northern California met its goal of 50 percent reduction one year later.

Safety pin graphic created for KP Northern California’s “Speak Up for Safety” campaign, 2011.

Another major effort is the KP Workplace Safety Program, which seeks to reduce injury on the job for all employees of Kaiser Permanente, from office workers to nurses to couriers. Planning and implementation is coordinated by a national leadership team with regional representation.

In Northern California, the WPS Program serves all represented employees, including those in non-LMP unions such as the California Nurses Association, Stationary Engineers Local 39, and the Guild for Professional Pharmacists.

The challenge continues. In 2011 Northern California WPS Program Executive Director Helen Archer-Duste, RN, MS, reiterated KP’s goal: “Working in health care is dangerous. I want to make us the safest place in health care . . . Our ultimate goal is to have a workplace with no injuries. I believe that can happen.”[vii]

Thanks to Kathy Gerwig (vice president, KP Employee Safety), Helen Archer-Duste (executive director, KP Workplace Safety and Care Experience), Patricia Hansen (KP regional workplace safety practice leader), and Maureen Anderson (Coalition of Kaiser Permanente Unions) for contributing to this article.

[i]http://www.dol.gov/oasam/programs/history/herman/reports/futurework/report/chapter5/main.htm

[ii]California Wire, “Workplace Safety Initiative: KP and Labor Partners Put Safety First,” Aug. 6, 2001.
[iii] California Wire, “U.S. Labor Leader, KP CEO, Employees, and Managers Launch Programwide LMP Workplace Safety Plans,” Nov. 4, 2002
[iv] California Wire, “Labor Management Partnership Reaches Staff in Workplace Safety ‘Walk-throughs’,” Nov. 11, 2002.
[v] California Wire, “Safety Is Key in KP HealthConnect® Deployment,” July 19, 2004.
[vi] California Wire, “Los Angeles Lift Team Wins LMP Award,” July 26, 2004.
[vii] “Workplace Injuries Plummet,” Inside KP, Nov. 8, 2011.

http://bit.ly/UhZopQ

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Third world nations seek Kaiser Permanente expertise

posted on February 23, 2012

By Ginny McPartland
Heritage writer

First in a series

Construction workers at Ghana job site, circa 1963. Volta River Authority photo

In the 1960s, dubbed the “Development Decade” by the United Nations, Henry J. Kaiser’s enterprises were literally all over the map. Kaiser’s companies were mining bauxite for aluminum in Jamaica, manufacturing cars in Argentina and Brazil and working on a huge hydroelectric project and aluminum smelting plant on the Volta River in the emerging West African country of Ghana.

Kaiser Engineers were also building a dam on the Bandama River in Ivory Coast, West Africa, as well as undertaking projects in various parts of India, including construction of a dam, hydroelectric plant, an aluminum plant, a steel mill and a cement facility. Kaiser Engineers were involved with the Snowy Mountain project – construction of tunnels, aqueducts, dams and hydroelectric plants in the mountains of eastern Australia.

As in his American ventures, Henry Kaiser’s enterprises on foreign soil developed medical services for workers at the job sites and often in the community. In many places, including Australia, India, and Ghana, the government required Kaiser to build hospitals at each of the construction locations.

Children began to go to school once Ghana became a republic in 1960.

“In a sense, this was a recapitulation of the early experience of our domestic medical care program, which had its origins in providing health care for workmen and their families at construction sites in the Western United States,” wrote James P. Hughes, MD, Kaiser Industries vice president of Health Services in 1972.

KP executives tapped to develop health facilities abroad

Clifford Keene, MD, Kaiser Permanente president at the time, was thrilled to participate in the launching of medical care projects in foreign lands.

“I went to Australia several times because Kaiser Engineers were involved in the Snowy Mountain Project and I was involved in the location and construction of hospitals there. . .I went to India twice, once for a period of almost a month. I found myself in places with exotic names, Uttar, Pradesh, Mysore, and Jamshedpur.

Kaiser companies helped design and equip this hospital in Akosombo, Ghana.

“So all of this was going on and it was just a big, spreading, challenging, wonderful, exhilarating kind of existence. While we were having all the troubles in the Permanente Medical Program (in California), getting reorganized, I was involved in these other challenges, which gave me satisfaction and sort of balanced the scales against the frustrations of dealing with the Permanente program.”

Ernest Saward, MD, medical director of Kaiser Permanente’s Oregon Region, traveled to Argentina in 1960 to help establish a medical care program for Kaiser automobile workers in Cordoba and Buena Aires. Saward said the Argentines didn’t trust the Kaiser organization initially and expected the company to superimpose a foreign health system on the community.

“The reaction back from Argentina was, ‘You folks in California put some millions in this and build us a hospital and everything will be all right.’ From what I’d already learned, I saw that if (Kaiser in partnership with the Argentines) put any millions in a hospital it would be confiscated within months. That was the nature of Argentina at the time. They play rough. Now I never personally got shot at; I was only threatened with a saber,” Saward said with a laugh in a 1986 oral history.

The river above the Ghana dam site was treated to eliminate the Black Fly that carried a debilitating disease. Volta River Authority photo

Saward and his artist wife managed over time to infiltrate the Argentine culture and make essential contacts for Kaiser. “They saw that we were somebody they could relate to, that (we) wanted to understand them and to understand what I would call their general, cultural events, and not be an isolated colony.

“They began to entertain us, and I spent hours lying on the living room floor, drinking red wine in front of a fireplace with these guys, until they finally understood what it was we were trying to do, and once they really got a feeling for what we wanted to do, they said, ‘Let’s do it’. We did it with the best medical group in town and with the best hospital in town, and it’s still going (1986) and it cost us in toto, $55,000.

“What had to be done in Argentina was to make an indigenous plan and not a foreign plan and (to make it go) it had to be done as an indigenous plan by what were respected elements in the community. (That’s how) we did it,” Saward said.

Requests for help from international community multiply

As Kaiser Industries continued to work abroad into the 1960s and 1970s, the challenges for providing health care kept coming.

Ghanaian physician at Akosombo Hospital, early 1960s

This was a period when African nations were gaining their independence, and the international community was interested in promoting industrial development to improve the economies of all underdeveloped countries. With new industry and its attendant growth, the budding nations were struggling to provide essential services to their citizens, both natives and newly arrived workers and their families.

To address these issues, seven hundred industrialists from 70 nations gathered in the San Francisco Bay Area in September of 1969 to figure out how to close the gap between the “have” and “have not” nations.

“There was much talk about the responsibilities of private enterprise in developing countries; about the need for more effective allocation of resources; about the need for business to interact with the society in which it finds itself,” noted KP President Clifford Keene in a talk to the Industrial Council for Tropical Health at the Harvard School of Public Health in Boston in 1969.

Kaiser’s people learned the hard way what this meant. In Ghana on the Volta Dam project, Kaiser leaders discovered pretty quickly that – despite the government’s well-laid plans – the company needed to initiate environmental programs to ensure safe water and pest-control measures to protect workers from the spread of debilitating disease.

Once the dam was completed, Kaiser began construction on a smelter plant to manufacture aluminum. “. . .the first responsibility was to provide care for the work injuries, since the existing health care facilities in the town were grossly overburdened,” wrote Hughes.

Health planners forced to improvise

For these foreign projects, many necessitating brand new cities or towns, Kaiser’s goal was to establish health care facilities for its workers, their families and often for the community at large. Hughes said in most countries where Kaiser had developments health care services had to be introduced in waves, depending on available services. Often, sanitation and safe water needs and the dire need for training of locals in basic care methods were the first priorities.

To provide health services, Kaiser Industries initially engaged the Kaiser Permanente Medical Care program. By 1964, however, Kaiser leaders realized the need for a separate entity and established the not-for-profit Kaiser Foundation International (KFI) to administer the foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence.

Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. By 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah and West Virginia.

Next time: Kaiser Foundation International gets contracts to resurrect a hospital devastated by the Nigerian civil war, to train Peace Corps workers for African rural health projects and to consult on many foreign health care projects.

 

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