Posts Tagged ‘Ghana’

Global enterprises gave rise to export of Kaiser Permanente health care

posted on February 27, 2012

by Ginny McPartland, Heritage writer

KFI nurse visits with NIgerian patients at Port Harcourt.

Second in a series

Established initially as an industrial health plan, Kaiser Permanente had grown and morphed into a community health plan with over one million members in six states by the mid-1960s. Meanwhile, Henry Kaiser’s ventures had spread across the globe and the basic concepts of industrial and preventive health care traveled with him.

This meant the idea of prepaid health care provided by doctors in group practice was getting a lot of exposure in places where it might be needed most.

The World Health Organization was busy helping African and other developing countries set down their “national health plans,” and industrial nations were taking a serious look at investments in these countries. Already with health care programs in Jamaica, Ghana, Argentina and Brazil, Kaiser Permanente seemed in a prime position to take the lead in other emerging nations.

“At first, we held the belief that since we managed a large, comprehensive and widely-accepted health care system in the United States, that we were in a favored position to cope with the health problems associated with industrial enterprises all over the world,” KP Health Plan President Clifford Keene told a group at Harvard University in 1969.

“This theory turned out to be true in a limited sense,” he continued. “We learned quickly that the medical care circumstances in rural India and in Jamaica are essentially different from those in California.”

A package disaster hospital (PDH) as it arrived in Lagos, Nigeria, to be transported by river steamer to Port Harcourt where KFI restored a war damaged hospital. Public Health Reports photo, 1970.


Keene explained that developing nations, especially those with a national health plan, urgently needed primary health care workers, clean water, sanitation and disease control before they could even think about clinics and hospitals. Adjusting to local circumstances, Kaiser industrial health care leaders filled in the gaps where needs were most urgent – and bided their time.

KP establishes independent international agency

By 1964, Kaiser Permanente was getting requests from the U.S. and foreign governments to help plan and launch health care services in needy countries. Feeling the strain and drain on the Permanente Medical Care Program whose staff was responding to the calls, Keene and the board of directors established Kaiser Foundation International (KFI).

This not-for-profit entity, with an $55,000 initial grant from the Kaiser Foundation, was a separate self-sustaining agency established to fulfill government contracts to provide help setting up health care in foreign or domestic rural areas.

In its life between 1964 and 1975, KFI was involved in projects in more than 30 countries, including the U.S. where the agency helped set up programs in rural areas of California, West Virginia and Utah. Its workers took on projects in 13 countries on the African continent, as well as in India, Pakistan, Bahrain, Italy, Indonesia, Venezuela, Argentina, Brazil, Peru, Jamaica, the Bahamas, Canada, Okinawa, Taiwan and the Island of Curacao.

Wood and canvas cots from a package disaster hospital (behind these Nigerian children) were put to good use. Public Health Reports photo, 1970.


Nigerian civil war leaves damaged hospital in its wake

KFI was called upon in 1969 to bring back to life a Nigerian hospital that had been debilitated in the civil war that started in 1967. James Hughes, MD, Kaiser Industries vice president of Health Services at the time, explained:

“This project was completely unrelated to any commercial activities by Kaiser Companies in Nigeria. It was undertaken strictly in response to an urgent request by the government (U.S. Agency for International Development) for technical assistance in a matter of general medical care. Presumably, the request was based upon our prior experience in the organization and delivery of health care on other West African (Ghana, Ivory Coast, Togo, and Senegal) projects.”

The 250-bed hospital at Port Harcourt in the area of Biafra previously had been the referral center for the entire Rivers State of Nigeria with a population of one million. “The Port Harcourt situation looked particularly grim,” reported Keene.

“The war was still in progress 50 miles north of the city and the Biafran troops were making periodic sorties toward the airfield on the outskirts of Port Harcourt. KFI existed to handle tough overseas assignments, but we have never acted in a war zone,” Keene continued.

KFI physician Carl Friedricks, right, explains his work in Nigeria to KP Hospital Administrator Peter Rout and Violet Rout, MD.

“When the physician (Carl Friedericks MD) arrived, he told us his first impulse was to turn around and come home. Medical care was critically needed by the remaining civilian population and by refugees streaming out of the jungle zone,” Keene reported.

KP team resuscitates Port Harcourt hospital

The initial team of five acquired a package disaster hospital (PDH)* from the U.S. Public Health Service. Electrical generators, emergency water equipment, and medical supplies and equipment were “scrounged from unbelievable sources,” Keene said. “A Nigerian staff was recruited and trained, on a counterpart system (that matched) native physicians, technologists and nurse volunteers to (our 20) personnel from the United States.”

In the first months at Port Harcourt, the hospital had a daily census of 80 to 100. Dr. Friedricks saw patients with familiar diseases such as diabetes, hypertension and pneumonia. But he also noted many patients with tuberculosis, parasitism, malnutrition and severe anemias.

“Tropical ulcers are common and yield to prolonged medical treatment and skin grafting. Malaria is the most common cause of fever . . . One young lad suffering from a heavy hookworm infestation came in with a hemoglobin of 2.0 grams, or about 13% of normal levels; blood transfusion and medication brought him up to 42% of normal hemoglobin to permit his discharge for home medication.”

Intravenous kits from the disaster hospital were used to save starving children, left. A technician, at right, displayed an X-ray developed by using a Polaroid process that didn’t require water, which was in very short supply at Port Harcourt. Public Health Reports photo, 1970.


They also dealt with issues such as having no dishes to feed the inpatients, getting fuel for the repaired coal stove and outfitting the makeshift operating room and exam rooms with light fixtures. Transportation was not a problem: the U.S. government supplied them with four Land Rovers and a Rambler station wagon. Nigerian Airways had regular flights between Port Harcourt and Lagos, the largest urban area in Nigeria.

San Francisco KP nurse goes to Nigeria

Frances Fuller, formerly assistant director of KP’s San Francisco Medical Center, arrived in Nigeria in September of 1969 as the KFI chief nurse. She went to work setting up nursing classes for 40 Nigerian students as well as developing a hospital procedure manual and a central supply and distribution system.

Fuller reported remodeling of a lecture theater for use as a temporary surgery. “When the room is ready, we will take the instruments and other supplies from the PDH (package disaster hospital) and start doing more surgery.” In the midst of her reporting on the status of the medical facilities, she interjected: “Grounds are being well kept. We even have flowers in the courtyard.”

In 1971, the KFI team departed Port Harcourt leaving a locally staffed, well-functioning and well-equipped community hospital.

Kaiser Foundation International report, circa 1972.

Financial troubles doom international agency

Unfortunately, all of KFI’s ventures didn’t end happily. In Peru, a project to set up a hospital system for blue-collar workers was ended abruptly when the government was overthrown and all funds for health care projects withdrawn.

In 1968, politics killed another KFI project, this time in Libya. At the request of the U.S. state department, KFI sent a physician to discuss improved medical staffing of hospitals and clinics in Libya. When Libyan government officials learned that Kaiser assembled its Jeeps in Israel, they dropped the project, due to the Arab League boycott of companies doing business with Israel.

An ill-fated project to bring prepaid group practice to Saudia Arabia in 1974 ultimately brought down KFI, Permanente medicine’s first but not last international arm. Scott Fleming, KP senior vice president, said the project presented major cultural and legal problems that were costly to solve. In general, the KFI financial picture didn’t look promising at that time so the directors decided to discontinue its operation altogether in 1975.

Next time: Great press about Kaiser Permanente abroad fuels renewed initiative to teach eager foreign health officials about the KP care delivery model.

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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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