JUBILEE (oct - Dec 2oo2), No 50

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of tbe Asso ciation of Former WHO StaffRoom 4141,IY/HO, CH-1211 Geneua 27, Sutitzerland, ( TP:+41 22 791 31 03; FX: +41 22 791 07 46)

E-rnail: afsm-aoms@who.ch'Website: <http://www.clubs.org/aoms.htm>

BEHOLD, Q.NAfter the creation ofAFSM, a casual conversation

took place about a newsletter for \WHO former staff.

Alain Vessereau, the Association's founding father,

asked me to accept responsibility for a publication to

keep colleagues informed and in touch. It was to be bi-lingual, and to appear regularly. That simple chat was all

that was needed to bring out a slim, eight page "PilotIssue" dated 1989-90, which eventually became the

Quarterly Netus, published four times a yeaf . The Jubileeissue now in your hands is 24 pages long.

Some 30 issues later, perhaps inevitably, "re-organ-

ization" entered. Under the chairmanship of RajindarPal, a three-member editorial board was established and

Têrms of Reference were adopted. To ensure smoothfunctioning, the terms of Ql/ separated authority and

responsibiliry for each of its three organizational levels

Excerpts of news of more than passing interest

follow:

IrurRopucrrrrc oURsELVES : (Pilot issue- I 9 I 9 - I 9 9 0)-This bilingual publication aims at providing news and viewsol general interest: both good and bad. Our aim is morethan to just fill pages with words, but to provide reportingthat is straight-lorward and understandable.

Co-HRsrrRroN: THE FIRsr rME: (QN 3 - Autumn,I 990)- For the lirst time ever former staff took part in theACM of the Stalf Association. Our resolutions requestedthe D-C to make available to us olfice space and that ourcontribution lor l99l would be 20 Snriss lrancs or theequivalent in another currency, with additional voluntarycontributions u'elcome.

Mo«r AND BETTER: (QN 4 - Winter, l99l) - ltsoon became apparent that AFSM f,illed a real need. Someof the most lavourable responses came from ex-colleaguesoutside the Geneva area. Even more significant r,vas theresponse lrom widolvs and lvidolvers, who leel that at theleast AFSM represents a helping hand flor them in resolvingproblems.

Now, 2 yEARs rArER: (QN 9 - Spring, I 992)- ltisa time-honoured, and indeed a much respected, custom forexperts to put their talent at the disposal of lormer employ-ers, becoming, in some cases, a $ I-a1ear consultant.

,S JUBILEE ISSUE-

the AFSM Executive Group, the QN Editorial Board

and the Editors.

Then, when the present Administration suddenlywithdrew the services of \ÿ'HO French translators,

volunteers stepped forward. That development and the

growth of the newsletter has evolved into an "editorial

staff" of Francophones and Anglophones that assists

the Editor. Now' serving chairman, David Cohen, has

increased membership on the editorial board to four,

the fourth being earmarked for a Francophone. (Allthose contributing dre listed in the 'Acknotuledgements".)

This issue, No 50, seems an apt time also to revisit

the QÀ/ pages of our yesteryears' -peter ozorio

ErJitor

That being said, we must make clear to our servingcolleagues that we have no designs on their iobs, nor is itour intention to obstruct promotion.

Wr rosr AppEAr: (QN 12, Winter, 1992-1993)- The ILO Administrative Tribunal has dismissed the appealof three lormer stalf rvho had challenged WHO's decisionto raise health insurance premiums by basing them on 30years' ol "notional" service irrespective ol the actual time olemployment.

Pru-onvrruc rHE rENSToNERs: (QN 14, Sttmme11993)- We should not be against the hiring of U.N. reti-rees, but we should be against them occupying establishedposts, thereby blocking the advancement ol servinE staff orthe recruitment ol lresh talent.

D-G's RESpoNSE rs "NO," Bur ...: QN 16, Winter,1993-94 - The D-C has said "no" to proposals made last

October by AFSM to work out what was described as "new"

and "fair" premiums to the health insurance lund that wouldhave lowered payments for many lormer staff. But he heldthe door open, slightÿ, for a revier,v olrates. AFSM pointedout that premiums lor lormer stall are calculated on pre-taxincome.

PRrrrrclpls AND pEopLE: (QN 19, Autumn, 1994)When AFSM was established in l,989, an emphasis lvas

placed equalÿ on: I. Ties. We pledged to maintain ties

amonE ourselves, with WHO, and, last but not least, withour sèrving colleagues. 2. Support. We pledged to sup-

port lormer stafl ànd families, committing ourselves to the

principle ol delence o[ their interests.

For those outside the area, our links are maintained

mainÿ through this newsletter.

Prrusror.rs AND rAxES: (QN 23, Autumn, 1995)

-There is therelore not the slightest doubt that a Seneralexemption ol U.N. pensions lrom national taxation r,vould

be accompanied by ât least a proportionate reduction in thelevel of our pensions.

$ 12,000 LMIT pLACED oN U.N. PENSIoNERs: (QN23, Autumn, 1995)- The General Assembÿ has placed a

yearly limit on what the United Nations may Pay pensionersemployed as their consultants.

Hnnosnrp cAsEs: (QN 20, Wnter, 1994-95)- AFSM has reiterated its request to hear lrom colleagues"who are having real difliculty in keeping up with their health

contributions."- It is anxious to collect factual data to dem-

onstrate the extent oi the hardship in the increased level olcontribution.

Sorr,te 300 pENSIoNs "suspENDED" IN 1995: (QN24, Winter, 1995-95)- A beneliciary assumed, wrongÿ,that the envelopes he had been receiving lrom the U.N. lointStalf Pension Fund contained nothing more thanyet anotherstatement ol "periodic benelits." When he did get around

to opening the'mail, what he found was a second request lora Certilicate ol Entitlement, which meant his pension lvas a

step away from being stopped.

Tur pruru rN SrAIN: (QN 25, Spring, 1996) - tn a

letter dated l4 May 1980, Hacienda,-thelesponsible min-istry, reasoned thai as pensions have the "same characteras earned income" they were tax-free. Hottever, a new

interpretation was given in March I 990. As the conventionbetween the U.N. ând Spain does not specificalÿ list "pen-

sions" as an exemption, they are, after all, not exempt.

Tne cnsr oF THE MtsslNG MoNEY: (QN 27, Autumn,1996)- Noticing that I 54,000 Sr,viss lrancs did not appear

to his credit, a coJleague lrom WPRO, a stall member for 23

years, queried UBS, onÿ then to discover that it had been

transf,erred to Thailand - to a nelvÿ-opened account in his

name. It was done, the bank explained, upon his instruc-

,t *l1 -

r

l\lil >Iil l-l|'nl s/i. t §\ttll x-,titl

,q, il/t:'41

G-i-tl :rl :/rêt.ttl sil

, lt\

Memory Lane:"Stroll down it alone - I"ll wait here."

page 2

tions in a letter. Responding, the colleague declared that he

had issued no such instructions, and that consequentÿ the

signature was a forgery.

THr uonr THTNGS cHANGE...: (QN 34, 35, 1998)

- If, this issue of QN has a theme, it is about change. WHOhas a new D-C, Gro Harlem Brundtland, and the changesshe has invoked are momentous, arguabÿ the most siSnifli-

cant in our lilÿyear history. Our old WHO will have a new

r,vay of doingi6ings. WfiO's old divisions and units have

given way to "clusters" (leading one waE to diagnose cases

ol "clusterphobia.")

Tue closrrrrc oF THE GENDER cap: (QN 36, Spring,1999) - Recent changes in the U.N. Pension Fund,

although allecting all spouses, essentialÿ represent a breakfor divorcees - the u'omen rvho hitherto had no claim on the

U.N. pension lund after the deaths of their ex-husbands.

Effective from I April I999, thanks to amendments(mainÿ to Article 35), they are now entitled to the "survi-

vor's beneflits" despite their divorce.

"Too oLD" - IF Nor ^GEISM,

THEN wFtAT?: (QN37, SttmmeL 1999) - Sadÿ, it seems that at least in one

Management Support Unit ageism exists. According to the"Serpént Enchainé", the serving stafl's publication of, revela-

tion, "An N4SU reiected a halfl-time contract of six months

for a long-serving lormer colleague - even though he was

vig.orously supported by the technical unit, and was on extra-

Ufageury fuààs. too'old, he was bluntÿ told."

Srn our IN LIMBo: (QN 39, Winter, 2000) - P*your Russian pensioners! Despite promises by the Eovern-ment, selfl-professed "sympathetic" over three years a6,o,

their claim Îor restoratiôn ôf their U.N. pension, which had

been signed away - against their will - to the lormer SovietUnion, remains unresolved.

Arrrn 20 vrans oF DEFIctr, A suRPLus: (QN 41,Sttmme1 2000) - Representatives of former stafl associa-

tions in Ceneva declarèd that, should the U.N. go out ofbusiness today, the lund could continue paying pensionsboth to formei and serving stafl. Their mood of, exuberanceis understandable as a report said that the fund "had previ-ousÿ experienced a deficit for some 20years."

Fourrro Gurlry oF GENDER stAs: /QN 43, Wnter,2001) - On 3l fanuary,, the ILO Tribunal, in f udgement2004, lound WHO's Administration guilÿ ol6ender bias

against a male colleague in Washington, D.C. N a first.

Fur pprusroNs FoR ALL Ar AGE 70:. (QN 44, Spring,2001) - With India cited as an example, a modest pro-posal has come from UNICEF, New Delhi, that colleagueswho elected to take a lump sum on retirement, and thus tobe satisfied with a reduced pension, should be entitled to a

lull pension after l0 years. By that time, the U.N. Joint StalfPenlion Fund would'hru. r..ior.r.d what it disbursed in the

lump sums, and thus should restore full pensions to them.

LoNc-rrRna c RE Now ar CERN mp U.N.: (QN46, Autumn, 200 l) - 2OO I may well be the turning pointin the struggle over recentyears to provide international civil

servants wi[h improved long-term care. While colleaguesof all ages may need long-term care, it will benelit us, the

former staff, most.

Surveys of readers inevitably bring in a disap-pointing response, at least numerically

- unless there

is much to grumble about. The QN Readership Survey,announced in QN43 (\Minter 2001) followed form,drawing but a modest 71 responses, or just under 10per cent of total membership. To put on a smiley facethough, that could be because most readers seem h"ppyenough with the newsletter. As the analysis publishedin this Jubilee issue shows (see box), responses indicatedsupport of the efforts of the QN team.

In response to Question 1, almost 90 per cent ofrespondents said they read QN "fully". R. Q. 2, virtu-ally all found contents either "very good" or "good,"though one thought it just "so so". As to the related Q.3, 9B per cent rated the layout, "very well done" or "welldone," while one thought ir "mediocre."

R. Q. 4, B0 per cent preferred four issues a year,confirming QN's publishing schedule of the past dec-ade. The crucial matter of periodicity is linked first toregular contact with AFSM membership, and then,inevitably, to costs, which, as reported previouslv, runto about 1,500 CHF each issue for editorial assistanceand layout. As for Q. 5, only 1 per cent thought the

o Criticising the layout as "mixed," and anarticle on retirement in Florida (QN43) as "singularlyuninformative to those already retired

- they know."

Respondent, No. 26 asked for "more regional input roavoid the impression that QN is for the Geneva club."Similar comments also showed concerns beyond thebasic topics of health insurance/pensions/taxes that arenormally the pensioners' preference.

Respondent l0 called for QN to carry "a briefand sincere account of what \fHO does;" Respondent35 (ex-TDR), asked for items about \XrHO poli-cies and politics and its "successes and failures;"Respondent 36 (ex-BUD), wanted news of WHOmeetings; Respondent 32 preferred medical issues andRespondent 48 (ex-iNF), news from the regions "theyhad come to love."

\7hile there were bouquets strewn before QN,there were brickbats thrown as well. Naturally, grum-bles often went beyond QN itself

- to SHI, pensions,

membership dues, and more. Some random shots.

Respondent 34 objected to the manner in whichcontributions to SHI are determi ned

-"les cotisations

calculées sur uru€ période de seruice fctiue (uirtuelle!) sontexorbitrtntes ?/tr r/lPPort au niueau des retraites, et ces coti-sdtions uiennent encore d'être augmentées". Respondent70 said: "§(/har irritates me is peoples' gripes aboutpensions. If they've done any serious (field) work with§fHO, they'll know their counrerparrs couldn't evendream of such riches."

ReSPoNSE MoDEST, BUT VIRTUALLY ALL LIKE 8NRssurrs oF READERSHTP Sunvpy

1. I read the Qr\/; Fully Most of it Not at all87(Yo (62) I -lol, (9) 0

2. Contents are Wry good Good So so

49o/o (35) 49o/o (i5) 7 o/o (1)

3. Layout is done: Wry uell Well Mediocre

4lo/o (29) 5\o/o (41) lo/o (1)

4.I prefer QN: 4x yearly 3 times 2 times

B0o/o (57) l5o/o (1t) 4Vo (3)

5.For AFSM, ON is: Essential Necessary Marginal

59o/o (39) 40o/o (26) r.5o/o (t)

newsletter "marginal" to AFSMT mission.

Almost 75 o/o, or 53, of the responses came fromAnglophones; the rest from Francophones, wirh oneresponse in Spanish. Predictably, the majority werefrom the Geneva area, including neighbouring France,but 11 were from the U.K. and others from Austria,Canada, Germany, India, Israel, New Zealand, thePhilippines, South Africa and Spain. Details:

The difficulties encountered by colleagues over-seas in paying membership dues also were singled out.Respondent 25 (ex-WPRO) suggested that AFSMask regional offices to accept dues for transferring toGeneva (an arrdngement already established, for SEARO

-Editor). Respondent 47 (also ex-WPRO) made the

point that pensioners overseas have no way of sendingSwiss francs to Geneva. They would like to but how todoit?

The most frequent grumble was of QN's latearrival, which, mea culpa, has been due in part to edi-torial workload but also to the postal service. Througha quirk in mailing, those in France , for instance,receive copies at least three weeks after colleagues inSwitzerlancl. Respondent 11 complained that rhe

QN43 January-March 2001 issue only arrived at theend of May (demanding "mais y-aurait-il moyen d'actiuerafin de receuoir les nouuelles plus tôt?') Respondent 16asked: "Why do I not receive it regularly ? Am I not a

member?"

There were bouquets a-plenty though.Respondent 19 noted, though cautiously: "So far, so

good." Respondent 27 (ex-EMRO) said: "The QNgives me great pleasure and is a window on happenings,past and present." Respondent 49 wrote: "Please keepit up. \ù7e all need it." Respondent 60 wrore: "QN is

»)m?dthique and fun reading -

and important forformer staff." And Respondent 46 (Corunna, Spain)said in Spanish: " My thanks to all those devoted peoplewho enable this publication to continue, as it is +

page 3

FeaTURES

ro Harlem Brundtland, a f'ormer prirne

minister of Norway, took ofÏce as D-G on

21 Julv 1998 and promised radical relorm fàr

§7HO. She restructured it, prioritised its activities, and

launched new health campaigns. \fHO made a come-

back to the global political stage. But in a few importantways, *ù7HO is still struggling. A new D-G takes office

next Jul1,, leaving the future of the reforms uncertain'

Two months befbre taking office, the new D-Crnade her first speech to the \Morld Health Assembl,v.

She promised major organisational reform. She laid out

four strategic directions for WHO: reducing the bur-

den of disease, particularlv in poor cottntries; reducing

risks to health; creating sustainable health svstems; and

"developing an enabling policv and institutional envi-

ronment in the health sector."

The most important pledge she n-rade - a pledge

that some wiil judge her term by -

was to create "one

\fHO". We must be able to say, she said, \fHO is one.

Not two -

meaning one financed by the regular budget

and one financed by extra-budgetary funds. Not seven

- meaning Geneva and the six regional offices.

he first three months of her leadership saw nlas-

sive upheaval aimed at giving §fHO a leaner

srructure. She reduced 50 programm€s to 35

departments and grouped them into nine (now eight)

clusters at headquarters. The new D-G and her execu-

tive directors became a tight, government-style cabinet.

But there has also been a constant reshuffling of the

D-G's cabinet -

only one original cabinet member

remains. The D-G argues that this was necessary to get

the right mix of people, but manv \fHO staff say the

changes created instability in the organisation.

She galvanised important health campaigns withnew partners from both the public and private sector.

In the months before taking office, she decided on two

page 4

important for everyone, especially those whose home isfar lrom Geneva."

Ql/ helps colleagr-res keep in touch with each

other, a point also made bv Respondent 13 "QN est

prdtiqu€m€nt le seul /iert qui ueut bie n ueruir encore me reli--er

à ruotre OMS. De graues atteintes à ma santé de retraite

nt'imtnobilisant quelqu€ Peu, QIV arriue éuoquant l'équipe

et ressuscitrtnt les espoirs. Merci", and echoed by others.

Respondent 9 (ex-ADM) wanted more shorr items on

what retired staff members are doing. And Respondent69 (ex-SDT) said "The longer one is retired, the r-r-rore

necessary to know what goes on; nice to see many oldfriends are still active."

Lamenting the passing of Tom Strasser and

his friend Albert. who loved chocolate cake' two

Respondents 9 and 12, asked whether a successor

.o.r[d b. lound for his "Health Corner" articles, whichalways "were so full of common sense, reassuring and

funnY"' -John

Bland(formerly Editor World Health)

Mourex' Frrtnce

BMJ JUOCES THE D.G,S TERM IN OFFICEcampaigns, the 'lobacco Free Initiative and Roll Back

Malaria, a public-private partnership that Brundtland

called a "pathfinder project." She established a new unit,

Evidence and Information for Policy, which produced

the \ÿorld Health Report 2000, released in June 2000,

measuring the performance of couutries' health svstems

and ranking them into a league table. The rePort was

explosive. Many countries objected to their ranking;

the report's methods were savagelv criticised and its rel-

evance to developing countries was questioned.

§(as a ranking a valuable exercise? It succeeded

in igniting an important debate about what rnakes for

a good health system and why various countries per-

form so differently. But its release was handled poorly,

and many \fHO staff I spoke to complained of an

unhealthy atmosphere at headquarters in rvhich internal

dissent about the report was stifled.

at progress did Brundtland rnake towards

streamlining activities at headquarters withthose of the regions? One stumbling block

was the long-running autonomv of the regions. The

D-G has little authorirv over the regional directors

Lrecause she does not elect them. Reform of tù7HO's

regional structure rvould have to address this structural

problem.

I visited VrHO's headquarters the week after her

announc€ment not to stand lor a second term. There

was widespread speculation about whether there might

have been other reasons for her departure. There was

a feeling that while she boosted staff morale when she

took office, she squandered their initial enthusiasm by

becoming increasingly isolated, uncommunicative, and

hidden behind her cabinet.

In summary, the D-G injected a strong sense

of direction into an ailing bureaucracy by focusing its

efforts on a few priorities. Through high profile global

health campaigns, she put \7HO back on the global

map. Donor governments have a renewed confidence in§7HO and have steadily increased their extra-budgetary

donations.

But her managerial changes have had a mixed

reception from \WHO staff, and she has failed to extend

her reforms beyond headquarters. Her vision of "One

W'HO" has not yet been realised. She recentralised

\fHO, concentrating its focus on Geneva. This tactic

helped launch new alliances, such as Roll Back Malaria,

but \ÿHO is not comfortable in its partnership role and

these alliances have not yet had a major impact on the

world's poor.

Deputy *i;:;;H;;,(Excerpted from tlte British Medical Journal,

2 Nou. 2002, the first ofrtrt articles»)

Of/HOi rebuttal to this article uill be publishedin QN51. -Editor)

All Aeour THe I .5o/o REDUcrloNThe "elimination of a 1,5 ?er cent reduction

factor of tbe initial adjustment of basic pensions,"

- phrase from a report by FAFICS (not to be confused

with AAFI/AFICS) following its council meeting held

in Rome in July 2002.

You may well ask, whatever does that mean? You

are in good company if you don't know. In fact, truth be

told, few do. \What should stop your eyes from glancing

over the phrase is the single word "pension." Actually,that opaque bit of officialese prose is a reference to ourlivelihood

-pensions. \fhat, precisely, is it all about?

Some two decades ago, to meet the deficit in the

actuarial balance in the U.N. Joint Staff Pension Fund,

a 1.5 per cent reduction in pensions was imposed uponthe new pensioner, not on retirement, but on the firstadjustment of pension that followed.

Much has changed since then. Three recent

valuations by the Committee of Actuaries have shown

surpluses of 0.36 per cent in 1997; of 4.25 Per cent

in 1999; and of 2.92 per cent in 2001, the last year

for which figures are available. That has resulted in a

tripartite \Working Group (gorernments/participants/

pensioners) to recornmend, after a two-yeâr "funda-

mental review" of pensions benefits, that the 1.5 per

cent reduction be stopped.

Long-ternx careU.N. FIELD STAFF PETITIONING FOR COVERAGE

Pensions

The initiative to provide long-term care to

international civil servants is gathering impetus, albeit

slowly but surely. After about a decade of deliberations

and discussion, the breakthrough came in mid-2001,when coverage was extended to colleagues in the U.N.,Geneva, through its Staff Mutual Insurance Society(which covers UNOG, UNHCR and-§ÿ'MO) as well as

to CERN, the European Nuclear Agency.

Now, Anders Tholle, President of AAFI/AFICS,formerly U.N. peace-keeping, and his colleague Gualtier

News & VlEws

However, because of turmoil in the stock markets

around the world and the weakening of the U.S. dol-lar, the Board of the U.N. Joint Staff Pension Fund,

meeting in early July also in Rome, temporised. Thefragile economic climate "had an impact on the moodof the Pension Board," the FAFICS report said, and

consequently led to the decision to defer considerations

of compensation to 2004, but, cautiously of course,"subject to a new, positive actuarial evaluation." Therecommendation was one of eleven made, all needing

the approval of the U.N. General Assembly.

Later, a r€port by the ILO Stalf Pension

Committee, dated 30 August, summed up develop-

ments thus : "Participants' representatives, as well as

some representatives of other groups, wishecl to recom-

mend that the U.N. General Assemblv implement all ofthe proposals contained in the report in order to restore

the benefits that had been eliminated in the 1980s (as

lor instance affecting the cost-oÊliving adjustment)."

As its name suggests, FAFICS is a federation of15 AAFI/AFICS-Iike organisations around the world,that meet regularly. Among the delegates at Rome

was AFSM Chairman, David Cohen, who represented

AAFI/AFICS, Geneva (though costs were borne bv

AFSM).

Fishère, f'ormerly UNDB are circulating a petition ask-

ing that long-term care be extended to U.N., UNDPand UNICEF staff who have served in the field.

Addressed to Secretary-General Kofi Annan, the

petition seeks signatures from those who have served

with the U.N. Field Service, U.N. Peacekeeping and

UNDB as well as in duty field stations of other agen-

cies. Similar representations are being undertaken by

serving colleagues also.

»page 5

The petition for retirees, which originated from

Geneva last October, appeals for reimbursement of the

cost of long-term care in the home as well as in clinics

or hospitals; in short, it seeks benefits "similar to those

adopted" by U.N. Geneva for retirees "who have opted

for after-service health insurance with the Van Brecla

plan." As yet there is no closing date for the petition.

\ân Breda, a commercial insurance companv in

Antwerp, provides healtl-r insurance to U.N. field staff

thor-rgh not stalf at Ne$/ York HQ, where, oddly, no

long-term care is oflered at all by anv of the insurers

(among them, Blue Cross-Blue Shield, and Aetna). Van

Breda recently çrroposed coverârge for long-term care at

an increase of 1.5 per cent in contributior-rs to the health

insurance that it manages for UN-UNIDO in Vienna.

According to stafÏsources, the Vienna administration is

hesitant about the proposal, citing costs, while 94 pet

cent o[UNIDO staff have lavoured it, lollowing a refer-

endum. Van Breda already provides insurance f'or FAO,

§fiPO ancl WTO which includes iong-term care.

"\7e are anxious to collect the signatures ol the

maximum number ol lonner fieid stalf for I petition to

the S-G, " the two sponsors have declared. "Throughout

\7HO, be it in Geneva or the regions, there are manv

who have served in the field and who have remained in

touch with colieagues from U.N., UNDP and UNICEFcovered by Van Breda. Tell them about the petition.

Every sigr-rature counts."

Ciopies of the petition are available lrom the spon-

sors at their e-rnail address: <tholle@cytanet.com.cy>

or <Gfulcheri@aol.com>.

LTFESTYLES

TwO WOMEN ELECTEDTwo women now serve on AFSM's l5-mern-

ber Executive Group lcrilowing elections last October

- Çsns\riève Màrtinod a newcomer, joining Averil

Foster, who was re-elected. Earlier, in July, a "special

appeal" was made for female colleagues to run for office.

\7hile three new candidates put themselves forward,

only one was elected, a sign that the membership-at-

large had not been entirely attuned to the call for a "bet-

ter balanced" committee of the sexes.

(The appeal did inspire a letter to QN49, how-

euer, dpPlduding ffirx for gender equality but dko urging

Anglophone colleagues of orl nationality, wlto constitute a

small minority on the Executiue Group, to stand. They are,

along tuith wonten, the writer said, both "untapped riches"

of talent and much "neededfor our common good".)

By their very nature, reunions are attended by

folk iust like us, whoïe shared common experiences

- except that AFSM's 16th reunion last December was

brightened by the presence of baby Quentin Thollier.

Comfortable in his stroller, the littlest guest, who is

the grandson of colleague Gabrielle Pierre, formerly

Admin (Visas), exuded the peace that's so badly needed

in our times.

The annual rite brought together 271 Persons(250 a year ago) to renew friendships, and also to hear

words of welcome from two speakers. Responding,

somewhat hurnourousl% to the "ban" on lengthy

addresses. Chairman David Cohen limited his remarks

TO EXECUTIVE GROUP-livo other newcomers elected to the Executive

Clroup were both male, Daniel Flahault, formerly

Ombudsman, and Dev Ray, a veteran of staff affairs

while on :rctive service. The other successful candidates

were those who had sen'cd previouslv. Yves Beigbeder

repeated as AFSM's top vote-getter, with 290 votes, two

votes ahead of David Cohen, now re-elected Chairman.

Others elected and their votes follow:

Roberto Masironi (275, now Vice-Chairman,

formerly Ti'easurer); Alain Vessereau (274); DanielFlahault (269); Averil Foster (268, now Tieasurer, for-

merly Vice-Chairman); Dev Ray (267): Roger Fontana(263, re-elected Vice Chairman); Stan Flache (261);

Samy Kossovsky (241, re-elected Assistant Tieasurer);

Rajindar Pal (238): Geneviève Màrtinod (237) .

AT T6rH REUNION,27l NOULTS, 1 BABYto essentials -awarm welcome

to all; a thank-you to those whohelped AFSM,notably servingcolleagues inprinting, mail-ing-distribution;to an announce-ment of a Baltic

cruise in summer 2OO3 (see deruils, P. 7) and to a tribute

to Gérard Dazin. In recognition of service beginning

with AFSM's first committee, he was presented »page 6

with an engraved Caran d'Ache pen, the Chairmanspeciÿing for his letter-writing as our colleague pos-

sessed neither e-mail nor computer.

Dennis Aitken, Chef de Cabinet, representingthe f)-G, referred to her presence then in Burkina Faso

for the closing ceremony of the Onchocerciasis ControlProgramme. He subsequently congratulated formercolleagues who had "worked hard one way or another"to help eliminate river blindness in the 11 African coun-tries that were afflicted. As a highlight of work in 2002,he singled out the Framework Convention on Tobacco

Control, in essence a treaty, to be ratified proposed by\7HO (see page 1l).

Among the other invited guests were MaryanBaquerot, Executive Director, Admin; Isabelle Nuttal,President, \fHO Staff Association, Anders Tholle,President, AAFI/AFICS; Jean Hanus, President, formerGATT staff; members of the Joint Medical Service, and

of §7HOt mailing and printing units.

The cost of catering was 4,444 CIHF (3,450 CHFat 15th reunion), financed in part by donations at thedoor, which amounted rc 1,374 CHF ( vs 1,645 CHF);and \ü7HO's regular contribution of $500. Stated diÊferently, the costs were higher in 2002 and donationslower than in 2001. At the 14th reunion, catering cost

2,000 CHF, and donations amounted to 1,300 CHF.

LIrce FATHER, LIKE DAUGHTERWith evident pride, Joe Chang-\Xi'ailing, former-

lv \7HO Ombudsman, recently spoke of his daughter,Catherine receiving a Diplôme de Médiateur from theUniuersité de Lumière, in Lyon. Already a practising bar-

rister at law, she follows father's footsteps in the delicateand difficult art of bringing people together

- 2 121çn1

badly needed in these querulous times.

(A family acbieaement, a blessed euenl? Tell QNand we'll tell others.

-Editor)

Nsrÿ§ §Nv§sÈmss §, /---ÿ' r'/ r-

, ,1 6(6uL_, 1

l.-t'J ,, r*, ry, ^"h{,

ÿ».h,\'/ r c'- -71 È.1hnt{)\"\-./

N§§§§ WNS Yssÿ

page 7

WHO LEADS, U.N. FoLLoWSIn a separate but related development, S-G Kofi

Annan announced last October, "with pleasure," the

appointment of the first ombudsman for the UnitedNations, thus, in effect following the example set dec-

ades ago bv Halfdan Mahler, D-G Emeritus.

For colleagues at the U.N., observes QN's Wise

Old Owl, it's better late than never. To be noted: inour times, the Ombudsman was elected bv po1',ular vote

from an agreed upon list of candidates who campaignedfor the job. Todav, the post is by appointment of thechief executive, with no direct staff participation.

BnurIC SUMMERAnother former Ombudsman, Daniei Flahault,

is again the driving force behind a proposed cruise,

announced at AFSM's annual reunion in Decemberfor this summer on the Baltic, again on the "Costa

Romantica."

Planned is a seven-day voyage with visits to Visbv(Sweden), Stockholm, Helsinki, St. Petersburg and

Tallinn (Estonia). The port oldeparture and return is

Copenhagen, respectivelv on 15 and 22 June.

The price for a minimum of 20 reservations

varies: for inside cabin, lower deck, 1,360€, lor upperdeck, 1,480€; lor outside cabin, lower, 1,750€; forupper, 1,920€. The cost of return fare, bv air Geneva(or Paris, or other major French cities) to Copenhagenis included.

The orqaniser,.just elected member of ourExecutive Group, broke new ground for AFSM in man-

aging its first cruise rwo yeârs ago, in the Mediterranean,which attracted serving as well as former colleagues - notonly from the Geneva area. Wnez nombreux,he says forthis ner,v adventure. A few cabins mav still be avail-able.

In MemoKlaffi(Ti.ibutesfor "ht Memoriatn" must include, at least, thefollotaing: tbe date and place of deatb, when the deceased joined

and retired fiom IVHO, the last position hebl, a personal assessrnent of the deceased, and when possiltle the names of sttruiuors.

Also, a photo. The contributor'sfonner offce should also be giuen. Because of space requirements, please limit tributes to no

more tltan 300 words. -QN))

Ernest M. Ungureanu. Dur-ing a lifetime devoted to fightingmalaria, he could count amonghis foremost achievement the dis-

coYery of a new method ol prepar-

ing insecticides, enabling thern tobe kept in frozen or dried form

-x mç1hsd accepted by some 100

iaboratories around the world. Hejoined Y/HO's Division of Malaria,Geneva, in 1963.

Belore that he worked as an

enton-rologist in Romania, at the

lnstitute of Hygiene. crrrving out

research into malaria control, alter

studying natural science and biol-ogy at lasi University. A League ofNations scholarship in 1946 tookhim to the Malaria-therapy lJnit inHorton, England, as well as to the

London School of topical Medi-

cine. Awarded a \fHO fèllori'ship

in 1956. he worked at the It,rlian

Institute of MalarioloqY' Rome '

Even while retiring frorr-r

\fHO in 1974 he remained a con-

sultant, accepting assignme nts towork in countries at the request ofRegional C)ffices and servins also as

a member of malaria expert commit-

tees. On his return to Romania he

was given the Chair of Parasitology,

Faculry of Medicine and PharmacY

at lasi University, where he had been

a professor earlier.

Colleagues appreciated his

skills, and his passion for the long-

term goal ol malaria eradication.

We will long ren-rember his tall ar-rd

clistinguished rnieu, his serenity and

his lv,rrm human qualities.

Born in 1912, he died, aged

90, ir-r Iirsi c'rt.r 13 Julv 2002. His

dar.rgl-rter \tiorica.,r prolessor ofphilologv and specialist in eco-phi-

iosophi' at I:rsi, cot'ttinues her fàther's

work.

-Rajindar Pal(formerly VBC)

Wrsoix, Suitzer/and

RIP

*"-$_

fi,l,J.;#

ffir

:-r,r,ih

the

The following deaths have

last announcement.

AYE. Khin Mu

BAIDYA, Giriraj

CHALAPATI. Lanka

DELOS. Rios S.

EDOLJARD. Donna

FAZZI. Pier Luigi

FIEDLER. Elson

GUR, Dev Singh

HUBER. Theodorus

KAYE, RitA

LAMBRECHT, Frank L.

LAMY. André A.D.

MALDONALDO, L.F.

MARTINAUD, M.L.

MARTINS. Iris de Abra

MASCOLO, Joseph J.

MORAN, Benjamin

MORCOS, George A.

NTADI. Gabriel

OGUN. I.

OLIVEIRA. Sebastaio

OMONY. LOUIS

RIZOS, Evangelos J.

RODRIGUES. B.D.A.

ROSEN. Ellen

SANSGUILHEM, JosePh

TAWA. Simone B.

TRAPMANN. Rudolf R.

URRUTIA. Justa

VARELA, Olaya

VYVER. R. van de

Compiled by RosemarY

AAFI/AFICS Bullerin and other

occurred since

19.04.02

12.02.02

16.02.02

23.01.02

t9.04.o2

24.04.02

t6.02.02

07.01.01

05.04.02

22.01.03

09.03.02

23.05.02

03.03.02

25.04.02

02.04.o2

03.05.02

18.04.02

24.01.02

18.02.02

23.01.02

to.o2.o2

16.03.02

27.01.02

02.04.02

07.03.02

F. 06.03.02

19.05.02

29.O3.02

07.12.01

12.05.02

15.04.02

Bell fromsources.

the

page 8

Iru rxe House

D-G To.BE rs 2ND FRoM WPROLong-time political adversaries, the

rwo governments of the Korean penin-sula patched up their differences at -ü7HO's

Executive Board to nominate the same can-

didate for the sixth and next D-G -

Dr.J.'§ü'. Lee, from Seoul. Currently director ofthe programme Stop TB Now, he will take

office in Jul,v, following pro /àrma confir-mation by the World Health Assembly, and

three months after his 5Bth birthdav on 12

April this year.

According to press reports, the vote nominatinghim was a clifÊhanger. He broke a tie and then defeated

Dr. Peter Piot (Belgium), Director of UNAIDS, by17 to 15 votes on the seventh ballot. He had the "edge

because he came from a developing countr%" Reuters

quoted a European delegate as saying and because the

D-G, Dr. Gro Brundtland, "was also a European."He is the second, after Dr. Hiroshi Nakajima (Japan),

from \MHO's §Testern Pacific region.

Associated Press reported that the nominee "ben-

efited from a smooth and well-funded campaign backed

by the South Korean government, and a solid block ofAsian support on the Executive Board - even pickingup the vote of North Korea, one of rts 32 members.

South Korean officials, said to number 96, "jumped

for joy as the results were announced," Reuters also

reported.

After the vote, the D-G-to-be told the Korea

Times he would try to improve North-South relations

in the peninsula by "rooting out epidemics plaguing theNorth." Another aim stated would be to move "75 per

cent of \ü7HO's resources and staff" out of Geneva by

a popularD-G from

2005, a proposal not without implicationsfor colleagues serving at HQ.

Three-other short-listed candidateswere eliminated in early voting

- Dr. Julio

Frenk, Minister of Health, Mexico (former-

ly \XfF{O Executive Director recruited bythe D-G herself); Prof. Ismail Salaam, ex-

Minister of Health, Egyp,t and Dr. Pascoal

Mocumbi, Prime Minister, Mozambique.The last named, "with a medical degree andtop political connections should have been

choice," in the view of the Economzsr, as firstAFRO.

The D-G in-waiting has been a staff memberfor 20 years, joining WPRO in 1983. He became

director of the Global Programme for Vaccines and

Immunizations in 1995, and director of \MHO's

tuberculosis programme in 2000. He received his MDfrom Seoul National University, and his MPH fromthe Universiry of Hawaii. Married, he has one son. AVrHO announcement said that he speaks English and

Japanese, in addition to Korean, reading Chinese and

French as well.

In a procedure unknown in our times, all candi-dates were interviewed by \7HOt EB the day before

the vote, which took place on 28 January. Amongqualities required to lead was "sufficient skill in at least

one of the official and working languages. "

In a joint statement released earlier, in December2002, Lnncet and the Rockefeller Foundation declared

that the \fHO directorship "carries more influence onhuman life than any single presidency or prime-ministe-rial position."

LErre ns(Readers lihe letters. Keep them coming and short.

HeppY JUeILEEPeter Ozorio, the Editor of Quarterly News,

should be congratulated on the occasion of the publica-tion of our periodical's 5Oth issue. He needed a lot ofenergy and devotion to carry out this difficult task, notforgetting his competence as a journalist.

Our thanks are also due to those who have con-tributed to this publication over the years -to

col-leagues who have submitted texts, to the translators and

revisers, notable Jean Leclercq, Michel Fèvre and John

Identifit yourself by your last'WHO ffice. -QN)

Bland, as well as, of course, Marianne King, the faithfuland dedicated editorial assistant.

Quarterly News has created a precious and neces-

sary link between the Association's members through-out the world and has kept former staff informed about

their organisation's activities. By encouraging colleagues

to send in Letters to the Editor, it is also a forum for an

exchange of views.

\7e must also thankAlain Vessereau, first President

of AFSM, who in 1989, with the support of the Dpage 9

headquarters Staff Association, founded our Association

which then gave birth to Q,n/. He was followed by Stan

Flache, Rajindar Pal and, now, by David Cohen.

Our Association plays an important role in the

domain of Staff Health Insurance; two of its mem-

bers represent it on the Surveillance Committee. TheAssociation also has two representatives on the \fHOPension Committee.

The Executive Grougr meets once a month tofollow the progress of the Associations activities and todecide new ones, for instance in the cultural field. TheGroup is also concerned with social questions, and itsupports the SelÊHelp Group rvhich provides assistance

to members who need it.

A General Assembly is held every Nvo years and

a friendly reception every year, u,hile the list of \fHOretir.:es with their addresses is published annually.

Bon courage, Peter, for the next 50 issues !

-YYes Beigbeder

Mentber, QN Editorinl Board

FnOnA EMRO: SERSOru,S GREETINGS

On this pleasant occasion, I send to formercolieagues

- especially those who have served in

EMRO, where I have worked for more than 37 years

- Season's Greetings from my wife, Leila, and myself,

wishing all a happy Christmas, good health and happi-ness for the New Year.

I take this opportunity also to indicate mv pleas-

ure at receiving the QÀ/, which remains the major linkwith former colleagues, conveying to us news of inter-

est.

I am pleased to inform you that I have sent to

you through the WHO Pouch (Beirut/EMRO-Cairo/Geneva) a cheque for US$100 as a contribution to sup-

Porr Q^/.-K. Mneimne

(formerll, WHO Regional Aduiser, EMRO)Beirut, Lebanoru

(QN colleagues mucb appreciate lour su?port.-Editor)

REECTING TO QN49(Re: Ql/49. July-september 2002)

QN 49 arrived in Rio de Janeiro early December.

Some comments:

Re: "To §7orry or Not to \7orry," disconcerting to

page 10

read about the fluctuations of the pension fund

Re: "His 'Biologicai \Tarfare' Crisis, "I wonderif Rajindar Pal, an alumnus of the LSHTM (London

School of Hygiene & T'opical Medicine, NOT School

of Hygiene & topical Medicine, London), studied inthe same Entomology f)ept I did, and under the s,rme

prof, Dougie Bertram!

Re: "§7HO Denies Studying Blondes." I think\7HO should study blondes -

they are an importanrnatural resource.

-Jack.Vÿ'oodall(formerll' HST)Rio de Janeiro, Brrtzil

CnyING WOLF(Re : uHis Biological V/arfare,, QN 49, Spring

)oo))

In the early seventies when I served in New

Delhi as information officer for SEARO, an item ina local paper caught my attention

-something about

an experiment alleging that \XfHO u,as using India as

a guinea pig iinked to American interest in biologicalwarfare .

This turned out to be a reference to the Genetic

Control of Mosqr-rito Project located on the outskirts ofthe city. I decided to pay it a visit and that proved reas-

suring, although I had never seen so many mosqr-ritoes

being bred or confined to cages. The plan was simple.

The head of the pro.iect carefully expiained that all the

male mosquitoes had been rendered sterile. -ù7hi1e even

sterile mosquitoes can mate rvith eager fèmales, the

result did not produce progeny. Even tnore reassur-

ing was the fact that male mosquitoes do not bite, onlyfemales do.

But the newspaper item and others that fol-lowed stirred up a storm and questions were raised

in Parliament as described in QN 49 by our col-

league Rajindar Pal, fbrmerlv Chiefl VBC and Project

Manager. To counter the adverse press, my strateÿ was

to invite journalists and \X/HO or foreign exPerts ro visit

the project and see what was going on. Unfortr-rnately,

perhaps due to the Cold \7ar, this had become a very

hot political potato. The Government of India, with an

eye on elections, stated that this was a \XrHO project'-W.FIO reacting in a less than forthright way, claimed

that the project was at the request, and under the con-

trol, of the Indian Government.

And so, as the buck was passed back and forth,the press coyerage got worse. Even reputable journals

in the U.K. had picked up the story without checking

and too easily accepted the false claims. They were

Iater to apologise. \fHO headquarters prohibited me

from inviting anyone, especially journalists to visit

the lab. Then, buckling to pressure, the first trial was

cancelled and soon after the project itself closed down.

The attempt to control mosquito populations withoutpesticides is now just a memory of the few who care to

remember.

Today, with real biological weapons for warfare

on the increase, well funded, and stoutly defended in a

country I know well, there would be good reason to cry

wolf in a loud voice. Instead, doors that should remain

open for i'spection are closed'

-Nedd §flillard

(Jàrmerly Information Oficer SEARO)

Geneua

..THE RIGHT LEADER,,The future health of billions of people around the

world hangs in the balance as nine candidates jockey

for votes in a largely ignored but desperately impor-tant election for the post of D-G, WHO. \X/hen its

Executive Board meets in January to interview candi-

dates and nominate one person, it will be presiding over

a crisis in global health.

Prime ministers and presidents alike agree thathealth is nou, central to human development. The

most obvious visible expression of this is the waf inwhich health targets dominate the U.N.'s MillenniumDevelopment Goals.

VrHO has been a weak partner in initiatives thatinfluence global health. Its work on susrainable devel-

opment has been too little, too late. It has failed todrive home the advantages won for public health duringthe VTO's negotiations at Doha in November, 2001.

Country-level work has been neglected. In sum, there

has been no sense of urgency in \yrlHO's leadership, no

sense that it is the only global agency to advocate on

behalf of the world's poorest people.

The right leader will be a person with strong pub-lic health instincts and a demonstrable commitment to

compaigning for global health equity. A leader, in otherwords, who is prepared to irritate enough governments

to ensure that he or she serves only one four-year term.

--Richard Horton

Editor The Lancet,

(Excerprcdfrom letter to tlteTimes, London, l0 Dec. 2002)

U.S. COI-I-EAGUES..D ISCRI M I NATED,, AGAI NSTFor its citizens abroad the United States makes an

invidious distinction between "earned" and "unearned"

income lr,hich does not appear in the domestic U.S. tax

code. Thus Americans who are retired and live entirelyon Lrnearned income (Social Security, investments, IRAs

etc.) do not receive an exemption and must pav U.S. tax

as well as taxes in the coLrntry in which they live.

I rvould love to know u,hy the Americans insist on

discriminating against their retired citizens who choose

to live abroad.--Gerry ThompsonWrbier, Switzerland

(ExcerptedJiom letter toIIHT, 23-24 Nou. 2002)

!ru rtrE PREss

EU -ro BAN FORCED RETIREMENT FROM 20,06The elderly suffer more discrimination than

almost any other group in U.K. society, being treated ina way that would be illegal for anvone else. At the age of60 for women, and 65 for men, employers have a legal

right to sack them however good they are at their job,

however good their health, however much they want tocarry on working. Except we don't call it sacking, we

call it retirement. Some, such as two British Airwavs

stewardesses forced to retire by contract at the age of 55,

try to fight. Most just meekly go.

Part of the problem will be solved with a

European directive which rn'ill ban age discriminationfrom 2006. No longer will companies be able to force

staff into retirernent before the state pension age. Themain employer affected will be the Government +

--t

-:

§\f*,]:t.J§

.\§§§

page I 1

- it spouts fine words on combating ageism but impos-

es ageist policies on its staff. While ministers have the

right to work as long as they want, their civil servants

are compelled to retire at 60.

But the European directive will leave state rctire-

ment ages unchallenged. Groups like the Third Age

Emplovment Network are pushing for the scrapping

of the state retirement age, but the Conlederation ofBritish Industry is insisting that it stays. Employers are

apparently addicted to the right to sack able workers for

no reason.

But before .anyone gets taken in, we should

look at other countries. Both the U.S. and Neu'

Zealancl have abolished compulsorv retirentent ages

on the ground of discrimination. Companies sr'tch as

Sainsbury's, Nationrvide and B&Q have abolished com-

pulsorv retirement, giving evervone the rieht to u'ork as

long as they want.

-Anthony Browne

(Excerpted fiom rhe -lin:'es of London , 9 Oct. 2002)

WHO,S TOBACCO TREATY

The Bush administration persists in siding withR.J. Revnolds and the other cigarette giants in inter-

national tobacco control negotiations convened by

§rHO.

Smuggling allegations based on informationcompiled by the 10 countries' iaw enforcement agencies

suggest that RJR knowingly sold large volumes of ciga-

rettes to mobsters, because criminals can be helpful ingaining access to some markets and thev pay rnore than

legitimate partners.

A lawsuit also claims that RJR obliged the mob-

sters by removing marks from its products to Preventthem from being traced; the firm and its affiliates

frequently switched bank accounts to cover up their

actions. Of course, the suit may fail, and RJR's reputa-

tion may recover its former level. But that level is still

Cell- PuoruEs: Rlsx\7HO has clarified its position on the health

effècts of mobile phone use. Media reports that WHO"insists mobile phone emissions are safe" are a distor-

tion of tWHO's position, according to a Note for the

Press dated 10 Oct 2001.

While \fHO states that "none of the r€cent

reviews have concluded that exposure to the radiofre-

pretty low.

To combat the (tobacco) epidemic, §7HO has

sponsored negotiations on a global tobacco conrroi

treary. Tl-re penultimate round finished last monthl the

next and final one will take place in February. Most

of the participating countries support a range of sensi-

ble measures. Tobacco advertising should be banned,

except in countries (as the United States) where this

rvould be unconstitutional. Tobacco control meAsures

should not be subject to challenge on trade grounds,

because trade rules should promote the free exchange ofgoods, not bads, such as tobacco. Smuggling should be

suppressed wherever possible. Cigarette packs should

carry prominent health warnings, and misleading terms

such as "light" and "mild" should be forbidden.

(ExcerptedJiomThe Washington Post, 26 Nou. 2002)

S STILL UNKNOWNquency (RF) fields frorn mobile phones, or their base

stations, caLlses any adverse health consequence, there

are gaps in knowledge that have been identified for

further research to better assess he,rlth risks." \7HOadds "It will take about 3-4 vears fbr the required RF

research to be completed and e'aluated and to publish

the final results of any heaith risks."(Norefor the Press Iÿo. 14, l0 October 2001)

A SPECIAL ACKNOWLEDGMENTThe senior generation wishes to acknowledge

with thanks the role of the iunior in helping us to man-

age our home computers -- overcoming a hard-drivecrash, the Bugbear virus, a breakdown in comptrter-

printer and mastering (though never fuily) the mvster-

ies ol new softrvare.

\Mithout the expertise of Alastair Bland (son

of John), Olivier Gigon (gr"ndson of Marianne King),

François Leclercq (son of Jean), and TJ. Ozorio (son

ol Peter), this issue, and others, would never have seen

the light of publication. So all hail to the kids!

Acbnowledgetnents : The Execwtiue Group thrrnl<s

thosc wlto li,rr, *ad, l,ossiblc rhis issue, ispeti,tlllPeter Ozorio (Editor') : Y'es Bcighcdet'.' DmiilFlahtult artd Dn Ray (Edirorinl Board) : DauidCohen (Chairman) ;'Mitlrcl Fèr,re. Jetn Leclercq(French translations) ; John Bland,l{edd Willard(English); also Marianne King ( Editoridl Assist,tnt).Lay'out by Humphrey Mdxltel, GLtsgow.

The uiews expraxed iz QN dre those oJ'tha

authors, not rtecesstrily oJ'AFSM

page 12

Feature

t has been a stock theme for columnists in recent

years. \(/e hear and read about it every day. Learned

studies using highly sophisticated and, to say the

least, far from pellucid technical terminology recur-

rently claim our attention. Yet the thing is simple.

Patients falling victim to an acute illness thatnonetheless leaves sequelae, to a chronic disease, or toan accident resulting in serious functional impairment,may find themselves totally, or partially in varyingdegrees, unable to cope with what French social legisla-

tion calls the everyday tasks of life : dressing, washing,

feeding oneself, following a prescribed course of treat-

ment - conducting the basic activities of day-to-dayliving. Such a state of dependency necessitates outside

assistance. It may improve, quickly or gradually, remain

stationary or even worsen. The problem of the cost ofthe outside assistance and how it is to be met throughinsurance then arises. Such a situation may occur at any

time of life, but its frequency increases with advancingage.

The steep rise in life expectancy during recent

decades has been reflected in a steady increase in the

number of elderly people with phvsical or mental defects

-ef1çn both- requiring help from other persons.

ospices for the aged were created a verv longtime ago. Living conditions for the inmates

were usually far from pleasant. The com-

munity bore their cost, which was relatively light as

mean longevity was low and death generally came

during the active period of life. As a rule, moreover,

particularly in rural areas, the different generations ina family lived together, the young taking care of the

old. In many developing countries that is still the case.

in industrial countries things are very different, and

the means adopted to cope with the resultant growingproblem vary widely from one country or social groupto another.

There exist cases where the handicaps sufferedfrom offer no prospect of improvement and clearly

necessitate special management. tù7hat are known as

"établissements médico-sociAux" (medico-social establish-

ments) cater for such needs. They provide help with the

routine activities of life such as washing, dressing and

feeding oneself, together with nursing and medical care.

The way the costs are defrayed varies widely.

or us retired \fHO staff the existing provisionsare inadequate. The Health Insurance reimburses

the costs of admission to a medico-social estab-

lishment on a regressive basis. While some of us have bigenough pensions to be able to cope without difficulty,the same does not apply to others who contributed forrelatively few years or had modest salaries.

There are still more cases where admission to a

medico-social establishment is not, from a strictly medi-cal viewpoint, indispensable. The patient would be able

to stay in his or her own home provided that regular

assistance was available in the form of medical and nurs-

ing care and domestic help. Some welfare systems have

woken up to the problem and measures to deal with ithave been taken in some countries and even some inter-national agencies.

ur Health Insurance does indeed take on the

medical and nursing costs; it rules out ofconsideration any domiciliary assistance not

definable as either medical or nursing services. \7ere itprepared to recognize such a state of affairs for what itis, namely a pathological condition calling for "long-

term care" which it agreed to reimburse, referral to a

medico-social establishment could in a great many cases

be avoided. That would be pure gain. For the patients,

the benefit to their morale from staying in their ownhomes is obvious : it can only be to their advantage

and spare them the psychic and psychosomatic conse-

quences that uprooting and placing in an institution all

too often entail (plus the financial burden that those

consequences represent for the Health Insurance).

The very learned technical studies I have referred

to -which

are still to be completed- seem to show

that the financial requirements could be met througha modest increase in the contributions to the HealthInsurance of all its partners. Certain organizations,

in particular within the United Nations system, have

begun to make arrangements on those lines. They need

to be developed.

The ever-growing number of distressing and even

tragic cases makes speedy action essential. Our AFSM is

working actively for that.

-Samy Kossovs§

(formerly JMS)(Translation: John Fraser,

formerly TRA)

LoNG.TERM CnnE : WHAT IS Ir ?

Supptettnwr