LETTER TO MR. ALLEN DULLES FROM D. A. FITZGERALD

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80B01676R001000090025-7
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 13
• Document Creation Date: December 15, 2016
• Document Release Date: September 5, 2003
• Sequence Number: 25
• Publication Date: November 15, 1955
• Content Type: LETTER

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INTERNATIONAL COOPERATION ADMINISTRATION
OFFICE OF THE DIRECTOR
Washington 25, D. C.
KOV 15195h
Mr. Allen Dulles
Director, Central Intelligence Agency
Washington 25, D. C.
Dear Allen:
In accordance with our telephone conversation, there is
attached a copy of the letter from Dr. Howard Rusk containing his
proposal for a Latin-American Rehabilitation Project.
As you will surmise, Dr. Rusk's idea was rather favorably
viewed by Governor Stassen, but it was not implemented in FY 1955
because of a shortage of funds.
Technically, we do not rate projects of this kird very
high in the scheme of priorities hich has been agreed to, not only
by our medical staff but by the Public Health Service, the Childrenf>'
Bureau of HEW and our Health Advisory Committee. This kind of
activity is, indeed, listed eighth in the third priority group (see
attached paper entitled "Priorities in International Technical
Assistance Health Programs"). We are far from giving adequate
coverage to first priority programs, not to mention the second
priorities. In view of our limited resources we are, therefore,
most reluctant to undertake a project so far down the line in the
third priority group.
I would be most grateful for any ideas you may have after
considering the attached material.
Sincerely yours,
Deputy Director
for Operations
Attachments:
Letter to Gov. Stassen
from Dr. Rusk, March 23, 1955
"Priorities in International
Technical Assistance Health Program"
State Department review completed
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Ur. D. A .. F ita(crlf
De y Directs r frr O aeritions
lnte aticnal Ccoplrati n ?idzruinibtratio3a
WasWaSton 25, D.
Your Jett---r of .bf: filt :auth f November, and Or. ;.uyk
prvpoe4 reg&rdiag = : h li 3tion in L.itin A.rneric . h .t base
discussed by r-upc naib1e rrtembe ?a Of my stiff. tls lxe
proposal hwas s*tcb merit and could contribute to ;-h,.: wcji- be
of many pereo u in :, crucial area, the project doer. nu-:
t directly int< tour ,per-4tiv l plans. If, howevctc,
agency decider that its budgetary and priority rtcluir^tn
do permit approval z- an Iv!. apr r ticn, we wool l Ap -y
oppurttuxity to di---cast, possible caordinatian c
with . uumbor 0.z our activ-itit.: that relate to it.
Sinc a rye ly.
SIIJNI-R
;Men V. DulL
Director
C /IO/Meyer:mvs (16 December 1955)
Distribution:
2 Addressee
2 - ER w/basic (ER 7-6253)
1 - DD/P
1 -RI
1 - C /10 File
1 -rono
2
IN -~
ILLEGIB
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My dear Mr. Stassen:
Following e series of. most satis1:acuory -.i.scuseicns.:a.ith Drs.
Hanlon and -sJilliams, I vrn pleased to subriit to. you. he fol?owiiig
:pro'iosal for e Latin-American r& b1litattcr: Project ;a.dar-
taken Jointly by the oreign Operations Pcthiinistration and tie
International Society for the Welfare of Cris j1e:3.
1. The international Society for the :velfare of "Cripples is a
federation. of. over 100 voluntary organizations. cor_ i.~ctine, rogracns
J s welfare, of the ph,sically handicapped in, thirty nations.
Its adquarters, are at ?27 Fast 52nd Street., ?~:ew York 22, _~ew
Yor.~ . The International Society ha: consu tativa status as r non-
governmental orgar_:iza.ticii with the "unitE(i Nations Fnd works co-
operrutively with many internnticnal ortan'_zations, such as the
International Jnlon for Child Weifar-a, Wont.) Council for the 7-lii.d_
and.tha, World Veterans Federation, in its activities.
The . fundamental f a- -'-
purpose of the ? 1_-~:.aes $ety is to r& ke
possible the most effecti-: a ser%yic es to assist the d isat71ed tiro
out 1d.L Tha._i~.rincip ,a._r~et o _. ra i ii~ss the st' u atto
and, development of loc 'l and national volantary organizations con-
corned with with rehabilitation of the handicapped within the various
nations. f Currently, tb?_! International Society has :.ember affiliate!-
and, close.. relationships in Brazil, Mexico, Argentino, `enezuela,
Haiti, Chile, Cuba, Columbia, and Uruguay. Attached is a list of
the names end adtiresses of each of these organizations. The pro-
grams of each of these countries are in various stsges of develop-
ment, but In each there is a fo~'mal voluntary organization which is
providing some type of direct or indirect services for the re -iabil-
itation of the handicap :ad.
,.r,he International Society for the slelfe.re of Cripples 1-as also
51eveloped close working relationships over the years with profession-
,11 persons and citizens interested in roha~jilitation in severr:l
+ther Latin-A.iicriean countries, such as 3oli.~ia, Cuatei-qala an
f,cuador and has bean in close; contact with the development and in.-
lerrientatiori of tie united FFa.tions Techilic~.l fis::sta:_ce ProLrams
hich has aided in the develo-oment 7~f rehabilitation ~ervices in
`.'ruatem.al.a and Venezuela. T'he ntc:rnat, oii1 Zo
i
t
c
e
y hb also tiad
relationships ,ri th ;;>ofessional persons Land
citizens interested in reh&:ui1itaticn {rn ;;urta r?ica, i,eru and Para-
iuay .
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11
T
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r the:: tev lop?;?rt-of its
Irie'ri0L nd to' ^r faS ? i
?~Yr.l :~~ ors F .~ C1t..zc. s ;~ntcrr,~tecl in'
those rAt,li : 11 V ;ci tile Irlterratianal ~oci
t
a
"cr, ~r~n'tly rigs ro meinb~r..aff~ l ate. t
v i v~ ~y4~c a; l or Y.c C ..C.rls ~'1e ' Qc ief Ilirv
f*Oir,dat on *rrA ?}1e 1C n 6r'C1 i.it1-, s .c ij'Gfess Onal
,'broaps mss the vor1d Go
f`
a
d
r
'
ti
i
n
e
e
t
t
c
rl orT- sicz:l `rr
.-, ea . '-T +'.... - 2 -~... ~. Y? Dr. anl,ari?
`:2?"'.. Y*., ??.;,?,..+.:. v..aiv ~._ivav ,i"GJ1:t..1 ~~it3j'-..1~J oetween
the n to natjoral' :ociet ?.rid ]M.r. David Amato
r.e ~aiiili`at
,
._>
'?n Gon
sultant, Institute of Inter-American, Affa; rs ? ri i:ex co.
2. It is proposed that the Foreign 0 t,:ratior,s Adir,istrat_on anU
rent of rehabilitation services for the : ysica7.ly Rr1icap ed ice,
a.. Provide a consultant anal/or co,:sultants .'to- c~ !d :.r he forrratior:.
and development of volur"tary: p;encies sconce^r:-??, : -t-h rehabi litatior4
and services to the hen ica
d i
'
ppe
n those rat
Xshs.hti
._i- wre suc naon--P
al,' voluntary or~;r;nizati ons do not now exist ?
' t
an:
o e i these new
and currently existing organizations tc develop the or anizational
--~-- r..y ,~~ ~~ ,ir?zr :pro i'Fris.., In
addl.- technical corsultatlcris trr~
~
t;
f
; .
1
ie ;~s e ;,
p ,bli;ti, fil
cx ohsm
arid` other media will be provided not only on the na ' is r 7 aspects of
ra?knh i -, IT +c+;
c
e i
l
u
o,.,a
o U 1!3 cholo1ld
, . , ,6ca an voc ' ati:onal services for the r~]lysicF.1ly harN;ca:
-ad All
;
.,-
consults
tons and planning would be done in cooperatieri J?titli the Health anl
e S
We]!
i
e
ar
erv
c
s of interntil
aona gcverriiww.nta1 and non- overxzmental
l
-- .o yep ,xuc.,, ga
or- i
;'ganzations.
It is envi sicre: th
t the
a
; ccrisultar_t and/or consultants would esta's-
t fish a headquarters in one of the Latin-American cities and from
that headquarters :iould visit the various nations for a period from
two to six sleeks ,to consult with
zL~' -;o;te.rnmen".; of`.icials, voluntary
associations, professlo4lal organizations and others interested in
_
d b
V i VV V VV.l
e arranged
.a . 1ti through the Fo-'ei~n G Herat. _ans Adnir.is;raticn Nissiou in each of
these
ati
r
ons or a body ditd Lh
esgnaeay te o-ei Operations Ad-
- ~ J _- - ~.....,..,y .,,.i l ilia ~ e V,? an organ J -
zatior, so designated by the international Society for the Welfare
ofrCripples. It is proposed that the consultant and;
or con: ultant
a;,st ;r:ed to t '?)IS project ve r n individual with experience in the
or ar:.zatior.al al:~ ad;ninistrative rtlases of the development of bot),
C,overiwental and r,on-goverrt,,ent r --,rograms of rehab? litation ser-
vices for' the phys c-.l1y her: .'icapped and be a -erson of suffic ient
,)rof essional tra.inir:, an_' experience to ;ono ride technical consul-
tations either directly or indirectly or, the dical, social, edu--
cational &L A vocational as~.;ets of rehe': I litat.ion services far
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Clonal `'c:.toty viI.: -~rcivt'& ?c icfi1 s.ii?arvi. Lon _
~t?.':n.^tntt,ftaht nd~or ^onsultart. 73r 8?1aJCAY';.G`vf'.the `ocie'.y~s
h
e
i-
I- U
regu] r p rv: .,rill ;)-o -,. Lde 7r i:n`ed "'1a, a ,.ia ,Ls , 1 L i:,is x.
dist~i ~ ~3F~nfi of ,e er:erc1 r.r..., }p chi;_c& 7. { ublicQt: on,.
ands`Portu ii se lanEu~agas for distriautyon -erica.
y out this proposed fro ject, it _{ As requested that a
T
c
arr
3.
o
be established Letweor. the Foreign ^- erationa Administration
tract
,,
con
and the-International Society ,or t`he Welfare of "ripples under
rovide a totF,l of ? 22, 04 crnufr].ly t~
ld
p
?~rhicY~ the u.A. wou
finance;'tne?project with the follc4iLi6 `JAat`t:
Attachment
SalarS* for consultants
racosts
-j-r^--
Admin stra ti on (10 )
Tot al
Ar-ru:i1
T;-r ce Years
12,000
a3~,000
2, X00
2,000
5.0--0
;;:22, 000
;.ob, 0^0
Sincerely,
-:oward A. "Us',
Prcesiden.t,nterrb
Society for he '::s11'are of
CripFles-
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the 'Disabled
Associacao de Asststencia a Cri.ance ')efituosa
arlos A. Ottole'r%hi
sso'cisticn for t ie. 6i3_and
uerios Aires, Argenvna
~
omf im
!fir. Renato de Costa
Sao Paulo, Brazil
98-80 Aridar,
Rua Xavier ale Toledo
T',r. Jose Par:oni
.Centro de is 1iLt.ae1Ofl cie i,lsa:7os rrmxllii L. ujO resiL.
Genova 2037
Sant; a o, Chile
Bogota, Colombia
Apartsdo aereo 4809
Instituto Colombiino',de ^ehabilitacion para Eirlos InvfLlides
Vedada, Ravana, Cuba":
Mrs. Elvira de Sa.Idarriaga
Box 1319, T-'ue c?e Internemer_t
Port-au-Prince, -Haiti
Sister Joan Var6s r. et
The Haitian Ascociation'for the re'mLil.itaticn of the randtcappe,
Dr. Carlos A. Oreliana
National l ohabilitation Asccclatfon of uexico
Tonalla flo. 16, Mexico
Miss Renee Lus iardo
National Association for Crippled :.:hildren
Avenida Iiillan X205.
Vontevideo, Uruguay
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PRIORITIES IN INTERNATIONAL TECHNICAL ASSISTANCE
Joint Statement by the
Public Health Division of the
FOREIGN OPERATIONS ADMINISTRATION
and the
Public Health Service and Children's Bureau of the
U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Need for Priorities
Some system of priorities in health technical assistance to under-
developed countries is essential since health needs are so vast and the
resources in funds and trained personnel are so limited. The establishment
of such priorities has been given attention, but not solved, by the World
Health Organization and other multilateral agencies. Widely differing con-
ditions, needs, and resources in different countries, varying motivations by
governments in requesting assistance, and diverse backgrounds and view-
points of health technicians in the field all complicate the pattern of sug-
gested projects for each country.
In the rush in which the U. S. bilateral technical assistance pro-
grams developed, the drive was to recruit effective and experienced person-
nel, to supply them with the means for getting things done, and to obtain early
results. There was little time for careful thought, little experience to draw
on, and pressures were great from all sides.
More recently, there has been time for stock taking. The evaluation
of the Institute of Inter-American Affairs' program by the Public Health
Service was a major step in this direction. This study emphasizes the im-
portance of orderly planning at the country level but does not provide a
framework of over-all health priorities--an approach which is badly needed
for the globe-girdling health program in which the United States is now
involved.
Such a program must be based on a clear--the clearest possible--
understanding of all the elements concerned in it. It must be shaped with
thought, not luck. Depending for success upon cooperation with other govern-
ments, it must shape itself to their wishes but must also avoid giving way to
inadvisable expediency.
Development of the Statement
The priorities statement which follows represents the results of
thoughtful consideration of the matter by experienced workers in the inter -
national health field, crystallized in a three-day conference of professional
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personnel of the Public Health Division of the Foreign Operations Adminis-
tration, the Division of International Health of the Public Health Service, and
the Division of International Cooperation of the Children's Bureau. This
group consisted of 12 individuals and included experienced members of the
major public health disciplines. One or another member of the group had
worked in or visited officially every country in which U. S. technical assist-
ance programs are being conducted.
At this meeting, the first step was to consider certain elemental
questions. What are the purposes and aims of U. S. technical assistance
programs? Is there really a need and place for health activities in the tech-
nical assistance programs? If so, what are they and why? Discussion of
these questions occupied about a full day and the result is very briefly sum-
marized in the first paragraph of the attached document.
The various bases on which health activities in technical assistance
programs should be chosen and judged were then discussed, keeping the gen-
eral program goals and justifications in the first paragraph constantly in
mind. It was felt by all that we are working in these countries for only a
limited period of time; that our basic purpose is to show other countries how
they may do the job themselves rather than for us to step in and try to do the
job for them; that for many reasons we should favor activities that could
affect the welfare of large numbers of the people and do so within a relatively
brief interval of time; and, that while a great many health activities are
theoretically or actually desirable, certain of them are impractical for tech-
nical or scientific reasons and certain others because of administrative or
cultural difficulties.
In the course of the discussion, a rather interesting chart was devel-
oped for a rough classification of various program elements. Down one axis
were listed the various types of activities in the field of public health, sani-
tation, professional education, etc., that had previously been suggested, en-
gaged in, or might conceivably be suggested. Across the other axis were
listed a series of criteria, some of which have been referred to above; eco-
nomic impact, political impact, technical feasibility in the light of present-
day scientific knowledge, administrative feasibility, cultural acceptability,
early recognizable results, results in relation to cost, take-over ability by
host country, and number of persons affected.
There followed careful discussion of each possible activity in relation
to each criterion. Each activity was then rated under each criterion from
zero to four plus. As a result, for the first time, it was possible to step back
and look at activities in international technical assistance in health from an
over-all, objective, yet relative view.
Priority Categories
From the consensus developed on each type of project as shown on the
chart, the r~1~#~k~OD~~OXb~?#~I~~Fi899S1 IQO~'9A~s:
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1. Certain activities or programs which were always and un-
questionably justified wherever the related problem existed,
2. Certain activities or programs to which we would ordinarily
not react particularly favorably in the absence of special
precise explanation and justification,
3. Certain activities or programs which it was definitely felt
were not justified and should not be engaged in by our tech-
nical assistance programs. In this latter case, it was
recognized that in rare instances certain peculiar non-
health considerations might result in a decision to engage
in one of these activities.
The group recognized fully that any such priority grouping would not
be subscribed to in every detail by all health technicians in all country pro-
grams. Application of the list must be related to country conditions and the
stage of development of the country's resources and health administration.
Because of this, each of the FOA health program chiefs has been urged to go
through the same evaluation and program development analysis in terras of
the problems and situations peculiar to the country in which he is working.
Despite its limitations, however, it is believed that thoughtful application of
this document to program plans on a country-by-country basis is resulting
in a more consistent policy and greater effectiveness in attaining the objec-
tives of the technical assistance program.
Review and Revision
Subsequent to its original issuance in August 1953, this priorities
statement was reviewed and discussed by the FOA Health Advisory Commit-
tee at its first meeting in March 1954. The Committee gave general a-
proval to the document, suggesting only a few changes. The present state-
ment includes revisions based on the views of the Committee.
General Principles
Priorities are based on demonstrated ability of a health program to
Strengthen economy by health benefits which release effective
human energy, improve citizen morale, improve environmk~nt f
local and foreign investment, open new land and project areas;
Contribute to our political objectives by reaching large popula-
tions with highly welcomed personal service programs; by
demonstrating our deep human interest in man and his dignity.
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In determining priority, the following factors have been weighed,
recognizing considerable country variation:
a. technical and administrative feasibility
b. early recognizable results
c. results attainable relative to cost
d. take-over ability by host country
e. number of persons affected
In applying the priorities, the mission will take into account local
economic, political, and cultural factors and the relationship of each project
to the current health administration and to the long-range health program of
the country.
Within each of the three priority groups which follow, the numerical
order is not intended to indicate priority within the group.
First Priority Programs
1. Mass campaigns against malaria and yaws, where they are major
problems, and against selected gross nutritional deficiencies such
as kwashiorkor, beri-beri, xerophthalmia and goiter, where they
may be readily attacked.
2. Development of protected small community water supplies.
3. Demonstrations through health centers of services on a commu-
nity-wide basis including sanitation, communicable disease con-
trol, health records and statistics, home visiting, maternal and
child health, nutrition, health education, laboratory, and general
clinical services where required to gain acceptance of the com-
munity. Health centers should be used for sub-professional train-
ing and field experience for professionals and should be limited in
scope and number to the national capacity to absorb and operate
them.
4. Advice and assistance in strengthening and lending stability to the
organization and operation of public health administration of the
host government.
5. Inclusion of training and health service projects in proposed or
existing community or village development programs.
6. Advice and assistance in planning and designing, and supervision
of construction, of hospitals, health centers, laboratories and
other health facilities.
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7. Development and support of basic training of nurses to demon-
strate the proper status of nursing as a profession and to :-)rovicae
leadership for indigenous training.
8. Training of sub-professionals to meet major specific health prob-
lems in preventive medicine, nursing, sanitation, limited medical
services; such training to develop personnel for a planned program
which must include professional supervision and periodic re-
fresher training. - Where practicable, opportunity should be given
for advancement of outstanding individuals to higher levels.
9. Fellowships in public health, preferably project related, in U. S; .
not necessarily limited to one year, awarded to physicians; en?:i
neers, nurses, health educators, laboratory technicians, public
health statisticians, and administrators. Training should t e pro -
vided in the host country or region to the maximum extentossibl-,
10. Programs for training key medical school teachers in major clin-
ical and pre-clinical specialties. Training should be provided erg
the host country or region to the maximum extent possible.
11. Construction of demonstration health centers and nursing shoot e
when necessary to success of these programs by insuring physi -
cally adequate, effectively planned facilities.
Second Priority
These projects require special explanation showing economic and
political values, feasibility and relationship to total health program.
1. Mass campaigns against other diseases where of major impor-
tance; e.g., trachoma, louse-borne typhus, leprosy.
2. Consultation on urban water or sewerage system.
3. X-ray, audio-visual, or other major equipment for hospitals or
health centers.
4. Excreta disposal projects, other than as an integral part of a
community general sanitation program.
5. Refuse disposal, fly control, and food protection projects.
6. Assignment of U. S. personnel to foreign institutions, except on a
short-term consultation basis (3 months or less).
7. Occ] pational health services.
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8. Projects for tuberculosis immunization (B.C.G.), case-finding,
and ambulatory treatment, where the problem warrants and
facilities permit.
Third Priority
The following types of projects, which have been suggested from time
to time, have too low a priority under FOA objectives to be undertaken within
available funds, except when fully justified by most unusual circumstances:
1. Mobile clinics requiring specialized motor equipment, or for
general medical care
2. Construction or financing of construction of hospitals, water and
sewerage systems, or other major structures
3. Operation of hospitals by U. S. personnel or at U. S. expense
4. Training of practicing physicians in clinical specialties in U. S.
5. Dental health projects
6. Mental hygiene projects
7. Establishment, equipping, or operation of blood banks
8. Medical rehabilitation projects
9. Mass treatment for intestinal parasites
10. Geriatrics projects
11. Poliomyelitis control or treatment projects
12. Training in tropical medicine in- U. S.
POLICY ON SUPPLIES AND EQUIPMENT
Purchase of such items from FOA health funds is justifiable
only when
1. Necessary to effectiveness of a technician;
2. Necessary to make an important demonstration complete and
convincing, or to initiate or complete a major control project;
3. Many people are reached through use in a training project.
BASIC HEALTH TEAM
The basic health team of a mission, to accomplish the desired ob-
jectives, must include a public health physician, nurse, sanitary engineer,
health edu ator aecdd health administrator. `
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k.
 k1NCLQSSIFIED Approved For Release 2003/1 & N1 I t.80B01676R001000090025-7 SECRET
ROUTING AND RECORD SHEET
ILLEGI
DD/P
INSTRUCTIONS: Officer designations should be used in the "TO" column. Under each comment a line should be irawn sheet
and each comment numbered to correspond with the number in the "TO" column. Each officer should initial tcher mar dent)
before further routing. This Routing and Record Sheet should be returned to Registry.
FROM:
TELEPHONE
NO.
Chief, IO
DATE
ROOM
DATE
OFFICER'S
TELEPHONE
'
COMMENTS
TO
NO.
RECD
FWD-D
INITIALS
INITIALS
2.
S.
DCI
4.
5.
6.
7.
9.
10.
11.
12.
13.
14.
15.
25-7
I APR 55 610 WHI H MAYBE SED. SECRET CONFIDENTIAL
SSIFIED
(40)