Health > Intergovernmental conference of Far-Eastern countries on rural hygiene : preparatory papers : national reports : report of Siam

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2. Personnel.
The history of medical education in Siam shows that there
has been a gradual raising of the standard to a course of five
years before a doctor is qualified to practise, and the present
standard is considered to be equal to that in any other country.
Such a standard is admittedly so high that the supply of doctors
to meet the demand of the country will not be available for
generations to come. There are at present only some 500 qualified
medical men and women in the service of the country with a
population of over thirteen millions. This is very far short of the
desirable ratio of one practitioner to every two thousand persons.
The obvious alternative of creating another class of qualifi¬
cation with a shorter course of study with a view to getting
a greater number is not acceptable in this country. As an official,
such a second-grade practitioner will not be so useful. He
must necessarily cover a large section of the country alone and
be ready to deal with all cases. The size of an area requires the
best possible training for the only medical officer available.
As a private practitioner, he will tend to work in a town. His
standard is too high for rural areas. For urban practice it
is more economical for the State to supply medical service
by a hospital, where a few well-qualified doctors can give better
general service to the community.
To meet the need of the rural areas, it is considered that
health centres will supply a more efficient service. A few beds
may be provided at a centre where a medical officer is one of
the staff, while at other centres where only medical assistants
are in charge, all serious cases may be transferred to one of the
base hospitals. It is obvious that a personnel consisting of the
medical assistant grade can be afforded as providers of local
medical service under the present economic condition of the
people, and the method of securing them has already been
discussed.
The training of an auxiliary staff for health work is not a
technical difficulty in Siam. It is purely a matter of funds.
Secondary education, both in the capital and other provincial
centres, is sufficiently advanced easily to provide suitable
recruits in sufficient number.