General Proposal

It is proposed that a modern Children’s Medical Center be established in Ankara for the purpose of rapidly raising pediatric standards both in the practice of medicine and in the public health service. In addition to providing desperately needed children’s medical facilities in Turkey, this Center would offer the most modern pediatric training, constitute a demonstrational technical assistance project, serve as a medical referral center and undertake research work in pediatrics. The center would be operated as a private non-profit institution supported by public subscription. Initially a Turkish Center, its scope might subsequently be widened to provide training and referral service for other Middle Eastern countries.

Reasons for Undertaking this Project

There is a genuine need for undertaking this project. While enormous strides have been in recent years in medicine and hospitalization in Turkey, much remains to be done. Improvement of child health is particularly urgent. Infant mortality (within the first year) is officially reported at 25 percent, but even government statisticians indicate these figures are probably much too low, because of the inadequacy of statistical reporting at the village level, where mortality is highest. There are only a handful of adequately trained pediatricians to serve a nation of 21 million people; of the 450 nurses of all kinds in Turkey, only a few have adequate training. Physiotherapists, trained medical technicians and/or dieticians are nonexistent in Turkey. Pediatric methods are seriously and in some areas dangerously antiquated. Of the few children’s wards, none are adequately run by modern standards. There are not even any properly administered isolation wards for children. And, in the whole country there are no adequate facilities for premature births.

On the other hand, there is ample evidence that the Turkish people, with their dramatic production increases and steadily rising standard of living, are becoming progressively more aware of this problem. Everywhere there are demands for information, and even peasants offer high prices to get the services of pediatricians. In our judgment, this problem is susceptible to rapid improvement, if the people were given information and leadership by properly trained doctors and public health officials. Unfortunately, however, as pointed out above, few Turkish doctors or public health officials are prepared for this role. Most doctors have been trained either in Turkey or briefly in Europe many years ago. In any case, they have had little opportunity to keep abreast of current progress in this field.

Furthermore, this project can eventually be expanded to include a large general medical center, research facilities, and schools of medicine, dentistry, physiotherapy, medical technology, dietetics and social work. After making substantial progress with respect to Turkey, provision might be made for a gradually expanding training program to include doctors; nurses and other health personnel from other countries, the referral service might be extended and publication projects broadened. Turkey is perhaps the only country in the Middle East where this could be done, as she is the only country on good terms with all the rest. She occupies a unique position of leadership in this area, arising historically from her position in the Ottoman Empire. This position of leadership and respect has increased with Turkey’s successful efforts to modernize and her astonishing production increases in recent years. In addition to the urgent and pressing need for a children’s medical center, there are psychological reasons for starting this project with the construction of a children’s hospital. Certainly, one of the outstanding problems understood and appreciated by even the humble is that of child health and welfare. “The hand that rocks the cradle rules the world.” An attack on this problem might therefore, be used as a key for approaching the ultimate goal.

Why Should This be a Private Institution?

In the United States and Europe many teaching hospitals are private or of a charity character, as the governments have insufficient funds to cover all the requirements of the people. Moreover, historically hospital and medical work have had strong support from charitable and eleemosynary institutions which have pioneered in this field.

In Turkey, unfortunately, practically all medical institutions are State owned and controlled, the exceptions being primarily missionary institutions or those of the minority religious or racial groups such as Jews and Greeks which have historical roots. Tremendous strides have been made during the past three decades in State hospitals and State medicine with benefits to the nation, and it is anticipated that in the future the bulk of medical hospital facilities will continue to be State supported. There is, however, an urgent need for private enterprise in this field which could be done in part by the establishment of a strong, outstanding example of a Turkish, non-profit private hospital with high standards.

State medicine tends to have the same faults in Turkey which have been so frequently observed in other countries, namely, too much red tape and burdensome regulations, overstaffing, the rule of seniority rather than promotion on merit, political meddling and too little of the experimental and pioneering attitude so necessary for progress in medical science. Moreover, State medicine in Turkey does not have the leavening effect of friendly competition from private medical institutions which has done so much to keep the government-owned hospitals on their toes in the Unites States. It should be added that the Turkish Government and the Ministry of Health urgently feel the need, and believe there is ample room for private institutions to work side by side and in close collaboration with government institutions. It may be added that the Government recognizes this by making small subventions to those operating private institutions doing substantial charity work, including institutions run by minority groups.

Furthermore, it is even more true in Turkey than in the United States that the Government simply cannot afford to provide the medical service required for all of the people. It therefore seems appropriate to tap private funds, particularly in view of the Turkish tradition of charity which is deeply embedded in religious feelings and mores of the people. It is believed that an outstanding institution like this can do much toward channeling this feeling toward the support of modern medicine and that doctors trained there will act as pioneers in spreading this idea through-out the country and in encouraging local communities to meet their own requirements rather than relying solely on assistance from the central government. It will be a major objective of this institution to instill in the medical profession a zeal for developing local initiative, both private and public, for supplying local needs.

Programs

The work of this Center would be aimed primarily at improving the practice of medicine and of public health work by training doctors, nurses, physiotherapists, social workers, technicians, and hopefully public health officials as well. It is believed that the program of the Center can, within a generation, basically improve the practice of medicine in Turkey. The relatively modest investment required by this project would in the long run, therefore, have a far greater and more permanent after effect than any attempt to improve public health by a program for the construction of other medical teaching centers throughout Turkey, a project requiring staggering sums of money. As personnel becomes trained, it is believed they will become the most effective agents to encourage local communities and the central government to establish other facilities throughout the country, which can then be adequately staffed and managed along modern lines.

Specifically, the first part of the project includes:

1. Full time pediatric training for interns, resident physicians, nursing students and technicians, It is also hoped that physiotherapists, social workers, and public health officials may eventually be included.
2. Professional improvement for specialists, general practitioners, nurses, and public health officials through clinical-pathological sessions, panel discussions on pediatric and other medical problems and interesting cases, evening lecture courses, and periodic medical conferences and conventions.
3. Provisions of a referral services for other hospitals, clinics, specialists and general practitioners throughout Turkey.
4. Publication of a professional pediatric journal and other scientific literature.
5. Publication of popular literature for laymen.
6. Research with special emphasis on adaptation of the most modern methods to Turkish conditions.
7. Lecture courses for parents on child care.
8. Substantively the medical program would include activities such as care of sick children in outpatient department, in the wards, and in special clinics; following the health of children in the well baby clinics; following cases in homes by means of visiting nurses or social workers; and disseminating information about preventive pediatrics, particularly through well baby clinics and through campaigns for immunizations.

While privately operated, this institution is to work in close collaboration with government institutions and other teaching institutions including universities. Without such collaboration, there would be little hope of making a large impact on the basically important area of public health and preventive medicine. It is also hoped that contractual arrangements can be made with the Ministry of Public Health for specialized training of pediatricians, nurses and public health officials and with the Ministry of Education for assisting in the development and execution of a parent training program. It is important to note, however, that since the institution will be under private control, the maintenance of highest professional standards and freedom from political influence can be assured.

Details of Project and Cost Estimates

A. Initial Installation

1. Land – An ideal plot of land in large public park centrally located between the poorest and well – to – do sections has already been promised by the city of Ankara. (Valued at a minimum of TL 1,500,000)
2. Building – A functionally designed, non-luxurious hospital of 180 beds, including:

Wards: Observation, children’s medical, infants, isolation, surgical and premature babies.

Clinics: Outpatient and well baby.

Operating theatre, x-ray department, hematology, bacteriology, chemistry and

pathology laboratories, and a blood bank.

Classrooms, 200-seat lecture room with projection facilities, library, and quarters for nurses, interns and resident physicians.

Admission and administration rooms and other appropriate accommodations.

TL.4,500,000.

3. Equipment - Furnishings, appliance, and laboratory and medical equipment. TL 2,800,000.

2. Operating costs
1. Personnel

2. Other Operating costs

Financing Plans

The size and extent of the building project and medical program will depend of course on the success in raising the necessary funds. Appropriate adjustments can be made in either direction as the magnitude of the availability of funds becomes apparent. The financial program is divided into three parts:

1. Initial installation costs - TL 7,300,000.

It is hoped that TL 2,800,000 ($ 1,000,000) could be obtained from American sources for equipment. If this could be assured, it is believed that the program could be initiated with complete confidence of success. No action would be taken, however, until sufficient funds were pledged to assure such success. The remaining TL 4,500,000 would be raised by public subscription in Turkey.

2. Operating costs – personnel - TL 2,500,000.

It is proposed that a strenuous public subscription campaign be initiated in Turkey to raise an additional TL 25,000,000 to serve as an endowment. These funds would be invested primarily in real estate and rental properties. Annual returns are conservatively estimated at 8-10 percent. Currently, rentals net 10-15 percent. Any shortfall in returns would have to be made up either by increasing the endowment or by raising annual subscriptions. There is substantial reason to believe that such a campaign would be successful. Individual businessmen have already tentatively indicated willingness to make large contributions, and high government officials, including the Prime Minister and the Governor of Ankara have indicated their full support, which is necessary if such a drive is to be successful in Turkey.

3. Other operating costs – TL 12.50 per patient per day

Since food and medication, the largest components, would vary in accordance with the number of patients, it is proposed that these expenses be borne entirely by patients' fees. Patients are to be divided into three categories and the hospital run on a 3-class basis; a practice customary in Turkey. The first class would pay full fees; the second, about half; and the third, whatever they can afford, many paying nothing. The rates of the first class would have to be adjusted to cover the expenses of the third, while the second would carry itself.

4. There would be additional income from such sources as training contracts with