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An essential drugs list seemed a good way to eliminate some ofthese inefficiencies and to increase the availability of drugs withoutraising costs. For the three levels of health care delivery there are tobe lists of rational, safe, and cost-effective generic drugs that will bebought centrally. Another important part of the programme is tosecure the cooperation of doctors and other health workers byshowing them how a reduction in the number of drugs will increasedrug availability in general. They should be encouraged to adopt amore scientifically based approach. For instance, some are still inthe habit of prescribing antibiotics, injectable antimalarials,antipyretics, and analgesics for every case of fever. Such

polypharmacy may impress the occasional patient but most patientscannot afford these "modern" prescriptions; furthermore, peopleare gradually becoming more knowledgeable about the toxicity ofdrugs and about their rights.As well as a comprehensive programme for selection,

procurement, distribution, and use of the drugs the Nigerianscheme will incorporate a revolving fund whereby patients will becharged a token affordable amount for drugs (so as to ensurecommunity participation in the process). The list is to be reviewedevery year. 70-80% of the Nigerian population live in rural areasand have access only to traditional medicine, and it is noteworthythat the drug list follows those of other countries by not includingany traditional medicines from the vast local pharmacopoeias.Perhaps that will come.

NepalDEPARTURE for our morning work is delayed by a consultation

with the dharmi (traditional healer). Our host’s wife has "painaround the heart", our host’s mother has fallen and had pain in herribs for 4 weeks, and Jagat, a primary health care worker, complainsof pain in his right wrist and low back ache. Jagat has not consultedme, knowing that at best he will get "Poor old thing!" as responseand at worst he will get "So what?" I’ve long since lost anycompassion for sufferers of minor aches and pains in a countrywhere I fmd travelling-on foot up and down 6000 foot hills-agony ; bathing-in icy streams--excruciating; and even eating-sitting down to a meal cross-legged on the floor-uncomfortable.

The dharmi is a charming old man with wizened face and atoothless impish grin when photographed poring over inscriptionsin a note book. He carefully copies the characters on to another sheetwhile chanting quietly to himself. After these preparations, hisconsultations consist of laying hands on the affected part, morechanting, and fmalty blowing on the affected part. He is not in theslightest perturbed by the lady with the painful ribs coming straightdown to me for a second opinion and continues his session withJagat.That night, after treating Jagat’s secondarily infected athlete’s

foot with salt-water soaks, the whole of the household’s sleep isdisturbed by another dharmi at a neighbouring house. He is

younger than the first with unshaven features and dishevelled hair,and works himself into a frenzy of chanting and drum beating formore than 6 hours. I ask what disease he is treating but nobodyknows, or will tell me.

The following morning another patient comes to the housecomplaining of low back pain. "Why doesn’t he visit the dharmi?" Iask, but he has no faith in the dharmi and I groan because I havenothing to offer people with chronic backache. People sleep on thefloor or on plank beds and have no excess weight to lose, but they dohave to perform hard physical work and carry heavy loads tosurvive. However, the patient is a Brahmin, all skin and bones, withacute onset of lumbar back pain 5 days earlier. It takes no time toexamine and manipulate him. After receiving a hefty thump overthe offending disc, he stands up cured. ’I am more than a littleconcerned about the numbers of patients who will turn up at thehouse having heard about this, but I am leaving the next day andwill not be returning for another 2 months.

Jagat’s sweaty feet are not the sort of condition that a dharmitreats. But what are the sorts of condition? Had my Brahmin alreadyconsulted a dharmi without success?

In England Now

From our Peripatetic CorrespondentsAPPARENTLY there has been a breakthrough in medical

education. It is called computer-graphics. A salesman came todemonstrate it to me at the end of my clinic recently. He staggeredthrough the door, laden with two huge black suitcases, and after hehad spent 10 minutes or so unpacking and fiddling with the plugsand switches, I was ready to be suitably astounded. A light appearedon the screen, and after a lot of arcane code-numbers and symbols,we reached the key-word-’Hair’-flash, flash, flash. After I hadread the word ’Hair’ two or three hundred times, I diffidentlysuggested that we might need to press a key or two to get somevaluable information on hair. "No," said the salesman, "this is sucha simple program that you shouldn’t have to do anything." He

% switched everything off, checked the connections, and started again.And again we reached ’Hair’-flash, flash, flash, but no further."How much is the equipment?" I asked pleasantly. "About C 1000will get you the basic kit, and the teaching tapes are extra. It has gottremendous potential, as I am sure you will agree when you haveseen it in action."

Eventually after much switching on and off, and after giving themachine a strategic tap, we again reached ’Hair’—flash, flash, flash,but this time-mirabile dictu-there followed a three minute

presentation on the embryology of the hair follicle, after which wehad a choice of several clinical subjects. I chose ’male-patternbaldness’ and was rewarded with 6 or 7 facts about male-patternbaldness, three of which, in my opinion, were wrong. I pointed outmy disappointment to the salesman who said he agreed thatmale-pattern baldness was the weakest section, and would I pleasechoose another topic. I did so, and in due course we again reached’Hair’-flash, flash, flash. After reading this for some time toimpress it in the memory, we went through the checking of theparts, and eventually achieved a three minute presentation of theembryology of the hair follicle. "I hope you don’t mind mementioning this," I said, "but we have actually seen this bit before,and it was pretty boring’the first time." "Yes," he said, "that’s themain weakness of the system at present."

* * *

MOST vegetables are best with plenty of butter. The AbbeChevrier’s week-long recipe (given in Elizabeth David’s FrenchCountry Cooking) merges a pound of spinach with ten ounces ofbutter-immoderate but delicious. Two excellent vegetables growwild by the seaside. Take unsalted butter and a sturdy saucepan. Seaspinach or sea kale (Beta vulgaris) has florid, fleshy, yew-greenleaves and grows above the tide. Pick young shoots, light the fire,and melt them patiently in the saucepan with butter but no water.Marsh samphire or glasswort (Salicornia europea) is the princess ofall greens: a slender succulent thriving on marshy coasts within thetide from summer equinox to solstice. Pick the jointed, glisteningemerald stems by the root; rinse well; bring sea-water to a rollickingboil, cook in bunches for ten minutes ; smother in butter and eat likeasparagus, stripping the flesh from the stalk between the teeth.Healthy eaters may be tempted to try these treats without butter.(Marsh samphire is edible plain boiled, even raw. Sea spinach isnot). Marge just won’t do, nor will oils. Those who once "were veryyoung" might recall A. A. Milne’s The King’s Breakfast:

"Nobody", he said, as he kissed her tenderly, "Nobody, mydarling, could call me a fussy man, but I do like a little bit of butter onmy bread". A little won’t harm the coronaries and what better use to

put our ration than making a feast of Nature’s bounty?* * *

THE present cost-conscious efforts of our NHS masters

regarding the reuse of items previously considered expendable afterone service brings to mind a conversation I had many years ago witha theatre sister in a part of Scotland noted for its frugality. "What doyou think of these new disposable gloves?" I asked. "Nae use at a’,"she replied. "After ye have boiled them twice, they come back fu’ o’holes." "