IN December last year, the Medex profession celebrated the 44th anniversary of its establishment in Guyana. The term Medex is an abbreviation of ‘Medical Extension’ and was an idea formulated by Dr Richard Smith, an African American. While visiting Cuba as a Methodist medical volunteer from his university, Howard, Dr Smith was appalled to see the abject poverty and absence of any medical care in the area to which he was assigned.
Adults and particularly children, were afflicted with common, easily treatable illnesses and suffered terribly and even died. He realised that if medical care were available, this pervasive ill-health would have been eliminated; the trained doctors remained in the cities and prosperous areas.
Dr Smith felt that young people interested in human welfare could receive some medical training and form a middle layer of health workers who could serve those areas of the developing countries in which the trained doctors would not practise. With his university, he was able to produce an adequate medical training course and those who went through the training were able to go out to developing countries. The US Aid programme recruited these medexes who began to serve abroad and Guyana was one of the earliest countries to use medexes and to establish the system.
The numbers of Western-trained doctors were never enough to serve the populations in developing countries, and each of these countries tried to meet the shortage in basically similar ways. In China, they used “barefoot doctors” and in Russia “Feldshers”, both groups had to undergo some medical training.
In Guyana, from the end of the 19th century until the advent of the Medical Faculty of the University of Guyana, the training of scores of doctors in Cuba and the Medex system, poorer Guynaese depended on folk medicine, which consisted largely of “bush medicines” or persons who had drug stores and were known as ‘drugists’ or “dispensers’ administering some medical attention along Western lines. These dispensers mixed the various drugs or chemicals doctors prescribed for their patients or themselves independently treated patients. Until two or three decades after the end of World II, doctors formulated their medicines, unlike today when they prescribe patent drugs produced by the big pharmacies abroad. The dispensers soon disappeared, since patients could now buy their patent drugs “over the counter.”
Despite the remarkable increase in numbers of Western-trained doctors with the output from the University of Guyana and the Cuban-trained, there is still a shortage of doctors in Guyana. This is especially so in the sparsely populated interior and the villages in the riverain areas and Medexes have been serving these communities. On the coast, medexes support doctors in the health centres, or manning the ambulances or provide first aid whenever there are large congregations of people. Medexes are therefore a necessary adjunct to the health care system of the country.
The training of a Medex is quite comprehensive. The student has to have five or more subjects at the CSEC examination before admission to the course. The training is for four years under the auspices of the University of Guyana and the candidate is awarded an Associate Degree on completion. In the first year, the student is trained in Nursing, in the second year in Midwifery and in the third and fourth years in Clinical Medicine. All students are on Ministry of Health scholarships and must serve the ministry for a minimum of five years on graduation. They cannot practise privately like a doctor but they could work with a doctor.
The programme is still developing: There are ideas of awarding a full Degree for the programme, of formally permitting Medexes to act as doctors’ assistants, of their working in the private hospitals, of their having easier admission to the Medical Faculty of the University of Guyana to pursue training as a doctor.
Some patients prefer to be treated by Medexes since, unlike doctors, they treat them comprehensively, applying their nursing skills.
Though their importance and impact on the country’s health care system is gradually being understood, there is a need for the medical profession and society to accord them the recognition and respect deserving of their service and dedication and to adequately remunerate them.