Up by the Bootstraps

When Guillermo Arbona picked up his M.D. diploma from St. Louis University and returned to his native Puerto Rico in 1934, the island's death rate was 19.3 per 1,000, as against 11 per 1,000 in the continental U.S. Malaria and tuberculosis were rampant, along with the so-called tropical diseases caused by intestinal parasites. The island's annual health budget came to only $1.3 million--a mere 80-c- per capita.

Today, as Secretary of Health for up-by-the-bootstraps Puerto Rico, Dr. Arbona could proudly report that his island's death rate has been cut to 7.2 per 1,000, while the U.S. is only down to 9.4 per 1,000. Malaria has been completely wiped out. Tuberculosis has been cut to 5% of its former incidence, and intestinal parasitic disease to 10%. The health budget is up to $70 million, or 21% of total Commonwealth spending (only education takes more, with 31%). And much of the credit for improving the island's health goes to Dr. Arbona himself.

Born in the little western mountain town of Maricao, he escaped the capital-city fixation that besets so many Latin American physicians. He resented the fact that in 1934 San Juan had 35% of the island's doctors while most of the communities had none. Working his way up through the Commonwealth's health department, Dr. Arbona spent years organizing Puerto Rico's scattered towns and villages into five medical regions, each with a modern medical center of its own.

He moved medical, nursing and welfare personnel out into the countryside so that the poorest sugar-cane workers' children would get the same medical and dental examinations as city youngsters. Now there are clinics for pregnant women and for well babies--along with proper care for the sick. Where TB patients once languished for lack of treatment in a sanatorium, health workers now give out supplies of isoniazid to be taken at home, and then they check to make sure the pills are really taken.

While he was inaugurating these improvements, Dr. Arbona relied heavily on the help of public-health experts from the mainland; now that Puerto Rico has become a showcase, it is Dr. Arbona himself who is in demand to give advice to other Latin American countries.

For his accomplishments, Dr. Arbona received one of three annual Bronfman Foundation awards ($5,000 each) of the American Public Health Association last week. The other winners: Dr. Alexander Langmuir, 55, chief of the U.S. Public Health Service's Communicable Disease Center in Atlanta (the famed "disease detectives"), and Dr. George James, 50, who is now taking the deanship of Manhattan's developing Mount Sinai School of Medicine, after three years as New York City's commissioner of health.

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