This paper describes some of the current health problems faced by a tropical country whose standard of living and lifestyle is approaching that of many countries in Western Europe. Long-term health problems such as cardiovascular diseases and diabetes have become at least as important as infectious diseases. A change in approach to a more proactive style of primary care is needed to allow the contribution of community doctors to be effective. The system of primary care in the Republic of Seychelles is based on the UK model of general practice where recent improvements in education and organization are raising standards. How some of these improvements might be transferred elsewhere is discussed.
PIP: The Royal College of General Practitioners has an International Travel Fellowship Program which allowed a Scottish general practitioner to return to the Seychelles where he worked as a community physician in 1987-1988. The primary health care system of this country, an archipelago off the east coast of Africa in the Indian Ocean, is based on the UK model of general practice. Implementation of this model has resulted in improved health of the population (e.g., infant mortality rate, about 15). The extended family and traditional healers provide nonmedical primary care at the community level. 17 community clinics dispense primary medial care. They are located on 3 of the 45 islands where 98% of the population live and are headed up by a senior community nurse. Each clinic has examination rooms, small laboratories, pharmacies, waiting areas, and record systems complete with summary cards. Larger health centers provide dental, physiotherapy, social, environmental, and occupational health services. There is 1 community physician per 3500 population in a contiguous area. 1 nurse serves 500 people. Nurses provide the family planning and maternal and child health services. Almost all nurses are Seychelloise, but 75% of all physicians are expatriates. A school in the capital trains, but there is no medical school. Many future physicians train at the medical school in Zimbabwe. The leading reasons for seeking care from a community physician are hypertension and upper respiratory infections. In fact, more than 35% of 35-64 year olds are hypertensive. The disease pattern of Seychellois matches that of the UK. Heath workers regularly visit the outlying islands to provide care for the inhabitants, but when the health workers are not on the outlying islands, the inhabitants depend on a radio to communicate with the community clinics.