세계보건기구 WHO에서 시행하는 활동 중 하나인 ‘블루 트렁크 도서관’(Blue Trunk Libraries, 줄여서 BTL) 프로젝트에
의하여 의료인을 위한 최신 의학정보를 담은 작은 책상자가 아프리카 지역으로 전해졌다.
블루 트렁크 도서관 창립 아이디어는 아프리카
기니아 지역의 WHO와 보건부가 지역 의료인들에게 지속적 교육을 제공하고자 실시한 조사의 결과에서 기인한다. 그 조사의 결론은 의료인들의 전문
기술과 지식 범위를 넓힐 필요가 있다는 것이다. 이는 기니아 지역 의료진들이 자신의 지식과 기술의 질을 향상시키기 위한 충분한 자료도 없을
뿐더러, 그 지역 도서관에 관련서적이나 간행물 조차도 거의 없었기 때문이라 한다.
그래서 제네바에 있는 ‘WHO 도서관’(WHO
Library)은 개개인의 전문 수준에 맞춰 적절한 책을 지급하고자 1998년부터 블루 트렁크 도서관 프로젝트를 실시하였다. 기니아는 이
프로젝트로부터 도움을 받은 첫 나라이며, 이를 시작으로 다른 아프리카 지역과 개발도상국들에게까지 퍼져나가는 중이다.
이렇게 인쇄된
책을 보내는 활동은 인터넷 시대에 대한 역류로 보일 수 있겠다. 눈부신 정보통신 기술의 발전 덕택으로 인터넷을 통한 정보 접근이 수월하게 되었고
이러한 정보 혁명이 전세계 의료인의 의료정보접속을 가능하게 했음은 사실이다. 또한 개인 컴퓨터의 일반화로 인하여 CD-ROM은 정보 전달하는데
매우 유용한 수단이 됐다. 이는 CD-ROM이 작은 공간에 많은 정보를 담을 수 있어 공간활용율이 좋을뿐만 아니라 작고 가벼워 운송비가 저렴하기
때문이다.
하지만, WHO에 따르면 개발도상국의 많은 지역에서는 컴퓨터 뿐만이 아니라 안정적인 전기 공급 서비스가 없는 까닭에
CD-ROM을 통한 정보제공은 성공적이지 못했다고 한다. 또한 현재 개발도상국의 많은 곳에서 인터넷 접속 환경이 열악한 형편이다고 한다. 이러한
불균형적 정보통신 발전으로 인한, '갖은 이와 갖지 못한 이'의 격차, 즉 빈부의 격차는 지속적으로 소외된 지역을 더 어렵게 한다. 지역에서,
소외된 지역에서의 수월한 정보접근을 위한 해결책은 여전히 책과 같은 인쇄물이다. 때문에 WHO 도서관은 인터넷 없는 곳을 대상으로‘블루 트렁크
도서관’프로젝트를 창립하였다.
아직까지 블루 트렁크 도서관이 미치는 영향에 대한 정식 평가는 있지 않았지만, 각 나라마다 자체
시행한 조사에 따르면 블루 트렁크 도서관이 소외된 지역에서 일하는 의료진들의 의료의 질을 향상시키는데 도움을 주었다고 한다.
블루
트렁크 도서관에 들어갈 책은 WHO 의료 전문인들과 협력관계에 있는 WHO 도서관과 WHO 출판부에 의하여 선정된다. 각 책 상자는 운송비를
제외하고 조교를 포함하여 $2,000의 비용이 든다. 이 프로젝트는 국제연합아동기구(UNICEF), 국제연합개발계획(United Nations
Development Programme), WHO, 지속적 발전을 위한 독일 의회(German Council for Sustainable
Development), 국제개발처(United States Agency for International Development), 그리고 그 외
비정부 기관으로부터 기금을 지원받는다.
Where There Is No Internet:
Delivering
Health Information via the Blue Trunk Libraries
Pascal
Mouhouelo*, Auguste Okessi, Marie-Paule Kabore
Pascal Mouhouelo, Auguste
Okessi, and Marie-Paule Kabore are at the WHO Regional Office for Africa,
Library, Brazzaville, Republic of Congo.
Competing Interests: The authors
declare that no competing interests exist.
Published: March 7, 2006
DOI:
10.1371/journal.pmed.0030077
Copyright: ? 2006 Mouhouelo et al. This is an
open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
Abbreviations: BTL, Blue Trunk Library; WHO, World Health
Organization
Citation: Mouhouelo P, Okessi A, Kabore MP (2006) Where There
Is No Internet: Delivering Health Information via the Blue Trunk Libraries. PLoS
Med 3(3): e77 * To whom correspondence should be addressed: E-mail:
mouhouelop@afro.who.int
The Technology Gap
“Information
access,” argued Packenham-Walsh and colleagues in the BMJ, “is the sine qua non
of the professional development of all health workers?the most vital asset of
any healthcare system” [1]. And the development of the Internet has brought hope
that access to health information might one day become universal. Access to
online databases gives users the opportunity to retrieve a wealth of relevant
and up-to-date information. Every day, health-related books, research, and other
articles are retrieved from the Internet, which has led to a worldwide
information revolution (Box 1).
Box 1. The Online Health Information
Revolution
However, the World Health Organization (WHO) is very much aware that there are many areas in the world where access to the Internet is not yet a reality. In developing countries, a large proportion of the population, including health professionals, has no or only poor access to the Internet. Even printed materials, such as up-to-date books, current periodicals, and newspapers, are scarce. In this situation, professionals are obliged to rely on the knowledge acquired during their original training to care for patients, to prevent disease, and to promote health.
In many regions, the health district centers are staffed by nurses, midwives, and community health workers who, having finished their basic studies, receive little in the way of continuing education, as libraries rarely exist at the district level or in regional hospitals. The distribution of CD-ROMs to developing countries is an important initiative, which has proven to be a valuable source of health information.
For example, the health-related CD-ROMs from TALC (Teaching-aids At Low Cost, http://www.talcuk.org) [2] and those distributed by the WHO and the joint United Nations Programme for HIV/AIDS (UNAIDS) are much appreciated by their users. The CD-ROM is an important tool for information delivery in Africa because it does not take up a lot of space and shipping it is inexpensive.
Unfortunately, there are still many areas in the developing world that have
neither computers nor a reliable electricity supply. Thus, in spite of the rapid
development of information and communications technologies, the gap between “the
haves and have-nots” continues to blight isolated areas (those outside a capital
city). In these areas, the appropriate solution to information access is still
printed material. In response to this need for printed health information, WHO
librarians created the Blue Trunk Library (BTL) project.
What Is the Blue Trunk Library?
The idea of creating the BTL collection stemmed from the conclusions of a joint survey conducted by the ministry of health and the WHO country office in Guinea to define the continuing education needs for health workers based in the health districts. The survey found that these workers needed to broaden their skills.
Therefore, the WHO library was asked to compile a collection of appropriate
books to suit the different education needs of health district workers at
various professional levels. The WHO library in Geneva started the BTL project
in 1998. Guinea was the first country to benefit from this prototype [3], which
was then extended to other African countries before being taken up in developing
countries in other parts of the world. There are English and French versions of
the BTL.,p> The BTL is “a ready-to-use documentation module” [4] of about 150
WHO and non-WHO books and manuals fitted into a blue metal trunk (Figure 1). The
materials are arranged and filed in such a way that users can easily identify
the ones that they need. Fourteen topics have been chosen using a basic
classification code, e.g., General Medicine and Nursing (100), Community Health
(110), and these codes are written on each filing box.
A Blue Trunk Library Training Session
The content is selected by the WHO press unit and the WHO library in collaboration with a group of WHO health professionals. The BTL's composition varies according to the books available in each language. For example, M?decine Tropicale by Marc Gentilini [5] is selected for the French version of the BTL, while the Oxford Handbook of Tropical Medicine [6] is selected for the English version. Books dealing with specific diseases are removed or replaced according to the needs of the specific geographical area that is receiving the BTL.
Each BTL costs US$2,000, which includes training users but not the cost of shipping (it costs about US$717 to send a BTL to Lusaka, Zambia, and about US$620 to Yaound?, Cameroon). The BTL project is funded by international and bilateral donors such as the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the WHO, the German Council for Sustainable Development (GTZ), the United States Agency for International Development (USAID); Belgian, Italian, French, German, and Irish embassies; and nongovernmental organizations such as Save the Children, Merlin, and Entre-Aide (see types of sponsorship in Figure 2). These donors and NGOs have funded BTLs in countries where they have development projects. Funders purchase a BTL directly from the BTL management team in Geneva (E-mail: bluetrunk@who.int).
In countries where at least 20 BTLs have been acquired, the ministry of
health appoints a national coordinator, and assistants are selected from the
health districts to attend a training session in the use of the BTL (Figure 1).
The BTL project supports this training, which is facilitated by WHO librarians
and national health librarians.
The African Experience
Health districts in the anglophone and francophone countries of Africa have been the major beneficiaries of the BTL. Training sessions have been organized in 14 countries, including Burundi, Guinea, Ethiopia, Republic of Congo, Mauritania, and Mali. Commitment to this project is shared both by donors (funding a BTL addresses the information needs of isolated rural Africa) and by the community health workers (who are given an opportunity to broaden their skills).
To date, the sub-Saharan countries have acquired about 850 BTLs out of the total of 1,488 distributed worldwide. The ambitious objective is to provide each health district with one BTL, but these districts are not the only health-related structures in need. For example, the WHO Regional Office library has received requests from nursing schools and NGOs in Zimbabwe, Burundi, Sierra Leone, and the Republic of Congo.
One of the problems the project is facing is how best to reach African
lusophone countries. While it is reasonably easy to identify suitable materials
in English and French, this is not the case for Portuguese learning materials.
We tried to translate some of the BTL contents into Portuguese, but with little
success because of the large number of books that needed to be translated.
Collaboration with institutions in Brazil that generate health materials
themselves is likely to be a more fruitful strategy. Portuguese-speaking
countries should not be left out and should have their own BTL. The WHO
publishes a large volume of health materials in Spanish, and so a Spanish
version of the BTL may also be developed. Another long-term strategic plan is to
update the content of the BTL.
The Impact of the Library
While there has not yet been a formal evaluation of the impact of the BTL, BTL training sessions have provided an opportunity for WHO facilitators to determine how appropriate and relevant the project is in different countries. In their written and oral reports, health workers who received training have said that the BTL has helped them to improve the quality of health care in remote areas. For example, they have said that the library helped them in making decisions such as diagnosing and managing diseases. Box 2 shows comments about Senegal's experience in using the library. In addition, the BTL is distributed along with a variety of tools?such as questionnaires for users, managers, and national coordinators?that WHO librarians or information officers use to collect comments and give feedback to the WHO regional offices and to the headquarters in Geneva.
Box 2. Impact of the Blue Trunk Library in Senegal
Marie Khemesse Ngom, at Senegal's Ministry of Health, commented: “Many reasons explain why the Blue Trunk Library is very much used. The users refresh their knowledge after their initial skills acquired in schools. They use this collection in order to read new techniques, standards, and practices in health and medicine. In K?dougou, the Blue Trunk Library manager said that since this collection has been installed in their health district, every year many health workers are passing their professional exams in hygiene and public health. In Nioro, the health district doctor thanks the Blue Trunk Library because he has specialized in Public Health.”
In some countries, national health promotion teams are using the BTL
materials for community health education by creating posters and simple
brochures in local languages based on the English or French manuals in the
library. The WHO Eastern Mediterranean Region (EMRO), which has its headquarters
in Cairo, Egypt, and which has already purchased about 250 BTLs, receives the
contents of the BTL from the WHO headquarters and “manufactures a wooden Blue
Trunk Library equipped with four wheels” [7]. It also adds Arabic materials
published in the EMRO Region to the original collection. Two other WHO regional
offices?in Southeast Asia and the Western Pacific?have purchased BTLs, and we
hope to extend the project to the Caribbean and Latin America.
References
1. Pakenham-Walsh N, Priestley C, Smith R (1997) Meeting the information
needs of health workers in developing countries. BMJ 314: 90.
2. Mapara E,
Morley D (2004) Picturing AIDS: Using images to raise community awareness. PLoS
Med 1: e43 DOI: 10.371/journal.pmed. 00100431.
Library and Information
Networks for Knowledge (2006) Blue Trunk Libraries?Outcomes. Available:
http://www.who.int/library/country/ trunks/outcomes/guinea/index.en.shtml.
Accessed 27 January 2006.
3. Certain E (1998) Blue Trunk Libraries. WHO
Liaison 9(3): 2?6.
4. Gentilini M (1995) M?decine Tropicale. 5th edition.
Paris: Flammarion Medecines-Sciences. 927 p.
5. Eddleston M, Davidson R,
Wilkinson R, Pierini S (1994) Oxford handbook of tropical medicine. Oxford:
Oxford University Press. 712 p.
6. Al Shorbaji N (2005) The importance of
the Blue Trunk Library project in the Eastern Mediterranean region. Blue Info
Bleue 1(1): 3.
원문 URL http://medicine.plosjournals.org/perlserv/?request=get-document &doi=10.1371/journal.pmed.0030077
류수진 책읽는사회 자원활동가
