Pesticides in Albania

into confusion last week by an unexpected for 15-vote defeat in the House for Clinton’s stream coalition, are likely to call for crime legislation. This bill would have health-care in the UK amendments on malpractice law reform, added 50 new crimes punishable by cost controls, and health-care bureaucradeath, 100000 new police officers, an Patients with "complex or multiple health cy ; Mitchell seemed confident that their assault weapons ban, and the "threecare needs" can take comfort in the govwishes could be met. With Senate Repubstrikes-and-you’re-out" clause that would ernment’s draft guidelines on National licans refusing to vote on amendments, send violent felons to prison for life on Health Service responsibilities for meeting Mitchell announced on Aug 9 that he their third offence (an ironic baseball health-care needs, because they long-term would break their filibuster by continuing metaphor in the week that baseball players : are the ones for whom the NHS should be the Senate debate day and night until they began a strike against owners). The time responsible for securing and funding the backed down. : that will now be devoted to reviving this care.’ For most of the others, long-term The House of Representatives was due legislation will cause the sharp focus needcare is likely to be met through social serto start its own debate on Richard A ed to persuade sceptical Representatives to vices, the financial implications of this Gephardt’s bill this week. His approachpass the Gephardt health proposal to be arrangement being that social services centred on an extension of Medicare covblurred. : benefits are means tested. The Senate now dominates the health- : erage-is perceived to be better designed . . The guidelines were prompted by a to reduce health-care costs than the care debate and its more conservative report that the Health Ombudsman proMitchell proposal and has received strong approach is likely to force Clinton into furduced six months ago, drawing attention : to how the NHS was not always shouldersupport from several unions. The House ther compromise. was expected to vote on Aug 19. But the ing its obligation to provide long-term pressured political timetable was thrown Richard Horton nursing care (see Lancet Feb 12, p 407). Patients were being discharged to private Only 7 of the 29 states comprehensively nursing or residential care homes, and Pollution on US beaches monitor their beaches, 9 do little or no their families were having to pick up the testing at all, and, in another 13, only bills. In some cases patients were being "Pollution continues to degrade our country’s prized coastal waters", the Natural selected beaches are tested regularly. sent to private homes against their wills, Moreover, water-quality standards vary in contravention of the Resources Defense Council (NRDC) conDepartment of between cities, countries, and states. The Health’s own cludes in its annual survey of American guidelines. territories seem no more reliable. Monibeaches (see Lancet May 14, p 1238). : Last week’s draft guidelines say that the NRDC is one of the nation’s foremost toring in the Virgin Islands occurs only NHS remains responsible for meeting, quarterly, while Puerto Rico tests monthenvironmental research and : "within available resources", the needs of ly, though laboratories take 2-3 months to people who require long-term physical or groups. According to the report, in 1993 US beaches were either closed or declared produce reports. Despite EPA recommenmental health care. The guidelines require unsanitary on more than 2400 occasions dations on "indicator organisms"-Enteroall health authorities and general practiin 29 coastal or Great Lakes states and in coccus for ocean and bay waters, tioner fundholders to review their arrangethe territories of Puerto Rico, Guam, and Enterococcus or Escherichia coli for Great ment for purchasing long-term health care the Virgin Islands. There have been over Lakes-local authorities often rely on less according to local needs and circum10 000 such public-health actions since accurate total coliform counts. Public stances ; ensure that they are making 1988. Most of the hazard is attributed to notification and proper remedy are equalappropriate provisions; and collaborate ly unpredictable. Only 5 states consistentpublic sewage disposal and treatment, pnwith local authorities and provider units to vate septic systems, rainstorm runoff, and ly close beaches after they are found to be draw up local policies on eligibility for polluted and even fewer compile public continuing care services. When a patient boaters. Contamination by polychlororecords on closings and bacteria levels. : is biphenyls and dichlorodiphenyltrichlorojudged by his doctor to be ready to be ethane (DDT) are additional risks moved from acute to long-term care, the common to the Great Lakes. :David H Frankel patient should be eligible for a multidisciThe report criticises the Environmental plinary assessment of his needs. The Protection Agency for ignoring its authorpatient and family should be informed of 1 Testing the waters IV: the unsolved problem ity under the Clean Water Act of 1972 to the procedures of hospital discharge, of of US beach pollution. New York: mandate monitoring of swimming waters Natural Resources Defense Council. the assessment, of the local options facing and to set uniform pathogen standards. August, 1994. Pp 116. $7.50. them (including the financial implications), and of decisions affecting them. children, and also other diseases in chilPesticides in Albania The guidelines also add that where a : patient refuses the options offered, dren that have no textbook explanation. so small a community, the absolute For After two and a half years of often acnmoaccount should be taken of the needs of nious negotiations, Albania and Germany figures are necessarily small and the epiother patients in determining how long have reached agreement over 460 tonnes demiology anecdotal. Although the Gerthe person can continue to occupy an of toxic pesticides improperly exported to mans have now agreed to remove the NHS bed. Albania in 1991-92. Ostensibly aid for . pesticides to Germany, the Federal Get- : With the ageing of the population, the Albanian agriculture, the pesticides . man Environment Ministry dismisses the difficulties of providing free long-term turned out to be time-expired products claims of pesticide-related disease, and care for all has been acknowledged. What from former East Germany whose proper says that the pesticides present no acute the government is being criticised for is danger. The Albanians, however, think focusing on local policies instead of a disposal was overlooked when that counTwo weeks ago, the trial national try ceased to exist. : otherwise. policy. The view is that people of two officials implicated in the opened The pesticides were dumped near the should have equal access to care irrespecvillage of Milot (population 3500), a import of the pesticides. They are charged tive of where they live. The government, with misusing their official position and name that in Albania carries connotations however, believes that, because communicontributing to an "economic and envisimilar to Seveso, Chernobyl, or Bhopal. ty care is a local service, its delivery will : vary according to local circumstances. Since the pesticides arrived, medical ronmental disaster". workers report, there have been increases Hence it is also introducing local commuin skin disease, miscarriages, anaemia in Vera Rich nity-care charters on standards to which success.

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