The role and major themes of the International Congress on Medical Librarianship, from its inception in 1953 (London) through 1995 (Washington, D. C.) are reviewed. The congresses have documented the status of medical libraries, especially in underdeveloped countries, over a span of 42 years. They have promoted the organization of national and regional networks of libraries and have provided opportunities for continuing education and for exchange of ideas. Perhaps most important, the congresses have become forums for discussion and for collective action under the organizational structure of the Section of Biological and Medical Libraries of the International Federation of Library Associations.

Beginning in 1953, there have been seven International Congresses on Medical Librarianship. Organized by the International Federation of Library Associations (IFLA), the World Health Organization (WHO), and medical library associations worldwide, the congresses have been recognized by the highest levels of the health professions and of governments (1-5). Among the distinguished attendees are Sir Cecil Wakely, president of the Royal College of Surgeons (England, 1953); John F. Kennedy, president of the United States (Washington, 1963); and HRH the Prince of Netherlands (Amsterdam, 1969). Each congress is organized by theme, reflecting concerns of the times, and addressed by international representatives of the profession.

What is the impact of the congresses on global information flow and management in the health sciences? Have the six congresses, held over 37 years, led to development of programs for assistance to developing countries (6); greater understanding within the international library community; better communication among colleagues; educational opportunities; and other outcomes? This paper explores major themes of the congresses and the policies and programs that have resulted from them.

Overview of the International Congresses, 1953-1995

The first congress (1953) was initiated by leaders of the medical library profession shortly after World War II and held in London. Some 300 persons attended with 37 countries represented. In this pre-computer age, library education, administration, and operations, the high cost of journals, and the history of medicine were among the concerns. An international exchange of publications in medical libraries had been set up by UNESCO, which was helping war-torn countries.

The difficult state of libraries in Asia, Africa, Australia, and Latin America was of great concern. At this time, the Congress Committee decided that discussion of international cooperation "should be exploratory and informal and consequently, no agenda was prepared" (7). The proposal that an international medical library association be formed was referred to a special committee for consideration.

Based in Washington, the second congress (1963) addressed six program areas: library organization, with particular reference to emerging medical libraries in developing countries; library resources and interlibrary cooperation; education and training around the world; medical subject bibliography; and history of medical libraries. New topics included "utilization of machines for bibliographic purposes" (8). A special progress report on the fledgling MEDLARS project was presented by the National Library of Medicine (9). UNESCO approached the World Health Organization to assume responsibility for international exchange of duplicate medical Literature. From 1960-62, WHO reported that 81 libraries in 42 countries had participated in the exchange (10).

The third congress (1969) in Amsterdam included a symposium on regional and national systems in both developed and developing countries. Conditions in Southeast Asia, Latin America, the Middle East, and Africa were described. Typical reports (India and Pakistan) cited lack of facilities, funds, and cooperation from neighboring countries. UNESCO was urged to provide aid for equipment, training personnel, and regional experts to advise. Latin America reported that medical collections serving its over 315,000 health professionals and paraprofessionals were in very poor condition. The Middle East had an acute shortage of trained librarians and appalling conditions in libraries that made it difficult to retain librarians after they have trained overseas (11). The delegate from India noted that WHO had spent millions of dollars for eradication of diseases and for public health, but not for libraries. He suggested that WHO play a leading role in the development of medical libraries, just as its counterpart, UNESCO, had done for school and public libraries (12).

Held in Belgrade, the fourth congress (1980) addressed the theme "Health Information For a Developing World." Saracevic reported that WHO had identified 588 medical schools in 79 developing countries, most of which were relatively new and did not have adequate resources, facilities, or trained personnel (13). Some 30 papers, from the Caribbean to Southeast Asia, were devoted to the need for cooperation and for the development of information networks. A general recommendation was for strengthening national networks, which would lead to regional networks for cooperation. Developments in Latin America (BIREME) and Southeast Asia (SEAMIC) were described, along with proposed networks for Africa and India. Corning cautioned that, given the focus on new information technology and the differences in needs and levels of development, the "selective principle7quot; should apply, that is, information services should be tailored to meet needs of the ultimate user - the indigenous health professional (14).

The fifth congress (1985) in Tokyo focused on information transfer and technology, bibliographic control, cooperation, services, and medical librarianship, with 571 contributions from 64 countries. Notably silent in previous meetings, China presented one of its first congress papers on problems of acquiring foreign journals, language differences in searching the literature, and quality filtering in MEDLINE (15). Matheson introduced the concept of the integrated academic information management system (IAIMS)((16) and Colaianni reported on MEDLARS III and the development of MEDLARS centers in 15 countries (17). There was much discussion of the infrastructure of information systems - national, regional, and international. Since the last congress, progress had been made in Southeast Asia and Latin America, but in East Africa, political upheaval had caused the collapse of cooperative efforts (18). The main problems of cooperation in many developing counties remained isolation of libraries, inadequate resources, and poor communication (19).

At the sixth congress (1990) in New Delhi, 46 papers (53%) were presented by delegates from developing countries, in contrast with the first congress (1953) in which only one delegate represented all of Africa. In evaluating local needs and their emerging national systems, the Arabic countries, Africa, India, and Latin America reported inadequate coverage of their medical literature in international databases. If South Africa were excluded, only 8% of African biomedical journals were indexed in Index Medicus (20). It was recommended that local area databases be developed, such as the LILACS database by BIREME for health sciences literature generated in Latin America (21). The political instability and socioeconomic dilemmas of developing countries were underscored by countries such as Zambia where 70% of subscriptions were recently cut (22). Attempts to develop networks and resource sharing among medical libraries in China were reported (23). While large centers in some areas are meeting the challenge of new technology and integrated systems, most libraries in developing countries are still confronted with basic problems of distance, lack of resources, poor communications, inadequate facilities, and insufficient budget for daily operations (24).

The theme of the seventh congress (1995) in Washington, D. C. is "Health Information for the Global Village." Subthemes include the impact of culture, language, and history on health information; education for health information delivery; measuring the effectiveness of health information on patient care; role of the government in health information delivery; standards for health information; medical informatics and telecommunication; and legal and ethical questions in the delivery of health care and health information.

What have the six international congresses achieved over the past 42 years? We have identified the formation of personal networks among colleagues; the development of national and regional networks of libraries; education of participants through exchange of ideas; the documentation of medical information activities among both developed and underdeveloped countries; and opportunity for the international medical library community to organize and mobilize for action.

Personal Networks Among Colleagues

"The technical razzle-dazzle which we can (fairly easily) provide," noted Pizer, "is not necessarily the medium or the message that will have the greatest impact on foreign librarians or libraries or do the greatest good. The congresses are one of the few opportunities for health sciences librarians to come together in large number for face-to-face discussion and exchanges of ideas and viewpoints" (25).

Networking is one the most important functions of the congresses - the opportunity to develop cooperative relationships with colleagues from other countries. This theme runs throughout the congress proceedings. According to Shimai (India), delegates discuss many issues and recycle ideas into their own activities on return (26). The meetings have provided the rare opportunity for African librarians across their vast continent to meet (27). Together, they have discussed mutual problems such as inadequate coverage, by international indexes, of local health conditions and diseases that are common problems in Southeast Asia, Latin America, and India. This, in turn, has led to development of regional, specialized databases. Although difficult to quantify, the effects of personal communication can be seen in reports of programs developed and their comparison with other regions.

Development of National and Regional Library Networks

This initiative is promoted by the World Health Organization, which encourages national networks for health literature services among health and educational institutions (28). The development of MEDLARS centers by the National Library of Medicine stipulates that participating countries meet technical criteria involving personnel, equipment, related resources, and a user community large enough to justify an extensive computerized service (29). In the last three congresses, the development of national and regional networks have been major themes.

As noted by Guirguis (Eastern Mediterranean Region), there is now general agreement that national infrastructures should first be strengthened then linked together to form regional centers (30). Progress on the development of regional networks in Africa, India, the Middle East, Southeast Asia, the Caribbean countries, and Latin America has been well documented in the congress proceedings.

Reporting Medical Information Activities of the World

Congress papers reflect activities of medical and health information centers and their current agendas; they provide important records of and perspectives on the contemporary scene. Each meeting is built around major themes and subthemes, some of which are recurring, even as new technology is applied. Concerns are usually presented within the framework of these themes, of which the following are most common:

-Managing information: bibliographic control, collection development, technical processing, IAIMS, and new technology. The brave new world of modern technology is still beyond the reach of many countries that are coping with very basic needs. Korale (Sri Lanka) suggested a list, similar to Brandon-Hill, but of limited size and appropriate for libraries of developing countries (31). Khan (Bangladesh) cited need for more documentation of diseases prevalent in Asia, such as diarrhea (32). Nagajarin and Jain (India) wanted more data on medicinal plants that are not in published sources (33).

-Cooperation: local, regional, and national infrastructures; national policies; resource sharing; and international cooperation. WHO has stressed the importance of national information policies and governmental recognition to provide legal and administrative bases for integrating health literature sources into the national health system (34). Over the past 37 years, the congresses have enabled delegates to share experiences in cooperation and have documented the progress. The 5th congress reported collapse of the East Africa network that flourished among university libraries during the 1970s, while Southeast Asia and Latin America reported new developments in resource sharing and regional databases.

-Resources and information services: outreach to remote users; services to primary care physicians, hospitals, nurses, and consumers; library services in developing countries.

Acknowledging that one of the most pressing problems for medical libraries in developing countries is lack of resources, Izant noted that the solution involves not only foreign assistance, but recognition and support by their own governing authorities (35). Sinadhira noted that the cost of new technology, such as online searching, is not yet affordable for widespread use among most developing countries (36). Gozo (Zimbabwe) suggested ways of achieving quality service despite meager resources and examined means of adapting services offered by the industrial world.

Medical Librarianship: Education and Training

The plight of librarians in developing countries is described extensively in the congress proceedings for all meetings. Representative is Bhatt (India) who suggested that national systems should be developed to meet at least 60-70% of requests, with an additional 10-20% through international assistance (38). Kulkarni compared services in developed versus underdeveloped countries and discussed the need for training at both basic and advanced levels (39).

While librarians in the western world are training for new challenges from rapid changes in technology and integration of information services, in many developing countries, the challenge is providing the most basic services under conditions of deprivation. Programs such as clinical librarianship and computer-based information systems are still viewed as remote from practical consideration at this time.

Organizing for Action

The first international congress in 1953 grew out of relationships among colleagues in national medical library associations who felt a need for worldwide communication. Organized by medical librarians of Britain, the first congress drew its membership from all over the world - 37 countries together with the Council for International Organizations of Medical Sciences, UNESCO, and WHO. The loosely governed consortium decided that a congress would be held approximately every five years and after each congress, the time, place, and chair for the next one would be designated. Under such informal conditions, there was instability, uncertain continuity, and a weak structure for organizing for action. In 1977, the Section of Biological and Medical Libraries of IFLA was founded, among other purposes, to give a secure organizational foundation for the international congress (40). Initially, the membership consisted of four library associations and eleven institutions; by 1990, there were over 60 institutional members throughout the world.

At the fourth congress, the section's Drafting Committee on Plans for the Future presented far-reaching recommendations for "shaping the future of the profession and the future of health care delivery"(41). The committee carefully studied the needs of developing countries, identified areas of greatest concern, and presented an agenda for action with mechanisms for accomplishing the goals. The issues of concern are:

-Role of health science libraries. The congress was asked to recognize the medical librarian as a member of the health care delivery team whose role in health care and maintenance is as vital as any other member of the health team. National and international library and information associations should support medical librarians in the key roles they play in health care.

-Education and training. Formal training for library and information personnel should be commensurate with the needs of each nation and training should be conducted on as many levels as is appropriate to meet those needs. Varying socioeconomic realities of each country should be considered. Health professionals, students, administrators, and other users should be informed about library services and how to use the resources of information centers. Medical library associations, both local and national should support these reforms in library education and develop both basic training and continuing education programs.

-Material resources development. There is an urgent need to facilitate the sharing and use of information resources between developed and less developed countries. The congress should endorse the IFLA concepts of universal bibliographic control and universal availability of publications. Potential sponsors should be sought to produce annual or biennial reports on the status of health sciences libraries in developing countries. Major health sciences libraries in developing countries are requested to assist in the flow of publications.

-Information transfer. New telecommunications and information-handling technology should be applied to facilitate the flow of information between developed and less developed countries.

The congress should endorse the need to establish national foci points for network development and bibliographic and human resources criteria for these centers. Efforts of the United Nations and WHO to strengthen regional and global mechanisms for cooperation should be supported.

The report of the committee was adopted by the Fourth International Congress. The IFLA Section of Biological and Medical Libraries was approved as the coordinating body for the Organizing Committee for the International Congresses of Medical Librarianship. Further, the Organizing Committee was constituted as a working group of the section (42).

Discussion

In realistic self-evaluation, Picken asked at the 5th International Congress (3):

We have gathered here from all parts of the world. All of us must be reflecting on the events of the last few days and all of us must have very sharp memories But why have we come here and has it lived up to our expectations? Why do many people make great efforts and in many cases considerable sacrifice or personal expenditure to travel the world to meet a group of strangers?

Janet Doe, in reviewing the first congress in London, noted that "it signifies the coming-of-age of the library world, and as such, a landmark, it gives an impressive panorama of the personnel, the library facilities of various countries, descriptions of many notable libraries, the status of medical library education, and presentation of the special problems in medical library work" (44).

Almost 40 years later, attendants confirm that "we come to further our knowledge" (45) and "through serious discussions among ourselves, the medical librarians of the world are forging guidelines for performance"(46).

Beyond learning and communicating, Ruff has recommended that development of national policies for health literature services be a major concern of the congresses and that professional associations participate actively in policy formulation (47). Lonzi has urged that we use the international congresses as benchmarks in planning towards a "Worldnet," a collective vision for cooperating, planning, and assuming a more assertive role in our respective countries regarding information policy issues (48). The recommendations of the Organizing Committee for the 5th International Congress underscore the potential strength of the congresses as instruments for change.

The theme of the 1995 International Congress on Medical Librarianship is the WHO objective of "Health for all by the year 2000." In accepting this challenge, the congress implies that medical information professionals are an integral part of the health care team and should contribute to both the policy making and functional roles.

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References

1. CUNNINGHAM ER. Report of the Committee on International and National Cooperation. Bull Med Libr Assoc 1949 Oct; 37(4) :343.

2. FRASER MD. The Medical Library Association: the span of its international activities: a chronology. Bull Med Libr Assoc 1971 Jul; (3) :495-510.

3. POLAND UH. Reflections on the Medical Library Association's International Activities: a chronology. Bull Med Libr Assoc 1982 Oct; 70(4): 359-368.

4. GROEN F. Building bridges: the role of the Medical Library Association in international affairs (President's Page). Bull Med Libr Assoc 1989 Oct; 77(4):391-2.

5. POLAND UH. MLA's international program. Bull Med Libr Assoc 1990 Oct; 78(4): 403-405.

6. HODDER WB. Economic development in the tropics. 2d ed. London: Metuchen, 1973:2. (For criteria in defining ":developing countries" as used in this paper)

7. PROCEEDINGS OF FIRST INTERNATIONAL CONGRESS ON MEDICAL LIBRARIANSHIP, LONDON, JULY 20-25, 1953. Libri 1954; 3: 419.

8. PROCEEDINGS OF SECOND INTERNATIONAL CONGRESS ON MEDICAL LIBRARIANSHIP, WASHINGTON, D. C., JUNE 16-22, 1963. Bull Med Libr Assoc 1964 Jan; 52(1):119-147.

9. IBID, 148-180.

10. IBID, 281-318.

11. ARRIENS L. Problems of medical information systems and centres in developing countries; survey of work in the Middle East. Proceedings of the Third International Congress on Medical Librarianship, Amsterdam, 5-9 May 1969. Amsterdam, Excerpta Medica, 1970.

12. CHITALE SA. A survey of work in South Asia. Proceedings of the Third International Congress on Medical Librarianship, LOC. CIT., 413-419.

13. SARACEVIC T. An approach to selective libraries for health sciences schools in developing countries. Proceedings of the Fourth International Congress on Medical Librarianship, Belgrade, September 2-5, 180. Topic 4. Additional papers: 27-36.

14. CORNING ME. International cooperation for ibrary and health information services. Proceedings of the Fourth International Congress on medical Librarianship. LOC. CIT., Topic 3. Cooperation through health information networks: 121-128.

15. QIAN BY. Field work study: a best approach for learning actual experience. Proceedings of the Fifth International Congress on Medical Librarianship, September 30-October 4, 1985, Tokyo, Japan. Tokyo: The Congress Organizing Committee, 1985; 1: 407-411.

16. MATHESON NW. Integrated academic information management systems: trends in U. S. academic health sciences centers. Proceedings of the Fifth International Congress on medical Librarianship. LOC. CIT., 407-411.

17. COLAIANNI LA. Medlars III - Improved services for medical libraries worldwide. Proceedings of the Fifth International Congress on Medical Librarianship. LOC. CIT., 116-119.

18. LULE FK. Co-operation and resource sharing among medical libraries in East Africa. Proceedings of the Fifth International Congress on Medical Librarianship. LOC. CIT., 394-399.

19. GOZO AJ. Appropriate health sciences library services for the third world. Proceedings of the Fifth International Congress on Medical Librarianship. LOC. CIT., 239-244.

20. OBAKA DN. The challenge of medical librarianship in Africa. Proceedings of the Sixth International Congress on Medical Librarianship, September 24-28, 1990, New Delhi, India: Medical Library Association of India, 1990: 313-8.

21. PIEGAS MHA; CEPADA LMR. LILACS (Latin American Literature in health Sciences): an approach to its methodology. Proceedings of the Sixth International Congress on Medical Librarianship, LOC. CIT., 349-53.

22. CHISANGA CJJ. Factors affecting utility of keys to resources in Zambia: a professional librarian's point of view. Proceedings of the Sixth International Congress on Medical Librarianship. LOC. CIT., 81-84.

23. ZHENG XQ. The network development and resources sharing of medical libraries in China. Proceedings of the Sixth International Congress on Medical Librarianship. LOC. CIT., 487-90.

24. ROWE RR. The impact of new technologies on medical library services in developing countries. Proceedings of the Sixth International Congress on Medical Librarianship. LOC. CIT., 7-13.

25. PIZER IH. The world of health sciences libraries. Bull Med Libr Assoc 1990 Oct; 78(4): 408-9.

26. SHIMAI K. Opening address. Proceedings of the Fifth International Congress on Medical Librarianship. LOC. CIT., 2:1-2.

27. OBAKA DN. The challenge of medical librarianship in Africa. Proceedings of the Sixth International Congress on Medical Librarianship, LOC. CIT., 313-8.

28. RUFF B, WEITZEL R. Is there a need for national policies for health literature services? Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 601-609.

29. CORNING ME. LOC. CIT., 121-128.

30. GUIRGUIS GM. Health science information cooperation and networking in the Eastern Mediterranean Region. Proceedings of the Fourth International Congress on Medical Librarianship, LOC. CIT., Topic 3: 17-43.

31. KORALE SR. An overview of medical literature sources in Sri Lanka. Proceedings of the Sixth International Congress on Medical Librarianship, LOC. CIT., 211-29.

32. KHAN MSI. Diarrhoeal disease information service network in Asia: problems and prospects. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 1: 345-352.

33. NAGAJARIN S, JAIN HC. Database on medicinal plants research at PID and its services. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., Abstracts: 23.

34. RUFF B, WEITZEL R, LOC. CIT., 1:604-609.

35. IZANT HA. Problems of medical information systems and centres in developing countries: survey of work being done by WHO and UNESCO. Proceedings of the Third International Congress on Medical Librarianship, LOC. CIT., 413-419.

36. SINADHIRA A. Resources in medical libraries. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 2:31-40.

37. GOZO AJ. Appropriate health sciences library services in the third world. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 1: 239-244.

38. BHATT MK. Indigency and internationality: a crisis of balance for the halth sciences library in developing countries. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 1: 60-63.

39. KULKARNI DM. Education and training for medical librarians in developing countries. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 1:373-380.

40. LAW DG. The international scene in biological and medical libraries. Bull Med Libr Assoc 1990 Oct; 78(4): 337-338.

41. REPORT OF THE DRAFTING COMMITTEE FOR PLANS FOR THE FUTURE. Fourth International Congress on Medical Librarianship, Belgrade, Yugoslavia. Bull Med Libr Assoc 1981 Apr; 69(2): 263-267.

42. IBID., 263-267.

43. PICKEN FM. International congresses - what value? Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 1:53-65.

44. DOE J. Proceedings of the First International Congress on Medical Librarianship, London, 1953 (Review). Bull Med Libr Assoc 1955 Apr; 43(2): 331-333.

44. SHIMAI K. LOC. CIT., 2: 1-2.

45. PICKEN FM. LOC. CIT., 1: 53-65.

46. RUFF B, WEITZEL R. LOC. CIT., 1:604-609.

47. LORENZI NM. Medical information worldwide: the challenge continues. Proceedings of the Fifth International Congress on Medical Librarianship, LOC. CIT., 24-30.

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