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First do no harm: does the Hippocratic Oath extend to developing countries?

BMJ 2002; 325 doi: (Published 05 October 2002) Cite this as: BMJ 2002;325:783
  1. Louise Woolrich-Burt, specialist registrar in emergency medicine (
  1. Yorkhill Children's Hospital, Glasgow

    From November 2000 until May 2001, I worked at a remote primary healthcare clinic in the Chitwan region of Nepal. The clinic serves a rural community of fishermen and subsistence farmers and is supported financially by a charity registered in the United Kingdom and Gibraltar.

    Half of the population is under 5 years of age, with infant mortality running at 82 per 1000. There is a 1 in 10 lifetime chance of death in childbirth (compared with 1 in 5100 in the United Kingdom and 1 in 3500 in the United States).

    The clinic aimed to improve the health of the local population by providing affordable health care and health education. But it soon became clear to me that, however laudable, this aim was not being met.

    My introductory visit to the onsite pharmacy provided me with first hand evidence of the inappropriate nature and naivety of first world donations. Many drugs were out of date and …

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