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Dr Khaled Mneimne

Please tell us about your childhood. I was born in Beirut, Lebanon, on 9 February 1936. I spent my childhood in Beirut, which was

considered as the SWIZERLAND of the Middle East.

Please tell us briefly about your education. I completed my elementary, intermediate, and secondary school education at the International

College of Beirut in the year 1954.

In 1958, I completed my undergraduate degree in Public Health at the American University of

Beirut.

Give us a brief history of your working experiences before WHO. Following my graduation from the American University of Beirut in 1958, I worked for one year

at the same university (AUB) as Teaching Assistant in Public Health.

What were your reasons to join WHO and when did you join? I thought early of making a professional career with an international organization like WHO.

I realized that Public Health in the Middle East countries was not a priority for local

governments. There was a lack of human resources for health, most of the health care services

offered by ministries of health were concentrating on curative aspects, and as a result the

people in EM countries were lacking knowledge about public health and disease prevention.

Furthermore, several communicable diseases were spreading in the region while they could

have been prevented and controlled through basic sanitation and community education. In

addition, specialists and public health workers were rare.

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While I was still a teaching staff member at the A.U.B, I was approached by WHO/EMRO. I

joined WHO in January 1959, recruited for a long-term assignment in Riyadh, K.S.A.1

Please describe the situation when you arrived in the Kingdom of Saudi Arabia? During that period (1959-1964), Saudi-Arabia was facing severe shortage of qualified persons

for public health work, and particularly, for environmental sanitation which was considered as

one of the main obstacles in carrying out any public health activities.

No country-wide census was undertaken during my assignment, but the population estimated in

1960 was around 4-5 millions. A large number were living in Jeddah, Riyadh, and Dhahran.

Most of the people in Riyadh were government employees or working in private business. The

rest of the population was in scattered communities living in villages, small towns and oases.

The populations of the Western areas were mainly businessmen, while in the Eastern provinces

were farmers or employees of the oil company (ARAMCO). Saudi-Arabia was considered as

one of the largest oil producing country in the world.

Health services were rendered in main cities and small towns. Such services did not reach all the

population living in remote areas.

The most important health problems were malnutrition, trachoma, tuberculosis and malaria.

Efforts were made to eradicate smallpox through organized vaccination programme, which was

endemic in some areas of the Kingdom.

Until 1959, there was no medical school or health training institute. The national physicians and

other health and para-medical technicians were few and received their education abroad. The

health services were relying on expatriates from Arab, Asian, and European countries.

What was your assignment about? I reported to Riyadh in February 1959 to assist the Ministry of Health in the establishment of the

first “Health Assistant and Sanitarians Training Institute” in the Kingdom. My terms of

reference included mainly the design of curricula and the development of teaching material.

The Ministry provided the premises of the institute to meet all its need including class-rooms,

offices of administration, supplies and teaching aids and residential building for students

coming from remote areas. Expatriates were also assigned as lecturers in health topics.

1 I am, most likely, one of the very few WHO retirees who started, developed and ended almost all (except one year)

of his professional career within the Organization (started on 1st.January 1959, and retired on 1

st.March 1996).

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Until the year 1964, the institute graduated (about 60 graduates) health assistants and sanitarians

that were absorbed by the health services of the MOH.

Then what happened?

Following my 5 years assignment in Riyadh, I was re-assigned to Mogadishu, (Republic of

Somalia) on a long-term assignment to establish training and education programmes for health

personnel to serve their national health services all over Somalia.

Was training and education already one of your professional competences or were you given

a “refresher course in educational science” before starting on this assignment? In that

period, as we both know, any person with a degree in Public Health was considered

“competent in E&T.

All I can say is that while I was a student at the AUB, I followed courses on “training and

education” as part of my university studies. In addition, I developed a personal interest and

skills in this area. Furthermore, EMRO used to supply me with WHO technical papers on the

subject which were very useful for developing my knowledge and skills in education and

training of health personnel. Most of these orientations were in form of WHO Technical Report

Series on Education and Training. Others related to WHO publications which were published

during the eighties such as “The Educational Handbook for Health Personnel” and “Teaching

for Better Learning”.

So, you moved to Mogadishu in 1964.

Yes, my assignment in Mogadishu was between 1964 and 1968. I consider those years as the

“good years of Somalia” after it became an independent country early in the sixties of the last

century. The Republic of Somalia had an estimated population of about 3.000.000

persons (1968). Mogadishu is the capital and had then an approximate population of 200.000.

The Somalia Republic is an extensive strip of land with a cost line extending from the Red Sea

along the Gulf of Aden to the Indian Ocean. On its Western side, it has long borders with

Ethiopia and Kenya.

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Health problems in Somalia were numerous. Serious nutritional deficiency and environmental

health problems were considered major contributing factors to high mortality among children.

Others are tuberculosis, water-borne diseases, childhood and diarrheal diseases. Malaria and

schistosomiasis were very common, especially along the banks of Shebelli and Juba rivers.

Small-pox was endemic in Ethiopia, and cases of small-pox at the borders of Somalia and

Ethiopia have been reported during my assignment. I was placed at the Health Training

Institute in Mogadishu, which was one of the WHO supported projects in Somalia.

It is important to indicate that the people of Somalia were very enthusiastic and eager to learn

and serve their country in order to compensate for the bad years when Somalia was

under British and Italian colonial rule.

What were your terms of reference?

They were, in collaboration with the national counterparts, to establish and develop three-year

training programmes to prepare different categories of health personnel, including paramedical

and nursing graduates to work in the different health services all over Somalia.

Training of these categories were important and essential to the Republic in order to prepare and

create enough manpower in the medical and public health fields to control possible outbreak of

communicable diseases and combat existing ones.

I successfully established an excellent relationship and contacts with national and international

officials. Partners were the government officials, WHO and other UN Organizations that were

operating in Somalia. During the period of my assignment, our dear colleague the late Dr.

Nuhad Beyhum was the WHO Representative.

Thee-year training programmes were established and graduated a number of Health

Superintendents, Sanitarians, Public Health Nurses/Midwives and Laboratory Technicians. All

those graduates were appointed by the government in the different health services of the

country.

What was your next assignment after you left Mogadishu in 1968?

I was assigned to Libya at the Benghazi Health Training Institute on November 1968. Benghazi

is located on the Mediterranean Sea. East to it is the Egyptian border. West is Tripoli, the

capital and Tunisia. South are borders of Chad and Niger. North is the Mediterranean Sea. The

total population of Libya was estimated at about 3,000,000 (1968).

When I reported to my new duty station, the Health Training Institute was already established

and a number of para-medicals and male nurses had graduated. The duration of all the training

programmes was 3 years.

The institute was accommodated in barracks of the former British Military Hospital in Benghazi.

Late in 1969, the MOH replaced the old barracks by temporary new pre-fabricated buildings

which included offices, classrooms, laboratories, demonstration rooms, a kitchen and a large

dinning hall, and sleeping wards for boarders. Simultaneously, a new and large health training

institute was under construction in the outskirts of Benghazi. In 1975, the institute was moved

to the new premises which were designed to accommodate more than 500 students.

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WHO assistance included experts, training supplies and equipment. The number of WHO staff

assigned to the project in 1968 was eight. The national teaching staffs who were recruited on

full-time basis were mainly graduates of the project, assisting the part-time professional

lecturers assigned by the Ministries of Health and of Education.

What were your terms of references in Benghazi?

I was to establish and support the development of a 3-year training programme to prepare Public

Health Inspectors, Laboratory Technicians, male Nurses, X-Ray Technicians, Assistant

Pharmacists, Physiotherapy Technicians, and Community Health Technicians/Nurses.

I also had to teach theoretical and practical subjects of public health focusing on the concept of

PHC including the follow-up of the graduates in their assigned duty stations.

In addition I was to offer technical advice to the national director of the project as well as train

national teaching counterparts so as to promote national self-sufficiency..

Towards the end of 1975, all WHO staff were withdrawn except myself who became the only

WHO staff member until December 1985.

In 1979, I was granted a WHO Fellowship for post-graduate studies in Tropical Community

Medicine & Health in Liverpool, U.K., after which I returned to the Training Institute in

Benghazi.

While I was still in Libya, I pursued my higher studies, and in June 1985, I completed a Master

of Science in California, USA, after which EMRO decided to re-assign me to the WHO

Regional office in Alexandria. Towards the end of December 1985, my assignment in Libya

was ended when the institute was completely handed over to the MOH.

After I completed my M.Sc. in 1985, I was encouraged by my Regional Office to continue

working for my Ph.D in Public Health, which I completed in 1988 in Saint Louis, USA.

How would you compare the situation in the countries where you were assigned?

Although the three countries I have been assigned to are considered as developing countries, yet

Saudi-Arabia and Libya resembled each other in their wealth as oil producing countries. On the

contrary, Somalia was a poor country, depending mainly on foreign aids.

In SOMALIA no research was made on life expectancy, but it was quoted to be 40 years,

reflecting the high mortality rate among children and adults. The infant mortality rate was

estimated to be around 200-250 per thousand live births. Although the health delivery system

was totally organized under the public sector (MOH and Labour), there were few para-

governmental organizations such as the Social Insurance Agency, and the newly established

European Common Market Hospital (1966). At regional and district levels, health assistants

(Auto Medico) who received their training in Italy were offering medical and health services to

the public in the regional and district hospitals, clinics and health centers.

In SAUDI-ARABIA and LIBYA, as oil producing countries, both governments introduced

socio-economic reforms, and developed their health services, including hospitals, polyclinics,

health centers, dispensaries, and their MCH centers. During my assignment in each of the

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above countries, there was a large number of medical and auxiliary health staff recruited from

different countries.

Please tell us about your assignment at the Regional Office (January 1986 -March 1996)

On 1st. January 1986, I was re-assigned to the Regional Office in Alexandria as Regional Adviser

for Teaching Learning Material (RA/TLM) which became in early 1992, the Educational

Development of Human Resources for Health unit (EDH), by amalgamating a unit of

Education Development and Support (EDS). I held this post until the date of my retirement in

1996.

The main objectives of this unit were to support member states of the Region in all areas related

to Education Development of Human Resources to ensure that educational approaches used

for health personnel education and training were scientifically sound, appropriate and effective

as well as in support of the concept of “integrated health system and health personnel

education”.

We cooperated and supported 22 countries of the region to develop and strengthen their national

capabilities in areas related to medical and health personnel education for the development of

their training programs to respond better to the needs of their health care services and in the

development of learning material in their national languages.

This was done in collaboration with selected schools which have adopted the concept of

community-based education for medical and health personnel

In collaboration with local authorities, I established and developed WHO collaborating

“Educational Development Centers“ (EDCs), either at the faculties of medicine or at the

Ministries of Health in Tunisia, Iran, Pakistan, Egypt, Yemen, Syria, Sudan and Jordan.

We organized intercountry and regional workshops, based on the concept of PHC proclaimed in

1978 in Alma-Ata as the key to attaining the goal of HFA, to re-orient the training programmes

in the countries of my assignments, to train different types of health personnel graduates to be

able to offer quality health care services to their communities.

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During the period of my assignment, I conducted more than 60 national and inter-country

workshops in different countries of the region on topics related to the development of human

resources for health.

You were indeed at the head of a very important program. I know by experience this was quite

a difficult and ambitious task. Please give some examples of how some of the schools you

just mentioned did concretely implement the concepts such as “community based”, “task-

based” and eventually “learner-centered”.

With the national counterparts in some countries of the region we re-oriented the training

programmes in the training institutions into task-based instead of subject-based programmes. It

was a hard work and required efforts to describe the tasks expected to be performed by each

category after graduation as their job descriptions.

Do you remember examples of schools where “final examinations” (for example in order to

obtain a medical degree in those schools) were based on those lists of tasks and no more

around subjects?

Yes, the Medical Schools of Suez-Canal, Egypt, and Gezira University, Sudan, developed a

“Community-based” education approach for their programmes. They adapted the final

examinations from lists of tasks which addressed the health needs of their communities as well

as their health services.

In addition, among a number of medical schools in the region I remember the medical schools of

Damascus, Syria, of Jordan University, which started implementing task-based medical

education in some courses within their medical programmes.

Were you able to verify some of the expected changes?

Yes, during my assignments in Saudi-Arabia, Somalia and Libya, the most interesting and

remarkable events were when I saw my graduates working in different health care services of

their countries. I saw how our graduates successfully introduced changes in the health services

in their assigned health centers to address the health needs of their communities. In SAUDI-

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ARABIA the graduates were serious to implement the local and international health rules and

regulations, especially during the pilgrimage period, to prevent spread of communicable

diseases among the pilgrims and provide educational messages. In LIBYA many of the

graduates established health centers to offer preventive and public health services in the

remote areas of their assigned stations such as in Sabha, Libya, which is one of the remote and

neglected area (at that time ) in the Libya desert .

Some of the graduates were granted fellowships and pursued their higher education in health

fields to become health leaders in their communities and professors in their health training

institutions. All those who were granted fellowships and pursued their higher education abroad

returned to their countries to contribute in the development of the health care services.

What is your opinion about the rather infrequent training in educational science of the

teaching corpus in Universities around the world?

I strongly believe that training in educational science is the pillar of development in all areas

including health. How can a country develop otherwise its services? This is the responsibility

of the universities that they should include training in educational science in all their training

programmes. 2

As from the seventies and eighties, especially when I was assigned to EMRO, I noticed that

several universities started training their teachers in educational science. For example, at

A.U.B, a center of “Educational Development” was established for the training of their

teachers in this domain. This was also the case in Damascus University. In Iran Aha’eed

Behishti and in Bahrain they established a “Continuing Education Programme” in educational

sciences for their professors and instructors to help them develop courses for the medical

students.

What is your retrospective look at strong and weak aspects of WHO work and in particular

your views about the advent of HFA and PHC, its influence on your work.

In my view, HFA did not mean that diseases and disability will no longer exist. As I understood

it, were those resources for health would be evenly distributed, and that essential health care

will be accessible to everyone, with full community involvement. It meant that health begins at

home, in schools and in factories, and that people will use better approaches for preventing

diseases and disability. It meant that people will realize that they have the power to shape their

own and their family life.

2 Khaled: Please note that I strongly suggest to delet the following sentence because it does NOT

relate to the preceding question. The fact of having been trained in the USA in PH or of being an

“American” does NOT imply having received some” training in educational science (“During the

years of my studies at the A.U.B, most of our professors were Americans or received their

post-graduate studies in Public Health and Preventive Medicine in the USA. I had no idea

about the teachers in other universities in the EM countries).

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What is your opinion about the “Multiculturalism” of WHO and its impact? During my services which exceeded 40 years with WHO (including some years after retirement),

I had to work with colleagues from different nationalities with different cultures. In addition, I

had to learn much about the cultures and habits of the people in Saudi Arabia, Somalia and

Libya. That was important and it enabled me to tackle several problems I faced during my

work.

Tell us about interesting situations you encountered. In Saudi-Arabia, I found the people very honest, humble, religious, and willing to learn and serve

their country.

In Somalia, the people feel proud of being Somali. They don’t consider themselves as Africans

neither as Arabs or mixed. The tribal feeling is important. During my presence, the Somali

language was not written but only spoken. In Mogadishu the Italian language was dominating

while in the North (Hargiza) it was the English language.

Once I accompanied our WR/Somalia, together with a team of WHO experts, to a leprosarium

located in a small island on the Juba River about 370 kms south to Mogadishu. The purpose

was to follow-up the effect of certain drugs (still under experiment at that time) distributed by

WHO to be used for the treatment of leprosy. The trip was unforgettable. On our way through

the bush, using land-rovers, we passed through several small villages where the villagers lived

in very primitive huts. We stopped in some of the villages and saw cases of malaria, filariasis

and onchocerciasis (nodules on the bodies were noted). There health services did not exist and

care was provided to the population of those isolated villages by local healers. The most

painful situation I saw was the human tragedy and suffering of lepers. The lepers were cared by

Italian nuns headed by an Italian M.D and supported by the Italian Catholic church. No

government (MOH) health services or support were offered.

At that moment, it confirmed for me the importance of public health and the control of

communicable diseases as such diseases are preventable.

In Libya I witnessed the revolution of Al-Ghazzafi against King Idris Al-Sunoussi. The Libyan

people remained loyal and lived as closed communities. It is also important to mention that the

presence of UN Organizations which were operating in Libya during my assignment was not

appreciated by the regime at that time.

What could you tell us about the fact that as Directors (either Regional or HQ) are “elected” it

does give them a certain “power” and “degree of independence” in relation to the DG in

Geneva?

During the 37 years of continuous services with WHO, and a total of additional about 4 years

after retirement, I witnessed 2 Regional Directors for EMRO. The late Dr.A.H. Taba and Dr.

H.A.Gezairy3 provided all necessary support during my assignments, and contributed much

towards the development of the Organization in the Region.

As you know a Regional Director of WHO is elected by the national governments of the region

(usually by the ministries of health). That means, the WHO Regional Director is not appointed

by the DG in Geneva. It gives the RD a certain power and a degree of independence. In another

3 Still on active service when this narrative is written in December 2009.

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word, a Regional Director does not need to please the DG as is the case in other sister

Organizations where the RD is appointed by his/her DG of the Agency.The WHO/RD in

his/her region can appoint staff members or terminate the services of others (local staff and I

think international staff below P4 grade) without the approval of the HQs. The RD has the

power to negotiate with the governments of his/her region without getting the blessing of the

DG/Geneva. For important matters and allocation of the regional budget, the RD informs HQs

through comments/or approval if needed.

What about your working relations with other UN agencies: UNICEF, UNDP etc? My working relationship with all UN sister Organizations was excellent. I cannot remember any

problem faced with other UN Organization during my WHO activities.

Were you witness to any kind of political pressure?

I faced some frustration and obstacles during my assignment in Libya, especially between 1980

and 1985 due to political interferences from the “popular committees” which were established

by the regime during that period. The “popular committees” had the power to change the

national director of the institute several times (disregarding his qualifications) and to interrupt

class sessions requesting students to attend lectures on the “green book” which was considered

as the constitution for Libya.

Other political interferences were experienced during my STC assignment in North Iraq from the

politicians of the local governments in Kurdistan. There was much interference and pressure by

the two local governments of Kurdistan requesting appointment of their followers to be

recruited as local staff members with WHO offices in North Iraq . Different Kurdish parties

were exerting pressure on our WHO main office in Erbil to take more shares of the health

commodities provided by WHO under the SCR/986.

I usually managed to deal and solve all such problems tactfully without embarrassing the

Regional Office.

Comparing the WHO Regional Office and its professional staff between the sixties and the

nineties of last century (prior to my retirement), I should admit that politics started to penetrate

WHO and a larger number of senior officials were recruited by EMRO due to political pressure

from their countries.

Did your activities have an influence on your family life? With my wife Leila Bawab, we have one son, one daughter, and six grand-children. My wife

delivered both our children (Maha and Muhieddin) in Beirut while I was away in Saudi Arabia

and Somalia. After delivery, my wife rejoined me with our very young children.

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While in Libya, my wife and two children were with me. We experienced difficult living

condition late in the seventies and during the eighties, especially when many of the food items

were not available. Life in general was tough also for the Libyans as personal freedom was

“controlled” by the regime.

The hard time was mainly experienced by my family due to my frequent travels and when I was

working on my post-graduate studies abroad and had to leave them alone in Benghazi.

In 1968, we registered both our young children in Beirut as boarders at the International College

for the boy, while our daughter was registered at the American School for Girls. Our children

used to spend their yearly vacations with us. In 1975, due to the war events in Lebanon, I had

to draw both our children from their boarding schools in Beirut to join us in Libya and

registered them in the Libyan schools. My daughter Maha completed her under-graduate

university degree at Benghazi University while my son Muhieddin completed his first year

under-graduate studies at the same university.

In 1985, when the Regional Office/EMRO informed me about my expected re-assignment to

EMRO, my family left Benghazi for Beirut. There my daughter got married and my son

completed his under-graduate degree at the University, after which he got married. After my

re-assignment to EMRO, my family remained in Beirut. My wife used to visit me in

Alexandria on occasions until my retirement in 1996.

How did you feel about having to retire at age 60? After completing more than 37 years of continuous services, I felt happy to reach the age of

retirement at 60. However, the organization continued to utilize my services for about 4 years

after retirement.

Did you keep in touch for example with Somalia?

Yes, I took three-week assignment to Somalia in 1983 as a WHO member of the Review Mission

for the health personnel training institutes and nursing schools. I had the chance to meet with

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some of my former graduates and observed their valuable contribution to the health services in

their duty stations although Somalia started facing unstable political situation at that time.

However, having witnessed the good years of Somalia during my assignment in the sixties, it is

so sad for me to watch all the tragic events of Somalia which started late in the

sixties/early seventies, especially after the assassination of the late president Sharmarki (the

father of the present Prime Minister). Somalia has not recovered. Let us hope and pray for

Somalia that the existing conflicts among its people will end soon in order to regain the

confidence of the international community and to reform and re-built its socio-economic

structures to enable the Somali people to contribute to the development of acceptable basic

services in their country.

What work have you done since your retirement? Following my retirement in March 1996, I was offered several STC assignments:

From 27 May to 6 June 1996 I represented WHO within the United Nations Technical Mission

(mandated by General Assembly Resolution A/50/22c), to report on the Israeli military attacks

against Lebanon and their consequences

Then I went to Jordan with CEHA (WHO/EMRO Center of Environmental Health Activities

established in Amman, Jordan) to plan and implement a project on “Environmentally Healthy

School Initiative” from 3 May to 20 June 1997.

Late in 1997, I became “WHO Coordinator” under SCR/986 for North Iraq where I stayed until

June 2001. My responsibilities were to manage WHO activities in Erbil, Douhuk and

Suleimanyya, including the collection and analyses of information pertaining to the distribution

and development of health related programs. I cooperated with the UN Humanitarian

Coordinator for Iraq. I supervised the activities of about 15 WHO International and 100

National staff members of different specialties in health fields. Due to health reasons, I

requested not to extend my contract beyond June 2001.

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In September 2006, I took a short assignment to Saudi-Arabia, as an evaluator and arbitrator with

AGFUND for its International Prize on “Sustainable Primary Health Services, Training and

Job Creation for Poor in Rural Areas “.

In June 2008, I spent one month STC assignment in Medical Education at the EMRO Cairo

office to advise about a strategy for networking the EDCs in the region, for sharing Teaching

and Learning Materials and for improving the work of the fellowship regional unit.

Late in 2008, I was elected by the UN retirees as a member of AFICS Executive Committee

(Beirut Chapter) to assist all Lebanese retirees on matters related to their pension and health

insurance. I am still serving AFICS until to-date.

Thank You for telling us about such an impressive career.