a. Geographically continuous root communities with 50 to 200 persons above age 15, in addition to the children in the community.

b. A leadership elected by direct democracy that has a staggered and limited non-repeatable period of service.

c. Full authority by the leadership for legislation, administration and adjudication, without any countervailing balance of power.

d. Full responsibility by the leadership for full employment of all the community's resources, including determination of entitlement.

e. The extention of these principles into an ever expanding hierarchy of networks.

a. community participation and allegiance

b. individual freedom of religion and expression

c. the importance of morality and spiritual growth

The leaders of the community must first identify and assign to the task of medical services, those individuals most qualified, just as they must also do for security, guidance of agriculture, training of children, and every other social and technological need.

One of the first concerns in a community may be obstetrics and the solution will be to find midwives. If there are none who are trained in that area then women who are mothers and have had the experience of giving birth - may have to do.

Initially, for other medical needs, the best a community may be able to do is to identify individuals who have been trained in first aid, animal care, or other similar skills. However limited may be these skills, the community must encourage and support the possessors of them to use and further develop them. Information and references can be collected from throughout the community. Books on home remedies, alternative health methods, and all other related materials may prove helpful.

There could also be a collecting in a central location of medicines, herbal remedies, medical tools and implements, such as a blood pressure monitor, a scale, scissors and cutting implements, needles, thread, water heating / sterilizing equipment along with material for bandages, blankets, some beds and anything else that might be useful in an emergency, to equip an emergency room / examining treatment area / hospital facility. Some suggestions for developing medical supplies will be found in the accompanying Recovery section.

Whatever facility location is designated - there needs to be one - so that people will know where to go in case of an emergency. And there needs to be one person designated in charge of the facility and its supplies. Others may come to the facility to give treatment. The facility may also be used as a location for providing continuous care for those who are seriously injured, incapacitated, senile, or infants needing post-natal care. Still another use of the facility may be for processing refugees into the community.

No matter how small a community - each and every community should have something in the way of a facility even if it is simply a single room or two in one of the homes. Larger communities may have larger special facilities and as a network of communities is established a more equipped centre may be established that serves all the communities in that network - no matter what the level of the network.

Broader networks of communities are more likely to find previously trained medical personnel and these can be a big help in giving guidance to the lower level communities in establishing their own facilities and training their own personnel. The mere sharing of personnel among several communities at the lowest level will undoubtedly expand the access of some of the communities to more skilled personnel.

In the previous order of things, the most skilled and specialized expertise was generally concentrated in the largest cites and will probably have suffered the largest casualties. In any case, the high technology, necessary for them to perform their specialties, will either no longer be available or will not be maintainable. For this reason, any surviving medical skills should be focused on developing additional skills at the lower community levels.

One suggestion emphasized by a member of the Ark Two Medical Group was that an extensive program of internship and mentorship be implemented. Another member felt that those selected to participate in it should begin at a very early age. Indeed the earliest inclinations should be encouraged but by the age of 15 those being so trained should be on a career path. At present it takes about 12 years beyond high school to train a medical specialist, meaning that practitioners usually become qualified at around the age of thirty, although they have been in practice as interns for some years previous. It is hoped to shorten this training period considerably by the above proposed method.

Still, it is important that people in medicine be as broadly and deeply educated as possible - and not simply be trained as technicians. In the Reconstruction of Medicine, as in the Reconstruction of Society, it is important that we take a different approach over the old way of doing things. In other areas this is looked upon as 'sustainable environment', 'sustainable agriculture', 'sustainable economy' and so forth. As a parallel, let us speak of 'sustainable medicine'. By sustainable medicine we will mean medicine that emphasises the sustaining of health and prevention of disease compared to an emphasis on curing and healing.

Practitioners of sustainable medicine must have a close community commitment. Every community, no matter how small, must have a practitioner that regularly visits every member of the community to determine their health and needs. This is particularly important in the recovery period of the catastrophe where faulty hygiene or sanitation can impact the whole community when it is without resources to combat an epidemic outbreak.

The community medical practitioners must be concerned about water purity, sanitation, radiation contamination, diet and so forth. Individual malpractices such as drug and alcohol abuse impact the resources of the entire community and therefore are the proper purview of community concern and intervention. Community and personal safety is another area that must be emphasized. Personal injuries will not only be damaging to the individual but may also stress the resources of the community. At a time when trauma response capabilities are limited there is additional reason for stressing safety procedures.

One obvious difference about the practice of medicine in the recovery situation, as compared to the way that things were done before, is that so much of what is done must be done on a local basis. This principle of community self reliance is something that must be developed and which should hereafter be sustained. Medicine, like everything else in the 'Reconstruction Philosophy' should be from the bottom up.

To sum up what is being said here about medical training is that communities should start locally, be responsible locally, sustain locally and build upwards through contacts in their higher networks - but they should always retain their local control while cooperating with and being obedient to the requirements of the higher more inclusive levels of their networks.

Local training should always be viewed as essential. Initially, because of limited transportation capabilities, such training as is available will probably be in the immediate community. Later some communities may specialize in training for others. Even then - smallness and compactness should remain as guidelines so as to conserve physical resources such as the energy required for travel.

What the future of medicine may be, is presently unknown. There must be much more concern given to social medical ethics. Even in the longer term the allocation of resources in the community may not permit dramatic intervention in single cases, such as that required for a heart transplant, or long-term artificial life support, when the same resources may be used to provide medical care that would improve the quality of life or extend the life of a considerable number of people. What is being proposed here is not necessarily 'socialized medicine' so much as medicine with a 'social view'. Concerns about scarce allocation of resources are perhaps misplaced so long as all the resources of a community are not being utilized. But that then is the reason that communities must be most concerned about having wise leaders.