WHO Regional office for the Eastern Mediterranean

CHAPTER 1
THE MEDICAL LIBRARY 1.1 Historical Background
Medical libraries are not a recent trend. Large collections of medical books existed in ancient Egypt, Assyria and China. The chief Egyptian medical papyri range in date from 1900-1200 B.C. The library of Ashurbanipal King of Assyria (668-626 B.C.) provided 30,000 fragments of cuneiform clay tablets of which 800 were medical. The two libraries of Alexandria - the Brucheum and the Serapeum - were the most famous of ancient world. The Romans in general despised medicine. But the libraries of Byzantium were well equipped with medical works. During the long period of Islamic supremacy in science (9th-11th centuries), great medical libraries were built up in the East and Spain. Avicenna left a description of the Royal Library at Bokhara. The earliest found-ers of monastic libraries in the 3rd century made provision for the custody and control of books. As soon as medical teaching began in the newly founded universities, medical libraries in a special sense were created, but grew slowly. But the outstanding examples were the libraries of medical corporations and societies of which many are still existent, an example of which is the present Royal Society of Medicine which has the leading British medical library. In U.S.A, the National Library of Medicine (NLM) was established in 1836 to become the most important medical library in the world(1).

1.2

Definition
Libraries fall traditionally into one of the following types : a. b. c. d. e. National libraries Public libraries Academic libraries Special libraries School libraries

(1)

Encyclopaedia of librarianship / edited by Thomas Landau, p. 239-241. 4

Medical Library Handbook

One is inclined here to consider medical libraries as special libraries as their clientele and services are directed towards specific community and subject respectively. But actually they are more than this, as they may be national, public or academic libraries as well. Moreover, the literature that medical libraries cater for is doubling at least every fifteen years, the number of medical students increases every year, the fields themselves are changing as medical activities now take into account the complex interplay of personal, emotional and environmental factors that affect an individuals health and well being, as well as evidencing new interests in such disciplines as psychology, anthropology, economics, sociology, biophysics, ecology, mathematics, electronics, communication science and operations research(2) as well as chemistry and physics. Saying this we may derive the following all-embracing definition of the medical library - better called health sciences library : The library that is exclusively or predominately concerned with materials and information whether acquired or accessible in the fields of health sciences, and exclusively or largely serves all the needs of members of health, allied and related professions and services .

1.3

Objectives of the Medical Library

The overall aim of the medical library, regardless of its location, size or parent organization is to provide organized library services to meet the information needs of its clientele in their activities relating to patient care, education, research, management and any other specialized services. To enable the medical library to meet this aim, and fulfill its mission, in harmony with the objectives and goals of its parent organization, the following objectives may be listed(3) : 1. Acquire, organize, provide access to, and process information so that a user has immediate access to all facts, concepts, ideas, or other items of information relevant to his particular needs ; Handle wide variety of inputs, including formal publications of all formats, informal notes and comments, and items derived

2.

from more than one source ; 3. 4. Reduce the difficulties now caused by the diversity of symbols, languages, jargons, and terminologies ; Essentially eliminate the publication lag ;

(2)

(3)

Miller, James G. Design of a university health science center, p. 101-121.

ibid, p. 103.
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WHO Regional office for the Eastern Mediterranean

5. 6. 7. 8.

Make possible the retrieval of all, or nearly all, existing information relevant to a search ; Respond immediately to a users request, interact with him, and adjust to his level of sophistication ; Facilitate interaction of groups of coworkers with each other and with the library ; Provide the user, on demand, with either the flexibility, legibility, portability, and convenience of the printed page, or the dynamic quality and immediate responsiveness enabled by information technology ; Store information on the users interests and needs for the purpose of formulating policies about acquisitions and retention, taking the initiative to keep each user informed about new information which is in his field of interest ;

9.

10. Develop flexible working relationships with other systems ; 11. Standardize cataloguing, indexing and abstracting activities to make them most efficient and most valuable to the users ; 12. Record and process all bookkeeping, billing, receipt and disbursement ; 13. Handle guidelines, strategies, tactics and rules of thumb intended to expedite solution of the problems of information processing ; 14. Provide for continuing efforts to improve the organization of and easy access to the existing body of knowledge, including resources sharing, and continuous education of both staff and users.

These objectives, to be achieved whether comprehensively or selectively, depending on the resources provided and clientele served, require the provision of various types of services and functions which will be covered later in the handbook.

1.4

Types of Medical Libraries

Medical libraries may be categorized by the subject they cover, the form of materials they collect, or by the type of users they serve. For instance there may be a nursing library covering the subject of nursing, and servicing the community of nurses, or a library that collects journals, historical materials or archives for researchers, while another library caters for clinicians, physiotherapists, or consumers.

Medical Library Handbook

But the more common categorization is based upon the parent organizations, bearing in mind that such organizations belong either to the private or public sector. This holds true for both the overall and individual categories, as in the case of hospitals, for instance, where there exist both government and private hospitals. Consequently, the types are stated here under the following headings :
1.4.1 National Medical Libraries

National libraries are those concerned with collecting and preserving the cultural heritage published in and/or on the respective country of the national library. But, in medicine and health sciences, there is a much bigger responsibility for a national medical library represented in providing information on the subject as a whole regardless where it was originated in the world, and the format in which it is available whether virtual or physical. On top of such libraries is the U.S. National Library of Medicine (NLM), which is actually an international medical library servicing any user anywhere in the world. As this library is also leading in cooperation and networking, it will be described more fully in the relevant chapter of this handbook. For other countries, there are national libraries that cater for all fields of knowledge without restricting its services to any specific discipline. But few of them do have, in addition, a national medical library concerned with servicing users rather than collecting the heritage. Of those countries, one may mention the National Medical Library of UAE University (Al-Ein, Abu Dhabi).
1.4.2 Medical Centre and Medical School Libraries

These libraries normally belong to the academic institution that teaches medicine, nursing and pharmacy. They may be departmental libraries of their university library, autonomous, or independent of them. In some university libraries such libraries are just subject sections without being physically separate. They vary in their size, space, staff, automation and the services they provide.
1.4.3 Hospital Libraries

There is a real confusion about the definition of the term Hospital Library . But, in all cases, whether public or private, it should be the one invested with responsibilities and authority to assure the hospitals educational, clinical, administrative and research personnel of access to information which enables them to give the best patient care within the

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WHO Regional office for the Eastern Mediterranean

formation which enables them to give the best patient care within the limitations of funds at hand(4). When we talk about hospitals themselves, we talk about a very big business as the largest proportion of money is spent there whether in the form of hospitalization, insurance or in cash outlay. When talking about classification of hospitals, it may be reasonable to consider that a large number of hospitals operates under some kind of private control : religious institution, proprietary, or voluntary. Other elements for classification are : size, average length of stay per patient, whether or not the hospital carries out a formal teaching programme, and whether or not the hospital serves one segment of the population like women, children or mentally ill(5). Some hospital libraries are not more than a service provided by public libraries to hospitals. Moreover, MLA (Medical Library Association), in its standards for hospitals, divided hospitals according to size, staffing and programmes into six categories giving the characteristics that pertain to each category. MLA also enlisted there qualitative standards for hospital libraries and quantitative minimum standards for health sciences libraries in hospitals(6). However, there are peculiar phenomena related to hospital libraries, particularly in developing countries, namely that they are mostly very small libraries with one staff member, if any. Contrast this with the hospitals they serve which are mostly technologically advanced even in information technology without involving the library. The other point is that the hospital library should be available to its users at all times, and at the point of need.
1.4.4 Libraries of Other Health Care Entities

These entities may be private or public too. They tend to have small libraries, if any. They may be better served if they have access to other resources in the locality or remotely through Internet, other networks, or some cooperation programmes.
1.4.5 Government Agency Libraries

Normally the Ministry of Health is considered the major agency which may be responsible for different health institutions such as hospitals, laboratories, and research centres. It may be centrally or decentrally organized. Other agencies include the Ministry of Agriculture (veterinary medicine) and environment agencies. Such libraries have a significant role, particularly in developed countries.

(4)

(5)

Johnson, Barbara Coe. Services an integrated hospital library can and cannot do, p. 284288.
ibid.
(6)

MLA. Standards for hospital libraries. 8

Medical Library Handbook

As such agencies represent their respective countries at the various regional and international intergovernmental organizations, they have access to a wide range of expertise and resources from such organizations, particularly the World Health Organization (WHO). On the regional level, the Council of Arab Ministers of Health of the League of Arab States may be mentioned. This Council established the Arab Centre for Medical Literature (ACMEL) seated in Kuwait.
1.4.6 Libraries of Professional Societies, Voluntary Health Organiza-tions (7) and Foundations

Professional societies are association of colleagues in an occupational context, i.e. : societies, syndicates, academies, or associations in medicine and allied health sciences. Some of these societies are responsible for bibliographic control over a specified discipline or areas of interest to their membership. They may be responsible for writing, editing and indexing reports, proceedings and digests related to the history and policies of the societies. Needless to say that professional medical library associations do exist, though not common in the various countries. The U.S Medical Library Association (MLA) is the most outstanding example in the world. It was established in 1898 and has 5000 members organized in 14 regional chapters and 23 special interest groups. It publishes a quarterly bulletin (Bulletin of the Medical Library Association) as well as numerous publications including Current practice in health sciences librarianship which will consist of eight volumes ; it is, in fact, the fifth edition of the classic handbook of medical library practice. It has an active continuing education programme. It established in 1989 the Academy of Health Information Professionals. The other two medical library associations that deserve to be mentioned are : the Canadian Health Libraries Association which publishes the quarterly Bibliotheca Medica Canadiana, and the European Association for Health Information and Libraries. Voluntary health organizations are composed of persons of heterogeneous background and orientation who organize to support special purposes related to the health field through voluntary contributions from the general public. Their libraries are generally small and specialized. They may be involved in one or more of the following activities : public education, support of services in diagnosis or treatment centres, support of research, publications for professional or general audiences. On the other hand, foundations, institutes and other similar organizations are supported by private benefactors or grants. These may include : family or personal foundations, corporate foundations, community trusts and
(7)

Crawford, Susan. Health sciences libraries of professional societies, voluntary health organizations, and foundations, p. 269-276.
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WHO Regional office for the Eastern Mediterranean

government foundations. Their libraries usually provide special services for a limited set of users as they support the programme of their institution in which they are situated, although the entire programme may consist of supporting a unique library collection. On the whole, such libraries may provide services to physicians, biomedical research, and/or assume the role of community libraries in the health field, serving students, teachers, pharmaceutical manufacturers, attorneys and the general public.
1.4.7 Pharmaceutical and other Company libraries

These firms belong to the private sector, and their libraries are not usually accessible to outsiders as their services are tailored to their staff and customers. Except for major companies these libraries tend to be small. In addition to the pharmaceutical companies, the following companies are included here : health insurance companies, medical advertisers, medical publishers, vendors of health information, and marketing departments in organizations doing business in the medical fields.
1.4.8 Libraries of Regional and International Organizations

The world health organization (WHO) together with its various regional offices and centres plays a significant role in the field of medical information and informatics in all its member states. It will thus be covered in more detail later in this handbook. Other organizations include the PanAmerican Health Organization (PAHO), and the Council of Arab Ministers of Health, previously mentioned, which established the Arab Centre for Medical Literature (ACMEL). Moreover, there are many libraries that hold medical collections, small or large, as part of providing services for their own clientele. Such libraries include public libraries, school libraries (school health and health education) particularly schools of the handicapped, sports centres and clubs. From a futurist point of view, another categorization is coming up not limited to any one type of medical libraries, but will encompass them all. This categorization states that there will be three types of libraries : 1- Paper library, where materials collected and technical operations are based largely on paper ; 2- Automated library, where most operations are computerized while the collections remain largely on paper ; 3- Virtual library, which some may call electronic or digital library, where both the operations and collections are stored and used in electronic format.

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