School Health
Item
- Title
- School Health
- extracted text
-
SAD-RF-CH-2.12
School Health *
Emphasis of School Health on
Malnutrition
Infectious Diseases
Intestinal Parasites
Dental Caries
Diseases of skin, eyes and cars.
Objectives of School Health
Promotion of Positive Health
Prevention of diseases
Early diagnosis, treatment and follow-up of defects
Health consciousness awakening
Maintaining a healthy environment
Different Aspects of School Health
Medical check-up of school children
Remedial measures and follow-up
Prevention of Communicable Diseases
Healthy school environment
Nutrition
First Aid and emergency care
Mental health
Dental health
Eye health
Health education
Education of handicapped
School health records.
Preliminary Note prepared for HNP project for discussion at the meeting on 7.3.2001 between
Department of Education and Health.
School Health Issues
Shift from medical chcck-ups only to comprehensive care of health and well being
throughout the school year.
Teacher should assist in medical examination.
Children should be explained the reason for regular check-ups (once in 4 years
adequate).
Daily morning inspection of children in the class by teacher
• unusually flushed face
• rash or spots
• cold, cough, sneezing, sore throat
• fever
• nausea or vomiting
• stiff neck
• redness or watering of eyes
• headache
• listlessness or sleepiness
• diarrhoea
• pains in the body, stomachaches, etc.
• any skin patches, itching, etc. (including scabies)
• head louse infection.
Children should be sent to the nearest medical facility after calling for the parents.
Healthy school environment
• playground
• toilets (separate for boys and girls)
• safe drinking water
• screening of eating facilities around the schools.
Nutrition programme if being implemented.
Mental health
• Counselling skills of teachers
• School is the place for shaping the child's behaviour and overall mental
development
• Gender bias and discrimination of marginalized.
Health education
• personal hygiene and care of eyes, cars, teeth
• nutrition, infectious diseases
• environment
• family life skills
• sex education and life skill education
“Every school child is a potential health worker".
Integrated education of the handicapped.
In the child to child method, children take new knowledge and better practices, learnt through
interesting activity based learning, home to their families. They could also be organised to reach.
out of school children.
CHi'IO
Voluntary Health Association of India
C-14, Community Centre
Safdarjung Development Area.
New Delhi-110016
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CHAPTER-I
Telegrams’: VOLHEALTH
New Delhi-110016 COMMUNITY HEALTH Ceti
Telephones :
' Block
668072 ACrarnanga|a
Bangalore-560034
India
introduction
SCHOOL HEALTH
Of the 60 crore Indians almost 420, i.e. 2J2 million are below
the age of 14 years and we plan to overtake China by the turn of the
century in terms of population.
We have not been able to provide basic health care to everyone,
inspite of our numerous hospitals and doctors. Our doctor population
ratio is 1:4246 almost fulfilling WHO1s recommendation criteria.
We have only 200 of our doctors taking care of the health needs
of our 800 population living in 5^0,000 villages of rural India.
Just to give an idea about the magnitude of the problem^quote from
March 4, 1979 Hindustan Times, "The number of children suffering from
malnutrition is estimated at between 40 million to 120 million and
every month nearly 100,000 children die of malnutrition. Nearly 92
million children in India live below the poverty line in a socio
economic environments, which are unfavourable for their survival.
Further 9C0 of the school going children in India weigh 10-400 less
than those in the affluent countries. Besides causing low birth weight
malnutrition is responsible for 170 pf premature births leading to
poor resistance to diseases and stunted growth, both physical and
mental. It is estimated that 220 of school going children show one
or more signs of nutritional deficiency."
There are over 5 million children suffering from some kind of handi
cap or other. There are 17 million births a month. Out of every 100
children who enter class 1, less than half complete class V and only
24 complete class VIII.
Out of the 6.260of the total plan outlay set aside for health, 9C0
is spent in urban areas.
With such meagre resources and such gross maldistribution of
manpower material, finances, two things become cle^r:
1.
There is an urgent need for the community to participate more activity
for its own health care delivery.
2.
It is essential that the meagre resources be used as sensibly as
possible through well planned programmes and not erratically.
The two programmes which can very effectively take care of 2/jrd of
our population (210 mothers in reproductive age group and 420 of 15)
are : Maternal' Child Health Programme and School Health Programme.
Bhore Committee on Health Services for School Children recommended the
establishment of school health programmes, the need to train teachers
for health education in 1946. It outlined the objectives and functions
of school health programme. Emphasised the need of provision of a
balanced midday meal as part of the scheme1 and for satisfactory
arrangements for school medical inspection and treatment.
In 1965 almost 20 years laterMthe Report of the School Health
Committee which studied the various aspects of school health admitted.:-
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"It is needless to point out that although the need for school
health services has been felt by one and all,no concrete steps have so
far/taken either by state or central govt, to implement any comprehensive /been
programme particularly in the rural parts of the country". It was mentioned
that some cities and towns did have some sort of health services
available, but the villages did not have any organised school health
service .
The Committee stated that "we are of the opinion that the facilities
available at present for school health in different states are not
satisfactory although the system of school medical inspection has been
in vogue for a number of years in many states. Carrying out of school
medical inspection in a perfunctory manner, the non availability of
remedial.facilities, lack of follow up even in the cases of those declared
to have defects and the lack of co-operation, between the school autho
rities and parents are some of the factors which have contributed to
unsatisfactory results in the school health services. We feel therefore,
that unless present system is considerably improved, ft would be a mere
waste of time and money to continue it."
The third Five Year Plan states that "Care of the health of such
large numbers of children is not only vital in itself but is a most
important aspect of the health of the community as a whole."
1. Clean drinking water sanitary facilities in schools;
2. Arrangements for medical inspection
5. Follow up services in association with primary health unit
in the development block and
4. Instruction of teachers in health education
These were to be the minimum services for care of health in the
schools.
Many recommendations have been made, many plans chalked out but so
far in rural schools, effective school health programmes have not yet
come into existence in most places.
Even the term School Health Programme is ill understood by most
teachers, school authorities, educationists and even those involved
in the health field.
It implies occasional medical check ups to some, midday meal to
others', physical education or giving of vaccination in school campus.
The concept, the knowledge of its various components has not
. reached down to those whom it is supposed to involve. School Health
Programme has remained an intellectual exercise in health planning
; at central and state level and wishful thinking and a seemingly
unrealistic dream by those involved with rural schools.
This report is written with those rural schools in mind who
are desirous of doing something for their school children but do not
'• know 'what to do and how'.
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Each individual school unit, with its differing management pattern,
financial capacity, staff and student population, health problems,
health facilities will have to have a rationally planned school health
programme to suit its own particular need.
The objectives of this report are to :
1.
2.
Emphasise the need of a well planned school health programme
Give outline of a procedure for formulating a simple
meaningful. S. H. P.
- defining its essential components
- health instruction
- school health service
- healthful school living
- presenting government's graded curriculum
- various methodologies for teaching,
evaluation and recording
- listing resource material relevant for
such a programme
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CH APTER - II
W H Y
DO WE
NEED
A.
SCHOOL
HEALTH
PROGRAMME
WHO and Govt, of India are formulating strategies for "health for all by bhe
year 2000 A.D.",
It is obviously our health care delivery system has
neglected a very large section of society - i.e. those living in rural
India.
When we talk of health care, we don't talk of high powered, sophis
ticated curative care, but of basic or primary health care.
Measles and Diarrhoea comprise about 50 - 700 of infections for'Uni.er-5'
in the third world. They cause not merely deaths but 50 - 700 of all
causes of malnutrition.
Hr 0, Gopalan addressing Indian Association for the Study of
Populations in Dec. 1982 said s
" Of the nearly 23 million children who will be born in our country
in' 1983, nearly 3 million may be expected to die before they reach
the first year, another 1 million will drop by the wayside before
they complete their childhood. Of the remaining 19 million, nearly
9 million will emerge into adulthood with impaired physical stamina,
low productivity and poor mentalabilities because of serious under
nutrition and ill healthduring their childhood; yet another million
who will suffer milder forms of malnutrition may reach adulthood
with less stucking physical and mental impairment. Only less than 3 million
of the 23 million to be born in 1983 will become truely healthy,
physically fit, productive and intellectually capable citizens of
this country."
Schools tend to reach
most even in under privileged rural
communities. Education field has highest concentration of educated
manpower p resource of high order.
There are s
'60,000,000 kids in 500,000 primary schools.
of the
710/school going population
i«e 800 of the population of 6 - 10 years age group . pt fs well known
that for 750,primary education is terminal.
Regarding
;
~7Education - Primary and Middle; Paragraph 3 (iv) of the National
Policy on Primary Secondary Middle Education statement states that
a time-bound programme should be prepared to cover all the children
in the age group 6 - 14 years with free and compulsory education.
This objective poses two fold problems:
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firstly, the quantitative problem. The population in the age group
6-14 years is expected to be 155 millions by 1982-85. The present
enrolment in this age groups is about 90 millions. Therefore, for total
coverage, the existing programme should expand by 50 per cent."
"secondly, the qualitative problem. An alarming feature of the
primary and middle school education is the high rate of dropouts
viz. 60 per cent at the primary stage (6-11 years) and about 40 per cent
at the middle stage (11-14 years). In other words out of 100 students who
enter the primary stage at the age of 6 years, only 25 complete the
middle class at the age of 14 years."
A document of the Union Department of Social Welfare views the present
picture where education is concerned, in the following words: "Thus,
if we look at the overall situation, child education presents a very
dismal picture".
Disparity where allocation for education budget is concerned is as
obvious as it is in health where 8U/0 budget is spent for 2O/o population
in urban areas:
Education Budget
1st plan
2nd plan
8.7 %
5rd plan
4.6%
Elementary Education
56/
(First Plan)
University
9^/
ti
In
11
ti
11
26% 5rd plan)
11
25/
1971
1975
1971
1976
29.5% literate
52.1$ literate
271 pillion
illiterates
410
"
"
"
"
The Alma-Ata Declaration states that' at least the following should be
included in primary health care;
"Education concerning prevailing health problems and the methods of
preventing and controlling them; promotion of food supply and proper
nutrition, an adequate supply of safe water and basic sanitation;
maternal and child health care, including family planning; immunization
against the major infectious diseases, prevention and control of locally
endemic diseases, appropriate treatments of common' diseases and injuries
and provision of essential drugs."
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A Community Health Programme goes beyond, the hospital walls, beyond
mere curative care - it looks at the preventive, promotive, curative
and rehabilitative aspects of health.
If the urgent need for the delivery of primary health care to the
community is recognised, the important role of school health in any such
programme becomes obvious.
1.
A sizable proportion of population constituting of children our
25$ of the national wealth can be reached through S.H.P.
"Children of school age should be considered a segment of the life
time of the whole population. During this segment of life span,
all children are exposed to situations and are undergoing deve
lopment changes with call for watchful care". WHO expert committee
on School Health Services Geneva, Aug. 5 - gave this as reasons
for special consideration of the school age group.
2.
Easy accessibility for delivery of different components of health
care, as children are consolidated in -one place.
J.
S.H.P. being an important component of C.H.P. (for proper functioning
of the latter due attention to the former has to.be given) school
is an avenue of approach to the community.
4.
These are the formative years of an individual, children and
youth respond better to health education developing favourable
attitudes and formulate desirable health practices. It is more
difficult to teach these to the adult.
5.
To learn effectively child or youth needs good health, also in the
final alanysis health is "both a requisite for amd a goal of,
formal education," for the student can hardly achieve any other
goal without having his health.
6.
Children and youth can receive correct instruction from qualified
teachers instead of relying only on information obtained from
peers neighbours and family members which may be based on
superstition.
7.
School is geared to handle these matters from the educational point
of view. It reaches a large percent of individuals of the ■
community face to face. Teaching this way has more impact than
mass media or any other mode of imparting health education because of difficulty in reaching out with our limited resources
and manpower.
8.
Health education (which can alter disease related poor health habits)
is taken home to siblings and parents by the child. A major thrust
at school going section of community shares its effects •in the
community as a whole. Those children not attending school, be it
due to poverty or ignorance, can also be reached this way indirectly.
These children are not forgotten and through the school health
programme something specific can be done for them because they too
are part of the community and a good school health programme should
be the community's programme based in school-but spreading out.
Early detection of problems and prevention of chronic and serious
defects and basic health care is possible through this "second front"
of health workers.
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Our objectives are :
1.
To teach students through their trained teachers to feel .
responsible for their own health, of that of their family and
community. To realize that health can't be 'given' or 'bought'
but has to be 'earned'.
2.
To avoid undue dependence on medical professionals and make
health care low cost, and easily available by using local resources
and inculcate self reliance.
3.
To make teachers the change agents in the community where health
knowledge - attitudes and behaviours of the community are
concerned.
OBJECTIVES OF THE TOTAL SCHOOL HEALTH PROGRAMME indicate that it seeks
to bring each child up to his optimum level through
- providing healthful school living
- providing children with protection against communicable and
other preventable diseases
- discovering physical defects and other abnormalities in the
child and promoting their connection if they are remedial at the
earliest.
- developing the knowledge and attitudes which will enable the
individual to make intelligent health decisions.
- provising desirable health habits.
- developing school, home and community cooperation in health
promotion.
Why do we need a planned programme in health education for the individual
school system a planned programme.
1.
2.
3.
4.
5.
6.
7.
It informs the teacher as to what is expected in health education.
Outlines the activities and relationships of different members of the
school health team.
Presents a progressive outline of work by grades suggesting to each
teacher the objectives for his grade and avoiding the same programme
for a individual in succeeding years.
It specifies a time allotment for health education.
Suggests many teaching possibilities, methods, procedures and
resources from which the teacher may choose.
It often suggests ways to evaluate results.
It helps to ensure the completeness of the programme as a whole.
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III
CHAPTER
THE
IMPORTANCE
OF
INVOLVEMENT
TEACHERS
IN
SCHOOL
HEALTH PROGRAMME
There are 1,500,000 primary school teachers for 500,000 primary schools
with 60,000,000 kids being taught,
1.
Teachers are where the schools are, and they are a rich local resource.
They are available in large numbers, present even in remotest areas.
2.
They are best equipped to undertake the task of health education,
their educational background and skills befit them for this work.
3.
Considerable acceptability - personal as well as of what they teach with pupils and their parents and through them the community. Most
teachers specially are ;natives of the region and know the beliefs
and customs. Convincing them to change those affecting will be something
exemplary for the community.
4.
Social status in the community and faith of the people, good support
with voluntary agencies and govt, and community.
5.
Involvement of teachers in health programme is consistent with overall
philosophy of developing nations to maximally utilize locally available
resources. Teacher knows the customary behaviour; therefore can pick
any deviations. A good teacher understandsstudents' physical, social
and emotional needs more than an outside health personnel.
- Teacher can observe pupils' eating, study, health and ,play habits
- their attendance
.
-.their growth chart
- their scholastic record any discrepancy between capacity and
performance.
Health education helps the teacher in developing and maintaining his
own health; objective consideration of existing prejudices and
superstitions about health are made.
The Principle Objectives in Teacher Preparation for Health Education
according to WHO/Unesco Expert Committee - are to develop
a.
a standard of personal health practices which will help maintain
the health of the individual and serve as an example to the pupils
b.
understanding and developing skill in maintaining an optional
emotional environment through desirable inter-personal relations.
c.
an appreciation of the value, importance and place of education in
health as a part of the total education programme.
d.
a willingness to play an appropriate part in the promotion of
health in the school and in the community.
e.
an adequate background of professional knowledge about child growth
development, personal and community health and programmes and
procedure in school health.
f.
understanding and appreciation of a healthy physical environment
and how it is maintained.
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g.
skill in promoting health education and in working cooperatively
with others in this sphere.
h.
a knowledge of community health and social agencies and the ways
in which the teacher may work effectively with them and with the
home.
Preparation in health education helps the teacher to meet the expectations
of society,,
She will help to develop attitudes, habits and knowledge in
the field of health which are needed by the younger generation.
It also makes the teacher aware of her own health requirements and she
learns how to meet them.
- it helps the teacher to understand the child psychologically
- it helps the teacher to work more effectively with the mother
members of the school staff and contribute more to the community.
- the teacher understands the health problems of children and can
collaborate with the home more effectively.
- it helps the teacher realize that even though knowledge of fundamental
health facts is essential for any positive change in health behaviour
mere imparting of knowledge cannot be expected to do so.
-Behaviour is more important than eithejr knowledge or elusive attitude
because without action the thought is ‘.unimporthnt arid- hence a trained
teacher's approach is 'behaviour oriented' rather than 'knowledge
oriented'.
No one is better equipped than an observant trained teacher who can
observe and encourage good health behaviour and can check unhealthy
behaviour.
Changing Role of Teachers
Past Role
New Role
Teaching facts and techniques preparing
child to pass examination
1.Transmitting of a capacity to handle
facts,, to know where and how to
find them and what to do with them
*
Preparing child to pass examination
2.Preparing the child for life long
learning.
Isolating child from environment
Teaching a curriculum irrelevant
and divorced from life needs and
aspiration of the community.
Being indifferent to the place of
school in the community.
J. Stimulating the child to identify'
himself/herself with the environ
ment and awakening in him/her a
loving concern to take care of it.
4. Implementing a curriculum relevant
and related to life, needs, aspi
rations of the community.
5.Taking loving care to make the
school an integral part of the
community and a centre of love
learning, beauty, harmony
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CHAPTER
PLANNING
IV
SCHOOL HEALTH
PROGRAMME
According to C.E. Turner in his hook 'Planning for Health
Education , he gives the values of a planned programme in health
*
education.
1.
It informs the teacher as to what is expected in health education.
2.
It outlines the activities and relationships of different members
of school health team.
3«
It presents a progressive outline of work .by grades suggesting to
each teacher the objectives for his grade and avoiding the same
pT-ogramne for an individual child in succeeding years.
4.
It specifies a time allotment for health education.
5.
It suggests many teaching possibilities, methods, procedures and
resources from which the teacher may choose.
6.
It often suggests ways to evaluate results.
7.
It helps to ensure the completeness of the programme as a whole.
Organization:
Need for a planning committee/advisory committee with representatives
from
5 Principal/Head Master
1. School administration
} MaJlager/Adlainistrator
2.
Parent or Community
3.
Community Health
- Govt, or Voluntary Agency
4.
Education Department
- Govt, official or anyone in charge
5.
Teachers trained
- Voluntary school or diocesan programme.
There is a need for school health councils in each school. Major
purpose is to
- identify and solve school health problem
- idea is to share responsibility and decentralize decision making
Functions and composition of council depend upon local interest and needs.
Some guides are:
1. The purposes, objectives, and policies of the council should be
stated clearly, reviewed periodically.
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2. The council should include representation from parents, school
health and education department.-
5. Each member agency should be given an opportunity to select its
own representative who may be elected for specified period of time.
4.
The council should meet at regular intervals’with prepared agenda.
5. Each agency should be permitted to present for council consideration
any problems dealing with the health of school children, particular atten
tion should be given to these problems requiring joint action by community,
school and professional group.
6. Sub-committees if needed may be made to report back to council
any specific matter of most feasible method to collect finances for health
fund.
7. Although long term, projects are necessary and appropriate projects
which can be completed successfully in a short period of time should
receive attention.
8. The community should be kept informed about the council's progress
accomplishments and problems, health and department.
9. Emphasis should be placed on solving pertinent problems rather
than organization or, on;-routine- procedures.
„
. Some'of the operating procedures of a council includes
1. Survey of .the entire^school health programme for strengths and
weaknesses.
2. Complete detailed data on the school health programme of morbidity
pattern absenteism due to illness etc.
'J. Analyse the various school and community resources for meeting
-certain health problems.
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4. Recommend to the school administratora course of action for
meeting each problem.
5. Evaluate the influence of recommended improvements that are put
into operation.
6.
Develop long range plans for coordination of the school and
■naijiyHrrity health programme.
Inter^iSaijetee&«i9etsbe«n-*sT5iw<t, home and community - Foundation being health
needs of interests of indiviMaXcs^nmmuni ty health-and .cultural problems,
conditions.
’.
v
:
/TheX
/indivX
dual A
/^student \
^/citizen fully V
<7/
developed
\
/
T
i
'' '
\
/ Mentally, PhysicallyX
/
Morally sound\
Home
♦♦12•
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Health agencies operating
in the area
Govt.
Voluntary-
s
Health Instruction
Instructional objectives
Learning opportunities
Organization of Health Institutions
Evaluation
Church related
Health Services
Parent Teacher Association
(if any)
Women's groups
(Mahila Mandals)
Teacher Observation
Medical Examination
Health Guidance and Follow up
Communicable Disease control
Special services - dental, eye
Healthful School Living
Youth Clubs
Youth Farmers Club
Cooperatives
Religious groups
Private Industry
Community Health Council
Safe drinking water
Sanitation
Toilet facilities
School meal
Health of School personnel and
healthy interaction
School Health Council
Inter-relationship of school, home and community is illustrated
with respect to nutrition by the following statement from joint
UNESCO/Vtho/FAO Committee Report in Paris Sept. 1964.
"A national programme for improvement of nutrition involves national
planning and local implementation in such areas as
- improved use of available foods
- improved production of essential foods
- prevention of the waste of foods through improved storage,
presentation, handling and marketing.
- wise selection of food for the daily diet of the individual
and in the family.
Using the vast network of rural schools as a "portal of entry" to the
community for preventive and promotive health programmes addressed to
the entire school , community( and not just to the school children alone)
was highlighted by Dr. C. Gopalan at the inaugural address at. National'
, Institute of Health Administration 1974, Swasth Hind 187 in 1974.
” Such a programme would greatly reinforce conventional health services ■
: undertaken by the public health department.
This vast ready made
■ infrastructure of rural schools can form a'2nd front' in the campaign
against ill health."
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The Prime Minister while addressin,.’ the national Heart Institute had paid?
"Government agencies function under certain constraints and rules,
regulations and also traditions. Voluntary organizations allow
for experimentation with newer ideas and can break fresh ground."
(e.g. Red Cross, Community Health Worker).
Hence the newer workable approaches to health care have to
come from people like you.
Organization and Administrative Set Up
Success of the S.H.P. depends largely on sound effective and
coordinated administration. Coordination between those who administer
Health, Education, Food, Agriculture and Community Development departments
from the national to the fiold levels is essential.
Such an organizational set up would aim at recognizing and mobili
zing voluntary efforts of the community. It would be able to facilitate
ipaximum utilization of limited resources of every department.
It is important that the S.H.P. should be the joint responsibility
of the departments mentioned above, the voluntary organizations,
panchayats and community.
area
Health agencies,- Govt, of voluntary, taking care of a particular
should also take care of the school health services in the area.
According to the Expert Committee on School Health Services'WHO, 1950 >
following should be the guiding principles 1
1. Form of administration can vary, depending upon the existing
circumstances.
2. Manner in which responsibilities are discharged and cooperation
obtained from all concerned by health teams influences efficacy more
than merely a good administrative framework.
3. Integration of school and community health services in advanta
geous to both.
4. The school health inchar-'e must have a definite assignment which
will place him in a position of responsibility towards the maintenance of
health in the school and not an occasional visitor with no community
responsibility.
5. For school and community's sound relationship the PHN or the
.HIM has to play an important role regarding follow up, treating and
referring emergency cases were concepts started by pioneers in the voluntary
sector.
6. School health services should serve all children of school age
in a defined community - children in private schools, non formal
education and even drop outs should be cared for.
7.
Health services and community health care should go side by
side.
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8. School health committees should bring together personnel interested
in school health - parents, philanthropists,social workers and professionals.
Village health committee may function S.H. Committee in small villages
where schools are centres of community activity.
9. Each child must be provided with uninterrupted continuity in
supervision so that his health guidance is not fractionized and save
medical administration for school and community.there
School
Health
"G'
L. >
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Administration
Administrative and organizational set up recommended by the
School Health Committee at National, State and local levels is given
in their report published by Ministry of Health in 1965.
The Government set up recommended for at district, block and local
is as follows;
Advisory Bodies
Executives
1
J1 ~
District;
District School Health
Committees as sub committee to
the Dist. Development Council.
1.
2.
J.
Dist. Education Officer y
Dist. Health Offic,r
Dist. Agriculture Officer-
—
Chairman; Chairman of the
Dist. Development Council
Joint Secretaries; Dist. Education
Officer and Dist.
Health Officer.
Block;
Block School Health Committee as
sub committee to the Block Development
Council.
Chairman;
Chairman of the Block
Dev. Council
i.
Medical Officer of the
Primary Health Unit.
ii.
Inspector of School
iii.
Agriculture Inspector
Jt. Secretaries :
Medical Officer
of the Primary
Health Unit and
Inspector of
Schools of
Education Dept.
Local:
Local School Health Committee
of the village paneb"i
i.
Health Team of the
Primary Health Unit
ii.
Headmaster and ClassTeachers
iii. Village Panchayat
iv. Mukhya Sevika, Grain
Sevikas and Gran Sevak
of Cormunity Dev. Dopt.
and Mahila Mandal.
a
6H
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India
SCHOOL HEALTH WORKSHOP REPORT
HYDERABAD, SEPTEMBER
1983.
Resource Personnel;
Dr Mira Shiva , VHAI
Ms Christina de Sa, VHAI
Mr D Rayanna ,
AP VHA.
LCD/a/5.5.84
SCHOOL HEALTH WORKSHOP
JEEVAN JYOTHI RETREAT HOUSEHyderabad -500016
September 7-10, 1985.
PARTICIPANTS
Teachers, Headmasters, Headmistresses, Doctors, Administrators, Nurses
and Health Workers involved in'rural community health programme from different
districts in Andhra Pradesh.
LANGUAGES
English ( and Telegu)
OBJECTIVES
The learning objectives of the present workshop were to:
Motivate participants to take responsibility for organizing and planning
a school health programme.
2. Introduce participants to different components of comprehensive school
health programme.
<
5. Recognise the roles and responsibilities of health and educational
personnel and facilitate a team approach among health and educational
personnel inorder to understand health issues and take responsibility for
the health care of school children.
■
4. Promote good health practices and attitudes among the students
5. Recognise defects and deviations in students from normal health-(physical,
emotional and social)
6. Assist in carrying out regular medical examinations and immunizations
7. Help to provide first aid, emergency and basic health care in the school
8. Incorporate the health education component in the school curriculum
9. Organize and plan.out activities related to health education needs and
ensure active community participation.
10. Help ensure that school health is seen as an integral part of community ■
health and that the neglected(unreached) non school going children are.
t
also reached.
1.
The workshop participants constituted mainly of individuals who had
voluntarily come to learn and share about organizing an ongoing need based
school health programme in their respective schools.
Due to the focus on under fives, children at school going age have tended
to be neglected. The responsibility for their health has neither been taken
by the health nor the education authorities. For those children who have had
no access to schools and have dropped out for economic reasons the situation.
is worse. For those of us believing strongly in the need for an alternative
health care system, the role of Teachers Health Guides is as important .as
the already widely accepted concept of Community Health Guides.
Ttie purpose of this workshop was to initiate the process of developing
self reliance in understanding and dealing with the health problems in the
schools.
The training methodologies used were essentially those which actively
involved the participants right from the point of identifying common school
health problems, to priority setting, to identifying different components
of the school health programme and use of different methods of giving health
education. Emphasis on a team approach, active collaboration and tapping of
all available resources was placed throughout.
2..
A list of the participants, their backgrounds and expectations are giver.
in Appendix I. A summary of the expectations of the participants is given
below:
1. To know and understand the fundamentals of a School Health programme
2. To understand the organizational and planning aspects of a school health
programme.
5. To learn about practical steps to be taken to improve health conditions
of school obildren in the following areas:
a) personal and environmental hygiene
b) common health problems
c) food and nutrition
d) first aid
e) behaviour problems.
4. To learn aspects of health education;
a) Ideas for creating awareness and motivating of students and teaching
community
b) The approach and improved teaching methodology
5. To understand organizational aspects of rural based school health prcgra6.
To recognise and be able to handle common health problems of school
children.
IDH16
WORK METHODOLOGY
More than mere sharing of information, we saw our role in ensuring that
each and every participant shared our enthusiasm about school health work
and developed the attitude, and obtained the knowledge and skills to do so
meaningfully. We knew that, the shortage of time would permit only the initi
ation of the process and hence investment of this time in motivation and
dealing mainly with the how and why of school health was. a very conscious
decision. Efforts at sharing of the resource material already available and
of the various experiences of the other school health programmes was aimed
id inspire and to leave the responsibility of further initiatives with the
participants.
The working methods used during the workshop were aimed at:
i) emphasising active involvement and participation of the learner
ii) providing opportunities to arise specific school health problems faced
by them
encouraging
iii)
the participant to develop a critical and constructive atti
tude towards their own problem solving
iv) facilitating the proposal and elicitation of solutions to the selected
need based problems, which seemed to be the most appropriate, but often
needed to be tried.
v) creating and maintaining an optimum environment where participants felt
free to contribute, question and draw their own conclusions.
The work methodology used has been classified in the present report as:
1.
WORKING PROGRAMME
II. BACKGROUND INFORMATION
III. LEARNING EXCERCISES
IV. EVALUATION
1.
WORKING PROGRAMME:
This was worked cut in order to ensure that the objectives relevant to
the needs of the participants were met in the limited duration of the
workshop. In some instances therefore, the programme of work was organized
on the basis of choices made by the participants themselves. When necessary
choices were modified during the workshop. The schedule, outline and methodo
logy of the work programme has been listed out in Appendix II-IV.
In retrospect - the first couple of sessions and introduction were very
valuable in determining the working atmosphere, (The priority list of health
problems drawn up by the group was not at all in keeping with out concept of
priority school health problems, but since we believe and were involved in a
Participatory training workshop, we had to respect the groups views). The
second and the third days were marked by productivity, the initiation of a
thinking process and establishment of a common tempo. With the fourth day
came the beginning of . new approaches and future plans.
II.BACKGROUND INFORMATION:
A)
1.
2.
J.
4.
5.
6.
?•
8.
B)
C)
D)
A wide range of handouts were used to render knowledge and background
information concerning objectives to be covered. They comprise _q£ the
following: (and have been included in Appendix V).
Introduction to School Health
Why do we need a School Health Programme?
Kain components of a s«hcol health programme
Importance of Teachers Involvement in school health programme
Planning school health programmes
Recording system
Evaluation of the school health programme
Recommended reading.
- Resource material for educational (students, teachers) and health
personnel
- School health programmes in the voluntary health sectors
- Government school health programmes
EPI Folders:
To help, recognize the disease and know the facts about common diseases,
but mainly to create an awareness about preventing these communicable
diseases through immunization.
AKAP Booklets - Phillipines:
A set of beautifully illustrated booklets covering health education
aspects of common health problems.
School Health Records:
A school health record was devised by Dr Mira Shiva on the basis of field
experiences and extensive visits to the school health programmes, during
the workshop held at RAHA in 1979. The draft of the compiled school health
record was finalised after discussions with : Sr Angela, Sr Pratiti,
Coordinator,RAHA, School Health Programme and Fr Van Besouw, Director,
Community Health Department, Bishop's House, RAHA(Record enclosed in
Appendix VIII).
Various school health records were also used to attain the participants
feed back and evaluation in order to identify and understand the most rele
vant information required for this purpose, These included records from MGDM
Hospital, Kangazha, Kerala, Institute of Child Health, Hyderabad, Municipal
Corporation Delhi etc.
. :
:
,
III.LEARNING EXCERCISES:
These excercises were carried out on the basis, of the various aims of
the work methodology. These included usage of :
1. Individual/Small group/Whole group Interactions
2. Group Discussion
" ~~
'
5. Group Presentation
:’
4. Role Play
'‘
■ *■ :
5. Brainstorming
6. Lectures
7. Different communication media and techniques.
(A visit to a school Health unit had been planned but due to the distance
involved, transport difficulties and shortage of time and communal riots
in the city the plan could not b& carried out). ’ -'-r
:........ J..- .,...-- ■ -
...4...
IV EVALUATION:
The group evaluation excercise conducted at:the end. of the workshop was
carried out in order to:
a) ’ assess the extent to which the work methodology used had helped the parti
cipants in attaining their individual objectives.
*
, '■
b) propose any changes that could aid in the improved functioning of the
workshop, selection of materials and course' planning. \
'
1
- The pa^tibipanig were:asked to list out? the various sessions of the
workshop from day to day with, their personal evaluations. Guidelines for
choices were given to be used with 1-10 grading level. The important criteria
to be considered were:
• —•
a) Content
-!
b) Presentatipn/JSethodology
.»
c) Practical utility
;1'’
Questions used included the following:
: ’■
. :
■■■’
1. V<hat did you like most? ■.
2. Vttiat did you dislike or not find useful? «
5. Would you like to add or delete anything? What?
4. What is your future plan of action?
/'
51' : What do you exppet from VHAl/AP VHA?
'
Thus’an assessment of . this type:
.
is timely and attempts to assess the appropriate skills and attitudes th.t
the participants should learn,
(2) it can be used as a guide about which topics and skills of the participa
nts need to develop further; which parte ..of the course, techniques, aids
and methodology Were found most useful and which areas need to be improve 1,
or changed,
,
(5) it can motivate the participants or the resource people to work hard
together in order to attain short term goals set in during the evaluation
process.
■. ,• . . :
(4) it gives a tremendous sense of sharing and solidarity- when done with
' sincerity, pg matter how critical it is a very valuable learning experi
ence- as itself assessment as well as assessment of the training programme.
(1)
The major outline of the areas covered can be referred to in Appendix IV. .
This will now be dealt with individually as covered in the course of the
workshop.
I. INTRODUCTION AND EXPECTATIONS
The objective of this initial introduction by the participants 'to the
group was to convey information regarding their
- work
- name
- organization
- reason for interest in school health programmes
- expectations and interests
Method:
Individual participants were given a paper slip with
the name of a
health problem on it. On finding their appropriate partners with the other
appropriate half they shared with each other information stated above. Later,
the partners introduced each other to the large group. ■
Materials used:
Paper slips with one part of the following health problems written on
each; were used. These were:
A
B
Eair
lice
Dental
caries
Ear
discharge
A
Sore
Joint
Loose
Nutritional
Sore
Skin
Cough
Night
Peer
Chest
Ear
Bad
Intestinal
B
eyes
pain
stools
deficiency
throat
rash
and cold
blindness
vision
pain
ache
breath
worms.
Learnings
The exercise helped gansge :
1. the individual participants understanding of school health
2. their background and expectations
J. their interest and motivation
4. their social and cultural background ,
5. their objectives
6. the course content .and suitable methodology which needed to be adopted
■ and priorities to be stressed. (What the participant must learn, what
would be useful to learn, what would be nice to learnJI
...6...
• From past experience we have realized there's a great need to visit the
various schools and meet the school authorities and teaching staff. This is
to introduce the concept of school health to a wider group that would later
form the support group - for those involved in school health work. Vic have
realized also the need to assess, understand and discuss the understanding
of health*
* and-h>ealth education by the decision makers of the schools. This
has helped us to realize the extent to which resources, personnel, time and
energy they would eventually be willing to make available for the School
Health Programme, so that the action programmes planned later at the workshop
by the representatives of the school are within a realistic framework of that
institution.
This also gives an opportunity to the school authorities to assess our
motives, our convictions and ideas about the importance of school health work.
For this workshop we had not had the opportunity of knowing the partici
pants earlier. Sharing about their institutions' involvement in school health
work, did not always give a very clear idea about their specific involvement
and role in it. Different levels cf education and training and roles in the
schools and hostels of the participants demanded that we function accordingly
in an attempt to meet each group's needs. It was definitely not easy.
The programme schedule was drawn up based on the stated objectives and
expectations expressed by the participants. An attempt to keep it need based
and relevant was made through out.
"Everyone who uses a word knows what he means by it. The
problem is that everyone doesn't realize that other people
may have different meanings for the same word".
Mager R F|
II.SCHOOL HEALTH PROGRAMMES:
Implications and Objectives:
The urgent needs of a School Health Programme were focussed on by using
statistics quiz (Appendix Vi). The objectives of thw quiz were to help the
participants realise the :
a) health situation of the country
b) health situation of the school going population
c) prevalence of communicable diseases and other health statistics
d) need for involvement of schools in health work
e) structure of the school health services
f) need for involvement of teachers in school health work.
Method:
!.
The participants were given the questionnaire and told to mark their
}5
own answers since the aim of the health quiz was to build awareness about the'
common preventable health problems. The accurate answers were then shared
which the participants compared with their own themselves. Discussion of the
data provided was then held. The questionnaire with its correct answers is1' <•
provided in Appendix VI.
*
2.Teacher's Involvement in School Health:
Objective:’
Method:
The need and importance of the teacher's involvement in school f
health programme.
'*
To assess the group's understanding of ideas, a group discussion
was followed by a brainstorming session by the participants.
* Alio James P Grant 'The state of the world's children' Report 1982-8},84
Ths theme:
Why doer the teacher have a pivotal role in school health progra
mme (A handout was distributed after the group inputs).
Learnings:
The following points were listed in response to the question stated above:
1. Maximum contact with students at an impressionable age
2. Ability of teacher to study curriculum and have access to health educat
ional material
5. Credibility with students and parents in community
4. Ability to spend time with students - opportunity for observation and
guidance
5. Knowledge of individual students.
Hie 5 phases of organizing a school health programme as shared by the partici
pants were as follows:
1. Orientation and motivation of school administration and teaching community
2. Setting up a school health Council- remuneration and adequate motivation
for Teacher Health Guides
3. Selection and training of Teacher Health Guides depending on credibility
in community
4« Selection and training of students health guides supportive to teachers.
for inspection and detection of disease.
5. Involvement in child to child programmes and activities; eg." ''Immunization-,- •
. detection of Vit A deficiencies," chlorination of wells.
3.Components of a school health programme:
Objectives:
a) To assess the group's understanding of the components'of a school-health
programme.
b) To encourage mutual learning by participants of the various components of
''a school, health programme
c) To encourage independent thinking regarding different potential components
by the participants before our sharing of our concepts of a school health
programme.
Method:
•
.
’ '■
The participants were divided into 5 groups. Each group was given time
for individual discussion and sharing. The group representatives then presen
ted the ideas of the group, with the aid of posters. Participants in other
groups asked for'clarifications and contributed by their own suggestions,
experience and ideas. The group then read and discussed the information pro
vided in the handouts.
Learnings:
. ‘
The participants shared the extent of their individual involvement in
school health work if it was existing in their respective schools:
1. It appeared that medical check ups and immunization programmes are made
available in urban based schools and those schools within range of the
Primaiy Health Centre, only.
2. The existing recording system of 2 schools who shared it with the group
was time consuming and too detailed. It was therefore, not fit to be used
as models for others.
3. A more comprehensive, specific problem-oriented method of recording needed.
to be introduced.
4« A need for resource material for health education,(methodology approaches)
and clinical inputs was expressed.
The following components were listed by the group:
1. Health Education:
- Personal hygiene, Environmental sanitation
- Nutrition
- Kitchen gardens
■
...8...
- Sex education class VIII-IX
- Prevention of communicable diseases
- Incorporation into other disciplines of curriculum.
2.
Healthful school living:
- Safe and healthful environment (drinking water, playground, clas:>- Planning of a healthful school day
room)
- Establishment of healthy interpersonal relationships
- Attention to removal of VENDOURS.
Scheel Health Services:
- Medical check up regularly and follow up of cases
- Curative care
- Immunization Programmes
- Maintenance of records
- Nutritional services
- Parent Teacher Association meetings annually
- Promotion of extra-curricular activities
- Health exhibitions, fairs, 'talks, demonstrations, workshops
- Kitchen gardens: allotment of responsibility to science teachers
4.Organizing and planning a school health‘programme:
3.
Objectives:
1. To encourage sharing of the ideas of different participants about how
to plan and organize a school health programme.
2. To aid the participants in understanding the roles and responsibilities
of the various personnel in a school health programme.
3. To give an outline of how school health programme could be planned and
organized based on existing and tried out workable replicable model of
school health programme.
Methods:
Through a brainstorming session involving the whole group, the partici
pants expressed their ideas and experiences about organizing a school health
programme. Posters were used as aids in the explanation of the various roles
and responsibilities of the (1) teacher health guide
(2) student health guide
(3) school health committee
(4) headmaster
(j) school health training team
The content of these has been compiled in Appendix VTI.
Learnings:
Some ideas from the action plan suggested by the participants are:
1. Get administration involved in implementing the school health programme.
This will include principals/Headmasters/Headnistresses,Parish Priest,
Nursing Sisters, Mahila Sanghs etc.
The approach suggested was (a) the utilization of health promoters,
volunteers from health organizations, the organizers of this workshop;
(b) collection and utilization of available resource material and relevant
literature.
2. Get teaching community ready: One method suggested was the organization
of a one day workshop for teaching staff of neighbouring schools on a
working day, with a simple, practical orientation to a school health
programme.
The roles and responsibilities of the school health training team
(Appendix VII) helped the participants to understand more clearly the import
ance of a team approach in a successful school health programme. The opport
unity was used to put before the participants some highlights of existing
school health programmes in various areas. These were:
(1)
(2)
(5)
(4)
(5)
(6)
5. Record Keepings
MGDM Hospital, Kangazha, Kerala
Institute of Child Health, Madras
Baigarh Ankikapur Health Association, Raigarh, M P.
Holy Family Hospital, Mandar
Fr Muller.’s Hospital, Kankanady, Mangalore
Institute of Child Health, Hyderabad.
The school health record gives information about:
i)
The growth and development of the child during school
ii) Immunization status
iii) Occurance of significant communicable diseases eg.TB leproiv) Results of routine medical check up before entropy, etc.
and after leaving school
v)
Medical history and treatment carried cut
vi) Follow up of illnesses and referrals to hospitals if nece000 Trv
Thus this system has the following advantages:
' ■
i)
Screening of children allows early detection of health
ii) Recognizing the existing morbidity patterns.
problems.
iii) Setting of accurate priorities for a schcol health program
iv) Appreciating overall changes'in the individual's health
status and preventing the onset of illness.
v)
Giving follow up treatment to those with common illnesses.
vi) Making available a record of the child’s health status on
leaving school for use in the future.
vii) Giving importance to positive health not merely freedom
from illness.
Facilitating
viii)
proper referral system in cases of major ill„ .
ness.
Objectives:
1. To encourage the formulation and maintainance of school health records
2. To understand the importance of the most essential information required
for a relevant schcol health record.
J. To promote need based data collection through relevant health records
4- To develop analytic skills to be able to analyze and utilize the infor
mation appropriately.
5. To- evaluate the existing school health records being used in various
places.
Methods:
The participants were asked to share their ideas about the essential
and most relevant criteria to be considered for a cumulative health record.
Various existing schcol health records from numerous governmental and non
governmental sources collected over past few years were evaluated and discu
ssed by the participants separately. This included a cumulative health record
that evclved out of a extensive data collection during the RAHA visits.
Dr Mira Shiva was involved for the formulation of the record which has been
included in Appendix VIII.
Learnings:
On evaluating and sharing their views and suggestions about each record, the
participants agreed that a useful school health record should be:
i)
comprehensive with only relevant information depending on priori
ties in the area.
ii) simple in language structure and terminology
. iii) durable and lasting
..
iv) problem oriented rather than system oriented
v)
in English aa well as vernacular
vi) appropriate to promote continuity in record filling
vii) accompanied by a master register to ensure a record of entries
even if the record is lost.
...10...
Eaintained
viii)
on specific instructions as to the personnel involved
in record filling
'
;:ix) obtained on payment of a nominal fee
.
x) periodically analysed tc allow need based modifications.
III.HEALTH EDUCATION: (1,3',7)
"Tlie student body represents the largest untapped educa
tional resource, in nest schools".
.G Miller 1977
Efforts made in Health Education must contribute towards a change in th.?
attitudes and knwledge affecting changes in health practices of people. Thus
it is a process involving a series of steps towards healthier living. It
involves efforts by the people. Changes in behaviour include changes in
thinking, feeling and.acting arid therefore, an'acquisition of ideas, habits, .
attitudes, interests, professional skills.and ways of thinking anew. Thus.
teaching activities are marked by interactions between the organizer and the
participant in order to bring about expected changes in the students' beha
viour. The activities and inputs provided.in the following sessions were
planned in order to help participants:
(1) acquire, retain and develop their ability to use knowledge provided,
(2) inderstand, analyse, synthesize and evaluate existing problems
(5) achieve skills:(i) by describing and demonstrating the skill
(ii) allowing every participant to practice the skill
(iii) providing opportunities to do so, eg. Bole playing,
simulations, group.presentations .by providing theme.:.
The skills to be taught would thus include psychomotor skills (actually
doing, using hands skilfully) and communication skills(of explaining and
Persuading). These will be dealt with in outline IV.
(4)
(5)
ahare knowledge which is.relevant and need based through planned acti
vities resulting from priority, setting; The participants were encourage -.
to gather information from each other and their own experiences, books, '
manual and other available literature. The list of material(VHAl) demon
strated and displayed can be referred to in Appendix V.
"
develop attitudes- tendencies to behave in a certain way by ■ providingi) numerous examples and models •
ii) experiences
in
iii)
group discussions and sharing.
iv) role playingoexercises
v) adequate background information.
"The student body represents the largest, untapped educational
resource in most, schools. How many teachers are really prepared
to have students reach conclusions different'from their own., ; .
giving first consideration to the logic of reasoning-rather tifdn-<
i the ability to arrive at a predetermined solution?". .
I
G Miller 1977
Abbatt F R 'Teaching for Better Learning' a guide for' teachers of primary
health care staff. WHO, Geneva 1980.
•
•
5-Guilbert JJ 'Educational Handbook for health personnel' WHO Offset pub
lication No.35 1981.
7. Park J E and Park K 'Textbook of preventive and social Medicine'(A
treatise on community health) 8th edition 1980.
1.
...11...
The activities chosen during this workshop were aimed at enabling the
participants to acquire the desired skills under conditions similar to those
. in which they will work later on. Thus these would be far from ideal lenrninsituaticn where the participant will be deprived of the stimulus of having tfall realities and will have less opportunity to propose improvements with t!
help cf fellow participants and resource personnel. They introduce the parti
cipants .to’team werk and allow then to practise what they had learnt.
1.
2.
3.
4.
The sessions held in the course cf the workshop are listed below:
Priority setting of health problems
Group presentation of a selected list of school health problems
Learning and Teaching Techniques
Nutrition game.
.
1. Priority setting of Health Problems : (2 )
Objectives:
i)Identification and focussing on common health problems
ii) Understanding various criteria to be kept in mind when assessing signifi
cance of a problem
iiijEnccuraging active participation in the group by drawing up their'own
priorities
iv) Introducing participants 'to the use of cut out symbols, flannelgraphs
v) Helping discussion^ arguments, sharing .and analyses with fellow partici,
pants.
Method:
The method used was based.on the one suggested by David Werner and Bill
Bower in 'Helping Health Workers Learn'(2) to make a community diagnosis.
Criteria used were how common, how serious, how contagious, how serious. We
used it to involve teachers and health personnel in diagnosing and assessing
the school health problems prevalent in their areas. David Morley's priority
setting criteria of how common, how serious, the degree of community concern,
solvability of the problem were used. The grading used ’was: 0, + ++•-++ and
++++. The various grades given were then multiplied to get the total figure
for each problem.
Individual participants were given paper slips with .the name of a health
problem.(Problems listed in Appendix IX), in two groups. The commonest ones
were listed in order of frequency. On regrouping and further discussion a
final list was made out on the flannel boards after a general consensus. The
cut cut symbols were then used by group representatives in the manner sugges
ted. A diagrammatic representation of these health problems can be' used with
younger children when dealing with illiterate health workers.
Learnings:
The list drawn up comprised of health problems in the following orders
1. Malnutrition
2. Loose stools
3- Behavioural problems
4. Worms
5. Fever
6. Scabies
7. Accidents
Although the exercise led to much discussion and arguments it made the
participants aware cf the common occurence of health problems in certain
schools. This can be taken as an opportunity to work together in finding sol
utions to common areas of concern.
2. Group presentation of some school health problems;
Objectives:
ijTo encourage participants to recognise difficulties related to health cf
some problems as compared to others.
*2. David Werner and Bill Bower'Helping health workers learn'-A book cf
methods, aids and ideas for instructions at the village level-1983.
12...
ii) To clarify niscencepts of the arising health problems
To
iii)
learn and utilize various methods of communication
iv) To assess the degree of integration of the various learning and teaching
methodologies dealt with in the course of the programme.
v) To discover one’s own potential during actual use of methods and come to
terms with practical difficulties that arise.
vi) Tc help participants get ever the hesitation in adopting different and.
new teaching methods.
To
vii)
learn different methods and techniques used for health education from
fellow participants.
Method;
AKAP booklets covering a host of common health problems and messages
were distributed to participants. They were divided into 8 small groups and
were allowed tc select one problem each. The group representative then prese
nted the chosen health problem to the whole' group. Out of the problem given
to the individual participants the following were chosen and dealth with;
1. Ascariasis
2. Malaria
3. Colds-flu
4. TB
5. Vomiting-Nausea
6. Typhoid—:.. . ,
7- Head cclds-Nasal Bleeding
8. Sore eyes
The participants used a variety of methods for their presentations: Sou.
of these were role playing, use. of puppets, posters, cutcut symbols and
illustrations.
Learnings:
The exercise gave the participants an
1. opportunity to explore and devise their own teaching methodology
2. experience practical difficulties during a health education lesson
3. emphasis, careful planning and implementation of new methods
4. exposure to groups interaction, sharing of ideas, and a critical evalua
tion by other group members.
Modifications possible:
The exercise could be followed up by an extensive clinical input for
dealing with practical solution for the required health problem. A visit to
a school health unit to observe functioning, and dealing of the actual problem
would be very valuable. A limited time bound schedule did not permit this.
3.
Learning and teaching- techniques : (3,6,8 )
Teaching is not a stationery process and its Eiain purpose is to facili
tate the learning process. Such a process lays more stress on what the
student learns (receives, perceives and assimilates) than on what the teacher
presents. Thus rather than the manner of transmission of material, the focus
is on the student- and a close investigation of what was learned, at what
speed and manner and for what purpose. The teacher becomes a learner himself
and the student undertakes some part of the teaching role. The process of
learning aims at sone modification in the way of thinking, feeling and doing
and is both an emotional and intellectual process. The purpose of teaching
as mentioned earlier is to help students to
a) acquire, retain and be able to use knowledge
b) understand, analyze, synthesize and evaluate it
c) achieve skills, establish habits and develop attitudes.
The learning process produces a behavioural change in the learner which
is gradual, and selective. It results from practice, repetitions and experi
ence and is not directly observable.
..15...
Teaching aids used for the learning process serve to:
1. simplify teaching and illustrate explanation of points not easily
achieved hy lecturing.
2.
provide a variety and thus make teaching acre interesting
5.
provide an opportunity to practise skills required to meet appropri
ate objectives
4.
summarise the main points and improve the overall efficiency of a '
lesson.
The advantages and disadvantages of certain teaching methods and of
different educational media has been listed in Appendix X.
viz. 1. Lectures
2. Practical work, field work
5. Real objects and specimens
4. Models and simulation devices
5. Books, handouts, programmed learning from books and simulation.
Self learning packages
6. Small group activities
7. Graphics, posters, paintings, photographic prints
3. Blackboard/flip chart
9. Flannelgraph board
10. Projectable media (slides and filmstrips)
As teaching techniques/the role of workshop/ thus is very useful and effici-.r. t
and the facilitator's role is to encourage the desire to learn rather than
the desire to knew.
'Assume always that a teaching activity is ineffective unless
there is evidence tc the contrary".
A L Cochrane
4. Nutrition game: Cards
Introduction:
Teaching aids can be prepared by the instructor to help students to
obtain information they need for learning independently. The student can take
over some part of the training while the instructor remains available only
when necessary. It is clear that group work and discussions stimulate moti
vation and cn independent thinking process. The nutrition card game provides
an example of such an aid.
Objectives: This learning game
1. promotes the use of self learning material
2. encourage adaptation and innovation of learning activities suitable
to individual needs and creativity
5.
enables the participants to learn food classification based on its
function and nutrient content
4.
allows adaptations to include locally available cheap foods
5.
gives opportunities to exchange and learn about new receipes for
various foods.
laat erial:
This material was conceived and arranged by Dr Uma. She was assisted by
Christina De Sa in the preparation of.the material. It consisted of:
(1) A pack of food cards :(6cni x 9 cm in size). Playing cards were converted
to food cards. This forms an inexpensive traditional medium to teach aspects
* Page 12.
5- Guilbert JJ 'Educational Handbook for health personnel' WHO
Offset publication No.55 1981.
6. Mackenzie Norman et al 'Teaching and.learning' UNESCO 1970 pp
8. Pine G P and Honne P J 'Principles and conditions for ftanning
in Adult Education' Adult Leadership October 1969-
I
...14...
of nutrition and also provide entertainment. Each card gives the food and t'.e
name of the food (English and Telugu). On the corner of the card the predomi
nant group number representing the nutrient is given. Sone cards have acre
than one number to indicate the different food groups. The four groups with
the foods included are as follows: A sample of each group has been included,
in the Appendix XI.
1. Energy foods: Rice,wheat,banana, sweet potato, ragi,jowar
2. Body building foods: Dais, groundnuts,fish, milk, chicken
J. Fats and sweet foods: Jaggery,honey,sugar,buttermilk,oil
4- Protective foods: Greens,tomato,orange,drumstick,tamarind,lemon,carrcts
The numbers of food cards can be chosen depending on the participants who
wish to play the game. (2,5,9)
2. An illustrated chart showing the various food cards. These were grouped
appropriately in order to guide the participants to choose the correct food
slips. The latter indicated the four groups and were detachable.
5. A Booklet; providing colourful illustrations and simplified information
about the different foods, their classification and function. It is an aid
to encourage participants toobtain the desired information from other s/.urc ..
Method:
Each participant was allowed to pick one food card from the pack at
random. The various food cards were chosen so that they could be categoriseu
to give a fair distribution in each group. The participants then grouped thenselves according to the number indicated on the cards (groupl-4). A group
discussion followed and consisted of an exchange of information, home remedies,
recipes and other uses regarding the foods in the group. The•booklet was
passed around for further information. On completing the discussion each
group representative placed the appropriate slip to label the food group.
The group members then proceeded to describe their individual food cards
sharing with the whole group the combined information of their group.
Learnings:
1. A "variety of food cards.can be used for this game but the pack should
contain enough representatives from each group in order to portray a
variety of foods....
-•
----------2. Initially the participants could be introduced ’to"familiar foods in order
to catch their interest.
5. Raw food items are to be used without confusing them with distracting
ready made foods.
4. The game opened out. new avenues to allow the participants to create their
own teaching methodology and games in a simple, inexpensive and interest
ing manner.
5- The participants were aware of nutrients (protein, carbohydrates,vitamins,
minerals, fats) but could not relate the nutrients and their functions.
The game helped them to clarify this classification.
Several adaptations were suggested by the participants after they had
Played the game. Some of the adaptations that emerged:
1. Cards could be used to constitute different types of balanced diets using
food cards from different group.
2. Balanced diets for different groups could be planned according to their
specific needs. Some of these condition could be:
Protein calorie malnutrition, Anaemia, Diarrhoea, Scurvy, Night-Blindness.
Needs of : a child/convalescent/adult.
2. David Werner and Bill Bower ''Helping health workers learn'-A-book of methods
aids and ideas for instructions at the village level-198}.
5- Joshi K 'Playing cards for Nutrition Education' an experimental study'
Lady Irwin College, New Delhi 1982.
9. Pau Parvathi'Visual aids for children'(available at VHAl)
...15...
Additional food cards (not supplied to participants) could be chosen
from the pack. The group members can then provide a description of the problem
and reasons for choice of cards.
3. Use of Clue cards(5)(Nutritional Diseases) Each clue card (suggested size:
25 cm x JO cm) shows:
1. Name of disease
2. Symptoms
3. Deficient nutrients
4. Food sources
5. Instruction for number of cards to be collected to complete
the game.
One clue card for each of the diseases: Kwashiorkor, Marasmus,Anaemia,
Night Blindness, and Scurvy.
Method:
One card from the clue cards and ten cards from the food card pack will be
given to each player. (Total number of players 2-4). Each player will arrange
and collect the food cards according to instructions on clue cards as indi
cated below:
Kwashorkcr:
for Protein
() Milk and milk products
-2 cards
!! Pulses
- 4 "
- 2 "
ij Nuts
- 2 "
1! Meat groups
Anaemia:
- 2 "
) Meat groups
j Green leafy vegetables
- 3 "
for Iron
j) Dry fruits dates, raisins
- 1 "
- 1 "
) Jaggery
) Any others in the pack
- 3 "
Marasmus:
- 1 11
i Milk and milk products
- 1 II
)
Pulses
for Protein
j
~ 1 11
) Nuts
- 1 11
j Meat group
for Carbohydrate
(
- 2- II
Cereals
- 1 It
j Starchy vegetables
- 1 It
j Sweet fruits
- 1 n
) Sugar and Jaggery
- 1 it
ij Ghee and oil
Night Blindness:
jj Meat group
- 2 "
( Green leafy vegetables
- 3 "
for Vit A
§ Milk and ipilk products
- 2 "
- 2 11
!j Yellow vegetables
■■ - 1 11
j Yellow fruits
’ 1
1
j Citrus fruits
- 3 11
1) Sprouted pulses
- 5 11
Vit C
iJ Green leafy vegetables
- 3 II
- 1 It
j Any others in pack
Thus the participant is able to:
1. relate the name of the disease to that of the deficient nutrient and foods
2. recognize symptoms of nutrition related diseases
3. be aware of the various foods to be supplemented in the daily diet in
order to prevent and treat the disease.
Scurvy:
* 5. Joshi K 'Playing cards for Nutrition Education' an experimental study'
Lady Irwin College, New Delhi 1982.
...16...
4* Sequential Cards; Cards can be made for various health related problems •
prevalent in an area. For each problem card there will be 5 others in the
pack which together in a sequence constitute the treatment or prevention of
the disease, eg. 1. Sore eyes- 2 Water - J. Clean towel - 4> Terramycin drops
Cards are distributed tc players; the game proceeds like in 'Rummy' and each
collects the sequence necessary to solve one particular problem. The first
player to collect the sequence wins the game.
5. *Mix 'N' Match Cards:
This card game consists of matching the correct pairs in a dispersed pack of
cards. Each 'problem' card has its appropriate 'solution' card. Thus the
Participant having one of these must find his suitable partner and give
reasons for choosing the particular card belonging to the other person.
6. Alphabet feed cards: These are cards with alphabets and an illustration of
a good item on them. Eg. Milk, Guava etc. grouping of participants would take
Place depending upon the kinds of health problems, posed. Eg. These caused by
contaminated water, those caused by unhygienic conditions, those prevented
by immunization.
Board Games:(10,11)
Tine Board games require more work and can be drawn on heavy cardboard,
cloth or ether available material. One such game is the variation of the
snakes and ladders game which was introduced to the participants. This com
prised of the inclusion of cards with written messages that would either
facilitate cr hinder the progress. Landing on a square with a 'good' practice
allows the player back a number of squares. To facilitate more active parti
cipation a clause can be introduced that nc participant can go forward without
the individual giving a reasonably satisfactory answer with regards to the
appropriate move.
eg. Card: Measles immunization taken go forward 5 squares..
reason: Why this helps in nutrition. Similarly, Card: Bottle feeding
introduced move back 6 squares. In the absence of a satisfactory reason
nc moves are permitted.
IV.COMMUNICATION METHODS:
It is important that the participants are able tc communicate effectively
during the workshop to enable them tc work together for mutual beneficiation.
Effective communication allows self expression and generated on openness and
togetherness in the group. It thus creates an atmosphere which:
- encourages people to be active
' - emphasizes the personal nature of learning
- accepts that difference is desirable
- recognizes and tolerates imperfection
- encourages an openness of mind and trust in self
- makes people feel respected and accepted
- facilitates discovery
- permits confrontation of ideas (s)
During the workshop two aspects were dealt with:
1. The importance of effective communication and factors that support it
2. Methods of communication
* (Courtesy N Hilda, Administrator, CSI Campell Hospital) Jammalamadugu,
Cuddapah Dt 516454)
10. Ruth Harnar and A Zelmer 'Learning can be fun - VHAI
11. Ruth Harnar, A -C Lynn Zelmer and A E Zelmer 'A Manual of learning
Exercises for use in health training programmes in India. VHAI and
ICI, Canada 19858. Pine G P and Honne P J 'Principles and conditions for learning in Adult
Education' Adult Leadership October 1969.
...17..
1. The participants were cade aware of the various factors which give rise
to ineffective communication, and allowed to gain an understanding of good
conmunicaticn. The following exercise was conducted during the initial sess
ions of the workshop so that the participants could utilise the opportunity
to overcome connunication problens during the workshop:
Rumour Chain :(11)
Objectives:
1. To demonstrate the shortcomings of one way communication
2. To enable the participants to realise how misunderstandings arise in
communication •
J. To make participants aware of the importance of avoiding misunderstandings
in order to facilitate effective communication.
Materials:
i)A copy of the original story or message that has been included in
ii) Six slips of paper for dividing the roles of each of the par4?8ipa^s^
*
Methods:
The six participants were chosen and their roles determined as :
1. Raju(Subject) 2. Friend $• Class Monitor 4« Teacher 5* Principal
6. Dispensary Sister-in-chargc.
The story was read aloud to Raju(l) who was asked to convey the message to
his friend(2) without help and without asking questions. The message was
then repeated in the sequence listed above in a similar manner. The whole
group was allowed to take part as observers nothing the message as it was
transferred from one person to the next. The exercise' was completed by a
group discussion and this was linked' up with real life situations.
Learnings
1. It is impossible to remember and repeat a message with too many unfami
liar names and facts
2. Oral messages must be kept simple- and. short
3. If the listner repeats message the speaker can correct the errors, made
4.
Messages from original- sources are easier to understand
,
5. Main points should be emphasised
6. A written message is more reliable. Underline or capitalize the main points.
7. Medical terminology should be simplified
8. More than one listener at a time can save time and error
9- Allow adequate opportunities for constant feedback(listner—Receiver)
and encourage questioning for reconfiriaation of message.
Many of these were noted by observers .in the whole group as those hind
ering good communication. This brought the focus on to learnings for
effective communication through an active experience.
2. Methods of Ccmijunication:
This aspect was covered by live demonstration by the Audio Visual
Departmental Team from Amruthavani Communications Centre, Secunderabad.
Since communication carried out depends on one’s perception and frame of
reference, a variety of methods are possible. Some of these were demonstra
ted to the group by active participation by group members. The objective
of this session was (1) tc expose the participants tc the.various methods
of communication available
(2) to encourage the development and trial of new teaching methodologies
(5) to become aware of the advantages and disadvantages of the communication
methods.
Method:
1. Visuals were demonstrated by group members. Each of the 4 groups were
given a symbol which they depicted by body movements.(eg. Bridge,
flower in bloom, water pump)
...18...
Audiovisuals: Eg. sinlple illustrations, flash cards, flip charts, phppet:
etc. used in order to reinforce teaching. The user and the language
used is more inportant than the material.
J. I,Sines can be performed individually or in groups and are entertaining
and easily capture the audience to bring hone the desired message.(eg.
Dentist, Hotel o-.vner).
2.
The salient features of effective coEimunication media can be summarised as:
1. Dialogical
2. Accessible(to touch and experience)
5- Creativity oriented
4- Participatory
5.
Ehancipatory-LiberatingS. Democratic.
Learnings:
Tiie various media demonstrated can be easily adapted to teaching health
related themes. The participants were exposed to these and this resulted in
an increased motivation to Health education. It served as an encouragement
to participants to use and experiment with different communication media to
aid in making teaching interesting and innovative.
V.FUTURE PLANS:
A Central Team formed, comprised of the following participants:
1. K S Darshanan, Physical Training Instructor
St Theresa's High School, Erragade 500018, Hyderabad, A P.
2. Pref G Baltha Raju, Convenor, Principal
Montfort High School, Khammom, A P 507005.
5. Ms Girija Krishnamurthy, School Assistant
• Holy Family girl's High School,Trimalgiri,Secunderabad, A P 5OOOI5.
4. iis N Hilda, administrator
Nuton Education Unit and Public Health Project,CSI Campbell Hospital,
Jammalamadugu, Cuddapal A P 516454.
5. Mr B Sudheir, Facilitator, Community Development
Community Health Outreach Programme, B C Hospital, Nellore A P 526002.
6. Dr Prasad, In-charge ,Community Health Programme
CROSS Office, Bhongir, Nalgonda Dist, A P 508116.
Team Functions:
The group will be meeting shortly to decide on the plan of actions to
be adopted in order to initiate school health programmes. The above members
were carefully chosen so as to include individuals from both the educational
and community health fields.
Mr D Rayanna, Executive Secretary AP VHA will coordinate the activities of
the group.
In order to keep the health groups and school authorities in the field
enthusiastic, about school health programmes, it .was decided to start a
periodical with
School Health Programme News .This periodical, will
provide information about various activities undertaken and performed by
those involved in school health programmes(Schools, AP VHA, VHAl).
The School Health Mirror will be printed as a poster sized Newspaper
which can be displayed on bulletin boards. Thel'ir.gu-geused will be English
and Telugu each on opposite sides of the poster. .
...19...
REFERENCES;
1.
Abbatt F R 'Teaching for Better Learning' a guide for teachers of Primary
health care staff. WHO Geneva I960.
2.
David Werner and Bill Bower 'Helping health workers Learn' a book of
methods, aids and ideas for instructions at the village level 198J.
3-
Guilbert J J 'Educational Handbook for health Personnel' WHO Offset
publication No.35 1981.
4.*
aJames
P Grant 'The state of the world's children' 1982-83 " UNICEF
b.
ii
ii
1984
n
5. Joshi K 'Playing cards for Nutrition Education' an experimental study
Lady Irwin College, New Delhi 1982.
6.
Mackenzie Norman et al 'Teaching and learning' UNESCO 1970 pp 44-50
7.
Park J E and Park K 'Textbook of preventive and social Medicine'
(A treatise on community health)8th edition 1980.
8.
Pine G P and Honne P J 'Principles and conditions for learning in Adult
Education' Adult Leadership October 1969.
9.
Rau Parvathi 'Visual aids for children'(available at VHAl)
10.
Ruth Harnar and A Zelner 'Learning can be fun'-VHAl
Ruth Harnar, A C Lynn Zelmer and A E Zelner 'A Manual of learning
Exercises for use in health training programmes in India. VHAI qnd
ICI, Canada 198312. Wakefcrd R E 'Teaching for effective learning and chart guide for teach
ers of health auxilaries' Retiaha pedagogicol booklet,WHO 197411.
Appendix
1.
-
Content
List of participants, their position, addresses, education
experience, expectations.
11.
Schedule
III.
Methodology used
IV
Major outline of Areas Covered
V.
Handouts
VI.
Statistics quiz
VII.
Roles and responsibilities of school health training team.
VIII.
School Health Record.
IX.
List of health problems, for priority setting
X.
XI.
Advantages and disadvantages of Teaching Methods and EducaticFood. Cards, Illustrations.
na^
XII.
Rumour story
APPENDIX I-I
Name 1
______ -Age
Position-1
Address
: ■
- Education
______ Experience
Expectation
I. (Ljija Krishnanurthy. 25 School Assistant
Holy Family High School
Trinalgary P 0
Secunderabad 5OOOI5.
BSc
MEd
5 yrs
Fundamentals of school health,
ideas for creating an awarenes,
improvisation first aid
2. Sr Raymond Medababipi 54 Incharge CHP
Vijay Mary Convent
Siripurain P 0
Guntur Dist 5224OI.
Oen.Nursing A
8 yrs
grade,Midwifery
P H N
Organization of rural connunity
schccl health programme
3. Sr Stanislous
40 Headmistress
St Anne's Hospital
Jaggayyapet
B A
B Ed
Bring up school children in a
healthy atmosphere, organize
school on healthy grounds.
4. Mr Simon Peter
Facilitator,
Conn.Devpt.
5. Mr B Sudheer
u
6. Sr PEJ.izebeth P
Assistant Co
7. Cecily Mahokal
28
Teacher
8. B Mothila
26
i»
Community Health Outreach BD+
c/c BC Hospital
6nthsRUHSA
Nellore, AP 524002.
(C„nn.Devpt)
it ■
11
4 yrs
6noths To learn how to organize,Ready
CHOP
tp start.
Hdnigin.
B A +
gniths CHOP Rampat nap
(6nths RUHSA
C^ran-Devpt)
RNRM+Public
Experience
Health 6mths. in Con.Health
St Joseph's E M High Schc:ol
BSc, BEd
Darganitta
Nellore, A P.
II
ssc
10n^s
1 yr
Solving health problems,teaching
techniques.
It
APPENDIX 1,-2
Nano
_________ Age
Position
Address
Education
Experience
_________ Expectation._________________
Personal hygiene and environmental
hygiene, common diseases, feuds, and
nutrition,growth,safety and first aid
family life education, health condi
tions in towns, socialization,Beha
viour, spirit of equality.
St Theresa's High
School
Erragadda
Hyderabad 500018.
B A
Dip.Ed
2 yrs
Montfort High School
Khanmam,AP 50?003.
B A
BEd
1 yr
KLC Hospital
Reniganta 517520
Chittcr Dist,A P.
MBBS,DO
IQyrs
12.' Channakistail and 25
•team
c/o Dr Prasad
Health Coordinator
CROSS, Dengin 508116.
SSC
5 yrs
13 • Dr Kunur?. Bp.tnar- 27
r.'ita
Scnpeta, Srikakul.au Dist
532284.
Physical Ejucati:sn
Teacher
9. K S Darshanan •
10. Bro.G Baltha Raju 55 Principal
11. Dr Bhaskar Naidu
55 Medical Super
intendent
Nil
CSI Campbell,Jamualanadugu
16 yrs
C^aarah 516434
Dip Nursing
Education
(Coeli. Health)
23 Nutrition Education
MSc(Hcrie science)
&Public health
11 Eths
project(administrator)
14. P fertha ferguret 40
15. N Hilda
BSc
liiBBS
Problems of school children in rural
areas.
How a school health programme can be
enriched.
starting
preceding.
-
Name
••
........ APPENDIX
- —
•Posi-tien -----...
■
36
18. D Kondalr’a
Headmistress
Secretary
'REVALTES'
.1.-5
Address
Education
Volunteer
16. Theresa
17. Imaca Mary
•
.....................
Experience
-■ . ........
CtlS I
Nursing .student.
RCM Ejenentary schccl
Madigula,Vizag Dist
531027.
Greater Vikokhs,Leprosy
Treatment & Health FDN
Scheme, AVN College Rd
Visakhapatanaia 530001.
B A
RCM Girl's High school
iviadugule, Vi sakhapatanaci
.-.•A P 531027.
BA 5 BEd
12 yrs
Middle Training
8 yrs
19 . Sr Mary V A
33
Headmistress
20. Sr Moksha Mary
42
Warden .
21. Sr Thcraasamiaa
Nettun
41
Warden
22. Sr Bertilla
39
Medical Coordinator. St Joseph Convent, ’
Nallapadu, Gundur 522005
Regeina Mundi Convent
Fatima Nagar, Kazipet
Warangal 506005.
II
Expectation
■ ■ - • ••........... - -
15 yrs
Early symptoms of leprosy
in school children ’
health education
11
RNRM
Practical steps to be taken
to improve health conditions
of children fron labour
class families whose income
day- Rg.5/-
18 yrs
Organizing schcol health
progranne.
APPENDIX
II
WORKSHOP : ORGANIZING SCHOOL HEALTH PROGRAMMES - SCHEDULE
1100-12.30
II
Date
9.OO-IO.3O
I
7.9.8?
Introduction and
Expectation.
Common school health problems
Priority setting.
Excercise in effective cc□nunicaticn-Ruacur chain.
Main ccnpenents of a school
health programme,role of parti
cipant,role of others.
8.9.83
Health problems and
health services in
the country, statistics
qu-z.
Govt.Health Team Nil oufer
Hospital, Institute of Child
Health, Hyderabad.
-Govt school health services
-ENT problems, eye problems
child to child programme.
Dental problens
Health education-objectives
and approaches, sharing
□aterial,Nutrition game.
9-9.83
Organizing and planning Record keeping,Need based data
a schccl health program collection and evaluation.
approaches and experience.
Available resources,
naterials, personnel.
Communication media and tech
niques.
jl ■
IO.9.83 Health oducaticnDenonstration and gropp
sharing.
Drawing up a school health
curriculum.
2.00-3.30
III
Drawing up action plans
for school health programs.
Evaluation.
4.00-5.30
IV
APPENDIX III-I
Dav I- 7.9.85___
Sub.iect/Session
Methods
METHODOLOGY
Learning Experience
Led By
Materials Required
1. Introduction
Wide group
Introduction to school health programme
paring and sharing.Introduction of partner, expectations
Existing concept of shool health programme.
Mira
Write chart paper slips
Felt pens
2. Common Health
problems.
small group
Listing common health problems,priority
then whole group -.setting, school and community's Diagnosis.
Mira
Board,cut out symbols
3. Communication
Methods.
v.hole gr oup
Effective communication a) one and two way
communication,b) rumour story.
Tina
Copy of rumour story,picture
4. Components of
school health
programme•.
slu.11 groups
the.. bi{ groups.
Formulating main components- of school health
our specific roles and that ..of'others
Mira
Write chart paper, felt pens
handouts.
1. Wny school
Indviduals
health prcgranwhole group
Statistics guessing, implications of
statistics.
Mira
Statistics quiz
2. Health services
common health
Knowledge of health problems in school children Dr Mathur
Status of govt school health services
Dr Sathyanarayanan
ENT problem
Dr Fisracasimha Reddy
Eye problem
Dr Narayana
Dental problea
Dr Nagaraja Rao
Child to child
pay 2- 8.9.83
problems_____
3. Health Education
Wide group
small group
HE approaches, content and objective's,
group sharing, sharing material.
Tina
Slides
Nutrition game, chart
booklet, cards
APPENDIX
III - 2
Da.v -3. 9.9.83'________________________________________________________________ '_________ ...
r
Learning Experience
Sub j ect
Motived
Led Ry
1. School health progran •
organizing ,nlannirg
group
approaches and experiences,roles
and responsibilities
Materials Required
Mira
Handouts, manila paper,
felt pens
Mira
Rayanna
various school records ,VHAI school
health record
2. Recording keeping '
snail groups sharing of record evaluation,and
group sharing.naintainance
3. Connunication aedit
snail group
Demonstration uf techniques, nedia
skills
A V Department
Anruthavani
Flannel graphs, flip charts, flash
cards, puppets, etc.
Health educa~uxon
whole group
Use of HE material ,Demonstration
and sharing.
Mira
Tina
Appendix V, VHAI WHO folders,CDC
snail groups
Method and techniques used for
presentation
teaching conncn health problems.
and group sharing.
Mira
AKAP booklets, posters, flannel
board, chart paper, felt pens
4*
Dav-4, 10.9.83
1.
health educaxxC-n
2.
School health curriculum whole group Objectives
.
Su<all group approaches
Rayanna
White chart paper, felt pens
3.
Evaluation
Mira
Rayanna
Questionnaire(Appendix VI)
Individual sharing.
Responses to workshop
content and relevance.
APPENDIX
IV
Major outline of Areas Covered:'. '
1.
INTRODUCATION AND EXPECTATIONS"~
2.
SCHOOL HEALTH PROGRAMMES:
3.
4.
5.
-
'
u'"-- r
’
l.; "Triplications, and objectives ’
"
'<-■■■ ’ .
2. TeacherA involvement in school health
’ '
*1256789
‘
3. Components of a school health programme
■
4. Organizing and planning of school health programme
5 • Becord keeping
....■'
6. Scheel health curriculum
HEALTH EDUCATION
Approaches, Objectives, Resources
1. Priority, setting of common school health problems
2. Health education methods of'some school health problems-group
' ’ \3. ».Nutrition
* -x■ presentation.
gane.
COMMUNICATION METHODS
Media and techniques.
FUTURE PLANNING AND IMPLEMENTATION
APPENDIX
VI •
Health Statistics Quiz
1. What percentage of India's population is under 15 years cf age?
20, 32, 42%
2. ?/hat nercentage of the population is between 6-and 15 years of age?
15, 2^. 35%
,3- What percentage of children leave school after the primary level of
education? 50, 75, 80%
4- Number of children who become- blind every year due to V^tamin/A .deficiency
is 20,000, 40.000,30.000 ■
5. V^at percentage if health problems can be dealt with by? a’- Wained village
health worker? 50, 60, .70% -• • •
6. What is the proportion of beds occupied by diarrhoea patients?"
1/3, 1/5, 1/10
■'
v .
7. What percentage of India's population lives in the rural areas?.
60, 70, 80%
8. What is the percentage of doctors in rural areas?
9. What is the existing doctor Nurse'ratio?
(Recommended ratio'; 1:3, Itl, ;1^4)
20, 30, 40%
1:2, -lij, 1:4 ...
~
'
'
APPENDIX
VII
Role of Teacher Health Guides
Health Appraisal and recording of Ht and Wt & vision of all pupils
Arrange Medical inspection of pupils with visiting school health teams
Dispensing medicines for minor ailnents
First Aid, Primary care of common ailnents & referrals
Promote Immunization
Prevent spread of common diseases by early case detection and application
of quarantine regulations.
7. Health Education
8. Training Supervision of student health guides
9. Record keeping
10. Organise: Health Education seminars exhibitions, School Gardens
11. Working with Training Team, Dispensary Sister & community for health
of pupils.
1.
2.
3.
45.
6.
Criteria for Selection of Teacher Health Guide :
1.
2.
3.
4.
5.
Interested & concerned about children's health
Teacher with creativity & ingenuity
Good support with the children
Good communication & teaching skills
Respected by the rest of the teaching community.
Role of student Health guides:
1.
2.
3.
4.
5.
6.
7.
8.
Help in Record keeping
Daily Appraisal of class children for cleanliness
Assist teacher health guides in dispensing drugs
Promote immunization
Help organize school garden, school meal programme
First Aid
Create Health awareness among classmates and other children in community
through child-child programme
Help in organizing exhibitions films and medical check up or whenever
help is needed.
Criteria for selection of student health guides
1. .Believes in cleanliness.
2. Good manners & pleasant accepted by classmates
3. Has leadership Qualities
4. Good in studies
5. Enthusiastic about school health programme’’
6. School health guide would.be involved in helping plan the course curri
culum & training.
Functions of a school health Committee:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Survey and priority setting
Setting objectives Develop long range plans
Concurrent Evaluation
Setforth new objectives as and when needed
Mobilization of resources and their collection
Compiling & reporting of data
Organizing institution training for teachers & students
Organize health education programmes
Coordination of school & community health activities close inter relat
ionship between mahila mandala, panchayat, agricultural development
officials .
Role of Headmaster:
1.
2.
J.
4.
5.
6.
7.
8.
Arrangement for periodic medical examination & health appraisal.
Gccd environmental sanitation/(water, ventilation, waste latrines etc)
Planned health instruction and motivating teachers for effective health
teaching of students
Coordination of health activities involving health & educational perso
nnel parents, teachers, community
Exclusion of common diseases laying down rules pertaining quarantine.
Helping school personnel meet their health needs.
Collection of school health funds- budgeting & maintainance of accounts
(responsibility can be delegated to someone)
To work with school health committee
-to identify & solve school health problems
-to share responsibility & decentralize decision making.
Functions of a school health training team;
1.
2.
J.
45.
6.
7.
8.
9.
10.
Training teachers in basic health care and in delivery of health education
Help with medical inspection
Immunization
Health education
Supply of eye chart, growth chart, weighing machine etc.
Inservice training of teachers & students & their follow up
Management of referral cases
Follow up visits to school health units
Meeting regularly to plan and execute school health programme
Motivation of school health personnel and helping them to solve health
related problems.
Primary-Middle I High
school school • school
( on joi
£on leavling)
J. .Arg).__
Immunization Record
If iuinunisaticn is done nark (
in the given space. Also write the
year of immunisation.
’ 1st' '2nd ■ 3rd Jg^ioster
Height
Weight
I
Chest(if easily possible
«
#sartisfactory/unsat^sfa-
Tetanus Toxoid
Polio
BCG
TABC
. ;
Others________________ .________
Past history of
If so, frequency of
episodes. Date of last
occurance
Fits
Discharging ears
Asthma or chronicQiugh ■
Nocturnal enuresis
(Bed wetting)
Measles
Chicken Pox
Whooping cough
Mumps
typhoid
iMalaria
Itysentry
Any other________
The above data is collected at the tine
of joining school ie. only once.
Posture
i
Threat
i
-Lungs
G/a/P( stoops)
1
1
*Abdocen-Liver
-Spleen
!
Foo Habits
!
i
Mouth
*Chest „
-Heart
Educational attainments
xs /a/p
■
Teeth and Guns
Neck
Personal hygiene
Regularity of attendance
DPT (Diphtheria
Pertusis Tetanus I
Primary Middle jHigh
school sbhoel ■ school
J
-Hernia
i
1
any other
>
*Genitalia
Gait N/abnormal(ii-nps)
Spine
Speech
i
i
Behaviour
Nutrition
G/a/P
J
1i
Bones and joints
Nervous system
i
....
1
Nutritional Deficiencies!
Renarks
Protein-calorie
Signatures Teacher ........................
Nurse/Doctor ........................
Vitamins
Iron
Iodine (^re)
Health appraisal by Doctcr/Nurse
Skin(Problems)
(X) needs observation
lymph nodes(enlarged)
Saclp and Hair
(XX) needs imabdiateattention
tye problems
(RD) permanent defect,correction not
possible
(#) satisfactcry/unsatisfactory
Ear?
"
Nose
ii
fl
Code:(
satisfactory
(C) correction of defects
G/A/PGocd/average/poor
)
(*
to be checked by nurse practitionei]
or Doctor.
!
APPENDS VIII
T
|
i>
Record' of illness
Height.in centimeters
SCHOOL HEALTH RECORD
(Date Problem Tre itmont Signature
1
■ —■• .
|Reco' rd; of re ferrals.
bate Ref err ec Diagnosis Treatment given
and results
for
I
Note: Both the graphs to b e ;p lo tte d s ta rtin g from the le f t hand sid e
Use f u ll lin e fo r h eig h t curve and d o tted lin e fo r w eight cubve.
•
Centre
A.
........................
Zone/Sector (Perish) ....................... '
Name of school
Type of school
high middle uppler pri. lower pri.any other!
Addresses of
School Village Panchayat Block
Name of child
........... sex
Date of birth .......... ..caste/Religion ...
Father’s/Guardian1 s name................'........
Address
Occupation-father
.........
Education
!
mother
Annual gross income
Socio economic status . Good Fair Poor very
„
,
j --<--1 •
poor
Health status of parents and siblings.
(
(any communicable disease like leprosy, TB)
Home conditions
Type of house(Pukka/Kuchcha)
Total number of rooms
Total number of occupants
Drinking water facilities
I
Weight in"kilograms
Latrine facilities
.
.
Individual/public
I
<
APPENDIX.IX
List of Health Problems - used for priority setting(Day 1 session 11)
1. Sore eyes
2. Ear Pain and discharge
- '
J. Tooth ache
4- Chronic cough : TB
■
5- Lice
6. Chest pain
7. Joint pains
8. Fungal Infection: Skin
9- Head ache
10. Deafness
.
11. Burns
12. Breathing problem : Asthma
13. Bites -wasp,
- Scorpion
'
. .
- snake
*14 Dental caries/Bad teeth
15. Poor vision
16. Poisoning: Kerosene, DDT, Drugs
17- Disability: Polio, Fracture ;
18. Common cold, sore throat
19- Poor growth -20. Sore mouth
•
■ Aneamia
21,
22. Stomach ache
23. Cuts and wounds
24. Loose stools
25. Behaviour problems.
26. Worms ■
27. Accidents
28. Weakness- Malnutrition
29. Fever
30. Itchy skin (Scabies)
APPENDIX
■.
•
■
•
X
Advantages and Disadvantages of certain teaching methods and of different
educational media (3)
I Lectures
Advantages
Apparent saving of time(for
teacher)and resources
2. Presence of teacher
1.
3.
4.
Disadvantages
1. Keeps the student in a passive situation
2. Does not facilitate learning how to solve
problems
Covers a large group of students. Offers hardly any possibility of check3.
ing learning progress.
Gives a feeling of security
4. Does not allow for individual pace of
r- T
.. . .
learning.
5- Low receptivity.
Practical
II.
Work/ Field work;
Disadvantages
Advantages
_________
1. Puts student in active situation. 1. High personnel, transport and mater2. Covers a.limited .group of ..students
"
ial‘costs.
J. Permits evaluation of degree to /. 2. Poor standardisation.
which objectives,practical and co
ted.,.
,. .,
mmunication skills have been attained
Narrow limits of utilization, ■thero4. Develops qualities of observation al—
fore requires careful planning,
division taking.
5. Ensures closer contact with reality
(Professional, health situation of
country,colleagues and teachers).
6. Permits comparison between practice
and theory.
7. Enables student to develop selfconfi8. Increases variability.
dance.
III. Books,Handouts,Programmed Learning from books and stimulatien(self lear____________________________________ ‘
___________ ning packages)_______
Advantages
Disadvantages
1. Enables student to work at his own pace. 1-. Necessitated special educat2. Facilitates self evaluation.
ional competence.
2. High additional investment
J. Makes mass teaching possible with high
costs(in time and money)
efficiency.
4. High availability
5. No grcup dynamics
5. Facilitates decision taking-promoting
solution of complex problems
6. Reduces risks for patient or society.
7. Avoid bias transmitted by bad teachers
8. Allows a good teacher to save time that
can then be spent on more complex activities
such as interpersonal reactions.
9. Can be kept up to date with new scientific
development and contain references to other
documents.
Objects and specimens;
Advantages
Disadvantages
1. Present reality not substitutes. 1. May not be easily obtainable
2. Three dimensional
-2. Inconvenience of size,danger in use
3. Permit use of all senses in study *3 Costly or not expendable
4. Usually only usable in small groups
Real
IV.
...
6. Problems in storages.
Models and stimulation Device;
Advantages
Disadvantages
1. Three dimensional.and concept of reality. 1. Craftsmanship required for
2. Size allows close examination.
local construction.
3. Good for magnified situation
2. Similar model often, expensive
4. Can be used to demonstrate function as
3. Usable for small groups
well as construction. ■
4. Models often easily. damaged
5. Can permit learning and practice of
5. Never sane as performing
different technique,
technique on a patient. Beware
6. Some can be made with local material .
of faulty learning.
V.
32X:_ Graphics (Charts,diagrams,schemator drawings) pesters,paintings,photogra
phic prints.
Advantages
Disadvantages
Pronote corelation of information. 1. For small audiences only(unless
2. Assist organization of material.
projected with epidiascope)
5. Photographs nearer to reality than 2. For effective use of gocd duplicadrawings, but association often
ting equipment and training staff
. duplicated
’ needed.
4. Usually easily produced and duplicated.
5. Easy to store,catalogue, and retrieve.
VII Blackboard or
Advantages
chart:
Disadvantages
1. Inexpensive, can be made locally.
1. Bqck to audience
2. Usable for wide range of graphic
2. Audience limited to 50 or sc
representation.
5. Careful drawings erased not prosor5. Allows step by step build up or
ved for future use, except in the
organization of structure or concept.
case of flip charts
4. Considerable skill required, for
effective use.
... ...
5. Rarely taught to teachers.
VII. Flannel Board(flannel graph)
(nest of the comments apply also to magnitic board)
Advantages
Disadvantages
1. May be used repeatedly
1. For limited audience only
2. Usually preparable from locally
2. Difficult technique to use convin
cingly.
available materials.
5- Good for showing changing relatign-g
4- Holds attention if well used.
5. Can be adopted for group participation.
IX. Projectable Media;
Still pictures- Opagne projection(epidiascope)
Disadvantages
Advantages
1. Enlargement of drawn or printed mater 1. Demands total darkness for clear
projection(except with - vexy
ials for large audience.
expensive models)
2. Obviate need for producing slides
2. Bulky machine, difficult to
and transparencies.
transport
5. Enlarged images may be transferred to
5. Electricity required
chart or blackboard for copying.
4. Small objects and specimens may be
Projected.
a)
b) Slides and Filmstrips:
Disadvantages
Advantages
1. Fixed order of grames in filmst
1. Suitable for large audience
rip restrictive use.
2. Relatively easy production and (in
2. Need partial darkness for viewing
black and white) reproduction.
unless near screen or daylight
5. Cheapest current forms of visual
screen used.
medium.
5. Duplication of colour slides
4. Easily adoptable to self learning
expensive.
packages.
5. Equipment available for viewing or
projection without electricity source.
c)
Transparencies for overhead projection:
Advantages
Disadvantages
'
1. Projectable in full daylight to 1. Electricity■required
large audiences.
2. Equipment and materials for-making
2. Presented facing audience
sophisticated transparencies expensive
3. Relatively easy to prepare with J. Not usually suitable for photographic
local materials.
material due to cost(althcugh adoption
4* Subjects can be drawn in advance
available to take 35 mm slides).
or developed by stages with the 4. Usually restricted to teacher use, as
group.
it is not easy to adapt for the learn?
to use.
d)
Films 8 urn and 16 m;
Aidvan tapes
Disadvantages
1. Close to reality with movement and 1. Does not permit snail pacing
sound?
~T'"
2. Films costly and difficult to pro2.. Suitable for large audiences(16m)
duce.
for small groups only ($ nn)
3- Individual films relatively expensive
3. Compression of time and space.
4- Electricity required.
4. Eaotive, can develou attitudes
5- Equipment difficult to transport
Pase problems demonstrate skills..
5- Good learning source if preceded. 6. Darkness needed for-viewing .
by teachers introduction and
7- Imported film may contain inappropfollowed by discussion.
riate information.
■t
APPENDIX ' XII.
CARD SAMPLES FROM DIFFERENT GROUPS:
Card Illustration:
The actual r-foodo__ was displayed on the cards wherever possible.(eg. Dais
(Card ?) ,wheat, jcwar etc.(Card 1). In other cases pictures could be
pasted on to the cards for a more realistic effect.
APPENDIX XII-
Rumour Story
Sub j ect : Raju:
I have a pain in my stomach since yesterday afternoon. I stole and
ate 3 raw guovas from Ryare's garden. Ivy grandmother says Devi’s mother
has caste an evil eye on me because she is jealous . fry father took me to
the new doctor's dispensary and the doctor says I have a worm problem
called ascariasis. I couldn't even pronounce it earlier, I requested him
to write it down for me and repeat it 2-3 times
*
Devi's mother's evil eye
has given me the worms problem. I am going to be eaten up by worms. I can feel them spreading all over. I think I will die in a few days with
Ascariasis. What is the use of going to school-say goodbye to my friends.
I think they will all miss me except Devi's mother. ••
SrtriMO*
-.2..
coMMufth’i y health f%ru.'^
47/1,(First HoorJSt. Mark's Hoad
'”
BANGALORE - 560 001
PROVISION OF PRIMARY HEALTH CARE THROUGH
REHBAR-i-SEHATS
A PROJECT IN KOT BHALWAL BLOCK, JAMMU’ (J and K STATE)
by
Dr. R.D. Bansal, Professor and Head,
Deptt. of Preventive and Social Medicine,
Government Medical College, Jammu.
Shrivastav Committee [1975] emphasized that school
teachers can play pivotal role in imparting health education
and first aid service to the masses at village level.
Argu
ments favouring involvement of school teachers in community
health work are many.
In May, 1975, Govt, of Jammu and Kashmir decided to
start pilot projects, one each in the region of Srinagar and
Jammu. It was decided to designate these teachers as
Rehhar-i-Sehats [Health guides]. Role of the teacher was
visualized in the promotion of health, early detection,
referral of cases, minor treatment and health education. The
syllabus for the training of teachers was evolved to cover
Environmental Sanitation, Nutrition, M.C
H.
*
and F.P., common
Communicable Diseases, School Health, Health Education and
first aid treatment.
The duration of the training period was 3 months and
it included theory and practical training.
The training
programme was conducted with the help of the staff from
Medical College, Directorate of Health Services and related
agencies.
Periodic in-course assessment and an objective
type end course evaluation were conducted.
extremely satisfactory.
The results were
«
— :2s —
The Rehbar-i-Sehats maintain a record of
referral done, health education talks, first aid •
and minor treatment given, school health and an
account of drugs and first-aid materials.
As a
Government policy, it has been decided that
Rehbar-i-Sehats will be paid an allowance of
Rs. 50/- per month for this work provided he/she
reside in the village of his/her posting.
Supervision and coordination of their work is
being done by a Block Medical Officer. This
is an experiment, the lessons learnt of which
may prove useful for the extension this
project to a wider population.
The Rehbar-i-Sehat scheme was studied
and evaluated by a team appointed by the Government
of India, in the Ministry of Health and Family
Welfare in May, 1979.
USE OF SCHOOL TEACHERS IN THE DELIVERY OF
PRIMARY HEALTH CARE
EXPERIENCES
AND . EVALUATION
by
Dr. L. Ramachandran, Director,
The G-andhigram Instt. of Rural Health and Family Planning,
P.O. Ambathurai R.S. Madurai District, Tamil Nadu 624309.
Objectives
To study feasibility and effectiveness of resident
school teachers for specific components of P.H.O.
To specify their roles and tasks
To assess their relative effectiveness under varying
input s
To identify problems and suggest a suitable methodology
Selection of Teachers, Training and Monitoring
18 teachers [15 male, 3 female] were selected, with
18 controls by stratified sampling from 2 Blocks.
All thoLselected teachers received an honorarium of
Rs. 50/- p.m. as incentive.
Training was similar to that of CHWS - for 3 months.
They received medicines, dressings
and
stationery.
For the experimental period of 2 years, a research
team monitored the work every fortnight.
Evaluation
Baseline data was collected at the beginning of the
project.
Terminal Evaluation is proposed to find out:
Feasibility
Effectiveness
.
Roles and tasks
Impact-based on morbidity
-:2:-
Roles Performed by the Teachers
Minor ailment treatment
Referral
MCH - idendification and registration of pregnat mothers
School Health - improvement of sanitation, health
education.
Environmental Sanitation: Chlorination of wells,
construction of soakage and compost pits
F.P. - To act as depot holders for condoms
Leprosy and Tuberculosis:identification and referral
Vital Statistics:importance of registration stressed
Health Education:Individual and informal contacts
circulation of pamphlats, health meassages
Conclusions
Feasibility: Teachers could be relied up for the
treatment of minor aimonts and referral, registration
of pregnancies, school health, sanitation, etc.
They wore willing to continue with this work. But
they were hesitant about being Community organizers
or change agents.
The Community were prepared to accept the
services as long as the Govt, paid for it.
The PHC Staff found the teachers quite helpful
in antenatal registration, immunizations, vital
statistics and school health. The total cost of
medicines worked out to Rs. 67/- per month per
teacher.
TEACHER_PUPIL__INTENSiyE_STRJTEGY.
A New Approach in Health Delivery.
l_Ori_M_.yr_Joseph_MD i_DCHi
UNITY HEALTH CELL
323. V Mein, I Clock
C','.-
Lo’am&ngala
Bsngalore-560034 ■
jn'Jia
‘The perspective.
The existing health delivery systems, in particular the school
health programme in the deirelcping countries, are in general, blue
print models of the western systems where-in emphasis is placed on
highly skilled professionals and advanced technology.
Is this
relevant in the context of a developing country with shortage in
material and manpower resources? Can the community (Teachers and
Pupils) be involved and pursue a system of ’Health by the pupil'
for a more effective health delivery?
Can the motivated teachers
and pupils be used as community health promoters?
The strategy.
The Kangazha model of school health care delivery which was
experimented on a 10,000 student population has identified two
functionaries - that is the teachers and the pupils - who can play
effective roles in a strategy of intensive and resourceful partici
pation by motivating and training them and' establishing school
based health units.
Health problems in school children - a new_look.
In an analytical frame-work relevant to this approach we find
that over 80% of the morbidity in our school children is constituted
by relatively simple ailments such as deficiency states and skin
diseases which are manageable at the school level.
Trained teachers
are able to recognise them and institute remedial measures.
Only
less than 5% of the morbid group required base hospital follow-up.
It is also seen that dental caries and other diseases are highly
prevalent and therefore dental prophylaxis demand special attention.
* Chief Pediatrician and Associate Director of Community Health
and Development Project M.G.D.i-1. Hospital Kangazha.
Paper presented
at 15th National Conference of Indian Academy of Pediatrics at
Madurai. Winner of James Flett endovement Award and gold medal
for research in Social Pediatrics (1978).
r>uWL
, ,
A
App^oACM
HtAtVA i)€LiVC«Y
I*
Programme profile.
A three tier organisation profile with the school-based health
unit manned by teacher and pupil health guides as the first tier,
a visiting team as the second tier and the base hospital as the
third tier was adopted as represented below.
........
T
!-■
j— — ••• —
-
— —• -
{
■
Health guide
;
i
------------- ---- r
——1
,i
:
r i
i i
! ■ Base Hospital
■
! i
Staff
' i
1 :
:
i--- -------------- +
Visiting School Health
Team
!
Second tier
: Teacher, Pupil
.......................... ............... .............. ........................................ I
--
j School Health Unit
First tier
-.-.--j
I....... ..... .. ..........
r—
Third tier
■
-
T
—- ------------- 1 i Base Hospital
School Clinic and
Facilities^'.
j
-School Health Administration; :
’
A phased approach and a strategy of grafting inputs was
adopted as shown below.
In the first two phases as shown here
the services were confined to the school and in the third phase
the school health guides were mobilised to the community.
Target
Approach
Phase
I
Training teachers
Pupils
II
Training pupils
Entire school
community.
III
Extended training
General Community.
77L.
*»-'
£■
"7eAU-«,
- j-j
Dr. M.v-lompX,
•>
V
/-tc.cv
e-
r
-3J
The new functionaries and their functions.
A trained, teacher is the hard core in this programme, and
is skilled for the following functions through a training progra
mme which commences as an institutional training and continues
on an inservice basis. The trained teachers have the following
functions. 1. Health appraisal and recording of Height, Weight
and vision of all pupils. 2. Arranging medical inspection of
pupils with visiting school health team. 5. Dispensing of
medicines. 4. First aid, primary care of common ailments and
referrals. 5- Promotion of immunisation. 6. Prevention of spread
of communicable diseases by early case detection and application
of quarantine regulations.
7. Health education and
of student health guides.
The student health guides play an
8. Supervision
accessary role as follows.
1. Record keeping. 2. Daily appraisal
of the health of pupils, and reporting. J. Assist teacher health
guides in dispensing. 4. Promote immunisation. 5. Organise school
meals, and vegetable gardens. 6. First aid. 7. Create health
awareness. 8. Organise health education seminars, exhibition,
film shows.
9. Community education in nutrition and environmental
hygiene.
Health guide training - the frame work.
The teachers and the pupils are enabled to perform the above
functions through a skill oriented training, knowledge being
limited to optimal levels.
Informal education model through group
discussions, role playing and demonstrations were found to be
more useful than formal methods.
The teacher health guide training
is offered through a 4 days institutional training at the base
hospital, or health centre followed by inservice training during
the school visits of health team.
The students' training consist
of four half days at weekly intervals at the base hospital.
Of late
a ‘built in' system for student training is adopted where the
teachers themselves are enabled in their training to trains a
batch of students to assist them and only the evaluation of school
level training being alone at the institutional level. A primary
health centre and health unit can be the site for training of these
guides.
-4-
Priorities and inputs.
The programme inputs were decided, based on the local prio
rities.
A school based primary curative care facility was
considered the first among the priorities in view of the high
prevelanco of common ailments manageable at the school level.
Dental health and prophylaxis, control of communicable diseases,
promotion of nutrition and health education of pupils were
considered important among the priorities.
Finally there was
felt a need for a newer and a simpler system which is primarly
school based.
A package of services consisting of 1. Primary
curative care through school based dispensaries manned by
teacher and student health guides.
2. Dental health and prophy
laxis.
J. Monitoring of growth and development. 4. Vision and
hearing screening.
tion education.
5» Immunisation of school children.
6. Nutri
7. Special care for scholastically backward
or handicapped. S. Health education and school sanitation are
offered through the programme.
mobilised to tho community.
In the third phase the health guides are mobilised for
general community service through ?. seven point action programme.
This programme was launched as a summer scheme with the following
targets for each health guide.
1. Immunise ten underfives.
2. Vit.A prophylaxis for ton undorfivon. 3. Compost and soakage
pits for i’ivo houses. 4. Chlorinate five wells, 5- Kitchen
gardens for five houses. 6. Five simple nutrition messages
to reach thn families.
for ten families.
7. A simple lesson in dental. hygiene
Cost and evaluation.
The programme is designed as a community supported one in
that part of the cost is met by the beneficiaries by contributions
to a special fund formed in the school for the purpose. Fig.I
depifcts the cost analysis under the various heads.
It can be
noted that a contribution of 50 Ps. by a student and equal. contri
bution of 50 Ps. by the institution or government per student
per year would suffice to run this programme.
-5A concurrent evaluation using evaluation models of Goal
Effectiveness (GE) realised efficiency (cost benefit analysis)
and potency efficiency (PE) revealed very satisfactory results.
Fig.II shows the percent reduction of common ailments.
As
shown here, thero was a significant reduction of common ailments
like Anaemia and. other deficiencies, Scabies and so on.
improvement in the school attendance was observed.
An
This was
attributable to the availability of first aid and minimal
medical care at the school level.
Improvement in scholastic
performance, probably related to correction of Anaemia and
other deficiency states was also noticed.
Appropriate technology and Methodology•
A low cost pro table dental unit locally fabricated and tthe
school dental service grafted to the school dental programme is
a contribution which comes through this programme.
A new device
for the screening of hearing called cassette i
ecord
*
audiometer
is another low costs appropriate technology developed.
The
resourceful participation of the school community make this
programme low cost, but of high duality and hence appropriate
for a developing country like ours.
fieIf reliance in Health.
In conclusion a grass root approach of motivating and
training teachers and pupils as health guides and establishing
school based health units can be an effective method of health
care in the school community. The trained teachers and pupils
can also play an effective role in other community health action
programmes and thereby extend the philosophy of community self
reliance in health.
■0.
GH 7--G
rots
THE LANCET, NOVEMBER 8,1980
at routine screening it the pre-school level.’ As a measure of
telling us what we want to know—i.e., whether children can
heat the spoken word—the VASC audiometer for pre-school
children (used in the Burlington screening programme) and
t he pure-tone audiometer (used in the present study) are more
appropriate. Tympanometry is mentioned because it is in
great vogue as a screening tool in North America. We did not
use it because it is too sensitive.
The next possibility is lack of compliance with recom
mended therapeutic measures, but there is no reason why
parents should comply with regard to vision problems
(screened children have significantly fewer vision problems
than unscreened, and 58% more screened children wear
glasses) and yet not comply with regard to hearing problems.
The third and likeliest possibility is that medical and
surgical therapies for the commonest cause of hearing deficit,
namely, serous otitis media, are not effective. Olson et al.!
found that children with serous otitis media did not improve
when treated medically, and Brown et al.
* found no improve
ment in hearing beyond the initial 3 months in cars in which
tubes had been inserted. Similarly, there is no conclusive
evidence" that tonsillectomy and adenoidectomy materially
affect serous otitis media.
Hearing is important in language and development,but
deficits in hearing are thought to be more important in this
regard in the first 2 years of life than at the immediate pre
school age.10 In addition, one must balance the potential
benefits of knowing a child has difficulty in hearing (appro
priate classroom placement, &c.) against the risks oflabclhng
a child with a transient self-limited hearing loss as being hard
of hearing. Indeed, it is important to look at side-effects of
screening as a recent editorial “The Menace of Mass Screen
ing" has suggested.””
Wc thank Dr 1. Ctinninghcm «nd Dr J. Chrmbcrkln, Medical Officers of
Health, and lhei’
for their help; the Board
*
of Education fat their
cooperation; Dr David Sackett for reviewing the paper; and Linda Teimland
Anne Glover for typing the manuicript.
This work was funded by the Ontario Ministry of Health (grant no.
DM 375). and it hns been presented at the Annual Meeting oftbc Ambulatory
Pediatric Association, San Antonio, Texas, on Ap'il 28, 1980.
Requeats for reprints should be addressed to W. F., Department of
Ptcdiatncs, McMaster University Medical Center, Hamilton, Ontario LAN
37.5. Canada
REFERENCES
I Kohkr L. -Sligmar G Visual disorders in 7 year old children *
ith and without previous
vision scrrcning .4r/u PiMSutd I97H; S7s *78 —77.
? Kaplan GJ. I'lcshmun |K, Render f'K. Baum C. Clark PS. Long term effects of otwit
media in a ten year cohort study of Alaskan Eskimo children. Ptdtatna 197); 32:
$77-85
1. Kohler I.. Nvenningsen NW, Lindquist B. Early detection of ptcxbool health
problems —rale of pciinatal risk factors, /feu PiM Stand 1979, <8: 229- 37.
4 Tibbcnham AD. Peckham C.S. Gardiner PA. Vision screening^! children .enod at 7,
11, and Id years Hr AM 7 1978; i ! *12-14.
5.
Doyle PJ. Mnrwood D Middle ear disease in native Indian children in British
6.
7.
Columbia-incidence of disease and an evaluation of screening methods. J
Otafarvngal 1976; 5: 103-15
Paradise JI.. Smith CG. Impedance screening for preschool children. Ann OlalRkittt
l.aryngal 1979; 88: $6-65
Olson Al, Klein 5W, Charney E, <l al Prevent ion and therapy ut serous otitis mesha by
oral decongestant' A double blind study In pediatric practice. Peduiria 1978; lit
*679-84
8 Brown MJK. Richards SH. Ambvr^aokar AG. Grommets and glue car: A five-year
follou up nf a emitrohcd trial 7^ov 5« AM 1978; 711 353-56
o Shaikh W. Vavda E, l-'chlman W. A systematic review of the literature on evaluative
*
studie
of lonsillectcmv and adennuketomy. PeJialrici 1976; 37; 401-07.
H» Holm \’A Ktinre I.II Effect of snroni, otitis media on language and developnj-nt.
iMiatnei |9t.9; 43: «))- 39
> I l-Jiioriii I he menace of mass screening .•!« .7 P“A Hhh 1977; <71 601-02.
_______ L____________________________________________________
Community Health
TEACHERS AND PUPILS
AS HEALTH WORKERS
M. V. Joseph
Department of Paediatrics,
Af. G. D. M. Hospnal, Kangaeha, India
Al THOUGH schools are an obvious target for health
promotion, their potential is often neglected in developing
countries. Health workers are scarce and expensive, and
existing programmes lend to concentrate on curative care.
Lately, however, there has been a recognition that
schoohu.ichers and even pupils can become effective health
educators ’•? In Kerala we have taken this concept further by
training teachers and pupils to engage in curative, preventive,
and promotivc care.
As a p» unary step we reviewed the health problems in a few
selected schools.
*
Simple ailments such as deficiency states
and akin diwjsc accounted for 85% of the morbidity—con
ditions amenable to prevention and treatment at school level.
THE PROGRAMME
Our target area was rural, situated in Central Kerala.
Thirty schools were selected within 20
of a hospital; the
average number of pupils was 1000. In this community the
literacy rate is 95% and schoolteachers are held in high
esteem. The programme,was implemented in four phases,
each consisting of one school year.
Phase 1—Training of Teachers
Thu tcachei attended □ short course at the base hospital, then
established :i xhotil health unit equipped withsimplc medicincsand
first-aid facilities Continued training and administration was the
responsibility o! the base hospital and a visiting health worker
formed the link between school health unit and hosnital.
Teachers had four davs’ intensive training, ending in a practical
test at one of the schools: they were required to identify scabies, skin
sepsis, trachoma, vuamm A deficiency, nutritional anaemia, and
dental canes. The Gaining was modified according to the problems
of particular areas—thus, some teachers had instruction in the
recognition oi, say. leprosy or malaria. In addition, all had to acquire
the following skills: (l)scrtcning for growth failure; (2)screening of
vision and hearing; (?) first-aid and symptomatic treatment; (4)
identifier! ion ofcommon, infect tons disease and application oftbetr
quarantine regulations; ?nd (5) impart inp health education.
In oui experience this training is adequate, provided that
continuing training is offered and the work is supervised
periods ally
To start j school unit, a stock of medicines and simple equipment
such as a weighing machine and vision chart are acquired. A register
is maintained in which the teacher carefully notes the eases, the
symptoms, tike treatment offered, and follow-up results, need for
referral, und so on. A special register is maintained for children who
need follow-up treatment. The teacher administers simple
*
medicine
according io standing instructions. The programme is
now being extended to other schools: a school with an established
unit and a trained teacher functions as the new training centre.
Phase 2—Pupih as Participants and Beneficiaries
Between 6 and 10 pupils from each school were put through an
initial training. They were trained to perform the following
functions: (1) mist the teacher in record-keeping; (2) appraise
pupib’ health with daily reporting to the teacher; (3) mist teacher
in dispensing; (4) promote immunisation among pupib; (5) organise
ion
THE LANCET, NOVEMBER 8,1980
•chool gerdena »nd vcbool meth; (6) jht firrt-tid; (7) create health
awareness in pupils; (8) organise health eduction vemlnvn,
exhibictDM, Him shows, Ac; (9) promote dental hygiene; (10)
participate in etfocMion of the community In nutrition end
environmental hygiene.
Platt 3—PttpHs he Community Action
A seven-point action acheme was formulated; (I) get 10 underfives immunised; (2) orgsnise vttamin-A prophylaxis foe 10 underfives; (J) organise compost and aoakage pits for 5 houses; (4)
chlorinate 5 wefla; (5) organise kitchen gardens for 5 houses; (6) 5
simple nutritioo messages to reach ten families; (7) give a simple
lesson in dental hygiene for ten famihea. Most pupils over-shot their
targeti.
At the programme spread, imtmitiontl training for tfl the
students was found to be impractical. Therefore, another model was
tried in which the teachers’ training was reoriented so M to enable
them on their own to train a batch of students. The evahsation ofthe
trained students b done in school by a member of the health team.
The pupils are thus seen not merely as beneficiaries but abo as
participants in health action.
Phau4-Child to Child
Most Kbooichildren ire involved in the care of, younger brother .
- or sister. The CHILD-ro-child programme
*
extends » school-based
programme to the family unit through the yotm^ schoolgoingchHd.
Involvement of children at this impressionable age promotes
community self-reliance in health.
RESULTS AND CONCLUSIONS
A five-year evaluation revealed substantial reduction bi
common ailments (figure). A nominee of the Voluntary
tawx” ia the Mth
teacbenand pupils, can bt tbe
care of a community.
I thank Dr3 feneph, Dr Thomas Abraham, sod manyether Mrigari for
tbrir parririparion hi I hit programme and encouragement te write Ms paper. I
abo that
*
Dr Mwi Shiva, ofthe Vahmaty Htahh Aaaocfottai af hrifc, for
her hripfoevriuetfon, Prof. Derid Morley far his comments on the script, end
the Indian Academy of Pediatrics for averring the femes Ftat eadowauot
award and told medal for Urie work.
Keauem for reprints sfeoold be addressed io M.VJ. at Deportment of
Pndfotiks, M.O.D.M. Hospital, Kanftrapora P.Oj fitiiim District.
Kerala, South India.
MFERENCRS
I Ahmed S. toatM cwmihvOoa primary tcM wadnn w the hsririafa dnriaate
cwntry. Law
*#
ISIS; H; JO7-O4
2. Rririr JF, Sactynmn T. Bkwtmary school pwfth ■ hcaM ibaim. frit < Sthari
Wafcfc prryramnci in primary htsfrfe cart. Loatw IWO, fc IHd-Sl
1. Jaarph MV. Heshh prebkma m ratal school childrra a arw lari at foam, jhriaa
Priarr 1077; I4t 24 J.
4. Aarwn A. Ik««
*
H. Gsywo J. CHILD
*
CMd I anlan.-Macwalha, HM.
Medical Education
MEDICAL STUDENTS AND THE JUVENILE
COURT
T. J. David
Bootit Hon CUUrtn't Hotpilak Mandttutr Mt tAA
A. Hargreaves
D. Clerc
MmeAerrer City Jmtnik Conn Pond
Au. doctors require some knowledge ofthe law. CNid care
to no exception. A recent survey of medical students in
Manchester at the completion of their child health and
pediatric course revealed ignorance of certain basic facts.
The students, in a multiple choke examination, were asked
sbout the meaning of a "place of safety order" and a "care
order". The answers given by 120 medical studentswere:
rtAce or SArrrv onosr
Xwttvr
h prevent' those over 14 using playgrounds ta
public places
h InsMts that playgrounds in aS primary schoris be
completely fenced in
It compel
*
a parent to take a child for regular
medical inspection
It forbids children under 12 year
*
of age to bamSe
*
firework
except m a private garden
fa h granted where a family with small children ia
homeless
fa lasts for six months
It ha
*
to be signed by the chief constable or km
assistant
fa can only be made by a magMtrate in a juvenile
court
fa prevents parental access to the child unless the
order m revoked or the order specifically gave
parents access
The place ef safety was always a hospital if the rinld
was under 12 months of age
Health Association of India who participated in the
evahzatioti of the programme, found that several thousand
school days had been saved in addition to other benefits. The
improvement in attendance is attributed to an overall
reduction in morbidity and correct application of quarantine
regulations (the usual forth to to overestimate quarantine
periods). The programme to inexpensive, costing less than 1
Indian rupee per student per year. The evaluator found the
programme "gfanpie and repttcxbte”. We conclude that a
school-baaed scheme such as this, with participation of both
Ms
14
10
8
4
28
II
3
14
22
•
CARE OHDC
*
The correct legal term for a bontal sentence
Lam 28 days
17
27
Removes a child from hts parents for a nummum of
6 month
*
Usually made by a judge ata hearing tn chambers
It
21
Similar rank, were found when the tame quettfoew were
put lo docton who had done pediatric
*
for * year and were
due to take the D.C H examination.
CH
CO’.t.'-iUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India
SCHOOL HEALTH
School Teachers and Students as Community Health Workers
The following proposal was submitted to these organisations.
1. The Christian Childrens Fund ,
Delhi and Bangalore
2. Action Aid,
Bangalore
-11 recent years, there has been, as is well-known, a greater
appreciation of the fact that the health services available to the vast
majority of our people are -woefully inadequate. '.Co rectify this, all kinds
of projects and programmes and approaches have been adopted under the
auspices of Voluntary bodies as well as the Government.
Considering the magnitude and complexity of the problems on the health
front, the virtually unlimited scope for innovative measures to meet the
situation can easily be appreciated. The present proposal visualises a
project, on an experimental basis, which will attempt at motivating and
equipping school teachers and students to play a useful role as community
health workers. This idc-a too, no doubt, has been tried out. The point of
departure in the proposed project is that the selection of the students
(and the teachers) will be confined to those covered by the services of
the Christian Childrens Furfd (CCF) and Action Aid
two major sponsoring
agencies in India.
It is hoped that the relationship between CCF,
Action Aid
and the
school will afford a more satisfactory basis for trying out this idea.
Apart from the obvious benefits the community, in great need of health
services/health education, may get from the students and their teachers
(eventually mid hopefully leading to an appreciation on the part of
the community of the need for standing on their own feet in this respect),
the students and teachers themselves can be expected to be vastly
enriched by the training/orientation and more importantly, by the
involvement in helping the community in this critical area.
indeed introduce a plus factor into CCF
This can
and Action Aid services
to children.
The Voluntary Health Association of India (VHAl) will be glad to
collaborate with the CCF and Action Aid in this project.
Below are given the salient features of the proposed project.
1. Sensitive students and teachers may be identified with the help of
■
CCF staff closely associated with the schools.
2. Suitable training/orientation may be designed and organised for then:.
..2/
: 2 :
5. Provision is to be made closely guide/supervise the students and
teachers as they start working in the community.
4. In conducting training, in preparing health material, and in
mobilising referral services, support and good will need to be
enlisted from existing community health centres, local hospitals
and other voluntary and government agencies engaged in health
and allied sphere®.
5. "•herever appropriate, maximum use may be made of innovative teaching
aids and techniques, with the students and teachers to begin with, but
eventually meant for use in the work with the community.
6.
The project needs to be reviewed from time to time. The experience
gained in working it out needs to be incorporated in the subsequent
measures.
7.
CCF will depute one person to work on this project, along with a
VHAI representative.
6. Villi will make available the services of its staff members for this.
9. The project will be, to begin with, for one year.
This proposal was well received.
The Christian Childrens Fund, Delhi was quite enthusiastic about the new
venture and was willing to finance the project. .
They wore
willin.-■ to collaborate with other organisations also, it was suggested
by them that this proposal
. be sent to the Christian Childrens Fund
Bangalore
>
The proposal was sent to CCF, Bangalore and Action Aid. j
! 3 :
•' . c A
requested for a final project proposal with
financial implications, staff pattern etc. This is yet to
be formulated.
The Christian Childrens fund, Bangalore wanted sometime to think.
it over ..‘Action Aid v.’as very positive about the proposal.
/
but they felt the need should evolve al the project level.
Thia
seems quite legitimate. Action Aid supports 7000 children
in
project in Anantapur and they felt
to begin with
teaching aids and common topics on health care be introduced
among teachers and students at few workshops in this project
with the help of project people. Since Anantapur was a Telugu
speaking area it was felt the
teaching aids be made in
Telugu and the workshops be conducted in Telugu. The field
officers of Action Aid at ADT felt nutritional deficiencies
and vitamin deficiencies vrere the major problems in these
areas and they requested we deal with these subjects right
away.
After observing the intitial reaction, Action Aid would be
interested in implementing this program only at the request
of the teachers, students and the project people. This way
it would seem the funding organisation is not forcing anything
on them.
Action Aid is willing to collaborate with other organisations.
..■I
:'.'hat needs to be done
1. A
final project proposal with financial implications and staff
pattern to be submitted to C.U.F.
2. Preparation for the visit to RDT Project Anantpur in June IJdJ.
Te plan to hold two or three workshops at three places in
Telugu -
Duration not more than J days each. Participants will be teachers
and students - the number of students being more 1:2 or 1:J ratio.
The whole procedure will be adapted in such a way that the
p.-irticipanIs will conduct the workshops on their own with the
materials prepared.
Tonics selected
1. Nutrition
2. Nutritional Deficiency
J. Vitamin Deficiency
4. Diarrhoea/Oral rehydration
5. Tuberculosis
For the preparation of booklets, teaching aids and games etc on the
above topics, all financial help will be given by Action Aid.
This includes extra, staff also. This will be for a period of
three months starting from March 15th 19BJ.
If we work hard, the materials should be ready by then.
CL H ;
which
often
beliefs
as
ugly
includes
that
for
pimples
breasts
outlandish
such
leads
masturbation
boys
girls.
for
Unfortunately, sex education in
neither emphasised
is
any
syllabi
the
of
for
the
tured
out
careful
into
India,
ian
inside
works
a
and
has
such
Some
provide
bodies
T
are
IX
most
them
discus
students
the
the
about
having
the
in
animated
which
sion
standard
peals
bell
an
of
film
initiated.
terparts
ded
debated
as
was
it
their
Fortunately
the
and
as
prose,
evening
the
how
be
to
no
was
innuendos
and
filling
source
whatever
a
the
in
material
the
quell
that
had
surged
long
after
and
they
return
body
to
Vernier's
1
I
Chandragupta
typical
of
I
India.
Suddenly
overdose
of
girls
answers
and
calipers
and
confronted
media
they
wherever
from
books
lucky,
from
parents
education
if
has
been
an
Eve's
few years
a
Wreklv,
for
among
ent
in
of
the
family
to
the
and
social
would
know about
to
like
families
a
laid
down
for
boys
both
periods
pertinent
to
assess
well
information.
Audio-visual
are
explain
used
issued
to
the
girls
introduction
to
visual
in
and
explains:
“A sperm
ther
must
with
an
egg
this
the
father
mother. . .To
do
his
the
At
the end
and
answers,
opt
for
ago,
women
teachers
These
in
Madurai
walked
passed
Nov.
10
--
16,
19B4
boys
are
through
and
as
to why
every
month
given
try
as
young
of
life
to
Eager
(or
find
classroom
the
whom
with
shared,
been
have
facts
the
jot
quickly
host
a
that
they
answers
for.
questions
of
wanted
all
stand
The
The
mo
with
the
thrown
is
children
ubts.
with.
up
up
ges
are
are
provided
a
of
taking
received,
the
winds
and
clear
their
do
to
to
are
questions
presentative
replies
credible
anoymity
br
youngsters
established
growing
is
session
and
basic
society
where
Answers
rapidly.
place
re
chan
questions
that
the
who
have
th-mselves
this
qu.
way.
..oning
stage.
they
have
as
the
of
are
filed
of
the
needs
Then
the
studied
so
spot.
and
are
educators
content
changing
the
on
able
to
programme
and
recurring
adapt
to
the
areas
doubt.
Mrs Sarla Mukhi and Mrs Elsa Saldha-
answers
their
information
adults
educator and
to their friends
come
books
friends
such
or
incid
Both
morning.
every
information
share
at
fur
whatever
sex
girls
no
for
whether
are
family
teenagers turn
in
rapport
em
shaved
by
places
vagina."
instructions
while
'padded'
air
relaxed
a
been
for
in
on
is
have
occasions
be
fa
the
tray of slides
first
of the
the
from
mother's
ment
as
to
in
penis
from
every
treated
had
join
appar
razor.
one
uncomplicated
way
doubts
a
are
simple
an
one
biology,
the
with
the
are
After
all.
out
of
cursory
in
ana
for
and
initial
a
human
ings
packet
period
few
ther explanations
once
absorb
mysteries
the
and
myths
to
techniques
question
a
first
barrassment
to
and
of
the child
of
ability
always
the
a
are
needs
their
anonymous
With
the
ents
the
pro
experience
have
life.
of
gifted
from
are
as
needs
the
This
indi
rules
and
and
later
and
as
the
to
re-
youngster
of
pads
existen
debate
in
sensitive
ren
handle
who
not
life.
set
onset
arc
as
curious
many
are
dispelled
physical,
well
In
follow-up
phy
an
changes
as
naturally
a
thing
the
who
role
puberty
more
covers
that
the
during
the
comprehen
teaching
of
from
promiscuous
institution
when
pattern
a
is
the
while
no
with
able
tomy
female
and
It
organs.
everything
if it is
prerogative
of those
sive
regarded
sole
ce. A
boys
exceedingly
large with suspicion, as
and
in
an
themselves.
and
licentious
with
—
can
and
scene
looking
themselves
find
a
both
fodder
peers,
Sex
film
classrooms
of
thousands
through
male
the
programme
for
and
is
human
in
from
basis
educators
group
the
down
productory
'emotional
avai
inexplica
is
and
blanks
is
education
Sex
of lessons
series
a
vidual
the
This
Maurya.
biology.
blatant
enters
teacher
The
the
in
the
them
ended.
out
mother
helps
had
of
suddenly
feelings
mind
a
siology
marriage
discussing
just
lable
i
1
while
heroine
the
going
is
there
sequence,
and
just
steps
ask
ble
boys
dance
others
with
the
of
sensual
she
plant
Some
the
when
television
before.
imitate
says
on
seen
have
later
and
facility.
there
of
from
session
deci
issue
important
got
requests
for just one
gramme
coun
program
a
hesitant ones provide time
The
schools
in
necessary
was
education
was
time
regular
a
of
non-sectar-
of schools. Some schools
managements
on
initial
with
parent-teacher
of
pro
programmes
these
of
way
under
school
make
Association
non-political
organisation,
me.
HE
to
classroom.
the
Planning
Family
The
middle
have
is interesting to see how' this
It
TERESA VIJU JAMES observed the success of one of the few FP
programmes that aim to impart correct and useful
information about sex to teenagers in schools
atmos
this
progress.
gramme
PLEASE MISS,
HOW IS A BABY MADE ?
or
that have ven
field
the
in
curricular
In
few agencies
India
included
nor
extra-currcular teaching.
phere,
to
outsize
and
the
na
of
of
India
associated
had
Family
who
with
interesting
Planning
have
these
Association
actively
been
programmes
observations
to
make.
1?
<C-H - T-
which
often
beliefs
as
ugly
outlandish
leads
masturbation
for
pimples
breasts
such
includes
that
boys
for girls.
Unfortunately, sex education
neither
is
any
emphasised
syllabi
the
of
for
phere,
the
tured
out
careful
works
under
Association
way
parent-teacher
got
requests
from
and
bodies
MISS,
<C\N
ones provide time
session
with
the
group
able
to
assess
ren
as
well
information.
used
are
tomy
TERESA ViJU JAMES observed Hie success of one of the few FP
programmes that aim to impart correct and useful
information about sex to teenagers in schools
school
HE
middle
standard
IX
most
them
of
an
of
about
of
film
the
television
on
seen
have
discus
students
the
having
are
the
in
animated
which
sion
peals
bell
initiated.
was
ded
it
before.
Some
of the
boys
just
dance
steps
while
siology
others
ask
how
says
going
is
she
there
when
just
innuendos
and
with
helps
ble
filling
feelings
and
had
ended.
they
return
surged
after
of
India.
Suddenly
thousands
overdose
of
and
find
and
calipers
and
is
from
books
lucky,
from
parents
education
if
exceedingly
themselves.
been
has
regarded
large with suspicion, as
sole
prerogative
licentious
ce. A
of
an
out
he's
and
few years
of those
a
Weoklv.
if it is
who
in
male
and
opt
pattern
sive
everything
the
in
thing
a
would
like
families
laid
down
for
both
periods
the
few
cursory
the
girls
the
his
the
the
are
there
is
as
young
of
life
for
share
the
boys
of
are
fur
to
why
to
be
em
Eager
for
teenagers turn
to
their friends
try
to
find
friends
through
such
or
their
who
have
themselves
this
qi..
information
jot
they
that
answers
all
for.
is
is
stand
ubts.
The
with.
The
mo
with
the
up
credible
children
thrown
ges
are
arc
provided
winds
and
their
do
and
re
basic
are
where
chan
Answers
rapidly.
place
taking
the
clear
to
society
a
of
received,
replies
to
up
questions
presentative
br
youngsters
established
growing
anoymity
session
doubts
the
and
educator
question
way.
..oning
stage,
they
have
as
questions
that
the
the
are
filed
educators
content
changing
the
on
of
* -1
th
needs
Then
the
studied
so
spot.
and
are
able
to
programme
and
recurring
adapt
to
the
areas
of
doubt.
Mrs Sarla Mukhi and Mrs Elsa Saldha-
answers
come
books
facts
the
quickly
month
every
morning.
every
incid
Both
given
'padded'
slides
classroom
instructions
no
shaved
and
al
as
had
answers,
girls
and
one
by
are
rules
while
family
are
shared,
wanted
rapport
for
the
vagina."
the
questions
of
been
occasions
in
host
a
have
as
explanations
places
tray of
whom
with
been
have
ment
treated
ther
adults
in
the
from
father
first
air
relaxed
a
the fa
from
egg
mother's
of the
every
razor.
barrassment
in
end
appar
a
passed
19B4
this
do
out
with
walked
16,
an
ings
packet
a
to
These
--
with
mother. . .To
an
one
uncomplicated
must
always
a
period
of
ents
and
sperm
ther
join
After
biology,
"A
anonymous
With
and
gifted
simple
have
life.
issued
first
to
explains:
This
indi
youngster
and
pads
later
as
of
onset
are
are
all.
covers
life.
boys
in
ana
mysteries
way
penis
techniques
re-
physical,
well
set
a
a
child
absorb
phy
an
changes
as
curious
many
teachers
10
the
know about
to
ago, women
Nov.
to
In
the
sex
family
social
information
whether
of
puberty
whatever
on
role
naturally
pertinent
that
the
and
during
ent
in
debate
in
the
to
comprehen
teaching
of
from
for
Madurai
not
female
a
is
It
organs.
existen
in
and
is
visual
of
human
for
and
introduction
At
of
the
and
myths
pro
experience
ability
explain
initial
down
productory
promiscuous
institution
when
for
among
—
and
a
in
an
boys
looking
can
and
with
both
fodder
they
wherever
scene
a
classrooms
of
themselves
peers,
Sex
enters
confronted
media
through
film
This
lessons
the
'emotional
the
teacher
Maurya.
typical
answers
had
prose,
human
of
blanks
avai
deci
as
and
vidual
is
coun-
and
education
scries
blatant
inexplica
the
Vernier's
to
the
long
The
Chandragupta
girls
quell
that
body
the
in
the
in
material
source
them
mind
mother
a
discussing
whatever
lable
be
to
suddenly
no marriage
was
sequence,
heroine
a
their
issue
Sex
biology.
sensual
the
the
important
as
was
plant
the
evening
Fortunately
schools
in
necessary
debated
terpaits
imitate
the
was
education
needs
the
needs
their
once
dispelled
the
to
Audio-visual
to
and
the
as
facility.
from
are
and
more
handle
who
sensitive
are
the
(or just one
follow-up
no
educators
gramme
I
the
while
hesitant
The
from
programme
for
basis
time
regular
a
later
Some schools
managements of schools.
provide
program
programmes
initial
with
a
such
has
of
non-sectar-
and
these
of
Some
pro
classroom.
the
non-political
a
organisation,
on
make
how this
inside
Planning
Family
India,
me.
atmos
to
have
interesting to see
is
ian
this
progress.
gramme
The
or
In
field
the
in
curricular
that have ven
few agencies
into
India
in
included
nor
extra-currcular teaching.
It
to
outsize
and
the
na
of
of
India
associated
had
Family
who
with
interesting
Planning
have
these
Association
actively
been
programmes
observations
to
make.
19
then
PLEASE MiSS,
HOW IS A BABY MADE?
the
tained
also
the
they
whether
exclusive
of
schools
are
sought
for
pattern
from
come
the
or
municipal
Answers
same.
are
doubts
nagging
same
the
students
the
schools
city
the
questions,
of
neither economic group
and fears and
any
had
ing
nor
social
on
the
question
type.
Boys
are
more
than
girls
when
it
comes
uninhibited
ciearing
to
impact
ques
putting
and
restrained
objected
even
sense of a
visual
more
are
school
one
and
doubts
Giris
tions.
status
the
to
male operator of
in
pre
the audio
the
of
through
it
the
group.
to
sex
the
better
are
as
the
parents
schools
exclusive
in
role
well
ergent
in
class
India
but
admits
that
in
every
programme
form
pport
which
those
the
to
children.
In
ly
also
a
pathetic
or
play
not
their
educa
sex
principal
stubborn
than
div
widely
with
is
hundred
a
Several
groups
of
a
similar
tremendous
place
that
the
when
found
that
separate
for
boys
and
girls
were
more
useful
than
joint
sessions.
One
for
felt
she
undergo
more
stress
during
puberty though at
at
stage
coincided
emphasis
developing
on
boys
this
often
with
was
a
informed con
not
with
help
about
much
how
on
to
satiated
life
Family
it.
by
imparted
agencies
with
theological
gets
too
doctrinal
and
easily accepted
by
ral
of
audience
be
to
concepts
gene
a
children.
important
Young adults
public
a
hymn.
also
laid
a
ad
with
devotional
Christian
do girls.
which
through
went
group
uncomfortable
science",
slight
a
than
ly later stage
The
who
by
commenced
education
and
turmoil
parent
Tremendous
go
boys
that
other
evident
was
it
and
programmes
mixed
a
practical
questions
where
conducted
"responsible
the
From
type.
Christian
groups
was
begun
session
From the same analysis it
able
feeling of sym
also
agency
church
ra
is
complete
are
a
session
a
the
group,
agencies
church
attended
of
leader
the
and
in
success
on
depends
of
cities
established.
have
mitted
educators
trust
the
barriers
down
broken
in
cland
Association
several
course
with
of the
a
him.
the
establish
new
a
become
Planning
Family
communication
views.
The
equipment.
branches
with
had
habit with
as
parents
heeled
has
The
the
parents
convince
India
makes
receive
one
estine
schools
whether
to
are
education
the
should
and
tion
what
who
In
school
of
deciding
children
easier
the
of
behalf
programme
into
than
off
on
the
sight
is
middle
institutions.
head
decision
well
lower
in
sophisticated
er
teachers
the
after
ob
date, after
that
with
children
schools
future
feedback
comes
present
When
Primarily
for a
scheduled
study
their
in
early
and
examinations
teens
the emotional upsets seem
sensitive
are
deli
to
berate omission of informa
ed to
affect even
performance
nations.
the
in
boys'
the
were,
Parents
tion;
exami
the
by
omes
fruitless exercise,
of
the
Christian
changes and
un
educators
derstood
the
to
able
the
im
to
them
why
ed.
This
often led to a
this
provide
queries
happen
issue
growing
future
family
agen
also
omit
any
refer
mi
adults
sought
the
teacher.
certain
that
unwilling
from
had
a
mere
the
subject
happy
it
they would
to
mation
in
made
the spot,
ning
be
infor
accept
person who
a
textbook
had
and
knowledge
of
enjoyed
never
within
a
the
family.
often
a
reveals
the
presence
which,
though
Very
not
obviously
a
the child.
Such
and
a
the
great
child
counsellor.
from
question
stated,
is
worry
to
followed
up
are
placed
in
the
of
the
hands
the
educator
group
is
not
yet
prepared
part
of
the
programme
to
judge
for
of
it
is
that
a
responses
for
50
floor
problem
expressly
easy
ond
the
source
cases
From
a
of
the
and
sec
it
is
part
a
of
one
school,
boy
stood
ship
he
ing
up
was
so
right
the
years
In
It
cept
how
handle
the
to
to
admit
long
He
felt
as
he
the
relation
a
an
with
having
he
prophy
the
mor
educator
asked
an
open
issue,
his
relationship
was
secrecy
and
let!
the
who
all
the
.ire
an
integral
hall
ac
ans
a
part
lesbian
parents
information
with
or
is avail
fully
and
the
values
such
of
to
some
freely
that
know
ledge.
Fve's
may
how
well
school
children
it
to
parent
for
why
the
a
or
other agency such
to
a
need
very
occurs
through
able
that
possible
combined
realised
(or
that
is
parents
explain
is
then
(.Hied
but
to
and
Admitting
boy
pregnancy
is
it
as
or
grammar
children
possible
able
a
see
for
that
the
one.
the
be
not
in
subject
ease
algebra.
fact
is
It
wers.
lesson
Io
secret
latter.
do
was
used
argue
older
a
trained
same
the
India
during
educators
are
in
the
for
they
important
is
of
courses
where
to
on
Family Plan
Association
special
would
problem
one
the
or a
integr
(hey
Bombay,
of
one
are an
fa
relationship.
whether
ality
the
of
suburban
wanting to
Not
lactics.
that
sexual
in
woman.
married
concept
the values
mily and
al
the
both
on
value
importance
teachers
the
has
with
relationship
sexual
the
involving
of
Young
credibility
This
these.
Realising
affecting
life.
other
request
often
other
giant
to
and
hom
such
and
from
ence to
proportions
termi
educators
cies
nor
con
on
medical
and
subjects,
to
replies
pregnancy,
of
osexuality
explain
or
overtly
to
nation
communicate
children
and
not
traception,
behaviour but were
pulsive
not
and
agencies
are
teenage
keen
occasional
of rudeness
bouts
to
aware
large,
bec
programme
a
emotional
and
happens
this
when
entire
Q
Weekly,
Nov.
10
—
16,
198-1
CH
3-'''
CH-45
Voluntary Health Association of India
C-14, Community Centre, S.D.A., New Delhi-110016
Gram : "VOLHEALTH"
NEW DELHI-110016
Phone : 652007,
652008
SCHOOL HEALTH
Health care of students includes diagnossis,
treatment and immunisations. An experienced
doctor will involve teachers and the hostel staff.
Some hostel staff and teachers are eager to learn.
one per day with (heir food. To treat this prob
lem cost only 3 paise per day and the child will
play and learn faster once treated. If it does not
get belter, in one month, or the child is very pale,
show him/her to a doctor.
DIAGNOSIS OF HEALTH PROBLEMS
Poor vision
The Medical Examination
Parts of the medical examination such as chec
king for lice and weighing the child can be done
by school staff without any special training. Other
screening tests for poor vision and hearing and
pallor of the tongue, can be quickly learnt pro
vided the doctor want to teach his skills. The more
the school staff take interest, the easier their work
of supervising school health becomes. The doctor
can not do everything. When a child is shy or
speechless, the school staff are often needed to tell
the child’s story. If the teacher does not notice a
certain child can not read the blackboard, the
child may drop out of school before the doctor can
see him to check his vision.
The parent is brought into the picture as much
as possible, through letters, through reports of
child’s height and weight, and the health record of
the child.
Leprosy
In most parts of India every child must be
checked every year for leprosy. Every child must
be examined in minimum clothing to check for this
disease. Big surveys in Bombay and Pune show
that 6 per 1000 children have leprosy. The child
with leprosy is examined for infectiousness. If not
of the infective kind of child should continue his
schooling. Leprosy is usually not highly infectious
in children. Every leprosy can be treated in com
plete confidentaillity.
Teachers can diagnose poor vision. Children
who can not read the blackboard from the back of
the room, may be able to see it well if parents will
pay for glasses and if the child will wear them.
Poor hearing
A child should be able to hear whispered num
bers from 1 meter behind him. The teacher can
help to diagnose this. Parents should be sent a
note suggesting that an ear specialist see if any
thing can be done. Meantime he needs to sit close
to the teacher.
Checks for poor vision and poor hearing can be
made part of the entrance examination for new
pupils. It costs almost nothing to check these things.
Tuberculosis
Children with constant moist cough who are
thin or with recurrent fever and tiredness, may be
suspected as having tuberclosis. A Mantoux skin
test is suspicious of this disease, if the reading is
over 15 mm in diameter.. Children are not usually
infectious for tuberculosis and so should stay in
school if on treatment.
Scabies and Lice
These should be diagnosed when the children
return to school. Staff can diagnose these infec
tions.
Anaemia
Roundworms
When the children are in line, the hostel warden
can ask them to show their tongues in the sunlight.
Some will be pale. Such children need iron tablets,
A child can be questioned during the medical
examinarion at the beginning of each school year,
to find out if roundworms (15 to 30 cm long) have
been passed in the last three months. If so the
child is dosed with piperazine. This will be foud
cheaper than testing or deworming everyone.
(Stool tests on hundreds of children cost money
which may be needed for treatment). Threadworms
are not very important. Hookworms cannot be seen
by the child in the stool, but they cause anaemia,
which cm be diagnosed by looking at the tongue.
Drug Allergy
Each school year, the school must ask if the
child is allergic or badly affected by any particular
drug. Penicillin given to the wrong child by the
school doctor or nurse, can be fatal in 15 minutes.
So before every injection, we ask the child and
look at his health record, and get a skin test done.
Teachers and wardens in place of parents must ask
question of the doctor and not assume he knows
everything. In particular, they must ask what drug
has been prescribed.
Weight
The child’s weight is recorded on his health re
cord twice or thrice a year. But bathroom scales
are not accurate and strong enough for hundreds
ofchildren. Heavy scales, as used in markets for
weighing grains are best. If the weight by these
scales is not increasing three times a year, the child
should see a doctor. Likely causes of loss of weight
include tuberculosis, tapeworm, roundworm or unhapoiness at home.
Malaria
Persuade the authorities to spray the hostel at
least twice a year, before the malaria season. The
mosquitoes which are spreading the disease will
usually be found on the ceiling of the dormitory.
Contact the district health office. Fill in all stag
nant water around the hostel. Ask parents to
supply mosquito nets if poisible, and treat
all
children
with
shivering
and
fever
promptly. If the situation is getting out of
hand, ask for assistence early from the district
health office.
Other pests
Use of rubbish tins with fitted lids and confi
ning of all eating to the dinning room, will help to
control rats and flies. Rats and snakes often get
inside through drain holes from bathrooms. These
can be covered with strong netting.
For stray dogs one can all the municipal dog cat
cher, or take the law into ones own hands by using
some poison from the college chemical laboratory.
Stray dogs spread rabies and rdies is a painful and
fatal disease. The injections to prevent rabies after
dog bite are painful and time consuming. A pet
dog can be immunised against rabies with the help
of the Government Veterinary Officer, for a few
rupees.
Bedwetting
TREATING COMMON HOSTEL HEALTH
PROBLEMS
Scabies
The treatment for scabies, is to scrubb off the
scales with soap and water, then paint benzyl ben
zoate over the whole body, avoiding the eyes. Then
wash the child’s clothes. Treat every affected child.
This process is repeated in a few days. To save
expenses this disease must be treated straight after
vacation, before it spreads. Termosol soap should
be issued to everyone for the first days back at
school for the purpose,
Boils
In the monsoon, boils, and in the dry not wea
ther, heat rash, can be controlled to a large extent
by using. Cinthol soap containing hexachlorophene. Daily showers with this soap will lower
the bacterial count on the skin. It has to be used
continuously for a few days to have this effect. So
as it is expensive, it may be used for a week at a
time, to control epidemics of boils and heat rash.
Head Lice
Combing and examination of hair should be done
on the first weekend of the new term. Gammexane
powder can be put in the hair at night. This should
be done on ail diagnosed cases on return from
vacation, to stop the lice spreading.
This is a common problem in hostels with young
children. Although a medical checkup is useful in
a few cases, the causes are mostly psychological,
unless the child is having the same problem in the
daytime.
Bedwetting is a nuisance to the hostel warden,
but blaming the child in any way makes the pro
blem worse. Small rewards, such as shiny stickers
or stars on a calender, can be given, to encourage
the child in succeeding. The child should be lifted
out of bed, and woken up enough to pass urine,
before the warden puts his/her own lights out.
Tea, and lots.of fluids after daik, may be restricted.
If the child still-wets the bed, it is best not to say
anything. Punishing such children makes them feel
even more ‘not OK’ when they are feeling very
much ‘not OK’ already. In fact unhappiness at
home or in School may be a cause of bedwetting.
Bedwetting is miserable for the warden, but even
worse for the child.
Health education
Better Health, a booklet at low cost in English,
Hindi, Tamil, and Oriya, is a good text on basic
health for primary school teachers. Children can
be encouraged to make their own health posters, but
watching their own seeds grow in the school garden,
may cost less and teach more. If school toilets are
clean and functioning, and soap and water are
available for hand washing, then lessons on hygiene
and the spread of disease are reinforced in daily
practice.
IMMUNISATION
Immunisation needs to be done each year with
special attention to the new students. It is no
small job to immunise a whole school or hostel.
It is better to contract out this work to a nearby
charitable or mission hospital, or to a Govern
ment Primary Health Centre.
The contact should state that a freshly sterilised
(boiled or autoclaved) needle should be used for
each child. The request for this service should be
sent to several hospitals asking them to state be
forehand what everything will cost. The arrange
ments have to be made three or more months in
advance. You must come to an agreement on what
immunisations are to be done and the cost of each.
This way the hospital has time to order the vacciness in advance at wholesale rates and you will
have some control over the cost.
Tuberclosis A partial protection against tuber
culosis can be provided with BCG vaccination. The
small scar on the shoulder will show whether or
not the children have been immunised with BCG
previously. If they have not been protected,
arrangements should be made through the District
TB Officer or the Deputy Medical Officer for send
ing a BCG team. It is appropriate to offer the
travelling expenses to the technician that comes
with the vaccine. The BCG teams are supposed
to visit every village every five years.
Smallpox immunisation against smallpox will
probably not be needed for school children after
1977.
It is best to give cholera vaccination
just before the monsoon or the cholera season.
The effects of the vaccine only lasts from 3 to 6
months. The vaccine is usually obtained free
from the Civil Hospital. The best prevention of
cholera however is sanitation. It would be well
to put in more hand washing places and more toi
lets, and to protect wells and handpumps from
surface seepage of waste water.
Cholera
Typhiod TAB or typhoid causes fever and is
best given just before the weekned, in a cool time
of the year. If the hospital can be persuaded to
order the newer acetone-killed and dried vaccine
then after 2 injections in the first course, it will
only need repeating once every 3 year and will give
nearly 100% protection.
Tetanus is uncommon, but it kills 3 out of 4
children who get it. Tetanus toxoid is very safe
and inexpensive and lasts 5 to 10 years, if 3 shots
are given in the first year at school. If one is sure
that the child had 2 shots or DPT or Triple when
a child, than one shot of Tetanus Toxoid every 5
years will be enough.
Anti tetanus (ATS) which is not so safe, has to
be given after injury to any child not protected
with 3 shots of tetanus toxoid. Tetanus toxoid is
much better and means that much time is saved
taking children to the doctor for ATS. Also some
children get tetanus through unnotice wasp stings
and throns.
nus toxiod.
Prevention is much better, with teta
Polio is not common in school children, and
the vaccine is expensive. But if one child in a fa
mily gets polio, there is a one in ten chance that
someone else will get polio in that house. So if in
a school or hostel, any child gets polio, everyone
must be immunised with 3 doses at monthly inter
vals. This is how Government controls this disease
in India. Normally about 1 in 10.000 children per
year come down with the disease. 10% of those who
get it die, and 15% are paralysed seriously and
permanently, 90% of polio occurs in per school
children. English medium school children have
likely been immunised when they are smaller.
Note : These vaccines can be given together :
Polio and any other
Tetanus and typhoid vaccine
BCG and any other
NUTRITION IN HOSTELS
Children are not getting enough energy foods
according to surveys by Indian Council for Medi
cal Research. Few children are suffering from shor
tage of high protein foods alone. This means that
more food mony should be spent on the cheaper
energy foods such as the wheat, rice, jowar, ragi, etc.
For grains also contain protein—about 7-12% of
a cereal’s weiaht is protein compared with around
20% for the high protein foods such as the dais.
Relative Nutritional Value of certain foods
Nutritional Value of Indian Foods is the title
of a book available at low cost from VHAI to help
you know which foods are nutritionally ‘best’, by
laboratyry analysis. You can judge cereals from
the calorie or energy column, dais from the protein
column, green leafy vegetables from the iron and
carotene column, and other vegetables mainly from
calories and iron.
Relative cost of the best foods
Nutritional value is important, but cost decides
how much and how otten the child is fed that food.
The price of the vegetables affects how much iron
and vitamin the child gets, much more than the
milligrame of vitamin or iron in each gram of
vegetable. For if one always buys what cost least
one can buy more of it. The same principle ap
plies to buying one of the cereals, or one of the pro
tein foods.
Among the protein foods, it is much better to .
spend on cheaper vegetable protein food such as a
dal and give it daily. This is much better than
giving the children amounts of expensive meat,
eggs, or fish, twice a week.
Good nutrition does not usually cost more
The biggest expense item in any hostel will be
the food bill. Analysis of food expenses in hostles
shows that well run hostels with well fed children
usually spend no more on food than others with
poorly fed children. This is because they have
oveicomc some or most of the following Problems :
— failure to adjust amount of food cooked when
some children are absent. This is especially
difficult if volume measures tire used instead of
weight.
— failure to check incoming supplies. This soon
tempts the merchant to supply less food than
paid for.
Every child’s diet should daily contain plenty
of cereal, (wheat, rrce, jowar, ragi, etc.) some dal,
channa soyabean or groundnut, and some green
leafy vegetable. Within these groups, different
food are chosen according to market price, availa
bility and to avoid monotony.
— buying at higher prices than tne market rates
often, from one supplier only, out of ignorance
or intent.
Acknowledgements
— use of volume measures instead of weight and
lack of weighing scales. Grains can be measured
5% wrong if not levelled off. Volume mea
sures for flour can be 30% wrong, compared with
more accurate weight measures.
The help of Joy Raghu, Anumamma Thomas
and Robert Nave is designing this article is grate
fully acknowledged.
Supplies and further information
— failure to buy the cheapest food out of a parti
cular food group. Prices keep changing, but if
the hostel-in-charge has given instructions to
buy a particular vegetable, the person buying
for him her, has no freedom to buy something
cheaper. Prices keep changing, and what was
the best buy last week may no longer be the
best buy this week.
Books mentioned in the article teaching aids,
posters, booklets on health, disease and nutrition
are available at low cost from Voluntary Health
Association of India, C-14, Community Centre
S.D.A., New Delhi-110016. A free catalogue is
available on request.
Murray Laugeson
s?
Reprinted from Christian Education Vol. LV No. 3, September 1976 (8/76-3C0)
Voluntary Health Association of India
C-14, Community Centre SDA,
New Delhi-110 016 India
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