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RF_COM_H_6_SUDHA_PART _2
CHECK LIST
OF
HEALTH
EDUCATION
MATERIALS
VOLUNTARY HEALTH
ASSOCIATION OF INDIA
40, INSTITUTIONAL AREA
SOUTH OF I.I.T., NEW DELHI-110016
PHONES : 668071,668072, 665018
CHECK LIST
OF
HEALTH
EDUCATION
MATERIALS
VOLUNTARY HEALTH
ASSOCIATION OF INDIA
40, INSTITUTIONAL AREA
SOUTH OF I.I.T., NEW DELHI-110016
PHONES : 668071, 668072, 665018
Where There Is No Doctor—a village health care
handbook
David Werner—revised for India by C Sathyamala, pp 510, 1986,
Rs.60.00 VHAI
This is not a conventional medical book. The scope of this book
with nearly 1,000 illustrations enables a reasonably educated per
son to acquire enough knowledge of:
*What to do in an emergency and
’What preventive measures can be taken to keep the village com
munity healthy.
This book is for mothers, midwives, health workers, teachers, vil
lage leaders, social workers, religious leaders, doctors and everyone
who is interested in health care. A must for all homes, sub-centres
and dispensaries.
Jahan Dactor Na Ho—Thia is the Hindi version of Where
There is No Doctor
The Feeding and Care of Infants and Young Children
Shanti Ghosh, pp 190, 1985 (5e), Ordinary Rs 18.00, Deluxe
Rs.33.00 VHAI
This is a revised and enlarged version of the earlier edition. In this
book the author authoritatively interprets the best ideas from re
cent Indian research on child care and nutrition. The advice given
is practical, based on the authors many years of experience as Pro
fessor of Paediatrics at Safdarjung Hospital, New Delhi.
This will prove to be a good reference book for doctors, nurses,
health workers and parents.
A Taste of Tears
Mira Shiva and Aspi B Mistry, pp 118, 1986, Rs 8.00, VHAI
This is the first in the Health Action Series. ‘A Taste of Tears’ was
first conceived and published as a special issue of Health for the
Millions. This book simplifies the concept of Oral Rehydration
Therapy in the treatment of diarrhoea. One of the main objectives
of this book is to get hospitals and doctors accept the rationale of
ORT and incorporate it even in the hospital situation. Conse
quently some stress is laid also on the more technical and theoreti
cal aspects of the subject.
This book will come handy for middle level health workers and will
expose them to information on diarrhoea management in their
work in the community.
This book is now available in Hindi also.
Nada Chulha—a handbook
Madhu Sarin, pp 128, 1984, Rs 15.00, VHAI
This handbook has been specially prepared for use by workers in
volved in spreading the improved immovable chulha. An improved
chulha helps women improve their daily lives. The Nada Chulha
design, the method for promoting it have evolved out of a learning
by doing approach. This handbook along with its companion pub
lication will meet a long felt need for teaching and working docu
ments on the improved chulha for field workers.
How to Make and Use the Nada Chulha — Chulha Mistry’s
Manual
Madhu Sarin, pp 73, 1984, Rs 8.00, VHAI
This is specially prepared for use by village women trained for
work as Chulha Mistries, including tho^e who cannot read or
write.
A Manual of Learning Exercises—for use in health train
ing programmes in India
Ruth Hamar. A.C. Lynn Zelmer and Amy E Zelmer, pp 70, 1983.
Rs. 15.00 VHAI
This manual is the outcome of years of experience in workshops
and short courses carried out in most of the states of India by the
staff of VHAI.
Participative learning exercises have come to be a major part of
these courses. Participatory methods are much more likely to
change attitudes and lead to action in the field programmes of
health care institutions and community health and development
programmes. This manual should prove useful in preparing and
motivating new health workers, others on the health team and
anyone interested in working with the people and community.
Helping Health Workers Learn—a book of methods, aids
and ideas for instructors at the village level
David Werner and Bill Bower, pp 640, 1983, Rs.72.00 VHAI
The book is based on 16 years’ experience with a village-run
health programme in the mountains of western Mexico. Although
many of the teaching ideas described here were developed in Latin
America, methods and experiences from at least 35 countries
around the world are discussed.
The focus of this book is educational rather than medical, especial
ly written for instructors and health workers who live with the peo
ple in villages.
Manual for Child Nutrition in Rural India
Cecile De Sweemer. Nandita Sen Gupta and others, pp 271, 1981
(2e), RS. 25.00 VHAI
Born of the famous Narangwal Project, Punjab, this manual of 12
chapters adequately covers the scope of nutrition in rural India.
The basic principles of nutrition are defined and thoroughly dis
cussed with examples, illustrations, graphs and charts. Availabili
ty or non-availability of food and its reasons are discussed in de
tail, as also how to teach the family help itself in such situations.
Management Process in Health Care
S Srinivasan (Ed), pp 650, 1983, Rs 45.00, VHAI
This is a book on the management of health care institutions.
Written by a team of people with training and experience in
administration, it is meant for managers and those-interested in
the art of management. In fact it will be of interest to all involved
in organising for health, be it in a hospital, a dispensary, a
community or a special care home for the disabled.
The book is meant as a guide. It can be used as a textbook or a
reference for basic principles and practices. It presents the Indian
experience of health care management by putting together notes,
cases and articles. The focus is more on the process of planning,
activating and reviewing than on tools and techniques of
management.
In Search of Diagnosis—an analysis of present system of
health care
Ashvin J Patel (Ed), pp 175, 1985, Rs 12.00, MFC
This is the first anthology of the articles selected from the back
issues of Medico Friend Circle bulletin. The articles attempt to
evolve a pattern of medical education and methodology of health
care relevant to Indian needs and conditions. Medico Friend Circle
is a nation-wide current which critically analyses its own
profession and tries to grapple with alternative strategies in the
field of health, with a view to creating a just, rational and
humanitarian medical system. Medical students as well as
interested public will find this book thought-provoking.
Health Care Which Way to Go?—an examination of issues
and alternatives
Abhay Bang and Ashvin J Patel (Ed), pp 256, 1985, Rs 15.00, MFC
This book is the second anthology of articles selected from the
back issues (24th-52nd) of the Medico Friend Circle bulletin. It
covers a wide range of topics with varied views and styles, touching
vital issues about people’s health.
Linder the Lens—Health and Medicine
Kamala S Jaya Rao (Ed), pp 326, 1986, Rs 19.00. MFC
This book is the third anthology of articles selected from the back
issues of MFC bulletin. The authors have tried to show the wrong
paths in health care, traps on seemingly right paths and a
frightening pattern of “no health^. This book is an attempt to bring
under focus issues which have hitherto been missed or ignored,
to adequately magnify them and to put them in proper
perspectives.
Teaching Village Health Workers—a guide to the
process
Ruth Harnar, Anne Cummins, 1978, Rs 30.00, VHAI
This is a teaching kit in three parts. The first part contains the
process of planning of the teaching of VHWs, the curriculum, les
sons, ways of teaching and simple audio-visual aids to make in vil
lages. The second and third parts contain a teaching guide/
curriculum charts/lesson plans etc.
A basic illustrated book about the concep an . training of VHWs,
the contents were drawn from prolonged d\cussions with village
health workers, health teams, medical professionals, government
officials, social workers and social scientists.
Banned and Bannable Drugs
Health Action Series-2
Catriona Robertson, Dr. Ali Mardanzai, Dr. Mira Shiva, pp. 68,
1986, Rs. 10.00, VHAI
Dangerous Medicines — The facts first of its kind brought out in
India. This-book gives details of which drugs should be banned or
steverely restricted. Drugs that have been recommended for ban
ning but are allowed to remain, a list of banned drugs, guidelines
for establishing a national programme for essential drugs and cri
teria for the selection of essential drugs etc.
The use of essential drugs
Second report of the WHO expert committee — Technical Report
Series 722 pp. 50, 1986, Rs. 10.00, WHO
This book gives a model list of essential drugs based on WHO
guide-lines. It furnishes a basis for countries to identify their own
priorities and to make their own selection of essential drugs.
Rational Drug Policy
Mira Shiva, Dinesh Abrol, Narendra Mehrotra, Amitava Guha,
W.V. Rane, pp. 163, 1986, Rs. 20.00, VHAI
i
This book was specially compiled for the drug policy campaign. It
gives an overview of problems perspective and recommendations
for a Rational Drug Policy. It deals with topics from National Drug
Policy! Objectives and Guidelines to self reliance of the Drug
Industry.
Rational Drug Policy for Rational Drug Use
A Drug information pack 1986, Rs. 15.00, VHAI
This drug information pack has the basic information about the
hazardous and irrational medicines still produced and used in In
dia while they are banned in the places of their origin. It also con
tains leaflets on Alma Ata declaration, the Bangladesh Drug Poli
cy, WHO’s Essential Drug List, the adequate production of
essential drugs and a statement on Rational Drug Policy.
f
1. COIWINITY HEALTH
Title and Author
Price
in Rs.
Code
number
Medium
CH:1
Reprint
Before and Beyond Objectives and Goals
- a vision
* David Werner English
0.50
CH:2
Book
Community Health
* Heiberg English
3.00
CH:3
Reprint
Guidelines for Success in Community
Health
* David Werner English
0.50
CH:4
Reprint
Health Car.e and Human Dignity
* David Werner English
1.00
CH:5
Book
Jahan Dactor Na Ho
# David Werner Hindi
CH:6
Book
Plan for a Village Health Programme
Using VHWs
* P.F. Wakeham English
3.00
CH:7
Reprint
Planning Dialogue in Community
* Johnston English
1.00
CH:8
Book
Where There is No Doctor
David Werner English
60.00
CH:9
Book
Taking Sides
- the choice before the health worker
* Dr. Sathyamala, Nirmala SUndram,
Nalini Bhanot English
75.00
CH:1O
Book
Text Book of Preventive and Social
Medicine
60.00
75.00
* Park English
CH:11
Slides
Project Piaxtla English
80.00
CH:12
Book
Development with People
* Walter Fernandes English
30.00
CH:13
Book
Learning from the Rural Poor
* Henry Volken, Ajoy Kumar,
Sara Kaithathra English
15.00
1
Code
number
Medium
CH:14
Book
Participatory Research and Evaluation
* Walter Fernandes English
25.00
CH:15
Book
Social Activists i People’s Movement
* Walter Fernandes English
30.00
CH:16
Book
Grameen Sevikayen Hindi
12.50
CH:17
Book
Prathmic Swasthya Karyakarta
* Girard Hotekar Hindi
20.00
CH:1B
Book
Practicing Health for All
* David Morley, John Rohde,
Glen Williams English
40.00
CH:19
Slides
Jamkhed
- an innovative agricultural and health
programme in India
English
24.00
Title and Author
Price
in Rs.
2. CHILD DEVELOPMENT
6.00
CD:-1
Booklet
Better Child Care All Indian Languages
CD:2
Booklet
Breast Feeding and the Child
0 Or. Shanti Ghosh English
1.00
CD:3
Slides
Feeding Your Baby on Correct Child
Nutrition English
24.00
CD:4
Book
Feeding and Care of Infants and
Young Children
* Dr. Shanti Ghosh English
CD:5
Book
Health Care of Children Under Five
English
5.00
CD:6
Reprint
Health and Sicknesses of Children
(from WTND,
*
ftpp 341 to 368)
* David Werner English
2.00
CD:7
t Approp.
Tech.
Indigenous Calander for Mother and
Child Clinics
(to calculate the date of birth,
date of delivery etc) English i Hindi
1.00
2
33.00
Code
number
Medium
Price
Title and Author
in Rs.
CD:8
Slides
Flore about Child Care English
CD:9
Book
Shishuon aur Bacchon Ka Aahar aur
Unki Dekhbhal
* Dr. Shanti Ghosh Hindi
00:10
Book
Shishu Palan
* Dr. Shanti Ghosh Hindi
1.00
CD:11
Booklet
Stan Pan Hindi
1.00
CD:12
Filmstrip
The Child (a set of 4 filmstrips)
- how a child grows
- needs of the child
- Play
- how a child learns English
48.00
C0:13
Filmstrip
The Balwadi ( a set of 3 filmstrips)
- environment in child care centre
- organisation of Balwadi
- freedom to grow English
36.00
CD:14
Filmstrip
The Balwadi or Anganwadi Worker
( a set of 5 filmstrips )
- role of the worker
- working with the child
- creating the right environment
- helping children to grow socially
- caring for the child English
60.00
CD:15
Flash
card
When Your Child is Sick
10.00
00:16
Flash
card
Child Safety English
& Tamil
25.00
CD:17
Flannel
Graph
Child Health & Weight Record for Use
in Class or OPD English
30.00
CD:18
Slides
Family Care of Disabled Children
English
30.00
CD:19
Slides
The importance of Breast Feeding
and not Bottle Feeding
English
18.00
3
English
Hindi
i.Nepali
55.00
33.00
Code
number
medium
Title and Author
Price
in Rs.
CO: 20
Book
Studies on Pre-School Children English
6.00
CD:21
Book
Studies on Weaning English
6.00
CD: 22
Book
Breast Feeding in Practice
- a manual for health workers
* E Helsing, Sauage King English
45.00
CD: 23
Book
Primary Child Care
- a manual For health workers
* m King, S martodipoero, F. King. English
45.00
CD: 24
Book
Primary Child Care
- a guide for the community leader,
65.00
manager, teacher
* m King, F King, S martodipoero English
C0:25
Book
Breast is Best English
16.00
CD: 26
Slides
Breast Feeding English
24.00
CO: 27
Slides
Charting Growth in Small Children English
24.00
CD: 20
Slides
Development in the First Year English
24.00
CO: 29
Slides
Management in Child Health English
24.00
CD: 30
Slides
Newborn Care English
24.00
CD:31
Slides
Primary Child Care English
240.00
CD; 32
Slides
Weaning Foods and Energy English
24.00
3. DISEASES
D:1
Book
A Taste of Tears
* Dr. mira Shiva, Aspy B.mistry
English
4 Hindi
15.00
0:2
Booklet
Better Care During Diarrhoea All Indian
languages
5.50
0:3
Slides
Better Care During Diarrhoea English
48.00
Price
in Rs.
Code
number
Medium
D:4
Booklet
Better Care ir Leprosy
* 1*. Laugesen English, Hindi, Bengali,
Telugu, Tamil and Nepali.
D:5
Booklet
Better Care in Venereal Diseases
* O.P. Singh, J.S. Pasricha All Indian
Languages
0:6
Slides
Better Care in Venereal Diseases
D:7
Booklet
Better Eye Care All Indian
languages
O.00
0:8
Booklet
Better Ear Care
6.00
0:9
Reprint
First Aid
(from WTNO, pp.87 to 123)
* David Werner English
2.00
0:10
Reprint
Home Cures and Popular Beliefs
(from WTND,pp.1 to 21 )
» David Werner English
2.00
0:11
Reprint
How to Take Care of a Sick Person
(from WIND, pp.49 to 54)
" David Werner English
1.00
0:12
Reprint
How to Examine a Sick Person
(from WIND, pp. 35 to 47 )
» David Werner English
1.00
0:13
Flash
Card
Lathyrism Hindi
15.00
0:14
Reprint
Prevention
- how to avoid many sicknesses
(from WTND , op.155 to 179)
a David Werner English
2.50
0:15
Flash
Card
Rehydration
Solution English
10.00
D:16
Flash
Card
Sores
Title and Author
All Indian
languages
English
8.00
10.00
55.00
10.00
English
4 Hindi
5
Price
in Rs.
Code
number
Medium
0:17
Reprint
Serious Illnesses that Need Special
Medical Attention.
(from WTND, pp 219 to 233 )
David Werner English
1.50
0:18
Reprint
Some Very Common Sicknesses
( from WTND, pp 181 to 216 )
* David Werner English
2.50
0:19
Reprint
Sicknesses that are Often Confused
(from WTND, pp 25 to 33 )
e David Werner English
1.00
0:20
Reprint
Skin Problem
(from WTND, pp 235 to 2S7 )
R David Werner English
2.00
9:21
Reprint
The Teeth, Gums, and Mouth
(from WTND, pp 273 to 276)
« David Werner English
1.50
D:22
Flash
Card
Tuberculosis is Curable English
& Hindi
10.00
D:23
Slides
Tuberculosis
is Curable English
& Hindi
15.00
0:24
Reprint
The Urinary System and the Genitals
( from WTND, pp 278 to 288 )
* David Werner English
2.00
D:25
Reprint
The Medicine Kit
(from WTND, pp 378 to 385 )
« David Werner English
1.00
0:26
Reprint
The Eyes
( from WTND, pp 259 to 272 )
* David Werner English
1.50
D:27
Flash
Cards
Control of TB
25.00
D:28
Flannel
graph
Early Signs of Leprosy English
Title and Author
English
6
30.00
Code
number
medium
Title and Author
Price
in Rs.
D:29
Flash
Card
Flash
Card
Hands that Feel No Pain English
25.00
Head Lice English
& Tamil
25.00
D:31
Flash
Card
Painless Feet English
& Tamil
25.00
D:32
Flash
Card
Prevention of Diarrhoea English
25.00
0:33
Flash
Card
Prevention of DPT
25.00
0:34
Flash
Card
Ramu Recovers from Leprosy English
25.00
0:35
Flash
Card
Scabies English
i Tamil
25.00
0:36
Flash
Card
Sore Eyes English
25.00
0:37
Flannel
Graph
Typhoid
0:38
Slides
Teaching about Diarrhoea and Rehydration
English
72.00
0:39
Slides
The measles monster English
25.00
0:40
Poster
Leprosy English
8.00
D:41
Book
Leprosy Diagnosis and management
* G.K. Job, A.J. Sehapandian English
12.00
0:42
Flash
Card
Get Your Child Immunized English
& Tamil
10.00
0:43
Book
The Complete Family medicine Book
* P.C. Dandiya, J.S. Bapna, S.K. Patni
English
60.00
0:30
English
English
7
30.00
Price
in Rs.
Code
number
Medium
0:44
Book
Skin Diseases for Medical Auxiliaries.
* Behl English
10.00
0:45
Book
Twacha Ke Rog
* Behl Hindi
10.00
0:46
Slides
Cold Chain
- target diseases English
24.00
0:47
Slides
Common Oral Diseases English
24.00
0:48
Slides
Diarrhoea Management English
24.00
0:49
Slides
Goitre and Cretinism English
24.00
Title and Author
English
D:50
Slides
Leprosy
0:51
Slides
0:52
Slides
Malnutrition in an Urban Environment
English
Malnutrition in Indian Children English
24.00
0:53
Slides
Management of Kwashiorkor English
24.00
D:54
Slides
Natural History of Childhood TB
24.00
0:55
Slides
Periodontal
0:56
Slides
Protein Calorie Deficiency English
24.00
D:57
Slides
Primary Eye Care English
24.00
0:58
Slides
Xerophthalmia English
24.00
0:59
Book
Symptom Treatment Manual
c M. Bomgars English
6.00
24.00
English
Disease English
24.00
24.00
4. ENVIRONMENTAL HEALTH
EH:1
Book
How to Make and Use the Nada Chulha
* Madhu Sarin English
8.00
EH:2
Book
Nada Chulha Kaise Bhanayen
Opayog Karen
8.00
* Madhu Sarin Hindi
8
aur
e
Price
in Rs.
Code
number
Medium
EH:3
Book
Nada Chulha
- a handbook
* Madhu Sarin English
15.00
EH:4
Book
Nada £hulha
* Madhu Sarin Hindi
15.00
EH:5
Poster
Nada Chulha Apnaiye Hindi
1.00
EH:6
Poster
Nada Chulha ka Pura Fayada Uthaiye Hindi
1.00
EH:7
Flash
Card
Prevention is Better Than Cure English
& Tamil
25.00
EH: 8
Flash
Card
Do’s of Cookings Hindi &
English
10.00
EH:9
Book
A Growing Problem
- Pesticides and the third world poor
* David Bull English
60.00
1.00
Title and Author
5. FAMILY WELFARE
FW:1
Reprint
Family Planning
- having the number of children you want
(from WTND, pp 330 to 340)
* David Werner English
FW:2
Flash
Card
Family Planning the Easy Way Tamil i
English
FW;3
Flash
Card
How Life Begins
- on sex education
FW:4
Flannel
graph
Modern Methods of Family Planning
30.00
FU:5
Flash
Card
Pramila Grows up
25.00
Fid: 6
Flash
Card
The Cost of An Another Child
25.00
FW:7
Slides
Contraceptive Devices
9
Tamil &
English
English
25.00
25.00
24.00
Code
number
Medium
Price
in Rs.
Title and Author
6. HEALTH COMMUNICATION
HC:1
Leaflet
Aiming and Teaching at What is Most
Important
(From HHWL pp. 5-9 to 5-11)
* David Werner English
1.00
HC:2
Book
Manual of Learning Exercises
* Ruth Harner, Lynn Zelmer English
15.00
HC:3
Book
Helping Health Workers Learn
* David Werner, Bill Bower English
72.00
HC:4
Leaflet
A Learning from, with, and, about the
Community
(from HHUL, pp. 6-6 to 6-17)
David Werner English
1.00
41.00
HC:5
Slides
Learning through Role Playing
HC:6
Slides
Learning to Draw and Use Pictures English
72.0
HC:7
Slides
Home-made Teaching Aids Principles and
Examples English
80.00
HC:8
Slides
Teaching Ideas Using Flannel-Boards English 50.00
HC:9
Book
Mahilaon Ke Liye. Anaupcharik Shiksha
Tatha Aaya Vriddhi
* J.T. Nayak Hindi
15.00
HC:10
Slides
Communication in Health English
24.00
English
7. HEALTH RECORDS
HR:6
Book
A Manual on Health Records English
6.00
HR:13
Apprpte
Techgy.
Anaemea Recognition Card All Indian
languages,
English &
Nepali.
1.00
HR:1
Card
Child Health and Weight Record
0.35
HR:7
Card
Eye Records Hindi,
English i
Punjabi.
0.35
10
Price
in Rs.
Title and Author
Code
number
Medium
HR:4
Card
General Records for School Children
and Adults All Indian
languages,
English i
Nepali.
0.35
HR:9
Card
Immunization Record English
& Hindi
0.15
HR:10
Card
Insert and Continuation Card to go
with other Records All Indian
languages
0.15
HR:12
Card
Married Women's Health Record English
& Hindi
0.35
HR:2
Card
0.35
HR:3
Card
Mother's Record for Pregnancy and After
All Indian
languages
T8 Records Oriya,Telugu,
Hindi,Marati,
Malayalam,
Nepali,kannada
Bengali,and
English.
HR:O
Cover
Plastic Cover for Health Records
0.25
0.35
8. NUTRITION EDUCATION
NE:1
NE:2
Flash
Card
Apprpte.
Techgy.
Feeding Your Baby English
& Hindi
Mid-Arm Circumference Measuring Tape
All Indian languages
10.00
Strip
1.00
NE:3
-do-
Mid-Arm Circumference Measuring
NE:4
Book
NE:5
Slides
Manual for Child Nutrition in Rural India
English
More about Child Care
- child care before birth
- diagnosis of under nutrition
- causes of under nutrition
- treatment of under nutrition English
11
2.00
14.00
55.00
Price
in Rs.
Code
number
Medium
NE:6
Reprint
Nutrition
- what to eat to be healthy
(from WIND, pp 125 to 153)
0 Dauid Werner English
2.50
NE:7
Flash
Card
Super Porridge English
A Hindi
10.00
NE:8
Flash
Card
Baby’s Diet from Birth to One Year
English
A Tamil
25.00
NE:9
Flash
Card
Flash
Card
Balanced Diet for the Family English
25.00
A Tamil
Better Nutrition Healthier Nation English
25.00
NE:1O
NE:11
Flash
Card
Title and Author
A Tamil
Supplementary Feeding for Babies Hindi
10.00
NE:12
Book
A Manual of Nutrition English
2.50
NE:13
Book
Menus for Low Cost Balanced Diet and
School Lunch Programme
English
2.00
NE:14
Book
5.00
NE:15
Book
Nutrition for Mother and Child
■ P.S. Venkatachalam English
Nutritive Value of Indian Foods
* C. Gopalan, Rama Sastri,
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HEALTH FOR THE MILLIONS is the official VHAI magazine
published every two months (6 times a year). Extensive and
indepth coverage is given to a health topic in every issue of
the magazine. Nearly 3,000 copies are circulated among
health professionals, activists and resource centres. Besides
very useful articles, the magazine also carries news from the
State VHAs, job opportunities, training programmes, new
publications and other useful information.
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VHAI
VOLUNTARY HALTH ASSOCIATION OF INDIA assists in
making community health a reality for all the people of India, with
priority for the less privileged millions, with their involvement and
participatioin, through the voluntary sector.
VHAI is a federation of voluntary health associations at the level of
States, Regions and Union Territories, linking over 3,000 health
institutions and community health programmes. Its services are also
available in non-affiliated areas.
Membership in VHAI and opportunity for its services are in principle
open to all health institutions and associations in the voluntary, non
profit sector of health care irrespective of religious affiliations.
VHAI is a non-profit registered society. Its constitution is secular. It helps
people to develop or extend community health services, or to add a
community health component to general development projects.
VHAI educates the public on rational drug therapy, oral rehydration
therapy, the value of mother and child welfare.
VHAI is now venturing into wide public education through mass mailing
of literature and health messages to both the health professionals and the
general public.
VHAI publishes books, pamphlets, flashcards, flannelgraphs, filmstrips
and slides.
VHAI collects, sifts, screens and distributes suitable health learning
materials from all over the world.
VHAI trains various groups in producing health learning materials.
VHAI provides information on various health and related issues and
trains various groups in information collection, documentation and
dissemination.
EDITORIAL INTERAMERICANA LTtJA
A TRAINING
WITH WOMEN'S
Many of you zoill have missed receiving the Health
Bulletin for nearly a year. This prolonged silence has
been difficult and detrimental for us too. We went
through a. long period of financial uncertainty, which
made it impossible for us to maintain the continuity of
this important communication. But now we're back
and, with the support of the International Council for
Adult Education, we hope to strengthen the Health
Network and move ahead
with publications and encounters.
This Newsletter N-14 contains all the information
accumulated since the end of last year, with the
exception of news and announcements that are now
out-of-date. It does include, however,
a substantial list of bibliographic references
and educational materials.
We hope to stay in touch, and we are always at your ■
disposition, ready to receive your contributions for the
next Health Bulletin.
The Health Area of the Manuela Ramos
Movement stems from our work in sexual
education at the beginning of the 1980's. We
approached the issue of sexuality in basic
courses for low-income women in the
marginal neighborhoods of Lima, because
we considered sexuality to be one of the
pillars of gender oppression.
In 1987, we began working in the Health
Area from a broader perspective aimed at
responding to the health care needs and
demands of the women, we were working
with. The care available to them through the
health services was inadequate due to the
lack of specific women's health programs
and community health programs that could
take advantage of women's role as health
care providers within the family.
We made a critique of existing programs
that only consider the mother-child pair, in
which women are seen only in terms of
producing" adequately rather than in terms
of their own needs. On the other hand
women's unpaid work is used, forgetting
that "health for all in the year 2000" also
includes women and therefore demands
specific actions to this end.
The Health Area of the Manuela Ramos
Movement proposes
to provide
comprehensive gynecological services;
develop an educational component that
emphasizes prevention; promote health care
actions for women at the community level
that go beyond the mother-child pair; and
help build a women's health movement
Within this framework, in 1988, we set up
the Women's Comm unity Health Service in
the San Juan de Miraflores district of Lima.
EXPERIENCE
HEALTH PROMOTERS
Movimiento Manuela Ramos
(Manuela Ramos Movement)
This primary health care program for women
is run by 18 women from thecomunity who
were trained as Women's Health Promoters.
This experience in women's health has been
incoiporatedas partof the Social Emergency
Program of the San Juan de Miraflores
District, Southern Cone of the City ofLima.
An effort is being made to expand this
experience and broaden some of the services
by setting up a "Women’s House" as a birth
center where women can be attended by
local midwives who have received prior
training.
OUR EXPERIENCE
In August 1989 we began to provide health
care for women in the Human Settlements
of Ollantay and Antunez de Mayolo, at the
Community Clinic in Ollantay.
These human settlements were chosen
because they include a low-income female
population needing health care, whose
experience of struggle and organization
provided the conditions for them to become
multiplying elements in their community.
Services provided include health monitoring,
prevention and treatment of minor injuries.
All cases requiring more specialized care
are referred to the clinics or hospitals of the
Health Ministry. These include medium and
high-risk pregnancy, tuberculosis and
infantile malnutrition.
Making referrals presupposes constant
coordination with the health services in the
area, which has not been fully achieved due
to resistence on the part of both health
service personnel and the promoters
themselves.
8^
The proposal was presented to neighborhood
leaders with whom we initialed the selection
process. All block-level social workers or
health delegates, and anyone else with any
kind of experience in the area of health,
were invited to apply. Through an evaluation
process, the women selected were those in
the community who were in the best
condition to take on the work of health
promoter.
The twenty-two women selected went
through a four-month training cycle from
May to August 1989. Topics covered
included female identity, primary health
care, community diagnosis, anatomy and
physiology, reproductive rights, birth con
trol, pregnancy, women's diseases, first aid,
firstaidkitmanagcmcntand monitoring the
growth and development of children.
Following the training, a final selection of
18 promoters was made, and, with them, the
Community Women's Health Clinic was
organized. The community provided a space
for them to work, where a series of actions
benefitting women's health arc now carried
out.
The experience began with a massive
campaign to attract the attention ofpregnant
and lactating women throughout the
community, culminating with an educational
talk for 26 of the 80 women identified in
these conditions.
The promoters are also attempting
establish a more direct relationship with
other local organizations, such as the
Neighborhood Councils and the District
Health Committee, where they are working
to incorporate women's health as an issue.
Pre-natal care consists basically of making
a nutritional diagnosis and determining level
of risk, and evaluating the overall situation
of the pregnant woman in order to identify
signs and symptoms of alarm. This involves
an initial clinical evaluation with
professional support.
The woman is then given detailed
information about her condition and dietary
rccommenations, general precautions, etc.
Iron supplements are provided, and she isreferred to local health services if slW
presents either medium or high risk
conditions.
Women for whom no risk is found continue
to receive regular check-ups during their
pregnancy and weight control check-ups
during the first six months of lactation.
Certain instruments are used by the Clinic to
maintain order in the provision of services,
and a file is kept on the health situation of
the women attended. The instruments used
include the following:
1.
A census and registry of pregnant and
lactating women, consisting of a form
used to identify such women in houseto-house visits.
ki
For this reason, we have designed a program
that considers the following components.
Involving pregnant women in observing
their own gestational process, leading
them to assume the care of their own
health and to manage information about
their bodies and their state of being.
2.
3.
A pre-natal control chart, containing
basic information about the woman and
her living conditions, criteria of
obstetrical risk, nutritional state and
follow-up of hcrpregnancy and lactation
period.
A file of all the women attended by the
promoters,
indicating
their
characteristics and follow-up provided.
4.
A pre- and post-natal control card, given
to each client, that includes her basic
health data, appointments and referrals
when necessary.
5.
A weekly client list of the women
attended during that period, used to
prepare progress reports on the clinic for
the health center.
'
In one trimester, 265 people received
attention out of a total of 300 families in the
two settlements closest to the clinic.
Services most frequently provided are for
pre-natal care, birth control and different
types of vaginal infections. Less frequent
services include growth and development
monitoring of children, first aid and
respiratory infections.
7. Ultimately, de-medicalizing health care
through the recovery and useoftraditional
medicine.
OUR METHODOLOGICAL
PROPOSAL
We see training as a permanent ongoing
process and as the product of frequent
interaction between the people we work with,
those that administrate the program and the
women that we want to reach through the
program.
OUR PROPOSAL: HEALTH AND
WOMEN
An interpretation of the reality of health
from a women's perspective implies valuing
ourselves differently as health subjects. This
requires recovering our everyday knowledge
of what it means to provide health and being
able to put this into practice through a
program and a service that puts fundamen
tal emphasis on self-help and self
examination by and for women.
Improving the situation of women’s health
requires making significant changes, both
in the health services and in questioning the
living conditions and the marginal situation
of women in society.
We understand women's health care as
comprehensive throughout our entire life
cycle. We have given priority to initiating
our action with pre- and post-natal care,
because this isoneof the most critical periods
for women in the popular sectors, when
their serious problems are likely to become
manifest.
Pre-natal care needs to beassumed by the
community, assuring that it is provided
by trained women, incorporating
adequate technologies, and usinga variety
of educational activities.
3.
Recovering and according real value to
women's knowledge about themselves
by including traditional midwives in
childbirth care, given that they currently
assist20% of births in the neighborhoods.
4.
Coordination with official health services
must be sought to obtain support for the
implementation of primary level care
and to generate a system of information
that creates awareness of women's
specific health needs.
We are a part
As a team, accompanying the promoters in
the administration of a community health
service program, we are part of the group to
the extent that we share the same needs,
health problems and demands in termsofour
gender, although recognizingour differences
because we belong to distinct social groups.
Going from Manuela Ramos to accompany
the health promoters in their daily work is
necessary, especially in the initial phase.
However, we also want them to generate
their own relationships with the different
groups and organizations in the
5. Providing neighborhood organizations neighborhood, the district and the country,
with diagnostic elements on the situation avoiding as much as possible a dependent
of women's health, leading to changes in relationship.
the quality of life and the social value
accorded to women as people.
This means that from time to time, the
6.
health team needs to take time to reflect,
Recognizing women's work as health restate and unify some basic concepls.
agents by paying them for their work as
give continuity and creativity to our
promoters.
activities.
Knowing the social context
We begin by studying the socio-economic
and cultural conditions and characteristics
of the population that will be reached by this
experience. The promoters have been trained
to do this through the preparation of a
diagnosis of the human settlements in which
they work, that will provide us with
knowledge about the living conditions and
thespecific needsof the women, particularly
in relation to their health problems.
These diagnoses are presented to the
Neighborhood Councils so that they will be
aware of the issue and propose the best
solutions.
Training is an ongoing activity
Our educational action is conceived as a
continuous process with three clearly defined
periods:
An initial training period in which the most
important issues for opening the Community
Health Service are developed.
Training in action, learning by participating
in the daily activities of the Clinic, in which
the promoters, the women from Manuela
Ramos and the clients all gain expertise in
specific women's health issues. It is in this
phase that we put most emphasis on
recovering the women's own knowledge
about health.
Nevertheless, we have found a space and a
time. We get together on Mondays, bringing
our children, and we talk about ourselves,
tell our stories, reflect on the work we have
done all week and
discuss a topic that we want to know more
about. At the last meeting, the promoters
said, "We can't miss a Monday, because this
time is ours and we're learning...nobody has
permission to be absent''
An easy task
We know how difficult it has been for many
women to understand their teachers in
school, so removed, such difficult language,
so hostil, etc. This situation often contributed
to a rejection of school and education, which
interfered with being able to defend our
right to information and knowledge.
This is why we want our training to be
assumed as a moment in which we come
Responding to women's needs
Our program aims for women to achieve or
recover the possibility for self-examination
and self-help in caring for their own health.
We realize, however, that this is a long
process that begins with women's most
urgent needs and demands. This is why our
work in the Community Clinic began with
providing care for pregnant and lactating
women. This is the period in which the
problemspertainingto their health and living
conditions become most evident and in
which they are most receptive to learning
about their bodies, as part of an effort to
improve their living conditions and recover
their sense of value as people
Time and space
All women perform many tasks in the course
ofa day, especially in times of crisis like the
present. We participate in community
kitchens, in mothers’ clubs and in
neighborhood organizations; we do
housework and paid work, etc. There are so
many demands on our time that we are
frequently distracted and uninterested in
education.
together to share our life experiences, lose
the fear of speaking out, be able to touch
what we didn't dare touch before, know and
control our bodies, express our feelings,
laugh, cry, etc.
Our techniques
We use whatever initially enables us to
break the ice and achieve good
communication, such as an interview;
activities in which everyone can participate
and that don't make unnecessary distinctions
between certain people, such as working in
small groups; activities that encourage us to
express our feelings about a subject as well
as our knowledge, such as dramatization^
and, to keep active and not get tired, we
think it is important to introduce elements
like music and games that make us move, or
dynamics to break the routine.
CHOLERA EN PERU: EXPER
As of April 1991, cholera had caused the
death of 1,088 people in Peru, with nearly
150,000 cases officially reported. In the
following weeks, the epidemic reached
Brazil and Chile, while cases continued to
multiply in Ecuador, Colombia and Bolivia.
The Director of the Pan American Health
Organization, Carlyle Guerra de Macedo,
predicted in Lima that the epidemic would
. probably affect 6 million people in Latin
.merica, 42,000 of whom would die in the
best conditions of care.
We are not going to expand here on the
■socioeconomic considerations that led to
the appearance and spread of the epidemic.
Nor will we analyze the medical components
of the problem. Rather we will attempt to
reflect on some of the experiences that have
accumulated during the first 12 weeks of the
epidemic in Peru, at the time of this writing.
/
The social response to cholera deserves an
initial reflection. There is no precedent for a
health problem that has brought death to
such diverse sectors of the population. The
educational sector has given its foremost
attention to children's health. Popular
grassroots organizations, organized labor,
A ivil institutions and non-governmental
organizations have worked together with
local government bodies and the health
sector to meet the challenge. Many agents
that, prior to this problem, would not readily
have been willing to work with some of the
others, have done so, thus gaining common
ground and coordinated work experience
that we will attempt to build on in the future.
Much of this permeability has also come
about by clearly recognizing the undisguised
social determination of health, a recognition
shared on all sides. The intricate relationships
between production, economy and health
were also clearly delineated.
One important element in this process has
been the participation of thecommunications
media. During the first three weeks, radio,
television and the press gave detailed
Pedro Mendoza Arana
Physician, Coordinator of the Health Promotion Program,
Centro "ALTERNATIVA". Lima, Peru. April 1991.
coverage to the progress-although slight at
that timc-of the disease, as well as to the
preventive measures to be taken by the
population. This constituted a display of
forces that demonstrated the tremendous
potential of the mass media for taking action
in the area of health. Nevertheless, when the
"ceviche war" was unofficially declared in
the middle of February, the press opted not
to opt; that is, it covered up information and
thus contributed to the generation of a false
image of a "problem overcome", as reports
were reduced to Sunday updates or small
charts.
In effect, both morbidity and mortality from
cholera doubled in the next eight weeks,
after which, due to the spread of the disease
internationally, it recovered space as news.
An unavoidable element in this massive
information effort was the appearance of
"experts" on the subject, each pretending to
contribute his/her version or emphasis to
the dispersion of information, including
some who took advantage of the situation
for their own self-promotion. As a result,
there were moments of great variety in the
messages, many of which were
contradictory, which was negative at such a
time. In other areas, this criteria operated
from the very beginning.
The non-governmental organizations
working in health, grouped in the Intercenters
for Health, perferred, despite discrepancies
with official messages, to subscribe to them,
precisely to avoid double messages, and to
voice our observations about them in the
Communications Commission of the
Cholera Emergency Committee in the
Ministry of Health, where we helped design
the information campaign. However, the
material printed by the Ministry and
UNICEF was insignificant in the face of the
informational needs, given the official
sector's emphasis on the cost of care for the
ill.
A correct strategy would have been (and
could be used in other countries) for the
Communications Office to centralize or
expedite authorization of educational
messages for dissemination, taking
maximum advantage of news media space.
One training session for journalists was
essential, given that the resources available
for advertising space was totally insignificant
compared to the volumn and penetration of
distorted information that could circulate
simultaneously.
COURSE IN HEALTH EDUCATION AND PROMOTION, ENGLAND,
recommendation disregarded two essential
considerations. One, that for the Peruvian
population,fishisthemosteconomical source
(and for a large sector, the only source) of
. protein; the other, that an important item in
our domestic and international economy
depends on fish. In the days that followed,
we wimessed the mobilization of the fishing
sector, demanding that the Slate respond to
their crisis. In one meeting, we maintained
thcimportanceofapromptcounter-campaign
to modify the message; the focus should
have been, "Eat fish fried or braised." But
this correction was made very weakly, and
Liverpool School of Tropical Medicine. Department of International Community
& Health.
& A 3-month course on health education and promotion oriented toward people with some
a experience in the field. Aims to provide health promoters with skills in creating,
thcPrcsident, in response to the fishing sector,
had no better idea than to publicly
demonstrate that ceviche wasn't harmful by
personally eating a plate of raw fish before
the TV cameras. Conclusions: one Health
Minister deprived of authoritiy, a
disaccredited health sector, and cholera full
managing and evaluating health education/promotion programs.
The first course will begin in January 1992.
More information: The Course Organiser (Health Education/Promotion for PHC).
Department of International Community Health, Liverpool School of Tropical Medi
cine. Pembroke Place L3 5QA, England.
$
ft
ft
steam ahead.
Q
A third element is the approach to be used
with food handlers. Several municipalities
resorted to repression toward this
phenomenon. As usual, die result has been
practically nil: food vendors on the streets
haven'tchanged,perhapsbecausethegreater
1 unit in u._
prccariousnessofthcirsituation.offersthcm
tighestlevel,while fewer possibilities for joining the fight
Another priority, for the same reasons,•'"cion
is the
against cholera. The experiences of several
organizationshas shownthatan efforttoward
designation of a command unit in the Anti
CholeraCampaign,atthehighestlcvel,while
co-management is more useful in
avoiding or carefully managing tension
discovering the contributions that each so
between sectors. Information management
le,v
cial agent is able to make. The food vendors
again demonstrated its capital role. In fatal,
the
-paradoxically, the informal workers
Peruvian experience, initial confusion and
(organized) more than the formal workers
the slight importance given to socio
Salaried, but unorganized)- are modifying
' - <>nd making proposals for
economic factors of the problem were 1Any
measure
taken
at the
beginning
of and
the ,(sa
epidemic
should
have
been
understood
’
. f and maK1
>lb--"'experience
ran cxpei
elaborated (to be maintained) as a long-term thc^causc
1S also
to take advantage of.
meaSUie‘
,
fish issue-
- This is elearh pirated by
ic,atmd
During *
e f«st week of theep'd
and
previously mentioned conf
lhc
message,
aZ-
Q
NEWS
5 Popular participation in health: new agents and new challenges, based on the
experience of promotion and popular education in Peru. This work was presented by
CESIP of Lima and is the product of a process of reflection among several
institutions.
NETWORK WORKSHOP
6.
A workshop on PARTICIPATION AND TRAINING FOR LOCAL DEVELOPMENT
IN HEALTH was held during the second CEAAL (Latin American Council for Adult
Education) Latin American Assembly in November 1990.
A few days before the Assembly, 18 people representing NGO's in the region met in the
El Canelo de Nos Center. All the workshop participants had experience in the areas of
social participation and training for the development of local health systems.
The goal of the workshop was to provide an opportunity for exchange and debate on
experiences in social participation and training for the development of local health
systems in Latin America. Through this exchange, we hoped to identify key challenges
that we can confront as non-govemmental organizations, through CEA AL's HEALTH
AND POPULAR EDUCATION NETWORK.
The workshop was organized with the full participation of those attending, all of whom
had made important contributions to the planning by suggesting topics, methodologies
and special activities.
The program included the exposition of experiences by all participants, organized in
three subject areas: social participation, training, and development of local or national
coordinating bodies. The presentation of each experience was followed by a debate and
a synthesis.
Social Participation
The first part of the exchange and debate focused on experiences with social participation
in health. Presentations included the following:
From the university, a multiprofcssional experience with landless settlers in
southeastern Brazil, promoted by UNIJUI in Rio Grande do Sul.
The exposition of these six cases, in their wealth of diversity, fed an extensive debate
that brought out the concerns and challenges shared by the majority of the participants.
Rather than conclusions, issues arose that require further examination and being put to
the test in a variety of social and sanitary' realities.
* The Right to Health: the question was raised, and the tension recognized, between
the right to access to public services and the demands on the State or self
management policies. Self-management strategics are conceived as spaces for
learning and organization, developing initiatives that enable the population to
demand their rights.
* New actors in the practice of social participation in health: to the extent that new
actors become incorporated, roles and identities need to be further clarified,
especially between organizations, monitors, NGO's, and public functionaries and
services.
* The definition of the NGO's role is a constant concern, especially if this is a role
based on relationships with the Slate and social organizations; but this challenge is
also latent in its own practice. The debate has cropped up recently in different
countries in the region; however, the concern remains, probably due to the impact
of social and political changes on die activities of civilian social organizations.
* The popular health movement: the debate on this issue needs to be furthered and
studies undertaken to show its real dimension and potential. The "popular health
movement" can mean many things without there being common or shared reference
points. A number of questions were raised about the movement's presence, identity,
projections, limits, challenges.
A participatory diagnosis with indigenous communities in Mexico, a program
carried out by "Health in the People's Hands". This work involved twenty groups in
seven regions of the country. It’s goal has been to support training processes in
primary health care, promote encounters and link-ups between different health
groups in indigenous communities, and strengthen the popular health movement in
Mexico.
* The presence and leadership of women: the contribution being made by women in
2.
Support the development of neighborhood clinics in Montevideo. The CLAEH
(Latin American Center of Human Economy) is providing support to organized
neighborhood groups for setting up a clinic.
community level, adjustments m power relationships, the inclusion of gender
elements in daily tasks, etc. The question always arises as to whether giving priority
to working with women is provoking new forms of exclusion and repercussions of
violence at the domestic level.
repercussions ol
3.
Contributions to a strategy for social participation in health in Chile. There has been
an effort to systematize and draw up proposals for unleashing a process of social
participation in health policy during the period of transition to democracy.
1.
4.
A critical analisis of the work of private social development institutions, presented
as a collective reflection by UNICRUZ (a coordination of NGO's in Santa Cruz,
Bolivia). Raised a series of questions about the intended purposes, practices and
tensions in health promotion projects.
developing strategies for social participation have a qualitative and quantitave value
as yet unmeasured. Their main contributions involve die gender dimension new
forms of management, the permanent articulation between public and private the
incorporation of subjective aspects. However, more exploratory work is neezled’that
will show the impact of incorporating women in primary ca7e^civS at die
* New contributions to strategies for social participation, accumulate
• P ,hP
role of NGO's, strengthening of popular orgtmizations, the
±
governments to incorporate participatory practices, and the coST f S
health systems policies are aU working to create a new setting n ,
n 5
responses and contributions have also made a leap. The task a/hL
Y’
7
its magnitude and put it forward in this decade.
d 1S 10 deternune
* The challenges facing us have to do with difininc the meani™^,
participation and, from there, theconcem for
different actors that enter into this process From a nooular ed
Mol<,
*
teconlritalionsmme
Efaa„deva]uato
terms of measunng the .mpact of this process from different angles
r°
purposes. Here lies the challenge of integrating the nature and meaning of popular
education in different types of programs.
°f
Training
In the second part of the workshop an exchange and debate were organized on training
experiences for local development in health. The following experiences were presented:
1.
A pedagogical proposal for popular action in health, presented by a group of NGO's
in Colombia, convened and led by CINEP in Bogota.
2.
A training experience with women's health promoters, carried out by the Manuela
Ramos Movement in Peru, starting with an experience in sexual education developed
by the institution.
3.
Support for organization and training in health, in the context of diedemocratization
and decentralization process carried out by the Montevideo city government; an
experience developed by the Aportes-Emaus Group.
4.
Training of a variety of actors in one community toward initiating development of
local health systems, carried out in Chile by PIIE (Interdisciplinary Educational
Research Program) and by the CEAAL Health Network.
5.
Training of human resources in community health, carried out by CODESEDH
(Commission for the Defense of Eithics, Health and Human Rights) in Argentina.
This experience sums up a long history of thought, reflection, encounter and the
constitution of a popular health movement in Argentina.
6.
A community health program in Venezuela, developed by CESAP, involving an
approach to health promoter training, implementing acampaign against malnutrition,
setting up popular dispensaries, and supporting the organization of health
professionals.
* Looking at training strategics in relation to processes of popular participation. In this
perspective, their intended purposes is political and social in nature. Training
experiences should give priority to articulation between different actors, in a way
that creates favorable condi lions for strengthening processes of social participation.
Several important challenges were then highlighted for consideration by the different
programs:
* Systematization of training practices, taking into corisideration the objectives,
content, pedagogical processes, subjects involved, role of educators. Alternatives
need to be identified for evaluating and measuring the impact of the training
practices and their achievements-those expected as well as those unimagined. } 4
*
Reflection on the role of NGO's working in association with state institutions and
universities in order to define their specific contributions and identify challenges. In
this new setting, new purposes are intended, development occurs on a higher scale
and at a different rhythm, a variety of social actors are involved, and classic
parameters are used for evaluation. The question now arises as to how to translate
and apply the proposals of popular education in a different context.
* Maintain a process of reflection on pedagogical processes, specifically learning
processes in the areas of health and daily life. It is also important to resume thedebate
on the tension between the different forms of knowledge and representation of
problems, that is, the articulation between technical and popular knowledge and the
construction of new knowledge.
WORKSHOP PARTICIPANTS
7.
Trainingwithwomenin theEl AltoscctorofLaPaz.carriedoutbyCIDEM.Presents
the systematization and evaluation of a period of training and support of organized
women in popular neighborhoods.
The presentation of this experience led to a debate on the contribution of framing
programs and the specific contribution of popular education in strategies for local
development and primary health care. As a result of this exchange, some ol the
central elements of the nature of training work could be identified, including the
following:
Recognition of the importance of associated work in training programs, whether
between different NGO’s, with universities, health services or others.
* ^understandingoftrainingasan interventionstrategy
this presupposes a pedagogical process in a broader area ot worK,
Institutions
Country
CLAEH
CODESEH
UNICRUZ
PRAXIS
CIAC
CESIP
UNIJUI
MANUELA RAMOS
EMAUS
CINEP
CESAP
CIDEM
INFOCAP
PIIE
SO1NDE
SERVICIO SUR
CAUQENES
URUGUAY
ARGENTINA
BOLIVIA
MEXICO
DOMINICAN REPUBLIC
PERU
BRAZIL
PERU
URUGUAY
COLOMBIA
VENEZUELA
BOLIVIA
CHILE
CHILE
CHILE
CHILE
CHILE
NETWORKS AND COORDINATORS IN DIFFERENT PARTS
OF LATIN AMERICA
planned for reflection on popular education, primary health care and participation. An
evaluation is scheduled soon in order to define the profile of this coordinating effort, in
general, it has been recognized by the NGO's. There has been a tacit relationship with
CEAAL; the groups have preferred to follow their own paths and in the future establish
ties with the CEAAL network.
The workshop included a debate on the CEAAL Health Network, its potential and
challenges. A presentation was made on the situation of the networks, coordinators or
collectives that have been set up in different countries. The following is a summary of
the principal conclusions:
8. BRAZIL: there arc no health networks at the national level, only strong national
institutions with a great deal of presence that join intellectuals and academics. At the
local level, UNIJU1 maintains contact with CEAAL, but there is a need today to improve
1. VENEZUELA: different networks have been set up in different states; it hasn't been
possible to create a national network. CES AP (a CEAAL affiliate) has given priority to
internal coordination, since it already has programs in different states, making ties with
other institutions and participating in a network organized by UNICEF and universities.
The group has opted for participating in several processes, rather than tairing leadership
itself. These different existing networks are not part of CEAAL, but the link could be
made at the right moment.
9. DOMINICAN REPUBLIC: coordination between health NGO's is quite recent, but
there is enthusiasm, and there have been some important achievements. CONGA serves
asa coordinator, bringing together institutions with social interests. The health initiative
is recent and a program is in preparation. There is experience with territorial and issue
coordination, always arising out of a felt need.
MEXICO: there is a Popular Health Movement that joins more than 600 groups,
which maintains an ongoing debate on heal tit policies and the role of the popular health
movement. They have established arelationship with the state apparatus; the relationship
with the universities is precarious; the NGO's arc divided and dispersed. This movement
is self-financed; solidarity and volunteer work prevail. The relationship with CEAAL
was at first marked by distance and mistrust that has given way more recently to certain
interest.
the articulation and thrust in this relationship.
2.
3.
CHILE: the NGO's lack coordination as such; some coordination exists at the
territorial level and around specific tasks in which there is common interest. In the
present democratic context, work is being carried out in association with the public
health services and social organizations. There is interest in greater coordination, but the
process is slow after a long period of isolation.
BOLIVIA: there are four national networks that were founded as spaces of institutional
defense, each one following a certain ideological line and its own objectives. There is
also a national federation of health NGO's, which in turn has regional associations. This
is a very broad organization united exclusively around the aspect of "health"; so broad
as to be somewhat unmanagable. Two networks in particular maintain a relationship
with CEAAL: UNICRUZ and AIPE.
4.
5. COLOMBIA: there arc regional coordinators but none that constitute a network.
CINEP has convened a group of NGO's with related interests for coordinating activities
and working together to provide support for grassroots health groups. This has led to
joint experiences. They maintain tics with CEAAL.
6. PERU: "Intercentros Salud" was set up in 1988, joining twenty non-gpvemmcntal
institutions in Lima. Here, the debate continues, actions are coordinated, and criteria arc
unified, especially in terms of strengthening the popular health movement and defining
perspectives for working with ministries and municipalities. Territorial "intercenters"
have been formed according to need. Coordinators have also been organized around the
issues of food, women and work. CEAAL maintains a relationship with Intercentros
Salud.
7. URUGUAY: in 198% several institutions called for an exchange of experiences and
further analysis of isspep
common concern. In the period since, workshops have been
CHALLENGES AND THE FUTURE OF THE HEALTH
NETWORK
\
This group of presentations facilitated the definition of the Health Network's goals in
order to set priorities for the next period. The principal agreements are summarized as
follows:
The meaning and perspectives of the Health Network were defined as follows: a Latin
American organization, capable of promoting debate and encounter; facilitating the
processes of systematizing experiences in health and popular education; and proposing
related policies and programs.
Priority has been given to tasks in the following fields:
-
Communication and dissemination: this area includes primarily the Health Bulletin
and the Experience Bank. Both areexpected to make strides in the course of this year.
’
Lraj.ning:
C°UrSC is P'anned for 1991 on "Systematization and Policy
Making in Health . A group of people from CESIP (Peru) and CINEP (Colombia)
arc in charge of preparing this work.
'
Coordination with the Health Network: NorbertoLiwsky (CODESEDH A ruminal
andM>naMadelengoitia(CESIP, Peru) will be acting as consultants
next elecuon of the Network's Board of Directors, drawing un b ?
establishing critera for a stable relationship with national coordinator
678qnd
Bibliographic and Educational
Materials
,alW
"CONTROL OF SEXUALLY TRANSMITTED
Organization; Geneva, Switzerland, 1985.
DISEASES". World Health
This book was edited by The World Health Organization to confront the rap^
propagation of sexually transmitted diseases. It is a useful manual containing a great
quantity of information on the strategies being used to deal with the problem. It also
contains an append i x that describes methods that may be useful in prevention campaigns
for these types of disease.
Available from: Office of Publications, World Health Organization, 1211 Geneva 27,
Switzerland.
"AIDS. PREVENTION AND CONTROL." World Health Organization and the
Pergamon Press; London, England, January 1988.
This publication is a product of the international conference, World Summitof Ministers
°f Health on Programmes for AIDS Prevention, organized by the World Health
Organization and the British government. It contains a variety of AIDS prevention
experiences from all over the world, indicates which general strategies are being used,
technical aspects, the role being played by health workers and a general analysis of the
issue.
Available from: Pergamon Press pic., Headington Hill Hall, Oxford 0X3 OBW,
England.
'
pPE0PLE- FREEDOM AND FERTILITY." International Planned Parenthood
1990rati°n <-IPPF): Vo1' 17 ■ No-4- Edited in English and French. Birmingham, USA,
People is an international magazine reporting on programs; bear g
family planning and development field. It contains arucles on different
this area from around the world.
.
tjsA.
Available from: People, P.O. Box 1584, Birmingham, AL
fences in
"AIDS WATCH." International Planned Parenthood Fcderatio t^
■ n CIPPF)' No. 12.4th
Quarter. Published in English, French and Spanis . on
.
This publication shows the progress that has been mad .
treatments that AIDS
confront the rapid propagation of AIDS, as well as 1
victims are currently receiving.
_ London KYI 4LQ. EnS an
Available from: IPPF Distribution Unit, P.O. Box / •
"FORUM." Vol. 6 No. 1, edited in English and Spanish, New York, USA, January
1990.
This isa magazine edited by the IntemationalPlannned Parenthood Federation, Western
Hemisphere Region, Inc. It covers different experiences and activities being carried out
in family planning in this hemisphere, and also includes a section of principal news items
about the Federation.
Available from: International Planned Parenthood Federation, Western Hemisphere
Region, 902 Broadway, New York, N.Y. 10010, USA.
"AIDS ACTION." Appropriate Health Resources and Technologies Action Group
Ltd. (AHRTAG); Issue 11, London, England, August 1990.
This publication contains information about AIDS prevention programs and how AIDS
is being combatted. It describes di fferent experiences carried out to combat, prevent and
control the disease.
Available from: AHRTAG. 1 London Bridge Street, London SEI 9SG, England.
"ANNUAL REPORT 1988." International Planned Parenthood Federation, Western
Hemisphere Region, Inc. Edited in English and Spanish, New York, USA.
An evaluation of the activities carried out by the Federation's associates during 1988.
Analyzes strategies and achievements in family planning, AIDS prevention and care,
work with adolescents, etc. Discusses which goals were reached, principal experiences
and perspectives for the following year.
Available from: International Planned Parenthood Federation, Western Hemisphere
Region, Inc., 902 Broadway-lOth floor, New York, NY 10010, USA.
"CRECIENDO." Asociacion Salud con Prevention; Bolctfn Informative; quarterly
publication, Vol. 1 No. 4, Bogotd, Colombia, April 1990.
Publication dedicated to the subject of adolescent health and prevention in Colombia.
Includes experiences working in the areas of sexuality, reproduction, contraception and
in general a variety of articles related to the issue of Colombian youth.
Available from: A.A. 56192, Bogota, Colombia.
MATERIALES ASOCIACION SALUD CON PREVENCION; Bogotd, Colombia.
This Association has published a series of sexual education pamphlets for adolescents.
Titles include "Mdtodos anticonceptivos," "El cond6n y el espermicida," "Hablemos de
responsabilidad sexual."
Available from: Asociacion Salud con Prevcncidn, Calle 54, No. 10-18, Oficina 901,
Bogota, Colombia.
"EARTHWATCH." International Planned Parenthood Federation (EPPF); No. 40,4th
Quarter. Edited in English, French and Spanish. London, England, 1990.
Earthwatch is a magazine about programs carried out in Asia on the theme of man-andthe-environment, the harmonious relationship between these two factors, ecological
programs, optimum use of resources, etc.
Available from: IPPF, P.O. Box 759, Inner Circle, Regent's Park, London NW1 4LQ,
England.
"WOMEN AS PROVIDERS OF HEALTH CARE." World Health Organization;
Geneva, Switzerland, 1987.
This book was written by H. Pizurki, A. Mejia, I. Butter and L. Dwart; it analyzes the
different roles played by women as important agents in promoting health. Discusses the
contributions of women, both in formal and informal health settings, their contribution
to national development and their status in this area.
Available from: Office of Publications. World Health Organization, 1211 Geneva 27,
Switzerland.
"MUJER/FEMPRESS." Latin America; No. 109, November 1990.
Mujer/Fempress is a monthly publication designed to expedite communication among
women. It is a Latin American magazine that contains a variety of articles on thc^_
condition of women in the continent, their work and their demands.
Available from: Mujer/Fempress, Casilla 16-637, Santiago 9, Chile.
"TEJIENDO NUESTRA RED." Year 2, No. 5, Quito, Ecuador, November 1990.
This magazine, edited by the Women's Popular Education Network
information about what is happening in women's popular education in
Drincjpa]
programs being developed, experiences, activities, intemationa eve
publications.
" WOMEN’S HEALTH JOURNAL." Latin American and Caribbean Women s Health
Network, Isis International; No. 17, Santiago, Chile, January-March 1990.
This magazine about the work of women in the area of
- s at the local
Programs,campaigns,etc.being carried outbywomenshealthorgmitza
and community levels, in medical centers and governmen
Santiago, Chile.
Available from: Isis International, Casilla 2067, Corrco
^OTHERS AND CHILDREN.” Vol. 9 No. 3. Edited in French, English and
Spanish; Washington, D.C., USA, 1990.
This is a bulletin about infant feeding and maternal nutrition. It is edited by the
Documentation Center on Infant Feeding and Maternal Nutrition of the American
Public Health Association. The bulletin contains documents, news, experiences and
bibliography on the subject.
Available from: Clearinghouse, American Public Health Association, 1015 15th St.
NW, Washington, D.C. 20005, USA.
"A GUIDE TO NUTRITIONAL ASSESSMENT." World Health Organization;
Geneva, Switzerland, 1988.
Written by I. Beghin, M. Cap and B. Dujardin, this is a guide for use by health workers
in combatting malnutrition. It discusses important methodologies for use in prevention
programs.
Available from: Office of Publications. World Health Organization, 1211 Geneva 27,
Switzerland.
" CONSUMIDORES Y DESA RROLLO." Regional Office of IOCU for Latin America
and the Caribbean; Year IV - No. 7, Montevideo, Uruguay, September 1990.
Consumidores y Dcsarrollo is a publication containing news and information about the
activities of the IOCU. The news section reflects the work being done in Latin America
and the Caribbean around the issue of consumer protection and development.
Available from: IOCU, Regional Office for Latin America and the Caribbean, Casilla
10993, Sue. 2, Montevideo, Uruguay.
"LA CHACRA. PROGRAMA DE HUERTOS." Centro de Investigacidn y Promocidn Educativa y Social (CIPES), Buenos Aires, Argentina.
An illustrated brochure explaining how to start a vegetable garden, basic varieties,
primary techniques and methods of household gardening.
Available from: CIPES, Sede Central, Zabala 2677, (1426)Buenos Aires, Argentina.
"PARA QUE NUESTROS HUOS CREZCAN Y VIVAN SANOS." Intemaional
Baby Food Action Network (IBFAN); Montevideo, Uruguay, October 1990.
Complete informational material about breastfeeding and infant feeding. Contains a
series of leaflets explaining the importance of breastfeeding for adequate infant
nutrition.
Available from: IBFAN c/o IOCU, Fax. 00592 - 950216. Casilla de Correos 10993.
"NEWSLETTER FROM THE SIERRA MADRE." NQ. 21, California, USA, July
1990.
Edited by The Hesperian Foundation, this newsletter contains important testimonies
about experiences in health education and programs designed to seek local solutions to
health problems. All these experiences are related to programs carried out in small towns
in western Mexico.
Available from: The Hesperian Foundation. P.O. Box 1692, Palo Alto, California
94302, USA.
"SALUD POPULAR. SUPERVIVENCIA INFANTIL." Institute de Salud Popular
(INSAP); No. 11, Lima, Peru, April 1990.
This issue is dedicated to an analysis of the situation of children in Peru. It contains a
series of articles describing strategies being used to confront basic health problems
affecting children.
Available from: INSAP, Av. Arcnales 1080 Of. 301, Lima 11, Peru.
"LETTER." The Victorian Health Promotion Foundation; No. 7, Carlton South,
Australia, August 1990.
In this magazine, the Victorian Health Promotion Foundation discusses its experiences
with health promotion programs, covering different health problems that span the life
cycle from birth to death; includes articles in the areas of biomedicine, clinical research
and epidemiology.
Available from: Victorian Health Promotion Foundation, P.O. Box 154, Carlton South
3053, Australia.
"PLANTAS MEDICINALES." Ramirez, Josd F. Serie Salud Popular, Ediciones
Cosalup; Santo Domingo, Dominican Republic, June 1990.
A practical guide that uses illustrations (charts, drawings, etc.) to explain the various
uses of medicinal plants, their classification, attributes and how to find them.
Available from: Cosalup, Apartado Postal 30290, Santo Domingo, Dominican Republic.
"REFLEXION. DERECHOS HUMANOS Y SALUD MENTAL." Centro de Invcstigacion y Tratamicnto del Stress (CENTRAS); No. 109, Santiago, Chile, September
1990.
Quarterly magazine containing articles about mental health problems among victims of
human rights violations in Chile and other Latin American countries.
Available from: CINTRAS, Miguel Claro 996, Santiago, Chiie.
■^k'FOQUES EN ATENCION PRIMARIA." PAESMI - Coopcracidn Italians; Year
5 No. 2 and No. 3, Santiago, Chile, July and October 1990.
A magazine of analysis of a variety of issues in primary health care. Reports on
experiences, programs and projects being carried out in this field in Chile.
Available from: Ediciones PAESMI Ltda., Casilla 121-A, Corrco 29, Santiago, Chile.
" ACCION CRITICA." CELATS and ALAETS; No. 26, Lima,Peru, December 1989.
Semi-annual publication of the Latin American Social Work Center and the Latin
American Association of Social Work Schools. Dedicated to the promotion, reflection
and analysis of different social policies (health, education, development policies, etc.)
being implemented in Peru.
Available from: CELATS, Jr. Jorge Vandcrghcn 351,Lima 18. Apartado 1262Lima 18,
Peru.
"CORREO DE AIS." Accidn Intemacional por la Salud; Bolctin AIS-Lac, No. 11,
Montevideo, Uruguay, July/August 1990.
This bulletin contains brief news items, experiences and campaigns undertaken in the
fields of health and the pharmaceutical industry.
More information: IOCU Regional Office for Latin America and the Caribbean; Elly
Kerkvliet, AIS Executive Coordinator, Casilla 10993, Sucursal 2, Montevideo, Uruguay.
"SALUD AL DIA." Institute de Salud Popular (INSAP); No. 5, Lima, Peru, May/July
1990.
Bulletin that compiles classified information appearing in several Peruvian newspapers;
covers a wide variety of health-related items, including special programs, health
policies and services, medicines, events, etc.
Available from: INSAP, Av. Arenales 1080, Of. 301, Lima 11, Peru.
"VHAI1989-90 ANNUAL REPORT." Voluntary Health Association of India; New
Delhi, India.
VHAI is a federation of more than 3000 health organizations from throughout India,
working on health promotion issues. This is its annual report of activities carried out
during 1989-90 at the local organizational level as well as the more general policy level.
Available from: Voluntary Health Association of India. Tong Swasthya Bhavan. 40
Institutional Area, Near Qutab Hotel, New Delhi - 110 016 India.
"THE COMMUNITY HEALTH WORKER." World Health Organization; Geneva,
Switzerland, 1987.
This guide for the primary health worker outlines the different problems that will present
themselves in a given community (diseases, campaigns, etc.), the different viable
strategics for use in each case, and ways of approaching an educational campaign. The
material is illustrated with diagrams, drawings and charts.
Available from: Office of Publications. World Health Organization, 1211 Geneva 27,
Switzerland.
"PROGRAMAS DE SALUD." CESAP; Caracas, Venezuela, 1990.
The CESAP health program has published a series of educational pamphlets for use in
working with community health groups. Topics include infant health, nutrition, respiratory
diseases, people's dispensary, diarrhea, health as a community problem, and others.
Available from: Apartado 4240, Caracas 1010-A, Venezuela.
"BOLETIN EDUCATIVO LA CANADA." ColectivodeSaludPopular(COSALUP);
Santo Domingo, Dominican Republic, 1990.
Educational pamphlets presenting the principal conclusionsand expcriencesof workshop
seminars on Natural Medicine and Diagnosing Disease, articles and invitations to
participate in its popular health education programs (child health, women s health, etc.).
Available from: COS ALUP, Apartado Postal 30290, Sto. Domingo, Dominican Republic.
"EDUCACION POPULAR Y SALUD. REFLEXIONES EN TORNO A LA
ACCION POPULAR EN SALUD"; Centro de Investigacion y Educacion Popular
(CINEP), Documcntos Ocasionales No. 61, Bogota, Colombia, July 1990.
This is an interesting document containing four analytical articles on the need for new
concepts and practices in community health work; the role of popular educators, the
work of health promoters, the need foraltemative practices and relationships in working
with popular groups.
Available from: CINEP, Cra. 5a. No. 33A-08. Bogota, Colombia.
"MANUALDECAPACITACIONPOPULAR.SANEAMIENTOAMBIENTAL."
Educacion Comunitaria Para la Salud (EDUCSA); Tegucigalpa, Honduras.
EDUCSA is an organization that works with rural communities in Honduras, training
and seeking strategic practices that will enable these sectors toconfrontthcenvironmcntal
health problems affecting them. The manual contains a scries of basic sanitation
^^asures, including control of water sources, vectors, excrement, liquid residue,
garbage, food; and methods by which the educator and the community can evaluate and
pul into practice the knowledge gained through study of the manual.
Available from; EDUCSA, Apartado Postal 3312, Tegucigalpa, Honduras, C.A.
"BOTI QUINES COMUNALES. UNA EXPERIENCIA DE AUTOGESTION EN
SALUD." Centro de Estudios y Promocion Comunal del Orientc (CEPCO), Serie Salud
Comunal, Tarapoto, Peru, 1990.
This publication describes in detail the functioning of self-managed dispensaries in rural
and marginal urban areas of Tarapoto, Peru, and the successful organizing and
participatory experience of the health committees and mothers' clubs, supported and
oriented by CEPCO. Also includes an evaluation of the health conditions of the
population in the same areas and alternative proposals for solving these problems.
Available from: CEPCO, Jr. Progreso 512, Apartado 253, Tarapoto, Peru.
'"LAS LAGUNAS DE LOS ENCANTOS." Mario Polia Mccomi; second edition,
Piura, Peru.
This book discusses traditional Andean medicine in northern Peru, analyzing its cultural
implications, religious meanings and medical practices.
Available from: CEPESER, Arequipa 642, 6o. piso, Piura, Peru.
"HYGIE." International Magazine of Health Education; Vol. IX, 1990/2, EnglishFrench edition, Paris, France, June 1990.
Edited by the International Union for Health Education, this magazine contains articles
on experiences and programs in health education; adolescent sexuality, educational
campaigns for disease prevention, drug use, smoking, AIDS.
Available from: HYGIE, c/o ISD, 15/21, rue de 1’Ecole de Mddicine, F-75270 Paris
Cedex 06, France.
st
Q)
"ASPBAE NEWS." Asian-South Pacific Bureau of Adult Education; No. 11, Sri
Lanka, May-August 1990.
This magazine contains news from the field of adult education (meetings, regional
activities, programs, financing, etc.), covering everything that's happening in South
Asia, China, Southeast Asia and the South Pacific.
Available from: ASPBAE, 30/63 A, Longden Place, Colombo 7, Sri Lanka.
"ICAE NEWS." No. 3. Ontario, Canada, 1990.
Reports news and activities of the International Council for Adult Education. News from
the Secretariat, subregions and the different program networks.
Available from: ICAE NEWS, 720 Bathurst St., Suite 500, Toronto, Ontario, Canada
M5S 2R4.
"THE SPIDER." The Spider Newsletter of the African Association for Literacy and
Adult Education; Vol. 4, No. 2, Nairobi, Kenya, July 1990.
This publication reports on the activities and programs of the members of the African
Association for Literacy and Adult Education. Also includes news from the international
field of adult education.
Available from: AALAE, P.O. Box 50768, Nairobi, Kenya.
"BOOKS AND PERIODICALS 1991 SUBSCRIPTIONS." World Health
Organization; Geneva, Switzerland.
Bulletin containing all the necessary information about 1991 subscriptions to the books
and magazines edited by the World Health Organization.
Available from: World Health Organization Publications, 1211 Geneva27, Switzerland.
"ANNUAL REPORT 1989." Centre for Adult and Continuing Education (CACE);
University of the Western Cape, Bellville, South Africa.
A report of activities carried out in 1989 by CASE, an institution that develops adult
education programs in South Africa and also works to promote a society free of racial
discrimination.
Available from: CACE. University of the Western Cape, Private Bag X17, Bellville
7530, South Africa.
.
,,
--
"ANNUAL REPORT 1989-90." South-South Solidarity; New Delhi, India, September
1990.
South-South Solidarity is an NGO seeking to increase relations between the countries
of Latin America, Asia and the Pacific, and Africa for obtaining technical assistance,
improving contacts and exchange. This report provides a review of activities carried out,
progress made, and future projects proposed during 1989-90.
Available from: South-South Solidarity, Post Box No. 4590, New Delhi, India.
"ICAE DIRECTORY." International Council for Adult Education; Toronto, Canada,
August 1990.
The ICAE Directory contains an address list of its members, cooperative bodies,
committees, programs, projects, networks and secretariats.
Available from: ICAE, 720 Bathurst St., Suite 500, Toronto, Ontario, Canada M5S 2R4.
"JUNTOS EN LA ACCION POPULAR." CESAP; Year 1 No. 2, Caracas, Vene
zuela, July-August 1990.
This Venezuelan magazine reports on activities in community work and shows how
community organizations resolve a variety of social problems.
Available from: CESAP, Apartado Postal 4240, Caracas 1010-A, Venezuela.
"DE SUPERMAN A SUPERBARRIOS. COMUNICACION MASIVA Y CULTURA POPULAR EN LOS PROCESOS SOCIALES DE AMERICA LATINA."
Latin American Council for Adult Education, CE AAL, with support from the Centro de
Estudios y Accidn Social Panamefio, CEASPA, Panama, Republic of Panama, 1990.
This book covers the main themes and papers presented at the Latin American
Conference on Popular Culture and Communication, held in Panama, September 10-15,
1989. The different articles provide an overview of what is happening in popular
communication in Latin America.
Available from: Programa de comunicacidn popg^(^(<j{^^L. lApar^o^-gl 6133, El Dorado, Panama, Republic of Panama,
V Main I Glock
K<ftmangala
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community health cell
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NEWSLETTER N2 14
OF THE HEALTH AND
POPULAR EDUCATION NETWORK
September 1991
Network Coordinator: Teresa Marshall
CEAAL General Secretariat:
Rafael Canas 218 Providencia - Casilla 163 T, Santiago, Chile
Telephones: 235 2506 - 235 2532 - 225-5761 Fax: 56-2-2235822
f
POPULAR PARTICIPATION
IN HEALTH AS A PART OF
FULL DEMOCRACY
Luis Weinstein
Amidst an unprecedented world crisis,
with an exacerbated greenhouse effect,
an accumulation of deadly bombs and
the situation in the Middle East rea
ching its maximum tension, accelerated
technological development modifies
daily life and representative democracy
co-opts it and contributes to disguise
and seduce governments and civil so
cieties with its market economies and
its mutilated conception of the individual.
Supermarkets, cellular phones, enthra
lling television sets, make up an attrac
tive landscape that doesn’t allow us to
j ^ee the forest of inequality and exploi
tation, ecological catastrophe and the
cancerous growth of the weapons industry.
It is true that dictatorships are giving
way to democratic regimes, but the
underlying beliefs arc competition,
profit, abuse and the lack of creative
solidarity in the face of injustice.
Incorrcct development manifests itself
in different pathologies such as the avid
consumption and the escapism of drugs,
the hunger of some and the voracity of
others, loneliness within crowds, the
lack of personalized communication
amidst the explosion of technical means
of communications, the paralysis of
transportation when vehicles multiply.
In these conditions, when the real socialist experience disintegrates or dies,
threatened by fundamentalism, with the
possibility of an ecological fascism as
an authoritarian solution to the crisis,
the destiny of the species depends on
the direction which democracy might
follow.
Representative democracy, composed
of elites of political, economic, military
and cultural power, is incapable of sol
ving the generalized discontent, the ai
ling social relationships, with nature
within mental situations.
Democracy needs depth, revision of the
paradigm of modernity, of instrumental
rationality, of a lack of concern of ends,
of values. The crisis calls for a culture of
wisdom, of deepening, so that homo
habilis might surrender his place to homo
sapiens. Wisdom, needs an anthropo
logical basis, to assume the needs, the
contradictions of the species that has
taken the planet and life to the moment
of greatest danger. Human wisdom can
no longer be anthropocentric, but rather
it must be directed to an ecosophy,
mental, social, with the environment.
An anthro-ecopolicy is a policy of com
prehensive health.
lust as democracy is the political re
gime which in its rhetoric and its con
sensus gives the basis for alternatives,
deep democracy, health, the existential,
biologic, psychologic, spiritual, episte
mological, economic, political, social,
cultural, ecological dimension, is pos
sible grounds for the convergence of
sensibilities, ideas, social subjects,
oriented towards a new development.
The public health discourse has opened
up the way to the conception of compre
hensive health, a category, of course, of
more scope than comprehensive medi
cine or primary health care.
It is health care because it is the primary
thing. The relationship with birth, the
rcalizationof potential and death. Love,
hate and indifference. The operative
problems and existential doubts, ran
domness and coincidences. The person,
the group, society, Latin America, the
planet. Health is an integrating initia- _
tive.
Popular participation in health starts
from this value, this intuition, this con
ception. Health is integrated human
development, both locally as well as
globally. It isn’t, obviously, only the
absence of pathology. It necessarily
includes the conflicts, the needs. It
expresses individual, social, commu
nity, national, Latin America and inter
national capacities.
In practice, popular participation in
health tends to identify with the integra
tion of the citizen into state, municipal
or private medical care. \ ou ‘partici
pate” effectively, as a neighborhood
brigade member or as an advisor of a
clinic.
There’s also a form of autonomous
neighborhood participation in organi
zed groups that perform primary care or
education.
Finally, from the specificity of Ute di
fferent ethnic groups, cultures or sex,
one participates since you transcend the
dominating cultural power and aborigi
nal forms of medicine are practiced,
and popular wisdom about hygiene and
therapy is assumed or a receptive diago
nal emphasis is given to the meeting
between professionals and the people
assisted or educators and students.
At the present moment, nevertheless,
popular participation in health should
be carried out in the crucial problems.
Our way of seeing reality, our episte
mology, is sick with certainty and lack
of subtlety. Our deep identity moves
between the uncommunicative autism
and giving ourselves to empty and dif
fuse interactions. Our relationship with
nature is a disappointment and osci
llates between continuing to rape it or to
find some refuge in some trivial ideal
ization. Human rights fill with incense
and becomes respected like icons when
rituals deem it convenient. And all of
s is a fog that covers the real pro
blems the environmental, arms, social,
mentalhealthcatastrophes amidstspacc
ravclandanopcningtowardstlieknowe ge of the secrets of the atom and of
consciousness.
Participation in health, now implies to
be a part” of the movement of compre
hensive health, of development for the
human being and ecology, lasting de
velopment at a human scale. It is par
ticipation in new social movements of a
holistic bent, women, ecology, indige
nous or oriental cultures, Christianity
reincarnated into the social, the cha
llenge of an economy of solidarity ins
tead of competition.
In health participation we join personal
and social development, beyond the old
dichotomies of the individual and so
ciety, human being and nature, daily
life and revolution.
Participation in health is based on iden
tity. In the basic tension between “the I
and its circumstances.” Along with the
empirical I, linked by “mutual” and
“external” relationships, there’s a one
self, a profound I, “identified,” inte
grated into the rest of reality. We par
ticipate, consciously or unconsciously,
because we are a part of reality, of the
“body” of nature. We participate cons
ciously in health inasmuch that, from
this “identification,” we overcome our
“separation^’ without losing our origi
nality, our “usual” I.
Participation in health is updated in the
struggle for change, to give a solution to
the crisis deepening democracy, over
coming the diseased logic of the inva
sive market. This participation requires
a constant work of consciousness rai
sing and expansion, of what is most
truly human.
Conscious participation is inseparable
from participation in the development
of consciousness. Critical conscious
ness is the result of an expanded cons
ciousness, the healthy conscience whicj^we open to the other and others, to a^
local relationships and the global ima
gery.
Representative democracy delegates
and re-presents. The deepening of
democracy is the passing through a lived,
visceral, existential, “presentative”
democracy. Its means and its indicator
is what is most human, the basis of
health, consciousness.
Popular participation in health, not
withstanding its expression in the di
fferent modes of health care is, in short,
the process of assuming the develop
ment of its part, its conscious part, from
the transforming practice, from trfjT
global threat to the profound hope, from
formal democracy to substantive de
mocracy, from unequal development,
destructive, competitive, to a healthy
and integrating development.
EXPLORING NEW
NEEDED COMMITMENTS
Why are we so often conciliatory when we should be confrontational?
I.
THE PROBLEM(S) OF HUNGER AND ITS (THEIR) SOLUTIONS
A belter understanding of the global context in which the world around us works and of
the implications thereof in the perpetuation of hunger in our midst are sorely needed.Too
often we rather see a “shish-kebab mentality”, being applied to make sense of cunent
world problems. This much easier and convenient approach looks at the various
problems affecting the world as if they were all separate events skewed together by
tragedy. (T. Vittachi)
There is thus an urgent need for us to identify and better define our very own positions
and priorities towards the more structural and global determinants of the present
domestic and world hunger situations, even if both may have vanished from the front
pages of our newspapers. Such a challenge calls for: a) an active effort on our part to try
to identify the present sociopolitical structure(s) that lead to the major constraints at the
base of the self-perpetuating cycle of poverty and hunger, b) a comparable effort to
identify and isolate the main actors (indivual or institutional; public, private or
corporate) responsible for the sorry present state of affairs -in an effort to elucidate wbo
and what forces we will have to oppose or support in the formidable task of eradicating
hunger, followed by, c) an identification of the current methods and interventions
proposed or implemented to tackle the existing and foreseeable future hunger problem5'
* Chilean doctor, since 1975 he has been working on nutrition and primary health care
issues in more than 15 countries in Africa. Since 1989 he has been working in health
planification in the Health Ministry of Kenya.
Most interventions we see being implemented deal with the symptoms and immediate
causes of malnutrition (i.e. malnourished mothers and children) rather than with th®
underlying and basic sociopolitical causes that perpetuate the situation. These symptoms -which we are relatively better at dealing with- will continue to be a problem35
long as actions to combat their roots do not attempt to make real structural changes
effectively change the power base of those sectors of society that suffer from hunger3,1(1
However, involvement in health and nutrition can be an entry point to nnn
>,•
„
nalities by lobbying these agencies in our country and/or openly protesting and opposing
some of their ongoing loans, grants or commodities disbursements.
Multidisciplinary approaches. of the traditional type per se -just making professionals of
different backgrounds sit tog er to discuss and decide- are not enough to refocus the
attention on theneedfordhangesthat really tackle the more basiccauses of malnutrition.
These approaches, so much in fashion nowadays, are simply not leading us to
aknowledgeand work within a more ideological and political framework to get to where
the real contradictions lie. Many people get “stuck” before reaching this crucial
realization and cannot change the major focus of their work, because it literally takes “a
second adolescent crisis to change the outlook and the actual content of the work they
routinely do.
n looking at ourselves and the other actors inthe battle
AGAINSTHUNGER AND MALNUTRITION. INDIVIDUALS, INSTITUTIONS
AND SOCIAL GROUPS
Where do we fit in this protracted struggle against hunger?, and who arc “we”? At what
level of the proposed framework are we acting? Why? Do we sometimes perceive the
futility of working on symptoms and at the immediate and occasionally the underlying
casual levels? Do our actions (individual/institutional) attack the real root causes of the
problem? What is stopping us from moving towards tackling the deeper issues? Why are
we so often conciliatory when we should be confrontational? (not necessarily to be
understood in a violent sense...) How much do we have to change ourselves? Is our own
class-bound ideology hampering us in our efforts to truly deal with the issues?
Strategies to face transnational corportions and banks -also central actors in the
determination and potential resolution of world hunger- arc in dire need of being
revamped as well, as much as possible using concerted approaches by as many as
possible of the governments of the South adversely affected by these corporations’
operations. Being watchful and militantly vocal on issues regarding transnational
corporations, especially as relates to the foreign debt, is central to a committed acti vism
on our part.
A number of grassroots organizations have begun springing up around the world
becoming vocal and active on development issues. Cooperatives, labor and consumer
unions, women’s organizations and others have begun to look into health and nutrition
issues. The potential of this emerging social movement is greatand needs all oursupport.
The World Food Assembly was organized in 1984 with the specific aim of pulling these
movements around the world together into a network that could exert some pressure to
change development schemes touching food and nutrition issues. The Institute for Foodand Development Policy is also collecting information on these organizations trying t
distill some of the pearls of wisdom that explain their success.
DI. ORGANIZING OURSELVES AND OTHERS
The continuous organization of constituencies is the cornerstone of lasting, positive
changes to combat hunger and malnutrition at its roots. The following are steps I think
should be followed consecutively in organizing community work: (adapted from H.
Bantje)
1.
The answers to this set of relevant questions are highly personal by any measure and,
not wanting to fall into unnecessary generalizations, I will leave the reader to sort them
out. But, in any case, a word of wisdom is called for: We must keep our eyes constandy
open or we will be“used” (in a national or an international context) to bolster the existing
unfair system while trying to “help”. Our energies may thus end up being devoted to
maintaining a status-quo we basically want to redress.
An ethical motivation -which I assume all of us have- is not enough when confronting
the status quo expressed in concrete situations in our daily work; the issues must be
placed and dealt with in the political context that the world operates in. The powerless
ness of the poor and hungry is what ultimately needs to be reverted and that requires
some bold, decisive steps to break the status-quo. Can we become catalysts in this
process?
A reform of development strategies is needed basically because most existing develop
ment institutions are hampered to take such bold steps due to the fact that they work
through governments which have little genuine interest in the needed structural changes
and prefer to “patch-up” the existing system. Moreover, these organizations arc pushing
development in the Third World coming from their own Western bi^es and^nservag
live charters and the modules thev “sell” are enihusiasucally adop ed by toca u g
Participation:
Participation in development work can and has become an empty catchword and often
ends up being a type of “resentful, controlled participation”. What participation should
really mean is democratization/decentralization of the decision-making process, ope
ning the avenues for the people to excercise the right to choose and to take collective
initiatives stemming from self-deliberation and leading to self-management of the tasks
to be initiated. Organization has an instructional role per se when linked to organize
activity. We have to reject a passive role for people; not only be indifferent about it. As
Paulo Freire noted: people have to be present at the historical process as thinking
activists, not maneuvered by the stablishment to think for them.
2.
Raising political consciousness:
In working with people, one should always ask why things are the way they are specifically avoiding to provide the answers...; this process exposes contradictions,
politicizes the issues and also brings out a strong sense of collective identity in people.
Additionally, it cultivates any existing spark of awareness into workable concrete
actions at the same time providing the pertinent rallying points for such action.
Note: Completion of this step makes the process (and you) vulnerable to repression by
local authorities...
or comrmuneni B ch
B issue
coodiuonaly » **
'
some dLruo-urai and/or — rights
™Sd tte “rigbr
3.
nrerm rtT brought 10
foreground over an ov
donors. All of us,
n ions are set, of which there is no assurance!
.j
of properconditiocolecuvely, ^d exerlsomepressureon demands along the lines o P
Mobilization is also called “practical politics” although it may initially involve dis
tinctly non-political issues and actions.
Mobilization:
Mobilization can be: for self-help, for lobbying, or for placing demands.
One should start with small, attainable goals, i.e. organizing unpretentious local
voluntary work, posing relevant questions to or making specific demands from
authorities. This by itself is a giant step forward.
Mobilization ultimately leads to a process of empowerment and some degree of control
of the siatuation(s) through building confidence in the ability to act and make a real
measurable or observable difference.
The existing discontent and anger can be mobilized creatively and can be used as a force
to start proposing some structural changes.
Note: Attainment of this step is even more vulnerable to repressive actions.
4.
Consolidation of movements:
a) Networking: Working together and organizing and coordinating work with others is
—of paramount importance in the process of empowerment. It helps create necessary
support systems. Networking can also link together in coalitions a number of dispersed,
existing single-issue constituencies, be it around limited or more general strategic or
tactical objetives and be it temporarily or permanently. This facet of organization can
be particulary relevant and positive in the First World, where single-issue constituencies
have become more vocal and visible (i.e., environment, women’s rights, consumer
rights, antinuclear, etc.), b) Solidarity work: Supporting positive attempts at change by
others -i.e. nationally or internationally as for example in Nicaragua or Southern Africais also vitally important.
IV. KEEPING OUR EYES OPEN BY CONSTANTLY LEARNING MORE
ABOUT THE ISSUES AT STAKE
You cannot be an activist in the world of poverty and remain in it without some kind of
preparation, without some kind of education, in a service which is not charity, not
begging, but which demands justice. (P. Wresinski)
ec Continuously question yourself to what extent your involvement (or non-in volvement)
is used to maintain the status-quo. Question, for example, the role of foreign aid in
perpetuating exploitative systems (aid cannot transform an antidemocratic srtucture of
power into a democratic one; it can only reinforce what is already there...).
In this questioning, you have to keep in mind that, unfortunately, fundamental change
is not possible without conflict with the powers that be. Whether we should help
precipitate this conflict or face it when it comes remains an open question.
Critically explore why/how some countries have made progress in addressing the
problem of ill-health, hunger, and malnutrition (i.e. China, Cuba, Costa Rica). Make it
a habit to critically review the role of the World Bank, the IMF and other donor agencies
(USAID, CIDA, etc.) in specific country and project contexts -always putting the
foreign debt crisis in its proper perspective (an example of how debtor countries arc now
subsidizing the banking system at the expense of the wellbeing of their poor). Who is
realy aiding whom when net flows of capital in the late eighties are towards the North...?
Last but not least, do not skip critically analyzing the role of particular NGOs (and some
of you within them) working on hunger issues. In last instance, ask yourself if those
NGOs are working for or against the best interest of the people. Our responsibility to the
hungry and sick is not to go in and “do for” them, but to help remove the obstacles
preventing people from providing for themselves. It is not for us to go into other
countries and “set things right”. (Food First)
V. SPEAKING UP!
Do not rely on others to do it; speak up! Each one of us must speak up and act atourvery
own levels. Every bit helps. Think globally, but act locally. Be forewarned, though, that
when you move from charity to speaking out, you are liable to step on some toes. When
you set out to “set free the oppressed” you risk being considered subversive and
unamerican...
Keep asking why? Constantly expose and denounce contradictions you find in your
analysis os specific situations and, most of all, do not be intimidated. The “silent
majority” is probably behind you on most issues. We need to become change agents and
effective advocates for social change leaving old fears behind.
If you are a student, influence your educational authorities to change or add courses on
the topics of hunger and its resolution. Foster a continuing dialogue and debate through
special workshops, seminars, guest lecturers or participation in World Food Day
activities every October 16th.
Procrastination, remember, is the lifeblood of the status quo! (World Food Assembly).
Lastly, never forget that the role of science and technology in resolving the worldhunger
problem is, in fact, peripheral. (Yes!, as opposed to what some self-appointed “experts”
want to make us believe). Such a focus and orientation -often calling for doing our
technical work better and using more and more efficient training, management and
supervision- only diverts the attention from the more basic political/structural issues
which have to be addressed if we are serious about wanting to combat hunger as a sign
of inequity. Efficiency is important. But not if only applied to the more technical aspects
of combatting ill-health and malnutrition.
Bringing together people actively involved in changing/challenging the sociopolitical
and economic structure(s) that pcrpetuate(s) a system in which people go hungry in a
world of plenty is thus an urgent task.
Here are some suggestions on groups you can contact to count yourself in and
consolidate your active participation into the type of major network we will be needing
for the tough years to come:
-
Institute for Food and Development Policy (Food First), 145 Ninth St., San
Francisco, CA 94103.
-
World Food Assembly (WFA), Secretariat: 5 Harrowby Court, Harrowby SL.
London W1H 5FA, England (c/o Robin Sharp).
-
World Hunger Year (publishers of Food Monitor), 261 W 35th St., N° 1402, b'eW
York, NY 10017-0374.
-
Ten Days for World Development (Canadian education/lobbying group with current
focus on food/hunger issues), 85 St. Clair Ave. East, Room 203, Toronto Ontari°
M4T 1M8, Canada.
TWO MODELS
FOR TRAINING
human
RESOURCES
IN HEALTH
Maria Rosa Cataldo and Salomon Magendzo
Oncof the main obstacles tocarrying out the
Alma-Ata proposal and through it a new
understanding of health, is the training of
human resources who work in the field.
Health care personnel although they have
technical training, often lack methodolo
gies and knowledge of the idiosy ncracies of
the popular sector, of how people in this
sector think and act.
In order to achieve this new understanding,
health care personnel need a special type of
training that would serve as a means of
exchange and a way to continually review
of their practices. That is, in order to over
come the automatization that has been
imposed on them in these last few years,
they need to meet with other professionals
who arc thinking about solutions to this
problem in health care with an alternative
focus and building a movement for Primary
Hcallh Care.
It is indispensable that along with a solid
technical formation, health care personnel
begin to understand again the significance
and value of the social and educational
aspects that enter into what they do. This is
even more important when all the members
of our society arc involved in a process of
redefinition in a democratic social system.
A process in which the participation of each
and every person in the community plays a
central role, a specific role which as it is
fulfilled in the social dynamic makes a
contribution to build a more free, just, and
equalitarian society in aclimate where basic
democracy governs social relations.
Because of this, the health care team and the
community will become involved in the
development of different actions that they
undertake with an understanding of the rela
tionship of prevention to health, and with
the consideration that integral health is a
subject which concerns the total population.
Without a doubt, it is evident that commu
nity participation will not be possible with
out the implementation of an adequate
educational strategy, and for this, personnel
with technical and social training are needed.
The need for social change that our poor
societies so urgendy call for require a seri
ous and profound commitment to human
development and to the struggle for justice
and equality.
In this task of promoting development, the
training of personnel becomes an effective
tool for generating change, as much at the
individual level as at the structural level; a
tool for mobilizing the political will to solve
problems with adequate strategies of social
development; to translate societal goals into
educational objectives; to develop newpersonal and collective identifies and va
lues, etc.
The development of training projects aimed
toward social change implies unleashing a
chain reaction of social participation that
grows larger every day.
Without a doubt, developing the skills to
initiate participatory actions requires basic
change - in lifestyle, in socio-economic
structures and policies, in the entire value
system of a society. Therefore, training when
it is understood this way, also leads to cul
tural transformation.
COMMUNITY HEALTH CEU
326. V Main.. I Block
Koramangala
Bancm'ore-560034
India
THE CONTRIBUTION OF POPULAR
EDUCATION
The Program of Training in Popular Educa
tion Salud of the Interdisciplinary Program
of Research in Education (Programa de
Capacitacion en Educacion Popular y Salud
cn cl Programa Interdisciplinario de Investigacioncs cn Educacion - PIIE) has deve
loped methods of training and educating
human resources that arc primarily guided
by the educational and methodological prin
cipals that underlie the concept of popular
education.
"Cun popular education, the act of educating
takes the form of a process of building
knowledge. The people involved in the
process build this knowledge as they criti
cally take possession of their own reality
and start to change it.
That is to say, that what popular education
aims to do is to provide the tools for the
participants to discover the internal contra
dictions of a given reality, making it possi
ble for them to draw conclusions and form
their own opinions; and to go through a
process where on the one hand, empirical
knowledge leads to rational theoretical
knowledge; and where, on the other hand,
abstract ideas lead to action.
This task requires an ongoing dialectic alti
tude which enables the participants to unite
practice and theory in a permanent and
dynamic learning process.
It is essential that this process of building
knowledge takes place with others, in a
suitable group, where shared responsibili
ties, horizontal structures of relating to each
other, creativity and compromise are able to
develop.
Therefore, it can be concluded first of all,
that training should facilitate a process of
reflection-action where the educator plans
and directs the process of training. Secon
dly, that this process is directed by certain
pedagogic principals, which give the train
ing its innovative character. These princi
pals can be stated in the following manner:
• Building knowledge from experience:
those who have immediate and natural
knowledge ofa social and cultural situa
tion are those who are part of that situ
ation. Knowledge is a product of experi
ence, of assigning meaning to what sur
rounds us.
• Knowledge and theory are conceived in
an integratedform; in this way, all theo
retical processes should arise in some
wayfrom practices that the participants
develop.
• Participation as a factor in education:
This principle is related to the require
ment that those who are being trained
become actively involved in the learning
process. It is only then that participation
becomes articulated as the fundamental
idea of the educational process, finally
translating itself into the distribution of
power that is generated within the group,
this implies involving the participants in
building knowledge, giving them access
to decision making and responsibility in
the group dynamic, etc.
• Considering the socio-political context
in the development of training: The task
of the participants is conditioned by a
context determined by social and politi
cal structures. Therefore, continued re
flection and analysis of this social dy
namic with the aim of understanding its
mechanisms of action and their reper
cussions on society as a whole and in
smaller social contexts, is needed.
• Concernfor the group process: all human
groups that operate over a period oftime
need to value and be committed to a
common goal, establish adequate cha
nnels of communication and solidarity,
as this isfinally what determines the level
and quality of their human relations.
• Because of this, it is important which
they create a climate where the members
of the group get to know each other and
develop democratic interpersonal rela
tionships. Toaccomplishthis, techniques
of group dynamics and exercises can be
used. This relaxes the participants, di
minishes their fears and inhibitions and
makes it possible for them to gradually
gel acquainted with each other - from
getting to know each other’s names to
sharing aspects of their personal lives.
• A social group is also ofitselfa learning
situation. This is true as much as for the
social interaction that develops within
the group as for its ability to generate
knowledge collectively through a pro
cess of group discussion and analysis.
TWO ALTERNATIVES FOR
TRAINING
Experience in training human resources for
social change has enabled us to form two
models fortraining: l)Long distance group
self-teaching; 2) Training of human re
sources for local development.
As has already been said, these two models
share certain basic principals about trai
ning. However, they differ in the strategies
that they use as they are designed to meet
different needs. Therefore, it isnotsomuch
that the use of one model excludes the useof
the other. Rather a question of competition
between models, it is a question of which
one should be used to attain the desired
goals.
That is why the first model, “Long-distance
group self-teaching” is designed to satisfy
certain basic needs that can be seen as essen
tial when we speak about generating social
change:
1. The growing need for an increasing
number of people to be able to take
advantage of a transforming style and
concept of education. This need exists
because social change requires that
people who play the role of educators in
society, and who therefore influence
society, are able to have a democratic
and liberating conception of the role
they play.
2.
The need for the training process to
transmit a principle essential to social
change: autonomy in the creation and
building of knowledge. This would
suggest that presential educational
models should be discarded and with
them the dependence on the educator
that they create. The training model
“Long-distance group self-teaching” was
designed with this in mind.
The long distance educational system func
tions by means ofan educational guide. This
guide allows a group of individuals who are
interested in being self-taught to take re
sponsibility themselves for the role of plan
ning and carrying out their own training. A
kind of interaction is created between the
tool that facilitates the process of self-tea
ching and those who undertake to train
themselves.
Therefore, the educational guide replaces
the teacher, and the participants themselves
take on the entire training process.
It must be pointed out that the usefulness of
this method of building knowledge for the
participants depends on the participants
themselves and on the context in which they
develop their practices. That is to say, the
circumstances of the place where the par
ticipants develop action as well as their
country are what determine what they will
do witli their knowledge.
In this model, because it is self-taught, the
participants are largely persons who are
already sensitive to social change, and who
see training as a means to perfect them
selves in an educational aspect.
The second model of training, that of “Local
Development” is based on a different pre
mise than the first.
This model grows out of the intention to
train human resources to generate or em
power a process of local development It
must be pointed out that local development
concerns itself with strengthening social
organizations, as a strategy for increasing
participation in the social, political, and cul
tural life of a country. It is not possible to
achieve this strengthening, if the organiza
tion is notable to attain coordination and the
ability to work with others, with the goal of
encouraging participation of different sec
tors and to create dynam ics of development,
growth and social transformation in a terri
tory or population.
However, differences can be observed in
the goals of the paining processes, in the
methodologies that they employ, in die type
of participants, and in the role that the socio
political context plays in the Paining pro
cess.
Therefore, training should be designed as
much to meet the needs for growth and
administration of the local system, as for
meeting the methodological and educational
requirements of the different groups in
volved in the local development process.
Therefore, this model views training as an
indivisible whole, where there is concern
for the ways groups are formed in the local,
for participative diagnosis, for personal
relationships, etc. as well as for reinforcing
ideological aspects and educational strate
gies for action.
The curriculum contents that each Paining
model intends to develop are similar, b
cause both start with the principles of popu
lar education.
It should be pointed out that for this model
to succeed, the existence of the political will
to decentralize where basic democracy, in
tersectorial work and social participation
are essential goals.
When it is considered that the second model
has community development as its main
concern, it can be pointed out that the Peatment of the above mentioned themes have
even more importance in Paining in action,
a means of working which permits the ca
rrying out of support activities y their fr ~
llow-up with actions taken by the commu
nity itself.
In this model, it is the trainers, together with
other social actors in the community, who,
while inaction,detect what training is needed
to allow them to continue the process of
local development, in as much as the needs
for training arise from action itself.
This model has a presential character, and
those who benefit from it can have different
levels of sensibility about social change. In
this sense, the training takes on relevance as
a strategy to reinforce a cognitive-attitudi
nal change, a fundamental step for persons
involved in the dynamic of local develop
ment
In short, these two models of Paining seek
social change and are guided by principles
and methodologies of popular education.
Also, both take the socio-political context
into consideration for their implementation.
Therefore, the following subjects are sug
gested: Concepts and Methodology of
Popular Education; Educational Planning,
Organization,PopularSocial Movcmentand
Group Process, Principals for die ConsPuction of Educational Materials; Participative
Research; Systematization and Evaluation;
and Community Development.
It should be noted that both models have
sufficient flexibility to make it possible to
adapt their curriculum to the needs of the
participants. This can be done by choosing
the most pertinent subjects as well as by
adding to the curriculum other subjects that
meet specific needs. For example, in the
area of health, all the subjects that have todo
with community health, participative health
education, training to create and develop
community health systems, etc. are essen
tial subjects and subjects which are compli
mentary to popular education.
oF NIJM£GEN’
COURSES AND CONFERENCES
,«[ uNlVt»srtY
>
INTERNATIONAL CONFERENCE: “HEALTH FOR MINORI
TIES IN THE YEAR 2000 - SHORTENING THE DISTANCES”
■oi
The Galilee Society for Research in Health and Services, a Non Governmental
Organization that docs work in the area of health for the Arab minority in Israel, is
organizing this International Conference that will take place in Nazareth, Israel, from
the 7th to the 1 Oth of April, 1991.
hcOtctical bases.
December 19901ptofessl
t
During the conference, professionals and community leaders will share opinions and
experiences about health conditions for minorities in developing countries. The aim of
this meeting is to encourage and find ways to eliminate the inequalities in health care
services for minorities in these countries.
courseis'O
[o[[erin6lhckoo
and Dentistry.?-u-
pa^onalhca^ ■
o(Medicine
_____ _____ ________
For more information: Galilee Society for Health Research and Services, P. O. Box 92
Rama, 30055 Israel.
LONG DISTANCE SELF EDUCATION GROUPS
PIIE (Interdisciplinary Program for Research in Education, Programa Inicrdisciplinario de Investigaciones cn Educacion) organizes long distance self education groups.
These courses are directed to community leaders, monitors, and professionals who arc
in training or perfecting skills in the theory and practice of popular education.
PROM0 '
otgam^j0 Sv;e(jcn),'n c0
Norway, and
t99IinSundsvall.S
d ^cPand,
. , [otmulas f°r
identify practica . caUh and
These long distance group courses (minimum 6 persons, maximum 10) makeitpossible
for people to receive training, when for one reason or other they are not able to attend
other courses or workshops. The total cost of each course for the whole group is S50.000
Chilean pesos or USS 170 for the rest of Latin America.
The three courses being offered now arc: Concepts and Methodology of Popular
Education; Production of Materials and Educational Processes in Popular Education;
and Research and Local Development in Popular Education.
**•
For more information: PIIE, Brown Sur 150, Santiago, Chile. Telephones- 223-1940
-496644. FAX (56-2) 2231940.
I
NEWS
HEALTH IN THE HANDS OFTHE PEOPLE - SECOND ANNUAL
MEETING
FIRST CONGRESS ON MEDICINAL PLANTS I
“With our feet on the ground.... building our future”, was the theme of the second annual
meeting of groups who make up Health in the Hands of the People, a program that trains
health promoters in Mexico. The meeting took place last April 25 - 28 in Mexico City.
In the last few years, various economic, social, and ecological factors have favored the
re-evaluation of the value of plants as a resource in Primary Health Care. The principal
advantage of the use of medicinal plants lies in their low cost and low risk factor when
compared with the high cost and the risks associated with the use of synthetic medicines.
The medical efficacy that some medicinal plants have traditionally demonstrated for
centuries has now been confirmed by scientific investigation. And medicinal plants
have the further advantage of being easy to use and less toxic than synthetic medicines.
The meeting produced a rich exchange of experiences from all the groups. Five basic
areas were covered: health and nutrition, health and culture, health and production,
health and technology, and health and policy. The different ways that community health
diagnosis can be carried out were examined, and materials from different parts of
Mexico were exchanged.
For more information: Teresa Zorrilla, Salud en Manos del Pueblo, PRAXIS, Vesubio
No. 57, Col. Alpes, 01010 Mexico D. F„ Mexico
INTERNATIONAL VITAMIN A CONSULTIVE GROUP (IVACG)
The relationship between Vitamin A deficiency and infant morbidity and mortality was
the focus of the XII Meeting of the International Vitamin A Consultive Group. The
IVACG was formed in 1975 with the objective of guiding international activities aimed
toward reducing Vitamin A deficiencies throughout the world.
At this meeting, experts from various disciplines presented and discuscd the results of
numerous studies, and at the conclusion of the meeting, they presented a declaration
based on the considerations of the Directive Committee on the available evidence.
-
An adequate level of Vitamin A prevents nutritional blindness and significantly
contributes to infant health and survival.
The role of Vitamin A in the prevention of nutritional blindness is well documented
and accumulated evidence exists that it also plays a role in the reduction of infant
mortality. The mechanism or mechanisms that produce this effect are not clear.
-
The impact of improved nutrition with Vitamin A will vary according to the severity
of ViL A deficiency and the contribution of other ecological factors.
-
Therefore, improving the diet and elevating the level of Vitamin A is imperative
when Vitamin A consumption habitually been chronically inadequate.
The Directive Committee of IVACG hopes that this declaration will be useful in the
process of formulating national and regional policy and programs to combat Vitamin A
deficiency.
For more information: International Vitamin A Consultive Group, The Nutrition
Fundation Inc., 1126 Sixteenth St. NW, Washington, D.C. 20036, UoA.
CHILE 90
In Chile, people have also shown a growing interest in medicinal plants, due to the searci.
for a solution to health problems with alternative medicines which are known to and
shared with popular culture. This interest has been expressed by an significant
proliferation of medical products based on plants which are available on the national
market.
It was in this context that the First Congress on Medicinal Plants, Chile 90, was held on
June 7, 8, and 9th. The event was sponsored by Caritas Chile, the SOINDE Clinic of
Conchali, CETA, PAESMI, and the Department of Phytochemistry and Pharmacology
of the University of Chile.
The 180 participants in this Congress came from different disciplines, which gave the
gathering the interdisciplinary character that had been hoped for. Health professionals,
doctors, nurses, nutritionists, botanists, anthropologists, sociologists, agronomists, as
well as distributors of alternative medicines such as naturalists, “yerbateros” (herba
lists), “veedores” (seers) and acupunturists all took part in working groups, discussions
and meetings. Also among the participants were Latin American experts on medicinal :
plants, such as Lidia Giron, a member of the National Commission on the Use of
Medicinal Plants of Guatemala, and Carlos Roersch of the Center of Andean Medicine
in Cuzco, Peru, who were invited by CEAAL. This great diversity in participant,
produced a fruitful dialogue and demonstrated the need for future work with contribu
tions from all the different professional perspectives.
A total of 38 reports, accounts of experiences, and conferences about the use of
medicinal plants touched on a wide range of subjects. Of these, about half dealt with
phytochemical and pharmaceutical studies [the hepatoregenerative properties of
bailhuen, the antimicrobial properties of Allium Sativum (alicina) and of Berberis
Vulgaris (berberina), among others]. Also discussed were the study of popular medicine
and its use in different countries; techniques for drying and conserving herbs; the history
of traditional medicine in China, India, and other ancient cultures; advances in the
research about the properties of cocaine, the phenomenon of urban herb sellers; and .
using the stories and documents of travelers as a resource for studying botanical
medicine. A proposal was also made for developing a national medical herbarium which
would help to guard against the danger of extinction which menaces a large number of
species of plants in Chile.
For more information: Adriana Fuenzalida, Consultorio SOINDE, Av. La Palmilia
3711, Conchali, Santiago, Chile.
THE COMMUNITY HEALTH AND POPULAR EDUCATION
INFORMATION BANK
The Health and Popular Education Network intends to be a place where groups
working to promote health in Latin America can establish contact with each
other and communicate with others about their activities. In order to do this, we
need to identify all of the groups in the network and learn about their programs
and activities.
QUESTIONAIRE TO RECORD COMMUNITY HEALTH AND
POPULAR EDUCATION PROJECT AND PROGRAMS
1. Name of the Program or Project.............................................................................
2. Type of activity (Primary Health Care, training, organizing, communica
tion, research, production of educational materials, etc.). . .
But we can only be effective as a network if our information about the latest
'' jtivities in the area of community health and popular education on our
3.
Sponsoring organization ... .
continent is kept up to date.
4.
Complete address and telephone number.
It is for this reason that the Health Network proposes to create a Latin American
Data Base of Experiences and Practices in Health and Popular Education.
5.
Name and profession of the person in charge of the program . . .
6.
Names and professions of the other members of the group . . . .
7.
Objectives of the program or project. . . ...
8.
Work schedule (date of the beginning and end of the program)
9.
Principal contents of the program
10.
Brief description of the activities carried out..
11.
Organizations who support the work
12.
Observations
13.
Date, and signature of the responsible person
We are interested in creating and developing an Data Base about community
health and popular education programs in Latin America which will enable us
to gather and distribute data about activities, attitudes, achievements and
products.
The Data Base would, in short, be a catalogue of activities in the area of health
and popular education which would have two fundamental goals:
1. Facilitate and make possible the exchange of information and experiences
among groups and individuals who work in community health.
i(A Stimulate and facilitate the growth of new community health projects and
' experiences.
Send the questionnaire to:
Health and PopularEducation Network - CEA AL
Perez Valenzuela 1634
Casilla 163-T
Providencia, Santiago, Chile
........
...
...________
This would also premit us to appreciate the true dimensions of the community
health programs on the continent, giving them more visibility, and finally, more
legitimacy in their practice and strategic propositions.
For all these reasons we are sending out this questionaire which we hope will
receive a wide response from all of you. Once we have gathered sufficient
information, we will start to send you periodic reports. We hope to be able to
send you information three times a year. All the programs that send in the
questionaire will recieve a list of all the projects that have already been
catalogued with basic information about each program’s activities.
......
. _
_ ______
_ ___
_____
Bibliographic
and Educational Materials
The Center for Information and Education for the Prevention of Drug Abuse (CEDRO
- Centro de Informacion y Educacion para la Prevencion del Abuso de Drogas) is a
private Peruvian institution that provides information and education about the drug
problem in Peru, indicating its causes and consequences, and trying to decrease the
availability of drugs and drug abuse. CEDRO offers technical assistance and coordi
nates the efforts of institutions and organizations. In all its programs, CEDRO seeks to
involve different sectors and groups in the community.
The CEDRO network, made up of the institutions which receive support from theccnter,
is made up of 1250 different groups.
As part of their work in generating and publicizing knowledge, information and
education about drugs, CEDRO produces an important and diverse scries of educational
and informative materials as well as research.
All of these materials can be ordered from: CEDRO, Sanchez Ccrro 2101, Lima 11,
Peru.
We will describe some of CEDRO’s publication below:
“PSICOACTIVA”. Scientific magazine of CEDRO. Lima, Peru, 1987-1989.
This magazine is published biannually and contains articles aboutlied
substances and their impact in different areas, based on empiric ,
’
studies. It also carries reviews of books, bibliographic resumes,
scientific developments, and news of conferences and events, esu
• pnc]ish.
“PASTA BASICA DE COCAINA. UN ESTUDIO MULTIDISCIPLINARIO”.
Leon F. & R. Castro de la Mata (publishers). CEDRO. Lima, Peru, 1989.
Basic Cocaine Paste (BCP) whose existence has been recognized in Peru for the last 15
years, has caused major social and scientific problems, much worse than could be
imagined in the last decade. In this context, CEDRO organized an interdisciplinary
minar to share up to date information and draw attention to the debate on the most
iportant aspects of the problem of cocaine paste in Peru. The seminar was held in Lima
(May 1988) with 100 participants - pharmacologists, psychologists, anthropologists,
educators, lawyers, economists, agronomists, ecologists, and politicians. This book
publishes the principal contributions to this seminar in 13 articles.
K
“MONOGRAFIA DE INVESTIGACION”. CEDRO. Nos. 1,2, and 3; Lima, Peru,
1987-1989.
The results of diverse scientific investigations about the problem of substance abuse and
its impact in Peru are the subject of this collection of monographs which CEDRO has
published annually since 1987. The collection of monographs serves as a vehicle for
reflection and information, an instrument to consult about a complex problem. The titles
of the monographs which have been published to date are: “Use and Abuse of Drugs lr*
Peru, (epidemiological research, 1987); Peruvian Legislation on Drugs From 1920 Unti
the Present (1988); A Study of Perceptions about Drugs in the Urban Population in eru
(study of public opinion, 1989). In Spanish.
EDUCATIONAL PAMPHLET SERIES. CEDRO. Lima, Peru, 1989-1990.
This series of CEDRO publications explains the drug problem easily understood texts
and illustrations so that people of all ages can understand it and help to solve it. Some
of the titles in the series are: “What Is Prevention?”; “Women and Prevention of Drug
Abuse”; “Working Together for Our Neighborhood”; “Your Body Is Very Valuable";
“Do You Smoke?”; “Inhalants”; “Basic Cocaine Paste”; “Drugs and the Family”. In
Spanish.
‘1NFORMATIVO DE CEDRO”. CEDRO, Lima, Peru, 1990.
This bulletin periodically published by CEDRO contains articles of interest to the
general public, as well as information about the numerous programs and activities
carried out by CEDRO, and abundant facts, news, experiences and services offered to
the those who arc interested in or are effected by the serious problem of drug abuse. In
Spanish.
Health - Promotion
“VALOR NUTRITIVO DE LOS ALIMENTOS”. Almendariz, Pedro. CEPRODE,
Serie: Cuadernos de Nutricion, No. 3, Lima, Peru, 1990.
This booklet, published by the Center for the Promotion of the Development of
Education (Centro de Promocion del Desarrollo y la Educacion - CEPRODE), contains
basic information about the nutritional value of the basic food groups (cereals, legumes,
fats, meats, fruits, dairy products, etc.), an evaluation of their contribution to diet, and
recommendations for maintaining their nutritive value.
Order from: CEPRODE, Apartado Postal 18-1672, Miraflorcs, Lima, Peru.
“FACTS FOR LIFE. A COMMUNICATION CHALLENGE”. Unieef, WHO,
Uncsco. Oxfordshire, United Kingdom, 1990.
This manual, which is directed to communicators, gathers abundant information about
mother-infant health. This information, about pregnancy, childbirth, breastfeeding, the
growth and feeding of the child, infectious diseases, diarrhea, malaria, AIDS, is written
fci a format that is easy to understand, so that it can be used in those countries that still
naven’t solved their basic sanitation problems. In English.
Formorc information: UNICEF, DIPA, Facts for Life Unit, 3 U:N Plaza, New York, NY
10017, USA.
“POLITICA DE POBLACION. MANUAL PARA PLANIFICADORES Y RECTORES DE LA POLITICA”. Isaacs, S.; Cairns, G.; Heckel, N. Universidad de
Columbia, Facultad de Salud Piiblica, Centro de Poblacion y Salud Familiar, Programa
de Leyes y Pollticas cn Desarrollo. New York, Estados Unidos, 1985.
This manual is a guide for policy makers, planners, and those interested in population
policy. It analyzes the essence of the population policies of 20 countries; numerous
common elements in these policies have been selected and compared so that the reader
can form an idea of how similar problems are handled in different countries. The text
of laws and policy documents are also included and analyzed. In English and Spanish.
Order from: Director, Development Law and Policy Program, Center for Population and
Family Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
“XIGUAPATE”. Bulletin of theCommunity Health Program of EDUCSA; Tegucigalpa,
Honduras, 1990.
EDUCSA, Educacion Comunitaria para la Salud, is a Honduran organization whose
purpose is to encourage and promote community development, by contributing to the
improvement of education levels, social conditions, culture, and health to better
people’s lives. EDUCSA offers services in organizing, training, teaching literacy,
primary health care, preventive medicine, and health education. “Xiguapate” is the
bulletin of EDUCSA, and it contains information about the activities this organization
carries out, and other themes related to community health.
May be ordered from: EDUCSA, Apartado 3312, Tegucigalpa, Honduras.
“CALIDAD DE VIDA”. CINEP, Proyecto Educacion y Organization para Reivindicaciones Basicas. Ano 2, No. 4, May 1990, Bogota, Colombia.
This bulletin deals with the quality of life and the nutritional status of Colombian,
workers. The subject of this issue is an aspect of the policy of the Colombia
Government: the policy to take action toward bettering the quality and quantity of foods
and to improve the buying power of low income consumers.
Order from: CINEP, Carrera 5a No. 33-A-08, Bogota, Colombia.
“BOLETIN CERSO-CHILE”. Centro de Estudios y Rehabilitation Psicosocial.
N° 2, May-June 1990, Concepcion, Chile.
This quarterly bulletin of the Psychosocial Rehabilitation Studies Center seeks to
exchange information with other institutions and individuals who develop initiatives for
and work with children. The bulletin is also informs the national and international
community about the activities of CERSO, which include programs to help street
children, groups to support adolescent mothers, and an orphanage for boys and girls in
the coal mining zone in the South of Chile.
For more information: CERSO, Casilla 1747, Concepcion, Chile.
“CATALOGO DE MATERIAL EDUCATIVE. BIBLIOTECA POPULAR DE
SALUD”. Institute de Formacion y Capacitacion Popular, INFOCAP, La Universidad
del Trabajador, Edicioncs INFOCAP, Santiago, Chile, 1989.
As a continuation of their line of publications intended to facilitate communication, and
exchange of information about the different activities and programs that have taken
place in the area of popular education and primary health care, the Women’s Program
of INFOCAP has published a Catalogue of Educational Materials that lists all the
materials which are available in INFOCAP’s Popular Health Library which was
recently opened. This catalogue is not only directed to users of this library. Il is directed
as well to any individual, organization, or institution that carries out educational
activities at the local level, with the aim of helping them to find the supporting material
they need. The catalogue contains 354 abstracts of the educational material available,
K order of subject and type.
More information: INFOCAP, Chorrillos 3614, Santiago, Chile.
CESO. Center for the Study of Education in Developing Countries. Publications
1963-1990. The Hague The Netherlands, 1990.
CESO is an interdisciplinary studies center which studies and documents developing
countries. The Center undertakes research and offers a number of services of informa
tion exchange. Among their various publications are books, articles, essays, reports, and
a series called “Verhandelingen”.
CESO has an exchange of references service that helps people working in the field of
education for development to obtain both published and not yet published material. The
series “Verhandelingen” contains abstracts of studies or projects that have taken place
or arc now being carried out. Their aim is to contribute to dialogue and stimulate future
works.
A complete list of CESO’s publications including prices can be ordered from:
CESO, c/o Badhuisweg 251, P.O. Box 90734,2509 LS The Hague, The Netherlands.
ORAL HEALTH SELF CARE PROJECT”. AHRTAG, London, U.K. 1990.
This pamphlet describes the Oral Health Self Care Project (OHSEC) that AHRTAG has
carried out in New Delhi, India, since 1983. Until now, the project has been functioning
as a pilot program, evaluating educational materials for school teachers, in order to
incorporate them into the curriculum. However, starting next year, it will be included
in curriculum throughout New Delhi, at the request of the different municipalities, and
it is ready to be incorporated into any school system as well. AHRTAG can supply more
information about this project, and they would like to receive news of any similar
projects being undertaken. In English.
More information: AHRTAG, 1 London Bridge Street, London, SE19SG, United
Kingdom.
“NOSOTROS”. Informative Bulletin aboutSocial Participation in Health. Department
of Social Work, Ministry of Health, N 1, San Jose, Costa Rica, June 1990.
This bulletin, published by the Ministry of Health of Costa Rica, has the objective of
promoting an exchange of experiences on social participation in health among institu
tional functionaries and Costa Rican community members, with theaim ofenriching the
forms of addressing the status of health of the population.
More information: Dcpartamento de Trabajo Social, Ministcrio de Salud, San Jose,
Costa Rica.
centro de
participacidn
popular
“DESCENTRALIZACION MUNICIPAL Y PARTICIPATION POPULAR”.
Centro de Participation Popular. Montevideo, Uruguay, s/f.
In 1989, the Center for Popular Participation organized a cycle of meetings about
municipal decentralization and popular participation, with the aim to reflect on, discuss,
and debate this subject, to enlarge its scope and reach and to explore the different
political concepts that exist in respect to it. They covered the role of neighborhoods, of
neighborhood social organizations in municipal management, and the existing diffe
rences in the programs of political parties about the role neighborhood participation.
This document contains the textual transcriptions of the conferences and round table
discussions.
For more information: CLAEH.ZelmarMichelini 1220,11100 Montevideo, Uruguay.
Popular Education
“INSTIA. BOLETIN”. Institute Intemacional de Andragogia. N 17, March 1990,
/Caracas, Venezuela.
This quarterly bulletin, published by the International Andragogia Institute seeks to fill
the need for publications on adult education in Venezuela. The Institute has lies with
Inter-American Federation for Adult Education (Fedcracion Intcramericana de Educacion de Adultos - FIDEA), an organization with representatives in almost every country
on the continent. The bulletin mainly provides information about academic activities
and congresses about adult education that take place in Venezuela.
Request from: Institute Intemacional de Andragogia, Avcnida Veracruz, Edificio
Capaya, piso 3, Urbanizacion Las Mercedes, Caracas, 1060, Venezuela.
‘EDUCACION POPULAR. HISTORIA. ACTUALIDAD. PROYECCIONES”.
Mejia, Marco Raul. UNICRUZ, AIPE, CEAAL; Santa Cruz de la Sierra, Bolivia, 1990.
This book comes out of a seminar held in La Paz and Santa Cruz with the Colombian
popular educator, Marco Raul Mejia. The intention of the seminar was to effect a
conceptual and theoretic re-ordering of popular education in order to carry out coherent
praxis and overcome posturing and political-educational ambiguities. This document
J opes to generate processes of confrontation and debate around the subject of popular
education in Latin America.
Order from: UNICRUZ (Union de Institucioncs Crucenas), Casilla 4041, Santa Cruz
de la Sierra, Bolivia.
“DESDE ADENTRO. LA EDUCACION POPULAR VISTA POR SUS PRACTI-
CANTES”. Muncz, C.; Caruso, A.; de Souza, J.; Osorio, J.; Rosero, R.; Fals Borda, O.
CEAAL; Santiago, Chile, 1990.
This study is the result of an exercise in self-diagnosis in which popular educators
participated. It is based on an active exchange of opinion and survey carried out in 1988
and 1989 among institutions and individuals who have made popular education their
mission and vocation. It presents a series of reflections founded on concrete action in
communities which help to deepen our understanding of this work.
For more information: Secretaria General CEAAL, Perez Valenzuela 1634, Providencia, Santiago, Chile.
Health - Women
“THE TRIBUNE. A QUARTERLY BULLETIN ON WOMEN AND DEVELOP
MENT”. Center of the International Women’s Tribune, N 38; New York, USA, July
1990.
The Center of the International Women’s Tribune has been working with women and
women’s groups in the Third World since 1976, supporting initiatives, activities and
programs in other countries which are committed to the struggle for women’s liberation
and the fight against the cultural, economic and political prejudices that oppress them.
Each edition of the bulletin is devoted to a particular subject; this issue’s is “Women and
the New Technology”. Earlier issues have dealt with: “Woman and Conscience”,
“Economy and the Home”, and “Taking Over the Mass Media”. (Publications in
Spanish, English, and French).
For more information: Center of the International Women’s Tribune, 777 United
Nations Plaza, New York, NY, 10017, USA.
“CATALOGO DE PUBLICACIONES, 1990”. Women’s Institute; Madrid, Spain,
1990.
This catalogue includes all the publications that the Women’s Institute, part of the
Spanish Ministry of Social Services, has produced since 1984. There are brief descrip
tions of the contents of each publications, and the catalogue includes different types of
material: research reports, documents that came out of meetings and seminars, publica
tions that the Institute prepared itself, folders, booklets, and videos.
For more information: Institute de la Mujcr, Almagro 36, 28010 Madrid. Soain.
“KILLA”. Bulletin of Filomcna, Woman Miner. N. 22; Lima, Peru, August 1990.
nFilomcnaTomaira Pasci is a group of women activists who work for the rights of women
miners in Peru. They are developing a health campaign “Let’s Take Health Matters into
Our Own Hands” and for more than a year they have run the Women Miner’s Health
Clinic in Huancayo. Killa publicizes the activities carried out by the group.
For more information: Filomena Tomaira Pasci, Jr. Apurimac 224, of. 305, Lima, Peru.
“LA SALUD NUESTRA DE CADA DIA: MANUAL PARA PROMOTORAS DE
SALUD”. Salinas, J.; Jansana, L.. UNICEF, Santiago, Chile, 1989.
This manual was created with women of the popular sectors in mind, to help support the
work of women health promoters in their communities. It presents knowledge about
health that enables women to work and fight for a healthier life. It is the product of the
work of Judith Salinas and Loreto Jansana, who both have long and interesting histories
of involvement in community and solidarity organizations in Chile.
For more information: UNICEF, Isidora Goyenechea 3322, Las Condes, Santiago,
Chile.
“MAGAZINE OF THE LATIN AMERICAN AND CARIBBEAN WOMEN’S
HEALTH NETWORK”. Isis International. Santiago, Chile; January, February,
March, 1990.
This quarterly magazine of the Latin American and Caribbean Women’s Health
Network, published by Isis International, contains abundant information about women’s
groups and organizations that work in the area of health, bibliographic references, news,
notices of conferences and meetings, campaigns, and the experiences of different
groups. This issue includes a large amount of information about AIDS. The Network has
developed a specialized data bank in the area of women’s health and groups who work
in the area of health care. Much of this interesting information is also contained in this
magazine. In English and Spanish.
For more information: Isis International, Casilla 2067, Corrco Central, Santiago, Ch
“QUIERO SER ALGO EN LA VIDA” Grupo de Trabajo Redes; Lima, Peru, 1990.
This publication is directed especially to young women under 20 years old, and is
intended to help them to make decisions about the future. It has information about
women’s bodies, the menstrual cycle, what methods of birth control are most appropria
te in what circumstances, where and with whom to seek help for problems, and why
women should consider family planning.
Can be ordered from: Grupo de Trabajo Redes, Curreo de Miraflorcs, Apartado Postal
1578, Lima 18, Peru.
“NINOS Y MUJERES. PRIORIDAD DEL DESARROLLO SOCIAL”. UNICEF;
Santiago, Chile, 1990.
The Area Office of UNICEF for Argentina, Chile and Uruguay published this important
document about the conditions and quality of life in Chile form 1975 to the present.
Information about demography, poverty, economic forecasting, the status of education,
health conditions, diet and nutrition, high risk children, housing and environmental
health, and the condition of women are presented through a series of complete and
attractive cards. (Contains a brief summary in English).
Order from: UNICEF, Area Office for Argentina, Chile and Uruguay, Isidora Goyencchea
3322, Las Condcs, Santiago, Chile.
“SALUD I, II, III AND IV”. Ministry of Social Services, Women’s Institute; Madrid,
Spain, 1989.
This scries of booklets edited by the Women’s Institute in Spain is intended to inform
women about subjects like methods of birth control and sex; pregnancy, birth, and
, ostpartum; voluntary interruption of pregnancy; and sexually transmitted diseases.
Lach number is dedicated to a subject, and the material is supplemented with illustrative
diagrams and drawings.
For more information: Ministcrio de Asuntos Sociales, Institute de la Mujcr, Almagro
Com H 6-2-3
NEWSLETTER N213
OF THE HEALTH AND
POPULAR EDUCATION NETWORK
September 1990
Network Coordinator: Teresa Marshall
Secretary General of CEAAL:
Perez Valenzuela 1634 - Casilla 163 T, Prov., Santiago, Chile
Telex 241044 CEAAL CL - FAX 56-2-2235822
Telephones 2239331 - 2256271
tOITORtAL INTERAMERICANA LTDA
Vi
GGiCTViUMITY HEALTH CELL
47/1,(First FloorlSt. Marks Road
BANGALORE-560 001
Popular Education
DR. RAVI NARAYAN
COMMUNITY HEALTH CELL
326 V.MAIN 1 BLOCK, KORAMANGALA,BANGALORE
560 034, KARNATAKA
INDIA
■^3-
s
ia
TRAINING
STRATEGY
Indonesia
Mary Johnson
This document emphasises the importance
of organizing a training strategy, involving
all the people who will be important in the
success of the program., to increase their
motivation and their skills. Leaders, or
program managers must also be convinced
of the importance of the program. It will be
important too, to con vince policy makers of
the relevancy of a new approach or program
so that they will provide support when re
quired.
In the large community health program
described in this paper, eight types of train
ing were implemented at three levels of
government. This strategy was designed to
prepare all parties so that they would pro
vide maximun support for the community
health program.
Training is never an end in itself. It is
basically a tool or strategy designed to fa
cilitate change, and usually only one of
several factors needed to achieve the re
quired change. This applies to any training,
and is undisputably true for participatory
training which is aimed at beginning a proc
ess ofchange, or facilitating a process which
is already underway.
If change is desired, it is clear that it is aimed
to improve an unsatisfactory condition. An
example may be a community which is
suffereing from poor nutrition, with a high
incidence of infectious diseases, a high in
fant mortality rate, and where the people
appear powerless to overcome their situ
ation. After studying such conditions the
decision may be reached to begin with train
ing. The aim would be to increase people’s
awareness and skills so that they would be
better equipped to tackle their problems.
However, a decision would then be needed
on who should be trained. Should it be key
people from the community, health workers
associated with the community, or possibly
the government officials responsible for
planning programs for the community?
Yayasan Indonesia Sejahtera (YIS) faced
this same problem several years ago. This
NGO was working in Banjamegara, a re
gency with a population of 678,000 who
lived in 297 villages in 18 districts. Banjarnegara was one of the poorest regencies in
entral Java, and severe health problems
were common in most villages.
Step of a strategy to improve the
. ®tatus of the population was a cross
heart
I^anaScment workshop run by the
result0^6 Regency health service. As a
all rm °
*S act’''* ty> the regency heads of
deveiVernmentdepartments involved in the
in
°f 1116 area became interested
ttter community participation in the
shoilldbeShcXrkey'XdeCidedtraining
■"formal leaders6 'formal
Perhaps in this wav thn
community.
of the importance of prevent COnvinced
tive health measures^
ve and Pr°mo» approve
development program. This
eluded community health activi
.
ever, the makers who attended the wo kshop faced the problem of who should
implement the program which they had
planned at the workshop. Their plan adopted
mS?^1***
off a series of seven trainings at three levels:
province, district and village, covering from
regency managers to formal and informal
leaders at the village level.
Training at District and village levels has
been an integral part of the community
health/development program for more than
10 years. Even today refresher courses and
training of new VHW and field workers
continue to be held. The experience, which
was confirmed by later experiences, has
highlighted some important pointers on
training.
a new approach which was more commu
nity based than programs in the past, which
were basically top-down.
It was at this point that YIS, with many years
of experience in participatory training, was
requested to assist. YIS decided to begin
with training for field staff of the Commu
nity Health Centres form each district of the
regency. This was the first time the health
workers had experienced participatory
methodology. They returned home with am
bitious plans of how they would work wi th
the village people.
More comprehensive representation can be
achieved if training is conducted close to the
place of action, such as the office of an
organization or in the field. Under these
circumstances it is easier to ensure that
participants represent all major aspects of
the program, and, if appropiate, several
levels.
At the following monthly meeting with the
local doctor, their reports were rather down
hearted. The response form the community
was disappointing and most of the doctors
in charge of the Community Health Centers
had given little or no back up. They did not
understand why or how the field workers
were changing their approach. Some con-
teteX'd“a
«to».
the CommuniJ, HScZlty
USed *°
service for the m
enlers Providing a
idea of the cXUnnyatthe ^nter.
major responsibriity foT'thefcTi? 1116
foreign to them. *
0,611 health was
At the Training Center these pointers can be
implemented by inviting an organization to
send their representatives in teams, prefera
bly representing different aspects of their
program, such as a health worker, agricul
turist and teacher. At YIS we also had or
ganizations sending multisectoral teams,
including representatives from villages and
from the districts and provincial govern
ment. In this way all levels were covered
and each had many opportunities during the
training to understand and appreciate the
circumstances faced by those at different
levels from them.
Implementation of the Plans ofAction drawn
upPat the training begain in most villages,
qfier the training of volunteer health workHowever it was not long before reports
SZeDisria Heads
ot other
hcalib aopartopa™" » *
s<x>„ ata, d,c
tivities was alsoi
^ning as trainers
field workers reques^ ^^^iH.
as they were ^d
health work
creasing number of voi
ers.
It is clear that thednitml
gency managers or
First, no training should stand on its own.
The initial training should be backed up
with similar activities to cover all those who
are important for the succesful implementa
tion of a program. If training, as part of a
community health program, is given in iso
lation, ie. once up to one group, it can cause
frustration, leading to failure. This may result
in wasted effort and funds, as well as dispir
ited people who may be umwilling to par
ticipate in future activities.
Second, participants should come in teams
in order to provide support for each other in
the field. It is very difficult for single fight
ers to introduce new, and maybe conflicting
ideas, on their return.
This multiprofessional and multi-level strat
egy implies that participants of a training
could be very heterogenous. Participatory
methodology has proved to be by far the
most effective way of coping with heterogenity. Not only that, it ensures maximum
interaction between the participants which
could mean good working relationships in
the future. Hence the careful mix of partici
pants is capitalised and chances arc high
that the training will contribute significantly
to the succesful implementation of the
community heal th,ordcvelopment program.
Chile
ADOLESCENTS AND HEALTH:
Four Chilean organizations, invited by the Popular Education and Health Network of
CEAAL met during 1989 to confront thechallenge of developing a program on sexuality
and pregnancy for adolescents. This group was made up by the Comprehensive Health
Program (Programa de Salud Integral) of Pirque, that functions in a rural area near the
city of Santiago in primary health care programs; the Conchali Clinic, that carries out
health and community participation activities in a popular neighborhood in the northern
section of the city; the Maternal Child and Adolescent Program of the Hospital
Parroquial de San Bernardo, which has implemented a comprehensive program for
pregnant adolescents; and the Health and Social Policies Program of the University
Academy of Christian Humanism, which studies social programs and policies.
This group had different experiences, which permitted a comprehensive and complex
vision of the problem: there were the questions from the field of primary and secondary
care, of the rural experience, of the psycho-social damage of youths from urban marginal
areas and at the same time the challenges posed by comprehensive programs with an
active community participation.
The reasons for this meeting were due to three consideration. First, the recognition of
the increasing number of adolescent pregnancies in Chile, with serious consequences
for the mother and child. Second, the accumulation of studies on the subject and the
implementation of experiences and pilot programs undertaken by universities and non
governmental organizations. Third, the absence of policies and prevention and compre
hensive care programs in the field of sexuality and adolescent pregnancy. These three
facts, made it necessary to study further the subject and to think about a future that
perm its joint efforts, increase knowledge, disseminate results and propose policies and
programs.
A PROFILE OF ADOLESCENTS IN CHILE
The group prepared a biodemographic profile of adolescents in Chile, with the aim of
obtaining a description of the principal tendencies in the biodemographic changes of the
adolescent population, using statistics at the national level.
This profile points out that the adolescent population (10-19 years of age) is 23% of the
country’s population. When observing the behavior of the population by sex according
to urban-rural condition, you can observe a higher rate of masculinity in rural areas,
which would indicate a tendency to emigration of the female population to urban areas.
Different studies have underscored the preference of female migration towards urban
areas that offer a job market in the service sector.
In the socioeconomic aspects it is pointed out that during the 70 to 82 period there’s an
increase of the adolescent economically active population; this change is especially
significant in men (16.7% of the adolescent women are economically active, while for
men the rate is 45.8%).
During the same period, there has also been an increase in the level of education of the
adolescent population. Only 1.7% of this population doesn’ t have an education. Both in
urban as well as rural sectors, the female population has more education than men at
every level of schooling. In the 15 to 19 years of age group, 58% of urban youths has
9 years or more ofeducation, while in rural areas only 17.2% have such a schooling level.
Another important change in social aspects is in regards to legal status, and an increase
of married or cohabitating women is observed, especially in rural areas.
The biomedical profile shows that the mortality p .
death arc external causes such as trauma and poiSo • *S VCry low; djc
in the 15 to 19 year old population), being higher ^n^KsPOnsibie
59^ Cause of
As to fertility, it is necessary to recall the cle^
Nevertheless this has not occurred with the adole
which has
cent mothers are between 14 and 17% of total birthCentP°Pu^at'On
*” Chile
mothers are for women 15 to 19ycarsofagc
S 3,1(1 98% Of
(,jL. Sfr°m adoles^s°fadolescent
mouiuis aic tvi
—
'',J—'“"
,hanonevearr,r,^„,_
Infant mortality inchildren
^Xen^wi^
0'^6"1 mOlhCrs hasbeen higher that
the national average. WhtleJ r(W to this average are important
they are even more so considering th g of the mother. In the group of mothers less
ters less
x -V
than than 15 years of age, the infant mortality rate is substantially higher than in women
15 to 19 years of age (39.4 in 1985).
STUDIES ON THE SUBJECT IN CHILE
In Chile there has been a lot of research on the subject; nevertheless, most of them are
descriptive or case studies.
In the area of sexuality, it is important to underscore the ignorance of adolescents, which
increases in youths from popular sectors.
The education programs in the school system do not impart knowledge that permits
adolescent to live their sexuality comprehensively. The training of teachers is weak or
ambiguous. The family does not offer the possibility for training and communication in
matters of sexuality. In this context, it is clear that adolescents don’t have information,
or adequate channels of communication. Nevertheless, adolescents initiate an active
sexual life at an earlier age and with greater frequency, with the male’s attitude and
behavior being more permissive. On the use of contraceptives they believe myths and
disinformation. The majority of them oppose abortion and don’t consider themselves to
be at risk for sexually transmitted diseases.
Biomedical research on adolescent pregnancy are also of a descriptive nature, and
therefore it is difficult to extract conclusions or establish comparisons with other peer
groups.
From a biomedical point of view, adolescents have an insufficient weight gain during
pregnancy. There’s a significant incidence of anemia. In other aspects of morbidity,
doubtful gestational age is important. When looking for causes of morbidity in
pregnancy, one of the hypothesis is that there’s inadequate prenatal care, psychosocial
factors (absence of a mate, broken families, sexual aggression, etc.) and that morbidity
is not only due to the mother’s age. There arc no studies aimed at looking for biological,
psychological and social risk factors of pathology in pregnancy, such a prematurity and
intrauterine malnutrition.
As to the health of the children of adolescent mothers, there are no studies that permit
any conclusions on morbidity, hospitalization, beatings, and accident risks.
The pregnant adolescent and mother from popular sectors is exposed to adverse psycho
social factors to her development: socioeconomic deterioration, broken or disorganized
families, with the presence of conflictive adults (violent or excessive drinkers), early
dropouts from the school system. Since the adolescentr is living through a training
period and a search for identity in the psychosocial level, maternity is experienced in an
unfavorable way: lack or limitations to her freedom, anger, resentment, guilt. These also
impact on their personal development and in the raising of the child. In adolescent
mothers, a high percentage remain unmarried -especially the more precocious- and their
children have a high probability of being illegitimate, with the corresponding lack of
protection on the part of the father
In these circumstances pregnant adolescents and mothers are subjected to a complex
circle of psychosocial damage, which are serious impediments to development as a
person in different spheres of life in society. The poverty in which they live deepens and
exacerbates this psychosocial damage, putting them in a situation of greater vulnerabil
ity, since young poor women have less and weaker protective resources, such as a
family, institutional insertion and information, and face greater risks.
THE EXPERIENCE IN CHILE
Comprehensive care programs were initiated for adolescent pregnant women more than
eight years ago. All of them under university and non-govemmental programs. They
have been a response to the non existence of official national programs and policies.
Each one has tried to “do something.” Therefore, we find a great number of initiatives
-more than 30- each one with a specific quality, trying to innovate, learn, obtain
resources, legitimate initiatives. In this exercise, coordination, exchange of informa
tion, transmission of experiences, continuity, has been difficult Nevertheless, some of
them have shown their lessons and agree on the criteria to orient their programs and
policies:
-
The needfor primary prevention, with a comprehensive initiative at the intersecto
rial level (education, health, communications media, community).
-
The need to place services at the level of primary health care, where it will be
necessary to create a system that serves adolescents in a comprehensive and
personalized manner.
-
The needfor training personnel to develop adolescent care programs, which permit
creating communications skills,for a psychosocial approach,andfor education and
community action.
The experiences which have achieved greatest impact have been those that have had
greater resource stability, university presence, human resources training, follow-up
systems and periodic evaluations.
These programs are at the present moment an excellent basis to formulate comprehen
sive programs, and are a challenge to the health policies of the democratic government
in Chile.
Ecuador
CAN
CURATIVE
CARE
BECOME AN
EDUCATIONAL
EXPERIENCE?
The Popular Health Teams Coordinator (CESAP) in Ecuador coordi
nates several organizations that carry out health programs in rural areas
ofthe country. For a Course-Workshop on Health and Popular Education
(Chile, 1988), the team presented their experience that sought to give it
curative care an educational, community and organizationalperspective.
In this article, they share their reflections on this interesting perspective.
, sham
u „„ -p
^riActcimnlemented
a magic
ceremonial
ritual
to expel
from
the sick
When the
humors that came
from
nature, they
pointed
out the
important
body the Pos?“'°"
individual act and the problems that arose within their social
relationship between^ mdvw
Their curative
ss
... . d«.nv the relationship between the conception of the process health-
been static in history.
“SSTtail
«•
”"‘“s
h""h w
Possibility of malting curative care a space for popular education and organization. Our
roposal arises from observing the fundamental problems of curative care.
First, the open clinic. We propose the direct participation of the community in all the
activities of the health center. Participation that must be the integration in all of the
process, from the admission of the patient to the home follow-up.
Second, the preconsultation. It will be the people in charge of the admission of the
patient who will fill their clinical chart and his admission to the office. This first step is
of capital importance. It breaks down the resistance and distrust towards the health
institution, gives the neccessary time for getting closer and preparing the patient and his
family, and the utilization of the waiting period, opens a dialogue between the health
team and the patient and between patients.
To apply this process, the role of every member of the team and the relationship between
themselves must be defined. We then have the collective participation of the team and
coordination between all activities is achieved.
The structure produced by scientific and technological progress segregates diagnosis,
treatment, recovery and the rehabilitation of the population.
In countries like Ecuador, there is a conflict between a national health system and the
meager socio-economic resources for its implementation.
When capitalist development begins, decentralization of services, increased coverage,
and universalization of curative care is stimulated. Infrastructure exists, but when a
resolution of health problems is required, it is limited by the lack of human, technical and
therapeutical resources. The population has no other alternative but to go to the more
developed hospital centers, to private practice or to traditional popular forms.
The great majority of patients who individually request care in hospital centers, begin a
pilgrimage of interminable administrative red tape to obtain an appointment, which
sometimes takes weeks. When he is finally able to see the “all powerful and omnipotent
physician,” they are treated as an object, a clinical case, who doesn’t have the right to be
heard, be seen or informed about his ailments, but rather he should present himself
submissively to the ceremony of the clinical examination, complementary tests, case
study, and he must be willing to receive an unintelligeble paper, where he is indicated
the therapeutic resources, which are almost always unaccesible to his memory.
It is much more tragic when this patient has to enter a health house. There, all
considerations as to the social rank of the patient are broken, and the patient becomes
inmeshed in the gears of hospital rules. Cultural aggression begins with the sudden
separation from his family, with the abrupt change in his habits, food, hygiene, a shcedule
for rest and sleep, medications and unusual treatments with respect to his local peasant
and neighborhood reality.
On the other hand, the conflcitive situation that health workers have because of their
limited labor rights, added to the frustration of daily work, has put the debate on their
role of giving health services to the population by the wayside.
The people or teams that implement joint work projects with popular organizations,
chose a democratizing model of medical practice, which is still marginal, but which little
by little has acquired strength and representativity.
Within the framework of these alternative experiences we ask ourselves about the
The principal educational objective is transforming the resistance of the population into
integration; the social history of the patient is recorded and in the post visit stage, the
team can be projected towards the community, encouraging community educational
activities on problems detected and which are relevant to the area. This community
organization is implemented by means of local organizational work and forms of
participation.
Third, the medical visit. It must begin with the concenms of the patient, being open to
the subjective and objective elements. In this sense, the health agent must avoid using
an interrogation framework. Once we have given a little time for the patient to air his
ailments freely, we can proceed with the guided questioning. And after that, we go on
to the physical examination.
At this time, due to respect for the patients intimacy, curtains are closed, but we keep
personal family participation, explaining to them the various actions which will be
undertaken. The explanation by the person carrying out the physical examination for the
rest of the people, has an educational objective, body recognition, identification of
pathology, of the patient as well as the person responsible for local health (community
agent). Therefore, the physical examination must be as detailed as possible.
Once the exam has ended, our diagnostic systematization must be explained as clearly
as possible to the patientand his family,relating the individual problem with community
resolution. We are conscious of die educational potential that this final step of the
medical visit has, since this is the moment of truth, of hope on the part of the patient that
his case will be solved. Since we have opened up the clinic to the community present
in the waiting room, we are guaranteed projecting ourselves towards the community.
Health agents must develop a work style that allow for the explanation of the problems,
so that they dont generate contradictions within the patient, the family or the community.
Fourth, post-visiL The guarantee of success to finish this educational process, is an
adequate treatment of the post-visit. It is not only a question of giving therapeutic
indications, but also of an efficient follow up. This begins with an explanation in the
post-visit office directed to the patient but also to the rest of the population which is at
the center or clinic. It tries to link efforts at the family level with community education
processes.
The responsibility for follow up must be earned out with the team’s aprticipation, the
family nucleus, the health committee or brigade and the community at large. The
principal health team directs the follow up process. Its importance is greater when this
must link local activities with external referall and counter-referall levels.
Fifth, referall and counter-referral. This section must take into account the impact
provoked by facing an established health system.
We must take into account the patient’s shock when confronted by an unknown world
view. Here, the reason why the patient came to the city must be resolved as responsibly
and seriously as possible.
In conclusion, we must underscore that the activities of an open clinic requires an
adequate infrastructure. An infrastructure that takes into account the organization of
physical space, creating an atmosphere which permits the community to be actors in the
educational process.
The adequate management of the open clinic permits a greater knowledge and relation
ship with the community. The levels of trust gained through this practice, facilitate
treating the problems of the community and a better level of communication. It
facilitates the evaluation of the impact of the project and the educational processes.
The lack of knowledge of the communities’ reality when a health project is initiated can
be overcome, systematizing the information given by curative care, complementing
them with bibliographic and field research. Clinical histories becomes a permanent
survey that feed a central data base. Our concern should be to link this information with
date coming from community educational practices and bibliographic studies. This
research process makes the formulation of policies and team work possible.
CESAP has accepted this ambitious challenge. For many this will seem utopian. A
practice which goes against the grain. But we are certyain that local work and
community corrcsponsibility can screen and solve the greater part of curative require
ments.
Our educational program has not restricted access to knowledge on the part of the
population. Let us proceed from the simple to the complex. Health committees are
progressively solving larger problems. The achievements of these activity avoids the
concentration of patients in the community center and creates an invaluable moment for
achieving a real curative care as an educational opportunity.
^1 frizt
Chile
NGO, HEALTH AND
With the aim of discussing the contribution
of non-governmental organizations to the
health policies of the democratic govern
ment in Chile, 25 institutions met called by
the Working Group of Non Governmental
Organizations of the Coalition of Parties for
Democracy (March, 1990).
The debate began with the elaboration of a
profile of health NGOs in Chile. The major
ity of them were founded during the dicta
torship and in 16 years they have accumu
lated experience in different fields.
They have put together high level profes
sional and technical teams, which have
developed the expertise in the formulation,
administration and evaluation of projects.
They have carried out programs that have
been proved at the community level and
they have used popular education method
ologies, promotion and articulation ofpopu
lar participation and coordination at the
perspective the APS.
local level. They also implemented medical
care systems, based on a humanized office
and nourished by community participation,
especially in emergency situations, repres
sion and violation of human rights.
The work of the NGOs has permitted the
promotion of a health concept based on the
quality of life and democracy, develop a
participative and intersectorial practice and
to mantain a reflection, formulating thought
and strategies based on action. It is from this
set of skills, that we hope to contribute to the
development of democratic health practices.
The contributions of health ONGs refer to
their accumulated skills. The following areas
are identified as possible areas of collabora
tion:
•
Participation strategies, strengthening
different forms of organization and
methodologies for community partici
pation, contributing from a democratic
Training programs, as a contribution to
the development of human resources
policies at the primary and secondary
care levels.
.
Intersectorial work, in which the NGOs
have developed confronting different
challenges: nutrition - consumption organization - medical care - produc
tion - appropiate technology.
•
Innovative projects, in which experi
ence and thought have accumulated; in
which it is possible to coordinate differ
ent contributions: participation, train
ing, technical assitance, intersectoriality and implementation ofdecentralized
programs at the local level.
Through these ideas, health NGOs hope to
be able to cooperate, contributing a renewed
conception of health, within the perspective
of quality of life, democratization of poli
cies and leadership of the grassroot organi
zations.
At the same time, the change in the political
scene poses new challenges for health
NGO’s. Now it is more urgent than ever to
strengthen coordination around specific
areas (training, participation, assitance, etc.)
to coordinate the contributions, keep though t
and strategies for longer periods of time.
Mantain a dialogue with government or
ganizations and international assitance in
stitutions. Advance towards a legitimiza
tion of NGO health programs, as a place
where one can undertake a career and as a
place for the training of university students.
And finally, encourage strategies to man
tain, strengthen and diversify international
cooperation to health NGOs.
B angkok
WORLD ASSEMBLY
ICAE - 1990
As a result of the Fourth World Assembly of
Adult Education “Literacy, Popular Educa
tion amd Democracy: Building the Move
ment,” held in Bangkok, a group of health
workers from different parts of the world
met.
We were all interested in learning other
experiences, present our practices, and es
tablish communication and exchange.
Nevertheless, the Assembly overwhelmed
those expectations, and permitted us to
involve ourselves in other discussions and
challenges: the situation of women in Thai
land, the contribution of the ecological
perspective to adult education, the situation
of education programs of countries at war or
occupied territories. And much more. The
Assembly was a space for the meeting,
recognizing ourselves as educators, work
ers, activists, militants in such distant con
texts, but marked by the same injustices and
hopes. And in this fashion, the struggle for
human rights and health which has been
undertaken in Argentina is very close to the
challenges of the struggles in Palestinian
territory occuppied by Israel. From another
perspective, the search for the roots of in
digenous medicine in Mexico makes us
value traditional medicine in Asia. And
there are so many more examples.
The meeting went beyond the limits of
“health practices,” and one of the important
things was debate with others. First, with
women’s organizations, concerned with
abuse and the sexual traffic of women in
South East Asia, a subject which has heatlh
implications (ETS, AIDS, violence, aban
doned children, etc.). With other educa
tional initiatives, the need to value the con
tribution of health initiatives in literacy,
community development, strengthening of
grassroots popular organizations.
But we also had a moment to find ourselves
among those of us who work directly with
health programs. There was an exchange of
our concerns and experiences. We went
through these subjects quickly; but this
wasn’t sufficient Rita Giacaman (Palestin
ian) asked about the objectives of this Net
work. The answer was unaninmous: we are
interested in struggling, exchange and
communicate with the aim of creating or
strengthening the leadership of popular
groups and community organizations in
health practices, programs and policies. Our
educational task is directed towards that
type of popular participation.
The we asked ourselves the meaning of an
international initiative in the adult educa
tion movement There were many answers
to this question. Health subjects are a starting point for educational action, they are a
permanent demand in the community. From
health we can reach the other social, politi
cal and cultural areas. The reverse also
occurs. Finally, the causes of deterioration
of health conditions of the people are not
only found within national borders. An intmational struggle to learn beyond each
border or culture is required.
The need also arose -stimulated by the per
manent scientific and cultural curiosity- of
getting to know the work of NGOs thatwork
in health in Thailand. It wasn’t an easy task.
We started making informal contacts, until
we got to know the Drug Study Group, who
have been active for 10 years in the study of
traditional medicine (Thai therapeutic mas
sage), and health policies in aspects of use
and abuse of medications. In Thai society,
the increase of medicalization is enormous
and this modernization process has made
traidtional medicine secondary. The coor
dination among NGOs, has also been a
priority task in Thailand and a council that
represents them has been formed.
Finally, after this long trip, we asked our
selves the challenges for the Health Net
work at the international level. The expertence of the Network in Latin America is an
example and motivation. Now we must
strengthen links, identify regional leaders
and initiate a road that will lead us to create
regional coordination, exchange and com
munication initiatives.
NEWS
TRAINING: HEALTH PROMOTION AT THE LOCAL LEVEL
The Latin American Popular Education and Health Network -CEEAL- and the Educa
tion Program for Health Professionals -PIIE- are working on a training workshops
program for health workers for the implementation of a policy of local development and
primary health care. This program is being implemented in a neighborhood in Santiago
which has a great number of poor people and in which the democratic government wants
to promote innovative programs for a real primary health care policy.
The concentration of experiences and efforts of CEAA1 and PIIE, has made it possible
to open a new space in training for health workers from the governmental and non
governmental sectors, and community organizations.
The present political context has made it possible to implement new health policies at
the local level and has invited all NGOs to jointly accept this challenge.
In the near future we’ll have more news on the development of this program and we hope
to share it with other health educators and workers in Latin America.
COURSES AND CONFERENCES
INSTITUTE OF VALENCIA FOR PUBLIC HEALTH STUDIES
(INSTITUTO VALENCIANO DE ESTUDIOS EN SALUD PUBLICA
[IVESP])
Between May and July of this year, the Institute of Valencia for Public Health Studies
(IVESP), a part of the Generalitat of Valencia, will give a series of courses aimed at
health professionals.
Among them: Environmental health and Air Pollution; Methodology for the Develop
ment of Infant Health Programs; Hospital Infections; Epidemiological Methods in
Infectious Diseases; and, Information and Management Systems.
To request further information, contact: Secretaria del IVESP, c/Dr. Rodriguez Fomos,
4,46010 Valencia, Espafia.
MODERNIZING THE NETWORK
In a short time the network has grown to regional and international levels. Communi
cations and exchange demands have diversified and expanded. With each passing day
more groups have become interested in contacting colleagues in other places of the
region or the world.
This process demands modernization. We must be more efficient and must respond
giving and exchange and communication service, making it possible to learn from the
different experiences.
We are going to establish a computerized Network of health experiences and popular
education, which will be an “active catalogue” of activities carried out in this field. The
Network will have three main objectives: reception, filing and dissemination of
information.
In a first stage we will start with Latin American experiences and then we will try to
expand this service to other regions. The incorporation to this Network will make it
possible to have a quick and systematic link with other experiences in the region; and
at the same time, find other health promotion networks (for example, the Andalucian
School of Public Health Network in Spain) or popular education (such as the Women’s
Network of ICAE). Questionnaires will soon be distributed to begin this daunting task.
INTERNATIONAL UNION FOR HEALTH EDUCATION (UNION
INTERNACIONAL DE EDUCACION PARA LA SALUD [UEES])
The International Union for Health Education (UIES) is organizing two important
events this year. On the one hand, the XIV World Conference on Health Education,
which will be held from June 16 to 21 of this year in Helsinki, Finland. This year’s motto
for the conference will be “Health - A Joint Effort.” On the other hand, in Rio de Janeiro,
Brazil the III Inter American Symposium on Health Education will be held on July 15
to 20. The principal subject of the symposium will be: Health Challenges in the
Americas in the Year 2,000.
For more information: Inter American Symposium: U.I.E.S./O.R.L.A.NoemiaKJigerman, Regional Director. Nutes, Box 8082, Rio de Janeiro, Brazil. World Conference:
Congrex, P.O. Box 1031, SF-00101 Helsinki, Finland.
INTERNATIONAL ASSOCIATION FOR ADOLESCENT HEALTH
The International Association for Adolescent Health will hold its Fifth Congress in
Montreux, Switzerland on July 3 to 6. Reproductive health, nutrition, use and abuse of
drugs violence, youth and sports, sexual behavior and other subjects will be discussed.
For more information: Office du Tourisme, Case postale 97,1820 Montreux, Switzer-
land'
COMMUNITY HEALTH CELL
47/1,(First FloorlSt. Marks Road
BANGALORE - 560 001
Educational and Bibliographical
Materials
Health - Promotion
fmarca
r REGISTRAR
“RFVISTA BIBLIOGRAFICA. PROGRAMA INTERAMERICANO DE INFoXctoNSOBREELMENORYLAFAMILIA”.InsumtoInteramencanodel
Ntifo/Volumen 3, No. 6, Serie sobre Salud, diciembre 1989, Montevideo, Uruguay.
The Inter American Program on Information on Minors and the Family (PIIMFA)
contributes to the dissemination, exchange and transfer of information on minors and
their families The Program publishes this magazine every six months, in which the
information is published in an automated way by thematic series. This issue deals with
health- other series are: Social Issues, Legal Issues, Education and Drug Addiction.
PIIMFA date base now has 14,000 bibliographical references, and 1,200 institutional
users in 29 countries.
For more information and subscriptions: Institute Interamencano del Nifio, Av. 8 de
Octubre 2904, Casilla de Correo 16212, Montevideo, Uruguay.
“CORREO DE AIS. ACCION INTERNACIONAL POR LA SALUD“. Red
Accion International por la Salud/ IOCU, Montevideo, Uruguay, 1989.
The newsletter is published bimonthly by the International Action Network for Health
(Red Accion International por la Salud <AIS>). AIS is an informal network with
members if the majority of Latin American and Caribbean countries. It tries to stimulate
the rational use of medications, the application of the Essential Medications Program of
WHO and promote non medical solutions caused by precarious living conditions. The
newsletter is an information and exchange instrument between people and institutions
interested in health matters.
For more information, write to: AIS/IOCU, Casilla 10993, Sucursal 2, Montevideo,
Uruguay.
“EL APORTE DE LAS ORGANIZACIONES DE LA SOCIEDAD CIVIL A LAS
POLITICAS DE SALUD EN CHILE”. Salinas, J.; Vergara, C.; Solimano, G.
PROSAPS, Docuemnto de Trabajo No. 1, Santiago, Chile, Noviembre 1989.
This document contains the preliminary results of the project “Contributions of civil
society Organizations to Health Policies in Chile.” It contains a brief historical outline
of public health policies in the country, a general description of 107 health non
governmental organizations and the results of case studies, through adescription of each
experience.
Request from: PROSAPS. Programa de Salud y Politicas Sociales, Universidad
Academia de Humanismo Cristiano, Maria Luisa Santander 0329, Santiago, Chile.
“DERECHOS DE LOS CONSUMIDORES, PROBLEMAS Y DESAFIOS”. Al-
temativa, Cesip, Fovida, Lima, Peru, July 1989
In June 1989, 32 Peruvian NGOs met to think collectively about the struggle and
organization from the consumers perspective. This publication is proof of the diversity
of subjects and concerns centered around the defense of consumers in present Peru,
althoguh it doesn t contain all the materials which were dealt with at the event •
Request from: CESIP, Coronel Zegarra 722, Jesus Maria, Lima, Peru.
“CMA BOLETIN.” Centro de Medicina Andina, Cusco, Peru, 1989
The bulletin is a bimonthly publication of the Andean Medical Center (Centro de
Medicina Andina), with information and short news for health professionals on
traditional medicine, medicinal herbs, medications and health policies; it also contains
reviews on publications and materials on the subject
Rqucst from: CMA, Jr. Ricardo Palma N 5, Santa Mdnica, Cusco, Peru.
SS^i v° Y MEDICINAINDIGENA ECOLOGICA”. Guevara, J.
rvicio Seccional del Vaupes, Colombia, n/d.
SltioXtoXT’T68 016 Prcsentation on ecological medicine in Vaupes and its
HealthnCare^<hddhiei984,IThnl’PreSented^dleaildlOr'ndleE'rst^ern'nar^Pr’mary
process of the ret tSe
e paper Presents the status of the participative research
“"»
medicine wiA »e.»m
For mZP °P°Sln? certain alternative solutions to improve it
S^ciontid'sZZ\^'SoXalUC1, SiStema NaCi°nal de Salud- Servici°
“RED DE ACTIVIDADES DE PROMOCION DE SALUD”. Escuela Andaluza de
Salud Publica, Aho 1, No. 1, Septiembre 1989, Granada, Spain.
This magazine presents a list of health promotion activities, ordered according to the
type of institution or group which carries them out. From each experience, basic
information to facilitate the exchange of knowledge among them is given. The Health
Action Promotion Network (Red de Actividades de Promotion de Salud) represents a
valauble effort to create a space for linking and exchanging ideas among groups that,
from different social sectors, are carrying out health promotion activities in Spain.
For more information, write to: Escuela Andaluza de Salud Publica, Avda. del Sur, 11,
18014 Granada, Spain.
“MEDICAMENTOS Y SALUD POPULAR”. Servicio de Medicinas Pro Vida,
Lima, Peru, 1989.
This periodical publication of the Pro Life Medication Service (Servicio de Medicinas
Pro Vida) is especially aimed at health professionals as a vehicle for information,
reflection and exchange of experiences in all that refers to medications, policies and
research on the subject.
Request from: Servicio de Medicinas Pro Vida, General Garzdn 2170, Jestis Maria,
Peru.
COMMUNITY HEALTH CELL
47/1,(First FloorlSt. Marlu
8AHG&L0RE -SCO 001
“AIDS. WHAT EVERY RESPONSIBLE CANADIAN SHOULD KNOW.” Greig,
J. Canadian Public Health Association, Ottawa, Canada, 1987.
TTiis book introduces in a deft question and answer format, the basic facts that every
citizen should know about AIDS; what it is, how its transmitted, what are the tests to
detect it, AIDS and sex, drugs and ways to prevent and treat it. Through nearly 80
questions, the reader will find all the information that he needs insofar as this terrible
disease,
Request from: Canadian Public Health Association, 1565 Carling Ave., suite 400,
Ottawa, Ontario K1Z 8R1.
“PARTNERS AROUND THE WORLD / PARTENAIRES AUTOUR DU
MONDE”.
International Health Secretariat, Canadian Public Health Association,
Ottawa, Canadd, 1989.
This newsletter is a quarterly publication of the International Health Secretariat of the
CPHA. Its aim is to inform the members and associates of the Association regularly on
the activities and programs of the Secretariat It tries to be a publication for reflection
and exchange of opinions on the subject of international health.
Request information from: Canadian Public Health Association, 1565 Carling Avenue,
Suite 400, Ottawa, Ontario K1Z 8R1, Canada.
“ACHAN NEWS.” Asian Community Health Action Network, Madras, India, 1990.
First issue of this monthly newsletter of the ACHAN group, with news and information
on the activities carried out by the Network. This newsletter will facilitate the contact
of the members of the Network and with the Coordination Office, located in Madras.
Published in English.
For more information: ACHAN, 61, Dr. Radhakrishnan Road, Madras 600004, India.
“ONE COUNTRY.” Office of Public Information. Baha’i International Community.
New York, USA, 1989.
One Country is a bimonthly publication produced by the Office of Public Information
of the Baha’i International Community. This community works as an intemationalNGO
that represents the members of this faith throughout the world. The programs carried out
by the community in the Third World are reported, which deal with, among others,
health and agriculture.
For more information: Office of Public Information. Baha’i Intmational Community,
Suite 120,866 United Nations Plaza, New York, NY 10017, USA.
“MEDICAMENTOS. LOS CASOS DE BOLIVIA, BRASIL, CHILE Y PERU”.
Accidn International por la Salud. AIS-LA, Chimbote, Peru, 1988.
This paper makes possible to know the scope and limits of the Essential Medication
Program of the countries under study, identifying the factors that hamper or favor the
implementation and consolidation of programs. It also includes, as a general framework,
the principal characteristics of the production and marketing of medications in the
countries in question, with a complete statistical annex.
Request from: Tierra Nueva, Apartado 126, Chimbote, Peru.
“APUNTES PARA TRABAJO SOCIAL”. Colectivo de Trabajadores Sociales, No.
17,2° scmestre, 1989, Santiago, Chile.
In this issue of Apuntes there are, among others, two reflections on future practices in
social work with women and with health; an experience from Costa Rica on policies on
community participation is also included, an experience with Latin American women
exiled in Belgium, a round table on social work and human rights and an article on the
changes of social work in the academic field.
For more information: Colectivo de Trabajadores Sociales, Casilla 178-11, Santiago,
Chile.
“HYGIE. REVISTA INTERNACIONAL DE EDUCACION PARA LA SALUD”.
Unidn International de Educacidn para la Salud, Paris, Francia, 1989.
Hygie is the official organ of the International Union of Education for Health. UIES is
a non governmental organization of professionals dedicated to the promotion of health
through education. Themagazine, which is published4 times a year, contains theoretical
information on research and experiences, and includes news on events and meetings at
the international level; eventually it will publish issues dedicated to specific subjects of
health education. Published in English and French with a Spanish abstract.
For more information on how to join UIES: Union Internationale d’ Education pour la
Sant6, c/o ISD, 15-21, rue de I’Ecole de Medicine, 75270 Paris CEDEX 06, France.
“SIDA. BOLETIN MENSU AL.” Consejo National para la Prevention y Control del
SIDA, Mexico D.F., Mexico, 1989.
This monthly newsletter on ATOS is the official publication of CONASIDA, and is
aimed at medical and paramedical personnel of different institutions with the objective
of informing on the epidemiological characteristics of AIDS in Mexico, give updated
information on viral and clinical aspects, as well as reporting on activities tending to
control the disease.
For more information: CONASIDA, Aniceto Ortega 1321, 5” piso, Col. del Valle,
Delegacidn Benito Juarez, 03100 Mexico, D.F., Mdxico.
“INTERCAMBIO. SIDA. PROMOCION DE LA SALlJD”.Organizacion Mundial
de la Salud,
Programa sobreel SIDA, Unidad de Promotion delaSalud, No. 1, Geneva, Switzerland.
Intcrcambio is a publication of the World Program on AIDS of WHO. It is the publicity
body of said program, with news on the subject, work projects and evaluation. It is
published in English, French and Spanish.
For more information: Intercambio, OMS/PMS, 1211 Geneva 27, Switzerland.
America Latina y el Caribe, Montevideo, Uruguay, Afio III, 1989.
Cosumidores y Desarrollo is a newsletter published 10 times a year, that reports on the
development of the consumer movement in Latin America and the Caribbean and the
activities of IOCU in the world, giving information on the most varied topics that interest
the consumer. Published in Spanish.
For more information: IOCU, Oficina Regional para America Latina y el Caribe, Casilla
10993, Sucursal 2, Montevideo, Uruguay.
Health - Work
‘TERMINAL SHOCK. THE HEALTH HAZARDS OF VIDEO DISPLAY TER
MINALS.” De Matteo, B., NC Press Limited, Toronto, Canada, 1986.
This book is an excellent source of information on video display terminals, and is aimed
at workers or employers, and at all users in general. It presents all the available
information on the potential risk of working with video display terminals, and it offers
concrete suggestions on what can be done. This is an indispensable source for all of those
who work with personal computers, and despite the fact that it has been four years since
it was first published, it hasn’t lost its relevance. Published in English.
For more information: Occupational Health Centre Inc. 98 Sherbrook St., Winipeg,
Manitoba R3C 2B3, Canada.
“WORK IS DANGEROUS TO YOUR HEALTH. A HANDBOOK OF HEALTH
HAZARDS IN THE WORKPLACE AND WHAT YOU CAN DO ABOUT
THEM.” Stellman, J.M; Daum, S.M. Vintage Books Edition, United States, 1973.
Just as the title indicates, this manual, which was published 17 years ago, informs us or|
the health hazards in our work environment and what can be done about it. Its aimed
especially at industrial workers; it teaches us how to detect risks and how to handle them.
Published in English.
For more information: Occupational Health Centre Inc. 98 Sherbrook St. Winipeg,
Manitoba R3C 2B3, Canada.
“OCCUPATIONAL REPRODUCTIVE HAZARDS.” OntarioFederation of Labour,
Occupational Health and Safety Training Centre, Jon Mills, Canada, n/d.
Its been proven that certain chemical compounds, processes and work conditions can
affect our reproductive system and, therefore, our children. This manual gives complete
information to identify and control our exposure to hazardous work conditions, which
not only endanger our lives, but also the health of future generations. In English.
Request from: OFL, Occupational Health and Safety Training Centre, 15, Gervais
Drive, Suite 703, Don Mills, Ontario, Canada.
.
> i
..
■.\
. ..
"
-. v.
" Wright. C. and theWaterloo
nsin organh. solvents which are widely
th-’ iii- uds they pose to health and the
• .■
men i.« u
>
■' ■
...-I. ■ ninr.i
< tlc< i". In English.
' 'i.-n-o Ke.. :>n ii (Jump, University of Waterloo,
-KO III
ERGONOMICS AT WORK.” National
e.v.vd.;. nil.
•V
X
'
i n »
v' " uvuit.’. Write! loo. (.’aniHla, 1985.
■
c X
> v.-...
• e scientific knowledge to work, with the airn of
.. . .-•. x ei ihcwoikctsiiiulthcorganiz.ation.Thispamphlet,
Cc ■
• Kesemvh Council, gives basic information on this
In English and French.
\-\ c.c.'incnt Industriel. Conseil National de Rccherches du
A.SS EST OS.” Manitoba Environment and Workplace Safety and Health,
jada,n/d.
7 oor.'.mon mineral, that when processed has the tendency to give off a
is used the manufacture of more than 3,000 prodcuts, but
. • .. .. permanent exposure can mean serious hazards to health. This
pr<->;i',e information on its risks and prevention.
J-.n /ironiiu ni and Workplace Safety and Health, 1000-330 St.
/Z ■
Manitoba l< 3(' 3Z5, Canada.
‘LAS MUJERES Y EL DERECHO A LA SALUD”’. CEPAM -UNFPA, Quito,
Ecuador, 1989.
This publication presents the papers and debates of the workshop and forum entitled
“Women and the Right to Health,” organized by CEPAM in June and July of 1989.
Among some of the subjects dealt with were, sexuality, reproductive rights, health
policies, and women as agents, promoters and consumers of health.
Request additional information from: CEPAM, Centro Ecuatoriano para la Promocion
y Accion de la Mujer, Apartado 182-C, Sucursal 15, Quito, Ecuador.
“LA MUJER CARIBENA EN LA AGRICULTURAL Organizacidn de lasNaciones
Unidas para la Agriculture y la Alimentacidn, Oficina regional para America Latina y
el Caribe, Santiago, Chile, 1989.
This publication is the results of a Cooperation Project of FAO in English speaking
Caribbean countries and Suriname, in the framework of a sub-regional study on the
situation of peasant women in those countries. In this study, whose documents are
presented here, four general subjects were analyzed: the macro-social and economic
context with respect to peasant women, analysis of femenine productive activies, study
of governmental and non governmental programs for peasant women in the Caribbean
and identification of public policies towards women. There are, also, five case studies.
It can be requested from: FAO, Santa Maria 6700, Las Condes, Santiago, Chile.
COMMUNITY H'JALTH C . Lt.
47/1,(FirstFloor)Si. Marks Hoad
BANGALORE
“ESCUELA DE MADRES PARA EL AUTOCUIDADO DE LA SALUD FAMI
LIAR Y COMUNITARIA”. Malagdn de Salazar, L.; Becerra C, J. CIMDER, Cali,
Colombia, 1989.
The publication gathers the results of a research carried out by a group of mothers for
two years in Colombia. The research, included the design, testing and adaptation of a
educational methodology and technological elements directed at training the mother so
that she may exercise an effective role as a health agent in her family and in the
community. A teaching methods was implemented and educational instruments that
would permit the mother to carry out her role of educational agent with capacity to solve
primary care problems.
For more information: CIMDER, Centro de Invcstigaciones Multidisciplinarias en
Dcsarrollo, Univcrsidad del Valle, Facultad de Salud, Apartado Adrco 3708, Cali,
Colombia.
“SONAMOS DESPIERTOS.... TESTIMONIO DE MADRES POBLADORAS”.
Kachcle, M.E.; Jaramillo, M. Programade Salud Pre-cscolar,CIASPO, Santiago, Chile,
Novicmbrc 1989.
This publication is an authentic and dramatic testimony of the status of pre-school
children in the Jose Maria Caro and La Victoria shantytowns in Santiago, Chile. Some
cases are presented, through interviews to the mothers, which permit us to come into
contact with a world of crowding and oppression, hunger and promiscuity, little known
even in Chile, as to its real magnitude.
For more information: CIASPO, Centro de Investigacion y Accion en Salud Popular,
Progrcma de Salud Pre-Escolar, San Geronimo 5020, San Miguel, Santiago, Chile.
“SALUD GINECOLOGICA”. CESIP - Area Mujcres, Lima, Peru, 1989.
Salud Ginecologica is a series made up of five pamphlets produced by the Women’s
Area of CESIP. They are: 1. Our bodies; 2. Always women; 3. Keeping healthy; 4 iLs
belter to prevent; 5. A visit to the gynecologogist. These materials are aimed at givin„
a better knowledge of our bodies and how to take care of it, to permit us to reflect jointly
on our situation as women and to concern ourselves of our physical and emotional wellbeing
Request from: CESIP, Centro de Estudios Socialcs y Publicaciones, Coronel Zegarra
722, Jesus Marfa, Lima 11, Peru.
Health - Education
‘SERIE: CUENTOS PARA LA VIDA: HILARIO EL ZORRO ENANO; EL
COLLAR DE RAMU”. Altemaliva, Lima, Peru.
These stories are part of a series called Stories for Life, whose aim to give the teacher
instruments which will help him structure his pedagogical-educational activities about
child health, either in or out of school. These children’s stories try to introduce health
subjects in every school course, including subjects such as language, natural sciences,
history and arithmetic.
For more information: Altemativa, Jr. Emeterio Perez 348, Urb. Ingenieria, San Martin
de Pones, Lima, Peru.
“SERIE: EDUCACION PARA LA SALUD. CARTILLAS 1, 2 Y 3”. Altemativa,
Lima, Peru, 1989.
This series of pamphlets produced by altemativa give basic information on prevention
and promotion of child health in the classroom. Pamphlet No 1 refers to child health
(growth and child development, diarrhea, respiratory infections and inmunizations), the
second deals with the subject of nutrition and school diet, and No. 3 with balanced meals
and nutritional compounds.
For more information: Altemativa, Jr. Emeterio Perez 348, Urb. Ingenieria, San Martin
de Porres, Lima, Peru.
“BETTER CARE OF MENTALLY DISABLED CHILDREN.” Voluntary Health
Association of India, New Delhi, India, 1989.
This manual teaches us how to discover if a child is mentally incapacitated, how to teach
him how to move and take care of himself. It also teaches us how to avoid the birth of
a mentally incapacitated child and how to avoid after birth problems of this type.
Request from: Voluntary Health Association of India, 40 Institutional Area, behind
Qutab Hotel, New Delhi 110 016, India.
“SALUD POPULAR”. Revista del INSAP, N5. 10, julio 1989, Lima, Peru.
This new issue of Salud Popular (Popular Health), “Communications and Health
Education,” presents some approaches and experiences that are being done in the field
of health education and communications. The summing up of the conclusions of the
meeting of educators and communicators who work in health projects is also included,
and who met to exchange experiences and discuss the different existing approaches on
this subject.
Request from: INSAP, Institute de Salud Popular, Av. Arenalcs 1080, Of. 301, Lima 11,
Peru.
“BOTIQUIN COMUNITARIO”. CIPROC -Area de Salud, Bogotd, Colombia, s/f.
Educational pamphlet with instructions to implement a community dispensary, drafted
by the Health Area of CIPROC. It contains basic instructions on its functioning, basic
materials that the dispensary must contain and minimum precautions on the use of
medications.
For more information: CIPROC, Apartado Aereo 38545, BogotA, Colombia.
Other subjects
“LOS HU OS DE LA POB REZA”. Dejo, F. Centro de Investigation Social Econdmica,
Octubre, 1989, Lima, Peru.
This publication presents the results of a research carried out in 1989 in different
communities in Lima on children who begged or worked. Interviews were carried with
133 children between 8 and 12 years of age, with the aim of finding out their socio family
conditions, as well as their nutrition, health, education, and work. The results are
presented statistically.
Request from: CISE, Centro de Investigacion Social Economica, Universidad National
Agraria La Molina, Apartado 456, La Molina, Lima, Peru.
“LA DEUDA GIGANTE DEL TERCER MUNDO. HISTORIA, ARGUMENTOS, PROPUESTAS”. Bowen, S.; Cavanagh, J.; Iguifiiz, J.; Sulmont, D.; Yafiez,
A.M. (editores). ADEC/ATC, Lima, Peru, 1989.
This work presents a series of extraordinary photographs, oral and statistical testimonies
on the subject of the foreign debt in Latin America and the rest of the Third World
countries. The reader will find abundant material to continue to discuss and reflect on
this troubling problem. Interviews to Peruvian specialists on the subject are included.
Request from: ADEC/ATC. Leon Velarde 890, Lima, Peru.
“CONVERGENCE/CONVERGENCIA”.ICAE<Consejo International de Educacion de Adultos, Toronto, Canada, 1989.
Convergence is a quarterly publication of the Intmational Council on Adult Education,
that contains subjects, practices and experiences in the field of non formal and adult
education. Its a link for information and expression for researchers, administrators,
teachers and students. It contains international articles in three languages: English,
French and Spanish.
For more information: Karen Yarmol-Franko, ICAE, 720 Bathhurst St. Suite 500,
Toronto, Ontario M5S 2R4, Canada.
“LA OTRA CARA DEL CRECIMIENTO URBANO. UNA APROXIMACION
AL ESTUDIO DE LA SOBREPOBLACION RELATIVA DE LA CIUDAD DE
SANTA CRUZ”. Soliz, E. UNICRUZ, Santa Cruz de la Sierra, Bolivia, 1989.
This work gathers the basic information on services, living conditions and organization
of the popular neighborhoods of Santa Cruz de la Sierra. Its aimed at popular
organizations that support development and governmental organizations, as a way to
promote thought for the formulation of policies that seek a solution to the more urgent
problems.
For more information: UNICRUZ, Calle Pero Velez Ns 282, Casilla 4041, Santa Cruz,
Bolivia.
GO/n h 6
NEWSLETTER #12
OF THE HEALTH AND
POPULAR EDUCATION NETWORK
COMMUNITY HEALTH CELL
47/1,{First Floor)St. Marks Road
BANGALORE. 560 001
May 1990
Network Coordinator: Teresa Marshall
General Secretariat:
cantiaeo, Chile
Perez Valenzuela 1634 - Casilla 163-T, Prov.,
Telex 241044 CEAAL CL - Fax 56-2-2235822
Telephone 2239331 - 2256271
Health and
^Popular Education
COWJMDNITV HEALTH CELL
Haf irst Floor) S t.. Marks Road
BANGALORE’560 001
DR. RAVI NARAYAN
COMMUNITY HEALTH CELL
326 V.MAIN 1 BLOCK,KORANANGALA,BANGALORE
560 034,KARNATAKA
INDIA
1a
Publicacidn con apoyo de ACDI (Canada)
.fi
Echos from the First Latin
American Conrse/Workshop on
Health and Popular
o
1. LOCAL
DEVELOPMENT AND
HEALTH
In this issue we would like to share some of
the discussions which took place during the
Latin American Workshop on Health and
Popular Education which was held in San
tiago, Chile in November 1988. Here you
will Find two different outlooks on the prob
lems facing those who want to make a
political and social impact on the health
situation in Latin America today. First we
will present the opinions of Sergio Galilca,
cautioning about the advantages and risks
involved in local development strategies;
then an analysis by Carlos Montes, who
questions the political scope of our prac
tices and formulates some hypothesis. Both
.<Sftt»rcc that it is a challenge to build on our
■experience, and to strengthen the relation
between theory and practice, in order to
have social and political impact.
I. Health and Local Development:
Promises and Concerns.
Sergio Galilea
Talking about health is complex. In Latin
American cities today, health problems are
much more severe than they were 10 to 20
years ago - conditions in general have wors
ened. There has been an increase of new
pathologies and it has become increasingly
evident that market forces are incapable of
providing the coverage or the efficacy to
resolve these problems. There is general
criticism in Latin America of health minis
tries or of public institutions. There is a
categorical and critical opinion of, and an
enormous debate about the institutional
deficiencies which exist in the area of
health.
Also, in examining the principal manifesta
tions of the crisis in Latin America, we find
these elements: a decrease in the real mini
mum wages, increasing informal modali
ties, and a growing similarity between the
critical conditions in different countries of
the region. A few years ago the problems
found in Montevideo today did not exist.
From this point of view, it can be said that
Montevideo and Buenos Aires are becom
ing more Latin American every day, and are
increasingly less of an exception to the
norms that apply to the rest of the hemi
sphere.
Since health problems have become more
complex, then trying to address these prob
lems is evidently more difficult than it once
was. This has to do with resources, with new
problems, with the relative unpopularity of
technical solutions and with the magnitude
of the crisis which has especially effected
the quality and conditions of life for the
larger part of the population. Today, in the
majority of Latin American countries, there
t are heterogeneous forms of poverty. We
have poverty that is associated with politi
cal exclusion, poverty which is consoli
dated and unstable poverty, as well as an
impoverished middle class.
_ There are obviously some situations which
are more dramatic than others. Probably,
from an international perspective, the case
of Lima, Peru is one of the most dramatic;
but so is Central America, where wars have
created a migration to the large cities. We
find explosive situations and burgeoning
urbanization in almost all of the countries in
the region. We have more problems today,
and more people with more problems.
What has this meant for local development?
Well, I would say that in the last few years,
speaking about local development has be
come fashionable. There has been progress
from the theoretical point of view and in the
methodology of work.
The value of local development is in its
recognition of a scale which is closer to
daily problems and subjective elements,
where participative approaches can be more
effective, where multisectorial relations are
perhaps more fluid, circumventing rigid
sectorial bureaucracies. This can be an
interesting benefit to countries with a great
deal of institutional rigidity. It also consti
tutes a kind of transformation vision at the
local level, which could be superior to a
transformation perspective at the general
level.
Others hold that it creates a field where
forms of technology and supply of services
can be practiced with originality and effi
cient forms of social activism. And, finally.
others state that at the local level it is pos
sible to produce a democratic revitalization,
II. Don’t Forget Politics.
Carlos Montes
Popular education experiences have inter
esting potential and a mission (especially
for Chileans today) to contribute to the
democratic reconstruction of the country. It
means relating to political and alternative
approaches in a different manner, espe
cially when planning projects to meet social
demands.
in so many socio-govemmental spheres,
where social dynamics and governmental
structures arcconcentrated. I here, an effort
must be made to see that social organiza
tions are more cohesive and solid, and are
also related to governmental initiatives, in
order to bring about progressive change of
public institutions.
These factors have produced the discover}of and justification for local development
scenarios. However, in many Latin Ameri
can countries, we have a limited concept of
region or of local space. In practice, we are
strongly centralized. Therefore, if there
were a series of ideas or proposals that
would impel us to value local development,
we should look at those effective possibili
ties we have in the different countries of the
region to put forms of local development
into practice. We must recognize that there
are many limitations. The first of these is
the absence of a local tradition. The second
important constraint, are institutional struc
tures, particularly municipal governments.
In Latin America, these are the most useful
institutions because of their service to the
community, but they are also lite institu
tions which are most stale and full of preju
dices.
Therefore, I feel that the transformation of
municipal government is an important con
cern, and that the ideas of local develop
ment would most likely be in sharp conflict
with these institutional constraints. They
would also be in conflict with cultural re
strictions, and with policies that are
strongly centralist Local development
therefore, has a great deal of promise, but
many limitations.
If we accept that local development holds
promise, then we must ask what role health
has m this process.
The public feels that health is of high prior
ity. Moreover, it is important to note that
when people unite to solve health problems
there is a high degree of appeal, and when
these problems begin to be solved, popular
organizations are strengthened. There is a
dynamic relationship between initiating
local development activities and finding
out what health needs exist in the first place.
It is possible to cany out activities in the
field of health on the local level with social
activism; that is to say, that the people
organize themselves to confront health
problems which are relevant to them. The
active organization of the people becomes
a real resource that has proved itself to be
effective for the efficiency of health pro
grams in numerous situations in Latin
America
Because health problems have priority at
the local level, cany ing out health programs
at the local level is more efficient. It makes
it possible to lower the cost of the supply of
services, to recognize of the nature of prob
lems more easily and, therefore, to
adequately adapt the solution to the prob
lem.
At the local level, health programs have the
potential to be creative, and technological,
social and organizational innovations could
be introduced.
At the local scale, some health programs
could establish real and effective tics be
tween social and government organiza
The movement of pedagogical renovation is
a movement with great potential, but it isn’t
capable of projecting itself further than
local working groups. There have been self
management projects in the field of em
ployment and basic needs which are very
stimulating in themselves, but which face
many problems. Something is happening.-''
Therefore, I want to formulate two hypothe
sis on this situation.
tions, and in this way advance the demo
cratic potential of this type of program.
Finally, it is important to add that a more
multiscctorial approach in relation to health
service is possible at the local level.
1 have proposed a group of hypothesis on
what could occur. Now a way must be found
to compare them with practices, and prac
tice is even more important than any meth
odological approach.
The question is, in what ways do local
experiences of health that you have led or
that you have observed show that the afore
mentioned questions are true? That is the
most important point: that we systematize
or that we have a better capacity to organize
our actions to draw important conclusions.
First hypothesis: Frequently these proc
esses have a serious problem as to the politi
cal, with regards to power, both national as
well as local. There’s a problem there, a
blockage in the relationship between these
projects and the political and the question of
power. It is very common to find defensive
attitudes with regards to this problem,
which arc normally a result of experience.
I’ve perceived a defensive attitude toward
social reform movements, a fear that the
richness of a project, for instance in health,
could be transformed into little more than a
point on a political platform. There’s fear in^.
being associated with more radical political
movements.
There is a great deal of apprehension about
associatiate with political parties. It is very
common to engage in the discussion that our
work is not represented in politics. There’s
no political party which expresses the type
of transformation discourse, the kind of
praxis which we arc carrying out. There’s
fear of being manipulated.
The state, in general, is seen as an agent of
deformation, since it accepts what we are
doing, distorting and altering it.
This defensive stance towards the political
leads us, in practice, to take part in political
processes without contributing our own
unique perspective.
Consequently, my first hypothesis is that
the limited political dimension of these
projects and the scant will to influence po
litical power, makes them lose strength and
has the tendency of relegating them to a
specific reality.
Second hypothesis: these projects tend to
have an extra-institutional character, these
projects have difficulty in recognizing the
real movement of things. These projects are
far removed from the problem of institutionality. Different aspects influence this.
There’s conceptual factors: an idea of the
state as purely an apparatus of domination,
g or, a perception of civil society very differ• ent from that of the state, as if it were
possible to generate a project not linked to
the state in civil society .
There are also political matters. This end
less discussion which began in the 30’s,
about reform and revolution, that influences
how we approach the institutional problem
and the concept of the extra-institutional.
It’s acknowledged that the institutional
doesn’t seem to elicit revolutions. In other
cases, there’s distrust of the capacity of
popular actors to incorporate themselves
autonomously into institutional processes.
It is thought that to commit oneself to insti
tutional processes implies a loss of identity
and experiences. Nevertheless, not to acknowlcge institutions is a divorce from
* common sense and a failure to recognize
the potential which exists in people. In the
Chilean case, for example, people have
exercised more power when they act within
the law. The problem in Mexico is similar:
a search for alternative forms, without
looking at or asking how to empower au
tonomous actors. This extra-institutional
character condemns them to a certain mar
ginality, producing low political productiv
ity in every initiative.
These two hypothesis have a lot of influ
ence on the difficulty of projecting the
richness of the projects, in debate, public
policy and social practices.
Bearing this in mind, I must ask myself how
can I increase and deploy the transforming
potential contained in these experiences?
It’s a difficult question to answer.
I attempt to formulate three proposals, all
related, which can contribute to debate this
dilemma.
First, it is important to acknowledge the
territorial approach in its totality, which
takes into account the pattern of social,
economic, cultural and political relation
ships, which exist within the local commu
nity in which we are working.
But the territorial approach has to be wed
ded to a class approach, which means work
ing with the neediest. Since social structure
in territories where popular sectors arc var
ied is complex, one must not lose sight that
the most important task is to address the
problems of poorer sectors. And its a ques
tion of acknowledging a multi-class reality
and empowering middle-class sectors and
professionals who are interested in and
capable of contributing to solving commu
nity problems.
Therefore, the first proposal is directed at
examining the territory in its complexity,
trying to simultaneously influence a spe
cific problem, in all of territory and its
power structure.
Second proposal: It is necessary to contrib
ute to the growth of democratization, trans
formation and local development move
ments. It is not sufficient that the project be
creative, interesting, but it’s also necessary
to join a movement of coordination, trans
formation and development at the local
level. Because the question of the autonomy
of popular actors would be enriched if they
had access to experiences which would al
lo w them to have proposals for the problems
of health and not just merely demands.
Nowadays, wc need demands accompanied
by proposals. And not only express the idea
that die government must acknowlcge the
problem, but to say "the problem must be
solved in thefollowing way." A very impor
tant idea is that popular movements and
actors must have positive proposals to solve
their problems and not only be a source of
pressure. This is the key content in popular
education experiences. This is the source of
the strength and richness of the movement
and of its possibility to spread and grow.
This second proposal aims at identifying
projects, as part of initiatives aimed at gencrating autonomous actors with transforma
tion potential.
The third point of the proposal, refers to the
need of appropriating the struggle for politi
cal democracy. In particular I want to refer
to the decentralization of the state and to
political reform at the local level. Because
the problem of the municipality can be a key
clement to solve the problems our projects
have with regards to difficulty of projection
and impact.
extent that the municipality is a place where
it ispossible to influence problems, popular
actors acquire more power, and a broader
democratic fabric is woven.
Also, our project finds a space where it
ceases being just an interesting and rich
experience microsocially, but it seeks to
challenge the content of the subjects,
change policies and influence actors and the
institutions generated at that local level.
It’s true that projects face many limitations
to solve problems, but they also have poten
tials that merit efforts at reform.
The reform of these municipalities means
that public administration is at the serviceof
the community; that the community has a
real possibility of controlling public ad
ministration, with forms of democratic rep
resentation in the local government and
with channels for participation. It’s also a
question of having resources, of being more
modem administratively, with greater tech
nical capacity, with clear responsibilities to
be able to confront problems, that is, a clear
From the national point of view, to build a
renewed, participatory democracy, it’s fun
damental that the municipality be an instru
ment for directing and linking daily life with
a general political transformation. To the
w
a'
articulation of responsibility between cen
tral and local governments.
2. LOCAL DEVELOPMENT: A
STRATEGY FOR SOCIAL CHANGE?
I wanted to point out these three proposals
because it is very important to know what
we can contribute to a new city. How our
work can support processes for a popular
reappropriation of the city, making the city
a more collective space, and, in the last
analysis, humanizing it
The subject of local development as a strat
egy for social and political change was the
focus of the debate, and was enriched by the
participant’s experiences. This core idea
was questioned as to the potential of mobi
lizing local popular organizations and its
link with the growth of the popular move
ment at the national level.
These three lines of thought can also help us
to rethink the articulation of the political
and not to fragment it, because we have a lot
to contribute to a broader, more societal
political movement, linked to the everyday
problems of people.
Let me reiterate that these microsocial ef
forts are tremendously valuable, but I think
that they could be richer and more produc
tive if we can incorporate them within a
larger transformation movement.
Hereafter we will present some aspects of
this discussion, using some comments by
the participants and speakers.
From the theoretical point of view, the
concept of local development tries to ad
dress several problems of our society.
There’s a critical vision of the state, as a
bureaucratic apparatus, distant from
people, as an entity that decides for the
community. Tnere is concern for discover-
Another source that delineates the origin of
this concept is a criticism of capitalism and
industrial society, that alienates and quanti
fies people. It is a criticism to a more gen
eral contemporary phenomenon: a mass
production industrial society, of global de
cision-making, of rationalizing everything.
The concept of local development is closer
to the idea of a human scale, of creating
human dimensions and local decision mak
ing. The subject of neighborhood, of
smaller spaces, of more local areas, arises.
This line of thought, underscores the idea
that social transformation and that spaces
for participation must also be sought within
the territorial realm, where people live and
work. That is to say, the territories where
one lives must be considered as spaces for
intervention and social initiatives.
NGO’s have contributed to formulate the
concept of local development, through
their role as support institutions for popular
organizations. These support institutions
are usually local and work at the micro
level. As a product of their work and of
systematic reflection, the need arises of
giving these practices a meaning and a
framework. The idea of local development
tries to give a global, comprehensive
framework to numerous isolated and dif
fuse practices. Notwithstanding limita
tions, the concept of local development has
— potential,and tries togiveapolitical frameIj work to NGO experiences in the popular
i1 sphere.
When support institutions are involved in
matters of health, housing, education, and
production at the local level, the question
arises of the meaning of these initiatives
and the question of development and social
change.
It’s no longer sufficient to continue with
health programs, improving methodolo
gies, discussing the experiences of popular
education, but rather the question arises of
the health problem as a whole, and, there
fore, of how we can develop our societies
from a democratic perspective and
popular leadership.
In that sense the concept of local develop
ment is relevant. Nowadays, the questions
arc: what potential do local spaces ha'< p
confront a national problem? What can die
municipality do? What can organized com
munities do? What are the relationships
between the local and national levels that
permit those conditions of local operations
to increase? In what way can the state
apparatusfacilitate development initiatives
at the local level, where the human scale
becomes real and where direct democracy
becomes a possibility?
In this way we are trying -through local
development strategics- to avoid separating
local and national practices, trying to relate
the initiatives of popular organizations with
national demands. The point is that these
local experiences must not remain at the
anecdotal level without a connection to
national processes, and that popular
proaches that deal with health at the loJd
level, have an influence in public health
policies.
These ideas of local development, both in
their ideological components as well as
their concrete social practices, contain an
abundance of questions that stimulate the
debate in Latin America.
POPULAR EDUCATION
AND HEALTH:
Community Based Health Programs in the Philippines
Barely a year after the Alma Ata conference, the community-based health programs
(CBHPs) in the country met to assess their four-year experience. At this time programs
had a rapid rate of expansion and thus there was a demand for improvements in training,
research, and program management. They saw the need for publications as venues for
sharing of trends and experiences. In this context we decided to form a coordinating
body which would answer these needs.
In the following year, this resolution was put into practice with the formation of tire
Council for Primary Health Care (CPHC), -a national consortium of community-based
health programs and institutions which aim to actively respond to the basic health needs
and to improve the health conditions of the Filipino people.
Currently the CPHC coordinates a network composed of 83 programs covering 46
provinces and 9 cities in the country. Each network member adheres to the basic phi
losophy of putting health in the hands of the people. Thus, popular education is the csleb, sence of CBHP work.
THE CONTEXT OF POPULAR EDUCATION IN CBHP
The Philippines produces thousands of health professionals every year. However, the
services of these professionals are way beyond the reach of the majority of Filipinos
who are living below the poverty line and who are the most vulnerable segment of the
population, in terms of deceases.
Their education and training is very colonial, urban-centered, and hospital-based. This
is the reason why the tendency of Filipino health professionals is to work in hospitals
which are concentrated in the cities, away from the 70% of the population that lives in
rural areas.
Hospitals in the Philippines are mostly privately owned, that is, quite profitable busi
ness ventures. The very over-supply of health professionals creates undesirable
working conditions for them. And instead of painstaking efforts to struggle for eco
nomic and general welfare demands, a majority of these professionals choose to work
abroad - making the country among the leading exporters of health professionals.
State neglect aggravates the health situation of the Filipinos. Despite a new regime,
health remains one of the lowest priorities.
The road to economic recovery is too narrow to tread on. Filipinos are mesmerized
witnesses of the economic crisis which worsens by the day. They will not even talk of
maintaining health as their basic needs are not met
If the health providers and the support structures fail, the people have no one to rely on
butthemselves.
neat TH
COMMUNITY HEAl-l"
47/1,(First Floor)St. Mar
BANGALOaE-6t>0°
2.
Health and development are interrelated.
Good health depends on the progressive improvements of living conditions and the
quality of lifeof the population. Development which isdefined as an upward and gradual
movement bringing about change from the status quo to something higher and better,
is measured by the capacity of the people to satisfy their basic needs - food, clothing,
and shelter. Since these basic needs are also determinants of good health, bad health is
to be expected in a country where people are enslaved by poverty. Thus, working
towards improvements in health means intensifying the commitment to the creation of
a society which provides equal access to opportunities and benefits to its members.
Moreover, health work means enabling the people to develop their appreciation of their
capacities and theenhancement of their innate potentials as they work towards a genuine
people’s development.
3.
Genuine people’s participation is essential.
People arc the center, subject and object of development. Thus, the success of apv
undertaking with the aim of serving the people, is dependent upon people’s partic..
tion at all levels of decision-making: planning, implementing, monitoring, and evalu
ation of such an undertaking. In general, health work is starting where thcpeople are and
building on what they have. It is enabling people to participate and get involved and to
act as a unified community
.METHODOLOGIES AND STRATEGIES IN POPULAR EDUCATION IN
CBHP
THE CONTENT OF POPULAR EDUCATION IN CBHP
The CBHP regards health as related to the socio-economic conditions of society. The
ill health of Filipinos is part of the basic socio-economic problems of an underdeveloped
country like the Philippines. The CBHP actively contributes to the solution of health
problems by bringing health care to the hands of the people by:
a.
the creation of awareness among the people of social realities, the development of
local initiatives, optimal use ofavailable human, technical and material resources,
and strengthening their capacities;
b.
the formation of organizational structures which uphold their basic interests as
oppressed and deprived sectors ofsociety and as people united in their work to serve
people; and
c.
the implementation of responsible actions addressed to holistically deal with the
various health and social problems.
The CBHP upholds the following principles in popular education:
1.
Health as a social phenomenon.
The interplay of political, socio-cultural, and economic factors to health is recognized
as one major determinant of the health status of the people.
In the last national consultation of CBHPs (February, 1988), these centers describe their
methods in popular education as participatory, experiential, dialogical, democratic, and
suggestive.
Popular education work in CBHP entails the following phases:
1.
Need assessment
The staff works with the community in identifying their needs. This entails a lot of
integration work with the community to be accepted as one of them.
The customary strategy is to make a community diagnosis, whose design and tools are
formulated, implemented, and the results analyzed and interpreted by the people
themselves. This requires a concrete analysis of specific conditions with the people
identifying their real needs.
2.
Establishment of formulas/mechanisms to respond to needs
After identification of needs, structures are established to carry out an action program
for their satisfaction. In CBHP, this means having a team of potential community health
workers (CHWs), and an initial structure of a village health committee. Usually, a
village is divided into clusters of 10 families who elect their own CHWs.
CHWs undergo a training sequence: a basic course on health skills with an equal dose
on attitudinal and value formation sessions. What a CHW learns is passed on to his
cluster. Concrete activities (e.g. direct services) are carried out to apply them as learning
experiences. Appropriate teaching-learning methodologies are applied.
A set of advanced CHWs attends additional courses (c.g. program management,
leadership skills, campaign management, etc.) in preparation for full-blown health
program directly managed by them.
3.
Integration with support structures
Health program/committec is made up of other community programs such as women,
youth, cooperatives, functional literacy, etc. within the basic organization (peasant,
workers, fishermen or organizations of urban poor).
This guarantees direct community support to the health structure as it complements
other community programs. It integrates popular education work in health with the
efforts of other sectors.
4. Consolidation through actions
_Asidc from the on-going health education work along the lines of the basic elements of
rimary health care and the forms of services it entails, the health program through
CHWs gets involved with community problems. Campaigns on community issues (e.g.,
land tenure, livelihood, etc.) are carried out by the program.
Direct actions are forms of consolidation as they test the preparedness of the program
and its strength; and they provide learning experiences for the people.
5.
Evaluation of efforts
Community evaluation of all efforts summarizes the impact of the program. It is always
the community who will recognize and appreciate the extent of accomplishments, the
joys of success, the limitations and lessons from the weaknesses and failures.
POPULAR EDUCATION WORK IN CBHP: WHERE TO GO FROM HERE?
An indicator of success in popular education work is the rise of critical awareness among
thepcople. When the culture of silence and apathy is destroyed, popular education starts
to bloom.
This is the moment when other health professionals, particularly when private physi
cians experience and complain of the decrease of their patients and the articulateness of
their patients as they begin to question procedures and methods.
This is also the time when the people themselves, in a collective spirit, implement
responsible actions towards improving their living conditions.
This also the time when government structures get paranoid and think that people are
destabilizing the state. At this point, the state apparatus begins to crush the popular
movement, which is a result of popular education.
Despite some gains, so much has to be done in popular education work. After 13 years,
CBHP reaffirms its commitment. It will carry on!
II NATIONAL SEMINAR ON PRIMARY HEALTH CARE AND
COMMUNITY PARTICIPATION IN ARGENTINA
The II National Seminar on Primary Health Care and Community Participation
in Argentina took place in Alta Gracia, in the Province of Cordoba from May 2528tlt this year. The seminar was sponsored by the Committee for the Defense of
Health, Professional Ethics and Human Rights of the Argentine People (Comite
para la Dcfensa de la Salud, la Etica Profesional y los Derechos Humanos del
Pueblo Argentino - CODESEDH) and the Movement for a Comprehensive
Health System, (Movimiento por un Sistema Integral de Salud - MOSIS) of
Cordoba.
More than six hundred persons participated in the seminar. Among them were
hundreds of community health agents who were elected and sent by the
communities they represented. Also in attendance were health promoters and
educators; community health professionals; popular healers (curanderas); tradi
tional midwives; representatives of community organizations, universities, and
NGOs; and government sanitary and education officials from all over the
country. Sanitary agents from different ethnic groups played a special role.
CODESEDH and MOSIS were asked to accept the challenge of organizing the
Seminar at the Meeting of Health Teams from 16 provinces of Argentina which
took place in May 1988, a responsibility they readily assumed. At this same
meeting, the Popular Health Network of Argentina was also formed. It is now
part of the Latin American Health and Popular Education Network of CEAAL
C
47/1
A set of advanced CHWs attends additional courses (e.g. program management,
leadership skills, campaign management, etc.) in preparation for full-blown health
program directly managed by them.
3.
Integration with support structures
Health program/commiltce is made up of other community programs such as women,
youth, cooperatives, functional literacy, etc. within the basic organization (peasant,
workers, fishermen or organizations of urban poor).
This guarantees direct community support to the health structure as it complements
other community programs. It integrates popular education work in health with the
efforts of other sectors.
4. Consolidation through actions
Aside from the on-going health education work along the lines of the basic elements of
C rimary health care and the forms of services it entails, the health program through
CHWs gels involved with community problems. Campaigns on community issues (e.g.,
land tenure, livelihood, etc.) are carried out by the program.
Direct actions are forms of consolidation as they test the preparedness of the program
and its strength; and they provide learning experiences for the people.
5.
Evaluation of efforts
Community evaluation of all efforts summarizes the impact of the program. It is always
the community who will recognize and appreciate the extent of accomplishments, the
joys of success, the limitations and lessons from the weaknesses and failures.
POPULAR EDUCATION WORK IN CBHP: WHERE TO GO FROM HERE?
An indicator of success in popular education work is the rise of critical awareness among
thcpcople. When the culture of silence and apathy is destroyed, popular education starts
to bloom.
This is the moment when other health professionals, particularly when private physi
cians experience and complain of the decrease of their patients and the articulateness of
their patients as they begin to question procedures and methods.
This is also the time when the people themselves, in a collective spirit, implement
responsible actions towards improving their living conditions.
This also the time when government structures get paranoid and think that people are
destabilizing the state. At this point, the state apparatus begins to crush the popular
movement, which is a result of popular education.
Despite some gains, so much has to be done in popular education work. After 13 years,
CBHP reaffirms its commitment. It will carry on!
II NATIONAL SEMINAR ON PRIMARY HEALTH CARE AND
COMMUNITY PARTICIPATION IN ARGENTINA
The II National Seminar on Primary Health Care and Community Participation
in Argentina took place in Alta Gracia, in the Province of Cordoba from May 2528th this year. The seminar was sponsored by the Committee for the Defense of
Health, Professional Ethics and Human Rights of the Argentine People (Comite
para la Defensa de la Salud, la Etica Profesional y los Derechos Humanos del
Pueblo Argentine - CODESEDH) and the Movement for a Comprehensive
Health System, (Movimiento por un Sistema Integral de Salud - MOSIS) of
Cordoba.
More titan six hundred persons participated in the seminar. Among them were
hundreds of community health agents who were elected and sent by the
communities they represented. Also in attendance were health promoters and
educators; community health professionals; popular healers (curanderas); tradi
tional midwives; representatives of community organizations, universities, and
NGOs; and government sanitary and education officials from all over the
country. Sanitary agents from different ethnic groups played a special role.
CODESEDH and MOSIS were asked to accept the challenge of organizing the
Seminar at the Meeting of Health Teams from 16 provinces of Argentina which
took place in May 1988, a responsibility they readily assumed. At this same
Urm
Pop“lar Health Network of Argentina was also formed. It is now
P o e Latin American Health and Popular Education Network of CE AAL.
C
47/1.
Debate: Popular Education and Participative Re
search
The methodology of the Seminar, which was based on working in small
discussion groups, stimulated active participation in the debate on popular
education and participative health research.
The participants in the seminar made valuable contributions to the discus
sion by sharing their experiences on the following topics:
The Seminar had the following objectives:
a.
b.
c.
To initiate an active dialogue between the public sector and the communities
regarding their different experiences.
To review past actions in order to arrive al agreement on proposals and rec
ommendations to develop and expand strategies and actions to promote
popular health.
Devote part of the meeting to technical training related to the needs and
objectives of health teams.
Popular education in health was a topic of discussion. This allowed the
seminar participants to acquaint themselves with and deepen their under
standing of the special features offered by popular education:
*
*
It is a learning process oriented toward action to change the status quo.
It is a teaching and learning process which tries to achieve horizontal
relationships and equality among the participants to acquire knowledge.
* It stimulates collective learning and critical consciousness.
* It is a participative process.
* It is derived from practice, from the experiences of everyone in the group and
*
the community.
It takes advantage of learning that is to be had in every setting, in a continuous
way and at any age; it is not the sole responsibility of institutions of
*
instruction such as schools and universities.
It is a process that grows by progressively joining and uniting with more
people, through democratic ties of solidarity in learning and action.
-
Grass roots organization.
Community organization for preventive health care.
Relating popular health projects to 'nose of the health teams at the level of
-
state provided primary care (Health Centers).
Progress in popular participation.
Implementation of curative health care assistance with education and health
promotion.
An advance in the development of the Popular Health
Network of Argentina
This Seminar demonstrates the high level of qualitative and quantitative devel
opment and evolution which the Popular Health Network of Argentina and the
social and health movement that supports it.
Coordinators of the Health and Popular Education Network of CEAAL were
present at the Seminar so they can attest to the effort it look to organize the event
in the midst of the grave economic and political crisis which affected the country
at this time, and which increased the administrative and financial difficulties of
preparing for and holding the seminar. An enormous effort was made to respond
to the great demand to participate in the seminar - a demand which came from
every comer of every territory of Argentina. It should be pointed out that in
overcoming this challenge the event showed:
*
*
*
Reflection „ pmWpati„ research 'n
““
‘h'
characteristics and contributions:
*
It is a social means of research which starts in the community and aims at the
full participation of everyone involved.
*
The powerful response to the idea of Popular Health Network in Argentina
in response to the invitation to participate in the seminar.
The vitality of the popular health movement in Argentina, which gives the
Network the necessary social energy and which is organized at the local level
even in the most remote provinces.
The clarity shown by the participants when discussing a large number of
different practices which share the basic orientation towards health care with
social justice, popular participation and democratically generated.
A high level of cooperation among those involved in health care - grass roots
social organizations, health agents, NGOs, the State, universities, and union
and trade organizations.
The Popular Health Network is a way to overcome Isolation and dispersion.
*
*
It allows us to break out of the isolation of our own communities.
Creates channels of continuous exchange, cooperation, critical analysis of
our work, and the setting for formal and informal training.
short, a Popular Health Network strengthens the growth and expansion of the
<«sk we have chosen and identified as popular health.
We want to make very clear that the Network does not mean to overlook the
different structures and jurisdictions of the formal system of Public Health. On
the contrary, by playing a role in it, government could recognize its errors and
its faults and actively contribute to making it meet the right to health of our
people.
The Health Network is an association of diverse horizontal democratic, popular
organizations who share thecommitmenl to better the heal tit of our country. This
association permits us to create simple, agile and non-burcaucratic ways to com
municate, meet, carry out research, and publish.
COLOMBIA
SEMINAR ON EDUCATION FOR HEALTH RESEARCH
The International Development Research centre (IDRC) organized the Seminar
on Education for Health Research in Bogota in April, 1989. Twenty researchers
from Latin America, Canada and the United States met at this event to share their
experiences in the area of health education with the aim of discussing priorities,
methodological approaches, and criterion for the selection and training of
researchers. Among the items that were discused were the importance of
educational and promotional work in health programs and the need to deploy
different investigative and systematizing efforts in order to take advantage of the
richness of local experiences.
More information about the meeting can be obtained from:
Jane Mac Donald, IDRC, 250 Albert Street, PO Box 8500, Ottawa, Ontario,
CANADA, KIG3H9
Its principal actors are community members themselves, grass roots and inter
mediate organizations, scientists, students, professional associations, etc. This is
to say, anyone who can contribute to our experience and analysis in order to
change the reality of health care in service of our people.
<The Latin American Health and Popular Education Network of CEA AL has
matched the development of Argentina’s Popular Health Network with a great
deal of interest. It is an example of the significant advances which can be made
by a social movement for popular health, and this makes it important to take a
close look at the strategy followed by the people who built and put the network
into effect. Their experiences can help others who arc hying to develop similar
networks in other Latin American countries.
Note: More information about the documents and conclusions of the Seminar,
as well as the development, activities and projects of the Popular Health Network
“Dr. Ramon Carrillo” can be requested from:
CHILE
Norbcno Liwsky
CODESEDEH
Rodrigucz Pena 236.60 B
1020 Buenos Aires
Argentina
Chilean Non-Governmental Organizations which work in programs to promote
health met to reflect on the role they will play in the future democratic
government In April, the first national meeting was held, where the importance
of the real participation of the people in future policies was emphasized. The role
of the NGOs will be fundamental in this area.
Horacio Barri
MOS IS - Coordinadora Cordoba
Avda. Velez Sarsficld 4093
5000 Cordoba
Argentina
Documents published as a result of this meeting can be obtained from'
CIASPO, San Geronimo 5050, San Miguel, Santiago, CHILE
ECUADOR
WORKSHOP ON POPULAR EDUCATION AND HEALTH
At the beginning of June the Popular Education and Health Workshop was
organized in Quito. Representatives ofNGOs, universities, international organi
zations, churches, communities, and government agencies from 30 different
countries participated.
In June, the Canadian Public Health Association organized a study and exchange
visit in which representatives of Asia, Dr. Rustamadji (Indonesia); of Africa, Dr.
Mduma (Tanzania); and of Latin America, Teresa Marshall, of the Health
Network, CEAAL (Chile) participated.
The exchange visit included three provinces; British Columbia, the Northwest
Territories and Alberta. In each place contact was made with groups dedicated
to community work, the promotion of health and community health care
programs. The itinerary permitted comparing experiences and orientations,
acknowledging the importance of debate and solidarity in common struggles.
The purpose of the workshop was to promote dialogue, share experiences and
perceptions, discuss common goals and needs, and to break down isolation by
bringing together groups working in the same field.
It was evident from this brief encounter that the different groups who have
programs in this field arc often distant from, or even unknown to each other, and
that there is great need to establish regular exchange between them, especially
when their programs address similar problems.
It was found that there is a lot of interest in deeper exploration both of popular
education and of its relation to the needs of community groups. At the same time,
the need could be seen to develop new proposals that could become global social
policies. Finally, the need to create networks and autonomous forms of exchange
and mutual support was recognized.
More information can be requested from:
Margaret Hillson.CPHA, 1655 Carling Ave, suite 400, Ottawa, Ontario, Canada
KIZ 8R1 or Teresa Marshall, Red de Salud y Educacion Popular de CEAAL,
Casilla 6257, Santiago 22, Chile
ADULT EDUCATION WORLD ASSEMBLY
Between the 8 and 18 of January, 1990, the International Council of Adult
Education (ICAE) will hold the Fourth Adult Education World Assembly in
Bangkok, Thailand. This event will also signal the initiation of the Literacy
International Year.
FIL1PINAS
international forum on the crisis in child
nutrition
An International Forum on the Crisis in Child Nutrition was held from October
9 - 14,1989. The subject of the forum was the struggle for child survival. The
forum was organized by the International Network for Child Nutrition Groups.
For more information:
IBFANIOCU, PO Box 1045, 10830 Penang, MALAYSIA
The principal subject of the meeting will be “Literacy, Popular Education and
Democracy: Building the Movement.” It is hoped that representatives of adult
education and literacy movements of more than 100 countries will participate in
workshops, plenary sessions, exhibitions and planning meetings. The World
Assembly will begin with solidarity visits to different grassroots educational
programs in different parts of Thailand.
At this time, the International Health Network of ICAE will meet to deal with
strategics and perspectives that strengthen and promote its international tasks in
the following years.
For more information:
General Secretariat, ICAE, 720 Bathurst st., suite 500
Toronto, Ontario, Canada M5S 2R4
Educational and Bibliographic Materials
TRAINING WORKSHOPS
Health- Promotion
“USO DE LAS PLANTAS MEDICINALES” MEXICO, D.F., 1988
SHORT TRAINING COURSES FOR HEALTH WORKERS
(1989-1990).
AHRTAG has published a booklet with detailed information about training courses for
health workers. Many institutions offer undergraduate and Masters Degree programs.
■jEor more information: AHRTAG, 1 London Bridge Street, London SEI 9SG, United
-Kingdom.
This practical guide contributes to preserve the tradition of the use of medicinal plants,
bearing in mind that the great majority of common ailments can be cured with medicinal
plants. The following subjects are treated: how to gather, dry and store medicinal plants;
how to prepare them; index of the conditions and diseases and, finally, Fifty plants and
their use.
You can order from: Arbol Editorial, S.A. de C.V. Av. Cuauhtemoc 1430, Col. Santa
Cruz Atoyac, Mexico, D.F. 03310, Mexico.
BOSTON UNIVERSITY, SCHOOL OF PUBLIC FIEALTH
Offers a 12 week course in areas related to health for developing countries. The credits
earned may be applied toward a master’s degree.
For more information: Boston University, School of Public Health, 80 East Concord
Street, Room A-310, Boston, MA. 02118-2394, USA
INSTITUT VALENCIA D’ESTUDIS EN SALUT PUBLICA
(Valcncian Institute for Studies in Public Health)
Course offerings for the period of 1989-1990:
-Certificate in Community Health Education
-Masters in Public Health
' -Certificate in Health for School children
■"’-Course in community action and intervention
For more information contact: Secretaria I.V.E.S.P., c/Rodriguez Fomos, 4. 461010
Valencia, Spain
MANCHESTER UNIVERSITY
Postgraduate studies in primary health care, rural development, and functional literacy
education. The courses focus on educational and organizational aspects.
For more information: The Secretary, CAHE, Manchester University, Oxford Road,
Manchester, M13 9PL, United Kingdom.
“RESUMEN DE LA REALIDAD NACIONAL” No. 16, Bolivia, 1989
In this issue there’s a complete analysis of the problem of coca, both at the national and
international level. Aspects related to consumption and drug traffic are included.
For more details write to: Centro de Documentation, Information y Biblioteca, Casilla
3302, Cochabamba, Bolivia.
“BOLETIN CETAAR.” Centro de Estudios sobre Tecnologias Apropiadas de la
Argentina .No. 3 December 1988, Buenos Aires, Argentina.
The bulletin reports on activities that have been carried out on different subjects that help
the balance of the ecosystem, as well as the activities and workshops which will b®
carried out in 1989.
For more details write to: Centro de Estudios sobre Tecnologias Apropiadas de la
Argentina, Casilla 5182, Corrco Central, 1000 Buenos Aires, Argentina.
“RESUMEN DE INVESTIGACION.” Centro de Informacion y Educacion para la
Prevcncion de Abuso de Drogas, CEDRO, May 1989, Lima, Peru.
This summary published the results of a public opinion survey on drugs, carried out
between May and September 1989 in the 13 Peruvian cities of 100,000 inhabitants or
more. 3,046 people were interviewed on the following subjects: Substances considered
drugs, most consumed drugs, degree of addiction they cause, more harmful and less
harmful drugs, reasons for drug consumption, effects of drug use on people and on the
country, national problems and the problem of drugs and, finally, prevention cam
paigns.
“ORGANIZANDOSE PARA EL DESARROLLO”
Institute for Development
Research Periodical (IDR), USA, 1988.
IDR is a non-profit research and consulting organization, aimed at organizations that
promote social and institutional change and which train underprivileged people to
actively participate in projects that improve their quality of life. In the 1988 summer
issue there are articles on the strategic role of voluntary organizations in and for
development, a program on the strategic management of private volunteers, IDR’s
history and the program for leaders with scholarships from Asian non-governmental
organizations.
For more information write: Institute for Development Research, 710 Commonwealth
Avenue, Boston, MA. 02215, United States of America.
“BOLETIN DE GRUPOS DE SALUD”. Organizacion Distrital de Grupos de Salud
de Bogota, Colombia, 1988.
This bulletin promotes communication between the different grassroots groups and
support institutions that work towards coordination of activities in health districts. The
bulletin gives news of the districts, the situation in the Bogota neighborhoods and
training experiences.
You can request it from: CINEP, Organizacion Distrital de Grupos de Salud, Carrera 5
No. 33A-08, Bogota, Colombia.
COMMUNiT
^7/1.(First Floor)St. Marks Road
BAN GAtOafi-660 00 j
“BOLETIN CINDER”. April 1989, Colombia.
This purpose of this bulletin is to promote the exchange of scientific information. Three
publications are announced: “Let’s talk about our health: prevention and cure at home”
(Hablcmos sobre nucstra salud: solucioncs para prevenir y curar cn casa.); “Manual for
the Administration of Supplies in Health Institutions” (Manual para la Administracion
de Suministros en Instituciones de Salud); “Primary Health Care for Large Cities:
Manual for the use of the Family Card (Atencion Primaria cn salud para las grandcs
ciudadcs: manual para el diligenciamiento de la Tarjeta Familiar). It also reports on the
First Institutional Seminar-Workshop on Health Plans in Barrancabcrmeja, whose
objective is to contribute to the improvement of the efficiency of health services.
For more information: Suzanne Bazar, Editora CIMDER, A.A. 3708, Cali (Valle),
Colombia.
“SALUD POPULAR”. Institute de Salud Popular, No. 9, May 1989, Lima, Peru.
ftsuc #9 of the magazine gives an overview of primary health during the past 10 years
m Peru. The following questions are posed: has PHC failed in Peru? Have the political
and social conditions for their implementation existed?
The problems and experiences of PHC, of the popular movement, local health services,
and of participation strategies are analyzed. The declarations of Alma Ata, Harare and
Riga are included.
You can request it from: INSAP, Av. Arenales 1080, Of. 301, Lima 11, Peru.
“TRANSFORM-ACTION/TRANSFORMATION.” Ottawa, Canada.
EBulletin of the Canadian Project for Healthy Communities, an initiative that rounds up
csfforts stemming from municipal urban areas, public health and local projects that are
hoeing implemented in Canada. It analyzes the subject and the status of local projects.
Published in English and French.
lit can be requested at: Transform Action, 126, Rue York, #404, Ottawa, Ontario, KIN
3T5 Canada.
“‘THINK PREVENTION. THE REPORT OF THE JOINT COMMITTEE ON
PREVENTIVE MEDICINE.” James M. Howell (Editor). Alberta Hospital Associa
tion, Health Unit Association of Alberta, Canada.
'The book presents a series of research projects sponsored by the Preventive Medicine
Committee (Alberta, Canada), giving thoughts on the concepts in preventive medicine,
Canadian experiences on health prevention and promotion and perspectives of interna
tional cases. Prevention experiences developed at the primary, secondary and tertiary
level arc presented, and new elements are given in the light of health promotion
concepts. Published in English.
You can request it from: Alberta Hospital Association, 10025 108 St., Edmonton,
Alberta T5J 1K9 Canada.
“HEALTH PROMOTION: HEALTH AND WELFARE.” Ottawa, Canada.
Periodical publication of the Directorate of Health Promotion of the Canadian Govern
ment. The winter issue 1988/89 gives information on the subject of mass media for the
promotion of health, news from Canada, community initiatives, audiovisual resources
and publications for health promotion work. Published in English and French.
Il can be requested at: Editor, Health Promotion: Health and Welfare, Ottawa, Ontario,
Canada KIA 1B4.
“THE MULTIPLIER. Strengthening Community Health Programs.” Canadian
Public Health Association. Ottawa, Canada, 1989.
Newsletter of the Canadian Public Health Association, in charge of the program of
strengthening community health programs. This newsletter encourages activities of
local Canadian groups in the fields of promotion and community health initiatives.
For further information contact: Dr. Tariq Bhatti, Canadian Public Health Association,
1565 Carling Ave., Suite 400, Ottawa, Ontario, Canada K1Z 8R1.
“A MIRACLE IN THE MAKING.” Canada’s International Immunization Program,
Ottawa, Canada, 1989.
Newsletter of the International Immunization Program of the Canadian Public Health
Association, which is cooperating with volunteer and private organizations in 42
countries, through 89 specific projects. The newsletter reports on the achievements of
this important program. Published in English and French.
It can be requested at: CIIP-CPHA, 1565 Carling Ave., Suite 400, Ottawa, Ontario,
Canada K1Z 8R1.
“TALC: TEACHING AIDS AT LOW COST.” Newsletter, TALC, England, 1989.
TALC newsletter with information on important and recent publications on AIDS,
vaccines, rehabilitation, games for children, existing medications, etc. Published in
English.
It can be requested at: TALC, P.O. Box 49, St. Albans, Herts AL14AX, United
Kingdom.
0 “LA SALUD: DIALOGOS DEL PUEBLO”. CODESEDH, Buenos Aires, Argen
tina, 1989.
Presents the dialogues on the course of primary health care and popular participation.
It gathers different perspectives and struggles around the issue of health for all in
Argentina, expressed in presentations, group work and opinions of participants in this
course.
You can request it from: CODESEDH, Rodriguez Perla 236,6o. B, 1020 Buenos Aires,
Argentina.
“DEVELOPMENT MIRROR.” A MAGAZINE ABOUT EVALUATIONS.”
Diakonia, Sweden, 1989.
This issue is devoted to the subject of evaluation and thinking about the subject of
NGO’s, development, and North-South international cooperation. Three evaluation
experiences are included: health problems in Bangladesh; a communications project in
Uruguay and in Tanzania, an education for health project Published in English with
Spanish and French abstracts.
It can be requested at DIAKONIA, Alvsjo Gardsvag 3, S - 12530, Sweden. .
PUBLICACIONES DEL COLECTIVO DE ATENCION PRIMARIA DE
SALUD (CHILE). Santiago, Chile, 1989.
After many years of work in the Chilean scene, the Collective has disseminated the
results of its work in several publications. One refers to the Metropolitan Congress of
Professionals and the other to the National Workshops of Health in Shanties.
You can request it from: Colectivo de Atencion Primaria de salud, Constitucion 125,
Santiago, Chile.
“SALUD Y PROMOCION SOCIAL” REGISTER OF INSTITUTIONS IN
SANTIAGO, CHILE (Catastro de Instituciones de Santiago, Chile)” INFOCAP,
Santiago, Chile, 1989.
The document includes information on the non-governmental institutions which sup
port the activities of the popular movement in Santiago. This document is a contribution
to establish communication and exchange between different programs that work t^
improve the health conditions of the population.
“
It can be obtained from: INFOCAP, Chorrillos 3614, Santiago, Chile.
“DESDE LAS BASES” INDEPENDENT PERIODICAL AT THE SERVICE OF
THE POPULAR MOVEMENT.” CEDEPO, Vol. VI, Buenos Aires, Argentina,
1989.
This bi-monthly periodical has interesting information on the status of popular organi
zations in Argentina and proposals for education and promotion work.
You can subscribe from: CEDEPO, Carlos Calvo 642,1102 Buenos Aires, Argentina.
floor)St. Mark#Hoad
jAKOBE'660 001
“BETTER CARE OF MALARIA.” Voluntary Health Association of India, New
Delhi, India, 1989.
Educational pamphlet with information aimed at health workers and promoters. It
emphasizes information and forms of prevention. In the same collection of pamphlets
there arc issues devoted to leprosy and sexually transmitted diseases. Published in
English.
It can be requested from: VHAI, 40, Institutional Area, New Delhi, 110016, India.
“ESTS AND PESTICIDES. FACTS AND ALTERNATIVES.” Voluntary Health
Association of India, New Delhi, India, 1989.
Educational material with general information on pesticides, organic agriculture
alternatives and advice for health initiatives. Published in English.
It can be requested from: VHAI, 40, Institutional Area, New Delhi, 110016, India.
“CHILD TO CHILD. AN APPROACHTO LEARNING.” Aarons, Audrey; Hawes,
Hugh and Juliet Gayton (Editors). Voluntary Health Association of India, New Delhi,
India, 1988.
This book presents a strategy for working with school children and the community in
child to child programs. This program was conceived by the Child Health Institute
(London) in 1979, and contains a proposal for health education that can be used by the
chi Idren themselves. At present, the program is carried out in different parts of the world.
The book is aimed at schoolteachers and contains information and methodological
recommendations to begin the work at the school and community level.
It can be requested from: VHAI, 40, Institutional Area, New Delhi, 110016, India.
“COMMUNITY INTERVENTION STRATEGIES.” B o J.A. Haglund; Per Till-
grcn (Editors), 1988, Sweden.
The book gives an account of the conference held in April, 1986 on the role of
community analysis and focus groups in intervention studies in the community, with the
participation of scientists from the U.S., Brazil, Finland and Sweden. The documents
presented give a frame of reference on the subject of self-diagnosis of the community
and of appropriate technology to carry out effective intervention programs. Published
in English.
It can be requested at: Karolinska Institute, Department of Social Medicine, Kronan
Health Centre, Sundbyberg, Sweden.
“ERITREA: PRIMARY HEALTH CARE IN DROUGHT AND WAR
SITUATION.” Eritrean Public Health Programme, Eritrea, 1988.
Report of the Second International Conference on Health in Eritrea held in April 19^
in London. It collects the presentations and papers presented by the participants on W
status of health services in Eritrea, laboratory programs, sanitation, incorporation
systems, vaccination and technology. Published in English.
You can request it from: ERA - Public Health Programme, BCM Box 865, London WC1
V6XX, United Kingdom.
“HEALTH FOR MILLIONS.” Voluntary Health Association of India. February
1989, Vol. XV #1 and #2, New Delhi, India.
Issue number one presents different experiences, among which are local culture and its
thought processes. Readers arc invited to share their experiences in the fields of
agriculture, health, construction, education, etc. The second issue is devoted to sexually
transmitted diseases and AIDS.
For more information: Voluntary Heath Association of India, 40, Institutional Area,
South of 1 IT, New Delhi 110016, India.
Health - Education
“MANUAL DE CAPACITACION, SUPERVISION Y EDUCACION CONTINUA PARA EL TRABAJADOR DE ATENCION PRIMARIA EN SALUD”.
Elsa Villafradcz L„ Programa de Aiencion Primaria de Salud, Bogota, Colombia, 1989.
This is a book aimed at health teams interested in training and educating people for local
and community initiatives. It is based on experiences carried out in this field over a six
year period. Itgives general and theoretical concepts on the training of health promoters,
supervision methodologies and continuing education.
It can be requested from: Grupo de Aiencion Primaria, Centro de Documcntacion, Calle
14 #8-27, Piso 3o., A.A. 056896, Bogota, Colombia.
“EDUCACION EN SALUD DESDE LA ATENCION CURATIVA”. CESAP,
£uadcmo No. 5, Quito, Ecuador, 1989.
This document contains the presentation given at the Latin American Course on Health
and Popular Education (Curso Latinoamericano de salud y Educacion Popular),
organized by CEAAL, on the experience of CESAP in curative and educational action.
It can be requested from: CESAP, Casilla 91 B, Quito, Ecuador.
“GUIA PARA LA CAPACITACION EN EDUCACION POPULAR”. PIIE, April
1989, Santiago, Chile.
Module 1: An experience applied to the field of health .
This training guide is the result of three workshops on popular education in health during
1988. This first module has two units: popular education and health and the methodol
ogy of popular education.
Module 2: Training for the revision of practices: one method.
With an experience similar to the previous module, this one offers a series of
considerations and questions on our practices and the challenge of their systematization.
For greater information: PIIE, Brown Sur 150, Santiago, Chile. Telephone: 2231940 -
496644.
MANUAL DE SALUD ESCOLAR. UNA TAREA PARA TODOS”. Guzman, M.
Paz; Moore, Rosario y Luz Maria Perez. Programa Salud Integral, Pirque, Chile, 1989.
This manual is die result of four years of experience, whose aim has been to improve
school children’s level of health. It aims to assist teachers in improving children’s
health. It provides material to carry'out health diagnosis and health educational work in
the school community.
It can be requested from: Programa de Salud Integral, Parroquia de Pirque, Pirque,
Chile.
“PROGRAMA DE CAPACITACION DE SALUD PARA NINOS DE
EDUCACION PRIMARIA EN LIMA”. EDAPROSPO, Lima, Peru, 1988.
Strategies for a program for teaching primary school children about health are set out
in this series of pamphlets. The program’s objective is incorporating children as active
members in health care, elevating the levels of participation in health programs. It^fc
publication that is directed towards both children and teachers.
It can be requested from: EDAPROSPO, Jr. Octavio Bcmal 598, Jesus Maria, Lima,
Peru.
“SALUD INFANTIL”. Altcmativa, Cartilla No. 1, Lima, Peru, 1989.
Through the scries “Educacion para la Salud,” the Altcmativa center offers pamphlets
to educate schoolteachers and heads of families, principally aimed at work in the school.
It can be requested from: Altcmativa, Jr. Emctcrio Perez 348, Urb. Ingcnicria, San
Martin de Porres, Lima, Peru.
Ith - Women
•■■^•VSLETTER.” Women’s Health and Reproductive Rights Information Center,
==No. 3.
s issue warns against medication abuse and the failure to control pharmaceutical
r'~~npanics - companies which have the highest profitability at the world level while
Adducing medications which induce dependency and, in some cases, harm the popu*mlion. It denounces the present tendency which is not towards prevention but rather to
•dependence on some medications.
•■Different articles appear on cases of specific medications and news on health in general,
lactation, fertility, contraception, and abortion.
For more information write: 52 Featherstone St. London, EC 18 RT, United Kingdom.
“MUJERES Y MEDICINA: COMO SON LAS COSAS”. Dora Cardacci (Compi-
ladora). Univcrsidad Autonoma Mctropolitana, Xochimilco, Mexico, 1989.
The magazine has articles on abortion, psychoanalysis, feminist clinics, women
workers in hospitals. A way of gathering words and lives of women and to advance in
the struggle of the women’s movement for health, so as to not “travel other roads or
travel in the opposite direction” (G. Berlinguer).
It can be requested from: Dora Cardacci, Area education y Salud, UAM-X, Apartado
Postal 23-181, Mexico 23, D.F., Mexico.
“MUJERES EN BARRIOS”. Boletin SUM Mujcr. Ano 1, Buenos Aires, Argentina,
1989.
This newsletter published by the World University Service, brings together women who
work in the shanties in Argentina. It’s an open space where groups can express their
cajjpems, suggestions and forward denunciations.
iff-h be requested from: Boletin SUM Mu jer, Talcahuano 889,2o. piso, Buenos Aires,
MATERIAL EDUCATIVO LA CASA DE LA MUJER. 1989, Chimbotc, Peru.
“Abuso sexual a menores de edad”. is a scries of pamphlets of the problem of the
sexual abuse of children. It gives legal information, a psychosocial approach, guidelines
for action, defense and prevention.
“La voz de la mujer,” presents the problems of women’s daily life through cartoons;
it gives legal information and resources for women’s organizations.
Both pamphlets can be requested from: La Casa de la Mujer, Jr. Balta 275, Apartado216,
Chimbotc, Peru.
“MUJER/FEMPRESS.”No.92,Junio 1989.UnidaddcComunicacion Altemativac^
la Mujer.
This Latin American newsletter aims at supporting the work of those who are stri'
*
—
to improve the condition of women and to raise their consciousness, within a framc'^^a
o socia justice and political democracy. There are articles and news from al
countries in the region. Published in Spanish.
or more information write: Mujcr/Fcmprcss, Casilla 16-637, Santiago 9, Chil^^^
“THE MOON ALSO HAS HER OWN LIGHT. THE STRUGGLE TO BUILD A
WOMEN’S CONSCIOUSNESS AMONG NICARAGUAN FARM WORKERS.”
The Women’s Program of the ICEA and the Nicaraguan Association of Rural Workers.
Toronto, Canada, 1989.
This book presents the struggle of Nicaraguan peasant women to strengthen conscious
ness and the women’s movement It was produced by the International Women’s
Program of ICAE and the Association of Peasant Workers (ATC) of Nicaragua. The
book presents the capacity of Nicaraguan women to simultaneously struggle against
gender oppression, develop class consciousness and construct the women’s movement.
Published in English.
Il can be obtained from: Women’s Program of ICEA, 394 Euclid Ave., Suite 308,
Toronto, Ontario, Canada M6G 2S9.
“LA MUJER Y LA SALUD COTIDIANA”. RESULTADOS DEL 1ER.
ENCUENTRO DEPARTAMENTAL “MUJERES Y SALUD”. Arequipa 22, 23,
24, abril 1988 pditado por Flora Tristan, Centro de la Mujer Peruana, Lima, Peru.
This publication presents the results of the work carried out at the First Departmental
Women and Health Meeting in Arequipa Peru in 1988 in two workshops - diagnosis of
women’s health and women and traditional medicine. There arc also interviews with
traditional midwives and the results of a panel on community medicine.
It can be requested from: Flora Tristan, Centro de la Mujer Peruana, Parque Hernan
Velarde 42, Lima 1, Peru.
DA MAGA, ESPACIO DE REFLECCION FEMINISTA. Aflo. 2, Nos. 1 y 2,
Guayaquil, Ecuador.
This Ecuatorian magazine presents different articles that underscore women’s problems
from different angles. Among them are: women and power in an article “To Politicize
the Private;’ women and work; women and divorce; women and maternity; “What is the
present feminist movement doing?”; “Shinning Solitude.” A report on the III Continen
tal Meeting of women is presented, and there is a large annex on violence.
For more information write: Cecilia Torres, Bogota 400, Casilla Postal 10201,
Guayaquil, Ecuador.
COMWTONITY HEALTH CELL
47/I, (First Floor) St. Marks Road
BANGALORE - 560 001
Com h 6-1-
LETTER N2 11
OF THE HEALTH AND
POPULAR EDUCATION NETWORK
October 1989
COMMUNITY HEALTH CELL
47/1,(First Floor)St. Marks Road
BANGALORE - 560 001
oordinator of the Network: Teresa Marshall
eneral Secretariat:
eirez Valenzuela 1634, Casilla 6257, Santiago 22, Chile.
: lephone: 2239331 - 2256271
•Jex CEA AL 240230 BOOTH CL-CHILE
ux 56-2-2235822
Health and
Popular Education
PORTE
ancia
A f
840
'll - 8’
igo 2!
DR. RAVI NARAYAN
COMMUNITY HEALTH CELL
326 V.MAIN 1 BLOCK,KORAMANGALA,BANG
560 034,KARNATAKA
P u b lic a c ib n con a p o y o d e ACDI (C a n a d i)
INDIA
First Latin American Course/Workshop
on Health and. Popular Education
In November last year the First Latin Ameri
can Course/Workshop on Health and Popu
lar Education was held, organized by
CEAAL’s Popular Education and Primary
Health Care Network. Twenty five educa
tors and health workers spent a month to
gether at El Canelo de Nos (San Bernardo,
Chile), analyzing and sharing their experi
ences on community health. They came
from Per, Bolivia, Ecuador, Venezuela,
Brasil, Panam , Mxico, Dominican Repub
lic, Argentina, Uruguay and Chile.
A.
The multiple initiatives and actions devel
oped locally by the groups involved in
CEAAL’s Latin American Popular Educa
tion and Primary Health Care had made
clear a need for training related to the
network’s two main work axis: community
health and popular education. Despite the
existence in each country of formative ac
tivities and experiences in education or
community health, there have been few
experiences combining the two. Given how
closely linked these are in daily practice, it
was seen as important to address the two in
an articulated way.
- The need to retrieve the classic debate on
public health, that guided health programs
in the 70’s and 80’s. What should be main
tained of this public health concept? what
modified? or rejected?
Many of the testimonies presented by the
Network’s active groups indicated common
needs in respect to learning and training. On
various occasions, in encounters, work
shops and debates, workers in NGOs popu
lar health programs stated their interest in
discussing and in going deeper into:
HEALTH CONCEPTS
POLICIES:
AND
- The need to arri ve at a common concept of
“health”; the lack of concept clearness is
admitted and the following question arises:
with which kind of health concepts arc we
working (community, popular, traditional)?
- The need to put this theoretical debate in
the context of the present stage of Latin
America’s history.
C.THE
CONTEXT
WITHIN
WHICH THESE PROGRAMS
EVOLVE:
- The need to understand the health reality of
popular sectors.
B. THE EXPERIENCES OF PAR
TICIPANTS IN POPULAR
HEALTH:
- The need to address the problem of the
different roles of the people involved in part
of popular health programs.
- The need to learn how to work in a climate
of participation and association among the
different actors (professionals, institutions,
popular organizations) and programs.
- The need to analyze the organizational
problems popular sectors face.
- The need to incorporate the debate on the
concepts of local development and inter
connection of popular organizations and
State institutions in order to develop a more
global vision of specific projects.
- The need to understand the connection
between local action and global context.
D. HEALTH AND POPULAR EDU
CATION PRACTICES:
. The need to enhance technical contents of
health programs at the same time as promot
ing response, which raise the voice of social
and political organization and transforma
tion.
- The need to converge therapeutic and
educational actions; how can these two
approaches nourish one another?
. The need to develop appropriate tools, to
combine health and education in health
programs.
This set ofquestions constituted the founds
lions for constructing the curriculum.
central objectives articulated the aclivid68’
These and other activities responded to a
methodological design that compiled and
gave priority to:
The firstattempted to broaden the vision and
analysis of participants experiences and
concerns, their challenges and proposals.
The second attempted to deepen the popular
health debate in Latin America, from its
concept bases to its program strategies.
Five steps formed the major learning units:
knowledge and interchange among partici
pants; the debate on health concepts and
policies in the region; analysis of the con
texts and actors in health programs; the
exchange of education and health method
ologies at the grassroot level, and finally, the
synthesis and the concrete proposals for
future work.
These learning units were achieved on the
basis of a broad range of activities:
- theoretical and concept expositions
- exchange of experiences
- visits with popular organizations
- conversation, debates and panels on po
lemic subjects and current national issues
- readings
- corporal expression and cultural promo
tion
I
■ current theoretical, political and technical
debates;
- participants’ experiences key successes
and current challenges;
- the creation of affective and deep commu
nication bonds among the participants, the
coordinators and the popular groups con
cerned;
- the elaboration of synthesis and proposals
to feed back to ongoing practices.
Throughout the experience much valuable
material was collected, which we will trans
mit through future Health Letters. The
minutes containing the most significant
dialogues and proposals will be published in
1989. The presentation on popular educa
tion (Jorge Osorio) and the conclusions of
the workshop resulting from the analysis of
the primary health case strategy are pre
sented below.
The main purpose of this presentation is to
put forward a series of reflections on the
current debate regarding popular education
in Latin America.
In recent years, we in Latin America have
come to understand popular education as an
experience of rupture and estrangement
from traditional adults education, especially
that which was implemented in the 50’s and
the 60’s. In this way, we are expressing a
categorical denial to an education addressed
to popular groups as compensatory answer
to maintain important peoples’s sectors
outside of the scholastic education. Popular
education asserts the'possibility of an edu
cation for the people, and also the need to
transform the entire educational project
starting from the view point of the popular
sectors.
Thus, in the 80’s, popular education clearly
abandoned its position of being only an
emergent model of education to become a
political-educational practice, whose start
ing point is the popular movement and its
organizations. We will include six remarks
that characterize Latin America’s popular
practice in the 80’s.
First, popular education defines itself as a
social practice that, working within the
scopeof knowledge, hasapolitical intention
and objective. Popular education is an
educational space and a tool destined to
define como una prdctica social que, tra-
promote the capacity of popular groups to
enable them to become the subject of their
own educational process and of their own
historical and political destiny. Conse
quently, education is an instrument at the
service of such groups’ liberation.
movements. A second position advocates a
more autonomous role for popular educa
tion centers, and sets forth a political and
cultural bond nature which also implies a
strong burden of autonomy for the popular
movements organizations.
Secondly, popular education is a process
which aims to contribute to social transfor
mation, with a view to constructe a new
society which will satisfy the interests and
ambitions of the popular sectors.
Fourthly, popular education relates to a
democratic educational model that seeks a
rupture with verticalism, authoritarianism
and, specially, with what Paulo Freire de
scribe as “banking practices” in the teaching
and leaming.relationship.
Third, the adjective “popular” in “popular
education” refers to objectives that are ori
ented to the construction of a political- so
cial project in accordance with popular
interests. As well “popular” refers to popu
lar movements as”subjects” taking the edu
cational action. “Popular” then relates to
both the political objective and also to the
dimension of subject as acquired by the
popular sectors as such. However, it should
be noted that there is a controversy about
how best to link popular education experi
ences with the organic experiences of the
popular movement.
There are two significant positions: the first
affirms that this relation should be organic
and that the popular education centers
should have a more subordinated role, as
elements of support and advisory of popular
las experiencias organicas del movimiento
popular?
Popular Education:
The Polemic in Latin America
Jorge Osorio
The fifth feature of popular education is that
it is conceived as a process, as an activity
which evolves during the life of popular
organizations and that is nourished by their
experiences. It is implemented based on
participants requirements, practical knowl
edge and personal experiences and, there
fore, is not restricted to events, workshops
or meetings. In this way, although popular
education is defined as an essentially politi
cal experience, it is not limited only to a
narrow version of politics. It is education
that attempts to feed, to provoke the emer
gence and to create awareness about the
integral dimension of human experience. It
aims to connect the particular processes of
individuality with social processes, articu
lating daily life with political realities, the
ory with practice, the personal with the
social, cognition with intuition, etc.
To think of popular education in terms of
production, elaboration or of taking posses
sion of knowledge is complex. Collective
production and appropriation ot knowledge
are things that go beyond the mechanical
exercise, the group work, a blackboard, a
plenary and a synthesis made by the promotor. We are setting forth to ourselves issues
of the learning and of production of knowl
edge that the traditional teacher solves in a
quite routinary and practical way becauseat
school the problem lies in formalizing a
knowledge, in packing itand distributing it.
This mechanics of the traditional teacher is
not the same mechanics of the popular edu
cator, the popular educator does not satisfy
himself by constructing its package from
outside and then dropping it into the partici
pants arena so that they can digest it, in the
way they deem is the best.
Finally, an ending note to stress that popular
education is a practice requiring systematic
and scientific rigor. Popular education does
not imply an inorganic, disorderly, or solely
intuitive process. By necessity, popular
education should mean a systematic proc
ess, whereby certain key points can be
scienti ficly assumed, for instance the evalu
ation, systematization, planning and, above
all, the learning process itself. This is a
polemic currently being carried out in Latin
America. This debate states as a central
problem the divorce between the speech and
the practice of popular educators.
Another criticism concerns the relationship
between turning into problems the specific
processes lived by people and that which we
ourselves do in the course ofour educational
activities. We say that popular education
promotes the critical conscience but, unfor
tunately, we are gradually realizing that we
do not always count on instruments which
permit us to generate conditions and meth
odologies destined to produce critical think
ing.
This debate furthers some questions on the
political intentionality of popular educa
tion. It is said that popular education is
linked to popular movements, that its con
tents are articulated in terms of those prac
tices, however, it is pointed out that we lack
a teaching speech, that we are not yet ca
pable of taking up the experiences being
generated in Latin America in order to for
malize a true popular teaching. How do the
people learn? How do the people teach and
learn? How is it possible to concretely lead
popular sectors towards that general politic
intentionality?
When reviewing the question of the inten
tionality of popular education, we question
ourselves about what sense popular educa
tion practices have?, towards which horizon
do they tend? It is important here to express
four basic criteria that permit us to clarify
the contribution of this educational practice:
- To reject the methodological malforma
tion present in many of our popular educa
tion projects that basically reduces popular
education to a question of methodologies.
0T
Rosa Mara Torres (Ecuatorian popular
educator) started this controversy but now
we are all discussing iL She has obliged us to
turn our practices into problematics, to be
more systematic and to give scientific rigor
to the popular education debate. She slates
that popular educators are too normative in
their speech and that this ends up asfixiating
the reality of our practice. When we say
popular education is, we should say popular
education should be, which calls to our
attention the need to have a critical con
science vis-a-vis our practices.
X
technicians, by no means a simple matter
because technical formation takes place in a
space of ideological and cultural conflict.
esses. This is a rather important point as it
visualizes the educator as a kind of intellec
tual capable of systematizing, investigating
and organizing learning processes.
It is urgent at present to make a profile of the
role of the technician, of the professional
expert in popular education processes.
Without denying the fundamental character
that the handling of participative techniques
and methodologies has in popular educa
tion, it should be indicated that the central
element of the popular education definition
is its political intentionality. Popular educa
tion is not defined through its teaching tech
niques, the definition element is not only its
capacity for being more participative than
other educational schools, it is its political
intentionality.
- Recognize that today popular education is
obliged to take a qualitative leap forward,
that we have 25 years of important experi
ences in Latin America as a whole and that
we are capable of showing that popular
education is no longer an emergent model,
but rather has a consolidated experience. It
is institutionally recognized for its innova
tion, for its capacity for developing educa
tional processes with marginal sectors. This
legitimacy of the movement should be
combined with a theoretical qualitative leap
forward, that should give more consistency
to its educational and political proposal.
Popular education of today should acquire
quality not only in its methodological pro
posal but also in its political profile.
Where is the central contribution of popular
education in Latin America of today? We
are working in CEAAL so that popular
education today should essentially contrib
ute to the democratization processes, not
only within the State scope, but also in civil
society.
- To understand the popular educator not as
a common activist, but as an organic intel
lectual capable of systematizing and inves
tigating the processes of learning and
knowledge being developed within the
popular movements; we think that there lies
the main role, the major task of popular
educators. The popular educator becomes
then not only a promotor, an expert in social
promotion techniques, but someone who
has to convert him or herself into an intellec
tual, capable of generate conditions for
organizing and systematizing learning proc
We verified the need to demystify the tech
nician. It is a matter of defining the insertion
of the professional in the popular sectors.
The technical cooperation process is stated
as a process of mutual interaction in which
everybody participates: those facing the
problems, the one that knows the technique,
the technicians, and those who in one or
another way and with different perceptions
participate in the same process.
We understand professionals as facilitators
of participation, encouraging reflection and
turning conflicts and general processes into
problems that are developed in the popular
sectors; and not only facilitating participa
tion, but expanding as well the capacities
inherent to settlers, thus contributing the
required methods and techniques so that
they can, by themselves, diagnose needs and
problems and prepare the strategies for fac
ing them. We, the technicians, should
understand cooperation processes as proc
esses destined to contribute technicians or
techniques to popular demands. We are at
present faced with the need of forming new
- Finally, to determine that political projec
tion is related to the contribution of popular
education to social movements. We know
that popular education has contributed to the
emergence of the social movements and
works today with a great strength. We
should state a question, how does popular
education continue contributing to these
processes? How does popular education
continue furthering the consolidation of
these movements that are not only begin
ning to emerge, but to consolidate them
selves particularly in the popular areas of
our countries?
If progress towards a more equitable distri
bution of resources in our countries is not
achieved in order to reduce the dramatic
social, economic and political differences,
the aim of “health for all” will become a
meaningless slogan.
Alma Ata: Plenary
Alma Ata is aware that it needs to overcome
serious obstacles to become a reality. Butin
our opinion, the mechanisms proposed for
confronting these obstacles are to a large
extent. While there is recognition that pri
mary health care can only emerge from a
spirit ofjustice and social equity, the magni
tude of the opposition coming from the
dominant sectors is not sufficiently ap
praised.
From this perspective our doubts about the
Alma Ata contents are valid. Have they
constituted a strategy for change in the sense
of our peoples liberation, the dignifity of
human beings and improvement in the qual
ity of life? Or has this strategy become an
instrument used by the dominant sectors to
promote their interests?
The discussion on the Alma Ata document
carried out among the course’s participants
led to two main conclusions.
We, the people working in community
health, consider Alma Ata as a useful refer
ence for promoting a vision of health as a
right.
1. The recognition of Alma Ata as a great
2. Ten years after this declaration, we can
step forward in respect to prior health state
verify the gap between general policy and
ments and policies. In particular, mention
the realities field of, and more generally, of
should be made of:
people’s life quality in our countries.
- the affirmation that health is a basic right;
- the admission ofthe considerable unequal
ity that exists and its appraisal as unaccept
able socially, politically and economically;
- the relation between the people's health
level and their economic and social devel
opment levels;
- the recognition that a medical approach is
insufficientfor solving health problems and
that there is a need for the intervention of
other social and economicforces (political,
multi-sectoral);
-promotionofactive linking between health
worker and community, underlining the
importance of social participation.
The Declaration of Alma Ata reflects the
agreement -at least in writing- of a large
number of nations on the basic tenets of a
health strategy, leaving to each government
and people the responsability for establish
ing standards and putting these concepts
into policy and practice.
Pri mary health care is viewed more as a th ird
or fourth category for attention than as an
integrate part of the national health system
for which -it is said- it constitutes the central
function and the nucleus, including for so
cial and economic development of the
community.
ASIAN WORKSHOP
The Asian Workshop on “Non Formal Education and Health Programs Learning among
Adults” took place in Penang, Malaysia in October 1988. It was organized by ICAE
(International Council for Adult Education), ACHAN (Asian Community Health
Action Network) and ASPBAE (Asia and South Pacific Bureau of Adults Education).
The objective was to exchange experiences and discuss adult education’s contribution
to the strengthening of health actions undertaken by popular groups.
Non governmental organizations in Asia had come to recognize the existence of
innovative efforts in this field and felt the moment had come to exchange and elaborate
common strategies.Tbere was also concern about the lack of forum at the Asian regional
level involving NGOs, health workers and adult educators. Thus the workshop was
organized in an attempt to get together activists, philosophers and academics to:
- initiate a more fruitful exchange of experiences;
- discuss problem areas and successes;
- identify key and relevant themes;
- create mechanisms for better regional coordination.
The health situation is characterized by programs based on “colonialist” needs and
priorities rather than on the people’s needs. Traditional health systems continue to be
practiced by the people, but the dominion of the western model prevails. High morbimortality rates are directly related to the life conditions of the poor. Medicines and drug
policies are kept under multinational control except in Bangladesh. Given this context,
Health for All by the year 2000 is totally unrealistic. A mention should be made of the
role played by volunteers’ and non governmental movements, especially in India; also
thedevelopment concept, as a circular perspective involving the different aspects of the
Asian societies life, should be underlined.
Concept debates on community-based health and adult education added to the experi
ences presented.
Five elements were agreed on as defining community-based health actions:
Twenty five persons participated in the workshop, representing India, Bangladesh, Sri
Lanka, Nepal, Malaysia, Indonesia, Korea, the Philippines and Australia.
The program was prepared jointly with the participants and the following priorities
identified:
- introduction to the different contexts of each of countries representes;
- presentation and discussion of the participants’ experiences;
- discussion of key concepts: non formal education, community health work and
relationship between the two;
- proposal ofperspectives forfuture work at the regional level.
The reports on each country’s situation allowed participants to understand the context
within which the community health programs were developing. The existence of social
classes, ethnic division and great opression and exploitation of women was shressed by
all.
1. Meet the people’s needs.
2. Attend to health in a comprehensive and integral manner, promoting
it within a development perspective.
3. Promote people’s self-organization around health issues.
4. Focus, promote, prevent and cure, in harmony with nature.
5. Demystify medical care and use adequate and more accesible technolo
gies and traditional medicine.
The following points emerged during the discussion of strategics and methodologies to
achieve such community health concept:
- work with the peoples's volunteers within a perspective of promoting the e le’s
organizations;
p ?
- promote educational and research actions, and make efforts to document these
experiences;
- demandfrom the State the people's rights and promote community health insurances
Health through
Education and Empowerment
Dr. Hari M. John
Background and Evolution of the Organisation
The discussion of non formal education made use of the concepts and contributions of
Latin America’s popular education. For example,
- the need to recognize “our own educational malformations and to re-learn in order to
work with the people";
- education’s contribution to the processes of social transformation;
-the political dimension ofpopular education.
Related to this it is clear that there is a need to analyse more deeply in order to find a
concept suitable for the region’s practices. The notion of “adult education” as such does
not reflect what is done, but also “popular education” is apparently more linked to the
political dimension as it is understood in Latin America than the nature of the
experiences described.
The workshop allowed a fruitful interchange based on the valuable experiences of
participants and the different organizations’ trajectories. We will share some of them
through the Health Letter. We start this journey with the work carried out by Dr. Hari
John in India.
Requests for further information to:
Anthia Madiath
Gram Vikas
P.O. Mohuda
Via Berhampur
Orissa 760002
INDIA
Prem Chadran John
ACHAN
61, Dr. Radhakrischnan Road
Madras 600004
INDIA
The Deenabandu Health Centre started in 1969, with the “simple and straightforward”
aim of treating the sick in the villages, when my husband and I started work there, fresh
from medical school. A small village 120 km west of the city, Deenabandu was started
by my father-in-law, a Ghandian pastor, and by the time we began work there, the village
was already well-accustomed to the tradition of free service and charity that had been
practised by the pastor and his wife, who was a medical doctor. We began our practice,
charging for services, and from that beginning evolved the health program as its stands
today -without a doctor, based on education and empowerment of women in the
communities and the use of indigenous and available resources and strongly geared
towards community self-sufficiency in health care.
The process began when we found that it was only the rich and educated who used our
services as doctors. In an attempt to make our services more accesible to the rest of the
villages, we began to operate a mobile clinic, taking drugs to the villages once a week.
However, we continued to observe the same phenomenon of being accesible only to the
rich. Another disturbing trend we noticed was that the patients we treated for kwashior
kor or malnutrition, would invariably return to us wi th the same problem six weeks later.
All this provoked us to reflect seriously our methods: thus emerged the Communit'~
Health Program, wherein we trained Village Health Workers (identified by the local
power structure -the Panchayat), to identify and treat simply illnesses in the village with
western drugs which they carried with them. In spite of the fact that these women were
from the villages, this strategy still did not make a dent in the problem, as it was only
the rich who could afford to pay for the medicines they dispensed.
This led us to another stage of serious re-examination and questioning of our relevance
as healers in the community. Having failed thus far, we realised that we needed to learn
from the people themselves in order to be relevant to them. We began to ask them what
they did when they fell ill and discovered that they hada resource of indigenous methods
and medicines with which they helped themselves before seeking medical help.
Fascinated by this first glimpse, we began to systematically leant more about the
medicines and methods they used for all the simple illnesses. We discovered that many
of the herbs they used posessed an active ingredient that was common to western
medicine. For instance, they commonly treat scabies with neem leaves, which contain
sulphur. Sulphur ointment is what western doctors prescribe for scabies!
Thus began the exciting process of identifying herbs and treatment methods with the
Our original approach, when we began training VHWs to treat simple alments in the
villages with western medicine, was a top-down one, the handing down of our
knowledge to those who did not posess it. The hierarchy in the training reflected that of
the medical system, it served, where the doctor remained at the pinnacle of the
relationship, and the direction of communication was one-way. A pre-formed currciculum that covered all that we thought they should learn guided the course.
'
help of community, and then researching the ingredients by looking them up in the
“Wealth of India”, a publication that comprehensively list plants, minerals and other
raw materials of India. We also studied whether and how these herbs were used in other
systems of medicine. We also did studies along with medicine students working on
similar subjects, to compare the efficacy of western medicines against indigenous
remedies for specific aliments such as, for example, hook worm, scabies, eye infection,
etc. We also studied the efficacy of the medicines from responses of patients treated by
the VHWs. What we found was that results were often dramatic for cases in which
western medicine could offer no specific cure. These findings we then communicated
back to the community who had taugh us, re-inforcing the knowledge they posessed
with scientific coroboration, and helping to strengthen their confidence in their own
resources.
The Training Program
Women fanned the centre and focus of the program, both because we strongly believed
that their role as catalysts and agents of behavorial change was crucial, and also because
we wanted to build up their assertiveness and self-confidence after centuries of male
domination, oppression and voicelessness.
When the VHWs trained in this way they failed to really reach the people in the villages.
However, the second phase of training was the turning-point in our approach. By
beginning to learn from the VHWs, a two-way communication was opened up from
which there could be no turning back. Our courses became more and more “participa
tory”. Although we had no notion then of the term and its now widely-celebrated
concepts, these concepts had forced their way into our scheme of operation in a very
natural and inevitable process.
Our original training programs were in the natural of “crash courses” -a week or two of
continuous sessions after which the women would be deployed in the field. As our ideas
changed towards more learned-based training, we changed this to one-day-a-week, onthe-job sessions, whereby the actual situations, problems and experiences encountered
by the VHWs in the field in the course of their work formed the basis of the training.
Thus the session would begin by finding out what the most common concern of the
women was, and the training would focus on that. The VHWs would first share all that
they knew and believed about the disease, its causes, manifestations, different types of
treatment, etc., and these would then be discussed, with our scientific or theoretical
knowledge helping to strengthen or sometimes rationalise, but often times being
modified by their rich store of experiential knowledge. The women were then able to
put into practice almost simultaneously what they had discussed. This approach builds
up commitment to the trainingand faith in themselves and in their capacity to leant and
Health as Socio-Economic Entity
As a result of our own evolving perception ofu, i h
phenomenon, the training programs began to nrovnkn h SOcio‘econ°mic and political
about fee root causes of ill-health in the commun i
discussi°ns among the VHWs
tracing it to poverty, deprivation and social iniu'sfe^vv- C™?their own Perceptions,
macro-perspective that we were able to give the hen
help of inPuts from a
thus began to be modified. They began to feel the
workers understanding of health
environmental and social handicaps in the comm ySSlty of ^Wing the economic,
changes in health behaviour and status.
Uniuesm order t° bringaboutcffective
Consequently, the program began to take on added aspects. Organising women into
women’s associations or Sanghams”, starting credit cooperatives, and initiation of
social forestry-and goat-rearing schems became part of the movement towards selfreliant health care. The credit-ccoperativcs operated through the Sanghams: each
member contributed a few rupees to create a small community fund, from which
members could then borrow when they needed, thus reducing their dependance on the
exploitative money-lender or the rich landlord. They paid back with an interest of 10%,
creating a small surplus which belonged to the community and could be used for
common purposes. Some villages have used this money to build drainage pipes and to
clear their roads of garbage and slush. More importandy, running of the credit
cooperative helps to build up women skills in collective management of funds and
collective decision-making. It also helps women, who were never credit-worthy with
banks before, to get loans on fee strength of their Sangham membership.
The Sangham is also intended to be a forum where women come together to discuss their
problems and to build a unified force for action to tackle local oppressors. In one
instance, women jointly demonstrated in front of fee local audtoriiy’s office to secure
a water-tap for their village.
As partof theattempt to restore fee degraded ecology of fee villages, health workers also
try to promote cultivate of Subabul (lucaena) trees in fee village for fuel, fodder and
fertiliser. Tied to this is a scheme feat encourages people to use this fodder to supplement
their nutrition and improve their economic status.
Towards Empowerment
The immediate fruits of fee training was VHWs increased confidence in themselves and
in their knowledge. They began to recognise their own contribution to fee process within
fee sessions itself, while feeir ability tocure people in their communities wifeouthaving
had any formal education (several of fee VHWs cannoteven spell their own names) re
inforced their faith in feeir indigenous resources and practices. This was definitely a step
towards self-sufficiency in health care. The communities no longer needed to depend
on fee vagaries of fee government’s Primary Health Care centres or on charity
dispensing doctors coming to the villages.
More interestingly, fee women, all from the landless outcaste “harijan” groups and
considered untouchable in rural societies, began to find themselves sought out even by
higher caste groups for feeir cures. Their traditional skills at mid-wifery, upgraded by
fee training, began to prove a tool feat could dissolve cast-barriers or be used to bargain
for better social positions in fee villages. Their own dependance on fee higher castes for
water, right-of-way, employment and other things could feus be off-set against fee high
caste people’s dependance on them. This produced a “reciprocal dependance”, a ste{ \
forward in fee road to cast liberation.
This increased confidence and assertiveness of fee health workers was communicated
to other women in fee Sangham and, combined wife fee new awareness of fee forces of
oppression, has created an atmosphere of activism feat is one of fee prime requisites of
a community based health care movement. Women that were voiceless have acquired
fee strength to stand up to feeir male oppressors in fee community as well as to demand
their rights from fee government. And a certain level of economic self-sufficiency
through fee credit-cooperatives has also allowed these women to bargain wife feeir
menfolk and with other caste people who often seek to borrow money from fee Sangham
through its members.
NEWS
FIRST LATIN AMERICAN SEMINAR ON THEORY AND PRAC
TICE IN THE APPLICATION OF TRADITIONAL MEDICINE TO
FORMAL HEALTH SYSTEMS
Th6 Centro de Medicina Andina commemorated its seventh anniversary by organizing
the First Latin American Seminar on the Theory and Practice in the Application of
Traditional Medicine to Formal Health Systems, The Seminar was held on November
16- 18, 1988, in Cuzco, Peru; with the collaboration of the Universidad Federal de
Paraiba, Brasil.
Requests for further information to: Centro de Medicina Andina, Apartado 711, Cuzco,
A process has been initiated whereby the health workers are made accountable to the
Sanghams. In many instances they are identified, supervised and monitored by the
Sanghams. A process of getting the Sanghams to financially support them is also under
way. This accountability of the health worker to the community is one of the essential
ingredients of community self-reliance in health. It is a long and difficult process that
rests on extensive education of both the health worker and the community.
In essence then, the Deenabandu Health Program is built on a conception of health as
a socio-eco-political phenomenon, uses multi-pronged strategies based on the organisaon, activism and empowering of women through economic and other resources, and
aims finally to place health care back with the community and the family, vesting them
with the responsability to secure and manage their own resources for health, and to
minimise their dependance on outside structures. All these are achieved purely through
a process of education -first and most importantly education of ourselves and our
attitudes, and then education for empowerment of the prime catalysts of change -the
women. That many of the formal indicators of health such as IMR, birth rates, maternal
mortality and morbidity have shown significant improvement, are revealing, but we
believe these are of secondary importance. Of greater and more lasting importance for
the health of the community is the process of awakening that has been stimulated.
WORKSHOP ON HEALTH AND POPULAR EDUCATION IN
BOLIVIA
The Latin American Network on Popular Education and Primary Health Care and A1PE
and UNICRUZ in Bolivia jointly organized a workshop on training and interchange in
the cities of La Paz and Santa Cruz, which took place in August, 1988.
POPULAR EDUCATION FOR A LATIN AMERICAN
DEMOCRACY
The Latin American Council for Adult Education has launched a strategic three-year
rogram to mobilize popular education groups and networks to promote Popular
Education for a Latin American Democracy.
DiCg° Palma’ Secretaria General de CEAAL- CasiUa 6257,
1990: INTERNATIONAL LITERACY YEAR
A campaign has been initiated to involve NGO’s and base organizations in plans for
International Literacy Year, 1990.
Contact: ICAE, 720 Bathurst Street, Suite 500, Toronto, Ontario, Canada M55 2R4. jgj
WORKSHOP FOR HEALTH PROFESSIONALS
The PIIE, Programa Interdisciplinario de Investigaciones en Educaci6n, has organized
a Worshop on Popular Education for Health Professionals in Chile to take place between
April and September, 1989. The course is designed for professionals working in
Primary Health Care.
Further information: PIIE, Brown Sur 150, Santiago, Chile. Tel.: 496644 - 2231940.
Educational and Bibliographical Material
“WOMEN’S ISSUES IN WATER AND SANITATION. ATTEMPTS TO
SOLVE AN OLD PROBLEM”. IDRC, Ottawa, Canada, 1986.
This publication is the result of a seminar centered on this theme, the discussion cen
tered on the problems that have restricted women’s participation in the past and ways
for improving this in the future. It includes an outline of women’s past efforts in this,
summaries of ongoing research efforts and preliminary proposals for future investiga
tion subjects. The seminar was attended by representatives from Africa, Latin America,
the Middle East and Asia. Spanish, English and French versions arc available.
Requests to: IDRC (International Development Research Centre), Apartado Airco
^3016, Bogota, Colombia.
“PARTICIPACION Y MOVILIZACION EN SALUD.
ALGUNOS
APORIES A PARTIR DE EXPERIENCES BARRIALES” (HEALTH
PARTICIPATION AND MOBILIZATION. SOME CONTRIBUTIONS
BASED ON NEIGHBOURHOOD EXPERIENCES). AnaPSrez; AnaSollazo.
Programa de Salud, Grupo Aportes - Emaus, Montevideo, Uruguay.
After analyzing the prevailing concepts in health and the role of technicians, the paper
reviews certain experiences about neighbourhood groups, polyclinics and university
extension. Reference is made to housing cooperatives and trade unions.
Requests to: Grupo Aportes - Emails. Javier Bamos Amorin 1168, Montevideo, Uru
guay.
“PLANTAS MEDICINALES DE USO COMUN EN CHILE” (MEDICI
NAL PLANTS OF COMMON USE IN CHILE). Cristina Farga; Jorge Lastra;
Adriana Hoffmann. Volumes I and II. PAESMI, Santiago, Chile, 1988.
The two volumes compile and systematize the results of exhaustive research on the
application of over 40 curative plants. The work permits to know part of the health
resources used in Chile. Spanish version.
Requests to: PAESMI, Miraflores 113, oficina 73, Santiago, Chile.
“SALUD Y DEMOCRACIA. LA EXPERIENCIA DE BOLIVIA (19821985)” (HEALTH AND DEMOCRACY. BOLIVIA’S EXPERIENCE,
1982-1985). Javier Torres Goitia, M. D. ILPES/UNICEF, 1st ed., Santiago, Chile,
1987.
With the purpose of analyzing the health policy implemented in Bolivia in 1983, the
volume compiles various documents, separately conceived, and the Bolivian experi
ence on primary health care. Mention is made to: Economic Dependency and Health;
Defense of Health and Responses to Illness; Primary Health Care and Social Demands,
and a Report on the Bolivia’s Ministry of Social Welfare and Public Health work team
between 1982 and 1985.
Requests to: UNICEF, Isidora Goyenechea 3322, Santiago, Chile.
“PROCESO SALUD - ENFERMEDAD” (THE HEALTH - ILLNESS
PROCESS). Asociacidn deOrganizaciones noGubemamentalesen Salud. LaPaz,
Bolivia, 1988.
4
Journal published by Bolivia’s Asociacidn Nacional de Organizaciones No Gubernamentales en Salud. Addresed to NGOs working on health and to health teams, this
report reflects health problems in Bolivia, from the perspective of the popular move
ment, social medicine and primary health care.
Requests to: ASONGS, Casilla 356, La Paz, Bolivia.
“SALUD MUJER” (WOMEN - HEALTH),Institute de Salud PopularMo. 8,
July 1988, Lima, Pent.
The articles of this issue of “Salud Popular” link descriptions of pathologies affecting
women with the precarious life conditions which women live. The articles present
experiences and reflections in connection with the axis women-life conditions-sickness. The attempt is to further debate, inform and promote changes in the health
conditions of women.
Requests to: INSAP (Institute de Salud Popular), Av. Arenales 1080,oficina301,Lima
11, Peru.
“LA MUJER Y LA SALUD EN NUESTRAS COMUNIDADES”
(WOMEN AND HEALTH IN OUR COMMUNITIES). CEPLAES, Quito,
Ecuador, 1988.
These “cahiers” document the experience of the community health promoters training
program. The materials were conceived as educational tools to share what was learned
with other women. This series is part of a CEPLAES series of support materials for the
•training and the organization of peasants and urban - popular sectors.
Requests to: CEPLAES (Centro de Planificacion y Estudios Sociales. Casilla Postal
6127 - CCI, Quito, Ecuador.
“MEJOREMOS NUESTRA ALIMENTACION” (LET’S IMPROVE OUR
FOOD). Euridicc Salguero. CEDIME, Quito, Ecuador, 1987.
This is a guide for improving food with products indigenous to the Andean region. The
aim is to support the process of training women from native and popular sectors.
Furthermore, an ideal basic diet is proposed.
Requests to: CEDIME (Centro de Documcntacidn e Informacidon de los Movimientos
Sociales del Ecuador), Apartado 18-C, Quito, Ecuador.
“EL PROGRAMA DE HUERTOS POPULARES” (THE POPULAI^
ORCHARDS PROGRAM). CEPES, Buenos Aires, Argentina, undated.
A descriptive leaflet of the CIPES Popular Orchards Program, which supports groups
of families from neighbourhood organizations and institutions to produce their own
vegetables, on the basis of the family and community orchards. A simple method is
proposed for obtaining vegetables with minimun work and no money expenses but
which will achieve good yields.
Requests to: CIPES, Zabala 2677, 1426 Buenos Aires, Argentina.
“EXPERIENCIA DE PROMOTORES DE SALUD EN CAILLOMA (THE
EXPERIENCE OF HEALTH PROMOTORS IN CAILLOMA). Alejandro
Vela Quico y Celso Anco Yucra. Accion Social y Desarrollo (ASDE), Arequipa, Peru,
1988.
The document, in addition to reporting on the health situation in the Cailloma province,
documents the work of health promotors within the framework of ASDE, emphasizing
training and the recuperation of traditional health techniques.
Requests to: ASDE, 13 de Abril 104-A, Arequipa, Peru.
“LA SALUD ES NUESTRO DERECHO” (HEALTH IS OUR RIGHT),
Asociaci6n Peru - Mujer, Lima, Peru 1988.
Educational leaflet for women to raise their awareness and promote their self-organi^bion todefend and demand their rights in health. It is part of a Popular Education series,
published by the Women and Health Area of the Asociacidn Peni-Mujer.
Requests to: Asociacidn Peni-Mujer, Apartado Postal 949, Correo Central, Lima 100,
Peru.
“POR LA VIDA” (FOR LIFE), FOVIDA, Lima, Peru, 1988.
Monthly bulletin of the Health - Life Promotion Program, in which experiences of
health and nutrition programs are as well as other information and news related to these
areas.
Requests to: FOVIDA, Jr. Camand 780, oficina 503, Lima, Peru.
“INFORMATI VO” (INFORMATION BULLETIN). CIAC, Santo Domingo,
Repiiblica Dominicana, 1988.
CIAC’s monthly bulletin, dealing primarily with their work in the field of popular
education. It includes information on the projects in health and alphabetization, plus
diverse news and bibliographic material.
Requests to: CIAC (Centro de Investigacidn y Apoyo Cultural), calle Sdnchez # 254,
Zona 1, Santo Domingo, Repiiblica Dominicana.
“SALUD Y TRABAJO” (HEALTH AND WORK), Red de Salud y Trabajo,
Santiago, Chile, 1988.
Information bulletin of the Health and Work Network, a panamerican group of NGOs
that support labour organizations in their activities in defense of health and work
conditions from the occupational health viewpoint. It contains information on various
Latin American countries, work groups and publications.
Requests to: Red Salud y Trabajo, Casilla 52604, Correo Central, Santiago 1, Chile.
“SYNERGY - CANADIAN INITIATIVES
FOR INTERNATIONAL
HEALTH”. Association of Universities and Colleges of Canada, Ottawa, Canada,
1988.
Quarterly publication of the Canadian Associations of Universities and Schools which
provides information on health at the international level with an emphasis on Canadian
initiatives. It encompasses various themes, such as international cooperation,
university scene, AIDS, etc. In addition, it offers information on employment 9K
experiences of Canadian students. Available in English and French.
Requests to: Association of Universities and Colleges of Canada, 151 Slater street,
Ottawa, Canada KIP 5N1
“DIALOGOS DE SALUD POPULAR” (DIALOGUES ON POPULAR
HEALTH).
Red de Grupos de Salud de la Mujer y el Nifio, Mexico D.F. Mexico, 1988.
Periodical publication addressed to popular groups as an instrument of information and
training for the organization and defense of rights in health matters. It includes
testimonies, articles and information on workshops and meetings.
Requests to: REGSAMUNI, A.C., Apartado Postal 22-443, Tlalp&n 14000, Mexico
D.F.
“MADRESY NINOS”. BOLETINSOBRE ALIMENTACIONINFANTIL
Y NUTRICION MATERNA” (MOTHERS AND CHILDREN. BULLE
TIN ON INFANT FOOD AND MATERNAL NUTRITION).
Asociacion Americana de Salud Publica, Washington, U.S.A.
published every four months, edited and produced by die Documentation Center on
^fants Food and Maternal Nutrition. The Center works in the distribution of materials
and information on these subjects. It contains information on programs, educational
materials and publications. Available in Spanish and French.
Requests to: Asociaci6n Americana de Salud Publica, 1015 Fifteenth Street, N.W.
Washington, D.C. 20005, U.S.A.
“AIDS ACTION”, AHRTAG, London, England, 1988.
International information bulletin on AIDS prevention and control, published in
English by AHRTAG. It contains detailed information on. AIDS and its treatment,
seminars and workshops on the subject (including the global AIDS program of WHO),
and bibliographic and educational material.
Requests to: AHRTAG, 1 London Bridge Street, London SEI 95G, England.
“PEOPLE”. IPPF, London, England, 1988.
Quarterly publication edited in English and French by the International Planned
^^renthood Federation (IPPF). Its basic subject is the promotion of planned parenthood
^Fd sharing information about efforts to balance resources and population at the world
level. Includes news, bibliography, projects, life stories, etc.
Requests to: IPPF (International Planned Parenthood Federation), P.O. Box 759, Inner
Circle, Regent’s Park, London NW1 4LP, England,
APPROPRIATE TECHNOLOGY FOR HEALTH. Division of Strengthening
of Health Services, World Health Organization, Geneve, Switzerland, 1988.
Quarterly publication of WHO, edited in English and Spanish (separate volumes). Each
issue includes a large variety of articles on various subjects concerning health:
community organization, utilization of resources, primary health care, etc. Includes
news and bibliographic material.
Requests to: Division of Stregthening of Health Services, WHO, 121 Geneve 27,
Switzerland.
“NOTICIAS DE SALUD PUBLICA Y ADMINISTRACION SANI
TARIA” (NEWS ON PUBLIC HEALTH AND SANITARY ADMINI
STRATION). Escuela Andaluza de Salud Publica, Granada, Espafia, 1988.
Periodic publication of the “Escuela Andaluza de Salud Publica”, the objective of which
is to establish communications among persons and institutions concerned with Public
Health. It includes abundant information on Spanish and europeans seminars, projects
development and bibliographic material.
Requests to: Escuela Andaluza de Salud Publica, Avenida del Sur 11,18014 Granada,
“CHETNA NEWS”. Chetna, Ahmedabad, India, 1988.
Quarterly information bulletin of Chetna, an Indian NGO working in the field of popular
education, primary training related to nutrition. The bulletin focuses on the programs
of Chetna and other Indian institutions.
Requests to: Chetna, second floor, Drive-in Cinema Building, Thaljtcjroad, Ahme
dabad 380.054, India.
“CONSUMER CURRENTS”, International Organization of Consumers Unions
(IOCU), Penang, Malaysia, 1988.
Periodic publication appearing 10 times per year, edited in English by IOCU, a
foundation serving as liaison for some 170 groups in 55 countries. It includes
information on subjects such as agriculture, communications, environment, health,
food, housing, etc. of interest for consumers, specially those in the Third World.
Requests to: IOCU (International Organizations of Consumer Unions), Regional
Riffice for Asia and the Pacific, P.O. Box 1045, 10830 Penang, Malaysia. (Oficina
Regional para America Latinay el Caribe, Casilla 10933, Sucursal 2, Montevideo,
Uruguay).
“NEWSLETTER”.
Non-formal Education Service Center, Kathmandu, Nepal,
1988.
Semi-annual bulletin published by NFESC, aNGO which has been working since 1984
in the field of education and community development, particularly in Nepal’s rural
areas.
The first issue includes information on various NFESC projects in
alphabetization, potable water and other areas.
Requests to: NFESC (non-formal Education Service Center), GPO Box 2986, Kath
mandu, Nepal.
“TAMBALAN”. Council for Primary Health Care, Manila, Philippines, 1988.
Quarterly journal elaborated by a committee of agencies and published by the Philip
pines Council on Primary Health Care. “Tambalan” contains news and information and
constitutes a guideline for base and community health programs. Includes subjects such
as traditional medicine, training and education and others. Edited in English.
Requests to: CPHC (Council for Primary Health Care), P.O. Box SM-463, Sta. Mesa,
Manila, Philippines.
“THE ROLE OF HEALTH EDUCATION AND COMMUNICATION IN
SANITATION PROGRAMMES”. John Hubley, Barry Jackson and Thabo
Khaketla. UNESCO/UNICEF/WFP, Paris, France, June 1988.
The paper presents a case study on the sanitation improvement program in Lesotho
which describes the work of the Sanitation Improvement Team of Lesotho’s Minist^^
of the Interior and its activities in the educational and communications field. Edited in
English.
Requests to: Urban Sanitation Improvement Team of the Ministry of the Interior.
Private Bag A41, Maseru, Lesotho.
“PIGLAS-DIWA. ISSUES AND TRENDS ABOUT WOMEN OF THE
PHILIPPINES”. Center for Women’s Resources, Quezon City, Philippines, 198j|
Quarterly publication in English of the Center for Women’s Resources of the Philip
pines, that attempts to contribute to the Philippine women’s liberation (“Piglas Diwa”
is a Philippine term that means a spirit trying to obtain freedom). The journal adresses
subjects related to women’s conditions: health, education, work, women’s centers and
organizations, urban poverty, etc.
Requests to: Center for Women’s Resources, 2nd floor, Marsantos Building, 43 A
Roces Avenue, Quezon City, Philippines.
“HEALTH CENTERS IN NEED OF TREATMENT. A JOINT EVALU
ATION OF SWEDEN’S SUPPORT TO THE HEALTH SECTOR DEVEL
OPMENT IN TANZANIA, 1972-1986". SIDA Evaluation Report, Stockholm,
Sweden, 1987.
An evaluation of Swedish cooperation in the construction of rural health centers in
Tanzania, representing practically half of the entire Swedish governmental cooperation
in Tanzania. The document evaluates the role of rural health centers in the implemen
tation of primary health strategies in Tanzania’s rural zones. Edited in English.
Request to: SIDA (Swedish International Development Authority), S-10525 Stock
holm, Sweden.
NEWSLETTER No. 10
POPULAR EDUCATION AND
PRIMARY HEALTH CARE NETWORK
April 1989
Coordinator of the Network: Teresa Marshall
Perez Valenzuela 1634 Casilla 6257 Santiago 22 Chile
Fono 2235822 Telex CEAAL 240230 BOOTH CL-CHILE
IMPROVING ENVIRONMENT FOR CHILD HEALTH
DEVELOPMENT.
Urban Examples, Unicef, March 88.
This issue of “urban examples” presents five case studies. They
are all reports on poor urban settlements that seek to face the need
for drinking water, sewage and health services (Argentina, Brazil,
Sri Lanka, Jordan, Honduras). (English)
It can be requested from: Urban Section - Programme Division
UNICEF HQ Rm H-11-F
3 U.N. Plaza
New York, N.Y. 10017, U.S.A
HEALTHY CITIES
Bulletin produced by Healthy Cities Centre it attempts to support
groups involved in public policies promoting health in the cities
of the world (english).
Contributions received.
It can be requested from: The Editor Healthy Cities
Normanton Grange, Laughan Avenue
Aigburth, Liverpool 17, ENGLAND
HEALTHY PUBLIC POLICY
Report on the Adelaide Conference.
Report on the Second International Conference on Health Promo
tion (April 1988, Australia), organized by WHO and the govern
ment of Australia. The report gives an account of the principal
subjects of the debate: the fairness of health policies and public
responsibility regarding them. It also refers to the main subjects
of future policies: intersectorial action, the action of the organized
community, the training of human resources, action in the envi
ronment.
Recognizing in short: “but meeting the goal of an indivisible and
global health depends on the political will of countries to orient
their own policies and strategies towards the common goal of
global health” (english).
It can be requested from: WHO
Health Promotion Unit
8 Schcrfigsvcj
DK-2100 Copcngahen, DENMARK
MARIA, LIBERACION DEL PUEBLO.
(MARIA, LIBERATION OF THE PEOPLE)
This is a monthly publication made by the women of the working
class settlements of Cuernavaca (Mexico). It contains information
on actual conditions in Central America and particularly in
Mexico; and includes a pholonovel, educational methodology and
advice on health matters. It can be requested from: (in Spanish)
Emma Pdrez H. Apartado Postal 158-B
62190 Cuernavaca, Mor.- MEXICO
HACIENDO NUESTRAS CONEXIONES.
(MAKING OUR CONNECTIONS)
A handbook for advisers that work with women on mass mental
health. It reflects an experience of working with women, and
includes exercises, dynamics and theory on metal health and sexu
ality (in Spanish).
It can be obtained from: Casa Sofia c/o Mdnica Kingston
Casilla 52414 - Correo Central
Santiago, CHILE
Cost: USS 9,50 (includes air mail postage)
$ 1.500 Chilean pesos
VOICES RISING.
Bulletin of the Women’s Program of the International Council of
.Adult Education. This is a publication on women and Mass
lEducation. It promotes the exchange of, debates on and the
(propagation of information on subjects that are vital for women
and mass education. It is published in Spanish, english and french.
lit contains the practices and the ideas of women in different parts
of the world. Including subjects related to Peace, Human Rights,
Health, Educational Methodologies, Social and Political Moverments.
lit can be requested from: ICAE Women’s Program c/o PRG
309-229 College Street - Toronto,Ont
CANADA MST 1RY
PERU: Friday, 10 June: Thirty people from different health or
ganizations held a workshop in Lima to exchange experiences,
share the debate on problems within their spheres and start the es
tablishment of the Peruvian Health and Popular Education Net
work. The event took place at the Casa ANC (Asociacibn
National de Centros), on the occasion of the conducting of the
Peruvian Symposium on Popular Education.
The workshop had been organized by Celats (Marta Escobar) and
Cidepsa (Alberto Goyoso), who had previously collected the
requirements of the Centres that work in this field and their expec
tations regarding the idea of setting up a Network. All were in
agreement that there was a need to have in Peru a space for
meeting and coordination, where debates, exchange and training
would be sponsored. The need for permanent collaboration in the
carrying out of collective activities (for example, the next Pri
mary Health Care Meeting), and the organization of small events,
apprenticeships, visits and research among the Centers was rec
ognized. The urgent need to share the materials produced by each
Center, so as to set up a Health Documentation Center was
pointed out.
The participation of so many groups.... Flora Tristdn, Manuela
Ramos, Provida, Peru Mujer, Cesip, Ceplar, Sea, Servicio de la
Mujer Minera, Calandria, Edaprospo, Visibn Mundial, Altemativa, Prisma, Incafam, Cipa, Cepco, Amauta - (Arequipa), Ti4^ pacom, Centro de Medicina Andina (Cuzco), Ces, Celats,
Cidepsa. And the enthusiasm shown, enable us to look ahead to
the success of this Network. Alberto Gayoso and Mbnica Escobar
assumed the responsibility for encouraging and coordinating this
process.
But, within a perspective of granting more importance to real
coordination than to the coordinators and hoping to unleash a
process of participation and rotation of those “responsible”.
Those who may be interested in contacting this initiative, may get
in touch with coordinators at: Red Salud - A.N.C.
Pablo Bermudez 234-Lima 11, PERU
CHILE: TRAINING, the plans for health training and popular
education continue.
PIIE (Programa Interdisciplinario de Investigacibn en
Educacibn) is developing a training course in popular education
methods for health workers. This course has the support of the
Canadian Public Health Association
INTERNATIONAL DAY OF ACTION
HEALTH OF WOMEN - 28 May 1988.
FOR
THE
THE INTERNATIONAL NETWORK OF WOMEN FOR RE
PRODUCTIVE RIGHTS AND THE HEALTH NETWORK
FOR WOMEN OF LATIN AMERICA AND THE CARIBBEAN
(ISIS) launched an international campaign with regard to the prob
lem of mortality. Both networks collected and spread information
on maternal mortality from a woman’s point of view, promoting
a campaign that was based on the women’s real needs, helping to
avoid their deaths, their risks, and improve the life and health of
women.
We ask all those interested in learning about this important
campaign to see how they can continue collaborating. Please
contact: The International Network of Women for Reproduc
CHILE: EPES launches the EPES games.... A few days
ago we celebrated the launching of the large folder of EPES
games. This is a new edition, corrected and coloured. Now eve
rybody can have them.
Thcv can be requested at: EPES
y
Casilla 15167 - Santiago, CHILE
This health letter contains a large number of previews speeches, experiences, publications, news- referring to
health related movements. What is happening now? How
are the changes expressed? Which are their principal
trends? If we run though the words of the Director of
WHD, Dr. Halfdan Mahler, we discover a marked em
phasis on those strategies which will place health policies
at the forefront. He invites us to work on health policies
that express equity, political accountability and that
require the active participation of grass roots organiza
tions. He invites us to place health in the forefront of the
debate on politics and culture. This is an appeal to all
social leaders to promote health development activities
on all fronts.
The interesting thing about this is to take a look at our
practices and discover in what this process already going
ahead. Action on the borders, of impoverishment for those
located in the centers of power. But, as some authors
have already pointed out, we are living the rebellion of
the chorus. Today in the rural communities with the
native peoples, in the poor sectors of the city, with these
spaces health is created, published, changed, produced. A
space that never stops creating even when sailing through
difficult seas. The experiences and publications described
briefly in this letter tell of this permanent itinerary.
Keynote Address
Opening Session - 5 April 1988
Dr Halfdan Mahler, Director-General, World Health Organization
I should first like to express our gratitude to the Prime Minister, the Right Honourable Mr Bob Hawke,
I for having honoured us by opening this Conference. This is an outstanding symbol of Australia's
commitment to health at the highest political level. A furthersign of that commitment is that Australia is
i honouring its bicentennial year and the 101 tieth bii thday of the World Health Organization by presenting a
set of health goals and targets based on the World Health Organization's Health for All policy. That surely
underlines the tone and aim of our meeting: the focus on action towards Health for All.
A major statement made at the First Interna
tional Conference on Health Promotion in 1986
in Ottawa was ’health is not divisible. We are
no longer in the period of the 'first fleet’, when
a country could hope to export its problems to
another continent. The world has become too
interlinked and interdependent for such
actions. The new environmental hazards and
chemical threats and the global challenge of
AIDS are perhaps the most obvious expressions
of this in the health arena.
National boundaries are a geopolitical fact.
But just as health is created largely outside the
health sector, so it is created largely across
these national boundaries. The winds and
viruses will not respect them. The international
markets have long transcended them. Not only
the industrialized to the developing countries:
tobacco, alcohol, pharmaceuticals, and con
sumer goods are also exported. To these I would
add the export of images, ideas about the world.
and lifestyles - all of which can be potentially
hazardous. These of course arewell-known
examples. Less obvious is the impact of the
industrialized countries' use of the developing
countries' resources. To meet the demands of
the rich and generate income for themselves.
the developing countries are often forced to
deplete their natural and human resources for
short-term benefit but long-term loss.
Let me illustrate this with some spotlights
on tobacco, since this Thursday will be the first
world-wide No-Tobacco Day.
In Bangladesh, one of the poorest coun
tries in the world, the tobacco-growing area has
increased rapidly from 47 000 hectares in 1976
than rice. Tobacco not only kills people, it kills *4
the soil, it destroys old farming cultures and
<’
patterns, and creates dependency on inter
national markets and subsidies.
and move from the area of rhetoric to the area
of action. At the First International Conference
on Health Promotion we discussed the changed
meaning of the words ’health’ and ’public' in
relation to the 'old' and the 'new' public health.
In Adelaide we intend to look closely not only at
the changes in the content and perception of
policy, but also at a new style of policy-making.
It is this type of fact that has led us to
select Healthy Public Policy as the theme for
this Second International Conference on Health
Promotion. We wished to underline the key
theme of the Ottawa Charter, that the domain
of personal health over which the individual has
direct control is very small when compared to
the influence of culture, economy, and environ
Let me quote here the working definition
ment. I could repeat the example I gave above
of Healthy Public Policy that the background
for many other areas and products, which to me
paper Healthy Public Policy Issues and Options
illustrate the lack of honesty and transparency
offers to the Conference:
in much policy-making. They exemplify a policy
choice of placing products and markets over the
health of people. It is against such policies that
Healthy Public Policy is the policy chal
we have set the challenge of Health for All.
lenge set by a new vision ofpublic health. It
3
to about 55 000 hectares in 1982. Tobacco
smoking in that country has doubled in the past
two decades. In the poorer parts of the world in
general, smoking is increasing faster than rs
With the commitment to Health for AIL
the World Health Organization and its Member
States have recognized the need to give health
priority in policy-making. With Health for All.
population growth. Governments and inter
national agencies are subsidizing tobacco
farming. About 60% of the costs to farmers of
growing tobacco in the European Community
we have moved from public health strategies
that were focused only on the health of the
nation-state to a world consensus on health
development, from which each country can
develop its national goals based on a common
understanding, not only of what constitutes the
world's health problems but - even more
importantly - of what constitutes common
strategies for solutions.
are met by Common Market funds.
Tobacco requires nutrients, a high input
of fertilizer and pesticides-Many tobacco
farmers all over the world are poor and take
refers to policy decisions in any sector or level
ofgovernment that are characterized by an
explicit concern for health and an accounta
bility for health impact. It is expressed through
horizontal strategies such as intersectoral
cooperation and public participation.
I believe vehemently that health policy
action must move closer to people. Rather than
controlling people, it must empower and pro
tect them, and it must aim at strengthening
international co-operation, equity, and human
rights. It must work towards a negotiated con
sensus. not a grand solution from above.
Governments should first be held accountable
Healthy Public Policy is one of these strat to their people before they ask their people to
egies. which we propose to develop even further be accountable to them.
COMMUNITY HEALTH CuLL
47/1,(First FloorjSt. Marks Road
BANGALORE ’ 560 OO1
also implies that we in public health do not
simply put the blame on the other sectors for
not acting as we think they should, but that w
take our role as advocates for the health of the
public seriously.
Honesty implies that we critically assess
whether we have raised our voice loudly
enough and whether we have worked hard
enough on developing strategies and mecha
nisms that reflect the new public health need
Only on such a basis can public health re
establish public confidence and trust. Agend;
for such action are outlined in the backgroui
paper and are illustrated by the case studies.
claimed an advocacy role tor the health sector.
We stressed that Health tor All had put policy
and related structural change tor health back
into locus and had retrieved some of the most
important roots of public health. 1 called this
the rediscovery of an old. forgotten melody. I
would like to urge you not to forget this melody
at this Conference. Many of the early public
health pioneers were also social reformers.
pioneers in the organization of labour, educa
tion. housing, and sanitation. Much of this link
has been lost in public health development.
Social medicine and social policy have taken
separate roads. Recent textbooks on public
health or epidemiology frighten me by showing
how much public health has lost its original
link to social justice, social change, and social
brm. and how it has opted for behavioural
victim-blaming instead.
A hundred years ago social reformers in
the industrialized countries were abolishing
child labour. They were making it possible for
children to go to school and get an education.
They were developing family policies. They were
developing what was then the major institution
within the medical care system, the hospital.
i
Many developing countries still have this
strong link between social policy, social justice.
and public health.
But many excellent attempts to integrate
health improvement strategies are limited by
macro influences that are far beyond their
control. Take the integrated rural development
projects in Latin America and the Caribbean:
the drop in infant mortality and the increase in
life expectancy at birth in Costa Rica during the
1970s were directly proportional to the cover
age and duration of the Rural I iealth
Programme. However, the consequences of the
world-wide economic crisis are beginning to
reverse this trend. Decreased income, austerity
in public health spending, and subsequent
higher poverty levels are now causing rising
malnutrition, increased morbiditv. and a halt in
the decline of infant mortality. The direct con
sequences of macro-economic policy-making
are rapid and brutal, and seriously impede
national health goals.
But it is not only the economy that can
have far-reaching effects on health. The World
Health Organization studies undertaken in the
context of the United Nations decade for women
showed a clear interrelationship between the
literacy rate of women, family-planning prac
tices. and the health of women and families.
Just a few years after the end of that decade
major cultural and religious changes in some
countries have brought about a drop in female
literacy and a related rise in female poverty and
infant mortality.
We all know that 'good public policy'
improves security, quality of life. and. we hope.
the ability of people to pursue happiness. This
has been proved by1 history, and is shown day by
But. with all the importance that needs!
be attached to responsible governmental actio
for health, we must not fall into another trap:
to think of Health for All as meaning only
governmental action for health. I insist that
Health for All is a movement. It is an idea, a
challenge we have put forward, and it takes
many forms. It includes many actors, some of
whom are not easily controlled. Of course 1
attach great importance to the fact that more
and more World Health Organization Membei
States are developing Health for All policies ai
actions - but I also insist that Health for All i
day in each of the World Health Organization 's
Member States. As public health proponents.
we must welcome any such policy. But let us
not too readily attribute such developments to a
higher value attached to health or to the suc
cessful advocacy of public health lobbies. Many
policy-makers still see health in purely medical
terms, and interpret all health costs as expendi
ture and not social investment.
movement of the people. The Scope and Pur
pose of the Conference states it dearly:
A five-country study on intersectorality
commissioned by the World Health Organiza
tion. and a number of case studies at this
Conference clearly show that intersectoral
action for health is still rare. More often than
not. other sectors take action for reasons of
Healthy Public Policy should be:
policy for the people
with the people
by the people.
their own. which then have an impact on
health. Health-related components of housing.-<?/' >■-.?•
agriculture, or education policy are seldom
1C'
made explicit. It is self-defeating to attribute
such policies to intersectoral action for health.
since that does not give us a realistic picture of
how the health sector has fulfilled its advocacy\
role, or of how tar governments are prepared to '<
be accountable for the effects of their actions on
the health of the people.
That is why we are suggesting honesty and,
transparency, or. in more technical language.
^accountability fOr health'. If societies truly
place a high value on health and see it as a right;
of each citizen, then each governmental policy
needs to be assessed in terms of its positive or
negative impact on health. But this honesty
,
As the Chinese maxim says:
Co to the people
live with them
team from them
love them.
The public in its many forms plays a major
role in setting agendas and forcing officials to
end practices that are harmful to health and
have become 'business as usual. In my opinion
this role still needs strengthening all over the
world.
I mention these movers, ,
must be constantly aware th-n5 because we
not the Scripture written iniq,-alth lor AI1 is
to be touched again. As such? '"'.8and never
rigid and die. Health for All m W°U d betorne
living thing, taking up the health
,
most trouble people and societ
nUeS
world.
soc’«ties all over the
For very, different reasons, sun-ival is
S’T,1"theIS8U^partsof
he world, Pubhc health has the responsibility
to respond with global action.
More usually, people have to
find other ways and means to express them
selves and to be heard. Public health is still far
from being as open and as public as I would
wish it to be - as it would need to be in order to
be truly successful.
Many different social movements have
been highly relevant to public health develop
ment. In the 1970s the social movements in the
developed countries were about identity and
autonomy and they had a strong influence on
how we began to rediscover health. The wom
en's movement is exemplar)' for drawing our
attention to the rights of the people in defining
their health and their health needs.
Movements now speak for
ecology, peace, and international co-operation.
This shift opens the way for a joint public
health voice from the developed and the devel
opingworld in the context of Health for All:
health is indivisible.
At the Ottawa Conference, our startingpoint in health promotion was to achieve a
wider understanding of where the health of
people is c reated and to see people as part of a
larger ecological system. The individual is not
only the body, but also the mind and the spirit.
The person is integrated intoa physical and
socio-economic environment. Health is created
by the specific interaction between human
biology and personal behaviour within a culture
and a biosphere.
It is a very special link between our past
and our future that this type of thinking is
reflected in those case studies that are con
cerned with traditional understandings of
health, such as the studies on Maori and Abo
riginal health. Health is seen by these people as
the result of a complex interplay between the
individual, his or her territory ol conception.
and his or her spiritual integrity: the body, the
• are we not confining ourselves to the health
sector at a time when we should be moving
radically out of it?
• are we really aware of the high relevance that
ecological and environmental questions have
to the future of public health'- They have
recently been outlined in Our Common
Future, the report of the World Commission
on Environment and Development;
land, the spirit.
Looking into the future I see that, just as
the understanding of social health has come to
include cultural and spiritual well-being, so will
physical well-being come to mean much more
than the biology of the human body: it will
include a safe environment and the responsi
bility for our physical surroundings on the
• do we really know how much changing
values, beliefs, and expectations will influence
public health?
Maybe we will be called upon to invent a
new type of World Health Organization to
respond to the new challenges I have touched
upon.
planet as a whole.
The keythemsoimv speech have beeg
the g|0ba| resEonsibib^^
d^^Urn^nierence we should also
i^wThe major geopolitical shuts due to
take place by the turn o'this century.
The reorientation of public health is the
, .,
... hv the World Health Organization
The Health for AH movement must con
tinue to be a challenge. In tackling today's
environmental and social risks, we must be able
to achieve results similar to those achieved by
traditional public health. We must confront
what now kills people, lets them suffer unbear
ably. causes pain - in short, gives them no
access to health. Healthy Public Policy is one of
the main areas for such action. I expect that
this Conference will outline the major strate
gies and ways to approach the main aim of
Healthy Public Policy as stated:
Healthy Public Policy aims to create the
preconditions for healthy living through:
• closing the health gap between social groups
and between nations;
• broadening the health choices ofpeople to
make the healthy choice the easier and the
possible choice: and
• ensuring supportive social environments.
It has become clear that health is not a
private good but a societal, social, and indi
vidual resource. We are now learning the "•me
about the environment. At the end of the - jOs
we were able to see our planet Earth from space
for the first time - and for the first time to
grasp it as a vulnerable system, whose ecology
we are responsible for.
Let us take up the challenge with this
Conference on Healthy Public Policy in order to
protect the interests of future generations and
the survival of this planet Earth.
I leave you with a quotation paraphrased
from George Bernard Shaw:
The problems of the world cannot possibly
be solved by sceptics or cynics whose horizons
are limited by the obvious realities. We need
men and women who can dream of things that
never were... and ask. why not?
“Where Education Begins
.
and entertainment Continues
The increasing use of popular theater (rechristened community
theater in Sierra Leone in 1986) as an instrument for popular
education, community organization, mobiization and develop
ment in the 3rd world has spread phenomenally during the last
2 decades. Besides, it has contributed significantly to building
people’s confidence, participation, self-expression and critical
awareness. From the urban squalor of Latin America’s favellas
and barrios, to the slums of India and Bangladesh and the un
developed rural areas of Africa, popular/community theater
drama, music, dance, puppetry and poetry - is a spontaneous
made of education and grassroots development communica-
« ttnn.
•»<t
Many reasons have been put forward for the use of community
theater as a tool for development. It is entertaining, educational
and developmental, is culturally relevant, inexpensive and is
based on the people’s performing arts. It makes use of the other
cultural resources and the creativity of the people and expresses
popular knowledge and concerns. As a codification of reality, it
can be used to raise issues of the moment and to stimulate
discussion and dialogue. But all these attributes do not guaran
tee that theater will be used to serve the interests and aspirations
and to satisfy the needs of the people. Theatre should not be
looked upon as a tool per se but as an integral part of a socioeducational process which engenders confidence-building,
problem identification, data collection and analysis, strategising
and organizing for collective action.
COMMUNICATION MODES IN COMMUNITY
development
The Government of Sierra Leone, people’s development organi
zations (PDOs) national a well as international, have embarked
with varying degrees of success on community development
programmes and projects aimed at improving the quality of life
of the people. Some have exploit the country’s rich and exuber
ant cultural resources and traditions and have used the indige
nous perfonning arts, especially, drama for education and conscientization and for the dissemination of all types of develop
ment messages and packages.
The idea of using drama for community education and mobili
zation is not a new phenomenon. Since the beginning of the UN
2nd Development Decade, it has been realized that most
poverty-focussed development programs for the rural have
foundered. One reason has been that the programmes are
conceptualized in government ministeries in urban and peri
urban areas where armchair and doctrinaire bureaucrats, totally
out of touch with the needs, interests and aspirations and
ignorant, if not oblivious, of the socio-economic and other
realities of the people; prepare their blueprints. The program
mes are implemented
by extension agents who traines as “constructed technocrats”
are conditioned to analyze problems in a narrowly technical
way and to propagate technical solutions which invariably fail
to address the socio-economic parameters which created the
problems in the first place. Essentially, this is because the
traditional communication modes in development and
extension work are largely top-down, directive, authoritarian
and impersonal. Extension workers assume that the informa
tion flow is linear and that development information is the
monopoly of “experts”. Extension workers usually assume the
paternalistic “I - know - what - is -best - for - you ‘, stance and
this has given rise to much, and at times stout opposition in the
part of the intended programme beneficiaries.
A usually held belief is that villagers do not like change and
they offer resistance to whatever plans are made for their
development.
Social Anthropological studies have debunked the myth that
villagers are lazy, conservative and bound by traditions and
superstitions. Such characterizations continue to be flaunted by
those developmentalists who wish to be absolved from respon
sibilities for project failures. Current trends are that the yawn
ing gap between extension workers as change agents and the
communities with whom, and not for whom, they work must
be bridged to promote dialogue and genuine participation and
forster better understanding, rapport and mutual confidence.
social science research. Experts in conventional social science
research now concede that qualitative methods can destroy
institutions and processes.
THEATRE FOR DEVELOPMENT IN SIERRA
LEONE.
In response to the crisis faced by conventional models, various
alternatives have emerged among them participatory/action re
search.
Theatre for development was introduced in Sierra Leone in the
late 1970s. The Planned Parenthood Association and Plan Inter
national of Sierra Leone and health educators in provincial
hospitals have all experimented with drama and other folic
media for community adult education and for the dissemination
of their family planning and primary health care messages.
The now-phased out CARE Project LEARN (Local Educa
tional Activities for Rural Networks) used drama to transmit its
agricultural, health, nutrition and sanitation messages in the
Northern and Southern provinces.
The LEARN experiment used resource kits which contained
among others a series of taped dramatised stories featuring the
day-to-day experiencies of a typical farm family. The l'm’tation
of all the above experiments was that the villagers - tf16 Pro"
gramme beneficiaries - were entirely left out not only in the
identification and analysis of their own problems but also in the
drama making, and dramatization and thus became passive lis
Whatever benefits development has brought to some - the very
tiny minority, it has bypassed the very people who are most in
need of an improved standard of life - the masses in the rural
and periurban areas and the slums of urban areas. Many socalled poverty-focussed projects have not focussed on the key
ingredients that would help extricate the poor from the quag
mire of their poverty. Rather, very many projects have made
life harder for the intended beneficiaries turning them into
peasants and tenants rather than helping them to develop as
selfsufficient farmers and rural workers. Mathur notes “most
studies recently conducted in rural Asia tend to confirm that the
standard of living of the absolute poor has declined over time...
By and large, the poor have tended to stay poor”. It has now
increasingly been realised that only rarely have the poor - the
real experts on poverty, the people who experience it day after
day - been consulted about what they need and want to develop
themselves. They have rarely been allowed to participate in de
cisions which affect their lives in a way that would unleash
their creative energies and abilities.
teners and mere objects of sloganistic messages.
In recent years a new consciousness has emerged both among
social scientists and within groups long used as subjects o
Out of all these failures, a glimmer of light has begun to
emerge. This light is marked Participatory Research (PR)
predicated on the genuine, effective and optimal participation of
the researched in the development process. “The PR process
arose in the context of questioning much basic research issues
as the relationship between the purposes and consequences of
the means and ends of social research, the implications and re
sults of using the traditional and conventional social science
methodologies, the relationship between the researcher and the
researched, neutrality, subjectivity and objectivity”.
PR has been described as a three-pronged activity : an ap
proach to social investigation with the full and active participa
tion of the community in the entire research process; a means
of taking action for development and an educational process of
mobilization for development, all of which are closely inter
woven with each other. In short, PR consists of three interre
lated and interdependent processes:
a) Collective investigation of problems and issues with the
active participation of the researched in the entire research
process .
b) Collective analysis in which the researched develop a better
understanding not only of the problems in hand but also of the
underiying structural causes of the problems.
c) Collective action by the community aimed at short-term as
well long-term solutions to the problems.
The above three interrelated processes of PR are related to the
three functional and existential questions in the process of conscientization.
- “What are the problems in our present situation?”; “Why do
the problems exist?” and “How can we rid ourselves of the
problems?” The basic objective, them, of PR is progressive
social change for the betterment and libertation of the op
pressed and marginalised peoples. PR is a tool which the
oppressed can use to begin to take control of the economic and
political forces that muzzle them.
THE COMMUNITY THEATRE FOR EDUCA
TION AND DEVELOPMENT:
Since October, 1986, the Institute of Adult Education and
Extra-Mural Studies (INSTADEX), Fourah Bay College,
University of Sierra Leone, has mounted a scries of innovative
training and orientation workshops for extension and develop
ment workers, theatre practitioners and activists in the Theory
and Practice of participatory research community theatre.
The Community Theatre for Development Workshop, from the
first stage of establishing rapport, mutual understanding and
confidence with the partiepating workshop communities to the
last stage of discussing for workshop follow-up strategies
before th; workshops ended, were holisitic learning experiences
on the
oflhe workshops participants (WPs), the resource
persons ftps)i the Local Liaison Persons (LLPs), the village
participarjs (vps) and the communities. Village participants
were cnc«uragcci to take part in the dramatizations and their
improvisajons clearly highlighted some of the underlying
contradictions, rationalisations promotional and obstructional the pushing and blocking - factors that undergird village
development. Storylines, drama-making, rehearsals, the per
formances, post
performance and post-”swop” performance discussions resulted
in new and valuable perspectives and the plays kept changing as
the understanding of the actors and onlookers deepened. The
constant interaction and dialogue with and participation of the
villagers produced what Kidd has called “transformational
drama” which enhanced the process of conscientization rather
than villagers merely watching and even discussing ready-made
plays produced by interventionists.
The development component is operationalised as workshop
follow-ups to concretize the awareness created in the participat
ing communities thanks to the dramatizations and post-perform
ance discussions. One major development strategy has been the
launching of the Institute’s Programme SWASH (Safe Water
and Adequate Sanitation for Health) (with in-built drama
components) which comprises community action, health and
sanitation projects the construction of a spring box, water wells
and pit latrines. Two of the identified, highlighted and drama
tized problems in most of the first (November 1986) training
workshop’s dramatizations were contaminated water and
unhealthy sanitation practices. These, no doubt, led to high
incidences of water-related diseases like diarrhoea, dysentery
and malaria, and also to high rates of morbidity and mortality,
especially among infants and children. The launching of
programme SWASH was predicated on the firm conviction that
improving only water quality or digging latrines will have little
or no effect on die incidence of diarrhoeal and malarial dis
eases. The Institute was convinced that a combination of
improved water quality, increased water availability, hygienic
as well as community-acceptable latrines and a vigorously sus
tained, multi-media community educational programme using
in particular the folk media, especially drama, can be very
effective in changing the health and sanitation practices of
individuals, families and communities.
THE DISSEMINATION
INSTADEX has now reached the Dissemination Stage in its
Community Theatre for Education and Development program
mes. Circular letters were despatched in 1987 to development
and adult education agencies in Sierra Leone informing them
of the great potentials of participatory research (PR) drama in
disseminatingall types of development messages and pack
ages. The institute now coIlaborales with local and national
agencies in training their social and community dcvclopm
workers in the theory and practice of this new genre of drIn similar vein it also collaborates with outside agencies jj^3'
The African Association for Literacy and Adult Education0
(AALAE), The African Council on Communication Educ ■
(ACCE). The African Association for Training and DevC],llOn
ment (AATD) and The Institute of Child Health in Londo *r'
a Child-To-Child pprogramme in Sierra Leone.
or
A NEW FOCUS
It is pertinent to note that all our training and orientation work
shops on Community Theatre for Development since 1986 have
been unfocussed in the sense that workshop participants (WPs
and RPs) have operationalised the workshops with no predeter
mined focus e.g. health, nutrition and sanitation education.
They have worked in seven villages in the Southern province
and in the Western area and have produced dramas based
squarely on what they and the village participants (VPs)
together identified as “solvable” community problems after
participatory researches.
For the next three years, INSTADEX will focus its community
theatre programmes on sensitizing not only the general public
but also development workers and even policy makers all over
Sierra Leone about the preventive and promotional measures in
regard to the largely preventable yet debilitating,disabling and
lethal diseases. To mention some - diarrhoea, malaria, filariasis,
schistosomiasis, onchocerciasis and the six childhood killer
diseases in the UNICEF sponsored child survival and develop
CONCLUSION
'Our experience at INSTADEX is an eloquent testimoy to the
fact that the theatre using the people’s language, their idiom
and their performing arts can be a very efficacious medium and
an appropriate technology (AT) for generating community
involvcnt in the process of participatory grassroots develop
ment. It can provide, when used as a liberating and not as a
domesticating mode, a forum for collective problem identifica
tion, data collection and analysis and development-focussed
dramatizations, all geared towards the continuing search for a
better life for our people. But the theatrical and cultural activi
ties should form an integral part of the community’s life and
should mirror its aspirations and represent its total psyche.
The final objective of our Community Theatre activities should
be to create a people’s theatre aimed al using the people’s
culture to engender the process of change and development.
Our ultimate goal-thc control of the very medium of drama by
the people themselves who will take the initiatives to marry
their culture with their development - will have brought our
grassroots community education and development programmes
full circle.
INSTITUTE OF ADULT EDUCATION
AND EXTRA-MURAL STUDIES
Fourah Bay College
University of Sierra Leone
FREETOWN-SIERRA LEONE
ment programme.
47H.(Firstrio“1'-'.......~ '
BANGALORE - 660 001
COMMUNITY HEALTH CELL
47/1, (First FloorlSt. Marks Hoad
EANGAiO.IE - 560 001
CO/n h g.icj
NEWSLETTER Ns 9
POPULAR
AND
pUMARY HEALTH EDUCATION
CARE NETWORK
July 1988
COMMUNITY HEALTH CELL
47/1,(First Floor)St. Marks Road
BANGALORE-560 001
Coordinator of the Network:
Teresa Marshall
Diagonal Oriente 1604, Casilla 6257, Santiago 22
Fono: 2235822 Telex CEAAL 240230 BOOTH CL-CHILE
Gong H 64S
Irr.ft for tr io.! and comment
C! iAIf-S
A Simulation Game
Devised by
Janaki fair, Paul Siromoni and John Staley
SEARCH
256, Off Seventh Cross,
First block, Jayansgar,
Panga’ore -■ 560 Oil.
Introduction
CHAINS is designed to simulate some of the dynamics of
relationships in a ’free market' economy. It has been used with a
variety of groups in India to encourage some reflection upon
society and the economy. In particular, it can be used to raise
questions about the ownership of industry, the distribution of wealth,
economic structures and power, employment, individualism, and the
organisation of the poor and unemployed.
It is a relatively unstructured game, and is simple to
prepare and organise. However, it is important that the discussion
afterwards should be thorough if the participants' insights are to be
shared, if learning is to be maximised, and if feelings and
interactions are to be processed and dealt with.
Outline
The game is suitable for a group of 20-40 people. Apart
from the organiser, at least three other persons will be needed
to help administer the game. The remainder of the group will be
the players.
The players are given 'money' roughly according to the
distribution of wealth in the population at large. The players
arc- then briefed, and the potential for certain economic activities
or industries is described. Various capital assets, together with
the raw materials for the industries, are then sold, mainly by
auction. Only those players with more money will find themselves
able to bid or to set up industries. The remainder will have to seek
employment or otherwise remain idle spectators. Every player must
contribute some money at intervals to represent his basic
consumption of food, etc.
The briefing takes about 20 minutes. Play then proceeds
for an hour or more, depending upon the size and the response of the
group. It is followed by a discussion for which at least half an
hour is required.
■Materials
The following materials are required :-
a)
for manufacturing paper chains:
1-2 pairs of scissors (depending upon the size of the
group)
1-2 rulers (or measured sticks)
1-2 pots of paste (flour-and-water paste is suitable)
for making nets:
5 - 10 balls of rough cheap string
1-2 pairs of scissors
1-2 rulers
c) for blowing balloons:
5 - 10 packets of small balloons, each of 10 balloons.
(All the balloons must he the same size)
b)
d)
for assembling paper-clips:
5-10 Packets of paper-clips, each of 100 clips.
the clips must be the same size.)
(All
All the above materials will he sold to the players.
. ..2
: 2 :
e)
"Currency":
Chips, counters or other materials to represent money in
units of 1 TO (v-e have used gherkins called tonelikai);
units of 13 (we hove used ground-nuts); and units of 1
(we have used Pc-ngal Cram). The distribution of money
among the players is shov.-n in the following section. In
addition the Purchasing Corporation will require some
working capital for payments.
f)
Ground-nuts, small sweets or whatever for the ’conversion ’
of money at the end of the game. A ratio of 1 sweet to 10
units of money is suggested.
g)
A ruler for checking the links in the paper-chains; and a
cotton tape previously measured off for checking the
balloons. (See the following section). These are for the
use of the Purchasing Corporation.
h)
List of the names of all players, mounted on a clip-board.
This is for the Collector.
If refreshments arc being served curing the game, they should
also he incorporated as pert of the materials.
Preparation
Apart from the Organiser, three other persons will be
needed to take the parts of Purchasing Corporation, Collector
and Policeman. If it is a large group, the- Organiser may also
need an assistant to act as Auctioneer; an:’ the person acting
as Purchasing Corporation will also need an assistant Inspector
or buyer. All these people must be briefed before the game
starts. (See the following section).
The room where the game is to be played must be considered
beforehand. The first stage of the game is to auction off the
asset? of the room, sue!, as all doors with access to toilets/
drinking water/telephone or whatever. Similarly the furniture,
especially the chairs, will also be sold. There should be a
place to which the unsold furniture car. be removed. Some
imagination must be- used in examining the room beforehand to
see vhat will have value during the game and can be offered
for sale.
A door-frame, window-frame or blackboard must be chosen
to correspond to the size specified for finished paper-chains.
The dimensions of the door-frame should be greater than the
reach of e single person’s arms. (See following section).
Similarly a window-frame not less than 4 ft. X 3 ft. must be
chosen to correspond to the size specified for finished nets.
A couple of the balloons must be blown to near-bursting
point, and then the distance round their circumference must be
marker off on a length of cotton tape, balloon-blowing is meant
to be a risky business, and some of the balloons should burst.
So an extra centimeter or two can be added on the tape to the
distance measured around their circumference. The tape should
be given to the Purchasing Corporation for use when inspecting
and purchasing balloons.
A table should be arranged for the Purchasing Corporation
near the door-frame mentioned above. It is convenient for the
Purchasing Corporation if players can approach the table from
one side only, and if there is some storage space behind the
table, the raw materials and the finished products can be kept
in this space.
....3.
: 3 :
The- money must be counted beforehand and wrapped in
covers or twists of paper. The distribution of money is as
follows:
20 - 30 players
1003 units
1 player
100 units
3 players
10 units
the remaining
players
r»
♦»
2 players
6 players
33 - 50 players
(The ratio 'in reality* is 1:6:50, but for the sake of the
game's dynamics, the above ratios are- recommended. )
Friefing the Assistants
The person taking the part of Purchasing Corporation has
the following tasks :a ) to collect the payments from those players who purchase
chairs or other assets in the room:
c ) to collect the amounts paid in the sales or bid in the
auctions, and to hand over the raw materials and equipment
purchased;
c ) to receive and inspect all finished products and purchase
them for the amount specified if the products are up to
standard.
The previously measured tape will be required for checking
the balloons. Any paper-chain which is brought for inspection
must be held up against all the four corners of the door-frame
by the manufacturer and his partners/employees. (This is
intended to be a task that cannot be performed by one person
alone - hence the importance of the frame's dimensions).
SimilarIv any net which is brought for inspection must be
stretched across the window-frame by the manufacturer and his
pa rt ne r s/emnloyee s.
The *
-purchas
g
Corporation should be very strict in
aprlying standards arc’ specified sizes for finished products.
(Fee the following section), and should not hesitate to reject
sub-standard products.
The Collector should circulate among the players every
10 or 15 minutes, and collect 5 units from each one. He
shook. have the list of the players anc record his collections.
Any player who cannot pay must bo told to crouch, squat or
sit. (See the following section). Hr should also inform the
organiser and the Policeman if anyone is reduced to this
situation.
The Policemen is asked to circulate among the players,
to enforce the- rules, to maintain law and order, and settle
disputes, both the Collector and the Policeman should be
ready to help in the removal of unpurchased chairs at the
beginning of the game.
briefing the Flayers
The introduction' should include the persons chosen to
assist in the game as Purchasing Corporation, Collector,
Policeman etc. This will help to establish them in their
particular roles. After the introduction of people, it may
be useful to say a few words about simulations in general.
: 4 :
This particular game can be described as an attempt to focus
on some aspects of the industrial economy. Participants can
also be told that the game itself -. ill take an hour or so to
play, and that there will be a discussion for half-an-hour
afterwards. If the group has not had much experience with
the games, it may be useful to stress the importance of the
discussion.
Coming next to the game itself, players should be told
that they will be given something to represent money, but
they need not be told that they will be given different amounts
of money. The money can be handed out according to the table
above; and the values of the 'currency' explained, and written
on a blackboard. The players should be told that at the end
of the game their money - or, better still, the profits they
have made - will he exchanged for some commodity of significant
(and edible) worth.
The briefing then continues with the following points:
the objectives of all players in the game is to earn money,
to survive, and to become rich. There will te various eco
nomic activities through which people can earn money,and
these will be explained shortly.
Ever-/ 15 minutes, every player in the game must contri
bute 5 units to represent the food he is eating and his basic
consumption. The Collector will be circulating among the
players and must he given the five units.
Any player who does not have enough to pay these units
must, from then on, keep one hand within reach of the floor
i.e., he must kneel, crouch or sit. He can crawl or creep
about, but he must no longer stand upright. He must continue
like this until he has paid the units. Any player who fails
to pay the five- units for a second time must thc-n sit against
the wall without moving or must lie down on the floor. Such
unfortunates are then virtually out of the game unless someone
else ‘feeds' them by paying off their dues.
There are three ways in which players can earn more
money. One is through the- ownership of assets. The assets
of the room in which the game is being played •« the doors,
the chairs etc., will be solf off after this briefing. Some
will be auctioned; and some will he sold at a flat rate.
People who buy them can then rent them out, or can charge a
toll for their use. Take the door for example: if anyone
wants to go out to the toilet for a drink of water, they will
have to pass through the door. The owner of the door can
then levy a toll on them.
The second way of earning money is to set up an indus
try. There will be four industries tn the game, which will
be described in a moment. The raw materials, and the equipment
needed for these industries will also be sanctioned. All the
finisher products can then be sold to the Purchasing Corporation.
Please note that the- Purchasing Corporation has set strict
standards and will not purchase anything which is not made
according to the standard.
The third way of earning money is to sell your labour
to anyone- who will give you work.
The first industry is the manufacture of paper-chains.
newspaper must be cut into strips, 1 inch wide and 6 inches
long, and pasted into chains. The final length of the chain
is to be the- outer dimensions of ....(Here indicate the door
frame? or whatever which was chosen before- the game began. )
The chains must be held up around all sides of the .... at
the time of sale for the inspection of the Purchasing
Corporation.
5
completed paper-chain with links as specified will be
purchased by the Corporation for 1073 units.
A
The second inrustry is the making of nets. String
must, be cut into lengths of exactly six inches. These must
then be knotted into equilateral triangles, and extended
into a net of such triangles. The finished net must be
large enough to cover
(Here indicate the window-frame
previously chosen). It must J e held up against the frame
at the time of sale for the inspection of the Purchasing
Cor~oration. A completed net with triangles as specified
v;ill be purchased for 750 units.
The third industry is blowing balloons. Unused balloons
will be auctioned in packets of ten. They must be blows to
their maximum size, and tied up before- they are taken to the
Purchasing Corporation. There they will be measured. If
they are accepted, the Corporation will pay 50 units for
every balloon.
The fourth industry is the assembling of paper-clips.
The clip- must be assembled in chains of 57, each clip
pointing in alternate directions, head to head, tail to tail.
Clips will be sold at a fixed rate of 75 units for a packet
of l~v') clips. For every completed chain, the purchasing
Corporation will pay 100 units.
Starting the Game
’•hen the briefing is finished, the sale of assets can
begin. The players should be invited' to buy their chairs
at a rate of 20 units. They should be told that they will
have to stand otherwise.
hen those who want to buy chairs
have said so and paid the- Purchasing Corporation, all the
other chairs should le removed by the Collector and Policeman.
Then the other assets of the room should be sold or auctioned.
’.hen that is done-, the raw mate-rials- and equipment for
the industries can be auctioned, one after another. The
auctioneer should accept bids only in ten units, arid should
make the auction as fast as possible. After one set of the
materials and equipment for each industry has been auctioned
and sold, it may be advisable to have a break for 15 minutes
before another round of sales.
If tea or coffee is being served during the period of
the game, this can also be- treated as a resource. Cups can
be offered for sale to the individuals at some- price which
prevents the poorest from 1 uying them. Or the v/hole supply
can be auctioned toythe hiqhest bidder, who may then retail
it to other players at a profit.
After play has been proceeded for some time, and after
one or ■two more auctions have been held, the organiser can
informally review the progress of the game with his colleagues.
Each of them should also he observing the players, are’ be
taking note of who is engaged in activity, and of what kind,
and who is standing idle. Sometimes all the initiatives
arc taken by the wealthy who may (or may not) employ the
poor as labourers or as caretakers of Their property. Some
times the poor will form some sort of association, and will
pool their resources and provide themselves with work. Such
trends should le observed for feed-back reflection later.
The game can be ended after an hour or so at the- dis
cretion of the Organiser and his colleagues. This may be
after one or two of the large paper-chains and string nets
have teen completed. The '-layers should he given warning
ten minutes before the end,
6
: 6 :
riscussion
Even at the discussion, only those who purchased chairs
should be allowed to sit on them.
People are first asked to Calculate the amount of money
with them at the end of the game and thus, together with the
amounts they started with, can be written on the blackboard.
Then the rewards can be presented to the- players, either on
the basis of money they have at the end of the game, or on
the basis of the profits they have accumulated.
People can then be asked to comment upon their experiences
and feclings/it different stages in the game, for example,
during the sale of assets, during the bidding >f raw materials,
at any time when they were without money and had to contribute
for their food, when they were seeking work, when they were
given work, when they could not have tea, and so on.
K>
Any group, partnership, or association should be asked
to comment on their experience. In particular, they should
ask how their association came to be formed, and on what
basis.
Those who set up industries are invited to describe their
experience, and to reflect upon the basis of which they
recruited people to work with them.
hat share of the profits
was paid out for wages? V.hat share did they retain for them
selves? ’.hat did their workers experience?
Finally the discussion may turn to reflection upon the
relationship between some of the processes wrbin the game,
and those in the economy at large
V.hat arc- the choices before
the poor, given the present distribution of wealth?
How can
the poor obtain a larger share of the total production? V.hom
does the industry benefit?
clom n G.i'h
1.
Relevant Health Education
Education by Appropriate Analogy(Chapter V)
2.
Doctrine of Multiple causality
3.
Notions of Etiology
(Appendix D)
(Appendix. D)
From
A
METHODOLOGY GUID=FOR THE COMMUNITY
DIAGNOSIS OF HEALTH
Project
Community Diagnosis 1978-79
Mark Nicter, K.H. Bhat, Srinivas Devadiga and
Mini Nichter
Office of Population and Health
USAID
New
Delhi
V.
Relevant Health Education;
Education by Appropriate _Ana 1 qgy
One cannot expect positive results from an educa
tion or political action program which fails to respect
the particular view of the world held by the people...
it is not our role to speak to the people about our
view of the world, nor to attempt to impose that view
on them, but rather to dialogue with the people about
their view and ours. We must realize that their
view of the world manifested variously in their action
reflects their situation in the world. Educational
and political action which is not critically aware of
this situation runs the risk either of the banking or
preaching in the desert.
Pedagogy of the Oppressed,
Paolo Friere
In the above quote by Paolo Friere, reference is made to the
banking mode of education, a mode of education prevalent through
out the developing world. What is implied by the term banking
is that information is deposited into a villager's mind verbatim,
as if the mind were empty. This mode of education presupposes
that once information is deposited it will incur interest over
time.
The poverty of this type of education is seen in village
India today in thedividend it is yielding in the form of inertia
and the compartmentalization of new ideas.
What is required is a form of education which engenders
synthesis and fosters the organization of new and existing infor
mation as opposed to the compartmentalization of information into
seperate spheres of reality . The process of education which is
advocated evolves out of dialogue and the posing of appropriate
questions which reveal and challenge assumptions. Such education
necessitates preliminary investigation of the cognitive universe,
the phenomenological context in which the villager lives.
One of the purposes of a community diagnosis of health
study is the identification of indigenous concepts which may be
used in the framing of relevant educational strategies. These
strategies, rather than being based on ideas outside the villagers
comprehension, are based on what is already known or questioned.
In this sense, the mode of education recommended is an extension
of classical modes of education which communicated knowledge con
ceptually through analogies and metaphors poetically orchestrated
around immediate experience.
The reasoning behind this mode of education can be
illustrated with reference to everyday speech. Theeeveryday
speech of villagers is composed of numerous analogies, metaphors,
and proverbs. To understand such speech one has to comprehend
more than simply the words spoken. What is necessary is an
understanding of the relationship between what is spoken about
and what is being referred to. Commonly, an idea which is
easily understood on one plane is used to describe an idea or
istuation on another plane. By explaining something in this manner,
one is able to convey knowledge within one's cognitive framework,
permitting a minimum number of words to be used to convey a
maximum amount of understanding; understanding facilitated by
reference to what is already known thus making memory easy.
During the project, core staff experimented with analogical
reasoning as means of explaining new health ideas. First, attention
was focused on domains of knowledge and experience with which
the villager was familiar andwhich were commonly exploited in
local proverbs, analogies, etc. Then, such domains of knowledge
were considered in relation to priority issues in health education.
It is the opinion of the research team that it is possible to
explain any common biomedical concept via a vis indigenous concepts
by maximising analogical reasoning. The examples given below may
illustrate the strategy used.
2.
V.
Relevant Health Education:
Education by Appropriate.Analogy
One cannot expect positive results from an educa
tion or political action program which fails to respect
the particular view of the world held by the people..,
it is not our role to speak to the people about our
view of the world, nor to attempt to impose that view
on them, but rather to dialogue
with
*
the people about
their view and ours. We must realize that their
view of the world manifested variously in their action
reflects their situation in the world. Educational
and political action which is not critically aware of
this situation runs the risk either of the banking or
preaching in the desert.
Pedagogy of the .Oppressed,
Paolo Friere
In the above quote by Paolo Friere, reference is made to the
banking mode of education, a mode of education prevalent through
out the developing world. What is implied by the term banking
is that information is deposited into a villager's mind verbatim,
as if the mind were empty. This mode of education presupposes
that once information is deposited it will incur interest over
time.
The poverty of this type of education is seen in village
India today in thedividend it is yielding in the form of inertia
and the compartmentalization of new ideas.
What is required is a form of education which engenders
synthesis and fosters the organization of new and existing infor
mation as opposed to the compartmentalization of information into
separate spheres of reality . The process of education which is
advocated evolves out of dialogue and the posing of appropriate
questions which reveal and challenge assumptions. Such education
necessitates preliminary investigation of the cognitive universe,
the phenomenological context in which the villager lives.
One of the purposes of a community diagnosis of health
study is the identification of indigenous concepts which may be
used in the framing of relevant educational strategies. These
strategies, rather than being based on ideas outside the villagers
comprehension, are based on what is already known or questioned.
Tn this sense, the mode of education recommended is an extension
of classical modes of education which communicated knowledge con
ceptually through analogies and metaphors poetically orchestrated
around immediate experience.
The reasoning behind this mode of education can be
illustrated with reference to everyday speech. Theeeveryday
speech of villagers is composed of numerous analogies, metaphors,
and proverbs. To understand such speech one has to comprehend
more than simply the words spoken. What is necessary is an
understanding of the relationship between what is spoken about
and what is being referred to. Commonly, an idea which is
easily understood on one plane is used to describe an idea or
istuation on another plane. By explaining something in this manner,
one is able to convey knowledge within one's cognitive framework,
permitting a minimum number of words to be used to convey a
maximum amount of understanding; understanding facilitated by
reference to what is already known thus making memory easy.
During the project, core staff experimented with analogical
reasoning as means of explaining new health ideas. First, attention
was focused on domains of knowledge and experience with which
the villager was familiar andwhich were commonly exploited in
local proverbs, analogies, etc. Then, such domains of knowledge
were considered in relation to priority issues in health education.
It is the opinion of the research team that it is possible to
explain any common biomedical concept vis a vis indigenous concepts
by maximising analogical reasoning. The examples given below may
illustrate the strategy used.
2.
-2-
1.
FIELD; BODY
1.1 Nutrition:
For your rice crop, you need cow manure, green leaf, and
ash, If you have less manure, your crop will have no heigh, if less
gree leaf is put, the crop will be less, if less ash is put the
husks will appear but inside there will not be grains. The body
is like that. Fish and grain are like manure, green leaf like
vegetables, minerals (iron, calcium) like ash. If you want a good
crop, you must make correct balance.
1.2 Family Planning - spacing
If you plant too many paddy seedlings very close to each
other, what will happen? Do they not interfere with each others
growth, do you not get a poor crop? Having children close together
is like that - should a mother give breast milk to one child
while pregnant with another? (Culturally women(South India) think
they should not continue breast feeding, but do because of a lack
of availibility of milk, funds to purchase milk or benevolence
particularly towards a male child.)
2.
WOMAN'S CYCLE: SEASONAL, MOON CYCLE
2.1 Relative fertility in woman's monthly cycle:
benefit?
cycle.
If a crop is planted in the wrong season is there any
A woman's cycle is like a seasonal cycle, like the moon
Menses is like amavase/amavas/ (no moon, an inauspicious
time of overheat when no new work is begun)— as the moon becomes
more full toward hunime (full moon- auspicious time which is cool
and linked to fertility) the benefit (labha) of acts begun is m
more. Hunime in a woman is the period 10-15 days after her
menses. if child is desired the seed should be planted in that
season. If a child is not wanted the seed should be thrown
at another time.
3.
GQOKING: DIGESTION
3.1 Dehydration
If you are cooking some food and there is not enough
water in the pot, what happens? The food becomes dry and burns,
the pot burns as well and if not removed from the fire it may
become spoiled. Digestion is like cooking. If water is less in
the body, the body becomes dry and begins to burn, fever comes as
well as weakness. If water is not put in the stomach pot, the
heat spoils the blood and a lack of water may cause a person to die
3.2 Dehyderation and Diarrhoea
Diarrhoea is like a hole in the stomach pot—water keeps
coming out and if more is not placed in the pot, the blood burns.
Wather must be placed in the pot until the hold can be repaired.
Repair requires medicine but even more immediately important
than repairing the hold is not spoilling what is in the pot L;
for that is life blood.
3.3 Dehyderation and Fever
Fever Is like a pot boiling without a cover. The
liquid evaporates and the food (blood) in the pot burns. To
reduce this problem, medicine may be given which acts as a cover
for the pot(aspirin) but sometimes the problem is that the fire
under the pot is too hot. In such cases, medicine must be given
to reduce the fire/fuel (food)
and the body must be kept cool.
But most important in any kind of fever is that the water in the
body be enough to prevent the blood in the stomach pot from
burning.
....3.
-3-
3.4 Fontanel sinking in baby
When boiling rice, if the water becomes less what happens?
Doesn't the rice in the center of the pot sink down? And then if
water is added doesn't the depression come back to normal level?
So it is with a baby, if the liquid in the body is less the fontanel/
netti depresses. When enough liquid is given the depressed area
comes to the normal level.
3.5 Preparing Electrolyte solution
In the cooking pot, water is needed. For the stomach pot,
when water is urgently needed, boiled water which contains sweet,
salt, and sour is best. Salt is needed for the blood, Kara
(piquant) should be reduced as this increases heat. To help
digestion some sweet and sour are needed. Therfore, for every glass
of water, a pinch of salt, a small amoutn of sour (lemon, local
fruits) and sweet (2 sppons of jaggery, sugar, honey), are needed.
Digestion is the center and the most important process in indi
genous ideology: connected to most illnesses)
4.
House: Body
Insects: Germs
4.1 Many types of insects may enter a house. If one is
inexperience and has much work these insects may be idisEegarded
expecially if the person thinks they are harmless. Then one day
the person may feel some irritation, like the trouble given by
bedbugs, and wonder what is the causes. By that time, many
insects may be in the house and it will be difficult to get rid
of them without disrupting the activities of the house. At
other times, a person may not know what causes such insects to
come in great numbers like oil being left on the floor attracting
cockroaches. It is the duty of family andfriends to help inexperi
enced people learn such things, just as it is the duty of adults
to instruct children which plants are foods and medicine and which
are poisons.
,
The body is like a house, Krimi enter because the doors
are left open(weakness), because something attracts them, or
because the body permits them to enter thinking they are harmless
guests or beggars. In the case of insects entering a house,
knowledge comes after seeing and experiencing them. In the case
of illness entering the body, however, Krimi (use a similar local
term) which cause illness are not visible. It is not enought to
tell a man that "some Krimi" cause illness," so he should not
allow them in his body. The body, however, can be taught a
lesson. This the purpose of a vaccination. A vaccination con
tains harmful Krimi made weak by poison. When these Krimi enter
the body, they make trouble—-but only a little trouble, not like
the trouble which many would cause if they came to the body in
number. They body learns how to both recognize these trouble
some Krimi and kill them. Side effects, such as fever and chilis
are not bad; they are good signs that the body is learning to ree
congnize and fight Krimi through experience. Yes, the side
effects, xxxh xx cause troubld but just as in children, sometimes
an important lesson must hurt just a little. In the future,
if these Krimi come they can be killed more easily and if a
body has learned to recognize them by experience, it will not let
them enter in number or willsweep them clear, the way a woman
sweeps a house clear when she sees ants coming in number. Like
sweeping, this requires a short gap in normal activity, in this
cas it may cause small problems like a one day fever or diarrhoea.
But better this thana big illness later, A vaccination then
is a way of the body gaining Krimi anubhawa (experience)—the
more anubhava for such Krimi diseases one has, the less chance of
getting an illness. That is why children with less body experience
get
-4-
get a Krimi diseases more, and why once a child gets Krimi
disease like chickenpox or whooping cough, his chances of getting
these diseases again is less than other children. Only some
krimi can be swept out of the body house, however, others are
so common that the body can not prevent them from entering
the house as this would be a full time job and man has other
works. In such cases, man must learn what attracts such Krimi,
what these Krimi do not like (e.g. smoke for mosquitoes), andhow
to keep this doors closed (good hygienic diet).
1. Krimi is one term used by villagers to describe invisible
worms.
*The diseases which should be used here ace those which
etiology surveys have indicated are associated with external
worm/germ type agents. Ayurvedic pandits tell us, for examples,
that undigested food or impure blood attracts certain Krimi. It
is necessary to make these conditions less and to teach the body
who are its friends and who are its enemies.
5.1
Harvest: Deliver
Fertilizer: Feeding of Woman during Pregnancy
Near the time of the harvest, if the crop looks weak 1, is
that the time to think of adding manure to the field 2 So it
is with pregnancy. A diffic It delivery is often caused by
weakness and lack of blood in the mother as well as the baby,
At the time of delivery, it is not passible to increase blood.
(unlessbbood is given by transfusion- -for villagers who are
aware of what a transfusion is). For this reason, it is necessary
for a pregnant mother to eat blood/strength producing foods.
Dhatu (a local term which refers to accumulated strength and is
associated with diet)
requires time to be produced and for
this reason blood/strength producing foods must be consumed
throughtout pregnancy.
1
Weakness is emphasized here, not crop size. It is commonpl
place throughout India for women to link large babies with
difficult delivery (as well as problems during pregnancy).
Rather than confront this strong attitude directly, it is better
to use a culturally appropriate health education strategy and
emphasize 'more blood and more strength.'
Big is best is an
ethnocentric approach and in any case, the size of a baby is
not directly correlated with strength as villagers speak of
babies whomlook big but are only full of water, indicating
an undersirable state.
2
A local proverb expresses a similar idea: "when a man isthirsty, is that the time to start digging a well?"
The Doctrine of Multiple Causality
Relatively few illnesses in rural South India are associated
with only one possible etiological factor. Most illnesses are
thought capable of being caused by any one of several factors acting
alone or in concert with others. Moreover, once ill, a villager is
considered vulnerable to additional etiological factors which may
prolong or compound illness making it more complex to manage or cure
This is one reason why patients sometimes consult different types
of practitioners simultaneously so as to remove/ manage multiple
etiologicalfactors or reduce their after effects. Another factor
which complicates illness classification and lay medical decision
making is the fact that similar symptiom sets may be interpreted
differently (as types of one illness or different illnesses ) due
to the onset or progression of symptoms as well as suspected
etiological factors, for this reason, data presented on the etio
logy of illnesses in this report, although based on considerable
survey and case observation research should be considered data on
dominant notions of etiology not fixed ideas.
The latter point is important when planning appropriate
health education strategies. It is stressed that ideas about etio
logy are flexible. We found that new ideas can readily be introduced
Xlixx in the context of dialogue when explained in terms of existing
etiological concepts or perceived states of the body (based on indi
genous notions of physiology) associated with the illness in question
As can be seen by the list of etiological factors which follows
indigenous concepts can be found for most biomedical concepts.
Scope exists to define particular illness episodes in terms of alter
native etiological notions (if a prevalent idea is counter-productive
to health behaviou) as long as the factor attributed is not anti
thetical (in qualitative affect)to the type of symptoms manifested.
For examples, most itchy skin rashes among children are ambigiously labelled Kajji: 1 a condition strongly associated with
over heat in the body and treated by a restricted dies (less Ushna
no nanjufoods) and the application of cooling leaves. A differen
tiation of Kaj ji into different types caused by a) worms of external
origin eating the skin (scabies, impetigo) and b) overheat (kwashi
orkor related skingjesopms /artimlarly on the limbs, phrynoderma,
vitamin A deficiency) was conveyed to villagers without much diffi
culty. This overt differentiation was invluable to us in communi
cating health education information. We were better able to explain .
why
1
2
This term is used in both South and North Kanara Districts.
See notes on etiology which follow and a forthcoming report on
dietary restrictions during illness.
Scabies treatment required the placing of a poisonous medicinal
lotion on the skin for 48 hours and the necessity for boiling one's
clothing (to kill minuscule worms and to get rid of worm eggs;
worm eggs being a concept known to villagers from their experience
with picking lice). It also helped us to convey dietary advice in
cases of malnutrition. As opposed to discounting local ideology,
we planned a nutrition strategy to confront existing ideology, we
about ka~j ji caused by states of malnutrition. When a state of mal
nutrition. SfkEx at xkxfcx
manifested in skin lesions with pruritus,
cooling fOO(js were suggested, such as green gram and ragi, seasine oil
(essential fatty a cids), and vine spinach (vegetable) protein and
vitamin A ) which were culturally acceptable. Accepting that one
form of Kaj ji was caused by overheat (and designing a nutrition strategy
accordingly) while differentiating Kaj ji into different types increased
the compliance rate of those under taking scabies therapy in our makesshift first aid station and more importatnly, the credibility of our
education message.
-2Another point to be appreciated is that what appears to be a
symptoms of illness may be interpreted as a sign of some broader
problem (dosha, upadra) effecting the one who is afflicted or his
family unit 2. Alternative notions of the possible etiology which
are dwelled upon may be related to attempts at linking causality
to particular social domains (social relationships ) where vulnera_
bility or instability exists; or they may be attempts to projected
resbosibility away from normal interaction spheres (onto wandering
spirits, inauspicious celestial effects, etc. ) as a means of reduc
ing guilt, etc.3 In other words, suspected etiological factors may
be functional expressions of anxiety connected to competition,
jealous^ or guilt, (in respect to fulfilling obligations, role ex
pectations, or one’s duty}
To sum up;
1,
Rather than underminging health education efforts, the doctrine
of multiple causality accomodates new ideas and facilitates inno
vative health education.
1
Sesame oil is considered cooling in South Kanara but heating in
parts of Tamil Nad. This is an example of why region-specific plan
ning based on a knowledge of indigenous ideology is import®
2 This is especially the case if the one afflicted is the weakest
or most vulnerable family member, i.e. a young child or pregnant
woman.
3
For example, evil eye as well as toxic breastmilk may be asso
ciated with a case of infant diarrhoea. Obviously notions of evil
eye focus.
2. Indigenous concepts of etiology complement biomedical concepts
of etiology (if not logically than analogically).
3. Nev/ ideas introduced appropriately in terms of concepts which
the xxxxEnxi. Rgd&eai hsafceK? villager can relates to, facilitate
both understanding and greater scope for their application of
these ideas.
4. An entrance into the villager's conceptual universe, as well
as personal medical history, can be gained by discussing both the
classification of symptoms as partic lar illness categories and
the suspected causes of an illness experience.
3
(cont.) attention away from the mother and feelings of guilt.
Notes on common notions of etiology and
associated symptoms in South Kanara District, Karnataka
t.
Less food/ Kadime tinas/
Specifically, this refers to eating an insufficient quantity
of the staple food one is accustomed to eating (in this case,
rice). It is important to keep in mind that the villagers' sense
of body cycle normality derives from the maintenance of a routine
digestive cycle and body signs associated with this staple specific
cycle 'faces consistency and regularity, urine color, timings
of hunger, etc.)
2.
Improper dies: /apathya/
a.
taking meals erratically (among castes maintaining
routine commensality patterns)
b.
eating foods having properties counter-indicated in par
ticular seasons, and taxing iii to particular age-groups.
3.
-3-
in transition periods, and during illness episodes.
commonly, in children, giving chillies and hot curries
before the age of 2.
commonly, in adults, eating excessively spicy foods /kara/
c.
d.
3.
Bad blood
/netter hal/
a.
bad blood is thought to be caused by overheat /ushna,
aaram/toxidity /nanju/, loss of slepp. inappropriate eating
habits, exposure to extreme weather conditions, hard work,
oast illnesses and powerful medicines '‘consumed presently
or in the past).
b.
Sluggishness and weakness are associated with bad blood
interfering with the flow of substance in the body. This
is sometimes associated with vata as well (see below).
c. Bed blood in the head and stomach is thought to be pushed
out by vomitting while bad blood in the intestines and
legs causes sores /pudi/
d.
Wounds which become infected are associated with bad
blood(an internal factor) more often than lack of external
cleanliness
e.
During amenorrhoea and pregnancy (a condition described
as nanjiin character) impure blood which is normally
Research in other regions of Karnataka and a knowledge of
ethnomedical literature in India, suggests that most of these
factors have widespread relevance to rural areas.
expelled frpip the body is thought to be retained and
mixed with good blood (causing bad blood.)
f.
4.
Some illnesses are ascribed to bad blood being passed on
from mother to fetus or breastfeeding child.
Climatic changes /have mana/
Bluctuations in temperature are thought to throw the body off
balance. For villagers, the healthiest time of the year is
when the temperature is most constant. Climate changes are
suspect especially at times of seasonal change. These times
are associated with bad winds and the movement of spirits
(discribed as qali or sonku)
5.
Heat in the body
a.
/ushna,qaram /
A certain arnoutit of controlled heat is required for the
maintenance of bodily processes especially the digestive
process. Controlled heat is associated with strength
(trana, shakti) while an exees of heat may cause and be
associated with the following symptoms.
1.
burning sensation in stomach.
2.
burning sensation in eyes.,feet, and hand (anaemia,
calcium deficiency)
3.
4.
burning sensation during urination
Indigestion
5.
6.
diarrhoea/ constipation/(especially dry stools)
blood in feces
7.
8.
redness of the skin/ rashes/ boils
dry cough
9.
body pain, particularly back ache
10.
cracking of soles and palms
-4-
11.
12»
balding/hairlessness
dissolving of bones: bones becoming brittle
13.
dhatu loss, mental upset and confusion
b.
A state of overheat (ushna) can be passed on from mother to
child, through the breastmilk causing the baby to experience
indigestion, diarrhoes, boils, or fever.
c.
Overheat is the after (end) effect of many other etiological
factors (e.g. food climate, evil eye, encounters with a spirit,
mental worry). Therefore it is important to ascertain if the
term is being used as a general statement or in conjunction with
notions revealed by further inquiry. The most common general
references to overheat is to refer to the easting foods, the feel
ing of hunger, or sleeplessness.
Excessive Coolness (tamou, tandi)
6.
In terms of prevalent health (and for that matter, ritual)
ideology, cool /tampu/ is needed to controlheat in the body.
Generally, in reference to health, tampu is associated with
with weight gain and slower digestion. Too much tampu is
thought to manifest the the following symptoms:
1. excess phlegm
2. cold, runny nose, sore throat
3. wet cough
a.
4.
indigestion and constipation (fewer bowel movements as
opposed to dry feces)
5.
complaints that the blood has become thick and doesn't flow
properly causing fatigue.
headache.
6.
b. Excess cool is thought to be transferred through breatmilk
causing baby to experience indigestion, cold and accumulation
of hlegm.
7.
Toxic substances /nan j1/
a.
Kan j1 can result from:
1.
the retention of bad blood not emitted by routine body cycles
(amenorrhoea and pregnancy seen as the disruption of the
menstrugl cycle).
2.
substances consumed by the body which it cannot digest such
as the unctuous juice of brinjal or drurnstick (foods classi
fied as nanju.
3.
the consumption of too many sweet foods, oils, or impure
foods.
4.
child receiving impure breastmilk from its mother.
b. Nanji is associated with infection, pus, boils and itchiness.
Nanji in the blood is thought to prolong the cure of most ill
nesses: particularly wounds, skin diseases and intestinal complaints.
for this reqon, foods classified as nanju are not eaten during
illness episodes.
c. Nanji (toxic) should not be confused with visha (poison). It ia
generally believed that nanju foods are the best tasting foods
tasting foods and their consumptions is common.
8.
An excess of one of the three body humors (tridosha):
a. The principle of body humoreis the basis of ayurveda, the classical
-5-
system of Indian medicine. It may first be emphasised that few
villagers (as well ad few vaidya , fural herbal practitioners.)
know much about the principles of ayurveda. However, ayurvedic
terminology and the use of ayurvedic regimens are very much part
of folk medical cultures in India. While tridos'na, as a principles
of body physiology, is not known, the effects of humoral aggra
vation (the symptoms manifesting) are known andhumoral terminology is
used in colloqial languages to describe the
course
*
1of such symptoms
Most commonly these 'causes’ are associated with the eating of foods
clssifed locally as having a quality (quna) which produces these symp
toms when consumed in excess or at inappropriate times. 1 As might
be imagined, interaction between laymen and learned ayurvedic
practitioners 2 has caused a number of ayurvedic terms to to flow
into the local vernacular where they are given local meanings.
and usuage.
b.
Symptoms associated with tridosha terminology:
1.
2.
Pitta
a. nausea
b.
tasting of bitterness in mouth
c.
d.
dizziness
loss of mental equilibrium, mental upset, taking
nonsense
e.
yellow urine
f.
g.
heartburn
yellowing of body / jaundice
h.
associated with overheat in the body
Kapha
a. aphlegm laden cough. It may be noted that young children
are thought to have a propensity toward kapha disorders
and have more kapha in the body. For this reason, res
piratory illnesses are often not treated in the early
stages. This does not mean, however, that mothers do
not try and check the excess of kapha, for a number of
curative and preventive home remedies are utilized.
b. mucus exuding from the nose, eyes, mouth, or anus
(foamy stools)
c. foaming at the mouth particularly after febrile fits
among infants is linked to an excess of kapha as well
as spirit attack.
1.
The classification of foods with reference to the tridosha is
more complex than this (one should consider the ayurvedic
concepts of triqruna , Viriya, and vinaka but for our purposes
this passing reference is sufficient).
2.
I will refer to these practitioners as pandits to differentiate
them from vaidya practitioners who dispenses herbal medicine but
do not follow a system of diagnosis and therapy.
3.
Vata:
vata is the wind (movement, motor function) principle in the
body. An excess of vata is thought to cause body pain and when
vata is blocked it is thought to cause stiffness in joints.
Vata conditions are sometimes linked to less blood. Vata is
associated with the effect of sanni planet (Saturn) and excretions
from the body which are blackish in color.
6
-6-
Vayu:
4.
Vayu is associated with wind in the form of gaseousness within
the body causing:
a.
b.
c.
d.
indigestion, flatulence
feeling of fullness and being stuffed up
feeling of breathlessness
fatigue, laziness
CONTAGICN FACTORS / antu, paqarana /
9.
gali
a. This term literally means wind. It is used to describe a
spirit wind (sometimes called sonku), a malevolent wind
carrying illness from one village to another, and the wind
ensuing from an ill for menstruating person when he/she
passes.
b.
if may be noted that some illnesses associated with gali
such as chickenpox or measles are thought to manifest
from the stomach first not the external surface of the
body. Pox fall / burundu/ on the body surface from the
interior.
c. Gali is thought to cause sudden dramatic symptoms usually
associated with overheat or cause impurity to theblood
resulting in boils, pox coming to surface of the skin
etc. Specific reference to sonku is more in Ati month
and is associated with sudden fever or pain.
10.
breath / svasa / of a person who is ill.
11.
crossing / kadapu/
An idea exists that crossing (steppin over, passing through
a transition point) associates one with the malevolent quali
ties of the material / force crossed. Common agents cited
are body excrements of the ill (faces, urine, saliva, scabs),
shadows or blood of menstruating women, food fouched by the
ill etc.
12.
Contact with impurity /mailqe, basta, made/
a.
direct contact with impurities such as saliva /dalle/ or
tlje consumption of impure substances is commonly associated
with ifection and the appearance of boils.
b.
contact with the pus of one who has a skin disease or
diseases in which lesions manifest.
contact with the breath of a diseased person in life and
the spirit of a diseased person after death /khale/.
c.
dd
13.
touching the body of a diseased person or his personal
effects (clothes, blankets, etc.)
Minuscule worms, germs / krimi, puri / keidi /
Many illnesses are attributed to be caused by worms of internal
of external origin. Folk notions of physiology give functional
role of worms / five da puri/ in the digestive process. Some
illnesses are spoken of as caused by having more or less of these
worms, more active or sleeping worms which for example may cause
loss of appetite or improper motion. These worms are particularly
suspect when a small child has a loss of appetite, is listless,
vomits, is irritable, has diarrhoea, grinds his teeth, or has a bulg
ing stomach, many other diseases, particularly fungal diseases and
infected wounds are also attributed to worms. The notions of
-7minuscule (invisible) external worms /Kriroi pudi/ which enter a
body causing illness are similar to biomedical concepts of germ,
virus, and are a part of the folk health culture.1 It may be noted
however, that the etiological factors are associated with precipitat
ing reasons for these external agents being attrated to particular
persons or being able to enter domains (body) domain, house domain,
village domain) normally protected (closed to intrusion, disruption)
ritually or by substances enhancing one's positive health. This
reasoning often focuses attention on states of vulnerability (due to
climatic changes, lack of spirit protection, transition in one's
life, states of impurity etc. ) Here we find the basis for a strong
indigenous concept of preventive and promotive (positive) health.
14.
Hereditary factors:
This is a complex concept which may refer to:
1.
a.
illness being passed on through the bloodline of a
lineage (matrilineal, patrilineal reference)
b.
an illness which comes as a course or recompense to an
individual or family due to non-fulfillment of obligations,
sin, papa, karma etc.
c.
an illness which another family member experienced in the
past associated with either spirit attact by the deceased
or a sign from the deceased of its presence.
The concept of external etiological factors (minuscule wormsKrimi, insects - Kita is found within ayurvedic dogma.
15. Spirits:
Each type of spirits is associated with a social domain or
state pf w3j;dmess wildness/uncontrol. Suspicion of a particular
type of spirit focuses attention on imbalance or vulnerability
in that domain. References to vague stars / spirits of the wild
(of the forest, transition points, etc.) focuses attention and
responsibility for illness away from social domains / relation
ships other wise suspect. Examples from South *;arnara are:
a.
Rule - ancestor spirit. Knowledge about the lineage
of Kule effecting the afflicted throw light on friction/
jealousy in that kin group or between the kin group of
the afflicted and that which the Kule represents.
b.
buta -spirit of a social domain jaga/be it the family
domain Kuturnba village, kingdom, forest etc. A buta
is a manifestation of power which can be either malevolent
of benevolent depending on his this personified power is
controlled. Suspicion about specific bpta usually is
associated with instability in domains ''commonly, non
fulfillment of obligations fowards the members of that
domain (alive and dead) with Reference to wild or controll
able buta are often associated with responsibility projectingaway from the person experiencing problems.
c.
naga - a snake deity associated with fertility as well as
skin diseases such as leprosy and herpes zoster, eye
complaints, menstrual problems, breast pain in a lactating
woman and sterility. In this case, folklore has influenced
the association certain illnesses with naga.
d.
pide - spirit of a deceased child thought to be attracted
to other children out of love or envy. The touch of pide
is associated with a wide range of childrens illnesses.
The pide may be a deceased family member or a roaming
spirit.
....8.
-8-
e.
friari - (Bhagavti, Anima) Goddesses associated with pox
diseases either inflicted out of love or anger. Goddess
linked illnesses are often not spoken about as speaking of the
goddess and the illness is thought to bring the goddess
into presence thus spreading the disease.
Note:
illnesses caused by spirit trouble are freferred to NOT
as a roqa (disease) but as dosha or upadra disturbances/
trouble.
16.
Stars:
The illeffect of celestial bodies is commonly referred to
as qraha chara . The lay public does not know much about astrology.
Saturn, Sanni is often associated with vata complaints, no moon
with over-heat in the body and full moon with coolness and an
increase in kapha. Coughting and fits are thought to increase
during the period of no moon and full moon as well as as
sankranti (another transitional point) andpatients report this
to practitioners to aid dianosis.
17.
18.
Fate: multiple notions exist of qualified (transformable)
and unqualified fate.
a.
hanne baraha - predetermined fate (writing no fore head). non- negotiable, ( at birth, one's destiny is
written)
b.
adrishta - bad luck
c.
Karma - inherited or self made sins or obligations
which necessitate and bring recompense.
d.
avasu - life expectation, associated with the concept
of rebirth.
e.
papa - accumulated sins.
Evil eye - dristhi/evil eye is associated with visible
signs of overheat in the body (sudden appearance of rashes,
fever, unconsciousness) especially in children and pregnant
women (e.e. those most vulnerable). Dristhi is also
related to guilt projection by mother when child falls ill.
19.
Witcheraft - associated with competition, jealousv, suppressed
anger within andacross linerage and caste lines /mata/
20.
Dhatu loss - dhatu is a body substances associated with
positive health and vitality. uhatu is responsible for the
control, the control of desire, concentration, virility and the
ability to gain weight. Commonly, dhatu is feared to be lost
due to masturbation or sexual excess where if leaves the body as
semen, Specific foods produce and reduce dhatu. A reducation
dhatu makes one vulnerable to illness.
21.
Pregnancy desires1 unfulfilled desires during preganancy
are thought to affect fetus development and are associated with
limbs and sense organs, defects, car discharges etc.
Review of etiological factors by broad category (internal),
external, moral
Internal:
1.
Food/diet:
a. less of staple food
b.
inappropriate food - season - age
-9-
2.
c.
Impure food, toxic (nanju) food eaten in excess
d.
e.
feed which aggravates tridosha
gaseous (vaya) foods interfering with movement and
body cycles
Excess of uncontrolled heat in the body or excess cold:
(see additional notes on the hot / cold idiom)
a.
b.
c.
3.
loss of feeling of balance in body/mind
lack of control over one's supply of vital qualitative
energy
Interference of physiological processes resulting in
blockage of basic life systems -- digestion, defe
cation movement of blood and energy/trana,shakti/
menstruation etc.
Blood becoming:
a.
b.
less
impure
c.
thick/thin
As a result of:
4•
1.
less or inappropriate food, poor digestion
2.
3.
4.
overheat in the body
over work
exposure to extreme climatic conditions
5.
spirits
6.
hereditary factor (related to moral factors
sin, etc.)
ancesors.
Aggravation of the tridosha •
Tridosha viewed as substances causing illness when in
excess; more than a view of humors playing a necessary
rold in the physiological process.
a. Vata
b. pitta
c. Kapha
5.
Dhatu loss:
1. overheat
2. improper diet
3. sexual excess, deviance, masturbation
6.
Aggravation or suppression of intestinal worm activity in
the gut, as well as reduction of optimum number of worms
necessary <§or digestion or an increase of worms past the opti
mum.
7.
Impurity (body or blood) due to natural processes (menstrua
tion the blocking of natural processes (amenorrhoea, consti
pation, or the entrance into a state of body (delivery) or
status (birth, death) transition. Associated with states of
vulnerability, or states where other etiological factors are
attracted.
10
-10-
S.
Non fulfillment of pregnancy desires.
External Factors;
3.
4.
5.
bad wind
Contact with those who are ill(touch, crossing them or
body excretions)
contact with impurity
minuscule worms or insects
negative qualities of seasons, seasonal changes
6.
7.
spirit contact; curse, trouble
evil eye
8.
9.
witchcraft
effect ofs cerestial bodies— stars, planets, etc.
1.
2.
Moral Factors:
1.
notions of fate (ayasu, karma, hane baraha)
2.
spirit trouble- failure to upkeep obligations/responsibility in domains of prescribed social interation (family
lineage caste, village.)
*
*w***
*** * *☆*
* ** *
C.G/V) hG.I
1.
Relevant Health Education
Education by Appropriate Analogy(Chapter V)
2.
Doctrine of Multiple causality
3.
Notions of Etiology
(Appendix D)
(Appendix. D)
From
A
METHODOLOGY GUID FOR THE COMMUNITY
DIAGNOSIS OF HEALTH
Project
Community Diagnosis 1978-79
Mark Nicter, K.H. Bhat, Srinivas Devadiga and
Mini Nichter
Office of Population and Health
USAID
New
Delhi
c AA H b •' '
V.
Relevant Health Education;
Education by Appropriate Analogy
One cannot expect positive results from an educa
tion or political action program which fails to respect
the particular view of the world held by the people...
it is not our role to speak to the people about our
view of the world, nor to attempt to impose that view
on fem, but rather to dialogue with the people about
their view and ours. We must realize that their
view of the world manifested variously in their action
reflects their situation in the world. Educational
and political action which is not critically aware of
this situation runs the risk either of the banking or
preaching in the desert.
Pedagogy of the Oppressed,
Paolo Friere
In the above quote by Paolo Friere, reference is made to the
banking mode of education, a mode of education prevalent through
out the developing world. What is implied by the term, banking
is that information is deposited into a villager's mind verbatim,
as if the mind were empty. This mode of education presupposes
that once information is deposited it will incur interest over
time.
The poverty of this type of education is seen in village
India today in thedividend it is yielding in the form of inertia
and the compartmentalization of new ideas.
What is required is a form of education which engenders
synthesis and fosters the organization of new and existing infor
mation as opposed to the compartmentalization of information into
separate spheres of reality . The process of education which is
advocated evolves out of dialogue and. the posing of appropriate
Questions which reveal and challenge assumptions. Such education
necessitates preliminary investigation of the cognitive universe,
the phenomenological context in which the villager lives.
One of the purposes of a community diagnosis of health
study is the identification of indigenous concepts which may be
used in the framing of relevant educational strategies. These
strategies, rather than being based on ideas outside the villagers
comprehension, are based on what is already known or questioned.
In this sense, the mode of education recommended is an extension
of classical modes of education which communicated knowledge con
ceptually through analogies and metaphors poetically orchestrated
around immediate experience.
The reasoning behind this mode of education can be
illustrated with reference to everyday speech. Theeeveryday
speech of villagers is composed of numerous analogies, metaphors,
and proverbs. To understand such speech one has to comprehend
more than simply the words spoken. What is necessary is an
understanding of the relationship between vzhat is spoken about
and vzhat is being referred to. Commonly, an idea which is
easily understood on one plane is used to describe an idea or
istuation on another plane. By explaining something in this manner,
one is able to convey knowledge within one’s cognitive framework,
permitting a minimum number of words to be used to convey a
maximum amount of understanding; understanding facilitated by
reference to what is already known thus making memory easy.
During the project, core staff experimented with analogical
reasoning as means of explaining new health ideas. First, attention
was focused on domains of knowledge and experience with which
the villager was familiar andwhich were commonly exploited in
local proverbs, analogies, etc. Then, such domains of knowledge
were considered in relation to priority issues in health education.
It is the opinion of the research team that it is possible to
explain any common biomedical concept vis a vis indigenous concepts
by maximising analogical reasoning. The examples given below may
illustrate the strategy used.
-21.
FIELD: L-OF-Y
1.1 Nutrition:
For your rice crop, you neeo cow manure, green leaf, and
ash. If you have less manure, your crop will nave no heigh, if less
gree leaf is put, the crop will be less, if less ash is put the
husks will appear but inside there will not be grains.. The body
is like that." Fish and grain are like manure, green leaf like
vegetables, minerals (iron,.calcium) like ash. If you want a good
crop, you must make correct balance.
1.2 Family Planning - spacing
If you plant too many paddy seedlings very close to each
other, what will happen? Do they not interfere with each others
growth, do you not get a poor crop? Having children close together
is like that - should a mother give breast milk to one child
while pregnant with another? (Culturally women(South India) think
they should not continue breast feeding, but do because of a lack
of availibility of milk, funds to purchase milk or benevolence
particularly towards a male child.)
2.
WCfAk'S CYCLE» SEASONAL, KCOM CYCLE
2.1 Relative fertility in woman’s monthly cycle:
benefit?
cycle.
If a crop is planted in the wrong season is there any
A woman’s cycle is like a seasonal cycle, like the moon
Senses is like amavase/amavas/ (no moon, an inauspicious
time of overheat when no new work is begun)— as the moon becomes
more full toward hunime (full moon- auspicious time which is cool
and linked to fertility) the benefit (labha) of acts begun is it.
more. Hunime in a woman is the period 10-15 days after her
menses, -f child is desired the seed should be planted in that
season, if a child is not wanted the seed should be thrown
at another time.
3.
GQOKIKG: DIGESTSON
3.1 Dehydration
If you are cooking some food and there is not enough
water in the pot, what happens? The food becomes dry and burns,
the pot bums as well and if not removed from the fire it may
become spoiled. Digestion is like cooking. If water is less in
the body, the body becomes dry and begins to burn, fever comes as
well as weakness. If water is not put in the stomach pot, the
heat spoils the blood and a lack of water may cause a person to die
3.2 Dehyderation and Diarrhoea
Diarrhoea is like a hole in the stomach pot—water keeps
coming out and if more is not placed in the pot, the blood bums.
Wather must be placed in the pot until the hold can be repaired.
Repair requires medicine but even more immediately important
than repairing the hold is not spoilling what is in the pot
for that is life blood.
3.3 Dehyderation and Fever
Fever is like a pot boiling without a cover. The
liquid evaporates and the food (blood) in the pot burns. To
reduce this problem, medicine may be given which acts as a cover
for the pot(aspirin) but sometimes the problem is that the fire
under the pot is too hot. In such cases, medicine must be given
to reduce the fire/fuel (food)
and the body must be kept cool.
But most important in any kind of fever is that the water in the
body be enough to prevent the blood in the stomach pot from
burning.
-3-
3.4 Fontanel sinking in baby
When boiling rice, if the water’ becomes less what happens?
Doesn’t the rice in’the center of the pot sink down? And then if
water is added doesn’t the depression come back to normal level?
So it is with a baby. If the liquid in the body is less the fontanel/
netti depresses. When enough liquid is given the depressed area
comes to the normal level.
3.5 Preparing Electrolyte solution
In the cooking pot, water is needed. For the stomach pot,
when water is urgently needed, boiled water which contains sweet,
salt, and sour is best. Salt is needed for the blood, Kara
(piquant) should be reduced as this increases heat. To help
digestion some sweet and sour are needed. Therfore, for every glass
of water, a pinch of salt, a small amoutn of sour (lemon, local
fruits) and sweet (2 sppons of jaggery, sugar, honey), are needed.
Digestion is the center and the most important process in indi
genous ideology: connected to most illnesses)
4.
House: Body
Insects: Germs
4.1 Many types of insects may enter a house. If one is
inexperience and has much work these insects may be idissegarded
expecially if the person thinks they are harmless. Then one day
the person may feel some irritation, like the trouble given by
bedbugs, and wonder what is the causes. By that time, many
insects may be in the house and it will be difficult to get rid
of them without disrupting the activities of the house. At
other times, a person may not know what causes such insects to
come in great numbers like oil being left on the floor attracting
cockroaches. It is the duty of family andfriends to help inexperi
enced people learn such things, just as it is the duty of adults
to instruct children which plants are foods and medicine and which
are poisons.
,
The body is like a house, Krimi enter because the doors
are left open(weakness), because something attracts them, or
because the body permits them to enter thinking they are harmless
guests or beggars. In the case of insects entering a house,
knowledge comes after seeing and experiencing them. In the case
of illness entering the body, however, Krimi (use a similar local
term) which cause illness are not visible. It is not enought to
tell a man that "some Krimi" cause illness," so he should not
allow them in his body. The body, however, can be taught a
lesson. This the purpose of a vaccination. A vaccination con
tains harmful Krimi made weak by poison. When these Krimi enter
the body, they make trouble-—but only a little trouble, not like
the trouble which many would cause if they came to the body in
number. They body learns how to both recognize these trouble
some Krimi and kill them. Side effects, such as fever and chilis
are not bad; they are good signs that the body is learning to ree
congnize and fight Krimi through experience. Yes, the side
effects, xHEk as cause trouble! but just as in children, sometimes
an important lesson must hurt just a little. In the future,
if these Krimi come they can be killed more easily and if a
body has learned to recognize them by experience, it will not let
them enter in number or willsweep them clear, the way a woman
sweeps a house clear when she sees ants coming in number. Like
sweeping, this requires a short gap in normal activity, in this
cas it may cause small problems like a one day fever or diarrhoea.
But better this thana big illness later, A vaccination then
is a way of the body gaining Krimi anubhawa (experience)—the
more anubhava for such Krimi diseases one has, the less chance of
getting an illness. That is why children with less body experience
get
-4-
get a Krimi diseases mere, and why once a child gets Krimi
disease like chickenpox or whooping cough, his chances of getting
these diseases again is less than other children. Only some
krimi can be swept out of the body house, however, others are
so common that the body can not prevent them from entering
the house as this would be a full time job and man has other
works. In such cases, man must learn what attracts such Krimi,
what these Krimi do not like (e.g. smoke for mosquitoes), andhow
to keep this doors closed (good hygienic diet).
1. Krimi is one term used by villagers to describe invisible
worms.
*The diseases which should be used here are those which
etiology surveys have indicated are associated with external
worm/germ type agents. Ayurvedic pandits tell us, for examples,
that undigested food or impure blood attracts certain Krimi. It
is necessary to make these conditions less and to teach the body
who are its friends and who are its enemies.
5.1
Harvest: Deliver
Fertilizer: Feeding of Woman during Pregnancy
Near the time of the harvest, if the crop looks weak 1, is
that the time to think of adding manure to the field 2 So it
is with pregnancy. A diffic It delivery is often caused by
weakness and lack of blood in the mother as well as the baby.
At the time of delivery, it is not possible to increase blood.
(unlessbbood is given by transfusion- -for villagers who are
aware of what a transfusion is). For this reason, it is necessary
for a pregnant mother to eat blood/stren.-tjth producing foods.
Dhatu (a local term which refers to accumulated strength and is
associated with diet) requires time to be produced and for
this reason blood/strength producing foods must be consumed
throughtcut- pregnancy.
1
Weakness is emphasized here, not crop size. It is common
place throughout India for women to link large babies with
difficult delivery (as well as problems during pregnancy).
Rather than confront this strong attitude directly, it is better
to use a culturally appropriate health education strategy and
emphasize 'more blood and more strength.' Big is best is an
ethnocentric approach and in any case, the size of a baby is
not directly correlated with strength as villagers speak of
babies whomiook big but are only full of water, indicating
an undersirable state.
2
A local proverb expresses a similar ideas "when a man is
thttsty, is that the time to start digging a well?"
The Doctrine of Multiple Causality
Relatively few illnesses in rural South India are associated
with only one possible etiological factor. Most illnesses are
thought capable of being caused by any one of several factors acting
alone or in concert with others. Moreover, once ill, a villager is
considered vulnerable to additional etiological factors which may
prolong or compound illness making it more complex to manage or cure
This is one reason why patients sometimes consult different types
of practitioners simultaneously so as to remove/ manage multiple
etiologicalfactors or reduce their after effects. Another factor
which complicates illness classification and lay medical decision
making is the fact that similar symptiom sets may be interpreted
differently (as types of one illness or different illnesses ) due
to the onset or progression of symptoms as well as suspected
etiological factors. For this reason, data presented on the etio
logy of illnesses in this report, although based on considerable
survey and case observation research should be considered data on
dominant notions of etiology not fixed ideas.
The latter point is important when planning appropriate
health education strategies. It is stressed that ideas about etio
logy are flexible. We found that new ideas can readily be introduced
that in the context of dialogue when explained in terms of existing
etiological concepts or perceived states of the body (based on indi
genous notions of physiology) associated with the illness in question
As can be seen by the list of etiological factors which follows
indigenous concepts can be found for most biomedical concepts.
Scope exists to define particular illness episodes in terms of alter
native etiological notions (if a prevalent idea is counter-productive
to health behavicu) as long as the factor attributed is not anti
thetical (in qualitative affect)to the type of symptoms manifested.
For examples, most itchy skin rashes among children are ambigiously labelled Ka-j i i a 1 a condition strongly associated with
over heat in the body and treated by a restricted dies (less Ushna
no nan-jufoods} and the application of cooling leaves. A differen
tiation of Ka j ■; i into different types caused by a) worms of external
origin eating the skin (scabies, impetigo) and b) overheat (kwashi
orkor related sking;esopms /artdsmlarly on the limbs, phrynoderrna,
vitamin A deficiency) was conveyed to villagers without much diffi
culty. This overt differentiation was invluable to us in communi
cating health education information. We were better able to explain
why
1
2
This term is used in both South and North Kanara Districts.
See notes on etiology which follow and a forthcoming report on
dietary restrictions during illness.
Scabies treatment required the placing of a poisonous medicinal
lotion on the skin for 48 hours and the necessity for boiling one’s
clothing (to kill minuscule worms and to get rid of worm eggs;
worm eggs being a concept known to villagers from their experience
with picking lice). It also helped us to convey dietary advice in
cases of malnutrition. As opposed to discounting local ideology,
we planned a nutrition strategy to confront existing ideology, we
about kaj ji caused by states of malnutrition. When a state of mal
nutrition. Hkian a Kfcni'K b£ manifested in skin lesions with pruritus,
S foods were suggested, such as green gram and ragi, seasme oil
(essential fatty a cids), and vine spinach (vegetable) protein and
vitamin A ) which were culturally acceptable, Accepting that one
form of Ka j ji was caused by overheat (and designing a nutrition strategy
accordingly) while differentiating Kaj ji into different types increased
the compliance rate of those under faking scabies therapy in our makesshift first aid station and more in®ortatnly, the credibility of our
education message.
.?
-2Another point to be appreciated is that what appears to be a
symptoms of illness may be interpreted as a sign of some broader
problem (dosha, upadra) effecting the one who is afflicted or his
family unit 2. Alternative notions of the possible etiology7 which
are dwelled upon may be related to attempts at linking causality
to particular social domains (social relationships ) where vulnera
bility or instability exists; or they ay be attempts to projected
resjbcsibility away from normal interaction spheres (onto wandering
spirits, inauspicious celestial effects, etc. ) as a means of reduc
ing guilt, etc.3 In other words, suspected etiological factors may
be functional expressions of anxiety connected to competition,
jealous^? or guilt, (in respect to fulfilling obligations, role ex
pectations, or one’s duty)
To sum uo:
1. Rather than underminging health education efforts, the doctrine
of multiple causality accomodates new ideas and facilitates inno
vative health education.
1
Sesame oil is considered cooling in South Kanara but heating in
parts of Tamil Rad. This is an example of why region-specific plan
ning based on a knowledge of indigenous ideology is import©
2 This is especially the case if the one afflicted is the weakest
or most vulnerable family member, i.e. a young child or pregnant
woman.
3
?or example, evil eye as well as toxic breastmilk may be asso
ciated with a case of infant diarrhoea. Obviously notions of evil
eye focus.
2. Indigenous concerts of etiology complement biomedical concepts
of etiology (if not logically than analogically).
3. Rew ideas introduced appropriately in terms of concepts which
the ymnramaSc EHdtejsi nxsitaEg: villager can relates to, facilitate
both understanding and greater sc pe for their application of
these ideas.
4. .An entrance into the villager's conceptual universe, as well
as personal medical history, can he gained by discussing both the
classification of symptoms as partic lar illness categories and
the suspected causes of an illness experience.
3
(cont.) attention away from the mother and feelings of guilt.
Rotes on common notions of etiology and
associated symptoms in South Kanara District, Karnataka
1.
Less food/ Kadime tinas/
Specifically, this refers to eating an insufficient quantity
of the staple food one is accustomed to eating (in this case,
rice). It is important to keep in mind that the villagers' sense
of body cycle normality derives from the maintenance of a routine
digestive cycle and body signs associated with this staple specific
cycle 'faces consistency and regularity, urine color, timings
of hunger, etc.)
2.
Improper dies: /apathya/
a.
taking meals erratically (among castes maintaining
routine commensality patterns)
b.
eating foods having properties counter-indicated in par
ticular seasons, aaat Eurxz-m iddz to particular age-groups.
..........3.
-3-
in transition periods, and during illness episodes.
c. commonly, in children, giving chillies and hot curries
before the age of 2.
d. cormonly, in adults, eating excessively spicy foods /kara/
3.
Bad blood
/setter hal/
a.
had blood is thought to be caused by overheat /ushna,
param,/toxicity /nanju/, loss of slepp. inappropriate eating
habits, exposure to extreme weather conditions, hard work,
past illnesses and powerful medicines 'consumed presently
or in the past).
b.
Sluggishness and weakness are associated with bad blood
interfering with the flow of substance in the body. This
is sometimes associated with vata as well (see below).
c. Bad blood in the head and stomach is thought to be pushed
out by vomitting while bud blood in the intestines and
legs causes sores /pudi/
d.
Wounds which become infected are associated with bad
bl: od(an internal factor) more often than lack of external
clear-liness
e.
During amenorrhoea and pregnancy (a condition described
as naniiin character) impure blood which is normally
Research in ether regions of Karnataka and a knowledge of
ethnomedical literature in India, suggests that most of these
factors have widespread relevance to rural areas.
expelled from the body is thought to b« retained and.
mixed with good blood (causing bad blood.)
f. Some illnesses are ascribed to bad blood being passed on
from mother to fetus or breastfeeding child.
4.
Climatic changes /have mana/
Bluctuations in temperature are thought to throw the body off
balance. For villagers, the healthiest time of the year is
when the temperature is most constant. Climate changes are
suspect especially at times of seasonal change. These times
are associated with bad winds and the movement of spirits
(discribed as gall or sonku)
5.
Heat in the holy
/ushna,qaram /
a. A certain amount of controlled heat is required for the
maintenance of bodily processes especially the digestive
process. Controlled heat is associated with strength
(trana, shakti) while an exees of heat may cause and be
associated with the following symptoms.
1.
burning sensation in stomach.
2.
burning sensation in eyes.,feet, and hand (anaemia,
calcium deficiency)
3.
4»
burning sensation during urination
Indigestion
5.
6.
diarrhoea/ constipation/(especially dry stools)
blcod in feces
7.
redness of the skin/ rashes/ boils
8.
dry cough
9.
body pain, particularly back ache
10.
cracking of soles and palms
-4-
11.
12t
balding/hairlessness
dissolving of bones: bones becoming brittle
13.
dhatu loss, mental upset and confusion
b.
A state of overheat (ushna) can be passed on from mother to
child, through the breastmilk causing the baby to experience
indigestion, diarrhoes, boils, or fever.
c.
Overheat is the after (end) effect of many other etiological
factors (e.g. food climate, evil eye, encounters with a spirit,
mental worry). Therefore it is important to ascertain if the
term is being used as a general statement or in conjunction with
notions revealed by further inquiry. The most common general
references to overheat is to refer to the eaxting foods, the feel
ing of hunger, or sleeplessness.
Excessive Coolness (tampu, tandi)
6.
a.
In terms of prevalent health (and for that matter, ritual)
ideology, cool /tampu# is needed to controlheat in the body.
Generally, in reference to health, tampu is associated with
with weight gain and slower digestion. Too much tampu is
thought to manifest the the following symptoms:
1. excess phlegm
2.
3.
cold, runny nose, sore throat
wet cough
4.
indigestion and constipation (fewer bowel movements as
opposed to dry feces)
5.
complaints that the blood has become thick and doesn't flow
properly causing fatigue.
headache.
6.
b. Excess cool is thought to be transferred through breatmilk
causing baby to experience indigestion, cold and accumulation
of hlegm.
7.
Toxic substances /nan j i/
a. Nanji can result from:
1.
the retention of bad blood not emitted by routine body cycles
(amenorrhoea and pregnancy seen as the disruption of the
menstrugl cycle).
2.
substances consumed by the body which it cannot digest such
as the unctuous juice of brinjal or drumstick (foods classi
fied as nanju.
3.
the consumption of too many sweet foods, oils, or impure
foods.
4.
child receiving impure breastmilk from its mother.
b. Nanji is associated with infection, pus, boils and itchiness,
Nanji in the blood is thought to prolong the cure of most ill
nesses: particularly wounds, skin diseases and intestinal complaints
for this reqon, foods classified as nan ju are not eaten during
illness episodes.
c. Nanji (toxic) should not be confused with visha (poison). It ia
generally believed that nanju foods are the best tasting foods
tasting foods and their consumptions is common.
8.
An excess of one of the three body humors (tridosha):
a. The principle of body humoreis the basis of ayurveda, the classical
system of Indian medicine. It may first be emphasised that few
villagers (as well ad few vaidya , fural herbal practitionersTT
know much about the principles of ayurveda. However, ayurvedic
terminology and the use of ayurvedic regimens are very much part
of folk medical cultures in India. While tridosha, as a principles
of body physiology, is not known, the effects of humoral aggra
vation (the symptoms manifesting) are known andhumoral terminology is
used in colloqial languages to describe the'course
of
*
such symptoms
Most commonly these 'causes
*
are associated, with the eating of foods
clssifed locally as having a quality (guna) which produces these symp
toms when consumed in excess or at inappropriate times. 1 As might
be imagined, interaction between laymen and learned ayurvedic
practitioners 2 has caused a number of ayurvedic terms to to flow
into the local vernacular where they are given local meanings.
and usuage.
b.
Symptoms associated with tridosha terminology:
1.
2.
Pitta
a. nausea
b. tasting of bitterness in mouth
c.
d.
dizziness
loss of mental equilibrium, mental upset, taking
nonsense
e.
yellow urine
f.
g.
h.
heartburn
yellowing of body / jaundice
associated with overheat in the body
Kaoha
a. aphlegm laden cough. It may be noted that young children
are thought to have a propensity toward kapha disorders
and have more kapha in the body. For this reason, res
piratory illnesses are often not treated in the early
stages.” This does not mean, however, that mothers do
not try’ and check the excess of kapha, for a number of
curative and preventive home remedies are utilized.
b. mucus exuding from the nose, eyes, mouth, or anus
(foamy stools)
c. foaming at the mouth particularly after febrile fits
among infants is linked to an excess of kapha as well
as spirit attack.
1.
The classification of foods with reference to the tridosha is
more complex than this (one should consider the ayurvedic
concepts of triguna , Viriya, and, vinaka but for our purposes
this passing reference is sufficient).
2.
I will refer to these practitioners as pandits to differentiate
them from vaidya practitioners who dispenses herbal medicine but
do not follow a system of diagnosis and therapy.
3.
Vata:
Vata is the wind (movement, motor function) principle in the
body. An excess of vata is thought to cause body pain and when
vata is blocked it is thought to cause stiffness in joints.
Vata conditions are sometimes linked to less blood. Vata is
associated with the effect of sanni planet (Saturn) and excretions
from the body which are blackish in color.
6
—6—
Vayu;
4.
Vayu is associated with wind in the form of gaseousness within
the body causing;
a.
indigestion, flatulence
b.
c.
d.
feeling of fihilness and being stuffed up
feeling of breathlessness
fatigue, laziness
CChTAGiCK FACTORS / antu, pagarana /
gali
9.
a»
This term literally means wind. It is used to describe a
spirit wind (sometimes called sonku) , a malevolent 'wind
carrying illness from one village to another, and the wind
ensuing from an ill for menstruating person when he/she
passes.
b.
It may be noted that sow illnesses associated with gali
such as chickenpox or measles are thought to manifest
from the stomach first not the external surface of the
body. Pox fall / burundu/ on the body surface from the
interior.
c. Cali is thought to cause sudden dramatic symptoms usually
associated with overheat or cause impurity to theblood
resulting in bolls, pox coming to surface of the skin
etc. Specific reference to sonku is more in Ati month
and is associated with sudden fever or pain.
10.
breath / svasa / of a person who is ill.
11.
crossing / kadapu/
An idea exists that crossing (steppin over, passing through
a transition point) associates one with the malevolent quali
ties of the material / force crossed. Common agents cited
are body excrements of the ill (faces, urine, saliva, scabs),
shadows or blood of menstruating women, food touched by the
ill etc.
12.
Contact with impurity /mailqe, basta, made/
a. direct contact with impurities such as saliva /dalle/ or
the consumption of impure substances is commonly associated
with ifection and the appearance of boils.
b. contact with the pus of one who has a skin disease or
diseases in which lesions manif&st.
c. contact with the breath of a diseased persoii in life and
the spirit of a diseased person after death /khale/.
d. touching the body of a diseased person or his personal
effects (clothes, blankets, etc.)
13. Minuscule worms, germs / brim!, puri / keidi /
Many illnesses are attributed to be caused by worms of internal
of external origin. Polk notions of physiology give functional
role of worms / five da puri/ in the digestive process. Some
illnesses are spoken of as caused by having more or less of these
worms, more active or sleeping worms which for example may cause
loss of appetite or improper motion. These worms are particularly
suspect when a small child has a loss of appetite, is listless,
vomits, is irritable, has diarrhoea, grinds his teeth, or has a bulg
ing stomach, many other diseases, particularly fungal diseases and
infected wounds are also attributed to worms. The notions of
-1-
minuscule (invisible) external worms /Krimi pudi/ which enter a
body causing illness are similar to biomedical concepts of germ,
virus, and are a part of the folk health culture.1 It may be noted
however, that the etiological factors are associated with precipitat
ing reasons for these external agents being attr-ted to particular
persons or being able to enter domains (body) domain, house domain,
village domain) normally protected (closed to intrusion, disruption)
ritually or by substances enhancing one’s positive health. This
reasoning often focuses attention on states of vulnerability (due to
climatic changes, lack of spirit protection, transition in one’s
life, states of impurity etc. ) Here we find the basis for a strong
indigenous concept of preventive and promotive (positive) health.
14.
Hereditary factors:
This is a complex concept which may refer to:
a,
illness being passed on through the bloodline of a
lineage (matrilineal, patrilineal reference)
b.
an illness which comes as a course or recompense to an
individual or family due to non-fulfillment of obligations,
sin, paua, karma etc.
c.
an illness which another family member experienced in the
past associated with either spirit attach by the deceased
or a sign from the deceased of its presence.
1.
The concept of external etiological factors (minuscule wormsKrimi, insects - Kita is found within ayurvedic dogma.
15.
Spirits:
Each type of spirits is associated with a social domain or
state of xSydsaass wildness/uncontrol. Suspicion of a particular
type of spirit focuses attention on imbalance or vulnerability
in that domain. References to vague stars / spirits of the wild
(of the forest, transition points, etc.) focuses attention and
responsibility for illness away from social domains / relation
ships other wise suspect. Examples from South ^arnara are:
a.
Kule - ancestor spirit. Knowledge about the lineage
of Kule effecting the afflicted throw light on friction/
jealousy in that kin group or between the kin group of
the afflicted and that which the Kule represents.
b.
butt -spirit of a social demain jaga/be it the family
domain Kutumba village, kingdom, forest etc. A buta
is a manifestation of power which can be either malevolent
of benevolent depending on his this personified power is
controlled. Suspicion about specific buta usually is
associated with instability in domains (commonly, non
fulfillment of obligations fowards the members of that
domain (alive and dead) with Reference to wild or controll
able buta are often associated with responsibility project—
ingaway from the person experiencing problems.
c.
naqa - a snake deity associated with fertility as well as
skin diseases such as leprosy and herpes zoster, eye
complaints, menstrual problems, breast pain in a lactating
woman and sterility. In this case, folklore has Influenced
the association certain illnesses with naga.
d.
nide - spirit of a deceased child thought to be attracted
to other children out of love or envy. The touch of pide
is associated with a wide range of childrens illnesses.
The pide may be a deceased family member or a roaming
spirit.
-8-
e.
Mari - (Bhagavti, Anima) Goddesses associated with pox
diseases either inflicted out of love or anger. Goddess
linked illnesses are often not spoken about as speaking of the
goddess and the illness is thought to bring the god ess
into presence thus spreading the disease.
Note:
illnesses caused by spirit trouble are freferred to NOT
as a roqa (disease) but as dosha or upadra disturbances/
trouble.
16.
Stars;
The illeffect of celestial bodies is commonly referred to
as qraha chara . The lay public does not know much about astrology.
Saturn, Sanni is often associated with vata complaints, no moon
with over-heat in the body and full moon with coolness and an
increase in kapha. Coughting and fits are thought to increase
during the period of no moon and full moon as well as as
sankranti (another transitional point) andpatients report this
to practitioners to aid dianosis.
17.
18.
Fate; multiple notions exist of qualified (transformable)
and unqualified fate.
a.
hanne baraha - predetermined fate (writing no fore head)non- negotiable. ( at birth, one’s destiny is
written)
b.
adrishta - bad luck
c.
Karma - inherited or self made sins or obligations
which necessitate and bring recompense.
d.
ayasu - life expectation, associated with the concept
of rebirth.
e.
papa - accumulated sins.
Evil eye - dristhi/evil eye is associated with visible
signs of overheat in the body (sudden appearance of rashes,
fever, unconsciousness) especially in children and pregnant
women (e.e. those most vulnerable). Dristhi is also
related to guilt projedtion by mother when child falls ill.
19.
Witcheraft - associated with competition, jealousv, suppressed
anger within andacross linerage and caste lines /mata/
20.
Dhatu loss - dhatu is a body substances associated with
positive health and vitality. °hatu is responsible for the
control, the control of desire, concentration, virility and the
ability to gain weight. Commonly, dhatu is feared to be lost
due to masturbation or sexual excess where if leaves the body as
semen. Specific foods produce and reduce dhatu. A reducation
dhatu makes one vulnerable to illness.
21.
Pregnancy desires; unfulfilled desires during preganancy
are thought to affect fetus development and are associated with
limbs and sense organs, defects, car discharges etc.
Review of etiological factors by broad category (internal),
external, moral
Internal;
1.
Food/diet:
q.
less of staple food
b.
inappropriate food - season - age
-9c.
d.
e.
2.
3.
Impure food. toxic (nanju) food eaten in excess
food which aggravates tridosha
gaseous (vayu) foods interfering with movement and
body cycles
Excess of uncontrolled heat in the body or excess cold;
(see additional notes on the hot / cold idiom)
a.
loss of feeling of balance in body/mind
b.
lack of control over one's supply of vital qualitative
energy
c.
Interference of physiological processes resulting in
blockage of basic life systems --- digestion, defe
cation movement of blood and enerqy/trana,shakti/
menstruation etc.
’
Blood becoming;
a.
b.
less
impure
c.
thick/thin
As a result of;
4.
1.
2.
3.
less or inappropriate food, poor digestion
overheat in the body
over work
4.
5.
exposure to extreme climatic conditions
spirits
6.
hereditary factor (related to moral factors — ancesors.
sin, etc.)
Aggravation of the tridosha:
Tridosha viewed as substances causing illness when in
excess; more than a view of humors playing a necessary
rold in the physiological process.
a. Vata
b. pitta
c. Kapha
5.
Dhatu loss;
1. overheat
2. improper diet
3. sexual excess, deviance, masturbation
6.
Aggravation or suppression of intestinal worm activity in
the gut, as well as reduction of optimum number of worms
necessary djor digestion or an increase of worms past the opti
mum.
7.
Impurity (body or blood) due to natural processes (menstrua
tion the blocking of natural processes (amenorrhoea, consti
pation, or the entrance into a state of body (delivery) or
status (birth, death) transition. Associated with states of
vulnerability, or states where other etiological factors are
attracted.
10
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8.
Non fulfillment of pregnancy desires.
External Factors;
3.
4.
bad wind
Contact with those who are ill(touch, crossing them or
body excretions)
contact with impurity
minuscule worms or insects
5.
6.
7.
negative qualities of seasons, seasonal changes
spirit contact; curse, trouble
evil eye
8.
witchcraft
9.
effect cfs cerestial bodies— stars, planets, etc.
1.
2.
.-oral Factors:
1.
notions of fate (ayasu, karma, hane, baraha)
2.
spirit trouble- failure to upkeep obligations/responsibility in domains of prescribed social intoration (family
lineage caste, village.)
A
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