Teaching Village Health Workers
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Teaching Village Health Workers
a Guide to the Process
PART II
LESSON PLANS
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"V HEALTH CELL
PART — n
A TEACHING GUIDE
Months ago, even years, when we first began getting requests for help in the teaching of
Village Health Workers, we realized that what people wanted was a book containing the whole
course content, something the teacher could give to the trainees consecutively, page after page.
We could not prepare such a book because as we have said before, there are too many diffe
rent things to be considered. WE STILL CANNOT GIVE YOU SUCH A BOOK. If you have
studied Part I of this volume, you will understand the reasons for this. If you have not studied
Part I, then, please do before you read further.
Nevertheless, we do realize that it would be helpful to give some kind of a guide which
could serve as a beginning. Part II, we hope, will serve this purpose, if you have been able to
accept the concepts in Part I. Following the same process which we have described in Chapter
III, we have developed some Curriculum charts to show how the Course Outline and Messages
to be taught were decided upon. To make this more realistic we have spent considerable time
in health projects which have the benefit of several years of experience when added together.
Although there are differences in what have been selected as priorities in various parts of the
country, there seem to be several common needs. We have therefore taken these a basis, con
sidering them to be the priorities which we want to include. These common priorities are :
1.
Care of Under-Fives
2.
Prevention of Malnutrition in Children
3.
Antenatal, Maternity and Postnatal Care
4.
Family Planning
5.
Control of Leprosy
6.
Prevention of Blindness
7.
Control of Tuberculosis.
1
The fifth priority Control of Leprosy, is an example of one which would not be included in
some parts of the country, where there may be others which would be more important. For
example, in several areas we have been told that drinking and gambling are the most serious
problems affecting health both directly and indirectly.
For these seven priorities, you will find what we have called Curriculum Development
Charts. The steps shown should be carried out by the Health Team or Faculty. The steps
are from the Process Charts shown in Chapter III, and including the following :
Project Goal and Priorities selected
to
Step 1. Broad Objectives (for each Priority)
to
Step 2. Work to be delegated to the VHWs
to
Step 3. What VHWs will need to
know feel and (required skills)
to
Step 4. Specific Objectives (of the training)
(after they learn,what will they be
able to actually do)
to
Step 5. Curriculum
(The clinical material to
be reviewed by health professionals)
Course Outline
Messages to be learned by VHWs
2
You will see that the actual curriculum, including the course outline and the messages to
be learned by the VHWs, is the last step in the process, and it means that many, many deci
sions have been made at each step.
The Specific Objectives are stated in a way that will make it possible for you to observe
and evaluate whether the VHW is actually doing it. For example, “Teaches and demonstrates
to Leprosy patients how they should care for hands, feet and eyes to prevent deformities.”
This can be tested by observation. What messages will she have to learn in order to do this ?
There may be three — “Ulcers and deformities can be prevented”. “Injury to feet and hands
must be avoided”, and “Eyes that cannot be closed need special care.” There are many different
ways of stating these, and you may have different ones. Please do improve on the messages in
any way you can.
Our purpose in including the charts for the seven priorities is two-fold: 1) we hope they
will help you to take your own steps for your own priorities, and 2) to give you a head start
if you want to use the course outline and messages in our charts, using the specific objectives
to test whether you have accomplished what you hoped. Remember that Curriculum Develop
ment is a continuous process, and you will not be hurting our feelings if you don’t agree, and
make changes in the chart. On the contrary, we will be pleased to hear from you about improve
ments you are making.
Before the Curriculum Charts you will find twenty sample lesson plans. Those included
have been marked by (*) on the Curriculum Charts. We have already referred to how these
are written in Chapter TV of Part I. We hope later to prepare more lesson plans and would like
to have you send any you may develop to us.Participants in many workshops throughout the
country have contributed ideas which are included in the samples. One of the reasons why we
have made Part II of this book a loose-leaf guide is so you can add your own lesson plans as
they are developed, or replace the samples as you improve on them. A few points to remem
ber are —
— May be some of these plans will not be useful in your area, only you can judge.
— Teaching aids and methods of all kinds can be used.
Be imaginative and innovative,
3
but relate your aids to the people you are teaching.
— The order in which the lessons are taught will depend on opportunities available or
needed at the moment. If too many babies are brought to the centre dying of tetanus,
maybe you should concentrate on teaching and carrying out an immunization cam
paign on this, leaving whatever you were teaching before.
— More than one class time may be needed to teach one lesson, or it may take less than
one time, so that another can be started. You will need to be flexible in your time
table.
— The VHWs will help you to find more imaginative teaching aids. One we know of used
a big round lemon with a hole in one end to represent a child with diarhhoea. As he
squeezed out the juice the lemon became thinner and more wrinkled and finally almost
dry !
1. You will see that every plan includes in the Introduction on the “How to Teach” side,
a long discussion on the village treatments, ideas and misconceptions the village people have
about the new topic. We consider this a very necessary part of the plan. The health professionals
can learn from the VHWs about the situation. Otherwise, the teaching is likely to be irrelevant,
or impossible for the people to accept or follow. Take TIME to LEARN; then teach accordingly.
The misconceptions, superstitions and ancient customs are one of the major barriers to
change, and have been “blamed” for the failure of development programmes and health care
systems to teach villagers or to change rural areas for the better. But we have seen that
where Village Health Workers have been trained in the way described in Part I of this book,
they have succeeded in changing old traditions. Therefore we urge that you who teach VHWs
spend time at this point in each lesson to LEARN about the villages and their people. This
will give you guidance in how you should teach the particular topic.
2. Each lesson plan contains only one or two short messages, and a few simply stated
points under these. This seems to be a better approach than covering a great deal of new in-
4
formation. For example, one class on giving semj.Solid foods to a baby from the age of four
months is enough to absorb at one time. To tell the mothers about the diet of a child from
birth to two years in one class is more than can be remembered and too many messages to
receive and accept at one time.
3. In planning the review' of the points learned in each class, try to think of various ways
to do this — questions, repeating the points with a different kind of visual aid, acting out or
“role play.” planning how they will teach their people. This will accomplish your purpose in
having the review, but it will also be more interesting.
We have already mentioned the Reminder Cards in Chapter IV. You will find one card
for each lesson plan in the Supplementary Audio-Visuals Kit. They are each marked with a
code number such as II, 13 which means it would belong to the lesson Plan for Unit II, Mes
sage 13. The same code appears on the corner of the lesson plan. These cards are simply
drawn, so you will be able to make sufficient copies (see Chapter IV) to give one to each of
your VHWs when they have learned the message. Rubber stamps can be made so you can
need to show them how they can use them toneed a plastic cover to keep them in. You will
prepare all the cards you need. The VHWs will help remember the lesson, and the way they
can teach in the village.
The challenge is ours, let us share our suceesses and failures.
5
Lesson Plan
I—11
UNIT I — CARE OF UNDER-FIVES
Message 11 :
Dehydration is a serious condition caused by diarrhoea which can be prevented by giving
the child plenty of water to drink.
WHAT to Teach
A.
Review of the causes of diarrhoea.
1. Wrong kind of diet (including water) and not
giving the child enough food, right kinds, and
clean water to drink.
2. Infections— germs, intestinal worms found in
dirty food and water.
B.
Introduction to need for water to drink.
1. Early symptoms of dehydration.
— lips and tongue are dry.
— child acts thirsty.
— eyes begin to look sunken.
— skin stands up on pinching.
2. Give enough water to replace what is lost in
watery stools.
3. Water can be added to food to make it liquid
or soft.
HOW to Teach
Discuss
Think of some children you have seen with
diarrhoea. Did they have enough food ? (Mother’s
breast milk is not enough after 3 months.)
Were they given water to drink ?
Where did the mother get the water ?
Where do the germs and worms come from ?
Do the mothers in your village give water to a child
with diarrhoea, or do they stop ? Why ? How can
we persuade them that water is needed ?
Equipment
2 empty tins or plastic bags with a hole in the
bottom of each. Water in a container. Empty
pan.
Experiment
Pour water in each tin or plastic bag. Show how
water runs out of the hole in each tin (or bag) into
the empty pan like a watery stool. Keep pouring
water into only one tin or bag to replace what is
lost. What happens ?
(One tin empty, while second remains full).
The empty tin is like the child who is not given
7
water to drink----- it dries up — loses weight etc.
c.
Review.
1. Early symptoms of dehydration.
2. Give water to replace what is lost.
3. Add water to food given.
Questions
How will you know that a child needs to have extra
water to drink ?
Why does a child with diarrhoea need more water ?
How can we give it to him ?
D.
Practice by each VH\V.
How can you persuade a mother to give water to her
children with diarrhoea.
Tell and show the experiment to persuade her.
E.
Give out Reminder Card.
8
Lesson Plan
1 — 13
UNIT I — CARE OF UNDER-FIVES
Message 13 ;
Water given to a child to drink should be from a clean source.
WHAT to Teach
HOW to Teach
A.
Review of need to give water to prevent dehydra
tion in children with diarrhoea.
1. Early symptoms of diarrhoea.
2. Give enough water to replace that lost in
stools.
3. Water can be added to food.
4. Serious symptoms of dehydration.
5. Give rehydration fluid (medicine water).
Discuss
Have you talked with any mother about giving water
to children with diarrhoea ? If you were able to per
suade them, how did you do it? Have any of them
tried it? Can you offer to give it and take the res
ponsibility ?
Make rehydration fluid.
B.
Introduction ; Need for clean water to drink.
1. Sources of Dirty water — Why dirty ?
—open well, ponds, river
—trash, leaves fall into water
—bird and animal droppings, and human
excretions wash down into water when it
rains or through the ground.
—washing dirty clothes, bathing near water
■source
—dirty buckets
—water stored in open containers on the
ground, and dipped out with dirty dipper
2. How to get clean water ;
—Pump in well if possible, otherwise clean
bucket to remove water.
Borehole well and pump.
Discuss What are the causes of diarrhoea ? Why did
we say to give boiled water to a new born baby?
Equipment
Flannelgraph on dirty and clean water.
Demonstrate Show visual aids. Discuss the sources of
water in their villages. Are they clean? Where do
you store water ?
How do you get it out of the container to drink ?
Discuss Does your village have a “pukka” well? Could
you talk to the panchayat leaders about WHAT can
be done to improve the water source ?
Discuss
Has anyone come from the Government to put medi
cine in your wells, especially in the cholera season ?
9
—Medicine put in contaminated (dirty) well to
kill germs.
—Potassium Permanganate ( “Lal ” or Red
medicine) may result in slightly pink water
— this is not harmful and will go away.
—Bleaching powder (Chlorinated lime) is
colorless but better than P.P. solution.
C. Review
1. Source of dirty water
2. How to get clean water in
sources.
D.
Practice by each VHW
E.
Give out Reminder Cards.
the community
Persuade the panchayat to make a plan for making
a good well, or improving the existing wells.
Have one of the VHWs repeat the class as if she were
teaching people in the village. Ask the others to
make necessary corrections.
Have as many of the VHWs as possible repeat the
class until all know it.
10
1 — 14
Lesson Plan
UNIT I — CAKE OF UNDER-FIVES
Message 14 : Water given to a child to drink can be made clean (purified).
WHAT to teach
HOW to Teach
A.
Review of water sources, and getting clean water
in the community or village.
— sources of dirty water
— how to get clean water to drink in the village.
Discuss
What are the sources of the water used for drinking
in your village ? What are ways in which clean
water can be made available ?
B.
Introduction to clean water in the home.
1. Clean water can become dirty by
— storing in an open jar or pot
— using unclean utensils, dipper or glass
— keeping the water pot on the ground open
and where dust and dirt from sweeping
can get in.
2. If clean water becomes dirty, how can it be
made safe to drink ?
i) Boiling is the best, but expensive; Filter
through a cloth, boil, and store in a covered
jar. Try to give under-five children in the
family boiled water during the time when
diarrhoea is most common in the village.
If your village has a good source of clean water for
drinking, a pukka well, borehole well with pumps, how
is it possible for it to get dirty before you drink it in
your house ?
ii) Filter with four-jar system
Equipment
Pot with cover, Dipper or cup, Visual aid —
Flannelgraph
Demonstrate
Covered pot on a raised stand. Dipper up side down
on the cover, or hanging nearby. (Show in a village
home if possible).
Equipment
Kerosene tin of water, 4 litres, 400 grams fresh
bleaching powder.
Demonstrate
Flannelgraph showing.
1) — boiling and storing water
11
2)
iii) Medicines for purifying water
— make bleaching powder solution (100
grams in 4j litres of water).
— or 5 drops of tincture of iodine in 1 litre
of water. Leave both of these half an
hour before drinking.
(Ask the Health team to help you pre
pare these medicines for either village wells or water
in the home).
3)
— Four-jar filtering
— each jar has a hole in the bottom excepting
the collecting jar on the bottom
— Top jar with gravel
-— Second jar with clean sand
— Third jar clean powdered charcoal
— Dirty water in the top one is clean when it
reaches the bottom.
Medicine
Put 100 grams of bleaching powder in 41 litres
of water and leave overnight. Store clear fluid
in dark glass bottle, the next morning. One
teaspoon of this liquid in 1 kerosene tin of
water for half an hour will purify it.
C.
Review Purifying water in the home.
1. How water gets dirty even when it was clean
when you brought it home.
2. Ways of cleaning water at home
-— boiling
— filtering with 4 jars
— medicines : Chlorinated lime. Iodine.
Questions
How would you tell the villagers about the ways
water gets dirty? Show the flannelgraph on boil
ing. filtering and storing water. Tell how the medi
cine was used to clean the water.
D.
Practice
Ask each of the WWs to answer the questions and
use the flannelgraphs as done in the Review.
Explain the card as usual. Stress that clean water is
especially important for children; but everyone needs
to have clean water for drinking.
E.
Give out Reminder Card
2)
iii) Medicines for purifying water
— make bleaching powder solution (100
grams in 4} litres of water).
— or 5 drops of tincture of iodine in 1 litre
of water. Leave both of these half an
hour before drinking.
(Ask the Health team to help you pre
pare these medicines for either village wells or water
in the home).
3)
■— Four-jar filtering
— each jar has a hole in the bottom excepting
the collecting jar on the bottom
— Top jar with gravel
■— Second jar with clean sand
— Third jar clean powdered charcoal
— Dirty water in the top one is clean when it
reaches the bottom.
Medicine
Put 100 grams of bleaching powder in 44 litres
of water and leave overnight. Store clear fluid
in dark glass bottle, the next morning. One
teaspoon of this liquid in 1 kerosene tin of
water for half an hour will purify it.
C.
Review Purifying water in the home.
1. How water gets dirty even when it was clean
when you brought it home.
2. Waj’s of cleaning water at home
— boiling
— filtering with 4 jars
— medicines : Chlorinated lime. Iodine.
Questions
How would you tell the villagers about the ways
water gets dirty? Show the flannelgraph on boil
ing, filtering and storing water. Tell how the medi
cine was used to clean the water.
D.
Practice
Ask each of the VHWs to answer the questions and
use the flannelgraphs as done in the Review.
Explain the card as usual. Stress that clean water is
especially important for children; but everyone needs
to have clean water for drinking.
E.
Give out Reminder Card
12
1 — 32
Lesson Plan
UNIT I — CARE OF UNDER-FIVES
Message 32 : Treat burns by placing the burned part in cold water for at least ten minutes.
WHAT to Teach
HOW to Teach
A.
Review of care of children with Fevers
— cool water sponge
— fresh air, no heavy covering
— lots of cool water to drink (not hot water)
— baby aspirin
Discuss
Have you taken care of children with fever? What
did you do? When should you take the child to see
the Health Team or doctor?
B.
Introduction of First aid for burns.
1. Put the burned part immediately in cold water
or pour cold water over it, or wrap in clean
cloth kept wet with water)
— Leave in cold water at least ten minutes,
or until it stops hurting
— What this does —
* stops pain
* cools the flesh so it won’t burn and damage
deeper part.
— Don’t remove clothing that is stuck to the
skin.
2. When to take the child to the clinic or Health
Team.
Discuss
Have you seen any children with burns ? How did
it happen ? What is the village treatment for this ?
Equipment
Burning stick. Pot of warm water (to represent
boiling water) Pot of cold water, dipper or cup,
clean cloth or rags.
Demonstrate
Put burning stick in cold water and leave until it
stops burning.
Have one VHW pretend to have her arm burned.
Show how to put her arm in cold water. Take part
out to see if it has stopped hurting. If not, put it
back in water.
Repeat using shoulder or head that can’t be put into
the water using cold wet cloth to wrap the part.
Keep the cloth wet. Check by removing to see if
pain has stopped.
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— the burned or blistered area is bigger
than the palm of your hand
— the face is burned.
3. What to do for small burn
— after burn stops hurting when you take it
out of water, keep it clean and dry.
Show how wet cloth can be kept on burned area
while the patient is taken to the clinic.
Discuss
What do you do for a small burn ? When surface
skin is red ? — blistered ? (re-enforce good prac
tices for example, leaving blisters unbroken).
C.
Review main points
1. First-aid — cold water
2. When to take patient to clinic
3. Small burns — keep clean and dry
Questions
Role play by two VHWs to show the points to be
followed.
D.
Practice by each trainee.
Acting out — VHWs take turns being the patient and
the VHW treating the burn. Use different parts
of the body (head, feet, etc.) and different sizes of
burns.
Ask some children to act as patients.
E.
Give out Reminder Card.
14
Lesson Plan
1 — 33
UNIT I — CAKE OF UNDER-FIVES
Message 33 : Prevent burns by safe practice with fire, hot stoves and hot plates.
HOW to Teach
WHAT to Teach
A.
Review First aid treatment of burns in children.
— cold water for ten minutes
— when to take to the clinic
— what to do for small burns
Role play or acting
Ask VHWs to act out a play —■ one pretending to
be burned, the other giving treatment. Or try to
have children play the part of the burned person.
Discuss experience of teaching they have carried out
on burns.
B.
Introduction on Prevention of Burns*
*(Note : Points to be taught will vary from place
to place. Find out most common causes of burns
in your area; include only 2 oi- 3 ways of preven
tion that will be most effective. You may find
better ways than the suggestions below).
Discuss which are the most common causes of burns
in your village ?
How can children be kept away from fires ?
Keep small children away from the cooking
fire, by a low protective wall.
— to prevent touching the fire
— to prevent pulling hot water or dal over
2. Store kerosene and matches out of reach of
children.
3. Used matches which are still hot.
— throw into fire
1.
Equipment
Fireplace, chula or common stove used for
cooking. Kerosene tin, matches. Empty tins
with covers or containers. Extra stores, brick
or mud.
Demonstrate
1. Build a “guard” of stones or brick which would
keep a crawling child from coming too close.
Keep matches in a tightly closed tin. Put kerosene
tin. tightly closed, high above the reach -of children.
3. Put used matches in an empty tin, or in fire.
2.
15
— put into an empty tin or something which
will not burn.
4. Pour kerosene carefully to avoid spills.
5.
Keep loose clothing from catching fire.
Teach an older child to watch younger children
to keep them away from fires and hot pots.
7. Build the fireplace high enough so small child
can’t reach it
6.
C. Review the points you have taught.
Have a VHW pour kerosene (or water to represent
it) from the tin into an empty tin.
Show how mother's sari can be tucked in when she is
working near the fire.
Discuss how they might build a guard around the fire,
and how children might be taught what ‘hot’ means
when used as a warning.
Discuss Possibility of raised fireplace.
4.
Questions
What could you do in your homes to prevent accidents
with the cooking fire, lanterns, or lights of other
kinds?
D.
Practice.
Have each VHW teach the others the points covered
until they know them.
E.
Give out Reminder Cards.
Show how the card can be used, to re-enforce review.
Ask them to teach others before the next class.
16
Lesson Plan
1 — 34,35
UNIT I — CAKE OF UNDER-FIVES
Message 34 ; Cuts and wounds should be kept clean and dry to help them heal quickly.
35: Cuts and wounds should be pre-vented by keeping dangerous cutting instruments out
of reach of children, and removing broken glass andsharp stones.
WHAT to Teach
HOW to Teach
Review prevention of burns.
— protection around the fire
-— safe keeping of matches and kerosene
— protection of clothing
— teaching of children about what is ‘hot’
— high fireplace
Discuss
Did you teach anyone how to protect children from
being burnt? Did you make any change in your
own home ?
Introduction On care of minor cuts and wounds.
1. Cut or broken skin allows dirt and germs to
get inside the body.
2. What to do —
— wash gently with clean water and soap (if
possible) or salt in the water, until it is
clean *wash surrounding skin first, then
the wound itself.
— Some bleeding is not harmful (If it con
tinues, stop it with pressure by putting a
pad of cloth on the wound and then
bandage).
— Keep the wound clean and open to the air.
(If it is on the foot or likely to get dirty,
then protect it with a bandage).
3. Keep cutting instruments put away where a
Discuss
What do you usually do in the village when a child
is cut, or the skin is broken ? Does it happen often ?
A.
B.
Equipment
Clean water in container, bowl, soap or salt, clean
cloth (bandage).
Demonstrate Pour water over the cut. Use soap on
a wet cloth to clean the skin around wound. (May
need to put the cut part into water in a bow) Gently
but thoroughly clean the cut or wound.
Dry and leave open, or bandage to keep clean.
If bleeding continues, then put folded cloth pad and
bandage on.
Discuss Where can knives, grass-cutters etc. be kept
.17
child will not find them.
— clean away broken glass or sharp stones
so child won’t be cut by these.
in the house ? Where can cut glass and stones be
thrown away so child won’t be injured ?
c. Review.
1. Germs and dirt get through cuts and breaks
in the skin.
2. Wounds must be kept clean and dry.
3. Dangerous instruments, stones etc. should be
kept away from children.
Question
Why are cuts dangerous to the child ? What will
help wounds to heal quickly ? How can we prevent
such injuries?
D. Practice.
Have VHW’s each do a dressing for an imaginary cut
or wound, using various parts of the body for the
location of the cut.
E. Reminder Cards.
18
1 — 36,37
Lesson Plan
UNIT I — CARE OF UNDER-FIVES
Message 36 : If a cut or wound is infected, it should be soaked and cleaned several times a day.
37: Make sure that a child with a wound has been immunised for tetanus.
WHAT to Teach
HOW to Teach
A.
Review of care of minor cut or wound.
— Germs can enter body.
•— Heal quickly if they are clean and dry
— Keep dangerous things away from children.
Role-play A VHW or child to act as patient and
others show how to care for a cut on the arm/foot.
Question Why are cuts dangerous ? How can we
prevent them ?
B.
Introduction to caring for an infected wound, or
sore.
1. Germs have gotten inside the skin making the
wound infected.
2. Dressing for an infected wound : soak 2 or 3
times a day in warm salt water.
— clean as for a fresh cut
— keep clean and dry
— cover with bandage only if the wound is
on the foot, or likely to get dirty.
3. Find out if the child has had a tetanus toxoid
immunization. If not, take him to the health
team for injection.
Equipment
Deep bowl or bucket, soap, clean warm water with
salt, clean cloth, bandage.
Demonstrate
“
~
Cover the sore with warm water (with salt dissolved
in it), and soak. With fresh salt water and clean
cloth, clean as you did the fresh cut. Dry and leave
open. Cover only if it is on the foot or likely to
get dirty.
Discuss
How does tetanus get into the body? Are all the
children in your village immunized against tetanus?
If not, plan a day for giving the immunization to
them, with the health team.
C.
Review
1. Germs are the cause of infected sores or
wounds.
Questions
(Make sure they know the main points).
19
Infected sores need to be soaked and kept
clean and dry.
3. Children with cuts or wounds need to be
immunized against tetanus.
2.
D.
Practice
What would you do for a child with an infected wound
or sore ? Show how you would do the dressing, after
soaking the part.
E.
Give out Reminder Card
Ask each VHW to use the Card to help her remember,
and to start treating a child with infected sores in her
village.
Lesson Plan
1 — 38
UNIT I — CARE OF UNDER-FIVES
dessage 38 :
If
a
child
stops
breathing. IMMEDIATE treatment is necessary.
WHAT to Teach
HOW to teach
A.
Review of Care of infected wounds.
1. Infection caused by germs.
2. Infected wound needs soaking and dressing to
clean it.
3. Tetanus immunization needed.
Equipment
Deep bowl or bucket, soap, clean warm water
salt, clean cloth, bandage, ointment.
Demonstrate by VHW of dressing for an infected
wound.
B.
Introduction What to do for a child who has
stopped breathing.
1. “Not breathing” caused by
— a block in the air passage
— damage to the brain which makes it stop
breathing, for example in suffocation and
lack of oxygen (or air).
2. “Blocks” are caused by thick mucus, blood.
vomiting, or food, a seed, or anything which
makes the child choke
— symptoms ; choking, coughing, child strug
gles, turns blue, unconscious.
3. What to do :
— hold baby up by ankles or over one arm and
pat sharply 2 or 3 times on the shoulders
— lay the child on its back with head back, and
clean out the mouth with your finger (and
cloth)
— blow some air into the child’s mouth about
Discuss
Have you ever seen a child when he stopped brea
thing ? What was the cause? Why does a new born
baby not start breathing sometimes ? What can you
do? What kind of things can block a child’s brea
thing? What do you think can be done about it ?
before demansbate
Demonstrate : using a balloon to represent lungs
in a doll, show how to breathe into it, and let the
air come out again.
Equipment
Balloon, doll, clean cloth pieces, Visual Aid
Demonstrate
Try to show the steps of the treatment
with a baby or child (as described in the left
column). The cloth may be used around the little
finger to clean the mouth and throat. BUT if you
don’t have any, use your finger.
21
20 times a minute until it starts breathing
again.
— you may need to clear out the mouth with your
finger again.
You may put a thin cloth over the child’s mouth
and nose before you put your mouth over them to
blow, Cover both the nose and mouth when you
blow in, then move your mouth away so air comes
out.
C.
Review
1. Caused by blockings in airway or by brain
damage.
2. Steps to take — pull head back, jaw up, re
move obstruction, give air “breaths” to start
child breathing.
Discuss — causes, How can we prevent these ?
Show how you would treat the child that stops
breathing.
How long would you do this ?
Explain the visual aid (balloon) on artificial respi
ration.
D.
Practice.
VHWs should show how to start breathing with a
child or explain the visual aid on artificial respiration.
E.
Give out Reminder Card.
22
II —7,8
Lesson Plan
UNIT II — PREVENTION OE MALNUTRITION INCHILDREN
Message 7: Breast milk is the best food for infants.
8 : Start breast feeding imediately after- birth and supplement with boiled water between feedings.
WHAT to Teach
HOW to Teach
A.
Renew the health problems in the villages, re
cognised by VHWs. Try to pick up the fact that
a majority of deaths are among the very young
children so we will begin with this problem.
Discuss
What do you think are serious problems in your
villages ? What deaths have there been recently ?
What is the age of those who died? Why did they
die? Are there many sick in the village? What
are their ages ? What are the symptoms of the sick
children ?
B.
Introduction to breast feeding of infants.
1. Why is breast milk best ?
— first three months provides all nutritional
requirements, and
— protection against some diseases.
— reduces diarrhoeal diseases caused by in
fections etc.
— always available (except when mother is ill
or has too little), making other arrange
ments necessary.
— mother can show her love for the baby
which is good for growth.
2. Should be started right after birth.
3. A little boiled water should be given to the
baby between feeding.
Do any of you have young children you are breast
feeding ? Are they taking anything else ? When
did you begin to feed your newborn baby ? (Reen
force usual practice of rural mothers to breastfeed
their babies until next baby is born)
It is the custom to wait for three days before feeding
the baby at the breast.
How is milk given in these three days? How can you
persuade the mother to start right away to breast
feed and to give boiled water ?
Equipment
Clean small bowl, boiled cool water, spoon or
other feeding instrument, clean cloth.
Demonstrate Give the child small sips of water (one
or two teaspoons the first time).
23
— the mother may object — try to reassure
her; take the responsibility, do it your
self. assuring that if there is any difficulty
you will care for the child and get help
from the health team.
— Give one or two teaspoons of boiled and
cooled water to the child.
— Put the baby over your shoulder and pat
on the back gently to get the air out.
— See the child frequently to reassure the
mother.
— Do this for several days.
4. Mother should give breast feeding as baby
wants it. A small baby may need it often.
Discuss A baby needs water and food when it is very
small just as planted seed needs water and fertiliser
to grow. We don't wait until late or they will be
very weak.
C.
Review
1. Breast milk is best food for baby.
2. Start breast feedings right after birth.
3. Give a baby boiled water.
4. Feed baby when it wants.
Questions
Why is breast milk good for the baby ? When should
it be started ?
When should we give water to a baby? How often
should the baby be fed ?
D.
Practice
(This may take more discussion in successive
classes because in many places, water is not given
during the first year).
Show and explain how and why we need to give water
and breast feeding to a baby soon after it is born.
E.
Reminder Cards
Explain how they can be used by the VHW to
help her Remember the points she needs to teach.
Give out the Cards and go through the points care
fully. The VHWs should understand how the pictures
show the main points she needs to teach.
‘•Bubble” the baby on your shoulder.
24
Wj
II —9
Lesson Plan
UNIT II — PREVENTION OF MALNUTRITION IN CHILDREN
Message 9: Soft, semi-solid foods should be given to the baby starting gradually from about the fourth month.
WHAT to Teach
HOW to Teach
A.
Review Give breast milk and boiled water to a
baby beginning soon after birth.
Like a seed that needs water and fertilizer to
grow, a baby needs water and food when it is
tiny.
Discuss (take plenty of time because this is against
the usual practice and belief).
Did you talk to anyone about giving boiled water
to a newborn baby? — starting breast feedings
right after birth? What was the reaction? Has
anyone tried giving water to a baby? What was
the result ?
B.
Introduction to give a baby semi-solid food beginn
ing from fourth month.
1. After the third month. Mother’s milk becomes
less and less, as the baby's body needs more
food, because it is growing.
2. From the fourth month the baby’s stomach is
ready to take more food.
3. Begin with a small amount of mashed banana
(or mango or papaya)
— other foods to try, according to what is
available in their homes :
— well cooked mashed rice with a little milk
and sugar (kanji is especially good).
— kanji of suji or ragi
— dal soup
— soft cooked yellow of egg (if they can
afford it).
Discuss — When do you give the baby something
besides mother’s milk? Which month is the “anna
prasana?” (bth) Why not continue to give food (as
many Brahmin families do) after this “ricefeeding”
ceremony ?
Equipment
Dish, ripe banana (mango or papaya)
Demonstrate Mash some banana (or mango or
papaya). Be sure everything is clean. Take a little
on your clean finger, and put it in a baby’s mouth.
(Try to do this with a VHW’s baby). If he spits
it out, try again, patiently. Repeat next day until
he learns how to swallow and to like it.
Equipment
Flour of Jawar, ragi or other grain, pan. water
(or milk if available), fire, sugar, gur or salt.
25
4. Add one at a time of these gradually every
week or so.
Remonstrate Jawar (or other grain) (ground flour).
Roast on the fire; cook in water (or milk). Add
sugar, salt or gur. Give a small amount to the
baby, as you gave fruit.
C.
Review begin to give baby semisolid food from
the fourth month.
1. Mother’s milk less, child needs more.
2. Baby’s stomach ready from four months.
3. Small amounts of mashed fruits, Kanji, dal
soup etc. may be given.
4. Increase amounts and kinds gradually.
Discuss — Did tire baby take the food? Has he learned
to swallow? Why does the baby need more food?
What can you give at four months?
D.
Practice
Have several VHWs practice one of the above, and
try to feed it to a child, Ask them to try at home.
E.
Give out Reminder Card.
26
Lesson Plan
in—g
UNIT HI — ANTENATAL, MATERNITY AND POSTNATAL CARE
Message 6 : A pregnant woman should eat more than she eats normally.*
HOW to Teach
WHAT to Teach
A.
Review on Tetanus Toxoid during pregnancy.
— protects mother, and the child (for three
months) from tetanus
— two injections by the eighth month. First any
time after three months.
Discuss
Why is it important for the mother to have this
injection ? How many should she have — When ?
B.
Introduction to nutrition of mother to be.
1. She is feeding herself, and the unborn baby
as well.
— baby grows rapidly, and needs food.
— mother will feel weak, tired because her
food is used for baby’s body.
— baby will be born weak, unable to suck
milk properly, get sick quickly or too easily.
Many born too soon, die quickly. Mother
is RESPONSIBLE for the unborn baby.
2. Baby growing in the mother is also a member
of the family.
— She is not selfish if she eats a little more.
because another member of the family is
growing in her.
— it is her DUTY to eat more.
Why should the mother eat more? Another way to
protect the child.
Where does the unborn baby get food ? How will the
mother feel if she doesn't eat enough ? What is likely
to happen to the child when it is born? Do mother’s
usually eat more when they are pregnant? How can
you persuade her to do so? Does she need to feel
guilty? When does the mother usually eat? Is there
enough left for her?
Demonstrate Ask VHW to put on the thali what she
usually eats. Add just a spoonful more, or half a
chapati for the growing baby.
Discuss Would this be possible ?
Review
1. Eat for two.
Question
Why should the pregnant mother eat more? Role-
C.
Equipment
Common food for a meal in pans, thali, spoon.
27
2. Baby is also a member of the family.
D.
Practice
E.
Give out Reminder Card.
Play — trying to persuade a mother.
Each VHW tells how she would teach this point to
a pregnant woman.
“PLEASE don’t tell a village mother to eat eggs and
fruits and drink milk every day. The great majority
of rural mothers just don’t have them, and often
they are not even available if she could buy them.
28
m—7
Lesson Plan
UNIT III — ANTENATAL. MATERNITY AND POSTNATAL CARE
Message 7 : A pregnant woman should eat some green, leafy vegetables every day.
WHAT to Teach
HOW to Teach
A.
Review on a pregnant woman eating more than
she usually does
— eating for two
— baby growing in the mother is a member of
the family.
The baby will be strong IF the mother is strong.
Discuss
Have you talked with other women about a pregnant
woman needing more of what she eats each day?
Did you succeed in persuading anyone to try this?
What problems did they bring up ?
B.
Introduction
She needs iron in her blood so the baby can get
it from her.
1. Green leafy vegetables have iron.
— One way to get iron into the body, eat 1
small bowl (katori) of cooked green leafy
vegetables every day in second half of
pregnancy.
2. The growth of the new baby’s brain may be
affected if the mother doesn’t have enough
food and green vegetables.
— a baby with a weak body can be improved
after birth.
— but the baby’s brain may not develop fully
if it is weak at the beginning.
How can you be sure the mother is strong? Besides
seeing that she eats more? What kind of green vege
tables do you have in your village? How do you pre
pare them to eat? Are they available all through the
year? How expensive are they ?
Review
1. Mother gets iron she needs from eating green
leafy vegetables every day.
What would you tell a mother about iron to make her
strong during pregnancy ?
C.
Example — Discuss
A seed or very young plant needs fertilizer when it
starts to grow. If it is used too late, the plant will
never be as strong as it should be.
29
2, Baby needs iron while its brain is forming
before it is born, so it will develop properly.
Advise a weak, tired pregnant woman to
— eat a little more each day
— eat green leafy vegetables every day.
Ask each VHW to think of a new way to teach this
— song, dance, play etc.
D.
Practice
Questions
Why should a mother have iron in her diet? Where
can she get it? What kinds of vegetables can you
find in your gardens and fields?
E.
Give out Reminder Card.
Ill —18
Lesson Plan
UNIT in — ANTENATAL, MATERNITY AND POSTNATAL CARE
Message 18 : Early recognition of danger signals indicating possible complications, can save a mother’s life.
WHAT to Teach
HOW to Teach
A.
Review of care the mother should take to make
sure she is healthy during her pregnancy.
Diet : enough green vegetables and yellow fruit
or vegetables.
Rest and exercise, breast care.
Avoid heavy work.
Discuss
What are the things the pregnant woman should re
member to do to keep herself healthy? How are these
different from old practices ?
B.
Introduction to danger signs in pregnancy.
1. Signs :
— Anemia — Eyelids pale (inside)
— Face and tongue look pale.
— Eyes look yellowish instead of white.
— Swelling of feet and hands maybe face
(Toxemia)
— Night-blindness (Vitamin A deficiency).
— Uncontrollable vomiting.
— Bleeding.
2. What to do when you see these signs?
— Show to a Health Team member or TAKE
TO THE CENTRE.
Discuss
Do you remember any pregnant woman who was
very sick or even died before or during delivery?
What were the symptoms ? (Try to show some of
the symptoms in an actual patient). WHENEVER
such a patient is admitted to the hospital or dispen
sary, show the VHWs the actual case, and allow
them to see what you do for them).
C.
Review
1. Danger signs (see above).
2. TAKE THE PATIENT TO THS CENTRE or
show to a Health Team member.
Questions
When would you take a pregnant woman to the Cen
tre. or ask a Health Team member to examine her?
Tell the danger signs.
I N\'~ UO
St
31
D.
Practice
E.
Give out Reminder Cards.
Ask each VHW to describe the danger sizns.
Lesson Plan
rv—1
UNIT IV — FAMILY PLANNING
Message 1 :
Family Planning is to improve the life of children and their mother and father.
WHAT to Teach
HOW to Teach
A.
Review postnatal care of mother — symptoms to
be reported to the Health Team or taken to the
Centre.
1. First day after delivery
— heavy bleeding
— severe headache
— unconsciousness
— muscular twitching
2. Second day
— difficulty in passing urine
— fever
— severe abdominal pains.
Discuss
Have you heard of any mother seriously sick or dying
one or two days after her delivery? What were the
symptoms? Could anything have been done during
her pregnancy to prevent these?
B.
Introduction to the need for Family Planning.
1. Fathers and mothers usually have great
“delight” in the first and second child, but as
more come, they may become a burden.
— Food needed for each addition
— Clothes — more needed
— Illnesses more because of less food — medi
cines cost more
— Shelter — more space needed or over
crowding.
— Education can’t afford for many children.
— Time needed to give mother’s care to
One of the reasons for a weak mother and a weak
baby is too many pregnancies and too many children.
As the number of children increase, who suffers when
there is not enough money for clothes, food, medi
cines, education etc? In addition, what happens to
the mother’s health?
Equipment
Flannelgraph on Father’s problems of providing
for family (Mouse story).
Demonstrate
33
children, becomes less and less.
Family Planning means to
— space the number of children so they don’t
come too often
— limit the number so that the parents can
look after them better.
— consider the ability of a father to provide
for children.
Flannelgraph — bring out the problems listed.
Discuss
What would happen if a family had only 2 or 3 chil
dren?
What do your children need during their lives? Can
you provide it? Could you provide it for more chil
dren? Parents can have the number of children they
really want and are able to care for.
C.
Review
1. Many children can become a “burden” instead
of a delight.
2. “Family. Planning” is being able to PLAN the
best life for your family.
Ask VHW to show the Flannelgraph and bring all
the points she has learned into the explanation.
D.
Practice.
Repeat demonstrations by others.
E.
Give out Reminder Cards.
2.
34
V —13,14
Lesson Plan
UNIT V — LEPROSY
Message 13 : Ulcers and Deformities can be prevented.
14 : Injuries to feet and hands must be avoided.
WHAT to Teach
HOW to Teach
A.
Review leprosy contacts may need to take medi
cation.
— Children need to live with parents even if the
latter have leprosy.
— Leprosy may be transmitted by long contact
as happens in families.
— So children, especially, may need to take the
medicine.
Discuss
Do any of your leprosy patients have children? Have
you persuaded them to come for skin tests? — to
take the tablets as the doctor has ordered?
What are the problems ?
B.
Introduction to New Topic
1. Ulcers and deformities are what frighten
people, cause ostracism (Look awful, smell,
hard to heal, discharging).
2. Caused by untreated injuries, as patients don’t
feel pain or have feeling in the skin, example,
thorn pricks.
3. Prevent injuries :
— use eyes before using hands
— watch where you are walking
— keep skin clean
— look carefully at hands and feet to find cuts,
blisters etc.
— massage hands daily with oil
— wash feet at night
Discuss
Do leprosy patients in your village have ulcers? defor
mities? Why are these a problem, since they are not
painful? What do people think about these cases?
How did we test for lack of feeling ? What would
happen if a patient
— touched hot things
— stubbed a toe on a rock
— stepped on a nail ?
How can we keep from getting injured ?
Equipment
Soap and water, oil clean cloth, special shoes.
Demonstrate
Washing and massaging hands and examining feet of
35
■—■ use shoes without nails.
C.
Review of main points
1. Difficulties caused by ulcers and deformities.
2. Caused by injuries.
3. Prevent injuries to hands and feet — using
eyes, cleanliness, massage, using special shoes.
leprosy patient. Show how special shoes are made.
Questions and Visual Aids.
What will you teach the patients in your village ? Why
do we need to prevent ulcers and deformities? How
are they caused? How can you prevent injuries to
hands? to feet?
4J
Equipment
Visual Aid on Care of hands and feet of leprosy
patients.
D. Practice by trainees until all know (in class, or
supervise in village).
E.
Questions:
Show how you care for feet,
patient.
for hands of leprosy
Give out Reminder Cards.
36
VI —7
Lesson Plan
UNIT VI — PREVENTION OF BLINDNESS
Message 7 :
Spread of Eye Infection to other people can be prevented.
WHAT to Teach
A.
Review Eye infections can be cured :
— symptoms — redness, swelling, discharge
— washing of eye with warm water
— use of ointments for 2 to 3 days
— put ointment on both eyes
Untreated eye infections can cause blindness.
HOW to Teach
Discuss
Have you seen redness, swelling or discharge from
eyes in your village? Did anyone try washing the
eyes and using ointment? What happened? Did anyone with sore eyes refuse treatment? What did you
say? What did he say? Did anyone else give him
treatment? What treatment ?
B.
Introduction to the idea that eye infections are
spread easily.
1. How do eye infections spread?
— Eye infections are spread by touching.
— Germs from one person come and touch
another —
— by cloth which has eye germs on it.
— by flies resting on eyes
— by hands which have touched eye germs.
2. To stop spread :
— wipe infected eyes with small cloth used
only for the eyes of that person.
— keep flies away from eyes
— wash hands after- touching infected eyes.
Discuss
Do parents in your village wipe the eyes of their
children with the end of their dhoti or sari? Could
something else be used for a person with sore eyes?
Do you ever see a baby with flies all over the eyes?
Could older children keep the flies away? Is there
some way to get rid of so many flies ? Do people wash
hands before eating? Why? Should eyes also be pro
tected ?
C.
Review
1. Spread by cloth
spread by flies
Questions
How will you get the people to use a separate cloth
to clean infected eyes? Will the people agree that
37
spread by hands
2. Stop spread by cleanliness of these.
flies can make eyes sore?
them?
D.
Practice by all the VHWs.
Each make up a story about how the eyes of many
are sore because people would not listen.
E.
Give out Reminder Card.
How will you convince
38
Lesson Plan
TV —8
UNIT VI — PREVENTION OF BLINDNESS
Message 8 :
If you look you will see things which can tell you a person is going blind.
HOW to Teach
WHAT to Teach
A.
Review
Eye infection symptoms : redness, swelling, dis
charge Treatment — warm water, ointments
Spread : wiping with cloth, hands, flies.
Discuss
How many sore eye cases have you seen this week?
What did you do? Did the people listen to you? Have
you told them how eye infections spread? What did
you say? What did they say? Did you see anyone
wiping the sore eyes of her child with her sari? Did
you suggest a different cloth? What about the flies?
Are the older children helping you ?
B.
Introduction. There are other things besides in
fections which can cause blindness.
1. How to recognize signs of night blindness —
watching the behaviour of the person. When
a person cannot see when it is dark, when
he stumbles at night because he cannot see,
that is a sign that he may be going blind.
2. If you look closely at a person’s eyes, you can
see
a) difficulty in looking at light; keeps eyes
closed
b) dryness of the white part
c) wrinkling of the white part
d) dark spots on the ear side of the white part
e) black part of the eye may become white.
Discuss Have you seen people, especially children, in
your village who have some difficulty in seeing at night
or in dark places? How many?
Bring cases if available to show dryness, wrinkling,
dark spots. Point out where to look and exactly what
to look for; show photos of eyes affected and unaffec
ted. Ask them to look at eyes of others and see the
difference between affected and unaffected eyes.
Suggest a detection campaign in the villages.
Equipment
Photos of eyes with and without Vit. A deficiency.
39
C. Review
Night blindness can be discovered by
a) watching people.
b) looking closely in the eyes.
D.
Practice — recognition and detection campaign
E.
Give out Reminder Card.
Questions
How will you go about organizing your detection of
night blindness campaign? Why is it important?
What is the most serious consequence of blindness ?
Prepare a “quawali” on the topic and bring it to the
next class.
VI —12
Lesson Plan
UNIT VI — PREVENTION OF BLINDNESS
Message 12 :
Immediate First Aid Treatment is necessary in eye injuries to prevent further damage.
WHAT to Teach
HOW to Teach
A.
Review nutritional blindness symptoms — beha
viour, eye examinations, causes poor diet; pre
vention, good diet, Vitamin A.
Discuss : Reaction of people to your teaching — by
people’s words and people’s action. Is detection cam
paign continuing? Could the Health Team help in
some way ?
B.
Introduction to the question of eye injuries.
1. How to know when eye is injured? Watering
of eyes, redness of eye, pain. Does not want to
open it in the light. Injury which is able to be
easily seen.
2. What to do? Clean it with water.
3. When to bring to centre — If the patient still
has pain after washing the eye.
Discuss Causes of Eye injuries: Have you had any
thing in your eye? How does “dirt” get in the eye?
How else can eye be injured? Have you ever seen
someone with an injured eye? How did it happen?
Are injuries frequent in your village? What did eye
look like? Patient says “something is in my eye”.
Equipment
Broad mouthed vessel, clean water.
Demonstrate washing eyes. Cover affected eye with
broad mouth vessel containing CLEAN water. Ask
patient to look up, down and across several times,
object should fall out. If patient still feels something
in the eye send immediately to centre; instruct patient
not to rub the eye.
C.
Review: Ordinary causes of eye injury. How
does an injured eye look? Wash eye with clean
water, send to centre.
Questions
What do your people do when something is in the eye?
How will you get them to wash the eye with clean
water ?
41
D. Practice Wash your own eyes, wash the eyes of
another.
E.
Prepare a drama on blindness being caused because
a patient did not have first aid.
Give out Reminder Cards.
42
vn—1,2
Lesson Plan
UNIT vn — CONTROL OF TUBERCULOSIS
Message 1: Tuberculosis is caused by germs which can be killed by taking medicine.
2 : Taking treatment early will prevent increased symptoms.
WHAT to Teach
HOW to Teach
A.
Review Rehabilitation of blind people.
Discuss progress and problems in the villages of
blindness rehabilitation cases.
B.
Introduction to Tuberculosis.
1. TB is caused by a germ which makes a home
in the chest of the patient.
2. Germs grow and increase in number inside the
chest. When there are too many the person
begins to cough.
3. Medicine will kill the germs and stop any more
from growing.
4. If we can begin the medicine early before the
germs grow to be very many, the person will
get well quickly.
Discuss
What do people do about people who are diagnosed as
TB? What do they say is the cause? treatment? Why
are patients, especially women, ostracised? What can
be done? Have you opened a wild fig and found worm
inside ?
Review 1. Caused by germs.
2. Greater number causes cough.
3. Can be killed.
4. Early treatment is successful quickly.
Questions : How is TB caused? How can germs be
killed? How can we persuade people not to send
patients away from their homes?
C.
Equipment
Several wild figs (or mangoes at end of the season)
Show — cut into the wild figs. One or more is likely
to have worms growing inside.
Discuss : In early cases there won’t be big “houses”
or cavities, and many fewer germs are easy to treat.
43
D. Practice by the trainees until all know.
E.
What will you teach the villagers about TB?
how you will do so.
Show
Give out Reminder Cards.
44
vn —3,4
Lesson Plan
UNIT vn — CONTROL OF TUBERCULOSIS
Message 3 :
4:
Tuberculosis is spreaded by breathing and especially in the cough of a patient.
Learning about how TB germs spread will make people less afraid of Tuberculosis.
WHAT to Teach
HOW to Teach
A.
Review Cause and need for early treatment of TB.
Discuss Have you talked with anyone in your village
about why TB occurs? What did they say? Could
you persuade them that it can be cured?
B.
Introduction to how TB is spread.
1. Germs like a wet place to live (They die when
they dry up)
2. They live in tiny droplets, water and mucus
that come from the lungs when we cough.
3. Coughing spreads germs much further than
breathing, and there is more mucus in the
droplets.
4. We can prevent germs from getting into a
well person if we
— ask the sick person not to allow moisture
from their mouths or nose to get to the
well person
How can germs get from the chest of one sick person
to a well person ?
— keep the cough droplets from spreading far
Equipment
Mirror
Experiment:
Ask someone to breathe on a mirror held close to
the nose. What is on the mirror? does it go away?
Breathe on it at various distances. From how far
does the moisture appear on the mirror ?
Now cough hard on the mirror at various distances.
What comes on to the mirror? Is it different when
it dries? From how far away does the cough leave
something on the mirror?
Conclusion Germs can be spread some distance by
coughing, but not far by normal breathing.
Discuss What does this experiment mean for a
person with tuberculosis? What can be done
instead of sending the patient away from home?
We don’t need to be so afraid.
45
C. Review
1. Germs die when they dry up.
2. Live in droplets from lungs
3. Coughing spreads germs.
4. Prevent spread by stopping droplets from
going from a sick to a well person.
Questions
Where do TB germs live?
Where do they die?
How are they spread?
What habits do we have that would help the TB germs
to spread to other people?
What can we do to stop the spread ?
D.
Practice by trainees.
Show how you can use a mirror to tell people about
germs spreading by a cough. Can you think of
another way (besides medicines) that TB germs can
be killed ? What can you tell people about keeping TB
from spreading ?
E.
Give out Reminder Cards.
46
RELEVANT
TEACHING
AIDS SAMPLES
ARE GIVEN
AS
EXAMPLES.
THEY ARE GIVEN
AS SEPERATE UNITS
BECAUSE THE USER
CAN EASILY USE THEM.
47
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