WHERE THERE IS NO DOCTOR A VILLAGE HEALTH CARE HANDBOOK

Item

Title
WHERE THERE IS NO DOCTOR A VILLAGE HEALTH CARE HANDBOOK
extracted text
C-21

COMMUNITY HEALTH CT.L
47/1. (First Floor) St. Merits r<acL
.

S'- •■>■■--

Words to the Village Health Worker

This is a reprint from

Where 'There Is No Doctor
(Indian adaptation)

published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016

Where There Is No Doctor
a village health care

handbook

David Werner
Adapted for India by
The Voluntary Health Association of India
under the supervision of
C.fjathyamala

widi drawings by the author
Gdachariah and Padam Khanna

Library of Congress Cataloging in Publication Data
Werner, David, 1934Where there is no doctor.
Translation of Donde no hay doctor.
Includes index.
1. Medicine, Popular—Handbooks, manuals, etc.
2. Community health aides-Handbooks, manuals, etc.
I. Title. [DNLM: 1. Rural health-Handbooks. 2. Com­
munity health aides—Handbooks. WA390 W492d]
RC81.W4813
362.1
77-12027

;

Published originally by
The Hesperian Foundation
P.O. Box 1692
Palo Alto, California 94302
U.S.A.

TPA-1\o

International Copyright © 1977 by the Hesperian Foundation

COMMUNITY HEALTH CELL Revised from the Spanish edition:
47/1. (First Floorj St. Morks Road,
Donde No Hay Doctor
Bangalore - 560 001,

^rst English Edition, October, 1977

Second, slightly revised printing —March, 1978

Third, slightly revised printing — September, 1978
Indian Edition

Copyright © 1 980 by V.H A L

First Indian Edition July 1980

Second Indian Edition July 1981
Any parts of this book, including the illustrations, may be copied, reproduced,
or adapted to meet local needs, without permission from the author or publisher,
provided the parts reproduced are distributed free or at cost—not for profit. For
any reproduction with commercial ends, permission must first be obtained from
the author or the publisher. The authors would appreciate being sent a copy of
any materials in which text or illustrations have been used.

THIS IS AN EXPERIMENTAL ENGLISH EDITION.
It can be improved with your help. If you are a village
health worker, doctor, mother, or anyone with ideas
or suggestions for ways this book could be changed to
better meet the needs of your people, please write to
the Voluntary Health Association of India.
Thank you for your help.

Copies of this book can be obtained from:
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi-1 10 016
India

A Hindi edition is now in preparation.

In order to keep down the cost of this book, the present English edition has
not been published by a commercial publisher. This means we need help in its
distribution. We are looking for ways to get this book to those it can serve bestnamely persons in isolated villages and fringe communities. I f you are able to
help or have suggestions, please contact the Publications Officer at the
VHAI address.

THANKS
I would like to thank the following persons for their important contributions to the
preparation and review of the original Spanish edition of this book

Vai Price. pediatrician.-AI Hotti. intermst;Rodney Kendall. dermatologist;Max
Capestany. obstetrician and gynecologist;Rudolf Bock. ophthalmologist.-Kent
Benedict. pediatrician.-Alfonzo Darncades. general practitioner;Carlos Felipe
Soto Miller, general practitioner and surgeon.-Paul Quintana, pediatrician.
For this English edition I would especially like to thank Dr. David Morley, pediatrician.
Dr. Vai Price, pediatrician. Bill Bower, medical educator, and Allison Orozco, physician's
assistant, for their careful review and valuable suggestions . .. also Susan and Greg Troll,
practical midwives, for their help in the revision of the chapter for mothers and midwives.

I would also like to thank the medical and health personnel in parts of Africa, Asia,
and Indonesia for their suggestions of what to include . . . and to thank Dr. Jack Lange of
Lange Medical Publications for helping make contact with many of these persons.
I thank McGraw-Hill Book Company for permission to use drawings appearing on
pages 85 and 104 taken from Emergency Medical Guide by John Henderson, illustrated
by Niel Hardy. My thanks to Dale Crosby for drawings on pages 29,32, 35, 100, 181, and
200. And to my father, Carl Werner, for drawings on pages 5-8, 121,187, 229, 231
235-238,240, 245,256, 276, and 281.

For assistance in translation from the Spanish, I would like to thank Roger Bunch,
Lynne Coen, George Kent, Jack May, Greg and Susan Troll, Dr. Rudolf Bock, Oliver
Bock, Bill Gonda.and Ray Bleicher. . . and for help in graphics, Jesus Manjarrez and Bill
Bower.

My appreciation to Hal Lockwood for his patience, hard work, and care in the
typesetting. For the long hard job of getting the manuscript into useful shape and ready
for printing I warmly thank the team that helped put it together: Carol Westberg, Bill
Bower, Lynn Gordon, Myra Polinger, and Trude Bock.
Trude Bock deserves very special thanks, for not only helping on the book in many
ways, but for generously providing her home, meals, and understanding to those who put
this book together.
This book can be made available at low cost because most of the work was done on a
volunteer basis. My heart-felt thanks to all those who, by giving of their time, money, and
concern, made this possible.

David Werner

WHERE THERE IS NO DOCTOR was revised for India by Dr Sathyamala. who has
worked in Comprehensive Rural Health Planning. Jamkhed. and-Integrated
Community Health Project (Deenabandhu Medical Mission) in Tamil Nadu. She
thanks Drs. Indira Kapoor. Betty Cowan and others of CMC (Christian Medical
College & Hospital). Raj and Maybelle Arole. Han and Prem Chandran John, Vijay
Kumar, R. Kousalya Devi. J.S. Gill. S.A. Kaul. Mira Sadgopal. Bas Bueno de Mesquita
and Sr. Lorraine Ryan. Special thanks to Meals for Millions Foundation. We
reproduce classification on p. 128-131 in the chapter on Nutrition.

Contents
A list of what is discussed in each chapter
INTRODUCTION TO THE ENGLISH EDITION
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages)
Health Needs and Human Needs w2
Many Things Relate to Health Care w7
Take a Good Look at Your Community w8
Using Local Resources to Meet Needs w12
Deciding What to Do and Where to
Begin w13
Trying a New Idea w15
A Balance Between People and Land w16

w1

A Balance Between Prevention and
Treatment w17
Sensible and Limited Use of Medicines w18
Finding Out What Progress Has Been
Made w20
Teaching and Learning Together w21
Tools for Teaching w22
Making the Best Use of This Book w28

Chapter 1
HOME CURES AND POPULAR BELIEFS
Home Cures That Help 1
Beliefs That Can Make People Well 2
Beliefs That Can Make People Sick 4
Witchcraft-Black Magic-and the Evil Eye 5
Questions and Answers 6
M( a ■
Chicken Pox ai d
Small Pox (Mata) 9

Ways to Tell Whether a Home Remedy
Works or Not 10
Some helpful Home Cures 13
Enemas, Laxatives, and Purges 21

Chapter 2

25

SICKNESSES THAT ARE OFTEN CONFUSED
What Causes Sickness? 25
Different Kinds of Sicknesses and Their
Causes 26
Non-infectious Diseases 26
Infectious Diseases 27
Sicknesses That Are Hard to Tell Apart 28

Examples of Local Names for Sicknesses 30
Confusion between Different Illnesses That
Cause Fever 32
Misunderstandings Due to Confusion of
Names 33

Chapter 3
HOW TO EXAMINE A SICK PERSON
Questions 35
General Condition of Health 36
Temperature 36
How to Use a Thermometer 37
Breathing (Respiration) 38
Pulse (Heartbeat) 39

Eyes 40
Ears 40
41

Skin 42
The Belly (Abdomen) 42
Muscles and Nerves 45

Feet 47

Chapter 4
HOW TO TAKE CARE OF A SICK PERSON ....................................................... 49
The Comfort of the Sick Person 49
Special Care for a Person Who Is Very III 50
Liquids 50
Food 51
Cleanliness and Changing Position in Bed 51

Watching for Changes 51
Signs of Dangerous Illness 52
When and How to Look for Medical Help 53
A B’( v< le Ambulance 54
What to Tqll the Health Worker 54

Chapter 5

HEALING WITHOUT MEDICINES...................................................................... 55
Healing with Water 56
When Water Is Better than Medicines

57

Chapter 6

RIGHT AND WRONG USE OF MODERN MEDICINES................................... 61
Guidelines for the Use of Medicine 61
The Most Dangerous Misuse of Medicine 62
What to Eat When Taking Medicines
65

When Should Medicine Not Be Taken?

66

Chapter 7
ANTIBIOTICS: WHAT THEY ARE AND HOW TO USE THEM........................67
Guidelines for the Use of Antibiotics 68
What to Do if an Antibiotic Does Not Seem
to Help 69
Importance of Limited Use of Antibiotics 70

Chapter 8

HOWTO MEASURE AND GIVE MEDICINE....................................................... 71
Medicine in Liquid Form’ 73
How to Give Medicines to Small Children
How to Take Medicines 75

74

Dosage Instructions for Persons Who
Cannot Read 75

Chapter 9

INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS.............................. 77
When to Inject and When Not To 77
Emergencies When It Is Important to Give
Injections 78
Medicines Not to Inject 79
Risks and Precautions 80

Dangerous Reactions from Injecting Certain
Medicines 81
Avoiding Serious Reactions to Penicillin 84
How to Prepare a Syringe for Injection 85
How to Inject 86

Chapter 10

FIRST AID..........................................

....................................................................... 87

Fever 87
Shock 89
Loss of Consciousness 90
When Something Gets Stuck in the
Throat 91
Drowning 92
When Breathing Stops: Mouth-to-Mouth
Breathing 92
Emergencies Caused by Heat 93
How to Control Bleeding from a Wound 95
How to Stop Nosebleeds 96
Cuts, Scrapes, and Small Wounds 97
Large Cuts: How to Close Them 98
Bandages 100

I n fected Wounds 101
Bullet, Knife, and Other Serious Wounds 103
Emergency Problems of the Gut
(Acute Abdomen) 106
Appendicitis, Peritonitis 108
Burns 109
Broken Bones (Fractures) 111
How to Move a Badly Injured Person 113
Dislocations
(Bones out of Place at a Joint) 114
Strains and Sprains 115
Poisoning 116
Snakebite 119
Other Poisonous Bites and Stings
123

Chapter 11
NUTRITION: WHAT TO EAT TO BE HEALTHY .............................................125
Sicknesses Caused by Not Eating Well 125
Foods Our Bodies Need to Stay Healthy 128
What It Means to Eat Right 131
Eating Better When You Do Not Have Much
Money or Land 135
Where to Get Vitamins: In Pills or
in Foods? 139
Things to Avoid in Our Diet 140
The Best Diet for Small Children 141
Harmful Ideas about Diet 145
Health Problems Related to What People Eat

Anemia 146
High Blood Pressure 147
Fat People 148
Diabetes 149
Stomach Ulcers, Heartburn, and Acid
Indigestion 149
Constipation 151
Goiter
(A Swelling or Mass on the Throat)
Lathyrism 153

152

Chapter 12

PREVENTION: HOWTO AVOID MANY SICKNESSES.................................. 155
Cleanliness —and Problems from Lack of
Cleanliness 155
How Are Diseases Spread 155
Basic Guidelines of Cleanliness 167
Sanitation and Latrines 171
Vaccinations (Immunizations)—Simple, Sure
Protection 175
Other Ways to Prevent Sickness and
Injury 176
Habits That Affect Health 176

Chapter 13

SOME VERY COMMON SICKNESSES............................................................. 181
Dehydration 181
Diarrhea and Dysentery 183
The Care of a Person with Acute Diarrhea 191
Vomiting 190
Wormsand Other Intestinal Parasites 193
Roundworm (Ascaris) 193
Threadworm (Pinworm, Enterobius'i 194
Whipworm (Trichuris) 195
Hookworm 195
Tapeworm 196
Trichinosis 197
Amebas 197
Giardia 198
Headaches a'nd Migraines
Colds and the Flu 200

199

Allergic Reactions
Asthma 204
Cough 205
Bronchitis 207

203

Bronchiectasis
208
Abscess . ’ th* lung 208
Pneumonia 208
Hepatitis 209
Arthritis (Painful, Inflamed Joints)
Back Pain 211
Varicose Veins 212
Piles (Hemorrhoids) 213
Anal Fissure
214

210

Swelling of the Feet and Other Parts of the
Body 214
Hernia (Rupture) 215
Fits (Convulsions) 216

Stuffy and Runny Noses 201
Sinus Trouble (Sinusitis) 202
Hay Fever (Allergic Rhinitis) 202

Chapter 14

SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION ... .219
Tuberculosis (TB, Consumption)
Rabies 221
Tetanus (Lockjaw) 222
Meningitis 225
Malaria 227

219

Sephantiasis

229

Typhoid Fever

229

Cholera

231

Leprosy (Hansen's Disease)

232

Chapter 15

SKIN PROBLEMS.................................................................................................. 235
General Rules for Treating Skin Problems 235
Instructions for Using Hot Compresses 237
Identifying Skin Problems 238
Scabies 241
Lice 241
Small Sores with Pus 242
Impetigo 243
Boils and Abscesses 243
Itching Rash, Welts, or Hives 244
Things That Cause Itching or Burning of the
Skin 245
Shingles (Herpes Zoster) 245

Ringworm, Tinea (Fungus Infections) 246
White Spots on the Face and Body 247
Mask of Pregnancy 248
Pellagra and Other Skin Problems Due to
Malnutrition 248

Warts (Verrucae) 251
Corns 251
Pimples arid Blackheads (Acne) 252
Cancer of the Skin 252
Tuberculosis of the Skin or Lymph
Nodes 253
Erysipelas 253
Gangrene (Gas Gangrene) 254

Eczema
(Red Patches with Little Blisters)
Psoriasis 257

Ulcers of the Skin Caused by Poor
Circulation 254
Bed Sores 255
Skin Problems of Babies 256

257

Chapter 16

....................................................... 259

THE EYES
How to take good care of the Eyes

259

Danger Signs 260
Injuries to the Eye 260
How to Remove a Speck of Dirt from the
Eye 218
Red, Painful Eyes-Different Causes 263
Sore Eyes (Conjunctivitis)
263
Trachoma 264
Infected Eyes in Newborn Babies
(Neonatal Conjunctivitis) 266
Iritis (Inflammation of the Iris) 266
Glaucoma 267

Infection of the Tear Sac
(Dacryocystitis) 268
Trouble Seeing Clearly 268
Cross-Eyes and Wandering Eyes 268
Sty (Hordeolum) 269
Pterygium 269
A Scrape, Ulcer, or Scar on the Cornea
Bleeding in the White of the Eye 270
Cataract 270
Night Blindness and Xerosis 271
Spots or 'Flies' before the Eyes 272
Double Vision 272

269

Chapter 17
THE TEETH, GUMS, AND MOUTH.................................................................... 273
Care of Teeth and Gums 273
If You Do Not Have a Toothbrush 274
Toothaches and Abscesses 275
Pyorrhea, a Disease of the Gums 275

Sores or Cracks at the Corners of the
Mouth
276
White Patches or Spots in the Mouth

276

Chapter 18
THE URINARY TRACT AND THE GENITALS
Urinary Tract Infections 278
Kidney or Bladder Stones 279
Enlarged Prostate Gland 279
Diseases Spread by Sexual Contact
(Venereal Diseases) 280
Gonorrhea (Clap, VD, the Drip) 280
Syphilis 281
Bubos: Bursting Lymph Nodes in
the Groin 283

277

Use of a Catheter to Drain Urine 284
Problems of Women 285
Vaginal Discharge 285
How a Woman Can Avoid Many
Infections
287
Pain or Discomfort in a Woman's Belly 287
Men and Women Who Cannot Have Children
(Infertility) 288

Chapter 19

INFORMATION FOR MOTHERS AND MIDWIVES ........................................ 291
The Menstrual Period
(Monthly Bleeding in Women) 291
The Menopause
(When Women Stop Having Periods) 292
Pregnancy 293
How to Stay Healthy during Pregnancy 293
Minor Problems during Pregnancy 294
Danger Signs in Pregnancy 295
Check-ups during Pregnancy
(Prenatal Care)
296
Record of Prenatal Care 299
Things to Have Ready before the Birth 300
Preparing for Birth 302
Signs That Show Labor Is Near 304
The Stages of Labor 305
Care of the Baby at Birth 308
Care of the Cut Cord (Navel) 309

The Delivery of the Placenta
(Afterbirth) 310
Hemorrhaging (Heavy Bleeding) 310
The Correct Use of Oxytocics:
Ergonovine, Oxytocin, Pitocin, etc. 312
Difficult Births 313
Tearing of the Birth Opening 315
Care of the Newborn Baby 316
Illnesses of the Newborn 318
The Mother's Health after Childbirth 322
Childbirth Fever
(Infection after Giving Birth) 322
Care of the Breasts 323
Lumps or Growths in the Lower Part of the
Belly 326
Miscarriage (Spontaneous Abortion) 327
High Risk Mothers and Babies 328

Chapter 20

FAMILY PLANNING­
HAVING THE NUMBER OF CHILDREN YOU WANT .................................. 329
Is Birth Control Good-and Is It Safe? 330
Choosing a Method of Birth Control 331
Birth Control Pills
(Oral Contraceptives) 332
Other Methods of Birth Control 336

Methods for Those Who Never Want to Have
More Children 337
Home Methods for Preventing
Pregnancy 338
Methods that Do Not Work Very Well 339
Combined Methods 340

Chapter 21
HEALTH AND SICKNESSES OF CHILDREN ................................................... 341
What to Do to Protect Children's
Health 341
Children's Growth—
and the 'Road to Health' 343
Road to Health Chart 344
Review of Children's Health Problems
Discussed in Other Chapters 351
Health Problems of Children Not
Discussed in Other Chapters 355
Earache and Ear Infections 355
Sore Throat and Inflamed Tonsils 356
Rheumatic Fever 356
Urinary Tract Infection
following Strep Throat 357

Infectious Diseases of Childhood 358
Chickenpox 358
Measles
358
German Measles 359
Mumps 359
Whooping Cough 360
Diphtheria 361
Infantile Paralysis (Polio) 361
How to Make Simple Crutches 362
Problems Children Are Born With 363
Dislocated Hip 363
Umbilical Hernia
(Belly Button That Sticks Out) 364

A 'Swollen Testicle'
(Hydrocele or Hernia) 364
Mentally Slow, Deaf, or Deformed
Children 365

The Spastic Child (Cerebral Palsy) 367
Retardation in the First Months of Life 368
Helping Children Learn 368

Chapter 22
HEALTH AND SICKNESSES OF OLDER PEOPLE...........................................369
Summary of Health Problems Discussed in
Other Chapters 369
Other Important Illnesses of Old Age 371
Heart Trouble 371
Words to Younger Persons Who Want to
Stay Healthy When Older 372
Stroke (Apoplexy, Cerebro-Vascular
Accident, CVA) 373

Deafness with Ringing of the Ears and
Dizziness 373
Loss of Sleep (Insomnia) 374
Diseases Found More Often in People over
Forty 374
Cirrhosis of the Liver 374
Gallbladder Problems 375
Accepting Death 376

Chapter 23

331

THE MEDICINE KIT.......................
How to Care for Your Medicine Kit 378
Buying Supplies for the Medicine Kit 379
The Home Medicine Kit 380

The Village Medicine Kit 382
Words to the Village Storekeeper
(or Pharmacist) 385

THE GREEN PAGES-The Uses, Dosage, and Precautions for Medicines......... 387

List of Medicines in the Green Pages.................................................................... 389
Index of Medicines in the Green Pages................................................................ 393
Information on Medicines..................................................................................... 397
VOCABULARY—Explaining Difficult Words..................................................... 427
ADDRESSES FOR TEACHING MATERIALS................................................... 437

INDEX (Yellow Pages)......................................................................................... 443
TEAR OUT SHEETS
Making Medical Reports
Dosage Instructions for Persons Who Cannot Read

Introduction to the English Edition
This handbook has been written primarily for those who live far from medical
centers, in places where there is no doctor. But even where there are doctors,
people can and should take the lead in their own health care. So this book is for
everyone who cares. It has been written in the belief that:
1.

Health care is not only everyone's right, but everyone's responsibility.

2.

Informed self-care should be the main goal of any health program or
activity.

3.

Ordinary people provided with clear, simple information can prevent and
treat most common health problems in their own homes—earlier, cheaper,
and often better than can doctors.

4.

Medical knowledge should not be the guarded secret of a select few, but
should be freely shared by everyone.

5.

People with little formal education can be trusted as much as those with a
lot. And they are just as smart.

6.

Basic health care should not be delivered, but encouraged.

Clearly, a part of informed self-care is knowing one's own limits. Therefore
guidelines are included not only for what to do, but for when to seek help. The
book points out those cases when it is important to see or get advice from a
health worker or doctor. But because doctors or health workers are not always
nearby, the book also suggests what to do in the meantime—even for very serious
problems.

This book has been written in fairly basic English, so that persons without
much formal education (or whose first language is not English) can understand it.
The language used is simple but, I hope, not childish. A few more difficult words
have been used where they are appropriate or fit well. Usually they are used in
ways that their meanings can be easily guessed. This way, those who read this
book have a chance to increase their language skills as well as their medical skills.

Important words the reader may not understand are explained in a word list or
vocabulary at the end of the book. The first time a word listed in the vocabulary
is mentioned in a chapter it is usually written in italics.
Where There Is No Doctor was first written in Spanish for farm people in the
mountains of Mexico where, for the past 13 years, the author has helped form a
health care network now run by the villagers themselves. Donde No Hay Doctor is
now being used throughout Latin America.

This experimental English edition has been prepared as a result of many
requests to adapt it for India. In spite of help and suggestions from persons
with experience in many parts of India, we are still not completely satisfied
with this edition.

To be fully useful, this book should be adapted by persons familiar with the
health needs, customs, special ways of healing, and local language of specific areas.

Persons or programs who wish to use this book, or portions of it, in preparing
their own manuals for villagers or health workers are encouraged to do so.
Permission from the author or publisher is not needed-provided the parts
reproduced are distributed free or at cost—not for profit. It would be appreciated
if you would (1) include a note of credit and (2) send a copy of your production
to the Voluntary Health Association of India. C-14. Community Centre. S. D A
New Delhi-1 10016.
For local or regional health programs that do not have the resources for revising
this book or preparing their own manuals, it is strongly suggested that if the
present edition is used, leaflets or inserts be supplied with the book to provide
additional information as needed.

In the Green Pages (the Uses, Dosage, and Precautions for Medicines) blank
spaces have been left to write in common brand names and prices of medicines.
Once again, local programs or organizations distributing the book would do well
to make up a list of generic or low-cost brand names and prices, to be included
with each copy of the book.

This book was written for anyone who wants to do something about his own
and other people's health. However, it has been widely used as a training and
work manual for community health workers. For this reason, an introductory
section has been added for the health worker, making clear that the health
worker's first job is to share his knowledge and help educate his people.
Today in over-developed as well as under-developed countries, existing health
care systems are in a state of crisis. Often, human needs are not being well met.
There is too little fairness. Too much is in the hands of too few.
Let us hope that through a more generous sharing of knowledge, and through
learning to use what is best in both traditional and modern ways of healing,
people everywhere will develop a kinder, more sensible approach to caring-for
their own health, and for each other.
-D.W.

Words to the Village Health Worker
Who is the village health worker?
A village health worker Is a person who helps lead family and neighbors toward
better health. Often he or she^nas been selected by the other villagers as someone
who is especially able and kind.
Some village health workers receive training and help from an organized
program, perhaps the Ministry of Health. Others have no official position, but are
simply members of the community whom people respect as healers or leaders in
matters of health. Often they learn by watching, helping, and studying on their own.

In the larger sense, a village health worker is anyone who takes part in making
his village a healthier place to live.

This means almost everyone can and should be a health worker:
■ Mothers and fathers can show their children how to keep clean;
■ Farm people can work together to help their land produce more food;
■ Teachers can teach schoolchildren how to prevent and treat many common
sicknesses and injuries;
■ Schoolchildren.can share what they learn with their parents;
■ Shopkeepers can find out about the correct use of medicines they sell and
give sensible advice and warning to buyers (see p. 385);
“ Midwives can counsel parents
about the importance of
eating well during pregnancy,
breast feeding, and family
planning.

This book was written for the
health worker in the larger sense.
It is for anyone who wants to
know and do more for his own,
his family's or his people's well­
being.
, If you area community health
worker, an auxiliary nurse, or even
a doctor, remember: this book is
not just for you. It is for all the
people. Share it!
Use this book to help explain
what you know to others. Perhaps
you can get small groups together
to read a chapter at a time and
discuss it. .

THE VILLAGE HEALTH WORKER LIVES AND WORKS
AT THE LEVEL OF HIS PEOPLE. HIS FIRST JOB IS TO
SHARE HIS KNOWLEDGE.

Dear Village Health Worker,

This book is mostly about people's health needs. But to help your village be a
healthy place to live, you must also be in touch with their human needs. Your
understanding and concern for people are just as important as your knowledge of
medicine and sanitation.
Here are some suggestions that may
help you serve your people's human
needs as well as health needs:
1. BE KIND. A friendly word, a smile,
a hand on the shoulder, or some other
sign of caring often means more than
anything else you can do. Treat others
as your equals. Even when you are
hurried or worried, try to remember
the feelings and needs of others. Often
it helps to ask yourself, "What would
I do if this were a member of my own
family?"

Treat the sick as people. Be
especially kind to those who are very
sick or dying. And be kind to their
families. Let them see that you care.

HAVE COMPASSION.

Kindness often helps more
than medicine. Never be
afraid to show you care.

2. SHARE YOUR KNOWLEDGE. As a health worker, your first job is to teach.
This means helping people learn more about how to keep from getting sick.
It also means helping people learn how to recognize and manage their illnesses—
including the sensible use
TO PMTIHT OH tre*,
of home remedies and
ttHYOKAKOM
common medicines.

LOOK FOR WAYS TO SHARE YOUR KNOWLEDGE.

w2

There is nothing you
have learned that, if
carefully explained,
should be of danger to
anyone. Some doctors
talk about self care as if
it were dangerous, perhaps
because they like people
to depend on their costly
services. But in truth,
most common health
problems could be
handled earlier and better
by people in their own
homes.

3.

RESPECT YOUR PEOPLE'S TRADITIONS AND IDEAS.

Because you learn something about modern medicine does not mean you
should no longer appreciate the customs and ways of healing of your people.Too
often the human touch in the art of healing is lost when medical science moves in.
This is too bad, because . . .
If you can use what is best in modern medicine, together with what is best
in traditional healing, the combination may be better than either one alone.

In this way, you will be adding to your people's culture, not taking away.
Of course, if you see that some of the home cures or customs are harmful
(for example, putting excrement on the freshly cut cord of a newborn baby), you
will want to do something to change this. But do so carefully, with respect for
those who believe in such things. Never just tell people they are wrong. Try to
help them understand WHY they should do something differently.
People are slow to change their attitudes and traditions, and with good reason.
They are true to what they feel is right. And this we must respect.

Modern medicine does not have all the answers either. It has helped solve some
problems, yet has led to other, sometimes even bigger ones. People quickly come
to depend too much on modern medicine and its experts, to overuse medicines,
and to forget how to care for themselves and each other.

w3

4.

KNOW YOUR OWN LIMITS.

No matter how great or small your
knowledge and skills, you can do_a good
job as long as you know and work within
your limits. This means: Do what you
know how to do. Do not try things you
have not learned about or have not
had enough experience doing, if they
might harm or endanger someone.

But use your judgment.
Often, what you decide to do or not
do will depend on how far you have
to go to get more expert help.

For example, a mother has just given
birth and is bleeding more than you
think is normal. If you are only half an
hour away from a medical center, it may
be wise to take her there right away.
KNOW YOUR LIMITS.
But if the mother is bleeding very
heavily and you are a long way from the health center, you may decide to
massage her womb (see p. 311) or inject an oxytocic (see p. 31 2) even if you were
not taught this.

Do not take unnecessary chances. But when the danger is clearly greater if you
do nothing, do not be afraid to try something you feel reasonably sure will help.
Know your limits—but also use your head. Always do your best to protect the
sick person rather than yourself
5. KEEP LEARNING. Use every chance
you have to learn more. Study whatever
books or information you can lay your
hands on that will help you be a better
worker, teacher, or person.

// Always be ready to ask questions of
' doctors, sanitation officers, agriculture
experts, or anyone else you can learn from.

Never pass up the chance to take
refresher courses or get additional
training.
KEEP LEARNING-Do not let
anyone tell you there arc things
you should not learn or know.

w4

Your first job is to teach, and unless
you keep learning more, soon you will
not have anything new to teach others.

6.

PRACTICE WHAT YOU TEACH.

People are more likely to pay attention to
what you do than what you say. As a health
worker, you want to take special care in ycur
personal life and habits, so as to set a good
example for your neighbors.

Before you ask people to make latrines,
be sure your own family has one.

Also, if you nelp organize a work group—
for example, to dig a common garbage holebe sure you work and sweat as hard as
everyone else.

A good leader does not
tell people what to do.
He sets the example.

7.

PRACTICE WHAT YOU TEACH
(or who will listen to you?)

WORK FOR THE JOY OF IT.

If you want other people to take part in improving their village and caring for
their health, you must enjoy such activity yourself. If not, who will want to
follow your example?

Try to make community work projects fun. For example, fencing off the
public water hole to keep animals away from where people take water can be hard
work. But if the whole village helps do it as a 'work festival'-perhaps with
refreshments and music—the job will be done quickly and can be fun.
Children will work
hard and enjoy it, if
they can turn work
into play.
You may or may
not be paid for your
work. But never
refuse to care, or
care less, for some­
one who is poor or
cannot pay.

This way you will
win your people's
love and respect.
These are worth far
more than money.

WORK FIRST FOR THE PEOPLE-NOT THE MONEY.
(People ire worth more.)

8.

LOOK AHEAD—AND HELP OTHERS TO LOOK AHEAD.

A responsible health worker does not wait for people to get sick. He tries to
stop sickness before it starts. He encourages people to take action now to protect
their health and well-being in the future.
Many sicknesses can be prevented. Your job, then, is to help your people
understand the causes of their health problems and do something about them.

Most health problems have many causes, one leading to another. To correct the
problem in a lasting way, you must look for and deal with the underlying causes.
You must get to the root of the problem.
For example, in many villages diarrhea is the most common cause of death in
small children. The spread of diarrhea is caused in part by lack of cleanliness
(poor sanitation and hygiene}. You can do something to correct this by digging
latrines and teaching basic guidelines of cleanliness (p. 167).

But the children who suffer and die most often from diarrhea are those who are
poorly nourished. Their bodies do not have strength to fight the infections. So
to prevent death from diarrhea we must also prevent poor nutrition.

And why do so many children suffer from poor nutrition?
■ Is it because mothers do not realize what foods are.most important (for
example, breast milk)?

• Is it because the family does not have enough money or land to produce the
food it needs?
■ Is it because a few rich persons control most of the land and the wealth?

Is it because the poor do
not make the best use of
land they have?

THINK befw

Is it because parents
have more children than
they or their land can
provide for, and keep
having more?

(its ho.rcler
after-)

W drink

Is it because fathers lose
hope and spend the little
money they have on
drink?

Is it because people do
not look or plan ahead?
Because they do not
realize that by working
together and sharing they
can change the conditions
under which they live
and die?

HELP OTHERS TO LOOK AHEAD.

You may find that many, if not all, of
these things lie behind infant deaths in
your area. You will, no doubt, find other
causes as well. As a health worker it is your
job to help people understand and do
something about as many of these causes
as you can.

DEATH

But remember: to prevent death from
diarrhea will take far more than latrines,
pure water, and nutrition centers. You may
find that family planning, better land use,
and.fairer distribution of wealth, land, and
power are more important in the long run.
The causes that lie behind much sickness
and human suffering are short-sightedness
and greed. If your interest is your people's
well-being, you must help them learn to
share, to work together, and to look ahead.

MANY THINGS
RELATE TO HEALTH CARE
The chain of causes leading

We have looked at some of the
to death from diarrhea.
causes that underlie diarrhea and poor
nutrition. Likewise, you will find that such
things as food production, land distribution, education, and the way people treat
or mistreat each other lie behind many different health problems.
If you are interested in the long-term welfare of your whole community, you
must help your people look for answers to these larger questions.
Health is more than not being sick. It is well-being: in body, mind, and
community. People live best in healthy surroundings, in a place where they can
trust each other, work together to meet daily needs, share in times of difficulty
and plenty, and help each other learn and grow and live, each as fully as he can.

Do your best to solve day-to-day problems. But remember that your greatest
job is to help your community become a more healthy and more human place to
live.

You as a health worker have a big responsibility.

Where should you begin?
w7

TAKE A GOOD LOOK AT YOUR COMMUNITY
Because you have grown up in your community and know your people well,
you are already familiar with many of their health problems. You have an inside
view. But in order to see the whole picture, you will need to look carefully at
your community from many points of view.
As a village health worker, your concern is for the well-being of all the people
—not just those you know well or who come to you. Go to your people. Visit
their homes, fields, gathering places, and schools. Understand their joys and
concerns. Examine with them their habits, the things in their daily lives that
bring about good health, and those that may lead to sickness or injury.
Before you and your community attempt any project or activity, carefully
think about what it will require and how likely it is to work. To do this, you
must consider all the following:
1.
2.
3.
4.
’

Felt needs—what people feel are their biggest problems.
Real needs—steps people can take to meet these problems in a lasting way.
Willingness—or readiness of people to plan and take the needed steps.
Resources-the persons, skills, materials, and/or money needed to carry out
the activities decided upon.

As a simple example of how each of these things can be important, let us
suppose that a man who smokes a lot comes to you complaining of. a cough that
has steadily been getting worse.

1. His felt need is to get rid of his cough.

3. To get rid of his cough will require his
willingness to give up smoking. For this he
must understand how much it really matters.

w8

2. His real need (to correct the problem) is
to give up smoking.

4. One resource that may help him give up
smoking is information about the harm it
can do him and his family (see p1 78).
Another is the support and encouragement
of his family, his friends, and you.

Finding Out the Needs
As a health worker, you will first want to find out your people's most
important health problems and their biggest concerns. To gather the information
necessary to decide what the greatest needs and concerns really are, it may help
to make up a list of questions.
On the next 2 pages are samples of the kind of things you may want to ask. But
think of questions that are important in your area. Ask questions that not only
help you get information, but that get others asking important questions
themselves.

Do not make your list of questions too long or complicated—especially a list
you take from house to house. Remember, people are not numbers and do not
like to be looked at as numbers. As you gather information, be sure your first
interest is always in what individuals want and feel. It may be better not even to
carry a list of questions. But in considering the needs of your community, you

w9

Sample Lists of Questions
To Help Determine Community Health Needs
And at the Same Time Get People Thinking
FELT NEEDS

What things in your people's daily lives (living conditions, ways of doing things,
beliefs, etc.) do they feel help them to be healthy?
What do people feel to be their major problems, concerns, and needs—not only
those related to health, but in general?

HOUSING AND SANITATION
What are different houses made of? Walls? Floors? Are the houses kept clean? Is
cooking done on the floor or where? How does smoke get out? On what do
people sleep?

Are flies, fleas, bedbugs, rats, or other pests a problem? In what way? What do
people do to control them? What else could be done?
Is food protected? How could it be better protected?

What animals (dogs, chickens, pigs, etc.), if any, are allowed in the house? What
problems do they cause?
What are the common diseases of animals? How do they affect people's health?
What is being done about these diseases?

Where do families get their water? Is it safe to drink? What precautions are taken?

How many families have latrines? How many use them properly?

Is the village clean? Where do people put garbage? Why?
POPULATION
How many people live in the community? How many are under 15 years old?
How many can read and write? What good is schooling? Does it teach children
what they need to know? How else do children learn?
How many babies were born this year? How many people died? Of what? At what
ages? Could their deaths have been prevented? How?

Is the population (number of people) getting larger or smaller? Does this cause
any problems?
How often were different persons sick in the past year? How many days was each
sick? What sicknesses or injuries did each have? Why?
How many people have chronic (long-term) illnesses? What are they?
How many children do most parents have? How many children died? Of what?
At what ages? What were some of the underlying causes?
How many parents are interested in not having any more children or in not
having them so often? For what reasons? (See Family Planning, p.32-9.)
w10

NUTRITION
How many mothers breast feed their babies? For how long? Are
these babies healthier than those who are not breast fed? Why?

What are the main foods people eat? Where do they come from?

Do people make good use of all foods available?
How many children are underweight (see p. 132) or show signs of poor nutrition?
How much do parents and schoolchildren know about nutritional needs?
How many people smoke a lot? How many drink alcoholic or soft drinks very
often? What effect does this have on their own and their families' health? (See p.
176 to 179)
.ij

LAND AND FOOD

Does the land provide enough food for each family? How long will it continue to
produce enough food if families keep growing?
How is farm land distributed? How many people own their land?
What efforts are being made to help the land produce more?

How are crops and food stored? Is there much damage or loss? Why?
HEALING, HEALTH
What role do local midwives and healers play in health care?

What traditional ways of healing and medicines are used? Which are of greatest
value? Are any harmful or dangerous?
What health services are nearby? How good are they? What do they cost? How
much are they used?

How many children have been vaccinated? Against what sicknesses?

What other preventive measures are being taken? What others might be taken?
How important are they?
>

SELF-HELP
What are the most important things that affect your
people's health and well-being—now and in the future?

~~1

r

How many of their common health problems can people care for themselves?
How much must they rely on outside help and medication?

Are people interested in finding ways of making self-care safer, more effective,
and more complete? Why? How can they learn more? What stands in the way?
What are the rights of rich people? Of poor people? Of men? Of women? Of
children? How is each of these groups treated? Why? Is this fair? What needs to be
changed? By whom? How?
Do people work together to meet common needs? Do they share or help each
other when needs are great?

What can be done to make your village a better, healthier place to live? Where
might you and your people begin?

wlT

USING LOCAL RESOURCES TO MEET NEEDS
How you deal with a problem will depend upon what resources are available.

Some activities require outside resources (materials, money, or people from
somewhere else). For example, a vaccination program is possible only if vaccines
are brought in—often from another country.

Other activities can be carried out completely with local resources. A family dr
a group of neighbors can fence off a water hole or build simple latrines using
materials close at hand.
Some outside resources, such as vaccines and a few important medicines, can
make a big difference in people's health. You should do your best to get them.
But as a general rule, it is in the best interest of your people to

Use local resources whenever possible.
The more you and your
people can do for yourselves,
and the less you have to
depend on outside assistance
and supplies, the healthier and
stronger your community will
become.

Not only can you count on
local resources to be on hand
when you need them, but
often they do the best job at
the lowest cost. For example,
if you can encourage mothers
to breast feed rather than
bottle feed their babies, this
will build self-reliance through
a top quality local resource­
breast milk! It will also
prevent needless sickness and
death of many babies.

In your health work
always remember:

Encourage people to make
the most of local resources.

BREAST MILK—A TOP QUALITY
LOCAL RESOURCE-BETTER TfyAN
ANYTHING MONEY CAN BUY!

The most valuable resource for the health of the people
is the people themselves.
w12

DECIDING WHAT TO DO AND WHERE TO BEGIN
After taking a careful look at needs and resources, you and your people must
decide which things are more important and which to do first. You can do many
different things to help people be healthy. Some are important immediately.
Others will help determine the future weil-being of individuals or the whole
community.

In a lot of villages, poor nutrition plays a part in other health problems. People
cannot be healthy unless there is enough to eat. Whatever other problems you
decide to work with, if people are hungry or children are poorly nourished, better
nutrition must be your first concern.
. There are many different ways to approach the problem of poor nutrition, for
many different things join to cause it. You and your community must consider
the possible actions you might take and decide which are most likely to work.
Here are a few examples of ways some people have helped meet their needs for
better nutrition Some actions bring quick results. Others work over a longer time.
You and your people must decide what is most likely to work in your area.
POSSIBLE WAYS TO WORK TOWARD BETTER NUTRITION

ROTATION OF CROPS
Every other planting season plary(.a crop that returns strength to the soil —like beans, peas, lentils, alfalfa,
peanuts or some other plant with seed in pods (legumes).

This year maize

Next year beans

w13

MORE WAYS TO WORK TOWARD BETTER NUTRITION

BEEKEEPING

Compost pile

SMALLER FAMILIES

w14

TRYING A NEW IDEA
Not all the suggestions on the last pages are
likely to work in your area. Perhaps some will
work if changed for your particular situation and
resources at hand. Often you can only know
whether something will work or not by trying it.
That is, by experiment.

When you try out a new idea, always start
small. If you start small and the experiment
START SMALL
fails, or something has to be done differently.
you will not lose much. If it works, people will see that it works and can begin to
apply it in a bigger way.

Do not be discouraged if an experiment does not work. Perhaps you can try
again with certain changes^Xou can learn as much from your failures as your
successes. But start small.'
Here is an example of experimenting with a new idea.
You learn that a certain kind of bean, such as soya, is an excellent body-building food.
But will it grow in your area? And if it grows, will people eat it?

Start by planting a small patch-or 2 or 3 small patches in different conditions of soil or
water. If the beans do well, try preparing them in different ways, and see’if people will eat
them. If so, try planting more beans in the conditions where you found they grew best. But
try out still other conditions in more small patches to see if you can get an even better crop.

There may be several conditions you want to try changing. For example, type of
soil, addition of fertilizer, amount of water, or different varieties of seed. To best
understand what helps and what does not, be sure to change only one condition at
a time and keep all the rest the same.
For example, to find out if animal fertilizer (manure) helps the beans grow, and how
much to use, plant several small bean patches side by side, under the same conditions of
water and sunlight, and using the same seed. But before you plant, mix each patch with a

no
manure

1 shovel
manure

2 shovels
manure

3 shovels
manure

4 shovels
manure

5 shovels
manure

This experiment shows that a certain amount of manure helps, but that too
much can harm the plants. This is only an example. Your experiments may give
different results. Try for yourself!
w15

WORKING TOWARD A BALANCE BETWEEN
PEOPLE AND LAND
As a health worker you should do all you can to protect the lives and health of
children. If, through your efforts, fewer children die, you must also consider how
this affects the future well-being of your community and the children to come.
Fewer deaths means more people. And in time this can mean hunger, for the land
can only feed a certain number.
The growing number of people in your village may be able to hold off hunger
for a while by better use of land, so that it produces more food. But if parents
continue to have big families, and their children in turn have big families, the time
will come when there is not enough land or food for all the people.

It would be very sad if preventing children's deaths now means more must
starve in the future. Yet this may happen if parents continue to have large families.
It is already happening in many parts of the world.
One of your most important jobs may be to help people realize how important
it is to limit the size of their families. This is especially true if many of your
people already do not have enough land to feed their families properly.

Chapter 20 gives information on different methods of family planning. Find
out which methods are possible in your area, and which your people prefer. Help
inform and supply parents and local midwives.

People will often come to you with health problems that relate to having large
families. When you see a mother who has had one child after another, and who is
very tired, anemic, or fails to produce milk for her baby, or when you see a child
who is badly nourished or bears the marks of crowding and poverty, talk to the
parents aoout family planning. Often a mother will not want another child, but
will not mention this until you ask.
Family planning may be one of the most important preventive measures you
can help with. Unless people learn to distribute their land and wealth more fairly
and to have smaller families, all other preventive measures may only mean that in
time more people starve.
If you help your people prevent children's deaths,
you should also help them prevent having more
children than they can clothe, educate, and feed.

A LIMITED AMOUNT OF LAND CAN ONLY SUPPORT A LIMITED NUMBER OF PEOPLE.

w16

WORKING TOWARD A
BALANCE BETWEEN
A balance between treatment and prevention often comes down to a balance
between immediate needs and long-term needs.

As a health worker you must go to your people, work with them on their terms,
and help them find answers to the needs they feel most. People's first concern is
often to find relief for the sick and suffering. Therefore, one of your first
concerns must be to help with healing.
But also look ahead. While caring for people's immediate felt needs, also help
them look to the future. Help them realize that much sickness and suffering can
be prevented and that they themselves can take preventive actions.
But be careful! Sometimes health planners and workers go too far. In their
eagerness to prevent future ills, they may show too little concern for the sickness
and suffering that already exist. By failing to respond to people's present needs,
they may fail to gain their cooperation. And so they fail in much of their
preventive work as well.

Treatment and prevention go hand in hand. Early treatment often prevents
mild illness from becoming serious. If you help people to recognize many of their
common health problems and to treat them early, in their own homes, much
needless suffering can be prevented.
Early treatment is a form of preventive medicine.
If you want their cooperation, start where your people are. Work toward a
balance between prevention and treatment that is acceptable to them. Such a
balance will be largely determined by people's present attitudes toward sickness,
healing, and health. As you help them look farther ahead, as their attitudes
change, and as more diseases are controlled, you may find that the balance shifts
naturally in favor of prevention.

You cannot tell the mother whose child is ill that prevention is more important
than cure. Not if you want her to listen. But you can tell her, while you help her
care for her child, that prevention is equally important.
Work toward prevention— do not force it.

Use treatment as a doorway to prevention. One of the best times to talk to
people about prevention is when they come for treatment. For example, if a
mother brings a child with worms, carefully explain to her how to treat him. But
also take time to explain to both the mother and child how the worms are spread
and the different things they can do to prevent this from happening (see Chapter
1 3). Visit their home from time to time, not to find fault, but to help the family
toward more effective self-care.

Use treatment as a chance to teach prevention.
w17

SENSIBLE AND LIMITED USE OF MEDICINES
One of the most difficult and important parts of preventive care is to educate
your people in the sensible and limited use of medicines. A few modern medicines
are very important and can save lives. But no medicine is needed for most
sicknesses. The body itself can usually fight off sickness with rest, good food,
and perhaps some simple home remedies.

People may come to you asking for medicine when they do not need any. You
may be tempted to give them some medicine just to please. But if you do, when
they get well, they will think that you and the medicine cured them. Really their
bodies cured themselves.

Instead of teaching people to depend on medicines they do not need, take time
to explain why they should not be used. Also tell the person what he can do
himself to get over his sickness.
This way you are helping the person to rely on a local resource (himself), rather
than on an outside resource (medicine). Also, you are protecting the person, for
there is no medicine that does not have some risk in its use.

Three common health problems for which people too often request medicines
they do not need are (1) the common cold, (2) minor cough, and (3) diarrhea.
The common cold is best treated by resting, drinking lots of liquids, and at the
most taking aspirin. Penicillin, tetracycline, and other antibiotics do not help at
all (see p.200).
For minor coughs, or even more severe coughs with thick mucus or phlegm,
drinking a lot of water will loosen mucus and ease the cough faster and better
than cough syrup. Breathing warm water vapor brings even greater relief (see
p.2051). Do not make people dependent on cough syrup or other medicines they
do not need.

For most diarrhea of children use of medicines does not make them get well.
Many of those commonly used (neomycin, streptomycfri, kaolin-pectin, Lomotil,
Entero-Vioform, chloramphenicol) may even be harmful. What is most important
is that the child get lots of liquids and enough food (see p. 186 to 187'). The key
to the child's recovery is the mother, not the medicine. If you can help mothers
understand this and learn what to do, many children's lives can be saved.
w18

Medicines are often used too much, both by doctors and by ordinary people.
'This is unfortunate for many reasons:

■ It is wasteful..
■ It makes people depend on something they do not need (and often cannot
afford).
■ Every medicine has some risk in its use. There is always a chance that an
unneeded medicine may actually do the person harm.
■ What is more, when some medicines are used too often for minor problems,
they lose their power to fight dangerous sicknesses.
An example of a medicine losing its power is chloramphenicol. The extreme
•overuse of this important but risky antibiotic for minor infections has meant that
lin some parts of the world chloramphenicol no longer works against typhoid fever,
;a very dangerous infection. Frequent overuse of chloramphenicol has allowed
typhoid to become resistant to it (see p. 70).

For all the above reasons the use of medicines should be limited.

But how? Neither rigid rules and restrictions nor permitting only highly trained
Ipersons to decide about the use of medicines has prevented overuse. Only when
the people themselves are better informed will the limited and careful use of
imedicines be common.

To educate people about sensible and limited use of medicines
is one of the important jobs of the health worker.
This is especially true in areas where modern medicines are already in great use.

/don't you
THINK HE. .
NEE Di AN I

INJECTION?

HE WILL GET WELL
' HIMSELF LET HIM
3E5T GIVE H/M
GOOD FOOD AND
LOTS TO DAINK.
STRONG MEDICINE
Wont help and
MIGHT EVEN HAKM
HIM.
-________ J

WHEN MEDICINES ARE NOT NEEDED, TAKE TIME TO EXPLAIN WHY.

For more information about the use and misuse of medicines, see Chapter 6,
ipage 61. For the use and misuse of injections, see Chapter 9, page 7 7. For sensible
tuse of home remedies, see Chapter 1.

w19

FINDING OUT WHAT PROGRESS HAS BEEN MADE
(EVALUATION)
From time to time in your health work, it helps to take a careful look at what
and how much you and your people have succeeded in doing. What changes, if
any, have been made to improve health and well-being in your community?

You may want to record each month or year the health activities that can be
measured. For example:
■ How many families have put in latrines?
• How many farmers take part in activities to improve their land and crops?
■ How many mothers and children take part in an Under-Fives Program
(regular check-ups and learning)?

This kind of question will help you measure action taken. But to find out the
result or impact of these activities on health, you will need to answer other
questions such as:

■ How many children had diarrhea or signs of worms in the past month or yearas compared to before there were latrines?
• How much was harvested this season (corn, beans, or other crops)—as
compared to before improved methods were used?
■ How many children show normal weight and weight-gain on their Road to
Health Charts (see p. 343 —as compared to when the Under-Fives Program
was started?

To be able to judge the success of any activity you need to collect certain
/information both before and after. For example, if you want to teach mothers
how important it is to breast feed their oabies, first take a count of how many
mothers are doing so.: Then begin the teaching program and each year take another
count. This way you*Can get a good idea as to how much effect your teaching has
had.

You may want to set goals. For example, you and the health committee may
hope that 80% of the families have latrines by the end of one year. Every month
you take a count. If, by the end of six months, only one-third of the families have
latrines, you know you will have to work harder to meet the goal you set for
yourselves.
Setting goals often helps people work harder and get more done.

To evaluate the results of your health activities it helps to count and measure
certain things before, during, and after.
But remember: The most important part of your health work cannot be
measured. It has to do with the way you and other people relate to each other;
with people learning and working together; with- the growth of kindness,
responsibility, sharing, and hope. You cannot measure these things. But weigh
them well when you consider what changes have been made.
w20

TEACHING AND LEARNING TOGETHER—
THE HEALTH WORKER AS AN EDUCATOR
As you come to realize how many things affect health, you may think the
health worker has an impossibly large job . And true, you will never get much
done if you try to deliver health care by yourself.
Only when the people themselves become actively responsible for their own
and their community's health, can important changes take place.

Your community's well-being depends on the involvement not of one person,
but of nearly everyone. For this to happen, responsibility and knowledge must be
shared.

This is why your first job as a health worker is to teach—to teach children,
parents, farmers, schoolteachers, other health workers—everyone you can.
The art of teaching is the most important skill a person can learn. To teach is to
help others grow, and to grow with them. A good teacher is not someone who
puts ideas into other people's heads; he is someone who helps others build on
their own ideas, to make new discoveries for themselves.

Teaching and learning should not be limited to the schoolhouse or health post.
They should take place in the home and in the fields and on the road. As a health
worker one of your best chances to teach will probably be when you treat th6
sick. But you should look for every opportunity to exchange ideas, to share, to
show, and to help your people think and work together.

On the next few pages are some ideas that may help you do this. They are only
suggestions. You will have many other ideas yourself.
TWO APPROACHES TO HEALTH CARE

TAKING CARE OF OTHERS ENCOURAGES
DEPENDENCY AND LOSS OF FREEDOM.

HELPING OTHERS LEARN TO CARE FOR
THEMSELVES ENCOURAGES SELFRELIANCE AND EQUALITY.

M2

VCJW/IUIM! 5 Y HEALTH C’VL
’42TL- (Firw-SteGr)
nlad.

Bangalore - 560 OCrL b

Tools for Teaching
Flannel-graphs are good for talking with
groups because you can keep making new
pictures. Cover a square board or piece of card­
board with a flannel cloth. You can place
different cutout drawings or photos on it. Strips
of sandpaper or flannel glued to the backs of
cutouts help them stick to the flannelboard.

Posters and displays. "A picture is worth a
thousand words." Simple drawings, with or
without a few words of information, can be hung
in the health post or anywhere that people will
look at them. You can copy some of the pictures
from this book.

If you have trouble getting sizes and shapes right,
draw light even squares in pencil over the picture
you want to copy.

Now draw the same number of squares lightly,—
but larger, on the poster paper or cardboard. Then
copy the drawing, square for square.

If possible; ask village artists to draw or paint
posters. Or have children make posters on different
subjects.

Models and demonstrations help get ideas across..
For example, if you want to talk with mothers and
midwives about care in cutting the cord of a
newborn child, you can make a doll for the baby.
Pin a cloth cord to its belly. Experienced midwives
can demonstrate to others.

Color slides and filmstrips are available on
different health subjects for many parts of the
world. Some come in sets that tell a story.
Simple viewers and battery-operated projectors
are also available.

Teaching materials to use for health education in your village are available fron
the Voluntary Health Association of India, C-14 Community Centre S.D.A.
New Delhi - 1 10 016. Please also see the addresses on p. 437 and 438

w22

Other Ways to Get Ideas Across
Story telling. When you have a hard time explaining something, a story, especially
a true one, will help make your point.

For example, if I tell you that sometimes a village worker can make a better
diagnosis than a doctor, you may not believe me. But if I tell you about a village
health worker called Lalan Bai, who works in a village called Jamkhed. you may
understand.
One day a small sickly child arrived at the nutrition centre. He had been sent by the doctor at the
nearby health centre because he was badly malnourished. The child also had acougn.
and the doctor had prescribed a cough medicine. Lalan Bai was worried about the child. She knew
he came from a very poor fatnily and that an older brother had died a few weeks before. She went to
visit the family and learned that the older brother had been sick for a long time and had coughed
blood. Lalan Bai went to the health centre and told the doctor she was afraid the child had
tuberculosis. Tests were made, and it turned out that Lalan Bai was right.... So you see. the health
worker spotted the real problem before the doctor - because she knew her people and visited their
homes.

Stories also make learning more interesting. It helps if health workers are good
story tellers.
Play acting. Stories that make important points can reach people with even more
force if they are acted out. Perhaps you, the schoolteacher, or someone on the
health committee can plan short plays
or 'skits' with the schoolchildren.

For example, to make the point
that food should be protected
from flies to prevent the spread
of disease, several small children
could dress up as flies and buzz
around food. The flies dirty the
food that has not been covered.
Then children eat this food and
get sick. But the flies cannot get
at food in a box with a wire screen
front. So the children who eat
this food stay well.

The more ways you can find to share ideas,
the more people will understand and remember.

w23

Tools for Teaching
Flannel-graphs are good for talking with
groups because you can keep making new
pictures. Cover a square board or piece of card­
board with a flannel cloth. You can place
different cutout drawings or photos on it. Strips
of sandpaper or flannel glued to the backs of
cutouts help them stick to the flannelboard.

Posters and displays. "A picture is worth a
thousand words." Simple drawings, with or
without a few words of information, can be hung
in the health post or anywhere that people will
look at them. You can copy some of the pictures
from this book.
If you have trouble getting sizes and shapes right,
draw light even squares in pencil over the picture
you want to copy.

Now draw the same number of squares lightly,
but larger, on the poster paper or cardboard. Then
copy the drawing, square for square.
If possible,' ask village artists to draw or paint
posters. Or have children make posters on different
subjects.

Models and demonstrations help get ideas across..
For example, if you want to talk with mothers and
midwives about care in cutting the cord of a
newborn child, you can make a doll for the baby.
Pin a cloth cord to its belly. Experienced midwives
can demonstrate to others.

Color slides and filmstrips are available on
different health subjects for many parts of the
world. Some come in sets that tell a story.
Simple viewers and battery-operated projectors
are also available.

Teaching materials to use for health education in your village are available from
the Voluntary Health Association of India. C-14 Community Centre S.D.A.
New Delhi - 110 016. Please also see the addresses on p. 437 and 438

w22

Other Ways to Get Ideas Across
Story telling. When you have a hard time explaining something, a story, especially
a true one, will help make your point.

For example, if I tell you that sometimes a village worker can make a better
diagnosis than a doctor, you may not believe me. But if I tell you about a village
health worker called Lalan Bai. who works in a village called Jamkhed, you may
understand.
One day a small sickly child arrived at the nutrition centre. He had been sent by the doctor at the
nearby health centre because he was badly malnourished. The child also had a cougn.
and the doctor had prescribed a cough medicine. Lalan Bai was worried about the child. She knew
he came from a very poor fa'mily and that an older brother had died a few weeks before. She went to
visit the family and learned that the older brother had been sick for a long time and had coughed
blood. Lalan Bai went to the health centre and told the doctor she was afraid the child had
tuberculosis. Tests were made, and it turned out that Lalan Bai was right.... So you see. the health
worker spotted the real problem before the doctor - because she knew her people and visited their
homes.

Stories also make learning more interesting. It helps if health workers are good
story tellers.

Play acting. Stories that make important points can reach people with even more
force if they are acted out. Perhaps you, the schoolteacher, or someone on the
health committee can plan short plays
or 'skits' with the schoolchildren.
For example, to make the point
that food should be protected
from flies to prevent the spread
of disease, several small children
could dress up as flies and buzz
around food. The flies dirty the
food that has not been covered.
Then children eat this food and
get sick. But the flies cannot get
at food in a box with a wire screen
front. So the children who eat
this food stay well.

The more ways you can find to share ideas,
the more people will understand and remember.

w23

Working and Learning Together for the Common Good
There are many ways to interest and involve people in working together to
meet their common needs. Here are a few ideas:
1.
A village health committee. A group of able, interested persons can be chosen
by the village to help plan and lead activities relating to the well-being of the
community—for example, digging garbage pits or latrines. The health worker can
and should share much of his responsibility, with other persons.

2.
Group discussions. Mothers, fathers, schoolchildren, young people, folk healers,
or other groups can discuss needs and problems that affect health. Their chief
purpose can be to help people share ideas and build on what they already know.
3.
Work festivals. Community
projects such as putting in a water
system or cleaning up the village
go quickly and can be fun if
everybody helps. Games, races,
refreshments, and simple prizes
help turn work into play. Use
imagination.
4.
Cooperatives. People can help
keep prices down by sharing tools,
storage, and perhaps land. Group
cooperation can have a big
influence on people's well-being.

CHILDREN CAN DO AN AMAZING AMOUNT
OF WORK WHEN IT IS TURNED INTO A GAME!

5.
Classroom visits. Work with the village schoolteacher to encourage health-related
activities, through demonstrations and play acting. Also invite small groups of
students to come to the health center. Children not only learn quickly, but they
can help out in many ways. If you give children a chance, they gladly become a
valuable resource.
6.
Mother and child health meetings. It is especially important that pregnant
women and mothers of small children (under five) be well informed about their
own and their babies' health needs. Regular visits to the health post are
opportunities for both check-ups and learning. Have mothers keep their children's
health records and bring them each month to have their children's age and
weight recorded (see the Road to Health Chart, p.343). Mothers who understand
the chart often take pride in making sure their children are eating and growing
well. They can learn to understand them even if they cannot read. Perhaps you
can help train interested mothers to organize and lead these activities.
7.
Home visits. Make friendly visits to people's homes, especially homes of families
who have special problems, who do not come often to the health post, or who do
not take part in group activities. But respect people's privacy. If your visit cannot
be friendly, do not make it—unless children or defenseless persons are in danger.

w24

Ways to Share and Exchange Ideas in a Group
As a health worker you will find that the success you have in improving your.
people's health will depend far more on your skills as a teacher than on your
medical or technical knowledge. For only when the whole community is involved
and works together can big problems be overcome.

People do not learn much from what they are told. They learn from what
they think, feel, discuss, see, and do together.
So the good teacher does not sit behind a desk and talk at people. He talks and
works with them. He helps his people to think clearly about their needs and to
find suitable ways to meet them. He looks for every opportunity to share ideas in
an open and friendly way.

TALK WITH PEOPLE

NOT AT THEM

Perhaps the most important thing you can do as a health worker is to awaken
your people to their own possibilities ... to help them gain confidence in
themselves. Sometimes villagers do not change things they do not like because
they do not try. Too often they may think of themselves as ignorant and
powerless. But they are not. Most villagers, including those who cannot read or
write, have remarkable knowledge and skills. They already make great changes in
their surroundings with the tools they use, the land they farm, and the things they
build. They can do many important things that people with a lot of schooling
cannot.
If you can help people realize how much they already know and have done to
change their surroundings, they may also realize that they can learn and do even
more. By working together it is within their power to bring about even bigger
changes for their health and well-being.

Then how do you tell people these things? Often you cannot!

But you can help them find out some of these things for themselves—by
bringing them together for discussions. Say little yourself, but start the discussion
by asking certain questions. Simple pictures like the drawing on the next page of a
farm family in Andhra Pradesh may help. You will want to draw your own
picture, with buildings, people, animals, and crops that look as much as possible
like those in your area.

w25

USE PICTURES TO GET PEOPLE TALKING AND THINKING TOGETHER

Show a group of people a picture similar to this and ask them to discuss it.
Ask questions that get people talking about what they know and can do. Here are
some sample questions:

■ Who are the people in the picture and how do they live?
■ What was this land like before the people came?
• I n what ways have they changed their surroundings?

• How do these changes affect their health and well-being?

■ What other changes could these people make? What else could they learn to
do?. What is stopping them? How could they learn more?

.■ How did they learn to farm? Who taught them?
• If a doctor or a lawyer moved onto this land with no more money or tools
than these people, could he farm as well? Why or why not?

■ In what ways are these people like ourselves?
w26

This kind of group discussion helps build people's confidence in themselves and
in their ability to change things. It can also make them feel more involved in their
community.
At first you may find that people are slow to speak out and say what they
think. But after a while they will usually begin to talk more freely and ask
important questions themselves. Encourage everyone to say what he feels and to
speak up without fear. Ask those who talk most to give a chance to those who are
slower to speak up.

You can think of many other drawings and questions to start discussions that
can.help people look more clearly at problems, their causes, and possible solutions.

What questions canyou ask to get people thinking about the different things
that lead to the condition of the child in the following picture?

Try to think of questions that lead to others and get people asking for
themselves. Wow many of the causes underlying death from diarrhea (see p. w7)
will your people think of when they discuss a picture like this?
w27

MAKING THE BEST USE OF THIS BOOK
Anyone who knows how to read can use this book in
his own home. Even those who do not read can learn
from the pictures. But to make the fullest and best use
of the book, people often need some instruction. This
can be done in several ways.
A health worker or anyone who gives out the book should make sure that
people understand how to use the list of Contents, the Index, the Green Pages and
the Vocabulary. Take special care to give examples of how to look things up. Urge
each person to carefully read the sections of the book that will help him
understand what may be helpful to do, what could be harmful or dangerous, and
when it is important to get help (see especially Chapters 1, 2, 6, and 9, and also
the SIGNS OF DANGEROUS ILLNESS, p. 52). Point out how important it is to
prevent sickness before it starts. Encourage people to pay special attention to
Chapters 11 and 12, which deal with eating right (nutrition) and keeping clean
(hygiene and sanitation).

Many of these things can be explained briefly. But the more time you spend
with people discussing how to use the book or reading and using it together, the
more everyone will get out of it.
You as a health worker might encourage people to get together in small groups
to read through the book, discussing one chapter at a time. Look at the biggest
problems in your area—what to do about health problems that already exist and
how to prevent similar problems in the future. Try to get people looking ahead.

Perhaps interested persons can get together for a short class using this book (or
others) as a text. Members of the group could discuss how to recognize, treat, and
prevent different problems. They could take turns teaching and explaining things
to each other.
To help learning be fun in these classes you can act out situations. For example,
someone can act as if he has a particular sickness and can explain what he feels.
Others then ask questions and examine him (Chapter 3). Use the book to try to
find out what his problem is and what can be done about it. The group should
remember to involve the 'sick' person in learning more about his own sickness—
and should end up by discussing with him ways of preventing the sickness in the
future. All this can be acted out in class.

As a health worker, one of the best ways you can help people use this book
correctly is this: When persons come to you for treatment, have them look up
their own or their child's problem in the book and find out how to treat it. This
takes more time, but helps much more than doing it for them. Only when
someone makes a mistake or misses something important do you need to step in
and help him learn how to do it better. In this way, even sickness gives a chance
to help people learn.
w28

Dear village health worker—whoever and wherever you are, whether you have a
title or official position, or are simply someone, like myself, with an interest in
the well-being of others—make good use of this book. It is for you and for
everyone.
But remember, the most important part of health care you will not find in this
book or any other. The key to good health lies within you and your people, in the
care, the concern, and the appreciation you have for each other. If you want to
see your community be healthy, build on these.

Caring and sharing are the key to health.

Yours truly.

w29

The book Where There Is No Doctor is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.

Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
Rs. 2.00
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