WHERE THERE IS NO DOCTOR PREVENTION : HOW TO AVOID MANY SICKNESSES
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COMMUNITY H1.UT3 C",
• 7/1. (First Floor) St. Mirkt;
D-70
i,
c^nciaJore - 560 001.
CHAPTER
PREVENTION:
How to Avoid Many Sicknesses
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
!
CHAPTER
PREVENTION:
How to Avoid Many Sicknesses
COMMUNITY HEALTH
An ounce of prevention is worth a pound of cure! If we all took more care to
eat well, to keep ourselves, our homes, and our villages clean, and to be sure that
our children are vaccinated, we could stop most sicknesses before they start.
CELL
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Call No :.
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Author : Where there
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• prevention:. How_to avoid
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CLEANLINESS AND ENOUGH FOOD PREVENT
MOST OF THE COMMON AND SERIOUS ILLNESSES
Many people in our country do not have enough to eat even for one meal or
enough water even to drink. And why is there no food or water for these people?
* Is it because the land and the only well in the village belongs to the high caste
people?
’ Is it because the people do not have the money to buy good food or firewood to
boil the water?
' Is it because each person in the village does not have enough land or work to
support himself?
• Is it because the people do not look or plan ahead? Because they do not realize
that by working together and sharing, they can change the conditions in
which they live?
As a health worker, it is your job to help people understand and do something to
improve their conditions. Your advice about prevention will have meaning only if
you help people find answers to these questions.
Good nutrition not only prevents sicknesses, it also helps the sick person fight
against his disease, see Chapter 11.
Cleanliness is of great importance in the prevention of many kinds of infections
-infections of the gut, the skin, the eyes, the lungs, and the whole body.
Personal cleanliness (or hygiene} and public cleanliness (or sanitation] are both
important.
HOW ARE DISEASES SPREAD
Fece»-to-mouth: They can be spread either by eating shit (see p 156) through water
or flies. Diseases spread this way include
- several types of intestinal worms
- diarrhoea, dysentry (caused by amebas and parasites)
- cholera, typhoid, and hepatitis
- certain types of diseases like polio
156
Direct Contact:These diseases are spread by touching the infected person, using
his clothes, sleeping on his bed. his blankets. They include
- skin diseases like scabies, ringworm
- lice, ticks
- venereal diseases like syphilis, gonorrhea are spread by sexual contact.
Coughing .sneezing: When a person coughs or sneezes . the germs present in his
respiratory passage are thrown out with a great force. Other persons who breathe
these germs can then get the disease. If an infected person spits out phlegm, the
phlegm gets mixed up with the dust around. The phlegm has the germs of the
disease in it. The dust is carried around by the air and other persons who breathe
this air get the disease. These types of diseases include:
tuberculosis
measles, chickenpox
common cold
pneumonia
diptheria
By insects and other animals: Sometimes, some germs which cause disease need
to spend a part of their lives in an insect or animal. When the insect bites us. or if we
eat raw meat from the infected animal, or if the infected animal bites us. we can also
get infected and sick.
Diseases spread this way include:
- malaria
- filaria (elephantiasis)
- tapeworm infection
- rabies
Feces-to-mouth infection
The way these infections are transmitted
can be very direct.
For example: A child who has worms and
who forgot to wash his hands after his last
bowel movement, offers his friend a biscuit;
His fingers, still dirty with his own stool, are
covered with hundreds of tiny worm eggs (so
small they cannot be seen). Some of these
worm eggs stick to the biscuit'. When his
friend eats the biscuits,he swallows the worm
eggs, too.
Soon the friend will also have worms.
His mother may say this is because he ate
too many sweets. But no, this is because he
ate shit!
157
Many times pigs, dogs, chickens, and other animals spread intestinal disease
and worm eggs. For example:
In the house a child is playing on the floor.
In this way, a bit of the man’s stool gets
on the child, too.
Then the mother prepares
food, forgetting to wash her
hands after handling the
The family eats the food.
158
If the family had taken any of the following precautions, the spread of the
sickness could have been prevented:
■ if the man had used a latrine or out-house,
■ if there was no latrine and the man had covered his shit with mud.
• if the family had not let the pigs come into the house,
• if they had not let the child play where the pig had been,
• if the mother had washed her hands after touching the child and before
preparing food.
Flies and other insects also spread many infections of the digestive system.
For example:
A man with
cholera has a
bowel movement
near his house.
Flies sit on his
stools and the
germs which
cause cholera
stick to their legs.
The flies sit on the food and rub
their legs.
Some of these
flies enter the
kitchen
The family eats this food
159
The family gets cholera.
Some of these flies enter a
sweet shop and sit
on the sweets.
The mother has
a bowel movement
near the house-.
Flies sit on her
stools.
A child buys and eats
these sweets
And soon, he
also gets cholera.
If the people had taken any of the following precautions, the spread of cholera
could have been prevented:
'
■
■
'
If the man (and the other patients ) had used a latrine or outhouse
If there was no latrine, if they had covered their stools with mud
If the food in the kitchen was kept covered
If the sweets in the shop were kept covered
If the child had not bought uncovered sweets
To prevent cholera and other diseases which are spread by flies.
’
"
if possible, put a wire netting on the kitchen doors and windows so that flies
cannot enter
keep all food and water covered
160
This man has hepatitis
(jaundice)
He has a bowel move
ment near a pond. The
germs of the disease
get into the water
Her family drinks the
water
They all get hepatitis
Another woman takes
water from this well.
Her family dnnks
this water.
This woman takes
water from the pond to
her house.
The baby passes stools
and dirties his clothes
Her family also gets
hepatitis.
161
If the people had faken any of the following precautions, they could have
prevented the spread of hepatitis:
•
•
•
•
if the man had not passed stools near the source of drinking water.
if both the women had boiled the water before giving it to their families to drink
if the woman had not washed infected clothes near the well
if the well had been protected with a wall and a platform.
Because they are spread easily, intestinal infections often strike a whole village or
community at the same time (epidemic)
If there are many cases of intestinal sicknesses like diarrhoea, worms, typhoid.
cholera, hepatitis, people are not being careful about cleanliness. If many children
die from diarrhoea, it is likely that poor nutrition is also part of the problem To
prevent deaths from infections of the digestive system, both cleanliness and good
nutrition are important (p. 341 and Chapter 11).
Infections spread by direct contact:
Many of these infections are transmitted through touch, or using or sharing the
same clothes, beds, blankets, towels Some of these infections can also be spread
by just sitting together. For example: Lice, scabies.
162
If the boy and his family has taken any of the following precautions they could
have prevented the spread of scabies:
*
*
'
if the boys had slept separately and had sat separate at school
when the family knew the boy had scabies, if they had taken treatment for it all
together.
if they had regularly washed their clothes and dried them, in the sun
Venereal diseases also spread directly from one person to the other through
sexual contact For example:
This man has syphilis
He had sexual contact
with an unknown
woman
163
All venereal diseases spread through sexual contact. If you suspect you have a
venereal disease, tell the health worker. And stop having sexual contact with anyone
till the health worker says you can.
Infections spread by coughing and sneezing:
These infections are very easy to get as the air around us normally has the germs
causing such sicknesses For example:
He coughs out his
phlegm, which has
T B. germs’ in it
164
When she delivers her
baby, the baby also gets
T.B after some time.
The mother starts taking
treatment to cure her
disease. The health
worker tells her that she
must continuetreatment
for at least 1 'h years.
165
If all these people had taken the following precautions they would have stopped
spreading T.B :
•
if the man had covered his nose and mouth when coughing.
•
if the man had spat his phlegm in a covered container and then burnt it
■
if the man had not given his hookah to his friend
•
if they all had taken early treatment
•
if the mother had taken complete regular treatment for 1’/a years
•
if they had all-taken vaccination against T.B. before getting the disease.
166
Infections spread by insects and other animals:
Among the diseases spread this way is malaria
If the man had taken any of the following precautions, he would not have got
malaria
if he had slept under a mosquito net.’or covered himself.
if he had got his house sprayed with an anti-mosquito medicine.
Most kinds of infections are passed from person to person in the ways just shown
Most of them can be prevented by persona.l and public cleanliness.
167
If there are many cases of diarrhea, worms, and other intestinal parasites in
your village, people are not being careful enough about cleanliness. If many
children die from diarrhea, it is likely that poor nutrition is also part of the
problem. To prevent death from diarrhea, both cleanliness and good nutrition are
important (see p.185 and Chapter 11).
BASIC GUIDELINES OF CLEANLINESS
PERSONAL CLEANLINESS (HYGIENE):
1. Always wash your
' hands with soap when
you get up in the
morning, after having a
bowel movement, and
before eating or preparing
food. Do not use mud or clay to wash hands.
2. Bathe often—every day when the weather is hot. Bathe
• after working hard or sweating. Frequent bathing helps
prevent skin infections, dandruff, pimples, itching, and'
rashes. Sick persons, including babies, should be
bathed daily.
3. In areas where hookworm is common, do not go barefoot
or allow children to do so. Hookworm infection causes
severe anemia. These worms enter the body through the
soles of the feet (see p 195).
4.
YES
Brush your teeth every day and after each
time you eat sweets. If you do not have a
toothbrush and toothpaste, rub your teeth
with salt and baking soda (see p. 274)
CLEANLINESS IN THE HOMF:
1. Do not let pigs come into the house
168
3.
If children or animals have a
bowel movement near the
house, clean it up at once.
Teach them to use a latrine or
at least to go farther from the
house.
4.
Hang or spread sheets and
blankets in the sun often. If there are bedbugs, pour
boiling water on the cots and wash the sheets and
blankets—all on the same day.
5.
De-Iouse the whole family often (see p. 242F.
Lice and fleas carry many diseases. Dogs and
other animals that carry fleas should not come
into the house.
6.
Do not spit on the floor. Spit can
spread disease. When you cough or
sneeze, cover your mouth with your
hand or a cloth or handkerchief.
7.
Clean house often. Sweep and wash the floors, walls, and beneath furniture.
Fill in cracks and holes in the floor or walls where roaches, bedbugs, and
scorpions can hide.
8.
Smear kutcha houses with cowdung and wet mud regularly so as to keep
away flies.
169
CLEANLINESS IN EATING AND DRINKING:
1.
Ideally all water that does not come from a pure
water system should be boiled before drinking.
This is especially important for small
children and at times when there is a lot
of diarrhea or cases of typhoid,
hepatitis, or cholera. Water from
holes or rivers, even when it looks
clean, may spread disease if it is not
boiled before use.
Keep boiled water in covered mud pots.
2. Do not let flies and other insects
land or crawl on food. These insects
carry germs and spread disease. Do
not leave food scraps or dirty dishes
lying around, as these attract flies
and breed germs. Protect food by
keeping it covered or in boxes or
cabinets with wire screens.
ALWAYS EAT FOOD THAT IS KEPT COVERED
Food that is sold outside on
the roads or shops, such as
laddus. jalebis.sweets. cut fruits.
is usually kept uncovered. You
may have noticed flies sitting
on them. They contaminate the
food. If you eat this fodd. yoo
may get diarrhoea. Cholera and
typhoid also spread this way.
170
3 Often the water used for farming
and gardening is not clean. The water
contains germs causing diarrhoea
Fruits and other vegetables.
especially vegetables which
grow under the ground like carrots
raddish, turnips, lie in this water
and have germs in them. Always
wash vegetables and fruits
before eating them.
4. Before eating fruit that has fallen to the ground, wash it well. Dc<not let children pick up and eat food that has been dropped
—wash it first.
5. Only eat meat that is well
cooked. Be careful that roasted
meat, especially pork,' does not have
raw parts.inside. Raw pork carries
dangerous diseases.
6. Do not eat food that is old or smells bad. It may be
poisonous. Do not eat canned food if the can is swollen or
squirts when opened. Be especially careful with canned fish.
7. People with tuberculosis, flu, colds, or other
infectious diseases should eat separately from
others. Plates and utensils used by sick people
should be boiled before being used by others.
HOW TO PROTECT YOUR CHILDREN'S HEALTH:
------ 1. A sick child like this one
.. should sleep apart from
children who are well.------ >■
171
Sick children or children with sores, itchy skin, or lice should always sleep
separately from those who are well. Children with infectious diseases like
whooping cough, measles, or the common cold should sleep in separate rooms, if
possible, and should not be allowed near babies or small children.
2.
Protect children from tuberculosis. People with long-term
coughing or other signs of tuberculosis should cover their
mouths whenever they cough. They should never sleep in
the same room with children. They should see a health
worker and be treated as soon as possible.
Children living with a person who has tuberculosis
should be vaccinated against TB (B.C.G. Vaccine).
3.
Bathe children, change their clothes, and. cut
their fingernails often. Germs and worm eggs often
hide beneath long fingernails.
4.
Treat children who have infectious diseases as
soon as possible, so that the diseases are not
spread to others.
5.
Foliowall the guidelines of cleanliness
mentioned in this chapter. Teach children to
follow these guidelines and explain why they are
important. Encourage children to help with
projects that make the home or village a
healthier place to live.
6. Be sure children get enough good food. Good
nutrition helps protect the body against many
infections. A well-nourished child will usually resist
or fight off infections that can kill a poorly nourished
child (read Chapter 11).
PUBLIC CLEANLINESS (SANITATION):
1.
Keep wells and public water holes clean. Do not let animals go near where
people get drinking water. If necessary, put a fence around the place to keep
animals out.
Do not defecate (shit) or throw garbage near the water hole. Take special care
to keep rivers and streams clean upstream from any place where drinking water is
taken-
COMMUNITY HEALTH CELL
'Fi.siitewj St.-Ms.iX Read.
172
2.
Burn all garbage that can be burned. Garbage that cannot be burned should
be buried in a special pit or place far away from houses and the places where
people get drinking water.
3.
Build latrines (out-houses, toilets) so pigs and other animals cannot reach the
human waste. A deep hole with a little house over it works well.
Here is a drawing of a
simple out-house that is
easy to build.
It helps to throw a little
lime, dirt, or ashes in the
hole after each use to
reduce the smell and keep
flies away.
Out-houses should be built
at least 20 meters from
homes or the source of
water.
If you do not have an out
house, go far away from
where people bathe or get
drinking water. Teach your
children to do the same.
Use of latrines helps
prevent many sicknesses.
Ideas for better latrines are found on the next
pages. Also latrines can be built to produce good
fertilizer for gardens. For plans write to I.T.D.G. or
V.l.T.A. (see p.438).
BETTER LATRINES:
The latrine or out-house shown on the previous page is very simple and costs
almost nothing to make. But it is open at the top and lets in flies.
Closed latrines are better because the flies stay out and the smell stays in. A
closed latrine has a platform or slab with a hole in it and a lid over the hole. The
slab can be made of wood or cement. Cement is better because the slab fits more
tightly and will not rot.
173
One way to make a cement slab:
1.
Dig a shallow pit, about 1 meter
square and 7 cm. deep. Be sure the bottom
of the pit is level and smooth.
2.
Make or cut a wire mesh or grid 1
meter square. The wires can be % to '/? cm.
thick and about 10 cm. apart. Cut a hole
about 25 cm. across in the middle of the grid.
3.
Put the grid in the pit. Bend the ends
of the wires, or put a small stone at each
corner, so that the grid stands about 3 cm.
off the ground.
4.
grid.
Put an old bucket in the hole in the
5.
Mix cement with sand, gravel, and
water and pour it until it is about 5 cm.
thick. (With each shovel of cement mix 2
shovels of sand and 3 shovels of gravel.)
6.
Remove the bucket when the cement
is beginning to get hard (about 3 hours).
Then cover the cement with damp cloths,
sand, hay, or a sheet of plastic and keep it
wet. Remove slab after 3 days.
To make the closed latrine, the slab should be placed over a round hole in the
ground. Dig the hole a little less than 1 meter across and between 1 and 2 meters
deep.
174
To be safe, the latrine should be at least 20 meters from all houses, wells,
springs, rivers, or streams. If it is anywhere near where people go for water, be
sure to put the latrine downstream.
Keep your latrine clean. Wash the slab often. Teach children and others not to
get it dirty.
Be sure the hole in the slab has a cover and that the
cover is kept in place. A simple cover can be made of
wood.
If you prefer to sit when you use the latrine, you
can make a cement seat like this:
You will have to make a mold or you can use 2
buckets of different sizes, one inside the other.
175
VACCINATIONS (IMMUNIZATIONS)SIMPLE,SURE PROTECTION
Vaccines give protection against many dangerous diseases. If health workers
do not vaccinate in your village, take your children to the nearest health center to
be vaccinated. It is better to take them for vaccinations while they are healthy,
than to take them for treatment when they are sick or dying. Vaccinations are
usually given free.
The most important vaccines for children are:
1.
B.C.G., for tuberculosis. A single injection is given into the skin of the right
shoulder. Children can be vaccinated at birth or any time afterwards. Early
vaccination is especially important if any member of the household has tuber
culosis. The vaccine makes a sore that heals after four weeks leaving a scar.
2.
SMALLPOX. I his vaccination, put into tne skin of the left shoulder, or
buttocks can be given at birth or anytime afterwards. It should make a sore and
leave a scar. It may cause a little fever. Try to keep children from scratching the
sore. Cut their fingernails very short. Do not put cowdung, ash or ghee on the
sore. Do not give small pox vaccination to those who have eczema.In many areas
smallpox is completely under control and the vaccine is no longer necessary.
3.
D.P.T., for diphtheria, whooping cough (pertussis), and tetanus. For full
protection, the child needs three injections: first at 3 months old, the second at 5
months, and the third at 2 years of age. After 3 years. D.T. is given
4.
POLIO (infantile paralysis). The child needs
drops in the mouth once each month for 3 months.
In some countries, polio vaccine is first given
shortly after birth; in other countries, when the baby
is 2 months old. Do breast feed the baby for
2 hours before and after giving the drops.
5.
TETANUS. For adults and children over 12 years old, the most important
vaccine is for tetanus (lockjaw). One injection every month for 3 months, another
after a year, and then one every 10 years. Everyone should be vaccinated against
tetanus—especially pregnant women, so that their babies will be protected against
tetanus of the newborn (see p. 2.23and296).
6.
TYPHOID (TAB).This is given once in 6 months. It is better to give this
vaccination during the summer months. The person may have pain and swelling at
the site of the injection Give aspirin tablets to relieve pain.
176
CHOLERA VACCINE: To be given once in 6 months, especially in summer or if
there is any case of cholera in your area. The person may get fever and pain at the
site of the injection. Give aspirin tablets to relieve the fever and pain
DO NOT GIVE ANY INJECTION DURINGTHE RAINY SEASON. THIS IS THE SEASON
OF POLIO EPIDEMIC EVEN ONE INJECTION MAY CAUSE PARALYSIS OF THE
7.
LIMBS
Vaccinate your children on time.
Be sure they get the complete series of each vaccine they need.
OTHER WAYS TO PREVENT SICKNESS AND INJURY
In this chapter we have talked about ways to prevent intestinal and other
infections through hygiene, sanitation, and vaccination. All through this book
you will find suggestions for the prevention of sickness and injury—from building
Jiealthy bodies by eating nutritious foods to the wise use of home remedies and
modern'medicines.
The Introduction to the Village Health Worker gives ideas for getting people
working together to change the conditions that cause poor health.
In the remaining chapters, as specific health problems are discussed, you will
find many suggestions for their prevention. By following these suggestions you
can help make your home and village healthier places to live.
Keep in mind that one of the best ways to prevent serious illness and death is
early and sensible treatment.
Early and sensible treatment is an
important part of preventive medicine.
Before ending this chapter, I would like to mention a few aspects of prevention
that are touched on in other parts of the book, but deserve special attention.
Habits that Affect Health
Some of the habits that people have not only damage their own health but in
one way or another harm those around them. Many of these habits can be broken
or avoided-but the first step is to understand why breaking these habits is so
important.
1
DRINKING:
If alcohol has brought much joy to man, it has
also brought much suffering—especially to the
women and children of men who drink. A little
alcohol now and then may do no harm. But too
often a little leads to a lot. In much of the world,
heavy or excessive drinking is one of the
underlying causes of major health problems—even
for those who do not drink. Not only can
drunkenness harm the health of those who drink
(through diseases such as cirrhosis of the liver,
p 374) but jt also hurts the family and community
in many ways. Through lossxjf judgment when
drunk—and of self-respect when sober—it leads to
much unhappiness, waste, and violence, often
affecting those who are loved most.
How many fathers have spent their last money on drink when their children
were hungry? How many sicknesses result because a man spends the little bit of
extra money he earns on .drink rather than on improving his family's living
conditions? How many persons, hating themselves because they have hurt those
they love, take another drink—to forget?
Once a man realizes that alcohol is harming the health and happiness of those
around him, what can he do? First, he must admit that his drinking is a problem.
He must be honest with himself and with others. Some individuals are able to
simply decide to stop drinking. More often people need help and support—from
family, friends, and others who understand how hard it may be to give up this
habit. People who have been heavy drinkers and have stopped are often the best
persons to help others do the same.
Drinking is not so much a problem of individuals as of a whole community. A
community that recognizes this can do much to encourage those who are willing
to make changes. If you are concerned about the misuse of alcohol in your
community, help organize a meeting to discuss these problems and decide what
actions to take.
Many problems can be resolved when people work together
and give each other help and support.
SMOKING:
There are many reasons why smoking is
dangerous to your own and your family's health.
178
1.
Smoking increases the risk of cancer of the
lungs and lips. (The more you smoke, the greater
the chance of dying of cancer.)
2.
Smoking causes serious diseases of the lungs,
including chronic bronchitis and emphysema (and
is deadly for persons who already have these
conditions or have asthma).
3.
Smoking can help cause stomach ulcers or
make them worse.
4.
Children whose parents smoke have more
cases of pneumonia and other respiratory illness
than children whose parents do not smoke.
5.
Smoking increases your chance of suffering or
dying from heart disease or stroke.
6.
Babies of mothers who smoked during
pregnancy are smaller and develop more slowly
than babies whose mothers did not smoke.
7.
Parents, teachers, health workers, and others who smoke set an unhealthy
example for children and young people, increasing the likelihood that they too
will begin smoking.
8.
Also, smoking costs money. It looks like little is spent, but it adds up to a lot
In poorer countries, many of the poorest persons spend more on tobacco than the
country spends per person on its health program. If money spent on tobacco were
spent for food instead, children and whole families could be healthier.
Anyone interested in the health of others should not smoke,
and should encourage others not to smoke.
CARBONATED DRINKS (soft drinks, soda ):
In some areas these drinks have become very popular. Often a poor mother will
buy coloured drinks for a child who is poorly nourished, when the same money
could be better used to buy 2 eggs or other nutritious food.
179
Carbonated drinks have no nutritional value apart from sugar. And for the
amount of sugar they contain, they are very expensive. Children who are given a
lot of carbonated drinks and other sweet things often begin to get cavities and
rotten teeth at an early age. Carbonated drinks are especially bad for persons with
acid indigestion or stomach ulcer.
Natural drinks you make from fruits are healthier and often much cheaper than
carbonated drinks.
Do not get your children used to drinking carbonated drinks.
The book V/hcrc ~Therc 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. 2.50
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