HEALTH FOR THE MILLIONS-VOL-5-NO-4 AUGUST 1979

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Title
HEALTH FOR THE MILLIONS-VOL-5-NO-4 AUGUST 1979
extracted text
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RDRTHE (VIIL.I—IOISIS
I VOL V

NO. 1

A bimonthly of the Voluntary Health Association of India

FEBRUARY 1979

COMMUNITY HEALTH CELL
326. V Main, I Block

Koramongala
Bangalore-560034 '
India

&V

editorial :

care is the word
Great health news will soon break upon us.
During 1978 and continuing in 1979, a nationally selected group of 15 competent and
dedicated persons, have been meeting periodically, to develop a new national health plan.
These scholars, planners and men of experience are focusing their energy on ways of providing
the maximum possible health care for all the x ill ages of India by the year 2000. The
emphasis of the plan is on community health services, particularly for the most deprived
people. The draft of the plan is being finalized and a summary of it is likely to be out within
a few months.
In the plan, little is being said of hospitals, and much about social justice in the provision and
distribution of health care. The spirit of the plan can be perceived from these words of
the draft;

“Improvement in the health status of the population can be achieved only if there is a
shift from the hospital-based, disease-oriented approach depending heavily on
sophisticated technology, to a system where attitudes, skills and approaches of the
trained personnel are in tune with the need of the common man and where the facilities
are acessible to the population in physical, social, cultural and financial terms. For this
to become possible, participation of the community in all health activities is of the
utmost importance.”

The central thrust of the plan is fourfold : Health Promotion, Prevention of illness, Curative
Services and Rehabilitation.

The plan urges that health services should be an integral part of total development. It calls
for the maximum co-operation of people actually living in the community, and the best
use of local resources.
The plan calls for health education on a wide scale. One of the goals by the year 2000 is
to have 100 per cent coverage for inoculations, safe drinking water and improved hygiene.
Envisioned also are adequate structures for primary health coverage in all villages and city
slums.
Other aspects of the plan are to utilize the knowledge and values available in all the systems of
medicine, re-orientation of medical education so that it will be more in tune with the needs
of the community, increased maternal and child care, and to work towards some self-sustaining
system of health security so that the eamings of individuals are not adversely affected during
periods of illness.

The Government feels that India should have its own national health plan as a way of
expressing solidarity with the international health goals agreed upon last year by the WHO
Conference at Alma Ata, Russia, which is “Health for All by the Year 2000.”
All the members and supporters of VHAI have reason to rejoice that Dr Raj Arole, the
President of VHAI, is a member of the national health planning team. Also Dr Carl Taylor
of the Public Health Department of John Hopkins has attended a couple of the meetings.
The Chairman of the team is Dr Ramalingaswami, Director of the All India Institute of
Medical Sciences. Dr J. P. Naik has contributed his characteristic wisdom and enthusiasm
to the team. The Indian Council of Medical Research is highly supportive.

When the plan is published and ultimately accepted by the Government, our consolation will
be that ideas of community health and people’s participation which VHAI has been promoting
for many years will receive official blessing and encouragement.

2

health by the pupil
a special correspondent
Can the community (Teachers and Pupils)
be involved and pursue a system of ‘Health
by the pupil for a more effective health de­
livery ? Can the motivated teachers and pupils
be used as community health promoters ?
The Kangazha experiment involving 10,000
students has demonstrated how teachers and
the pupils can play effective roles in a school
based health programme.

functions through a training programme which
commences as an institutional training, and
continues on an inservice basis. The trained
teachers have the following functions.

*• Health appraisal and recording of height,
weight and vision of all pupils.
• * Arranging medical inspection of pupils
with visiting school health team.

* -Dispensing of medicines.
* First aid, primary care ol common ail­
ments and referrals.

A new look at school health problems

Over 80% of the morbidity in our school
children is caused by relatively simple ailments
such as deficiency states and skin diseases • "* Promotion of immunisation.
which are manageable at the school level.
1'rained teachers are able to recognize them
*■ Prevention of spread of communicable
and institute remedial measures. Only less than diseases by early case detection and applica­
5% of the affected morbid group required tion -of quarantine regulations.
hospital follow-up. It is also seen that dental
caries and other diseases are highly prevalent
* Health education.
and therefore dental prophylaxis demands spe­
* Supervision of student health guides.
cial attention.

Tier I teachers and pupils
Programme profile

Tier II Visiting health team
j

A three tier organization profile with the
school-based health unit manned by teachers
and pupil health guides as the first tier, a visit­
ing team as the second tier and the base hospi­
tal as the third tier was adopted as represented
above.
A phasdd approach and a strategy of graft­
ing inputs were adopted as shown opposite. Tn
the first two phases as shown here the services
were confined to the school. In the third phase
the school health guides began functioning in
the community.
New functionaries

A trained teacher is the hard core in tills
programme, and is skilled for the following

3

Tier III base hospital

Phase

Approach

Target

I

Training teachers

Pupils

If

Training, pupils

Entire
school
community
Extended training
General
com­
111
munity
. The student health guides play an accessary
role as follows.
* Record keeping.
* Daily appraisal of health of pupils, and
reporting.
* Assist teacher health guides in dispensing.
* Promote immunization.
* Organize school meals, and vegetable
gardens.

♦ First aid.
♦ Create health awareness.
* Organize health education seminars, exhi­
bitions, film shows.
♦ Community education in nutrition and
environmental hygiene.
Health guide in the making

gramme was launched as a summer scheme
with the following targets for each health
guide.
♦

* Vit. A prophylaxis for ten underfiives.
♦ Compost and soakage pits for five
houses.*
*

The teachers and the pupils are enabled
to perform the above functions through a skill
oriented training, knowledge being limited to
optimal levels. Informal education model
through group discussions, role playing and
demonstrations were found to be more useful
than formal methods. The teacher health guide
training is offered through a four davs institu­
tional training at the base hospital, or health
centre followed bv inservice .training during
the. school visits of health team. The students*
training consist of four half davs at weekly in­
tervals at the base hospital. Of late a ‘built in’
svstem for student training is adonted where
the teachers themselves are enabled in their
training to train a batch of students to assist
them and only the evaluation of school level
training being alone at the institutional level.
A primary health centre and health unit can
be the venue for training of these guides.

Immunize ten underfives.

Chlorinate five wells.

* Kitchen gardens for five houses.
♦ Five simple nutrition messages to reach
the families.

* A simple lesson in dental hygiene for
ten families.
Cost and evaluation

This is a community supported programme.
The beneficiaries meet part of the cost by con­
tributing to a special fund formed in the school
for the purpose. A contribution of 50 Ps. by a
student and equal contribution of 50 Ps. by
the institution or government per student per
year would suffice to run this programme.

A concurrent evaluation using evaluation
models of Goal Effectiveness (GE) realised
efficiency (cost benefit analysis) and potency
efficiency (PE) revealed very satisfactory re­
sults. There was a significant reduction of com­
mon ailments like anaemia and other deficien­
cies, scabies and so on. School attendance has
improved. This was attributable to the avail­
ability of first aid and minimal medical care
at the school level. Improvement in scholastic
performance, probably related to correction of
anaemia and other deficiency states was also
noticed.

Priorities and inputs

The programme inputs were decided, based
on the local priorities. A school based primary
curative care facility was' considered the first
among lhe priorities in view of the hiph prevelance of common ailments manageable at the
school level. Dental health and prophylaxis.
control of communicable diseases, promotion
of nurition and health education of pupils were
considered important among the priorities.
Finally there was felt a need for a newer and
simpler system which is primarily school based.

Appropriate technology and methodology

A low cost portable dental unit locally fab­
The package of services consists of
ricated and the school dental service grafted
♦ Primary curative care through school to the school dental programme is a contribubased dispensaries manned by teacher * lion which comes through this programme. A
new device for the screening of hearing called
student health guides.
cassette record audiometer is mother low cost
appropriate technology developed. The re­
♦ Dental health and prophylaxis.
* Monitoring the growth and development. sourceful participation of the school commu­
nity make this programme low cost, but of
* Vision and hearing screening.
high quality, and hence appropriate for a
♦ Immunization of school children.
developing country like ours.
♦ Nutrition education.
♦ Special care for scholastically backward
In conclusion a grass root approach of
handicapped.
motivating and training teachers and pupils as
♦ Health education and school sanitation health guides and establishing school based
are offered through the programme.
health units can be an effective method of
health care in the school community. The
trained teachers and pupils can also play an
Reaching into the community
effective role in other community health
In the third phase the health guides are action programmes and thereby extend the
mobilized for general community service through philosophy of community self reliance in
a seven point action programme. This pro­ health.

4

spy games for children
david drucker
Enter any village and child­
ren will be seen working. Park
a vehicle near any market and
the children will want to sell
you something or seek casual
employment. In fact, a recent
report states that in South Asia
alone, by ILO standards, 29
million children are gainfully
employed.

Another fact is that children
They know an enor­
mous amount and we adults
have failed to gather and put
to use the very careful research
undertaken quite
unguided
and voluntarily by children
with their inherent sense of
curiosity.

thorough-going and persevering
way. If we can help this to
happen we may have earned
sufficient trust, so that they
might be ready and want to
listen to and incorporate any
new knowing that we deve­
lopers think we know and we
are prepared to humbly and
simply contribute (with a com­
mon touch) to the common
pool of community knowing.

know.

Watch a child staring intent­
ly at a parasitic growth on the
trunk of a tree; watch him
prod with a stick at an insect;
listen to him tell about a neigh­
bour’s baby, or discuss who
died and how they were sick;
notice how every little hole is
investigated, and every puddle
or trickle of water becomes a
focus of attention; listen to my
sophisticated ly educated son
tell me about fantastic and
truly obscure “achievements”
which he has gleaned from the
Guiness Book of Records, or
my small daughter tell me her
skin is full of tiny, tiny holes
— all research, however, aca­
demically faulted.

Let me not labour the point
— children know. But, just as
in any community which is to
be involved in development,
we who are in the develop­
ment business fail to recognize
that those whose lives are, we
hope, to be positively trans­
formed, and who have for
centuries known the local cir­
cumstances and condition of
their lives, need to assist them­
selves and educate us by being
skillfully encouraged to know
what they know:

what is re­

quired is the organizing and
presentation of their know­
ledge and for us together to
examine their knowledge in a

We must do this not in an
unconsciously arrogant manner
of ‘we-know-best-really”, but
in a .. genuinely egalitarian
“how-does-this-fit-in-with-whatyou-know” spirit of enquiry,
which truly expresses a com­
munity development philoso­
phy of partnership. We must
remember that we are required
to ally centuries of experience
which tells communities that
much of what is initiated by
outsiders is self-seeking and
accrues to those up the hierar­
chy in the high status positions.
If community participation
is to have the vitalising effect
which rather suddenly all the
sectoral programmes arc begin­
ning to say is essential to their
development projects, it will
be necessary to painstakingly
generate (with sufficient and
appropriately allocated resour­
ces and skilled personnel) a
process leading to viable com­
munity planning mechanisms
from the “bottom-up” with
Ministries and agencies gearing
themselves to the largely un­
familiar role of “support­
down”.

Illis brings me a long way
round back to the children, for
they can most certainly contri­
bute and might even spear­
head development. After all
they will be around longer
than most of us in either en­
joying or carrying the burden
of all our activities!
Take for example those pud­
dles and trickles of water, and

5

add the wells and the ponds,
and the tanks, even storage
jars, and the springs and the
waterfalls, the creeks and the
drains and the rivers that chil­
dren are the local experts in
splashing, floating, falling-in
and knowing about. We know
that contaminated water is the
cause of untold discomfort,
disease, and is one of the main
outriders of death itself for
many, many, too many, of
these children.
We know a lot about a
range of possible technical in­
novations and technical hard­
ware, drills and pumps and
pipes. We know something
about the macro-economics of
such matters and we know
something about how start-up
(pump-priming”) funds might
be assembled.
How can we put all this
knowing, both available and
potential, together ? Well, how
about inventing “I-Spy type
games”? — pleasurable and
exciting games, yet serious as
the best games should be. One
game would be for the
children to spy out and
note down every conceiv­
able source of water in the
surrounding area. The children
could work in pairs or teams
and some kind of marker or
agreed “secret sign” be left at
each source discovered, so that
the same item is not claimed
more than once by any
“player”, and so that a proper
claim is made of each “find”
and can be judged to belong to
the first finder. Some kind of
points system and reward for
the most points should be de­
vised, All the information from
this I-Spy Game would then
be brought together and dis­
played on the largest possible
area on which an outline map
of the village or community
can be marked out. It could be
the size of the school play­
ground, a sportsfield, a market
square, the side of a house???
The map can be outlined in

I

chalk, or with stones, or bam­
boo, or scraped in the dry
earth. The children can make
models (with mud, coconut
shells, card, anything**.. Then
with sections of the map allo­
cated to pairs of children,
they should fill in the map,
marking all the water sources
which will show the total
situation.

A village leader, a health
worker or a youth group
might organize the whole
game. Better still, an enter­
prising school teacher might
use a water 1-Spy Game to
teach and link many aspects
of his curriculum, preferably
as a practical activity illus­
trating what the school is sup­
posed to be teaching anyway—
map-making, charts, graphs,
handicrafts, hygiene, social
studies, essay-writing, etc., etc.,
or as a valuable learning pro­
ject in its own right.
For example, children could
be asked to write a “24 hours
of water use in my family”
and be encouraged to describe
where it comes from, how it is
collected and stored, how much
is used for what, and some­
thing about the seasonal varia­
tions. The art class pupils
could be set the task of pro­
ducing a huge wall mural
(children, paired, taking a small
section of the wall each) illus­
trating water use in the village.
All of this clearly has direct
relevance to the school curri­
culum. The educational pro­
gramme itself could be en­
hanced this way.

From this basic game, we
can move on to an “I-Spy Sani­
tary Inspector Game”. Teams
are again formed and reward
given this time to the team
that identifies from all the
sources the most water risk
danger situations (having been
told all about these before­
hand, cattle drinking, washing,
clothes washing, open wells,
defecation, and so on). They
must place a sign to mark the
danger and to claim the site
for their team. The signs could
be semi-permanent so that
they stood/hung/marked the
site until the risk had eventual­
ly been eradicated.

How the risks would be
added (big red spots?) to the
sources plotted on the huge
map. These water games might
be linked appropriately to local
water festivals like Holi.
When the whole layout is satis­
factorily completed, the village
leaders and the whole village
should be invited to attend a
ceremonial inspection of the
map. Then the whole thing
will be explained (perhaps by
the children themselves) and
a full presentation made, on
“Our Village Water Conditions
and What Might be Done for
a Clean Village Water Supply”.
Of course, these games and
the whole procedure expects
much of the school teacher or
whoever, and might require a

campaign to back them up
with an orientation and prac­
tice sessions sponsored by the
education or welfare (?) or
health (?) authorities.
All this information and the
community involvement and
interest engendered by these
“game” activities are the fer­
tile ground upon which can be
built specifically local tailormade plans. In full consulta­
tion with a well-informed com­
munity, the engineers, the
health educators, the commu­
nity organizers can tackle to­
gether a whole range of prob­
lems. We would, under these
circumstances, have every rea­
son to believe that the com­
munity has a full stake and

will give a full effort to imple­
mentation, for the plans will
be a reality to them and a
challenge to us to fulfill our
part in mutually realistic ex­
pectations.
This is only one illustration
for a child-contributed ap­
proach to planning. Variations
of I-Spy can be prepared and
experimented within relation to
many if not all developmental
activity such as malaria con­
trol, immunization, nutrition
(remember children are the
experts in knowing the where­
abouts and condition of pre­
school children and babies),
etc., etc. Other sectors con­
cerned with agriculture, irriga­
tion, forestry, husbandry, trans­
port, markets, and so on could

help devise action-oriented
exercises in this way.
What we need to do is to
try it, learn from real expe­
rience in the communities and
villages where development ac­
tivity is to take place and
work out some persuasive
“How to.......... Guides” com­
plete with kits, check-lists, and
so on.
Is there any one listening
and interested out there on the
knowledge network? Can we
get together, hammer out the
details, design the materials
and try to approach out some­
where in relation to specific
projects ? Let’s hear from you!

a happy healthy school
The idea

Being healthy and staying
healthy is a result of good
health habits. A community
that has good health habits :

is clean and pleasant to live
in;

their own rules for keeping
their surroundings healthy :
clearing away rubbish and
having it in special places;
keeping holes free of water
and mosquitoes;
storing materials and equip­
ment;

has people who are strong
and not often sick;

keeping the play areas safe.

has people who are kind
and care for all who live
there.

They can form
‘health
patrols’ who are responsible
for seeing that these habits
are kept.

Children begin to learn the
health habits of their com­
munity from the time they
are young babies. We can en­
courage the right health prac­
tices in children so that they
become good habits.

Sometimes children (and
adults) lose their tempers or
do things' which seem cruel
or unkind., Discuss these feel­
ings with children :

Older children can help
develop good health habits in
younger children so that they
learn how :
to keep their surroundings
healthy;

to keep their bodies strong
and healthy;

to live in a happy, healthy
way with others.
Who can introduce the acti­
vity to children ?

Teachers can involve school
children;
health workers and volun­
teer health workers can tell
children at school or in outof-school activities;

Guide, Scout and other
youth leaders can help:
Press, radio, posters and
songs can all be used to
spread these ideas to child­
ren.
The activity

make up stories and games
that help
children realise
the needs and feelings of
others;
let them decide what is the
kind thing to do in these
difficult situation, for exam­
ple, when children fight, or
steal, or tease each other;

they can make up a play
about a difficult situation
like this, perhaps based on
something that has hap­
pened to them. They can
tell how it was solved in a
kindly way;
the older children can each
be made responsible for a
younger one to help him if
he is in trouble of any kind.
j

If a child has ringworm it
is important that other peo­
ple do not share his comb.
brush, razor or scissors.
A ringworm cream from the
clinic may help cure it. Often
tablets are needed.
Scabies

This is an itchy skin
disease.. The insect is very
small and lives in the skin.
The insect bites in the dark,
and at night, especially on
the fingers, feet and buttocks.

If someone in the house­
hold has scabies
everyone
who lives there will need to
be treated. A special lotion
from the dispensary is need­
ed. This is put all over the
body.
All bedding and clothes
need to be changed and aired.
Itching

Lots of insects bite us and
make us itch. Flying insects
like mosquitoes and
gnats
bite skin not covered by
clothes and make itchy lumps
that last a day or so. Some
of these insects breed in pools
of water, so clearing
the
water will get rid of the in­
sects.

Healthy skin habits

Children often have skin
diseases like ringworm, sca­
bies, or itches from insect
bites. Good health habits can
help prevent these.
The following are some
common skin conditions. Child­
ren can discuss them and
how to prevent and cure
them.

A happy healthy school
Ringworm

Children at school or in
youth groups can be encour­
aged to discuss and make up

out in a round patch, and a
large swelling can grow. On
the rest of the body ringworm
looks like red scaly rings,
sometimes with swellings and
spots with yellow matter in
them.

This can follow a cut or a
prick. On the head hair falls

7

Insects like fleas and mites
get in clothes and on animals,
and live in bedding.
Keep­
ing animals like dogs, cats
and chickens out of the house
will help keep these insects
out too.
Lice can live in hair and
clothing. To get rid of them
you need to clean bedding
and clothing and to get a spe­
cial lotion from the dispen­
sary for washing the hair.
Treat everyone in the house
or class.

The children should learn
to recognize these skin prob­
lems. They can organize regu­
lar inspections at school. If
they see other children with
any of these skin problems
they can tell them how to get
the right treatment.
Healthy teeth habits

Children should understand
the importance of caring for
their teeth every day. They
should brush their teeth after
eating, with a brush or brush­
ing stick. They should not
eat too much sweet food of
tizzy drinks. These may rot
teeth.

Let the children look at
each other’s teeth.
When
children were looking at teeth,
did they notice that some
teeth were black? Did they
notice that some teeth have
holes in them? These teeth
have decay and are rotting.
The hole needs to be filled
by a dental worker. This may
not be possible. The children
could suggest local pain killers
to put on the tooth. However,
this does not stop the tooth
from rotting.
Teeth go rotten if you eat
a lot of sweet food, for exam­
ple, cakes, fizzy drinks and
sweets. Here is simple experi­
ment, if you can find two
teeth (for example, teeth from
children whose first set is fall­
ing out). Drop one in a fizzy
drink. Drop the other in wa­
ter. Leave them overnight.
Look at them the next day.
The tooth in the fizzy drink
rots. The tooth in water does
not.

The children can learn to
brush their teeth the correct
way. If they have a toothbrush
show them how to use it.

Practise using the slick or
toothbrush. Show the children
how to brush up and down
the front, back, top and bot­
tom of their teeth. They should
not brush from side to side.
The children can bring their
brushing sticks or toothbru­
shes to school each day and

brush their teeth together be­
fore school.

They can make a brushing
stick for their younger bro­
thers or sisters at home and
leach them how to brush their
teeth well.
The children could learn
to make ‘toothpaste’. They
can make a tooth powder by
mixing salt and bicarbonate
of soda in equal amounts.
Just plain salt can also be
used.
To make it stick, wet the
brush or stick before putting
it in the powder.
Healthy eyes

We all want to have bright.
shiny eyes. Care of our eyes
is very important.

Children should understand
that it is important to eat
foods like dark green vege­
tables and yellow and orange
fruits and vegetables.

The children could visit the
local market or walk around
the village, and make a list of
all the dark green vegetables,
and yellow and orange fruits
and
vegetables,
such as
spinch, cassava and papaya
leaves and
papaya fruit,
mango and many others. Are
these foods expensive ? Who
eats them? How are they
eaten? When?
The older children can bring
a piece of yellow fruit to
school. They can share it with
a younger child. They can try
to see that their younger bro­
ther or sister at home eats
some green leafy vegetable or
yellow fniit each day.

Often children get sticky
eyes. They get dirt or pus in
them. Older children can leam
to wash eyes with clean water
to keep them clear and healthy.
If they notice pus in younger
children’s eyes they should tell
an adult. This can help to
prevent diseases such as tra­
choma which may cause blind­
ness.
Healthy ears

Discuss with the children
;how it might feel if you can't

8

hear well. Ask questions like :

Do you know anybody who
does not hear well?
Do you act differently with
these people? Why?
How would you feel if you
did not hear well?

The children can test each
other's hearing in a game
like this :
(1) An older child stands
several metres behind a line
of younger children who are
about to enter school.

(2) Besides each
young
child, an older child stands
with pencil and paper.
(3) The first child says the
name of an animal VERY
LOUD.

(4) The young
whisper the word
older partner.
(5) And the
writes it down.

children
to their

older

child

Then the first child says
names of other animals, each
one in a softer voice than the
one before until at last he is
whispering.
After a list of about ten
animals has been said and
the words that the younger
children hear are written
down, the different lists can
be compared.
If any child heard a lot less
words than the others he pro­
bably has a hearing problem.
Let him sit at the front of his
class. If possible he should be
examined by a health worker,
especially if he has pus in an
ear or frequent earache.

Older children can help
look after the ears of brothers
and sisters. They can regularly
look in the ears of their bro­
thers and sisters to see that
there is no pus or small ob­
ject If they do see anything
wrong they should tell an
older person who should take
the child to a health worker
for help.

Book Review

Check on activities.

Children can keep a chart
and record on it each day if
they are green or yellow fruits
or vegetables.

from the depth of a child's heart
by Sr. M. Pin Nazareth, r.j.m.
Frank Bros. ft Co.

New Delhi 1978
Each month they can do a
Rs. 8 50
check of their school. Check Pages 112
each class and give a prize
From the Depth of a Child’s how they themselves measure
for the healthiest group.
Heart is a study of children’s up to them. The children do
expectations. It is a collection not seek happiness in material
They can make a list of from the original copies of goods but in values that gene­
‘healthy habits’ to notice.
children’s work in middle rate warmth.
schools.
In the International Year
Older children can give a
This probe into their inner of the Child here is a book
‘brushing’ test to children to
see if they clean teeth the best most feelings uncovers the that reminds us that no educa­
deeper perceptions of the chil­ tion is complete unless th?
way.
dren’s world, the homes they hopes of children are given due
would like, their ideals and consideration.

Other activities for children

The article Happy Healthy School is adapted from a chapter
in "CHILD-to-child". This 104 pages, profusely illustrated
book is published on behalf of CHILD-to-chi!d programme
based at the institutes of Education and Child Health at the
The children could do a University of London.
play about their teeth. The
characters could be as fol­
Cut Here_______________________
lows :

Children can make a list
of healthy habits to notice.

Ravan Germ — a bad man.

Kindly Reserve........................................ no of copies of CHILDto-child edited by Audrey Aarons and Hugh Hawes.

Ramesh Molar — a good
but rather stupid man.

[Tick whichever is appropriate].

Shri Dental Worker — two j-j
good helpful
people who
stop.

When the book is ready for despatch kindly inform me.
I shall send the amount by money order/draft/cheque.

Shrimati Brushstick — Ravan Germ from attacking
Ramesh Molar.

I would prefer to have, it by VPP.
man Rs. 17....... plus postage.

The play can be developed
by teachers and children.
Ramesh Molar tells Mr.
Worker what it is like to be a
tooth.

He says how frightened he
is of Ravan Germ.
Ravan Germ appears and
tells the audience how he plans
to rot Ramesh Molar.

Shri Dental Worker and
Shrimati Brushstick discuss
how to stop Ravan Germ from
attacking Ramesh Molar.

O

I shall pay the post­

......................................................................... Name
......................................................................... Post held
......................................................................... Institution
......................................................................... Address
.................. ....................................................... Dist 8- state
..........................................................................Pin code
Cut Here

Please send this Form to Publications Manao^, VHAI C-14
Community Centre, SDA New Delhi-110
' "UN,TY HEALTH

9

?* “
| Block
cnung~|a
Ban3a;Ore.o60034 •

India

GE^

school health
-more than a footnote

The eye specialist visits
the schools, examines the
children’s eyes, talks to
them about how to prevent
eye infections and what
foods they should eat in
order to have good eyes.
The
dentist
visits the
schools, examines the chil­
dren’s teeth, talks about
mouth care and the danger
of eating too many sweets.
and calls the children to
the dental clinic to have
small cavities filled, badly
decayed teeth removed.
The community health wor­
ker visits the schools. He
talks about sanitation and
cleanliness and the impor­
tance of
immunizations.
The school teacher con­
ducts hygiene classes.

What do the children
loam about
health
in
school? Charts and pictures
or stories may help them
to remember what they are
taught. Tt is important that
they do, for they have far
more influence on the peo­
ple at home than the visit- '
ing hospital team or the
government nurse can. If
parents are telling their
children that school is im­
portant, they must listen to
what the children are learn­
ing.

Dr. Eric Ram, now with
the Christian Medical Com­
mission of the W.C.C. in
Geneva, feels that it is a
waste of time to lecture to
adults. A little girl in a

school he used to visit told
her grandmother, who was
preparing for the delivery
of a new baby, “You must
not use the sickle. You
must boil a new razor
blade and use that to cut
Lhe baby’s cord. If you
don’t the baby may get
tetanus and die.” She was
so concerned and insistent
that the skeptical grand­
mother complied.

School health is reaching
out to the minds of youngs­
ters with a message about
how theirs can be a heal­
thier, happier life. If the
lesson is clear and convinc­
ing, the children will take
it from there.
—Ron Seaton

Do you know that one half of all the
nurses in service are girls of from five to
twenty years old ? You can see you are very
important little people. Then there are all
the girls who are nursing mother’s baby
at home; and, in all these cases, it seems
pretty nearly to come to this, that baby’s
health for its whole life depends upon you,
girls, more than upon anything else.
I need hardly say to you, what a charged
For I believe that you, all of you, or nearly
all, care about too much not to feel this
•nearly as much as I do. You, all of you,
want to make baby grow up well and
happy, if you knew how.
Perhaps you will say to me, “I don’t
know what you would have me do. You
puzzle me so. You tell me, don’t feed the
child too much, and don’t feed it too little;
don’t keep the room shut up, and don’t let
there be a draught; don’t let the child be
dull, and don’t amuse it too much.” Dear
little nurse, you must learn to manage.
Some people never do learn management.
I have felt all these difficulties myself; and
I can tell you that it is not from reading
my book that you will learn to mind baby
well, but from practising yourself how best
to manage to do what other good nurses
(and my book, if you like it) tell you.

Half the nurses

‘ Florence Nightingale

10

madhya pradesh

from the states

nursing a slum to health
Al the Mid India Board of
Examiners Graduate School
for Nurses, Indore, M.P. there
are courses to prepare gra­
duate nurses to become Ward
Sisters, (or Brothers), Nurse
Administrators, Sister (or Bro­
ther) Tutors and Public Health
Nurses. The Director, Miss S.
Patras, and faculty members
are constantly revising the
couse in order to keep up with
the cuurent thoughts and ideas
in Nursing and Education.
This year the public health
couse has actually become a
community health course and
the students’ enthusiasm plus
the stess on new trends has
put up a very strong emphasis
on communit}' health, health
education and primary health
care in all the classes. Here
Alice Porter reports what
the Nursing Students were
able to do within a short time.

The
community
health
course has worked out even
belter than I had hoped —
perhaps it is beginner’s luck.
The integrated field work with
the theory has been a good
experience. The students were
assigned a slum area to visit
at least once a week.

who are not too welcome since
the forced sterilization pro­
gramme during the Emergency;
however, they soon explained
that they were students who
had come to learn from the
local residents.

By the end of the first visit
a number of people said:
“Our home is your home.
Come any time.” One rather
older lady had been there for
many years and said this was
the first time any one had
made her feel she was wanted
and her opinion counted;
needless to say the students
were soon learning much. 1
think they were surprised, as
were the residents, that nurses
could learn from the village
people. They also contacted
village leaders, the dai (three
months trained midwife) and
the village priest — all of
whom are doing health work
in their own way. The stu­
dents were glad to find the
dai especially is doing good

work and they could encourage
her as well as learn from her.

In the primary school they
went to teach and they decid­
ed to do eye testing. They
found two children each with
a severely damaged eye. They
were able to get the children
to a specialist but unfortunate­
ly it was too late to help.
They taught hygiene, the “Five
Finger” health talk, and the
K.G. children marched right
out to the girl sitting in front
of the school selling channa
nuts, etc. The children told
her that if she did not get a
cover on the tray to keep the
flics off they would not buy
from her. The next day the
tray had a cover! It has been
covered each visit since.
On the 15lh of August a
lesson on food was taught by
puppet drama and song. The
children repeated it fairly and
accurately to the nurses the
next time they visited them.

With a little guidance they
made their own plans and
came back almost every time
with such enthusiastic reports.
Very soon they were going
twice a week and would have
liked to go more often.

Their initial visit set the
tone — they were rather fear­
ful of acceptance as there was
no organized medical work in
the area and only through the
YWCA were they able to get
an entrance. The YWCA does
a little work in the primary
school each week. The students
came back reporting their feel­
ings of “fear and trembling”
and uncertainty of how to be­
gin. They also reported their
introduction. They were in uni­
form and were mistaken for
the family planning workers

A CONSUMER REVOLT PRODUCES RESULTS. The Girl vendor
at the centre agrees to cover the edibles. The kintergarten boys1 first
lesson in hygeine has not gone in vain.

11

The students also had to do
a family study and the diet
analysis of a family for a
week. This the students were
able to do in the community
and so it fitted into the over­
all plan. One student had very
disturbing findings. In the sur­
vey they had found a post
polio child whose family was
subject for study. When the
nurse asked about food the
mother started to weep — they
were starving. The father was
out of work and they were
eating once a day at that time.
The calorie intake for the mo­
ther was about 600 and the
children still less — per day!
Needless to say the parents
were extremely thin. Through
the church and fellowship
groups some help was given
and contacts made for pos­
sible work. The mother is very
artistic so some home industry
has been started and she has
today started to teach sew­
ing.
About this time I was con­
cerned about continuing the
work as were the students and
by then the people of the area
were also asking, “Who will
help us when you leave?” We
have been able to arrange with
the student nurses in the Chris­
tian hospital that they go there
for experience and so carry
on some work.

When they all went together
one lady instructed my stu­
dents : “Give a good report.
You know all about us. Our
eyes have been opened and we
want someone to help us
carry on.”

cause. the)- said, they saw the
nurses coming each week to
help and they decided they too
could do something to help
their own community. The
hope is that they may become
involved in the adult education
programme which was inaugu­
rated on October 2nd all over
India.... The programme is
not merely to learn to read
and write but to widen the
horizons so they can help with
development. This will include
health and one of the book­
lets already published for these
new literate is on health.
With so many possibilities
for advancing good health in
the area the students are hat­
ing to leave. They are relieved

that at least the sewing classes
are started and the adult edu­
cation seems to be fairly sure
too. It is the old saying of
“being in the right place at the
right time,” that has made the
whole experience so good. Af­
ter the survey the students de­
cided that the number one
health problem was lack of
education. So they planned to
see what they could do and it
is all fitting together. In one
way it is good that they were
short term as the people know
it and realized they had to be
prepared to carry on them­
selves and not depend on the
nurse. However, support and
guidance is needed and I hope
we can give it through the
hospital students.

—Alice Porter

uttar pradesh

chotabhai and friends
Four kilometres from Bareil­
ly, U.P., is a clump of tall
trees decorating fields of sugar
cane. The trees shelter a hum­
ble
ashram inhabited by
Deenabandhu and Chotabhai.
They live here for the quiet
and to. allow their spirits to
expand.
They visit nearby villages.
The village folk return the
kindness. In the chats and
visits, the needs of the people
are revealed.

One obvious need was for a
health service.. Sisters have
been engaged to operate a
There have been a good
number of steps forward: a health centre in nearby village
Kareli. A speciality of their
there is much more commu­
approach is emphasis on health
nity feeling and they are talk­
education, and the training of
ing more together, they had
village health workers. Their
a “town” meeting and 75 sign­
leaching is not by a course,
ed a petition to get a public
but by on going sharing of
latrine and city water connec­
learning, experience and mu­
tion in the area. Forty persons
tual help. A doctor visits once
have signed up for sewing and
a week. The dispensary is tiny
adult education classes and
and simple, yet in the past year
teachers located. The YWCA
patients came from 32 vil­
is supervizing this project.
lages.
A group of about 30 young
Some of these were far away.
men who go to night school
People could more easily have
came and asked the nurses
gone to the city. They come
what they could do to help be­

12

here because of their confi­
dence in Sister Felicia and her
companions, and the consola­
tion and courage to face life
that they receive from the sis­
ters. There have been a few
seriously ill patients, given up
as hopeless by the doctors, who
have been cured by the sisters
praying over them at the dis­
pensary. The sisters customa­
rily pray oyer patients who
ask for it.

The sisters have an underfive centre for less privileged
children.
A supplementary
feeding is made possible for
them by the kindeness of Soya
Production and Research As­
sociation, Bareilly. 120 child­
ren are given a daily ration of
“Postikahar”, a high protein
food made especially for child­
ren. A village health worker,
Urmila Saxena, looks after the
feeding.
There are leprosy patients in
the area. To cover the cost of
their treatment a Leprosy Wel­
fare Association has been
formed of leading local citi­
zens. It has at present 41
members. It is open to all peo­
ple of good will. They con tn-

bate and raise enough money
(o cover the medical care of
240 leprosy patient. The Asso­
ciation has also provided shel­
ter for patients needing it, dis­
tributed goats for them to rear
and supplied rickshaws to
seven men who were able
bodied.

community. He is a retired
gentleman, competent and high­
ly dedicated.

For the landless labour and
the small farmers who own 1 /2
to 5 acres of land, a Small
Farmers Welfare Society has
been started. The membership

is Rs. 10 a year. The Society
provides a liaison service with
the Government departments.
It has provided a movable
pumpset for irrigation and a
godown to store fertilizers and
seeds. It has helped a few far­
mers to rebuild their houses
which fell during the floods of
this year. Hand pumps have
been installed for poor people
who did not have safe drink­
ing water. The Farmers Wel­
fare Society is managed by a
volunteer resident in the local

andhra pradesh

those who have experience in
relief and1 reconstruction work.

karnataka

□ A five day workshop on
Community Health was end­
ed
in Dichpalli, Victoria
Hospital on 11th December
1979. Ms. Simone was the
facilitator and consultant. Drs
Bas Mcsquita, Mrs Mesquita
and Mr Rayanna were also in
the faculty.

O Andhra State government
employees who undergo sterili­
zation operation under private
medical practitioners are eligi­
ble for benefit of family wel­
fare incentives. According to a
Government of Andhra Pra­
desh Medical and Health De­
partment memo the steriliza­
tion certificate issued by a me­
dical practitioner who perform­
ed the sterilization operation
has to be counter signed by a
Government doctor not below
the rank of a Civil Assistant
surgeon within five days from
the date of operation.

□ A weekend refresher pro­
gramme in community health
was organized by Voluntary
Health Association, Karnataka
on October 20, 1978. There
were thirty eight participants
who were community health
nurses, creche nurses, and
field officers. The topics cover­
ed during the programme
were : (i) Dynamics of commu­
nity health,” (ii) Practical as­
pects of a community health
programme, (iii)
Common
health problems in women and
children, (iv) a group discus­
sion on health problems, (v)
a discussion lecture on nutri­
tion and balanced diet, (vi)
First-aid
demonstration lec­
ture, (vii) Principles of mental
health and mental hygiene, etc.
The function was presided
over by Mrs Teresa Bhattacharya. T.A.S, Jt. Director.
Personnel Department, Gov­
ernment of Karnataka.

Dichpalli will be again the
venue for a similar workshop
from March 12-16, 1979.
* APVHA Educational and
Training
programmes for
the year 1979

—Seminar on Hospital Admi­
nistration (5 days).

—Seminar for Departmental
Heads (Middle management)
—(3 days).

—-Workshop on Community
Health (5 days).
—Workshop on Record Keep­
ing (4 days).

—Workshop on Human Rela­
tions & Communications.
□ Ms Zina Kidd, is back and
will be assisting APVHA as
Promotion Secretary (Com­
munity Health).
□ With Village Reconstruction
Organization APVHA is work­
ing on a Manual “How to
Deal with Disasters”. APVHA
welcomes suggestion
from

bihar
□ Armed with roll-up black­
board, a few chalks, slates and
pencils and a couple of pri­
mers, two
ex-students of
Xavier Institute of Social Ser­
vice have launched an adult
education centre. They are
Ms A. b. Mundu and Mr
N. B. Bam.

Adult education was started
in June and today 21 adult
education centres are run in
seven villages. Night classes
function in houses, a school
building or a community house.
People bring their own lamps
and contribute 10 paise per
week for buying necessaries
to keep the centre going. If
Government funds arrive the
village animators will be paid
Rs 50 per month as honora­
rium.

13

Dccnabandhu and Chotabhai with their colleagues and
co-workers, provide us with
an ideal small model of com­
munity health and develop­
ment in a village. In all the
activities there is community
involvement. The energies of
the strong are focused, and
the hopes of the weak are en­
couraged.

The Government of Karna­
taka has entrusted the task of
contacting voluntary organiza­
tions and invite specific pro­
grammes for welfare of needy
children to the Karnataka
State Council of Child Wel­
fare, which will be then pre­
sented to the Ministry of So­
cial Welfare.

A ihree-day workshop, in
this connection is to be held in
Bangalore during Feb. 23, 24
and 25, 1979 on various as­
pects such as child in the
home/ school / society,
health

and nutrition of the child,
sex education, etc., etc. Inte­
rested persons arc asked to
join hands.

This training will be impart­
ed through training Labs,
seminars, workshops, etc., con­
ducted every month at local
centres. For further informa­
tion please write to :

kerala

The KVHS Organizing Sec­
retary, St. Thomas Hospital,
Changanachcrry - 636 104,
Kerala.

□ Management expertise is now
at the door steps of Kerala
Hospitals.
Kerala Voluntary Health
Services has introduced a ten­
tative one year Management
training programme for the
benefit of hospitals which can­
not afford to send their per­
sonnel for formal training in
Hospital Administration.

tamil nadu
□ The seminar on “Rural Nu­
trition” in Dcenbandu Medi­
cal Mission organized- by Tamil
Nadu VHA was attended by
seventeen participants. Mrs
and Dr Prem C. John con­
ducted the seminar.

w. bengal
□ At Purulia Leprosy Hospital
various types of simple foot­
wear are produced in several
designs which will suit the pa­
tient and be acceptable to the
community.

Many leprosy patients can
stay as outpatients by prevent­
ing ulcers on their feet if these
shoes are worn by them. The
rates for this orthopaedic shoes
varies from Rs 22 to Rs 45
only.
For further
please contact :

information

Mr P. K. Roy, Superinten­
dent, The Leprosy Mission,
P. Box No. 9, Purulia 723 101, West Bengal.

unemployed doctors
The Medico Friend Circle
discussed this topic at their
annual convention, Varanasi,
January 26 to 28, 1979.
The purpose of the dicussion
was to call attention to the
fact that while there is indeed
unemployment among doctors,
there is also in many states
a considerable number of sanc­
tioned rural posts available
where doctors do not accept
to go.
In a background paper, Dr
Vinayak Sen of Rasulia, near
Hoshangabad, called attention
to a number of interesting
facts. One was that from infor­
mation in the 1971 census there
were at that time 1978 men
allopathic doctors and 791 wo­
men doctors unemployed and
looking for a job. This num­
ber, therefore, would not in­
clude retired doctors, or groups
like women doctors who have
married and ceased to have an
interest in practice.

The total number of econo­
mically active doctors in India
in 1978, he said, was 170,000.

Dr Luis Barreto, Lecturer
Sevagram, near Wardha said:
“The most obvious shortcom­
ing of the health system in
India is that it caters to the
few at the cost of the majority.
In his paper he quoted
B. R. Bloom as saying “People
are sick because they are poor,
they become poorer because
they are sick, and they become
sicker because they are poorer.”
Dr Barreto points out that
most medical doctors come
from an urban background,
and even if they are from a
village, during their education
they become urbanized. He
says that it is but natural that
when such students pass out,
they will refuse to work in
rural areas where amenities
like a good house, social life,
education for their children,
etc., are not available.
He said the number of doc­
tors on the registered roles in
India are 200,003. Of these
3,940 have post graduate de­
grees. This gives a doctor popu­
lation ratio of 1:4200. Of

14

course, this kind of average
can give a distorted picture.
The doctors are so heavily
concentrated in the cities that
in rural areas there are places
where there is one doctor to
10,000 reaching possibly as
high as 50,000 in a few places.

Relevant to this situation,
the goals of the Medico Friend
Circle are as follows :
1. to evolve a pattern of me­
dical education relevant to
Indian needs and condi­
tions;

2- to evolve a suitable me­
thodology of health care;
and
3.

to make positive efforts to­
words improving the nonmedical aspects of society
for a better life, more hu­
mane and just in contents
and purposes.

For information about MFC,
write to Mr Ashok Bhargava,
Convener, Medico Friend Cir­
cle, 21 Nirman Society, Vado­
dara - 390 005, Gujarat.

delhi news
ock

farm people of mexico
Mr Martin Reyes, Commu­
nity Health Programme Co­
ordinator, Sinlao, Mexico lead
the discussions on Rural Health
at India International Centre
on December 15, 1978, Lodi
Estate, New Delhi. Jointly or­
ganized
by the Vountary
Health Association of India
and the India International
Centre, the meeting was at­
tended by leading health mi­
nistry officials, health profes­
sionals and
representatives
from various voluntary organi­
zations. Mr. C. R. Krishnamurthi, Joint Secretary in the
Ministry of Health and Fami­
ly Welfare presided.
With the help of a short film
titled Health Care by the Peo­
ple. Mr Reyes gave glimpses
of the Project Piaxtala, a
health care network run by
farm people (Compesinos) that
covers several thousand square
miles of mountain terrain and
serves a population of more
than ] 0,000 persons living in
more than 100 small settle­
ments and villages. It attempts
to involve the mountain com­
munities in a process of meet­
ing their own health needs in
a manner that is economically
realistic, ecologically sound,
and personally humane.

The project is essentially a
personal venture founded on
friendship, dedication and trust.
It has evolved slowly, by trial
and error, since 1963 when
David Werner, an American
biologist and former high
school teacher, first hiked
through the barrancas in
search of interesting birds and
plants. Struck by the beauty
of the landscape, the friendli­
ness of the campesinos (farm
people), but also by the enor­
mity of their health problems,
David later returned to work
with the people.
Villagers—especially some of
the enthusiastic village child­

ren — were involved with the
health work from the start.
Today the community based
health programme is run and
staffed completely by local
villagers. The main referral
and training centre is in the
small village of Ajoya, at the
base of the mountains and ac­
cessible by a dirt road. The
centre operates an out-patient
(and occasionally in-patient)
clinic complete with laboratory
and X-ray facilities. Also
locally trained dental techni­
cians drill and fill teeth, and
make dentures. Other activities
include primary veterinary ser­
vices and repair of orthopedic
braces. All this work is done
by the villagers themselves,
most of whom have not gone
beyond the sixth grade of for­
mal education. Rosa who is
in charge of the clinical labo­
ratory, has never attended
school.

Perhaps the
most
im­
portant activity of the program­
me is the training of village
health workers, cSled promoteres de salud. These come
from remote ranchos and vil­
lages farther back into the
mountains. Selected by their
own communities, they spend
two months training in Ajoya.
The “learning through doing”
approach to training includes
preventive and curative medi­
cine, with a strong emphasis
on community organization,
conscientization (consciousness
raising), and teaching tech­
niques. The most recent course
was taught completely by the
Ajoya village team, headed by
Martin Reyes, the project co­
ordinator. David Werner and
his co-worker, Bill Bower, as­
sisted as consultants but re­
mained very much in the back­
ground.
Now completely self-sufficient
in terms of personnel, the vil­
lage health team is working
very hard to achieve financial

15

ln^"-^0034

self-sufficiency. Already the
promoters in outlying villages
are self-sufficient; they are
part-time health workers who
continue to earn their Jiving
through farming and make
very modest charges for their
services, providing necessary
medication at cost. Their com­
munities even contribute half
cost of their room and board
during the training programme.

Villagers may pay for health
services either with money or
with work. During the summer
rainy season, “work fiestas”
have been conducted in whicn
many villagers pitch into plough
and plant fields loaned to the
clinic. For each two hours of
work, a family receives credit
for a consultation, complete
with medicine if needed. To
keep upgrading their know­
ledge and to learn new skills,
the village team continues to
invite doctors, nurses, dentists,
veterinarians, lab techs, and
other professions to visit in a
teaching capacity. Such visitors
are encouraged to maintain a
low profile and to limit their
contribution to teaching and
making suggestions. It is felt
important that the visits of
professionals be brief (usually
two to six weeks) and that they
serve as auxiliaries or assis­
tants to the local team that
provides the continuity of care.

One of the most recent and
exciting developments of the
project is that it appears to be
self-seeding.
In addition to helping launch
a sister project in a neigh­
bouring area, Project Piaxtla
has begun a programme of
student exchange with other
rural health programmes in
more distant parts of Mexico
and as far away as Honduras.
Thus the team in Ajoya is
beginning to gather ideas and
to have an impact far afield.

in the news

situations

As reported earlier Dr
Rezia Laila Akbar has taken
over as Executive Director of
Bangladesh Voluntary Health
Service Society.

awards
Dr Shanti Ghosh, till re­
cently, Head, Department of
Paediatrics, Safdarjung Hospi­
tal. New Delhi has been
awarded Dr M. K. Seshadri
Award and medal for com­
munity medicine by the Indian
Council of Medical Research
for the year 1979. Dr Ghosh
as most of our readers will
recall is the author of “Feedding and Care of Infants and
Young Children” and “Shishu
Palan”.
Among other who have won
awards are Dr P. M. Udani,
Director/Professor,
Institute
of Child Health, Grant Me­
dical College, Bombay — Dr
Kamala Menon award (for
Paediatrics) for his work “Tu­
berculosis in Children in India”,

The 200 beded St Luke’s
Hospital, Tinsukia, has the
following vacancies :
1. A physician, MRCP or MD.
2. An Ophthalmologist, MS.
J 3. A Paediatrician, MD.
4. An Orthopaedician, MS.
5. A Lab technician, well
versed in Microbiology as
well.
6. A pharmacist.
7. An X-ray technician.
The minimum consolidated
salary for posts 1-4 will be Rs
■2000 p.m. inclusive all. Higher
salary will be given according
.to the experience . and other
qualifications.
For post No. 5, 6 and 7
salary to match qualifications
.and experience.
Furnished quarters will be
provided in all categories.
Please apply with complete
bio-data to Medical Superin­
tendent, St Luke’s Hospital,
Tinsukia, P.O. Chabua, As­
sam - 786 184.

wanted
A qualified young doctor to
work in Jhabua with a mobile
unit to develop a health pro­
ject serving 10,000 tribal fa­
milies and to train 24 volun­
teers.
Interested persons can con­
tact Mr Purushothaman M.,
Vikas Yojana (Trust), P.O.
Bhabra (Via
Dafibd), Dist.
Jhabua (M.P.), Pin. 457 332.

nutritionist
Wanted a female Nutri­
tionist for an international
voluntary
organization
in

Bombay. Qualification M.Sc.
Foods and Nutrition or Child
development
or Community
extension.
Knowledge
of
English and Gujarati essen­
tial. Apply Director GPO.
Box 1650, Bombay - 400 001.

training
Paramedical workers training
course in leprosy (Duration :
likely to be 9 months course
instead of 6-months) TXth
batch.
4th June 1979 to 26th
February 1980.
Physiotherapy technicians course
in leprosy (9 months duration)
Hird batch.
1st August 1979 to
30th April 1980.
Six weeks doctors course in lep­
rosy (Vlth batch)
15th October 1979 to
24th November 1979.
Non-medical supervisors course
in leprosy (4-months duration)
Vth batch
1st November 1979 to
26th February 1980.
Refresher course for Paramedi­
cal workers of The Leprosy
Mission hospitals (3 weeks
duration)
1st September 1979 to
22nd September 1979.
NB : For all the above courses
sponsored candidates only will
be taken. These courses arc re
cognized by the Government of
India and Andhra Pradesh State
Government and recognized
certificates will be issued.
For further details please
contact :
Dr Alexander Thomas, MD.,
Philadelphia Leprosy Hospital,
Sahir - 532 501.
Srikakulam Dt.
Andhra Pradesh.

Health for the Millions is owned and published every two months by the Voluntary Health Association of
India. C-14, Community Centre, Safdarjung Development Area, New Delhi 110 016, India. The Editor Printer
and Publisher is James S. Tong, S.J., of Indian nationality. His address is the same as the place
of publication. Printed at Sanjivan Press, Kailash Market. New Delhi.

For Private Circulation only

at the

national

iyc
seminar
The deprived child is alive and ill. Pneumonia and diarrhoeal disorders take the highest toll
of children said the discussion paper on nutrition. Yet what this national seminar failed to
recognize is the “causal chain” which leads from the hungry child with diarrhoea to the
legalized inequities of those in power.

Analyzing the similar predicament of the “wretched of the earth” of Latin America, David
Werner wrote “Beyond doubt, anything we can do to minimize inequities perpetuated by the
existing power structure will do far more to reduce the high infant mortality than all our
conventional preventive measures put together”.
The participants all agreed that radical reforms were needed, and mere palliatives would not
do. But who will bell the cat? The government officials?
Certainly not! “We have our
procedures, you see....” The voluntary sector? “We arc far too few in number, too isolated to
have any impact.... ”
And meanwhile, the deprived child will continue her — more often than not, the deprived
child is “she”, not “he” — none too sure precarious battle with life unaided by any of the
national seminars, regardless of any number of status papers issued by the state governments.
Having decided to bypass this issue, the seminar went as expected. There was the usual
disenchantment with the past, realization of the inadequacy of measures adopted at present,
the inevitable contempt for cosmetic solutions, a clarion call for radicitl measures. It was
the 109th day of the Internation Year of the Child. The voluntary sector received many
positive strokes for its “good” work in child care.

Yet flickers of hope flashed here and there. Dr S. N. Chaudhury, Director. Child-in-Need
Institute, presented a paper based on his own experiences in conducting programmes for
child welfare — how not to run a child welfare programme. Unfortunately, this paper did
not provoke as many thoughts as it should have. Nor did his poignant question—“Do we
still want only to reach the deprived child, but not to touch him?”
While a number of states have rejected out of hand, the community health worker scheme,
the seminar in its resolutions, unanimously recommended strengthening this scheme. With
his usual aplomb, the Health Minister, Rabi Ray called primary health care the Yuga
Dharma — “duty of our times”. He said the central point of primary health care is the
child, and hence the mother.
The Regional Director of Unicef, Glen Davies, speaking at the inaugural session, emphasized
the need for Integrated Basic Services Approach.
Mr Barnala. the Union Agriculture and Irrigation Minister, showed a lot of interest. He
has set aside Rs 1 lakh for the Food-for-Nutrition Programme. Ms Murlidharan, Coordi­
nator, Children’s Media Laboratory, Centre for Educational Training. Delhi, has opened
angaaiwadis which she runs under trees, in village courtyards. What is important in this
method is the careful institutional training that Balsevika receive before they are sent to the
field.
The two-day national seminar, which was organized by the National Institute of Public
Cooperation and Child Development, ended in Delhi on April 20, 1979.

3

A huge gathering, attended
by the President of India,
launched
the
International
Year of the Child in India,
and thousands of children went
to Delhi. For many days the
newspapers were full of pic­
tures of children—happy chil­
dren, who did not look “de­
prived". The miserable, maras­
mic and potbellied were cons­
picuous by their absence.

this girl

i

asked for

The special theme chosen by
the country for the IYC is a
very worthwhile one, “Reach­
ing the Deprived Child”. Plans
for the year include books for
children—but the deprived can­
not read. Their mothers have
no time to send them to school.
Many films suitable for child­
ren will be made. Will the de­
prived ever see these films?
Where are these deprived chil­
dren? How can we find them?
Will they attend any of the
special programmes for child­
ren? Almost certainly not.
More than half of the children
we care for are not deprived.

Let me tell you about Mangi,
a baby girl.
The name
means “1 asked for you”. Here
is a baby who is much wanted
and cared for. Girls are less
popular than boys, but in
Mangi’s home there were al­
ready three boys and no girls.
It is not a rich home, but there

is enough for all. They have
some land. Simple food is avail­
able. And the buffalo, who
occupies part of the courtyard,
supplies some milk to all. The
home-visiting teams from the
health centre tell her mother
that the time has come to
start giving six-monlh old
Mangi
some solid food.
This, and other advice such
as taking Mangi to the
health centre every month for
immunizations, is accepted by
her mother. So Mangi grows
into a healthy little girl, an
ordinary village child. It would
not be impossible to imagine
Mangi amongst the balloon­
waving masses of children who
inaugurated the IYC.
And now hear about Akki.
Akki means “fed up” and this
describes the feelings of her
mother when the fifth girl ar­
rived in a house where all the
previous children were girls.
There is very little of anything
to spare in Akki’s home, very
little food, and least of all,
time. Nobody has any time to
spend on Akki.
People of the socio-economically underprivileged group
are fully occupied with the
business of existing. They are
poor., When he can get work,
the father is paid by the day.
The house is of mud. The mo-

The
Community
Health
Department of Christian
Medical College, Ludhiana,
has worked out a metho­
dology
for
identifying
"high risk" children—the
"Akkis" in tho communi­
ties which they care for.

Dr Betty Cowan is the Joint
Director of the Department.
Her co-author is Dr Jasbir
Dhanoa, also working in the
same department.

It’s love that weighs. “Mangi”...the much wanted 11 month old boy in.the
centre weighs 2 lb more than the two threc-year old “Akkis” on either
side of him.

4

ther has to go out to the fields
to gather fodder for the buffalo
—not their own buffalo, but
the one which they feed while
it is not giving milk—this
brings in some money.
Everybody knows how time
consuming it is to try and give
food to a seven-month old
baby. She spits it out. She
turns her head away.
How can Akki’s mother,
with so much to do, not know­
ing how to modify the food
she has so that Akki can eat
it, how can she “waste” part of
a day in trying to feed Akki,
when the buffalo—who brings
in money—and the father and
other children will be coming
in, hungry, looking for din­
ner? How can she do that
when the very thought of Akki
makes her “fed up”? And so
she docs nothing about her, ex­
cept handing her over to a six
year old sister.

if they do not die before the
third birthday is reached. It is
the “Akkis” who make up a
big part of those who die in
the second half of the first
year. No balloon waving for
her, nobody will ever know
about her, there is nobody to
take her to children’s clinics
or other programmes for the
welfare of children. Often she
is just a statistic on an infant
mortality list.

How many “Akkis” will be
reached during 1979 — and
after that? Very few, until we
change our methods of finding
them. There is no point in

looking for them in the happy
crowds who “come”—Akkis
have to stay at home. How
many are there? Is this really
a problem, or am I describing
an insignificant fraction of
India’s child population?

In the rural community of
our programme, there are
50,000 people with approxi­
mately 7,500 children under
the age of five. Half are the
“Mangis”—or the equivalent
inales, and even of the other
half, not all have malnutrition.
Let us assume that the under­
privileged half has 750 children
per year of life. Of these, the

The sister should be in
school, but very few of her age
go to school. The burden of
caring for Akki makes her
“fed up” too. When the baby
cries, there is nothing to give
except a piece of sugar cane
which the children like to suck.
It does not matter if she has
to pick it up from the ground
—it will keep Akki quiet.

Very soon Akki gets diar­
rhoea from the dirty sugar
cane, and she is very sick.
There is no time to take her to
the doctor. The local quack
gives her something.

A few days later, Akki is
better, and her mother tries
to give her something before
going off to work. But her illTness has made her so thin
that she will not even try to
eat the food. And thus Akki’s
programme continues — a
downward spiral of lack of
food, malnutrition, illness, fur­
ther weight loss, until Akki is
one of the 50 per cent of the
little girls in this community
who spend their second and
third years in a miserable
state of malnutrition, that is,

Akki into Mangi. This girl, the third in the family with no boys was
frankly not wanted. Her death would have been a blessing. The programme
withits detection, nutrition and family planning advice, has turned her
into a wanted child. Though still called Akki, this little girl is now well
on the Road to Health.

5

375 who arc less than six
months, are just fine on breast
feeding. The 750 who have
passed their fourth birthday,
have teeth to chew chapalis
and can run about, feeding
themselves. This leaves appro­
ximately 1600 children. Of
these, one-third have severe
malnutrition. This means that,
in our rural programme, there
may be 500 such children. And
in India—5,00.000 such child­
ren. An insignificant problem?
—surely not! The Executive
Director of Unicef has said
this year 15.5 million children
under five will die and of these,
15 million will be in develop­
ing countries like India.
Akki—a figure on the in­
fant morality list, Mangi—an
eager, healthy, balloon waving
youngster. Can we, who are in
the health care job in Lidia,
or anywhere in the world, be
complacent about our achieve­
ments in the health field while
this huge number of Akkis
wither away? Can we do any­
thing?

Has the community health
department
done
anything
apart from identifying
the
Akkis? Have we done anything
to prevent babies, whose arri­

"throw away"
babies
It is estimated that about a
million babies out of the 21
million born every year be­
come “throw away” babies,
abandoned soon after birth due
to various social and economic
pressures. Social workers’ esti­
mates place the number of
destitute, orphaned and aban­
doned children at between one
and five per cent of the total
child population. Only about
25,000 of such children are in
the care of some kind of ins­
titution. In most orphanages,
female children outnumber
males, reflecting the greater
value placed on sons in Indian
society.

val provoked from their mo­
thers the response of being
“fed up”, becoming one of the
47 per cent of the little girls in
the second and third years of
life who are so miserably mal­
nourished?

We believe that we have
made a start, a start encourag­
ing enough to make us conti­
nue a new approach. In our
programme, more than 100 out
of every 1000 babies who are
born, die before they reach
their first year. Half of them
die in the first seven days of
life. If they survive the first
month, the Akkis and Mangis
are equally fit for the first five
to six months, breast feeding
being enough for their needs.
Thereafter, their paths diverge
sharply. So, as it reaches five
months of age, we put on spe­
cial care every baby of the
underprivileged homes. With
the help of a village woman,
a community health worker
who visits the home every
second day, we try to change
the attitudes and customs of
the mother for whom the
baby may be a non-priority,
so that it receives enough food
for good nutrition. The com­
munity health worker secs that
it gets its immunizations at

the right time, and, if it be­
comes ill. is quickly brought
to the health centre.

The first 185 babies, who
have had a minimum of three
months and maximum of 12
months care--we began this
approach only at the end of
1977 — have been evaluated,
and we find that something has
happened. Before this ap­
proach, we found that no baby
of this class was receiving
enough food by the first birth­
day, and only 11 per cent were
receiving something, but not
enough. Previously only 26 per
cent of the baby girls in the
second year had normal nutri­
tion and 17 per cent had very
severe malnutrition. Now 49
per cent have normal nutrition
and only 23 per cent have
severe malnutrition.
Almost more important than
individual babies feeding are
the changes in the attitudes of
these mothers. Of 60 mothers
whose attitude was indeed
“fed up”, 43 have changed and
care for their babies and give
them enough food. This is our
mission, to be agents of change
for good, so that all babies,
whether they are called Mangi
or not, are wanted.

simple home remedies
Fungal infections of the skin

Take the leaves of Ficus
carica (Hind5, anjir; Tamil
checmai agathi) and grind it.
Apply the juice three times a
day. Boil the clothes and dry
them in the sun.
Ronndvvouns

Crush two papaya seeds and
mix it with a glass of milk.
Give this to the child before
he eats anything else in the
morning. Do this for two days.
Pinworms

Grind neem leaves to a fine
paste. Give the child a marble­
sized ball of this paste first
thing in the morning for seven

6

days. Do not give this for the
next seven days. During the
third week, give this paste
again before the child cats any­
thing else.
If one child in the family
has pinworms, probably the
whole family has them. The
whole family should take this
treatment together.
Chicken pox blisters

Spread neem leaves on the
bed of the sick child. These
leaves are cooling and antisep­
tic. Boil the leaves in water,
and bathe the sick child with
this water. A daily bath is
good.

the child’s year
and medical training

"The challenge of reaching the deprived child is as important as finding a cure for
cancer" argue three heads of the Community Health Department at the Christian
Medical College, Ludhiana. This article outlines the contributions that India's medi­
cal Graduates and colleges could make during the IYC and after. The authors are
Dr H Dhillon, Director; Dr Betty Cowan and Dr H I\1 S Grewal, both Joint Directors
of the Community Health Department.

Will India’s medical gaduates
be able to make a significant
contribution to the Interna­
tional Year of the Child and to
the child care in rural areas af­
ter 1979? The general theme
chosen for the year by India
is “reaching the deprived
child”. The Central Depart­
ment of Social Welfare pro­
poses to undertake the prepa­
ration of a review document
on the status of the child in
India. This document should
reveal, not only the size of the
“deprived” group in India, but
the etiology of “deprivation”,
so that effective remedial and
preventive measures may be
found and implemented.

Speaking at the world's first
International Conference on
Primary Health at Alma-Ata,
Russia in 1978, Dr Halfdan
Mahler, Director of WHO,
said that nations must give top
priority to allocating health re­
sources for the benefit of the
most needy communities. Even
if these resources are allocated
for this purpose in India, how
will the needy communities be
reached, their needs identified
and met? The needy will not
come spontaneously to centres
where programmes arc orga­
nized for their benefit.
If we in India are serious in
our desire to reach those in
the “weaker” section, to iden­
tify their problems and raise
their standard of health, we

can no longer rely on schemes
which succeed only partially
because their implementation
has been put into the hands of
those who have not been
trained for the task. The ans­
wer docs not lie in extending
the existing health services out­
ward, but in beginning to build
at the other end. in villages
and slums, mobilizing people
themselves to improve health
standards.

graduates and'vhws
Who will begin this build­
ing in the villages of India?
The health planners or village
level workers? The former,
having expertise and an over­
view of the problem, can plan,
but are inevitably remote from
the areas where plans have to
be implemented. The latter,
with excellent acceptance by
the people, lack this over­
view, and are unable to see
any need to change situations
which they have come to ac­
cept with a fatalistic attitude.
Who then will bridge the gap
between the planners and the
people?
India’s medical graduates are
the obvious choice. A large
proportion of today’s medical
graduates will find their way
into the country’s health ser­
vice, but there appears to be
some doubt in the minds of the

7

health planners regarding the
ability of these doctors to meet
the health needs of the com­
munity. Moreover, there is a
reluctance to commit them­
selves to community service on
the part of these doctors them­
selves.

In the Republic Day issue of
the Indian Express, reference
was made to the fact that the
post of pediatrician, created
especially to intensify the ICDS
scheme in Nupur Bedi, Punjab,
has been vacant since its in­
ception three years ago. It was
stated that “in spite of this
having been declared an Agrade project by the Social
Welfare Department at the
Centre, the medical officer post­
ed invariably managed to
‘wriggle’ out of a tenure at
Nupur Bedi”.
Why should this happen? Do
doctors feel that they have not
been trained for this work and
that they will quickly lose
touch with academic medi­
cine? Or are they afraid that
their contribution will seem of
less importance when compared
with that of their colleagues
in large hospitals or in re­
search
laboratories?
Many
problems which receive a large
share of the country’s budget
for research have much less
relevance to India’s health
needs today than the problem
of reaching the deprived child.

"hakims are better"
Many graduates feel that,
having been highly trained in
scientific methodologies, they
can be of best use in large hos­
pitals or training centres. Their
skills will be “wasted” in vil­
lages since the diagnosis of the
community and plans for its
treatment appear, of necessity,
to be based on vague impres­
sions, hard to accept by some­
one with professional training.
Few are familiar with the con­
cept of community diagnosis,
still fewer are trained to make
iucIi a diagnosis.
Moreover,
they see their colleagues mov­
ing ahead with residency pro­
grammes, post-graduate deg­
rees and research fellowships,
with financial rewards as well
as promotion, academic attain­
ment, and for some, a reputa­
tion for expertise. It is hard for
them to contemplate a life of
struggle with a community
they do not understand, for
which understanding there ap­
pears to be no guidelines, a
people who do not value their
services, and whose problems
they are unable to identify,
and who in fact hold the local
hakim in higher esteem.
Mobilization of a country’s
resources and rigorous train­
ing to a high degree of compe­
tence, is the only course open
to any country when threaten­
ed by war. The toll taken by
loss of child life in the socio­
economically deprived section
of the community and the cost
to the country of the morbidity
of this section of people, how­
ever, is as great as the cost of
war. Drawing special attention
to the urgent health needs of
the world’s children, Mr
Labouisse, Director Unicef,
said that 15.5 million infants
and children under five will
die this year for lack of health
care, and 15 million will be in
developing countries. “Govern­
ments would have to drasti­
cally reorder their priorities”
if nation-wide health care is to
become a reality. This change
would have to begin at the top
level of government and na­

tional leadership. We suggest
that this change of attitude
could result in the mobiliza­
tion of India’s doctors for
community health service, not
as reluctant “conscripts” but
as eager “volunteers”.

community medicine:
a prestige speciality
Can we, the medical col­
lege teachers, show them that
the challenge of reaching the
deprived child is as important
as finding a cure for cancer?
Can we change our teaching
methods so that graduates be­
come convinced that we mean
it, and that this new ap­
proach is not just another
gimmick of getting them into
a primary health centre? Is it
possible for us to convince
young doctors that we, the
medical teachers, mean to
make community medicine one
of the “prestige” specialities in
India?. All our assurances will
lack conviction unless we em­
phasize that a new type of
training is mandatory for this
speciality.
No time could be more oppor­
tune than the present to make
this change. Medical coDeges
are each, taking up for care
three blocks of the District in
which they are situated. Those
of us who have been engaged
in academic medicine wifiin
the walls of a hospital know
that, without some training
and guidance, the only care
we could provide as faculty,
will be by means of clinics in
rural areas, teaching under­
graduates in a village, exactly
the same kind of facts that we
would have taught in a hos­
pital ward.. Some departments
might take responsibility for an
academic term and might even
live for part of that term in the
rural area. Those patients who
attend the professor’s clinic
might well be impressed with
the seniority of their doctor, but
the government health service
doctor will be made more
aware than ever, of the gulf
which separates the academic
from the community-based

8

doctor. The latter has to ful­
fil to his communities and to
his superiors certain responsi­
bilities of which college tea­
chers know little.

There is no medical college
department in the world today,
which would undertake a new
speciality, for example renal
transplantation, without years
of preparatory training for the
staff, and gaining experience
from earlier workers in the
field before setting up such a
unit. Has it ever been suggest­
ed that faculty members of
medical colleges might need
training before taking on res­
ponsibility for
community
health? India’s health needs are
great. Most are in rural areas.
Few medical college staff know
anything about the problems in
these areas. This is the time
for the college staff to ask
“what are the health needs of
the country? What does gov­
ernment expect from colleges?
Who will teach us how to
know a community and make
community diagnosis manda­
tory if we are to make effective
treatment poheies?” The re­
luctance of some medical col­
leges to commit themselves to
block involvement stems from
the fact that few experts in
their own field know what to
do in a village. The leaders
in the field of medical educa­
tion must recognize the need
for such training, find centres
where it can be given, teachers
who can give it, and formulate
guidelines for functioning of
college departments in a block.
Community medicine, prac­
tised in three blocks by each
medical college, should become
a recognized discipline of the
college, with a training pro­
gramme which must have the
approval and recognition by
the Medical Council of India.
Graduates will then have the
opportunity to apply for posts
in residency programmes lead­
ing to post-graduate degrees in
this discipline. When this hap­
pens, there will be at least
some “volunteers”. “Cons­
cripts” wDl not become “volun­
teers”, however, until they see
that their teachers are behind
them, and that, instead of be­

coming “drop-outs” in a rural
setting, they will be accorded
as much, if not more, in terms
of respect and financial gain
as the hospital-based specialist.

conscripts into volunteers
There can be no question of
“two. streams” of doctors in
the blocks which arc attached

to colleges: medical officers
with obligations to the govern­
ment health service—the “se­
cond class physicians”—and
the medical college staff, who
are happy to leave the admi­
nistrative problems to the for­
mer. This scheme will not
work until the government
and college staff function as
a team.

inaugurated the

India has

IYC with many laudable aims.
Bold and drastic reorganizing
of priorities is needed so that
the Indian doctors are chan­
nelled into the immense task,
not only for identifying and
rehabilitating those deprived
of health, including children,
but preventing deprivation by
medical and social change.

COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India

housewives promote health care
Housewives in Honduras
have invented their own ver­
sion of “Health by the People”.
Housewives clubs have for the
last six years sponsored female
health promoters (promotoras
de sahid). The community­
based promotoras do not work
set hours; they are on call day
and night.
The origin, organization,
philosophy and effectiveness of
the programme are closely re­
lated to the network of house­
wives clubs, which are the com­
munity vehicle for the pro­
gramme. If a community wants
to have a promotora, it must
first form a viable club of 10
to 20 women.
A woman, selected by the
club and the team, is then
trained to work from her home,
seeing an average of four pa­
tients daily, and visiting a
weekly average of four patients
in their own homes. Her work
is entirely voluntary. The pa­
tients pay only the cost price
foi medicines or a small fee
for simple treatments. Injec­
tions are only given in conjunc­
tion with a medical prescrip­
tion.

Initially, the club raises an
equivalent of approximately
Rs 150 via dances or dona­
tions, to purchase the wooden
medicine cupboard or “botiquin” kept by the promotora
and stocked with basic drugs
and equipment. These are go­
at wholesale price from pro­
gramme headquarters. Money
resulting from drug sales in
the community is kept by the
club treasurer until the month­
ly meeting, where the promo­
tora can replenish supplies. The
club is also supposed to assist
the promotora with her fare to
meetings, and with a food do­
nation. But if the clubs are a
strength of the programme,
they can also become a weak­
ness. If the club ceases, so does
the work of the promotora. Of
the 60 promotoras trained since
1972, 25 per cent left because
of club closures and similar
problems.
Two thirds of them were bet­
ween 20 and 40 years of age,
and none had more than a sixth
grade primary education. Seven
communities contained between
40 and 100 houses and three
had between 500 and 600
houses.

9

The community can buy
from the promotora 30 vitamin
capsules for one and a half
rupee as opposed to paying
in the commercial pharmacies,
for a comparable item, over
Rs 30. Antispasmodics can be
purchased here at 15 paise a
dose, instead of a commercial­
ly prepared bottle for Rs 9.30.
The term “health program­
me” is not sufficiently broao
to cover all the activities in­
volved in the reality of the
promoira programme, for it is
not just a group of rural wo­
men
selling basic medi­
cines and administering first
aid from their own homes. The
small general store in nearly
every small community could
achieve the first function just
as well, if not better, and tra­
ditional crude home remedies
were often largely effective
without any extra health train­
ing. The objectives of the pro­
gramme relate not only to the
more traditional health goals,
but also to concepts like “conscientizing the people concern­
ing the importance of their
health in the process of libe­
ration”.

any woman can...

Do you know that grand­
mothers can breast feed in­
fants after a Jong interval of
over ten years since their last
pregnancy? Reports from over
the world give various instan­
ces when such grandmothers,
and even women who have not
given birth, have successfully
breast fed babies when it was
necessary. The physiological
process by which milk pro­
duction in a woman, which for
some reason has not started,
or has lessened or completely
stopped, is started again is
known as relactation.
Successful bi eastfeeding needs
three prerequisites: (1)
a
healthy woman who is inte
rested in nursing her infant;
(2) a healthy baby; and (3)
a support system of some sort.
This third prerequisite may
include anyone—the father,
the grandmother, the midwife,
a relative, neighbours, the
doctor, or a combination of
any of these. This is particu­
larly necessary in the case of
a first-born child, as the mo­
ther may have some difficulty
in breast feeding at the begin­
ning.
To increase or start milk
production in women who
have not given birth, requires
the same three components,
the third being of especial im­
portance. The mother has to
continue putting her baby to
breast, so as to induce milk
production. The support of a
third person or system has a
very beneficial effect on her,
and helps her psychologically
accept the idea of relactation.

The commonest method of
relactation is sufficient suck­
ling by the infant. In many so­

cieties, when a mother dies
during childbirth, the surviv­
ing infant is immediately
given to another woman to
feed and rear. If the woman
is not producing milk, the in­
fant is put to breast many
times a day, and a variety of
herbal medicines are also
given. These may have a com­
bined physiological and psy­
chological effect and help in­
duce lactation.
Although the amount of
milk production first may not
be adequate, the baby, given
additional supplementary feed­
ing, will suckle strongly enough
to produce a normal flow of
milk within a short period of
time. This takes only a few
days if the mother had stop­
ped producing milk. In case
of women who have not given
birth, it may take a little lon­
ger. Adequate nutrition for the
mother is also equally impor­
tant.

The Indian government used
this method of relactation
successfully during the 1971
war, when Bengal was flood­
ed with refugees from Bangla­
desh, and many intestinal
diseases like gastroentritis and
diarrhoea were rampant among
the infants. During the final
months of the Vietnam war,
there
were an estimateci
1,00,000 orphaned children in
South Vietnam. A plan to
hire women as wetnurses for
such infants was presented.
The wetnurse would receive,
in addition to minimal wages,
three meals daily, would stay
in the orphanage to assist with
the care of infants, and once
her milk supply was re­
established, would provide milk
for two infants. There were

10

many women interested in the
programme.
A variety of pharmacolo­
gical agents are also known
to induce rclactation—estro­
gen,
progesterone, oxytocin,
thorazine, metoclopramide. But
these may produce side effects,
or may have to be used regu­
larly. Rclactation through suf­
ficient suckling is the cheapest
and safest method.

do you know
The Adoption of Children Bill
was introduced in Parliament
in 1972, but has yet to be en­
acted. Its aim is to provide an
enabling law for all Indians
seeking to adopt the many
abandoned, destitute, neglected
and orphaned children in the
country.

Under the Factories Act
(Section 48), every factory or­
dinarily employing 50 or more
women workers has been ob­
liged to provide and maintain
creches for children under six
years old. But this stipulation
of the Act is openly violated.
With the enforcement of the
Factories (Amendment) Act of
1976, the obligation has been
extended to every factory emp­
loying a minimum of 30 wo­
men workers.
Strict enforcement of these
laws is an urgent need.

Do the staff of some of our
hospitals need a creche?

book news
Problems of the Aged—by
Col Barkat Narain 98 pp.
Rs 10 (paper), Rs 30 (cloth)

The first part of the hand­
book deals mainly with the
physical, biological, physiologi­
cal and sociological aspects
of ageing. Col. Narain sug­
gests ideal standards of nutri­
tion, housing and leisure acti­
vities for the aged, mainly in
an urban situation. He exhorts
the governments and business
houses to utilize the experience
of people who are retired from
active service and are yet in
excellent physical and mental
health.
The complaints of elderly
persons reflect illness, not old
age, and in the second half of
the book, Col. Narain details
these health problems, though
he does not specify any reme­
dial action. His major thrust
is toward spurring the govern­
ment on to plan health care
facilities for the aged like in­
volving their care as a special
subject in primary health work,
training community
health
workers in prevention and
curative services for them, and
making mass media program­
mes for them so as to keep
them alive to the challenge of
living.

The cornerstone of the
screening procedure is the
commonly used Morley weight
chart. Voluntary Heath Asso­
ciation of India has made
available to many health pro­
jects in India cards for each
child under five. This enables
the VHW to identify those
children requiring extra atten­
tion. As a result of such selec­
tivity projects have been able
to reduce the number of those
receiving supplementary rations
to as low as 23 per cent of the
under five population.
Tn

addition,

the

weight

See How They Grow—Moni­
toring Growth for Appropriate
Health Care in Developing
Countries by David Morley and
Margaret Woodland, 241 pp.

Now David Morley and
Margaret Woodland in their
forthcoming book bring to­
gether experiences gained over
the years in the use of weigh­
ing and weight charting forpromotion of child health and
caring for children.

The discussion on
the
importance of the growth
curve in the child with
diarrhoea highlights a simple
technique for rehydration—the
use of the salt and water solu­
tion. This can be taught to illi­
terate members of the commu­
nity for use by them in the
early stages of diarrhoea. Many
lives have been saved by this
therapeutic measure.

According to Dr O.. Ransome-Kuti, Professor of Pedia­
trics and Hon. Professor of
Child Health, University of
Lagos, Nigeria, the stage is
now set for evolving health
technologies for rural areas in
developing countries. It is the
duty of health workers to dis­
cover innovative health techno­
logies appropriate for their own
setting either through their
efforts or by adopting those
that are traditionally practised
in the community, for example,

chart provides an excellent
longitudinal record of a child’s
development (nutritional status
as well as morbidity), serves
as an educational tool demons­
trating to the mother improve­
ment or decline in the child’s
growth, gives the immuniza­
tion history, and lists the fami­
ly members which can serve as
a family planning reminder to
the VHW. Some projects also
utilize a card for the mother
which includes a history of
previous pregnancies, menstural
cycles, weight during pregnancy
and important ante-and post­
natal observations,

11

the practice of cutting the um­
bilical cord of the newborn with
a red-hot knife, in Northern
Nigeria’s rural areas which
virtually eliminates neonatal
tetanus. Information thus ga­
thered should be disseminated
widely.

The effectiveness of these
health technologies will be
limited unless a system of health
care is designed and instituted
which will ensure complete
coverage of the community,
bearing in mind the available
resources. Moreover, the health
manpower must be appropriate­
ly trained to operate the sys­
tem. fn the introduction to this
book, the authors have made
a strong case for such a sys­
tem of health care delivery
and the method of training
suitable to it. It should be read
and studied carefully by deci­
sion makers and all levels of
health workers involved in the
planning and implementation
of health services.
More details of these books
and the “Road to Health
Charts” in all Indian languages
and English are available from
the Voluntary Health Associa­
tion of India, C-14 Community
Centre, S.D.A., New Delhi110 016, Price for 250 cards:
Rs 55.00. Plastic envelopes for
cards: Rs. 50.00 for 250 cards.
Please note the correct pri­
ces of the following ICMR pub­
lications listed in our Cata­
logue of Education material:

Ch 16 Studies on Preschool
Children
Rs 3.50
Ch 17 Studies on Weaning
and
Supplementary'
Foods
Rs 3.50
E 1 Rural Water Supply in
India—review of work
done
Rs 3.50
E 2 Diagnosis and Treatment
of Pesticide Poisoning
Rs 3.50
E 14 Manual of Standards of
Quality For Drinking
Water Supplies Rs 3.50
P 33 Techniques in Blood
Group Serology Rs 3.50

news from the states

andhra pradesh
□ AP VHA sponsored another
Community Health Workshop
at Dichapalli from March 12
to 16. Twenty-five participants
entered enthusiastically into
the learning experiences at the
Community Health Project
Centre at Victoria Hospital
where a good VHW training
programme is in operation. Ms
Simone Liegcois of VHAI was
consulted, assisted by Drs Bas
and Joke Mesquita, Mr Rayanna and Ms Nirmala. Ms
Zina Kidd was also at hand to
help.

□ The
Canadian
Baptist
Church has started a VHW
training programme in Avanigadda area of Krishna District
in Andhra. Twenty women are
under training. The courses and
return meetings are held in a
large thatched hall, where the
VHWs live. A public health
nurse and a fully qualified mid­
wife are faculty. A lot of teach­
ing is done through attractive
health songs.
Incidentally,
while Ms Sadie Cann, the Di­
rector of the Mission, has been
organizing this, her husband,
Rev Roger Cann has been
building nine village cyclone
shelters and several primary
schools.

kola and Nalli every week as
extension work.
The Society has also started
training VHWS at Patharcddipalem. Now each of the seven
health workers trained at the
first session has a medical kit
with medicines and simple
equipment to detect and treat
common diseases. At present
they are working without pay
and assist the medical team in
immunization, antenatal check­
ups, midwifery, and MCH pro­
grammes.

madhya pradesh
□ The Seventh Annual Meet­
ing of the MP VHA was held
from February 2 to 3 at Dhamtari Christian Hospital, Dhamtari, in Raipur District. The 66
delegates included hospital
managers, medical directors,
nursing superintendents, com­
munity health nurses, lawyers,
farmers and community orga­
nizers. The topic of the meet­
ing was “Health, Development
and Social Justice”.

The two day meeting inclu­
ded many lively sessions on
Social Justice in Hospitals,
Labour Unions and Hospitals,
Participative Management, De­

□ Divi Seema, Social Service
Society continues to give the
cyclone affected people of the
region new life and hope. The
pace of development has been
maintained.
Of the two clinics which ren­
der medical service in the
adopted villages, the one at
Mandapakala has completed a
full year of admirable service.
83,478 patients have been treat­
ed here. The Kammanamolu
clinic has served 9500 patients
from January to November
1978. The staff of both clinics
visit Lingarcddipalem, Chinta-

12

The Society is also involved
in other aspects of develop­
ment including agriculture,
adult education, women’s wel­
fare and
self-employment.
Every' scheme undertaken is
carried out in consultation and
cooperation with the village
council established in every
village by the field officers,
There are regular meetings bet­
ween this council and the
DSSSS staff when works un­
dertaken are evaluated, needs
expressed and points explained.

velopment and Justice
in
Community
Health
and
Action-Oriented Development.
Through group and panel dis­
cussions, films, sharts and
simulation games, the partici­
pants faced up to the comp­
lexities and challenges in inter­
relationships between health,
development and social justice.

The MP VHA has elected
Dr Mahashadbe, Indore, as
President, Dr V. K. Ali, Shadol, as Vice-President and Ms
P. Brown, Jobat, as Secretary.
The participants also thanked
Dr E. E. Moss, Padhar and
Dr D. W. Mategaonkar of
Chatarpur for their service to
the Association. Dr Moss will
be retiring and leaving India
next year.

have been taken up with the
labour minister of the state
Individual members can use
the reference of MVHA to gel
their rights with the dealers
and companies enforced.
Thirty-five new members
have been enrolled in the
MVHA.

□ MVHA Workshop on Com­
munity Orientation and Deve­
lopment for Health Centres
was held in Jamkhed from
February 19 io 24, 1979.

maharashtra
□ The six-week Community
Health
and
Development
Course held in Jamkhed has
ended very successfully. Four
of the 26 participants have
been chosen for the year-long
Residency
in
Community
Health. Plans include extend­
ing this course for the whole
of South East Asia.

The participants saw the
change in the health status in
the villages around Jamkhed,
and shared with the village
health workers their experien­
ces. George Ninan, who was
faculty for management prin­
ciples, says “the transforma­
tion of these illiterate women,
many of them Harijans and
Muslims, from silent sufferers
to community leaders is fan­
tastic”. One of these is now
a Panchayat leader.

□ The Executive Committee of
MVHA met on February' 18,
1979, at Ruby Hall Clinic.
The VHA plans to bring out
a comprehensive directory of
government, charitable and
private hospitals, and commu­
nity health projects in the state.
Details of training facilities,
health care facilities, mobile
units, blood bank and other
facilities would also be covered
in the directory.
The MVHA has also decid­
ed to act as a forum to voice
the grievances of member
institutions to the government.
The grievances of one hospital

The first four weeks of the
course were on Principles of
Community Organization, se­
lection of VHWs, their train­
ing. The last two were on
Management Principles and
Transactional Analysis, which
was taken by Dr Carol Huss
of VHAT. Others in the faculty
were Drs Arole, Ruth Harner
and Simone Licgeois of VHAI,
Dr Ron Seaton and Edith
Seaton.

13

With the help of games and
exercises,
the
participants
attempted to understand the
trends in delivery of health
care in India, and the reasons
for change: to know the fac­
tors which arc important in
community involvement gain­
ing through participation and
sharing of resources; to select
the priorities in the many
health and development needs
recognized by the health pro­
fessionals and the people; and
to teach adults, both the pub­
lic and the health workers the
principles of good health and
prevention of
illness.
Dr
Mabclle Arole explained the
philosophy of community de­
velopment with special refe­
rence to the project at Jam­
khed.

Faculty

were

Drs Arole,

February 14, 1979. The office
bearers now are: Dr K. V. Rao
President), Dr Charlotte Manoharan (Secretary), and Dr
Mohan Mallya (Treasurer).

As a part of the meeting,
there was a lively discussion
on Mini Health Centres with
Dr S. A. Kabir. Later the
Minister for Health also attend­
ed the session. An evaluation
committee is formed for the
VHA Mini Health Centres, and
the few resolutions that were
passed in this meeting, are
sent to the government for
ratification.

Ruth Harner, Ron Seaton and
Edith Seaton.

bihar
The Kurji Holy Family Hos­
pital has entered into the Year
of the Child with a souvenir and
two plays for raising funds.
Free clinics were conducted
at six centres from March. 5
to 15, and the total attendance
was 1,768 children. Follow up
clinics at the same centres have
been planned after one month,
for three consecutive months.

These clinics will provide
immunization, and medical
attention will be given where
necessary at the Public Health
Department of the hospital at
concessional rates. The hos­
pital also plans to conduct
similar camps in slum areas
and villages in the latter half
of the year.

The hospital will also be
providing free health checkups
by specialists in pediatrics, eye,
ENT, and dentistry in selected
poor schools during the year.
The Public Health Department
of the hospital will provide
follow-up care.
Damien Social Welfare Cen­
tre, Dhan bad, celebrated the
anti-leprosy week from Janu­
ary 30 to February 5, 1979.

Announcements, and communi­
cation of slogans such as “Lep­
rosy is curable”, “Early treat­
ment prevents deformity”, and
pamphlets describing the early
signs and symptoms of lep­
rosy drove the messages home.
Group talks and discusions
with small groups at various
centres in town helped increase
awareness about the facts of
leprosy and dispelled some of
the myths that surround this
disease.
Dr Margaret Owen’s Lep­
rosy Education Programmecum-Exhibition also generated
a lot of interest. Such program­
mes have been responsible for
the government’s taking notice
of the positive work done in
this field by the voluntary sec­
tor.

goa
The Goa VHA organized a
two-day seminar on Hospital
Administration, which was
attended by twenty partici­
pants. Dr Carol and George
Ninan were the resource per­
sons. The VHA is also plan­
ning a small seminar on Com­
munity Health.

tamil nadu
Sr Muriel very successfully
organized the General Body
Meeting of the TN VHA on

14

Dr Prem John and Hari
John hosted the seminar on
Rural Nutrition, to inaugurate
the Year of the Child. The
work and sessions Jed by Drs
John was particularly useful.
Dr John is planning to start a
Consultancy Account for the
benefit of the TNVHA with
what he gets as remuneration
for the personal help he gives
to any institution or project.

karnataka
The state VHA General
Body met on February 12 and
re-elected Dr Benjamin Isaac,
Dr Silgardo and Dr Marie
Mascarenhas as President,
Treasurer and Secretary. They
have formed three sub-commit­
tees to deal with seminars,
compilation of a directory,
and community health and
nutrition education kit. The
state VHA has also acquired
a plot of land in Bangalore,
for putting up an office.

kerala
Mr. W. A. Stein of Medical
Services, Overseas of Christoffel
Blinden Mission (CBM) open­
ed the Outpatient Department
of CBM Eye block of the
Little Flower Hospital, Angamally on February 6, 1979.
His Execellency, Rt. Rev. Dr
Sebasban Mankuzhikary, Auxi­
liary Bishop of Ernakulam,

delhi
□ Most Rev. Dr Angelo Fer­
nandes, Archbishop of Delhi,
inaugurated the formal opening
of Ozanam Clinic, a free me­
dical service for the poor, on
Friday, January 26, at St.
Michael’s Church, Pusa Road,
Delhi.
□ Public Enterprises Centre for
Continuing Education, Faculty
of Management Studies, Uni­
versity of Delhi, and Sri Ram
Centre for Industrial Relations
and Human Resources, Delhi,
conducted a national seminar
on Developing Effective Orga­
nizations fro.m February 21 to
n

man

The objectives were to re­
view and learn from the expe­
rience of innovative Indian or­
ganizations, examine the rele­
vance and feasibility of plan­
ned change for coping with and
adapting to some key problems
faced as environmental sensiti­
vity, dysfunctional conflict,
authoritarianism, and lack of
dedication.

Sr Carol Huss of VHAI was
among the group facilitators.

After discussions and case
studies, the group arrived at
the conclusion that OD efforts
in hospitals are more success­
ful than in Industries because
the people arc motivated, inte­
rested, and the exchange of
external and internal OD
agents of change is better.

situations vacant
1. Apaji Arogya Mandir,
Mantri, Banasthali Vidyapith,
Rajasthan-304 022 requires:
(a)

Medical Superintendent: to
look after a 50-bed health
centre and Rural health
project. Remuneration ac­
cording to qualifications
and experience. Age no bar.

(b)

Physician (one) and lady
doctor (one): M.D., M.S.,
M.B.B.S. with 2 years
housemanship. Pay scale:
750 - 30-1020-40-1300-50 1350. Initial start Rs 870
for M.D /M.S. Higher start
or grade can be considered
for specially suitable can­
didates.

(c)

Staff Nurse (Male or Fe­
male): to take independent
charge of Operation Thea­
tre. Remuneration accord­
ing to qualification and
experience.

cost of health care
Restoration of a balance
between hospitals and primary
health care was the keynote of
the B. L. Kapur Memorial Ora­
tion this year. Delivering the
oration, Dr Daniel Isaac, Sec­
retary of Christian Medical As­
sociation of India, told the
members of Indian Hospital
Association on February 7, in
New Delhi that hospitals should
become truly a component in
the spectrum of comprehensive
health care.

According to him, even with
the extension service, the hos­
pital today stands alone “seg­
regated as a centre of excel­
lence for episodic care” provi­
ding “upto five per cent of the
health needs of the people and
in the wake of it, expending
more than half the resources
earmarked for health care pro­
vision”.

pitals and its operating style
is to be determined.
Healing profession, accord­
ing to him, has mystified health
and disease beyond the gene­
ral understanding of people.
“If people are to be benefited,
by health care facilities, a pro­
cess of demystification and sim­
plification
of health and
disease” has to be set in. The
hospital should
shed
its
“though fascinating, but often
confusing” image, and its cum­
bersome procedures.

Health care, he pointed out,
has sadly degenerated into a
“commodity for the consumer
to obtain at a price fixed by
the provider or subsidized
heavily through tax money”.

The challenge before us, he
continued, is to redefine the
role and functions of the hos­
pital in the context of the com- I
munity.

Drawing from the experi­
ments conducted in 280 health
care institutions, out of the
400 affiliated to CM A I, Dr “Can wc rearrange our think­
Isaac pleaded for the integra­ ing, where we are primarily
tion of promolive and preven­ concerned about the commu­
tive scryices with curative ser­ nity and its health and the
vices. A process of rationali­ hospital is a means to support
zation is required and the this concern and meet the
justification for the current requirements of the people in
organizational pattern of hos­ the community?”

15

ANMs
(d)
570.

(four): Grade 355-

D.A. and N.P.A. as per rules.
P.F., Insurance and gratuity
benefits on confirmation. Wear­
ing of Khadi is compulsory on
appointment. Apply on plain
paper giving details of age,
within 20 days to the above
address.
2. BAM
India, Garden
Reach Community Health Pro­
gramme, Calcutta, is looking
for a laboratory technician. He
should be able to carry out
sputum (AFB), blood (ESR/
TC/DC/Sugar), urine (sugar/
protein), stool test, smear exa­
mination tests. He will collect
samples and draw blood from
patients, assist in training com­
munity health workers in cer­
tain tests, maintain proper re­
cords and stock of laboratory
material and reagents. He
should be at least a matricu­
late, and trained as laboratory
technician or with sufficient
experience to carry out the
above mentioned duties. Good
command over English is nc-

|

(Contd. on page 16)

opportunities

scientific dairy farming, project
technicians, farm managers,
extension workers.

L Christian
Community
Health Centre, Ambilikai624 612, Madurai District,
Tamil Nadu will conduct the
following training:

The participants should have
a minimum educational quali­
fication of Matriculation, and
should be able to understand
and communicate in Malaya­
lam.

Training Courses for Mul­
tipurpose Health Workers
Community Health Guides.
The course will start on 15
July 1979, and will be of
18 months duration, with 6
months of field experience.
Candidates should
have
passed S.S.L.C. at least.
Those with higher qualifi­
cation will be preferred.
Only sponsored candidates
are acceptable.

(a)

(b)

Auxiliary Nurse Midwife’s
Course: Starts on 1st Au­
gust 1079, and lasts 2 years.
Minimum
qualifications:
S.S.L.C. (or equivalent)
with more than 60% of to­
tal marks. Age: Should not
have completed 17 years of
age.

For prospectus and applica­
tion forms write to the Direc­
tor, with a M.O. of Rs. 3.00.

2. AFPRO will be conduct­
ing its Course No. 6 on Dairy
Management in collaboration
with Agricultural University,
Mannuthy, Trichur, from June
1 to 30, 1979. The venue will
be College of Veterinary Scien­
ces, Kerala Agricultural Uni­
versity, and medium of instruc­
tion Malayalam. The course
will cover all factors affecting
efficient milk production, and
will consist of leeture-cumdemonstrations, farm work,
field trips and film study.
The course is open to project
staff interested in learning

Fee: Rs 150.00 per partici­

pant includes tution, board,
and lodging. Participants are
requested to meet their own
travel expenses.
Application forms are avail­
able with the Livestock De­
partment, AFPRO, Community
Centre, S.D.A., New Delhi110 016. The last date for re­
ceiving applications is 15 May,
1979.

situations vacant
(Continued from page 15)
cessary and also knowledge of
either Bengali/Hindi. Salary
negotiable. Those interested
may write with details to the
Executive Director, Garden
Reach Community Health Pro­
gramme, J 221/A Paharpur
Road, Calcutta-700 024.

3. Nur Manzil Psychiatric
Centre, Lal Bagh, Lucknow226 001. UiP., requires one
Psychiatrist and one Junior
Doctor. For application forms
write to the Director.

(b) Medical
Supervisor
in
charge of medical services
and consultations with spe­
cial reference to maternity,
child health, and family
welfare, and special disease
programme for TB, leprosy
and malaria. Training and
evaluation. Qualifications:
MBBS. Scale: 775-25-10251305-50-1655, field allow­
ance 75, rentfree quarters,
provident fund facilities.
Knowledge of Telugu essen­
tial.
(c)

Accounts Assistant: Quali­
fications: B Com. or rele­
vant experience. Scale: 24010-320-15-500, starting sa­
lary negotiable. House rent
allowance 15 per cent pro­
vident fund facilities.

(d)

ANM : to work rotating
assignment in outpatient,
inpatient, village clinics and
health education program­
me. Scale: 180-30-240-16400-20-440. Minimum sa­
lary 200. Field allowance
75, provident fund facili­
ties, rent free quarters.

4. Community Health Pro­
ject, Victoria Hospital, Dichapalli-503 175, A.P., requires
for its rural medical work and
socio-economic development;

(a) Programme Director: a se­
nior administrative person
with special responsibilities
for developmental services,
contact with government
personnel, reports, accounts,
training and evaluation. Re­
levant experience in health
and develogm^^itaI jjer^es
essential. Powraduat teg._o
rce, medical or other, pre­
ferred. Scale: 1025-25-127535-1555-55-1905, field al­
lowance
75, rentfree
q.uar4____
’i' r C t i • r .

Apply within 15 days with
biodata to the Programme Di­
rector, Victoria Hospital, Dichapalli-503 175, Andhra Pra­
desh.

Health for the Millions is owned and published ever/.two fpSfcths by. the Voluntary Health Association of
India. C-14, Community Centre, Safdarjung Development Ar^'.JMcw Delhi 110 016, India. The Editor, Printer
and Publisher is James S. Tong, S.J., of India'n nationality. His address is the same as the place
Sanjivs Rress^ Kailash Market, New Delhi.
of publication. Printed at Sanjivgn
For Private Circulation only
Media
HEALTH FOR THE MILLIONS-VOL-5-NO-4 AUGUST 1979.pdf

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