Where There Is No Doctor   A Village Health Care Handbook   d Werner

Where  There  Is  No  Doctor

a viCCaat  heeded  cart  handbook

-revised  edition

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Vavld  Werner

mcfi

Carol  Thuman  and  Jane  MaxwdC

mtfv  drawings  hy  David  Werner

Compiled  by  noonya

Library  of  Congress  Cataloging-in-Publication  Data
Werner,  David,  1934-

Where  there  is  no  doctor:  a village  health  care
handbook  / by  David  Werner;  with  Caro!  Thuman  and
Jane  Maxwell.  — Rev.  ed.

Includes  Index.

ISBN  0-942364-15-5

1.  Medicine,  Popular.  2.  Rural  health.  I.  Thuman,  Carol,
1959-  . II.  Maxwell,  Jane,  1941-  . III.  Title.

[DNLM:  1.  Community  Health  Aides — handbooks.

2.  Medicine — popular  works.  3.  Rural  Health — handbooks.
WA  39  W492w]

RC81.W4813  1992  610— dc20

DNLM/DLC  92-1539

for  Library  of  Congress  CIP

Published  by:

The  Hesperian  Foundation
1919  Addison  St.,  #304
Berkeley,  California  94704
United  States  of  America

Copyright©  1992  by  the  Hesperian  Foundation
First  English  edition:  October  1977

Revised  English  edition:  May  1992

Seventh  printing,  June  2003

The  original  English  version  of  this  book  was  produced  in  1977  as  a revised
translation  of  the  Spanish  edition,  Donde  no  hay  doctor.

The  Hesperian  Foundation  encourages  others  to  copy,  reproduce,  or  adapt
to  meet  local  needs,  any  or  all  parts  of  this  book,  including  the  illustrations,

provided  the  parts  reproduced  are  distributed  free  or  at  cost — not  for  profit.

Any  organization  or  person  who  wishes  to  copy,  reproduce,  or  adapt  any  or
all  parts  of  this  book  for  commercial  purposes,  must  first  obtain  permission  to
do  so  from  the  Hesperian  Foundation.

Please  contact  the  Hesperian  Foundation  before  beginning  any  translation
or  adaptation  to  avoid  duplication  of  efforts,  and  for  suggestions  about
adapting  the  information  in  this  book.  The  Foundation  would  appreciate  receiving
a copy  of  any  materials  in  which  text  or  illustrations  from  this  book  have  been  used.

THIS  REVISED  EDITION  CAN  BE  IMPROVED  WITH  YOUR  HELP.

If  you  are  a village  health  worker,  doctor,  mother,  or  anyone  with
ideas  or  suggestions  for  ways  this  book  could  be  changed  to  better
meet  the  needs  of  your  people,  please  write  to  the  Hesperian
Foundation  at  the  above  address.  Thank  you  for  your  help.

OTHER  BOOKS  FROM  THE  HESPERIAN  FOUNDATION

Where  Women  Have  No  Doctor,  by  A.  August  Burns,  Ronnie  Lovich,  Jane
Maxwell  and  Katharine  Shapiro,  combines  self-help  medical  information  with
an  understanding  of  the  ways  poverty,  discrimination,  and  cultural  beliefs  limit
women's  health  and  access  to  care.  Clearly  written  and  with  over  1000
drawings,  this  book  is  an  essential  resource  for  any  woman  who  wants  to
improve  her  health,  and  for  health  workers  who  want  more  information  about
the  problems  that  affect  only  women,  or  that  affect  women  differently  from
men.  584  pages.

A Book  for  Midwives,  by  Susan  Klein,  is  written  for  midwives,  traditional  birth
attendants,  community  health  workers  and  anyone  concerned  about  the  health
of  pregnant  women  and  their  babies.  The  book  is  an  invaluable  tool  for
midwives  facilitating  education  and  training  sessions  as  well  as  an  essential
reference  for  practice.  The  author  emphasizes  helping  pregnant  women  stay
healthy;  giving  good  care  and  dealing  with  complications  during  labor,
childbirth  and  after  birth;  family  planning;  breastfeeding;  and  homemade,  low-
cost  equipment.  528  pages.

Where  There  Is  No  Dentist,  by  Murray  Dickson,  shows  people  how  to  care  for
their  own  teeth  and  gums,  and  how  to  prevent  tooth  and  gum  problems.
Emphasis  is  placed  on  sharing  this  knowledge  in  the  home,  community,  and
school.  The  author  also  gives  detailed  and  well-illustrated  information  on  using
dental  equipment,  placing  fillings,  taking  out  teeth,  and  suggests  ways  to  teach
dental  hygiene  and  nutrition.  208  pages.

Disabled  Village  Children,  by  David  Werner,  contains  a wealth  of  information

about  most  common- disabilities  of  children,  including,  polio,  xerebral  palsy,

juvenile  arthritis,  blindness,  and  deafness.  The  author  gives  suggestions  for
simplified  rehabilitation  at  the  village  level  and  explains  how  to  make  a variety
of  appropriate  low-cost  aids.  Emphasis  is  placed  on  how  to  help  disabled
children  find  a role  and  be  accepted  in  the  community.  672  pages.

Helping  Health  Workers  Learn,  by  David  Werner  and  Bill  Bower,  is  an
indispensable  resource  for  anyone  involved  in  teaching  about  health.  This
heavily  illustrated  book  shows  how  to  make  health  education  fun  and  effective.
Includes  activities  for  mothers  and  children;  pointers  for  using  theater,  flannel-
boards,  and  other  techniques;  and  many  ideas  for  producing  low-cost  teaching
aids.  Emphasizing  a people-centered  approach  to  health  care,  it  presents
strategies  for  effective  community  involvement  through  participatory  education.
640  pages.

Helping  Children  Who  Are  Blind,  by  Sandy  Niemann  and  Namita  Jacob,  aids
parents  and  other  caregivers  in  helping  blind  children  from  birth  through  age  5
develop  all  their  capabilities.  Topics  include:  assessing  how  much  a child  can
see,  preventing  blindness,  moving  around  safely,  teaching  common  activities,
and  many  others.  192  pages.

All  titles  are  available  from  Hesperian  in  both  English  and  Spanish.  For  information  regarding  other
language  editions,  prices  and  ordering  information,  or  for  a brochure  describing  the  Foundation's  work,
please  write  to  us:

The  Hesperian  Foundation

1919  Addison,  St.,  #304
Berkeley,  California  94704  USA
Telephone:  (510)  845-4507
Fax:  (510)  845-0539
e-mail:  bookorders@hesperian.org
Visit  our  website:  www.hesperian.org

Where  l~here  Is  No  Docfor

is  more  than  a book  on  first  aid.  It  covers  a wide  range  of  things  that  affect  the
health  of  the  villager  — from  diarrhea  to  tuberculosis,  from  helpful  and  harmful
home  remedies  to  the  cautious  use  of  certain  modern  medicines.  Special
importance  is  placed  on  cleanliness,  a healthy  diet,  and  vaccinations.  The  book
also  covers  in  detail  both  childbirth  and  family  planning.  Not  only  does  it  help
readers  realize  what  they  can  do  for  themselves,  but  it  helps  them  recognize
which  problems  need  the  attention  of  an  experienced  health  worker.  This  new
revised  edition  includes  information  about  some  additional  health  problems  —
AIDS,  dengue,  complications  from  abortion,  drug  addiction,  among  many
others  — and  updated  advice  on  topics  covered  in  the  first  edition.

THIS  BOOK  IS  FOR  . . .

THE  VILLAGER  who  lives  far  from  medical
^ centers.  It  explains  in  simple  words  and

drawings  what  he  can  do  to  prevent,  recognize,
and  treat  many  common  sicknesses.

THE  VILLAGE  STOREKEEPER  OR  PHARMACIST
who  sells  medicines  and  health-care  supplies.  The
book  explains  which  medicines  are  most  useful  for
specific  sicknesses  and  warns  against  ones  that  are
useless  or  dangerous.  Risks  and  precautions  are
carefully  explained.  Guidelines  are  given  for  the
sensible  use  of  both  traditional  and  modern  medicines.

THE  TEACHER  in  a rural  school.  The  book  will  help
him  give  practical  advice  and  care  to  the  sick
and  injured.  It  also  gives  guidelines  for  teaching
children  and  adults  in  his  community  about  the
problems  of  health,  cleanliness,  and  nutrition.

THE  VILLAGE  HEALTH  WORKER,  or  anyone  who
is  concerned  about  the  health  and  well-being
of  those  in  her  community.  An  introductory
section  for  the  village  health  worker
discusses  ways  to  determine  needs,  share
knowledge,  and  involve  the  community  in
activities  that  can  better  people’s  health.

MOTHERS  AND  MIDWIVES  will  find  useful
the  clear,  easy-to-understand  information

for  home  birth,  care  of  the  mother,  and  child  health.  ISBN  □ TM23L4  15  5

THANKS

This  revision  of  Where  There  Is  No  Doctor  has  been  a cooperative  effort.  We  thank  the
many  users  of  the  book  around  the  world  who  have  written  us  over  the  years  with
comments  and  suggestions — these  have  guided  us  in  updating  this  information.

David  Werner  is  the  author  of  the  original  Spanish  and  English  versions  of  the  book.

His  vision,  caring,  and  commitment  are  present  on  every  page.  Carol  Thuman  and  Jane
Maxwell, share  credit  for  most  of  the  research, 'writing,  and  preparation  of  this  revised
version.  We  are  deeply  grateful  for  their  excellent  and  very  careful  work.

Thanks  also  to  others  who  researched  portions  of  this  revised  edition:  Suellen  Miller,
Susan  Klein,  Ronnie  Lovich,  Mary  Ellen  Guroy,  Shelley  Kahane,  Paula  Elster,  and  George
Kent.  For  information  taken  from  the  African  edition,  our  thanks  to  Andrew  Pearson  and
the  other  authors  at  Macmillan  Publishers.

Many  doctors  and  health  care  specialists  from  around  the  world  generously  reviewed
portions  of  the  book.  We  cannot  list  them  all  here,  but  the  help  of  the  following  was
exceptional:  David  Sanders,  Richard  Laing,  Bill  Bower,  Greg  Troll,  Deborah  Bickel,  Tom
Frieden,  Jane  Zucker,  David  Morley,  Frank  Catchpool,  Lonny  Shavelson,  Rudolph  Bock,
Joseph  Cook,  Sadja  Greenwood,  Victoria  Sheffield,  Sherry  Hilaski,  Pam  Zinkin,  Fernando
Viteri,  Jordan  Tapero,  Robert  Gelber,  Ted  Greiner,  Stephen  Gloyd,  Barbara  Mintzes,

Rainer  Arnhold,  Michael  Tan,  Brian  Linde,  Davida  Coady,  and  Alejandro  de  Avila.  Their
expert  advice  and  help  have  been  of  great  value.

We  warmly  thank  the  dedicated  members  of  the  Hesperian  Foundation  for  their  help
in  preparing  the  manuscript:  Kyle  Craven  for  computer  graphic  arts  and  layout,  Stephen
Babb  and  Cynthia  Roat  for  computer  graphics,  and  Lisa  de  Avila  for  editorial  assistance.
We  are  also  grateful  to  many  others  who  helped  in  this  book’s  preparation:  Kathy
Alberts,  Mary  Klein,  Evan  Winslow-Smith,  Jane  Bavelas,  Kim  Gannon,  Heidi  Park,  Laura
Gibney,  Nancy  Ogaz,  Martin  Bustos,  Karen  Woodbury,  and  Trude  Bock.  Our  special
thanks  to  Keith  and  Luella  McFarland  for  being  there  when  we  needed  them  most.

For  help  updating  this  book,  we  thank  Manisha  Aryal,  Marcos  Burgos,  Todd  Jailer,  Erika
Leemann,  Malcolm  Lowe,  Jane  Maxwell,  Susan  McCallister,  Gail  McSweeney,  Elena  Metcalf,
Christine  Sienkiewicz,  Lora  Santiago,  Peter  Small,  Melissa  Smith,  Fred  Strauss,  Fiona  Thomson,
Kathleen  Vickery,  and  Sarah  Wallis.

Artwork  for  the  new  edition  was  created  by  David  Werner,  Kyle  Craven,  Susan  Klein,
Regina  Faul-Jansen,  and  Sandy  Frank.  We  also  thank  the  following  persons  and  groups
for  permission  to  use  their  artwork:  Dale  Crosby,  Carl  Werner,  Macmillan  Publishers  (for
some  of  Felicity  Shepherd’s  drawings  in  the  African  edition  of  this  book),  the  “New
Internationalist”  (for  the  picture  of  the  VIP  latrine),  James  Ogwang  (for  the  drawings  on
page  417)  and  McGraw-Hill  Book  Company  (for  drawings  appearing  on  pages  85  and
104  taken  from  Emergency  Medical  Guide  by  John  Henderson,  illustrated  by  Niel  Hardy).

The  fine  work  of  those  who  helped  in  the  creation  of  the  original  version  is  still
reflected  on  nearly  every  page.  Our  thanks  to  Val  Price,  Al  Hotti,  Rodney  Kendall,  Max
Capestany,  Rudolf  Bock,  Kent  Benedict,  Alfonzo  Darricades,  Carlos  Felipe  Soto  Miller,

Paul  Quintana,  David  Morley,  Bill  Bower,  Allison  Orozco,  Susan  Klein,  Greg  Troll,  Carol
Westburg,  Lynn  Gordon,  Myra  Polinger,  Trude  Bock,  Roger  Bunch,  Lynne  Coen,  George
Kent,  Jack  May,  Oliver  Bock,  Bill  Gonda,  Ray  Bleicher,  and  Jesds  Manjarrez.

For  this  new  edition,  we  are  grateful  for  financial  support  from  the  Carnegie
Corporation,  Gladys  and  Merrill  Muttart  Foundation,  Myra  Polinger,  the  Public  Welfare
Foundation,  Misereor,  the  W.K.  Kellogg  Foundation,  the  Sunflower  Foundation,  and  the
Edna  McConnell  Clark  Foundation.

Finally,  our  warm  thanks  to  the  village  health  workers  of  Project  Piaxtla  in  rural  Mexico
— especially  Martin  Reyes,  Miguel  Angel  Manjarrez,  Miguel  Angel  Alvarez,  and  Roberto
Fajardo— whose  experience  and  commitment  have  provided  the  foundation  for  this  book.

CONTENTS

A list  of  what  is  discussed  in  each  chapter

INTRODUCTION

NOTE  ABOUT  THIS  NEW  EDITION

Health  Needs  and  Human  Needs  w2
Many  Things  Relate  to  Health  Care  w7
Take  a Good  Look  at  Your  Community  w8
Using  Local  Resources  to  Meet  Needs  w12
Deciding  What  to  Do  and  Where  to
Begin  w13

Trying  a New  Idea  w15
A Balance  Between  People  and  Land  w16

wl

A Balance  Between  Prevention  and
Treatment  w17

Sensible  and  Limited  Use  of  Medicines  w18
Finding  Out  What  Progress  Has  Been
Made  w20

Teaching  and  Learning  Together  w21

Tools  for  Teaching  w22

Making  the  Best  Use  of  This  Book  w28

WORDS  TO  THE  VILLAGE  HEALTH  WORKER  (Brown  Pages)

Chapter  1

HOME  CURES  AND  POPULAR  BELIEFS

Home  Cures  That  Help  1
Beliefs  That  Can  Make  People  Well  2
Beliefs  That  Can  Make  People  Sick  4
Witchcraft — Black  Magic — and  the  Evil  Eye  5
_Questions_and  Answers  6
Sunken  Fontanel  or  Soft  Spot  9

_L

Ways  to  Tell  Whether  a Home  Remedy
Works  or  Not  10
Medicinal  Plants  12

Homemade  Casts — for  Broken  Bones  14
Enemas,  Laxatives,  and  Purges  15

Chapter  2

SICKNESSES  THAT  ARE  OFTEN  CONFUSED  17

Examples  of  Local  Names  for  Sicknesses  22
Misunderstandings  Due  to  Confusion  of
Names  25

Confusion  between  Different  Illnesses  That
Cause  Fever  26

Chapter  3

HOW  TO  EXAMINE  A SICK  PERSON 29

Questions  29

Eyes  33

General  Condition  of  Health

30

Ears  34

Temperature  30

Skin  34

How  to  Use  a Thermometer

31

The  Belly  (Abdomen)

35

Breathing  (Respiration)  32

Muscles  and  Nerves

37

Pulse  (Heartbeat)  32

What  Causes  Sickness?  17
Different  Kinds  of  Sicknesses  and  Their
Causes  18

Non-infectious  Diseases  18

Infectious  Diseases  19

Sicknesses  That  Are  Hard  to  Tell  Apart  20

Chapter  4

HOW  TO  TAKE  CARE  OF  A SICK  PERSON

39

The  Comfort  of  the  Sick  Person  39
Special  Care  for  a Person  Who  Is  Very  ill  40
Liquids  40
Food  41

Cleanliness  and  Changing  Position  in  Bed  41

Chapter  5

HEALING  WITHOUT  MEDICINES  .

Healing  with  Water  46

When  Water  Is  Better  than  Medicines  47

Watching  for  Changes  41

Signs  of  Dangerous  Illness  42

When  and  How  to  Look  for  Medical  Help  43

What  to  Tell  the  Health  Worker  43

Patient  Report  44

45

Chapter  6

RIGHT  AND  WRONG  USE  OF  MODERN  MEDICINES 49

Guidelines  for  the  Use  of  Medicine  49  When  Should  Medicine  Not  Be  Taken?  54

The  Most  Dangerous  Misuse  of  Medicine  50

Chapter  7

ANTIBIOTICS:  WHAT  THEY  ARE  AND  HOW  TO  USE  THEM  55

Guidelines  for  the  Use  of  Antibiotics  56

What  to  Do  if  an  Antibiotic  Does'  Not  Seem  to  Help  57

Importance  of  Limited  Use  of  Antibiotics  58

Chapter  8

HOW  TO  MEASURE  AND  GIVE  MEDICINE

Medicine  in  Liquid  Form  61

How  to  Give  Medicines  to  Small  Children  62

How  to  Take  Medicines  63

Chapter  9

When  to  Inject  and  When  Not  To  65
Emergencies  When  It  Is  Important  to  Give
Injections  66
Medicines  Not  to  Inject  67
Risks  and  Precautions  68
Dangerous  Reactions  From  Injecting  Certain
Medicines  70

59.

Dosage  Instructions  for  Persons  Who
Cannot  Read  63

65

Avoiding  Serious  Reactions  to  Penicillin  71
How  to  Prepare  a Syringe  for  Injection  72
How  to  Inject  73

How  Injections  Can  Disable  Children  74
How  to  Sterilize  Equipment  74

INSTRUCTIONS  AND  PRECAUTIONS  FOR  INJECTIONS

Chapter  10
FIRST  AID

75

Fever  75
Shock  77

Loss  of  Consciousness  78
When  Something  Gets  Stuck  in  the
Throat  79
Drowning  79

When  Breathing  Stops:  Mouth-to-Mouth
Breathing  80

Emergencies  Caused  by  Heat  81

How  to  Control  Bleeding  from  a Wound  82

How  to  Stop  Nosebleeds  83

Cuts,  Scrapes,  and  Small  Wounds  84

Large  Cuts:  How  to  Close  Them  85

Bandages  87

Infected  Wounds  88

Bullet,  Knife,  and  Other  Serious  Wounds  90
Emergency  Problems  of  the  Gut
(Acute  Abdomen)  93
Appendicitis,  Peritonitis  94
Burns  96

Broken  Bones  (Fractures)  98

How  to  Move  a Badly  Injured  Person  100

Dislocations

(Bones  out  of  Place  at  a Joint)  101
Strains  and  Sprains  102
Poisoning  103
Snakebite  104

Other  Poisonous  Bites  and  Stings  106

Chapter  11

NUTRITION:  WHAT  TO  EAT  TO  BE  HEALTHY

Sicknesses  Caused  by  Not  Eating  Well  107
Why  It  Is  Important  to  Eat  Right  109
Preventing  Malnutrition  109
Main  Foods  and  Helper  Foods  110
Eating  Right  to  Stay  Healthy  111
HowTo  Recognize  Malnutrition  112
Eating  Better  When  You  Do  Not  Have  Much
Money  or  Land  115
Where  to  Get  Vitamins:  In  Pills  or
in  Foods?  118

Things  to  Avoid  in  Our  Diet  119
The  Best  Diet  for  Small  Children  120
Harmful  Ideas  about  Diet  123

Chapter  12

Cleanliness— and  Problems  from  Lack  of
Cleanliness  131

Basic  Guidelines  of  Cleanliness  133

Sanitation  and  Latrines  137

Worms  and  Other  Intestinal  Parasites  140

Roundworm  (Ascaris)  140

Pinworm  (Threadworm,  Enterobius)  141

Whipworm  (Trichuris)  142

Hookworm  142

Tapeworm  143

107

Special  Diets  for  Specific  Health
Problems  124
Anemia  124
Rickets  125
High  Blood  Pressure  125

Fat  People-  J26

Constipation  126
Diabetes  127

Acid  Indigestion,  Heartburn,  and  Stomach
Ulcers  128
Goiter

(A  Swelling  or  Lump  on  the  Throat)  1 30

131

Trichinosis  144
Amebas  144
Giardia  145
Blood  Flukes

(Schistosomiasis,  Bilharzia)  146
Vaccinations  (Immunizations) — Simple,  Sure
Protection  147

Other  Ways  to  Prevent  Sickness  and  Injury  148
Habits  That  Affect  Health  1 48

PREVENTION:  HOW  TO  AVOID  MANY  SICKNESSES

Chapter  13

SOME  VERY  COMMON  SICKNESSES

151

Dehydration  151

Diarrhea  and  Dysentery  153

The  Care  of  a Person  with  Acute  Diarrhea  160

Vomiting  161

Headaches  and  Migraines  162
Colds  and  the  Flu  163
Stuffy  and  Runny  Noses  164
Sinus  Trouble  (Sinusitis)  165
Hay  Fever  (Allergic  Rhinitis)  165
Allergic  Reactions  166
Asthma  167
Cough  168

Bronchitis  170
Pneumonia  171
Hepatitis  172

Arthritis  (Painful,  Inflamed  Joints)  173
Back  Pain  173
Varicose  Veins  175
Piles  (Hemorrhoids)  175
Swelling  of  the  Feet  and  Other  Parts  of  the
Body  176

Hernia  (Rupture)  177
Fits  (Convulsions)  178

Chapter  14

SERIOUS  ILLNESSES  THAT  NEED  SPECIAL  MEDICAL  ATTENTION

Tuberculosis  (TB,  Consumption)  179

Rabies  181

Tetanus  (Lockjaw)  182

Meningitis  185

Malaria  186

Chapter  15

SKIN  PROBLEMS

General  Rules  for  Treating  Skin  Problems  193
Instructions  for  Using  Hot  Compresses  195
Identifying  Skin  Problems  196
Scabies  199
Lice  200
Bedbugs  200
Ticks  and  Chiggers  201
Small  Sores  with  Pus  201
Impetigo  202
Boils  and  Abscesses  202
Itching  Rash,  Welts,  or  Hives  203
Things  That  Cause  Itching  or  Burning  of  the
Skin  204

Shingles  (Herpes  Zoster)  204
Ringworm,  Tinea  (Fungus  Infections)  205
White  Spots  on  the  Face  and  Body  206
Mask  of  Pregnancy  207
Pellagra  and  Other  Skin  Problems  Due  to
Malnutrition  208

- • ■ 179

Dengue  (Breakbone  Fever,  Dandy
Fever)  187

Brucellosis  (Undulant  Fever,  Malta  Fever)  188
Typhoid  Fever  188
Typhus  190

Leprosy  (Hansen's  Disease)  191

193

Warts  (Verrucae)  210
Corns  210

Pimples  and  Blackheads  (Acne)  211
Cancer  of  the  Skin  211
Tuberculosis  of  the  Skin  or  Lymph
Nodes  212

Erysipelas  and  Cellulitis  212
Gangrene  (Gas  Gangrene)  213
Ulcers  of  the  Skin  Caused  by  Poor
Circulation  213
Bed  Sores  214
Skin  Problems  of  Babies  215
Eczema

(Red  Patches  with  Little  Blisters)  216
Psoriasis  216

Chapter  16
THE  EYES

Danger  Signs  217
Injuries  to  the  Eye  218
How  to  Remove  a Speck  of  Dirt  from  the
Eye  218

Chemical  Burns  of  the  Eye  219
Red,  Painful  Eyes — Different  Causes  219
'Pink  Eye’ (Conjunctivitis)  219
Trachoma  220

Infected  Eyes  in  Newborn  Babies
(Neonatal  Conjunctivitis)  221
Iritis  (Inflammation  of  the  Iris)  221
Glaucoma  222
Infection  of  the  Tear  Sac
(Dacryocystitis)  223

Chapter  17

THE  TEETH,  GUMS,  AND  MOUTH

Care  of  Teeth  and  Gums  229
If  You  Do  Not  Have  A Toothbrush  230
Toothaches  and  Abscesses  231
Pyorrhea,  a Disease  of  the  Gums  231

217

Trouble  Seeing  Clearly  223
Cross-Eyes  and  Wandering  Eyes  223
Sty  (Hordeolum)  224
Pterygium  224

A Scrape,  Ulcer,  or  Scar  on  the  Cornea  224
Bleeding  in  the  White  of  the  Eye  225
Bleeding  behind  the  Cornea  (Hyphema)  225
Pus  behind  the  Cornea  (Hypopyon)  225
Cataract  225

Night  Blindness  and  Xerophthalmia  226
Spots  or  'Flies’  before  the  Eyes  227
Double  Vision  227

River  Blindness  (Onchocerciasis)  227

229

Sores  or  Cracks  at  the  Corners  of  the
Mouth  232

White  Patches  or  Spots  in  the  Mouth  232
Cold  Sores  and  Fever  Blisters  232

Chapter  18

THE  URINARY  SYSTEM  AND  THE  GENITALS  233

Urinary  Tract  Infections  234
Kidney  or  Bladder  Stones  235
Enlarged  Prostate  Gland  235
Diseases  Spread  by  Sexual  Contact

(Sexually  Transmitted  Diseases)  236
Gonorrhea  (Clap,  VD,  the  Drip)  and
Chlamydia  236
Syphilis  237

Bubos:  Bursting  Lymph  Nodes  in  the
Groin  238

Use  of  a Catheter  to  Drain  Urine  239
Problems  of  Women  241
Vaginal  Discharge  241
How  a Woman  Can  Avoid  Many
Infections  242

Pain  or  Discomfort  in  a Woman's  Belly  243
Men  and  Women  Who  Cannot  Have  Children
(Infertility)  244

Chapter  19

INFORMATION  FOR  MOTHERS  AND  MIDWIVES

The  Menstrual  Period

(Monthly  Bleeding  in  Women)  245
The  Menopause

(When  Women  Stop  Having  Periods)  246
Pregnancy  247

245

How  to  Stay  Healthy  during  Pregnancy  247
Minor  Problems  during  Pregnancy  248
Danger  Signs  in  Pregnancy  249
Check-ups  during  Pregnancy
(Prenatal  Care)  250

Record  of  Prenatal  Care  253

Things  to  Have  Ready  before  the  Birth  254

Preparing  for  Birth  256

Signs  That  Show  Labor  Is  Near  258

The  Stages  of  Labor  259

Care  of  the  Baby  at  Birth  262

Care  of  the  Cut  Cord  (Navel)  263

The  Delivery  of  the  Placenta  (Afterbirth)  264

Hemorrhaging  (Heavy  Bleeding)  264

The  Correct  Use  of  Oxytocics:

Ergonovine,  Oxytocin,  Pitocin,  etc.  266
Difficult  Births  267

Tearing  of  the  Birth  Opening  269
Care  of  the  Newborn  Baby  270
Illnesses  of  the  Newborn  272
The  Mother's  Health  after  Childbirth  276
Childbirth  Fever

(Infection  after  Giving  Birth)  276
Care  of  the  Breasts  277
Lumps  or  Growths  in  the  Lower  Part  of  the
Belly  280

Miscarriage  (Spontaneous  Abortion)  281
High  Risk  Mothers  and  Babies  282

Chapter  20
FAMILY  PLANNING-

HAVING  THE  NUMBER  OF  CHILDREN  YOU  WANT

Choosing  a method  of  Family  Planning  284
Oral  Contraceptives

(Birth  Control  Pills)  286
Other  Methods  of  Family  Planning  290
Combined  Methods  292

283

Methods  for  Those  Who  Never  Want  to  Have
More  Children  293
Home  Methods  for  Preventing
Pregnancy  294

Chapter  21

HEALTH  AND  SICKNESSES  OF  CHILDREN

What  to  Do  to  Protect  Children’s
Health  295
Children's  Growth —

and  the  ‘Road  to  Health'  297
Child  Health  Chart  298
Review  of  Children’s  Health  Problems
Discussed  in  Other  Chapters  305
Health  Problems  of  Children  Not

Discussed  in  Other  Chapters  309
Earache  and  Ear  Infections  309
Sore  Throat  and  Inflamed  Tonsils  309
Rheumatic  Fever  310
Infectious  Diseases  of  Childhood  311
Chickenpox  311
Measles  (Rubeola)  311
German  Measles  (Rubella)  312

295

Mumps  312

Whooping  Cough  313

Diphtheria  313

Infantile  Paralysis  (Polio)  314

How  to  Make  Simple  Crutches  315

Problems  Children  Are  Born  With  316

Dislocated  Hip  316

Umbilical  Hernia

(Belly  Button  That  Sticks  Out)  31 7
A 'Swollen  Testicle’

(Hydrocele  or  Hernia)  317
Mentally  Slow,  Deaf,  or  Deformed
Children  318

The  Spastic  Child  (Cerebral  Palsy)  320
Retardation  in  the  First  Months  of  Life  321
Sickle  Cell  Disease  321
Helping  Children  Learn  322

Chapter  22

HEALTH  AND  SICKNESSES  OF  OLDER  PEOPLE

323

Summary  of  Health  Problems  Discussed  in
Other  Chapters  323

Other  Important  Illnesses  of  Old  Age  325
Heart  Trouble  325

Words  to  Younger  Persons  Who  Want  to
Stay  Healthy  When  Older  326
Stroke  (Apoplexy,  Cerebro-Vascular
Accident,  CVA)  327

Deafness  327

Loss  of  Sleep  (Insomnia)  328
Diseases  Found  More  Often  in  People  over
Forty  328

Cirrhosis  of  the  Liver  328
Gallbladder  Problems  329
Accepting  Death  330

Chapter  23

THE  MEDICINE  KIT

How  to  Care  for  Your  Medicine  Kit  332
Buying  Supplies  for  the  Medicine  Kit  333
The  Home  Medicine  Kit  334

331

The  Village  Medicine  Kit  336
Words  to  the  Village  Storekeeper
(or  Pharmacist)  338

THE  GREEN  PAGES — The  Uses,  Dosage,  and  Precautions  for  Medicines  . 339

List  of  Medicines  in  the  Green  Pages 341

Index  of  Medicines  in  the  Green  Pages  345

Information  on  Medicines  351

THE  BLUE  PAGES— New  Information

AIDS  399

Sores  on  the  Genitals  402
Circumcision  and  Excision  404
Special  Care  for  Small,  Early,

and  Underweight  Babies  405
Ear  Wax  405
Leishmaniasis  406

399

Guinea  Worm  406
Emergencies  Caused  by  Cold  408
How  to  Measure  Blood  Pressure  41 0
Poisoning  from  Pesticides  412
Complications  from  Abortion  414
Drug  Abuse  and  Addiction  416

VOCABULARY— Explaining  Difficult  Words  419

ADDRESSES  FOR  TEACHING  MATERIALS  429

INDEX  (Yellow  Pages)  433

Dosage  Instructions  for  Persons  Who  Cannot  Read
Making  Medical  Reports
Information  About  Vital  Signs

INTRODUCTION

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

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

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

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

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

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

6.  Basic  health  care  should  not  be  delivered,  but  encouraged.

Clearly,  a part  of  informed  self-care  is  knowing  one’s  own  limits.  Therefore
guidelines  are  included  not  only  for  what  to  do,  but  for  when  to  seek  help.

The  book  points  out  those  cases  when  it  is  important  to  see  or  get  advice  from
a health  worker  or  doctor.  But  because  doctors  or  health  workers  are  not
always  nearby,  the  book  also  suggests  what  to  do  in  the  meantime — even  for
very  serious  problems.

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

Important  words  the  reader  may  not  understand  are  explained  in  a word  list
or  vocabulary  at  the  end  of  the  book.  The  first  time  a word  listed  in  the
vocabulary  is  mentioned  in  a chapter  it  is  usually  written  in  italics.

Where  There  Is  No  Doctor  was  first  written  in  Spanish  for  farm  people  in  the
mountains  of  Mexico  where,  27  years  ago,  the  author  helped  form  a health  care
network  now  run  by  the  villagers  themselves.  Where  There  Is  No  Doctor  has
been  translated  into  more  than  50  languages  and  is  used  by  village  health
workers  in  over  100  countries.

The  first  English  edition  was  the  result  of  many  requests  to  adapt  it  for  use  in
Africa  and  Asia.  I received  help  and  suggestions  from  persons  with
experience  in  many  parts  of  the  world.  But  the  English  edition  seems  to  have
lost  much  of  the  flavor  and  usefulness  of  the  original  Spanish  edition,  which
was  written  for  a specific  area,  and  for  people  who  have  for  years  been  my
neighbors  and  friends.  In  rewriting  the  book  to  serve  people  in  many  parts  of
the  world,  it  has  in  some  ways  become  too  general.

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

Persons  or  programs  who  wish  to  use  this  book,  or  portions  of  it,  in
preparing  their  own  manuals  for  villagers  or  health  workers  are  encouraged  to
do  so.  Permission  from  the  author  or  publisher  is  not  needed — provided  the
parts  reproduced  are  distributed  free  or  at  cost— not  for  profit.  It  would  be
appreciated  if  you  would  (1)  include  a note  of  credit  and  (2)  send  a copy  of
your  production  to  the  Hesperian  Foundation,  1919  Addison  St.,  #304,  Berkeley,
California  94704,  U.S.A.

For  local  or  regional  health  programs  that  do  not  have  the  resources  for
revising  this  book  or  preparing  their  own  manuals,  it  is  strongly  suggested  that
if  the  present  edition  is  used,  leaflets  or  inserts  be  supplied  with  the  book  to
provide  additional  information  as  needed.

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

— —■ ..  • —

This  book  was  written  for  anyone  who  wants  to  do  something  about  his  or
her  own  and  other  people’s  health.  However,  it  has  been  widely  used  as  a
training  and  work  manual  for  community  health  workers.  For  this  reason,  an
introductory  section  has  been  added  for  the  health  worker,  making  clear  that

the  health  worker’s  first  job  is  to  share  her  knowledge  and  help  educate
people.

Today  in  over-developed  as  well  as  under-developed  countries,  existing
health  care  systems  are  in  a state  of  crisis.  Often,  human  needs  are  not  being
well  met.  There  is  too  little  fairness.  Too  much  is  in  the  hands  of  too  few.

Let  us  hope  that  through  a more  generous  sharing  of  knowledge,  and
through  learning  to  use  what  is  best  in  both  traditional  and  modern  ways  of
healing,  people  everywhere  will  develop  a kinder,  more  sensible  approach  to
caring — for  their  own  health,  and  for  each  other.

— D.W.

How  to  Use  This  Book

When  you  get  this  book:

Read  the  list  of  CONTENTS  at  the  beginning.  This  tells  what  each  chapter  is
about  and  gives  the  page  numbers  for  the  different  subjects  discussed.

To  look  up  an  illness  or  other  health  subject:

1.  Look  in  the  YELLOW  PAGES  at  the  end  of  the  book.  This  is  an  INDEX  that
lists,  in  the  order  of  the  alphabet,  all  the  subjects  in  this  book.  Also,  if  you  look
up  a particular  problem,  it  refers  you  to  the  possible  causes  (for  example,  look
up  ‘itching’).  If  you  cannot  find  what  you  want,  look  for  it  under  another  name.
Or...

2.  Check  the  list  of  CONTENTS.  When  you  find  what  you  want,  turn  to  the  pages
shown.

If  you  do  not  understand  the  meaning
of  some  of  the  words  in  this  book:

Look  for  the  word  in  the  VOCABULARY  right  after  the  blue  pages  in  the  back  of
the  book.  Words  explained  in  the  Vocabulary  are  written  in  italics  the  first  time
they  are  used  in  a chapter.

Before  using  any  medicine:

Always  look  at  the  GREEN  PAGES  for  information  on  uses,  dosage,  risks,  and
precautions.  A LIST  OF  MEDICINES  and  an  INDEX  OF  MEDICINES  can  be  found
near  the  beginning  of  the  GREEN  PAGES.

To  be  ready  for  emergencies:

1.  Keep  a Medicine  Kit  like  the  ones  recommended  in  Chapter  23  handy  in  the
house  or  in  the  village.

2.  Study  this  book  before  it  is  needed,  especially  Chapter  10,  FIRST  AID,  and
Chapter  4,  HOW  TO  CARE  FOR  A SICK  PERSON.

To  help  keep  your  family  in  good  health:

Carefully  study  Chapter  11,  on  NUTRITION,  and  Chapter  12,  on  PREVENTION,  and
pay  attention  to  the  guidelines  and  precautions.

To  improve  health  in  your  community:

Organize  a meeting  of  your  neighbors,  to  study  this  book  and  discuss  local  health
problems.  Or  ask  a teacher  to  give  classes  to  the  children  and  adults,  using  the
book.  You  will  find  many  useful  suggestions  in  the  brown  pages.  WORDS  TO  THE
VILLAGE  HEALTH  WORKER,  in  the  first  part  of  this  book.

Thanks  |y  the  Wrtrfc  and

■Jed  i Lillian  <.if  nijiiy  y.r : iU  |JS  3 ltd
in(i(vidii£t]i  aroiind  Lha  world,
Where  There  f.f  Nti  line tttf
1)3.3  teen  translated  imo
nunc  llian  SO  languages-
The  following  arc  some
of  ih-c-  translations  and
Lhc  addicsscK  where
you  can  obtain  (tiarn-

SPANISH  AND  ENGLISH:

The /Hesperian  Foundation
1910  Addison  SL.-kfJOd
i SftrKeHey,  OilAjiTia  $4704
Umted  Stales  ol  America
www.  hesper  l an  rg
bOflkonrasi  sS^espei  ian  org

FRENCH:

EN0A

Publicstinns  Dept
B P 3370
Dakar.  SENEGAL

ARABIC:

Arab  Resource  Collective
PO  Bc*73B0
Nipeele.  CYPRUS

HINDI:

vha]

40,  InalHullqnal  Area
(Hear  Gulab  Hotel  S of  l.l  T.J
New  Delhi,  IIMlfc
JNDIA

INDONESIAN:

Yayysani  Esse^a  Medic®

F.Q.  Sox  TQ5$

Yogyakarla,  INDONESIA  65010

SPANISH:

Editorial  Fax-M4xico
Avc  Cuauhtemoc  143*

Mexico.  D.F.  03310
MEXICO

NEPALI:

Health  Learning  Materials  Ctr
Institute  of  Medtoine
P.O.  Bq:h.  2533
Kalhmandu.  NEPAL

RUSSIAN:

Mercy  Craps  Internationa)

3030  SW  la!  Avenue
Porlland,  Oregon  07201
United  Slates  &l  America

UZBEK:

AntHijiXi  Osvatflpmenl  Center
£h.  Rainidov  Kb'Chasi  1 A
Andiibfl  City,  7ia000
UZBEKISTAN

ITALIAN:

akjq  Eer,p0kei!i

ijmversiia  Delia  Pace  Jc»orgit>  La  Pira-
C so  IV  Nevembre,  2R
13100  Ctmeo.  ITALY

Please  wote  to  i he  Hesperian.  Foundation  for  information  on  other  editions,
including!  Aymara,  Bengali.  Chinese,  Creole,  Dari,  German.  Kannada,  Korean,
Lao,  Marathi.  PortuguesH.  Pushtu,  Quochua,  Shuar,  Sindhi,  Sshheia.  Tamil,  Thai,
Tigre,  Tigrina,  Tswana,  and  Urdu,  as  well  as  English  editions  adapted  for
speciiic  countries.

We  are  looking  lor  ways  to  get  ihis  book  ig  lhaee  Mean  serve  beet — namely
persons  in  soiated  villages  ard  fringe  oommunilies  of  poor  countries.  II  you  are
able  lo  nelp  or  have  sag  goal  ions,  please  contact  the  Hssparian  Foundai  on.

We  oHIer  this  book  al  a lower  price  10  persons  pi  low  income  living  in  poor
countries.

WORDS  TO  THE  VILLAGE  HEALTH  WORKER

Who  is  the  village  health  worker?

A village  health  worker  is  a person  who  helps  lead  family  and  neighbors
toward  better  health.  Often  he  or  she  has  been  selected  by  the  other  villagers
as  someone  who  is  especially  able  and  kind.

Some  village  health  workers  receive  training  and  help  from  an  organized
program,  perhaps  the  Ministry  of  Health.  Others  have  no  official  position,  but
are  simply  members  of  the  community  whom  people  respect  as  healers  or
leaders  in  matters  of  health.  Often  they  learn  by  watching,  helping,  and
studying  on  their  own.

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

This  means  almost  everyone  can  and  should  be  a health  worker:

• Mothers  and  fathers  can  show  their  children  how  to  keep  clean;

• Farm  people  can  work  together  to  help  their  land  produce  more  food;

• Teachers  can  teach  schoolchildren  how  to  prevent  and  treat  many
common  sicknesses  and  injuries;

• Schoolchildren  can  share  what  they  learn  with  their  parents;

• Shopkeepers  can  find  out  about  the  correct  use  of  medicines  they  sell
and  give  sensible  advice  and  warning  to  buyers  (see  p.  338V.

• Midwives  can  counsel  parents
about  the  importance  of
eating  well  during  pregnancy,
breast  feeding,  and  family
planning.

This  book  was  written  for  the
health  worker  in  the  larger  sense.

It  is  for  anyone  who  wants  to
know  and  do  more  for  his  own,
his  family’s  or  his  people’s  well-
being.

If  you  are  a community  health
worker,  an  auxiliary  nurse,  or  even
a doctor,  remember:  this  book  is
not  just  for  you.  It  is  for  all  the  __
people.  Share  it!

Use  this  book  to  help  explain
what  you  know  to  others.  Perhaps
you  can  get  small  groups  together  THg  village  health  worker  lives  and

to  read  a chapter  at  a time  and  works  at  the  level  of  his  people,  his

discuss  it.  FIRST  JOB  IS  TO  SHARE  HIS  KNOWLEDGE.

wl

Dear  Village  Health  Worker,

This  book  is  mostly  about  people's  health  needs.  But  to  help  your  village  be
a healthy  place  to  live,  you  must  also  be  in  touch  with  their  human  needs.  Your
understanding  and  concern  for  people  are  just  as  important  as  your  knowledge
of  medicine  and  sanitation.

Here  are  some  suggestions  that  may
help  you  serve  your  people’s  human
needs  as  well  as  health  needs:

1 . BE  KIND.  A friendly  word,  a smile,
a hand  on  the  shoulder,  or  some  other
sign  of  caring  often  means  more  than
anything  else  you  can  do.  Treat  others
as  your  equals.  Even  when  you  are
hurried  or  worried,  try  to  remember  the
feelings  and  needs  of  others.  Often  it
helps  to  ask  yourself,  “What  would  I do
if  this  were  a member  of  my  own  family?”

Treat  the  sick  as  people.  Be  have  compassion.

especially  kind  to  those  who  are  very  Kindness  often  helps  more

sick  or  dying.  And  be  kind  to  their  than  medicine.  Never  be

families.  Let  them  see  that  you  care.  afraid  to  show  you  care.

2.  SHARE  YOUR  KNOWLEDGE^  As  a health  worker;  your  first  job  is  to  teach.  “

This  means  helping  people  learn  more  about  how  to  keep  from  getting  sick.  It
also  means  helping  people  learn  how  to  recognize  and  manage  their  illnesses

— including  the  sensible
use  of  home  remedies
and  common  medicines.

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

look  for  ways  to  share  your  knowledge.  their  own  homes.

w2

3.  RESPECT  YOUR  PEOPLE'S  TRADITIONS  AND  IDEAS,

Because  you  learn  something  about  modern  medicine  does  not  mean  you
should  no  longer  appreciate  the  customs  and  ways  of  healing  of  your  people.
Too  often  the  human  touch  in  the  art  of  healing  is  lost  when  medical  science
moves  in.  This  is  too  bad,  because  ...

If  you  can  use  what  is  best  in  modern  medicine,  together  with  what  is  best  in
traditional  healing,  the  combination  may  be  better  than  either  one  alone.

In  this  way,  you  will  be  adding  to  your  people’s  culture,  not  taking  away.

Of  course,  if  you  see  that  some  of  the  home  cures  or  customs  are  harmful
(for  example,  putting  excrement  on  the  freshly  cut  cord  of  a newborn  baby),
you  will  want  to  do  something  to  change  this.  But  do  so  carefully,  with  respect
for  those  who  believe  in  such  things.  Never  just  tell  people  they  are  wrong.  Try
to  help  them  understand  WHY  they  should  do  something  differently.

People  are  slow  to  change  their  attitudes  and  traditions,  and  with  good
reason.  They  are  true  to  what  they  feel  is  right.  And  this  we  must  respect.

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

So  go  slow — and  always  keep  a deep  respect  for  your  people,  their
traditions,  and  their  human  dignity.  Help  them  build  on  the  knowledge  and
skills  they  already  have.

WORK  WITH  TRADITIONAL
HEALERS  AND  MIDWIVES—
NOT  AGAINST  THEM.

Learn  from  them
and  encourage  them
to  learn  from  you.

w3

4.  KNOW  YOUR  OWN  LIMITS.

f I KNOW  ITS  A LONG  WAY  TO  THE
j health  center,  but  here  we.

I cannot  give  him  THE  TREATMEMT
\HE  NEEDS,  i'll  Go  WITH  YOU.

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

But  use  your  judgment.

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

For  example,  a mother  has  just  given
birth  and  is  bleeding  more  than  you
think  is  normal.  If  you  are  only  half  an
hour  away  from  a medical  center,  it  may
be  wise  to  take  her  there  right  away.

But  if  the  mother  is  bleeding  very

heavily  and  you  are  a long  way  from  the  health  center,  you  may  decide  to
massage  her  womb  (see  p.  265)  or  inject  an  oxytocic  (see  p.  266)  even  if  you
were  not  taught  this.

KNOW  YOUR  LIMITS.

Do  not  take  unnecessary  chances.  But  when  the  danger  is  clearly  greater  if
you  do  nothing,  do  not  be  afraid  to  try  something  you  feel  reasonably  sure  will
help.

Know  your  limits — but  also  use  your  head.  Always  do  your  best  to  protect
the  sick  person  rather  than  yourself.

5.  KEEP  LEARNING.  Use  every  chance
you  have  to  learn  more.  Study  whatever
books  or  information  you  can  lay  your
hands  on  that  will  help  you  be  a better
worker,  teacher,  or  person.

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

Never  pass  up  the  chance  to  take
refresher  courses  or  get  additional
training.

KEEP  LEARNING-Do  not  let
anyone  tell  you  there  are  things
you  should  not  learn  or  know.

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

w4

6.  PRACTICE  WHAT  YOU  TEACH.

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

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

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

Good  leaders  do  not
tell  people  what  to  do.
They  set  the  example.

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

7.  WORK  FOR  THE  JOY  OF  IT.

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

Try  to  make  community  work  projects  fun.  For  example,  fencing  off  the  public
water  hole  to  keep  animals  away  from  where  people  take  water  can  be  hard
work.  But 'if  the  whole  village  helps  do  it  as  a ‘work  festival’ — perhaps  with
refreshments  and  music — the  job  will  be  done  quickly  and  can  be  fun.

Children  will  work

hard  and  enjoy  it,  if
they  can  turn  work
into  play.

You  may  or  may
not  be  paid  for  your
work.  But  never
refuse  to  care,  or
care  less,  for  some-
one who  is  poor  or
cannot  pay.

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

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

w5

8.  LOOK  AHEAD— AND  HELP  OTHERS  TO  LOOK  AHEAD.

A responsible  health  worker  does  not  wait  for  people  to  get  sick.  She  tries  to
stop  sickness  before  it  starts.  She  encourages  people  to  take  action  now  to
protect  their  health  and  well-being  in  the  future.

Many  sicknesses  can  be  prevented.  Your  job,  then,  is  to  help  your  people
understand  the  causes  of  their  health  problems  and  do  something  about  them.

Most  health  problems  have  many  causes,  one  leading  to  another.  To  correct
the  problem  in  a lasting  way,  you  must  look  for  and  deal  with  the  underlying
causes.  You  must  get  to  the  root  of  the  problem.

For  example,  in  many  villages  diarrhea  is  the  most  common  cause  of  death
in  small  children.  The  spread  of  diarrhea  is  caused  in  part  by  lack  of
cleanliness  (poor  sanitation  and  hygiene).  You  can  do  something  to  correct  this
by  digging  latrines  and  teaching  basic  guidelines  of  cleanliness  (p.  133).

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

And  why  do  so  many  children  suffer  from  poor  nutrition?

• Is  it  because  mothers  do  not  realize  what  foods  are  most  important  (for
example,  breast  milk)?

• Is  it  because  the  family  does  not  have  enough  money  or  land  to  produce
the  food  it  needs?

• Is  it  because  a few  rich  persons  control  most  of  the  land  and  the  wealth?

• Is  it  because  the  poor  do
not  make  the  best  use  of

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

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

• Is  it  because  parents

they  or  their  land  can
provide  for,  and  keep
having  more?

land  they  have?

have  more  children  than

HELP  OTHERS  TO  LOOK  AHEAD.

w6

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

But  remember:  to  prevent  frequent
deaths  from  diarrhea  will  take  far  more
than  latrines,  pure  water,  and  'special
drink’  (oral  rehydration).  You  may  find
that  child  spacing,  better  land  use,  and
fairer  distribution  of  wealth,  land,  and
power  are  more  important  in  the  long  run

The  causes  that  lie  behind  much  sickness
and  human  suffering  are  short-sightedness
and  greed.  If  your  interest  is  your  people's
well-being,  you  must  help  them  learn  to
share,  to  work  together,  and  to  look  ahead.

MANY  THINGS

RELATE  TO  HEALTH  CARE

We  have  looked  at  some  of  the  causes
that  underlie  diarrhea  and  poor  nutrition.
Likewise,  you  will  find  that  such  things  as

food  production,  land  distribution,
education,  and  the  way  people  treat  or
mistreat  each  other  lie  behind  many
different  health  problems.

DEATH

__1_

DIARRHEA

SPREAD  OF
INFECTION

POOR  HYGIENE
AND  LACK  OF
CLEANLINESS

LARGE  FAMILIES
(MANY  CHILDREN)

UNFAIR  DISTRIBUTION
OF  LAND  AND  WEALTH

GREED  AND  FAILURE
TO  LOOK  AHEAD

The  chain  of  causes  leading
to  death  from  diarrhea.

If  you  are  interested  in  the  long-term  welfare  of  your  whole  community,  you
must  help  your  people  look  for  answers  to  these  larger  questions.

Health  is  more  than  not  being  sick.  It  is  well-being:  in  body,  mind,  and
community.  People  live  best  in  healthy  surroundings,  in  a place  where  they  can
trust  each  other,  work  together  to  meet  daily  needs,  share  in  times  of  difficulty
and  plenty,  and  help  each  other  learn  and  grow  and  live,  each  as  fully  as  he  or
she  can.

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

You  as  a health  worker  have  a big  responsibility.
Where  should  you  begin?  \

w7

TAKE  A GOOD  LOOK  AT  YOUR  COMMUNITY

Because  you  have  grown  up  in  your  community  and  know  your  people  well,
you  are  already  familiar  with  many  of  their  health  problems.  You  have  an  inside
view.  But  in  order  to  see  the  whole  picture,  you  will  need  to  look  carefully  at
your  community  from  many  points  of  view.

As  a village  health  worker,  your  concern  is  for  the  well-being  of  all  the
people — not  just  those  you  know  well  or  who  come  to  you.  Go  to  your  people.
Visit  their  homes,  fields,  gathering  places,  and  schools.  Understand  their  joys
and  concerns.  Examine  with  them  their  habits,  the  things  in  their  daily  lives  that
bring  about  good  health,  and  those  that  may  lead  to  sickness  or  injury.

Before  you  and  your  community  attempt  any  project  or  activity,  carefully
think  about  what  it  will  require  and  how  likely  it  is  to  work.  To  do  this,  you  must
consider  all  the  following:

1 . Felt  needs — what  people  feel  are  their  biggest  problems.

2.  Real  needs — steps  people  can  take  to  correct  these  problems  in  a lasting
way.

3.  Willingness — or  readiness  of  people  to  plan  and  take  the  needed  steps.

4.  Resources — the  persons,  skills,  materials,  and/or  money  needed  to  carry
out  the  activities  decided  upon.

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

that  has  steadily  been  getting  worse.

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

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

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

4.  One  resource  that  may  help  him  give
up  smoking  is  information  about  the  harm
it  can  do  him  and  his  family  (see  p.  149).
Another  is  the  support  and  encouragement
of  his^family,  his  friends,  and  you.

Finding  Out  the  Needs

As  a health  worker,  you  will  first  want  to  find  out  your  people’s  most
important  health  problems  and  their  biggest  concerns.  To  gather  the
information  necessary  to  decide  what  the  greatest  needs  and  concerns  really
are,  it  may  help  to  make  up  a list  of  questions.

On  the  next  2 pages  are  samples  of  the  kinds  of  things  you  may  want  to  ask.
But  think  of  questions  that  are  important  in  your  area.  Ask  questions  that  not
only  help  you  get  information,  but  that  get  others  asking  important  questions
themselves.

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

W9

Sample  Lists  of  Questions

To  Help  Determine  Community  Health  Needs
And  at  the  Same  Time  Get  People  Thinking

FELT  NEEDS

What  things  in  your  people’s  daily  lives  (living  conditions,  ways  of  doing  things,
beliefs,  etc.)  do  they  feel  help  them  to  be  healthy?

What  do  people  feel  to  be  their  major  problems,  concerns,  and  needs— not
only  those  related  to  health,  but  in  general?

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

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

Is  food  protected?  How  could  it  be  better  protected?

What  animals  (dogs,  chickens,  pigs,  etc.),  if  any,  are  allowed  in  the  house?
What  problems  do  they  cause?

What  are  the  common  diseases  of  animals?  How  do  they  affect  people's
health?  What  is  being  done  about  these  diseases?

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

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

Is  the  village  clean?  Where  do  people  put  garbage?  Whv?

How  many  people  live  in  the  community?  How  many  are  under  15  years  old?

How  many  can  read  and  write?  What  good  is  schooling?  Does  it  teach  children
what  they  need  to  know?  How  else  do  children  learn?

How  many  babies  were  born  this  year?  How  many  people  died?  Of  what?  At
what  ages?  Could  their  deaths  have  been  prevented?  How?

Is  the  population  (number  of  people)  getting  larger  or  smaller?  Does  this  cause
any  problems?

How  often  were  different  persons  sick  in  the  past  year?  How  many  days  was
each  sick?  What  sickness  or  injuries  did  each  have?  Why?

How  many  people  have  chronic  (long-term)  illnesses?  What  are  they?

How  many  children  do  most  parents  have?  How  many  children  died?  Of  what?
At  what  ages?  What  were  some  of  the  underlying  causes?

How  many  parents  are  interested  in  not  having  any  more  children  or  in  not
having  them  so  often?  For  what  reasons?  (See  Family  Planning,  p.  283.)

HOUSING  AND  SANITATION

POPULATION

wlO

NUTRITION

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

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

Do  people  make  good  use  of  all  foods  available?

How  many  children  are  underweight  (p.  ,109)  or  show  signs  of  poor  nutrition?
How  much  do  parents  and  schoolchildren  know  about  nutritional  needs?

How  many  people  smoke  a lot?  How  many  drink  alcoholic  or  soft  drinks  very
often?  What  effect  does  this  have  on  their  own  and  their  families’  health?  (See
p.  148  to  150.)

LAND  AND  FOOD

Does  the  land  provide  enough  food  for  each  family?

How  long  will  it  continue  to  produce  enough  food  if  families  keep  growing?

How  is  farm  land  distributed?  How  many  people  own  their  land?

What  efforts  are  being  made  to  help  the  land  produce  more?

How  are  crops  and  food  stored?  Is  there  much  damage  or  loss?  Why?

HEALING,  HEALTH

What  role  do  local  midwives  and  healers  play  in  health  care?

What  traditional  ways  of  healing  and  medicines  are  used?

Which  are  of  greatest  value?  Are  any  harmful  or  dangerous?

What  health  services  are  nearby?  How  good  are  they?  What  do  they  cost?  How
much  are  they  used?

How  many  children  have  been  vaccinated?  Against  what  sicknesses?

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

SELF-HELP

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

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

Are  people  interested  in  finding  ways  of  making  self-care  safer,  more  effective,
and  more  complete?  Why?  How  can  they  learn  more?  What  stands  in  the  way?

What  are  the  rights  of  rich  people?  Of  poor  people?  Of  men?  Of  women?  Of
children?  How  is  each  of  these  groups  treated?  Why?  Is  this  fair?  What  needs
to  be  changed?  By  whom?  How?

Do  people  work  together  to  meet  common  needs?  Do  they  share  or  help  each
other  when  needs  are  great?

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

wl  1

USING  LOCAL  RESOURCES  TO  MEET  NEEDS

How  you  deal  with  a problem  will  depend  upon  what  resources  are  available.

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

Other  activities  can  be  carried  out  completely  with  local  resources.  A family
or  a group  of  neighbors  can  fence  off  a water  hole  or  build  simple  latrines
using  materials  close  at  hand.

Some  outside  resources,  such  as  vaccines  and  a few  important  medicines,
can  make  a big  difference  in  people’s  health.  You  should  do  your  best  to  get
them.  But  as  a general  rule,  it  is  in  the  best  interest  of  your  people  to

Use  local  resources  whenever  possible.

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

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

In  your  health  work
always  remember:

Encourage  people  to  make
the  most  of  local  resources.

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

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

w12

DECIDING  WHAT  TO  DO  AND  WHERE  TO  BEGIN

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

In  a lot  of  villages,  poor  nutrition  plays  a part  in  other  health  problems.

People  cannot  be  healthy  unless  there  is  enough  to  eat.  Whatever  other
problems  you  decide  to  work  with,  if  people  are  hungry  or  children  are  poorly
nourished,  better  nutrition  must  be  your  first  concern.

There  are  many  different  ways  to  approach  the  problem  of  poor  nutrition,  for
many  different  things  join  to  cause  it.  You  and  your  community  must  consider
the  possible  actions  you  might  take  and  decide  which  are  most  likely  to  work.

Here  are  a few  examples  of  ways  some  people  have  helped  meet  their
needs  for  better  nutrition.  Some  actions  bring  quick  results.  Others  work  over  a
longer  time.  You  and  your  people  must  decide  what  is  most  likely  to  work  in
your  area.

POSSIBLE  WAYS  TO  WORK  TOWARD  BETTER  NUTRITION

FAMILY  GARDENS

CONTOUR  DITCHES
to  prevent  soil  from
washing  away

ROTATION  OF  CROPS

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

This  year  maize

Next  year  beans

w13

MORE  WAYS  TO  WORK  TOWARD  BETTER  NUTRITION

IRRIGATION  OF  LAND  FISH  BREEDING

Compost  pile

w14

TRYING  ANEW  IDEA

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

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

that  it  works  and  can  begin

Do  not  be  discouraged  if  an  experiment  does  not  work.  Perhaps  you  can  try
again  with  certain  changes.  You  can  learn  as  much  from  your  failures  as  your
successes.  But  start  small.

Here  is  an  example  of  experimenting  with  a new  idea.

You  learn  that  a certain  kind  of  bean,  such  as  soya,  is  an  excellent  body-building
food.  But  will  it  grow  in  your  area?  And  if  it  grows,  will  people  eat  it?

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

There  may  be  several  conditions  you  want  to  try  changing.  For  example,
type  of  soil,  addition  of  fertilizer,  amount  of  water,  or  different  varieties  of  seed.
To  best  understand  what  helps  and  what  does  not,  be  sure  to  change  only  one
condition  at  a time  and  keep  all  the  rest  the  same.

For  example,  to  find  out  if  animal  fertilizer  (manure)  helps  the  beans  grow,  and  how
much  to  use,  plant  several  small  bean  patches  side  by  side,  under  the  same
conditions  of  water  and  sunlight,  and  using  the  same  seed.  But  before  you  plant,  mix
each  patch  with  a different  amount  of  manure,  something  like  this:

5 shovels
manure

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

wl  5

WORKING  TOWARD  A BALANCE  BETWEEN
PEOPLE  AND  LAND

Health  depends  on  many  things,  but  above  all  it  depends  on  whether  people
have  enough  to  eat.

Most  food  comes  from  the  land.  Land  that  is  used  well  can  produce  more
food.  A health  worker  needs  to  know  ways  to  help  the  land  better  feed  the
people — now  and  in  the  future.  But  even  the  best  used  piece  of  land  can  only
feed  a certain  number  of  people.  And  today,  many  of  the  people  who  farm
do  not  have  enough  land  to  meet  their  needs  or  to  stay  healthy.

In  many  parts  of  the  world,  the  situation  is  getting  worse,  not  better.  Parents
often  have  many  children,  so  year  by  year  there  are  more  mouths  to  feed  on  the
limited  land  that  the  poor  are  permitted  to  use.

Many  health  programs  try  to  work  toward  a balance  between  people  and
land  through  'family  planning’,  or  helping  people  have  only  the  number  of
children  they  want.  Smaller  families,  they  reason,  will  mean  more  land  and
food  to  go  around.  But  family  planning  by  itself  has  little  effect.  As  long  as
people  are  very  poor,  they  often  want  many  children.  Children  help  with  work
without  having  to  be  paid,  and  as  they  get  bigger  may  even  bring  home  a little
money.  When  the  parents  grow  old,  some  of  their  children — or  grandchildren—
will  perhaps  be  able  to  help  care  for  them.

For  a poor  country  to  have  many  children  may  be  an  economic  disaster.  But
for  a poor  family  to  have  many  children  is  often  an  economic  necessity —
especially  when  many  die  young.  In  the  world  today,  for  most  people,  having
many  children  is  the  surest  form  of  social  security  they  can  hope  for.

Some  groups  and  programs  take  a different  approach.  They  recognize  that
hunger  exists  not  because  there  is  too  little  land  to  feed  everyone,  but  because
most  of  the  land  is  in  the  hands  of  a few  selfish  persons.  The  balance  they
seek  is  a fairer  distribution  of  land  and  wealth.  They  work  to  help  people  gain
greater  control  over  their  health,  land,  and  lives.

It  has  been  shown  that,  where  land  and  wealth  are  shared  more  fairly  and
people  gain  greater  economic  security,  they  usually  choose  to  have  smaller
families.  Family  planning  helps  when  it  is  truly  the  people’s  choice.  A balance
between  people  and  land  can  more  likely  be  gained  through  helping  people
work  toward  fairer  distribution  and  social  justice  than  through  family  planning
alone.

It  has  been  said  that  the  social  meaning  of  love  is  justice.  The  health  worker
who  loves  her  people  should  help  them  work  toward  a balance  based  on  a
more  just  distribution  of  land  and  wealth.

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

A LASTING
BALANCE  BETWEEN
PEOPLE  AND  LAND
MUST  BE  BASED  ON
FAIR  DISTRIBUTION.

w16

WORKING  TOWARD  A
BALANCE  BETWEEN

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

As  a health  worker  you  must  go  to  your  people,  work  with  them  on  their
terms,  and  help  them  find  answers  to  the  needs  they  feel  most.  People’s  first
concern  is  often  to  find  relief  for  the  sick  and  suffering.  Therefore,  one  of  your
first  concerns  must  be  to  help  with  healing.

But  also  look  ahead.  While  caring  for  people’s  immediate  felt  needs,  also
help  them  look  to  the  future.  Help  them  realize  that  much  sickness  and
suffering  can  be  prevented  and  that  they  themselves  can  take  preventive
actions.

But  be  careful!  Sometimes  health  planners  and  workers  go  too  far.  In  their
eagerness  to  prevent  future  ills,  they  may  show  too  little  concern  for  the
sickness  and  suffering  that  already  exist.  By  failing  to  respond  to  people's
present  needs,  they  may  fail  to  gain  their  cooperation.  And  so  they  fail  in  much
of  their  preventive  work  as  well.

Treatment  and  prevention  go  hand  in  hand.  Early  treatment  often  prevents
mild  illness  from  becoming  serious.  If  you  help  people  to  recognize  many  of
their  common  health  problems  and  to  treat  them  early,  in  their  own  homes,
much  needless  suffering  can  be  prevented.

If  you  want  their  cooperation,  start  where  your  people  are.  Work  toward  a
balance  between  prevention  and  treatment  that  is  acceptable  to  them.  Such  a
balance  will  be  largely  determined  by  people’s  present  attitudes  toward
sickness,  healing,  and  health.  As  you  help  them  look  farther  ahead,  as  their
attitudes  change,  and  as  more  diseases  are  controlled,  you  may  find  that  the
balance  shifts  naturally  in  favor  of  prevention.

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

Use  treatment  as  a doorway  to  prevention.  One  of  the  best  times  to  talk
to  people  about  prevention  is  when  they  come  for  treatment.  For  example,  if  a
mother  brings  a child  with  worms,  carefully  explain  to  her  how  to  treat  him.  But
also  take  time  to  explain  to  both  the  mother  and  child  how  the  worms  are
spread  and  the  different  things  they  can  do  to  prevent  this  from  happening
(see  Chapter  12).  Visit  their  home  from  time  to  time,  not  to  find  fault,  but  to
help  the  family  toward  more  effective  self-care.

Early  treatment  is  a form  of  preventive  medicine.

Work  toward  prevention— do  not  force  it.

Use  treatment  as  a chance  to  teach  prevention.

SENSIBLE  AND  LIMITED  USE  OF  MEDICINES

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

People  may  come  to  you  asking  for  medicine  when  they  do  not  need  any.

You  may  be  tempted  to  give  them  some  medicine  just  to  please.  But  if  you  do,
when  they  get  well,  they  will  think  that  you  and  the  medicine  cured  them.

Really  their  bodies  cured  themselves.

Instead  of  teaching  people  to  depend  on  medicines  they  do  not  need,  take
time  to  explain  why  they  should  not  be  used.  Also  tell  people  what  they  can
do  themselves  to  get  well.

This  way  you  are  helping  people  to  rely  on  local  resources  (themselves),
rather  than  on  an  outside  resource  (medicine).  Also,  you  are  protecting  their
health,  for  there  is  no  medicine  that  does  not  have  some  risk  in  its  use.

Three  common  health  problems  for  which  people  too  often  request
medicines  they  do  not  need  are  (1)  the  common  cold,  (2)  minor  cough,  and  (3)
diarrhea.

The  common  cold  is  best  treated  by  resting,  drinking  lots  of  liquids,  and  at
the  most  taking  aspirin.  Penicillin,  tetracycline,  and  other  antibiotics  do  not
help  at  all  (see  p.  163).

For  minor  coughs,  or  even  more  severe  coughs  with  thick  mucus  or  phlegm,
drinking  a lot  of  water  will  loosen  mucus  and  ease  the  cough  faster  and  better
than  cough  syrup.  Breathing  warm  water  vapor  brings  even  greater  relief  (see
p.  168).  Do  not  make  people  dependent  on  cough  syrup  or  other  medicines
they  do  not  need.

For  most  diarrhea  of  children,  medicines  do  not  make  them  get  well.  Many
commonly  used  medicines  (neomycin,  streptomycin,  kaolin-pectin,  Lomotil,
chloramphenicol)  may  even  be  harmful.  What  is  most  important  is  that  the
child  get  lots  of  liquids  and  enough  food  (see  p.  155  to  1 56).  The  key  to  the

child’s  recovery  is  the  mother,  not  the  medicine.  If  you  can  help  mothers
understand  this  and  learn  what  to  do,  many  children’s  lives  can  be  saved.

w18

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

• It  is  wasteful.  Most  money  spent  on  medicine  would  be  better  spent  on
food.

% It  makes  people  depend  on  something  they  do  not  need  (and  often  cannot
afford).

% Every  medicine  has  some  risk  in  its  use.  There  is  always  a chance  that  an
unneeded  medicine  may  actually  do  the  person  harm.

% What  is  more,  when  some  medicines  are  used  too  often  for  minor
problems,  they  lose  their  power  to  fight  dangerous  sicknesses.

An  example  of  a medicine  losing  its  power  is  chloramphenicol.  The  extreme
overuse  of  this  important  but  risky  antibiotic  for  minor  infections  has  meant  that
in  some  parts  of  the  world  chloramphenicol  no  longer  works  against  typhoid
fever,  a very  dangerous  infection.  Frequent  overuse  of  chloramphenicol  has
allowed  typhoid  to  become  resistant  to  it  (see  p.  58).

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

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

To  educate  people  about  sensible  and  limited  use  of  medicines
is  one  of  the  important  jobs  of  the  health  worker.

This  is  especially  true  in  areas  where  modern  medicines  are  already  in  great
use.

/don't  YOu\
think  he  r
needs  an  \a

IN  J ECU  ON ?)fj  f'\

NO!  ALL~HE~HA5  15  A \
COLO ■ HE  WILL  GET  WELL
QY  HIMSELF  LET  HIM
REST  GIVE  HIM
G OOP  FOOD  AND
LOTS  TO  DRINK.

strong  medicine
Won't  help  and

MIGHT  EVEN  HARM

Vj4lM. J

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

For  more  information  about  the  use  and  misuse  of  medicines,  see  Chapter J3,
page  49.  For  the  use  and  misuse  of  injections,  see  Chapter.9,  page  65.  For
sensible  use  of  home  remedies,  see  Chapter _1_.

w19

FINDING  OUT  WHAT  PROGRESS  HAS  BEEN  MADE
(EVALUATION)

From  time  to  time  in  your  health  work,  it  helps  to  take  a careful  look  at  what
and  how  much  you  and  your  people  have  succeeded  in  doing.  What  changes,
if  any,  have  been  made  to  improve  health  and  well-being  in  your  community?

You  may  want  to  record  each  month  or  year  the  health  activities  that  can  be
measured.  For  example:

• Flow  many  families  have  put  in  latrines?

• How  many  farmers  take  part  in  activities  to  improve  their  land  and  crops?

• How  many  mothers  and  children  take  part  in  an  Under-Fives  Program
(regular  check-ups  and  learning)?

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

• How  many  children  had  diarrhea  or  signs  of  worms  in  the  past  month  or
year — as  compared  to  before  there  were  latrines?

• How  much  was  harvested  this  season  (corn,  beans,  or  other  crops)— as
compared  to  before  improved  methods  were  used?

• How  many  children  show  normal  weight  and  weight-gain  on  their  Child
Health  Charts  (see  p.  297) — as  compared  to  when  the  Under-Fives
Program  was  started?

• Do  fewer  children  die  now  than  before?

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

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

Setting  goals  often  helps  people  work  harder  and  get  more  done.

To  evaluate  the  results  of  your  health  activities  it  helps  to  count  and  measure
certain  things  before,  during,  and  after.

But  remember:  The  most  important  part  of  your  health  work  cannot  be
measured.  It  has  to  do  with  the  way  you  and  other  people  relate  to  each  other;
with  people  learning  and  working  together;  with  the  growth  of  kindness,
responsibility,  sharing,  and  hope.  It  depends  on  the  growing  strength  and  unity
of  the  people  to  stand  up  for  their  basic  rights.  You  cannot  measure  these
things.  But  weigh  them  well  when  you  consider  what  changes  have  been  made.

TEACHING  AND  LEARNING  TOGETHER—

THE  HEALTH  WORKER  AS  AN  EDUCATOR

As  you  come  to  realize  how  many  things  affect  health,  you  may  think  the
health  worker  has  an  impossibly  large  job.  And  true,  you  will  never  get  much
done  if  you  try  to  deliver  health  care  by  yourself.

Only  when  the  people  themselves  become  actively  responsible  for  their  own
and  their  community’s  health,  can  important  changes  take  place.

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

This  is  why  your  first  job  as  a health  worker  is  to  teach— to  teach  children,
parents,  farmers,  schoolteachers,  other  health  workers— everyone  you  can.

The  art  of  teaching  is  the  most  important  skill  a person  can  learn.  To  teach
is  to  help  others  grow,  and  to  grow  with  them.  A good  teacher  is  not
someone  who  puts  ideas  into  other  people’s  heads;  he  or  she  is  someone
who  helps  others  build  on  their  own  ideas,  to  make  new  discoveries  for
themselves.

Teaching  and  learning  should  not  be  limited  to  the  schoolhouse  or  health
post.  They  should  take  place  in  the  home  and  in  the  fields  and  on  the  road.

As  a health  worker  one  of  your  best  chances  to  teach  will  probably  be  when
you  treat  the  sick.  But  you  should  look  for  every  opportunity  to  exchange
ideas,  to  share,  to  show,  and  to  help  your  people  think  and  work  together.

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

TWO  APPROACHES  TO  HEALTH  CARE

w21

Tools  for  Teaching

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

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

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

Now  draw  the  same  number  of  squares  lightly,

but  larger,  on  the  poster  paper  or  cardboard.

Then  copy  the  drawing,  square  for  square.

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

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

Pin  a cloth  cord  to  its  belly.  Experienced  midwives
can  demonstrate  to  others.

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

A list  of  addresses  where  you  can  send  for  teaching  materials  to  use  for
health  education  in  your  village  can  be  found  on  pages  429  to  432.

w22

Other  Ways  to  Get  Ideas  Across

Story  telling.  When  you  have  a hard  time  explaining  something,  a story,
especially  a true  one,  will  help  make  your  point.

For  example,  if  1 tell  you  that  sometimes  a village  worker  can  make  a better
diagnosis  than  a doctor,  you  may  not  believe  me.  But  if  I tell  you  about  a
village  health  worker  called  Irene,  who  runs  a small  nutrition  center  in  Central
America,  you  may  understand.

One  day  a small  sickly  child  arrived  at  the  nutrition  center.  He  had  been  sent  by
the  doctor  at  a nearby  health  center  because  he  was  badly  malnourished:  The  child
also  had  a cough,  and  the  doctor  had  prescribed  a cough  medicine.  Irene  was
worried  about  the  child.  She  knew  he  came  from  a very  poor  family  and  that  an  older
brother  had  died  a few  weeks  before.  She  went  to  visit  the  family  and  learned  that
the  older  brother  had  been  very  sick  for  a long  time  and  had  coughed  blood.  Irene
went  to  the  health  center  and  told  the  doctor  she  was  afraid  the  child  had
tuberculosis.  Tests  were  made,  and  it  turned  out  that  Irene  was  right.  ...  So  you  see,
the  health  worker  spotted  the  real  problem  before  the  doctor — because  she  knew  her
people  and  visited  their  homes.

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

Play  acting.  Stories  that  make  important  points  can  reach  people  with  even
more  force  if  they  are  acted  out.  Perhaps  you,  the  schoolteacher,  or  someone
on  the  health  committee  can  plan  short  plays
or  ‘skits’  with  the  schoolchildren.

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

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

w23

Working  and  Learning  Together  for  the  Common  Good

There  are  many  ways  to  interest  and  involve  people  in  working  together  to
meet  their  common  needs.  Here  are  a few  ideas:

1.  A village  health  committee.  A group  of  able,  interested  persons  can  be
chosen  by  the  village  to  help  plan  and  lead  activities  relating  to  the  well-being
of  the  community — for  example,  digging  garbage  pits  or  latrines.  The  health
worker  can  and  should  share  much  of  his  responsibility  with  other  persons.

2.  Group  discussions.  Mothers,  fathers,  schoolchildren,  young  people,  folk
healers,  or  other  groups  can  discuss  needs  and  problems  that  affect  health.
Their  chief  purpose  can  be  to  help  people  share  ideas  and  build  on  what  they
already  know.

3.  Work  festivals.  Community
projects  such  as  putting  in  a water
system  or  cleaning  up  the  village
go  quickly  and  can  be  fun  if
everybody  helps.  Games,  races,
refreshments,  and  simple  prizes
help  turn  work  into  play.  Use
imagination.

4.  Cooperatives.  People  can  help
keep  prices  down  by  sharing  tools,
storage,  and  perhaps  land.  Group
cooperation  can  have  a big
influence  on  people’s  well-being.

5.  Classroom  visits.  Work  with  the  village  schoolteacher  to  encourage
health-related  activities,  through  demonstrations  and  play  acting.  Also  invite
small  groups  of  students  to  come  to  the  health  center.  Children  not  only  learn
quickly,  but  they  can  help  out  in  many  ways.  If  you  give  children  a chance,
they  gladly  become  a valuable  resource.

6.  Mother  and  child  health  meetings.  It  is  especially  important  that  pregnant
women  and  mothers  of  small  children  (under  five  years  old)  be  well  informed
about  their  own  and  their  babies'  health  needs.  Regular  visits  to  the  health
post  are  opportunities  for  both  check-ups  and  learning.  Have  mothers  keep
their  children’s  health  records  and  bring  them  each  month  to  have  their
children’s  growth  recorded  (see  the  Child  Health  Chart,  p.  297).  Mothers  who
understand  the  chart  often  take  pride  in  making  sure  their  children  are  eating
and  growing  well.  They  can  learn  to  understand  these  charts  even  if  they
cannot  read.  Perhaps  you  can  help  train  interested  mothers  to  organize  and
lead  these  activities.

7.  Home  visits.  Make  friendly  visits  to  people’s  homes,  especially  homes  of
families  who  have  special  problems,  who  do  not  come  often  to  the  health  post,
or  who  do  not  take  part  in  group  activities.  But  respect  people’s  privacy.  If
your  visit  cannot  be  friendly,  do  not  make  it — unless  children  or  defenseless
persons  are  in  danger.

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

w24

Ways  to  Share  and  Exchange  Ideas  in  a Group

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

People  do  not  learn  much  from  what  they  are  told.  They  learn  from  what  they
think,  feel,  discuss,  see,  and  do  together.

So  the  good  teacher  does  not  sit  behind  a desk  and  talk  at  people.  He  talks
and  works  with  them.  He  helps  his  people  to  think  clearly  about  their  needs
and  to  find  suitable  ways  to  meet  them.  He  looks  for  every  opportunity  to  share
ideas  in  an  open  and  friendly  way.

TALK  WITH  PEOPLE

Perhaps  the  most  important  thing  you  can  do  as  a health  worker  is  to
awaken  your  people  to  their  own  possibilities  ...  to  help  them  gain  confidence
in  themselves.  Sometimes  villagers  do  not  change  things  they  do  not  like
because  they  do  not  try.  Too  often  they  may  think  of  themselves  as  ignorant
and  powerless.  But  they  are  not.  Most  villagers,  including  those  who  cannot
read  or  write,  have  remarkable  knowledge  and  skills.  They  already  make  great
changes  in  their  surroundings  with  the  tools  they  use,  the  land  they  farm,  and
the  things  they  build.  They  can  do  many  important  things  that  people  with  a lot
of  schooling  cannot.

If  you  can  help  people  realize  how  much  they  already  know  and  have  done
to  change  their  surroundings,  they  may  also  realize  that  they  can  learn  and  do
even  more.  By  working  together  it  is  within  their  power  to  bring  about  even
bigger  changes  for  their  health  and  well-being.

Then  how  do  you  tell  people  these  things?

Often  you  cannot!  But  you  can  help  them  find  out  some  of  these  things  for
themselves— by  bringing  them  together  for  discussions.  Say  little  yourself,  but
start  the  discussion  by  asking  certain  questions.  Simple  pictures  like  the
drawing  on  the  next  page  of  a farm  family  in  Central  America  may  help.  You
will  want  to  draw  your  own  picture,  with  buildings,  people,  animals,  and  crops
that  look  as  much  as  possible  like  those  in  your  area.

w25

USE  PICTURES  TO  GET  PEOPLE  TALKING  AND  THINKING  TOGETHER

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

• Who  are  the  people  in  the  picture  and  how  do  they  live?

• What  was  this  land  like  before  the  people  came?

• In  what  ways  have  they  changed  their  surroundings?

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

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

• How  did  they  learn  to  farm?  Who  taught  them?

• If  a doctor  or  a lawyer  moved  onto  this  land  with  no  more  money  or  tools
than  these  people,  could  he  farm  it  as  well?  Why  or  why  not?

• In  what  ways  are  these  people  like  ourselves?

w26

This  kind  of  group  discussion  helps  build  people’s  confidence  in  themselves
and  in  their  ability  to  change  things.  It  can  also  make  them  feel  more  involved
in  their  community.

At  first  you  may  find  that  people  are  slow  to  speak  out  and  say  what  they
think.  But  after  a while  they  will  usually  begin  to  talk  more  freely  and  ask
important  questions  themselves.  Encourage  everyone  to  say  what  he  or  she
feels  and  to  speak  up  without  fear.  Ask  those  who  talk  most  to  give  a chance
to  those  who  are  slower  to  speak  up.

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

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

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

w27

MAKING  THE  BEST  USE  OF  THIS  BOOK

Anyone  who  knows  how  to  read  can  use  this  book  in
her  own  home.  Even  those  who  do  not  read  can  learn
from  the  pictures.  But  to  make  the  fullest  and  best  use
of  the  book,  people  often  need  some  instruction.  This
can  be  done  in  several  ways.

A health  worker  or  anyone  who  gives  out  the  book  should  make  sure  that
people  understand  how  to  use  the  list  of  Contents,  the  Index,  the  Green  Pages
and  the  Vocabulary.  Take  special  care  to  give  examples  of  how  to  look  things
up.  Urge  each  person  to  carefully  read  the  sections  of  the  book  that  will  help
her  understand  what  may  be  helpful  to  do,  what  could  be  harmful  or
dangerous,  and  when  it  is  important  to  get  help  (see  especially  Chapters  1,
JL JL  and  8,,  and  also  the  SIGNS  OF  DANGEROUS  ILLNESS,  p.  42).  Point  out
how  important  it  is  to  prevent  sickness  before  it  starts.  Encourage  people  to
pay  special  attention  to  Chapters  H and  12,  which  deal  with  eating  right
(nutrition)  and  keeping  clean  (hygiene  and  sanitation).

Also  show  and  mark  the  pages  that  tell  about  the  most  common
problems  in  your  area.  For  example,  you  can  mark  the  pages  on  diarrhea
and  be  sure  mothers  with  small  children  understand  about  ‘special  drink’  (oral
rehydration,  p.  152).  Many  problems  and  needs  can  be  explained  briefly.  But
the  more  time  you  spend  with  people  discussing  how  to  use  the  book  or
reading  and  using  it  together,  the  more  everyone  will  get  out  of  it.

You  as  a health  worker  might  encourage  people  to  get  together  in  small
groups  to  read  through  the  book,  discussing  one  chapter  at  a time.  Look  at
the  biggest  problems  in  your  area— what  to  do  about  health  problems  that
already  exist  and  how  to  prevent  similar  problems  in  the  future.  Try  to  get
people  looking  ahead.

Perhaps  interested  persons  can  get  together  for  a short  class  using  this
book  (or  others)  as  a text.  Members  of  the  group  could  discuss  how  to
recognize,  treat,  and  prevent  different  problems.  They  could  take  turns
teaching  and  explaining  things  to  each  other.

To  help  learning  be  fun  in  these  classes  you  can  act  out  situations.  For
example,  someone  can  act  as  if  he  has  a particular  sickness  and  can  explain
what  he  feels.  Others  then  ask  questions  and  examine  him  (Chapter  3),  Use
the  book  to  try  to  find  out  what  his  problem  is  and  what  can  be  done  about  it.
The  group  should  remember  to  involve  the  ‘sick’  person  in  learning  more  about
his  own  sickness — and  should  end  up  by  discussing  with  him  ways  of
preventing  the  sickness  in  the  future.  All  this  can  be  acted  out  in  class.

Exciting  and  effective  ways  to  teach  about  health  care  are  in  the  book
Helping  Health  Workers  Learn,  also  available  from  the  Hesperian  Foundation.

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

Dear  village  health  worker — whoever  and  wherever  you  are,  whether  you
have  a title  or  official  position,  or  are  simply  someone,  like  myself,  with  an
interest  in  the  well-being  of  others — make  good  use  of  this  book.  It  is  for  you
and  for  everyone.

But  remember,  the  most  important  part  of  health  care  you  will  not  find  in  this
book  or  any  other.  The  key  to  good  health  lies  within  you  and  your  people,  in
the  care,  the  concern,  and  appreciation  you  have  for  each  other.  If  you  want  to
see  your  community  be  healthy,  build  on  these.

w29

NOTICE

This  book  is  to  help  people  meet  most  of  their  common
health  needs  for  and  by  themselves.  But  it  does  not  have  all
the  answers.  In  case  of  serious  illness  or  if  you  are  uncertain
about  how  to  handle  a health  problem,  get  advice  from  a
health  worker  or  doctor  whenever  possible.

Home  Cures
and  Popular  Beliefs

CHAPTER

1

Everywhere  on  earth  people  use  home  remedies.  In  some  places,  the  older
or  traditional  ways  of  healing  have  been  passed  down  from  parents  to  children
for  hundreds  of  years.

Many  home  remedies  have  great  value.  Others  have  less.  And  some  may  be
risky  or  harmful.  Home  remedies,  like  modern  medicines,  must  be  used  with
caution.

Try  to  do  no  harm.

Only  use  home  remedies  if  you  are  sure  they  are  safe
and  know  exactly  how  to  use  them.

HOME  CURES  THAT  HELP

For  many  sicknesses,  time-tested  home
remedies  work  as  well  as  modern  medicines
— or  even  better.  They  are  often  cheaper.

And  in  some  cases  they  are  safer.

For  example,  many  of  the  herbal  teas
people  use  for  home  treatment  of  coughs
and  colds  do  more  good  and  cause  fewer
problems  than  cough  syrups  and  strong
medicines  some  doctors  prescribe.

Also,  the  ‘rice  water’,  teas,  or  sweetened
drinks  that  many  mothers  give  to  babies
with  diarrhea  are  often  safer  and  do  more
good  than  any  modern  medicine.  What
matters  most  is  that  a baby  with  diarrhea
get  plenty  of  liquids  (see  p.  ,151).

The  Limitations
of  Home  Remedies

Some  diseases  are  helped  by  home  remedies.  Others  can  be  treated  better
with  modern  medicine.  This  is  true  for  most  serious  infections.  Sicknesses  like
pneumonia,  tetanus,  typhoid,  tuberculosis,  appendicitis,  diseases  caused  by
sexual  contact,  and  fever  after  childbirth  should  be  treated  with  modern
medicines  as  soon  as  possible.  For  these  diseases,  do  not  lose  time  trying  to
treat  them  first  with  home  remedies  only.

It  is  sometimes  hard  to  be  sure  which  home  remedies  work  well  and  which
do  not.  More  careful  studies  are  needed.  For  this  reason:

FOR  COUGHS,  COLDS,  AND  COMMON
DIARRHEA,  HERBAL  TEAS  ARE  OFTEN
BETTER,  CHEAPER,  AND  SAFER  THAN
MODERN  MEDICINES.

It  is  often  safer  to  treat  very  serious  illnesses  with  modern
medicines — following  the  advice  of  a health  worker  if  possible.

2

Old  Ways  and  New

Some  modern  ways  of  meeting  health  needs  work  better  than  old  ones.  But
at  times  the  older,  traditional  ways  are  best.  For  example,  traditional  ways  of
caring  for  children  or  old  people  are  often  kinder  and  work  better  than  some
newer,  less  personal  ways.

Not  many  years  ago  everyone  thought  that  mother's  milk  was  the  best  food
for  a young  baby.  They  were  right!  Then  the  big  companies  that  make  canned
and  artificial  milk  began  to  tell  mothers  that  bottle  feeding  was  better.  This  is
not  true,  but  many  mothers  believed  them  and  started  to  bottle  feed  their
babies.  As  a result,  thousands  of  babies  have  suffered  and  died  needlessly
from  infection  or  hunger.  For  the  reasons  breast  is  best,  see  p.  271.

Respect  your  people’s  traditions  and  build  on  them.

For  more  ideas  for  building  on  local  traditions,  see  Helping  Health  Workers
Learn,  Chapter  7.

BELIEFS  THAT  CAN  MAKE  PEOPLE  WELL

Some  home  remedies  have  a direct  effect  on  the  body.  Others  seem  to  work
only  because  people  believe  in  them.  The  healing  power  of  belief  can  be
very  strong.

For  example,  I once  saw  a man  who
suffered  from  a very  bad  headache.

To  cure  him,  a woman  gave  him  a
small  piece  of  yam,  or  sweet  potato.

She  told  him  it  was  a strong  painkiller.

Fie  believed  her — and  the  pain  went
away  quickly.

It  was  his  faith  in  her  treatment,
and  not  the  yam  itself,  that  made
him  feel  better.

Many  home  remedies  work  in  this
way.  They  help  largely  because  peopleV
have  faith  in  them.  For  this  reason,

they  are  especially  useful  to  cure  illnesses  that  are  partly  in  people’s
minds,  or  those  caused  in  part  by  a person’s  beliefs,  worry,  or  fears.

Included  in  this  group  of  sicknesses  are:  bewitchment  or  hexing,
unreasonable  or  hysterical  fear,  uncertain  ‘aches  and  pains’  (especially  in
persons  going  through  stressful  times,  such  as  teenage  girls  or  older  women),
and  anxiety  or  nervous  worry.  Also  included  are  some  cases  of  asthma,
hiccups,  indigestion,  stomach  ulcers,  migraine  headaches,  and  even  warts.

For  all  of  these  problems,  the  manner  or  ‘touch’  of  the  healer  can  be  very
important.  What  it  often  comes  down  to  is  showing  you  care,  helping  the  sick
person  believe  he  will  get  well,  or  simply  helping  him  relax.

3

Sometimes  a person’s  belief  in  a remedy  can  help  with  problems  that  have
completely  physical  causes.

For  example,  Mexican  villagers  have  the  following  home  cures  for  poisonous
snakebite:

In  other  lands  people  have  their  own  snakebite  remedies — often  many
different  ones.  As  far  as  we  know,  none  of  these  home  remedies  has  any
direct  effect  against  snake  poison.  The  person  who  says  that  a home  remedy
kept  a snake’s  poison  from  harming  him  at  all  was  probably  bitten  by  a
non-poisonous  snake!

Yet  any  of  these  home  remedies  may  do  some  good  if  a person  believes  in  it.
If  it  makes  him  less  afraid,  his  pulse  will  slow  down,  he  will  move  and  tremble
less,  and  as  a result,  the  poison  will  spread  through  his  body  more  slowly.  So
there  is  less  danger!

But  the  benefit  of  these  home  remedies  for  snakebite  is  limited.  In  spite  of
their  common  use,  may  people  still  become  very  ill  or  die.  As  far  as  we  know:

No  home  cure  for  poisonous  bites

(whether  from  snakes,  scorpions,  spiders,  or  other  poisonous  animals)
has  much  effect  beyond  that  of  the  healing  power  of  belief.

For  snakebite  it  is  usually  better  to  use  modern  treatment.  Be  prepared:  obtain
‘antivenoms’  or  ‘serums'  for  poisonous  bites  before  you  need  them  (see  p.
105).  Do  not  wait  until  it  is  too  late.

4

BELIEFS  THAT  CAN  MAKE  PEOPLE  SICK

The  power  of  belief  can  help  heal  people.  But  it  can  also  harm  them.  If  a
person  believes  strongly  enough  that  something  will  hurt  him,  his  own  fear  can
make  him  sick.  For  example:

Once  I was  called  to  see  a woman
who  had  just  had  a miscarriage  and
was  still  bleeding  a little.  There  was
an  orange  tree  near  her  house.  So  I
suggested  she  drink  a glass  of  orange
juice.  (Oranges  have  vitamin  C which
helps  strengthen  blood  vessels.)  She
drank  it — even  though  she  was  afraid
it  would  harm  her.

Her  fear  was  so  great  that  soon
she  became  very  ill.  I examined  her,
but  could  find  nothing  physically
wrong.  I tried  to  comfort  her,  telling
her  she  was  not  in  danger.  But  she
said  she  was  going  to  die.  At  last  I
gave  her  an  injection  of  distilled
(completely  pure)  water.  Distilled
water  has  no  medical  effect.  But
since  she  had  great  faith  in
injections,  she  quickly  got  better.

Actually,  the  juice  did  not  harm  her.  What  harmed  her  was  her  belief  that  it
would  make  her  sick.  And  what  made  her  well  was  her  faith  in  injections!

In  this  same  way,  many  persons  go  on  believing  false  ideas  about  witchcraft,
injections,  diet,  and  many  other  things.  Much  needless  suffering  is  the  result.

Perhaps,  in  a way,  I had  helped  this  woman.  But  the  more  I thought  about  it,
the  more  I realized  I had  also  wronged  her;  I had  led  her  to  believe  things  that
were  not  true.

I wanted  to  set  this  right.  So  a few  days  later,  when  she  was  completely  well,

I went  to  her  home  and  apologized  for  what  I had  done.  I tried  to  help  her
understand  that  not  the  orange  juice,  but  her  fear  had  made  her  so  sick.  And
that  not  the  injection  of  water,  but  her  freedom  from  fear  had  helped  her  get
well.

By  understanding  the  truth  about  the  orange,  the  injection,  and  the  tricks  of
her  own  mind,  perhaps  this  woman  and  her  family  will  become  freer  from  fear
and  better  able  to  care  for  their  health  in  the  future.  For  health  is  closely
related  to  understanding  and  freedom  from  fear.

5

Many  things  do  harm  only  because
people  believe  they  are  harmful.

WITCHCRAFT— BLACK  MAGIC— AND  THE  EVIL  EYE

If  a person  believes  strongly  enough  that  someone  has  the  power  to  harm
him,  he  may  actually  become  ill.  Anyone  who  believes  he  is  bewitched  or  has
been  given  the  evil  eye  is  really  the  victim  of  his  own  fears  (see  Susto,  p.  24).

A ‘witch’  has  no  power  over
other  people,  except  for  her  ability
to  make  them  believe  that  she  has.
For  this  reason:

It  is  impossible  to  bewitch
a person  who  does  not  believe
in  witchcraft.

Some  people  think  that  they
are  ‘bewitched’  when  they  have
strange  or  frightening  illnesses
(such  as  tumors  of  the  genitals  or
cirrhosis  of  the  liver,  see  p.  328).
Such  sicknesses  have  nothing  to
do  with  witchcraft  or  black  magic.
Their  causes  are  natural.

Do  not  waste  your  money  at  ‘magic  centers’  that  claim  to  cure
witchcraft.  And  do  not  seek  revenge  against  a witch,  because  it  will  not
solve  anything.  If  you  are  seriously  ill,  go  for  medical  help.

6

QUESTIONS  AND  ANSWERS  ON  SOME  FOLK  BELIEFS
AND  HOME  REMEDIES

These  examples  are  from  the  mountains  of  Mexico,  the  area  that  I know  best.
Perhaps  some  of  the  beliefs  of  your  people  are  similar.  Think  about  ways  to
learn  which  beliefs  in  your  area  lead  to  better  health  and  which  do  not.

When  people  think
someone  is  bewitched,  is  it
true  that  he  will  get  well  if
his  relatives  harm  or  kill
the  witch?

FALSE!  No  one  is  ever
helped  by  harming
someone  else.

Is  it  true  that  when  the  ‘soft
spot’  on  top  of  a baby’s
head  sinks  inward  this
means  the  baby  will  die
of  diarrhea  unless  he
gets  special  treatment?

This  is  often  true.  The  'soft
spot’  sinks  because  the
baby  has  lost  too  much
liquid  (see  p.  151).  Unless
he  gets  more  liquid  soon,
he  may  die  (see  p.  152).

Is  it  true  that  if  the
light  of  the  eclipsing
moon  falls  on  a
pregnant  mother,
her  child  will  be  born
deformed  or  retarded?

/

This  is  not  true!  But
children  may  be  born
retarded,  deaf,  or  deformed
if  the  mother  does  not  use
iodized  salt,  if  she  takes
certain  medicines,  or  for
other  reasons  (see  p.  318).

It  is  true  that  soft  light
is  easier  on  the  eyes  of
both  the  mother  and
the  newborn  child.  But
there  should  be  enough
light  for  the  midwife  to
see  what  she  is  doing.

7

Is  it  true  that  a newborn  \\  / X

baby  should  not  be  bathed  /

. until  the  cord  falls  off?  / /d~~

^ yf  ~ i ■

True!  The  stump  of  the
n cord  should  be  kept  dry
<n  until  it  falls  off.  But  the
1z  baby  can  be  gently
7 cleaned  with  a clean,

/ soft,  damp  cloth.

it

How  many  days  after  giving  A ' ^ j

birth  should  a mother  wait  / L*/  J

before  she  bathes?  r j\

A mother  should  wash  with
warm  water  the  day  after
giving  birth.  The  custom  of
not  bathing  for  weeks
following  childbirth  can
lead  to  infections.

Is  it  true  that  traditional
breast  feeding  is  better
than  'modern'  bottle
feeding?

TRUE!  Breast  milk  is
} better  food  and  also
/ helps  protect  the  baby

/ against  infection.

What  foods  should  ^ i£j

women  avoid  in  the  ^

first  few  weeks  after  ^ A

childbirth?  'XJ  JT-

do

In  the  weeks  following
childbirth,  women  should
not  avoid  any  nutritious
foods.  Instead,  they
should  eat  plenty  of  fruit,
vegetables,  meat,  milk,
eggs,  whole  grains,  and
beans  (see  p.  276).

8

Is  it  a good  idea  to  bathe
sick  person,  or  will  it  do
him  harm?

It  is  a good  idea.  Sick
people  should  be  bathed
in  warm  water  every  day.

Is  it  true  that  oranges,
guavas,  and  other
fruits  are  harmful
when  one  has  a
cold  or  a fever?

NO!  All  fruits  and
juices  are  helpful  when
one  has  a cold  or  fever.
They  do  not  cause
congestion  or  harm  of
any  kind.

NO!  When  a person  has  a
high  fever,  take  off  all
covers  and  clothing.  Let
the  air  reach  his  body.
This  will  help  the  fever
go  down  (see  p.  76).

Is  it  true  that  tea  made
from  willow  bark  will  help
bring  fever  down  and
stop  pain?

True.  It  helps.  Willow
bark  has  a natural
medicine  in  it  very
much  like  aspirin.

9

SUNKEN  FONTANEL  OR  SOFT  SPOT

The  fontanel  is  the  soft  spot  on  the  top  of  a
newborn  baby's  head.  It  is  where  the  bones  of
his  skull  have  not  formed  completely.  Normally  it
takes  a year  to  a year  and  a half  for  the  soft  spot
to  close  completely.

Mothers  in  different  lands  realize  that  when  the
soft  spot  sinks  inward  their  babies  are  in  danger.

They  have  many  beliefs  to  explain  this.  In  Latin
America  mothers  think  the  baby’s  brains  have  slipped
downward.  They  try  to  correct  this  by  sucking  on  the
soft  spot,  by  pushing  up  on  the  roof  of  the  mouth,  or
by  holding  the  baby  upside  down  and  slapping  his
feet.  This  does  not  help  because  ...  A sunken  soft
spot  is  really  caused  by  dehydration  (see  p.  151).

This  means  the  child  is  losing  more  liquid  than  he  is  drinking.  He  is  too

dry — usually  because  he  has  diarrhea,  or  diarrhea  with  vomiting.

Treatment:

1.  Give  the  child  plenty  of  liquid:  Rehydration  Drink  (see  p.  152),  breast  milk,
or  boiled  water.

2.  If  necessary,  treat  the  causes  of  the  diarrhea  and  vomiting  (see  p.  152  to
161).  For  most  diarrheas,  medicine  is  not  needed,  and  may  do  more  harm
than  good.

TO  CURE  A SUNKEN  SOFT  SPOT  . . .

Note:  If  the  soft  spot  is  swollen  or  bulges  upward,  this  may  be  a sign  of

meningitis.  Begin  treatment  at  once  (see  p.  185),  and  get  medical  help.

WAYS  TO  TELL  WHETHER  A HOME  REMEDY
WORKS  OR  NOT

Because  a lot  of  people  use  a home  cure  does  not  necessarily  mean  it  works
well  or  is  safe.  It  is  often  hard  to  know  which  remedies  are  helpful  and  which
may  be  harmful.  Careful  study  is  needed  to  be  sure.  Here  are  four  rules  to  help
tell  which  remedies  are  least  likely  to  work,  or  are  dangerous.  (Examples  are
from  Mexican  villages.)

1 . THE  MORE  REMEDIES  THERE  ARE  FOR  ANY  ONE  ILLNESS,  THE  LESS
LIKELY  IT  IS  THAT  ANY  OF  THEM  WORKS.

For  example:  In  rural  Mexico  there  are  many  home  remedies  for  goiter,  none
of  which  does  any  real  good.  Here  are  some  of  them:

Not  one  of  these  many  remedies  works.  If  it  did,  the  others  would  not  be
needed.  When  a sickness  has  just  one  popular  cure,  it  is  more  likely  to  be
a good  one.  For  prevention  and  treatment  of  goiter  use  iodized  salt  (p.  130).

2.  FOUL  OR  DISGUSTING  REMEDIES  ARE  NOT  LIKELY  TO  HELP— AND  ARE
OFTEN  HARMFUL.

For  example:

1 . the  idea  that  leprosy  can  be  cured
by  a drink  made  of  rotting  snakes

2.  the  idea  that  syphilis  can
be  cured  by  eating  a vulture

DON’T

These  two  remedies  do  not  help  at  all.  The  first  one  can  cause  dangerous
infections.  Belief  in  remedies  like  these  sometimes  causes  delay  in  getting
proper  medical  care.

11

3.  REMEDIES  THAT  USE  ANIMAL  OR  HUMAN  WASTE  DO  NO  GOOD  AND
CAN  CAUSE  DANGEROUS  INFECTIONS.  NEVER  USE  THEM.

Examples:

1.  Putting  human  feces  around  the
eye  does  not  cure  blurred  vision
and  can  cause  infections.

2.  Smearing  cow  dung  on  the  head
to  fight  ringworm  can  cause  tetanus
and  other  dangerous  infections.

Also,  the  droppings  of  rabbits  or  other  animals  do  not  help  heal  burns.  To
use  them  is  very  dangerous.  Cow  dung,  held  in  the  hand,  cannot  help  control
fits.  Teas  made  from  human,  pig,  or  any  other  animal  feces  do  not  cure
anything.  They  can  make  people  sicker.  Never  put  feces  on  the  navel  of  a
newborn  baby.  This  can  cause  tetanus.

4.  THE  MORE  A REMEDY  RESEMBLES  THE  SICKNESS  IT  IS  SAID  TO  CURE,
THE  MORE  LIKELY  ITS  BENEFITS  COME  ONLY  FROM  THE  POWER  OF
BELIEF.

The  association  between  each  of  the  following  illnesses  and  its  remedy  is
clear  in  these  examples  from  Mexico:

1.  for  a nosebleed,  using  yesca
(a  bright  red  mushroom)

2.  for  deafness,  putting
powdered  rattlesnake’s
rattle  in  the  ear

3.  for  dog  bite,  drink  tea  made
from  the  dog’s  tail

4.  for  scorpion  sting,  tying  a
scorpion  against  the  stung
finger

5.  to  prevent  diarrhea  when  a child
is  teething,  putting  a necklace  of
snake’s  fangs  around  the  baby’s

6.  to  ‘bring  out’  the  rash  of
measles,  making  tea  from
kapok  bark

These  remedies,  and  many  other  similar  ones,  have  no  curative  value  in
themselves.  They  may  be  of  some  benefit  if  people  believe  in  them.  But  for
serious  problems,  be  sure  their  use  does  not  delay  more  effective  treatment.

12

MEDICINAL  PLANTS

Many  plants  have  curative  powers.  Some  of  the  best  modern  medicines  are
made  from  wild  herbs.

Nevertheless,  not  all  ‘curative  herbs'  people  use  have  medical  value  . . . and
those  that  have  are  sometimes  used  the  wrong  way.  Try  to  learn  about  the
herbs  in  your  area  and  find  out  which  ones  are  worthwhile.

CAUTION!  Some  medicinal  herbs  are  very  poisonous  if  taken  in
more  than  the  recommended  dose.  For  this  reason  it  is  often  safer
to  use  modern  medicine,  since  the  dosage  is  easier  to  control.

Here  are  a few  examples  of  plants  that  can  be  useful  if  used  correctly:

ANGEL’S  TRUMPET  (Datura  arborea)

The  leaves  of  this  and  certain  other  members
of  the  nightshade  family  contain  a drug  that  helps
to  calm  intestinal  cramps,  stomach-aches,  and
even  gallbladder  pain.

Grind  up  1 or  2 leaves  of  Angel’s  Trumpet  and  soak
them  for  a day  in  7 tablespoons  (100  ml.)  of  water.

Dosage:  Between  10  and  15  drops  every  4 hours  (adults  only).

WARNING:  Angel’s  Trumpet  is  very  poisonous  if  you  take
more  than  the  recommended  dose.

CORN  SILK  (the  tassels  or  ‘silk’  from  an  ear  of  maize)

A tea  made  from  corn  silk  makes
a person  pass  more  urine.  This  can  help
reduce  swelling  of  the  feet — especially  in
pregnant  women  (see  p.  176  and  248).

Boil  a large  handful  of  corn  silk  in  water  and
drink  1 or  2 glasses.  It  is  not  dangerous.

GARLIC

A drink  made  from  garlic  can  often  get  rid  of  pinworms.

Chop  finely,  or  crush,  4 cloves  of  garlic  and  mix  with  1
glass  of  liquid  (water,  juice,  or  milk).

Dosage:  Drink  1 glass  daily  for  3 weeks.

To  treat  vaginal  infections  with  garlic,  see  p.  241  and  242.

13

CARDON  CACTUS  (Pachycerius  pectin-aboriginum)

Cactus  juice  can  be  used  to  clean  wounds  when  there  is  no
boiled  water  and  no  way  to  get  any.  Cardon  cactus  also  helps
stop  a wound  from  bleeding,  because  the  juice  makes  the  cut
blood  vessels  squeeze  shut.

Cut  a piece  of  the  cactus
with  a clean  knife  and  press
it  firmly  against  the  wound.

When  the  bleeding  is
under  control,  tie  a piece
of  the  cactus  to  the  wound
with  a strip  of  cloth.

After  2 or  3 hours,  take  off  , -

the  cactus  and  clean  the  wound  with  boiled  water  and  soap.  There  are  more
instructions  on  how  to  care  for  wounds  and  control  bleeding  on  pages  82  to  87.

ALOE  VERA  (Sabila)

Aloe  vera  can  be  used  to  treat  minor  burns  and  wounds.
The  thick,  slimy  juice  inside  the  plant  calms  pain  and
itching,  aids  healing,  and  helps  prevent  infection.  Cut  off
a piece  of  the  plant,  peel  back  the  outer  layer,  and  apply
the  fleshy  leaf  or  juice  directly  to  the  burn  or  wound.

Aloe  can  also  help  treat  stomach  ulcers  and  gastritis.

Chop  the  spongy  leaves  into  small  pieces,  soak  them  in  water
then  drink  one  glass  of  the  slimy,  bitter  liquid  every  2 hours.

PAPAYA

Ripe  papayas  are  rich  in  vitamins  and  also  aid
digestion.  Eating  them  is  especially  helpful  for  weak
or  old  people  who  complain  of  upset  stomach  when
they  eat  meat,  chicken,  or  eggs.  Papaya  makes  these
foods  easier  to  digest.

Papaya  can  also  help  get  rid  of  intestinal  worms,
although  modern  medicines  often  work  better.

Collect  3 or  4 teaspoons  (15-20  ml.)  of  the  ‘milk’  that  comes  out  when  the  green
fruit  or  trunk  of  the  tree  is  cut.  Mix  this  with  an  equal  amount  of  sugar  or  honey
and  stir  it  into  a cup  of  hot  water.  If  possible,  drink  along  with  a laxative.

Or,  dry  and  crush  to  a powder  the  papaya  seeds.  Take  3 teaspoons  mixed
with  1 glass  water  or  some  honey  3 times  a day  for  7 days.

Papayas  can  also  be  used  for  treating  pressure  sores.  The  fruit  contains
chemicals  that  help  soften  and  make  dead  flesh  easier  to  remove.  First  clean
and  wash  out  a pressure  sore  that  has  dead  flesh  in  it.  Then  soak  a sterile  cloth
or  gauze  with  ‘milk’  from  the  trunk  or  green  fruit  of  a papaya  plant  and  pack
this  into  the  sore.  Repeat  cleaning  and  repacking  3 times  a day.

14

HOMEMADE  CASTS—

FOR  KEEPING  BROKEN  BONES  IN  PLACE

In  Mexico  several  different  plants  such  as  tepeguaje  (a  tree  of  the  bean
family)  and  solda  con  solda  (a  huge,  tree-climbing  arum  lily)  are  used  to  make
casts.  However,  any  plant  will  do  if  a syrup  can  be  made  from  it  that  will  dry
hard  and  firm  and  will  not  irritate  the  skin.  In  India,  traditional  bone-setters
make  casts  using  a mixture  of  egg  whites  and  herbs  instead  of  a syrup  made
from  plant  juices.  But  the  method  is  similar.  Try  out  different  plants  in  your  area.

For  a cast  using  tepeguaje:  Put  1 kilogram
of  the  bark  into  5 liters  of  water  and  boil  until
only  2 liters  are  left.  Strain  and  boil  until  a thick
syrup  is  formed.  Dip  strips  of  flannel  or  clean
sheet  in  the  syrup  and  carefully  use  as  follows.

Make  sure  the  bones  are  in  a good  position  (p.  9£

Do  not  put  the  cast  directly  against  the  skin.

Wrap  the  arm  or  leg  in  a soft  cloth.

Then  follow  with  a layer  of  cotton  or  wild  kapok.

Finally,  put  on  the  wet  cloth  strips  so  that
they  form  a cast  that  is  firm  but  not  too  tight.

Most  doctors  recommend  that  the  cast  cover  the
joint  above  and  the  joint  below  the  break,  to  keep
the  broken  bones  from  moving.

This  would  mean  that,  for  a broken  wrist,  the  cast
should  cover  almost  the  whole  arm,  like  this:

Leave  the  finger  tips  uncovered  so  that
you  can  see  if  they  keep  a good  color.

However,  traditional  bone-setters  in  China  and
Latin  America  use  a short  cast  on  a simple  break  of
the  arm  saying  that  a little  movement  of  the  bone-
ends  speeds  healing.  Recent  scientific  studies
have  proven  this  to  be  true.

A temporary  leg  or  arm  splint  can  be  made  of
cardboard,  folded  paper,  or  the  thick  curved  stem
of  dried  banana  leaf,  or  palm  leaf.

CAUTION:  Even  if  the  cast  is  not  very  tight  when  you  put  it  on,  the  broken  limb
may  swell  up  later.  If  the  person  complains  that  the  cast  is  too  tight,  or  if  his
fingers  or  toes  become  cold,  white,  or  blue,  take  the  cast  off  and  put  on  a new,
looser  one.

Never  put  on  a cast  over  a cut  or  a wound.

D-

15

ENEMAS,  LAXATIVES,  AND  PURGES:
WHEN  TO  USE  THEM  AND  WHEN  NOT  TO

Many  people  give  enemas  and  take  laxatives  far
too  often.  The  ‘urge  to  purge’  is  world  wide.

' Enemas  and  purges  are  very  popular  home
cures.  And  they  are  often  very  harmful.  Many
people  believe  fever  and  diarrhea  can  be  ‘washed
out’  by  giving  an  enema  (running  water  into  the
gut  through  the  anus)  or  by  using  a purge,  or
strong  laxative.  Unfortunately,  such  efforts  to
clean  or  purge  the  sick  body  often  cause  more
injury  to  the  already  damaged  gut.

Rarely  do  enemas  or  laxatives  do  any  good  at  all.
Often  they  are  dangerous— especially  strong  laxatives.

CASES  IN  WHICH  IT  IS  DANGEROUS  TO  USE  ENEMAS  OR  LAXATIVES

Never  use  an  enema  or  laxative  if  a person  has  a severe  stomach-ache  or
any  other  sign  of  appendicitis  or  'acute  abdomen’  (see  p.  93),  even  if  he
passes  days  without  a bowel  movement.

Never  give  an  enema  or  laxative  to  a person  with  a bullet  wound  or  other
injury  to  the  gut.

Never  give  a strong  laxative  to  a weak  or  sick  person.  It  will  weaken  him
more.

Never  give  an  enema  or  purge  to  a baby  less  than  2 years  old.

Never  give  a laxative  or  purge  to  a child  with  high  fever,  vomiting,  diarrhea
or  signs  of  dehydration  (see  p.  151).  It  can  increase  dehydration  and  kill
the  child.

Do  not  make  a habit  of  using  laxatives  often  (see  Constipation,  p.  126).

THE  CORRECT  USES  OF  ENEMAS

1.  Simple  enemas  can  help  relieve  constipation  (dry,  hard,  difficult  stools).
Use  warm  water  only,  or  water  with  a little  soap  in  it.

2.  When  a person  with  severe  vomiting  is  dehydrated,  you  can  try  replacing
water  by  giving  an  enema  of  Rehydration  Drink  very  slowly  (see  p.  152).

16

PURGES  AND  LAXATIVES  THAT  ARE  OFTEN  USED

CASTOR  OIL
SENNA  LEAF

CASCARA  (cascara  sagrada)

These  are  irritating  purges  that  often  do
more  harm  than  good.  It  is  better  not  to
use  them.

MAGNESIUM  HYDROXIDE

These  are  salt  purges.  Use  them  only  in

MILK  OF  MAGNESIA

low  doses,  as  laxatives  for  constipation.

EPSOM  SALTS  (magnesium  sulfate)  Do  not  use  them  often  and  never  when

(see  p.  383)

there  is  pain  in  the  belly.

MINERAL  OIL

This  is  sometimes  used  for  constipation  in

(see  p.  383)

persons  with  piles...  but  it  is  like  passing

greased  rocks.  Not  recommended.

CORRECT  USES  OF  LAXATIVES  AND  PURGES

Laxatives  are  like  purges  but  weaker.  All  the  products  listed  above  are
laxatives  when  taken  in  small  doses  and  purges  when  taken  in  large  doses.
Laxatives  soften  and  hurry  the  bowel  movement;  purges  cause  diarrhea.

Purges:  The  only  time  a person  should  use  a strong  dose  of  a purge  is  when
he  has  taken  a poison  and  must  clean  it  out  quickly  (see  p.  103).  At  any  other
time  a purge  is  harmful.

Laxatives:  One  can  use  milk  of  magnesia  or  other  magnesium  salts  in  small
doses,  as  laxatives,  in  some  cases  of  constipation.  People  with  hemorrhoids
(piles,  p.  175)  who  have  constipation  can  take  mineral  oil  but  this  only  makes
their  stools  slippery,  not  soft.  The  dose  for  mineral  oil  is  3 to  6 teaspoons  at
bedtime  (never  with  a meal  because  the  oil  will  rob  the  body  of  important
vitamins  in  the  food).  This  is  not  the  best  way.

Suppositories,  or  bullet-shaped  pills  that  can  be  pushed  up  the  rectum,  can
also  be  used  to  relieve  constipation  or  piles  (see  pages  175,  383,  and  392).

A BETTER  WAY

Foods  with  fiber.  The  healthiest  and  most  gentle  way  to  have  softer,  more
frequent  stools  is  to  drink  a lot  of  water  and  to  eat  more  foods  with  lots  of
natural  fiber,  or  'roughage'  like  cassava,  yam,  or  bran  (wheat  husks)  and  other
whole  grain  cereals  (see  p.  126).  Eating  plenty  of  fruits  and  vegetables  also
helps.

People  who  traditionally  eat  lots  of  food  with  natural  fiber  suffer  much  less
from  piles,  constipation,  and  cancer  of  the  gut  than  do  people  who  eat  a lot  of
refined  'modern'  foods.  For  better  bowel  habits,  avoid  refined  foods  and  eat
foods  prepared  from  unpolished  or  unrefined  grains.

17

Sicknesses  That
Are  Often  Confused

CHAPTER

2

WHAT  CAUSES  SICKNESS?

Persons  from  different  countries  or  backgrounds  have  different  ways  to
explain  what  causes  sickness.

A baby  gets  diarrhea.  But  why?

People  in  small  villages  may  say

it  is  because  the  parents  did
something  wrong,  or  perhaps
because  they  made  a god  or
spirit  angry.

A doctor  may  say  it  is  because
the  child  has  an  infection.

A public  health  officer  may  say

it  is  because  the  villagers
do  not  have  a good  water
system  or  use  latrines.

A social  reformer  may  say  the  unhealthy  conditions  that  lead  to  frequent
childhood  diarrhea  are  caused  by  an  unfair  distribution  of  land  and  wealth.

A teacher  may  place  the  blame  on  lack  of  education.

People  see  the  cause  of  sickness  in  terms  of  their  own  experience  and  point
of  view.  Who  then  is  right  about  the  cause?  Possibly  everyone  is  right,  or  partly
right.  This  is  because  . . .

Sickness  usually  results  from  a combination  of  causes.

“Why  my  child?”

Each  of  the  causes  suggested  above  may  be  a part
of  the  reason  why  a baby  gets  diarrhea.

To  prevent  and  treat  sickness  successfully,  it  helps
to  have  as  full  an  understanding  as  possible  about  the
common  sicknesses  in  your  area  and  the  combination
of  things  that  causes  them.

In  this  book,  different  sicknesses  are  discussed
mostly  according  to  the  systems  and  terms  of  modern
or  scientific  medicine.

To  make  good  use  of  this  book,  and  safe  use  of
the  medicines  it  recommends,  you  will  need  some
understanding  of  sicknesses  and  their  causes
according  to  medical  science.  Reading  this  chapter
may  help.

18

DIFFERENT  KINDS  OF  SICKNESSES  AND  THEIR  CAUSES

When  considering  how  to  prevent  or  treat  different  sicknesses,  it  helps  to
think  of  them  in  two  groups:  infectious  and  non-infectious.

Infectious  diseases  are  those  that  spread  from  one  person  to  another.
Healthy  persons  must  be  protected  from  people  with  these  sicknesses.

Non-infectious  diseases  do  not  spread  from  person  to  person.  They  have
other  causes.  Therefore,  it  is  important  to  know  which  sicknesses  are  infectious
and  which  are  not.

Non-infectious  Diseases

Non-infectious  diseases  have  many  different  causes.  But  they  are  never
caused  by  germs,  bacteria,  or  other  living  organisms  that  attack  the  body.  They
never  spread  from  one  person  to  another.  It  is  important  to  realize  that
antibiotics,  or  medicines  that  fight  germs  (see  p.  55),  do  not  help  cure
non-infectious  diseases.

Remember:  Antibiotics  are  of  no  use  for  non-infectious  diseases.

EXAMPLES  OF  NON-INFECTIOUS  DISEASES

Problems  caused  by  something
that  wears  out  or  goes  wrong
within  the  body:

rheumatism
heart  attack
epileptic  fits
stroke

migraine  headaches
cataract

Problems  caused  by  something
from  outside  that  harms  or
troubles  the  body:

allergies

asthma

poisons

snakebite

cough  from  smoking
stomach  ulcer
alcoholism

Problems  caused  by  a lack  of
something  the  body  needs:

malnutrition

anemia

pellagra

night  blindness  and
xerophthalmia
goiter  and  cretinism
cirrhosis  of  the  liver
(part  of  the  cause)

Problems  people  are  born  with:

harelip

crossed  or  wall-eyes
(squint)

other  deformities

epilepsy  (some  kinds)
retarded  (backward)
children
birthmarks

Problems  that  begin  in  the  mind
(mental  ‘illnesses’):

fear  that  something  is  harmful  when  it  is  not
(paranoia)

nervous  worry  (anxiety)
belief  in  hexes  (witchcraft)
uncontrolled  fear  (hysteria)

Infectious  Diseases

Infectious  diseases  are  caused  by  bacteria  and  other  organisms  (living
things)  that  harm  the  body.  They  are  spread  in  many  ways.  Here  are  some  of
the  most  important  kinds  of  organisms  that  cause  infections  and  examples  of
sicknesses  they  cause:

19

EXAMPLES  OF  INFECTIOUS  DISEASES

Organism  that  causes
the  sickness

Name  of  the  sickness

How  it  is  spread  or
enters  the  body

Principal  medicine

tuberculosis

through  the  air
(coughing)

tetanus

dirty  wounds

some  diarrhea

dirty  fingers,  water,  flies

bacteria

(microbes  or  germs)

pneumonia
(some  kinds)

through  the  air
(coughing)

different
antibiotics
for  different
bacterial
infections

gonorrhea,
chlamydia,  and
syphillis

sexual  contact

earache

with  a cold

infected  wounds

contact  with  dirty  things

sores  with  pus

direct  contact
(by  touch)

virus

(germs  smaller

colds,  flu,  measles,
mumps,  chickenpox,
infantile  paralysis,
virus  diarrhea

from  someone  who  is
sick,  through  the
air,  by  coughing,
flies,  etc.

aspirin  and  other
painkillers  (There  are
no  medicines  that  fight
viruses  effectively.

than  bacteria)

rabies

animal  bites

Antibiotics  do  not
help.)  Vaccinations

warts

touch

help  prevent  some
virus  infections.

fungus

ringworm
athlete’s  foot
jock  itch

by  touch  or  from
clothing

sulfur  and  vinegar
ointments:  undecylenic,
benzoic,  salicylic  acid
griseofulvin

internal  parasites
(harmful  animals
living  in  the  body)

In  the  gut:
worms
amebas

(dysentery)

feces-to-mouth
lack  of  cleanliness

different  specific
medicines

In  the  blood:
malaria

mosquito  bite

chloroquine  (or  other
malaria  medicine)

external  parasites
(harmful  animals
living  on  the  body)

lice

fleas

bedbugs

scabies

by  contact  with
infected  persons
or  their  clothes

insecticides,

lindane

Bacteria,  like  many  of  the  organisms  that  cause  infections,  are  so
small  you  cannot  see  them  without  a microscope— an  instrument  that —
makes  tiny  things  look  bigger.  Viruses  are  even  smaller  than  bacteria.  j

Antibiotics  (penicillin,  tetracycline,  etc.)  are  medicines  that  help  ^ ^

cure  certain  illnesses  caused  by  bacteria.  Antibiotics  have  no  effect
on  illnesses  caused  by  most  viruses,  such  as  colds,  flu,  mumps,  chickenpox,
etc.  Do  not  treat  virus  infections  with  antibiotics.  They  will  not  help  and  may
be  harmful  (see  Antibiotics,  p.  55).

20

SICKNESSES  THAT  ARE  HARD  TO  TELL  APART

Sometimes  diseases  that  have  different  causes  and  require  different
treatment  result  in  problems  that  look  very  much  alike.  For  example:

1.  A child  who  slowly  becomes  thin  and  wasted,  while
his  belly  gets  more  and  more  swollen,  could  have
any  (or  several)  of  the  following  problems:

• malnutrition  (see  p.  112)

• a lot  of  roundworms,  p.  140,

(usually  together  with  malnutrition)

• advanced  tuberculosis  (p.  179)

• a long-term  severe  urinary  infection  (p.  2341

• any  of  several  problems  of  the  liver  or  spleen

• leukemia  (cancer  of  the  blood)

2.  An  older  person  with  a big,  open,  slowly
growing  sore  on  the  ankle  could  have:

• bad  circulation  that  results  from  varicose
veins  or  other  causes  (p.  213)

• diabetes  (p.  127)

• infection  of  the  bone  (osteomyelitis)

• leprosy  (p.  191)

• tuberculosis  of  the  skin  (p.  212)

• advanced  syphilis  (p.  237)

The  medical  treatment  for  each  of  these  diseases  is  different,  so  to  treat
them  correctly  it  is  important  to  tell  them  apart.

Many  illnesses  at  first  seem  very  similar.  But  if  you  ask  the  right  questions
and  know  what  to  look  for,  you  can  often  learn  information  and  see  certain
signs  that  will  help  tell  you  what  illness  a person  has.

This  book  describes  the  typical  history  and  signs  for  many  illnesses.  But  be
careful!  Diseases  do  not  always  show  the  signs  described  for  them — or  the
signs  may  be  confusing.  For  difficult  cases,  the  help  of  a skilled  health
worker  or  doctor  is  often  needed.  Sometimes  special  tests  or  analyses  are
necessary.

Work  within  your  limits!

In  using  this  book,  remember  it  is  easy  to  make  mistakes.
Never  pretend  you  know  something  you  do  not.

If  you  are  not  fairly  sure  what  an  illness  is  and  how  to
treat  it,  or  if  the  illness  is  very  serious— get  medical  help.

SICKNESSES  THAT  ARE  OFTEN  CONFUSED
OR  GIVEN  THE  SAME  NAME

21

Many  of  the  common  names  people  use  for  their  sicknesses  were  first  used
long  before  anyone  knew  about  germs  or  bacteria  or  the  medicines  that  fight
them.  Different  diseases  that  caused  more  or  less  similar  problems — such  as
‘high  fever’  or  'pain  in  the  side’ — were  often  given  a single  name.  In  many  parts
of  the  world,  these  common  names  are  still  used.  City-trained  doctors  often
neither  know  nor  use  these  names.  For  this  reason,  people  sometimes  think
they  apply  to  ‘sicknesses  doctors  do  not  treat’.  So  they  treat  these  home
sicknesses  with  herbs  or  home  remedies.

Actually,  most  of  these  home  sicknesses  or  ‘folk  diseases’  are  the  same  ones
known  to  medical  science.  Only  the  names  are  different.

For  many  sicknesses,  home  remedies  work  well.  But  for  some
sicknesses,  treatment  with  modern  medicine  works  much  better  and  may
be  life-saving.  This  is  especially  true  for  dangerous  infections  like  pneumonia,
typhoid,  tuberculosis,  or  infections  after  giving  birth.

To  know  which  sicknesses  definitely  require  modern  medicines  and  to
decide  what  medicine  to  use,  it  is  important  that  you  try  to  find  out  what  the
disease  is  in  the  terms  used  by  trained  health  workers  and  in  this  book.

If  you  cannot  find  the  sickness  you  are  looking  for
in  this  book,  look  for  it  under  a different  name  or  in
the  chapter  that  covers  the  same  sort  of  problem.
Use  the  list  of  CONTENTS  and  the  INDEX.

If  you  are  unsure  what  the  sickness  is — especially  if  it  seems  serious — try  to
get  medical  help.

The  rest  of  this  chapter  gives  examples  of  common  or  traditional  names
people  use  for  various  sicknesses.  Often  a single  name  is  given  to  diseases
that  are  different  according  to  medical  science.

Examples  cannot  be  given  for  each  country  or  area  where  this  book  may  be
used.  Therefore,  I have  kept  those  from  the  Spanish  edition,  with  names  used
by  villagers  in  western  Mexico.  They  will  not  be  the  same  names  you  use.
However,  people  in  many  parts  of  the  world  see  and  speak  of  their  illnesses  in
a similar  way.  So  the  examples  may  help  you  think  about  how  people  name
diseases  in  your  area.

Can  you  think  of  a name  your  people  use  for  the  following  ‘folk
diseases’?  If  you  can,  write  it  in  after  the  Spanish  name,  where  it  says,

Name  in  Your  Area:

22

EXAMPLES  OF  LOCAL  NAMES  FOR  SICKNESSES

Spanish  Name:  EMPACHO  (STOPPED-UP  GUT)  Name  in  Your  Area:

In  medical  terms  empacho
(impaction)  means  that  the  gut  is
stopped  up  or  obstructed  (see
p.  94).  But  in  Mexican  villages  any
illness  causing  stomach-ache  or
diarrhea  may  be  called  empacho.

It  is  said  that  a ball  of  hair  or
something  else  blocks  a part  of
the  gut.  People  put  the  blame  on
witches  or  evil  spirits,  and  treat
with  magic  cures  and  cupping
(see  picture).  Sometimes  folk
healers  pretend  to  take  a ball  of  hair  and  thorns  out  of  the  gut  by  sucking  on
the  belly.

Different  illnesses  that  cause  stomach  pain  or  discomfort  and  are  sometimes
called  empacho  are:

• diarrhea  or  dysentery  with  cramps  (p.  153)

• worms  (p.  140)

• swollen  stomach  due  to  malnutrition  (p.  112)

• indigestion  or  stomach  ulcer  (p.  128)

• and  rarely,  true  gut  obstruction  or  appendicitis  (p.  94)

Most  of  these  problems  are  not  helped  much  by  magic  cures  or  cupping.  To
treat  empacho,  try  to  identify  and  treat  the  sickness  that  causes  it.

Spanish  Name:  DOLOR  DE  IJAR  (SIDE  PAINS)  Name  in  Your  Area:

This  name  is  used  for  any  pain  women  get  in  c
side  of  their  belly.  Often  the  pain  goes  around  to
the  mid  or  lower  back.  Possible  causes  of  this  kii
of  pain  include:

• an  infection  of  the  urinary  system  (the
kidneys,  the  bladder,  or  the  tubes  that
join  them,  see  p.  234)

• cramps  or  gas  pains  (see  diarrhea,  p.  153)

• menstrual  pains  (see  p.  245)

• appendicitis  (see  p.  94)

• an  infection,  cyst,  or  tumor  in  the  womb
or  ovaries  (p.  243)  or  an  out-of-place
pregnancy  (see  p.  280)

23

Spanish  Name:  LA  CONGESTION  (CONGESTION)  Name  in  Your  Area:

Any  sudden  upset  or  illness  that  causes  great  distress  is  called  la
congestion  by  Mexican  villagers.  People  speak  of  congestion  of:

the  head,  the  chest,  the  stomach,  or  the  whole  body.

It  is  said  that  la  congestion  strikes  persons  who  break  ‘the  diet'  (see  p.  1 23),
by  eating  foods  that  are  forbidden  or  taboo  after  childbirth,  while  taking  a
medicine,  or  when  they  have  a cold  or  cough.  Although  these  foods  usually
cause  no  harm  and  are  sometimes  just  what  their  bodies  need,  many  people
will  not  touch  them  because  they  are  so  afraid  of  getting  la  congestion.

Different  illnesses  that  are  sometimes  called  la  congestion  are:

• Food  poisoning,  from  eating  spoiled  food:  causes  sudden  vomiting
followed  by  diarrhea,  cramps,  and  weakness  (see  p.  135).

• A severe  allergic  reaction,  in  allergic  persons  after  they  eat  certain  foods
(shellfish,  chocolate,  etc.),  take  certain  medicines,  or  are  injected  with
penicillin.  May  cause  vomiting,  diarrhea,  cold  sweat,  breathing  trouble,
itchy  rash,  and  severe  distress  (see  p.  166).

• Any  sudden  upset  of  the  stomach  or  gut:  see  diarrhea  (p.  153),  vomiting
(p.  161},  and  acute  abdomen  (p.  93).

• Sudden  or  severe  difficulty  breathing:  caused  by  asthma  (p.  167),
pneumonia  (p.  171),  or  something  stuck  in  the  throat  (p.  79).

• Illnesses  that  cause  fits  or  paralysis:  see  fits  (p.  178),  tetanus  (p.  182),
meningitis  (p.  185),  polio  (p.  314),  and  stroke  (p.  327).

• Heart  attacks:  mostly  in  older  persons  (p.  325).

Spanish  Name:  LATIDO  (PULSING)  Name  in  Your  Area:

Latido  is  a name  used  in  Latin  America  for  a pulsing  or  ‘jumping1  in  the  pit  of
the  stomach.  It  is  really  the  pulse  of  the  aorta  or  big  blood  vessel  coming  from
the  heart.  This  pulse  can  be  seen  and  felt  on  a person  who  is  very  thin  and
hungry.  Latido  is  often  a sign  of  malnutrition  (p.  1 12) — or  hunger!  Eating
enough  good  food  is  the  only  real  treatment  (see  p . 110  and  111).

24

Spanish  Name:  SUSTO  (HYSTERIA,  FRIGHT)  Name  in  Your  Area:

According  to  Mexican  villagers,  susto  is  caused  by  a sudden  fright  a person
has  had,  or  by  witchcraft,  black  magic,  or  evil  spirits.  A person  with  susto  is
very  nervous  and  afraid.  He  may  shake,  behave  strangely,  not  be  able  to  sleep,
lose  weight,  or  even  die.

Possible  medical  explanations  for  susto:

1 . In  many  people,  susto  is  a state  of  fear  or  hysteria,  perhaps  caused  by
the  ‘power  of  belief’  (see  p.  4).  For  example,  a woman  who  is  afraid  someone
will  hex  her  becomes  nervous  and  does  not  eat  or  sleep  well.  She  begins  to
grow  weak  and  lose  weight.  She  takes  this  as  a sign  she  has  been  hexed,  so
she  becomes  still  more  nervous  and  frightened.  Her  susto  gets  worse  and
worse.

2.  In  babies  or  small  children,  susto  is  usually  very  different.  Bad  dreams
may  cause  a child  to  cry  out  in  his  sleep  or  wake  up  frightened.  High  fevers
from  any  illness  can  cause  very  strange  speech  and  behavior  (delirium).  A
child  that  often  looks  and  acts  worried  may  be  malnourished  (p.  1 12).
Sometimes  early  signs  of  tetanus  (p.  182)  or  meningitis  (p.  185)  are  also  called
susto.

Treatment:

When  the  susto  is  caused  by  a specific  illness,  treat  the  illness.  Help  the
person  understand  its  cause.  Ask  for  medical  advice,  if  needed.

When  the  susto  is  caused  by  fright,  try  to  comfort  the  person  and  help  him
understand  that  his  fear  itself  is  the  cause  of  his  problem.  Magic  cures  and
home  remedies  sometimes  help.

If  the  frightened  person  is  breathing  very  hard  and  fast,  his  body  may  be
getting  too  much  air — which  may  be  part  of  the  problem:

EXTREME  FRIGHT  OR  HYSTERIA  WITH  FAST  HEAVY  BREATHING
(HYPERVENTILATION)

Signs:

• person  very  frightened

• breathing  fast  and  deep

• fast,  pounding  heartbeat

• numbness  or  tingling  of  face,
hands,  or  feet

• muscle  cramps

Treatment:

BEFORE

Keep  the  person  as  quiet  as  possible.

Have  her  put  her  face  in  a paper  bag  and  breathe
slowly.  She  should  continue  breathing  the  same  air
for  2 or  3 minutes.  This  will  usually  calm  her  down.
Explain  to  her  that  the  problem  is  not  dangerous,
and  she  will  soon  be  all  right.

25

MISUNDERSTANDINGS  DUE  TO  CONFUSION  OF  NAMES

This  page  shows  2 examples  of  misunderstandings  that  can  result  when
certain  names  like  ‘cancer’  and  ‘leprosy’  mean  one  thing  to  medical  workers
and  something  else  to  villagers.  In  talking  with  health  workers — and  in  using
this  book:

Avoid  misunderstanding— go  by  the  signs  and  history
of  a person’s  sickness,  not  the  name  people  give  it!

Spanish  Name:  CANCER  (CANCER)  Name  in  Your  Area:

Mexican  villagers  use  the  word  cancer  for  any  severe  infection  of  the  skin,
especially  badly  infected  wounds  (p.  88)  or  gangrene  (p.  213).

In  modern  medical  language,  cancer  is  not  an  infection,  but  an  abnormal
growth  or  lump  in  any  part  of  the  body.  Common  types  of  cancer  that  you
should  watch  out  for  are:

Any  hard,  painless,  slowly  growing  lump  in  any  part  of  your  body  may  be
cancer.  Cancer  is  often  dangerous  and  may  need  surgery.

At  the  first  suspicion  of  cancer  seek  medical  help.

Spanish  Name:  LEPRA  (LEPROSY)  Name  in  Your  Area:

Mexican  villagers  call  any  open  spreading  sore
lepra.  This  leads  to  confusion,  because  medical
workers  use  this  term  only  for  true  leprosy  (Hansen’s
disease,  p.  191).  Sores  commonly  called  lepra  are:

• impetigo  and  other  skin  infections  (p.  202)

• sores  that  come  from  insect  bites  or  scabies  (p.  199)

• chronic  sores  or  skin  ulcers  such  as  those  caused
by  poor  circulation  (p.  213)

• skin  cancer  (p.  21 1)

• less  commonly,  leprosy  (p.  191)  or  tuberculosis  of
the  skin  (p.  212)

This  child  has  impetigo,
not  leprosy.

26

CONFUSION  BETWEEN  DIFFERENT  ILLNESSES
THAT  CAUSE  FEVER

Spanish  Name:  LA  FIEBRE  { THE  FEVER)  Name  in  Your  Area:

Correctly  speaking,  a fever  is  a body
temperature  higher  than  normal.  But  in

Latin  America,  a number  of  serious
illnesses  that  cause  high  temperatures
are  all  called  la  fiebre — or  ‘the  fever’.

To  prevent  or  treat  these  diseases
successfully,  it  is  important  to  know
how  to  tell  one  from  another.

Here  are  some  of  the  important  acute  illnesses  in  which  fever  is  an
outstanding  sign.  The  drawings  show  the  fever  pattern  (rise  and  fall  of
temperature)  that  is  typical  for  each  disease.

Malaria:  (see  p.  186)

Begins  with  weakness,  chills  and
fever.  Fever  may  come  and  go
for  a few  days,  with  shivering
(chills)  as  the  temperature  rises,
and  sweating  as  it  falls.  Then,
fever  may  come  for  a few  hours
every  second  or  third  day.  On
other  days,  the  person  may
feel  more  or  less  well.

MALARIA-TYPICAL  The  solid  line  shows  the  rise
FEVER  PATTERN  and  fall  of  temperature.

Typhoid:  (see  p.  188)

Begins  like  a cold.  Temperature
goes  up  a little  more  each  day.

Pulse  relatively  slow.  Sometimes
diarrhea  and  dehydration.

Trembling  or  delirium  (mind
wanders).  Person  very  ill.

Typhus:  (see  p.  190)

Similar  to  typhoid.  Rash  similar  to
that  Of  measles,  With  tiny  bruises.  HEPATITIS-  Usually  the  fever

TYPICAL  FEVER  PATTERN  is  mild.

Hepatitis:  (see  p.  172)

Person  loses  appetite.  Does  not
wish  to  eat  or  smoke.  Wants  to
vomit  (nausea).  Eyes  and  skin  turn
yellow;  urine  orange  or  brown;
stools  whitish.  Sometimes  liver
becomes  large,  tender.  Mild  fever.

Person  very  weak.

TYPHOID—  The  fever  goes  up

TYPICAL  FEVER  PATTERN  a little  each  day.

27

Pneumonia:  (see  p.  171)

Fast,  shallow  breathing.
Temperature  rises  quickly.
Cough  with  green,  yellow,
or  bloody  mucus.  May  be
pain  in  chest.  Person  very  ill.

PNEUMONIA-TYPICAL  FEVER  PATTERN

I i bacterial  infection
I 1 | (untreated)

Rheumatic  fever:  (see  p.  310)

Most  common  in  children  and
teenagers.  Pain  in  joints.

High  fever.  Often  comes  after
a sore  throat.  May  be  pain  in
the  chest  with  shortness  of
breath.  Or  uncontrolled
movements  of  arms  and  legs.

RHEUMATIC  FEVER-TYPICAL  FEVER  PATTERN

Brucellosis  (undulant  fever,
Malta  fever):  (see  p.  188)

Begins  slowly  with  tiredness,
headache,  and  pains  in  the
bones.  Fever  and  sweating
most  common  at  night.  Fever
disappears  for  a few  days  only
to  come  back  again.  This  may
go  on  for  months  or  years.

BRUCELLOSIS-
TYPICAL  FEVER  PATTERN

Fever  comes  in  waves.  Rises  in
the  afternoon  and  falls  at  night.

o o

41*1

(?

I

O J)

Weeks  of  Illness

CHILDBIRTH  FEVER-TYPICAL  FEVER  PATTERN

Childbirth  fever:  (see  p.  276)  r

j <5  <r>  ^ ^

,J  I I 1 I I ! 1

Begins  a day  or  more  after  giving

■ 1 ! ! I 1 ! 1

_ 40o|  j person  gets  worse

birth.  Starts  with  a slight  fever,

1 1 1 and  fever  rises  /i  i'-'

which  often  rises  later.  Foul-smelling

1 1 | 1 1 J | 1

_ 3a=l  i usually  begins  with  1y  i i

vaginal  discharge.  Pain  and

,J  jlow  fever'V-^]  \ |

sometimes  bleeding.  j

1 I 1 i t l i i

- 36°l  l 1 J i III

12  34  56  70

1

| Days  following  childbirth

All  of  these  illnesses  can  be  dangerous.  In  addition  to  those  shown  here,
there  are  many  other  diseases  that  may  cause  similar  signs  and  fever.  For
example,  fevers  that  last  for  more  than  1 month,  or  night  sweats,  may  be
caused  by  the  HIV/AIDS  virus  (see  p.  399).  When  possible,  seek  medical  help.

29

CHAPTER

How  to  Examine
a Sick  Person

■ To  find  out  the  needs  of  a sick  person,  first  you  must  ask  important  questions
and  then  examine  him  carefully.  You  should  look  for  signs  and  symptoms  that
help  you  tell  how  ill  the  person  is  and  what  kind  of  sickness  he  may  have.

Always  examine  the  person  where  there  is  good  light,  preferably  in  the
sunlight — never  in  a dark  room.

There  are  certain  basic  things  to  ask  and  to  look  for  in  anyone  who  is  sick.
These  include  things  the  sick  person  feels  or  reports  (symptoms),  as  well  as
things  you  notice  on  examining  him  (signs).  These  signs  can  be  especially
important  in  babies  and  persons  unable  to  talk.  In  this  book  the  word  ‘signs’  is
used  for  both  symptoms  and  signs.

When  you  examine  a sick  person,  write  down  your  findings  and  keep
them  for  the  health  worker  in  case  he  is  needed  (see  p.  44).

QUESTIONS

Start  by  asking  the  person  about
her  sickness.  Be  sure  to  ask  the
following:

What  bothers  you  most  right  now?

What  makes  you  feel  better  or
worse?

How  and  when  did  your  sickness
begin?

Have  you  had  this  same  trouble
before,  or  has  anyone  else  in
your  family  or  neighborhood
had  it?

Continue  with  other  questions  in  order  to  learn  the  details  of  the  illness.

For  example,  if  the  sick  person  has  a pain,  ask  her:

Where  does  it  hurt?  (Ask  her  to  point  to  the  exact  place  with  one  finger.)

Does  it  hurt  all  the  time,  o.r  off  and  on?

What  is  the  pain  like?  (sharp?  dull?  burning?)

Can  you  sleep  with  the  pain?

If  the  sick  person  is  a baby  who  still  does  not  talk,  look  for  signs  of  pain.
Notice  his  movements  and  how  he  cries.  (For  example,  a child  with  an  earache
sometimes  rubs  the  side  of  his  head  or  pulls  at  his  ear.)

30

GENERAL  CONDITION  OF  HEALTH

Before  touching  the  sick  person,  look  at  him  carefully.  Observe  how  ill  or
weak  he  looks,  the  way  he  moves,  how  he  breathes,  and  how  clear  his  mind
seems.  Look  for  signs  of  dehydration  (see  p.  151)  and  of  shock  (p.  77).

Notice  whether  the  person  looks  well  nourished  or  poorly  nourished.  Has  he
been  losing  weight?  When  a person  has  lost  weight  slowly  over  a long  period
of  time,  he  may  have  a chronic  illness  (one  that  lasts  a long  time).

Also  note  the  color  of  the  skin  and  eyes.  These  sometimes  change  when  a
person  is  sick.  (Dark  skin  can  hide  color  changes.  So  look  at  parts  of  the
body  where  the  skin  is  pale,  such  as  palms  of  the  hands  or  soles  of  the  feet,
the  fingernails,  or  the  insides  of  the  lips  and  eyelids.)

• Paleness,  especially  of  the  lips  and  inside  the  eyelids,  is  a sign  of  anemia  (p.  124).
Skin  may  also  go  lighter  as  a result  of  tuberculosis  (p.  1 79),  or  kwashiorkor  (p.  1 13).

• Darkening  of  the  skin  may  be  a sign  of  starvation  (see  p.  1 12).

• Bluish  skin,  especially  blueness  or  darkness  of  the  lips  and  fingernails,  may  mean
serious  problems  with  breathing  to.  79,  167,  and  313)  or  with  the  heart  (p.  325).
Blue-gray  color  in  an  unconscious  child  may  be  a sign  of  cerebral  malaria  (p.  186).

• A gray-white  coloring,  with  cool  moist  skin,  often  means  a person  is  in  shock  (p.  77).

• Yellow  color  (jaundice)  of  the  skin  and  eyes  may  result  from  disease  in  the  liver
(hepatitis,  p.  172,  cirrhosis,  p.  328,  or  amebic  abscess,  p.  145)  or  gallbladder  (p.
329).  It  may  also  occur  in  newborn  babies  (p.  274),  and  in  children  born  with
sickle  cell  disease  (p.  321).

Look  also  at  the  skin  when  a light  is  shining  across  it  from  one  side.  This  can
show  the  earliest  sign  of  measles  rash  on  the  face  of  a feverish  child  (p.  31 1).

TEMPERATURE

It  is  often  wise  to  take  a sick  person’s  temperature,  even  if
he  does  not  seem  to  have  a fever.  If  the  person  is  very  sick,
take  the  temperature  at  least  4 times  each  day  and  write  it  down.

If  there  is  no  thermometer,  you  can  get  an
idea  of  the  temperature  by  putting  the  back
of  one  hand  on  the  sick  person's  forehead
and  the  other  on  your  own  or  that  of  another
healthy  person.  If  the  sick  person  has  a
fever,  you  should  feel  the  difference.

It  is  important  to  find  out  when  and  how  the  fever  comes,  how  long  it  lasts,
and  how  it  goes  away.  This  may  help  you  identify  the  disease.  Not  every  fever
is  malaria,  though  in  some  countries  it  is  often  treated  as  such.  Remember
other  possible  causes.  For  example:

• Common  cold,  and  other  virus  infections  (p.  163).  The  fever  is  usually  mild.

• Typhoid  causes  a fever  that  goes  on  rising  for  5 days.  Malaria  medicine  does  not  help.

• Tuberculosis  sometimes  causes  a mild  fever  in  the  afternoon.  At  night  the  person  often
sweats,  and  the  fever  goes  down.

31

How  to  Use  a Thermometer

Every  family  should  have  a thermometer.  Take  the  temperature  of  a sick
person  4 times  a day  and  always  write  it  down.

How  to  read  the  thermometer  (using  one  marked  in  degrees  centigrade — ° C):
Turn  the  thermometer  until  High  Fever

The  point  where  the  silver  line  Th  is  thermometer

stops  marks  the  temperature.  marks  40  degrees  C.

How  to  take  the  temperature:

1.  Clean  the  thermometer  well  with  soap
and  water  or  alcohol.  Shake  it  hard,  with
a snap  of  the  wrist,  until  it  reads  less  than
36  degrees.

2.  Put  the  thermometer  . . .

under  the  tongue
(keeping  the  or

mouth  shut)

in  the  armpit  if  there
is  danger  of  biting
the  thermometer

carefully,  in  the  anus
or  of  a small  child

(wet  or  grease  it  first)

3.  Leave  it  there  for  3 or  4 minutes.

4.  Read  it.  (An  armpit  temperature  will  read  a little  lower  than  a mouth
reading;  in  the  anus  it  will  read  a little  higher.)

5.  Wash  the  thermometer  well  with  soap  and  water.

Note:  In  newborn  babies  a temperature  that  is  unusually  high  or  unusually  low
(below  36°)  may  mean  a serious  infection  (see  p.  275).

♦ To  learn  about  other  fever  patterns,  see  p._26  to  27.

♦ To  learn  what  to  do  for  a fever,  see  p.  75.

32

BREATHING  (RESPIRATION)

Pay  special  attention  to  the  way  the  sick  person  breathes — the  depth  (deep
or  shallow),  rate  (how  often  breaths  are  taken),  and  difficulty.  Notice  if  both
sides  of  the  chest  move  equally  when  she  breathes.

If  you  have  a watch  or  simple  timer,  count  the  number  of  breaths  per  minute
(when  the  person  is  quiet).  Between  12  and  20  breaths  per  minute  is  normal  for
adults  and  older  children.  Up  to  30  breaths  a minute  is  normal  for  children,  and
40  for  babies.  People  with  a high  fever  or  serious  respiratory  illnesses  (like
pneumonia)  breathe  more  quickly  than  normal.  More  than  40  shallow  breaths  a
minute  in  an  adult,  or  60  in  a small  child,  usually  means  pneumonia.

Listen  carefully  to  the  sound  of  the  breaths.  For  example:

• A whistle  or  wheeze  and  difficulty  breathing  out  can  mean  asthma  (see
p.  167).

• A gurgling  or  snoring  noise  and  difficult  breathing  in  an  unconscious
person  may  mean  the  tongue,  mucus  (slime  or  pus),  or  something  else  is
stuck  in  the  throat  and  does  not  let  enough  air  get  through.

Look  for  ‘sucking  in'  of  the  skin  between  ribs  and  at  the  angle  of  the  neck
(behind  the  collar  bone)  when  the  person  breathes  in.  This  means  air  has
trouble  getting  through.  Consider  the  possibility  of  something  stuck  in  the
throat  (p.  79),  pneumonia  (p.  171),  asthma  (p.  167),  or  bronchitis  (mild  sucking
in,  see  p.  170).

If  the  person  has  a cough,  ask  if  it  keeps  her  from  sleeping.  Find  out  if  she
coughs  up  mucus,  how  much,  its  color,  and  if  there  is  blood  in  it.

PULSE  (HEARTBEAT)

To  take  the  person’s  pulse,
put  your  fingers  on  the  wrist
as  shown,  (Do  not  use  your
thumb  to  feel  for  the  pulse.)

If  you  cannot  find  the  pulse
in  the  wrist,  feel  for  it  in  the
neck  beside  the  voicebox,

or  put  your  ear  directly  on
the  chest  and  listen  for  the
heartbeat  (or  use  a
stethoscope  if  you  have  one),

Pay  attention  to  the  strength,  the  rate,  and  the  regularity  of  the  pulse.  If  you
have  a watch  or  timer,  count  the  pulses  per  minute.

NORMAL  PULSE  FOR  PEOPLE  AT  REST

adults  from  60  to  80  per  minute

children  80  to  100

babies 100  to  140

The  pulse  gets  much  faster  with  exercise  and  when  a person  is  nervous,
frightened,  or  has  a fever,  As  a general  rule,  the  pulse  increases  20  beats  per
minute  for  each  degree  (°C)  rise  in  fever.

When  a person  is  very  ill,  take  the  pulse  often  and  write  it  down  along  with
the  temperature  and  rate  of  breathing.

It  is  important  to  notice  changes  in  the  pulse  rate.  For  example:

• A weak,  rapid  pulse  can  mean  a state  of  shock  (see  p.  77).

• A very  rapid,  very  slow,  or  irregular  pulse  could  mean  heart  trouble
(see  p.  325),

• A relatively  slow  pulse  in  a person  with  a high  fever  may  be  a sign  of
typhoid  (see  p.  188).

EYES

Look  at  the  color  of  the  white  part  of  the  eyes.  Is  it  normal,  red  (p.  219),  or
yellow?  Also  note  any  changes  in  the  sick  person’s  vision.

Have  the  person  slowly  move  her  eyes  up  and  down  and  from  side  to  side.
Jerking  or  uneven  movement  may  be  a sign  of  brain  damage.

Pay  attention  to  the  size  of  the  pupils  (the  black  ‘window’  in  the  center  of  the
eye).  If  they  are  very  large,  it  can  mean  a state  of  shock  (see  p.  77).  If  they  are
very  large,  or  very  small,  it  can  mean  poison  or  the  effect  of  certain  drugs.

Look  at  both  eyes  and  note  any  difference  between  the  two,  especially  in  the
size  of  the  pupils:

A big  difference  in  the  size  of  the  pupils  is  almost  always  a medical
emergency.

• If  the  eye  with  the  larger  pupil  hurts  so  badly  it  causes  vomiting,  the
person  probably  has  GLAUCOMA  (see  p.  222).

• If  the  eye  with  the  smaller  pupil  hurts  a great  deal,  the  person  may  have
IRITIS,  a very  serious  problem  (see  p.  221).

• Difference  in  the  size  of  the  pupils  of  an  unconscious  person  or  a person
who  has  had  a recent  head  injury  may  mean  brain  damage.  It  may  also
mean  STROKE  (see  p.  327).

Always  compare  the  pupils  of  a person  who  is  unconscious  or  has  had  a
head  injury.

EARS,  THROAT,  AND  NOSE

Ears:  Always  check  for  signs  of  pain  and
infection  in  the  ears — especially  in  a child  with
fever  or  a cold.  A baby  who  cries  a lot  or  pulls
at  his  ear  often  has  an  ear  infection  (p.  309).

Pull  the  ear  gently.  If  this  increases  pain,  the
infection  is  probably  in  the  tube  of  the  ear  (ear
canal).  Also  look  for  redness  or  pus  inside  the  ear.

A small  flashlight  or  penlight  will  help.  But  never
put  a stick,  wire,  or  other  hard  object  inside  the  ear.

Find  out  if  the  person  hears  well,  or  if  one  side  is  more  deaf  than  the  other.
Rub  your  thumb  and  fingers  together  near  the  person’s  ear  to  see  if  he  can
hear  it.  For  deafness  and  ringing  of  the  ears  see  page  327.

Throat  and  Mouth:  With  a torch  (flashlight)  or  sunlight  examine  the  mouth
and  throat.  To  do  this  hold  down  tongue  with  a spoon  handle  or  have  the
person  say  ‘ahhhhh...’  Notice  if  the  throat  is  red  and  if  the  tonsils  (2  lumps  at
the  back  of  the  throat)  are  swollen  or  have  spots  with  pus  (see  p.  309).  Also
examine  the  mouth  for  sores,  inflamed  gums,  sore  tongue,  rotten  or  abscessed
teeth  and  other  problems.  (Read  Chapter  17.)

Nose:  Is  the  nose  runny  or  plugged?  (Notice  if  and  how  a baby  breathes
through  his  nose.)  Shine  a light  inside  and  look  for  mucus,  pus,  blood;  also
look  for  redness,  swelling,  or  bad  smell.  Check  for  signs  of  sinus  trouble  or
hayfever  (p.  165).

SKIN

It  is  important  to  examine  the  sick  person’s  whole  body,  no  matter  how  mild
the  sickness  may  seem.  Babies  and  children  should  be  undressed  completely.
Look  carefully  for  anything  that  is  not  normal,  including:

• sores,  wounds,  or  splinters

• rashes  or  welts

• spots,  patches,  or  any  unusual  markings

• inflammation  (sign  of  infection  with
redness,  heat,  pain  and  swelling)

• swelling  or  puffiness

• swollen  lymph  nodes  (little  lumps  in  the
neck,  the  armpits,  or  the  groin,  see  p.  88)

Always  examine  little  children  between  the
buttocks,  in  the  genital  area,  between  the  fingers
and  toes,  behind  the  ears,  and  in  the  hair  (for
lice,  scabies,  ringworm,  rashes,  and  sores).

For  identification  of  different  skin  problems,
see  pages  196-198.

• abnormal  lumps  or  masses

• unusual  thinning  or  loss  of  hair,
or  loss  of  its  color  or  shine

35

THE  BELLY  (ABDOMEN)

If  a person  has  pain  in  the  belly,  try  to  find  out  exactly  where  it  hurts.

Learn  whether  the  pain  is  steady  or  whether  it  suddenly  comes  and  goes,
like  cramps  or  colic.

When  you  examine  the  belly,  first  look  at  it  for  any  unusual  swelling  or  lumps.

The  location  of  the  pain  often  gives  a clue  to  the  cause  (see  the  following
page).

First,  ask  the  person  Then,  beginning  on  the  opposite  side  from  the  spot

to  point  with  one  finger  where  he  has  pointed,  press  gently  on  different  parts

where  it  hurts.  of  the  belly  to  see  where  it  hurts  most.

See  if  the  belly  is  soft  or  hard  and  whether  the  person  can  relax  his  stomach
muscles.  A very  hard  belly  could  mean  an  acute  abdomen — perhaps
appendicitis  or  peritonitis  (see  p.  94).

If  you  suspect  peritonitis  or  appendicitis,  do  the  test  for  rebound  pain
described  on  page  95.

Feel  for  any  abnormal  lumps  and  hardened  areas  in  the  belly.

If  the  person  has  a constant  pain  in  the  stomach,  with  nausea,  and  has  not
been  able  to  move  her  bowels,  put  an  ear  (or  stethoscope)  on  the  belly,  like
this:

Listen  for  gurgles  in  the
intestines.  If  you  hear
nothing  after  about  2
minutes,  this  is  a danger  sign.
(See  Emergency  Problems  of
the  Gut,  p.  93. )

A silent  belly  is  like  a silent  dog.  Beware!

36

These  pictures  show  the  areas  of  the  belly  that  usually  hurt  when  a person
has  the  following  problems:

Gallbladder

(see  p.  329)

the  pain
often  reaches
to  the  back

Liver

Urinary  system

(see  p.  2341

Inflammation  or

tumor  of  the  ovaries,

Note:  For  different  causes  of  back  pain  see  p.  173.

37

MUSCLES  AND  NERVES

If  a person  complains  of  numbness,  weakness,  or  loss  of  control  in  part  of
his  body,  or  you  want  to  test  it:  notice  the  way  he  walks  and  moves.  Have  him
stand,  sit,  or  lie  completely  straight,  and  carefully  compare  both  sides  of  his
body.

Face:  Have  him  smile,  frown,  open  his  eyes  wide,  and
squeeze  them  shut.  Notice  any  drooping  or  weakness  on
one  side.

If  the  problem  began  more  or  less  suddenly,  think  of  a
head  injury  (p.  91),  stroke  (p.  327),  or  Bell’s  palsy  (p.  327).

If  it  came  slowly,  it  may  be  a brain  tumor.  Get  medical  advice

Also  check  for  normal  eye  movement,  size  of  pupils  (p.  217),  and  how  well
he  can  see.

Arms  and  legs:  Look  for  loss  of  muscle.  Notice — or  measure — difference  in

Watch  how  he  moves  and  walks.  If  muscle  loss  or  weakness  affects  the
whole  body,  suspect  malnutrition  (p.  1 12)  or  a chronic  (long-term)  illness  like
tuberculosis.

If  muscle  loss  and  weakness  is  uneven  or  worse  on  one  side,  in  children,
think  first  of  polio  (p.  314);  in  adults,  think  of  a back  problem,  a back  or  head
injury,  or  stroke.

For  more  information  on  muscle  testing  and  physical  examination  of  disabled
persons,  see  Disabled  Village  Children , Chapter  4,

Also  have  him  hold  his  arms  straight
out  and  turn  his  hands  up  and  down.

Have  him  lie  down  and  lift  one  leg
and  then  the  other.

38

Check  for  stiffness  or  tightness  of  different  muscles:

• If  the  jaw  is  stiff  or  will  not  open,  suspect  tetanus  (p.  182)
or  a severe  infection  of  the  throat  (p.  309)  or  of  a tooth
(p.  231).  If  the  problem  began  after  he  yawned  or  was
hit  in  the  jaw,  he  may  have  a dislocated  jaw.

If  the  neck  or  back  is  stiff  and  bent
backwards,  in  a very  sick  child,  suspect
meningitis.  If  the  head  will  not  bend
forward  or  cannot  be  put  between  the
knees,  meningitis  is  likely  (p.  185).

• If  a child  always  has  some  stiff  muscles  and  makes  strange  or  jerky
movements,  he  may  be  spastic  (p.  320).

• If  strange  or  jerky  movements  come  suddenly,  with  loss  of  consciousness,

he  may  have  fits  (p.  178).  If  fits
happen  often,  think  of  epilepsy.

If  they  happen  when  he  is  ill,  the
cause  may  be  high  fever  (p.  76)
or  dehydration  (p.  151)  or  tetanus
(p.  182)  or  meningitis  (p.  185).

To  test  a person’s  reflexes  when  you  suspect  tetanus,  see  p.  183.

To  check  for  loss  of  feeling  in  the  hands,  feet,  or  other
parts  of  the  body:

Have  the  person  cover  his  eyes.  Lightly  touch
or  prick  the  skin  in  different  places.  Ask  him  to  say
'yes'  when  he  feels  it.

% Loss  of  feeling  in  or  near  spots  or  patches  on  the
body  is  probably  leprosy  (p.  191 ).

* Loss  of  feeling  in  both  hands  or  feet
may  be  due  to  diabetes  (p.  127)

or  leprosy.

* Loss  of  feeling  on  one  side  only  could
come  from  a back  problem  (p.  174)
or  injury.

39

How  to  Take  Care
of  a Sick  Person

chapter

4

Sickness  weakens  the  body.  To  gain  strength  and  get  well  quickly,
special  care  is  needed.

The  care  a sick  person  receives  is  frequently
the  most  important  part  of  his  treatment.

Medicines  are  often  not  necessary.  But  good  care  is  always  important.
The  following  are  the  basis  of  good  care:

1 . The  Comfort  of  the  Sick  Person

A person  who  is  sick  should
rest  in  a quiet,  comfortable  place
with  plenty  of  fresh  air  and  light.
He  should  keep  from  getting  too
hot  or  cold.  If  the  air  is  cold  or
the  person  is  chilled,  cover  him
with  a sheet  or  blanket.  But  if  the
weather  is  hot  or  the  person  has
a fever,  do  not  cover  him  at  all  (s<

/

/

pi

2.  Liquids

In  nearly  every  sickness,  especially  when  there  is
fever  or  diarrhea,  the  sick  person  should  drink
plenty  of  liquids:  water,  tea,  juices,  broths,  etc.

3.  Personal  Cleanliness

It  is  important  to  keep  the  sick  person
clean.  He  should  be  bathed  every  day.

If  he  is  too  sick  to  get  out  of  bed,
wash  him  with  a sponge  or
cloth  and  lukewarm  water.  His
clothes,  sheets,  and  covers
must  also  be  kept  clean.

Take  care  to  keep  crumbs  and
bits  of  food  out  of  the  bed,

A SICK  PERSON  SHOULD
BE  BATHED  EACH  DAY

4.  Good  Food

If  the  sick  person  feels  like  eating,  let  him.  Most
sicknesses  do  not  require  special  diets.

A sick  person  should  drink  plenty  of  liquids  and
eat  a lot  of  nourishing  food  (see  Chapter  1 1 ).

If  the  person  is  very  weak,  give  him  as  much
nourishing  food  as  he  can  eat,  many  times  a day.

If  necessary,  mash  the  foods,  or  make  them  into
soups  or  juices.

Energy  foods  are  especially  important — for
example,  porridges  of  rice,  wheat,  oatmeal,  potato,
or  cassava.  Adding  a little  sugar  and  vegetable  oil
will  increase  the  energy.  Also  encourage  the  sick  person  to  drink  plenty  of
sweetened  drinks,  especially  if  he  will  not  eat  much.

A few  problems  do  require  special  diets.  These  are  explained  on  the
following  pages:

stomach  ulcers  and  heartburn  p.  128

appendicitis,  gut  obstruction,  acute  abdomen

(in  these  cases  take  no  food  at  all)  p.  93

diabetes  p.  127

heart  problems  p.  325

gallbladder  problems  p.  329

SPECIAL  CARE  FOR  A PERSON
WHO  IS  VERY  ILL

1 . Liquids

It  is  extremely  important  that  a very  sick  person  drink  enough  liquid.  If  he
only  can  drink  a little  at  a time,  give  him  small  amounts  often.  If  he  can  barely
swallow,  give  him  sips  every  5 or  10  minutes.

Measure  the  amount  of  liquids  the  person  drinks  each  day.  An  adult  needs  to
drink  2 liters  or  more  every  day  and  should  urinate  at  least  a cup  (60  cc.)  of
urine  3 or  4 times  daily.  If  the  person  is  not  drinking  or  urinating  enough,  or  if
he  begins  to  show  signs  of  dehydration  (p.  151),  encourage  him  to  drink  more.
He  should  drink  nutritious  liquids,  usually  with  a little  salt  added.  If  he  will  not
drink  these,  give  him  a Rehydration  Drink  (see  p.  152).  If  he  cannot  drink
enough  of  this,  and  develops  signs  of  dehydration,  a health  worker  may  be
able  to  give  him  intravenous  solution.  But  the  need  for  this  can  usually  be
avoided  if  the  person  is  urged  to  take  small  sips  often.

2.  Food

If  the  person  is  too  sick  to  eat  solid  foods,  give  her  soups,  milk,  juices,
broths,  and  other  nutritious  liquids  (see  Chapter  11).  A porridge  of  cornmeal,
oatmeal,  or  rice  is'also  good,  but  should  be  given  together  with  body-building
foods.  Soups  can  be  made  with  egg,  beans,  or  well-chopped  meat,  fish,  or
chicken.  If  the  person  can  eat  only  a little  at  a time,  she  should  eat  several
small  meals  each  day.

3.  Cleanliness

Personal  cleanliness  is  very  important  for  a seriously  ill  person.  She  should
be  bathed  every  day  with  warm  water.

Change  the  bed  clothes  daily  and  each  time  they  become  dirty.  Soiled  or
bloodstained  clothes,  bedding,  and  towels  of  a person  with  an  infectious
disease  should  be  handled  with  care.  To  kill  any  viruses  or  germs,  wash  these
in  hot  soapy  water,  or  add  some  chlorine  bleach.

4.  Changing  Position  in  Bed

A person  who  is  very  weak  and  cannot  turn  over  alone  should  be  helped  to
change  position  in  bed  many  times  each  day.  This  helps  prevent  bed  sores
(see  p.  214).

A child  who  is  sick  for  a long  time  should  be  held  often  on  her  mother’s  lap.

Frequent  changing  of  the  person’s  position  also  helps  to  prevent  pneumonia,
a constant  danger  for  anyone  who  is  very  weak  or  ill  and  must  stay  in  bed  for  a
long  time.  If  the  person  has  a fever,  begins  to  cough,  and  breathes  with  fast,
shallow  breaths,  she  probably  has  pneumonia  (see  p.  171).

5.  Watching  for  Changes

You  should  watch  for  any  change  in  the  sick  person's  condition  that  may  tell
you  whether  he  is  getting  better  or  worse.  Keep  a record  of  his  ‘vital  signs’.
Write  down  the  following  facts  4 times  a day:

temperature  pulse  breathing

(how  many  degrees)  (beats  per  minute)  (breaths  per  minute)

Also  write  down  the  amount  of  liquids  the  person  drinks  and  how  many  times
a day  he  urinates  and  has  a bowel  movement.  Save  this  information  for  the
health  worker  or  doctor.

It  is  very  important  to  look  for  signs  that  warn  you  that  the  person’s  sickness
is  serious  or  dangerous.  A list  of  Signs  of  Dangerous  Illness  is  on  the  next
page.  If  the  person  shows  any  of  these  signs,  seek  medical  help  immediately.

42

y

SIGNS  OF  DANGEROUS  ILLNESS

A person  who  has  one  or  more  of  the  following
signs  is  probably  too  sick  to  be  treated  at  home
without  skilled  medical  help.  His  life  may  be  in
danger.  Seek  medical  help  as  soon  as  possible.

Until  help  comes,  follow  the  instructions  on  the
pages  indicated.

page

1 . Loss  of  large  amounts  of  blood  from  anywhere  in  the  body  . .82,  264,  281

2.  Coughing  up  blood  179

3.  Marked  blueness  of  lips  and  nails  (if  it  is  new)  30

4.  Great  difficulty  in  breathing;  does  not  improve  with  rest  167,  325

5.  The  person  cannot  be  wakened  (coma) 78

6.  The  person  is  so  weak  he  faints  when  he  stands  up  325

7.  A day  or  more  without  being  able  to  urinate  234

8.  A day  or  more  without  being  able  to  drink  any  liquids  151

9.  Heavy  vomiting  or  severe  diarrhea  that  lasts  for  more  than  one  day  or

more  than  a few  hours  in  babies  151

10.  Black  stools  like  tar,  or  vomit  with  blood  or  feces  128

1 1.  Strong,  continuous  stomach  pains  with  vomiting  in  a person

who  does  not  have  diarrhea  or  cannot  have  a bowel  movement  93

12.  Any  strong  continuous  pain  that  lasts  for  more  than  3 days  29  to  38

13.  Stiff  neck  with  arched  back,  with  or  without  a stiff  jaw 182,  185

14.  More  than  one  fit  (convulsions)

in  someone  with  fever  or  serious  illness 76,  185

15.  High  fever  (above  39°C)  that  cannot  be

brought  down  or  that  lasts  more  than  4 or  5 days  75

16.  Weight  loss  over  an  extended  time  20,  400

17.  Blood  in  the  urine 146,  234

1 8.  Sores  that  keep  growing  and  do  not  go  away  with  treatment  ...  191,  196,

211,  212

19.  A lump  in  any  part  of  the  body  that  keeps  getting  bigger  196,  280

20.  Problems  with  pregnancy  and  childbirth:

any  bleeding  during  pregnancy  249,  281

swollen  face  and  trouble  seeing  in  the  last  months 249

long  delay  once  the  waters  have  broken  and  labor  has  begun  . . . . 267
severe  bleeding  264

WHEN  AND  HOW  TO  LOOK  FOR  MEDICAL  HELP

Seek  medical  help  at  the  first  sign  of  a dangerous  illness.  Do  not  wait  until
the  person  is  so  sick  that  it  becomes  difficult  or  impossible  to  take  him  to  a
health  center  or  hospital.

If  a sick  or  injured  person’s  condition  could  be  made  worse
by  the  difficulties  in  moving  him  to  a health  center,  try  to
bring  a health  worker  to  the  person.  But  in  an
emergency  when  very  special  attention  or  an
operation  may  be  needed  (for  example,
appendicitis),  do  not  wait  for  the  health
worker.  Take  the  person  to  the  health
center  or  the  hospital  at  once.

When  you  need  to  carry  a
person  on  a stretcher,  make  sure
he  is  as  comfortable  as  possible
and  cannot  fall  out.  If  he  has  any
broken  bones,  splint  them  before
moving  him  (see  p.  99).  If  the
sun  is  very  strong,  rig  a sheet
over  the  stretcher  to  give  shade
yet  allow  fresh  air  to  pass  under-
neath

WHAT  TO  TELL  THE  HEALTH  WORKER

For  a health  worker  or  doctor  to  recommend  treatment  or  prescribe  medicine
wisely,  she  should  see  the  sick  person.  If  the  sick  person  cannot  be  moved,
have  the  health  worker  come  to  him.  If  this  is  not  possible,  send  a responsible
person  who  knows  the  details  of  the  illness.  Never  send  a small  child  or  a
fool.

Before  sending  for  medical  help,  examine  the  sick  person  carefully  and
completely.  Then  write  down  the  details  of  his  disease  and  general  condition
(see  Chapter J3).

On  the  next  page  is  a form  on  which  you  can  make  a PATIENT  REPORT.
Several  copies  of  this  form  are  at  the  end  of  this  book.  Tear  out  one  of  these
forms  and  carefully  complete  the  report,  giving  all  the  details  you  can.

When  you  send  someone  for  medical  help,
always  send  a completed  information  form  with  him.

PATIENT  REPORT

TO  USE  WHEN  SENDING  FOR  MEDICAL  HELP

Name  of  the  sick  person: Age:

Male Female Where  is  he  (she)?

What  is  the  main  sickness  or  problem  right  now?

When  did  it  begin?

Flow  did  it  begin?

Plas  the  person  had  the  same  problem  before? When?

Is  there  fever? Flow  high? ° When  and  for  how  long?

Pain? Where? What  kind?

What  is  wrong  or  different  from  normal  in  any  of  the  following?

Skin: Ears:

Eyes: Mouth  and  throat:

Genitals:

Urine:  Much  or  little? Color? Trouble  urinating?

Describe: Times  in  24  hours: Times  at  night:

Stools:  Color? Blood  or  mucus? Diarrhea?

Number  of  times  a day: Cramps? Dehydration? Mild  or

severe? Worms? What  kind?

Breathing:  Breaths  per  minute: Deep,  shallow,  or  normal?

Difficulty  breathing  (describe): Cough  (describe):

Wheezing? Mucus? With  blood?

Does  the  person  have  any  of  the  SIGNS  OF  DANGEROUS  ILLNESS  listed  on
page  42? Which?  (give  details)

Other  signs:

Is  the  person  taking  medicine? What?

Has  the  person  ever  used  medicine  that  has  caused  a rash,  hives  (or  bumps)

with  itching,  or  other  allergic  reactions? What?

The  state  of  the  sick  person  is:  Not  very  serious: Serious:

Very  serious:

45

Healing  Without
Medicines

CHAPTER

5

For  most  sicknesses  no  medicines  are  needed.  Our  bodies  have  their  own
defenses,  or  ways  to  resist  and  fight  disease.  In  most  cases,  these  natural
defenses  are  far  more  important  to  our  health  than  are  medicines.

People  will  get  well  from  most  sicknesses
—including  the  common  cold  and  ‘flu’  —
by  themselves,  without  need  for  medicines.

To  help  the  body  fight  off  or  overcome  a sickness,  often
keep  clean  get  plenty  of  rest

all  that  is  needed  is  to:

eat  well  and  drink
a lot  of  liquid

Even  in  a case  of  more  serious  illness,  when  a medicine  may  be  needed,

it  is  the  body  that  must  overcome  the  disease;  the  medicine  only  helps.
Cleanliness,  rest,  nutritious  food,  and  lots  of  water  are  still  very  important.

Much  of  the  art  of  health  care  does  not — and  should  not — depend  on  use  of
medications.  Even  if  you  live  in  an  area  where  there  are  no  modern  medicines,
there  is  a great  deal  you  can  do  to  prevent  and  treat  most  common
sicknesses — if  you  learn  how.

Many  sicknesses  can  be  prevented  or  treated  without  medicines.

If  people  simply  learned  how  to  use  water  correctly,  this  alone  might  do
more  to  prevent  and  cure  illnesses  than  all  the  medicines  they  now  use  . . . and
misuse.

46

HEALING  WITH  WATER

Most  of  us  could  live  without  medicines.  But  no  one  can  live  without  water.  In
fact,  over  half  (57%)  of  the  human  body  is  water.  If  everyone  living  in  farms  and
villages  made  the  best  use  of  water,  the  amount  of  sickness  and  death
— especially  of  children — could  be  reduced.

For  example,  correct  use  of  water  is  basic  both  in  the  prevention  and
treatment  of  diarrhea.  In  many  areas  diarrhea  is  the  most  common  cause  of
sickness  and  death  in  small  children.  Contaminated  (unclean)  water  is  often
part  of  the  cause.

An  important  part  of  the  prevention  of  diarrhea  and  many  other  illnesses  is  to
make  sure  that  drinking  water  is  safe.  Protect  wells  and  springs  from  dirt  and
animals  by  putting  fences  or  walls  around  them.  Use  cement  or  rock  to  provide
good  drainage  around  the  well  or  spring,  so  that  rain  or  spilled  water  runs
away  from  it.

Where  water  may  be  contaminated,
an  important  part  of  the  prevention  of
diarrhea  is  to  boil  or  filter  the  water  used
for  drinking  or  for  preparing  foods.  This  is
especially  important  for  babies.  Babies'
bottles  and  eating  utensils  should  also
be  boiled.  If  regular  boiling  of  bottles  is
not  possible,  it  is  safer  to  use  a cup  and
spoon.  Washing  hands  with  soap  and
water  after  a bowel  movement  (shitting)
and  before  eating  or  handling  foods  is
also  important.

A common  cause  of  death  in  children
with  diarrhea  is  severe  dehydration,
or  loss  of  too  much  water  from  the  body
(see  p.  151).  By  giving  a child  with
diarrhea  plenty  of  water  (best  with
sugar  or  cereal  and  salt),  dehydration
can  often  be  prevented  or  corrected
(see  Rehydration  Drink,  p.  152).

Giving  lots  of  liquids  to  a child  with  diarrhea  is  more  important  than  any
medicine.  In  fact,  if  enough  liquid  is  given,  no  medicine  is  usually  needed  in
the  treatment  of  diarrhea.

On  the  next  2 pages  are  a number  of  other  situations  in  which  it  is  often
more  important  to  use  water  correctly  than  to  use  medicines.

2 0 1 2 m < m CD  T)

Times  When  the  Right  Use  of  Water
May  Do  More  Good  than  Medicines

47

to  help  prevent

1 . diarrhea,  worms,
gut  infections

2.  skin  infections

3.  wounds  becoming
infected;  tetanus

to  treat

1 . diarrhea,
dehydration

2.  illnesses  with  fever

3.  high  fever

4.  minor  urinary
infections  (common
in  women)

5.  cough,  asthma,
bronchitis,
pneumonia,
whooping  cough

PREVENTION

use  water  see  page

boil  or  filter  drinking  135
water,  wash  hands,
etc.

bathe  often  133

wash  wounds  well  84,  89

with  soap  and  clean
water

TREATMENT

use  water

drink  plenty  of
liquids

drink  plenty  of
liquids

remove  clothing
and  soak  body
with  cool  water

75

76

drink  plenty  of  235

water

drink  a lot  of  168

water  and  breathe
hot  water  vapors
(to  loosen  mucus)

48

to  treat

use  water

see  page

6.  sores,  impetigo,
ringworm  of  skin
or  scalp,  cradle
cap,  pimples

scrub  with  soap
and  clean  water

201,  202,
205,  211,
215

7.  infected  wounds,
abscesses,  boils

hot  soaks  or
compresses

88,  202

8.  stiff,  sore  muscles
and  joints

hot  compresses

102,  173,
174

9.  strains  and  sprains

the  first  day:  soak
joint  in  cold  water;
then  use  hot  soaks

102

&%\

10.  itching,  burning,  or
weeping  irritations
of  the  skin

cold  compresses

193, 194

1 1 . minor  burns

hold  in  cold  water
at  once

96

12.  sore  throat  or
tonsillitis

gargle  with  warm
salt  water

309

13.  acid,  lye,  dirt,  or
irritating

substance  in  eye

flood  eye  with  cool
water  at  once,  and
continue  for  30
minutes

219

14.  stuffed  up  nose

sniff  salt  water

164

15.  constipation,
hard  stools

drink  lots  of  water
(also,  enemas  are
safer  than  laxatives,
but  do  not  overuse)

15,  126

16.  cold  sores  or
fever  blisters

hold  ice  on  blister
for  1 hr.  at  first  sign

232

In  each  of  the  above  cases  (except  pneumonia)  when  water  is  used
correctly,  often  medicines  are  not  needed.  In  this  book  you  will  find  many
suggestions  for  ways  of  healing  without  need  for  medicine.  Use  medicines
only  when  absolutely  necessary.

Right  and  Wrong  Uses
of  Modern  Medicines

CHAPTER

49

6

Some  medicines  sold  in  pharmacies  or  village  stores  can  be  very  useful.  But
many  are  of  no  value.  Of  the  60,000  medicines  sold  in  most  countries,  the
World  Health  Organization  says  that  only  about  200  are  necessary.

Also,  people  sometimes  use  the  best  medicines  in  the  wrong  way,  so  that
they  do  more  harm  than  good.  To  be  helpful,  medicine  must  be  used
correctly.

Many  people,  including  most  doctors  and  health  workers,  prescribe  far  more
medicines  than  are  needed — and  by  so  doing  cause  much  needless  sickness
and  death.

There  is  some  danger  in  the  use  of  any  medicine.

Some  medicines  are  much  more  dangerous  than  others.  Unfortunately,
people  sometimes  use  very  dangerous  medicines  for  mild  sicknesses.  (I  have
seen  a baby  die  because  his  mother  gave  him  a dangerous  medicine,
chloramphenicol,  for  a cold.)  Never  use  a dangerous  medicine  for  a mild
illness.

REMEMBER:  MEDICINES  CAN  KILL

Guidelines  for  the  use  of  medicine:

1 . Use  medicines  only  when  necessary.

2.  Know  the  correct  use  and  precautions  for  any  medicine  you  use  (see  the
GREEN  PAGES).

3.  Be  sure  to  use  the  right  dose.

4.  If  the  medicine  does  not  help,  or  causes  problems,  stop  using  it.

5.  When  in  doubt,  seek  the  advice  of  a health  worker.

Note:  Some  health  workers  and  many  doctors  give  medicines  when  none  is
needed,  often  because  they  think  patients  expect  medicine  and  will  not  be
satisfied  until  they  get  some.  Tell  your  doctor  or  health  worker  you  only  want
medicine  if  it  is  definitely  needed.  This  will  save  you  money  and  be  safer  for
your  health.

Only  use  a medicine  when  you  are  sure  it  is  needed
and  when  you  are  sure  how  to  use  it.

50

THE  MOST  DANGEROUS  MISUSE  OF  MEDICINE

Here  is  a list  of  the  most  common  and  dangerous  errors  people  make  in
using  modern  medicines.  The  improper  use  of  the  following  medicines  causes
many  deaths  each  year.  BE  CAREFUL!

1.  Chloramphenicol  (Chloromycetin)  (p.  357)

The  popular  use  of  this  medicine  for  simple  diarrhea  and
other  mild  sicknesses  is  extremely  unfortunate,  because  it  is
so  risky.  Use  chloramphenicol  only  for  very  severe  illnesses,
like  typhoid  (see  p.  188).  Never  give  it  to  newborn  babies.

2.  Oxytocin  (Pitocin),  Pituitrin,  and  Ergonovine  (Ergotrate)  (p.  391)

Unfortunately,  some  midwives  use  these  medicines  to  speed
up  childbirth  or  ‘give  strength’  to  the  mother  in  labor.  This
practice  is  very  dangerous.  It  can  kill  the  mother  or  the  child.
Use  these  medicines  only  to  control  bleeding  after  the  child
is  born  (see  p.  266).

3.  Injections  of  any  medicine

The  common  belief  that  injections  are  usually  better
than  medicine  taken  by  mouth  is  not  true.  Many  times
medicines  taken  by  mouth  work  as  well  as  or  better
than  injections.  Also,  most  medicine  is  more
dangerous  injected  than  when  taken  by  mouth.  Injections  given  to  a child
who  has  a mild  polio  infection  (with  only  signs  of  a cold)  can  lead  to  paralysis
(see  p.  74).  Use  of  injections  should  be  very  limited  (read  Chapter  9 carefully).

4.  Penicillin  (p.  351)

Penicillin  works  only  against  certain  types  of  infections.  Use  of  penicillin  for
sprains,  bruises,  or  any  pain  or  fever  is  a great  mistake.  As  a general  rule,
injuries  that  do  not  break  the  skin,  even  if  they  make  large  bruises,  have  no
danger  of  infection;  they  do  not  need  to  be  treated  with  penicillin  or  any  other
antibiotic.  Neither  penicillin  nor  other  antibiotics  helps  colds  (see  p.  163).

Penicillin  is  dangerous  for  some  people.  Before  using  it,  know  its  risks  and
the  precautions  you  must  take — see  pages  70  and  351 .

5.  Kanamycin  and  Gentamicin  (Garamycin)  (p.  359)

Too  much  use  of  these  antibiotics  for  babies  has  caused  permanent  hearing
loss  (deafness)  in  millions  of  babies.  Give  to  babies  only  for  life-threatening
infections.  For  many  infections  of  the  newborn,  ampicillin  works  as  well  and  is
much  less  dangerous.

51

6.  Anti-diarrhea  medicines  with  hydroxyquinolines  (Clioquinol,

di-iodohydroxyquinoline,  halquinol,  broxyquinoline:  Diodoquin,

EnteroquinoJ,  Amicline,  Quogyl,  and  many  other  brand  names)  (p.  370)

In  the  past  clioquinols  were  widely  used  to  treat  diarrhea.  These  dangerous
medicines  are  now  prohibited  in  many  countries — but  in  others  are  still  sold.

They  can  cause  permanent  paralysis,  blindness,  and  even  death.  For  treatment
of  diarrhea,  see  Chapter  13.

7.  Cortisone  and  cortico-steroids  (Prednisolone,  dexamethasone,  and  others)

These  are  powerful  anti-inflammatory  drugs  that  are  occasionally  needed  for
severe  attacks  of  asthma,  arthritis,  or  severe  allergic  reactions.  But  in  many
countries,  steroids  are  prescribed  for  minor  aches  and  pains  because  they
often  give  quick  results.  This  is  a big  mistake.  Steroids  cause  serious  or
dangerous  side  effects — especially  if  used  in  high  doses  or  for  more  than  a few
days.  They  lower  a person’s  defenses  against  infection.  They  can  make
tuberculosis  much  worse,  cause  bleeding  of  stomach  ulcers,  and  make  bones
so  weak  that  they  break  easily.

8.  Anabolic  steroids  (Nandrolone  decanoate,  Durabolin,  Deca-Durabolin,

Orabolin;  stanozolol,  Cetabon;  oxymetholone,  Anapolon;  ethylestrenol,

Organaborat.  There  are  many  other  brand  names.)

Anabolic  steroids  are  made  from  male  hormones  and  are  mistakenly  used  in
tonics  to  help  children  gain  weight  and  grow.  At  first  the  child  may  grow  faster,
but  he  will  stop  growing  sooner  and  end  up  shorter  than  he  would  have  if  he
had  not  taken  the  medicine.  Anabolic  steroids  cause  very  dangerous  side
effects.  Girls  grow  hair  on  their  faces  like  boys,  which  does  not  go  away,  even
when  the  child  stops  taking  the  medicine.  Do  not  give  growth  tonics  to
children.  Instead,  to  help  your  child  grow,  use  the  money  to  buy  food.

9.  Arthritis  medicines  (Butazones:  oxyphenbutazone,  Amidozone;  and

phenylbutazone,  Butazolidin)

These  medicines  for  joint  pain  (arthritis)  can  cause  a dangerous,  sometimes
deadly,  blood  disease  (agranulocytosis).  They  can  also  damage  the  stomach,
liver,  and  kidneys.  Do  not  use  these  dangerous  medicines.  For  arthritis,
aspirin  (p.  379)  or  ibuprofen  (p.  380)  is  much  safer  and  cheaper.  For  pain  and
fever  only,  acetaminophen  (p.  380)  can  be  used.

10.  Vitamin  B12,  liver  extract,  and  iron  injections  (p.  393)

Vitamin  B12  and  liver  extract  do  not  help  anemia  or  ‘weakness’
except  in  rare  cases.  Also,  they  have  certain  risks  when  injected.
They  should  only  be  used  when  a specialist  has  prescribed  them
after  testing  the  blood.  Also,  avoid  injectable  iron,  such  as  Inferon.
To  combat  anemia,  iron  pills  are  safer  and  work  as  well  (see  p.  124).

52

11.  Other  vitamins  (p.  392)

As  a general  rule,  DO  NOT  INJECT  VITAMINS.  Injections  are  more
dangerous,  more  expensive,  and  usually  no  more  effective  than  pills.

Unfortunately,  many  people  waste  their  money  on  syrups,  tonics,  and  'elixirs’
that  contain  vitamins.  Many  lack  the  most  important  vitamins  (see  p.  118).  But
even  when  they  contain  them,  it  is  wiser  to  buy  more  and  better  food.
Body-building  and  protective  foods  like  beans,  eggs,  meat,  fruit,  vegetables,
and  whole  grains  are  rich  in  vitamins  and  other  nutrients  (see  p.  111).  Giving  a
thin,  weak  person  good  food  more  often  will  usually  help  him  far  more  than
giving  him  vitamin  and  mineral  supplements.

A person  who  eats  well  does  not  need  extra  vitamins.

THE  BEST  WAY  TO  GET  VITAMINS:

For  more  information  about  vitamins,  when  they  are  necessary,  and  the  foods
that  have  them,  read  Chapter  1_[,  especially  pages  1 1 1 and  118.

12.  Combination  medicines

Sometimes,  2 or  more  medicines  are  combined  in  the  same  pill  or  tonic.
Usually  they  are  less  effective,  and  more  expensive,  when  prepared  this  way.
Sometimes  they  do  more  harm  than  good.  If  someone  wants  to  prescribe
combination  medicines,  ask  him  or  her  to  prescribe  only  the  medicine  that  is
really  necessary.  Do  not  waste  your  money  on  these  medicines.

Some  common  combination  medicines  that  should  be  avoided  are:

• cough  medicines  which  contain  medicines  both  to  suppress  a cough  and
also  to  get  rid  of  mucus.  (Cough  medicines  are  almost  always  useless  and
a waste  of  money,  whether  or  not  they  combine  medicines.)

* antibiotics  combined  with  anti-diarrhea  medicine

• antacids  to  treat  stomach  ulcers  together  with  medicine  to  prevent
stomach  cramps

* 2 or  more  pain  medicines  (aspirin  with  acetaminophen — sometimes  also
with  caffeine)

53

13.  Calcium

Injecting  calcium  into  a vein  can  be  extremely  dangerous.  It
can  quickly  kill  someone  if  not  injected  very  slowly.  Injecting
calcium  into  the  buttocks  sometimes  causes  very  serious
abscesses  or  infections.

Never  inject  calcium  without  first  seeking  medical  advice!

Note:  In  Mexico  and  other  countries  where  people  eat  a lot  of  corn  tortillas  or
other  foods  prepared  with  lime,  it  is  foolish  to  use  calcium  injections  or  tonics
(as  is  often  done  to  ‘give  strength’  or  ‘help  children  grow’).  The  body  gets  all
the  ca
…[truncated]

Summary: Where  There  Is  No  Doctor   a viCCaat  heeded  cart  handbook    -revised  edition    %   Vavld  Werner   mcfi   Carol  Thuman  and  Jane  MaxwdC    mtfv  drawings  hy  David  Werner    Compiled  by  noonya    Library  of  Congress  Cataloging-in-Publication  Data  Werner,  David,  1934-   Where  there  is  no  doctor:  a village  health  care  handbook  / by  David  Werner;  with  Caro!  Thuman  and  Jane  Maxwell.  — Rev.  ed.   Includes  Index.   ISBN  0-942364-15-5   1.  Medicine, …